Long-acting Steroid Research Articles

New strategies for the prevention of radiation injury: possible implications for countering radiation hazards of long-term space travel.

New strategies for the prevention of radiation injuries are currently being explored with the ultimate aim of developing globally radioprotective, nontoxic pharmacologics. The prophylactic treatments under review encompass such diverse pharmacologic classes as novel immunomodulators, nutritional antioxidants, and cytokines. An immunomodulator that shows promise is 5-androstenediol (AED), a well-tolerated, long-acting androstene steroid with broad-spectrum radioprotective attributes that include not only protection against acute tissue injury, but also reduced susceptibility to infectious agents, as well as reduced rates of neoplastic transformation. Other potentially useful radioprotectants currently under study include the nutraceutical vitamin E and analogs, a chemically-engineered cytokine, interleukin-1beta, and a sustained-release formulation of an aminothiol, amifostine. Results suggest that a new paradigm is evolving for the prophylaxes of radiation injuries, based on use of newly identified, nontoxic, broad-spectrum prophylactic agents whose protective action may be leveraged by subsequent postexposure use of cytokines with organ-specific reparative functions.

Infiltration of the Craniovertebral Region

The objective of this article is to explain the technique of C1-C2 arthrography as a suitable treatment for pain due to C1-C2 abnormalities. The technique is consistent with the puncture of the posterior aspect of the C1-C2 joint under fluoroscopic control. Arthrography is performed with 1 mL of contrast media. After that, 1 mL of long-acting steroid is injected. The articular cavity has an anterior recess and a posterior recess. The posterior recess is large and easily punctured. In 5% of cases, the ipsilateral joint is also opacified. This injection is indicated in cases of upper cervical pain because of C1-C2 osteoarthritis, inflammatory arthritis of the upper spine (rheumatoid disease, spondylarthritis), and cervico-occipital neuralgia (Arnold's neuralgia) of the same causes or of unknown local origin. C1-C2 arthrography appears to be an efficient and safe technique for the treatment of upper cervical pain due to C1-C2 abnormalities.

Traumatic arthritis in sport

After the introduction of ultrasonography in sports medicine, traumatic arthritis is recognized relatively frequently among athletes. In this case study, the ultrasonographic findings and the prompt effect of ultrasonographically guided intra-articular injection of long-acting steroid are demonstrated in two patients.

Imaging-guided injection techniques with fluoroscopy and CT for spinal pain management.

Local spinal pain and radiculopathy are common conditions that debilitate millions of Americans annually. Most cases are successfully treated conservatively with rest or physical therapy. Chiropractic manipulation or, in some cases, surgery may also be performed. Percutaneous injection has been used for spinal pain management for many years, but many of these procedures have historically been performed without imaging guidance. Recently, however, newer minimally invasive, imaging-guided percutaneous techniques have been added to the list of available treatment options for spinal pain. Imaging-guided techniques with fluoroscopy or computed tomography increase the precision of these procedures and help confirm needle placement. Cervical, thoracic, lumbosacral, and sacroiliac pain can be evaluated and treated safely and effectively with injections of local anesthetics or long-acting steroids into facet joints, sacroiliac joints, selective nerve roots, spondylolytic areas, and the epidural space. Because imaging-guided techniques appear to provide better results and reduce complication rates, they are becoming more popular despite controversy regarding their effectiveness. Controversy will continue to surround these imaging-guided techniques until large, double-blinded studies become available. In the meantime, there is an increased demand for these procedures from referring physicians, and it is important to be able to safely perform them with a minimum of patient discomfort.

Long-acting β-agonists and steroids - trial experience

Long-acting β-agonists and steroids - trial experience

IM Long-Acting Steroid vs. Oral Course in Kids with Asthma

Children who visit the ED for acute asthma often require a short course of corticosteroids, but the bad taste of oral preparations complicates

Blindness as a Complication of Subcutaneous Nasal Steroid Injection

Blindness as a result of steroid injection into areas adjacent to the eyes, namely the interior of the nose and eyelids, has been described in the otolaryngologic and ophthalmologic literature but at no time in the plastic surgery literature. We describe a case of permanent visual loss at the time of injection of a long-acting steroid to the dorsum of the nose for postrhinoplasty scarring. We suggest that before steroid injection for elective procedures, the patient be informed of all possible consequences of complications even if their occurrence is very rare.

Blindness as a Complication of Subcutaneous Nasal Steroid Injection

Blindness as a result of steroid injection into areas adjacent to the eyes, namely the interior of the nose and eyelids, has been described in the otolaryngologic and ophthalmologic literature but at no time in the plastic surgery literature. We describe a case of permanent visual loss at the time of injection of a long-acting steroid to the dorsum of the nose for postrhinoplasty scarring. We suggest that before steroid injection for elective procedures, the patient be informed of all possible consequences of complications even if their occurrence is very rare.

Jumper's knee

Jumper's knee is an overuse disease. The initial subjective complaints are well-localized pain, usually occurring after physical activities and often at the lower pole of the patella. The diagnosis of jumper's knee is usually easily established after acquiring a detailed history and a carefully performed physical examination, but the lesion can be mistaken for other disorders or injuries, such as bursitis, meniscal injuries or chondromalacia (1) or other causes of the patellofemoral pain syndrome. Today ultrasonography is the method of choice for the evaluation of jumper's knee as it is both time and cost saving, non-invasive, repeatable, accurate and allows a dynamic image of the tendon, guided injections and control of treatment. Conservative therapy is the treatment of choice in the early stages and includes adequate warm-up, stretching of the quadriceps muscle and physical activity with respect to the pain, and ice pack application after activity. When the pain disappears, the training intensity can be increased. NSAID (Non-Steroidal Anti-Inflammatory Drugs) and local peritendinous injections with long-acting steroids can be a helpful and safe adjuvant to the conservative treatment and should be tried before surgery. Surgical treatment is indicated only if a prolonged and well-supervised conservative treatment program fails in chronic jumper's knee (including local injection with steroid) or in acute total rupture. Review papers concerning jumper's knee are already published (2-5), but in this review the importance of ultrasonography to make the diagnosis, to plan therapy and control the treatment and the safety of peritendinous injection with steroid is pointed out. The scientific documentation for the recommanded treatment (conservative, steroid injection and operation) is, however, insufficient. Many more controlled studies are needed. Ultrasonography and placebo-controlled, double-blinded, cross-over studies for treatment with local injection of steroid are ongoing (6, 7).

Lumbar facet joint arthrography with the posterior approach.

Lumbar facet joint (LFJ) arthrography with intraarticular injections of long-acting steroids and local anesthetics is routinely used for therapeutic purposes in selected patients for relief of low back pain. The procedure may also be used for diagnostic reasons to establish the source of such pain. However, because direct access to the LFJ space is not always possible owing to degenerative changes such as osteophytes, another posterior approach has been proposed for LFJ arthrography. With the patient in the prone position, a spinal needle is inserted vertically into the inferior recess of an LFJ with fluoroscopic guidance and the patient under local anesthesia. To facilitate puncture, cushions are placed under the patient's abdomen to flatten normal lumbar lordosis, which enlarges the inferior recess of the LFJ. Use of cushions also results in a decrease in tissue thickness in the patient, thereby improving image quality and decreasing radiation exposure. LFJ arthrography can demonstrate the causative role of facet disease in abnormalities responsible for low back pain or sciatica and can be performed easily and rapidly with this direct posterior approach.

How to promote guidelines on asthma management

Summary Difficulties to comply with prescribed therapy can be cause of failure to establish and/or maintain asthma control. All current guidelines recommend regular long-term treatment in patients with persistent asthma. This includes the administration of inhaled corticosteroids combined, when necessary, with long-acting bronchodilators and/or systemic steroids, administering inhaled short-acting β2-agonists only on a prn basis. It is becoming clear that in addition to therapy: a) education for an active partnership with patients remains the cornerstone of asthma management; b) education should be carried out by health care providers involved in asthma care; c) education to asthma self-management should be tailored to the needs of each individual patient.

Parenteral triamcinolone acetonide: an alternative corticosteroid for the treatment of asthma.

Corticosteroids are effective in reducing the airway inflammation and controlling the symptoms of asthma. Many patients with chronic, severe asthma are steroid-dependent, requiring daily oral corticosteroids. Although corticosteroids may be effective, many patients suffer from their intolerable side effects. Various medications have been used as steroid-sparing agents in patients who suffer from the side effects of long-term high-dose steroids. While drugs like methotrexate and cyclosporine are promising, none have clearly been shown to be beneficial in most patients with asthma. The long-acting parenteral steroid triamcinolone acetonide has been tested by various investigators in these patients for over 20 years. Intramuscular triamcinolone appears to beneficial, with no significant increase in adverse effects.

C1-2 arthrography

To describe the technique of C1-2 arthrography and recommend it as a suitable treatment for pain due to C1-2 abnormalities. One hundred patients with the following conditions were studied: cervical pain or neuralgia without radiographic changes (group 1, n = 23), osteoarthritis (group 2, n = 37), rheumatoid arthritis (group 3, n = 23), ankylosing spondylarthritis (group 4, n = 5) and diverse conditions (group 5, n = 12). The technique consists of lateral puncture of the posterior aspect of the C1-2 joint with a 20-gauge needle under fluoroscopic control, arthrography using 1 ml contrast medium, and a 1-ml long-acting steroid injection subsequently. The articular cavity has an anterior and a posterior recess. Sometimes the posterior recess is large. In 18% of cases the contralateral joint also opacifies. C1-2 arthrography appears to be an efficient and safe technique for the treatment of upper cervical pain due to C1-2 articular disorders.

Intramuscular methylprednisolone acetate for the prevention of relapse in acute asthma

To examine the hypothesis that an IM long-acting steroid injection will decrease the relapse rate of asthma patients. A randomized, single-blind, placebo-controlled trial. The emergency department of an urban academic medical center. Acute asthma patients aged 18 to 45 years who were treated successfully in the ED. Participants received either IM saline placebo or 240 mg methylprednisolone acetate suspension at the time of discharge. MEASUREMENTS AND MAIN OUTCOME: Relapse, defined as the need to seek nonroutine medical care for asthma within seven days of discharge, was the main outcome measure. Of 70 patients entered, 56 (80%) completed follow-up, including 30 in the steroid group and 26 in the placebo group. The groups had similar characteristics and peak expiratory flow values on arrival and at discharge. Relapse occurred in two steroid patients (6.7%) and eight placebo recipients (30.8%) (P < .05). There was one death in the placebo group. Reported side effects were similar. IM long-acting steroids reduced the rate of relapse in patients with acute asthma.

Education Contraception: What pharmacists should tell their patients

Unintended pregnancies occur despite the availability of highly effective contraceptives. Patients' contraceptive choices, as well as the availability of certain methods, however, may be affected by social, religious, and political forces. It is therefore vital that health care professionals provide consumers with unbiased, factual information on contraceptive methods, in a comfortable environment. All sexually active individuals who wish to prevent unwanted pregnancy should be counseled on contraception. Pharmacists are well-placed to counsel consumers on the efficacy, safety, cost, convenience, and availability of birth control methods in an unbiased fashion. The author discusses menstrual cycle physiology, selecting a contraceptive method, oral contraceptives, combination oral contraceptives, progestin-only oral contraceptives, long-acting steroid contraceptives, and barrier methods, emphasizing information on hormonal contraceptives. Consumers need to be educated to keep pace with the development and marketing of new forms of contraception. Moreover, both health care professionals and consumers need to be reeducated on the health benefits and risks of low-dose combination oral contraceptives.

Pupillary membrane after cataract extraction with posterior chamber lens in glaucoma patients

Deposition of a fibrin-like material leading to a membrane in the pupillary opening is described in glaucoma patients following extracapsular cataract extraction and intraocular lens implantation. The fibrinoid reaction was observed in 4 out of 57 eyes (7%), all operated on within two years by the same surgeon (CTL). The fibrinoid reaction appeared 2 to 15 days postoperatively in glaucoma patients on whom iridoplasty or synechiolysis had been performed during surgery. It seems advisable to give such patients long-acting subconjunctival steroids at the end of the operation.

Rotator cuff impingement syndrome: MR imaging.

Ten patients with clinically suspected rotator cuff impingement syndrome were evaluated with magnetic resonance (MR) imaging, double contrast arthrography, and conventional radiography. An area of increased signal intensity in the tendinous portion of the rotator cuff was seen in eight of ten patients on images obtained with a short repetition time (TR) and short echo time (TE) and those obtained with a long TR and long TE with spin-echo sequences. Microscopic findings, available in five patients, indicated that these areas of increased intensity corresponded to degeneration and inflammation of the rotator cuff. A previously injected long-acting steroid preparation combined with a local anesthetic, which also produces an area of increased signal intensity on long TR, long TE images, can cause problems with image interpretation. No tears of the rotator cuff were detected with MR imaging. However, a full-thickness cuff tear was detected with arthrography in three patients. Although based on a relatively small group of patients, these preliminary findings suggest that MR imaging is capable of demonstrating rotator cuff abnormalities in patients with impingement syndrome.

An investigation on the influence of steroidal contraceptives on milk lipid and fatty acids in Hungary and Thailand

A double-blind clinical trial to examine the effects of oral and long-acting injectable contraceptive steroids on milk lipid and its fatty acid content has been done in Szeged, Hungary, and Khon-Kaen, Thailand. In Szeged, a combined and a progestin-only pill did not significantly alter total milk lipid. In Khon-Kaen, treatment with the combined pill was followed by a significant increase in the proportion of milk lipid. In the group treated with the long-acting injectable contraceptive, depot-medroxyprogesterone acetate (DMPA), the milk lipid decreased significantly in the first six weeks in comparison with the control group and the individual pretreatment values. A similar but weaker effect was noticed with the progestin-only pill in Khon-Kaen.Few consistently significant differences were found in the shorter chain fatty acids (myristic, lauric and palmitic acids) during treatment. The percentage proportions were increased during the combined pill treatment in Szeged and Khon-Kaen, and reduced in DMPA and progestin-only treatment in Khon-Kaen milks. The possibility that these reflected a response to a milk volume-decrease in the combined pill treatment and a reduction in milk lipid synthesis in association with DMPA and the progestin-only pill is discussed. In Khon-Kaen, linoleic acid (which is not synthesized in the body) was increased by comparison with the controls, as a percentage proportion of the fatty acids in the progestin-only and DMPA groups. Calculation of the amounts of linoleic acid per litre of milk revealed that there had been a significant decrease of linoleic, eicosadienoic, dihommo-gamma-linolenic, arachidonic, docosatetraenoic acids in the w6 family and alpha-linolenic acid in the w3 family in the first two post-treatment visits (3 and 4). This reduction in essential fatty acid output follows the reduction in milk volume.In Khon-Kaen, the combined pill group showed a significant decrease compared with the controls, in the proportions of dihommo-gamma-linolenic acid. The difference in response of the mothers in Khon-Kaen and Szeged is discussed in relation to their different nutritional backgrounds.

When shoulder pain isn't bursitis. The myofascial pain syndrome.

Pain in the shoulder girdle and the arm is often referred pain from a remote trigger point, ie, the myofascial pain syndrome. Once initiated, this definite disease entity perpetuates itself through various feedback loops. Treatment consists of interrupting the pain cycle. Local block of the trigger point with 1% lidocaine (Xylocaine), to which a short- or long-acting steroid may or may not be added, has proved to be most effective.

Long-acting contraceptive agents: Design of the who chemical synthesis programme

The great demand for improved long-acting injectable steroid contraceptives, particularly in developing countries, and the relative lack of interest from the pharmaceutical industry to develop such products stimulated WHO to launch a synthetic and screening programme to find improved, safe and acceptable injectable preparations. More than 210 esters of norethisterone (17α-ethynyl-17β-hydroxyestr-4-en-3-one) and levonorgestrel (D-(-)-13β-ethyl-17α-ethynyl-17β-hydroxygon-4-en-3-one) have been prepared in university-based research laboratories situated mainly in developing countries, and then screened by NICHHD in animal models. The following three compounds, levonorgestrel butanoate, cyclopropylcarboxylate and cyclobutylcarboxylate, proved to be particularly long-acting when administered as microcrystalline suspensions. The overall strategy of this research and development programme is described.