Steroidal Anti-inflammatory Treatment Research Articles

A SPINAL TRAUMA, A TUMOR AND EVERYTHING IN BETWEEN

Introduction Burkitt lymphoma is a male predominant (3:1 male:female ratio) aggressive B-cell non-Hodgkin lymphoma that can present as a sporadic variant with meningeal involvement in about 20% of cases. Therefore, it can manifest with neurologic deficits due to compression of the spinal cord or spine nerve root. Case Report We report the case of a 6 years-old girl who presented in the emergency department following a traumatic vertebral injury (fall from around 1.5 meters) with no spinal cord involvement. She accused upper back pain, walking and orthostatism difficulties and manifested a light to moderate inferior paraparesis (MCR 3/5) The MRI revealed a space-occupying epidural mass between T1-T4, severely compressing the spinal cord initially thought to be an epidural hematoma. Emergency surgery was performed with duro-radicular decompression and mass excision through a T1-T4 laminotomy followed by a laminoplasty. The unveiled mass was white, minimally vascularized and adherent to the dura raising the suspicion of a tumor. Postoperatively the patient exhibited significant neurological improvement with resolution of the paraparesis and normal gait restoration. Three weeks later, the patient returned with complaints of abnormal gait, lumbar pain radiating in the right lower leg and upon examination a light right lower limb monoparesis (MRC 4/5) following another traumatic event. Emergency MRI of the whole spine with contrast was requested just as the pathologist in charge of the case suggested a diagnosis of Burkitt lymphoma, prompting a whole-body MRI. A severe recurrence was noted at the site of the previous lesion along with a new lumbar lesion, and several intraabdominal, intrathoracic, ovarian tumor sites with diffuse infiltration of the bone marrow. The patient was urgently referred to the pediatric oncology department and started on steroidal anti-inflammatory treatment and chemotherapy. Conclusions Burkitt lymphoma involving the nervous system in children requires increased medical attention during the clinical, histopathological examination and treatment phase, due to the association with advanced disease and, although rare, should be considered as a differential diagnosis in pediatric patients with epidural lesions. The management of such lesions demands a solid collaboration between neurosurgeon, pediatrician, pathologist and oncologist for an early diagnosis and proper treatment.

Optical Coherence Tomography-guided intravitreal bevacizumab in the treatment of refractory pseudophakic cystoid macular edema – case study

One of the serious vision threatened complications of cataract surgery is refractory PCME. That is why this complication has to be managed in time and adequately. Non steroidal and steroidal antiinflammatory and anti VEGF agents like bevazicumab are useful for refractory PCME. OCT has an important role in detecting PCME and measurement of central macular thickness to control the treatment of PCME. In this case study patient after rutin uncomplicated FACO surgery with refractory PCME at postop 4-th week is described. Despite of using of topical NSAID+steroidal antiinflammatory treatment there was no improvement in decreased vision and CMT was remained stable increased (811 mmk). Vision was increased only after 2 week of i/v bevazicumab injection, macular edema resolved and CMT decreased (280 mmk) which was revealed by OCT. In conclusion, OCT quided i/v bevacizumab is safe and well tolerated treatment option for refractory PCME.

Urinary Lithiases: Epidemiological, Clinical and Therapeutic Aspects of 164 Cases at Sheikh Zayed Hospital in Nouakchott—Mauritania

Urinary lithiases occupy an important position with respect to urological activities in our department. In our Sahel region, lithiasic pathology represents 40% in urology in Senegal [1]. In Mauritania, we did not find a study evaluating the prevalence of this pathology. The frequency and gravity are variable. The objective of the study was to report the clinical profile and the results of management of urinary lithiasis in our environment. Materials and Methods: We conducted a retrospective, descriptive study spanning over two years (April 2015 to March 2017) in the urology department of Sheikh Zayed Hospital in Nouakchott. All patients operated for urinary lithiasis during this period were included in the study. The operative techniques used were semi rigid ureteroscopy, extra corporeal lithotrity, open surgery. Our center did not have flexible ureteroscopy and percutaneous nephrolithotomy. The indications were lithotrity for calculations lower than 20 mm of low density. Biger than 20 mm were by open surgery. Semi rigid ureteroscopy for distal ureteral calculi. Medical treatment or monitoring for non-obstructive calculi is less than 7 mm. Urine drainage by jj probe or nephrostomy are performed. We excluded all patients with lithiasis for the medical treatment. The result was good when absence of lithiasis residues was less than 7 mm and removal of the obstruction. Results: A total of 164 patients were found. The average age was 41 years, and F/M ratio was 1/10. Considering geographical origin, 82% of patients came from rural areas. The presenting complaint was mainly Lower Urinary Tract Symptoms (56%) and Renal Colicky Pain (31%). The bladder and kidneys were the most common (respective 45% and 35%) sites of stone location. Bilateral stones were 18%. Staghorn stones constituted 6% of the cases. Non steroidal anti-inflammatory treatment was administered in 82% of cases, while antibiotic therapy was administered in 32% of cases. Complications occurred in open surgery about 11% like parietal infection and residual stones. 0.6% of ESWL got uretere obstruction that needed jj catheter. 4% of cystolithotomy had infection. Conclusion: Urinary lithiasis often consults at the complication stage. Minimally invasive techniques are limited in our service and offer less complication.

Low back pain radiating to the leg: an atypical cause.

This study reports the case of a 47-year old female with low back pain radiating to groin and anterior regions of the left thigh and leg. At symptoms onset, electromyography showed left L3-L4 radiculopathy, and nuclear magnetic resonance revealed disc protrusion at the same level with impingement of the spinal nerve root. The clinical symptoms were ascribed to lumbar disco-radicular conflict. The patient underwent steroidal anti-inflammatory treatment with epidural steroid injections, chiropractic spinal manipulations and rehabilitation program, with no relief. Thirteen months after the onset of pain, a computed tomography of sacroiliac joints showed osteolytic lesion in the iliac bone of left joint, and a bone scintigraphy highlighted foci of intense uptake at left iliac bone and left proximal extremity of the femur. The bone biopsy and pathological examinations showed findings consistent with large B-cell non-Hodgkin lymphoma. This case report highlights the fact that in making differential diagnosis of low back pain radiating to the leg we have to consider the rare possibility that pain can be due to non-Hodgkin lymphoma that involves simultaneously the iliac bone and proximal extremity of the femur.

Condition-specific role of colonic inflammatory molecules in persistent functional colorectal hypersensitivity in the mouse.

A low-level inflammation has been hypothesized to mediate visceral hypersensitivity in functional bowel disorders that persist after or even in the absence of gut inflammation. We aimed to test the efficacy of a steroidal anti-inflammatory treatment, and identify local inflammatory molecules mediating post- and non-inflammatory colorectal hypersensitivity using two mouse models. Visceromotor responses to colorectal distension were quantified as a measure of colorectal sensitivity. On day 1, mice received intracolonic saline (control), trinitrobenzenesulfonic acid (postinflammatory on day 15), or acidified hypertonic saline (non-inflammatory). Colorectal sensitivity before (day 10) and after (day 15) 4-day dexamethasone (Dex) treatment was compared, and colonic gene expression of inflammatory molecules was quantified. Dexamethasone effectively inhibited gene expression of inflammatory molecules such as interleukin (IL)-1β and mast cell protease-1 in the colon, but did not attenuate colorectal hypersensitivity in either model. Gene expression of inflammatory molecules in the colon did not differ between control and the non-inflammatory model, but the postinflammatory model showed increased IL-10 and tight junction protein 2, and decreased IL-6, transforming growth factor (TGF)-β, a precursor of β-endorphin, occludin, and mucin 2. While no common molecule explained colorectal hypersensitivity in these models, hypersensitivity was positively correlated with TGF-β2 mRNA in control, and with IL-1β, inhibin βA, and prostaglandin E2 synthase in the Dex-treated postinflammatory model. In the non-inflammatory model, cyclooxygenase-2 mRNA was negatively correlated with colorectal sensitivity. These results suggest that persistent functional colorectal hypersensitivity is mediated by condition-specific mediators whose gene expression in the colon is not inevitably sensitive to steroidal anti-inflammatory treatment.

Evaluation of the muscle relaxant cyclobenzaprine after third-molar extraction

Pain, swelling and trismus are undesirable effects of extraction of impacted mandibular third molars. The authors conducted a study to evaluate the effectiveness of the muscle relaxant cyclobenzaprine when used as a supplement to cryotherapeutic, antibiotic and steroidal anti-inflammatory treatment with the aim of reducing undesirable consequences after third-molar extraction. The authors conducted a prospective, randomized, double-masked, placebo-controlled clinical trial involving 50 participants aged 18 to 29 years randomly assigned to receive cyclobenzaprine or the placebo. The authors used a split-mouth design, so each participant acted as his or her own control. For each participant, the authors extracted one impacted mandibular third molar on each side of the mouth at different times. Participants received 10 milligrams of cyclobenzaprine or a placebo once per day the day before surgery, the day of surgery and the first day after surgery. The authors assessed the participants' postoperative pain by means of a visual analog scale at four, six, eight, 12, 24 and 48 hours. They measured the participants' swelling and maximal interincisor distance at 48 hours and seven days. The authors assessed both sides of each participant's mouth for differences in pain, swelling and trismus. They found no statistically significant differences between sides of the mouth regarding these three variables. The results of this trial indicate that the influence of cyclobenzaprine over pain, swelling and trismus does not justify prescribing additional medication for patients undergoing third-molar extraction. The muscle relaxant cyclobenzaprine was ineffective in reducing pain, swelling and trismus after third-molar extraction.

Syndrome de la dent couronnée : à propos de trois nouveaux cas

Introduction. – Crowned dens syndrome is due to a microcrystalline infringement (hydroxyapatite or calcium pyrophosphate) of the retro-odontoidal ligament of atlas, often leading to the erroneous diagnosis of meningitis or spondylitis. We report on three new cases diagnosed from 1996 to 1999. Exegesis. – The patients complained of cervicalgies, headaches or fever. The initially evoked diagnoses were meningitis, spondylodiscitis or endocarditis. Clinical exam found meningism and an inflammatory syndrome in all patients. Analysis of the cerebro-spinal fluid realised in two cases was normal. The diagnosis of crowned dens syndrome was assessed in two cases by cervical CT scan of C1/C2. In the third case, chondrocalcinosis of a wrist allowed this diagnosis. We report a probably non fortuitous case of crowned dens syndrome associated with genetic hemochromatosis. A non steroidal anti-inflammatory treatment allowed a dramatic regression of clinical symptoms. Conclusion. – This entity should be better known; it can mimick numerous diagnosis and be responsible for fever in the long course.

Efficacy of diclofenac sodium ophthalmic solution versus placebo in reducing inflammation following cataract extraction and posterior chamber lens implantation

One hundred forty-eight patients were enrolled in a randomized, prospective, placebo-controlled clinical trial evaluating the efficacy of diclofenac sodium (Voltaren Ophthalmic®) in reducing ocular inflammation following extracapsular cataract extraction with posterior chamber intraocular lens implantation. Eligible patients were enrolled and randomized (2:1 diclofenac:placebo) if the sum of anterior chamber cells plus flare one day postoperatively (baseline) was at least four. None of the patients received concomitant steroidal anti-inflammatory treatment. The 99 patients receiving diclofenac sodium had significantly greater improvement from baseline in summed flare plus cell score than the 49 placebo patients at two to five days and seven to nine days after baseline. Similarly, diclofenac sodium patients had significantly less post-baseline conjunctival erythema and ciliary flush than placebo patients. Significantly more diclofenac sodium patients than placebo patients showed moderate to marked improvement from baseline in overall assessment of inflammatory response. Forty-nine percent of placebo patients but only 17% of diclofenac patients were considered therapeutic failures (P < .001). By five to seven days, 82% of diclofenac sodium patients and 59% of placebo patients had corrected visual acuities of 20/40 or better (P < .001). There were no clinically important differences in mean intraocular pressure at any visit.

Efficacite D'Une Nouvelle Cephalosporine (Ceftiofur) Associee Ou Non A Un Antiinflammatoire Steroidien (Succinate De Methyl Prednisolone) Dans Un Modele Experimental De Pasteurellose Respiratoire Du Veau A Pasteurella Haemolytica Bio-Serogroupe Al

After randomization, 18 calves were inoculated with a Pha1 isolate as described in an earlier protocol. After the first inoculation 6 calves received Ceftiofur (CEF), 1 mg/kg by intramuscular route (IM) every day for 5 days together with methyl-prednisolone-succinate (MPS) 3 mg/kg IM on two consecutive days, 6 calves received CEF + an MPS placebo, and 6 calves a CEF placebo+ an MPS placebo. Twice a day before the meal all calves were clinically examined to determine a mean disease score (MOS). After their death or sacrifice, 7 days at most after the first inoculation, all calves were autopsied. The lungs were weighed, the extent of the lesions quantified by a score (mean lung score= MLS) based on combined inspection and palpation and a quantitative bacteriological examination carried out on the damaged lung parenchyma. The validity of the model was confirmed by the percentage mortality observed in the control group (83 % versus 17 % in the other groups). A similar trend was apparent in the clinical results (significant difference p ≤ 0,05 between the mean MOS of the control group and that of the other group) in the necropsy results (significant difference p ≤ 0,05 between the control group and the other groups for mean lung weight and MLS)) and in the microbiological results (significant difference p ≤ 0,05 between the mean number of cfu Pha1/g of lung in the control group and other groups). This demonstrate the efficacy of both therapeutic regimens (i.e. CEF and CEF + MPS) in our model. The advantage of the antibiotic + steroidal anti-inflammatory treatment is not clear.&#x0D; Full article in French, English and German summary in PDF.

Nail involvement in osteoarthritis

Two cases of nail involvement associated with primary interphalangeal osteoarthritis of the hand, including leukonychia and longitudinal nail ridge, are reported. Osteoarthritic changes of the distal interphalangeal joints may cause nail lesions by exerting direct pressure on the nail matrix or by interfering with local blood flow. Moreover, inflammation of the Heberden's nodes is often present and seems to participate in the development of nail alteration. In our patients, leukonychia disappeared after local steroidal anti-inflammatory treatment of the osteoarthritic node and longitudinal nail ridge disappeared after treatment with nonsteroidal anti-inflammatory agents.