Perioperative Steroid Therapy Research Articles

Efficacy and Safety of Excision Combination Therapies for Earlobe Keloids: A Systematic Review and Meta-analysis.

Different combinations of excision and adjuvant therapies have been applied to improve outcomes for earlobe keloids, though evidence in this field is still lacking. This study sought to systematically investigate efficacy and safety of these treatments. We conducted a systematic search on PubMed, Embase, Web of Science, and Cochrane Library to find all relevant studies. Meta-analysis of recurrence rates (RRs) and adverse event rates with 95% confidence intervals, and individual participants data (IPD) were calculated for each intervention when possible. Otherwise, narrative syntheses were performed. A total of 85 articles, covering 23 treatments for earlobe keloids, were included, indicating a preference for multiple combination therapy. The estimated RRs for 6 interventions (i.e., excision monotherapy, combinations of excision with imiquimod, pressure therapy, radiotherapy, steroids, and steroids with pressure therapy) appeared to be comparable. Electron radiotherapy was found to have potential advantages over X-ray treatment, contributing to the observed heterogeneity. Further meta-analysis using IPD revealed that both combination therapies of excision plus steroid therapy (p=0.003) and excision plus radiotherapy (p=0.003) yielded better recurrence-free survival compared to excision alone. The median recurrence-free interval for combination therapy was 10months. Adverse event rates were similar among different intervention groups. This study suggests that combining excision with radiotherapy or perioperative steroid therapy has the potential to improve prognosis of earlobe keloids without increasing the risk of adverse events. Overall evaluation of patients' conditions and further studies with sufficient follow-up are warranted for clinical practice. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Variability in Perioperative Steroid Therapy Regimen for Cochlear Implantation as It Relates to Hearing Preservation

Hypothesis We aimed to identify practice trends and association between physician training and administration of perioperative steroids for cochlear implantation (CI) as it relates to hearing preservation. Background Perioperative steroid therapy regimens are postulated to protect residual hearing and improve hearing preservation outcomes in CI. Methods A 27-question online survey was developed by the senior authors using the Qualtrics Survey Tool, then distributed via email from September to November 2022 to otolaryngologists specializing in otology or neurotology and who practice in the United States or Canada. Results The survey was sent to 463 physicians, 162 (35.0%) of whom completed the survey. One hundred forty-four (31.1%) responses underwent analysis. All physicians administering preoperative steroids (n = 31) prefer preoperative oral prednisone. Of 143 physicians administering intraoperative steroids, 54.5% prefer intraoperative intravenous dexamethasone. More than half (77.6%) of 85 physicians administering postoperative steroids prefer postoperative oral prednisone. Postoperative steroid administration (p < 0.006) and taper utilization (p < 0.041) were greater among physicians who complete greater than 40 CIs annually (n = 47 [71.2%]; n = 30 [49.2%]) than physicians who complete up to 40 CIs annually (n = 37 [48.7%]; n = 20 [31.3%]), respectively. Physicians practicing for 5 to 20 years after residency are more prevalent in using postoperative steroid tapers than physicians practicing for fewer than 5 years after and more than 20 years after residency (n = 37 [51.4%] versus n = 14 [25.5%], p < 0.001). Conclusion Consensus is needed about the optimal steroid treatment for CI patients. Level of Evidence 4.

Prosthetic valve detachment complicated with intervalvular fibrous body destruction in Behcet\u2019s disease: a case report

BackgroundProsthetic valve detachment is not rare after aortic valve replacement in Behcet’s disease. However, destruction of the intervalvular fibrous body (IFB) due to Behcet’s disease was rarely reported.Case presentationWe report a case of 30 year-old woman, with valve detachment and IFB separation. The patient received aortic valve replacement three months ago. Her medical history included recurrent oral ulcers and cutaneous lesions. Finally, reoperation was performed and peri-operative steroid therapy was carried out.ConclusionsThe case presented a rare complication of valve detachment in Behcet’s disease.

Preclinical Modeling of Surgery and Steroid Therapy for Glioblastoma Reveals Changes in Immunophenotype that are Associated with Tumor Growth and Outcome.

Glioblastoma (GBM) immunotherapy clinical trials are generally initiated after standard-of-care treatment-including surgical resection, perioperative high-dose steroid therapy, chemotherapy, and radiation treatment-has either begun or failed. However, the impact of these interventions on the antitumoral immune response is not well studied. While discoveries regarding the impact of chemotherapy and radiation on immune response have been made and translated into clinical trial design, the impact of surgical resection and steroids on the antitumor immune response has yet to be determined. We developed a murine model integrating tumor resection and steroid treatment and used flow cytometry to analyze systemic and local immune changes. These mouse model findings were validated in a cohort of 95 patients with primary GBM. Using our murine resection model, we observed a systemic reduction in lymphocytes corresponding to increased tumor volume and decreased circulating lymphocytes that was masked by dexamethasone treatment. The reduction in circulating T cells was due to reduced CCR7 expression, resulting in T-cell sequestration in lymphoid organs and the bone marrow. We confirmed these findings in a cohort of patients with primary GBM and found that prior to steroid treatment, circulating lymphocytes inversely correlated with tumor volume. Finally, we demonstrated that peripheral lymphocyte content varies with progression-free survival and overall survival, independent of tumor volume, steroid use, or molecular profiles. These data reveal that prior to intervention, increased tumor volume corresponds with reduced systemic immune function and that peripheral lymphocyte counts are prognostic when steroid treatment is taken into account.

Postoperative Level of C-Reactive Protein Is a Prognosticator After Esophageal Cancer Surgery With Perioperative Steroid Therapy and Enhanced Recovery After Surgery Care.

This study investigated the impact of postoperative C-reactive protein (CRP) level on survival in patients with esophageal cancer who received perioperative steroid therapy and enhanced recovery after surgery (ERAS) care. Overall, 115 patients were retrospectively reviewed. The patients were classified into those with a high CRP level (≥4.0 mg/dl) on postoperative day 4 and those with low CRP level (<4.0 mg/dl). The risk factors for overall survival (OS) and recurrence-free survival (RFS) were identified. The OS and RFS rates at 5 years after surgery were significantly low in patients with high CRP level on postoperative day 4. The multivariate analysis demonstrated that high CRP level on postoperative day 4 was a significant independent risk factor for OS and RFS. The present results suggest that the postoperative CRP level can be a prognosticator in patients with esophageal cancer who have received perioperative steroid therapy and ERAS care.

Perioperative steroid therapy: where's the evidence?

Review of historical and current evidence of adrenal suppression in patients on chronic glucocorticoid therapy during perioperative period, and discussion of current recommendations for perioperative stress dose steroid administration. Evidence suggests low incidence of perioperative adrenal insufficiency in patients receiving chronic glucocorticoid therapy. Recent studies show no difference in survival or hemodynamic sequella by withholding perioperative stress steroids; however, these studies are limited in size and universal applicability. Current recommendations for perioperative stress dose steroids for patients on chronic glucocorticoid therapy are based on duration and dose of maintenance steroids. All patients should take their regular daily dose of steroid preoperatively regardless of dose or chronicity of prior treatment. Additional, stress dose steroid dosing is based on patient risk of adrenal suppression and surgical complexity and stress.

Prediction of postoperative inflammatory complications after esophageal cancer surgery based on early changes in the C-reactive protein level in patients who received perioperative steroid therapy and enhanced recovery after surgery care: a retrospective analysis

BackgroundSerum C-reactive protein (CRP) level can be an indicator of the early stage of infectious complications. However, its utility in advanced esophageal cancer patients who receive radical esophagectomy with two- or three-field lymph node dissection with perioperative steroid therapy and enhanced recovery after surgery (ERAS) care is unclear.MethodsThe present study retrospectively examined 117 consecutive esophageal cancer patients who received neoadjuvant chemotherapy followed by radical esophagectomy. All patients received perioperative steroid therapy and ERAS care. The utility of the CRP value in the early detection of serious infectious complications (SICs) was evaluated based on the area under the receiver operating characteristic curve (AUC). Univariate and multivariate logistic regression analyses were performed to identify the risk factors for SICs.ResultsSICs were observed in 20 patients (17.1%). The CRP level on postoperative day (POD) 4 had superior diagnostic accuracy for SICs (AUC 0.778). The cut-off value for CRP was determined to be 4.0 mg/dl. A multivariate analysis identified CRP ≥ 4.0 mg/dl on POD 4 (odds ratio, 18.600; 95% confidence interval [CI], 4.610–75.200) and three-field lymph node dissection (odds ratio, 7.950; 95% CI, 1.900–33.400) as independent predictive factors.ConclusionsCRP value on POD 4 may be useful for predicting SICs in esophageal cancer patients who receive radical esophagectomy with perioperative steroid therapy and ERAS care. This result may encourage the performance of imaging studies to detect the focus and thereby lead to the early medical and/or surgical intervention to improve short-term outcomes.

A Randomized Controlled Trial Studying the Role of Dexamethasone in Scalp Nerve Blocks for Supratentorial Craniotomy.

The aim of this double-blinded randomized control study was to examine the role of the steroid dexamethasone as an adjuvant to lignocaine and ropivacaine in scalp nerve blocks in adults undergoing supratentorial craniotomy under general anesthesia. We compared the intraoperative anesthetic and postoperative analgesic requirement with and without the addition of dexamethasone to the local anesthetics. The consented 90 patients were randomized into 2 groups: one group received 8 mg (2 mL) of dexamethasone, whereas the other received 2 mL of normal saline along with the local anesthetics in the scalp nerve block administered soon after induction of general anesthesia. All patients received oral/intravenous dexamethasone perioperatively to decrease cerebral edema. The general anesthetic technique for induction, maintenance, and recovery was standardized in the 2 groups. The primary outcome assessed was the time to administration of the first dose of analgesic postoperatively. The secondary outcomes included intraoperative opioid requirement, time to emergence, and incidence of postoperative nausea and vomiting. There was no significant difference between the dexamethasone and saline groups with respect to time to first analgesic requirement, intraoperative fentanyl requirements, time to emergence from general anesthesia, and incidence of postoperative nausea and vomiting. Addition of dexamethasone as an adjuvant to local anesthetics in scalp nerve blocks in the setting of perioperative steroid therapy does not appear to provide any additional benefit with respect to prolongation of the duration of the block.

Traumatic superior orbital fissure syndrome: a rare case report

Superior orbital fissure syndrome is a severe clinical entity characterized by injuries of neurovascular structures passing through the superior orbital fissure. A 38-year-old male patient admitted to outpatient clinic with left upper eyelid ptosis, ecchymosis, mydriasis, hypoesthesia in upper eyelid and frontal region, blepharoptosis, restriction of ocular movements in all directions, loss of accommodation reflex and absence of direct pupillary reflex. Three-dimensional computed tomography scans demonstrated left-sided orbital fractures resulting in obliteration of the superior orbital fissure. He underwent surgical decompression. The patient had intravenous methylprednisolone administration at preoperative and postoperative periods during hospitalization. He was discharged on the postoperative day 5. At the 9 th postoperative month, the cranial nerve functions were almost completely recovered. We consider that the decompressive surgery in conjunction with perioperative steroid therapy may be effective for the traumatic superior orbital fissure syndrome.

PERIOPERATIVE SUPERVISION OF CHILDREN WITH ADRENAL NEOPLASMS

Aim. To optimize the perioperative safety and to improve the results of surgical treatment of children with adrenal neoplasms. Materials and methods. The perioperative supervision of 18 patients (children aged 2 months to 15 years) with adrenal neoplasms who underwent laparoscopic adrenalectomy for different adrenal neoplasms was analyzed. The following two groups of patients were formed depending on the hormone activity of neoplasm originating from the adrenal gland: children with hormonally inactive adrenal tumors (14 cases) and patients with hormone-producing neoplasms (4 cases). Patients underwent complex examination confirming the character and localization of pathological process. Operative intervention - endoscopic adrenalectomy - was performed in conditions of multicomponent anesthesia and perioperative replacement steroid therapy. Results. The study indicated that the applied methods of general anesthesia are adequate anesthetic measures. So as to ensure safety of patients during operative intervention, uninterrupted monitoring of electrocardiography, noninvasive arterial pressure, pulsoxymetry, carbonic acid concentration in the expired gas-narcotic mixture, control of glycemia level, monitoring of blood gas composition and acid-base balance, temperature control, hourly diuresis were used. An obligatory condition for adequate perioperative supervision of children is replacement steroid hydrocortisone therapy in the perioperative period by the age dosage scheme irrespective of hormonal activity of neoplasms. The postoperative period in all cases, except one, was smooth, on the days 1-2 patients were transferred from resuscitation unit to the ward. Conclusions. For the purpose of preventing development of hypoadrenal crisis in the postoperative period after unilateral adrenalectomy irrespective of presence or absence of hormonal activity of adrenal neoplasm, it is necessary to carry out replacement steroid therapy since before the surgery it is not possible to assess the function of contrlateral adrenal gland.

Intercostal Muscle Flap in Post Tuberculous Pneumonectomy: A New Technique

Objective: There are many risk factors for postoperative bronchopleural fistula (BPF), including extensive resection, diabetes, chronic infection, perioperative steroid therapy, preoperative chemotherapy, and radiotherapy, the risk of bronchopleural fistula increases with resection for inflammatory diseases, especially Mycobacterium tuberculosis (MTB). The aim of this study is to evaluate the efficacy and safety of using double pedicled intercostal muscle flaps with dual blood supply to buttress the bronchial stump after pneumonectomy for tuberculous lesions as a prophylactic new technique from post-pneumonectomy BPF. Methods: Between 2007 and 2011, 47 patients with pneumonectomy for post tuberculous lesions in the department of cardiothoracic surgery, Zagazig University Hospital were divided into two groups. Group A: 28 patients with single pedicled intercostal muscle flap used and applied on the bronchial stump after pneumonectomy. Group B: 19 patients with double pedicled intercostal muscle flaps used and applied on the bronchial stump. The mean age of the patients was 42.9 years (range 27 - 67 years) in Group A, 44.8 years (range 36 - 71 years) in Group B. Results: Bleeding in one patient in Group A (3.5%) and two patients in Group B (10.5%); empyema in two patients (7.1%) in Group A only one of them developed bronchopleural fistula; arrhythmias in one patients (3.5%) in Group A and one patient in Group B (5.2%); chylothorax in one patients (3.5%); Chronic chest pain in one patient in Group A (3.5%) and two patients in Group B (10.5%). The mean follow up period was 32.7 ± 12.9 months (range between 3 and 48 months). All patients remained symptom free with no evidence of late bronchopleural fistula in Group B. Conclusions: Double pedicled intercostal muscle flaps with dual blood supply buttressing the bronchial stump is new prophylactic technique from BPF after pneumonectomy for pulmonary tuberculous lesions in high risk patients.

Perioperative steroid administration inhibits angiogenic host tissue response to porous polyethylene (medpor®) implants

Porous polyethylene (Medpor) is an alloplastic biomaterial, which is commonly used in plastic and reconstructive surgery. In the present study, we analyzed the effect of perioperative steroid administration on the inflammatory and angiogenic host tissue response to implanted Medpor. For this purpose, Medpor was implanted into the dorsal skinfold chamber of prednisolone-treated and vehicle-treated (control) balb/c mice and analyzed by means of intravital fluorescence microscopy over a 14-day period. Incorporation of the implants was evaluated by histology. An aortic ring assay and Western blot analyses were performed to determine in vitro the effect of prednisolone on angiogenesis. Implantation of Medpor did not induce a leukocytic inflammatory host tissue response. However, in prednisolone-treated and control animals giant cells could be detected at the interface between the implants and the surrounding granulation tissue as a typical indicator for a chronic foreign body reaction. Interestingly, perioperative prednisolone administration inhibited vascularisation of the implants, as indicated by a significantly decreased functional density of newly developing capillary blood vessels. Accordingly, prednisolone suppressed in vitro endothelial sprouting and tube formation in the aortic ring assay and reduced proliferating cell nuclear antigen (PCNA), Tie2, vascular endothelial growth factor (VEGF) and matrix metalloproteinase (MMP)-9 expression of murine endothelioma cells. In conclusion, prednisolone treatment inhibits the early vascularisation of Medpor implants due to direct inhibition of distinct angiogenic mechanisms. Therefore, perioperative steroid therapy should be avoided in case of Medpor implantation to achieve a rapid incorporation of the biomaterial at the implantation site.

Hemofiltration During Cardiopulmonary Bypass Does Not Decrease the Incidence of Atrial Fibrillation After Cardiac Surgery

Atrial fibrillation (AF) occurs in 20%-50% of patients after cardiac surgery and is associated with increased morbidity and mortality. Corticosteroids are reported to decrease the incidence of postoperative AF, presumably by attenuating inflammation caused by surgery and cardiopulmonary bypass (CPB). We hypothesized that hemofiltration during CPB, which may attenuate inflammation, might decrease the incidence of AF after cardiac surgery. This was a retrospective review of patients previously enrolled in a double-blind, placebo-controlled trial evaluating the effects of perioperative steroid therapy and hemofiltration during CPB on duration of postoperative mechanical ventilation. In that study, 192 patients undergoing cardiac surgery were randomized to 1 of 3 groups: controls (placebo), hemofiltration during CPB, or perioperative steroid therapy. Patient records were reviewed to determine the incidence of new onset AF defined as any electrocardiogram evidence of AF or AF diagnosed by the patients' clinicians. Of the 192 enrolled patients, 3 were excluded for protocol violations and 4 were excluded for history of chronic AF. Data from 185 patients from the original study were available for review. Sixty patients (32%) had new onset AF after cardiac surgery. There was no difference among groups in the incidence of AF (control group, 21%; steroid group, 41%; hemofiltration group, 36%; P = 0.057 among groups). The only risk factor for the development of AF was age (mean age of patients with AF, 65.4 +/- 10.1 yr vs patients without AF, 61.4 +/- 11.5 yr; P = 0.024). When age, procedure type, and presence or absence of chronic obstructive pulmonary disease were controlled for in multivariate analysis, the difference among study groups remained nonsignificant (P = 0.108). Perioperative corticosteroids or the use of hemofiltration during CPB did not decrease the incidence of AF after cardiac surgery. Further studies evaluating the efficacy and safety of perioperative corticosteroids for prevention of postoperative AF are warranted before their routine use can be recommended.

Occipitocervical Fusion Using Recombinant Human Bone Morphogenetic Protein-2

Case presentation and literature review. To review the safety of using INFUSE bone graft (recombinant human bone morphogenetic protein-2 applied to an absorbable collagen sponge) in occipitocervical (OC) fusion. Although INFUSE bone graft is currently approved for use in certain tibial fractures, oral maxillary procedures, and anterior lumbar interbody fusion, it has been extensively used "off-label" in posterolateral lumbar and anterior cervical fusions. INFUSE is highly effective in promoting cervical spine fusion via an anterior approach, but its potential role in promoting bony fusion in posterior cervical or OC fixation has not been studied. A 53-year-old woman with basilar invagination underwent OC fixation using INFUSE bone graft. Three days after surgery she experienced neurologic decline associated with significant tissue swelling and a large postoperative seroma under significant pressure. She made excellent recovery after reoperation and drainage. An extensive review of the literature was performed to propose a modified approach to the use of INFUSE in OC fixation. Proper dosing and delivery of INFUSE for posterior cervical/OC fixation is not currently known. Previously published experience with anterior cervical fusion suggests that INFUSE can have potent inflammatory effects on paraspinal soft tissue. INFUSE should only be used for OC fixation in patients at elevated risk of nonunion. To prevent complications due to soft tissue swelling, consideration should be given to preventing direct exposure of INFUSE to paraspinal musculature, prolonged soft tissue drainage, and prophylactic treatment with perioperative steroid therapy.

40. Surgical Site Infection in Spinal Metastasis - Risk Factor and Countermeasure

Study Design. A retrospective review (Phase 1) and prospective clinical study (Phase 2) Objectives. The objectives of this study were to identify independent risk factors for surgical site infection (SSI) and to evaluate the positive effect of prostaglandin E1 (PGE1) to decrease the risk of SSI in patients with spinal metastasis. Summary of Background Data. Surgery for spinal metastasis is associated with an increased risk of SSI. Although previous reports have evaluated risk factors of SSI for spinal metastasis, most of the studies lack multivariate analysis. A recent study demonstrated the utility of PGE1 in decreasing wound complications in patients with prior irradiation. The role of PGE1 in surgery for spinal metastasis has not been previously evaluated. Methods. 110 patients with spinal metastasis were retrospectively reviewed (phase 1). Risk factors for SSI were analyzed using logistic regression. Phase 2 was a prospective clinical trial investigating the utility of PGE1 at reducing the rate of SSI. 94 patients for with spinal metastasis were treated at our institute. The infection rate and risk factors identified in phase 1 and 2 were compared. Results. The rate of SSI during Phase 1 was 7.1%. Independent risk factors identified by multivariate logistic regression were diabetes, and preoperative irradiation. The rate of SSI for patients who had irradiation before surgery was 32%, while the rate for patients without irradiation was 1.1%. This difference was statistically significant. The rate of SSI in Phase 2 was 3.1%. In Phase 2 patients who received preoperative irradiation, the rate of SSI was 4.5%. The difference between Phase 1 and Phase 2 was statistically significant. Conclusions: This study identified diabetes and preoperative irradiation to be independent risk factors for SSI in patients with spinal metastasis. PGE1 administration was found to significantly decrease the incidence of SSI in patients with spinal metastasis who underwent preoperative irradiation. Introduction The purposes of surgical treatment for spinal metastasis are to avoid recurrence of the tumor, and to control spinal paralysis to maintain the patient's quality of life until the last moment. On the other hand, patients with spinal metastasis might have poor nutritional status and be prone to immunosupression from disease or treatments. Hence, the surgery for spinal metastasis is still controversial because it has potential risks of postoperative systemic complications. Recent literatures have reported excellent functional outcomes after the surgery for spinal metastasis with falling morbidity rates , although, the rate of complication remains relatively high compared to other spinal surgeries. Wise et al reported that the rate of complication was 25%. In all these reports, a major cause of morbidity was surgical site infection (SSI). SSI is one of the serious complications and may compromise the quality of outcome. A variety of risk factors for SSI in spinal surgery have been reported. Patient characteristics reported to increase the risk of SSI following spinal surgery are advanced age, preoperative malnutrition, presence of diabetes, preoperative or perioperative steroid therapy, and preoperative adjunctive therapy including chemotherapy or irradiation at the surgical site. Surgery-related risk factors reported to be associated

Effect of perioperative steroid therapy on the postoperative course of patients with oesophageal cancer

Background Perioperative steroid therapy is often used in oesophageal cancer surgery and we evaluate the effect of this therapy on the secretory leukocyte protease inhibitor levels in the lungs (a major antiprotease in the conducting airways) and postoperative course in oesophageal cancer patients. Methods Twenty-one patients operated on for oesophageal cancer in 2003–2004 were treated with perioperative steroid therapy (250 mg of methylprednisolone intravenously 1 h before the operation). Fifteen consecutive patients operated on in 2002 served as a control group. Secretory leukocyte protease inhibitor in bronchoalveolar lavage fluid and the postoperative course in the two groups were compared. Results The mortality rate was 0% and there was no significant difference in the morbidity rate between the two groups. Days of intubation and systemic inflammatory response syndrome were significantly shorter for the steroid group. The bronchoalveolar lavage fluid secretory leukocyte protease inhibitor level was significantly higher in the steroid group than in the control group on postoperative days 2 and 3. The secretory leukocyte protease inhibitor level on postoperative day 3 was remarkably lower for the patients intubated for ≥5 days and for those with pulmonary complications. Conclusion Perioperative steroid therapy increased the bronchoalveolar lavage fluid secretory leukocyte protease inhibitor level and reduced the days of intubation and systemic inflammatory response syndrome in patients with oesophagectomy.

Induction immunosuppression with rabbit antithymocyte globulin in pediatric liver transplantation

Routine use of rabbit antithymocyte globulin (RATG) induction therapy remains controversial in pediatric liver transplantation. We reviewed our experience of 18 cadaveric liver transplants in 18 children over a span of 2 years. All patients received the same immunosuppression: perioperative steroid therapy with taper, 3 doses of RATG, and maintenance therapy of steroids and tacrolimus started on postoperative day 3. Mean follow-up was 2.2 +/- 0.2 years. End-stage liver disease was secondary to biliary atresia in 10 patients (56%) and metabolic disorders in 4 patients (22%). Graft and patient survival were 89%. Serum bilirubin was 1.2 mg/dL, 1.1 mg/dL, 0.5 mg/dL, and 0.5 mg/dL at 1, 3, 6, and 12 months, respectively. The 2 mortalities were secondary to multiple organ system failure. Overall rejection rate was 17% (3/18). Rejection episodes occurred at 4, 6, and 7 months. Two patients were treated with steroids; the third was treated with OKT3. No patient has developed posttransplant lymphoproliferative disease. Serum creatinine was 0.7 mg/dL, 0.6 mg/dL, 0.6 mg/dL, and 0.6 mg/dL at 1, 3, 6, and 12 months, respectively, among surviving patients. In conclusion, our data suggest that RATG induction with steroid and tacrolimus maintenance therapy is safe, easy to use, and effective in the prevention of rejection.

Effect of steroid therapy on postoperative course and survival of patients with thoracic esophageal carcinoma

Perioperative steroid therapy has been shown to be safe and effective in inhibiting the production of inflammatory mediators and reducing postoperative hospital morbidity. However, there is limited information to show the effect of steroid therapy on long-term survival. In this study we evaluated the effect of perioperative steroid therapy on long-term survival of patients with thoracic esophageal cancer. Between 1993 and 2000, 141 consecutive patients with primary thoracic esophageal cancer underwent radical esophagectomy. A total of 78 patients who underwent surgery between 1997 and 2000 received perioperative steroid therapy. Sixty-three patients who underwent surgery between 1993 and 1996 were analyzed as the control group. In the steroid group, 250 mg methylprednisolone was administered intravenously just before surgery followed by 125 mg on postoperative days 1 and 2. The postoperative course and overall cause-specific survival rates were compared between the groups. The postoperative hospital morbidity rate was significantly lower in the steroid group than in the control group. Although overall survival of the steroid group was better than the control group, cause-specific survival of both groups was similar. Multivariate analysis suggested that the depth of tumor and postoperative hospital morbidity were significant independent prognostic factors; however, steroid therapy was not statistically significant after adjusting for pathological variables. Perioperative steroid therapy may improve the postoperative course but does not improve the long-term survival of patients with thoracic esophageal cancer.

Clinical benefits of steroid therapy on surgical stress in patients with esophageal cancer

Background. Despite improvements in surgical techniques and perioperative care, severe complications lead to long hospital stays for some esophageal cancer patients. The purpose of this study was to evaluate the safety and effectiveness of perioperative steroid therapy on the postoperative clinical course. Methods. Fifty-seven patients operated for esophageal cancer in 1997 and 1998 were treated with perioperative steroid therapy. Fifty consecutive patients operated in 1995 and 1996 served as a control group. In the steroid group, each patient was given 250 mg of methylprednisolone intravenously before operation followed by 125 mg on postoperative days 1 and 2. Serum interleukin-6, polymorphonuclear cell elastase, and C-reactive protein levels, and the postoperative clinical course were compared between the groups. Results. Morbidity rates including hyperbilirubinemia, anastomotic leakage, and liver dysfunction were significantly lower in the steroid group than in the control group. Days until extubation and hospital stay were significantly shorter for the steroid group. Inflammatory mediators, body temperature, heart rate, and respiratory index after the surgical procedure were significantly lower in the steroid group. Adverse effects possibly caused by steroid therapy were not observed. Conclusions. Perioperative steroid therapy was safe and effective for the inhibition of inflammatory mediators and the improvement of the postoperative clinical course of patients with esophageal cancer. (Surgery 2000;128:791-8.)

The Efficacy of Perioperative Steroid Therapy in Pediatric Primary Palatoplasty

The Efficacy of Perioperative Steroid Therapy in Pediatric Primary Palatoplasty