Steroid Solution Research Articles

Query to the author of ′comparison of different techniques of cataract surgery in bacterial contamination of the anterior chamber in diabetic and non-diabetic population′

Sir, We have read the article published in the current issue of IJO, titled “Comparison of different techniques of cataract surgery in bacterial contamination of the anterior chamber in diabetic and non-diabetic population.”[1] We have the following observations and would like to have author's comments on them. Side port in phacoemulsification surgery is understandable, but irrigation of the anterior chamber using the side port in MSICS indicates that a side port was made in MSICS patients also. However this is not mentioned in the MSICS steps. Kindly clarify, when was that made and the purpose served by the side port. Sub-conjunctival injection at the end of surgery was not given. As we see it, this is a usual practice in cataract surgery that a sub-conjunctival injection of steroid and antibiotics is given just before patching the eye in surgery under local anesthesia. Apart from a depot of antibiotic and steroid, sub-conjunctival injection helps in reposition of the conjunctival flap. Why this deviation from the routine practice? Only an antibiotic solution drop was instilled at the end of surgery. Was there any specific reason for not instilling steroid solution? As mentioned, the eye patch was opened after 6 h of surgery. Again we would consider this as a deviation from routine practice as the dressing is opened on the next day. Any advantage of not giving sub-conjunctival injection of antibiotic steroid solution and then early opening of the eye dressing to start topical medication? Kindly clarify. The eye drop regimen after opening the eye dressing was too aggressive. One hourly instillation of antibiotic steroid eye drop is not justified routinely without any evidence of excessive inflammation or infection. Kindly comment. The antibiotic steroid combination was started at one hourly frequency and later tapered to once daily. It is incorrect to taper the dose of any antibiotic. The antibiotics should be used in adequate dosage and stopped immediately, with no tapering, to prevent emergence of acquired bacterial resistance. Tapering of antibiotics is not justified at all. Author should have used separate antibiotic and steroid drops if they wanted to taper the steroid drop dosage instead of using fixed dose combination of steroid and antibiotic. It is ironical that the authors have condemned the use of antibiotics in irrigating solution for possibility of inducing resistance and at the same time indulged in tapering the dosage of antibiotic eye drop which itself is capable of inducing resistance by exposing the bacteria to sub-minimal lethal dosage.

Episacral Lipoma: A Treatable Cause of Low Back Pain (Case Report)

Episacral lipoma is a small, tender subcutaneous nodule primarily occurring over the posterior iliac crest. Episacral lipoma is a significant and treatable cause of acute and chronic low back pain. Episacral lipoma occurs as a result of tears in the thoracodorsal fascia and subsequent herniation of a portion of the underlying dorsal fat pad through the tear. This clinical entity is common, and recognition is simple. The presence of a painful nodule with disappearance of pain after injection with anaesthetic, is diagnostic. Medication and physical therapy may not be effective. Local injection of the nodule with a solution of anaesthetic and steroid is effective in treating the episacral lipoma. Here we describe 2 patients with painful nodules over the posterior iliac crest. One patient complained of severe lower back pain radiating to the left lower extremity and this patient subsequently underwent disc operation. The other patient had been treated for greater trochanteric pain syndrome. In both patients, symptoms appeared to be relieved by local injection of anaesthetic and steroid. Episacral lipoma should be considered during diagnostic workup and in differential diagnosis of acute and chronic low back pain.

Management of Central Giant Cell Granuloma of Mandible Using Intralesional Corticosteroids: Case Report and Review of Literature

We read ‘‘Management of Central Giant Cell Granuloma of Mandible Using Intralesional Corticosteroids: Case Report and Review of Literature’’ by Ferretti et al. with great interest. The paper reports a case of managing central giant cell granuloma (CGCG) in a 16-year-old girl through the administration of intralesional corticosteroids. The authors state that complete opacification was noted after only 2 administrations of the steroid solution. They also report that this rapid response was unique among the cases previously reported. However, the authors did not compare the age of their patient and localization of the CGCG with previously reported cases. Even if their case was unique, their patient was only 16 years old and the lesion was located on the mandible. We believe that younger patients experience faster treatment responses. Also, the localization of the CGCG reported in their case may be related to the response. As is commonly known, the regeneration capability of the mandible is better than that of the maxilla. Because the authors did not report, in their literature review, the age and gender of the patients and the localization of the CGCGs covered, we would like to add these data to clarify things for readers (Table 1).

Forced Degradation Studies of Corticosteroids With an Alumina–Steroid–Ethanol Model for Predicting Chemical Stability and Degradation Products of Pressurized Metered-Dose Inhaler Formulations

An alumina (Al(2)O(3))-steroid-ethanol model is used for forced degradation testing of corticosteroids to predict chemical stability and degradation products in pressurized metered-dose inhaler (pMDI) solution formulations. The model involves an ethanolic solution of a test steroid with Al(2)O(3), stressed at elevated temperatures to mimic the chemical interaction of drug, excipient, and packaging (an aluminum aerosol canister). The reactivity order of eight synthetic corticosteroids toward Al(2)O(3)-induced reactions is ranked with the stress model. The corticosteroids containing a C21-OH group possess the highest reactivity, suggesting that aluminum canisters with an inert interior coating are needed to stabilize their solution pMDIs. The Al(2)O(3)-induced degradation products and degradation pathways of a steroid containing C21-OH and triamcinolone acetonide are presented, and the role of Al(2)O(3) in the degradation pathways is briefly discussed. A potential degradation profile of beclomethasone dipropionate (BDP) established with an Al(2)O(3)-BDP-ethanol stress model is the same as the actual degradation profile of the BDP pMDI product, indicating that the model indeed predicts the degradation products.

Early postoperative care following endoscopic sinus surgery: an evidence‐based review with recommendations

Early postoperative care following endoscopic sinus surgery (ESS) has been suggested to minimize avoidable complications and optimize long-term outcomes. Several postoperative care strategies have been proposed but a formal comprehensive evaluation of the evidence has never been performed. The purpose of this article is to provide an evidence-based approach to early postoperative care following ESS. A systematic review of the literature was performed and the Clinical Practice Guideline Manual, Conference on Guideline Standardization (COGS), and the Appraisal of Guidelines and Research Evaluation (AGREE) instrument recommendations were followed. Study inclusion criteria were: adult population >18 years old; chronic rhinosinusitis (CRS) based on published diagnostic criteria; ESS following failed medical therapy; primary study objective was to evaluate an ESS early postoperative care strategy; and clearly defined primary clinical end-point. This review identified and evaluated the literature on 7 early postoperative care strategies following ESS: saline irrigations, sinus cavity debridements, systemic steroids, topical steroids, oral antibiotics, topical decongestants, and drug-eluting spacers/stents. Based on the available evidence, use of nasal saline irrigation, sinus cavity debridement, and standard topical nasal steroid spray are recommended early postoperative care interventions. Postoperative antibiotic, systemic steroid, nonstandard topical nasal steroid solution, and/or drug-eluting spacers/stents are options in postoperative management. These evidence-based recommendations should not necessarily be applied to all postoperative patients and clinical judgment, in addition to evidence, is critical to determining the most appropriate care.

The Preliminary Results of a Comparative Effectiveness Evaluation of Adhesiolysis and Caudal Epidural Injections in Managing Chronic Low Back Pain Secondary to Spinal Stenosis: A Randomized, Equivalence Controlled Trial

Lumbar surgery and epidural injections for spinal stenosis are the most commonly performed interventions in the United States. However, there is only moderate evidence to the effectiveness of surgery and caudal epidural injections. The next sequential step is adhesiolysis and hypertonic neurolysis with targeted delivery. There have not been any randomized trials evaluating the effectiveness of percutaneous adhesiolysis and targeted delivery of local anesthetic, steroid and hypertonic sodium chloride solution in lumbar spinal stenosis. A randomized, equivalence, controlled trial. An interventional pain management practice, a specialty referral center, a private practice setting in the United States. To evaluate the effectiveness of percutaneous epidural adhesiolysis in patients with chronic low back and lower extremity pain with lumbar central spinal stenosis and compare with fluoroscopically directed caudal epidural injections. Patients were randomly assigned to one of 2 groups with 25 patients in each group. Group I patients received caudal epidural injections with catheterization up to S3 with local anesthetic, 0.9% sodium chloride solution, non-particulate betamethasone and served as the control group. Group II patients received percutaneous adhesiolysis with targeted delivery and injection of lidocaine, 10% hypertonic sodium chloride solution, and non-particulate Betamethasone and formed the intervention group. Randomization was performed by computer-generated random allocation sequence by simple randomization. Multiple outcome measures were utilized including the Numeric Rating Scale (NRS), the Oswestry Disability Index 2.0 (ODI), employment status, and opioid intake with assessment at 3, 6, and 12 months post treatment. Significant pain relief was described as 50% or more, whereas significant improvement in the disability score was defined as a reduction of 40% or more. This evaluation showed significant pain relief (>or= 50%) in 76% of the patients at one year follow-up in the adhesiolysis group compared to 4% of the patients in the control group. The results of this study are limited by the lack of a placebo group, the fact that it is a preliminary report, and there are only 25 patients in each group. With significant pain relief in 76% of patients, percutaneous adhesiolysis utilizing local anesthetic, steroids and hypertonic sodium chloride solution may be effective in patients with chronic function-limiting low back and lower extremity pain with spinal stenosis.

Ovarian histology and follicular score in female rats treated with nandrolone decanoate and submitted to physical effort

The study was conducted to analyze the histology of the ovaries of adults rats treated with steroids, and submitted or not to physical effort. The control group consisted of females submitted to physical effort and sedentary females, both of which received a physiological solution of 0.9% saline. Treated females, sedentary or not, received 6 mg/kg of body weight of nandrolone decanoate. The steroid and physiological solution were administered intraperitoneally, with a single injection per week for 4 consecutive weeks. The applied physical effort was swimming (20 minutes daily, 5 days/week, for the 4 weeks of treatment). Serial sections (5 mum) of ovaries were prepared for histological evaluation and follicular score. The weight of ovaries and hypophysis, the number of antral and atretic follicles, and the area of corpus luteum were all affected by the steroids. In the ovaries of the control groups, well-developed corpus luteum was observed. In the treated groups, the cortical stroma was occupied by ovarian interstitial tissue. The females treated with steroids presented estral acyclicity. The use of nandrolone decanoate, whether associated with physical effort or not, affected the morphological pattern of the ovaries.

CBF changes in relation to the phase of ovarian cycle in guinea pig Fallopian tube: effects of estrogen and progesterone

Ciliary beat frequency (CBF) of Fallopian tube of guinea pig was measured using a light microscope connecting a high‐speed camera (500 Hz), CBFs ranged from 10 to 15 Hz in the phases of ovarian cycle. In follicular phase, CBF increased transiently; an increase at the beginning of estradiol (E2) rise (14 Hz) followed by a rapid decrease at the peak of E2 rise (10 Hz). In ovulatory and luteal phase (high progesterone), CBF was maintained 12 Hz. β‐Estradiol‐benzoate (βE2‐benz) and medroxy‐progesterone (m‐prog) dissolved in a steroid solution were administered subcutaneously for 1.5 ‐ 4 days. A high concentration of βE2‐benz administered (20 mg/day) decreased CBF (11 Hz), while a low concentration (2 mg/day) increased it (14.5 Hz), and these βE2‐benz actions were inhibited by an estrogen inhibitor (ICI 182,780, 2 mg/day). m‐Prog administered (2‐20 mg/day) maintained CBF approximately 12.5 Hz, which was abolished by a progesterone inhibitor (mifepristone, 50 mg/day). Ciliary cells of Fallopian tube were immuno‐positively stained for estrogen and progesterone receptors. The present study demonstrated that βE2‐benz accelerates CBF at a low concentration and suppresses it at a high concentration, and that progesterone maintains CBF around 12 Hz. CBF in Fallopian tube is regulated by estrogen and progesterone in relation to the ovarian cycle.

Central serous chorioretinopathy associated with unusual routes of steroid administration.

To report three cases in which unusual routes of administration were associated with subsequent central serous chorioretinopathy (CSR). All three cases occurred in patients who were being treated for dermatologic conditions. Retrospective review of three cases of patients who presented with a diagnosis of CSR and use of steroids in an unusual route for treatment of various dermatologic conditions (intradermal injection to the scalp for keloids, topical cream for psoriasis, and topical solution for cradle cap). Patient 1 had complete resolution and restoration of baseline visual acuity at the follow-up examination. This patient had no further injections to his keloids. Patient 2 drastically decreased the dose of topical cream and had resolution of symptoms. Patient 3 discontinued use of the steroid solution and had no new episodes of visual decline. This case series suggests that occult steroid use should be suspected for patients presenting with CSR who are concurrently being treated for dermatologic conditions. The knowledge gained from this thorough history is vital to the management and long-term counseling of the patient.

Use of collagen shields for ocular-surface drug delivery

Collagen shields are contact lens-shaped, dissolvable protein matrixes placed on the cornea, primarily indicated for the promotion of epithelial wound healing. The shield can also serve to deliver ocular medications if soaked in a water-soluble antibiotic and/or steroid solution prior to their placement. Collagen shields have distinct advantages over other precorneal drug reservoirs, such as intensive topical therapy, which inconveniences both the patients and caregivers, and subconjunctival injections, which risks hemorrhaging and perforation. It has also been suggested that collagen shields can be used to augment ocular tissue concentrations of various medications over topical administration alone. Despite these potential advantages, the use of collagen shields in drug delivery has not become common practice. In this article, we summarize the evidence for and against the use of collagen shields in delivering and sustaining high levels of ocular therapeutics, with a special focus on the prevention of postoperative endophthalmitis.

Assessing Treatment of Pruritic Scalp

Pruritic scalp has not traditionally been specifically categorized as a separate dermatologic condition; but rather it has been included within the broad category of seborrheic dermatitis. This has severely limited testing and understand- ing of this entity. The objective of this study was to assess patient satisfaction with various topical and oral therapies for pruritic scalp. For this purpose, an open-label, five-week study, 12 patients with pruritic scalp were given five different therapies, each to be used for one week. The participants then completed a survey to assess their opinion on the different therapies. No one treatment was universally preferred. Lanacaine solution and steroid solution achieved slightly higher marks. In a few cases, oral antihistamines proved curative. In short, pruritic scalp is a distinct condition in which one experiences episodic itching of the head without any visible or pathological sign of psoriasis, head lice, or any other scalp disorder. The divergent responses in this study underlines that there are probably different factors and trigger points which elicit the condition. More studies on this entity are warranted.

Intravascular Uptake During Fluoroscopically Guided Cervical Interlaminar Steroid Injection at C6-7: A Case Report

Kaplan MS, Cooke J, Collins JG. Intravascular uptake during fluoroscopically guided cervical interlaminar steroid injection at C6-7: a case report. We report 4 cases of intravascular venous uptake of contrast material during fluoroscopically guided cervical interlaminar epidural steroid injection at the C6-7 level. The blood vessel probably involved is the posterior internal vertebral venous plexus, which drains the interlaminar space and returns blood to the right atrium through the paired vertebral veins and right and left brachiocephalic veins. In all 4 cases, intravascular uptake occurred despite negative aspiration of blood before the contrast material was injected. All patients were successfully injected at the C7-T1 level. We recommend the use of fluoroscopic guidance and the injection of contrast to identify potential placement of the injection needle within the vascular space. Potential complications of intravascular venous uptake of contrast material and steroid solution are discussed.

Solid Phase Extraction of Neutral Analytes through Silica Gel Coated with Layers of Au Nanoparticles Self‐Assembled with Alkanethiols

AbstractIn this study, we used Au nanoparticle (NP)‐coated silica gel as a solid phase extraction sorbent for the preconcentration of neutral analytes (steroid drugs). The sorbent was fabricated using two alkanethiol self‐assembly processes: one to deposit the Au NPs onto a 3‐aminopropyltrimethoxysilane‐modified silica gel and the other to functionalize the surfaces of the Au NPs. A large volume of the steroid solution was passed through the silica gel to facilitate adsorption mediated by hydrophobic interactions between the steroids and the hydrophobic moieties on the silica gel surface. Extraction of the steroids was accomplished by flushing the silica gel with a low‐polarity solvent. In this preliminary study, we found that the particle size of the silica gel and the number of layers of Au NPs coated on the silica gel both affected the preconcentration performance for the steroids. When using six layers of Au NPs coated on 5–20‐μm silica gel, the detection limits for steroids were below 80 ng L−1; the preconcentration efficiency was over 170‐fold higher than that of the original steroid solution. Our findings provide further evidence that nanotechnology has much to benefit analytical science.

Endoscopic Balloon Dilation of Stomal Stenosis following Gastric Bypass

Roux-en-Y gastric bypass (RYGBP) is a common operation for severely obese patients, particularly those with co-morbid disease. Postoperative complications include those amenable to endoscopic therapy, specifically those involving the gastric stoma. 26 patients with prior history of RYGBP for morbid obesity presented with symptoms of gastric outlet obstruction. Symptoms included accelerated weight loss (n=22), nausea/vomiting (n=26), dehydration (n=5), and dysphagia (n=2). Endoscopic dilatation was performed using through-the-scope dilating balloons (8-15 mm). Following dilatation, a steroid solution was injected to prevent re-stenosis. Patients underwent 1-7 dilating sessions (mean 2.7/patient) at 2-week intervals. Estimated stoma diameter prior to dilation ranged from 1 mm to 8 mm (mean 3.5). Following dilation, diameter of the stoma increased to 10 to 15 mm (mean 12.4) at final endoscopy. In patients requiring a single dilating session (n=7), predilation stoma size was a mean 5.8 mm (range 3-8 mm), which increased to a mean of 12.7 mm (range 10-15 mm). In patients requiring multiple dilating sessions (n=19), pre-dilation stoma size was a mean of 2.7 mm (range 0-4 mm), which increased to a mean of 12.2 mm (range 10-14 mm). 25 of 26 patients had good long-term response, with follow-up of 6-38 months (mean 26). No treatment-related complications occurred. All had appropriate weight loss as determined at the bariatric clinic following endoscopic therapy. Of the complications following bariatric surgery that are amenable to endoscopic therapy, stomal stenosis appears to be relatively common. Endoscopic balloon dilation is an effective nonsurgical method for treatment of stomal stenosis, with no complications observed in this, the largest reported, series.

好酸球性中耳炎の保存的治療

Objective: The eosinophilic-otitis-media have characteristic pooling of viscous liquids and granulation tissues in the tympanic cavity. The basic treatment is removal of granulation tissue allowed by an eardrum incision, steroid injection into the tympanic cavity. Therefore, we made eardrum incisions and removed the fluid accumulation and granulation tissues. However, this treatment may induce postoperative eardrum perforation. Therefore, to avoid eardrum perforation after treatment, we injected steroid liquids into tympanic cavity using a 23G fine needle without making an eardrum incision or inserting a tube into the tympanic cavity. Then, we examined the treatment outcomes.Materials and Methods: We diagnosed 17 cases, 33 ears (male: 2 cases 4 ears, female: 15 cases, 29 ears) (average age: 51.4 years old) as having eosinophilic-otitis-media without perforations based on standard diagnostic criteria. Then, we retrospectively investigated the hearing levels and eardrum perforation after treatment by dividing two groups. One group was treated without making eardrum incisions using a 23G fine needle to inject steroid solution, into the tympanic cavity along with oral steroid administration. The other group was treated by making an eardrum incision or inserting a tube, then, injecting steroid solution into the tympanic cavity along with oral steroid administration.Result: The group undergoing eardrum incisions had an eardrum perforation rate of 76.4% (13/17 ears) after treatment. However, the group without eardrum incisions had an eardrum perforation rate of 25.0% (4/16 ears) after treatment. Regarding hearing improvement, there was not a meaningful hearing improvement after treatment in the group receiving eardrum incisions. However, there was a meaningful postoperative hearing improvement of 500-4000Hz in the group without eardrum incisions.Conclusion: We found that treating eosinophilic-otitis-media without eardrum incisions by using a fine needle to inject steroid solution into the tympanic cavity along with oral steroid administration significantly diminished the rate of postoperative perforations.

Intralesional Laser Therapy Treatment for Hemangiomas

The authors have treated over 500 consecutive pediatric patients with voluminous hemangiomas (thickness of over 10 mm), since 1996. They were all treated with intralesional laser therapy using the potassium, titanyl, phosphate (KTP) laser. Since the initiation of KTP laser therapy for deep hemangiomas in 1996, the authors have significantly modified their treatment regimen. Changes from our original treatment protocol include lower power settings, and decreased treatment intervals. Additionally, we are now simultaneously treating the deep component, using intralesional KTP laser, and the superficial component using a pulsed dye laser. Fibrosis associated with intralesional therapy has been greatly decreased by injecting small amounts of dilute steroid solution during treatment of the deep component. While maintaining the efficacy of the procedure, we have been able to greatly decrease complications associated with it. The authors detail their current techniques as well as the evolution and rationale for modifying the original treatment regimen.

Endoscopic Balloon Dilation of Stomal Stenosis Following Gastric Bypass Surgery

Obesity has reached epidemic proportions in the US with significant impact on pt health. Many therapies have been unsuccessful. Surgery appears to be the only effective long-term solution. Roux-en-Y bypass (RYGB), takes advantage of both restrictive (small pouch) & malabsorptive technique (bypass). An occasional problem with restrictive procedures is postoperative stenosis of the gastric outlet (stoma) causing variable obstructive symptoms. Methods: Over 4-yrs, 29 RYGB pts with symptoms of gastric outlet obstruction presented for endotherapy. 23 F/6 M, age 28-45 (mean 37.5). Pt presentation: rapid wt loss (24), N/V (28), dehydration (5), & dysphagia (2). Pts presented 1-18 mo following RYGB (mean 4). All procedures were done with standard upper scope under fluoro. Dilation was performed using graduated CRE balloons (8-10, 10-12, 12-15) to maximum diameter (8 atm), 60 sec intervals. One CRE balloon sz range was used per endo session. Following dilation, the stoma was injected with a steroid solution (Kenalog 40 mg, mixture 1:4), 1 cc/quadrant, circumferentially. Results: All underwent successful balloon dil. Dilating sessions ranged from 1-7 (mean 2.4) at 2-wk intervals. This included 8 pts-one dil, 10 pts-two dil, 7 pts-3 dil, 3 pts-4 dil, 1 pt-7 dil. Those pts requiring repeat dil (21) underwent repeat maximum dil with 8-10 CRE (4), 10-12 CRE (11), & 12-15 CRE (7). Need for repeat dil was determined by persistence of initial symptoms, & stoma sz <10 mm at F/U. Estimated stoma diameter prior to dil was 1-8 mm (mean 3.5). None could be traversed with standard scope. Following dil, diameter of stoma increased to 10-15 mm (mean 12.5). Of pts who required a single dil (8), pre dil stoma sz was a mean of 5.6 mm (range 3-8), which increased to a mean of 12.7 mm (range 10-15). Those requiring multiple dil (21), pre dil stoma sz was a mean of 2.6 mm (range 1-4), which increased to a mean of 12.1 mm (range 10-14). 28 of 29 pts had good long-term response at 6-38 mo. One pt with concomitant large stomal ulcer required surgical revision following 7 dil sessions. All pts had resumption of wt loss expected for RYGB following successful endotherapy. Conclusions: Stomal stenosis following RYGB is a common post surgical complication. Endoscopic balloon dil is an effective, nonsurgical option in the treatment of stomal stenosis with no complications observed in this, the largest reported series. Tabled 1 Stoma Diameter-mm(mean) Frequency of Dilation Pt (n) Pre Dilation (mean) Post Dilation (mean) Single 8 5.6 12.7 Multiple 21 2.6 12.1 Total 29 3.5 12.2 Open table in a new tab

In vitro efficacy of the successive or staggered use of eardrops

Chronic suppurative otitis media is still a significant health problem. Several topical agents such as antibacterials, steroids and acid media eardrops are widely used alone or in combination to control active otorrhea and obtain a dry ear. Patients frequently ask if there is any benefit or loss in the effect of these due to their use in a successive or staggered manner. This question led us to design this in vitro study to investigate the effect of the acetic acid solution and dexamethasone sodium phosphate on the antimicrobial effects of some ototopical antibiotics during their successive or staggered usage. Staphylococcus aureus, Pseudomonas aeruginosa, Proteus mirabilis and Escherichia coli were used for testing the antimicrobial activities of the selected antibiotic drops. Six microliters of acetic acid solution and dexamethasone sodium phosphate were used alone or together with 6 microl each of ciprofloxacin HCl, tobramycin and ofloxacin solution. Drops were placed on Whatman no. 1 paper disks with a diameter of 6 mm, and the disks were placed onto Mueller-Hinton agar plates on which bacteria had been swabbed over the entire surface. After overnight incubation of the plates at 35 degrees C, the diameters of the inhibition zones were recorded. There was no antibacterial effect in response to either acid solution or dexamethasone used alone. The inhibition zones of the antibiotics did not change with either steroid or acid media solution added onto the antibiotic disks alone or together. Acid solution or steroids should be preferred to use in combination with antibacterial otic drugs in in-vivo settings; no negative or positive effects were seen in in-vitro conditions. Therefore, prescribed eardrops can be used in a successive or staggered manner without any influence on the treatment results.

Paraplegia After Intracord Injection During Attempted Epidural Steroid Injection in an Awake-Patient

Epidural steroid injection is recommended in patients with back ache from spinal and radicular pain or pain suggestive of radiculopathy. During needle placement and injections, clinicians often rely on the patient's complaint of paresthesia or shooting pain along the nerve root, dura, or cord in case a needle pierces these areas. We report the accidental intracord injection of steroid solution during epidural block using fluoroscopy in a conscious patient, which caused paraplegia. This case suggests failure of undue reliance on a patient reporting pain in the vicinity of needle puncturing the spinal cord structures. Intracord injection of triamcinolone acetate and local anesthetic, resulting in permanent paraplegia, may occur in conscious patients.

A group III steroid solution without antibiotic components: an effective cure for external otitis

The present study was undertaken to compare the clinical benefits of prescribing ear drops containing 0.05% solution of betamethasone dipropionate (BD), and ear drops containing hydrocortisone with oxytetracycline hydrochloride and polymyxin B (HCPB), for topical treatment of external otitis. Fifty-one patients were enrolled in this open randomized, parallel-group, multicentre study, performed in eight different ENT departments. The patients were randomly assigned to one of the two treatment groups: BD (n = 26) and HCPB (n = 25). Only ENT specialists investigated the patients. Bacterial and fungal cultures were raised on days 1 and 11, using swabbed material from ear canals. Twice daily the patients recorded their symptoms during the acute phase, using special diary cards.BD proved a significantly more effective cure than HCPB during the acute phase of external otitis and afforded a lower relapse frequency during a six-month follow-up period. The patients of the BD group were significantly less troubled by itching (p < 0.01) than those in the HCPB group. On day 11, at the end of the acute phase, growth of bacteria (p = 0.03) and fungi (p < 0.01) was less frequent in the BD group than in the HCPB group. No serious adverse events occurred, and those minor events observed were comparable between the two groups.Our conclusion is that the group III steroid solution, BD, cured the external otitis more effectively than did the HCPB solution, whether infected by bacteria or by fungi. No difference was evident regarding adverse effects. Furthermore, price favours a solution without any antibiotic component. In view of these observations, a group III steroid solution ought to be the preferred remedy for external otitis, whether infected or not.