Oral Steroid Administration Research Articles

A case of idiopathic encapsulating peritoneal sclerosis with intractable ileus successfully treated by surgery and steroid therapy.

Encapsulating peritoneal sclerosis (EPS) occurring without a history of peritoneal dialysis is rare. We report on a patient with idiopathic EPS following intractable ileus who was successfully treated by surgery and postoperative steroid therapy without any sign of recurrence. A 67-year-old woman was referred to our department for further treatment of intractable ileus. Abdominal CT scanning revealed wall thickening of the proximal jejunum. Double-balloon enteroscopy disclosed stenosis of the jejunum at 20cm anally from the Treitz ligament, although the intestinal mucosa appeared normal without specific biopsy findings. In addition, FDG-PET showed no abnormal accumulation, thus discounting a malignant lesion. Since conservative therapy failed to improve the ileus, we performed an operation on her in order to release the ileus and make a histological diagnosis. Surgical findings included a whitish thickening of the serosa extending to the intestine and the whole mesentery. Accordingly, we made a diagnosis of idiopathic encapsulating peritoneal sclerosis because of her negative history of peritoneal dialysis, laparotomy or peritonitis, in addition to the above-noted findings. Postoperative oral administration of steroid has suppressed EPS recurrence. In patients with intractable ileus, EPS should be added to the list of differential diagnoses, even if they have not undergone peritoneal dialysis.

HEART's Original [症例] 冠動脈インターベンション後早期から腎機能悪化を認めステロイド治療が奏効したコレステロール塞栓症の1例

HEART's Original [症例] 冠動脈インターベンション後早期から腎機能悪化を認めステロイド治療が奏効したコレステロール塞栓症の1例

Electrocautery therapy combined with oral steroid administration for refractory corrosive esophageal stenosis prevents restenosis

A 61-year-old female with refractory corrosive esophageal stenosis repeatedly underwent endoscopic balloon dilation at another hospital; however, no improvements were observed in the esophageal stenosis. Consequently, she had been on a liquid diet for the previous three years. She was admitted to our department for further treatment. A radial incision was made, by use of the SB knife Jr, for a pinhole-like stenosis in a short segment 39 cm from the incisor, and dilation was safely performed by use of a CRE balloon dilator. Subsequently, prednisolone was orally administered to prevent re-stenosis. This was followed by a favorable clinical course.

Steroids for preventing recurrence of acute severe migraine headaches: a meta‐analysis

Recurrence of migraine headaches after treatment is common. The evidence regarding steroids for preventing migraine headache recurrence is controversial. This meta-analysis examined the effectiveness of steroids for prevention of recurrent headaches. Databases (PubMed, Embase and the Cochrane Library) and conference proceedings were searched for randomized controlled trials comparing steroids and placebo in the treatment of migraine headaches. Two independent reviewers assessed studies and extracted data. Relative risks (RRs) of headache recurrence and adverse events were calculated and reported with 95% confidence intervals (95% CIs). Eight studies with 905 patients were included. Pooled analysis showed that when steroids were added to standard abortive therapy they reduced the rate of moderate or severe headache recurrence after 24-72 h of follow-up evaluation (RR = 0.71; 95% CI = 0.59-0.86). There was no significant benefit of steroids compared with placebo in the proportion of totally resolved migraines (RR = 1.11; 95% CI = 0.94-1.32). The side effects of steroids are mild and not significant except for dizziness. Subgroup meta-analysis showed that parenteral dexamethasone tends to be more effective in reducing moderate or severe recurrent headaches (RR = 0.68; 95% CI = 0.55-0.84). However, no significant differences were found between oral administration and parenteral administration of steroids (P = 0.37). When steroids are added to standard abortive therapy for migraine headaches, they are effective and safe for preventing moderate or severe headache recurrence.

Mometasone implant for chronic rhinosinusitis

The Propel mometasone-eluting stent (Intersect ENT, Palo Alto, CA) is the first Food and Drug Administration-approved device for delivering steroid medication into the ethmoid cavity following surgery. The implant is composed of a biodegradable polymer in a lattice pattern that expands in a spring-like fashion to conform to the walls of a dissected ethmoid cavity and contains a total of 370 μg of mometasone furoate designed for gradual release over 30 days. The purpose of this article is to review the mode of action and the evidence supporting the efficacy of this novel technology. Three recently published clinical trials have demonstrated that the mometasone-eluting stent produced statistically significant reductions in inflammation, polyp formation, and postoperative adhesions. In addition, the implant has been found to significantly reduce the need for postoperative administration of oral steroids and to decrease the frequency of postoperative lysis of adhesions. Minimal adverse effects were reported in these trials and included infection, crusting, and granulation tissue formation. Although the placement of steroid-impregnated packing, stents, sponges, and gels has previously been used in the postoperative sinus cavities, the Propel mometasone-eluting stent introduces a new mechanism for localized and controlled delivery of topical therapy directly to the nasal mucosa for chronic rhinosinusitis.

A case of the "cellular variant" of focal segmental glomerulosclerosis with acute renal failure that remitted completely with oral steroid administration.

A 73-year-old man with systemic edema and oliguria, which appeared within several days, was referred to our hospital. Urinalysis showed massive proteinuria, and the blood examination results indicated nephrotic syndrome. Renal biopsy revealed the existence of focal segmental glomerulosclerosis (FSGS), and further investigation indicated that the microscopic features were consistent with the "cellular variant (CELL)" according to the Columbia Classification. After biopsy, 40mg per day of oral prednisolone was administered daily. With steroid therapy, the abnormal values of the blood examination and urinalysis gradually reached normal, and complete remission was achieved on day 43 after initiating steroid administration. Microscopic investigation by follow-up renal re-biopsy revealed several sclerosing glomeruli; however, other intact glomeruli had no endothelial proliferation, which is a hallmark of CELL. The patient was discharged after biopsy and observed as an outpatient, with maintenance of clinical remission.

Subdural hematoma after an epidural blood patch

We report the case of a 37-year-old postpartum patient who developed a contained subacute spinal subdural hematoma causing mass effect on the cauda equina and severe spinal stenosis after undergoing an epidural blood patch for postdural puncture headache. Recovery occurred following administration of oral steroids.

Impact of periodontal treatment in combination with tonsillectomy plus methylprednisolone pulse therapy and angiotensin blockade for pediatric IgA nephropathy

We previously reported the efficacy of extensive eradication of infectious foci in oral and ENT lesions, combined with tonsillectomy plus methylprednisolone (MP) pulse therapy, for curing pediatric Henoch-Schönlein purpura (HSP) and HSP nephritis. In the present study, we used this therapy in patients with pediatric IgA nephropathy (IgAN) to assess whether similar results could be obtained. In 11 pediatric patients newly diagnosed with IgAN, exploration for infectious foci showed severe oral infection, including dental caries and apical periodontitis, in many. The overall decayed, missing and filled teeth score was elevated to 5.91. Two patients had rhinosinusitis. After extensive treatment of infectious foci, patients underwent tonsillectomy plus MP pulse therapy with angiotensin II receptor blockade. Clinical remission was achieved in all patients with pediatric IgAN (various histologic grades). Remission was achieved by 7.2 ± 5.7 months after initiation of steroid therapy, and disappearance of proteinuria by 3.3 ± 3.0 months. The mean duration of oral steroid administration was 9.5 ± 3.6 months. No relapse has occurred during follow-up of 4.3 ± 2.4 y. Careful examination and thorough elimination of infectious foci in oral and ENT lesions can optimize the effect of tonsillectomy plus MP pulse therapy, promoting recovery from IgAN.

A unique presentation of a spinal dural arteriovenous fistula exacerbated by steroids

Spinal dural arteriovenous fistula (DAVF) is an acquired vascular malformation of the spinal cord that presents as a congestive myelopathy resulting from venous hypertension, edema, and ischemia within the cord. Acute clinical exacerbations have been demonstrated in a variety of clinical settings. We report a unique presentation of a 45-year-old male with progressive paraplegia that acutely worsened following three independent treatments with oral and intravenous steroid administration. Spinal angiogram revealed a spinal DAVF at L3 and the patient underwent successful surgical repair. This report highlights the clinical presentation of spinal DAVF and emphasizes the unique and important potential relationship between steroid administration and clinical deterioration.

Endoscopic Submucosal Dissection for Superficial Esophageal Neoplasms

Background and Aim: There has been a marked increase in the number of esophageal squamous cell neoplasms (SCNs) which are applicable to local treatment by virtue of recent developments in endoscopy. Endoscopic submucosal dissection (ESD) is an effective treatment for early noninvasive gastrointestinal cancers.
 Aim of this study was to evaluate efficacy of ESD for superficial esophageal squamous cell neoplasms.
 Subjects & Methods: Between November 2010 and March 2012, seventy-two lesions with superficial esophageal squamous cell neoplasms, which were treated by ESD in Kumamoto University Hospital, were analyzed in this study. Therapeutic efficacy, complications, and follow-up results were assessed.
 Results: Mean size of the lesions was 19±14 mm (range; 1-80 mm); and mean size of the resection specimens was 29±13 mm (range; 7- 80mm). Extensive lesions over 2/3 of the circumference were observed in 17 patients. En bloc resection rate was 100% (72/72), and en block resection rate with tumor-free lateral/basal margins was 95.8% (69/72). Perforation didn’t occur. Endoscopic dilation was performed for post-operative stenosis in 10 patients. In 3 patients who developed pinhole-like stenosis followed by circumferential ESD, combination treatment of oral steroid administration with endoscopic dilation could achieve favorable courses. None of the patients developed local recurrence or distant metastasis in the follow-up period.
 Conclusion: ESD is a minimally invasive, relatively safe treatment method for esophageal SCNs. In particular, it is suggested that ESD combined with oral steroid administration and endoscopic dilation, might be applicable to the patients with circumferential SCNs where post-operative stenosis must follow circumferential ESD.

Combined Intratympanic and Systemic Use of Steroids for Idiopathic Sudden Sensorineural Hearing Loss

To compare hearing results in idiopathic sudden hearing loss patients treated with systemic steroids alone or combined intratympanic and steroids. Prospective. Tertiary referral hospital. Idiopathic sudden sensorineural hearing loss patients. The patients in the systemic therapy group received consecutive administration of 100 mg intravenous methylprednisolone in the first day, 80 mg/day oral prednisolone in 3 divided doses for the next 2 days, and continued with oral administration of steroids by tapering the dose 20 mg in every 2 days. The patients in the combined treatment group received intratympanic injection of methylprednisolone (an approximate dose of 0.5 ml of 125 mg/ml). A total of 5 injections on alternate days were performed. The mean and median PTA gains of systemic corticosteroid therapy (SCT) group were 7.5 and 5 dB at 5th day, 12.1 and 7.5 dB at 10th day, and 13.0 and 8.8 dB at 15th day. The mean and median PTA gains for combined treatment (CT) group were 12.5 and 7.5, 17.8 and 13.8, 21.8 and 20.0 dB, respectively. Both the mean and the median PTA gains were statistically significantly different between SCT and CT groups. According to improved hearing results (more than 10 dB gain), there was statistically significant difference between SCT and CT groups. None of the patients had an important complication. The results of this study suggest that adding intratympanic methylprednisolone to systemic therapy increases the probability of hearing recovery in ISSHL patients.

Treatment of sudden sensorineural hearing loss with transtympanic injection of steroids as single therapy: a randomized clinical study

The aim of this study was to verify the efficacy and the safety of transtympanic dexamethasone to treat sudden sensorineural hearing loss as first and single drug method. Considering ethical implication of performing a mininvasive procedure on middle ear, we matched such proposed treatment with systemic prednisone administration that represents the widest adopted protocol. Randomized prospective study was conducted. The inclusion criterion was a sudden sensorineural hearing loss of at least 30dB across three contiguous frequencies over a period of 24h. Group A received transtympanic steroid injections; Group B received oral administration of steroids. 25 patients were treated with transtympanic therapy whereas 21 underwent systemic treatment. The mean of initial PTA was 59dB for the whole series: 65dB for group A and 51dB for group B. The recovery better than 10dB was obtained in 80% of patients of group A and in 17 81% of patients of group B, with a total of 80.5%. The mean relative gain in PTA was 41.16% in the group A and 44.7% in the group B. In the frequencies tested (0.5, 1, 2, and 4kHz) PTA improvements after transtympanic treatment were higher than after systemic treatment, but these differences were not statistically significant (P=0.61). Both transtympanic and systemic treatment had similar clinical recovery times. This prospective randomized clinical study showed good result in terms of hearing recovery, better than the expected results of the simple observation without treatment. We can consider transtympanic administration as a first line treatment, because of the statistical analysis confirmed similar results with systemic therapy, reducing possible side effects of systemic drug administration. The delay of treatment does not influence the outcome, allowing treating patients within 10days of onset.

Actinic lichen planus in a Japanese man: first case in the East Asian population

Actinic lichen planus (ALP) is a rare variant of lichen planus in which lichen planus develops on the light-exposed areas of the skin. ALP is reported to occur in the African, Middle Eastern,and Indian populations, with very few cases reported in Caucasians. Here, we report a case of ALP in a Japanese man; to the best of our knowledge, this is the first reported occurrence of ALP in the East Asian population. A 52-year-old Japanese man developed recurrent painful annular erythema on the face and hands. Histopathological examination of his skin biopsy revealed lichenoid-type infiltrates of lymphocytes and histiocytes. We established a diagnosis of ALP on the basis of the distribution of eruptions only on the sunlight-exposed areas and histological findings. Oral administration of systemic steroids proved effective in improving his condition. Lichen planus is known to be induced by an irritant (Koebner phenomenon);we believe that our patient is genetically susceptible to sunlight exposure and that sunlight acted as an irritant stimulating the development of ALP.

Effect on Pain of Oral Administration of Steroids in Patients with Trigeminal Herpes Zoster

Effect on Pain of Oral Administration of Steroids in Patients with Trigeminal Herpes Zoster

Biochemistry and the Selection of Oral Contraceptives*

Once a small group of unsuitable patients have been identified by clinical observations, the great majority of women requiring contraception are best treated by combined-type oral contraceptives. Some of these contain steroids now known to require metabolic activation and such products are best avoided. Dose-related changes in a wide range of biochemical parameters can be demonstrated following administration of oral contraceptive steroids. Most of these are induced by the estrogen component, so that the lowest estrogen dose compatible with efficacy and acceptability should be used. This appears to be 30 ug/d ethynylestradiol. Only one currently available progestogen (norgestrel) possesses appreciable anti-estrogenic actions in women and is therefore the progestogen of choice in most cases.

Successful treatment of massive ascites with intraperitoneal administration of a steroid in a case of systemic lupus erythematosus

Massive ascites is a rare manifestation of systemic lupus erythematosus (SLE) and has a poor response to glucocorticoid therapy, probably because of impaired vascular circulation due to persistent peritoneal inflammation. We describe a young woman presenting with massive painless ascites as the predominant manifestation of SLE. Peritoneal effusion was resistant to the oral administration of steroids and the conventional therapies for ascites. Intraperitoneal injection of triamcinolone, an insoluble glucocorticoid, induced dramatic remission of massive ascites, with no adverse event or recurrence.

Adenocarcinoma of the small intestine complicating Crohn’s disease

Dear Sir, Small bowel adenocarcinoma is an uncommon tumor comprising 2% of all gastrointestinal tract malignancies. Chronic inflammatory bowel disease predisposes to the development of carcinoma in the colon of patients with ulcerative colitis and Crohn’s disease (CD). There is growing evidence that CD is associated with an increased incidence of adenocarcinoma of the small bowel. In contrast with ulcerative colitis, the magnitude of the problem (risk for cancer development) in CD remains controversial. Large series from tertiary referral centers report a significant comparative risk for small intestinal cancer development in CD ranging from six to 320 times than in the general population. Neoplastic lesions have been often described on the grounds of fibrotic strictures and fistulas. A few cases of adenocarcinoma arising at the site of previous strictureplasty have also been confirmed. Unfortunately, specific radiographic findings that would indicate the presence of carcinoma in these patients have not been identified. We present a patient with CD complicated by the development of small bowel adenocarcinoma. The relevant literature is briefly reviewed. A 61-year-old man with a 27-year history of CD presented with a 6-month history of increasing colicky abdominal pain and vomiting, eventually resulting in frank complete small bowel obstruction. The patient appeared with general malaise and loss of weight. Clinical investigation revealed a recrudescence of symptoms of anemia. Physical examination confirmed a firm, tender mass in the right ileac fossa. Erect abdominal X-rays depicted multiple small bowel fluid levels, indicating intestinal obstruction. Abdominal computed tomography scan showed a concentric, sharply marginated mass lesion with mucosal destruction and associated enterocolic fistulas combined with strictures near the ileocolic anastomosis. Endoscopic bioptical sampling demonstrated CD in the active stage. In the past, he had recurrent episodes which required the administration of both rectal and oral steroids and sulfasalazine to obtain control of his symptoms. Further acute exacerbation failed to respond satisfactorily to medical treatment and he was referred for surgery. Histology showed transmural disease, patchy involvement of the mucosa, noncaseating epithelioid granulomas with Langhans giant cells, fissures, and neuromatous hyperplasia, and the diagnosis of CD was confirmed. One year later, he presented with symptoms of ankylosing spondylitis. The long-term distribution of vitamin B12 was implemented for the improvement of associated polyneuropathy. The patient was operated on with the diagnosis of intestinal obstruction due to CD. During laparotomy, the small bowel showed the typical macroscopic manifestations of CD. Moreover, extensive malignant deposits were found throughout the peritoneum and the pelvis, probably representing metastatic peritoneal implantations. The diseased part of the bowel was resected and an end-to-side ileotransverse anastomosis was performed. Intraoperative examination of the resected specimen showed numerous strictures and sacculation with superficial ulceration and fissures, mucosal edema, and fibrosis. A larger ulcerated lesion was also identified within the resected specimen. The postoperative course was Int J Colorectal Dis (2009) 24:1245–1246 DOI 10.1007/s00384-009-0718-y

Steroid-induced Glaucoma

Steroid-induced glaucoma is a form of open-angle glaucoma occurring as an adverse effect of corticosteroid therapy.1 It is usually associated with topical steroid use, but it may develop with oral, intravenous, inhaled, or periocular steroid administration by causing decrease in aqueous outflow facility. A number of drugs have been implicated in corticosteroid-induced glaucoma including dexamethasone, betamethasone, prednisolone, medrysone, fluoromethalone, hydrocortisone, cortisone, etc. Glucocorticoids may exert their effect by increased expression of the MYOC (TIGR) gene at Locus GLC1A .2

Eosinophilic gastroenteritis with eosinophilic infiltration of the gall bladder.

Eosinophilic gastroenteritis (EG) is a rare disease of unknown etiology characterized by eosinophilic infiltration of the gastrointestinal tract wall with various gastrointestinal manifestations. Several organs in the digestive tract may be involved by EG, but biliary tract involvements are rare. We report here a case of EG with eosinophilic infiltration of the gall bladder. A 57-year-old man was admitted to the hospital complaining of abdominal pain and diarrhea. As ultrasonography and magnetic resonance imaging showed thickened gall bladder wall and debris in the neck of gall bladder, we performed cholecystectomy, but his symptoms were not improved. Esophagogastroduodenoscopy showed multiple erosions, redness and edema in the duodenum and stomach. Biopsy specimens from the duodenum and stomach showed infiltration of eosinophils, plasma cells and lymphocytes. Microscopic findings of resected gall bladder showed eosinophilic infiltration into the all layers of gall bladder wall without vasculitis. Based on these findings, EG with eosinophilic infiltration of the gall bladder was diagnosed. Following oral steroid administration, clinical symptoms were immediately improved. One month after the therapy, esophagogastroduodenoscopy did not show any findings of gastritis or duodenitis, and there were no eosinophilic infiltrations in biopsy specimens from duodenum and stomach.

Influence of allergy in patients with nasal polyposis after endoscopic sinus surgery

Conclusion. Allergy does not modify the symptoms and steroid consumption (oral and local) of nasal polyposis (NP) patients after functional endoscopic sinus surgery (FESS). Objectives. To assess the role of allergy in the evolution after FESS of patients presenting with the diagnosis of NP. Patients and methods. This was a prospective study of 63 consecutive patients with NP (57% males, mean age 45.8 years), who were analyzed to detect whether the results of a surgical treatment of NP were influenced by the presence of positive allergic tests (Phadiatop®). Three nasal criteria were scored: nasal obstruction, posterior rhinorrhea, and the loss of smell. The frequency of asthma was evaluated. Medical treatment of NP after FESS consisted of washing of the nasal cavities, steroid spray, and oral steroid administration. The amount of consumption of steroids (prednisolone and beclomethasone) was studied. Results. Decrease of all nasal symptoms was not statistically different in the two groups of patients with and without allergy. Cumulative consumption of prednisolone and beclomethasone after surgery was similar in the two groups.