Administration, drugs regional perfusion

As indicated in Table 2.1, drugs may be injected into veins, muscles, subcutaneous tissue, arteries, or into the subarachnoid space of the spinal canal (intrathecal). For obvious reasons, intraarterial and intrathecal injections are reserved for specialized drug administration requirements, such as regional perfusion of a tumor with a toxic drug or induction of spinal anesthesia, respectively. Therefore, the more routine injection routes are intravenous (IV), intramuscular (IM), and subcutaneous (SC). Because these three modalities involve skin puncture, they carry the risks of infection, pain, and local irritation. 

TNF was originally identified because of its cytotoxic activity against some tumor cell lines and its ability to induce hemorrhagic necrosis of solid tumors in various animal models. However, the clinical use of TNF as an anticancer drug has been so far limited by its severe cardiovascular side effects. Therefore, TNF treatment is limited to regional and local administration of high doses of TNF, often in combination with chemotherapy, as accomplished in isolated limb and isolated hepatic perfusion (ILP and IHP, respectively) [5]. In the case of ILP, typically metastases are treated, patients benefit from this procedure by salvage of limbs from a loss by amputation. 

Regional (as opposed to systemic) administration of drugs intrathecal, intraarterial liver perfusion. 

Intra-arterial. Direct injection into the arteries is not a usual route for therapeutic drug administration. Arterial puncture and injection of contrast material has been carried out for angiography. Most of the intra-arterial injections or arterial perfusions via catheters placed in arteries are for regional chemotherapy of some organs and limbs. Intra-arterial chemotherapy has been used for mahgnant tumors of the brain. 

Brain imaging is stiU an active field of research in radiopharmaceutical chemistry. The compounds for brain imaging can be divided into two classes, one of which is discussed in this section. For the evaluation of the brain, one can apply either regional blood flow agents or receptor specific agents. Currently, the only Food and Drug Administration (FDA)-approved Tc radiopharmaceuticals are from the first class, so-called perfusion agents, but substantial efforts for the introduction of radiopharmaceuticals of the second class are currendy... 

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