Concomitant Administration Of Steroids Research Articles

Pre-Existing and Treatment-Emergent Autoimmune Cytopenias in Patients with Chronic Lymphocytic Leukemia Treated with Targeted Drugs

Pre-Existing and Treatment-Emergent Autoimmune Cytopenias in Patients with Chronic Lymphocytic Leukemia Treated with Targeted Drugs

The Effects of Propofol and Ketamine on the Cytokine Levels of Children With Acute Lymphoblastic Leukemia

The immune system of children with acute lymphoblastic leukemia (ALL) is affected by both the underlying disease and the chemotherapy. Children with ALL receive sedation for diagnostic and therapeutic procedures, which may contribute to immune competence alteration. The effects of propofol-ketamine combination on the immune system of children with ALL have not been investigated. This cohort study was designed to assess the immunomodulatory activity of the propofol-ketamine combination on proinflammatory and anti-inflammatory cytokines of children with ALL undergoing painful procedures. We enrolled 20 children with ALL undergoing bone marrow aspiration (BMA) and lumbar puncture with methotrexate. All children received sedation with IV ketamine (0.5 mg/kg) and propofol (3±2 mg/kg). Plasma concentration of cytokines interleukin (IL)-1β, IL-2, IL-6, IL-10, IL-8, IL-12p70, and interferon-γ before sedation for BMA was represented as T0, during lumbar puncture with methotrexate sedation 6 hours after T0 was represented as T1, and 24 hours after BMA was represented as T2. Sedation with propofol-ketamine combination did not modify the plasma concentration of the most measured cytokines and the T helper 1/2 ratio in children with ALL. There was a significant reduction in IL-8 concentration 24 hours after BMA associated with the concomitant administration of steroids and methotrexate. These data suggest that sedation with propofol-ketamine combination may not affect the immediate outcome of children with ALL.

SAT0078 Decreased peripheral CD3 zeta chain expression in patients with active rheumatoid arthritis can be restored by various biologic DMARDs and methotrexate

BackgroundCD3 zeta chain (CD3 zeta) is a member of T cell antigen receptor CD3 complex and has crucial role in proximal signal transduction after peptide antigen recognition. CD3 deficiency and...

Clinical treatment outcomes for 40 patients with bisphosphonates-related osteonecrosis of the jaws

Bisphosphonates (BPs) are used to treat osteoporosis and bone metastases from malignancy. They may result in BPs-related osteonecrosis of the jaws (BRONJ) in a subset of patients receiving BPs. This study examined whether conservative or aggressive surgical approach could result in successful treatment of BRONJ lesions and assessed whether concomitant steroid administration or tobacco smoking habit might hinder the remission of BRONJ lesions. The 40 BRONJ patients were evenly divided into four different groups. Group 1 contained 10 patients with concomitant corticosteroid medication but without smoking habit. Group 2 contained 10 patients with smoking habit but without concomitant corticosteroid medication. Groups 3 and 4 each consisted of 10 patients without concomitant corticosteroid medication and smoking habit. To avoid bias, each group contained equal number of patients with different stages of BRONJ. Patients in Groups 1, 2, and 3 received conservative treatment, including antibiotic coverage, antibacterial solution irrigation, and minor surgical debridement. Patients in Group 4 were treated with aggressive surgical excision of necrotic bone segment. The mean duration to achieve complete remission of BRONJ lesion was 19.7±0.6, 18.2±0.5, 13.0±1.0, and 7.6±1.1 months for patients in Groups 1, 2, 3 and 4, respectively. Student's t-test showed significant differences in the mean duration to achieve complete remission of BRONJ lesion between Groups 1 and 3, between Groups 2 and 3, between Groups 3 and 4, between Groups 1 and 4, and between Groups 2 and 4 (all p values < 0.001). Although both conservative and aggressive surgical approaches can result in successful treatment of BRONJ lesions, aggressive surgical treatment needs a shorter mean duration to achieve complete remission of BRONJ lesion than conservative treatment. Concomitant corticosteroid administration or tobacco smoking may prolong the duration for complete remission of BRONJ lesion.

Cholesterol-lowering effect of hydroxychloroquine in patients with rheumatic disease: Reversal of deleterious effects of steroids on lipids

purpose: The effects of hydroxychloroquine (HCQ) on serum levels of cholesterol, triglycerides, and high- (HDL) and low-density lipoprotein (LDL) were studied in patients with rheumatoid arthritis or systemic lupus erythematosus. patients and methods: A total of 155 women were divided into the following treatment groups: Group A: patients taking HCQ and no steroids (n = 58); Group B: patients taking steroids and no HCQ (n = 35); Group C: patients receiving both HCQ and steroids (n = 18); and Group D: patients receiving neither HCQ nor steroids (n = 44). results: HCQ therapy had a high statistical association with low serum levels of cholesterol (181 mg/dL; p = 0.0006), triglycerides (106 mg/dL; p = 0.0459), and LDL (101 mg/dL; p = 0.0004), irrespective of concomitant steroid administration. The HCQ-treated group (A) had lower cholesterol (181 mg/dL; p = 0.0039) and LDL (101 mg/dL; p = 0.007) levels than those receiving neither HCQ nor steroids (205 mg/dL) and 128 mg/dL) (Group D). No HDL differences were observed. conclusion: The effects of HCQ do not appear to be due to changes in diet or weight, and the drug was well tolerated. Although the mechanism of cholesterol lowering by HCQ is not known, this drug deserves further investigation for its lipid-lowering properties.

INFLUENCE OF HYDROCORTISONE ON GENTAMICIN-INDUCED NEPHROTOXICITY IN RATS

Many risk factors associated with aminoglycoside nephrotoxicity have been identified in humans and experimental animals. They include an initial high rate of creatinine clearance, high initial peak levels in serum, age, sex, duration of therapy, liver disease, and renal infection. The concomitant administration of steroids has never been investigated. We evaluated the role of hydrocortisone on gentamicin-induced nephroxicity in a model of infused rats. We showed that hydrocortisone given over 3 days after the infusion did not modify the gentamicin half-life in the renal cortex, gentamicin-induced lysosomal phospholipidosis, or histopathology but did reduce significantly the 3H/DNA ratio on day 4 after gentamicin infusion. We concluded that hydrocortisone interferes with the postnecrotic cellular regeneration process, an important step that is responsible for the recovery of normal kidney structure following toxic injuries associated with aminoglycoside therapy.

Isolated pituitary cells: glucocorticoids do not rapidly suppress ACTH secretion in response to CRF

The possibility of a direct rapid suppressive effect of glucocorticoids on stimulated adrenocorticotropic hormone (ACTH) release was investigated in perifused normal pituitary cells attached to microcarriers. Forty-eight hours after attachment to Cytodex beads, cells were transferred to two columns (one experimental, one control), perifused at a rate of 300-350 microliters/min, and equilibrated for 3 h. Either rat or ovine corticotropin-releasing factor (CRF; 2 nM) were used to stimulate ACTH release, and fractions collected every 5 min were assayed for immunoreactive ACTH. Concomitant treatment with CRF and glucocorticoids (dexamethasone 100 nM or corticosterone 1 microM), or glucocorticoid pretreatment for up to 2 h, did not affect the release of ACTH occasioned by repetitive 5-min exposures to CRF at 30-min intervals. In addition, when ovine CRF was given as two 30-min infusions 1 h apart, neither concomitant steroid administration nor steroid pretreatment for 90 min affected the release of ACTH compared with controls. The lack of rapid steroid inhibition was not an artifact of enzymatic dispersion or microcarrier attachment, since no rapid inhibitory response was seen with acutely perifused rat anterior pituitary quarters. We thus conclude that in vitro rapid inhibitory effects of glucocorticoids on ACTH release do not occur at the level of the pituitary. Accordingly such action in vivo presumably reflects acute steroid-induced effects on the hypothalamus or higher centers.

Influence of hydrocortisone on gentamicin-induced nephrotoxicity in rats.

Many risk factors associated with aminoglycoside nephrotoxicity have been identified in humans and experimental animals. They include an initial high rate of creatinine clearance, high initial peak levels in serum, age, sex, duration of therapy, liver disease, and renal infection. The concomitant administration of steroids has never been investigated. We evaluated the role of hydrocortisone on gentamicin-induced nephroxicity in a model of infused rats. We showed that hydrocortisone given over 3 days after the infusion did not modify the gentamicin half-life in the renal cortex, gentamicin-induced lysosomal phospholipidosis, or histopathology but did reduce significantly the 3H/DNA ratio on day 4 after gentamicin infusion. We concluded that hydrocortisone interferes with the postnecrotic cellular regeneration process, an important step that is responsible for the recovery of normal kidney structure following toxic injuries associated with aminoglycoside therapy.

Hyperlactacidemia associated with acute ritodrine infusion

The use of β-mimetic tocolytics has been associated with various metabolic derangements which have been the topic of investigational reports. Lactic acidosis has been reported to follow concomitant steroid administration. The purpose of this investigation was to delineate more clearly hyperlactacidemia in patients receiving various tocolytics with and without concomitant use of steroids in a prospective manner. Twenty patients in premature labor who received ritodrine had markedly increased blood levels of lactate (baseline, 1.0 ± 0.1 mmol/L [SEM] versus 3.5 ± 0.3 mmol/L [SEM] after 6 hours' intravenous infusion). In the other treatment groups, ritodrine plus hydrocortisone, hydrocortisone alone, and magnesium sulfate alone, lactate levels failed to change significantly. Clinical relevance and implications for metabolic alterations associated with β-mimetic tocolysis are discussed.

Response to Pneumococcal Vaccination in Children With Nephrotic Syndrome

Serologic responses to a 14-valent pneumococcal vaccine were measured in 20 children with steroid-responsive idiopathic nephrotic syndrome. All patients were free of proteinuria and receiving either daily (five patients) or alternate-day (15 patients) prednisone in a dosage of 1-2 mg/kg/day at the time of vaccination. Patients on alternate-day steroids received the vaccine on a day prednisone was not given. The mean fold rise in antibody titer was found to be normal in these children when antibody levels measured 3-6 wk post-vaccination were compared to prevaccination levels. This serologic response has correlated well with a 3-yr follow-up of the patients, none of whom has developed peritonitis secondary to any pneumococcal types in the vaccine. Also described are three patients who developed pneumococcal peritonitis during this period despite prior vaccination; in two of these patients, the pneumococcal type was not included in the vaccine (types 6b and 10a) and in one patient the organism was not typed. It is concluded that in children with nephrotic syndrome pneumococcal vaccination confers good protection against types included in the vaccine despite the concomitant administration of steroids. However, the patients who developed peritonitis secondary to other pneumococcal types remind us that pneumococcus must still be considered as an etiologic agent for peritonitis in nephrotic children who have been vaccinated.

The superior vena cava syndrome and radiation therapy. Clinical response, survival, and postmortem findings.

The beneficial effects of external irradiation for the superior vena cava syndrome secondary to malignant disease have been studied by numerous observers. One aspect that has received little emphasis is the nature and extent of the pathologic findings at necropsy. The purpose of this report is to focus attention on these findings and to consider the apparent effects of external irradiation on mediastinal pathology and patient survival. Methods And Materials Eleven hundred and fifty cases of primary lung cancer were treated in the Veterans Administration Hospital, Philadelphia, between January 1953 and November 1967. In 941 patients the diagnosis was confirmed by histologic examination. Sixty-nine patients with superior vena cava syndrome were treated in the radio-therapy department, and in 57 of these there was histologic proof of bronchogenic carcinoma. Three had biopsy-proved lymphoma (Table I). In 15 per cent of the patients with primary lung cancer seen in the Radiotherapy Department and in 5.7 per cent of all hospital cases of primary lung cancer, the superior vena cava syndrome was either a presenting complaint or a development. Radiotherapy at this hospital has been administered with a 250 kV unit with a Thoraeus II filter, resulting in a beam with a half value layer of 3 mm Cu. Our experience over a fifteen-year period reflects the application of changing concepts in the treatment of superior vena cava syndrome. Several patients were treated in 1953 with the grid technic. During the middle and later 1950's most patients were given small initial doses with increasing daily increments to a total dose which averaged 2,900 rads. Pretreatment with one or two doses of nitrogen mustard or concomitant steroid administration was used in some patients, presumably to reduce so-called radiation edema. Approximately two-thirds of the patients were given diuretics, usually mercurials, during the course of x-ray therapy. An occasional patient was digitalized. These various adjunctive measures have not been evaluated. After Jan. 1, 1961, our treatment protocol became rather standardized. All patients received a tumor dose of 200 rads per day, 1,000 rads per week, to a total of 4,000 rads. Consequently, the total dose since 1961 exceeds the earlier dose by an average of 1,100 rads. The survival and the clinical response were significantly improved (TABLE II). Results And Discussion Response to radiation therapy can be judged by clinical evaluation, measurement of venous pressure, venography, duration of survival, and autopsy findings. Clinical response to therapy, i.e., clearing of venous obstructive signs and symptoms, was graded as either (a) marked or complete or (b) poor or unimpressive.