High-dose Steroid Treatment Research Articles

Cyclosporin in Steroid-Resistant Auto-Immune Haemolytic Anaemia

A case of Evans' syndrome which was refractory to conventional and high dose steroid treatment and to splenectomy was treated with cyclosporin, beginning with the dose of 10 mg/kg/day and then gradually tapering to 4 mg/kg/day. The patient experienced excellent benefit from cyclosporin; his haematological parameters were completely normal at the 12th month of therapy, without any side effect of the drug.

Glucocorticoid-treatment does not influence the synthesis of thromboxane B 2 and bicyclo-PGE 2 in humans

It has been reported that the anti-inflammatory action of glucocorticoids is due to the inhibition of phospholipases. Consequently, after high-dose steroid treatment in humans a decrease in cyclooxygenase products should be expected. In 15 patients (10 males, 5 females, 29–62 y) undergoing 6-methyl-prednisolone-treatment (40–80 mg daily) for various clinical reasons and in 5 healthy volunteers (4 male, 1 female, 28–37 y) receiving 500 mg 6-methyl-prednisolone daily for 3 days plasma- and serum-thromboxane B 2 (TXB 2), as well as bicyclo-prostaglandin E 2 (bicyclo-PGE 2) were monitored over 3 weeks. In the entire follow-up period, however, no significant change in either serum- or plasma-TXB 2 or bicyclo-PGE 2 could be measured in either, patients and volunteers, under glucocorticoid-treatment. These findings indicate that even high-dose glucocorticoid-treatment does not affect the serum- and plasma-metabolites of the eicosanoids examined. It is concluded that in humans a significant inhibition of phospholipases by glucocorticoids and subsequently reduced formation of cyclooxygenase products seems to be rather unlikely.

Brain abscess: a complication of esophageal dilatations

In this article, we report two new cases of brain abscess in patients under treatment for esophageal stricture secondary to caustic ingestion. This supports Rontal's hypothesis that “the pressure from esophageal dilatation may result in microscopic perforation and/or bacteremia and that high-dose steroid treatment facilitates bacterial seeding by impeding the formation of protective scar tissue”. This serious complication should be kept in mind when long-term treatment by repeated esophageal dilatations is planned.

Anabolic steroids alter the haemodynamic effects of endurance training on the canine left ventricle.

The effects of six week, high-dose anabolic steroid treatment (methandienone, 1.5 mg/kg/day) on the changes in left ventricular function induced in dogs by endurance training were studied by a catheterization technique under anaesthesia. Pacing, isoproterenol and dextran infusions were used as loading tests (respectively). Dogs were randomized into an exercise group (EG, n = 7) and an exercise-steroid group (ESG, n = 7), the latter receiving anabolic steroids as well as participating in the training program. In a standardized submaximal exercise test, the heart rate of unanesthetized dogs was lower both in the EG (p less than 0.001) and in the ESG (p less than 0.01) after the training period than before it. In the EG the resting systemic vascular resistance (SVR) before haemodynamic interventions was lower (p less than 0.05) and left ventricular stroke work (SW) was higher (p less than 0.05) after the training period than before. In the ESG, left ventricular ejection fraction (EF) decreased with training and anabolic steroid treatment (p less than 0.05). After the training period isoproterenol increased the maximum velocity of the cardiac contractile element significantly more (p less than 0.05) in the EG than in the ESG. Also SW increased in the EG (29%, p less than 0.001), but not in the ESG (-11%, NS). Endurance training increased the left ventricular end-diastolic and stroke volumes during isoproterenol infusion, but this training effect was attenuated by simultaneous anabolic steroid treatment (p less than 0.05 between the groups in both cases). During the isoproterenol test SVR decreased less in ESG than in EG (p less than 0.05 between).(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis and therapy of gigantism

Some of the most important types of nonfamilial tall stature are discussed by stressing the clinical features, diagnostic aspects and therapeutic possibilities. The indications of treatment, the diagnostic procedures and steroid therapy of the familial type of tall stature, the predominant variant of tall stature, are presented in detail. The effects, side effects and contraindications of high dose steroid treatment are described. The important prerequisite for the evaluation of psychosomatic problems of tall stature is the understanding of the dynamics and variations of normal growth. This and the knowledge of methods concerning growth analyses continue to be the basis of an accurate diagnosis.

Pyoderma gangrenosum occurring at multiple surgical incision sites

Ten weeks after subtotal colectomy and ileostomy for ulcerative colitis, a 16-yr-old girl developed wound drainage and back pain. Massive ulceration and skin separation occurred at the abdominal wound incision as well as at the incision sites of a previous central venous line. A diagnosis of pyoderma gangrenosum was made. High-dose steroid treatment induced prompt healing of the abdominal wound as well as the catheter sites. Pyoderma gangrenosum has rarely been seen in surgical wounds. To our knowledge, this is the first reported case of pyoderma gangrenosum occurring simultaneously in multiple surgical incision sites in a patient with ulcerative colitis.

Disseminated Sporotrichosis in a Patient With HIV Infection After Treatment for Acquired Factor VIII Inhibitor

SYSTEMIC sporotrichosis is a rare but well-recognized opportunistic fungal infection, usually occurring in patients with hematological or lymphoreticular malignant neoplasms, alcohol abuse, long-term high-dose steroid treatment, or diabetes mellitus.1-3We describe a woman who became infected with human immunodeficiency virus ([HIV], formerly denoted human T-lymphotropic virus type III/lymphadenopathy-associated virus) following transfusion therapy for an acquired factor VIII inhibitor and who developed disseminated cutaneous sporotrichosis three years later. Report of a Case A 71-year-old woman was initially seen in March 1986 with a four-month history of progressive fatigue, weight loss, fever, and multiple enlarging cutaneous ulcers. More recently she had also noted night sweats, nonproductive cough, left shoulder pain, and painless right ankle swelling. Three years before admission to the hospital, in December 1982, gross cutaneous hemorrhage developed, and she was found to have an acquired factor VIII inhibitor of high titer (25 Bethesda units) with a residual plasma factor

Steroid treatment for experimental autoimmune myasthenia gravis.

Short-term, high-dose steroids (prednisolone sodium succinate) were given to female Lewis rats in the chronic stage of experimental autoimmune myasthenia gravis (EAMG). Abnormally low amplitude miniature endplate potentials (MEPPs) persisted, and were even slightly lower than those seen in saline-treated animals with chronic EAMG. The MEPPs were also studied in normal female Lewis rats treated with short-term, high-dose steroids, and no significant change was noted when compared with normal controls. Previous investigators have reported normalization of the abnormally low amplitude MEPPs within 24 hours of high-dose steroid treatment. Our different results might be explained by our higher dose of receptor, addition of pertussis to the inoculum, and study of a different muscle. A survey of endplate ultrastructure revealed some definite postsynaptic membrane abnormalities in both steroid-treated and saline-treated rats with EAMG, but clear distinction among the groups studied was not possible by direct visualization.

Avascular necrosis of bone in children receiving high-dose steroid treatment.

Avascular necrosis of bone in children receiving high-dose steroid treatment.

Glucocorticosteroids and growth hormone secretion under physiological conditions and in states of steroid excess.

Cortisol and growth hormone (GH) secretion (spontaneous variations at night and the release induced by insulin hypoglycaemia) were investigated in 69 children and adolescents. Statistical analysis of approximately 600 pairs of cortisol and GH values in this study demonstrated that physiological fluctuations of cortisol do not alter GH secretion. A review of the literature shows that GH secretion is consistently depressed in Cushing's disease of central origin and in Cushing's syndrome due to adrenal carcinoma. When acutely administered, doses higher than 100 mg of cortisol (or equivalent amounts of other steroids) per adult are necessary to block GH secretion and the hormones have to be given several hours previously. In long-term steroid treatment, suppression of GH is observed in only 1 out of 3 patients. The effect apparently does not persist beyond elimination of the last dose, i.e. generally not longer than 12 to 24 h. These data can be taken as a rationale for intermittent or alternating dosage schedules, and for the use of short acting derivatives if long-term, high-dose steroid treatment is necessary in children. It remains to be established whether growth deficiency in exogenous hypercortisolism is due to suppression of GH secretion, decreased production of somatomedins, direct antagonism of the action of somatomedins on growing cartilage, or a combination of these mechanisms.

Long-term prednisone followed by thymectomy in myasthenia gravis.

The present series of thirty patients has led us to certain conclusions concerning the management and treatment of patients with myasthenia gravis. The use of cholinesterase inhibitors alone is reserved for those patients with purely ocular myasthenia whose deficits can be satisfactorily corrected with those agents. Some of those with ocular involvement may be disabled; and in light of our excellent results with that small group, as well as similar findings presented by Fischer et al., patients with disabling or refractory ocular myasthenia should be considered for treatment with prednisone. All other patients with myasthenia are given a course of oral corticosteroids (prednisone) initially at high doses, with subsequent tapering to maintenance, alternate-day low-dose therapy. Cholinesterase inhibitors are used as needed while the patient is receiving corticosteroids. We now anticipate that patients will exhibit sustained improvement within the first two weeks, reaching maximal improvement at about three months. Exacerbations of myasthenic weakness may occur in the early phases of treatment. Such exacerbations have been commonly mild and occur with a mean onset at 5 days, and have a mean duration of 6 days. Most patients have been able to tolerate an alternate-day schedule of prednisone therapy when maintenance levels were achieved. The effective maintenance dose has been determined as the smallest dose of prednisone which allows the patient to maintain maximal improvement. Following the establishment of maximal improvement, patients have been considered for thymectomy. In our experience, the sternum-splitting procedure has been tolerated extremely well by patients exhibiting marked imporvement or remission while on corticosteroids. In those patients where thymectomy is contraindicated, irradiation of the thymus might be considered. Patients are continued on maintenance steroid therapy following surgery for a period of time that has been arbitrary. Currently, we consider an attempt to discontinue steroids at approximately one year reasonable. Should the patient relapse after discontinuation of the medication, oral corticosteroid treatment is reinitiated. Consideration is given to the possibility of recurrent thymus in patients who repeatedly fail to maintain a remission when steroids have been stopped. Our experience has not permitted us to draw firm conclusions concerning how long a time high-dose daily steroid treatment should be continued in patients who show no favorable response to that therapy. Other modes of treatment, such as courses of parenteral ACTH, methyl prednisolone, dexamethazone, or antimetabolites might be considered if there is no response after 12 weeks of high-dose, daily corticosteroid therapy.

Metastatic abscess as a complication of retrograde esophageal dilatation.

Retrograde dilatation of the esophagus for lye stricture has resulted in two patients with metastatic abscesses. One patient developed a brain abscess and the other a septic arthritis. It is postulated that: 1) the pressure from esophageal dilatation may result in microscopic perforation and/or bacteremia, and 2) that high dose steroid treatment facilitates bacterial seeding by impeding the formation of protective scar tissue. It is therefore felt that a longer time duration should lapse between termination of steroid therapy and the dilatation of an esophageal stricture.

Steroid-Induced Diabetic Ketoacidosis.

Meeting Abstracts1 May 1970Steroid-Induced Diabetic Ketoacidosis.I. A. Alavi, M.R.C.P., V. K. G. Pillay, M.R.C.P.I. A. Alavi, M.R.C.P.Search for more papers by this author, V. K. G. Pillay, M.R.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-72-5-787_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptAlthough diabetes mellitus is not uncommon in patients on highdose steroid treatment, ketoacidosis is distinctly rare. Indeed only a few patients have been reported, and the ketoacidosis was so mild that none required insulin. We have studied four patients with systemic lupus erythematosus (SLE) who developed diabetic ketoacidosis after treatment with large doses of steroids. All received at least 60 mg of prednisone for 2 to 8 months. In addition, two had been maintained on small doses for 1 and 10 years. Family history of diabetes mellitus was present in two. One patient was on chlorothiazide diuretic for several months,... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Chicago, Ill. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 May 1970Volume 72, Issue 5Page: 787-787KeywordsDiabetes mellitusDiureticsInsulinLupus erythematosus Issue Published: 1 May 1970 PDF downloadLoading ...