Underwent Steroid Therapy Research Articles

軽微な外力で発症した完全横断性頚髄麻ひの一例

A 53-year-old male was admitted on suspicion of spondylitis and underwent antibiotic therapy. On the day following admission, low back pain decreased, but he experienced neck and shoulder pain and numbness in the left upper extremity. On the third day, when cervical spine was extended slightly on evacuation, he experienced sudden back pain. Neurological examination at that time revealed complete paraplegia. Anesthesia and motor paralysis below C7 was noticed. The symptoms were in the category of Frankel A. We found the spinal canal to be relatively narrow and disc herniation at the C6/7 level. He underwent steroid therapy in large quantities and lamimoplasty from C3 to C7. Intraoperatively, it was found that the cervical vertebrae were slightly unstable at the C6/7 level. Postoperatively, symptoms of paralysis improved to the Frankel D.

Experience of tooth extraction in patients undergoing steroid therapy

Experience of tooth extraction in patients undergoing steroid therapy

Clinical significance of histological grading and staging for predicting the effectiveness of steroid therapy in IgA nephropathy

Background. A beneficial effect of steroid therapy for IgA nephropathy (IgAN) has been reported. However, precise histological criteria for steroid therapy have not yet been established. The present study was designed to assess the clinical validity of histological grading and staging for predicting the responsiveness to steroid therapy in IgAN. Methods. We performed a retrospective study of 27 patients with IgAN who underwent steroid therapy. The duration of steroid therapy was 42.9 ± 23.1 months, and the mean follow-up period was 7.5 ± 2.4 years, ranging from 4 to 14 years. Responsiveness to the steroid therapy was evaluated by reduction of urinary protein at 1 year after treatment; more than 50% reduction of initial urinary protein and less than 1.0 g/day. Responsiveness to the therapy was also evaluated by preservation of renal function; i.e., maintenance of serum creatinine level under 2.0 mg/dl during follow-up. The histological grading and staging method (G-S system) proposed by Shigematsu was used to evaluate the histological severity of lesions in renal biopsy specimens. Univariate analyses of clinical and histological parameters, using the logistic regression model or Cox proportional hazards model, were performed to find predictive factors for the effectiveness of steroid therapy. Results. No clinical parameters at the start of treatment predicted the effectiveness of the steroid therapy. However, some histological parameters – crescent formation rate (%), grade of glomerular extracapillary lesions (Gex) and grades of acute and chronic interstitial inflammation (Gint and Sint) – were predictive for the effectiveness of steroid therapy. To predict reduction of proteinuria at 1 year after steroid therapy, the crescent formation rate, Gex, Gint, and Sint were significant (odds ratio; P value): crescent formation rate per 10% increment (2.91; P = 0.019), Gex per 0.1 grade increment (1.56; P = 0.021), Gint per one grade increment (0.20; P = 0.022), and Sint per one grade increment (0.33; P = 0.039). These results indicated that a high crescent formation rate and active extracapillary lesions predicted favorable response, and active and chronic interstitial lesions predicted lower efficacy in proteinuria reduction. To predict deterioration of renal function, Gint and Sint were significant (hazard ratio; P value): Gint per one grade increment (3.30; P = 0.015) and Sint per one grade increment (2.99; P = 0.006), indicating that high degrees of acute and chronic interstitial inflammation predicted the deterioration of renal function. Conclusions. The severity of acute glomerular extracapillary lesions predicts the possibility of reduction in proteinuria after steroid therapy, while the severity of interstitial inflammation suggests a lower efficacy for proteinuria reduction and a high risk of renal dysfunction even after steroid therapy in IgAN.

Indium-111 labelled platelet scintigraphy can predict the immunological origin of fever in patients on dialysis carrying a non-functioning renal allograft.

The purpose of this study was to evaluate the usefulness of labelled platelet scintigraphy in the differential diagnosis of a prolonged febrile syndrome (PFS) in patients on dialysis carrying a non-functioning renal allograft. We prospectively performed an indium-111 mercaptopyridine-labelled platelet scan on 91 patients (54 men, 37 women; mean age 39.6+/-12 years). The mean duration of PFS was 35 days (range 7-122). Forty-six of the 91 patients underwent steroid therapy (2-10 mg/day). Platelet labelling was carried out following Thakur's method. Platelet scans were performed 48 h after reinjection of labelled platelets. The platelet uptake index (PUI) was calculated by dividing the cpm/pixel in the allograft ROI by cpm/pixel in a mirror background ROI. The final diagnosis of PFS was established depending on the outcome after treatment. In 61/91 patients the fever had an immunological origin because it disappeared after graft embolisation or transplantectomy. In 30/91 patients the PFS disappeared after antibiotic therapy (non-immunological origin). The PUI in patients with immunological PFS was 1.80+/-0.7, while in patients with non-immunological PFS it was 1.12+/-0.1 (P<0.05). When a PUI of > or =1.5 was considered as the threshold to establish PFS of immunological origin, the sensitivity of platelet scan was 76%, the specificity 100%, and the negative and positive predictive values 69% and 100%, respectively. In patients classified with immunological PFS who underwent steroid therapy, the PUI was significantly lower than in patients without steroids (P<0.05). These results suggest that 111In-labelled platelet scintigraphy can accurately predict an immunological PFS in patients on dialysis carrying a non-functioning renal allograft. Therapy with steroids could reduce the sensitivity of 111In-labelled platelet scintigraphy in detecting immunological PFS.

Autoimmune pancreatitis with F-18 fluoro-2-deoxy-D-glucose PET findings

Two cases of pancreatitis induced by autoimmunity with PET images using F-18 fluoro-2-deoxy-D-glucose (FDG) are reported. The patients had abdominal pain and were thought to have possible pancreatic neoplasms. In one patient, PET showed intense uptake of the entire pancreas, but a Ga-67 scan yielded a negative result. Because the serum immunoglobulin G level was high, autoimmune pancreatitis was diagnosed in this patient. He underwent steroid therapy and fully recovered. In another patient with positive antinuclear antibodies and hyperglobulinemia, focal intense uptake was found in the head of the pancreas on the FDG PET. She also recovered with steroid therapy. Autoimmune pancreatitis is a relatively new form of chronic pancreatitis and should be kept in mind when making a differential diagnosis of pancreatic cancer with the assistance of FDG PET.

Expression and release of the monocyte lipopolysaccharide receptor antigen CD14 are suppressed by glucocorticoids in vivo and in vitro.

The effect of glucocorticoid (GC) treatment on expression and release of the monocyte cell surface LPS receptor Ag CD14 was studied in vivo and in vitro. In patients with acute inflammatory diseases receiving GC pulse therapy serum concentrations of soluble CD14 and CD14 expression by peripheral blood monocytes decreased significantly. The LPS-binding capacity correlated positively with the amount of cell surface CD14 by human blood monocytes. In vitro, a time- and dose-dependent effect of GC preparations on monocyte membrane and soluble CD14 by cultured peripheral blood monocytes was found. Incubation with 2 x 10(-8) M prednisolone down-regulated cell surface CD14 after 72 h, and 2 x 10(-7) M suppressed CD14 expression even after 24 h. Prednisolone also decreased release of the soluble CD14 Ag, where a 10-fold higher GC concentration was required for a significant suppression compared with membrane CD14 during culture. Expression of other monocyte membrane Ags were either unchanged (CD33, CD35), diminished (CD13, CD89), or increased (CD32) by GC, indicating no general down-modulation of cell surface Ag expression. Preincubation with glucocorticoids for 24 h significantly down-regulated CD14 expression during subsequent steroid-free culture for at least 7 days. In cultured monocytes, the LPS-induced increase of membrane and soluble CD14 was markedly but not completely inhibited by prednisolone. Therefore, GC treatment suppresses the up-regulation of the LPS receptor during endotoxin challenge, and likewise, the IL-1 secretion after LPS stimulus was significantly diminished. Taken together, the suppression of the monocytic cell surface and soluble endotoxin receptor CD14 by GC may contribute to the increased risk of infections in patients undergoing steroid therapy.

Hemorheological and Hemostatic Parameters in Children with Nephrotic Syndrome Undergoing Steroid Therapy

Disturbances in hemostatic and hemorheological parameters have been investigated in a group of 29 children with nephrotic syndrome: 23 children classified as steroid-sensitive and 6 as steroid-resistant. Studies were performed before prednisone treatment and 3 weeks later, after initiation of steroid therapy. Before treatment, the alterations in hemostatic system involved moderate thrombocytosis with spontaneous aggregation in 19 patients. High levels of fibrinogen, factor VIII, Willebrand factor, protein C, protein S and alpha 2-macroglobulin (alpha 2M) were observed. Factor XII and alpha 1-antitrypsin (alpha 1AT) were lower than normal. Antithrombin III (ATIII) level was normal in the majority of patients. A plasma and blood hyperviscosity syndrome was also observed as well as an increase in erythrocyte aggregation. During treatment, an improvement in the hemostatic parameters was observed in the patients who responded to prednisone. The expected increase in factor VIII (frequently described in the literature) was not observed, while there was a significant increase in protein C. In the steroid-resistant patients, the only significant changes observed were decreased fibrinogen and increased protein C. The hemorheological parameters showed a tendency towards normality regardless of whether or not the treatment provided remission of NS. The relationship between hemorheological and hemostatic factors changes are discussed.

Clonazepam in the treatment of recurrent symptoms of depression and anxiety in a patient with systemic lupus erythematosus

A patient undergoing steroid therapy for systemic lupus erythematosus developed symptoms of depression and anxiety that did not respond to conventional drug therapy. A regimen of clonazepam, an anticonvulsant drug, did relieve the symptoms.