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Sample records for intralesional steroid injection

  1. Treatment of laryngeal sarcoidosis with intralesional steroid injection.

    PubMed

    Krespi, Y P; Mitrani, M; Husain, S; Meltzer, C J

    1987-01-01

    Laryngeal sarcoidosis presents with hoarseness, cough, and dysphagia. Shortness of breath due to upper airway obstruction may occur. Indirect laryngoscopy reveals mucosal edema and erythema, granulomas, and nodules. The supraglottic larynx is the most frequently affected area. Systemic corticosteroids can be used initially; however, with persistent symptoms and/or severe airway problems, intralesional steroid injections may be more effective, as in the six patients presented. PMID:3688765

  2. Comparative study of intralesional steroid injection and cryotherapy in alopecia areata

    PubMed Central

    Amirnia, Mehdi; Mahmoudi, Seyed-Sajjad; Karkon-Shayan, Farid; Alikhah, Hossein; Piri, Reza; Naghavi-Behzad, Mohammad; Ranjkesh, Mohammad-Reza

    2015-01-01

    Background and Objectives: Alopecia areata (AA) is a common, non-scarring type of hair loss, affecting approximately 2.1% of the population, many modality of treatment recommended like steroid injection, topical Immunotherapy and several systemic therapies. The aim of this study was to compare intralesional steroid injection and cryotherapyoutcomes in AA. Materials and Methods: In an analytical-descriptive study, 120 AA patients treated with intralesionalsteroid injection and 120 AA patients treated with cryotherapy were randomly selected. These two groups matched for location, duration and size of lesion and also matched for age and gender. From March 2011 to September 2013, the effect and complications of the therapies after 3, 6, 9 and 12 weeks were assessed and results were compared between the two groups. Results: Mean age of patients in steroid injection group was 30.2 ± 6.8 and in cryotherapy group was 31.8 ± 7.1. Sexual distribution in both groups was 56.7% and 43.3 % for male and female, respectively. Location of disease in 80% was in scalp and 20% was in face in both groups. The time of beginning response in steroid group was 4.13 ± 2.13 weeks and in cryotherapy group was 6.14 ± 0.29 weeks, difference between two groups was significant (P = 0.001). In term of clinical response at the end of study, in steroid group,20 patients (16.7%) no response, 32 patients (26.7%), moderate response and68 patients (56.7%) had a complete response, and also in cryotherapy group was, 52 patients (43.3%) no response, 40 patients (33.3%) moderate response and 28 patients (23.3%) had a complete response. There was significant different in complete response rate and steroid injection was more effective than cryotherapy(P < 0.05). Conclusion: As the cryotherapy isa considerable treatment of AA, alsothis study proposes intralesional injection of corticosteroid, as a replacement of AA therapy; particularly the short-term complications are not significantly different. PMID

  3. Normalisation of asymmetric astigmatism after intralesional steroid injection for upper eye lid hemangioma in childhood.

    PubMed

    Langmann, A; Lindner, S

    1994-01-01

    Infantile hemangiomas affect about 5% (3%-8%) of the population, showing a predilection for the face. After a phase of rapid enlargement between the 3rd and the 9th month of life, 70% regress by the age of six after a period of stability. 43%-60% of the children with eye lid hemangiomas develop strabismic, anisometropic, or deprivation amblyopia. Previous studies found the majority of cases resulting from anisometropia (especially asymmetric astigmatism) rather than strabism or occlusion of the visual axis. Several methods of treatment--surgical excision, irradiation, sclerosing agents, systemic steroids, ligation, cryotherapy--have been used but all with a risk of local or systemic complications. Local injections of steroids are a simple method of therapy with a high rate of resolution of hemangiomas, but still with a high degree of bad visual output because of persistent astigmatism. In four children with asymmetric astigmatism (axis of astigmatism towards the hemangioma) in which the injection was given at the beginning of the phase of enlargement, amblyopia could be avoided by preventing corneal steepening from becoming permanent. PMID:7835197

  4. Treatment of localized Langerhans' cell histiocytosis of the mandible with intralesional steroid injection: report of a case.

    PubMed

    Esen, Alparslan; Dolanmaz, Doğan; Kalayci, Abdullah; Günhan, Omer; Avunduk, Mustafa Cihat

    2010-02-01

    Localized Langerhans cell histiocytosis (LLCH), formerly known as eosinophilic granuloma, mainly affects the skull, mandible, vertebrae, and ribs in children and the long bones of adults. Symptoms range from none to pain, swelling, and tenderness over the site of the lesion. General malaise and fever occasionally are present. Radiographically, lesions appear as radiolucent areas with well demarcated borders. LLCH may resolve spontaneously after biopsy in a period of months to years. However, if features include continuous pain, decrease of function, pathologic fractures, migration and resorption of teeth, or rapid progression, then active treatment needs to be considered. Treatment approaches include surgery, radiotherapy, chemotherapy, and intralesional injection of corticosteroids. In children with mandibular LLCH, 1 dose of methyprednisolone succinate injection has proven to be adequate. However, injections have not been performed in cases involving pathologic fracture. We report a new case of LLCH of the mandible that caused a pathologic fracture in an adult patient. Repeated intralesional corticosteroid injections resulted in fracture line disappearance within 14 months and lesion healing by the end of the 36-month follow-up. PMID:20123398

  5. Comparison of curcumin with intralesional steroid injections in Oral Submucous Fibrosis – A randomized, open-label interventional study

    PubMed Central

    Yadav, Monu; Aravinda, K.; Saxena, Vasu S.; Srinivas, K.; Ratnakar, P.; Gupta, Jyothi; Sachdev, Arti Saluja; Shivhare, Peeyush

    2014-01-01

    Introduction Oral Submucous Fibrosis (OSMF) is precancerous condition caused by areca nut chewing characterized by restricted mouth opening, burning sensation and stiffness & blanching of oral mucosa. Complete regression of the condition had not been achieved in all cases with any of the present treatment regimens. Curcumin is (diferuloylmethane), a yellow pigment in curry powder, exhibits anti-oxidant, anti-inflammatory, and pro-apoptotic activities. Hence an interventional study was undertaken to establish the efficacy of curcumin in OSMF patients. Settings & design A randomized open label, interventional study was conducted in forty patients with clinically and histologically proven Oral Submucous Fibrosis. Materials & methods Forty patients with clinically and histologically proven Oral Submucous Fibrosis were selected for the study and were randomly divided into 2 groups. The first group was treated with weekly intralesional injection of 4 mg Dexamethasone & 1500 I.U Hyaluronidase and the second group by oral administration of two Curcumin tablets (Turmix 300 mg) per day for 3 months each. Improvement of burning sensation, interincisal distance and tongue protrusion was evaluated on a weekly basis. Results Burning sensation improved in both the groups from early to late stages. Complete resolution of burning sensation was noted with turmix. The mean increase in interincisal distance was 3.13 mm and 1.25 mm respectively in groups 1 &2. The interincisal distance improved in both the groups, with significant results at the end of first month. Tongue protrusion showed greater recovery at the end of 1st month in group 1 when compared with group 2. Conclusion Turmix is beneficial and effective in reducing burning sensation in early OSMF patients. PMID:25737939

  6. Epidural Steroid Injections

    MedlinePlus

    ... Assessment Tools Injection Treatments for Spinal Pain Epidural Steroid Injections Lumbar Zygapophysial (Facet) Joint Injections Surgical Options Nonsurgical Treatments Alternative Medicine Epidural Steroid Injections General Information Why Get an Epidural Steroid ...

  7. Benign Post-Radiation Rectal Stricture Treated with Endoscopic Balloon Dilation and Intralesional Triamcinolone Injection

    PubMed Central

    Karanikas, Michael; Touzopoulos, Panagiotis; Mitrakas, Alexandros; Zezos, Petros; Zarogoulidis, Paul; Machairiotis, Nikolaos; Efremidou, Eleni; Liratzopoulos, Nikolaos; Polychronidis, Alexandros; Kouklakis, George

    2012-01-01

    Post-radiation stricture is a rare complication after pelvis irradiation, but must be in the mind of the clinician evaluating a lower gastrointestinal obstruction. Endoscopy has gained an important role in chronic radiation proctitis with several therapeutic options for management of intestinal strictures. The treatment of rectal strictures has been limited to surgery with high morbidity and mortality. Therefore, a less invasive therapeutic approach for benign rectal strictures, endoscopic balloon dilation with or without intralesional steroid injection, has become a common treatment modality. We present a case of benign post-radiation rectal stricture treated successfully with balloon dilation and adjuvant intralesional triamcinolone injection. A 70-year-old woman presented to the emergency room complaining for 2 weeks of diarrhea and meteorism, 11 years after radiation of the pelvis due to adenocarcinoma of the uterus. Colonoscopy revealed a stricture at the rectum and multiple endoscopic biopsies were obtained from the stricture. The stricture was treated with endoscopic balloon dilation and intralesional triamcinolone injection. The procedure appears to have a high success rate and a very low complication rate. Histologic examination of the biopsies revealed non-specific inflammatory changes of the rectal mucosa and no specific changes of the mucosa due to radiation. All biopsies were negative for malignancy. The patient is stricture-free 12 months post-treatment. PMID:23271987

  8. Effect of intralesional 5 fluorouracil injection in primary pterygium

    PubMed Central

    Khan, Muhammad Saim; Malik, Sidra; Basit, Imran

    2016-01-01

    Objective: To determine mean change in visual acuity, corneal astigmatism and clinical appearance of pterygium after intralesional injection of 5-Fluorouracil. Methods: This was a Quasi experimental study conducted at Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan from June 2014 to May 2015. Total 68 eyes of 54 patients were included in the study. Patients were treated by injecting 0.1 ml of 5-FU (5mg) weekly injections for 04 weeks. All the patients underwent ophthalmic clinical examination that included Uncorrected distant visual acuity (UCVA), corrected distant visual acuity (CDVA), keratometery with Auto Ref-keratometer (RK-F1, Canon) and slit lamp examination before and 04 weeks after the last injection. Results: Total 68 eyes of 54 patients (18 females and 36 males) were treated with intralesional injection of 5 FU. Out of total, 30 were right eyes while 38 were left eyes. Age of patients ranged from 23 to 53 years with mean age of 39.2 ± 4.90 years. Mean UCVA and corneal astigmatism before treatment were 0.162 ± 0.167 and 2.12 ± 1.53 respectively while the same parameters 04 weeks after last injection of 5 FU were 0.166 ± 0.168 and 1.92±1.45 respectively. The magnitude of induced change in astigmatism was (0.235 ± 1.35). Ninety seven percent of the patients showed improvement in clinical appearance. Conclusion: Intralesional 5-FU injection results in significant clinical and cosmetic improvement of primary pterygium. PMID:27022360

  9. Recent developments in the use of intralesional injections keloid treatment.

    PubMed

    Trisliana Perdanasari, Aurelia; Lazzeri, Davide; Su, Weijie; Xi, Wenjing; Zheng, Zhang; Ke, Li; Min, Peiru; Feng, Shaoqing; Zhang, Yi Xin; Persichetti, Paolo

    2014-11-01

    Keloid scars are often considered aesthetically unattractive and frustrating problems that occur following injuries. They cause functional and cosmetic deformities, displeasure, itching, pain, and psychological stress and possibly affect joint movement. The combination of these factors ultimately results in a compromised quality of life and diminished functional performance. Various methods have been implemented to improve keloid scars using both surgical and non-surgical approaches. However, it has proven to be a challenge to identify a universal treatment that can deliver optimal results for all types of scars. Through a PubMed search, we explored most of the literature that is available about the intralesional injection treatment of hypertrophic scars and keloids and highlights both current (corticosteroid, 5-fluorouracil, bleomycin, interferon, cryotherapy and verapamil) and future treatments (interleukin-10 and botulinum toxin type A). The reference lists of retrieved articles were also analysed. Information was gathered about the mechanism of each injection treatment, its benefits and associated adverse reactions, and possible strategies to address adverse reactions to provide reliable guidelines for determining the optimal treatment for particular types of keloid scars. This article will benefit practitioners by outlining evidence-based treatment strategies using intralesional injections for patients with hypertrophic scars and keloids. PMID:25396172

  10. Recent Developments in the Use of Intralesional Injections Keloid Treatment

    PubMed Central

    Trisliana Perdanasari, Aurelia; Lazzeri, Davide; Su, Weijie; Xi, Wenjing; Zheng, Zhang; Ke, Li; Min, Peiru; Feng, Shaoqing; Persichetti, Paolo

    2014-01-01

    Keloid scars are often considered aesthetically unattractive and frustrating problems that occur following injuries. They cause functional and cosmetic deformities, displeasure, itching, pain, and psychological stress and possibly affect joint movement. The combination of these factors ultimately results in a compromised quality of life and diminished functional performance. Various methods have been implemented to improve keloid scars using both surgical and non-surgical approaches. However, it has proven to be a challenge to identify a universal treatment that can deliver optimal results for all types of scars. Through a PubMed search, we explored most of the literature that is available about the intralesional injection treatment of hypertrophic scars and keloids and highlights both current (corticosteroid, 5-fluorouracil, bleomycin, interferon, cryotherapy and verapamil) and future treatments (interleukin-10 and botulinum toxin type A). The reference lists of retrieved articles were also analysed. Information was gathered about the mechanism of each injection treatment, its benefits and associated adverse reactions, and possible strategies to address adverse reactions to provide reliable guidelines for determining the optimal treatment for particular types of keloid scars. This article will benefit practitioners by outlining evidence-based treatment strategies using intralesional injections for patients with hypertrophic scars and keloids. PMID:25396172

  11. Canine lipomas treated with steroid injections: clinical findings.

    PubMed

    Lamagna, Barbara; Greco, Adelaide; Guardascione, Anna; Navas, Luigi; Ragozzino, Manuela; Paciello, Orlando; Brunetti, Arturo; Meomartino, Leonardo

    2012-01-01

    Lipomas are common benign tumours of fat cells. In most cases, surgical excision is curative and simple to perform; however, such a procedure requires general anaesthesia and may be associated with delayed wound healing, seroma formation and nerve injury in deep and intramuscular tumours. The objective of this study was to evaluate treatment of subcutaneous, subfascial or intermuscular lipomas using intralesional steroid injections in dogs. Fifteen dogs presenting with lipomas were selected for treatment with ultrasound-guided intralesional injection of triamcinolone acetonide at a dose of 40 mg/mL. Nine subcutaneous and subfascial tumours showed a complete regression. The other lipomas decreased in diameter, achieving, in some cases, remission of discomfort and regression of lameness. Steroid injection was a relatively safe and effective treatment for lipomas in dogs; only six dogs experienced polyuria/polydipsia for about 2 weeks post-treatment. PMID:23226250

  12. Canine Lipomas Treated with Steroid Injections: Clinical Findings

    PubMed Central

    Lamagna, Barbara; Greco, Adelaide; Guardascione, Anna; Navas, Luigi; Ragozzino, Manuela; Paciello, Orlando; Brunetti, Arturo; Meomartino, Leonardo

    2012-01-01

    Lipomas are common benign tumours of fat cells. In most cases, surgical excision is curative and simple to perform; however, such a procedure requires general anaesthesia and may be associated with delayed wound healing, seroma formation and nerve injury in deep and intramuscular tumours. The objective of this study was to evaluate treatment of subcutaneous, subfascial or intermuscular lipomas using intralesional steroid injections in dogs. Fifteen dogs presenting with lipomas were selected for treatment with ultrasound-guided intralesional injection of triamcinolone acetonide at a dose of 40 mg/mL. Nine subcutaneous and subfascial tumours showed a complete regression. The other lipomas decreased in diameter, achieving, in some cases, remission of discomfort and regression of lameness. Steroid injection was a relatively safe and effective treatment for lipomas in dogs; only six dogs experienced polyuria/polydipsia for about 2 weeks post-treatment. PMID:23226250

  13. Intralesional vinblastine injections for treatment of classic Kaposi sarcoma in diabetic patients.

    PubMed

    Vassallo, Camilla; Carugno, Andrea; Derlino, Federica; Ciocca, Olga; Brazzelli, Valeria; Borroni, Giovanni

    2015-05-01

    Classic Kaposi sarcoma (KS) usually is a localized and slowly progressing disease that mainly affects elderly patients; therefore, local treatment generally is recommended. In this study, we evaluated the clinical efficacy of intralesional vinblastine (VNB) for the treatment of classic KS in 6 participants with type 2 diabetes mellitus. Results indicated that intralesional VNB injections may be an effective alternative treatment of classic KS in diabetic patients. PMID:26057517

  14. Intralesional bleomycin injection in management of low flow vascular malformations in children.

    PubMed

    Mohan, Anita T; Adams, Saleigh; Adams, Kevin; Hudson, Donald A

    2015-04-01

    Low flow vascular malformations are challenging to manage, particularly with their propensity to grow, and can lead to severe disfigurement and dysfunction. Traditional surgical excision is fraught with tedious dissection and complications, particularly in the head and neck region. Trends toward less invasive techniques, such as intralesional sclerotherapy, are proving to be successful independent treatments or adjuncts in management in low flow vascular malformations. This study was a retrospective case note review, over an 8-year period, reporting the outcomes of 32 children (mean = 5.8 years, range = 5 months-11.5 years) with radiologically confirmed low flow vascular malformations, treated with serial intralesional bleomycin injection (IBI) therapy. Patient demographics, lesion characteristics, imaging findings, treatment course, radiological and clinical response to treatment were recorded. An overall 91% (n = 29) response rate was achieved, with 28% obtaining complete resolution for low flow vascular malformations. Lesions were sub-categorized into venous malformation, including mixed venous-capillary (n = 27) or lymphatic malformation (LM) (n = 5). Twenty-seven of 32 children experienced no complications. Local complications included superficial skin infection (n = 2), skin necrosis (n = 1), hyperpigmentation, and minor contour deformity. There was no recurrence and no systemic side-effects to bleomycin. Mean follow-up was 38 months (range = 6-95 months). In conclusion, serial intralesional bleomycin injections can be effective and also safe in a paediatric population for the successful management of symptomatic or disfiguring low flow vascular malformations. PMID:25204206

  15. Elastosis perforans serpiginosa: a case successfully treated with intralesional steroids and topical allium cepa-allantoin-pentaglycan gel.

    PubMed

    Campanati, Anna; Martina, Emanuela; Giuliodori, Katia; Ganzetti, Giulia; Marconi, Barbara; Conta, Irene; Giangiacomi, Mirella; Offidani, Annamaria

    2014-01-01

    Elastosis perforans serpiginosa is a rare skin disease in which abnormal elastic fibers, other connective tissue elements, and cellular debris are expelled from the papillary dermis through the epidermis. Three clinical variants of EPS can be detected: idiopathic, reactive, and drug-induced. Clinically it consists of small horny or umbilicated papules arranged in a linear, arciform, circular, or serpiginous pattern. It usually occurs in young adults and shows a predilection for the head and neck. The lesions are generally asymptomatic or slightly itching. Several treatments have been reported with poor long-term success; these include intralesional and topical corticosteroids, tazarotene, imiquimod, and cryotherapy. We report a case of 40-year-old black woman affected by elastosis perforans serpiginosa that was referred to our department and treated with intralesional injections of triamcinolone acetonide and topical application of allium cepa-allantoin-pentaglycan gel. PMID:24964949

  16. Pre-tibial myxedema: treatment with intralesional corticosteroid*

    PubMed Central

    Ramos, Luana Oliveira; Mattos, Paloma Corrêa; de Figueredo, Giuseppe Lemos Pertoti; Maia, Alef Alioscha Andrade; Romero, Sandra Adolfina Reys

    2015-01-01

    The pretibial myxedema is a manifestation of Graves' disease characterized by accumulation of glycosaminoglycans in the reticular dermis. The dermopathy is self-limiting but in some cases may cause cosmetic and functional damage. Conventional treatment is use of topical steroids under occlusive dressing, however the intralesional application has shown good results. We present a case of pretibial myxedema treated with single injection of intralesional corticosteroid. PMID:26312698

  17. Pre-tibial myxedema: treatment with intralesional corticosteroid.

    PubMed

    Ramos, Luana Oliveira; Mattos, Paloma Corrêa; Figueredo, Giuseppe Lemos Pertoti de; Maia, Alef Alioscha Andrade; Romero, Sandra Adolfina Reys

    2015-01-01

    The pretibial myxedema is a manifestation of Graves' disease characterized by accumulation of glycosaminoglycans in the reticular dermis. The dermopathy is self-limiting but in some cases may cause cosmetic and functional damage. Conventional treatment is use of topical steroids under occlusive dressing, however the intralesional application has shown good results. We present a case of pretibial myxedema treated with single injection of intralesional corticosteroid. PMID:26312698

  18. The Clinical Effectiveness of Intralesional Injection of 2% Zinc Sulfate Solution in the Treatment of Common Warts

    PubMed Central

    Mohamed, Essam-elden Mohamed; Tawfik, Khaled Mohamed; Mahmoud, Asmaa Moneir

    2016-01-01

    Objective. To investigate the clinical efficacy and safety of intralesional injection of 2% zinc sulfate solution in the treatment of common warts. Patients and Methods. One hundred and twenty patients (78 females and 42 males) aged 5–55 years with 225 common warts participated in this prospective monocentric randomized study. All lesions were treated with intralesional injection of 2% zinc sulfate. Results. From 225 warts injected, 135 warts (60%) cured from the first session, 51 warts (22.67%) cured from the second session, and 12 warts (5.33%) cured from the third session. There is no significant relation between improvement and patient's ages, duration, or number of warts (P > 0.05). All patients complained from pain during injection, and all treated lesions showed redness, tenderness, and swelling in the first 3 days after injection. Late complications were postinflammatory hyperpigmentation in 90 patients (75%), scaring in 9 patients (7.5%), and ulceration in 3 patients (2.5%). Recurrence occurred in 3 lesions (1.33%). Conclusion. The clinical data indicate that intralesional injection of 2% zinc sulfate is an effective maneuver in the treatment of common warts; however, its associated complications limit its use. PMID:27123361

  19. Comparison between intralesional injection of zinc sulfate 2 % solution and intralesional meglumine antimoniate in the treatment of acute old world dry type cutaneous leishmaniasis: a randomized double-blind clinical trial.

    PubMed

    Farajzadeh, Saeedeh; Hakimi Parizi, Maryam; Haghdoost, Ali Akbar; Mohebbi, Azadeh; Mohammadi, Saman; Pardakhty, Abbas; Eybpoosh, Sana; Heshmatkhah, Amireh; Vares, Behrooz; Saryazdi, Simin; Fekri, Ali Reza; Mohebbi, Elham

    2016-09-01

    Zinc sulfate (ZS) has been used for the treatment of acute cutaneous leishmaniasis (CL) in both forms of in vivo and in vitro recently. The aim of the present study was to compare the efficacy of intralesional injection of ZS 2 % solution with intralesional glucantime in the treatment of acute CL. In this double-blind randomized clinical trial, 80 cases with acute old world dry type CL were enrolled in the study. The treatment protocol in the first group consisted of intralesional injection of ZS 2 % vials once a week for 10 weeks or sooner in case of complete resolution of the lesions. In the second group, intralesional glucantime once a week for 10 weeks or sooner in case of complete resolution of the lesions were used. In both groups cryotherapy was performed once every other week for 10 weeks. In ZS versus second group, partial and complete clinical response was observed with fewer injections although this difference was not statistically significant. In addition, we found that the trend of treatment in second group was faster but again it was not significant [partial treatment: hazard ratio (HR) 1.4, 95 % CI 0.7-2.9; complete treatment: HR 1.3, 95 % CI 0.6-2.8]. The results of this study showed that the intralesional injection of ZS 2 % solution was as effective as glucantime on the healing of the acute old world dry type CL. PMID:27605813

  20. Tadalafil once daily and intralesional verapamil injection: A new therapeutic direction in Peyronie's disease

    PubMed Central

    Dell’Atti, Lucio

    2015-01-01

    Introduction: The aim of this study was to evaluate the combination of intralesional verapamil injection (IVI) therapy with and tadalafil in men affected by Peyronie's disease (PD). Materials and Methods: In this study, 59 patients diagnosed with PD, were divided into three groups. Group A (GA) counted 23 patients treated with IVI; Group B (GB) treated 19 patients with tadalafil 5 mg once a day, and Group C (GC) treated 17 patients with IVI and tadalafil for 3 months. There were assessed at baseline and follow-up: Erectile function, presence and severity of painful erections, penile plaque size and penile curvature degree. Results: After 3 months pain resolved completely in 57% cases of GA, 61% of GB and 76% of GC; the final mean curvature degree further decreased in all groups without statistically significant differences; mean plaque size remained stable in GA: 1.57 versus 1.59 at baseline (P = 0.364) and GB: 1.51 versus 1.52 at baseline (P = 0,265), while a further decrease was evident in GC: 1.46 versus 1.58 at baseline (P = 0.03). Mean International Index of Erectile Function-5 score further improved significantly in the group treated with verapamil plus tadalafil: 23.1 versus 14.4 of GA and 18.2 of GB (P ≤ 0.01). Conclusions: The association of IVI and tadalafil showed better pain control while reducing penile curvature and erectile function, improving the quality of life. PMID:26229323

  1. Paraplegia following lumbosacral steroid epidural injections.

    PubMed

    AbdeleRahman, Kader Tawfiq; Rakocevic, Goran

    2014-09-01

    Spinal cord ischemia is a rare but possible neurological complication following routine conservative treatment of lumbosacral radiculopathy. A case of a 46 year old woman with chronic L5 radiculopathy, who developed spinal cord ischemia following epidural steroid injection, is reported. Two months after the epidural injection, she required crutches for walking and had neurogenic bladder and bowel. PMID:25200706

  2. Neurological complications associated with epidural steroid injections.

    PubMed

    Manchikanti, Laxmaiah; Hirsch, Joshua A

    2015-05-01

    Multiple case reports of neurological complications resulting from intraarterial injection of corticosteroids have led the Food and Drug Administration (FDA) to issue a warning, requiring label changes, warning of serious neurological events, some resulting in death. The FDA has identified 131 cases of neurological adverse events, including 41 cases of arachnoiditis. A review of the literature reveals an overwhelming proportion of the complications are related to transforaminal epidural injections, of which cervical transforaminal epidural injections constituted the majority of neurological complications. Utilization data of epidural injections in the Medicare population revealed that cervical transforaminal epidural injections constitute only 2.4 % of total epidural injections and <5 % of all transforaminal epidural injections. Multiple theories have been proposed as the cause of neurological injury including particulate steroid, arterial intimal flaps, arterial dissection, dislodgement of plaque causing embolism, arterial muscle spasm, and embolism of a fresh thrombus following disruption of the intima. PMID:25795154

  3. Efficacy of Optical Internal Urethrotomy and Intralesional Injection of Vatsala-Santosh PGI Tri-Inject (Triamcinolone, Mitomycin C, and Hyaluronidase) in the Treatment of Anterior Urethral Stricture

    PubMed Central

    Singh, Shrawan Kumar; Mandal, Arup Kumar

    2014-01-01

    Purpose. To study the efficacy of optical internal urethrotomy with intralesional injection of Vatsala-Santosh PGI tri-inject (triamcinolone, mitomycin C, and hyaluronidase) in the treatment of anterior urethral stricture. Material and Methods. A total of 103 patients with symptomatic anterior urethral stricture were evaluated on the basis of clinical history, physical examination, uroflowmetry, and retrograde urethrogram preoperatively. All patients were treated with optical internal urethrotomy followed by injection of tri-inject at the urethrotomy site. Tri-inject was prepared by diluting the combination of triamcinolone 40 mg, mitomycin C 2 mg, and hyaluronidase 3000 in 5–10 mL of saline according to length of stricture. An indwelling 18 Fr silicone catheter was left in place for a period of 7–21 days. All patients were followed up for 6–18 months postoperatively on the basis of history, uroflowmetry, and, if required, retrograde urethrogram and micturating urethrogram every 3 months. Results. The overall recurrence rate after first OIU is 19.4% (20 out of 103 patients), that is, a success rate of 80.6%. Overall recurrence rate after second procedure was 5.8% (6 out of 103 patients), that is, a success rate of 94.2%. Conclusion. Optical internal urethrotomy with intralesional injection of Vatsala-Santosh PGI tri-inject (triamcinolone, mitomycin C, and hyaluronidase) is a safe and effective minimally invasive therapeutic modality for short segment anterior urethral strictures. PMID:25349604

  4. Epidural hematoma after routine epidural steroid injection

    PubMed Central

    Alkhudari, Azzam M.; Malk, Craig S.; Rahman, Abed; Penmetcha, Taruna; Torres, Maria

    2016-01-01

    Background: There are few reported cases of an epidural spinal hematoma following interventional pain procedures. Case Description: We report a case of a spinal epidural hematoma in a patient with no known risk factors (e.g. coagulopathy), who underwent an epidural steroid injection (ESI) in the same anatomic location as two previously successful ESI procedures. Conclusion: Early detection was the key to our case, and avoiding sedation allowed the patient to recognize the onset of a new neurological deficit, and lead to prompt diagnosis as well as surgical decompression of the resultant hematoma. PMID:27213109

  5. Cervical Meningomyelitis After Lumbar Epidural Steroid Injection.

    PubMed

    Lee, Yujin; Kim, Joon-Sung; Kim, Ji Yeon

    2015-06-01

    Epidural steroid injections (ESI) are a common treatment for back pain management. ESI-related complications have increased with the growing number of procedures. We report a case of cervical meningomyelitis followed by multiple lumbar ESI. A 60-year-old male with diabetes mellitus presented to our hospital with severe neck pain. He had a history of multiple lumbar injections from a local pain clinic. After admission, high fever and elevated inflammatory values were detected. L-spine magnetic resonance imaging (MRI) revealed hematoma in the S1 epidural space. Antibiotic treatment began under the diagnosis of a lumbar epidural abscess. Despite the treatment, he started to complain of weakness in both lower extremities. Three days later, the weakness progressed to both upper extremities. C-spine MRI revealed cervical leptomeningeal enhancement in the medulla oblongata and cervical spinal cord. Removal of the epidural abscess was performed, but there was no neurological improvement. PMID:26161360

  6. Exserohilum Infections Associated with Contaminated Steroid Injections

    PubMed Central

    Ritter, Jana M.; Muehlenbachs, Atis; Blau, Dianna M.; Paddock, Christopher D.; Shieh, Wun-Ju; Drew, Clifton P.; Batten, Brigid C.; Bartlett, Jeanine H.; Metcalfe, Maureen G.; Pham, Cau D.; Lockhart, Shawn R.; Patel, Mitesh; Liu, Lindy; Jones, Tara L.; Greer, Patricia W.; Montague, Jeltley L.; White, Elizabeth; Rollin, Dominique C.; Seales, Cynthia; Stewart, Donna; Deming, Mark V.; Brandt, Mary E.; Zaki, Sherif R.

    2014-01-01

    September 2012 marked the beginning of the largest reported outbreak of infections associated with epidural and intra-articular injections. Contamination of methylprednisolone acetate with the black mold, Exserohilum rostratum, was the primary cause of the outbreak, with >13,000 persons exposed to the potentially contaminated drug, 741 confirmed drug-related infections, and 55 deaths. Fatal meningitis and localized epidural, paraspinal, and peripheral joint infections occurred. Tissues from 40 laboratory-confirmed cases representing these various clinical entities were evaluated by histopathological analysis, special stains, and IHC to characterize the pathological features and investigate the pathogenesis of infection, and to evaluate methods for detection of Exserohilum in formalin-fixed, paraffin-embedded (FFPE) tissues. Fatal cases had necrosuppurative to granulomatous meningitis and vasculitis, with thrombi and abundant angioinvasive fungi, with extensive involvement of the basilar arterial circulation of the brain. IHC was a highly sensitive method for detection of fungus in FFPE tissues, demonstrating both hyphal forms and granular fungal antigens, and PCR identified Exserohilum in FFPE and fresh tissues. Our findings suggest a pathogenesis for meningitis involving fungal penetration into the cerebrospinal fluid at the injection site, with transport through cerebrospinal fluid to the basal cisterns and subsequent invasion of the basilar arteries. Further studies are needed to characterize Exserohilum and investigate the potential effects of underlying host factors and steroid administration on the pathogenesis of infection. PMID:23809916

  7. Intralesional Injection of Mitomycin C at Transurethral Incision of Bladder Neck Contracture May Offer Limited Benefit: TURNS Study Group

    PubMed Central

    Redshaw, Jeffrey D.; Broghammer, Joshua A.; Smith, Thomas G.; Voelzke, Bryan B.; Erickson, Bradley A.; McClung, Christopher D.; Elliott, Sean P.; Alsikafi, Nejd F.; Presson, Angela P.; Aberger, Michael E.; Craig, James R.; Brant, William O.; Myers, Jeremy B.

    2015-01-01

    Purpose Injection of mitomycin C may increase the success of transurethral incision of the bladder neck for the treatment of bladder neck contracture. We evaluated the efficacy of mitomycin C injection across multiple institutions. Materials and Methods Data on all patients who underwent transurethral incision of the bladder neck with mitomycin C from 2009 to 2014 were retrospectively reviewed from 6 centers in the TURNS. Patients with at least 3 months of cystoscopic followup were included in the analysis. Results A total of 66 patients underwent transurethral incision of the bladder neck with mitomycin C and 55 meeting the study inclusion criteria were analyzed. Mean ± SD patient age was 64 ± 7.6 years. Dilation or prior transurethral incision of the bladder neck failed in 80% (44 of 55) of patients. Overall 58% (32 of 55) of patients achieved resolution of bladder neck contracture after 1 transurethral incision of the bladder neck with mitomycin C at a median followup of 9.2 months (IQR 11.7). There were 23 patients who had recurrence at a median of 3.7 months (IQR 4.2), 15 who underwent repeat transurethral incision of the bladder neck with mitomycin C and 9 of 15 (60%) who were free of another recurrence at a median of 8.6 months (IQR 8.8), for an overall success rate of 75% (41 of 55). Incision with electrocautery (Collins knife) was predictive of success compared with cold knife incision (63% vs 50%, p=0.03). Four patients experienced serious adverse events related to mitomycin C and 3 needed or are planning cystectomy. Conclusions The efficacy of intralesional injection of mitomycin C at transurethral incision of the bladder neck was lower than previously reported and was associated with a 7% rate of serious adverse events. PMID:25200807

  8. Key safety considerations when administering epidural steroid injections.

    PubMed

    Manchikanti, Laxmaiah; Benyamin, Ramsin M

    2015-01-01

    Neurological and other complications of epidural steroid injections have been widely discussed in recent years. Consequently, the US FDA issued a warning about serious neurological events, some resulting in death, and consequently is requiring label changes. Neurological adverse events numbering 131, including 41 cases of arachnoiditis, have been identified by the FDA, and 700 cases of fungal meningitis following injection of contaminated steroids. A review of the literature reveals an overwhelming proportion of the complications are related to transforaminal epidural injections, with the majority of them to cervical transforaminal epidural injections. This perspective describes the prevalence of administering epidural injections, complications, pathoanatomy, mechanism of injury and various preventive strategies. PMID:26059467

  9. Central Retinal and Posterior Ciliary Artery Occlusion After Intralesional Injection of Sclerosant to Glabellar Subcutaneous Hemangioma

    SciTech Connect

    Matsuo, Toshihiko; Fujiwara, Hiroyasu; Gobara, Hideo; Mimura, Hidefumi; Kanazawa, Susumu

    2009-03-15

    The aim of this study is to describe vision loss caused by central retinal artery and posterior ciliary artery occlusion as a consequence of sclerotherapy with a polidocanol injection to a glabellar hemangioma. An 18-year-old man underwent direct injection with a 23-gauge needle of 1 mL of a polidocanol-carbon dioxide emulsion into the glabellar subcutaneous hemangioma under ultrasound visualization of the needle tip by radiologists. He developed lid swelling the next day, and 3 days later at referral, the visual acuity in the left eye was no light perception. Funduscopy revealed central retinal artery occlusion and fluorescein angiography disclosed no perfusion at all in the left fundus, indicating concurrent posterior ciliary artery occlusion. The patient also showed mydriasis, blepharoptosis, and total external ophthalmoplegia on the left side. Magnetic resonance imaging demonstrated the swollen medial rectus muscle. In a month, blepharoptosis and ophthalmoplegia resolved but the visual acuity remained no light perception. Sclerosing therapy for facial hemangioma may develop a severe complication such as permanent visual loss.

  10. Geographic Variation in Epidural Steroid Injection Use in Medicare Patients

    PubMed Central

    Friedly, Janna; Chan, Leighton; Deyo, Richard

    2008-01-01

    Background: The rates of epidural steroid injections have increased dramatically over time, with conflicting evidence regarding the efficacy of epidural steroid injections for the treatment of various low-back pain disorders. Given the uncertainty about their role, we sought to evaluate the geographic variation in the use of epidural steroid injections for low back pain within the United States. We also sought to determine whether greater rates of epidural steroid injections are associated with lower rates of lumbar surgery. Methods: We used the 2001 Medicare Physician Part-B claims to examine the geographic variation in the use of epidural steroid injections. Current Procedural Technology codes were used to identify the number of procedures performed as well as the percentage of injections that were fluoroscopically guided. Procedure rates were analyzed with use of several geographic indicators, including state, United States Census Bureau regions (Northeast, South, Midwest, and West), and health referral regions as defined by the Dartmouth Atlas of Health Care. Results: In 2001, there was a 7.7-fold difference between the state with the lowest rate (Hawaii at 5.2 per 1000) and the state with the highest rate (Alabama at 39.9 per 1000). The variation among health referral regions, which are smaller in size, was even greater, with an 18.4-fold difference from 5.6 per 1000 in Honolulu, Hawaii, to 103.6 per 1000 in Palm Springs, California. Higher statewide rates of epidural steroid injections were associated with significantly higher rates of lumbar surgery (p = 0.001). In areas with high injection rates, a significantly higher percentage of patients who sought care for low back pain received injections (p < 0.001). In addition, in areas with high injection rates, a significantly higher percentage of patients who presented with low back pain received both injections and lumbar surgery within the same year (p < 0.001). Conclusions: There is substantial geographic

  11. Incidence of intravascular penetration in transforaminal cervical epidural steroid injections.

    PubMed

    Furman, Michael B; Giovanniello, Michael T; O'Brien, Erin M

    2003-01-01

    STUDY DESIGN A prospective, observational, human, study was conducted. OBJECTIVES To evaluate the incidence of vascular penetration during fluoroscopically guided, contrast-enhanced transforaminal cervical epidural steroid injections, and to determine whether the observation of blood in the needle hub can be used to predict a vascular injection. SUMMARY OF BACKGROUND DATA Incorrectly placed intravascular cervical spinal injections result in medication flow systemically and not to the desired target. A recently published study demonstrates a high incidence of intravascular injections in transforaminal lumbosacral epidural injections. No studies so far have evaluated the incidence of vascular injections in transforaminal cervical epidural steroid injections, nor have they calculated the ability of observed blood in the needle hub to predict a vascular injection in the cervical spine.METHODS The incidence of fluoroscopically confirmed intravascular uptake of contrast was prospectively observed in 337 patients treated with cervical transforaminal epidural steroid injections. The ability of observed blood in the needle hub to predict intravascular injection was also investigated. For each subject, the injection level was chosen on the basis of the clinical scenario including history, physical examination, and review of imaging studies. Some patients had multilevel injections. Using fluoroscopic guidance, the authors placed a 25-gauge needle into the epidural space using a transforaminal approach according to accepted standard technique. Needle tip location was confirmed with biplanar imaging. The presence or absence of blood in the needle hub spontaneously ("flash") and after attempted aspiration by pulling back on the syringe's plunger was documented. Contrast then was injected under real-time fluoroscopy to determine whether the location of the needle tip was intravascular. The results were recorded in a prospective manner indicating the presence or absence of blood

  12. Refractory strictures despite steroid injection after esophageal endoscopic resection

    PubMed Central

    Hanaoka, Noboru; Ishihara, Ryu; Uedo, Noriya; Takeuchi, Yoji; Higashino, Koji; Akasaka, Tomofumi; Kanesaka, Takashi; Matsuura, Noriko; Yamasaki, Yasushi; Hamada, Kenta; Iishi, Hiroyasu

    2016-01-01

    Background: Although steroid injection prevents stricture after esophageal endoscopic submucosal dissection (ESD), some patients require repeated sessions of endoscopic balloon dilation (EBD). We investigated the risk for refractory stricture despite the administration of steroid injections to prevent stricture in patients undergoing esophageal ESD. Refractory stricture was defined as the requirement for more than three sessions of EBD to resolve the stricture. In addition, the safety of steroid injections was assessed based on the rate of complications. Patients and methods: We analyzed data from 127 consecutive patients who underwent esophageal ESD and had mucosal defects with a circumferential extent greater than three-quarters of the esophagus. To prevent stricture, steroid injection was performed. EBD was performed whenever a patient had symptoms of dysphagia. Results: The percentage of patients with a tumor circumferential extent greater than 75 % was significantly higher in those with refractory stricture than in those without stricture (P = 0.001). Multivariate analysis adjusted for age, sex, history of radiation therapy, tumor location, and tumor diameter showed that a tumor circumferential extent greater than 75 % was an independent risk factor for refractory stricture (adjusted odds ratio [OR] 5.49 [95 %CI 1.91 – 15.84], P = 0.002). Major adverse events occurred in 3 patients (2.4 %): perforation during EBD in 2 patients and delayed perforation after EBD in 1 patient. The patient with delayed perforation underwent esophagectomy because of mediastinitis. Conclusions: A tumor circumferential extent greater than 75 % is an independent risk factor for refractory stricture despite steroid injections. The development of more extensive interventions is warranted to prevent refractory stricture. PMID:27004256

  13. Fungal Infections Associated with Contaminated Steroid Injections.

    PubMed

    Kauffman, Carol A; Malani, Anurag N

    2016-04-01

    In mid-September 2012, the largest healthcare-associated outbreak in U.S. history began. Before it was over, 751 patients were reported with fungal meningitis, stroke, spinal or paraspinal infection, or peripheral osteoarticular infection, and 64 (8.5%) died. Most patients had undergone epidural injection, and a few osteoarticular injection, of methylprednisolone acetate that had been manufactured at the New England Compounding Center (NECC). The offending pathogen in most cases was Exserohilum rostratum, a brown-black soil organism that previously was a rare cause of human infection. Three lots of methylprednisolone were contaminated with mold at NECC; the mold from unopened bottles of methylprednisolone was identical by whole-genome sequencing to the mold that was isolated from ill patients. Early cases manifested as meningitis, some patients suffered posterior circulation strokes, and later cases were more likely to present with localized infection at the injection site, including epidural abscess or phlegmon, vertebral diskitis or osteomyelitis, and arachnoiditis with intradural involvement of nerve roots. Many patients with spinal or paraspinal infection required surgical intervention. Recommendations for treatment evolved over the first few weeks of the outbreak. Initially, combination therapy with liposomal amphotericin B and voriconazole was recommended for all patients; later, combination therapy was recommended only for those who were most ill, and voriconazole monotherapy was recommended for most patients. Among those patients who continued antifungal therapy for at least 6 months, outcomes for most appeared to be successful, although a few patients remain on therapy. PMID:27227303

  14. Transplantation of Mesenchymal Stem Cells for Acute Spinal Cord Injury in Rats: Comparative Study between Intralesional Injection and Scaffold Based Transplantation.

    PubMed

    Kim, Yoon Chung; Kim, Young Hoon; Kim, Jang Woon; Ha, Kee Yong

    2016-09-01

    Experimental stem cell therapy for spinal cord injury (SCI) has been extensively investigated. The selection of effective cell transplantation route is also an important issue. Although various types of scaffold have been widely tried as a carrier of stem cells to the injured spinal cord, there was little comparative study to investigate the efficacy of transplantation comparing with conventional transplantation route. A total of 48 Sprague-Dawley rats were subjected to standardized SCI, followed by transplantation of allogeneic mesenchymal stem cells (MSCs), either via intralesional injection (IL group), or via the poly (lactic-co-glycolic acid) (PLGA) scaffold (IP group) or chitosan scaffold (IC group). Engraftment and differentiation of the transplanted cells, expression of neurotrophic factors in the injured spinal cord, and functional recovery were compared with those of the control group. The mean numbers of engrafted MSCs in the IL, IP, and IC groups were 20.6 ± 0.7, 25.6 ± 1.7 and 26.7 ± 1.8 cells/high power filed (HPF), respectively. Results showed higher success rate of MSCs engraftment in the scaffold groups compared to the IL group. Expression of neuroprotective growth factors in the SCI lesions showed no significant differences between the IL, IP, and IC groups. The mean Basso, Beattie and Bresnahan locomotor scales at 6 weeks post-transplantation in the IL, IP, IC, and control groups were 7.9 ± 1.1, 7.9 ± 2.1, 8.7 ± 2.1, and 2.9 ± 1.0, respectively. The functional improvement was most excellent in the IC group. The scaffold based MSC transplantation for acute SCI presented the better cell engraftment and neuroprotective effect compared to the intralesional injection transplantation. PMID:27510379

  15. Effectiveness of steroid injections for bamboo nodules: A case report.

    PubMed

    Imaizumi, Mitsuyoshi; Tada, Yasuhiro; Okano, Wataru; Tani, Akiko; Omori, Koichi

    2016-01-01

    Vocal nodules are generally caused by vocal abuse, and conservative treatments such as voice therapy have been advocated as a first-choice treatment for vocal nodules. Reports of vocal fold lesions related to autoimmune diseases, such as bamboo nodules, are rare in the literature. Here we report a very rare case of bamboo nodules in a 30-year-old woman treated by steroid injection into the vocal folds by videoendoscopic laryngeal surgery in an outpatient setting. She was successfully treated without further recurrence. This report indicates that a steroid injection into bamboo nodules might be a useful treatment option, especially in patients who have not shown any improvement after conservative treatments. PMID:27140024

  16. Possible mechanisms of action of the compounds injected intralesionally in the treatment of cutaneous leishmaniasis, in addition to their direct effects on the parasites.

    PubMed

    Najim, R A; Sharquie, K E; Al-Zubaidy, S A A

    2006-01-01

    By injecting uninfected rabbits intradermally with one of the test compounds or the isotonic saline (0.9% NaCl) used as a control, the possible mechanisms of the indirect action of some drugs used intralesionally in the treatment of human cutaneous leishmaniasis [sodium stibogluconate, 2% zinc sulphate, and hypertonic (7% NaCL) saline] were explored. The 24 injected rabbits (six for the control and six for each test compound) were followed up for 30 days, both macroscopically, with checks for erythema and increases in skin thickness, and microscopically, with the histopathological examination of sections of biopsies from the injection sites. Although the microscopy revealed inflammatory-cell infiltration, beginning with eosinophils, followed by lymphocytes and finally by the proliferation of fibroblasts, at all of the injection sites, these changes were most intense with the sodium stibogluconate and 2% zinc sulphate, less marked with the hypertonic saline, and minimal and relatively short-lived with the isotonic saline. Presumably as a result of their metal content, sodium stibogluconate and zinc sulphate each probably induce tissue damage and, subsequently, severe inflammatory changes. The antileishmanial activity of hypertonic saline, however, may be entirely attributable to its osmotic effects. PMID:16417711

  17. Caudal epidural steroid injection: a randomized controlled trial

    PubMed Central

    Murakibhavi, V. G.; Khemka, Aditya G.

    2011-01-01

    Study design: Prospective study. Study rationale: A recurrent phenomenon, the lifetime prevalence of low back pain has been reported as 54%–80%, while annual prevalence ranges from 15%–45%.1 It is also associated with enormous economic, societal, and health impact.2 India, being a developing country, has its problem compounded by the occupational compulsions in parts of the rural areas.3 For some interventional therapies, like epidural steroid injections, utilization rates have increased dramatically.4,5,6,7,8,9 They have become one of the most commonly performed interventions in the United States for low back pain with radiculopathy.10 Clinical question: Multiple systematic reviews,11 a meta-analysis,12 several guidelines,13 health technology assessments by insurers, and local medical review policies and coverage decisions have been published. However, controversy continues regarding the effectiveness of epidural steroid injections. In addition three types of epidurals, namely interlaminar, transforaminal, and caudal, with variable results complicate the picture for practice of interventional pain management. The underlying mechanism of action of epidurally administered steroid and local anesthetic injections is still not well understood and compounds the problem.14 Objective: To evaluate and update the effects of caudal epidural injection in the management of chronic low back pain and sciatica. Final Class of evidence-treatment Yes Study design:  RCT •  Cohort  Case control  Case series Methods  Concealed allocation (RCT) •  Intention to treat (RCT) •  Blinded/independent evaluation of primary outcome •  F/U ≥ 85% •  Adequate sample size • Control for confounding Overall class of evidence II The definiton of the different classes of evidence is available here. PMID:23230402

  18. Efficacy of holmium laser urethrotomy and intralesional injection of Santosh PGI tetra-inject (Triamcinolone, Mitomycin C, Hyaluronidase and N-acetyl cysteine) on the outcome of urethral strictures

    PubMed Central

    Kishore, Lalit; Sharma, Aditya Prakash; Garg, Nitin; Singh, Shrawan Kumar

    2015-01-01

    Introduction To study the efficacy of holmium laser urethrotomy with intralesional injection of Santosh PGI tetra-inject (Triamcinolone, Mitomycin C, Hyaluronidase and N-acetyl cysteine) in the treatment of urethral strictures. Material and methods A total of 50 patients with symptomatic urethral stricture were evaluated by clinical history, physical examination, uroflowmetry and retrograde urethrogram preoperatively. All patients were treated with holmium laser urethrotomy, followed by injection of tetra-inject at the urethrotomy site. Tetra-inject was prepared by diluting acombination of 40 mg Triamcinolone, 2 mg Mitomycin, 3000 UHyaluronidase and 600 mg N-acetyl cysteine in 5–10 ml of saline, according to the stricture length. An indwelling 18 Fr silicone catheter was left in place for 7–10 days.All patients were followed-up for 6-18 months postoperatively by history, uroflowmetry, and if required, retrograde urethrogram and micturating urethrogram every 3 months. Results 41 (82%) patients had asuccessful outcome,whereas 9 (18%) had recurrences during a follow-up ranging from 6–18 months. In <1 cm length strictures, the success rate was 100%, while in 1–3 cm and >3 cm lengthsthe success rates were 81.2% and 66.7% respectively. This modality, thus, has an encouraging success rate, especially in those with short segment urethral strictures (<3 cm). Conclusions Holmium laser urethrotomy with intralesional injection ofSantosh PGI tetra-inject (Triamcinolone, Mitomycin C, Hyaluronidase, N-acetyl cysteine) is a safe and effective minimally-invasive therapeutic modality for short segment urethral strictures. PMID:26855803

  19. Intralesional Cidofovir application in recurrent laryngeal papillomatosis.

    PubMed

    Pudszuhn, Annett; Welzel, Cornelia; Bloching, Marc; Neumann, Kerstin

    2007-01-01

    Recurrent laryngeal papillomatosis is a benign disease of the larynx often leading to organic and functional restrictions. The therapeutic treatment of choice in larynx-obstructing papillomatosis is at present surgical laser ablation. The effectiveness of adjuvant intralesional injection of the virustaticum Cidofovir has been investigated recently in a variety of therapeutic models. The present case study deals with the treatment of recurrent laryngeal papillomatosis by means of surgical laser ablation of the laryngeal papillomas with adjuvant local injection of the virustaticum Cidofovir (dose of 5 mg/1 ml). Within the period from October 2001 to August 2004, ten patients aged between 5- and 70 years were treated with intralesional injections of Cidofovir. Papillomatosis was confirmed histologically in all cases, and the virus types were defined in part. Each of the patients underwent clinical-phoniatric examinations and was photographed for documentation. After 2-7 treatments with surgical laser papilloma ablation and intralesional Cidofovir injections, all patients showed a definite papilloma reduction, while in six cases complete remission was achieved. During the follow-up period of 8-30 months, not a single recurrence of the laryngeal papillomatosis occurred. In the majority of patients, a clear improvement in the voice was achieved. There were no local or systemic side effects caused by the virustaticum. Intralesional injection of Cidofovir is an adjuvant, but not a curative therapeutic option in recurrent laryngeal papillomatosis. Remission of previously frequently recurrent laryngeal papillomas can be achieved, but recurrence after longer treatment-free intervals is also possible. PMID:17058091

  20. Steroids

    MedlinePlus

    ... Got Homework? Here's Help White House Lunch Recipes Steroids KidsHealth > For Kids > Steroids Print A A A ... a good idea to avoid them. What Are Steroids? "Steroids" has more than one meaning. Your body ...

  1. Steroid injections in the upper extremity: experienced clinical opinion versus evidence-based practices.

    PubMed

    Kegel, Gary; Marshall, Astrid; Barron, O Alton; Catalano, Louis W; Glickel, Steven Z; Kuhn, Margaret

    2013-09-01

    A survey regarding upper-extremity steroid injection practices was distributed to all active members of the American Society for Surgery of the Hand (ASSH) and American Shoulder and Elbow Surgeons (ASES) using SurveyMonkey. Response rates for the ASSH and ASES were 26% and 24%, respectively. The potency-adjusted dose of steroid injected for common hand and wrist injections ranged from 0.375 to 133.33 mg and for shoulder injections ranged from 0.375 to 250 mg. These ranges span 356-fold and 667-fold differences, respectively. Potency-adjusted doses differed significantly between steroid types for all injections evaluated in this study. American Society for Surgery of the Hand members gave significantly smaller doses of steroid for the glenohumeral and acromioclavicular joints than ASES members. Only 9% of respondents based injection practice on a scientific reference. Sixteen percent of ASSH and 31% of ASES respondents reported no specific rationale for their steroid injection practice; 78% of ASSH and 52% of ASES respondents attributed their rationale to some kind of instruction from their mentors or colleagues. Upper-extremity surgeons demonstrate substantial variability in their practice of steroid injections, with up to a 667-fold range in steroid dose. Experienced clinical opinion is the principal rationale for these injection practices; little rationale is based on formal scientific evidence. PMID:24025004

  2. Safe relief of rest pain that eases with activity in achillodynia by intrabursal or peritendinous steroid injection: the rupture rate was not increased by these steroid injections.

    PubMed

    Read, M T

    1999-04-01

    A history of morning and rest pain that eases with activity was found to improve after anti-inflammatory injections around the paratenon or within the Achilles bursae. The reduction in pain morbidity was significant, and the peritendinous steroid injections did not increase the rupture rate. PMID:10205700

  3. Hypothalamic-Pituitary-Adrenal Suppression and Iatrogenic Cushing's Syndrome as a Complication of Epidural Steroid Injections

    PubMed Central

    2013-01-01

    Epidural steroid injections are well accepted as a treatment for radicular back pain in appropriate candidates. While overall incidence of systemic side effects has not been well established, at least five biochemically proven cases of iatrogenic Cushing's Syndrome have been reported as complications of epidural steroid treatment. We present an additional case of iatrogenic Cushing's Syndrome and adrenal suppression in a middle-aged woman who received three epidural steroid injections over a four-month period. We review this case in the context of previous cases and discuss diagnostic and management issues. PMID:23991341

  4. Steroid Injection Versus Physiotherapy for Patients With Adhesive Capsulitis of the Shoulder

    PubMed Central

    Sun, Yaying; Lu, Shuai; Zhang, Peng; Wang, Zhaohui; Chen, Jiwu

    2016-01-01

    Abstract To compare the effect of steroid injection and physiotherapy for patients with adhesive capsulitis of the shoulder (ACS). An electronic search was performed on Pubmed, Embase, and Cochrane library, and reference lists were also reviewed for randomized controlled trials (RCTs) comparing steroid injection and physiotherapy for patients with ACS. The quality of included studies were assessed using PEDro scale. Standardized mean differences (SMDs) and 95% confidence interval (CI) were used for comparisons. The primary outcome was functional improvement. Nine RCTs including 453 patients were identified. From 6–7 weeks to 24–26 weeks postintervention, no superiority was noted in favor of either steroid injection or physiotherapy for functional improvement (SMD 0.28; 95% CI −0.01–0.58; P = 0.06) or pain relief (SMD −0.10; 95% CI −0.70–0.50; P = 0.75). Steroid injection provided more improvement in passive external rotation at 24 to 26 weeks (3 studies, SMD 0.42; 95% CI 0.11–0.72; P = 0.007) but not at 6 to 7 weeks (4 studies, SMD 0.63; 95% CI 0.36–0.89; P = 0.32) or 12 to 16 weeks (3 studies, SMD −0.07; 95% CI −0.79–0.65; P = 0.85). Steroid injection was as safe as physiotherapy for patients with ACS (risk ratio 0.94; 95% CI 0.67–1.31). Both steroid injection and physiotherapy are equally effective for patients with ACS. One steroid injection might be the 1st choice for ACS. Results should be interpreted with caution due to the heterogeneity among the studies. PMID:27196452

  5. Symptomatic Spinal Epidural Lipomatosis After a Single Local Epidural Steroid Injection

    SciTech Connect

    Tok, Chung Hong Kaur, Shaleen; Gangi, Afshin

    2011-02-15

    Spinal epidural lipomatosis is a rare disorder that can manifest with progressive neurological deficits. It is characterized by abnormal accumulation of unencapsulated epidural fat commonly associated with the administration of exogenous steroids associated with a variety of systemic diseases, endocrinopathies, and Cushing syndrome (Fogel et al. Spine J 5:202-211, 2005). Occasionally, spinal epidural lipomatosis may occur in patients not exposed to steroids or in patients with endocrinopathies, primarily in obese individuals (Fogel et al. Spine J 5:202-211, 2005). However, spinal lumbar epidural lipomatosis resulting from local steroid injection has rarely been reported. We report the case of a 45-year-old diabetic man with claudication that was probably due to symptomatic lumbar spinal lipomatosis resulting from a single local epidural steroid injection.

  6. Treatment of postherpetic neuralgia using a thoracic transforaminal epidural steroid injection.

    PubMed

    Mehta, Priyesh; Maher, Patrick; Singh, Jaspal Ricky

    2015-04-01

    A 64-year-old male patient with a history of herpes zoster exposure presented with severe, constant, burning pain in the left T10 dermatome consistent with postherpetic neuralgia. Previous treatment included oral and topical medications as well as an intercostal nerve block; however, these treatment options did not provide significant relief. The patient was treated with a single-level T10 thoracic transforaminal epidural steroid injection for refractory postherpetic neuralgia. He reported complete resolution of his symptoms at 2- and 12-week follow-ups. This case illustrates transforaminal epidural steroid injections may be a successful treatment option for postherpetic neuralgia. PMID:25479280

  7. The Effect and Safety of Steroid Injection in Lumbar Spinal Stenosis: With or Without Local Anesthetics

    PubMed Central

    Song, Sung Hyuk; Ryu, Gi Hyeong; Park, Jin Woo; Lee, Ho Jun; Nam, Ki Yeun; Kim, Hyojun; Kim, Seung Yeon

    2016-01-01

    Objective To compare the long-term effect and safety of an epidural steroid injection in spinal stenosis patients, with or without local anesthetics. Methods Twenty-nine patients diagnosed with spinal stenosis were included and randomly divided into two groups. Translaminar epidural and selective nerve root spinal injection procedures were performed using steroids mixed with local anesthetics or normal saline. The effects of spinal injection procedures were measured with visual analogue scale (VAS) and functional rate index (FRI). These measurements were performed before injection, at 1 month after injection and at 3 months after injection. The occurrence of side effects was investigated each time. Results The VAS and FRI scores were significantly reduced in both the local anesthetics group and normal saline group at 1 and 3 months after the injection. However, there was no significant difference in VAS and FRI score reduction between the two groups each time. Side effects are not noted in both groups. Conclusion The spinal injection procedures using steroids mixed either with local anesthetics or normal saline have an effect in reducing pain and improving functional activities. However, there was no significant difference between the two groups in relation to side effects and the long-term effects of pain and function. PMID:26949664

  8. The Impact of Epidural Steroid Injections on the Outcomes of Patients Treated for Lumbar Disc Herniation

    PubMed Central

    Radcliff, Kristen; Hilibrand, Alan; Lurie, Jon D.; Tosteson, Tor D.; Delasotta, Lawrence; Rihn, Jeffrey; Zhao, Wenyan; Vaccaro, Alexander; Albert, Todd J.; Weinstein, James N.

    2012-01-01

    Background: The Spine Patient Outcomes Research Trial (SPORT) is a prospective, multicenter study of operative versus nonoperative treatment of lumbar intervertebral disc herniation. It has been suggested that epidural steroid injections may help improve patient outcomes and lower the rate of crossover to surgical treatment. Methods: One hundred and fifty-four patients included in the intervertebral disc herniation arm of the SPORT who had received an epidural steroid injection during the first three months of the study and no injection prior to the study (the ESI group) were compared with 453 patients who had not received an injection during the first three months of the study or prior to the study (the No-ESI group). Results: There was a significant difference in the preference for surgery between groups (19% in the ESI group compared with 56% in the No-ESI group, p < 0.001). There was no difference in primary or secondary outcome measures at four years between the groups. A higher percentage of patients changed from surgical to nonsurgical treatment in the ESI group (41% versus 12% in the No-ESI, p < 0.001). Conclusions: Patients with lumbar disc herniation treated with epidural steroid injection had no improvement in short or long-term outcomes compared with patients who were not treated with epidural steroid injection. There was a higher prevalence of crossover to nonsurgical treatment among surgically assigned ESI-group patients, although this was confounded by the increased baseline desire to avoid surgery among patients in the ESI group. Given these data, we concluded that more studies are necessary to establish the value of epidural steroid injection for symptomatic lumbar intervertebral disc herniation. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence. PMID:22739998

  9. Comparison of Two Methods of Epidural Steroid Injection in the Treatment of Recurrent Lumbar Disc Herniation

    PubMed Central

    Ebrahimi-Nejad, Ali; Shahsavarani, Shahram; Keikhosravi, Ehsan; Shahba, Mohsen; Ebrahimi, Farzaneh

    2014-01-01

    Study Design Prospective study. Purpose We compared the effects of two methods of epidural steroid injection in patients with recurrent disc herniation. Overview of Literature To our knowledge, there is no previous report of such a comparison in these patients. Methods The study was performed with 30 patients with relapsed lumbar disc herniation whose pain was not relieved by conservative remedies. The patients were divided into two groups, each of 15 patients, and entered the study for caudal or transforaminal injections. The degree of pain, ability to stand and walk, and the Prolo function score were evaluated in both groups before the injection and 2 months and 6 months after the injection. Results The degrees of pain reduction in the caudal injection group in the second and sixth months were 0.6 and 1.63, respectively, and in the transforaminal injection group were 1.33 and 1.56, respectively. The difference between the two methods was not statistically significant. Similarly, no other evaluated criterion showed a significant difference between the methods. Conclusions In the current study, the caudal and transforaminal steroid injection methods showed similar outcomes in the treatment of relapsed lumbar disc herniation. However, more detailed patient categorizing may help in finding possible subgroups with differences. PMID:25346818

  10. Nicolau syndrome after intramuscular injection of non-steroidal anti-inflammatory drugs (NSAID).

    PubMed

    Dadaci, Mehmet; Altuntas, Zeynep; Ince, Bilsev; Bilgen, Fatma; Tufekci, Osman; Poyraz, Necdet

    2015-01-01

    Nicolau syndrome is a rare complication of intramuscular injection that leads to local ischemic necrosis of the skin and adipose tissue. In this paper, we discuss etiologies, risk factors, and treatment options for gluteal Nicolau syndrome referring to patients treated in our hospital. Our study includes 17 women who visited our clinic with symptoms of gluteal necrosis secondary to intramuscular injection. The following variables were taken into account: injection site, drug administered, frequency of injections, the person who administered the injections, needle size, and needle tip color. Magnetic resonance images obtained in the aftermath of intramuscular injection application were carefully analyzed for presence of necrosis, cyst formation and the thickness of the gluteal fat tissue layer. Drugs that had been received in intramuscular injection were exclusively non-steroidal anti-inflammatory drugs. Mean patient BMI was 41.8 (all patients were considered as obese), and mean gluteal fat thickness was 54 mm. Standard length of needles (3.8 cm) had been used in procedures. The wounds were treated with primary closure in 11 patients and with local flap therapy in 6 patients. The observed necrosis was a consequence of misplaced gluteal injection, where drugs were injected into the adipose tissue instead of the muscle due to the extreme thickness of the fat layer, on one hand, and the inappropriate length of standard needles, on the other hand. Intramuscular injection should be avoided in obese patients whenever possible: if it is necessary, proper injection technique should be used. PMID:25725145

  11. Steroid injection for shoulder pain causes prolonged increased glucose level in type 1 diabetics

    PubMed Central

    Povlsen, Bo; Povlsen, Sebastian D

    2014-01-01

    Shoulder pain is very common in diabetic patients and often treated with steroid injections, with subsequent increases in blood glucose levels or the need for additional insulin being questioned. We report a case of significant and prolonged elevation of blood glucose levels and resultant insulin requirement in a type 1 diabetic man after a single 40 mg injection of triamcinolone for shoulder pain. Within 48 h, the shoulder pain as assessed by a visual analogue scale (0–10) was reduced to zero, but the elevated insulin requirements continued for 4 weeks after the injection. This finding suggests that steroid injections for shoulder pain in diabetics may not always be as safe as previously thought. We propose that medical practitioners advise their patients to monitor their glucose levels more carefully after such injections and that caution is exercised when considering administrating these injections to those who have poorly controlled blood glucose levels preinjection to avoid ketoacidosis. PMID:25199186

  12. [Ocular hypertension after intravitreal steroid injections: Clinical update as of 2015].

    PubMed

    Dot, C; El Chehab, H; Russo, A; Agard, E

    2015-09-01

    Intravitreal injections are a therapeutic delivery method best suited to the treatment of retinal diseases. Recent years have been marked by the use of anti-VEGF agents as well as the arrival of sustained-release corticosteroid implants in France, replacing triamcinolone acetonide. A common complication of IVT steroids is secondary ocular hypertension (OHT) resulting from increased outflow resistance. This article summarizes current understanding. OHT induced by topical steroids has been described for 60 years. Intravitreal use also shows a temporary effect if the exposure is short, dose dependence, and varying incidence depending on the drug used. Sustained release formulations and discontinuing treatment have reduced the risk of induced OHT. Risk factors that induce OHT must be clearly identified prior to an injection. Most cases of OHT can be controlled medically, although differences exist between different drugs. In cases where it cannot be controlled, removal of the implant, selective laser trabeculoplasty, and filtration surgery can be discussed. PMID:26099427

  13. Ocular Leishmaniasis Treated by Intralesional Amphotericin B

    PubMed Central

    Nikandish, Malihe; Goyonlo, Vahid Mashayekhi; Taheri, Ahmad Reza; Kiafar, Bita

    2016-01-01

    Leishmaniasis is a group of diseases with varied clinical manifestations. Ocular involvement is an unusual presentation of leishmaniasis, and the eyelid is not a common site of cutaneous lesions, likely due to the mobility of the lids. Some case reports of conjunctival involvement are either a contiguous dissemination from lid margin or in the setting of disseminated leishmaniasis in an immunocompromised host. To our knowledge, isolated involvement of the bulbar conjunctiva has not been reported. We present the first case in the literature of a patient with an erythematous fibrovascular lesion in the interpalpebral zone that was clinically diagnosed as pterygium, but recurred at the site of surgical excision. After histopathologic diagnosis, the lesion was treated with intralesional injection of amphotericin B and improved completely within a few weeks. An accurate diagnosis of leishmaniasis in the eye may be challenging in many clinical settings. To our knowledge, an isolated pterygium.like lesion has not been reported in literature. In addition, intralesional injection of amphotericin B is a novel treatment method in this setting. PMID:26957858

  14. The Effects of a Forceful Transforaminal Epidural Steroid Injection on Radicular Pain: A Preliminary Study

    PubMed Central

    Byun, Jong Min; Woo, Jae Hee; Kim, Jin

    2014-01-01

    Background Lumbar transforaminal epidural steroid injections (TFESIs) are performed to provide symptom relief in patients with radicular pain. Recent articles suggested that injected volume itself have analgesic effects and higher volumes are associated with better outcomes. To date, few studies have been conducted to investigate the effects of volume. Therefore, well-designed controlled studies were necessary to confirm the effect of volume itself on pain relief. The purpose of this study was to examine the effectiveness of a forceful saline injection on lumbar TFESI using non-particulate steroids. Methods Fifty consecutive patients with lumbar radicular pain were enrolled. The participants were allocated into one of two groups: dexamethasone with volume (Group DV) and dexamethasone alone (Group DO). The volume was delivered by a forceful injection of 5ml of normal saline. The primary end-point for this study was a VAS pain score and modified MacNab score indicating the rate of effectiveness at the four-week follow-up. Results There were no significant post-procedural VAS differences between two groups (P = .252). The effectiveness rate among the patients was 47.8% in DV group, 34.8% in DO group, measured by modified MacNab score. The difference was not statistically significant (P = .117). Conclusions A forceful saline injection did not have a significant effect during the treatment of radicular pain. Further studies with greater volumes and with additional techniques would offer a more conclusive perspective. PMID:25317282

  15. The Role of Intralesional Therapies in Melanoma.

    PubMed

    Agarwala, Sanjiv S

    2016-05-01

    The US Food and Drug Administration has been rapidly approving new checkpoint inhibitors and targeted therapies for melanoma and other tumors. Recently, it approved the first intralesional therapy, talimogene laherparepvec (T-VEC), for the treatment of metastatic melanoma lesions in the skin and lymph nodes. Several other intralesional therapies (PV-10, interleukin-12 electroporation, coxsackievirus A21 [CVA21]) are entering later-stage testing. Locally injected agents have clearly shown their ability to produce local responses that can be durable. The possibility that they also stimulate a regional and even systemic immune response is exciting, as this potential effect may have utility in combination regimens; such regimens are an area of active research. Favorable responses with minimal toxicities in monotherapy trials have led to the first melanoma studies of T-VEC in combination with the cytotoxic T-lymphocyte-associated antigen 4 inhibitor ipilimumab and, separately, with the programmed death 1-blocking antibody pembrolizumab. Studies of PV-10 with pembrolizumab and of CVA21 with pembrolizumab are also being initiated. Preliminary analyses of the results of the first combination trials, which show higher response rates than with either agent alone, offer some optimism that these locoregional therapies will find application--as treatment for patients who cannot tolerate systemic immunotherapies, to alleviate locoregional morbidity, and perhaps even to "prime" the immune system. PMID:27188674

  16. Comparison of Transforaminal and Parasagittal Epidural Steroid Injections in Patients With Radicular Low Back Pain

    PubMed Central

    Hashemi, Seyed Masoud; Aryani, Mohamad Reza; Momenzadeh, Sirus; Razavi, Seyed Sajad; Mohseni, Gholamreza; Mohajerani, Seyed Amir; Esmilijah, Ali Akbar

    2015-01-01

    Background: Epidural steroid injection (ESI), including transforaminal (TF) epidural injections and interlaminar (IL) epidural steroid injections are commonly performed procedures for the management of lumbosacral radicular pain. Parasagittal interlaminar (PIL) approach could enable higher ventral epidural spread, with fewer complications than TF. Objectives: This study aims to compare the effectiveness of PIL and TF ESI in relieving the pain and disability of patients with lumbosacral pain. Patients and Methods: This prospective study enrolled 64 patients, aged between 18 to 75 years, with a diagnosis of low back pain and unilateral lumbosacral radicular pain. The patients were randomized to receive fluoroscopically guided epidural injection, through either the PIL or TF approach. Patients were evaluated for effective pain relief [numerical rating scale (NRS) < 3] by 0 - 10 numeric rating scale (NRS) and functional improvement by the Oswestry Disability Index (ODI). Results: Effective pain relief [numeric rating scale (NRS) < 3] was observed in 77.3% (95% CI: 67‒90.5%) of patients in PIL group and 74.2% (95% CI: 62.4 - 89.4%) of patients in the TF group (P = 0.34), at 4 weeks. Mean NRS score was not significantly different between the PIL group compared to the TF group, at 4 weeks (P = 0.19). Number of patients with improved disability (measured by ODI < 20%) was not significantly different in PIL group (78% of cases) compared to the TF group (76% of cases), at 4 weeks (P = 0.21). There were no adverse effects observed in any of our patients. Conclusions: The PIL epidural injection is as effective as TF epidural injection in improving pain and functional status, in patients with chronic lumbosacral low back pain, due to disc degeneration. PMID:26587400

  17. Intra-arterial injection of sclerosants: Report of three cases treated with systemic steroids.

    PubMed

    Parsi, Kurosh; Hannaford, Patricia

    2016-05-01

    Intra-arterial injection of sclerosants is a significant but uncommon complication of sclerotherapy that may result in extensive tissue necrosis and in rare cases digit or limb amputation. We have managed three cases in the past 10 years. One patient was referred for immediate treatment following intra-arterial injection of liquid polidocanol. The other two had undergone foam sclerotherapy with polidocanol and sodium tetradecyl sulphate, respectively. All patients were treated with a combination of oral steroids (prednisone 0.5-1 mg/kg) and systemic anticoagulants (enoxaparin 1.5 mg/kg daily subcutaneous injection). One case progressed to skin ulceration where prednisone was started five days after the adverse event and prematurely stopped after four weeks. The other cases did not progress to necrosis or other long-term sequelae. In these patients, prednisone was commenced immediately and slowly reduced over the following 12 weeks. The inflammation that follows ischemia plays a significant role in tissue necrosis and the immediate management of this adverse event may benefit from anti-inflammatory measures and in particular systemic steroid therapy unless contraindicated. PMID:25837790

  18. Lumbar Epidural Steroid Injection for Painful Spasticity in Cervical Spinal Cord Injury: A Case Report

    PubMed Central

    Bang, Hyun; Chun, Seong Min; Park, Hee Won; Bang, Moon Suk

    2015-01-01

    We report a case of a 53-year-old male with traumatic cervical spinal cord injury (SCI). He could not maintain a standing position because of painful spasticity in his lower limbs. A magnetic resonance imaging and electromyography indicated chronic lumbosacral radiculopathy, explaining his chronic low back pain before the injury. For diagnostic as well as therapeutic purposes, transforaminal epidural steroid injection (ESI) to the right L5 root was performed. After the intervention, the spasticity decreased and his ambulatory function improved. This case illustrates that lumbar radiculopathy concomitant with a cervical SCI can produce severe spasticity and it can be dramatically improved by ESI. PMID:26361605

  19. Ultrasonic findings of fetal axillary lymphangioma with intralesional hemorrhage.

    PubMed

    Furue, Akiko; Mochizuki, Junko; Onishi, Yoko; Kawano, Shoko; Kanai, Yuji; Kemmochi, Manabu; Tanaka, Kiyoshi; Unno, Nobuya

    2016-04-01

    We report a case of an axillary lymphangioma in a fetus delivered at 30 weeks' gestation with suspected intralesional hemorrhage based on the ultrasonic findings. In the ultrasonic examination at 15 weeks' gestation, the fetus was found to have a multilocular mass spreading from the axilla to the chest wall, which was diagnosed as an axillary lymphangioma. Chromosome analysis by amniocentesis showed a normal karyotype, and no other malformations were observed. At 29 weeks, the mass had increased in size, and color Doppler ultrasound examination revealed that the middle cerebral artery peak systolic velocity (MCA-PSV) reached 80.2 cm/s [1.86 MoM (multiples of the median)]. Intralesional bleeding was suspected because of the multiple images of hemorrhage in which sites of blood spouting in a pulsatile fashion were detected within the mass. Cordocentesis at 30 weeks revealed that fetal hemoglobin concentration was 5.1 g/dL. An emergency Cesarean section was performed. A female weighing 2810 g, including the mass, was delivered, and the blood hemoglobin level was 5.9 g/dL at birth. Blood transfusion, fine-needle aspiration of the fluid in the mass, intralesional injection of OK-432, and partial excision of the lymphangioma were performed after birth. Ultrasonic examination proved useful in the diagnosis of intralesional bleeding in this lymphangioma. PMID:26707998

  20. Arthroscope assisted intralesional curettage of GCT

    PubMed Central

    Kekatpure, Aashay; Pimprikar, Milind; Kekatpure, Aditya

    2015-01-01

    Introduction: Incomplete intralesional curettage remains the most important factor contributing to the recurrence of the GCT tumor. A 360 degree view of the tumor cavity can be achieved with the help of an arthroscope, which can aid complete intralesional curettage. Case Report: This technical note describes the use of arthroscope assisted curettage of the distal femur GCT. Conclusion: Use of an arthroscope can improve the visibility for intralesional curettage 5 of Giant Cell tumor. PMID:27299030

  1. Phantom radiculitis effectively treated by fluoroscopically guided transforaminal epidural steroid injections.

    PubMed

    DeGregoris, Gerard; Diwan, Sudhir

    2010-01-01

    Lower back and extremity pain in the amputee patient can be challenging to classify and treat. Radicular compression in a patient with lower limb amputation may present as or be superimposed upon phantom limb pain, creating diagnostic difficulties. Both patients and physicians classically find it difficult to discern phantom sensation from phantom limb pain and stump pain; radicular compression is often not considered. Many studies have shown back pain to be a significant cause of pain in lower limb amputees, but sciatica has been rarely reported in amputees. We present a case of L4/5 radiculitis in an above-knee amputee presenting as phantom radiculitis. Our patient is a 67 year old gentleman with new onset 10/10 pain in a phantom extremity superimposed upon a 40 year history of previously stable phantom limb pain. MRI showed a central disc herniation at L4/5 with compression of the traversing left L4 nerve root. Two fluoroscopically guided left transforaminal epidural steroid injections at the level of the L4 and L5 spinal nerve roots totally alleviated his new onset pain. At one year post injection, his phantom radiculitis pain was completely gone, though his underlying phantom limb pain remained. Lumbar radiculitis in lower extremity amputee patients may be difficult to differentiate from baseline phantom limb pain. When conservative techniques fail, fluoroscopically guided spinal nerve injection may be valuable in determining the etiology of lower extremity pain. Our experience supports the notion that epidural steroid injections can effectively treat phantom lumbar radiculitis in lower extremity amputees. PMID:21102962

  2. Miniscalpel-Needle versus Steroid Injection for Plantar Fasciitis: A Randomized Controlled Trial with a 12-Month Follow-Up

    PubMed Central

    Li, Shuming; Shen, Tong; Liang, Yongshan; Zhang, Ying; Bai, Bo

    2014-01-01

    Plantar fasciitis is the most common cause of heel pain in adults. A novel alternative medical instrument, the miniscalpel-needle (MSN), which is based on an acupuncture needle, has been recently developed in China. The objective of this study was to evaluate the effectiveness of the MSN release treatment versus that of traditional steroid injection for plantar fasciitis. Patients with plantar fasciitis were randomly assigned to 2 groups and followed up for 12 months, with 29 receiving MSN treatment and 25 receiving steroid injection treatment. The results showed that visual analog scale scores for morning pain, active pain, and overall heel pain all were decreased significantly in the MSN group from 1 to 12 months after treatment. In contrast, treatment with steroid injection showed a significant effect only at the 1-month follow-up but not at 6 or 12 months after treatment. Moreover, the MSN group achieved more rapid and sustained improvements than the steroid group throughout the duration of this study. No severe side effects were observed with MSN treatment. Our data suggest that the MSN release treatment is safe and has a significant benefit for plantar fasciitis compared to steroid injection. PMID:25114704

  3. Infectious disease, injection practices, and risky sexual behavior among anabolic steroid users.

    PubMed

    Ip, Eric J; Yadao, Michael A; Shah, Bijal M; Lau, Bonnie

    2016-01-01

    Anabolic-androgenic steroids (AAS) and other performance-enhancing drugs (PEDs) are commonly misused to increase muscle size and strength, as well as improve physical appearance. Many AAS and certain PEDs are administered via injection and therefore pose a risk for transmission of infectious diseases such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and skin and soft tissue infections (SSTIs). Further, AAS users may be more likely to take part in high-risk sexual behaviors than non-AAS users. This review explores the prevalence of infectious diseases as well as risky injection practices and sexual behaviors of AAS users in the current literature. A comprehensive MEDLINE search (1984-17 April 2015) for English language reports was performed on AAS users. Ten studies analyzed the prevalence of HIV infection, 6 studies analyzed HBV infection, and 6 studies analyzed HCV infection; 20 studies analyzed injection practices and 7 studies analyzed high-risk sexual behaviors of AAS users. HIV, HBV, HCV, and SSTIs have been associated with AAS users. In particular, HIV infection seems much higher among homosexual male AAS users. AAS users also take part in high-risk injection practices but to a much lower extent than intravenous drug users. AAS users are also more likely to engage in high-risk sexual behaviors than the general population. Clinicians and health-policy leaders may utilize these findings to implement strategies to decrease the spread of infectious diseases. PMID:26422090

  4. A comparative study of efficacy of oral nonsteroidal antiinflammatory agents and locally injectable steroid for the treatment of plantar fasciitis

    PubMed Central

    Biswas, Chaitali; Pal, Anirban; Acharya, Amita

    2011-01-01

    Objectives: To compare the effectiveness of oral nonsteroidal antiinflammatory drugs (NSAIDs) and locally injectable steroid (methylprednisolone) in the treatment of plantar fasciitis. Materials and Methods: One hundred and twenty subjects with unilateral plantar fasciitis were recruited and randomly allocated to two study groups. Group I (NSAIDs group) (n=60) received oral tablet diclofenac (50 mg) and paracetamol (500 mg) twice a day (BD) along with tab. ranitidine 150 mg BD. Group II (injectable steroid group) (n=60) received injection of 1 ml of methylprednisolone (Depomedrol) (40 mg) and 2 ml of 0.5% bupivacaine into the inflammed plantar fascia. Pain intensity was measured using 10 cm visual analog scale (VAS). Subjects were evaluated clinically before, and 1 week, 2 weeks, 4 weeks, and 8 weeks (2 months) after the initiation of treatment in both the groups. The outcome was assessed in terms of VAS score and recurrence of the heel pain. Statistical Analysis Used: “Z” test and Chi-square test were used wherever applicable. Results: Pain relief was significant after steroid injection (P<0.001) and the improvement was sustained. The recurrence of heel pain was significantly higher in the oral NSAIDS group (P<0.001). Conclusion: Local injection of steroid is more effective in the treatment of plantar fasciitis than oral NSAIDs. PMID:25885380

  5. Prospective Randomized Comparison of the Effectiveness of Radiation Therapy and Local Steroid Injection for the Treatment of Plantar Fasciitis

    SciTech Connect

    Canyilmaz, Emine; Canyilmaz, Fatih; Aynaci, Ozlem; Colak, Fatma; Serdar, Lasif; Uslu, Gonca Hanedan; Aynaci, Osman; Yoney, Adnan

    2015-07-01

    Purpose: The purpose of this study was to conduct a randomized trial of radiation therapy for plantar fasciitis and to compare radiation therapy with local steroid injections. Methods and Materials: Between March 2013 and April 2014, 128 patients with plantar fasciitis were randomized to receive radiation therapy (total dose of 6.0 Gy applied in 6 fractions of 1.0 Gy three times a week) or local corticosteroid injections a 1 ml injection of 40 mg methylprednisolone and 0.5 ml 1% lidocaine under the guidance of palpation. The results were measured using a visual analog scale, a modified von Pannewitz scale, and a 5-level function score. The fundamental phase of the study was 3 months, with a follow-up period of up to 6 months. Results: The median follow-up period for all patients was 12.5 months (range, 6.5-18.6 months). For the radiation therapy patients, the median follow-up period was 13 months (range, 6.5-18.5 months), whereas in the palpation-guided (PG) steroid injection arm, it was 12.1 months (range, 6.5-18.6 months). After 3 months, results in the radiation therapy arm were significantly superior to those in the PG steroid injection arm (visual analog scale, P<.001; modified von Pannewitz scale, P<.001; 5-level function score, P<.001). Requirements for a second treatment did not significantly differ between the 2 groups, but the time interval for the second treatment was significantly shorter in the PG steroid injection group (P=.045). Conclusion: This study confirms the superior analgesic effect of radiation therapy compared to mean PG steroid injection on plantar fasciitis for at least 6 months after treatment.

  6. Interspinous Ligament Lidocaine and Steroid Injections for the Management of Baastrup's Disease: A Case Series

    PubMed Central

    Okada, Kentaro; Inoue, Gen; Orita, Sumihisa; Eguchi, Yawara; Nakamura, Junichi; Aoki, Yasuchika; Ishikawa, Tetsuhiro; Miyagi, Masayuki; Kamoda, Hiroto; Suzuki, Miyako; Kubota, Gou; Sakuma, Yoshihiro; Oikawa, Yasuhiro; Inage, Kazuhide; Sainoh, Takeshi; Toyone, Tomoaki; Yamauchi, Kazuyo; Takahashi, Kazuhisa

    2014-01-01

    Study Design Prospective study. Purpose To examine the long-term effects of interspinous ligament injections of local anesthetics and steroids for the treatment of Baastrup's diseases. Overview of Literature Baastrup's disease is associated with axial low back pains. Baastrup's disease has been more recently described as the "kissing spinous processes" disease. Several authors have reported methods for the diagnosis and treatment of the disease. However, there has been only one report of patients receiving interspinous ligament injections of agents for the treatment of Baastrup's disease. Methods Seventeen patients showed severe low back pains between spinous processes at L3-L4 or L4-L5. X-ray imaging, computed tomography, and magnetic resonance imaging revealed kissing spinous processes, consolidation of spinous process, or inflammation of an interspinous ligament. Pain reliefs after lidocaine and dexamethasone administration into interspinous ligament as therapy for low back pains were being examined and followed up. Results Low back pain scores significantly improved immediately after injection of the agents into interspinous ligaments. At final follow-up (1.4 year), low back pain scores significantly improved as compared with before the treatment. Conclusions Findings from the current study indicate that lidocaine and dexamethasone administration into interspinous ligament in patients diagnosed with Baastrup's disease is effective for managing the pain associated with this disease. PMID:24967039

  7. Epidural Steroid Injections for the Treatment of Cervical Radiculopathy in Elite Wrestlers: Case Series and Literature Review

    PubMed Central

    Clark, Randy; Doyle, Matthew; Sybrowsky, Christian; Rosenquist, Richard

    2012-01-01

    Background Elite wrestlers place tremendous stress through their cervical spine. These athletes are at risk for cervical trauma and may develop radiculopathy from recurrent episodes of injury. Team physicians and athletic trainers are faced with the challenge of treating these injuries in such a way as to allow the athlete to safely and expeditiously return to competition. Epidural steroid injections can be a successful complement to a conservative treatment algorithm for these complex injuries. Study Design Case Series Methods Five upper-level NCAA collegiate wrestlers who experienced symptomatic cervical radiculopathy were identified from an archival review. The majority of the athletes had MRI evidence of cervical disc disease, with corresponding subjective complaints and physical examination findings including pain and weakness that precluded continued competition. All athletes were treated conservatively with initial activity modification, strengthening, rehabilitation, NSAIDs, and, ultimately, cervical epidural steroid injections. Results All five athletes successfully returned to competition without negative clinical sequelae or need for operative intervention. The athletes demonstrated subjective improvement in their symptoms and strength, and all were able to return to a high level of competition. The cervical epidural steroid injections were found to be safe, effective, and well tolerated in all of the athletes. Conclusions Elite wrestlers with cervical radiculopathy can be effectively and safely managed with a conservative regimen that includes cervical epidural steroid injections, which may allow them to continue to compete at a high level. PMID:23576942

  8. The Incidence of Lumbar Discectomy after Epidural Steroid Injections or Selective Nerve Root Blocks

    PubMed Central

    Mroz, Thomas; Lieberman, Isador

    2015-01-01

    Background The purpose of this study was to determine the use of Central Epidural Steroid Injections (ESI) and Selective Nerve Root Blocks (SNRB) along with the crossover rate to lumbar discectomy in patients with a lumbar disc herniation using retrospective records database search. Butterman et al found a crossover rate for patients with symptomatic disc herniations treated with ESI of 54% (27/50), while Riew similarly found a 53% (29/55) crossover patients receiving SNRB. Methods The database was searched in a sequential Boolean style for patients with the diagnosis of a lumbar disc herniation (Displaced Lumbar Disc - 722.1) and a SNRB (64483) or ESI (62311) who subsequently underwent a Lumbar Discectomy (63030) over a three year time period from January 2004 through December 2006. Statistical analysis was preformed examining the impact of injection type, age, location, gender, and year. Results Of 482,893 patients with the diagnosis of a disc herniation, 27,799(5.76%) underwent a lumbar discectomy. The 29,941 patients who received at least one SNRB for a disc herniation, 10.80% later underwent a lumbar discectomy. The 41,420 patients who received at least one ESI for a disc herniation 9.34% later underwent a lumbar discectomy. There was a noted increase in injection procedures, particularly SNRB during the study with a greater than 50% increase. Conclusions Our examination found a much smaller, but similar crossover rate to surgery between both injection methods, which argues against one method being more effective than another in avoiding surgery. It is likely that patients are receiving these procedures more frequently during the course of conservative treatment for a disc herniation. Level of Evidence This was a Level III study. PMID:26056627

  9. Exserohilum infections associated with contaminated steroid injections: a clinicopathologic review of 40 cases.

    PubMed

    Ritter, Jana M; Muehlenbachs, Atis; Blau, Dianna M; Paddock, Christopher D; Shieh, Wun-Ju; Drew, Clifton P; Batten, Brigid C; Bartlett, Jeanine H; Metcalfe, Maureen G; Pham, Cau D; Lockhart, Shawn R; Patel, Mitesh; Liu, Lindy; Jones, Tara L; Greer, Patricia W; Montague, Jeltley L; White, Elizabeth; Rollin, Dominique C; Seales, Cynthia; Stewart, Donna; Deming, Mark V; Brandt, Mary E; Zaki, Sherif R

    2013-09-01

    September 2012 marked the beginning of the largest reported outbreak of infections associated with epidural and intra-articular injections. Contamination of methylprednisolone acetate with the black mold, Exserohilum rostratum, was the primary cause of the outbreak, with >13,000 persons exposed to the potentially contaminated drug, 741 confirmed drug-related infections, and 55 deaths. Fatal meningitis and localized epidural, paraspinal, and peripheral joint infections occurred. Tissues from 40 laboratory-confirmed cases representing these various clinical entities were evaluated by histopathological analysis, special stains, and IHC to characterize the pathological features and investigate the pathogenesis of infection, and to evaluate methods for detection of Exserohilum in formalin-fixed, paraffin-embedded (FFPE) tissues. Fatal cases had necrosuppurative to granulomatous meningitis and vasculitis, with thrombi and abundant angioinvasive fungi, with extensive involvement of the basilar arterial circulation of the brain. IHC was a highly sensitive method for detection of fungus in FFPE tissues, demonstrating both hyphal forms and granular fungal antigens, and PCR identified Exserohilum in FFPE and fresh tissues. Our findings suggest a pathogenesis for meningitis involving fungal penetration into the cerebrospinal fluid at the injection site, with transport through cerebrospinal fluid to the basal cisterns and subsequent invasion of the basilar arteries. Further studies are needed to characterize Exserohilum and investigate the potential effects of underlying host factors and steroid administration on the pathogenesis of infection. PMID:23809916

  10. Resolution of a fungal mycotic aneurysm after a contaminated steroid injection: a case report

    PubMed Central

    2014-01-01

    Background In the past ten years there have been three separate outbreaks of fungal contaminated steroid injections from compounding pharmacies. The 2012 outbreak of central nervous system fungal infections associated with contaminated methylprednisolone produced by a United States compounding pharmacy has led to 750 infections (151 with meningitis and paraspinal infections and 325 cases with paraspinal infections without meningitis) and 64 deaths as of October 23, 2013. Exserohilum rostratum has been the predominant pathogen identified by culture, polymerase chain reaction or antibody tests. According to previous reports, cerebral involvement with phaeohyphomycosis has a high risk of morbidity and mortality. Case presentation We report a 41 year-old Caucasian woman who received a lumbar methylprednisolone injection from a contaminated lot in August 2012. She was diagnosed with fungal meningitis by cerebrospinal fluid pleocytosis and positive (1, 3) beta-D-glucan after cultures and polymerase chain reaction were negative. Two weeks after onset of therapy, she developed a 4.1 mm superior cerebellar artery mycotic aneurysm associated with new stroke symptoms, which resolved with thirty-two weeks of antifungal treatment. Conclusions This is the rare case report of successful medical management of a cerebral mycotic aneurysm with stroke symptoms related to a presumed phaeohyphomycosis in an immunocompetent individual. Further studies are needed to determine the utility of cerebrospinal fluid (1, 3) beta-D-glucan in diagnosing and monitoring patients with meningitis thought to be related to fungal infection. PMID:24885172

  11. The Effectiveness of Transforaminal Versus Caudal Routes for Epidural Steroid Injections in Managing Lumbosacral Radicular Pain

    PubMed Central

    Liu, Jun; Zhou, Hengxing; Lu, Lu; Li, Xueying; Jia, Jun; Shi, Zhongju; Yao, Xue; Wu, Qiuli; Feng, Shiqing

    2016-01-01

    Abstract Epidural steroid injection (ESI) is one of the most commonly used treatments for radiculopathy. Previous studies have described the effectiveness of ESI in the management of radiculopathy. However, controversy exists regarding the route that is most beneficial and effective with respect to the administration of epidural steroids, as both transforaminal (TF) and caudal (C) routes are commonly used. This analysis reviewed studies comparing the effectiveness of TF-ESIs with that of C-ESIs in the treatment of radiculopathy as a means of providing pain relief and improving functionality. This meta-analysis was performed to guide clinical decision-making. The study was a systematic review of comparative studies. A systematic literature search was performed using the PubMed, EMBASE, and Cochrane Library databases for trials written in English. The randomized trials and observational studies that met our inclusion criteria were subsequently included. Two reviewers, respectively, extracted data and estimated the risk of bias. All statistical analyses were performed using Review Manager 5.3. Six prospective and 2 retrospective studies involving 664 patients were included. Statistical analysis was performed utilizing only the 6 prospective studies. Although slight pain and functional improvements were noted in the TF-ESI groups compared with the C-ESI groups, these improvements were neither clinically nor statistically significant. The limitations of this meta-analysis resulted primarily from the weaknesses of the comparative studies and the relative paucity of patients included in each study. Both the TF and C approaches are effective in reducing pain and improving functional scores, and they demonstrated similar efficacies in the management of lumbosacral radicular pain. PMID:27149443

  12. Fluoroscopy-guided Intra-articular Sacroiliac Joint Steroid Injection for Sacroiliitis in Ankylosing Spondylitis: A Case Report

    PubMed Central

    Dawson, PUA; Dewar, NA; Tulloch-Reid, D

    2014-01-01

    Sacroiliitis, a condition commonly seen in ankylosing spondylitis, is well known to be one of the main pain generators of low back pain, which may result in difficulty with walking. A 20-year old male with history of ankylosing spondylitis presented to the University Hospital of the West Indies, Physical Medicine and Rehabilitation Clinic, with a two-year history of right buttock, low back and groin pain. Radiographic evaluation revealed increased sclerosis and erosive changes in bilateral sacroiliac joints, right greater than left. Right intra-articular sacroiliac joint steroid injection was administered under fluoroscopy guidance. Post-injection visual analogue pain scale (VAS) score with activity improved from 8 to 1 and Oswestry Disability Index improved from 40% moderate disability to 16% minimal disability. The patient's overall assessment was 95% perceived improvement in pain. This case report illustrates the effectiveness of intra-articular sacroiliac joint steroid injection in treating sacroiliitis in ankylosing spondylitis. PMID:25303203

  13. Intracranial Chronic Subdural Hematoma Presenting with Intractable Headache after Cervical Epidural Steroid Injection.

    PubMed

    Kim, Myungsoo; Park, Ki-Su

    2015-08-01

    Postdural punctural headache (PDPH) following spinal anesthesia is due to intracranial hypotension caused by cerebrospinal fluid (CSF) leakage, and it is occasionally accompanied by an intracranial hematoma. To the best of our knowledge, an intracranial chronic subdural hematoma (CSDH) presenting with an intractable headache after a cervical epidural steroid injection (ESI) has not been reported. A 39-year-old woman without any history of trauma underwent a cervical ESI for a herniated nucleus pulposus at the C5-6 level. One month later, she presented with a severe headache that was not relieved by analgesic medication, which changed in character from being positional to non-positional during the preceding month. Brain magnetic resonance imaging revealed a CSDH along the left convexity. Emergency burr-hole drainage was performed and the headache abated. This report indicates that an intracranial CSDH should be considered a possible complication after ESI. In addition, the event of an intractable and changing PDPH after ESI suggests further evaluation for diagnosis of an intracranial hematoma. PMID:26361532

  14. Factors Affecting Radiation Exposure during Lumbar Epidural Steroid Injection: A Prospective Study in 759 Patients

    PubMed Central

    Kim, Suyoung; Shin, Joon-Ho; Lee, Joon Woo; Kang, Heung Sik; Lee, Guen Young

    2016-01-01

    Objective To estimate and compare radiation exposure and intervention time during lumbar epidural steroid injection (ESI) 1) under different practitioners and methods with continuous fluoroscopic monitoring, and 2) under one practitioner with different methods and monitoring. Materials and Methods We consecutively recruited 804 patients who underwent lumbar ESI and 759 patients who underwent 922 interventions were included for analysis in this investigation. Three different practitioners (a senior faculty member, junior faculty member, trainee) performed lumbar ESI using different methods (caudal, interlaminar, transforaminal). The senior faculty member performed lumbar ESI under two different methods of fluoroscopic monitoring (continuous [CM] and intermittent monitoring [IM]). The dose area product (DAP) fluoroscopy time, and intervention time during lumbar ESI were compared for 1) ESI methods and practitioners under CM, and 2) ESI methods and monitoring. Results With CM, interaction between the effects of the practitioner and the intervention on DAP was significant (p < 0.001), but not fluoroscopy time (p = 0.672) or intervention time (p = 0.852). The significant main effects included the practitioner and intervention on DAP, fluoroscopy time, and intervention time with CM (p < 0.001). DAPs and fluoroscopy time for caudal, interlaminar, and transforaminal ESI were higher with CM than with IM (p < 0.001). Intervention time did not differ between CM and IM. Conclusion Radiation exposure is dependent on the practitioners and methods and within the established safety limits during lumbar ESIs under CM. With an experienced practitioner, IM leads to less radiation exposure than CM. PMID:27134528

  15. Epidural steroid injections compared with gabapentin for lumbosacral radicular pain: multicenter randomized double blind comparative efficacy study

    PubMed Central

    Hanling, Steven; Bicket, Mark C; White, Ronald L; Veizi, Elias; Kurihara, Connie; Zhao, Zirong; Hayek, Salim; Guthmiller, Kevin B; Griffith, Scott R; Gordin, Vitaly; White, Mirinda Anderson; Vorobeychik, Yakov; Pasquina, Paul F

    2015-01-01

    Objective To evaluate whether an epidural steroid injection or gabapentin is a better treatment for lumbosacral radiculopathy. Design A multicenter randomized study conducted between 2011 and 2014. Computer generated randomization was stratified by site. Patients and evaluating physicians were blinded to treatment outcomes. Settings Eight military, Veterans Administration, and civilian hospitals. Participants 145 people with lumbosacral radicular pain secondary to herniated disc or spinal stenosis for less than four years in duration and in whom leg pain is as severe or more severe than back pain. Interventions Participants received either epidural steroid injection plus placebo pills or sham injection plus gabapentin. Main outcome measures Average leg pain one and three months after the injection on a 0-10 numerical rating scale. A positive outcome was defined as a ≥2 point decrease in leg pain coupled with a positive global perceived effect. All patients had one month follow-up visits; patients whose condition improved remained blinded for their three month visit. Results There were no significant differences for the primary outcome measure at one month (mean pain score 3.3 (SD 2.6) and mean change from baseline −2.2 (SD 2.4) in epidural steroid injection group versus 3.7 (SD 2.6) and −1.7 (SD 2.6) in gabapentin group; adjusted difference 0.4, 95% confidence interval −0.3 to 1.2; P=0.25) and three months (mean pain score 3.4 (SD 2.7) and mean change from baseline −2.0 (SD 2.6) versus 3.7 (SD 2.8) and −1.6 (SD 2.7), respectively; adjusted difference 0.3, −0.5 to 1.2; P=0.43). Among secondary outcomes, one month after treatment those who received epidural steroid injection had greater reductions in worst leg pain (−3.0, SD 2.8) than those treated with gabapentin (−2.0, SD 2.9; P=0.04) and were more likely to experience a positive successful outcome (66% v 46%; number needed to treat=5.0, 95% confidence interval 2.8 to 27.0; P=0.02). At three

  16. Efficacy of Epidural Steroid Injection in Management of Lumbar Prolapsed Intervertebral Disc: A Comparison of Caudal, Transforaminal and Interlaminar Routes

    PubMed Central

    2016-01-01

    Introduction Epidural steroid is an important modality in the conservative management of prolapsed lumbar disc and is being used for over 50 years. However, controversy still persists regarding their effectiveness in reducing the pain and improving the function with literature both supporting and opposing them are available. Aim To study the efficacy of epidural steroid injection in the management of pain due to prolapsed lumbar intervertebral disc and to compare the effectiveness between caudal, transforaminal and interlaminar routes of injection. Materials and Methods A total of 152 patients with back pain with or without radiculopathy with a lumbar disc prolapse confirmed on MRI, were included in the study and their pre injection Japanese Orthopaedic Association (JOA) Score was calculated. By simple randomization method (picking a card), patients were enrolled into one of the three groups and then injected methyl prednisone in the epidural space by one of the techniques of injection i.e. caudal, transforaminal and interlaminar. Twelve patients didn’t turn up for the treatment and hence were excluded from the study. Remaining 140 patients were treated and were included for the analysis of the results. Eighty two patients received injection by caudal route, 40 by transforaminal route and 18 by interlaminar route. Post injection JOA Score was calculated at six month and one year and effectiveness of the medication was calculated for each route. The data was compared by LSD and ANOVA method to prove the significance. Average follow-up was one year. Results At one year after injecting the steroid, all three routes were found to be effective in improving the JOA Score (Caudal route in 74.3%, transforaminal in 90% and interlaminar in 77.7%). Transforaminal route was significantly more effective than caudal (p=0.00) and interlaminar route (p=0.03) at both 6 months and one year after injection. No significant difference was seen between the caudal and interlaminar

  17. Evaluation of intralesional 0.2% ciprofloxacin as a treatment for cutaneous leishmaniasis.

    PubMed

    Al Hamdi, K; Awad, A H; Moker, H M

    2010-01-01

    Although cutaneous leishmaniasis lesions usually heal spontaneously they cause unsightly scarring. This study evaluated a possible new therapy in 38 patients, with 70 lesions, randomly assigned to intralesional injection of ciprofloxacin (0.2%) or intralesional sodium chloride hypertonic solution (7%). After excluding patients who defaulted on treatment, lesions assigned to sodium chloride treatment (n = 21) were completely healed (with or without scarring) in 76.2% of cases, and, when a scar remained, the scar size was reduced 66.0% compared with the original lesion. Lesions assigned to ciprofloxacin (n = 27) showed an 81.5% healing rate with an average scar size reduction of 68.6%. Intralesional 0.2% ciprofloxacin was as effective as hypertonic saline in the treatment of cutaneous leishmaniasis infection. PMID:20214164

  18. Effect of caudal epidural steroid or saline injection in chronic lumbar radiculopathy: multicentre, blinded, randomised controlled trial

    PubMed Central

    Solberg, Tore K; Romner, Bertil; Wilsgaard, Tom; Twisk, Jos; Anke, Audny; Nygaard, Øystein; Hasvold, Toralf; Ingebrigtsen, Tor

    2011-01-01

    Objective To assess the efficacy of caudal epidural steroid or saline injection in chronic lumbar radiculopathy in the short (6 weeks), intermediate (12 weeks), and long term (52 weeks). Design Multicentre, blinded, randomised controlled trial. Setting Outpatient multidisciplinary back clinics of five Norwegian hospitals. Participants Between October 2005 and February 2009, 461 patients assessed for inclusion (presenting with lumbar radiculopathy >12 weeks). 328 patients excluded for cauda equina syndrome, severe paresis, severe pain, previous spinal injection or surgery, deformity, pregnancy, ongoing breast feeding, warfarin therapy, ongoing treatment with non-steroidal anti-inflammatory drugs, body mass index >30, poorly controlled psychiatric conditions with possible secondary gain, and severe comorbidity. Interventions Subcutaneous sham injections of 2 mL 0.9% saline, caudal epidural injections of 30 mL 0.9% saline, and caudal epidural injections of 40 mg triamcinolone acetonide in 29 mL 0.9% saline. Participants received two injections with a two week interval. Main outcome measures Primary: Oswestry disability index scores. Secondary: European quality of life measure, visual analogue scale scores for low back pain and for leg pain. Results Power calculations required the inclusion of 41 patients per group. We did not allocate 17 of 133 eligible patients because their symptoms improved before randomisation. All groups improved after the interventions, but we found no statistical or clinical differences between the groups over time. For the sham group (n=40), estimated change in the Oswestry disability index from the adjusted baseline value was −4.7 (95% confidence intervals −0.6 to −8.8) at 6 weeks, −11.4 (−6.3 to −14.5) at 12 weeks, and −14.3 (−10.0 to −18.7) at 52 weeks. For the epidural saline intervention group (n=39) compared with the sham group, differences in primary outcome were −0.5 (−6.3 to 5.4) at 6 weeks, 1.4 (−4.5 to 7

  19. Comparative Effectivenesses of Pulsed Radiofrequency and Transforaminal Steroid Injection for Radicular Pain due to Disc Herniation: a Prospective Randomized Trial

    PubMed Central

    2016-01-01

    Transforaminal Epidural steroid injections (TFESI) have been widely adopted to alleviate and control radicular pain in accord with current guidelines. However, sometimes repeated steroid injections have adverse effects, and thus, this prospective randomized trial was undertaken to compare the effectivenesses of pulsed radiofrequency (PRF) administered to a targeted dorsal root ganglion (DRG) and TFESI for the treatment of radicular pain due to disc herniation. Subjects were recruited when first proved unsuccessful (defined as a score of > 4 on a visual analogue scale (VAS; 0-10 mm) and of > 30% according to the Oswestry Disability Index (ODI) or the Neck Disability Index (NDI)). Forty-four patients that met the inclusion criteria were enrolled. The 38 subjects were randomly assigned to receive either PRF (PRF group; n = 19) or additional TFESI (TFESI group; n = 19) and were then followed for 2, 4, 8, and 12 weeks. To evaluate pain intensity were assessed by VAS. ODI and NDI were applied to evaluate functional disability. Mean VAS scores for cervical and lumbar radicular pain were significantly lower 12 weeks after treatment in both study groups. NDI and ODI scores also declined after treatment. However, no statistically significant difference was observed between the PRF and TFESI groups in terms of VAS, ODI, or NDI scores at any time during follow-up. PRF administered to a DRG might be as effective as TFESI in terms of attenuating radicular pain caused by disc herniation, and its use would avoid the adverse effects of steroid. PMID:27478346

  20. Comparative Effectivenesses of Pulsed Radiofrequency and Transforaminal Steroid Injection for Radicular Pain due to Disc Herniation: a Prospective Randomized Trial.

    PubMed

    Lee, Dong Gyu; Ahn, Sang-Ho; Lee, Jungwon

    2016-08-01

    Transforaminal Epidural steroid injections (TFESI) have been widely adopted to alleviate and control radicular pain in accord with current guidelines. However, sometimes repeated steroid injections have adverse effects, and thus, this prospective randomized trial was undertaken to compare the effectivenesses of pulsed radiofrequency (PRF) administered to a targeted dorsal root ganglion (DRG) and TFESI for the treatment of radicular pain due to disc herniation. Subjects were recruited when first proved unsuccessful (defined as a score of > 4 on a visual analogue scale (VAS; 0-10 mm) and of > 30% according to the Oswestry Disability Index (ODI) or the Neck Disability Index (NDI)). Forty-four patients that met the inclusion criteria were enrolled. The 38 subjects were randomly assigned to receive either PRF (PRF group; n = 19) or additional TFESI (TFESI group; n = 19) and were then followed for 2, 4, 8, and 12 weeks. To evaluate pain intensity were assessed by VAS. ODI and NDI were applied to evaluate functional disability. Mean VAS scores for cervical and lumbar radicular pain were significantly lower 12 weeks after treatment in both study groups. NDI and ODI scores also declined after treatment. However, no statistically significant difference was observed between the PRF and TFESI groups in terms of VAS, ODI, or NDI scores at any time during follow-up. PRF administered to a DRG might be as effective as TFESI in terms of attenuating radicular pain caused by disc herniation, and its use would avoid the adverse effects of steroid. PMID:27478346

  1. Pushing quantitation limits in micro UHPLC-MS/MS analysis of steroid hormones by sample dilution using high volume injection.

    PubMed

    Márta, Zoltán; Bobály, Balázs; Fekete, Jenő; Magda, Balázs; Imre, Tímea; Mészáros, Katalin Viola; Szabó, Pál Tamás

    2016-09-10

    Ultratrace analysis of sample components requires excellent analytical performance in terms of limits of quantitation (LoQ). Micro UHPLC coupling with sensitive tandem mass spectrometry provides state of the art solutions for such analytical problems. Decreased column volume in micro LC limits the injectable sample volume. However, if analyte concentration is extremely low, it might be necessary to inject high sample volumes. This is particularly critical for strong sample solvents and weakly retained analytes, which are often the case when preparing biological samples (protein precipitation, sample extraction, etc.). In that case, high injection volumes may cause band broadening, peak distortion or even elution in dead volume. In this study, we evaluated possibilities of high volume injection onto microbore RP-LC columns, when sample solvent is diluted. The presented micro RP-LC-MS/MS method was optimized for the analysis of steroid hormones from human plasma after protein precipitation with organic solvents. A proper sample dilution procedure helps to increase the injection volume without compromising peak shapes. Finally, due to increased injection volume, the limit of quantitation can be decreased by a factor of 2-5, depending on the analytes and the experimental conditions. PMID:27423010

  2. Peyronie's Disease: Intralesional Therapy and Surgical Intervention.

    PubMed

    Aliperti, Louis A; Mehta, Akanksha

    2016-09-01

    Peyronie's disease is a collagen wound healing disorder of the penis that negatively affects the quality of life of afflicted men. According to the 2015 AUA Consensus Guidelines on Peyronie's Disease, minimally invasive intralesional therapies and surgical intervention form the basis of contemporary therapy for this disorder. These therapeutic options, along with selected portions of the guidelines, are explored in this review. PMID:27432377

  3. Steroid Injection and Nonsteroidal Anti-inflammatory Agents for Shoulder Pain: A PRISMA Systematic Review and Meta-Analysis of Randomized Controlled Trials.

    PubMed

    Sun, Yaying; Chen, Jiwu; Li, Hong; Jiang, Jia; Chen, Shiyi

    2015-12-01

    Advantages and possible risks associated with steroid injection compared with nonsteroidal anti-inflammatory drugs (NSAIDs) for shoulder pain are not fully understood. To compare the efficiency and safety of steroid injection versus NSAIDs for patients with shoulder pain. PubMed, Embase, and the Cochrane Library were searched through July 2015. Study eligibility criteria, participants, and interventions: randomized controlled trials (RCTs) that assessed steroid injection versus NSAIDs for patients with shoulder pain. Study appraisal and synthesis methods: predefined primary efficacy outcome was functional improvement; and secondary efficacy outcomes included pain relief and complications. Relative risks (RRs) and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using a random-effects model accounting for clinical heterogeneity. Eight RCTs involving 465 participants were included in the meta-analysis. Five trials compared steroid injection with oral NSAIDs, and 3 compared steroids injection with NSAIDs injection. Compared with steroid injection, oral NSAIDs were less effective in 4 or 6 weeks for functional improvement (SMD 0.61; 95% CI, 0.08-1.14; P = 0.01), while there was no significant difference in pain relief (SMD 0.45; 95% CI, -0.50-1.40; P < 0.00001) or complication rate (RR 1.10; 95% CI, 0.26-4.58; P = 0.29). Meta-analysis was not performed for NSAIDs injection due to considerable heterogeneity. Conflicting results were observed in favor of either steroid or NSAIDs injection. Not all diseases that can lead to shoulder pain were included, detailed intervention protocols were inconsistent across studies, and some estimated data were input into comparison while some data were lost, which could exert an influence on pooled results. Steroid injection, compared with oral NSAIDs, provides slightly more improvement in shoulder function without superiority in pain relief or risk of complications at 4 to 6 weeks

  4. Analysis of anabolic androgenic steroids in urine by full-capillary sample injection combined with a sweeping CE stacking method.

    PubMed

    Wang, Chun-Chi; Cheng, Shu-Fang; Cheng, Hui-Ling; Chen, Yen-Ling

    2013-02-01

    This study describes an on-line stacking CE approach by sweeping with whole capillary sample filling for analyzing five anabolic androgenic steroids in urine samples. The five anabolic steroids for detection were androstenedione, testosterone, epitestosterone, boldenone, and clostebol. Anabolic androgenic steroids are abused in sport doping because they can promote muscle growth. Therefore, a sensitive detection method is imperatively required for monitoring the urine samples of athletes. In this research, an interesting and reliable stacking capillary electrophoresis method was established for analysis of anabolic steroids in urine. After liquid-liquid extraction by n-hexane, the supernatant was dried and reconstituted with 30 mM phosphate buffer (pH 5.00) and loaded into the capillary by hydrodynamic injection (10 psi, 99.9 s). The stacking and separation were simultaneously accomplished at -20 kV in phosphate buffer (30 mM, pH 5.0) containing 100 mM sodium dodecyl sulfate and 40 % methanol. During the method validation, calibration curves were linear (r≥0.990) over a range of 50-1,000 ng/mL for the five analytes. In the evaluation of precision and accuracy for this method, the absolute values of the RSD and the RE in the intra-day (n=3) and inter-day (n=5) analyses were all less than 6.6 %. The limit of detection for the five analytes was 30 ng/mL (S/N=5, sampling 99.9 s at 10 psi). Compared with simple MECK, this stacking method possessed a 108- to 175-fold increase in sensitivity. This simple and sensitive stacking method could be used as a powerful tool for monitoring the illegal use of doping. PMID:23263519

  5. Facial Granulomas Secondary to Injection of Semi-Permanent Cosmetic Dermal Filler Containing Acrylic Hydrogel Particles

    PubMed Central

    Sachdev, Mukta; Anantheswar, YN; Ashok, BC; Hameed, Sunaina; Pai, Sanjay A

    2010-01-01

    Various reports of long-term complications with semi-permanent fillers, appearing several years after injections have created some concern about their long-term safety profile. We report a case of foreign body granuloma secondary to dermal filler containing a copolymer of the acrylic hydrogel particles, hydroxyethylmethacrylate and ethylmethacrylate, occurring 2 years after the injection. The foreign body granulomas could not be treated satisfactorily with intralesional steroids, and the patient required a surgical excision of her granulomas. The physical and psychological consequences to such patients can be quite devastating. PMID:21430829

  6. Young Adult Hip: Reactivation of dormant, previously undiagnosed Mycobacterium Tuberculosis infection following intra-articular steroid injection

    PubMed Central

    B.J, Tadros; G.H, Stafford

    2016-01-01

    Introduction: Tuberculosis (TB) still remains a common problem in the UK and, with the increasing number of patients being offered arthroplasties; periprosthetic involvement is not uncommon anymore. However, the diagnosis of TB infected arthroplasties still remains difficult and misdiagnosis is common, therefore delaying treatment. Case Report: We describe a 36-years old Caucasian female with no known history of TB who presented with hip pain thought to be due to femoro-acetabular impingement (FAI). In the course of 18 months, the patient had been investigated extensively; including steroid injection, hip arthroscopy (including synovial biopsies), and eventually a total hip arthroplasty. During arthroplasty, further extensive biopsies were performed which raised the suspicion of TB on histology. Further synovial biopsies obtained arthroscopically were microbiologically positive for TB (PCR). The patient was sent to an infectious disease specialist. It appeared that the patient had TB in the past, of which she was unaware. Conclusion: We hypothesise that the immunosuppressant effects of the steroid injections she received reactivated her TB. PMID:27299119

  7. Effectiveness of splinting and splinting plus local steroid injection in severe carpal tunnel syndrome: A Randomized control clinical trial

    PubMed Central

    Khosrawi, Saeid; Emadi, Masoud; Mahmoodian, Amir Ebrahim

    2016-01-01

    Background: The Study aimed to compare the effectiveness of two commonly used conservative treatments, splinting and local steroid injection in improving clinical and nerve conduction findings of the patients with severe carpal tunnel syndrome (CTS). Materials and Methods: In this randomized control clinical trial, the patients with severe CTS selected and randomized in two interventional groups. Group A was prescribed to use full time neutral wrist splint and group B was injected with 40 mg Depo-Medrol and prescribed to use the full time neutral wrist splint for 12 weeks. Clinical and nerve conduction findings of the patients was evaluated at baseline, 4 and 12 weeks after interventions. Results: Twenty-two and 21 patients were allocated in group A and B, respectively. Mean of clinical symptoms and functional status scores, nerve conduction variables and patients’ satisfaction score were not significant between group at baseline and 4 and 12 weeks after intervention. Within the group comparison, there was significant improvement in the patients’ satisfaction, clinical and nerve conduction items between the baseline level and 4 weeks after intervention and between the baseline and 12 weeks after intervention (P < 0.01). The difference was significant for functional status score between 4 and 12 weeks after intervention in group B (P = 0.02). Conclusion: considering some findings regarding the superior effect of splinting plus local steroid injection on functional status scale and median nerve distal motor latency, it seems that using combination therapy could be more effective for long-term period specially in the field of functional improvement of CTS. PMID:26962518

  8. Sodium Tetradecyl Sulphate Direct Intralesional Sclerotherapy of Venous Malformations of the Vulva and Vagina: Report of Five Cases

    SciTech Connect

    Krokidis, Miltiadis; Venetucci, Pietro; Hatzidakis, Adam; Iaccarino, Vittorio

    2011-02-15

    We report five cases of female patients affected by symptomatic focal external genital venous malformations treated with percutaneous direct intralesional injection of sodium tetradecyl sulphate (STS). All patients were referred because of discomfort and pain when sexual intercourse was attempted. Direct sclerotherapy with 3% STS was performed on a day-hospital basis with the patient under local anesthesia. Complete resolution of the symptoms was achieved in all cases. No major adverse effects were reported. Direct intralesional sclerotherapy with STS may be considered a safe and effective method for the treatment of female external genital malformation without the necessity of general anesthesia for pain control.

  9. A novel stacking method of repetitive large volume sample injection and sweeping MEKC for determination of androgenic steroids in urine.

    PubMed

    Wang, Chun-Chi; Chen, Jia-Ling; Chen, Yen-Ling; Cheng, Hui-Ling; Wu, Shou-Mei

    2012-09-26

    In this research, a novel stacking capillary electrophoresis method, repetitive large volume sample injection and sweeping MEKC (rLVSI-sweeping MEKC) were developed to analyze the presence of three androgenic steroids considered as sport doping drugs, testosterone (T), epitestosterone (E) and epitestosterone glucuronide (EG) in urine. This method provides better sensitivity enhancement than the traditional large volume sample stacking-sweeping strategies due to sensitivity enhancement by repetitive injections. This multiple sampling method enhances sensitivity of monitoring of urine samples by UV detection (254 nm). Firstly, the phosphate buffer was filled into an uncoated fused silica capillary and the samples were injected into the capillary at 10 psi for 20s, and then stacked at -10 kV for 1 min using phosphate buffer containing SDS. The above injecting and stacking steps were repeated five times. Finally, separation was performed at -20 kV, using phosphate buffer containing methanol, SDS and (2-hydroxypropyl)-β-cyclodextrin. Method validation showed that calibration plots were linear (r≥0.997) over a range of 5-200 ng mL(-1) for T, 20-200 ng mL(-1) for E and 0.5-500 ng mL(-1) for EG. The limits of detection were 1.0 ng mL(-1) for T, 5.0 ng mL(-1) for E and 200.0 pg mL(-1) for EG. When evaluating precision and accuracy, values of RSD and RE in intra-day (n=3) and inter-day (n=5) analysis were found to be less than 10.0%. Compared with the simple LVSS-sweeping, which is also a stacking strategy, this method further improves sensitivity up to 25 folds (~2500 folds with MEKC without preconcentration). This method was applied to monitor 10 athletes' urine, and did not detect any analyte. The novel stacking method was feasible for monitoring of doping by sportsmen. PMID:22935380

  10. Intra-lesional 5 fluorouracil for the management of recurrent pterygium

    PubMed Central

    Said, D G; Faraj, L A; Elalfy, M S; Yeung, A; Miri, A; Fares, U; Otri, A M; Rahman, I; Maharajan, S; Dua, H S

    2013-01-01

    Aim Recurrence is the most common complication arising from pterygium surgery. The aim of this study was to investigate the effectiveness of 5 fluorouracil (5FU) in halting the recurrence of pterygium after surgical excision. Methods A retrospective review of patients treated for pterygium recurrence was carried out. Patients with recurrent (secondary) pterygium were treated with multiple weekly intra-lesional injections of 0.1–0.2 ml (2.5–5 mg) 5FU post-operatively depending on the size of the recurrence. The treatment was started within 1 month from the date of recurrence. The time from surgery to start of recurrence, previous treatment modalities, and number of recurrences were documented. The number of injections required to induce arrest of progression and/or regression of vascularity and fleshiness of the pterygium and any complications related to 5FU treatment were examined. Results Fifteen eyes from 14 patients with recurrent pterygium treated with intra-lesional 5FU injections were analysed. Three of the 15 eyes had undergone a secondary excision and 12 had undergone a primary excision. In all, 93.3% of patients showed regression of the fibrovascular tissue (thickness and vascularity) and arrest of progression following a dose of 0.1–0.2 ml (2.5–5 mg) 5FU. Twelve eyes required three injections or fewer, whereas one patient required eight injections. This beneficial effect was maintained over an average follow-up period of 17 months. No complications from 5FU were observed. Conclusion The use of weekly intra-lesional 5FU injections for the treatment of recurrent pterygium is safe and effective in limiting the progression and inducing the regression of recurrent pterygium. The number of injections can be tailored according to clinical need. PMID:23807385

  11. Correlation between Rotator Cuff Tears and Repeated Subacromial Steroid Injections: A Case-Controlled Study

    PubMed Central

    Bhatia, M; Singh, B; Nicolaou, N; Ravikumar, KJ

    2009-01-01

    INTRODUCTION Concern exists regarding potential damage to the rotator cuff from repeated corticosteroid injections into the subacromial space. PATIENTS AND METHODS In this retrospective, case-controlled study, 230 consecutive patients presenting to three orthopaedic units with subacromial impingement and investigated as an end-point with magnetic resonance imaging (MRI) of the shoulder were divided into groups having received less than three or three or more subacromial injections of corticosteroids. RESULTS With no significant difference in age and sex distribution, analysis by MRI showed no significant difference between the two groups in the incidence of rotator cuff tear (P < 1.0). CONCLUSIONS This suggests that corticosteroid use in patients with subacromial impingement should not be considered a causative factor in rotator cuff tears. PMID:19409148

  12. Epidural injections with or without steroids in managing chronic low back pain secondary to lumbar spinal stenosis: a meta-analysis of 13 randomized controlled trials

    PubMed Central

    Meng, Hai; Fei, Qi; Wang, Bingqiang; Yang, Yong; Li, Dong; Li, Jinjun; Su, Nan

    2015-01-01

    Background Epidural injections of anesthetic with or without steroids are widely used for treating lumbar spinal stenosis, a common cause of chronic low back pain, but there is a lack of rigorous data comparing the effectiveness of epidural injections of anesthetic with and without steroids. This meta-analysis presents a current, comprehensive picture of how epidural injections of anesthetic with steroids compare with those using local anesthetic alone. Methods PubMed, Embase, Web of Science, and Cochrane Library databases were searched from their inception through February 5, 2015. Weight mean difference, risk ratio, and 95% confidence intervals were calculated. A random effects model or fixed effects model was used to pool the estimates, according to the heterogeneity between the included studies. Results We included 13 randomized controlled trials, involving 1,465 patients. Significant pain relief (≥50%) was demonstrated in 53.7% of patients administered with epidural injections of anesthetic with steroids (group 1) and in 56.4% of those administered with local anesthetic alone (group 2). Patients showed a reduction in numeric rating scale pain score of 3.7 and 3.6 in the two groups, respectively. Significant functional improvement was achieved in 65.2% of patients in group 1 and 63.1% of patients in group 2, with Oswestry Disability Index reductions of 13.8 and 14.5 points, respectively. The overall number of injections per year was 3.2±1.3 and 3.4±1.2 with average total relief per year of 29.3±19.7 and 33.8±19.3 weeks, respectively. The opioid intakes decreased from baseline by 12.4 and 7.8 mg, respectively. Among the outcomes listed, only total relief time differed significantly between the two groups. Conclusion Both epidural injections with steroids or with local anesthetic alone provide significant pain relief and functional improvement in managing chronic low back pain secondary to lumbar spinal stenosis, and the inclusion of steroids confers no

  13. Conflicting conclusions from two systematic reviews of epidural steroid injections for sciatica: which evidence should general practitioners heed?

    PubMed Central

    Hopayian, K; Mugford, M

    1999-01-01

    Systematic reviews and meta-analyses are becoming increasingly important in informing clinical practice and commissioning. Two systematic reviews of a treatment for low back pain and sciatica using epidural steroid injections, published in the same year, arrived at conflicting conclusions. Only one was reported in a digest for evidence-based medicine. This paper aims to find the reasons for the discordance between the reviews, and draw conclusions for users of reviews. Using comparative analysis of two published systematic reviews and their source material, it was found that the two reviews had the same overall aims and met the criteria for review methods. They differed in their choice of methods, including the judgement of quality of studies for inclusion and for summing-up evidence. Estimation of summary odds ratios in one review led to stronger conclusions about effectiveness. In conclusion, the choice of methods for systematic review may alter views about the current state of evidence. Users should be aware that systematic reviews include an element of judgement, whatever method is used. PMID:10622020

  14. Should routine MRI of the lumbar spine be required prior to lumbar epidural steroid injection for sciatica pain?

    PubMed Central

    Ghaly, Ramis F.; Lissounov, Alexei; Candido, Kenneth D.; Knezevic, Nebojsa Nick

    2015-01-01

    Background: We describe three patients who received lumbar epidural steroid injections (LESI) for lumbosacral radicular pain that resulted in worsening of their symptoms. The procedures were performed following a review of remote diagnostic imaging studies. These cases demonstrate the lack of consensus in pain management domains for how to approach the workup and treatment of persistent/chronic low back pain, with a noted fragmentation in pain management strategies and applied therapies. Case Description: We present three patients; two female patients (37 and 38 years old) undergoing LESI for remotely diagnosed disc herniations, and one 61-year-old male receiving an LESI for a presumed, unverified lumbar intervertebral disc disorder. Following a worsening of symptoms after LESI, neurosurgical consultations ultimately determined the presence of, respectively, an epidural hematoma, a neurilemoma, and a lung cancer metastasis to the sacrum as the source of symptoms, instead of being due to the intervertebral disc pathology. Conclusions: We would like to emphasize several principles in the diagnosis and use of imaging of the lumbosacral region prior to undertaking invasive neuraxial procedures. PMID:25883840

  15. TREATMENT OUTCOMES OF INTRADISCAL STEROID INJECTION/SELECTIVE NERVE ROOT BLOCK FOR 161 PATIENTS WITH CERVICAL RADICULOPATHY

    PubMed Central

    ITO, KEIGO; YUKAWA, YASUTSUGU; MACHINO, MASAAKI; INOUE, TARO; OUCHIDA, JUN; TOMITA, KEISUKE; KATO, FUMIHIKO

    2015-01-01

    ABSTRACT Patients with cervical radiculopathy (CR) were treated with intradiscal injection of steroids (IDIS) and/or selective nerve root block (SNRB) at our hospital. We retrospectively report the outcomes of these nonsurgical treatments for CR. 161 patients who were followed up for >2months were enrolled in this study. Patients’ clinical manifestations were classified as arm pain, arm numbness, neck and/or scapular pain, and arm paralysis. Improvement in each manifestation was classified as "disappeared," "improved," "poor," or "worsened." Responses of "disappeared" or "improved" manifestations suggested treatment effectiveness. Final clinical outcomes were evaluated using the Odom criteria. Changes in herniated disc size were evaluated by comparing the initial and final MRI scans. On the basis of these changes, the patients were divided into regression, no-change, or progression groups. We investigated the relationship between the Odom criteria and changes observed on MRI. Effectiveness rates were 89% for arm pain, 77% for arm numbness, 82% for neck and/or scapular pain, and 76% for arm paralysis. In total, 91 patients underwent repeated MRI. In 56 patients (62%), the size of the herniated disc decreased, but 31 patients (34%) exhibited no change in disc size. The regression group showed significantly better Odom criteria results than the no-change group. In conclusion, IDIS and SNRB for CR are not widely performed. However, other extremely effective therapies that can rapidly improve neuralgia should be considered before surgery. PMID:25797986

  16. Analysis of Androgenic Steroids in Environmental Waters by Large-volume Injection Liquid Chromatography Tandem Mass Spectrometry

    PubMed Central

    Backe, Will J.; Ort, Christoph; Brewer, Alex J.; Field, Jennifer A.

    2014-01-01

    A new method was developed for the analysis of natural and synthetic androgenic steroids and their selected metabolites in aquatic environmental matrices using direct large-volume injection (LVI) high performance liquid chromatography (HPLC) tandem mass spectrometry (MS/MS). Method accuracy ranged from 88 to 108% for analytes with well-matched internal standards. Precision, quantified by relative standard deviation (RSD), was less than 12%. Detection limits for the method ranged from 1.2 to 360 ng/L. The method was demonstrated on a series of 1-hr composite wastewater influent samples collected over a day with the purpose of assessing temporal profiles of androgen loads in wastewater. Testosterone, androstenedione, boldenone, and nandrolone were detected in the sample series at concentrations up to 290 ng/L and loads up to 535 mg. Boldenone, a synthetic androgen, had a temporal profile that was strongly correlated to testosterone, a natural human androgen, suggesting its source may be endogenous. An analysis of the sample particulate fraction revealed detectable amounts of sorbed testosterone and androstenedione. Androstenedione sorbed to the particulate fraction accounted for an estimated five to seven percent of the total androstenedione mass. PMID:21391574

  17. Efficacy of intralesional immunotherapy for the treatment of warts: A review of the literature.

    PubMed

    Aldahan, Adam Souhail; Mlacker, Stephanie; Shah, Vidhi V; Kamath, Preetha; Alsaidan, Mohammed; Samarkandy, Sahal; Nouri, Keyvan

    2016-05-01

    Warts are common epidermal growths caused by human papillomavirus that often cause significant discomfort and embarrassment. Current treatment options include topical therapies, cryotherapy, laser vaporization, and surgical excision. Many of these options are destructive and may result in scarring, while less aggressive approaches can lead to lesion recurrence. Additionally, these local modalities are not practical for patients with a large number of warts. Systemic approaches such as immunotherapy have demonstrated success in treating multiple lesions by combining a targeted approach with upregulation of the host immune system. An extensive literature review was performed to evaluate the various vaccine antigens that have been used intralesionally to treat cutaneous and anogenital warts. The specific intralesional immunotherapies that have been studied include: Candida albicans; measles, mumps, and rubella; Trichophyton; and tuberculin antigens such as purified protein derivative, Mycobacterium w vaccine, and Bacillus Calmette-Guerin. Intralesional vaccine injection represents a safe, effective, and tolerable treatment for warts, including recalcitrant and anogenital warts. This approach has been somewhat overlooked in the past despite substantial evidence of high response rates with a low side effect profile. Large comparative trials are necessary to determine the most effective immunotherapy treatment option as well as the most appropriate dosing parameters. PMID:26991521

  18. Comparison between Steroid Injection and Stretching Exercise on the Scalene of Patients with Upper Extremity Paresthesia: Randomized Cross-Over Study

    PubMed Central

    Kim, Yong Wook; Yoon, Seo Yeon; Park, Yongbum; Chang, Won Hyuk

    2016-01-01

    Purpose To compare the therapeutic effects on upper extremity paresthesia of intra-muscular steroid injections into the scalene muscle with those of stretching exercise only. Materials and Methods Twenty patients with upper extremity paresthesia who met the criteria were recruited to participate in this single-blind, crossover study. Fourteen of 20 patients were female. The average age was 45.0±10.5 years and duration of symptom was 12.2±8.7 months. Each participant completed one injection and daily exercise program for 2 weeks. After randomization, half of all patients received ultrasound-guided injection of scalene muscles before exercise, while the other was invested for the other patients. Results After two weeks, there was a significant decrease of the visual analog scale score of treatment effect compared with baseline in both groups (6.90 to 2.85 after injection and 5.65 to 4.05 after stretching exercise, p<0.01). However, injection resulted in greater improvements than stretching exercise (p<0.01). The number of patients with successful treatment, defined as >50% reduction in post-treatment visual analog scale, was 18 of 20 (90.0%) after injection, compared to 5 of 20 (25.0%) after stretching exercise. There were no cases of unintended brachial plexus block after injection. Conclusion Ultrasound-guided steroid injection or stretching exercise of scalene muscles led to reduced upper extremity paresthesia in patients who present with localized tenderness in the scalene muscle without electrodiagnostic test abnormalities, although injection treatment resulted in more improvements. The results suggest that symptoms relief might result from injection into the muscle alone not related to blockade of the brachial plexus. PMID:26847305

  19. About Steroids (Inhaled and Oral Corticosteroids)

    MedlinePlus

    ... dose-inhalers ( inhaled steroids ), oral forms (pills or syrups) , injections (shots) and intravenous (IV) solutions. Healthcare providers ... slowly decreased. Inhaled steroids and steroid pills and syrups are often prescribed for people with a chronic ...

  20. Transforaminal epidural steroid injections prevent the need for surgery in patients with sciatica secondary to lumbar disc herniation: a retrospective case series

    PubMed Central

    Manson, Neil A.; McKeon, Melissa D.; Abraham, Edward P.

    2013-01-01

    Background The median orthopedic surgery wait time in Canada is 33.7 weeks, thus alternative treatments for pathologies such as lumbar disc herniations (LDH) are needed. We sought to determine whether transforaminal epidural steroid injections (TFESIs) alleviate or merely delay the need for surgery. Methods We retrospectively reviewed the charts of patients with LDH who received TFESIs between September 2006 and July 2008. Patient demographics, level and side of pathology, workers’ compensation status, levels injected, treatment outcome and time from referral to treatment were evaluated. The primary outcome measure was the need for versus the avoidance of surgery. Results We included 91 patients in our analysis. Time from family physician referral to injection was 123 (standard deviation [SD] 88) days; no significant differences in wait times were found between TFESI patients and those requiring surgery. In all, 51 patients (22 women, 29 men) with a mean age of 45.8 (SD 10.2) years avoided surgery following TFESI, whereas 40 patients (16 women, 24 mean) with a mean age of 43.1 (SD 12.0) years proceeded to surgery within 189 (SD 125) days postinjection. In all, 15 patients received multiple injections, and of these, 9 did not require surgical intervention. Age, sex and level/side of pathology did not influence the treatment outcome. Workers’ compensation status influenced outcome significantly; these patients demonstrated less benefit from TFESI. Conclusion Transforaminal epidural steroid injections are an important treatment tool, preventing the need for surgery in 56% of patients with LDH. PMID:23351495

  1. No difference in pain reduction after epidural steroid injections in diabetic versus nondiabetic patients: A retrospective cohort study

    PubMed Central

    Wong, Francis; Namdari, Bahram; Dupler, Suzanne; Kovac, Mario Farias; Makarova, Natalya; Dalton, Jarrod E.; Turan, Alparslan

    2016-01-01

    Background and Aims: Diabetes affects peripheral and central neurons causing paresthesia, allodynia, hyperalgesia, and spontaneous pain. However, the effect of diabetes on response to epidural steroid injection (ESI) remains unknown. We hypothesized that diabetic patients receiving ESI will have different pain scores compared to nondiabetic patients. We tested a secondary hypothesis that pain reduction differs at different levels of hemoglobin A1c (HbA1c) for patients with diabetes. Material and Methods: Data from 284 consecutive patients given ESIs for radiculopathy were obtained via a manual review of electronic medical records. We initially compared diabetic and nondiabetic groups with respect to balance on baseline demographic and morphometric characteristics. Next, a linear regression model was developed to evaluate the association between existing diabetes and postinjection reduction in pain scores. And finally, we univariably characterized the association between HbA1c and pain reduction. Results: After exclusion of nine patients, 275 patients were analysed, including 55 (20%) who were diabetic. Pain reduction after ESI was comparable in diabetic and nondiabetic patients (Wald test P = 0.61). The degree of pain reduction generally decreased with the level of HbA1c until reaching HbA1c levels of approximately 7.5%, after which point it stayed fairly constant. Conclusion: There was no difference in pain reduction after ESIs comparing diabetic with nondiabetic patients; however, for diabetic patients, pain reduction may decrease with uncontrolled diabetes determined by high HbA1c values, thus suggesting pain physicians to take an active role in guiding their patients to have their blood glucose levels better regulated to improve outcomes of their ESIs. PMID:27006548

  2. Effect of Cervical Interlaminar Epidural Steroid Injection: Analysis According to the Neck Pain Patterns and MRI Findings

    PubMed Central

    Choi, Ji Won; Lim, Hyung Woo; Lee, Jin Young; Lee, Won Il; Lee, Eun Kyung; Chang, Choo Hoon; Yang, Jae Young

    2016-01-01

    Background It is widely accepted that cervical interlaminar steroid injection (CIESI) is more effective in treating radicular pain than axial neck pain, but without direct comparison. And the differences of effect after CIESI according to MRI findings are inconsistent. In this retrospective study, we evaluated the therapeutic response of CIESI according to pain sites, durations, MRI findings, and other predictive factors altogether, unlike previous studies, which evaluated them separately. Methods The medical records of 128 patients who received fluoroscopy guided CIESI were analyzed. We evaluated the therapeutic response (more than a 50% reduction on the visual analog scale [VAS] by their second visit) after CIESI by (1) pain site; neck pain without radicular pain/radicular pain with or without neck pain, (2) pain duration; acute/chronic (more than 6 month), and (3) findings of MRI; herniated intervertebral disc (HIVD)/spinal stenosis, respectively and altogether. Results Eighty-eight patients (68%) responded to CIESI, and there were no significant differences in demographic data, initial VAS score, or laboratory findings. And there were no significant differences in the response rate relating to pain site, pain duration, or MRI findings, respectively. In additional analysis, acute radicular pain with HIVD patients showed significantly better response than chronic neck pain with spinal stenosis (P = 0.04). Conclusions We cannot find any sole predictive factor of therapeutic response to the CIESI. But the patients having acute radicular pain with HIVD showed the best response, and those having other chronic neck pain showed the worst response to CIESI. PMID:27103964

  3. Inhaled Steroids

    MedlinePlus

    ... potential for side effects than steroid pills or syrups. There have been concerns regarding the possibility of ... treatment. Learn about oral steroids (steroid pills and syrups), and more about steroid side effects. What are ...

  4. Intralesional Bleomycin as an Adjunct Therapeutic Modality in Eyelid and Extraocular Malignancies and Tumors

    PubMed Central

    Meyer, David; Gooding, Caroline

    2015-01-01

    To present our recent experience with intralesional bleomycin (IBI) in nonmelanoma extraocular tumors, and present previous experience on periocular capillary hemangiomas and orbital lymphangiomas in a tertiary referral hospital. This was a retrospective descriptive study of patients with eyelid and extraocular malignancies where conventional therapies failed, or surgery was contraindicated or refused and were offered IBI as an alternate therapy. All patients were recruited from the Oculoplastics Clinic at Tygerberg Academic Hospital, Cape Town, South Africa. A solution containing 1 international unit of bleomycin per milliliter saline was injected intralesionally together with 2% lignocaine in a ratio of 4:1. The injected volume was calculated to be equivalent to the estimated volume of the lesion. A multipuncture technique with a 29-gauge needle was used. Patients requiring retreatment were injected every 4–8 weeks until satisfactory clinical endpoints were achieved. Our previous experience with IBI in extensive capillary hemangiomas and orbital lymphangiomas is reviewed. Cases are presented to illustrate that IBI induced significant regression and reduction in tumor size and marked clinical improvement of the eyelid and orbital basal cell carcinomas, Kaposi sarcoma, and mycosis fungoides. The improvements obviated the need for further surgical intervention in most cases. Based on clinical experience we propose that IBI should be considered a treatment modality in select cases of the malignant eyelid and ophthalmic vascular tumors where the conventional standard of care is not possible. IBI is a reasonable alternative or adjunct to consider in such cases. PMID:26692709

  5. Intralesional immunotherapy for difficult to treat warts with Mycobacterium w vaccine

    PubMed Central

    Garg, Shilpa; Baveja, Sukriti

    2014-01-01

    Background: Immunotherapy is an evolving therapeutic modality for the treatment of warts. We conducted a study to assess the efficacy and safety of intralesional Mycobacterium w vaccine for the treatment of warts at sites that were difficult to treat. Materials and Methods: Thirty patients with at least one wart present on either the plantar surface of their feet, palms, volar aspect of their fingers, or periungual or subungual region, were treated with 0.1 ml of killed Mycobacterium w vaccine given intralesionally in a single wart, without any prior sensitisation dose. Thereafter, a single injection of 0.1 ml of vaccine was given at intervals of four weeks in a single wart till there was complete resolution of the warts or a maximum of 10 injections. Treatment was stopped if there was no response after three injections. The patients were followed up for at least six months. Results: Out of the 30 patients, 28 (93.33%) patients had complete resolution of their warts, both at the injected and distant sites. The mean (SD) time for complete clearance of warts was 43.71(32.82) days and the mean (SD) dose of vaccine that was required for complete clearance of warts was 0.186 ml (0.101). Four patients (14.28%) had a recurrence of warts. The treatment was well-tolerated and the side effects were reversible in the majority of the patients. Conclusion: In comparison to the earlier studies using Mycobacterium w vaccine for the treatment of warts, our study was different in the following aspects: No sensitisation dose was given, only a single wart was injected at a time and the duration between the period of injections was increased to four weeks. With all these changes we eliminated the complications due to the sensitisation dose and achieved good results. This study provides new insight into the dose and schedule of treatment of this evolving therapeutic modality. PMID:25722598

  6. Efficacy of Holmium Laser Urethrotomy in Combination with Intralesional Triamcinolone in the Treatment of Anterior Urethral Stricture

    PubMed Central

    Kapoor, Ankur; Ganesamoni, Raguram; Nanjappa, Bhuvanesh; Sharma, Varun; Mete, Uttam K

    2012-01-01

    Purpose To evaluate the outcome of visual internal urethrotomy with a holmium:yttrium-aluminum-garnet laser along with intralesional triamcinolone injection. Materials and Methods Patients with an anterior urethral stricture less than 3 cm in length were evaluated by clinical history, physical examination, uroflowmetry, and retrograde urethrogram preoperatively. All patients were treated with holmium laser urethrotomy and intralesional triamcinolone (80 mg) injection under general or regional anesthesia. An 18 F urethral catheter was placed for 5 days. All patients were followed up for 12 months postoperatively by history, uroflowmetry, and if required, retrograde urethrogram or urethroscopy every 3 months. Results The mean age of the patients was 42.9 years (range, 14 to 70 years). The overall recurrence rate was 24%. The success rate in patients with strictures less than 1 cm in length was 95.8%, whereas that in patients with strictures of 1 to 3 cm in length was 57.7% (p=0.002). The outcome did not depend on age, duration of symptoms, etiology, or location of stricture. Conclusions Holmium laser urethrotomy with intralesional triamcinolone is a safe and effective minimally invasive therapeutic modality for urethral strictures. This procedure has an encouraging success rate, especially in those with stricture segments of less than 1 cm in length. PMID:23060998

  7. Usefulness of a Hanging Position With Internal Rotation of Shoulder in Ultrasonography-Guided Intra-articular Steroid Injection for Adhesive Capsulitis

    PubMed Central

    2016-01-01

    Objective To evaluate the feasibility of a new position (internal rotation in hanging) in ultrasonography, we compared the length of the glenohumeral joint space and the effectiveness of steroid injection with the hanging position and with the commonly used abdomen or cross position. Methods A prospective, randomized controlled trial was performed in 42 patients with adhesive capsulitis of shoulder. We used three arm positions for the posterior approach as follows: the patient's palm on thigh, other hand on abdomen (abdomen position); hand on patient's opposite shoulder (cross position); arm in hanging position with internal rotation of shoulder (hanging position). The order of shoulder position was randomized and blinded. Real-time ultrasonography-guided intra-articular steroid injection was performed by posterior approach at the first position in each patient. The Brief Pain Inventory (BPI), the Shoulder Pain and Disability Index (SPADI), and range of motion (ROM) were measured before steroid injection and 2 weeks after injection. Results The lengths of the joint space were 2.88±0.75, 2.93±0.89, and 2.82±0.79 mm in abdomen, cross, and hanging position respectively, with no significant difference among the three positions (p=0.429). Treatment efficacy was significantly improved in ROM, total BPI, and SPADI in all three positions (p<0.001). The changes in ROM for shoulder abduction were 23.6°±19.7°, 22.2°±20.9°, and 10.0°±7.8° in abdomen, cross, and hanging position, respectively. Changes in total BPI scores were 25.1±15.7, 23.6.±18.0, 11.6±6.1, and changes in total SPADI score were 35.0±14.2, 30.9±28.9, and 16.5±10.3 in abdomen, cross, and hanging position, respectively. There were no significant difference among the three positions for all parameters (p=0.194, p=0.121, and p=0.108, respectively. Conclusion For patients with adhesive capsulitis who cannot achieve or maintain abdomen or cross position, scanning and injection with the shoulder in

  8. Randomized, double-blind, comparative-effectiveness study comparing pulsed radiofrequency to steroid injections for occipital neuralgia or migraine with occipital nerve tenderness.

    PubMed

    Cohen, Steven P; Peterlin, B Lee; Fulton, Larry; Neely, Edward T; Kurihara, Connie; Gupta, Anita; Mali, Jimmy; Fu, Diana C; Jacobs, Michael B; Plunkett, Anthony R; Verdun, Aubrey J; Stojanovic, Milan P; Hanling, Steven; Constantinescu, Octav; White, Ronald L; McLean, Brian C; Pasquina, Paul F; Zhao, Zirong

    2015-12-01

    Occipital neuralgia (ON) is characterized by lancinating pain and tenderness overlying the occipital nerves. Both steroid injections and pulsed radiofrequency (PRF) are used to treat ON, but few clinical trials have evaluated efficacy, and no study has compared treatments. We performed a multicenter, randomized, double-blind, comparative-effectiveness study in 81 participants with ON or migraine with occipital nerve tenderness whose aim was to determine which treatment is superior. Forty-two participants were randomized to receive local anesthetic and saline, and three 120 second cycles of PRF per targeted nerve, and 39 were randomized to receive local anesthetic mixed with deposteroid and 3 rounds of sham PRF. Patients, treating physicians, and evaluators were blinded to interventions. The PRF group experienced a greater reduction in the primary outcome measure, average occipital pain at 6 weeks (mean change from baseline -2.743 ± 2.487 vs -1.377 ± 1.970; P < 0.001), than the steroid group, which persisted through the 6-month follow-up. Comparable benefits favoring PRF were obtained for worst occipital pain through 3 months (mean change from baseline -1.925 ± 3.204 vs -0.541 ± 2.644; P = 0.043), and average overall headache pain through 6 weeks (mean change from baseline -2.738 ± 2.753 vs -1.120 ± 2.1; P = 0.037). Adverse events were similar between groups, and few significant differences were noted for nonpain outcomes. We conclude that although PRF can provide greater pain relief for ON and migraine with occipital nerve tenderness than steroid injections, the superior analgesia may not be accompanied by comparable improvement on other outcome measures. PMID:26447705

  9. Randomized, double-blind, comparative-effectiveness study comparing pulsed radiofrequency to steroid injections for occipital neuralgia or migraine with occipital nerve tenderness

    PubMed Central

    Cohen, Steven P.; Peterlin, B. Lee; Fulton, Larry; Neely, Edward T.; Kurihara, Connie; Gupta, Anita; Mali, Jimmy; Fu, Diana C.; Jacobs, Michael B.; Plunkett, Anthony R.; Verdun, Aubrey J.; Stojanovic, Milan P.; Hanling, Steven; Constantinescu, Octav; White, Ronald L.; McLean, Brian C.; Pasquina, Paul F.; Zhao, Zirong

    2015-01-01

    Occipital neuralgia (ON) is characterized by lancinating pain and tenderness overlying the occipital nerves. Both steroid injections and pulsed radiofrequency (PRF) are used to treat ON, but few clinical trials have evaluated efficacy, and no study has compared treatments. We performed a multicenter, randomized, double-blind, comparative-effectiveness study in 81 participants with ON or migraine with occipital nerve tenderness whose aim was to determine which treatment is superior. Forty-two participants were randomized to receive local anesthetic and saline, and three 120 second cycles of PRF per targeted nerve, and 39 were randomized to receive local anesthetic mixed with deposteroid and 3 rounds of sham PRF. Patients, treating physicians, and evaluators were blinded to interventions. The PRF group experienced a greater reduction in the primary outcome measure, average occipital pain at 6 weeks (mean change from baseline −2.743 ± 2.487 vs −1.377 ± 1.970; P <0.001), than the steroid group, which persisted through the 6-month follow-up. Comparable benefits favoring PRF were obtained for worst occipital pain through 3 months (mean change from baseline−1.925 ± 3.204 vs−0.541 ± 2.644; P = 0.043), and average overall headache pain through 6 weeks (mean change from baseline −2.738 ± 2.753 vs −1.120 ± 2.1; P = 0.037). Adverse events were similar between groups, and few significant differences were noted for nonpain outcomes. We conclude that although PRF can provide greater pain relief for ON and migraine with occipital nerve tenderness than steroid injections, the superior analgesia may not be accompanied by comparable improvement on other outcome measures. PMID:26447705

  10. Efficacy of Topical Liposomal Amphotericin B versus Intralesional Meglumine Antimoniate (Glucantime) in the Treatment of Cutaneous Leishmaniasis

    PubMed Central

    Layegh, Pouran; Rajabi, Omid; Jafari, Mahmoud Reza; Emamgholi Tabar Malekshah, Parisa; Moghiman, Toktam; Ashraf, Hami; Salari, Roshanak

    2011-01-01

    Background. Topical treatment of cutaneous leishmaniasis is an attractive alternative avoiding toxicities of parenteral therapy while being administered through a simple painless route. Recently liposomal formulations of amphotericin B have been increasingly used in the treatment of several types of leishmaniasis. Aims. The efficacy of a topical liposomal amphotericin B formulation was compared with intralesional glucantime in the treatment of cutaneous leishmaniasis. Methods. From 110 patients, the randomly selected 50 received a topical liposomal formulation of amphotericin B into each lesion, 3–7 drops twice daily, according to the lesion's size and for 8 weeks. The other group of 60 patients received intralesional glucantime injection of 1-2 mL once a week for the same period. The clinical responses and side effects of both groups were evaluated weekly during the treatment course. Results. Per-protocol analysis showed no statistically significant difference between the two groups (P = 0.317, 95% confidence interval (CI) = 1.610 (0.632–4.101)). Moreover, after intention-to-treat analysis, the same results were seen (P = 0.650, 95% CI = 0.1.91 (0.560–2.530)). Serious post treatment side effects were not observed in either group. Conclusions. Topical liposomal amphotericin B has the same efficacy as intralesional glucantime in the treatment of cutaneous leishmaniasis. PMID:22174993

  11. Analysis of Efficacy Differences between Caudal and Lumbar Interlaminar Epidural Injections in Chronic Lumbar Axial Discogenic Pain: Local Anesthetic Alone vs. Local Combined with Steroids

    PubMed Central

    Manchikanti, Laxmaiah; Pampati, Vidyasagar; Benyamin, Ramsin M.; Boswell, Mark V.

    2015-01-01

    Study Design: Comparative assessment of randomized controlled trials of caudal and lumbar interlaminar epidural injections in chronic lumbar discogenic pain. Objective: To assess the comparative efficacy of caudal and lumbar interlaminar approaches of epidural injections in managing axial or discogenic low back pain. Summary of Background Data: Epidural injections are commonly performed utilizing either a caudal or lumbar interlaminar approach to treat chronic lumbar axial or discogenic pain, which is pain exclusive of that associated with a herniated intervertebral disc, or that is due to degeneration of the zygapophyseal joints, or due to dysfunction of the sacroiliac joints, respectively. The literature on the efficacy of epidural injections in managing chronic axial lumbar pain of presumed discogenic origin is limited. Methods: The present analysis is based on 2 randomized controlled trials of chronic axial low back pain not caused by disc herniation, radiculitis, or facet joint pain, utilizing either a caudal or lumbar interlaminar approach, with a total of 240 patients studied, and a 24-month follow-up. Patients were assigned to receive either local anesthetic only or local anesthetic with a steroid in each 60 patient group. Results: The primary outcome measure was significant improvement, defined as pain relief and functional status improvement of at least 50% from baseline, which was reported at 24-month follow-ups in 72% who received local anesthetic only with a lumbar interlaminar approach and 54% who received local anesthetic only with a caudal approach. In patients receiving local anesthetic with a steroid, the response rate was 67% for those who had a lumbar interlaminar approach and 68% for those who had a caudal approach at 12 months. The response was significantly better in the lumbar interlaminar group who received local anesthetic only, 77% versus 56% at 12 months and 72% versus 54% at 24 months. Conclusion: This assessment shows that in patients

  12. Formation of steroids by the pregnant mare. VI. Metabolism of [14C]farnesyl pyrophosphate and [3H]dehydroepiandrosterone injected into the fetus.

    PubMed

    Bhavnani, B R; Woolever, C A

    1978-12-01

    A mixture of [4,8,12-14C]farnesyl pyrophosphate and [3H]dehydroepiandrosterone was injected into a horse fetus im during laparotomy, after which maternal urine was collected for 6 days. Steroid conjugates in the urine were extracted with Amberlite XAD-2 resin, hydrolyzed, and separated into phenolic and neutral fractions. Estrone, 17 alpha-estradiol, equilin [3-hydroxy-1,3,5(10),7-estratetraen-17-one], and 17 alpha-dihydroequilin [1,3,4(10),7-estratetraene-3,17 alpha-diol] were isolated from the phenolic fraction and their radiochemical purities were established. Only estrone and 17 alpha-estradiol contained both 3H and 14C, while the B ring unsaturated estrogens, equilin and 17 alpha-dihydroequilin, contained only 14C. From the neutral fraction, 14C-labeled 3 beta-hydroxy-5 alpha-pregnan-20-one, 5 alpha-pregnane-3 beta-20 beta-diol, and 5 alpha-pregnane-3 beta, 20 alpha-diol were isolated. These results together with our previous findings demonstrate that the route of biosynthesis of both the ring B saturated and unsaturated estrogens is the same up to the stage of farnesyl pyrophosphate. Thus, the bifurcation in the classical pathway of steroid biosynthesis is occurring at a point after the formation of farnesyl pyrophosphate and before the formation of squalene and cholesterol. PMID:155006

  13. Formation of steroids by the pregnant mare. V. Metabolism of 14C-isopentenylpyrophosphate and 3H-dehydroisoandrosterone injected into the fetus.

    PubMed

    Bhavnani, B R; Martin, L J; Baker, R D

    1975-04-01

    A mixture of 1-14C-isopentenylpyrophosphate and 3H-dehydroisoandrosterone was injected into a horse fetus intramuscularly during laparotomy, after which maternal urine was collected for 4 days. Steroid conjugates in the urine were extracted with Amberlite XAD-2 resin, hydrolysed and separated into phenolic and neutral fractions. From the phenolic fraction estrone, 17alpha-estradiol, equilin and equilenin were isolated. Only estrone and 17alpha-estradiol contained both 3H and 14C, while the ring B unsaturated estrogens contained only 14C. From the neutral fraction 14C-labeled 3beta-hydroxy-5alpha-pregnan-20-one, 5alpha-pregnane-3beta,20beta-diol and 5alpha-pregnan-3beta, 20alpha-diol were isolated. These results demonstrate that the route of biosynthesis of both the ring B saturated and unsaturated estrogens is the same up to the stage of isopentenylpyrophosphate. Thus, the bifurcation in the classical pathway of steroid biosynthesis reported previously by us is occurring at a point after the formation of isopentenylpyrophosphate and prior to the formation of squalene. PMID:164338

  14. Separation and online preconcentration by multistep stacking with large-volume injection of anabolic steroids by capillary electrokinetic chromatography using charged cyclodextrins and UV-absorption detection.

    PubMed

    Urban, Pawel L; García-Ruiz, Carmen; García, M Angeles; Marina, M Luisa

    2005-11-01

    The separation of three common anabolic steroids (methyltestosterone, methandrostenolone and testosterone) was performed for the first time by capillary EKC. Different charged CD derivatives and bile salts were tested as dispersed phases in order to achieve the separation. A mixture of 10 mmol/L succinylated-beta-CD with 1 mmol/L beta-CD in a 50 mmol/L borate buffer (pH 9) enabled the separation of the three anabolic steroids in less than 9 min. Concentration LODs, obtained for these compounds with low absorption of UV light, were approximately 5 x 10(-5) mol/L. The use of online reverse migrating sample stacking with large-volume injection (the effective length of the capillary) enabled to improve the detection sensitivity. Sensitivity enhancement factors (SEFs) ranging from 95 (for testosterone) to 149 (for methyltestosterone) were achieved by single stacking preconcentration. Then, the possibilities of multistep stacking to improve the sensitivity for these analytes were investigated. SEFs obtained by double stacking preconcentration ranged from 138 to 185, enabling concentration LODs of 2.79 x 10(-7) mol/L (for methyltestosterone), 3.47 x 10(-7) mol/L (for testosterone) and 3.56 x 10(-7) mol/L (for methandrostenolone). Although online triple stacking preconcentration was achieved, its repeatability was very poor and SEFs for the studied analytes were not calculated. PMID:16318218

  15. Efficacy of Intralesional Amphotericin B for the Treatment of Cutaneous Leishmaniasis

    PubMed Central

    Goyonlo, Vahid Mashayekhi; Vosoughi, Elham; Kiafar, Bita; Nahidi, Yalda; Momenzadeh, Akram; Taheri, Ahmad Reza

    2014-01-01

    Background: Antimoniate compounds have been used as gold standard treatment for cutaneous leishmaniasis since many years ago, but with increase in incidence of drug as well as individual contraindications, more attention has been given to alternative treatments. Aim: The aim of this study was to evaluate the efficacy of intralesional amphotericin B as an alternative treatment for cutaneous leishmaniasis in Mashhad, Iran, during 2007-2009. Materials and Methods: Non-random sampling from both sexes and without any age limitation of cases eligible for this alternative treatment was done. Size and induration of lesions were measured before beginning and weakly during the treatment. Amphotericin B (2 mg/ml) was injected into lesions weekly for up to 12 weeks and the cases were followed up for the treatment responses, possible side effects and recurrence of the disease. Results: A total of 93 patients with a mean age of 20.81 ± 15.26 years were included in this study. At the end of 12th week, 61.4% of the patients were recovered completely (more than 90% reduction in size and induration), 21.6% had partial remission (60-90% reduction in size and induration), and 17% had less than 60% reduction in size and induration of skin lesions. Injection side effects were insignificant and did not lead to premature discontinuation of treatment in any patients. Conclusion: Weekly intralesional injection of amphotericin B looks promising, considering the fact that most of the patients in this study were resistant to antimoniates. PMID:25484415

  16. Ultrasound versus fluoroscopy-guided caudal epidural steroid injection for the treatment of chronic low back pain with radiculopathy: A randomised, controlled clinical trial

    PubMed Central

    Hazra, Arindam Kumar; Bhattacharya, Dipasri; Mukherjee, Sayantan; Ghosh, Santanu; Mitra, Manasij; Mandal, Mohanchandra

    2016-01-01

    Background and Aims: Caudal epidural steroid administration is an effective treatment for chronic low back pain (LBP). Fluoroscopy guidance is the gold standard for pain procedures. Ultrasound guidance is recently being used in pain clinic procedures. We compared the fluoroscopy guidance and ultrasound guidance for caudal epidural steroid injection with respect to the time needed for correct placement of the needle and clinical effectiveness in patients with chronic LBP. Methods: Fifty patients with chronic LBP with radiculopathy, not responding to conventional medical management, were randomly allocated to receive injection depot methyl prednisolone (40 mg) through caudal route either using ultrasound guidance (Group U, n = 25) or fluoroscopy guidance (Group F, n = 25). Pre-procedural visual analogue scale (VAS) score and Oswestry Disability Index (ODI) were noted. During the procedure, the time needed for correct placement of needle was observed. Adverse events, if any, were also noted. All patients were followed up for next 2 months to evaluate Visual Analogue Scale (VAS) score and ODI at the 2nd week and again at the end of 1st and 2nd month. Results: The needle-placement time was less using ultrasound guidance as compared to fluoroscopy guidance (119 ± 7.66 vs. 222.28 ± 29.65 s, respectively, P < 0.001). Significant reduction in VAS score and ODI (clinical improvement) was noted in the follow-up time points and comparable between the groups at all time points. Conclusion: Ultrasound guidance can be a safe alternative tool for achieving faster needle placement in caudal epidural space. Clinical effectiveness (reduction of VAS and ODI scores) remains comparable between both the techniques. PMID:27330199

  17. Epidural injection with or without steroid in managing chronic low back and lower extremity pain: ameta-analysis of ten randomized controlled trials

    PubMed Central

    Zhai, Jinshuai; Zhang, Long; Li, Mengya; Tian, Yiren; Zheng, Wang; Chen, Jia; Huang, Teng; Li, Xicheng; Tian, Zhi

    2015-01-01

    Background: Chronic low back and lower extremity pain is mainly caused by lumbar disc herniation (LDH) and radiculitis. Various surgery and nonsurgical modalities, including epidural injections, have been used to treat LDH or radiculitis. Therefore, we conducted this meta-analysis to assess the effects of the two interventions in managing various chronic low and lower extremity pain. Methods: A systematic literature search was conducted to identify randomized controlled trials (RCTs) which compared the effect of local anesthetic with or without steroids. The outcomes included pain relief, functional improvement, opioid intake, and therapeutic procedural characteristics. Pooled estimates were calculated using a random-effects or fixed-effects model, depending on the heterogeneity between the included studies. Results: 10 RCTs (involving 1111 patients) were included in this meta-analysis. The pooled results showed that 41.7% of patients who received local anesthetic with steroid (group 1) and 40.2% of patients who received local anesthetic alone (group 2) had significant improvement in pain relief. And the Numeric Rating Scale pain scales were significantly reduced by 4.09 scores (95% CI: -4.26, -3.91), and 4.12 (95% CI: -4.35, -3.89) scores, respectively. Similarly, 39.8% of patients in group 1 and 40.7% of patients in group 2 achieved significantly improved functional status. The Oswestry Disability Index in the two groups were reduced by 14.5 (95% CI: -15.24, -13.75) and 12.37 (95% CI: -16.13, -8.62), respectively. The average procedures per year in group 1 was 3.68 ± 1.17 and 3.68 ± 1.26 in group 2 with an average total relief per year of 31.67 ± 13.17 weeks and 32.64 ± 13.92 weeks, respectively. The opioid intake decreased from baseline by 8.81 mg (95% CI: -12.24, -5.38) and 16.92 mg (95% CI: -22.71, -11.12) in the two groups, respectively. Conclusion: This meta-analysis confirms that epidural injections of local anesthetic with or without steroids have

  18. Exuberant local tissue reaction to intramuscular injection of nandrolone decanoate (Deca-Durabolin)--a steroid compound in a sesame seed oil base--mimicking soft tissue malignant tumors: a case report and review of the literature.

    PubMed

    Khankhanian, N K; Hammers, Y A; Kowalski, P

    1992-12-01

    We present an unusual pseudotumor that formed in reaction to self-administered intramuscular injections of an anabolic steroid, nandrolone decanoate (Deca-Durabolin) in a young soldier. The histopathologic features which closely mimicked several malignant neoplasms could have led to an incorrect diagnosis of malignancy and unnecessary extensive surgery. To our knowledge, this phenomenon has not been previously reported. PMID:1470383

  19. Intralesional Sclerotherapy - A Novel Approach for The Treatment of Intraoral Haemangiomas

    PubMed Central

    Reddy, G.Siva Prasad; Reddy, G. Venkateshwara; Priyadarshini, B. Srilatha; Sree, P. Karuna

    2016-01-01

    In infancy and childhood haemangiomas are the most common neoplasms in head and neck region with an occurrence of about 60%. Approximately 40%-50% of all haemangiomas resolve incompletely, leaving permanent changes in the skin, such as telangiectases, epidermal atrophy, hypopigmentation or redundant skin with fibro-fatty residue but a few stubborn, problematic haemangiomas may result in serious disfigurement and dysfunction, and even become life-threatening. Most haemangiomas are managed by conservative methods that include corticosteroids (either systemic or local injection), sclerotherapy, interferon-alpha, laser therapy, embolization, cryotherapy, and radiation. Due to risk of haemorrhaging, surgical removal for small vascular lesions is not considered and it is more invasive than sclerotherapy. This case report presents the efficacy of intralesional sclerotherapy for the management of haemangiomas on dorsum and lateral border of tongue. PMID:26894188

  20. Intralesional Sclerotherapy - A Novel Approach for The Treatment of Intraoral Haemangiomas.

    PubMed

    Reddy, G Siva Prasad; Reddy, G Venkateshwara; Reddy, K Sravan Kumar; Priyadarshini, B Srilatha; Sree, P Karuna

    2016-01-01

    In infancy and childhood haemangiomas are the most common neoplasms in head and neck region with an occurrence of about 60%. Approximately 40%-50% of all haemangiomas resolve incompletely, leaving permanent changes in the skin, such as telangiectases, epidermal atrophy, hypopigmentation or redundant skin with fibro-fatty residue but a few stubborn, problematic haemangiomas may result in serious disfigurement and dysfunction, and even become life-threatening. Most haemangiomas are managed by conservative methods that include corticosteroids (either systemic or local injection), sclerotherapy, interferon-alpha, laser therapy, embolization, cryotherapy, and radiation. Due to risk of haemorrhaging, surgical removal for small vascular lesions is not considered and it is more invasive than sclerotherapy. This case report presents the efficacy of intralesional sclerotherapy for the management of haemangiomas on dorsum and lateral border of tongue. PMID:26894188

  1. A technique for periorbital syringomas: intralesional radiofrequency ablation

    PubMed Central

    Huang, Li-Ping; Zhang, Leng; Wang, Xing-Lin; Liu, Xiao-Cui; Jiang, Tian-Yu; Lin, Bi-Weng

    2012-01-01

    AIM To evaluate the efficacy of intralesional radiofrequency ablation in the treatment of periorbital syringomas. METHODS We tried the intralesional radiofrequency ablation for 64 patients with periorbital syringomas from 2007 to 2011. The operation was performed under 2.5 loupe magnifications. The handpiece was assembled with a needle electrode and connected to the radiofrequency ablation apparatus. The electrode was then inserted into the target lesions in dermis and delivering injury to the base of these tumors. Results were assessed clinically by comparing pre- and post-treatment photographs and patient satisfaction rates. RESULTS Clinical improvement increased with each subsequent treatment session. The percent of patients whose clinic improvement grade were≥3 after each session was respectively 71.9%(Session1), 83.3%(Session2), and 100%(Session3). The statistical results indicated the concordance of the clinical assessment and the satisfaction level of patients (kappa=0.78 of the session1; kappa=0.82 of the session2). The majority of patients had good or excellent cosmetic results. Postoperatively, there were no permanent side effects or recurrences. CONCLUSION As a new technique of minimally invasion, the intralesional radiofrequency ablation was found to be an effective, inexpensive, highly precise and safe way of treating periorbital syringomas. PMID:22762046

  2. Comparison of the efficacy of saline, local anesthetics, and steroids in epidural and facet joint injections for the management of spinal pain: A systematic review of randomized controlled trials

    PubMed Central

    Manchikanti, Laxmaiah; Nampiaparampil, Devi E.; Manchikanti, Kavita N.; Falco, Frank J.E.; Singh, Vijay; Benyamin, Ramsin M.; Kaye, Alan D.; Sehgal, Nalini; Soin, Amol; Simopoulos, Thomas T.; Bakshi, Sanjay; Gharibo, Christopher G.; Gilligan, Christopher J.; Hirsch, Joshua A.

    2015-01-01

    Background: The efficacy of epidural and facet joint injections has been assessed utilizing multiple solutions including saline, local anesthetic, steroids, and others. The responses to these various solutions have been variable and have not been systematically assessed with long-term follow-ups. Methods: Randomized trials utilizing a true active control design were included. The primary outcome measure was pain relief and the secondary outcome measure was functional improvement. The quality of each individual article was assessed by Cochrane review criteria, as well as the criteria developed by the American Society of Interventional Pain Physicians (ASIPP) for assessing interventional techniques. An evidence analysis was conducted based on the qualitative level of evidence (Level I to IV). Results: A total of 31 trials met the inclusion criteria. There was Level I evidence that local anesthetic with steroids was effective in managing chronic spinal pain based on multiple high-quality randomized controlled trials. The evidence also showed that local anesthetic with steroids and local anesthetic alone were equally effective except in disc herniation, where the superiority of local anesthetic with steroids was demonstrated over local anesthetic alone. Conclusion: This systematic review showed equal efficacy for local anesthetic with steroids and local anesthetic alone in multiple spinal conditions except for disc herniation where the superiority of local anesthetic with steroids was seen over local anesthetic alone. PMID:26005584

  3. The Effectiveness of Transforaminal Versus Caudal Routes for Epidural Steroid Injections in Managing Lumbosacral Radicular Pain: A Systematic Review and Meta-Analysis.

    PubMed

    Liu, Jun; Zhou, Hengxing; Lu, Lu; Li, Xueying; Jia, Jun; Shi, Zhongju; Yao, Xue; Wu, Qiuli; Feng, Shiqing

    2016-05-01

    Epidural steroid injection (ESI) is one of the most commonly used treatments for radiculopathy. Previous studies have described the effectiveness of ESI in the management of radiculopathy. However, controversy exists regarding the route that is most beneficial and effective with respect to the administration of epidural steroids, as both transforaminal (TF) and caudal (C) routes are commonly used.This analysis reviewed studies comparing the effectiveness of TF-ESIs with that of C-ESIs in the treatment of radiculopathy as a means of providing pain relief and improving functionality. This meta-analysis was performed to guide clinical decision-making.The study was a systematic review of comparative studies.A systematic literature search was performed using the PubMed, EMBASE, and Cochrane Library databases for trials written in English. The randomized trials and observational studies that met our inclusion criteria were subsequently included. Two reviewers, respectively, extracted data and estimated the risk of bias. All statistical analyses were performed using Review Manager 5.3.Six prospective and 2 retrospective studies involving 664 patients were included. Statistical analysis was performed utilizing only the 6 prospective studies. Although slight pain and functional improvements were noted in the TF-ESI groups compared with the C-ESI groups, these improvements were neither clinically nor statistically significant.The limitations of this meta-analysis resulted primarily from the weaknesses of the comparative studies and the relative paucity of patients included in each study.Both the TF and C approaches are effective in reducing pain and improving functional scores, and they demonstrated similar efficacies in the management of lumbosacral radicular pain. PMID:27149443

  4. Estimated deaths and illnesses averted during fungal meningitis outbreak associated with contaminated steroid injections, United States, 2012-2013.

    PubMed

    Smith, Rachel M; Derado, Gordana; Wise, Matthew; Harris, Julie R; Chiller, Tom; Meltzer, Martin I; Park, Benjamin J

    2015-06-01

    During 2012-2013, the US Centers for Disease Control and Prevention and partners responded to a multistate outbreak of fungal infections linked to methylprednisolone acetate (MPA) injections produced by a compounding pharmacy. We evaluated the effects of public health actions on the scope of this outbreak. A comparison of 60-day case-fatality rates and clinical characteristics of patients given a diagnosis on or before October 4, the date the outbreak was widely publicized, with those of patients given a diagnosis after October 4 showed that an estimated 3,150 MPA injections, 153 cases of meningitis or stroke, and 124 deaths were averted. Compared with diagnosis after October 4, diagnosis on or before October 4 was significantly associated with a higher 60-day case-fatality rate (28% vs. 5%; p<0.0001). Aggressive public health action resulted in a substantially reduced estimated number of persons affected by this outbreak and improved survival of affected patients. PMID:25989264

  5. Estimated Deaths and Illnesses Averted During Fungal Meningitis Outbreak Associated with Contaminated Steroid Injections, United States, 2012–2013

    PubMed Central

    Derado, Gordana; Wise, Matthew; Harris, Julie R.; Chiller, Tom; Meltzer, Martin I.; Park, Benjamin J.

    2015-01-01

    During 2012–2013, the US Centers for Disease Control and Prevention and partners responded to a multistate outbreak of fungal infections linked to methylprednisolone acetate (MPA) injections produced by a compounding pharmacy. We evaluated the effects of public health actions on the scope of this outbreak. A comparison of 60-day case-fatality rates and clinical characteristics of patients given a diagnosis on or before October 4, the date the outbreak was widely publicized, with those of patients given a diagnosis after October 4 showed that an estimated 3,150 MPA injections, 153 cases of meningitis or stroke, and 124 deaths were averted. Compared with diagnosis after October 4, diagnosis on or before October 4 was significantly associated with a higher 60-day case-fatality rate (28% vs. 5%; p<0.0001). Aggressive public health action resulted in a substantially reduced estimated number of persons affected by this outbreak and improved survival of affected patients. PMID:25989264

  6. Anabolic Steroids

    MedlinePlus

    Anabolic steroids are man-made substances related to male sex hormones. Doctors use anabolic steroids to treat some hormone problems in men, delayed ... some diseases. Bodybuilders and athletes often use anabolic steroids to build muscles and improve athletic performance. Using ...

  7. The potential contributing effect of ketorolac and fluoxetine to a spinal epidural hematoma following a cervical interlaminar epidural steroid injection: a case report and narrative review.

    PubMed

    Chien, George C Chang; McCormick, Zack; Araujo, Marco; Candido, Kenneth D

    2014-01-01

    Cervical interlaminar epidural steroid injections (ESIs) are commonly performed as one part of a multi-modal analgesic regimen in the management of upper extremity radicular pain. Spinal epidural hematoma (SEH) is a rare complication with a reported incidence ranging from 1.38 in 10,000 to 1 in 190,000 epidurals. Current American Society of Regional Anesthesia (ASRA), American Society of Interventional Pain Physicians (ASIPP), and the International Spine Intervention Society (ISIS) recommendations are that non-steroidal anti-inflammatory drugs (NSAIDs) do not need to be withheld prior to epidural anesthesia. We report a case wherein intramuscular ketorolac and oral fluoxetine contributed to a SEH and tetraplegia following a cervical interlaminar (ESI). A 66 year-old woman with chronic renal insufficiency and neck pain radiating into her right upper extremity presented for evaluation and was deemed an appropriate CESI candidate. Cervical magnetic resonance imaging (MRI) revealed multi-level neuroforaminal stenosis and degenerative intervertebral discs. Utilizing a loss of resistance to saline technique, an 18-gauge Tuohy-type needle entered the epidural space at C6-7. After negative aspiration, 4 mL of saline with 80 mg of methyl-prednisolone was injected. Immediately thereafter, the patient reported significant spasmodic-type localized neck pain with no neurologic status changes. A decision was made to administer 30 mg intramuscular ketorolac as treatment for the spasmodic-type pain. En route home, she developed a sudden onset of acute tetraplegia. She was brought to the emergency department for evaluation including platelet and coagulation studies which were normal. MRI demonstrated an epidural hematoma extending from C5 to T7. She underwent a bilateral C5-T6 laminectomy with epidural hematoma evacuation and was discharged to an acute inpatient rehabilitation hospital. Chronic renal insufficiency, spinal stenosis, female gender, and increasing age have been

  8. Steroidal Saponins

    NASA Astrophysics Data System (ADS)

    Sahu, N. P.; Banerjee, S.; Mondal, N. B.; Mandal, D.

    The medicinal activities of plants are generally due to the secondary metabolites (1) which often occur as glycosides of steroids, terpenoids, phenols etc. Saponins are a group of naturally occurring plant glycosides, characterized by their strong foam-forming properties in aqueous solution. The cardiac glycosides also possess this, property but are classified separately because of their specific biological activity. Unlike the cardiac glycosides, saponins generally do not affect the heart. These are classified as steroid or triterpenoid saponins depending on the nature of the aglycone. Steroidal glycosides are naturally occurring sugar conjugates of C27 steroidal compounds. The aglycone of a steroid saponin is usually a spirostanol or a furostanol. The glycone parts of these compounds are mostly oligosaccharides, arranged either in a linear or branched fashion, attached to hydroxyl groups through an acetal linkage (2, 3). Another class of saponins, the basic steroid saponins, contain nitrogen analogues of steroid sapogenins as aglycones.

  9. Ultrasound-guided aspiration and steroid injection of a posterior cruciate ligament ganglion cyst: report of a case.

    PubMed

    Vilella, Giuseppe Maria; Guerrisi, Pietro; Lucignani, Giulia; Pasquali, Gaia; Drudi, Francesco Maria

    2015-09-01

    Ganglion cysts are benign masses that originate from mucinous degeneration of the connective tissues and are quite rare when arising from the knee joint. Symptoms are often represented by pain, joint tenderness, effusion and occasional swelling with a palpable mass in the popliteal region of the knee. Percutaneous aspiration followed by a corticosteroid injection of a ganglion cyst has either a diagnostic or therapeutic meaning and its guidance through ultrasound allows the operator to make more accurate the procedure, ensuring the correct placement of the needle inside the lesion. We report our experience in the treatment of a voluminous ganglion cyst of the posterior cruciate ligament performed through the ultrasound guidance in a symptomatic young patient. PMID:26261469

  10. Percutaneous Adhesiolysis Versus Transforaminal Epidural Steroid Injection for the Treatment of Chronic Radicular Pain Caused by Lumbar Foraminal Spinal Stenosis: A Retrospective Comparative Study

    PubMed Central

    Park, Yongbum; Lee, Woo Yong; Ahn, Jae Ki; Nam, Hee-Seung

    2015-01-01

    Objective To investigate the efficacy of percutaneous adhesiolysis (PA) compared to fluoroscopy (FL)-guided transforaminal epidural steroid injection (TFESI) in patients with radicular pain caused by lumbar foraminal spinal stenosis (LFSS) by assessing pain relief and functional improvement at 4 and 12 weeks post-procedure. Methods This retrospective study included 45 patients who underwent PA or FL-guided TFSEI for radicular pain caused by LFSS of at least 3 months' duration. Outcomes were assessed with the Oswestry Disability Index (ODI) and Verbal Numeric Pain Scale (VNS) before the procedure and at 4 and 12 weeks post-procedure. A successful outcome was defined by >50% improvement in the VNS score and >40% improvement in the ODI score. Results ODI and VNS scores improved 4 and 12 weeks post-procedure in both groups. Statistically significant differences between groups were observed in ODI and VNS at 12 weeks (p<0.05). The proportion of patients with successful outcomes was significantly different between the two groups only at the 12-week time point. Conclusion Our study suggests that PA is effective for pain reduction and functional improvement in patients with chronic radicular pain caused by LFSS. Therefore, PA can be considered for patients with previous ineffective responses to conservative treatment. Although PA seems to be more effective than TFEFI according to the results of our study, in order to fully elucidate the difference in effectiveness, a prospective study with a larger sample size is necessary. PMID:26798608

  11. Mitoxantrone Injection

    MedlinePlus

    ... of disability in patients with certain forms of multiple sclerosis (MS). Mitoxantrone injection is also used together with steroid ... a class of medications called anthracenediones. Mitoxantrone treats MS by stopping certain cells of the immune system ...

  12. Steroid osteopathy

    SciTech Connect

    Conway, J.J.; Weiss, S.C.

    1984-01-01

    Patients receiving steroids or having disease processes which increase natural steroid production often demonstrate ''the classic x-ray changes'' of avascular necrosis of bone. Bone scintigraphy in these patients most frequently demonstrates an increased radionuclide localization. The literature suggests that the increased activity is related to healing of the avascular process. In a recent study of Legg-Calve-Perthes Disease (LCPD), 37 of the children had multiple studies and increased activity within the epiphysis during revascularization was extremely rare. Not only are the scintigraphic findings in steroid osteopathy dissimilar to that in healing LCPD, but the time interval for healing is much to short for that of a vascular necrosis and no patients demonstrated an avascular phase on bone scintigraphy. Of 15 children with renal transplants on steroid therapy, 9 demonstrated x-ray and clinical findings of osteopathy. In 8 of 9 instances, bone scintigraphy showed increased localization of radionuclide in the affected bone. Improvement or a return to normal occurred in those patients in whom steroids were discontinued. The following is a proposed mechanism for steroid osteopathy. Steroids affect the osteoblastic and osteoclastic activity of bone and weaken its internal structure. Ordinary stress produces microtrabecular fractures. Fractures characteristically stimulate reactive hyperemia and increase bone metabolism. The result is increased bone radiopharmaceutical localization. The importance of recognizing this concept is that steroid osteopathy is preventable by reducing the administered steroid dose. As opposed to avascular necrosis, bone changes are reversible.

  13. Combined excision and intralesional bevacizumab for sebaceous carcinoma of the eyelid in an Amur tiger (Panthera tigris altaica).

    PubMed

    Edelmann, Michele L; Utter, Mary L; Klein, Lin V; Wotman, Kathryn L

    2013-05-01

    An 18-year-old zoo-kept female Amur tiger presented with an approximately 5 mm diameter lateral canthal eyelid mass in the left eye which grossly appeared red and irregular. The mass was completely excised via lateral canthoplasty. Histopathologic evaluation was consistent with a diagnosis of sebaceous cell carcinoma, which is a potentially aggressive cutaneous neoplasm. The sebaceous carcinoma recurred within 3 months and slowly increased in size until a second surgical excision was performed 9 months following the first surgery. The second surgical excision was combined with intralesional injection of 10 mg of the antiangiogenic drug bevacizumab. Histology confirmed the diagnosis. The tiger was euthanized 16 months postoperatively for reasons unrelated to, and without recurrence of, the eyelid neoplasm. At postmortem, no gross periocular or metastatic lesions were noted, and histopathology of the lateral canthus provided no evidence of recurrence. Surgical excision combined with intralesional bevacizumab treatment induced life-long resolution of the sebaceous carcinoma. Bevacizumab treatment may be associated with the regression of periocular angiogenic proliferative conditions, including neoplasia, by inhibiting angiogenesis. PMID:22857265

  14. Combination of intralesional verapamil and oral antioxidants for Peyronie's disease: a prospective, randomised controlled study.

    PubMed

    Favilla, V; Russo, G I; Privitera, S; Castelli, T; Madonia, M; La Vignera, S; Condorelli, R; Calogero, A E; Farina, F P; Cimino, S; Morgia, G

    2014-10-01

    The aim of this study was to evaluate the efficacy of the association of intralesional verapamil (ILV) injection with oral antioxidants compared with ILV monotherapy in patients with early onset of Peyronie's disease (PD) at 12-week follow-up. Group A (n = 52) received ILV 10 mg weekly for 12 weeks, while group B (n = 53) received ILV 10 mg weekly for 12 weeks + antioxidants orally one tablet once a day for 3 months. The main efficacy outcomes were the change in plaque size (PS), penile curvature (PC), visual analogue score (VAS), IIEF-15 and IIEF-15 subdomains. Both groups showed significant improvement from baseline to week 12 relative to PS and PC, while group B also in IIEF-15 score (mean difference: 5.51, P < 0.01) and VAS (mean difference: -2.71, P < 0.01). No significant differences were observed between both groups in PS and PC. Finally, both groups showed significant increase in orgasmic function (IIEF-OF) and overall satisfaction (IIEF-OS), while group B showed significant improvement also in intercourse satisfaction (IIEF-IS). Significant differences were found relative to IIEF-OF, IIEF-IS, IIEF-OS and VAS scores in the group B compared with group A. Patients affected by PD may benefit from combination treatment with ILV and oral antioxidants thanks to the improvement in IIEF-OF, IIEF-IS and IIEF-OS at 12 weeks. PMID:24124921

  15. [Effect of intralesional treatment with emetine hydrochloride on Leishmania (Viannia) braziliensis in hamsters].

    PubMed

    Cazorla, D; Yépez, J; Añez, N; Sánchez de Mirt, A

    2001-03-01

    The therapeutic effect of the emetine hydrochloride alkaloid administered intralesionally was compared with that of standard parenteral treatment with Glucantime in outbred male hamsters experimentally infected with 4 x 10(3) amastigotes of Leishmania (Viannia) braziliensis. Both chemotherapeutic agents reduced significantly (P < 0.01) the average lesion sizes in experimental animals in comparison with those untreated. The alkaloid infiltration was found to be as effective as the antimonial injection for clinical resolution. The ultrastructural effects on the Leishmania parasites exposed to emetine were observed mainly in the inner cytoplasm, which appeared disorganized, pycnotic and with loss of morphological definition; however, any known emetine hydrochloride action mechanism factor could not be directly related with ultrastructure effects detected on leishmanial parasites. Smears, conventional histopathology, culture in NNN medium and indirect immunoperoxidase method showed viable amastigotes in nodules and/or scars of all the evaluated hamsters 75 to 230 days after the end of treatment. These findings suggest that measurement of the size of cutaneous leishmania lesions does not appear to be a valid criterion for evaluating the efficiency of chemotherapy in experimental LT. Detection of leishmania parasites in the lesion scars, supports the hypothesis that man could be considered as an domestic reservoir. PMID:11294031

  16. Management of Oral Submucous Fibrosis with Injection of Hyaluronidase and Dexamethasone in Grade III Oral Submucous Fibrosis: A Retrospective Study

    PubMed Central

    James, Leena; Shetty, Akshay; Rishi, Diljith; Abraham, Marin

    2015-01-01

    Background: Oral submucous fibrosis (OSMF) is a chronic debilitating and potentially malignant condition of the oral cavity. It is resistant and progressive affecting the entire oral cavity that sometimes causes a gradual reduction in mouth opening that may even extend up to the pharynx. Although the medical treatment is not completely systematized, optimal doses of its treatment with local injection of corticosteroids with hyaluronidase or placental extract is effective to some extent. However, a combination of steroids and topical hyaluronidase shows better long-term results than either agents used individually. To evaluate the efficacy of dexamethasone and hyaluronidase in the treatment of Grade III OSMF. Materials and Methods: A total of 28 patients diagnosed with OSMF were treated in Sri Rajiv Gandhi College of Dental Sciences for a time period of 9 months, by obtaining the patient’s consent and with the approval of the institution’s research ethical committee. They were treated by administering an intralesional injection of dexamethasone1.5 ml, hyaluronidase 1500 IU with 0.5 ml lignocaine HCL injected intralesionally biweekly for 4 weeks. Results: Improvement in the patient’s mouth opening with a net gain of 6 ± 2 mm (92%), the range being 4-8 mm. Definite reduction in burning sensation, painful ulceration and blanching of oral mucosa and patient followed up for an average of 9 months. Conclusion: Injection of hyaluronidase with dexamethasone is an effective method of managing Grade III OSMF and can possibly eliminate the morbidity associated with surgical management. PMID:26464545

  17. Oral Steroids (Steroid Pills and Syrups)

    MedlinePlus

    ... more about steroids? How are steroid pills and syrups used? Steroid pills and syrups are very effective at reducing swelling and mucus ... liver or cause sterility Available as pills and syrups. Often necessary for treating more severe episodes of ...

  18. Inhibition of GABAA receptor-mediated current responses by enoxacin (new quinolone) and felbinac (non-steroidal anti-inflammatory drug) in Xenopus oocytes injected with mouse-brain messenger RNA.

    PubMed

    Kawakami, J; Shimokawa, M; Yamamoto, K; Sawada, Y; Asanuma, A; Yanagisawa, K; Iga, T

    1993-07-01

    The convulsant interaction between enoxacin (ENX), a new quinolone antibacterial agent (NQ), and felbinac (FLB), a non-steroidal anti-inflammatory drug (NSAID), in vivo was reproduced as the change of GABA-induced current response in Xenopus oocytes injected with mouse brain mRNA. GABA (10 microM) response was inhibited by ENX in a dose-dependent manner, and IC50 of ENX was 96 microM. Moreover, the inhibitory effect of ENX was 80-fold potentiated in the presence of 10 microM FLB. The GABAA-antagonistic interaction between these two drugs in vitro was considered a possible mechanism of convulsant reaction after concomitant administration of NQs and NSAIDs in vivo. PMID:7691340

  19. Topical Steroids.

    PubMed

    Oakley, Gretchen M; Harvey, Richard J

    2016-01-01

    Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory condition with heterogeneous pathophysiology. A cornerstone of the management of this condition is the use of anti-inflammatory agents. Corticosteroids are very effective and the most commonly used, but other drugs with immunodulatory activity such as anti-IL5, doxycycline (Th2), and macrolides (anti-neutrophilic/IL8) have been shown to have efficacy. Although systemic corticosteroids have shown benefit in managing this condition, the frequency of use often required in this condition is associated with significant adverse effects. Topical corticosteroids, particularly when utilized after endoscopic sinus surgery and delivered in a high volume, high pressure manner, provide the desired anti-inflammatory effects with nearly negligible systemic absorption. Studies assessing the long-term use of second generation topical corticosteroids have demonstrated no significant effects on cortisol levels, growth rate, intraocular pressures or lens opacification, or local mucosal atrophy. Patients who often respond most favorably to corticosteroid treatment are those with a Th2-mediated, highly eosinophilic CRSwNP. However, there is a subset of patients who are steroid resistant. In the case of a predominantly neutrophilic CRSwNP, it is important to be aware that patients may respond well to the use of macrolide therapy. Additionally, the use of verapamil has shown promise in increasing steroid responsiveness in a difficult to treat group of patients with steroid resistance. Topical corticosteroids play a key role in the long term management of this complicated inflammatory condition by providing the much needed pharmacologic local control with minimal systemic adverse effects. PMID:27466854

  20. An exploration of fluoroscopically guided spinal steroid injections in patients with non-specific exercise-related lower-limb pain

    PubMed Central

    Neve, Leon; Orchard, John; Gibbs, Nathan; van Mechelen, Willem; Verhagen, Evert; Sesel, Ken; Burgess, Ian; Hines, Brett

    2010-01-01

    Background Fluoroscopically guided lumbar cortisone injections have been proven useful in cases of lower-limb pain caused by lumbar disc prolapse (with evidence levels ll-1/ll-2). These injections are also sometimes used clinically in sports medicine for patients with non-specific exercise-related lower-limb pain, where no prolapse or other obvious cause of nerve-impingement is diagnosed via magnetic resonance imaging (MRI) or computed tomography (CT), even though this treatment scenario has not been adequately studied for this last diagnosis. Objectives To explore whether fluoroscopically guided transforaminal lumbar cortisone injections may be a valid treatment method for non-specific exercise-related lower-limb pain. Study design Retrospective case series. Methods Patients were selected from databases at two sports clinics and divided into two groups: Group D, with back-related lower-limb pain and disc prolapse proven on CT or MR; and Group N, with non-specific exercise-related lower-limb pain. Patients were sent a questionnaire regarding: symptoms, improvement, effect of injections, satisfaction, side effects and other used treatments. Outcomes were compared between Group D and N. Results 153 patients were eligible for the study (Group D: 93/Group N: 60). Eventually 110 patients responded (Group D: 67/Group N: 43). Twelve percent of Group D and 14% of Group N indicated that the injections had fully cured their symptoms. Altogether, 27% of Group D and 24% of Group N were certain the injections had improved their symptoms in the long term. A larger proportion however, indicated that the injection had certainly improved their symptoms in the short term, but noted that the effects were non-lasting (Group D: 28%/Group N: 30%). Two patients were certain the injections had actually worsened their symptoms. No significant differences in characteristics and outcomes between Group D and Group N were noted. Conclusions Outcomes of this study suggest fluoroscopically

  1. Radiofrequency thermal ablation of breast tumors combined with intralesional administration of IL-7 and IL-15 augments anti-tumor immune responses and inhibits tumor development and metastasis

    PubMed Central

    Habibi, Mehran; Kmieciak, Maciej; Graham, Laura; Morales, Johanna K; Bear, Harry D; Manjili, Masoud H

    2008-01-01

    Tumor development or recurrence is always a matter of concern following radiofrequency thermal ablation (RFA) of tumors. To determine whether combining RFA with immunologically active cytokines might induce tumor-specific immune responses against mammary carcinoma and inhibit tumor development or metastasis, we evaluated intralesional injection of IL-7 and IL-15 in RFA-treated murine tumors. We used two different breast carcinoma models: neu-overexpressing mouse mammary carcinoma (MMC) in FVBN202 transgenic mouse and 4T1 tumors in Balb/c mouse. MMC tend to relapse even in the presence of neu-specific immune responses, and 4T1 is a weakly immunogenic, aggressive and highly metastatic transplantable tumor. In vivo growth of both of these tumors is also associated with increased numbers of CD11b+Gr1+ myeloid-derived suppressor cells (MDSC). We showed for the first time that unlike RFA alone, RFA combined with the administration of intralesional IL-7 and IL-15 (after RFA), induced immune responses to tumors, inhibited tumor development and lung metastasis, and reduced MDSC. PMID:18425677

  2. Intralesional administration of epidermal growth factor-based formulation (Heberprot-P) in chronic diabetic foot ulcer: treatment up to complete wound closure.

    PubMed

    Fernández-Montequín, José I; Betancourt, Blas Y; Leyva-Gonzalez, Gisselle; Mola, Ernesto L; Galán-Naranjo, Katia; Ramírez-Navas, Mayte; Bermúdez-Rojas, Sergio; Rosales, Felix; García-Iglesias, Elizeth; Berlanga-Acosta, Jorge; Silva-Rodriguez, Ricardo; Garcia-Siverio, Marianela; Martinez, Luis H

    2009-02-01

    Previous studies have shown that an epidermal growth factor-based formulation (Heberprot-P) can enhance granulation of high-grade diabetic foot ulcers (DFU). The aim of this study was to explore the clinical effects of this administration up to complete wound closure. A pilot study in 20 diabetic patients with full-thickness lower extremity ulcers of more than 4 weeks of evolution was performed. Mean ulcer size was 16.3 +/- 21.3 cm(2). Intralesional injections of 75 microg of Heberprot-P three times per week were given up to complete wound healing. Full granulation response was achieved in all 20 patients in 23.6 +/- 3.8 days. Complete wound closure was obtained in 17 (85%) cases in 44.3 +/- 8.9 days. Amputation was not necessary in any case and only one relapse was notified. The most frequent adverse events were tremors, chills, pain and odour at site of administration and local infection. The therapeutic scheme of intralesional Heberprot-P administration up to complete closure can be safe and suitable to improve the therapeutic goal in terms of healing of chronic DFU. PMID:19291119

  3. Adolescent Steroid Use.

    ERIC Educational Resources Information Center

    Office of Inspector General (DHHS), Washington, DC.

    The study focused on non-medical steroid use by adolescents according to data obtained from the National Institute on Drug Abuse, professional literature, 30 key informants knowledgeable in steroid issues, and 72 current or former steroid users. The findings indicated: (1) over 250,000 adolescents, primarily males, used or have used steroids, and…

  4. Intralesional meglumine antimoniate for the treatment of localised cutaneous leishmaniasis: a retrospective review of a Brazilian referral centre

    PubMed Central

    da Silva, Rosiana Estéfane; Toledo, Antonio; Senna, Maria Camilo; Rabello, Ana; Cota, Gláucia

    2016-01-01

    Although intralesional meglumine antimoniate (MA) infiltration is considered an option for cutaneous leishmaniasis (CL) therapy and is widely used in the Old World, there have been few studies supporting this therapeutic approach in the Americas. This study aims to describe outcomes and adverse events associated with intralesional therapy for CL. This retrospective study reviewed the experience of a Brazilian leishmaniasis reference centre using intralesional MA to treat 31 patients over five years (2008 and 2013). The median age was 63 years (22-86) and the median duration time of the lesions up to treatment was 16 weeks. In 22 patients (71%), intralesional therapy was indicated due to the presence of contraindications or previous serious adverse events with systemic MA. Other indications were failure of systemic therapy or ease of administration. Intralesional treatment consisted of one-six infiltrations (median three) for a period of up to 12 weeks. The initial (three months) and definitive (six months) cure rates were 70.9% and 67.7%, respectively. Most patients reported mild discomfort during infiltration and no serious adverse events were observed. In conclusion, these results show that the intralesional MA efficacy rate was very similar to that of systemic MA treatment, and reinforce the need for further studies with adequate design to establish the efficacy and safety of this therapeutic approach. PMID:27508321

  5. Treatment of in-transit melanoma with intralesional bacillus Calmette-Guérin (BCG) and topical imiquimod 5% cream: a report of 3 cases.

    PubMed

    Kibbi, Nour; Ariyan, Stephan; Faries, Mark; Choi, Jennifer N

    2015-01-01

    Local therapy for in-transit melanoma (ITM) is a treatment alternative for patients who are not good candidates for systemic therapy, regional therapy, or surgical management. In this case report, we describe 3 patients with ITM who were treated with intralesional Bacillus Calmette-Guérin (ILBCG) and/or topical imiquimod. Treatment course was dictated by the clinical response. Patient 1's response to ILBCG monotherapy was not sufficient to cause disease regression; however, transition to topical imiquimod therapy resulted in complete and sustained response. Although patient 2 responded to ILBCG and imiquimod, she developed a hypersensitivity reaction to ILBCG; when topical imiquimod was continued as monotherapy, her clinical response was complete. Patient 3 responded completely to ILBCG monotherapy in injected lesions, but expired shortly thereafter from unrelated disease. Reports like this one are needed to define the success measures of local therapy in the treatment of ITM. PMID:26448581

  6. Treatment of In-Transit Melanoma With Intralesional Bacillus Calmette-Guérin (BCG) and Topical Imiquimod 5% Cream: A Report of 3 Cases

    PubMed Central

    Kibbi, Nour; Ariyan, Stephan; Faries, Mark

    2015-01-01

    Local therapy for in-transit melanoma (ITM) is a treatment alternative for patients who are not good candidates for systemic therapy, regional therapy, or surgical management. In this case report, we describe 3 patients with ITM who were treated with intralesional Bacillus Calmette-Guérin (ILBCG) and/or topical imiquimod. Treatment course was dictated by the clinical response. Patient 1’s response to ILBCG monotherapy was not sufficient to cause disease regression; however, transition to topical imiquimod therapy resulted in complete and sustained response. Although patient 2 responded to ILBCG and imiquimod, she developed a hypersensitivity reaction to ILBCG; when topical imiquimod was continued as monotherapy, her clinical response was complete. Patient 3 responded completely to ILBCG monotherapy in injected lesions, but expired shortly thereafter from unrelated disease. Reports like this one are needed to define the success measures of local therapy in the treatment of ITM. PMID:26448581

  7. Gym and tonic: a profile of 100 male steroid users.

    PubMed Central

    Evans, N A

    1997-01-01

    OBJECTIVE: To identify unsupervised anabolic steroid regimens used by athletes. METHODS: 100 athletes attending four gymnasia were surveyed using an anonymous self administered questionnaire. RESULTS: Anabolic steroid doses ranged from 250 to 3200 mg per week and users combined different drugs to achieve these doses. Injectable and oral preparations were used in cycles lasting four to 12 weeks. Eighty six per cent of users admitted to the regular use of drugs other than steroids for various reasons, including additional anabolic effects, the minimisation of steroid related side effects, and withdrawal symptoms. Acne, striae, and gynaecomastia were the most commonly reported subjective side effects. CONCLUSIONS: Multiple steroids are combined in megadoses and self administered in a cyclical fashion. Polypharmacy is practised by over 80% of steroid users. Skeletal muscle hypertrophy along with acne, striae, and gynaecomastia are frequent physical signs associated with steroid use. Images Figure 2 PMID:9132214

  8. Assisted Reproduction Technologies Impair Placental Steroid Metabolism

    PubMed Central

    Collier, Abby C.; Miyagi, Shogo J.; Yamauchi, Yasuhiro; Ward, Monika A.

    2009-01-01

    The placenta plays a vital role in pregnancy by facilitating steroid passage from maternal to fetal circulation and/or direct production of hormones. Using a murine model, we demonstrated the differences in placental steroid metabolism between pregnancies conceived naturally and with assisted reproduction technologies (ART): in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). While the ovarian steroid production was similar (estrone, 17β-estradiol) or higher (estriol) in ART pregnancies compared to mating, the levels of placental estriol were significantly lower in ART group. Placentas from ART had significantly higher activities of the steroid metabolizing enzymes UDP-glucuronosyltransferase (UGT) and sulfotransferase (SULT), which in ICSI were also coupled with decreased activity of the steroid regenerating enzymes β-glucuronidase (β-G) and Aryl sulfatase (AS). Levels of steroid metabolites androstane-3α-17β-diol glucuronide and dehydroepiandrosterone sulfate were higher in fetal compared to maternal blood in ART, but not in mating. This study demonstrates that in murine ART pregnancies, higher metabolism and clearance of steroids by the placenta may seriously affect the passage of essential hormones to the fetus. If a similar phenomenon exists in humans, this could provide a plausible explanation for obstetric and neonatal complications associated with ART, including the higher incidence of low birth weight babies. PMID:19406239

  9. Should steroids be offered to patients with nonarteritic anterior ischemic optic neuropathy (NAION)?

    PubMed Central

    Lee, Andrew G.; Biousse, Valérie

    2010-01-01

    The treatment of nonarteritic anterior optic neuropathy remains very limited and disappointing. Recent publications have suggested that oral steroids as well as intravitreal injections of steroids might be helpful to accelerate resolution of disc edema and improve visual outcome. However, the use of steroids to treat acute NAION remains largely debated. PMID:20523196

  10. Periorbital Lipogranuloma after Facial Autologous Fat Injection and Its Treatment Outcomes

    PubMed Central

    Park, Jun Young

    2016-01-01

    Purpose To investigate periorbital lipogranuloma cases that developed after autologous fat injection and to determine various treatment outcomes from these cases. Methods This retrospective study involved 27 patients who presented with periocular mass (final diagnosis of lipogranuloma) and had history of facial autologous fat injection. The collected data included information on patient sex, age, clinical presentation, number and site of fat injections, interval between injections, duration from injection to symptom onset, fat harvesting site, use of cryopreservation, and treatment outcome. Results The most common presenting symptom was palpable mass (92.6%), followed by blepharoptosis and eyelid edema. The mean time from injection to symptom onset was 13.6 ± 29.2 months (range, 2 to 153 months). Patients were managed by intralesional triamcinolone injection (six patients) and surgical excision (three patients); 18 patients were followed without treatment. Among the six patients who underwent intralesional triamcinolone injection, five showed complete resolution, and one showed partial resolution. Among the 18 patients who were followed without management, three showed spontaneous resolution over a 5-month follow-up period. Conclusions Lipogranuloma can develop in the eyelid after autologous fat injection into the face. Both surgical excision and intralesional triamcinolone injection yield relatively good outcomes. Simple observation can be a good option because spontaneous resolution can occur in a subset of patients. PMID:26865798

  11. Oral Steroids for Dermatitis.

    PubMed

    Fisher, Andrew D; Clarke, Jesse; Williams, Timothy K

    2015-01-01

    Contact/allergic dermatitis is frequently treated inappropriately with lower-than-recommended doses or inadequate duration of treatment with oral and intramuscular glucocorticoids. This article highlights a case of dermatitis in a Ranger Assessment and Selection Program student who was improperly treated over 2 weeks with oral steroids after being bit by Cimex lectularius, commonly known as bed bugs. The article also highlights the pitfalls of improper oral steroid dosing and provides reasoning for longer-duration oral steroid treatment. PMID:26125159

  12. Epidural Injections for Spinal Pain

    MedlinePlus

    ... located outside the dural membrane. Steroids, anesthetics and anti-inflammatory medications are typically delivered in an epidural injection. ... create different effects for patients. Corticosteroids act as anti-inflammatory agents, reducing swelling and nerve irritation to allow ...

  13. Mind Over Matter: Anabolic Steroids

    MedlinePlus

    ... Term(s): Teachers / NIDA Teaching Guide / Mind Over Matter Teaching Guide and Series / Anabolic Steroids Print Mind Over Matter: Anabolic Steroids Order Free Publication in: English Spanish Download PDF 830.69 KB Anabolic steroids are ...

  14. Epidural steroid warning controversy still dogging FDA.

    PubMed

    Manchikanti, Laxmaiah; Candido, Kenneth D; Singh, Vijay; Gharibo, Christopher G; Boswell, Mark V; Benyamin, Ramsin M; Falco, Frank J E; Grider, Jay S; Diwan, Sudhir; Hirsch, Joshua A

    2014-01-01

    On April 23, 2014, the Food and Drug Administration (FDA) issued a letter of warning that injection of corticosteroids into the epidural space of the spine may result in rare, but serious adverse events, including "loss of vision, stroke, paralysis, and death." The advisory also advocated that patients should discuss the benefits and risks of epidural corticosteroid injections with their health care professionals, along with the benefits and risks associated with other possible treatments. In addition, the FDA stated that the effectiveness and safety of the corticosteroids for epidural use have not been established, and the FDA has not approved corticosteroids for such use. To raise awareness of the risks of epidural corticosteroid injections in the medical community, the FDA's Safe Use Initiative convened a panel of experts including pain management experts to help define the techniques for such injections with the aim of reducing preventable harm. The panel was unable to reach an agreement on 20 proposed items related to technical aspects of performing epidural injections. Subsequently, the FDA issued the above referenced warning and a notice that a panel will be convened in November 2014. This review assesses the inaccuracies of the warning and critically analyzes the available literature. The literature has been assessed in reference to alternate techniques and an understanding of the risk factors when performing transforaminal epidural injections in the cervical, thoracic, and lumbar regions, ultimately resulting in improved safety. The results of this review show the efficacy of epidural injections, with or without steroids, in a multitude of spinal ailments utilizing caudal, cervical, thoracic, and lumbar interlaminar approaches as well as lumbar transforaminal epidural injections . The evidence also shows the superiority of steroids in managing lumbar disc herniation utilizing caudal and lumbar interlaminar approaches without any significant difference as

  15. Comparison between Intralesional Triamcinolone and Kligman's Formula in Treatment of Melasma.

    PubMed

    Eshghi, Gholamreza; Khezrian, Leila; Esna Ashari, Fariba

    2016-01-01

    Melasma is a common acquired skin disorder. While different treatments are currently being used, in many cases it is refractory to treatment. According to the effects of topical steroids in decreasing skin pigmentation, we studied the efficacy of this new method for treatment of melasma. A total of 42 women with facial melasma, admitted to the department of dermatology of Hamadan, were enrolled in the study. They were divided randomly into two groups (A and B), group A (case) received subepidermal triamcinolone injections with a dose of 4 mg per cc and 5 mm intervals until complete blanching of melasma lesions, and group B (control) received Kligman's formula (hydroquinone 5%, tretinoin 0.1%, and dexamethasone 0.1%). At the first visit, we completed the MASI score papers, and we repeated that at weeks 4 and 8 of the study. We followed them for two months, every two weeks. At each visit, side effects and clinical response to treatment were noted. A decrease in MASI was observed in both group (11.57 ± 4.33 vs 9.31 ± 3.75 at 4th week and vs 8.01 ± 3.1 at 8th week, P-value < 0.001 in group A, and 10.46 ± 5.61 vs 9.76 ± 5.21 at 4th week and vs 8.96 ± 4.96 at 8th week, P-value< 0.001 in group B). In comparison between 2 groups, response to treatment was much better in group A than group B (P-value<0.001). In comparison to topical treatments, based on these findings, triamcinolone microinjection is a new, safe and strong therapeutic method for treatment of melasma. PMID:26853293

  16. Intralesional epidermal growth factor for diabetic foot wounds: the first cases in Turkey

    PubMed Central

    Ertugrul, Bulent M.; Buke, Cagri; Ersoy, Ozlem Saylak; Ay, Bengisu; Demirez, Dilek Senen; Savk, Oner

    2015-01-01

    Background Intralesional recombinant epidermal growth factor (EGF) was produced in the Centre for Genetic Engineering and Biotechnology (CIGB), Cuba, in 1988 and licensed in 2006. Because it may accelerate wound healing, it is a potential new treatment option in patients with a diabetic foot wound (whether infected or not) as an adjunct to standard treatment (i.e. debridement, antibiotics). We conducted the initial evaluation of EGF for diabetic foot wounds in Turkey. Methods We enrolled 17 patients who were hospitalized in various medical centers for a foot ulcer and/or infection and for whom below the knee amputation was suggested to all except one. All patients received 75 μg intralesional EGF three times per week on alternate days. Results The appearance of new granulation tissue on the wound site (≥75%) was observed in 13 patients (76%), and complete wound closure was observed in 3 patients (18%), yielding a ‘complete recovery’ rate of 94%. The most common side effects were tremor (n=10, 59%) and nausea (n=6, 35%). In only one case,a serious side effect requiring cessation of EGF treatment was noted. That patient experienced severe hypotension at the 16th application session, and treatment was discontinued. At baseline, a total of 21 causative bacteria were isolated from 15 patients, whereascultures were sterile in two patients. The most frequently isolated species was Pseudomonas aeruginosa. Conclusion Thus, this preliminary study suggests that EGF seems to be a potential adjunctive treatment option in patients with limb-threatening diabetic foot wounds. PMID:26268583

  17. Helpful tips for performing musculoskeletal injections.

    PubMed

    Metz, John P

    2010-01-01

    Injections are valuable procedures for managing musculoskeletal conditions commonly encountered by family physicians. Corticosteroid injections into articular, periarticular, or soft tissue structures relieve pain, reduce inflammation, and improve mobility. Injections can provide diagnostic information and are commonly used for postoperative pain control. Local anesthetics may be injected with corticosteroids to provide additional, rapid pain relief. Steroid injection is the preferred and definitive treatment for de Quervain tenosynovitis and trochanteric bursitis. Steroid injections can also be helpful in controlling pain during physical rehabilitation from rotator cuff syndrome and lateral epicondylitis. Intra-articular steroid injection provides pain relief in rheumatoid arthritis and osteoarthritis. There is little systematic evidence to guide medication selection for therapeutic injections. The medication used and the frequency of injection should be guided by the goal of the injection (i.e., diagnostic or therapeutic), the underlying musculoskeletal diagnosis, and clinical experience. Complications from steroid injections are rare, but physicians should understand the potential risks and counsel patients appropriately. Patients with diabetes who receive periarticular or soft tissue steroid injections should closely monitor their blood glucose for two weeks following injection. PMID:20052957

  18. Musculoskeletal injections: a review of the evidence.

    PubMed

    Stephens, Mark B; Beutler, Anthony I; O'Connor, Francis G

    2008-10-15

    Injections are valuable procedures for managing musculoskeletal conditions commonly encountered by family physicians. Corticosteroid injections into articular, periarticular, or soft tissue structures relieve pain, reduce inflammation, and improve mobility. Injections can provide diagnostic information and are commonly used for postoperative pain control. Local anesthetics may be injected with corticosteroids to provide additional, rapid pain relief. Steroid injection is the preferred and definitive treatment for de Quervain tenosynovitis and trochanteric bursitis. Steroid injections can also be helpful in controlling pain during physical rehabilitation from rotator cuff syndrome and lateral epicondylitis. Intra-articular steroid injection provides pain relief in rheumatoid arthritis and osteoarthritis. There is little systematic evidence to guide medication selection for therapeutic injections. The medication used and the frequency of injection should be guided by the goal of the injection (i.e., diagnostic or therapeutic), the underlying musculoskeletal diagnosis, and clinical experience. Complications from steroid injections are rare, but physicians should understand the potential risks and counsel patients appropriately. Patients with diabetes who receive periarticular or soft tissue steroid injections should closely monitor their blood glucose for two weeks following injection. PMID:18953975

  19. Tendo Achillis pain: steroids and outcome.

    PubMed

    Read, M T; Motto, S G

    1992-03-01

    A retrospective study is presented of 83 athletes with tendo Achillis pain (TAP) treated conservatively over a 12-year period from 1976 to 1988. Local steroid injections did not contribute to an earlier return to sport, though many individuals were improved symptomatically. Local steroids were not found to have a deleterious effect on outcome. Steroids were used most frequently in the chronic cases that presented late and had been treated previously: this group had most recurrences and surgical intervention. One case of Achilles rupture (3%) occurred in the group treated with steroids. Early presentation for treatment led to an earlier return to sport and avoidance of recurrences. Recurrences were most frequent in athletes with bilateral Achilles tendinopathy. The tendo Achillis lesion may range from peritendinitis through a mixed lesion of the tendon and paratenon, to complete rupture. The management depends upon accurate diagnosis, its chronicity and the age and aspirations of the patient. Steroids are safe to use and further prospective trials should note presentation time and disease staging accurately. PMID:1600448

  20. Tendo Achillis pain: steroids and outcome.

    PubMed Central

    Read, M T; Motto, S G

    1992-01-01

    A retrospective study is presented of 83 athletes with tendo Achillis pain (TAP) treated conservatively over a 12-year period from 1976 to 1988. Local steroid injections did not contribute to an earlier return to sport, though many individuals were improved symptomatically. Local steroids were not found to have a deleterious effect on outcome. Steroids were used most frequently in the chronic cases that presented late and had been treated previously: this group had most recurrences and surgical intervention. One case of Achilles rupture (3%) occurred in the group treated with steroids. Early presentation for treatment led to an earlier return to sport and avoidance of recurrences. Recurrences were most frequent in athletes with bilateral Achilles tendinopathy. The tendo Achillis lesion may range from peritendinitis through a mixed lesion of the tendon and paratenon, to complete rupture. The management depends upon accurate diagnosis, its chronicity and the age and aspirations of the patient. Steroids are safe to use and further prospective trials should note presentation time and disease staging accurately. PMID:1600448

  1. Steroids (For Parents)

    MedlinePlus

    ... by some athletes and bodybuilders. Anabolic steroids are synthetic hormones that can boost the body's ability to ... doses every day can significantly increase levels of testosterone, which can lead to a number of health ...

  2. Anabolic steroid abuse and dependence.

    PubMed

    Brower, Kirk J

    2002-10-01

    Anabolic-androgenic steroids (AAS) are mainly used to treat androgen deficiency syndromes and, more recently, catabolic states such as AIDS-associated wasting. There is no evidence in the reviewed literature that AAS abuse or dependence develops from the therapeutic use of AAS. Conversely, 165 instances of AAS dependence have been reported among weightlifters and bodybuilders who, as part of their weight training regimens, chronically administered supraphysiologic doses, often including combinations of injected and oral AAS as well as other drugs of abuse. A new model is proposed in which both the "myoactive" and psychoactive effects of AAS contribute to the development of AAS dependence. The adverse consequences of AAS are reviewed, as well as their assessment by means of a history and physical, mental status examination, and laboratory testing. When patients with AAS use disorders are compared with patients with other substance use disorders, both similarities and differences become apparent and have implications for treatment. PMID:12230967

  3. Pharmacology of anabolic steroids

    PubMed Central

    Kicman, A T

    2008-01-01

    Athletes and bodybuilders have recognized for several decades that the use of anabolic steroids can promote muscle growth and strength but it is only relatively recently that these agents are being revisited for clinical purposes. Anabolic steroids are being considered for the treatment of cachexia associated with chronic disease states, and to address loss of muscle mass in the elderly, but nevertheless their efficacy still needs to be demonstrated in terms of improved physical function and quality of life. In sport, these agents are performance enhancers, this being particularly apparent in women, although there is a high risk of virilization despite the favourable myotrophic–androgenic dissociation that many xenobiotic steroids confer. Modulation of androgen receptor expression appears to be key to partial dissociation, with consideration of both intracellular steroid metabolism and the topology of the bound androgen receptor interacting with co-activators. An anticatabolic effect, by interfering with glucocorticoid receptor expression, remains an attractive hypothesis. Behavioural changes by non-genomic and genomic pathways probably help motivate training. Anabolic steroids continue to be the most common adverse finding in sport and, although apparently rare, designer steroids have been synthesized in an attempt to circumvent the dope test. Doping with anabolic steroids can result in damage to health, as recorded meticulously in the former German Democratic Republic. Even so, it is important not to exaggerate the medical risks associated with their administration for sporting or bodybuilding purposes but to emphasize to users that an attitude of personal invulnerability to their adverse effects is certainly misguided. PMID:18500378

  4. Distribution of injected technetium(99m)-labeled mesenchymal stem cells in horses with naturally occurring tendinopathy.

    PubMed

    Becerra, Patricia; Valdés Vázquez, Miguel A; Dudhia, Jayesh; Fiske-Jackson, Andrew R; Neves, Francisco; Hartman, Neil G; Smith, Roger K W

    2013-07-01

    This study aimed to investigate immediate cell survival and distribution following different administration routes of mesenchymal stem cells (MSCs) into naturally occurring tendon injuries. Ten million MSCs, labeled with technetium-99m hexamethylpropyleneamine oxime, were implanted into 13 horses with naturally occurring tendon or ligament injuries intra-lesionally, intravenously and by regional perfusion, and traced for up to 48 h using planar gamma scintigraphy. Labeling efficiencies varied between 1.8% and 18.5% (mean 9.3%). Cells were retained in the damaged area after intra-lesional administration but only 24% of cells were still present within the tendon after 24 h. After intravenous injection, cells largely distributed to the lung fields, with no detectable cells in the tendon lesions. Significant labeling of the tendon lesions was observed in 11/12 horses following regional perfusion but at a lower level to intra-lesional injection. The highest cell numbers were retained after intra-lesional injection, although with considerable cell loss, while regional perfusion may be a viable alternative for MSC delivery. Cells did not "home" to damaged tendon in large numbers after intravenous administration. Cells were detected in the lungs most frequently after intravascular administration, although with no adverse effects. Low cell retention has important implications for designing effective clinical therapies for human clinical use. PMID:23508674

  5. Intravitreal injection

    MedlinePlus

    Retinal vein occlusion-intravitreal injection; Triamcinolone-intravitreal injection; Dexamethasone-intravitreal injection; Lucentis-intravitreal injection; Avastin-intravitreal injection; Bevacizumab-intravitreal injection; Ranibizumab- ...

  6. Anabolic steroid boosts weight.

    PubMed

    1996-09-01

    A randomized study of nandrolone decanoate (Deca-Durabolin) showed that the anabolic steroid can increase weight in people with HIV infections. The group receiving nandrolone experienced a greater increase both in fat-free mass and body cell mass (although the latter measure did not reach statistical significance) than those on placebo. Deca-Durabolin had little to do with two occurrences of Kaposi's sarcoma (KS) in the study group, but until further studies are completed, caution is advised when using this steroid in patients with KS. A new study comparing nandrolone to growth hormone in patients with wasting is slated to begin in the next 3 or 4 months. PMID:11363845

  7. Detection of designer steroids

    PubMed Central

    Yuan, Xiaohui; Forman, Barry Marc

    2005-01-01

    Illicit use of performance-enhancing steroids has proliferated among a wide range of professional and amateur athletes. This problem has attracted broad public attention and has led the United States Congress to draft legislation that proposes frequent testing of athletes. However, current testing protocols are inadequate as athletes can evade detection by using novel steroids that are unknown to authorities. We have developed a strategy that overcomes this limitation by virtue of its ability to detect “designer steroids” without prior knowledge of their existence. PMID:16604170

  8. Insulin Glulisine (rDNA origin) Injection

    MedlinePlus

    ... oral medication(s) for diabetes. Insulin glulisine is a short-acting, man-made version of human insulin. Insulin ... contraceptives (birth control pills, patches, rings, injections, or implants); octreotide (Sandostatin); oral medications for diabetes; oral steroids ...

  9. Steroids. A Resource Guide.

    ERIC Educational Resources Information Center

    New York State Education Dept., Albany. Bureau of School Health Education and Services.

    This guide provides information on steroid use as well as prevention and intervention strategies. It is intended to serve as a supplement to drug abuse education and prevention programs in elementary and secondary schools and as the basis for local curriculum development and instructional activities. The following topics are covered: (1) history…

  10. Anabolic Steroids...What's the Hype?...

    ERIC Educational Resources Information Center

    Landry, Gregory L.; Wagner, Lauris L.

    This pamphlet uses a question-and-answer format to examine the use and abuse of anabolic steroids. It begins by explaining that all steroids are not anabolic steroids and that anabolic steroids are those used specifically to build muscles quickly. Medical uses of anabolic steroids are reviewed; how people get steroids, how they take them, and…

  11. Nonprescription steroids on the Internet.

    PubMed

    Clement, Christen L; Marlowe, Douglas B; Patapis, Nicholas S; Festinger, David S; Forman, Robert F

    2012-02-01

    This study evaluated the degree to which anabolic-androgenic steroids are proffered for sale over the Internet and how they are characterized on popular Web sites. Searches for specific steroid product labels (e.g., Dianabol) between March 2006 and June 2006 revealed that approximately half of the Web sites advocated their "safe" use, and roughly one third offered to sell them without prescriptions. The Web sites frequently presented misinformation about steroids and minimized their dangers. Less than 5% of the Web sites presented accurate health risk information about steroids or provided information to abusers seeking to discontinue their steroid use. Implications for education, prevention, treatment, and policy are discussed. PMID:22080724

  12. Nonprescription Steroids on the Internet

    PubMed Central

    McDonald, Christen L.; Marlowe, Douglas B.; Patapis, Nicholas S.; Festinger, David S.; Forman, Robert F.

    2008-01-01

    This study evaluated the degree to which anabolic-androgenic steroids are proffered for sale over the Internet and how they are characterized on popular websites. Searches for specific steroid product labels (e.g., Dianabol) between March and June, 2006 revealed that approximately half of the websites advocated their “safe” use, and roughly one-third offered to sell them without prescriptions. The websites frequently presented misinformation about steroids and minimized their dangers. Less than 5% of the websites presented accurate health risk information about steroids or provided information to abusers seeking to discontinue their steroid use. Implications for education, prevention, treatment and policy are discussed. PMID:22080724

  13. Active post-marketing surveillance of the intralesional administration of human recombinant epidermal growth factor in diabetic foot ulcers

    PubMed Central

    2013-01-01

    Background After several exploratory and confirmatory clinical trials, the intralesional administration of human recombinant epidermal growth factor (hrEGF) has been approved for the treatment of advanced diabetic foot ulcers (DFU). The aim of this work was to evaluate the effectiveness and safety of this procedure in medical practice. Methods A prospective, post-marketing active pharmacosurveillance was conducted in 41 hospitals and 19 primary care polyclinics. Patients with DFU received hrEGF, 25 or 75 μg, intralesionally 3 times per week until complete granulation of the ulcer or 8 weeks maximum, adjuvant to standard wound care. Outcomes measured were complete granulation, amputations, and adverse events (AE) during treatment; complete lesion re-epithelization and relapses in follow-up (median: 1.2; maximum 4.2 years). Results The study included 1788 patients with 1835 DFU (81% Wagner’s grades 3 or 4; 43% ischemic) treated from May 2007 to April 2010. Complete granulation was observed in 76% of the ulcers in 5 weeks (median). Ulcer non-ischemic etiology (OR: 3.6; 95% CI: 2.8-4.7) and age (1.02; 1.01-1.03, for each younger year) were the main variables with influence on this outcome. During treatment, 220 (12%) amputations (171 major) were required in 214 patients, mostly in ischemic or Wagner’s grade 3 to 5 ulcers. Re-epithelization was documented in 61% of the 1659 followed-up cases; 5% relapsed per year. AE (4171) were reported in 47% of the subjects. Mild or moderate local pain and burning sensation, shivering and chills, were 87% of the events. Serious events, not related to treatment, occurred in 1.7% of the patients. Conclusions The favorable benefit/risk balance, confirms the beneficial clinical profile of intralesional hrEGF in the treatment of DFUs. PMID:24004460

  14. Steroid Receptor-Associated Immunophilins: A Gateway to Steroid Signalling

    PubMed Central

    Ratajczak, Thomas; Cluning, Carmel; Ward, Bryan K

    2015-01-01

    The steroid receptor-associated immunophilins FKBP51, FKBP52, CyP40 and PP5 have specific roles in steroid receptor function that impact steroid hormone-binding affinity, nucleocytoplasmic shuttling and transcriptional activation of target genes in a tissue-specific manner. Aberrant expression of these functionally unique immunophilins has the potential to cause steroid-based diseases, including breast and prostate cancer, diabetes and related metabolic disorders, male and female infertility and major depressive disorders. This review addresses the function of these proteins as co-chaperones in steroid receptor-Hsp90 complexes and extensively covers current knowledge of the link between the steroid receptor-associated immunophilins and human disease. An improved understanding of their mechanisms of action has revealed opportunities for molecular therapies to enhance or inhibit cellular processes under immunophilin control that contribute both to human health and disease. PMID:26224894

  15. Clinical features, epidemiology, and efficacy and safety of intralesional antimony treatment of cutaneous leishmaniasis: recent experience in Turkey.

    PubMed

    Uzun, Soner; Durdu, Murat; Culha, Gulnaz; Allahverdiyev, Adil M; Memisoglu, Hamdi R

    2004-08-01

    A total of 1,030 patients, 40.2% men and 59.8% women, identified during the period of October 1998 to November 2002 as having cutaneous leishmaniasis (CL), were studied; 1,431 lesions were identified in the 1,030 patients. One lesion was present in 80.7% of the patients. The size of the lesions (longest axis) was 13.6 mm (standard, 12.1 mm; range 3-150 mm). Most of the lesions were of the papular type (51.2%), although several atypical clinical presentations of CL were observed. The duration of the disease ranged between 1 and 72 mo (mean duration, 10.8 mo). The clinical suspicion of CL was confirmed by the observation of amastigotes on lesion tissue samples stained by Giemsa. The test was positive in 851 of 1,030 patients (82.6%). Intralesional meglumine antimonate solution (85 mg Sb/ml, 0.2-1 ml, depending on the size of the lesion) weekly until complete cure or up to 20 wk was used for first-line therapy of 890 patients (86.4%). We found that this regimen of intralesional Sb has an efficacy of 97.2% with a low relapse rate of 3.9% and no serious adverse side effects. PMID:15357081

  16. Steroid Administration is Effective to Prevent Strictures After Endoscopic Esophageal Submucosal Dissection

    PubMed Central

    Wang, Wenjin; Ma, Zhiyuan

    2015-01-01

    Abstract Esophageal stricture is a severe adverse event after circumferential endoscopic submucosal dissection (ESD). Steroid administration is a new method to prevent stricture formation. We performed a meta-analysis to investigate the efficacy and safety of steroid administration to prevent esophageal stricture after circumferential ESD. PubMed, the Cochrane Library, EMBASE, Chinese Biomedical Database, and Clinicaltrials.gov were searched. Studies on steroid administration + endoscopic balloon dilation (EBD) versus EBD alone for esophageal stricture were included and pooled analyzed in random-effects models. Besides, subgroup analysis and network analysis were performed to define the influence of ESD type and steroid administration method. Twelve studies involving 513 patients were included. Meta-analysis showed that steroid administration significantly achieved a lower stricture rate (risk ratio [RR], 0.40; 95% CI, 0.20–0.81) and less required EBD sessions (mean difference [MD], −4.33; 95% CI, −6.10 to −2.57) than control. Subgroup analysis indicated that steroid was effective after both semi- and complete circumferential ESD. Network meta-analysis showed that compared with oral steroid, local injected steroid had a similar effect to prevent stricture (RR, 1.16; 95% CI, 0.48–2.85), whereas a better effect to reduce required EBD sessions (MD, 7.77; 95%CI, 0.26–15.3). Additional steroid administration is effective to reduce the stricture rate and required EBD sessions. And local injected steroid was superior to oral steroid in EBD reduction, whereas due to the varied method and dose of steroid administration, the finding needs to be clarified in the future. PMID:26426665

  17. Role of Guided Ultrasound in the Treatment of De Quervain Tenosynovitis by Local Steroid Infiltration.

    PubMed

    Danda, Raja Shekar; Kamath, Jagannath; Jayasheelan, Nikil; Kumar, Prashanth

    2016-04-01

    Ultrasound guidance for steroid injection in de Quervain disease is useful in identifying the presence of subcompartments and effectively injecting the drug into tendon sheath. We prospectively studied 50 patients with features of de Quervain disease to determine the effectiveness of ultrasound in positioning of needle for steroid injection and effectiveness of single versus multiple injections in the presence of subcompartments. Scalp vein set was inserted into the tendon sheath under ultrasound guidance and sterile conditions. Mixture containing 1 mL of methylprednisolone 40 mg with 1 mL of 2% lignocaine was injected and the patient followed for 6 months. In patients having subcompartments, improvement was better when two separate injections into each subcompartment were given compared with single. Ultrasound guidance is helpful in identifying the existence of subcompartment and injecting the subcompartments separately. Scalp vein set may be very effective in ultrasound-guided injection. This is a level III study. PMID:27616825

  18. Skin depigmentation along lymph vessels of the lower leg following local corticosteroid injection for interdigital neuroma.

    PubMed

    van Vendeloo, Stefan N; Ettema, Harmen B

    2016-06-01

    Steroid injection is frequently used in the treatment of interdigital neuroma and has a high rate of success. We report the case of a patient who develops skin depigmentation at the injection site and linear streaks of depigmentation over the foot, the ankle and half way up to the knee after a steroid injection for interdigital neuroma. Minor disadvantages such as subcutaneous fat atrophy and depigmentation of the skin at the injection site are well known problems following steroid injection. Depigmentation of the skin with a lymphatic distribution in the foot after steroid injection for interdigital neuroma however, has not yet been reported before. This complication is a serious aesthetic problem and clinicians should be aware of this complication when treating patients with steroid injections for interdigital neuroma. PMID:27301735

  19. Roles of Steroids in Nematodes

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The inability of nematodes to biosynthesize steroids de novo and the resulting dependence of parasitic nematodes upon their hosts have enhanced the importance of elucidating the metabolism of sterols and the hormonal and other functions of steroids in nematodes. Biochemical research has revealed th...

  20. [Longterm effects of steroid therapy].

    PubMed

    Kuna, P

    1998-01-01

    Asthma is a chronic inflammatory disease of the airways play. Anti-inflammatory drugs the fundamental role in the treatment of asthma and among them steroids are the most important. However, oral steroids may cause many serious side effects. A major breakthrough in the treatment of asthma was introducing inhaled steroids. Inhaled steroids have much less side effects than oral steroids, although they have the same anti-inflammatory activity. Long term effect of inhaled steroids can be divided into wanted and unwanted outcome. The desirable anti-inflammatory effect of steroids is reflected by lowering of bronchial hyperresponsiveness and a better control of asthma symptoms. Inhaled corticosteroid may have systemic side effects similar to those observed with oral steroids such as 1) adrenal suppression, 2) effect on bone metabolism, 3) growth suppression in children, 4) impaired skin collagen synthesis, 5) cataract, 6) metabolic disturbances, 7) effect on central nervous system. Topical side effects of inhaled corticosteroid such as oral candidiasis, dysphonia and cough effect about 10 to 30% of patients taking those drugs. Summing up it is advisable to use inhaled corticosteroid in the lower effective dose. PMID:9610231

  1. Crystallization of steroids in gels

    NASA Astrophysics Data System (ADS)

    Kalkura, S. Narayana; Devanarayanan, S.

    1991-03-01

    The crystal growth and characterization of certain steriods, viz., cholesterol, cholesteryl acetate, β-sitosterol, progesterone and testosterone, in a silica gel medium is discussed. The present study shows that the single test tube diffusion method can be used to grow crystals of steroids in a silica gel medium by the reduction of steroid solubility.

  2. Anabolic Steroid Use: Federal Efforts to Prevent and Reduce Anabolic Steroid Abuse among Teenagers. Report to the Committee on Oversight and Government Reform, House of Representatives. GAO-08-15

    ERIC Educational Resources Information Center

    Government Accountability Office, 2007

    2007-01-01

    The abuse of anabolic steroids by teenagers--that is, their use without a prescription--is a health concern. Anabolic steroids are synthetic forms of the hormone testosterone that can be taken orally, injected, or rubbed on the skin. Although a 2006 survey funded by the National Institute on Drug Abuse (NIDA) found that less than 3 percent of 12th…

  3. Steroids in allergic disease.

    PubMed

    Webb, D R

    1981-09-01

    From the experience above, it may be concluded that corticosteroid therapy in allergic disease has become more effective than ever before. The expected variations in usage of new important pharmacologic agents is seen with special clarity in the use of corticosteroids. The wide acclaim for the "miracle drug of the 1950's", which followed penicillin of the 1940's, soon gave away to anguish about side-effects that threatened to abolish its use entirely in the late 1950's. The 1960's brought alternate day therapy for chronic usage and recognition that short term usage was relatively safe. The 1970's saw proliferation of topically active steroids similar to those so important to the practice of Dermatology in the previous decade. Results in treating asthma and nasal diseases have been excellent and extensive research for adverse effects has been largely unrevealing. PMID:6793795

  4. Unidentified intralesional and intracellular coccoid microorganism discovered in the young man with a diffuse erosive gastroduodenitis and multiple superficial ulcerations.

    PubMed

    Okada, Takayuki; Adkins, Graham

    2014-01-01

    A Helicobacter pylori-negative young Japanese man with dyspeptic symptoms suffered from a diffuse erosive gastroduodenitis and multiple superficial ulcerations. Histology and electron microscopic examinations on the biopsy specimens revealed the presence of multiple unidentified intralesional and intracellular coccoid microorganisms in the pathological gastroduodenal mucosa. Microaerophilic and anaerobic Gram-negative coccoid and filamentobacillary bacteria were cultured from the gastric aspirate. The triple therapy containing tetracycline for 14 days followed by 4 months treatment with omeprazole resulted in the resolution of the gastroduodenal pathology. The question, therefore, was raised regarding a possible role for the cultured coccoid bacteria in the pathogenesis. 16S rRNA gene sequence analysis of the isolated Gram-negative coccoid bacteria revealed a close relationship with Haemophilus haemolyticus. The unidentified coccoid microorganisms and cultured X and V factors independent coccoid bacteria, however, shared similar phenotypic, microbiological and pathological characteristics to the novel Gram-negative Streptococcaceae: Okadaella gastrococcus. PMID:24495976

  5. Peyronie's disease: intralesional treatment with interferon alpha-2A and evaluation of the results by magnetic resonance imaging.

    PubMed

    Polat, O; Gül, O; Ozbey, I; Ozdikici, M; Bayraktar, Y

    1997-01-01

    In this clinical study, to determine the therapeutic efficacy of interferon (IFN) treatment for Peyronie's disease, we applied interferon alpha-2A (IFN alpha-2A) intralesionally in the treatment of Peyronie plaques in 15 patients and results were evaluated by magnetic resonance imaging (MRI). Patients whose plaque sizes were 0.5 and 1 cm responded better to the treatment. There was about a 90% lessening in the sizes of the plaques of 1.5 cm, 83.3% of 2 cm, as the ones which were 0.5 cm and 1 cm disappeared completely after treatment. As a conclusion, the treatment of Peyronie's disease with IFN alpha-2A is effective and side effects are minimum. PMID:9406006

  6. Intralesional cryotherapy versus excision and corticosteroids or brachytherapy for keloid treatment: study protocol for a randomised controlled trial

    PubMed Central

    2013-01-01

    Background Keloids are a burden for patients due to physical, aesthetic and social complaints and treatment remains a challenge because of therapy resistance and high recurrence rates. The main goal of treatment is to improve the quality of life (QoL); this implies that, apart from surgical outcomes, patient-reported outcome measures (PROMs) need to be taken into account. Decision making in keloid treatment is difficult due to heterogeneity of the condition and the lack of comparative studies. Methods/Design This is a multicentre, randomised controlled open trial that compares 1) intralesional cryotherapy versus excision and corticosteroids for primary keloids, and 2) intralesional cryotherapy versus excision and brachytherapy for therapy-resistant keloids. The primary outcome is the Patient and Observer Scar Assessment Scale (POSAS), a 12-item scale (with score 12 indicating the best and 120 indicating the worst scar imaginable). A difference of six points on the total score is considered to be of clinical importance. Secondary outcomes are recurrence rates, volume reduction, Skindex-29 scores, SF-36 scores and complication rates. Primary and secondary outcome measurements are taken at baseline, and at 2, 12, 26 and 52 weeks postoperatively. For analysis, a linear mixed model is used. A total of 176 patients will be included over a period of 2.5 years. The protocol is approved by the Medical Ethics Committee of the Erasmus University Medical Centre Rotterdam and follows good clinical practice guidelines. Discussion The outcomes of this study will improve evidence-based decision making for the treatment of keloids, as well as patient education. Trial registration Dutch Trial Register NTR4151. PMID:24354714

  7. Combined Intralesional Neodymium-Doped Yttrium Aluminium Garnet Laser and Intratumoral Ligation as Curative Treatment for Craniofacial Arteriovenous Malformations.

    PubMed

    Rojvachiranonda, Nond; Lerdlum, Sukalaya; Mahatumarat, Charan

    2016-03-01

    Craniofacial arteriovenous malformation (AVM), although very rare, has been a very difficult problem to treat especially when it is large and involves important structures. Surgical resection often results in unacceptable complications but still not curative. At our institution, treatment by combined intralesional neodymium-doped yttrium aluminium garnet laser and intratumoral ligation has been successful in venous malformation. This minimally invasive technique was then applied to more challenging AVM on the head and neck. Disease control was studied using clinical parameters and magnetic resonance imaging.Four patients with moderate-to-severe (Schobinger 2-4) craniofacial AVM were treated by this technique from 2001 to 2011. Patient age ranged from 2 to 51 years (mean: 25 years). After 2 to 4 treatments and follow-up period of 1456 days, 3 (75%) were cured. One of them was infant with huge mass and secondary pulmonary hypertension. Clinical cure was achieved after 3 treatments without residual cardiovascular compromise. The other patient (25%) had cheek mass with intraorbital involvement. The authors did not treat periorbital lesion so as to avoid triggering intraorbital spreading. The rest of the cheek lesion was clinically and radiologically cured.Laser energy setting, ablative technique, and skin cooling are the main factors determining the success. Individualized laser settings and properly set endpoints can increase treatment effectiveness in shorter period. In conclusion, this minimally invasive technique was successful in curing AVM without complication. With more clinical study and development of soft tissue monitoring tools, it is possible that intralesional laser could become the treatment of choice for all cutaneous AVM. PMID:26825744

  8. Abrupt Intralesional Color Change on Dermoscopy as a New Indicator of Early Superficial Spreading Melanoma in a Japanese Woman.

    PubMed

    Sadayasu, Anna; Tanaka, Masaru; Maumi, Yoshifumi; Ikeda, Eriko; Sawada, Mizuki; Ishizaki, Sumiko; Murakami, Yoshiyuki; Fujibayashi, Mariko

    2015-01-01

    Diagnosis of superficial spreading melanoma in the early stage is often difficult, even with dermoscopy. We report the case of a 37-year-old Japanese woman with superficial spreading melanoma in her left buttock. The lesion developed 20 years before becoming visible and gradually enlarged over the past few years without any symptoms. Physical examination showed a well-demarcated dark-brown macule 10 mm in diameter. Dermoscopy demonstrated a central dark area with a blue-grey structureless area, a milky-red area with irregular blue-grey dots or globules suggestive of regression structures, and multifocal black pigmentation with whitish scaly areas. An abrupt intralesional change in color from a central dark area to a peripheral light-brown area was also seen. The peripheral area showed an atypical pigment network with an obscure mesh and holes. Histopathologic examination of the lesion showed acanthosis with melanocytic proliferation and nuclear atypia, a band-like lymphocytic infiltrate, melanophages and a few nests of melanocytes just beneath the epidermis. The epidermal melanocytes were positive for S-100, Melan-A and HMB-45, but the dermal nests of melanocytes were negative for HMB-45 and positive for S-100 and Melan-A. A diagnosis of superficial spreading melanoma with a tumor thickness of 0.4 mm (pT1aN0M0, stage 1A) was established based on the clinical, dermoscopic and histopathologic findings. This case suggests that dermoscopy is useful in the diagnosis of this condition. An abrupt intralesional change of color might be a new indicator of early superficial spreading melanoma. PMID:26269701

  9. Topical Steroid-Damaged Skin

    PubMed Central

    Abraham, Anil; Roga, Gillian

    2014-01-01

    Topical steroids, commonly used for a wide range of skin disorders, are associated with side effects both systemic and cutaneous. This article aims at bringing awareness among practitioners, about the cutaneous side effects of easily available, over the counter, topical steroids. This makes it important for us as dermatologists to weigh the usefulness of topical steroids versus their side effects, and to make an informed decision regarding their use in each individual based on other factors such as age, site involved and type of skin disorder. PMID:25284849

  10. Steroids in Central Retinal Vein Occlusion: Is There a Role in Current Treatment Practice?

    PubMed Central

    Ashraf, Mohammed; Souka, Ahmed A. R.

    2015-01-01

    With the current widespread use of anti-VEGFs in the treatment of central retinal vein occlusion (CRVO), the role for steroids has become greatly diminished. Recent large scale randomized control trials (RCTs) have established the efficacy and safety of anti-VEGFs in the treatment of CRVO. Steroids are known to cause elevations in intraocular pressure as well as increase the risk of cataract formation. With that in mind many ophthalmologists are injecting steroids less frequently. This paper aims to review some of the data pertaining to the use of steroids either as a first line monotherapy, adjunct therapy, or an alternative therapy to help answer the question: Is there currently any role for steroids in the management of CRVO? PMID:26635973

  11. Steroids in Athletics: One University's Experience.

    ERIC Educational Resources Information Center

    Lopez, Mike

    1990-01-01

    Presents an account of one university's experience in conducting an investigation into possible steroid use by student athletes and the development of a program to deal with the problem. Discusses why athletes use steroids and how steroids are taken. Concludes it is likely many steroid-related deaths of athletes go undetected. (Author/ABL)

  12. Steroid Assays in Paediatric Endocrinology

    PubMed Central

    2010-01-01

    Most steroid disorders of the adrenal cortex come to clinical attention in childhood and in order to investigate these problems, there are many challenges to the laboratory which need to be appreciated to a certain extent by clinicians. The analysis of sex steroids in biological fluids from neonates, over adrenarche and puberty present challenges of specificities and concentrations often in small sample sizes. Different reference ranges are also needed for interpretations. For around 40 years, quantitative assays for the steroids and their regulatory peptide hormones have been possible using immunoassay techniques. Problems are recognised and this review aims to summarise the benefits and failings of immunoassays and introduce where tandem mass spectrometry is anticipated to meet the clinical needs for steroid analysis in paediatric endocrine investigations. It is important to keep a dialogue between clinicians and the laboratory, especially when any laboratory result does not make sense in the clinical investigation. Conflict of interest:None declared. PMID:21274330

  13. Anabolic steroids and Norwegian weightlifters.

    PubMed Central

    Solberg, S.

    1982-01-01

    The mean bodyweight, in kilograms, and mean weightlifting result, in points, for the ten best weightlifters at the annual Norwegian championships 1962-82 have been studied. During the 21 years, the mean bodyweight for these ten increased by 18 kg, probably due to the effect of androgens. The weightlifting results improved rapidly from 1968 onwards, probably reflecting an increasingly widespread use of anabolic steroids by Norwegian weightlifters. In 1977 doping tests were introduced, and from then on, rate of improvement has increased much more slowly. The annual sale of anabolic steroids 1963-81 and testosterone 1974-81, in Norway have been recorded. The sale of anabolic steroids increased irregularly until 1974-75, and has since shown a 42% decrease. The sale of testosterone 1974-81 showed a slight reduction, thus giving no support to the suggestion that doping tests for anabolic steroids would lead to a transfer to testosterone abuse. PMID:7139228

  14. Dehydroepiandrosterone: a neuroactive steroid.

    PubMed

    Stárka, Luboslav; Dušková, Michaela; Hill, Martin

    2015-01-01

    Dehydroepiandrosterone (DHEA) and its sulfate bound form (DHEAS) are important steroids of mainly adrenal origin. They are produced also in gonads and in the brain. Dehydroepiandrosterone easily crosses the brain-blood barrier and in part is also produced locally in the brain tissue. In the brain, DHEA exerts its effects after conversion to either testosterone and dihydrotestosterone or estradiol via androgen and estrogen receptors present in the most parts of the human brain, through mainly non-genomic mechanisms, or eventually indirectly via the effects of its metabolites formed locally in the brain. As a neuroactive hormone, DHEA in co-operation with other hormones and transmitters significantly affects some aspects of human mood, and modifies some features of human emotions and behavior. It has been reported that its administration can increase feelings of well-being and is useful in ameliorating atypical depressive disorders. It has neuroprotective and antiglucocorticoid activity and modifies immune reactions, and some authors have also reported its role in degenerative brain diseases. Here we present a short overview of the possible actions of dehydroepiandrosterone and its sulfate in the brain, calling attention to various mechanisms of their action as neurosteroids and to prospects for the knowledge of their role in brain disorders. PMID:24704258

  15. Golimumab Injection

    MedlinePlus

    ... it.Golimumab injection comes in prefilled syringes and auto-injection devices for subcutaneous injection. Use each syringe ... method.Do not remove the cap from the auto-injection device or the cover from the prefilled ...

  16. Myeloid regeneration after whole body irradiation, autologous bone marrow transplantation, and treatment with an anabolic steroid.

    PubMed

    Ambrus, C M; Ambrus, J L

    1975-01-01

    Stumptail monkeys (Macaca speciosa) received lethal whole body radiation. Autologous bone marrow injection resulted in survival of the majority of the animals. Treatment with Deca-Durabolin, an anabolic steroid, caused more rapid recovery of colony-forming cell numbers in the bone marrow than in control animals. Both the Deca-Durabolin-treated and control groups were given autologous bone marrow transplantation. Anabolic steroid effect on transplanted bone marrow colonyforming cells may explain the increased rate of leukopoietic regeneration in anabolic steroid-treated animals as compared to controls. PMID:124758

  17. The proinflammatory function of lymphocytes in non-immune inflammation: effect of steroidal and non-steroidal anti-inflammatory agents.

    PubMed Central

    Leme, J. G.; Bechara, G. H.; Sudo, L. S.

    1977-01-01

    Leucopenia rendered rats unresponsive to various inflammatory stimuli. The intensity of the inflammatory response in such animals was restored by i.v. administration of suspensions of lymphocytes, but not of granulocytes. This restorative effect was blocked by both steroidal and non-steroidal anti-inflammatory drugs. Utilizing carrageenin to induce inflammatory responses in the rat's paw, the effect of these drugs on lymphocytes was observed in two circumstances. First, following incubation of the cells with the drugs in concentrations not exceeding the peak plasma levels estimated for these substances in man or laboratory animals; the effect of the drugs seemed selective, since anti-histamine and anti-serotonin agents, as well as amethopterin, were devoid of action. Second, when lymphocytes were collected from rats previously treated with the various anti-inflammatory agents, injected 6-hourly during periods of 18 and 36 h, respectively, for steroidal and non-steroidal anti-inflammatory substances. The total amounts given were lower than those required to produce consistent anti-inflammatory effects in normal animals, when the drug was given as a single dose before injection of the irritant. It is concluded that the pro-inflammatory function of lymphocytes in non-immune inflammation can be blocked by steroidal and non-steroidal anti-inflammatory agents. PMID:607989

  18. Femoral perfusion after pulsed electromagnetic field stimulation in a steroid-induced osteonecrosis model.

    PubMed

    Ikegami, Akira; Ueshima, Keiichiro; Saito, Masazumi; Ikoma, Kazuya; Fujioka, Mikihiro; Hayashi, Shigeki; Ishida, Masashi; Fujiwara, Hiroyoshi; Mazda, Osam; Kubo, Toshikazu

    2015-07-01

    This study was designed to evaluate femoral perfusion after pulsed electromagnetic field (PEMF) stimulation in a steroid-induced osteonecrosis rabbit model by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Steroid-induced osteonecrosis was produced by single intramuscular injection of methylprednisolone in 15 rabbits. Eight rabbits underwent PEMF stimulation (PEMF group) and seven did not (control group). DCE-MRI was performed before PEMF stimulation, immediately before steroid administration, and 1, 5, 10, and 14 days after steroid administration. Regions of interest were set in the bilateral proximal femora. Enhancement ratio (ER), initial slope (IS), and area under the curve (AUC) were analyzed. ER, IS, and AUC in the control group significantly decreased after steroid administration compared with before administration (P<0.05). In PEMF group, IS significantly decreased; however, ER and AUC showed no significant differences after steroid administration compared with before. ER and IS in PEMF group were higher than in control group until 10th day, and AUC was higher until 5th day after steroid administration (P<0.05). PEMF stimulation restrains the decrease in blood flow after steroid administration. PMID:25808585

  19. Insulin Injection

    MedlinePlus

    ... others) and rosiglitazone (Avandia, in Avandamet and others); oral steroids such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), and prednisone (Deltasone); quinine; quinidine; salicylate pain relievers such as aspirin; sulfa antibiotics; and thyroid medications. Your doctor may ...

  20. Pamidronate Injection

    MedlinePlus

    ... prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: cancer chemotherapy medications; oral steroids such as dexamethasone (Decadron, ...

  1. [Steroid receptors and mechanism of action of sex steroids].

    PubMed

    Guiochon-Mantel, A; Milgrom, E

    1999-01-01

    Steroid hormone receptors define a large family of proteins. Recently, a new estradiol receptor has been identified. This discovery suggests the existence of a previously unrecognized pathway of estrogen signalling. Moreover, it implies important pharmacological consequences. Receptors activation induces the modulation of transcription of specific genes. Proteins involved in this effect have been identified: coactivators, corepressors and cointegrators. Their mechanism of action have been characterized. They modify histone acetylation of the corresponding promotor. Sex steroid receptors are located in the nucleus. This nuclear localization is in fact a dynamic situation, resulting from a continuous shuttling of the receptor between the cytoplasm and the nucleus. Non genomic effects of steroids have also been described. PMID:10542957

  2. Steroidal Saponins in Oat Bran.

    PubMed

    Yang, Junli; Wang, Pei; Wu, Wenbin; Zhao, Yantao; Idehen, Emmanuel; Sang, Shengmin

    2016-02-24

    Saponins are one type of widespread defense compound in the plant kingdom and have been exploited for the production of lead compounds with diverse pharmacological properties in drug discovery. Oats contain two unique steroidal saponins, avenacoside A, 1, and avenacoside B, 2. However, the chemical composition, the levels of these saponins in commercial oat products, and their health effects are still largely unknown. In this study, we directly purified 5 steroidal saponins (1-5) from a methanol extract of oat bran, characterized their structures by analyzing their MS and NMR spectra, and also tentatively identified 11 steroidal saponins (6-16) on the basis of their tandem mass spectra (MS(n), n = 2-3). Among the five purified saponins, 5 is a new compound and 4 is purified from oats for the first time. Using HPLC-MS techniques, a complete profile of oat steroidal saponins was determined, and the contents of the two primary steroidal saponins, 1 and 2, were quantitated in 15 different commercial oat products. The total levels of these two saponins vary from 49.6 to 443.0 mg/kg, and oat bran or oatmeal has higher levels of these two saponins than cold oat cereal. Furthermore, our results on the inhibitory effects of 1 and 2 against the growth of human colon cancer cells HCT-116 and HT-29 showed that both had weak activity, with 2 being more active than 1. PMID:26852819

  3. Analysis of Inadvertent Intradiscal Injections during Lumbar Transforaminal Epidural Injection

    PubMed Central

    Lee, Sung Mun; Bae, Jin Hong

    2014-01-01

    Background Recently, there have been several case reports and retrospective studies about the incidence of intradiscal (ID) injection during transforaminal epidural steroid injection (TFESI). Inadvertent ID injection is not a rare complication, and it carries the risk of developing diskitis, although there has been no report of diskitis after TFESI. We prospectively evaluated the incidence of inadvertent ID injection during lumbar TFESI and analyzed the contributing factors. Methods Ten patients received 2-level TFESI, and the remaining 229 patients received 1-level TFESI. When successful TFESI was performed, 2 ml of contrast dye was injected under real-time fluoroscopy to check for any inadvertent ID spread. A musculoskeletal radiologist analyzed all magnetic resonance images (MRIs) of patients who demonstrated inadvertent ID injection. When reviewing MRIs, the intervertebral foramen level where ID injection occurred was carefully examined, and any anatomical structure which narrowing the foramen was identified. Results Among the 249 TFESI, we identified 6 ID injections; thus, there was an incidence of 2.4%. Four patients had isthmic spondylolisthesis, and the level of spondylolisthesis coincided with the level of ID injection. We further examined the right or left foramen of the spondylolisthesis level and identified the upward migrated disc material that was narrowing the foramen. Conclusions Inadvertent ID injection during TFESI is not infrequent, and pain physicians must pay close attention to the type and location of disc herniation. PMID:24748946

  4. Bioconversion of steroid glycosides by Nocardia restricta.

    PubMed

    Belic, I; Kastelic-Suhadolc, T; Kralj, B

    1985-09-01

    The bioconversion of steroid alkaloid tomatine by Nocardia restricta yields the conjugate with lactic acid. We studied the bioconversion of some steroid glycosides without a nitrogen atom in the molecule to determine the effect of the nitrogen atom. The glycosides were of three different types: sterol glycosides, bufadienolide rhamnoside and steroid saponine. The results of bioconversions showed that Nocardia restricta converts steroid glycosides differently according to the sugar bound to the steroid aglycone. It can be concluded that in the absence of a nitrogen atom in the steroid molecule no conjugation with lactic acid by Nocardia restricta occurs. PMID:4046605

  5. Actions of steroids in mitochondria.

    PubMed

    Gavrilova-Jordan, Larisa P; Price, Thomas M

    2007-05-01

    Investigations of indirect and direct actions of steroids on the mitochondria are relatively new areas of research. In this review we provide brief background information regarding mitochondrial structure and function and then focus upon interactions of glucocorticoid, estrogen, androgen, and progesterone receptors with mitochondria. We evaluate the current evidence for steroid receptor localization in the mitochondria based on techniques of Western blot analysis, immunocytochemistry, electron microscopy, and mass spectrometry. Steroid receptor-dependent interactions with mitochondria may include transcriptional regulation of nuclear DNA-encoded mitochondrial proteins, transcriptional regulation of mitochondrial DNA-encoded proteins, or indirect effects on mitochondria due to interactions with cytoplasmic signaling peptides and non-genomic control of cation fluxes. These interactions may play a role in mitochondrial-dependent processes of oxidative phosphorylation and apoptosis. Physiological examples of these interactions are discussed. PMID:17447205

  6. Anabolic steroids and the athlete: a case study

    PubMed Central

    Oklobdzija, Edward; Weyrauch, David

    1989-01-01

    This paper examines the pharmacokinetic activities of anabolic steroids and their potential deleterious effects. A review of literature reveals the most significant pathological sequelae resulting from anabolic use to be peliosis hepatis and liver cell carcinoma. These ill effects have been more closely associated with those steroids whose chemical structures are specifically alkylated at the 17th carbon in the Alpha position as opposed to their Beta esterified counterparts. Testing of these drugs was attempted by way of a single case study. A 23 yr old male bodybuilder was subject to both oral and parenteral forms of steroid over a six week period of his training program. Serum, urinalysis and subjective parameters were monitored before during and after steroid administration. The results show elevated levels of urea, creatinine, bilirubin, CPK, AST, ALT and LDH. In this case study, the elevated parameters appear to be more a function of muscle breakdown induced by a combination of severe exercise and intramuscular injection than a measure of organ (liver) pathology.

  7. Golimumab Injection

    MedlinePlus

    ... at golimumab injection before injecting it. Check the expiration date printed on the auto-injection device or carton and do not use the medication if the expiration date has passed. Do not use a prefilled syringe ...

  8. An inside perspective on anabolic steroid abuse.

    PubMed

    Schaive, Chad; Kohler, Tobias S

    2016-04-01

    Steroid abuse is common across gyms across the world. This unique article features an inside perspective/opinion in a question and answer format from a former steroid user/high level body builder. PMID:27141450

  9. Hypochlorite Oxidation of Select Androgenic Steroids

    EPA Science Inventory

    Steroid hormones are vital for regulation of various biological functions including sexual development. Elevated concentrations of natural and synthetic androgenic steroids have been shown to adversely affect normal development in indigenous aqueous species. Androgens and their s...

  10. An inside perspective on anabolic steroid abuse

    PubMed Central

    Schaive, Chad; Kohler, Tobias S.

    2016-01-01

    Steroid abuse is common across gyms across the world. This unique article features an inside perspective/opinion in a question and answer format from a former steroid user/high level body builder. PMID:27141450

  11. Anabolic-androgenic steroids and brain reward.

    PubMed

    Clark, A S; Lindenfeld, R C; Gibbons, C H

    1996-03-01

    Anabolic-androgenic steroid (AAS) effects on brain reward were investigated in male rats with electrodes implanted in the lateral hypothalamus using the rate-frequency curve shift paradigm of brain stimulation reward. In the first experiment, treatment for 2 weeks with the AAS methandrostenolone had no effect on either the reward or performance components of intracranial self-stimulation. In the second experiment, treatment for 15 weeks with an AAS "cocktail" consisting of testosterone cypionate, nandrolone decanoate, and boldenone undecylenate did not alter brain reward but did produce a slight but significant change in bar press rate. In addition to the AAS treatment, animals in the second study were administered a single injection of d-amphetamine before and after 15 weeks of AAS exposure. The rate-frequency curve shift observed in response to a systemic injection of amphetamine was significantly greater in animals after 15 weeks of treatment with the AAS cocktail. Although AAS do not appear to alter the rewarding properties of brain stimulation, AAS may influence the sensitivity of brain reward systems. PMID:8866980

  12. The steroid benefit in treating complicated haemangioma

    PubMed Central

    Saleh, Kamal H.

    2009-01-01

    The clinical study included 30 patients with complicated cutaneous haemangioma (ulceration, bleeding, obstruction of anatomical orifices, and interference with function or movement). The patients were studied regarding the age group, sex, site of lesion, size of lesion, and the percentage of regression after treatment with steroid. The age ranged from three months to six years, there were 20 female patients and 10 male patients. We used local injection of diluted triamcinolone 4 mg with 5 ml. 0.9% NACI (normal saline), injected through 23-guage syringe under local or general anaesthesia every two weeks for six to eight sessions depending on the severity of the case, followed by a local pressure dressing. We measured the size of the lesion before each session and recorded the regression of the lesion. The patients were followed up for two years. Haemangioma commonly presents in infants and children, most commonly in females, especially in the head and neck and are usually of a small size. It regresses if the treatment is started earlier. PMID:20368866

  13. Adolescents and Steroids: A User Perspective.

    ERIC Educational Resources Information Center

    Office of Inspector General (DHHS), Washington, DC.

    Anabolic-androgenic steroids ("steroids") are synthetic derivatives of the natural male hormone testosterone. They were first used non-medically by elite athletes seeking to improve performance. More recently, however, steroid use has filtered down to high school and junior high school levels. The purpose of this study was to describe adolescent…

  14. Adjuvant steroids and relapse of typhoid fever.

    PubMed

    Cooles, P

    1986-10-01

    In a retrospective study, relapse after non-severe acute typhoid fever was highly significantly related to the use of adjuvant steroid in the initial illness. The steroid was given late and in small doses when compared with other studies. Caution should be observed when using steroids in this way as relapse though often mild may be a severe illness. PMID:3795323

  15. Intralesional hemorrhage and thrombosis without rupture in a pure spinal epidural cavernous angioma: a rare cause of acute lumbal radiculopathy.

    PubMed

    Floeth, Frank; Riemenschneider, Markus; Herdmann, Jörg

    2010-07-01

    Pure spinal epidural cavernous angiomas are extremely rare lesions, and their normal shape is that of a fusiform mass in the dorsal aspects of the spinal canal. We report a case of a lumbo-sacral epidural cavernous vascular malformation presenting with acute onset of right-sided S1 radiculopathy. Clinical aspects, imaging, intraoperative findings, and histology are demonstrated. The patient, a 27-year-old man presented with acute onset of pain, paraesthesia, and numbness within the right leg corresponding to the S1 segment. An acute lumbosacral disc herniation was suspected, but MRI revealed a cystic lesion with the shape of a balloon, a fluid level and a thickened contrast-enhancing wall. Intraoperatively, a purple-blue tumor with fibrous adhesions was located between the right S1 and S2 nerve roots. Macroscopically, no signs of epidural bleedings could be denoted. After coagulation of a reticular venous feeder network and dissection of the adhesions the rubber ball-like lesion was resected in total. Histology revealed a prominent venous vessel with a pathologically thickened, amuscular wall surrounded by smaller, hyalinized, venous vessels arranged in a back-to-back position typical for the diagnosis of a cavernous angioma. Lumina were partially occluded by thrombi. The surrounding fibrotic tissue showed signs of recurrent bleedings. There was no obvious mass hemorrhage into the surrounding tissue. In this unique case, the pathologic mechanism was not the usual rupture of the cavernous angioma with subsequent intraspinal hemorrhage, but acute mass effect by intralesional bleedings and thrombosis with subsequent increase of volume leading to nerve root compression. Thus, even without a sudden intraspinal hemorrhage a spinal cavernous malformation can cause acute symptoms identical to the clinical features of a soft disc herniation. PMID:20213297

  16. Accuracy of low-field magnetic resonance imaging versus radiography for guiding injection of equine distal interphalangeal joint collateral ligaments.

    PubMed

    Lamb, Megan M; Barrett, Jennifer G; White, Nathaniel A; Werre, Stephen R

    2014-01-01

    Desmopathy of the distal interphalangeal joint collateral ligament is a common cause of lameness in the horse and carries a variable prognosis for soundness. Intralesional treatment has been proposed for improving outcome; however, limited reports describe methods for injecting this ligament. The purpose of this study was to compare accuracy of low-field magnetic resonance imaging (MRI) vs. radiography for injecting the collateral ligament of the distal interphalangeal joint. Equine cadaver digit pairs (n = 10) were divided by random assignment to injection of the ligament by either technique. An observer unaware of injection technique determined injection success based on postinjection MRI and/or gross sections acquired from the proximal, middle, and distal portions of the ligament. McNemar's test was performed to determine statistical difference between injection techniques, the number of injection attempts, and injection of the medial or lateral collateral ligament. Magnetic resonance imaging guided injection was successful more frequently than radiographic-guided injection based on postinjection MRI (24 of 30 vs. 9 of 30; P = 0.0006) and gross sections (26 of 30 vs. 13 of 30; P = 0.0008). At each level of the ligament (proximal, middle, and distal), MRI-guided injection resulted in more successful injections than radiographic guidance. Statistical significance occurred at the proximal aspect of the collateral ligament based on postinjection MRI (P = 0.0143) and the middle portion of the ligament based on gross sections (P = 0.0253). Findings supported future testing of standing, low-field MRI as a technique for delivering intralesional regenerative therapy in live horses with desmopathy of these collateral ligaments. PMID:24102665

  17. Steroid hormones, steroid receptors, and breast cancer stem cells.

    PubMed

    Finlay-Schultz, Jessica; Sartorius, Carol A

    2015-06-01

    The ovarian hormones progesterone and estrogen play important roles in breast cancer etiology, proliferation, and treatment. Androgens may also contribute to breast cancer risk and progression. In recent years, significant advances have been made in defining the roles of these steroid hormones in stem cell homeostasis in the breast. Stem cells are potential origins of breast cancer and may dictate tumor phenotype. At least a portion of breast cancers are proposed to be driven by cancer stem cells (CSCs), cells that mimic the self-renewing and repopulating properties of normal stem cells, and can confer drug resistance. Progesterone has been identified as the critical hormone regulating normal murine mammary stem cell (MaSC) populations and normal human breast stem cells. Synthetic progestins increase human breast cancer risk; one theory speculates that this occurs through increased stem cells. Progesterone treatment also increases breast CSCs in established breast cancer cell lines. This is mediated in part through progesterone regulation of transcription factors, signal transduction pathways, and microRNAs. There is also emerging evidence that estrogens and androgens can regulate breast CSC numbers. The evolving concept that a breast CSC phenotype is dynamic and can be influenced by cell signaling and external cues emphasizes that steroid hormones could be crucial players in controlling CSC number and function. Here we review recent studies on steroid hormone regulation of breast CSCs, and discuss mechanisms by which this occurs. PMID:26265122

  18. The Efficacy of Adjuvant Intratympanic Steroid Treatment for Otitis Media with Effusion in Children

    PubMed Central

    Amer, Hazem Saeed; El-Anwar, Mohammad Waheed; Elfeky, Alaa Eldin

    2015-01-01

    Introduction  Otitis media with effusion (OME) is a leading cause of hearing impairment in children. Therefore, early and proper management is essential. Objectives  The objective of this research is to assess the efficacy of intratympanic (IT) steroids injection for management of otitis media with effusion (OME). Methods  This study involved 42 children (84 ears) with bilateral OME. We used tympanometry to confirm the childreńs middle ear effusion and pure tone audiometry to determine hearing threshold. We performed myringotomy and inserted ventilation tubes (VTs) bilaterally, followed by a steroid injection of 0.4–0.6 mL methylprednisolone (40 mg/mL) into one randomly selected middle ear. This procedure was followed by once-weekly administration of steroids (0.5 mL methylprednisolone at a concentration of 40 mg/mL) into the middle ear for three consecutive weeks. Results  We found recurrent OME after VT alone in nine (21.4%) ears; whereas, after VT combined with steroid administration, we found two (4.76%), with statistically significant difference. We noted tympanosclerosis postoperatively in six (12.9%) ears and in one of the injected ears (2.3%) (p = 0.0484). Otorrhea occurred in eight (19%) ears with VT alone and in three (7.1%) injected ears, with non-significant difference. The duration between VT insertion and its extrusion was 6.6 = 1.1 months for ears with VT alone and 6.95 =1.12 months in injected ears (p = 0.1541 NS). Conclusion  IT Steroids injection for treatment of OME is a safe and simple intervention with lower incidence of symptoms recurrence and postoperative complications. Thus, its use in management of OME is recommended.

  19. Cidofovir Injection

    MedlinePlus

    ... 300), tobramycin (Nebcin), vancomycin (Vancocin) and non-steroidal anti-inflammatory agents (Advil, Aleve, others). You must stop taking these medications at least 7 days before starting to take cidofovir. Be sure to tell your doctor about all drugs, over-the-counter medicines and herbal products you ...

  20. [New insights in steroid diabetes].

    PubMed

    Kurir, Tina Ticinović; Bozić, Josko; Markotić, Anita; Novak, Anela

    2012-10-01

    Glucocorticoids (GC) are the cornerstone in the treatment of numerous chronic autoimmune and inflammatory diseases. GC treatment is accompanied by significant metabolic adverse effects, including insulin resistance, glucose intolerance and diabetes, visceral adiposity, dyslipidemia and skeletal muscle atrophy. GCs are the most common cause of drug-induced diabetes mellitus. However, not everyone treated with glucocorticoids develops diabetes. Predictors of development of diabetes are age, weight, family history of diabetes mellitus, or personal history of gestational diabetes. There is evidence that patients with decreased insulin secretory reserve are much more likely to develop diabetes. Diabetes from topical steroid use is uncommon, but high-dose steroids have been associated with significant hyperglycemia, including development of hyperglycemic hyperosmolar syndrome and even diabetic ketoacidosis in patients with type 1 diabetes mellitus. Several mechanisms contribute to the development of hyperglycemia and steroid-induced diabetes, including decreased peripheral insulin sensitivity, increased hepatic glucose production, and inhibition of pancreatic insulin production and secretion. Physicians treating patients with GCs should be aware of the induction of metabolic disturbances and should not solely rely on fasting measurements. In addition, our review indicates that insulin therapy could be considered when treating patients on GC therapy. PMID:23814973

  1. Paclitaxel Injection

    MedlinePlus

    ... with other medications. Paclitaxel injection manufactured with polyoxyethylated castor oil is used to treat ovarian cancer (cancer that ... cancer, and lung cancer. Paclitaxel injection with polyoxyethylated castor oil is also used to treat Kaposi's sarcoma (a ...

  2. Mipomersen Injection

    MedlinePlus

    ... become pregnant during your treatment, stop using mipomersen injection and call your doctor immediately. ... Mipomersen injection may cause side effects. Tell your doctor if any of these ... and tiredness that are most likely to occur during the first 2 days ...

  3. Levofloxacin Injection

    MedlinePlus

    ... infections. Levofloxacin injection is also used to prevent anthrax (a serious infection that may be spread on ... in people who may have been exposed to anthrax germs in the air. Levofloxacin injection is in ...

  4. Ciprofloxacin Injection

    MedlinePlus

    ... injection is also used to prevent or treat anthrax (a serious infection that may be spread on ... in people who may have been exposed to anthrax germs in the air. Ciprofloxacin injection is in ...

  5. Romidepsin Injection

    MedlinePlus

    ... with at least one other medication given by mouth or by injection. Romidepsin injection is in a ... antifungals such as itraconazole (Sporanox), ketoconazole (Nizoral), and voriconazole (Vfend); cisapride (Propulsid) (not available in the U.S.); ...

  6. Degarelix Injection

    MedlinePlus

    Degarelix injection is used to treat advanced prostate cancer (cancer that begins in the prostate [a male reproductive gland]). Degarelix injection is in a class of medications called gonadotropin-releasing hormone (GnRH) ...

  7. Paclitaxel Injection

    MedlinePlus

    ... other medications. Paclitaxel injection manufactured with polyoxyethylated castor oil is used to treat ovarian cancer (cancer that ... and lung cancer. Paclitaxel injection with polyoxyethylated castor oil is also used to treat Kaposi's sarcoma (a ...

  8. Glatiramer Injection

    MedlinePlus

    ... course of disease where symptoms flare up from time to time) of multiple sclerosis (MS; a disease in which ... to inject glatiramer, inject it around the same time every day. Follow the directions on your prescription ...

  9. Daratumumab Injection

    MedlinePlus

    ... any laboratory test, tell your doctor and the laboratory personnel that you are receiving or received daratumumab injection. ... a blood transfusion, tell your doctor and the laboratory personnel that you are receiving or received daratumumab injection. ...

  10. Pralatrexate Injection

    MedlinePlus

    ... will need to take folic acid and vitamin B12 during your treatment with pralatrexate injection to help ... that you will need to receive a vitamin B12 injection no more than 10 weeks before your ...

  11. Cefoxitin Injection

    MedlinePlus

    ... injection is used to treat infections caused by bacteria including pneumonia and other lower respiratory tract (lung) ... medications called cephamycin antibiotics. It works by killing bacteria.Antibiotics such as cefoxitin injection will not work ...

  12. Chloramphenicol Injection

    MedlinePlus

    ... treat certain types of serious infections caused by bacteria when other antibiotics cannot be used. Chloramphenicol injection ... antibiotics. It works by stopping the growth of bacteria..Antibiotics such as chloramphenicol injection will not work ...

  13. Oxacillin Injection

    MedlinePlus

    ... is used to treat infections caused by certain bacteria. Oxacillin injection is in a class of medications called penicillins. It works by killing bacteria.Antibiotics such as oxacillin injection will not work ...

  14. Nafcillin Injection

    MedlinePlus

    ... to treat infections caused by certain types of bacteria. Nafcillin injection is in a class of medications called penicillins. It works by killing bacteria.Antibiotics such as nafcillin injection will not work ...

  15. Doripenem Injection

    MedlinePlus

    ... tract, kidney, and abdomen that are caused by bacteria. Doripenem injection is not approved by the Food ... medications called carbapenem antibiotics. It works by killing bacteria.Antibiotics such as doripenem injection will not work ...

  16. Medroxyprogesterone Injection

    MedlinePlus

    ... Medroxyprogesterone injection is a very effective method of birth control but does not prevent the spread of human ... you have been using a different method of birth control and are switching to medroxyprogesterone injection, your doctor ...

  17. Chloramphenicol Injection

    MedlinePlus

    Chloramphenicol injection is used to treat certain types of serious infections caused by bacteria when other antibiotics cannot be used. Chloramphenicol injection is in a class of medications called ...

  18. Levoleucovorin Injection

    MedlinePlus

    ... injection is used to prevent harmful effects of methotrexate (Rheumatrex, Trexall) when methotrexate is used to to treat certain types of ... people who have accidentally received an overdose of methotrexate or similar medications. Levoleucovorin injection is in a ...

  19. Estrogen Injection

    MedlinePlus

    ... forms of estrogen injection are used to treat hot flushes (hot flashes; sudden strong feelings of heat and sweating) ... If you are using estrogen injection to treat hot flushes, your symptoms should improve within 1 to ...

  20. Palonosetron Injection

    MedlinePlus

    Palonosetron injection is used to prevent nausea and vomiting that may occur within 24 hours after receiving ... occur several days after receiving certain chemotherapy medications. Palonosetron injection is in a class of medications called ...

  1. Leuprolide Injection

    MedlinePlus

    ... normal number of red blood cells) caused by uterine fibroids (noncancerous growths in the uterus). Leuprolide injection is ... Your doctor will tell you how long your treatment with leuprolide injection will last. When used in ...

  2. Naltrexone Injection

    MedlinePlus

    Naltrexone injection is used along with counseling and social support to help people who have stopped drinking large ... injection is also used along with counseling and social support to help people who have stopped abusing opiate ...

  3. Posaconazole Injection

    MedlinePlus

    Posaconazole injection is used to prevent fungal infections in people with a weakened ability to fight infection. Posaconazole injection is in a class of medications called azole antifungals. It works ...

  4. Epinephrine Injection

    MedlinePlus

    Adrenalin® Chloride Solution ... a pre-filled automatic injection device containing a solution (liquid) to inject under the skin or into ... device when this date passes. Look at the solution in the device from time to time. If ...

  5. Trastuzumab Injection

    MedlinePlus

    Trastuzumab injection is used along with other medications or after other medications have been used to treat ... has spread to other parts of the body. Trastuzumab injection is also used during and after treatment ...

  6. Fondaparinux Injection

    MedlinePlus

    ... using fondaparinux injection while you are in the hospital at least 6 to 8 hours after your ... you will continue to use fondaparinux after your hospital stay, you can inject fondaparinux yourself or have ...

  7. Doxycycline Injection

    MedlinePlus

    Doxycycline injection is used to treat or prevent bacterial infections, including pneumonia and other respiratory tract infections. ... certain skin, genital, intestine, and urinary system infections. Doxycycline injection may be used to treat or prevent ...

  8. Medroxyprogesterone Injection

    MedlinePlus

    ... Medroxyprogesterone subcutaneous injection is also used to treat endometriosis (a condition in which the type of tissue ... parts of the body in women who have endometriosis. Medroxyprogesterone injection is a very effective method of ...

  9. Ferumoxytol Injection

    MedlinePlus

    Ferumoxytol injection is used to treat iron-deficiency anemia (a lower than normal number of red blood ... and may cause the kidneys to stop working). Ferumoxytol injection is in a class of medications called ...

  10. Aripiprazole Injection

    MedlinePlus

    ... aripiprazole injection and aripiprazole extended-release injection developed gambling problems or other intense urges or behaviors that ... even if you do not realize that your gambling or any other intense urges or unusual behaviors ...

  11. The immune response in steroid deficient mice

    PubMed Central

    Streng, Charlotte B.; Nathan, P.

    1973-01-01

    Adrenalectomy, gonadectomy and combined adrenalectomy—gonadectomy resulted in increased spleen weights, spleen cell counts and 19S plaque-forming cells following primary and secondary immunization of mice with SRBC when compared to controls. Plaque-forming cells of the 7S type in the spleen did not increase when measured on the eleventh day following the primary or the third day following secondary sensitization. Combined adrenalectomy—gonadectomy had a greater effect on spleen cell counts, spleen weights and plaque-forming cells in the primary and secondary response than either operation alone. Haemolysin titres were not significantly different between test and sham operated animals in the primary and secondary responses. In the primary responses, it appears that the increase in spleen weight and cell count is responsible for the increase in 19S plaque-forming cells. The response to a second injection of SRBC demonstrated that 19S antibody-producing cells increased three-fold in steroid depleted mice above the control values. In the test animals the 19S antibody-producing cells of the spleen were relatively enriched above that of the controls. PMID:4574579

  12. Intratympanic steroids as a salvage treatment for sudden sensorineural hearing loss? A meta-analysis.

    PubMed

    Ng, Jia Hui; Ho, Roger Chun Man; Cheong, Crystal Shuk Jin; Ng, Adele; Yuen, Heng Wai; Ngo, Raymond Yeow Seng

    2015-10-01

    Sudden sensorineural hearing loss is typically treated with systemic steroids. The aim of this meta-analysis was to evaluate the efficacy of salvage intratympanic steroid treatment in patients who have initial treatment failure with systemic steroids. A MEDLINE literature search was performed, supported by searches of Web of Science, Biosis, and Science Direct. Articles of all languages were included. Selection of relevant publications was conducted independently by three authors. Only randomized controlled trials were considered. In one arm of the studies, the patients received salvage intratympanic steroids. In the other arm, patients did not receive further treatment. The standard difference in mean (SDM) amount of improvement in hearing threshold between patients who did and did not receive salvage intratympanic steroids was calculated. From an initial 184 studies found via the search strategy, 5 studies met inclusion criteria and were included. There was a statistically significant greater reduction in hearing threshold on pure-tone audiometry in patients who received salvage intratympanic steroids than in those who did not (SDM = -0.401, p = 0.005). Subgroup analysis showed that administration by intratympanic injection (SDM = -0.375, p = 0.013) rather than a round window catheter (SDM = -0.629, p = 0.160) yielded significant improvement in outcome. The usage of dexamethasone yielded better outcomes (SDM = -0.379, p = 0.039) than the use of methylprednisolone (SDM = -0.459, p = 0.187). No serious side effect of treatment was reported. In patients who have failed initial treatment with systemic steroids, additional treatment with salvage intratympanic dexamethasone injections demonstrate a statistically significant reduction in the hearing thresholds as compared to controls. PMID:25217083

  13. A review of steroids from Sarcophyton species.

    PubMed

    Zubair, Muhammad Sulaiman; Al-Footy, Khalid O; Ayyad, Seif-Eldin N; Al-Lihaibi, Sultan S; Alarif, Walied M

    2016-04-01

    This review reports the structural diversity of steroids from Sarcophyton species based on literature from the beginning of marine steroid research until now. There are 65 compounds studied from eight species. Most of them are polyhydroxy-type steroids of C-27-C-31 carbon skeleton. Their biological activities are highly diverse ranging from cytotoxic, antibacterial, antifungal, antiviral, anti-inflammatory, antidiabetic to antiosteoporosis properties. PMID:26299957

  14. Injectables in the Nose: Facts and Controversies.

    PubMed

    Thomas, William Walsh; Bucky, Lou; Friedman, Oren

    2016-08-01

    Nasal injectables and surface treatments alter the appearance of the nose both primarily and following nasal surgery. Fillers such as hyaluronic acids, calcium hydroxyapatite, and fat have a variety of advantages and disadvantages in eliminating small asymmetries postrhinoplasty. All nasal injectables have rare but severe ocular and cerebral ischemic complications. The injection of steroids following nasal reconstruction has a role in preventing supratip swelling and can improve the appearance of grafts to the nose. Resurfacing techniques reduce the appearance of autotransplanted grafts to the nose; there is little controversy about their benefit but surgeon preference for timing is varied. PMID:27400851

  15. Steroid metabolism by monkey and human spermatozoa

    SciTech Connect

    Rajalakshmi, M.; Sehgal, A.; Pruthi, J.S.; Anand-Kumar, T.C.

    1983-05-01

    Freshly ejaculated spermatozoa from monkey and human were washed and incubated with tritium labelled androgens or estradiol to study the pattern of spermatozoa steroid metabolism. When equal concentrations of steroid substrates were used for incubation, monkey and human spermatozoa showed very similar pattern of steroid conversion. Spermatozoa from both species converted testosterone mainly to androstenedione, but reverse conversion of androstenedione to testosterone was negligible. Estradiol-17 beta was converted mainly to estrone. The close similarity between the spermatozoa of monkey and men in their steroid metabolic pattern indicates that the rhesus monkey could be an useful animal model to study the effect of drugs on the metabolic pattern of human spermatozoa.

  16. Extensive visual loss with topical facial steroids.

    PubMed

    Aggarwal, R K; Potamitis, T; Chong, N H; Guarro, M; Shah, P; Kheterpal, S

    1993-01-01

    Steroid creams applied topically to the skin are routinely used in the treatment of many dermatoses. Their use on the face in severe atopic eczema is relatively common. We report a series of three patients who whilst using topical facial steroids developed advanced glaucoma. A further two cases of ocular hypertension secondary to topical facial steroids are also described. This is the first series of cases to be reported demonstrating the potentially blinding complications of topical facial steroids. Recommendations are made with regard to screening such patients for glaucoma. PMID:8287990

  17. Steroid receptor coactivator 2 modulates steroid-dependent male sexual behavior and neuroplasticity in Japanese quail (Coturnix japonica).

    PubMed

    Niessen, Neville-Andrew; Balthazart, Jacques; Ball, Gregory F; Charlier, Thierry D

    2011-11-01

    Steroid receptor coactivators are necessary for efficient transcriptional regulation by ligand-bound nuclear receptors, including estrogen and androgen receptors. Steroid receptor coactivator-2 (SRC-2) modulates estrogen- and progesterone-dependent sexual behavior in female rats but its implication in the control of male sexual behavior has not been studied to our knowledge. We cloned and sequenced the complete quail SRC-2 transcript and showed by semi-quantitative PCR that SRC-2 expression is nearly ubiquitous, with high levels of expression in the kidney, cerebellum and diencephalon. Real-time quantitative PCR did not reveal any differences between intact males and females the medial preoptic nucleus (POM), optic lobes and cerebellum. We next investigated the physiological and behavioral role of this coactivator using in vivo antisense oligonucleotide techniques. Daily injections in the third ventricle at the level of the POM of locked nucleic acid antisense targeting SRC-2 significantly reduced the expression of testosterone-dependent male-typical copulatory behavior but no inhibition of one aspect of the appetitive sexual behavior was observed. The volume of POM, defined by aromatase-immunoreactive cells, was markedly decreased in animals treated with antisense as compared with controls. These results demonstrate that SRC-2 plays a prominent role in the control of steroid-dependent male sexual behavior and its associated neuroplasticity in Japanese quail. PMID:21854393

  18. Unusual locations of localized myxedema in Graves disease. Report of three cases

    SciTech Connect

    Noppakun, N.; Bancheun, K.; Chandraprasert, S.

    1986-01-01

    Three patients with Graves disease had very unusual locations of localized myxedema. One patient had localized myxedema on the pretibial and shoulder areas after sodium iodide I 131 therapy. The second patient had localized myxedema on his neck, shoulders, and upper part of the back as well as on the pretibial area. The third patient had localized myxedema on the pinnae, also following sodium iodide I 131 therapy. After surgical removal followed by intralesional triamcinolone acetonide injections, the first patient's lesions recurred. The lesions in the second case did not respond to topical steroid cream. The third patient had a partial response to intralesional steroid injections.

  19. [Paraffin oil injection in bodybuilders calls for preventive action].

    PubMed

    Henriksen, Trine Foged; Løvenwald, Jette Bisgaard; Matzen, Steen Henrik

    2010-01-18

    Injection of paraffin oil to change physical configuration is an obsolete procedure from 1899, revived by bodybuilders as an alternative to intramuscular injections of steroids. Paraffin oil has destructive consequences: skin inflammation, hard oedema, sterile abscesses, diffuse lymphangitis and paraffinomas. We report a case of a 24-year-old male bodybuilder who self-injected one litre of paraffin oil in each arm. Hazard notice and advice to bodybuilders with potential risk attitude or "reverse anorexia" are warranted. PMID:20089216

  20. Steroid influences on GABAergic neurotransmission: A behavioral and biochemical approach

    SciTech Connect

    McCarthy, M.M.

    1989-01-01

    Steroid influences on GABAergic neurotransmission are varied and complex. However, there has been little investigation into the behavioral relevance of steroid effects on GABA. GABA had been implicated in the control of lordosis, a steroid dependent posture exhibited by sexually receptive female rats, but with conflicting results. This data demonstrated that GABA plays a dual role in the regulation of lordosis; stimulation of GABAergic transmission in the medial hypothalamus enhances lordosis whereas stimulation of GABA in the preoptic area inhibits lordosis. In separate experiments it was determined that progesterone enhances binding of the GABA{sub A} agonist, muscimol, in an in vitro exchange assay utilizing synaptic membranes prepared from the hypothalamus of ovariectomized rats. Scatchard analysis revealed a difference in affinity of the GABA{sub A} receptor between ovariectomized, receptive and post receptive females. In the preoptic area there was a significant decrease in the binding of {sup 3}H-muscimol in receptive females versus post-receptive and ovariectomized rats. In other behavioral experiments, the influence of estrogen and progesterone on GABA-induced analgesia was assessed. Intrathecal infusion of a low dose of muscimol at the lumbar level of the spinal cord did not alter nociceptive thresholds in ovariectomized rats. However, when intact females were administered the same dose of muscimol, they exhibited differential responses over the estrous cycle. Females in estrus were analgesic after muscimol, whereas diestrus females did not differ from ovariectomized controls. Ovariectomized rats injected s.c. with progesterone (2mg) exhibited a pronounced analgesia after intrathecal muscimol beginning 15 minutes after steroid treatment, whereas similar treatment with estrogen (10ug) was without effect.

  1. Steroidal esters from Ferula sinkiangensis.

    PubMed

    Li, Guangzhi; Li, Xiaojin; Cao, Li; Shen, Liangang; Zhu, Jun; Zhang, Jing; Wang, Junchi; Zhang, Lijing; Si, Jianyong

    2014-09-01

    Two new steroidal esters with an unusual framework, Sinkiangenorin A and B, a new organic acid glycoside, Sinkiangenorin C, and four known lignin compounds were isolated from the seeds of Ferula sinkiangensis. The structures of these compounds were established by spectroscopic analysis and single-crystal X-ray diffraction. All of the isolated compounds were tested against Hela, K562 and AGS human cancer cell lines. Sinkiangenorin C showed cytotoxic activity against AGS cells with an IC50 of 36.9 μM. PMID:24979220

  2. Steroids, triterpenoids and molecular oxygen

    PubMed Central

    Summons, Roger E; Bradley, Alexander S; Jahnke, Linda L; Waldbauer, Jacob R

    2006-01-01

    There is a close connection between modern-day biosynthesis of particular triterpenoid biomarkers and presence of molecular oxygen in the environment. Thus, the detection of steroid and triterpenoid hydrocarbons far back in Earth history has been used to infer the antiquity of oxygenic photosynthesis. This prompts the question: were these compounds produced similarly in the past? In this paper, we address this question with a review of the current state of knowledge surrounding the oxygen requirement for steroid biosynthesis and phylogenetic patterns in the distribution of steroid and triterpenoid biosynthetic pathways. The hopanoid and steroid biosynthetic pathways are very highly conserved within the bacterial and eukaryotic domains, respectively. Bacteriohopanepolyols are produced by a wide range of bacteria, and are methylated in significant abundance at the C2 position by oxygen-producing cyanobacteria. On the other hand, sterol biosynthesis is sparsely distributed in distantly related bacterial taxa and the pathways do not produce the wide range of products that characterize eukaryotes. In particular, evidence for sterol biosynthesis by cyanobacteria appears flawed. Our experiments show that cyanobacterial cultures are easily contaminated by sterol-producing rust fungi, which can be eliminated by treatment with cycloheximide affording sterol-free samples. Sterols are ubiquitous features of eukaryotic membranes, and it appears likely that the initial steps in sterol biosynthesis were present in their modern form in the last common ancestor of eukaryotes. Eleven molecules of O2 are required by four enzymes to produce one molecule of cholesterol. Thermodynamic arguments, optimization of function and parsimony all indicate that an ancestral anaerobic pathway is highly unlikely. The known geological record of molecular fossils, especially steranes and triterpanes, is notable for the limited number of structural motifs that have been observed. With a few exceptions

  3. Into the world of steroids

    PubMed Central

    2010-01-01

    Evolution of steroids such as sex hormones and ecdysteroids occurred independently in the animal and plant kingdoms. Plants use phytoecdysteroids (PEs) to control defense interactions with some predators; furthermore, PEs can exert beneficial influence on many aspects of mammalian metabolism. Endocrine disrupting compounds such as the estrogen agonist bisphenol A (BPA) are widespread in the environment, posing a potential hormonal risk to animals and plants. Adverse BPA effects on reproductive development and function are coupled with other toxic effects. BPA bioremediation techniques could be developed by exploiting some tolerant plant species. PMID:20671439

  4. Comparison of classical and ultrasound-assisted extractions of steroids and triterpenoids from three Chresta spp.

    PubMed

    Schinor, Elisandra C; Salvador, Marcos J; Turatti, Izabel C C; Zucchi, Orghêda L A D; Dias, Diones A

    2004-09-01

    A comparative study of classical and ultrasound-assisted extractions of steroids and triterpenoids from stem, leaves and flowers of Chresta exsucca, C. scapigera and C. sphaerocephala is described. The direct analysis of crude apolar and medium-polar extracts has been conducted by high-resolution gas chromatography followed by co-injections of the crude extract with certified standards on capillary columns of different polarities. The use of ultrasound decreased significantly the total time of treatment and in addition, this extraction method was more effective for the steroids and most of the triterpenes. PMID:15302029

  5. Steroids as γ-secretase modulators

    PubMed Central

    Jung, Joo In; Ladd, Thomas B.; Kukar, Thomas; Price, Ashleigh R.; Moore, Brenda D.; Koo, Edward H.; Golde, Todd E.; Felsenstein, Kevin M.

    2013-01-01

    Aggregation and accumulation of Aβ42 play an initiating role in Alzheimer's disease (AD); thus, selective lowering of Aβ42 by γ-secretase modulators (GSMs) remains a promising approach to AD therapy. Based on evidence suggesting that steroids may influence Aβ production, we screened 170 steroids at 10 μM for effects on Aβ42 secreted from human APP-overexpressing Chinese hamster ovary cells. Many acidic steroids lowered Aβ42, whereas many nonacidic steroids actually raised Aβ42. Studies on the more potent compounds showed that Aβ42-lowering steroids were bonafide GSMs and Aβ42-raising steroids were inverse GSMs. The most potent steroid GSM identified was 5β-cholanic acid (EC50=5.7 μM; its endogenous analog lithocholic acid was virtually equipotent), and the most potent inverse GSM identified was 4-androsten-3-one-17β-carboxylic acid ethyl ester (EC50=6.25 μM). In addition, we found that both estrogen and progesterone are weak inverse GSMs with further complex effects on APP processing. These data suggest that certain endogenous steroids may have the potential to act as GSMs and add to the evidence that cholesterol, cholesterol metabolites, and other steroids may play a role in modulating Aβ production and thus risk for AD. They also indicate that acidic steroids might serve as potential therapeutic leads for drug optimization/development.—Jung, J. I., Ladd, T. B., Kukar, T., Price, A. R., Moore, B. D., Koo, E. H., Golde, T. E., Felsenstein, K. M. Steroids as γ-secretase modulators. PMID:23716494

  6. CONTAMINANT INTERACTIONS WITH STEROID RECEPTORS: EVIDENCE FOR RECEPTOR BINDING.

    EPA Science Inventory

    Steroid receptors are important determinants of endocrine disrupter consequences. As the most frequently proposed mechanism of endocrine-disrupting contaminant (EDC) action, steroid receptors are not only targets of natural steroids but are also commonly sites of nonsteroidal com...

  7. Intravitreal Steroids for the Treatment of Retinal Diseases

    PubMed Central

    Veritti, Daniele; Boscia, Francesco

    2014-01-01

    Diabetic macular edema (DME), pseudophakic cystoid macular edema (CME), age-related macular degeneration (AMD), retinal vascular occlusion (RVO), and uveitis are ocular conditions related to severe visual impairment worldwide. Corticosteroids have been widely used in the treatment of these retinal diseases, due to their well-known antiangiogenic, antiedematous, and anti-inflammatory properties. Intravitreal steroids have emerged as novel and essential tools in the ophthalmologist's armamentarium, allowing for maximization of drug efficacy and limited risk of systemic side effects. Recent advances in ocular drug delivery methods led to the development of intraocular implants, which help to provide prolonged treatment with controlled drug release. Moreover, they may add some potential advantages over traditional intraocular injections by delivering certain rates of drug directly to the site of action, amplifying the drug's half-life, contributing in the minimization of peak plasma levels of the drug, and avoiding the side effects associated with repeated intravitreal injections. The purpose of this review is to provide an update on the use of intravitreal steroids as a treatment option for a variety of retinal diseases and to review the current literature considering their properties, safety, and adverse events. PMID:24526927

  8. Intravitreal steroids for the treatment of retinal diseases.

    PubMed

    Sarao, Valentina; Veritti, Daniele; Boscia, Francesco; Lanzetta, Paolo

    2014-01-01

    Diabetic macular edema (DME), pseudophakic cystoid macular edema (CME), age-related macular degeneration (AMD), retinal vascular occlusion (RVO), and uveitis are ocular conditions related to severe visual impairment worldwide. Corticosteroids have been widely used in the treatment of these retinal diseases, due to their well-known antiangiogenic, antiedematous, and anti-inflammatory properties. Intravitreal steroids have emerged as novel and essential tools in the ophthalmologist's armamentarium, allowing for maximization of drug efficacy and limited risk of systemic side effects. Recent advances in ocular drug delivery methods led to the development of intraocular implants, which help to provide prolonged treatment with controlled drug release. Moreover, they may add some potential advantages over traditional intraocular injections by delivering certain rates of drug directly to the site of action, amplifying the drug's half-life, contributing in the minimization of peak plasma levels of the drug, and avoiding the side effects associated with repeated intravitreal injections. The purpose of this review is to provide an update on the use of intravitreal steroids as a treatment option for a variety of retinal diseases and to review the current literature considering their properties, safety, and adverse events. PMID:24526927

  9. Cyanobacterial Bioamarkers: Triterpenoids plus Steroids?

    NASA Astrophysics Data System (ADS)

    Summons, R. E.; Jahnke, L. L.; Cullings, K. W.; Logan, G. A.

    2001-12-01

    Reconstructing the biomarker record of the early Earth requires us to make assumptions about the constancy and specificity of lipid biosynthetic pathways through geological time and rests upon our knowledge of the lipid composition of extant organisms.\\x90\\x90 For example, the three domains of extant life Eukarya, Archaea and Bacteria were present in Archean ecosystems if we are to believe the record of chemical fossils that have been found in rocks as old as 2700Ma.\\x90 However, the validity of the steroid signature as an indicator for Eukarya has questioned because of some reports of Ophytosterol, biosynthesis in cyanobacteria and we examined this issue in some new experiments with cyanobacteria grown in culture.\\x90 After initial cultures of Phormidium and Chlorogloeopsis proved to contain sterols, in addition to the expected complement of hopanoid and 2-methylhopanoid, we hypothesized that these might be the result of fungal contamination.\\x90 Subsequent cultures grown after repeated sub-culturing in the presence of cycloheximide proved to be devoid of sterol. Our results are therefore consistent with the notion that sterol biosynthesis is, with very few exceptions, a primary characteristic of Eukarya.\\x90 Consequently, the steroid hydrocarbons that are found in ancient sediments are most likely the remains of algae and other eukaryotes.\\x90

  10. Psychological Characteristics of Adolescent Steroid Users.

    ERIC Educational Resources Information Center

    Burnett, Kent F.; Kleiman, Mark E.

    1994-01-01

    Used Millon Adolescent Personality Inventory and Profile of Mood States to assess psychological characteristics in 72 adolescent males: 24 adolescent athletes who reported steroid use, 24 athletes with no steroid use, and 24 nonathletes. Although some personality variables differentiated between athletes and nonathletes, no personality variables…

  11. Steroids Update, Part 1 and Part 2.

    ERIC Educational Resources Information Center

    Miller, Calvin; Duda, Marty

    1986-01-01

    Part 1 of this two-part article describes the views of a physician who believes that athletes who want to take steroids are best protected by receiving a prescription and monitoring. Part 2 discusses the more general view of physicians that steroids should not be prescribed but perhaps should be monitored. (MT)

  12. Steroids: To Test or to Educate?

    ERIC Educational Resources Information Center

    LaFee, Scott

    2006-01-01

    In February 2005, The Dallas Morning News published a multipart series on steroid use among high school students in Texas. The paper's four-month investigation was wide-ranging, but shined a particular spotlight upon alleged abuses in the 13,700-student Grapevine-Colleyville Independent School District, north of Dallas. Use of steroids and other…

  13. Steroid allergy: report of two cases.

    PubMed

    Peng, Y S; Shyur, S D; Lin, H Y; Wang, C Y

    2001-06-01

    Corticosteroid preparations have anti-inflammatory and immunosuppressive properties and are widely used in the treatment of asthma and allergic disorders. Steroids themselves, however, can induce hypersensitivity reactions. The number of reports on contact allergy or anaphylactic reactions is increasing. Steroid hypersensitivity should be considered in any patient whose dermatitis becomes worse with topical steroid therapy, or in patients who develop systemic allergic reactions after the use of systemic steroids. The diagnosis can be confirmed by skin testing, in vitro evidence of specific IgE, oral or parenteral challenge, or an allergic patch test. The latter may be positive within 20 min, which indicates immediate contact urticaria, or at 72 to 96 h, which indicates delayed contact hypersensitivity. In this article we report two cases of steroid allergy. Case 1 was a 5-year-old asthmatic boy with an anaphylactic reaction to steroids and aspirin. Case 2 was a 2-year-old boy with atopic dermatitis and steroid contact urticaria. Both cases 1 and 2 showed positive results to triamcinolone, dexamethasone, hydrocortisone, and methylprednisolone in the immediate skin allergy test. Case 2 had immediate contact urticaria to hydrocortisone and clobetasone butyrate. Case 1 had a positive systemic allergic reaction to cortisone acetate, prednisolone, and dexamethasone on the oral steroid challenge test, and also had aspirin induced angioedema and urticaria 10 min after challenge with 50 mg aspirin. PMID:11456363

  14. Naturally occurring steroids in Xenopus oocyte during meiotic maturation. Unexpected presence and role of steroid sulfates.

    PubMed

    Haccard, Olivier; Dupré, Aude; Liere, Philippe; Pianos, Antoine; Eychenne, Bernard; Jessus, Catherine; Ozon, René

    2012-10-15

    In the ovary, oocytes are surrounded by follicle cells and arrested in prophase of meiosis I. Although steroidogenic activity of follicle cells is involved in oogenesis regulation, clear qualitative and quantitative data about the steroid content of follicles are missing. We measured steroid levels of Xenopus oocytes and follicles by gas chromatography-mass spectrometry. We show that dehydroepiandrosterone sulfate is the main steroid present in oocytes. Lower levels of free steroids are also detected, e.g., androgens, whereas progesterone is almost undetectable. We propose that sulfatation is a protective mechanism against local variations of active steroids that could be deleterious for follicle-enclosed oocytes. Steroid levels were measured after LH stimulation, responsible for the release by follicle cells of a steroid signal triggering oocyte meiosis resumption. Oocyte levels of androgens rise slowly during meiosis re-entry whereas progesterone increases abruptly to micromolar concentration, therefore representing the main physiological mediator of meiosis resumption in Xenopus oocyte. PMID:22687883

  15. Steroid use in Acute Liver Failure

    PubMed Central

    Karkhanis, Jamuna; Verna, Elizabeth C.; Chang, Matthew S.; Stravitz, R. Todd; Schilsky, Michael; Lee, William M; Brown, Robert S

    2014-01-01

    Background/Aims Drug-induced and indeterminate Acute Liver Failure (ALF) might be due to an autoimmune-like hepatitis that is responsive to corticosteroid therapy. The aim of this study was to evaluate whether corticosteroids improve survival in fulminant autoimmune hepatitis, drug-induced or indeterminate ALF, and whether this benefit varies according to the severity of illness. Methods We conducted a retrospective analysis of autoimmune, indeterminate and drug-induced ALF patients in the Acute Liver Failure Study Group from 1998-2007. The primary endpoints were overall and spontaneous survival (SS, survival without transplant). Results 361 ALF patients were studied, 66 with autoimmune (25 steroids, 41 no steroids), 164 with indeterminate (21 steroids, 143 no steroids), and 131 with drug-induced (16 steroids, 115 no steroids) ALF. Steroid use was not associated with improved overall survival (61% vs. 66%, p=0.41), nor with improved survival in any diagnosis category. Steroid use was associated with diminished survival in certain subgroups of patients, including those with the highest quartile of MELD (MELD > 40, survival 30% vs. 57%, p=0.03). In multivariable analysis controlling for steroid use and diagnosis, age (OR 1.37 per decade), coma grade (OR 2.02 grade 2, 2.65 grade 3, 5.29 grade 4), MELD (OR 1.07) and pH<7.4 (OR 3.09) were significantly associated with mortality. Though steroid use was associated with a marginal benefit in SS overall (35% v. 23%, p=0.047), this benefit did not persistent in multivariable analysis; mechanical ventilation (OR 0.24), MELD (OR 0.93), and ALT (1.02) were the only significant predictors of SS. Conclusions Corticosteroids did not improve overall survival or SS in drug-induced, indeterminate or autoimmune ALF and were associated with lower survival in patients with the highest MELD scores. PMID:23929808

  16. Lacosamide Injection

    MedlinePlus

    ... may be prescribed for other uses; ask your doctor or pharmacist for more information. ... Before using lacosamide injection,tell your doctor and pharmacist if you are allergic to lacosamide, any other medications, or any of the ingredients in lacosamide injection. Ask your pharmacist for a ...

  17. Dexamethasone Injection

    MedlinePlus

    ... lines under the skin skin depressions at the injection site increased body fat or movement to different areas of your body inappropriate happiness difficulty falling asleep or staying asleep extreme ... increased appetite injection site pain or redness Some side effects can ...

  18. Pralatrexate Injection

    MedlinePlus

    ... you that you will need to receive a vitamin B12 injection no more than 10 weeks before your first ... tests to check your body's response to pralatrexate injection.Ask your ... such as vitamins, minerals, or other dietary supplements. You should bring ...

  19. Leucovorin Injection

    MedlinePlus

    ... lack of vitamin B12 or inability to absorb vitamin B12. Your doctor will not prescribe leucovorin injection to treat this type of anemia.tell your ... tests to check your body's response to leucovorin injection.It is ... such as vitamins, minerals, or other dietary supplements. You should bring ...

  20. Etanercept Injection

    MedlinePlus

    ... and colorless. The liquid may contain small white particles, but should not contain large or colored particles. Do not use a syringe or dosing pen ... liquid is cloudy or contains large or colored particles.The best place to inject etanercept injection is ...

  1. Musculoskeletal Injection

    PubMed Central

    Wittich, Christopher M.; Ficalora, Robert D.; Mason, Thomas G.; Beckman, Thomas J.

    2009-01-01

    Patients commonly present to primary care physicians with musculoskeletal symptoms. Clinicians certified in internal medicine must be knowledgeable about the diagnosis and management of musculoskeletal diseases, yet they often receive inadequate postgraduate training on this topic. The musculoskeletal problems most frequently encountered in our busy injection practice involve, in decreasing order, the knees, trochanteric bursae, and glenohumeral joints. This article reviews the clinical presentations of these problems. It also discusses musculoskeletal injections for these problems in terms of medications, indications, injection technique, and supporting evidence from the literature. Experience with joint injection and the pharmacological principles described in this article should allow primary care physicians to become comfortable and proficient with musculoskeletal injections. PMID:19720781

  2. High-throughput functional screening of steroid substrates with wild-type and chimeric P450 enzymes.

    PubMed

    Urban, Philippe; Truan, Gilles; Pompon, Denis

    2014-01-01

    The promiscuity of a collection of enzymes consisting of 31 wild-type and synthetic variants of CYP1A enzymes was evaluated using a series of 14 steroids and 2 steroid-like chemicals, namely, nootkatone, a terpenoid, and mifepristone, a drug. For each enzyme-substrate couple, the initial steady-state velocity of metabolite formation was determined at a substrate saturating concentration. For that, a high-throughput approach was designed involving automatized incubations in 96-well microplate with sixteen 6-point kinetics per microplate and data acquisition using LC/MS system accepting 96-well microplate for injections. The resulting dataset was used for multivariate statistics aimed at sorting out the correlations existing between tested enzyme variants and ability to metabolize steroid substrates. Functional classifications of both CYP1A enzyme variants and steroid substrate structures were obtained allowing the delineation of global structural features for both substrate recognition and regioselectivity of oxidation. PMID:25243177

  3. High-Throughput Functional Screening of Steroid Substrates with Wild-Type and Chimeric P450 Enzymes

    PubMed Central

    Truan, Gilles; Pompon, Denis

    2014-01-01

    The promiscuity of a collection of enzymes consisting of 31 wild-type and synthetic variants of CYP1A enzymes was evaluated using a series of 14 steroids and 2 steroid-like chemicals, namely, nootkatone, a terpenoid, and mifepristone, a drug. For each enzyme-substrate couple, the initial steady-state velocity of metabolite formation was determined at a substrate saturating concentration. For that, a high-throughput approach was designed involving automatized incubations in 96-well microplate with sixteen 6-point kinetics per microplate and data acquisition using LC/MS system accepting 96-well microplate for injections. The resulting dataset was used for multivariate statistics aimed at sorting out the correlations existing between tested enzyme variants and ability to metabolize steroid substrates. Functional classifications of both CYP1A enzyme variants and steroid substrate structures were obtained allowing the delineation of global structural features for both substrate recognition and regioselectivity of oxidation. PMID:25243177

  4. CNS: sex steroids and SERMs.

    PubMed

    Bernardi, F; Pluchino, N; Stomati, M; Pieri, M; Genazzani, A R

    2003-11-01

    The central nervous system (CNS) is one of the main target tissues for sex steroid hormones, which act both through genomic mechanisms, modulating synthesis, release, and metabolism of many neuropeptides and neurotransmitters, and through nongenomic mechanisms, influencing electrical excitability, synaptic function, and morphological features. The identification of the brain as a de novo source of neurosteroids modulating cerebral function, suggests that the modifications in mood and cognitive performances occurring in postmenopausal women could also be related to a modification in the levels of neurosteroids, particularly allopregnanolone and DHEA, GABA-A agonist, and antagonist, respectively. The selective estrogen receptor modulators (SERMs) are compounds that activate the estrogen receptors with different estrogenic and antiestrogenic tissue-specific effects. In addition to the effects of the classic steroid hormones on the CNS, the study of selective estrogen receptor modulators impact on the neuroendocrine system has recently provided encouraging results, indicating that raloxifene analog LY 117018 and the new generation SERM EM-652 have an estrogen-like action on beta-endorphin and on allopregnanolone in ovariectomized rats, while they exert an anti-estrogenic effect in fertile rats and in ovariectomized rats treated with estrogens. In addition, raloxifene administration in postmenopausal women plays an estrogen-like effect on circulating beta-EP and allopregnanolone levels, and it restores the response of beta-EP and allopregnanolone to neuroendocrine tests. In conclusion, the positive effects of HRT on mood and cognition in postmenopausal women occur via the modulation of neuroendocrine pathways and probably also of neurosteroidogenesis. The effects of raloxifene on mood and cognition encourage the efforts in the research of an ideal estrogen replacement therapy, showing all the positive effects of estrogens and fewer side effects. PMID:14644845

  5. Measurement of steroid concentrations in brain tissue: methodological considerations.

    PubMed

    Taves, Matthew D; Ma, Chunqi; Heimovics, Sarah A; Saldanha, Colin J; Soma, Kiran K

    2011-01-01

    It is well recognized that steroids are synthesized de novo in the brain (neurosteroids). In addition, steroids circulating in the blood enter the brain. Steroids play numerous roles in the brain, such as influencing neural development, adult neuroplasticity, behavior, neuroinflammation, and neurodegenerative diseases such as Alzheimer's disease. In order to understand the regulation and functions of steroids in the brain, it is important to directly measure steroid concentrations in brain tissue. In this brief review, we discuss methods for the detection and quantification of steroids in the brain. We concisely present the major advantages and disadvantages of different technical approaches at various experimental stages: euthanasia, tissue collection, steroid extraction, steroid separation, and steroid measurement. We discuss, among other topics, the potential effects of anesthesia and saline perfusion prior to tissue collection; microdissection via Palkovits punch; solid phase extraction; chromatographic separation of steroids; and immunoassays and mass spectrometry for steroid quantification, particularly the use of mass spectrometry for "steroid profiling." Finally, we discuss the interpretation of local steroid concentrations, such as comparing steroid levels in brain tissue with those in the circulation (plasma vs. whole blood samples; total vs. free steroid levels). We also present reference values for a variety of steroids in different brain regions of adult rats. This brief review highlights some of the major methodological considerations at multiple experimental stages and provides a broad framework for designing studies that examine local steroid levels in the brain as well as other steroidogenic tissues, such as thymus, breast, and prostate. PMID:22654806

  6. Sex Steroid Signaling: Implications for Lung Diseases

    PubMed Central

    Sathish, Venkatachalem; Martin, Yvette N.; Prakash, Y.S.

    2015-01-01

    There is increasing recognition that the sex hormones (estrogen, progesterone, and testosterone) have biological and pathophysiological actions in peripheral, non-reproductive organs, including the lung. Clinically, sex differences in the incidence, morbidity and mortality of lung diseases such as asthma, chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, lung cancer and pulmonary hypertension have been noted, although intrinsic sex differences vs. the roles of sex steroids are still not well-understood. Accordingly, it becomes important to ask the following questions: 1) Which sex steroids are involved? 2) How do they affect different components of the lung under normal circumstances? 3) How does sex steroid signaling change in or contribute to lung disease, and in this regard, are sex steroids detrimental or beneficial? As our understanding of sex steroid signaling in the lung improves, it is important to consider whether such information can be used to develop new therapeutic strategies to target lung diseases, perhaps in both sexes or in a sex-specific manner. In this review, we focus on the basics of sex steroid signaling, and the current state of knowledge regarding how they influence structure and function of specific lung components across the life span and in the context of some important lung diseases. We then summarize the potential for sex steroids as useful biomarkers and therapeutic targets in these lung diseases as a basis for future translational research in the area of gender and individualized medicine. PMID:25595323

  7. Fuel injection

    SciTech Connect

    Iiyoshi, A.; Vogoshi, S.

    1983-12-01

    The Plasma Physics Laboratory and the Dept. of Electrical Engineering report on three types of pellet injectors which have different applications: injection of a pellet into a magnetic bottle for magnetic confinement; injection of a pellet into a vacuum chamber for an inertial confinement experiment; and injection of a pellet into a magnetic bottle where the pellet is ionized by high-power laser irradiation for target plasma production. The requirements of pellet injectors are summarized in a table. Theoretical studies on pellet ablation in hot plasma and ablated particle diffusion are underway.

  8. Homologous Series of Liquid Crystalline Steroidal Lipids

    SciTech Connect

    Thiemann, T.; Vill, V.

    1997-03-01

    Steroids are an important source of chiral mesophases. The melting behavior and mesomorphic properties of homologous series of steroidal derivatives have been extracted from the literature, tabulated, and discussed. The tables provide the reader with an evaluated compilation of the type of mesophases found for the individual compounds, including their transition temperatures. Where the literature gives more than one set of data for a specific substance, one has been chosen as the main reference, but all alternatives are listed in the footnotes. The data can be used for statistical analysis to show the specific role of substructures within the steroidal framework. {copyright} {ital 1997} {ital American Institute of Physics and American Chemical Society}

  9. Antibacterial properties of cationic steroid antibiotics.

    PubMed

    Savage, Paul B; Li, Chunhong; Taotafa, Uale; Ding, Bangwei; Guan, Qunying

    2002-11-19

    Cationic steroid antibiotics have been developed that display broad-spectrum antibacterial activity. These compounds are comprised of steroids appended with amine groups arranged to yield facially amphiphilic morphology. Examples of these antibiotics are highly bactericidal, while related compounds effectively permeabilize the outer membranes of Gram-negative bacteria sensitizing these organisms to hydrophobic antibiotics. Cationic steroid antibiotics exhibit various levels of eukaryote vs. prokaryote cell selectivity, and cell selectivity can be increased via charge recognition of prokaryotic cells. Studies of the mechanism of action of these antibiotics suggest that they share mechanistic aspects with cationic peptide antibiotics. PMID:12445638

  10. Certolizumab Injection

    MedlinePlus

    ... has not improved when treated with other medications, rheumatoid arthritis (a condition in which the body attacks its ... continues. When certolizumab injection is used to treat rheumatoid arthritis, it is usually given every other week and ...

  11. Ramucirumab Injection

    MedlinePlus

    ... dose of ramucirumab injection. Tell your doctor or nurse if you experience any of the following while you receive ramucirumab: uncontrollable shaking of a part of the body; back pain or spasms; chest pain and tightness; chills; flushing; ...

  12. Topotecan Injection

    MedlinePlus

    ... organs where eggs are formed) and small cell lung cancer (a type of cancer that begins in the ... topotecan injection is used to treat ovarian or lung cancer, it is usually given once a day for ...

  13. Colistimethate Injection

    MedlinePlus

    ... antibiotic, to help treat your infection. The drug will be either injected directly into a vein through ... catheter or added to an intravenous fluid that will drip through a needle or catheter into a ...

  14. Mitoxantrone Injection

    MedlinePlus

    ... medications to relieve pain in people with advanced prostate cancer who did not respond to other medications. Mitoxantrone ... doses). When mitoxantrone injection is used to treat prostate cancer, it is usually given once every 21 days. ...

  15. Palivizumab Injection

    MedlinePlus

    ... this medicine each month during RSV season. Your health care provider will let you know when the monthly injections are no longer needed.Your child's health care provider (doctor, nurse, or pharmacist) may measure ...

  16. Terbutaline Injection

    MedlinePlus

    Terbutaline injection is used to treat wheezing, shortness of breath, coughing, and chest tightness caused by asthma, chronic bronchitis, and emphysema. Terbutaline is in a class of medications called beta ...

  17. Leuprolide Injection

    MedlinePlus

    ... of the body and causes pain, heavy or irregular menstruation [periods], and other symptoms). Leuprolide injection (Lupron ... mention any of the following: certain medications for irregular heartbeat such as amiodarone (Cordarone), disopyramide (Norpace), procainamide ( ...

  18. Sumatriptan Injection

    MedlinePlus

    ... accompanied by nausea and sensitivity to sound and light). Sumatriptan injection is also used to treat the ... children. Store it at room temperature, away from light, excess heat, and moisture (not in the bathroom). ...

  19. Insulin Injection

    MedlinePlus

    ... contraceptives (birth control pills, patches, rings, injections, or implants); niacin (Niacor, Niaspan, Slo-Niacin); octreotide (Sandostatin);oral ... cramps abnormal heartbeat large weight gain in a short period of time swelling of the arms, hands, ...

  20. Fondaparinux Injection

    MedlinePlus

    ... had a serious allergic reaction (difficulty breathing or swallowing or swelling of the face, throat, tongue, lips, ... the face, throat, tongue, lips, or eyes difficulty swallowing or breathing Fondaparinux injection may cause other side ...

  1. Daclizumab Injection

    MedlinePlus

    ... course of disease where symptoms flare up from time to time) of multiple sclerosis (MS; a disease in which ... injections. Before you use daclizumab yourself the first time, read the written instructions that come with it. ...

  2. Haloperidol Injection

    MedlinePlus

    ... emotions). Haloperidol injection is also used to control motor tics (uncontrollable need to repeat certain body movements) ... people who have Tourette's disorder (condition characterized by motor or verbal tics). Haloperidol is in a class ...

  3. Certolizumab Injection

    MedlinePlus

    ... causes pain, swelling, and damage) including the following: Crohn's disease (a condition in which the body attacks the ... home. When certolizumab injection is used to treat Crohn's disease, it is usually given every two weeks for ...

  4. Natalizumab Injection

    MedlinePlus

    ... prevent episodes of symptoms in people who have Crohn's disease (a condition in which the body attacks the ... If you are receiving natalizumab injection to treat Crohn's disease, your symptoms should improve during the first few ...

  5. Daptomycin Injection

    MedlinePlus

    ... blood infections or serious skin infections caused by bacteria. Daptomycin injection is in a class of medications called cyclic lipopeptide antibiotics. It works by killing bacteria. Antibiotics will not work for treating colds, flu, ...

  6. Ciprofloxacin Injection

    MedlinePlus

    ... is used to treat certain infections caused by bacteria. Ciprofloxacin injection is also used to prevent or ... of antibiotics called fluoroquinolones. It works by killing bacteria that cause infections. Antibiotics will not work for ...

  7. Gentamicin Injection

    MedlinePlus

    ... treat certain serious infections that are caused by bacteria such as meningitis (infection of the membranes that ... medications called aminoglycoside antibiotics. It works by killing bacteria.Antibiotics such as gentamicin injection will not work ...

  8. Ertapenem Injection

    MedlinePlus

    ... abdominal (stomach area) infections, that are caused by bacteria. It is also used for the prevention of ... medications called carbapenem antibiotics. It works by killing bacteria.Antibiotics such as ertapenem injection will not work ...

  9. Cefepime Injection

    MedlinePlus

    ... is used to treat certain infections caused by bacteria including pneumonia, and skin, urinary tract, and kidney ... medications called cephalosporin antibiotics. It works by killing bacteria.Antibiotics such as cefepime injection will not work ...

  10. Ceftriaxone Injection

    MedlinePlus

    ... is used to treat certain infections caused by bacteria such as gonorrhea (a sexually transmitted disease), pelvic ... medications called cephalosporin antibiotics. It works by killing bacteria.Antibiotics such as ceftriaxone injection will not work ...

  11. Moxifloxacin Injection

    MedlinePlus

    ... skin, and abdominal (stomach area) infections caused by bacteria. Moxifloxacin injection is in a class of antibiotics called fluoroquinolones. It works by killing the bacteria that cause infections. Antibiotics will not work against ...

  12. Ceftaroline Injection

    MedlinePlus

    ... infections and pneumonia (lung infection) caused by certain bacteria. Ceftaroline is in a class of medications called cephalosporin antibiotics. It works by killing bacteria.Antibiotics such as ceftaroline injection will not work ...

  13. Tobramycin Injection

    MedlinePlus

    ... treat certain serious infections that are caused by bacteria such as meningitis (infection of the membranes that ... medications called aminoglycoside antibiotics. It works by killing bacteria.Antibiotics such as tobramycin injection will not work ...

  14. Cefazolin Injection

    MedlinePlus

    ... is used to treat certain infections caused by bacteria including skin, bone, joint, genital, blood, heart valve, ... medications called cephalosporin antibiotics. It works by killing bacteria.Antibiotics such as cefazolin injection will not work ...

  15. Cefotaxime Injection

    MedlinePlus

    ... is used to treat certain infections caused by bacteria including pneumonia and other lower respiratory tract (lung) ... medications called cephalosporin antibiotics. It works by killing bacteria.Antibiotics such as cefotaxime injection will not work ...

  16. Amikacin Injection

    MedlinePlus

    ... treat certain serious infections that are caused by bacteria such as meningitis (infection of the membranes that ... medications called aminoglycoside antibiotics. It works by killing bacteria.Antibiotics such as amikacin injection will not work ...

  17. Ampicillin Injection

    MedlinePlus

    ... to treat certain infections that are caused by bacteria such as meningitis (infection of the membranes that ... of medications called penicillins. It works by killing bacteria.Antibiotics such as ampicillin injection will not work ...

  18. Cefuroxime Injection

    MedlinePlus

    ... is used to treat certain infections caused by bacteria including pneumonia and other lower respiratory tract (lung) ... medications called cephalosporin antibiotics. It works by killing bacteria.Antibiotics such as cefuroxime injection will not work ...

  19. Vancomycin Injection

    MedlinePlus

    ... medications called glycopeptide antibiotics. It works by killing bacteria that cause infections.Antibiotics such as vancomycin injection ... infection may not be completely treated and the bacteria may become resistant to antibiotics.

  20. Ceftazidime Injection

    MedlinePlus

    ... is used to treat certain infections caused by bacteria including pneumonia and other lower respiratory tract (lung) ... medications called cephalosporin antibiotics. It works by killing bacteria.Antibiotics such as ceftazidime injection will not work ...

  1. Telavancin Injection

    MedlinePlus

    ... serious skin infections caused by certain types of bacteria. Telavancin injection is in a class of medications ... antibiotics. It works by stopping the growth of bacteria. Antibiotics will not work for colds, flu, or ...

  2. Teduglutide Injection

    MedlinePlus

    ... injection, prefilled syringes containing diluent (liquid to be mixed with teduglutide powder), needles to attach to the diluent syringe, dosing syringes with needles attached, and alcohol swab pads. Throw away needles, syringes, and vials ...

  3. Cefoxitin Injection

    MedlinePlus

    ... is in a class of medications called cephamycin antibiotics. It works by killing bacteria.Antibiotics such as cefoxitin injection will not work for colds, flu, or other viral infections. Taking antibiotics when they are not needed increases your risk ...

  4. Nafcillin Injection

    MedlinePlus

    ... medications called penicillins. It works by killing bacteria.Antibiotics such as nafcillin injection will not work for colds, flu, or other viral infections. Taking antibiotics when they are not needed increases your risk ...

  5. Cefepime Injection

    MedlinePlus

    ... is in a class of medications called cephalosporin antibiotics. It works by killing bacteria.Antibiotics such as cefepime injection will not work for colds, flu, or other viral infections. Using antibiotics when they are not needed increases your risk ...

  6. Oxacillin Injection

    MedlinePlus

    ... medications called penicillins. It works by killing bacteria.Antibiotics such as oxacillin injection will not work for colds, flu, or other viral infections. Taking antibiotics when they are not needed increases your risk ...

  7. Dexamethasone Injection

    MedlinePlus

    ... severe allergic reactions. It is used in the management of certain types of edema (fluid retention and ... needed for normal body functioning) and in the management of certain types of shock. Dexamethasone injection is ...

  8. Pembrolizumab Injection

    MedlinePlus

    ... treat a certain type of non-small-cell lung cancer that has spread to nearby tissues or to ... successfully with other medications for non-small-cell lung cancer. Pembrolizumab injection is in a class of medications ...

  9. Ibandronate Injection

    MedlinePlus

    ... Ibandronate is in a class of medications called bisphosphonates. It works by preventing bone breakdown and increasing ... while receiving this medication.Being treated with a bisphosphonate medication such as ibandronate injection for osteoporosis may ...

  10. Omalizumab Injection

    MedlinePlus

    ... asthma attacks (sudden episodes of wheezing, shortness of breath, and trouble breathing) in people with allergic asthma ( ... receiving a dose of omalizumab injection shortness of breath coughing up blood skin sores severe pain, numbness ...

  11. Necitumumab Injection

    MedlinePlus

    ... chest pain; shortness of breath; dizziness; loss of consciousness; or fast, irregular, or pounding heartbeat.Keep all appointments with your doctor and the laboratory.Talk to your doctor about the risks of receiving necitumumab injection.

  12. Dolasetron Injection

    MedlinePlus

    ... receiving cancer chemotherapy medications. Dolasetron is in a class of medications called serotonin 5-HT3 receptor antagonists. ... stiff or twitching muscles seizures coma (loss of consciousness) Dolasetron injection may cause other side effects. Call ...

  13. Topotecan Injection

    MedlinePlus

    ... also used together with other medications to treat cervical cancer (cancer that begins in the opening of the ... days. When topotecan injection is used to treat cervical cancer, it is usually given once a day for ...

  14. Ertapenem Injection

    MedlinePlus

    Ertapenem injection is used to treat certain serious infections, including pneumonia and urinary tract, skin, diabetic foot, ... for the prevention of infections following colorectal surgery. Ertapenem is in a class of medications called carbapenem ...

  15. Octreotide Injection

    MedlinePlus

    ... immediate-release injection is also used to control diarrhea and flushing caused by carcinoid tumors (slow-growing ... symptoms are severe or do not go away: diarrhea constipation pale, bulky, foul-smelling stools constantly feeling ...

  16. Infliximab Injection

    MedlinePlus

    ... injection may cause serious allergic reactions during an infusion and for 2 hours afterward. A doctor or ... the following symptoms during or shortly after your infusion: hives; rash; itching; swelling of the face, eyes, ...

  17. Vedolizumab Injection

    MedlinePlus

    ... injection may cause serious allergic reactions during an infusion and for several hours afterward. A doctor or ... of the following symptoms during or after your infusion: rash; itching; swelling of the face, eyes, mouth, ...

  18. Panitumumab Injection

    MedlinePlus

    ... as a solution (liquid) to be given by infusion (injected into a vein). It is usually given ... doctor or nurse in a doctor's office or infusion center. Panitumumab is usually given once every 2 ...

  19. Tositumomab Injection

    MedlinePlus

    ... is in a class of medications called monoclonal antibodies with radioisotopes. It works by attaching to cancer ... you receive tositumomab injection, your body may develop antibodies (substances in the blood that help the immune ...

  20. Ibritumomab Injection

    MedlinePlus

    ... is in a class of medications called monoclonal antibodies with radioisotopes. It works by attaching to cancer ... you receive ibritumomab injection, your body may develop antibodies (substances in the blood that help the immune ...

  1. Temozolomide Injection

    MedlinePlus

    Temozolomide is used to treat certain types of brain tumors. Temozolomide is in a class of medications called ... injected once a day. For some types of brain tumors, temozolomide is given daily for 42 to 49 ...

  2. Tigecycline Injection

    MedlinePlus

    ... to treat certain serious infections including community acquired pneumonia (a lung infection that developed in a person ... Tigecycline injection should not be used to treat pneumonia that developed in people who were in a ...

  3. Acetaminophen Injection

    MedlinePlus

    ... injection is also used in combination with opioid (narcotic) medications to relieve moderate to severe pain. Acetaminophen is in a class of medications called analgesics (pain relievers) and antipyretics (fever reducers). It works by changing ...

  4. Dexrazoxane Injection

    MedlinePlus

    ... certain side effects that may be caused by chemotherapy medications. Dexrazoxane injection (Zinecard) is used to prevent ... tissues that may be caused when an anthracycline chemotherapy medication such as daunorubicin (Daunoxome, Cerubidine), doxorubicin (Doxil), ...

  5. Denosumab Injection

    MedlinePlus

    ... menstrual periods), who have an increased risk for fractures (broken bones) or who cannot take or did ... receiving certain treatments that increase their risk for fractures. Denosumab injection (Xgeva) is used to reduce fractures ...

  6. Dexrazoxane Injection

    MedlinePlus

    ... and pharmacist if you are allergic to dexrazoxane injection or any other medications.tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking ...

  7. Oritavancin Injection

    MedlinePlus

    ... for at least 5 days after receiving oritavancin injection.tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking ...

  8. Ferumoxytol Injection

    MedlinePlus

    Ferumoxytol injection is used to treat iron-deficiency anemia (a lower than normal number of red blood cells due to too little iron) in adults with chronic kidney disease (damage to the kidneys which may worsen over ...

  9. Exenatide Injection

    MedlinePlus

    ... month. Exenatide extended-release solution is injected once weekly at any time of day without regard to ... you remember it and then continue your regular weekly schedule. However, if there are less than 3 ...

  10. Fluconazole Injection

    MedlinePlus

    ... injection is used to treat fungal infections, including yeast infections of the mouth, throat, esophagus (tube leading from ... by fungus. Fluconazole is also used to prevent yeast infections in patients who are likely to become infected ...

  11. Mipomersen Injection

    MedlinePlus

    Mipomersen injection is used to decrease levels of cholesterol and other fatty substances in the blood in people who have homozygous familial hypercholesterolemia (HoFH; a rare inherited condition that ...

  12. Cefuroxime Injection

    MedlinePlus

    ... pneumonia and other lower respiratory tract (lung) infections; meningitis (infection of the membranes that surround the brain ... hearing loss, if you are being treated for meningitis Cefuroxime injection may cause other side effects. Call ...

  13. Busulfan Injection

    MedlinePlus

    ... cancer cells in preparation for a bone marrow transplant. Busulfan is in a class of medications called ... a total of 16 doses) before bone marrow transplant.Busulfan injection may cause seizures during therapy with ...

  14. Methylnaltrexone Injection

    MedlinePlus

    ... injection is used to treat constipation caused by opioid (narcotic) pain medications in patients with advanced illnesses ... a class of medications called peripherally acting mu-opioid receptor antagonists. It works by protecting the bowel ...

  15. Methylprednisolone Injection

    MedlinePlus

    ... treatment.You may receive methylprednisolone injection in a hospital or medical facility, or you may be given ... doctor or if you are admitted to a hospital. It is also important information to carry with ...

  16. Ampicillin Injection

    MedlinePlus

    ... have.You may receive ampicillin injection in a hospital or you may administer the medication at home. ... doctor or if you are admitted to a hospital. It is also important information to carry with ...

  17. Romidepsin Injection

    MedlinePlus

    ... bleeding fever, cough, flu-like symptoms, muscle aches, burning on urination, worsening skin problems, and other signs of infection rash blistering or peeling skin Romidepsin injection may cause other side effects. Call your doctor if you have any unusual ...

  18. Ranitidine Injection

    MedlinePlus

    ... the pancreas and small intestine that caused increased production of stomach acid). Ranitidine injection is in a ... your doctor and the laboratory. Your doctor may order certain lab tests to check your body's response ...

  19. Ganciclovir Injection

    MedlinePlus

    ... injection is for intravenous (into a vein) use only. Giving ganciclovir through intramuscular (into a muscle) or ... the storage of ganciclovir solution. Store your medication only as directed. Make sure you understand what you ...

  20. Teduglutide Injection

    MedlinePlus

    ... syndrome in people who need additional nutrition or fluids from intravenous (IV) therapy. Teduglutide injection is in ... analogs. It works by improving the absorption of fluids and nutrients in the intestines.

  1. Olanzapine Injection

    MedlinePlus

    Olanzapine extended-release injection is used to treat schizophrenia (a mental illness that causes disturbed or unusual ... treat episodes of agitation in people who have schizophrenia or in people who have bipolar I disorder ( ...

  2. Risperidone Injection

    MedlinePlus

    ... release (long-acting) injection is used to treat schizophrenia (a mental illness that causes disturbed or unusual ... do not already have diabetes. If you have schizophrenia, you are more likely to develop diabetes than ...

  3. Aripiprazole Injection

    MedlinePlus

    ... injections (Abilify Maintena, Aristada) are used to treat schizophrenia (a mental illness that causes disturbed or unusual ... treat episodes of agitation in people who have schizophrenia or in people who have bipolar I disorder ( ...

  4. Secukinumab Injection

    MedlinePlus

    ... to see if you need to receive any vaccinations. It is important to have all vaccines appropriate ... treatment with secukinumab injection. Do not have any vaccinations during your treatment without talking to your doctor. ...

  5. Tesamorelin Injection

    MedlinePlus

    ... fat in the stomach area in adults with human immunodeficiency virus (HIV) who have lipodystrophy (increased body ... injection is in a class of medications called human growth hormone-releasing factor (GRF) analogs. It works ...

  6. Naloxone Injection

    MedlinePlus

    ... emergency medical treatment to reverse the life-threatening effects of a known or suspected opiate (narcotic) overdose. ... is also used after surgery to reverse the effects of opiates given during surgery. Naloxone injection is ...

  7. Methotrexate Injection

    MedlinePlus

    ... Methotrexate injection is also used to treat severe psoriasis (a skin disease in which red, scaly patches ... slowing the growth of cancer cells. Methotrexate treats psoriasis by slowing the growth of skin cells to ...

  8. Sumatriptan Injection

    MedlinePlus

    ... sometimes are accompanied by nausea and sensitivity to sound and light). Sumatriptan injection is also used to ... stomach pain sudden weight loss paleness or blue color of the fingers and toes shortness of breath ...

  9. Denosumab Injection

    MedlinePlus

    ... injection is in a class of medications called RANK ligand inhibitors. It works by decreasing bone breakdown ... medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. ...

  10. Omacetaxine Injection

    MedlinePlus

    ... for CML and can no longer benefit from these medications or cannot take these medications due to side effects. Omacetaxine injection is ... side effects. Tell your doctor if any of these symptoms are severe or do not go away: ...

  11. Basiliximab Injection

    MedlinePlus

    ... is used with other medications to prevent immediate transplant rejection (attack of the transplanted organ by the immune system of the person receiving the organ) in people who are receiving kidney transplants. Basiliximab injection is in a class of medications ...

  12. Metoclopramide Injection

    MedlinePlus

    ... is used to relieve symptoms caused by slow stomach emptying in people who have diabetes. These symptoms include ... When metoclopramide injection is used to treat slowed stomach emptying due to diabetes, it may be given up ...

  13. Intrathymic Injection.

    PubMed

    Manna, Sugata; Bhandoola, Avinash

    2016-01-01

    Intrathymic injection is used in several T cell-associated immunological studies to deliver cells or other substances directly into the thymus. Here, we describe the intrathymic injection procedure involving surgical incision of the mouse with or without a thoracotomy. Though this procedure can result in poor recovery, postsurgical complications, and distress to the animal, it is actually a simple procedure that can be carried out relatively easily and quickly with experience. PMID:26294410

  14. 21 CFR 1308.34 - Exempt anabolic steroid products.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 9 2013-04-01 2013-04-01 false Exempt anabolic steroid products. 1308.34 Section... SUBSTANCES Exempt Anabolic Steroid Products § 1308.34 Exempt anabolic steroid products. The list of compounds, mixtures, or preparations that contain an anabolic steroid that have been exempted by the...

  15. 21 CFR 1308.34 - Exempt anabolic steroid products.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 9 2014-04-01 2014-04-01 false Exempt anabolic steroid products. 1308.34 Section... SUBSTANCES Exempt Anabolic Steroid Products § 1308.34 Exempt anabolic steroid products. The list of compounds, mixtures, or preparations that contain an anabolic steroid that have been exempted by the...

  16. 21 CFR 1308.34 - Exempt anabolic steroid products.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 9 2012-04-01 2012-04-01 false Exempt anabolic steroid products. 1308.34 Section... SUBSTANCES Exempt Anabolic Steroid Products § 1308.34 Exempt anabolic steroid products. The list of compounds, mixtures, or preparations that contain an anabolic steroid that have been exempted by the...

  17. 21 CFR 1308.34 - Exempt anabolic steroid products.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 9 2011-04-01 2011-04-01 false Exempt anabolic steroid products. 1308.34 Section... SUBSTANCES Exempt Anabolic Steroid Products § 1308.34 Exempt anabolic steroid products. The list of compounds, mixtures, or preparations that contain an anabolic steroid that have been exempted by the...

  18. 21 CFR 1308.34 - Exempt anabolic steroid products.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 9 2010-04-01 2010-04-01 false Exempt anabolic steroid products. 1308.34 Section... SUBSTANCES Exempt Anabolic Steroid Products § 1308.34 Exempt anabolic steroid products. The list of compounds, mixtures, or preparations that contain an anabolic steroid that have been exempted by the...

  19. Characteristics of Steroid Users in an Adolescent School Population.

    ERIC Educational Resources Information Center

    Adlaf, Edward M.; Smart, Reginald G.

    1992-01-01

    Examined rates of steroid use among Ontario adolescent students. Findings from 3,892 students revealed that 1.1 percent reported using steroids over past year. Steroid users were significantly more likely to use stimulants, caffeine, and relaxants than were nonsteroid users. Demographically, steroid users were significantly more likely to be male…

  20. Metabolic effects of contraceptive steroids.

    PubMed

    Sitruk-Ware, Regine; Nath, Anita

    2011-06-01

    Estrogen and progestins have been used by millions of women as effective combined contraceptives. The safety of hormonal contraceptives has been documented by years of follow-up and serious adverse events that may be related to their use are rare in the young population exposed to these agents. The balance between the benefits and the risks of contraceptive steroids is generally positive in particular when comparing to the risks of pregnancy and especially in women with risk factors. The metabolic changes induced by the synthetic steroids used in contraception, such as lipoprotein changes, insulin response to glucose, and coagulation factors have been considered as potential markers of cardiovascular and venous risk. Observations of these effects have led to modifications of the composition of hormonal contraceptive in order to minimize these changes and hence potentially decrease the risks. The synthetic estrogen Ethinyl-Estradiol (EE) exerts a stronger effect that natural estradiol (E2) on hepatic metabolism including estrogen-dependent markers such as liver proteins. This stronger hepatic impact of EE has been related to its 17α-ethinyl group which prevents the inactivation of the molecule and results in a more pronounced hepatic effect of EE as compared to estradiol. Due to its strong activity, administering EE via a non-oral route does not prevent its impact on liver proteins. In order to circumvent the metabolic changes induced by EE, newer products using more natural compounds such as estradiol (E2) and estradiol valerate (E2V) have been introduced. The synthetic progestins used for contraception are structurally related either to testosterone (T) (estranes and gonanes) or to progesterone (pregnanes and 19-norpregnanes). Several new progestins have been designed to bind more specifically to the progesterone receptor and to minimize side-effects related to androgenic, estrogenic or glucocorticoid receptor interactions. Dienogest (DNG), and drospirenone (DRSP

  1. Plasma steroid-binding proteins: primary gatekeepers of steroid hormone action.

    PubMed

    Hammond, Geoffrey L

    2016-07-01

    Biologically active steroids are transported in the blood by albumin, sex hormone-binding globulin (SHBG), and corticosteroid-binding globulin (CBG). These plasma proteins also regulate the non-protein-bound or 'free' fractions of circulating steroid hormones that are considered to be biologically active; as such, they can be viewed as the 'primary gatekeepers of steroid action'. Albumin binds steroids with limited specificity and low affinity, but its high concentration in blood buffers major fluctuations in steroid concentrations and their free fractions. By contrast, SHBG and CBG play much more dynamic roles in controlling steroid access to target tissues and cells. They bind steroids with high (~nM) affinity and specificity, with SHBG binding androgens and estrogens and CBG binding glucocorticoids and progesterone. Both are glycoproteins that are structurally unrelated, and they function in different ways that extend beyond their transportation or buffering functions in the blood. Plasma SHBG and CBG production by the liver varies during development and different physiological or pathophysiological conditions, and abnormalities in the plasma levels of SHBG and CBG or their abilities to bind steroids are associated with a variety of pathologies. Understanding how the unique structures of SHBG and CBG determine their specialized functions, how changes in their plasma levels are controlled, and how they function outside the blood circulation provides insight into how they control the freedom of steroids to act in health and disease. PMID:27113851

  2. Acute kidney injury associated with androgenic steroids and nutritional supplements in bodybuilders†

    PubMed Central

    Almukhtar, Safa E.; Abbas, Alaa A.; Muhealdeen, Dana N.; Hughson, Michael D.

    2015-01-01

    Four bodybuilders who injected anabolic steroids and ingested commercial protein (78–104 g/day) and creatine (15 g/day) products presented with serum creatinine levels between 229.84 and 335.92 µmol/L (2.6–3.8 mg/dL). Renal biopsies revealed acute tubular necrosis. Four weeks after discontinuing injections and supplements, serum creatinine was in the normal range and estimated glomerular filtration rate > 1.00 mL/s (60 mL/min), including two patients with biopsies showing >30% interstitial fibrosis and tubular atrophy. The findings highlight a risk for acute and potentially chronic kidney injury among young men abusing anabolic steroids and using excessive amounts of nutritional supplements. PMID:26251708

  3. Topical steroid addiction in atopic dermatitis

    PubMed Central

    Fukaya, Mototsugu; Sato, Kenji; Sato, Mitsuko; Kimata, Hajime; Fujisawa, Shigeki; Dozono, Haruhiko; Yoshizawa, Jun; Minaguchi, Satoko

    2014-01-01

    The American Academy of Dermatology published a new guideline regarding topical therapy in atopic dermatitis in May 2014. Although topical steroid addiction or red burning skin syndrome had been mentioned as possible side effects of topical steroids in a 2006 review article in the Journal of the American Academy of Dermatology, no statement was made regarding this illness in the new guidelines. This suggests that there are still controversies regarding this illness. Here, we describe the clinical features of topical steroid addiction or red burning skin syndrome, based on the treatment of many cases of the illness. Because there have been few articles in the medical literature regarding this illness, the description in this article will be of some benefit to better understand the illness and to spur discussion regarding topical steroid addiction or red burning skin syndrome. PMID:25378953

  4. [Steroid use in free time bodybuilders].

    PubMed

    Michels-Lucht, Felicitas; Schirmer, Jan; Klauer, Thomas; Freyberger, Harald; Lucht, Michael

    2011-12-01

    A sample of 74 male bodybuilders was analyzed for relationships between steroid abuse (abuse n=31; no abuse n=43) and self-esteem (Multidimensionale Selbstwertskala MSWS), body-image (Body-Image Questionnaire FK-ASA) as well as teasing (Physical Appearance Related Teasing Scale PARTS). In a logistic regression analysis age (p=0.001), low values for body expression (p=0.036) and high self-esteem (p=0.024) predicted steroid intake; training frequency or teasing experiences showed no effect. Contrary to earlier findings high and not low self-esteem was associated with steroid abuse. Because of the overlap between constructs narcissism and self-esteem further studies should disentangle the role of narcissism and self-esteem for steroid abuse in bodybuilders. PMID:22161857

  5. Steroids/Nutritional Supplements/Antibiotics

    MedlinePlus

    ... that prednisone may also somehow stimulate muscle protein production. Because of this sugar effect, catabolic steroids are ... suppressing the immune cells that rush in to clean up and remove "leaky" muscle cells and debris. ...

  6. Antifungal Activity of C-27 Steroidal Saponins

    PubMed Central

    Yang, Chong-Ren; Zhang, Ying; Jacob, Melissa R.; Khan, Shabana I.; Zhang, Ying-Jun; Li, Xing-Cong

    2006-01-01

    As part of our search for new antifungal agents from natural resources, 22 C-27 steroidal saponins and 6 steroidal sapogenins isolated from several monocotyledonous plants were tested for their antifungal activity against the opportunistic pathogens Candida albicans, Candida glabrata, Candida krusei, Cryptococcus neoformans, and Aspergillus fumigatus. The results showed that the antifungal activity of the steroidal saponins was associated with their aglycone moieties and the number and structure of monosaccharide units in their sugar chains. Within the 10 active saponins, four tigogenin saponins (compounds 1 to 4) with a sugar moiety of four or five monosaccharide units exhibited significant activity against C. neoformans and A. fumigatus, comparable to the positive control amphotericin B. The antifungal potency of these compounds was not associated with cytotoxicity to mammalian cells. This suggests that the C-27 steroidal saponins may be considered potential antifungal leads for further preclinical study. PMID:16641439

  7. Steroids: Pharmacology, Complications, and Practice Delivery Issues

    PubMed Central

    Ericson-Neilsen, William; Kaye, Alan David

    2014-01-01

    Background Since their identification nearly 80 years ago, steroids have played a prominent role in the treatment of many disease states. Many of the clinical roles of steroids are related to their potent antiinflammatory and immune-modulating properties. Methods This review summarizes the basic pharmacology, complications, and practice delivery issues regarding steroids. Results Clinically relevant side effects of steroids are common and problematic. Side effects can occur at a wide range of doses and vary depending on the route of administration. The full spectrum of side effects can be present even in patients taking low doses. Conclusions Practitioners must be aware that these drugs might exacerbate a preexisting condition or present a new medical condition. Knowledge of the clinical implications of prescribing these agents is critical. PMID:24940130

  8. Sex Steroids and the Dentate Gyrus

    PubMed Central

    Hajszan, Tibor; Leranth, Csaba

    2006-01-01

    In the late 1980s, the finding that the dentate gyrus contains more granule cells in the male than in the female of certain mouse strains provided the first indication that the dentate gyrus is a significant target for the effects of sex steroids during development. Gonadal hormones also play a crucial role in shaping the function and morphology of the adult brain. Besides reproduction-related processes, sex steroids participate in higher brain operations such as cognition and mood, in which the hippocampus is a critical mediator. Being part of the hippocampal formation, the dentate gyrus is naturally involved in these mechanisms and as such, this structure is also a critical target for the activational effects of sex steroids. These activational effects are the results of three major types of steroid-mediated actions. Sex steroids modulate the function of dentate neurons under normal conditions. In addition, recent research suggests that hormone-induced cellular plasticity may play a larger role than previously thought, particularly in the dentate gyrus. Specifically, the regulation of dentate gyrus neurogenesis and synaptic remodeling by sex steroids received increasing attention lately. Finally, the dentate gyrus is influenced by gonadal hormones in the context of cellular injury, and the work in this area demonstrates that gonadal hormones have neuroprotective potential. The expression of estrogen, progestin and androgen receptors in the dentate gyrus suggests that sex steroids, which could be of gonadal origin and/or synthesized locally in the dentate gyrus, may act directly on dentate cells. In addition, gonadal hormones could also influence the dentate gyrus indirectly, by subcortical hormone-sensitive structures such as the cholinergic septohippocampal system. Importantly, these three sex steroid-related themes, functional effects in the normal dentate gyrus, mechanisms involving neurogenesis and synaptic remodeling, as well as neuroprotection, have

  9. Steroids' transformations in Penicillium notatum culture.

    PubMed

    Bartmańska, Agnieszka; Dmochowska-Gładysz, Jadwiga; Huszcza, Ewa

    2005-03-01

    The application of Penicillium notatum genus for biotransformations of steroids has been investigated. The reactions observed include insertion of an oxygen atom into D-ring of steroids, 15alpha-hydroxylation of 17alpha-methyl testosterone derivatives, ester bond hydrolysis, and degradation of a testosterone derivatives side chain. Microbial production of testolactones, the biologically active compounds, was also achieved using this strain in up to 98% yield. PMID:15763598

  10. Anabolic steroid abuse: psychiatric and physical costs.

    PubMed

    Talih, Farid; Fattal, Omar; Malone, Donald

    2007-05-01

    The psychiatric effects of anabolic-androgenic steroids (i.e., testosterone and its derivatives) have been less well studied than their physical effects but are reported to include depression, mania, psychosis, and aggression. Dependence can also occur, with withdrawal involving psychiatric and physical symptoms. Adverse effects of steroid abuse should be managed by discontinuing the drugs-by tapering if necessary-and by treating the symptoms. PMID:17506239

  11. Steroidal saponins from Tribulus terrestris.

    PubMed

    Kang, Li-Ping; Wu, Ke-Lei; Yu, He-Shui; Pang, Xu; Liu, Jie; Han, Li-Feng; Zhang, Jie; Zhao, Yang; Xiong, Cheng-Qi; Song, Xin-Bo; Liu, Chao; Cong, Yu-Wen; Ma, Bai-Ping

    2014-11-01

    Sixteen steroidal saponins, including seven previously unreported compounds, were isolated from Tribulus terrestris. The structures of the saponins were established using 1D and 2D NMR spectroscopy, mass spectrometry, and chemical methods. They were identified as: 26-O-β-d-glucopyranosyl-(25R)-furost-4-en-2α,3β,22α,26-tetrol-12-one (terrestrinin C), 26-O-β-d-glucopyranosyl-(25R)-furost-4-en-22α,26-diol-3,12-dione (terrestrinin D), 26-O-β-d-glucopyranosyl-(25S)-furost-4-en-22α,26-diol-3,6,12-trione (terrestrinin E), 26-O-β-d-glucopyranosyl-(25R)-5α-furostan-3β,22α,26-triol-12-one (terrestrinin F), 26-O-β-d-glucopyranosyl-(25R)-furost-4-en-12β,22α,26-triol-3-one (terrestrinin G), 26-O-β-d-glucopyranosyl-(1→6)-β-d-glucopyranosyl-(25R)-furost-4-en-22α,26-diol-3,12-dione (terrestrinin H), and 24-O-β-d-glucopyranosyl-(25S)-5α-spirostan-3β,24β-diol-12-one-3-O-β-d-glucopyranosyl-(1→4)-β-d-galactopyranoside (terrestrinin I). The isolated compounds were evaluated for their platelet aggregation activities. Three of the known saponins exhibited strong effects on the induction of platelet aggregation. PMID:25172515

  12. Mitochondrial benzodiazepine receptors regulate steroid biosynthesis

    SciTech Connect

    Mukhin, A.G.; Papadopoulos, V.; Costa, E.; Krueger, K.E. )

    1989-12-01

    Recent observations on the steroid synthetic capability within the brain open the possibility that benzodiazepines may influence steroid synthesis in nervous tissue through interactions with peripheral-type benzodiazepine recognition sites, which are highly expressed in steroidogenic cells and associated with the outer mitochondrial membrane. To examine this possibility nine molecules that exhibit a greater than 10,000-fold difference in their affinities for peripheral-type benzodiazepine binding sites were tested for their effects on a well-established steroidogenic model system, the Y-1 mouse adrenal tumor cell line. 4{prime}-Chlorodiazepam, PK 11195, and PK 14067 stimulated steroid production by 2-fold in Y-1 cells, whereas diazepam, flunitrazepam, zolpidem, and PK 14068 displayed a lower (1.2- to 1.5-fold) maximal stimulation. In contrast, clonazepam and flumazenil did not stimulate steroid synthesis. The potencies of these compounds to inhibit {sup 3}H-labeled PK 11195 binding to peripheral-type benzodiazepine recognition sites correlated with their potencies to stimulate steroid production. Similar findings were observed in bovine and rat adrenocortical cell preparations. These results suggest that ligands of the peripheral-type benzodiazepine recognition site acting on this mitochondrial receptor can enhance steroid production. This action may contribute specificity to the pharmacological profile of drugs preferentially acting on the benzodiazepine recognition site associated with the outer membrane of certain mitochondrial populations.

  13. Anabolic steroid use in high school students.

    PubMed

    Pallesen, Ståle; Jøsendal, Ola; Johnsen, Bjørn-Helge; Larsen, Svein; Molde, Helge

    2006-01-01

    A total of 1351 high school students (52.3% males, 47.7% females) with mean age 17.5 years (SD = 2.2) from randomized school classes in Hordaland County, Norway, participated in an Internet survey conducted in 2004 about the lifetime use of anabolic steroids and personal acquaintance with at least one user of anabolic steroids. In addition to questions about anabolic steroids the participants completed the Hospital Anxiety and Depression Scale and the Alcohol Use Disorders Identification Test. They also answered questions about demography, smoking, and narcotic use. The lifetime prevalence for use of anabolic steroids was 3.6% for males and 0.6% for females. In all, 27.9% of the respondents reported having at least one acquaintance that used or had used anabolic steroids. Use of anabolic steroids and having acquaintances using such drugs were strongly related to use of other drugs such as alcohol, nicotine, and narcotics. Implications for prevention are discussed and the study's limitations are noted. PMID:17118811

  14. Rapid steroid hormone actions via membrane receptors.

    PubMed

    Schwartz, Nofrat; Verma, Anjali; Bivens, Caroline B; Schwartz, Zvi; Boyan, Barbara D

    2016-09-01

    Steroid hormones regulate a wide variety of physiological and developmental functions. Traditional steroid hormone signaling acts through nuclear and cytosolic receptors, altering gene transcription and subsequently regulating cellular activity. This is particularly important in hormonally-responsive cancers, where therapies that target classical steroid hormone receptors have become clinical staples in the treatment and management of disease. Much progress has been made in the last decade in detecting novel receptors and elucidating their mechanisms, particularly their rapid signaling effects and subsequent impact on tumorigenesis. Many of these receptors are membrane-bound and lack DNA-binding sites, functionally separating them from their classical cytosolic receptor counterparts. Membrane-bound receptors have been implicated in a number of pathways that disrupt the cell cycle and impact tumorigenesis. Among these are pathways that involve phospholipase D, phospholipase C, and phosphoinositide-3 kinase. The crosstalk between these pathways has been shown to affect apoptosis and proliferation in cardiac cells, osteoblasts, and chondrocytes as well as cancer cells. This review focuses on rapid signaling by 17β-estradiol and 1α,25-dihydroxy vitamin D3 to examine the integrated actions of classical and rapid steroid signaling pathways both in contrast to each other and in concert with other rapid signaling pathways. This new approach lends insight into rapid signaling by steroid hormones and its potential for use in targeted drug therapies that maximize the benefits of traditional steroid hormone-directed therapies while mitigating their less desirable effects. PMID:27288742

  15. New steroid derivative with hypoglycemic activity

    PubMed Central

    Lauro, Figueroa-Valverde; Francisco, Díaz-Cedillo; Lenin, Hau-Heredia; Elodia, García-Cervera; Eduardo, Pool-Gómez; Marcela, Rosas-Nexticapa; Bety, Sarabia-Alcocer

    2014-01-01

    Data indicates that some steroid derivatives may induce changes on glucose levels; nevertheless, data are very confusing. Therefore, more pharmacological data are needed to characterize the activity induced by the steroid derivatives on glucose levels. The aim of this study was to synthesize a new steroid derivative for evaluate its hypoglycemic activity. The effects of steroid derivative on glucose concentration were evaluated in a diabetic animal model using glibenclamide and metformin as controls. In addition, the pregnenolone-dihydrotestosterone conjugate was bound to Tc-99m using radioimmunoassay methods, to evaluate the pharmacokinetics of the steroid derivative over time. The results showed that the pregnenolone-dihydrotestosterone conjugate induces changes on the glucose levels in similar form than glibenclamide. Other data showed that the biodistribution of Tc-99m-steroid derivativein brain was higher in comparison with spleen, stomach, intestine liver and kidney. In conclusion, the pregnenolone-dihydrotestosterone conjugate exerts hypoglycemic activity and this phenomenon could depend of its physicochemical properties which could be related to the degree of lipophilicity of the steroidderivative. PMID:25550906

  16. Mitochondrial Fusion Is Essential for Steroid Biosynthesis

    PubMed Central

    Cooke, Mariana; Soria, Gastón; Cornejo Maciel, Fabiana; Gottifredi, Vanesa; Podestá, Ernesto J.

    2012-01-01

    Although the contribution of mitochondrial dynamics (a balance in fusion/fission events and changes in mitochondria subcellular distribution) to key biological process has been reported, the contribution of changes in mitochondrial fusion to achieve efficient steroid production has never been explored. The mitochondria are central during steroid synthesis and different enzymes are localized between the mitochondria and the endoplasmic reticulum to produce the final steroid hormone, thus suggesting that mitochondrial fusion might be relevant for this process. In the present study, we showed that the hormonal stimulation triggers mitochondrial fusion into tubular-shaped structures and we demonstrated that mitochondrial fusion does not only correlate-with but also is an essential step of steroid production, being both events depend on PKA activity. We also demonstrated that the hormone-stimulated relocalization of ERK1/2 in the mitochondrion, a critical step during steroidogenesis, depends on mitochondrial fusion. Additionally, we showed that the SHP2 phosphatase, which is required for full steroidogenesis, simultaneously modulates mitochondrial fusion and ERK1/2 localization in the mitochondrion. Strikingly, we found that mitofusin 2 (Mfn2) expression, a central protein for mitochondrial fusion, is upregulated immediately after hormone stimulation. Moreover, Mfn2 knockdown is sufficient to impair steroid biosynthesis. Together, our findings unveil an essential role for mitochondrial fusion during steroidogenesis. These discoveries highlight the importance of organelles’ reorganization in specialized cells, prompting the exploration of the impact that organelle dynamics has on biological processes that include, but are not limited to, steroid synthesis. PMID:23029265

  17. Immunological Adjuvant Activity of Pectinioside A, the Steroidal Saponin from the Starfish Patiria pectinifera.

    PubMed

    Kawase, Osamu; Ohno, Osamu; Suenaga, Kiyotake; Xuan, Xuenan

    2016-05-01

    The steroidal saponin, pectinioside A, was isolated from the starfish, Patiria pectinifera. When it was subcutaneously injected into mice with ovalbumin (OVA), it facilitated the production of OVA-specific total IgG and IgG1 but not IgG2a. To our knowledge, this is the first report suggesting that starfish saponin has the potential to be an immunological adjuvant, stimulating Th2 type immune response. PMID:27319128

  18. Effect of maternal steroid on developing diaphragm integrity.

    PubMed

    Song, Yong; Demmer, Denise L; Pinniger, Gavin J; Lavin, Tina; MacMillan, Mia V; Pillow, Jane J; Bakker, Anthony J

    2014-01-01

    Antenatal steroids reduce the severity of initial respiratory distress of premature newborn babies but may have an adverse impact on other body organs. The study aimed to examine the effect of maternal steroids on postnatal respiratory muscle function during development and elucidate the mechanisms underlying the potential myopathy in newborn rats. Pregnant rats were treated with intramuscular injections of 0.5 mg/kg betamethasone 7 d and 3 d before birth. Newborn diaphragms were dissected for assessment of contractile function at 2 d, 7 d or 21 d postnatal age (PNA), compared with age-matched controls. The expression of myosin heavy chain (MHC) isoforms and atrophy-related genes and activity of intracellular molecular signalling were measured using quantitative PCR and/or Western blot. With advancing PNA, neonatal MHC gene expression decreased progressively while MHC IIb and IIx isoforms increased. Protein metabolic signalling showed high baseline activity at 2 d PNA, and significantly declined at 7 d and 21 d. Antenatal administration of betamethasone significantly decreased diaphragm force production, fatigue resistance, total fast fibre content and anabolic signalling activity (Akt and 4E-BP1) in 21 d diaphragm. These responses were not observed in 2 d or 7 d postnatal diaphragm. Results demonstrate that maternal betamethasone treatment causes postnatal diaphragmatic dysfunction at 21 d PNA, which is attributed to MHC II protein loss and impairment of the anabolic signalling pathway. Developmental modifications in MHC fibre composition and protein signalling account for the age-specific diaphragm dysfunction. PMID:24681552

  19. Enoxaparin Prevents Steroid-Related Avascular Necrosis of the Femoral Head

    PubMed Central

    Beckmann, Rainer; Shaheen, Hayfaa; Kweider, Nisreen; Ghassemi, Alireza; Fragoulis, Athanassios; Hermanns-Sachweh, Benita; Pufe, Thomas; Kadyrov, Mamed; Drescher, Wolf

    2014-01-01

    Nontraumatic osteonecrosis of the femoral head is still a challenging problem in orthopedic surgery. It is responsible for 10% of the 500,000 hip replacement surgeries in the USA and affects relatively young, active patients in particular. Main reasons for nontraumatic osteonecrosis are glucocorticoid use, alcoholism, thrombophilia, and hypofibrinolysis (Glueck et al., 1997; Orth and Anagnostakos, 2013). One pathomechanism of steroid-induced osteonecrosis is thought to be impaired blood flow to the femoral head caused by increased thrombus formation and vasoconstriction. To investigate the preventive effect of enoxaparin on steroid-related osteonecrosis, we used male New Zealand white rabbits. Osteonecrosis was induced by methylprednisolone-injection (1 × 20 mg/kg body weight). Control animals were treated with phosphate-buffered saline. Treatment consisted of an injection of 11.7 mg/kg body weight of enoxaparin per day (Clexane) in addition to methylprednisolone. Four weeks after methylprednisolone-injection the animals were sacrificed. Histology (hematoxylin-eosin and Ladewig staining) was performed, and empty lacunae and histological signs of osteonecrosis were quantified. Histomorphometry revealed a significant increase in empty lacunae and necrotic changed osteocytes in glucocorticoid-treated animals as compared with the glucocorticoid- and Clexane-treated animals and with the control group. No significant difference was detected between the glucocorticoid and Clexane group and the control group. This finding suggests that cotreatment with enoxaparin has the potential to prevent steroid-associated osteonecrosis. PMID:25110730

  20. Inherited antithrombin deficiency and anabolic steroids: a risky combination.

    PubMed

    Choe, Hannah; Elfil, Mohamed; DeSancho, Maria T

    2016-09-01

    A 20-year-old male with asymptomatic inherited type 1 antithrombin deficiency and a family history of thrombosis started injecting himself with testosterone 250 mg intramuscularly twice weekly for 5 weeks. He presented to the hospital with progressive dyspnea on exertion, chest pain and hemoptysis. Workup revealed bilateral submassive pulmonary embolism and proximal right lower extremity deep vein thrombosis. He was treated with intravenous (IV) unfractionated heparin and underwent catheter-directed thrombolysis with alteplase to the main pulmonary arteries. Postprocedure, he remained on IV alteplase infusion for 24 h and unfractionated heparin in the intensive care unit. Concomitantly he received plasma-derived antithrombin concentrate. He was transitioned to subcutaneous enoxaparin twice daily and discharged from the hospital on oral rivaroxaban 15 mg twice a day. This case highlights the heightened thrombogenic effect of anabolic steroids in the setting of underlying thrombophilia especially in younger subjects. PMID:26588446

  1. STEROID RECEPTOR COACTIVATOR 2 (SRC-2) MODULATES STEROID-DEPENDENT MALE SEXUAL BEHAVIOR AND NEUROPLASTICITY IN JAPANESE QUAIL (COTURNIX JAPONICA)

    PubMed Central

    Niessen, Neville-Andrew; Balthazart, Jacques; Ball, Gregory F.; Charlier, Thierry D.

    2011-01-01

    Steroid receptor coactivators are necessary for efficient transcriptional regulation by ligand-bound nuclear receptors, including estrogen and androgen receptors. SRC-2 modulates estrogen- and progesterone-dependent sexual behavior in female rats but its implication in the control of male sexual behavior has not been studied to our knowledge. We cloned and sequenced the complete quail SRC-2 transcript and showed by semi-quantitative PCR that SRC-2 expression is nearly ubiquitous, with high levels of expression in the kidney, cerebellum and diencephalon. Real time quantitative PCR did not reveal any differences between intact males and females the medial preoptic nucleus (POM), optic lobes and cerebellum. We next investigated the physiological and behavioral role of this coactivator using in vivo antisense oligonucleotide (AS) techniques. Daily injections in the third ventricle at the level of the POM of locked nucleic acid antisense targeting SRC-2 significantly reduced the expression of testosterone-dependent male-typical copulatory behavior but no inhibition of one aspect of the appetitive sexual behavior was observed. The volume of POM, defined by aromatase-immunoreactive cells, was markedly decreased in animals treated with AS as compared to controls. These results demonstrate that SRC-2 plays a prominent role in the control of steroid-dependent male sexual behavior and its associated neuroplasticity in Japanese quail. PMID:21854393

  2. Use of Candida antigen injections for the treatment of verruca vulgaris: A two-year mayo clinic experience.

    PubMed

    Alikhan, Ali; Griffin, John R; Newman, Catherine C

    2016-08-01

    Common warts (verruca vulgaris) are one of the most common problems encountered in dermatology and may present a difficult treatment dilemma, as no particular therapy has demonstrated complete efficacy. Intralesional injection of purified Candida antigen has produced impressive treatment results in small prospective and retrospective studies and is thought to produce its effect through stimulation of a cell-mediated immune response. We report a retrospective study of adult and pediatric patients treated with Candida antigen therapy in clinical practice. Of the 100 patients treated, 80% responded to therapy: 39% demonstrated a complete response and 41% demonstrated a partial response. In addition, 6 out of 7 immunocompromised patients who were treated demonstrated a partial or complete response. Injections were generally well-tolerated and adverse events were minimal and short-lived. Our data indicate that intralesional Candida antigen therapy for cutaneous warts is an efficacious option in a clinical practice setting. The treatment may also be effective in immunosuppressed patients with cutaneous warts. Our results add to the literature one of the largest retrospective series reported to date and treatment outcomes are similar to previously reported studies evaluating this therapeutic modality. PMID:26558635

  3. Statement on injectable contraception.

    PubMed

    1982-12-01

    Injectable hormonal contraception with 2 longacting steroidal preparations--norethisterone enanthate (NET-EN) and depot medroxyprogesterone acetate (DMPA)--provides an effective means of fertility regulation and has become an important method of family planning. DMPA and NET-EN have several advantages which make them particularly appropriate for some women and acceptable in family planning programs. A single injection can provide highly effective contraception for 2 or more months, delivery is simple, independent of coitus, and ensures periodic contact with medical or other trained health personnel. Currently, DMPA is registered as a therapeutic agent in nearly all countries and as a contraceptive agent in over 80 developed and developing countries. NET-EN is registered as a contraceptive in 40 countries. Administered by intramuscular injection in an aqueous microcrystalline suspension, DMPA exerts its contraceptive effect primarily by suppression of ovulation, but its effects on the endometrium, the uterine tubes, and the production of cervical mucus may also play a role in reducing fertility. DMPA as a contraceptive agent is generally given at a dosage of 150 mg every 90 days. NET-EN when administered as an intramuscular injection of an oil preparation at a dose of 200 mg inhibits ovulation. It should be administered at 8 weekly intervals for the 1st 6 months of use, then at intervals of 8 or 12 weeks. Longterm animal studies with DMPA have been completed mainly on beagle bitches and rhesus monkeys, and similar studies with NET-EN are nearing completion. None of the findings in beagles is considered applicable to human populations because the beagle responds differently than humans to steroidal hormones. None of the deaths among rhesus monkeys was attributable to effects of the drug. Endometrial carcinoma was found in 2 of the replacement monkeys but the number of animals was too small for statistically significant studies, and it is not possible to conclude

  4. Anaesthetics, steroids and platelet-rich plasma (PRP) in ultrasound-guided musculoskeletal procedures.

    PubMed

    Barile, Antonio; La Marra, Alice; Arrigoni, Francesco; Mariani, Silvia; Zugaro, Luigi; Splendiani, Alessandra; Di Cesare, Ernesto; Reginelli, Alfonso; Zappia, Marcello; Brunese, Luca; Duka, Ejona; Carrafiello, Giampaolo; Masciocchi, Carlo

    2016-09-01

    This review aims to evaluate the role of anaesthetics, steroids and platelet-rich plasma (PRP) employed with ultrasound-guided injection in the management of musculoskeletal pathology of the extremities. Ultrasound-guided injection represents an interesting and minimally invasive solution for the treatment of tendon and joint inflammatory or degenerative diseases. The availability of a variety of new drugs such as hyaluronic acid and PRP provides expansion of the indications and therapeutic possibilities. The clinical results obtained in terms of pain reduction and functional recovery suggest that the use of infiltrative procedures can be a good therapeutic alternative in degenerative and inflammatory joint diseases. PMID:27302491

  5. Steroidal saponins from Chlorophytum deistelianum.

    PubMed

    Tabopda, Turibio Kuiate; Mitaine-Offer, Anne-Claire; Paululat, Thomas; Delemasure, Stéphanie; Dutartre, Patrick; Ngadjui, Bonaventure Tchaleu; Lacaille-Dubois, Marie-Aleth

    2016-06-01

    Phytochemical investigation of the aerial parts of Chlorophytum deistelianum led to the isolation of four previously undescribed steroidal saponins called chlorodeistelianosides A-D with five known ones. Their structures were established mainly by extensive 1D and 2D NMR spectroscopic techniques and mass spectrometry as (25R)-3β-[(β-d-glucopyranosyl-(1→3)-[α-l-rhamnopyranosyl-(1→4)]-β-d-xylopyranosyl-(1→3)-[β-d-glucopyranosyl-(1→2)]-β-d-glucopyranosyl-(1→4)-β-d-galactopyranosyl)oxy]-5α-spirostan-12-one, (24S,25S)-24-[(β-d-glucopyranosyl)oxy]-3β-[(β-d-glucopyranosyl-(1→2)-[β-d-xylopyranosyl-(1→3)]-β-d-glucopyranosyl-(1→4)-β-d-galactopyranosyl)oxy]-5α-spirostan-12-one, (25R)-26-[(β-d-glucopyranosyl)oxy]-2α-hydroxy-22α-methoxy-5α-furostan-3β-yl β-d-glucopyranosyl-(1→2)-[β-d-xylopyranosyl-(1→3)]-β-d-glucopyranosyl-(1→4)-β-d-galactopyranoside, and (25R)-26-[(β-d-glucopyranosyl)oxy]-3β-[(β-d-glucopyranosyl-(1→2)-[β-d-xylopyranosyl-(1→3)]-β-d-glucopyranosyl-(1→4)-β-d-galactopyranosyl)oxy]-5α-furost-20(22)-en-12-one. Cytotoxicity of most compounds was evaluated against one human cancer cell line (SW480) and one rat cardiomyoblast cell line (H9c2). Among them, three known spirostane-type glycosides exhibited cytotoxicity on both cell lines with IC50 ranging from 8 to 10μM. PMID:27012932

  6. Steroidal glycoalkaloids in Solanum chacoense.

    PubMed

    Mweetwa, Alice M; Hunter, Danielle; Poe, Rebecca; Harich, Kim C; Ginzberg, Idit; Veilleux, Richard E; Tokuhisa, James G

    2012-03-01

    Potato (Solanum tuberosum L.), a domesticated species that is the fourth most important world agricultural commodity, requires significant management to minimize the effects of herbivore and pathogen damage on crop yield. A wild relative, Solanum chacoense Bitt., has been of interest to plant breeders because it produces an abundance of novel steroidal glycoalkaloid compounds, leptines and leptinines, which are particularly effective deterrents of herbivory by the Colorado potato beetle (Leptinotarsa decemlineata Say). Biochemical approaches were used in this study to investigate the formation and accumulation of SGAs in S. chacoense. SGA contents were determined in various organs at different stages of organ maturity during a time course of plant development. Leptines and leptinines were the main contributors to the increased levels in SGA concentration measured in the aerial versus the subterranean organs of S. chacoense accession 8380-1. Leptines were not detected in aboveground stolons until the stage where shoots had formed mature chlorophyllous leaves. To gain insights into SGA biosynthesis, the abundance of SGAs and steady-state transcripts of genes coding for enzymes of the central terpene and SGA-specific pathways in various plant organs at anthesis were compared. For two genes of primary terpene metabolism, transcript and SGA abundances were correlated, although with some discrepancies. For genes associated with SGA biosynthesis, transcripts were not detected in some tissues containing SGAs; however these transcripts were detected in the progenitor tissues, indicating the possibility that under our standard growth conditions, SGA biosynthesis is largely limited to highly proliferative tissues such as shoot, root and floral meristems. PMID:22217745

  7. Aflibercept Injection

    MedlinePlus

    ... injection is used to treat wet age-related macular degeneration (AMD; an ongoing disease of the eye that causes loss of the ability to see straight ahead and may make it more ... used to treat macular edema after retinal vein occlusion (an eye disease ...

  8. Cabazitaxel Injection

    MedlinePlus

    ... prednisone to treat prostate cancer (cancer of a male reproductive organ) that has already been treated with other medications. Cabazitaxel injection is in a class of medications called microtubule inhibitors. It works by slowing or stopping the growth of cancer cells.

  9. Hydrocortisone Injection

    MedlinePlus

    ... purple blotches or lines under the skin skin depressions at the injection site increased body fat or movement to different areas of your body difficulty falling asleep or staying asleep inappropriate happiness extreme ... increased sweating muscle weakness joint pain dizziness irregular ...

  10. Methylprednisolone Injection

    MedlinePlus

    ... purple blotches or lines under the skin skin depressions at the injection site increased body fat or movement to different areas of your body difficulty falling asleep or staying asleep inappropriate happiness extreme ... increased sweating muscle weakness joint pain dizziness irregular ...

  11. Triptorelin Injection

    MedlinePlus

    ... a sudden wave of mild or intense body heat) decreased sexual ability or desire leg or joint pain breast pain pain, itching, swelling, or redness at the place where injection was given difficulty falling asleep or staying asleep Some side effects can be serious. If you experience any of ...

  12. Eribulin Injection

    MedlinePlus

    ... tests to check your body's response to eribulin injection.It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring ...

  13. Pegaptanib Injection

    MedlinePlus

    ... to 7 days after you receive each pegaptanib injection.It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring ...

  14. Omalizumab Injection

    MedlinePlus

    ... and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: allergy shots (a series of injections given regularly to prevent the body from developing ...

  15. Famotidine Injection

    MedlinePlus

    ... treat ulcers (sores in the lining of the stomach or intestine) that were not successfully treated with other medications. ... Ellison syndrome (tumors in the pancreas and small intestine that caused increased production of stomach acid). Famotidine injection is in a class of ...

  16. Ranitidine Injection

    MedlinePlus

    ... treat ulcers (sores in the lining of the stomach or intestine) that were not successfully treated with other medications. ... Ellison syndrome (tumors in the pancreas and small intestine that caused increased production of stomach acid). Ranitidine injection is in a class of ...

  17. Oxytocin Injection

    MedlinePlus

    ... provider immediately: chest pain or difficulty breathing confusion fast or irregular heartbeat severe headache irritation at the injection site If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting ...

  18. Ganciclovir Injection

    MedlinePlus

    ... will be given to you two times a day for 2 to 3 weeks, and then once a day, 5 to 7 days of each week.Your dose of ganciclovir will ... may give you several doses (enough for a day's supply) of premixed ganciclovir injection solution at one ...

  19. Ibritumomab Injection

    MedlinePlus

    ... have received ibritumomab injection.do not have any vaccinations without talking to your doctor.you should know ... cells) and myelodysplastic syndrome (condition in which blood cells do not ... online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

  20. Tositumomab Injection

    MedlinePlus

    ... have received tositumomab injection.do not have any vaccinations without talking to your doctor.you should know ... blood cells), myelodysplastic syndrome (condition in which blood cells do not ... online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

  1. Dulaglutide Injection

    MedlinePlus

    ... other body tissues where it is used for energy. Dulaglutide injection also works by slowing the movement ... In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at ...

  2. Liraglutide Injection

    MedlinePlus

    ... other body tissues where it is used for energy. Liraglutide injection also slows the emptying of the ... In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at ...

  3. Albiglutide Injection

    MedlinePlus

    ... other body tissues where it is used for energy. Albiglutide injection also works by slowing the movement ... In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at ...

  4. Pressure-assisted electrokinetic supercharging for the enhancement of non-steroidal anti-inflammatory drugs.

    PubMed

    Meighan, Michelle M; Dawod, Mohamed; Guijt, Rosanne M; Hayes, Mark A; Breadmore, Michael C

    2011-09-23

    Electrokinetic supercharging (EKS) combines field-amplified sample injection with transient isotachophoresis (tITP) to create a powerful on-line preconcentration technique for capillary electrophoresis. In this work, EKS is enhanced with a positive pressure (pressure-assisted EKS, or PA-EKS) during injection to improve stacking of non-steroidal anti-inflammatory drugs (NSAIDs). Several parameters, including buffer composition and concentration, terminating electrolyte, organic modifier, and injection voltage and injection time of both terminating electrolyte and sample were optimized. Detection limits for seven NSAIDs were determined and an enhancement in sensitivity of almost 50,000-fold was obtained. The PA-EKS method has the potential to be a simple MS compatible preconcentration method to improve the sensitivity of CE. PMID:21855878

  5. RSK in Tumorigenesis: Connections to Steroid Signaling

    PubMed Central

    Eisinger-Mathason, T.S. Karin; Andrade, Josefa; Lannigan, Deborah A.

    2010-01-01

    The Ser/Thr kinase family, RSK, has been implicated in numerous types of hormone-dependent and -independent cancers. However, there has been little consideration of RSKs as downstream mediators of steroid hormone non-genomic effects or of their ability to facilitate steroid receptor-mediated gene expression. Steroid hormone signaling can directly stimulate the MEK/ERK/RSK pathway to regulate cellular proliferation and survival in transformed cells. To date, multiple mechanisms of RSK and steroid hormone receptor-mediated proliferation/survival have been elucidated. For example, RSK enhances proliferation of breast and prostate cancer cells via its ability to control the levels of the estrogen receptor co-activator, cyclin D1. While in lung and other tumors RSK may control apoptosis via estrogen-mediated regulation of mitochondrial integrity. Thus the RSKs could be important anti-cancer therapeutic targets in many different transformed tissues. The recent discovery of RSK-specific inhibitors will advance our current understanding of RSK in transformation and drive these studies into animal and clinical models. In this review we explore the mechanisms associated with RSK in tumorigenesis and their relationship to steroid hormone signaling. PMID:20045011

  6. Review of Androgenic Anabolic Steroid Use

    SciTech Connect

    T. Borges; G. Eisele; C. Byrd

    2001-07-31

    An area that has been overlooked within personnel security evaluations is employee use of androgenic-anabolic steroids (AAS). Current drug testing within the federal government does not include testing for anabolic steroids, and the difficulties to implement such testing protocols-not to mention the cost involved-make AAS testing highly improbable. The basis of this report is to bring to the forefront the damage that anabolic steroids can cause from both a physical and a psychological standpoint. Most individuals who use AASs do so to increase their muscle mass because they wish to gain some type of competitive edge during athletic competition or they wish to enhance their physical features for self-satisfaction and self-esteem (i.e., body building). Security officers are one group of men who often take high doses of anabolic steroids, according to the Second Report of the Senate Standing Committee (1990). The negative psychological characteristics for AAS use is extensive and includes prominent hostility, aggressiveness, irritability, euphoria, grandiose beliefs, hyperactivity, reckless behavior, increased sexual appetite, unpredictability, poor impulse control, mood fluctuations, and insomnia. The drug may invoke a sense of power and invincibility (Leckman and Scahill, 1990). Depressive symptoms, such as anhedonia, fatigue, impaired concentration, decreased libido, and even suicidality (Pope and Katz, 1992) have been noted with steroid withdrawal. It appears that long-term users of AAS experience similar characteristics as other substance abusers (i.e., craving, dependence, and withdrawal symptoms).

  7. Reproductive Steroid Regulation of Mood and Behavior.

    PubMed

    Schiller, Crystal Edler; Johnson, Sarah L; Abate, Anna C; Rubinow, David R; Schmidt, Peter J

    2016-01-01

    In this article, we examine evidence supporting the role of reproductive steroids in the regulation of mood and behavior in women and the nature of that role. In the first half of the article, we review evidence for the following: (i) the reproductive system is designed to regulate behavior; (ii) from the subcellular to cellular to circuit to behavior, reproductive steroids are powerful neuroregulators; (iii) affective disorders are disorders of behavioral state; and (iv) reproductive steroids affect virtually every system implicated in the pathophysiology of depression. In the second half of the article, we discuss the diagnosis of the three reproductive endocrine-related mood disorders (premenstrual dysphoric disorder, postpartum depression, and perimenopausal depression) and present evidence supporting the relevance of reproductive steroids to these conditions. Existing evidence suggests that changes in reproductive steroid levels during specific reproductive states (i.e., the premenstrual phase of the menstrual cycle, pregnancy, parturition, and the menopause transition) trigger affective dysregulation in susceptible women, thus suggesting the etiopathogenic relevance of these hormonal changes in reproductive mood disorders. Understanding the source of individual susceptibility is critical to both preventing the onset of illness and developing novel, individualized treatments for reproductive-related affective dysregulation. © 2016 American Physiological Society. Compr Physiol 6:1135-1160, 2016e. PMID:27347888

  8. Steroid and sterol 7-hydroxylation: ancient pathways.

    PubMed

    Lathe, Richard

    2002-11-01

    B-ring hydroxylation is a major metabolic pathway for cholesterols and some steroids. In liver, 7 alpha-hydroxylation of cholesterols, mediated by CYP7A and CYP39A1, is the rate-limiting step of bile acid synthesis and metabolic elimination. In brain and other tissues, both sterols and some steroids including dehydroepiandrosterone (DHEA) are prominently 7 alpha-hydroxylated by CYP7B. The function of extra-hepatic steroid and sterol 7-hydroxylation is unknown. Nevertheless, 7-oxygenated cholesterols are potent regulators of cell proliferation and apoptosis; 7-oxygenated derivatives of DHEA, pregnenolone, and androstenediol can have major effects in the brain and in the immune system. The receptor targets involved remain obscure. It is argued that B-ring modification predated steroid evolution: non-enzymatic oxidation of membrane sterols primarily results in 7-oxygenation. Such molecules may have provided early growth and stress signals; a relic may be found in hydroxylation at the symmetrical 11-position of glucocorticoids. Early receptor targets probably included intracellular sterol sites, some modern steroids may continue to act at these targets. 7-Hydroxylation of DHEA may reflect conservation of an early signaling pathway. PMID:12398993

  9. Environments, risk and health harms: a qualitative investigation into the illicit use of anabolic steroids among people using harm reduction services in the UK

    PubMed Central

    Kimergård, Andreas; McVeigh, Jim

    2014-01-01

    Objectives The illicit use of anabolic steroids among the gym population continues to rise, along with the number of steroid using clients attending harm reduction services in the UK. This presents serious challenges to public health. Study objectives were to account for the experiences of anabolic steroid users and investigate how ‘risk environments’ produce harm. Methods Qualitative face-to-face interviews with 24 users of anabolic steroids engaged with harm reduction services in the UK. Results Body satisfaction was an important factor when deciding to start the use of anabolic steroids. Many users were unaware of the potential dangers of using drugs from the illicit market, whereas some had adopted a range of strategies to negotiate the hazards relating to the use of adulterated products, including self-experimentation to gauge the perceived efficacy and unwanted effects of these drugs. Viewpoints, first-hand anecdotes, norms and practices among groups of steroid users created boundaries of ‘sensible’ drug use, but also promoted practices that may increase the chance of harms occurring. Established users encouraged young users to go to harm reduction services but, at the same time, promoted risky injecting practices in the belief that this would enhance the efficacy of anabolic steroids. Conclusions Current steroid-related viewpoints and practices contribute to the risk environment surrounding the use of these drugs and may undermine the goal of current public health strategies including harm reduction interventions. The level of harms among anabolic steroid users are determined by multiple and intertwining factors, in addition to the harms caused by the pharmacological action or injury and illness associated with incorrect injecting techniques. PMID:24898090

  10. Augmented transport and metabolism of sex steroids in lymphoid neoplasia in the rat

    SciTech Connect

    Cefalu, W.T.; Pardridge, W.M.

    1987-03-01

    Sex steroid hormones have been shown to influence a number of biological properties of lymphoid neoplastic tissue. Receptor occupancy is a function of the pool size of cellular exchangeable hormone therefore it is important to understand the mechanisms regulating hormone transport from the microcirculation and hormone metabolism. In this study, steroid hormone transport and metabolism were investigated in control and neoplastic lymph nodes after transplanting control rats with the WR-6 leukemic line. Steroid hormone transport and metabolism were studied after pulse labeling the nodal tissue in vivo with arterial bolus injections of (/sup 3/H)testosterone. Residual vascular radioactivity was monitored by simultaneously injecting 113m indium chelated to bovine transferrin. Both testosterone and estradiol were partially available for transport through the capillary barriers of control and neoplastic lymph nodes from the circulating albumin-bound pool. Estradiol was readily available for transport from the circulating sex hormone-binding globulin-bound pool in both control and neoplastic lymph nodes. Testosterone was not available for transport from the sex hormone-binding globulin-bound pool in control lymph nodes, but was readily available for transport in metastatic lymph nodes. Thaw-mount autoradiography and physiological measurements showed that plasma proteins such as albumin or transferrin were confined to the microcirculation compartment. The transport of protein-bound hormones into lymph node represents a mechanism of enhanced steroid hormone dissociation from the binding protein without the plasma protein per se significantly exiting the microcirculation compartment. Metabolic studies showed no measurable metabolism of (/sup 3/H)testosterone in the control lymph nodes by 60 sec after arterial injection.

  11. Measurement of Steroid Concentrations in Brain Tissue: Methodological Considerations

    PubMed Central

    Taves, Matthew D.; Ma, Chunqi; Heimovics, Sarah A.; Saldanha, Colin J.; Soma, Kiran K.

    2011-01-01

    It is well recognized that steroids are synthesized de novo in the brain (neurosteroids). In addition, steroids circulating in the blood enter the brain. Steroids play numerous roles in the brain, such as influencing neural development, adult neuroplasticity, behavior, neuroinflammation, and neurodegenerative diseases such as Alzheimer’s disease. In order to understand the regulation and functions of steroids in the brain, it is important to directly measure steroid concentrations in brain tissue. In this brief review, we discuss methods for the detection and quantification of steroids in the brain. We concisely present the major advantages and disadvantages of different technical approaches at various experimental stages: euthanasia, tissue collection, steroid extraction, steroid separation, and steroid measurement. We discuss, among other topics, the potential effects of anesthesia and saline perfusion prior to tissue collection; microdissection via Palkovits punch; solid phase extraction; chromatographic separation of steroids; and immunoassays and mass spectrometry for steroid quantification, particularly the use of mass spectrometry for “steroid profiling.” Finally, we discuss the interpretation of local steroid concentrations, such as comparing steroid levels in brain tissue with those in the circulation (plasma vs. whole blood samples; total vs. free steroid levels). We also present reference values for a variety of steroids in different brain regions of adult rats. This brief review highlights some of the major methodological considerations at multiple experimental stages and provides a broad framework for designing studies that examine local steroid levels in the brain as well as other steroidogenic tissues, such as thymus, breast, and prostate. PMID:22654806

  12. Use of anabolic-androgenic steroids masking the diagnosis of pleural tuberculosis: a case report

    PubMed Central

    2009-01-01

    Introduction Tuberculous pleural effusions are not always easy to diagnose but the presence of a lymphocyte-rich exudate associated with an increased adenosine deaminase level and a positive skin test result are highly sensitive diagnostic signs. Case presentation We report a case of pleural tuberculosis in a 31-year-old white male patient from Caracas, Venezuela who was negative for human immunodeficiency virus and presented 2 weeks after injecting the anabolic-androgenic steroid nandrolone decanoate, in whom all the tests for tuberculosis were initially negative; an eosinophilic pleural effusion with a low adenosine deaminase level, a negative tuberculin skin test and negative for acid-fast bacilli staining and culture of the pleural fluid. After excluding other causes of eosinophilic pleural effusion malignant pleural effusion was suspected. The patient did not return until 4 months later. The second thoracentesis obtained a pleural fluid suggestive for tuberculosis, with a predominance of lymphocytes, an elevated adenosine deaminase level (51 U/l) and a positive tuberculin skin test. Culture of pleural fragments confirmed pleural tuberculosis. Conclusion This case suggests that the use of an anabolic-androgenic steroid masks the definitive diagnosis of pleural tuberculosis by changing the key diagnostic parameters of the pleural fluid, a finding not previously reported. Available evidence of the effects of anabolic steroids on the immune system also suggests that patients using anabolic-androgenic steroids might be susceptible to developing tuberculosis in either reactivating a latent infection or facilitating development of the disease after a recent infection. PMID:19175931

  13. Steroid promiscuity: Diversity of enzyme action. Preface.

    PubMed

    Lathe, Richard; Kotelevtsev, Yuri; Mason, J Ian

    2015-07-01

    This Special Issue on the topic of Steroid and Sterol Signaling: Promiscuity and Diversity, dwells on the growing realization that the 'one ligand, one binding site' and 'one enzyme, one reaction' concepts are out of date. Focusing on cytochromes P450 (CYP), hydroxysteroid dehydrogenases (HSDs), and related enzymes, the Special Issue highlights that a single enzyme can bind to diverse substrates, and in different conformations, and can catalyze multiple different conversions (and in different directions), thereby, generating an unexpectedly wide spectrum of ligands that can have subtly different biological actions. This article is part of a Special Issue entitled 'Steroid/Sterol Signaling' . PMID:25596328

  14. Anabolic steroids and acute schizophrenic episode.

    PubMed

    Annitto, W J; Layman, W A

    1980-04-01

    The use of anabolic steroids by athletes to increase physical performance has vastly increased over the last 10 years. A case is described which temporally relates the use of these organic compounds with the development of an acute schizophreniform illness. The dearth of literature on this particular "side-effect" is noted, as are the diagnostic implications vis-a-vis anabolic steroids and the anamnestic interview in an athlete who presents with an acute schizophrenic mental status examination. Recommendation is made to consider this "side-effect" in differential diagnosis of schizophrenic episode. PMID:7364737

  15. Three new steroidal saponins from Helleborus thibetanus.

    PubMed

    Zhang, Hui; Su, Yan-Fang; Yang, Feng-Ying

    2016-08-01

    Three new steroidal saponins including two spirostanol glycosides (1-2) and one furostanol glycoside 1-sulphate (3) were isolated from the dried roots and rhizomes of Helleborus thibetanus. Structures of the compounds were determined on the basis of extensive use of 1-D and 2-D NMR experiments, together with HR-ESI-MS and IR measurements, as well as the results of acid hydrolysis. Compounds 1-2 represented steroidal saponins with an unusual substitution pattern, which possessed a double bond at C-25 and were glycosylated at 1-OH. PMID:26821553

  16. Histopathological alterations after a growth promoter boldenone injection in rabbits.

    PubMed

    Tousson, Ehab

    2016-02-01

    Boldenone (BOL) is a derivative of the testosterone that has dual effects on humans, both directly and indirectly; directly as injection to build muscles and indirectly as through consuming meat of animals that where treated with BOL. However, the action of these steroids on different body organs structures is still unclear; therefore, the aim of the present study was to investigate the effect of the intramuscular injection of BOL undecylenate on the different organ structures. A total of 10 adult New Zealand rabbits were divided into two main groups, the first group was the control group, which includes animals that were injected intramuscularly with olive oil and the second group included animals that received two intramuscular injections of 5 mg/kg body weight BOL dissected after 6 weeks. Our results showed that intramuscular injection of rabbits with BOL showed hypertrophy in both skeletal and cardiac muscles, disturbances of the hepatocytes radially arranged cords with multifocal hepatocellular vacuolations in the liver, glomerulus mass reduction with multifocal glomerular injury in the kidney, disturbances of the cycle of spermatogenesis in the testes. In conclusion, using BOL, while preparing for a young bodybuilding contest, may cause an alteration in the histological structure of most of the body organs; these findings suggested that especially young people who misuse anablic androgenic steroids should be careful if they want to use such steroids to enhance their strength and endurance. PMID:24097356

  17. Bell's Palsy: Treatment with Steroids and Antiviral Drugs

    MedlinePlus

    ... PATIENTS and their FAMILIES BELL’S PALSY: TREATMENT WITH STEROIDS AND ANTIVIRAL DRUGS This information sheet is provided to help you understand the role of steroids and antiviral drugs for treating Bell’s palsy. Neurologists ...

  18. Certain Steroids Raise Risk for Serious Staph Infections

    MedlinePlus

    ... nih.gov/medlineplus/news/fullstory_159290.html Certain Steroids Raise Risk for Serious Staph Infections Study finds ... to infection," he added. Glucocorticoids -- a form of steroids -- are powerful immunosuppressive drugs used to treat a ...

  19. Fewer Inhaled Steroids May Be OK for Asthmatic Children

    MedlinePlus

    ... gov/medlineplus/news/fullstory_159083.html Fewer Inhaled Steroids May Be OK for Asthmatic Children Study suggests ... 2016 FRIDAY, May 27, 2016 (HealthDay News) -- Inhaled steroid therapy is commonly used to treat asthmatic children ...

  20. Certain Steroids Raise Risk for Serious Staph Infections

    MedlinePlus

    ... https://medlineplus.gov/news/fullstory_159290.html Certain Steroids Raise Risk for Serious Staph Infections Study finds ... to infection," he added. Glucocorticoids -- a form of steroids -- are powerful immunosuppressive drugs used to treat a ...

  1. Injectable therapy for Peyronie's disease.

    PubMed

    Chong, Weiliang; Tan, Ronny Ban Wei

    2016-06-01

    Peyronie's disease is a disfiguring and psychologically devastating disease, which continues to pose a significant clinical conundrum to the attending doctor. Many forms of therapy have been trialled but results have been inconsistent at best. Non-surgical therapy revolves around oral, intralesional and shockwave therapies. The focus of this paper is on intralesional agents, their evolution and efficacy of treatments. The mere fact that so many agents have been tried is a testament to the incomplete knowledge that we have with regards to the underlying pathophysiology of the disease. Currently, the only U.S. Food and Drug Administration (FDA) approved agent that has shown fairly consistent results is Clostridium histiolyticum collagenase (Xiaflex(TM)), whereas calcium channel blockers and interferons (IFN) remain as off-label options. PMID:27298778

  2. Panniculitis with crystals induced by etanercept subcutaneous injection.

    PubMed

    Llamas-Velasco, Mar; Requena, Luis

    2015-06-01

    Panniculitis with lipid crystallization within adipocytes may be seen in several disorders, including crystal-storing histiocytosis, gouty panniculitis, subcutaneous fat necrosis of the newborn, post-steroid panniculitis, sclerema neonatorum, oxalosis and subcutaneous fungal infections by mucormycosis, zygomycosis or aspergillosis. Panniculitis at the sites of subcutaneous injection of drugs are frequent, but to our knowledge no crystals have been described in the drug-induced panniculitis at the sites of subcutaneous injections. We report on a patient who developed a panniculitis with lipid crystallization at the site of etanercept injection. PMID:25727404

  3. Severe Scapular Pain Following Unintentional Cervical Epidural Air Injection.

    PubMed

    Henthorn, Randall W; Murray, Kerra

    2016-03-01

    This a unique case of severe scapular pain following unintentional epidural space air injection during epidural steroid injection.A 70-year-old woman presented for a fluoroscopically guided C7-T1 interlaminar epidural steroid injection. Three injection attempts were made using the loss of resistance with air technique. On the first attempt the epidural space was entered, but contrast injection showed that the needle was intravenous. On the second attempt an equivocal loss of resistance with air was perceived and 5 mL of air was lost from the syringe. The needle was withdrawn and redirected, and upon the third needle passage the contrast injection showed appropriate epidural space filling up to the C4-5 level. Injection of betamethasone mixed in lidocaine was initially uneventful.However, 20 minutes post-injection the patient experienced sudden sharp and continuous pain along the medial edge of the scapula. After failing to respond to multiple intravascular analgesics, the patient was transferred to the emergency room. Her pain subsided completely following an intravenous diazepam injection. Cervical spine computerized tomography showed obvious air in the posterior epidural space from C4-5 to C6-7 as well as outside the spinal canal from (C4-T2). Having recovered fully, she was discharged the following morning. In reviewing the procedure, the equivocal loss of resistance on the second passage was actually a true loss of resistance to epidural space and air was unintentionally injected. Surprisingly, severe scapular pain resulted in a delayed manner after the steroid solution was injected. The authors theorize that unintentional prefilling of the epidural space with air prior to the injection of the subsequent steroid mixture added sufficient pressure to the epidural space to cause right-sided C4 nerve root stretching/entrapment and ensuing radicular pain to the right scapular border. The subsequent intravenous diazepam provided cervical muscle relaxation and

  4. The Incidence of Anabolic Steroid Use among Competitive Bodybuilders.

    ERIC Educational Resources Information Center

    Tricker, Ray; And Others

    1989-01-01

    Investigated incidence of anabolic steroid use among 380 competitive male and female bodybuilders in Kansas and Missouri. Results indicated more than half (54 percent) of the male bodybuilders were using steroids on a regular basis compared to 10 percent of the female competitors. Found main reason for use of steroids was desire to win. (Author/TE)

  5. Hypercholesterolemia in Male Power Lifters Using Anabolic-Androgenic Steroids.

    ERIC Educational Resources Information Center

    Cohen, Jonathan C.; And Others

    1988-01-01

    Measurement of serum cholesterol concentrations in male power lifters who used anabolic-androgenic steroids for eight weeks, three years, or eight years indicated that mean serum cholesterol levels increased with drug use, but decreased promptly to near pre-steroid levels after steroid use ended. (Author/CB)

  6. Steroids and Other Ergogenic Aids: A Resource Guide.

    ERIC Educational Resources Information Center

    Virginia State Dept. of Education, Richmond.

    Steroids have become one of society's "short cuts" to athletic prowess and success. This guide includes information and teaching materials for educators and others who work with youth on how to teach that steroids are drugs, that drugs can harm and kill, and that a "no-use" policy applies to steroids as well as to alcohol and other drugs. It is…

  7. ent-Steroids: Novel Tools for Studies of Signaling Pathways

    PubMed Central

    Covey, Douglas F.

    2008-01-01

    Membrane receptors are often modulated by steroids and it is necessary to distinguish the effects of steroids at these receptors from effects occurring at nuclear receptors. Additionally, it may also be mechanistically important to distinguish between direct effects caused by binding of steroids to membrane receptors and indirect effects on membrane receptor function caused by steroid perturbation of the membrane containing the receptor. In this regard, ent-steroids, the mirror images of naturally occurring steroids, are novel tools for distinguishing between these various actions of steroids. The review provides a background for understanding the different actions that can be expected of steroids and ent-steroids in biological systems, references for the preparation of ent-steroids, a short discussion about relevant forms of stereoisomerism and the requirements that need to be fulfilled for the interaction between two molecules to be enantioselective. The review then summarizes results of biophysical, biochemical and pharmacological studies published since 1992 in which ent-steroids have been used to investigate the actions of steroids in membranes and/or receptor-mediated signaling pathways. PMID:19103212

  8. Elemental diet in steroid-dependent and steroid-refractory Crohn's disease.

    PubMed

    O'Brien, C J; Giaffer, M H; Cann, P A; Holdsworth, C D

    1991-11-01

    Sixteen patients with Crohn's disease who had symptoms uncontrolled by high-dose steroids (n = 11) or symptoms invariably appearing on reduction or withdrawal of immunosuppressive therapy (n = 5) were treated with elemental diet. After 4 wk of dietary treatment, 10 patients were in remission and off all medication. Seven continued to be well without treatment for a minimum of 6 months, and four for at least 1 yr. No patient who subsequently relapsed had further steroid-refractory symptoms. Of the six patients failing to respond to elemental diet, four with steroid-refractory disease required early resective surgery for symptom relief, and two continued with steroid therapy, one in much reduced dosage. Elemental diet can bring about a sustained remission in many patients with Crohn's disease dependent on or refractory to corticosteroids, and reduce the need for surgical intervention. PMID:1951239

  9. Preventing Anabolic Steroid Use: Guidelines and Activities.

    ERIC Educational Resources Information Center

    Nutter, June; Rauhe, Betty

    1997-01-01

    Information about anabolic steroids should be included in the school health curriculum as early as possible. The paper presents suggestions for planning education programs and offers a variety of activities and strategies appropriate for many age groups, including case studies, story completion, posters, demonstrations, projects, creative writing,…

  10. Sox and Drugs: Baseball, Steroids and Physics

    NASA Astrophysics Data System (ADS)

    Tobin, Roger

    2008-03-01

    The sports world is in an uproar over performance-enhancing drugs. In the United States steroids in baseball have received the most attention, in part because the purported effects are much more dramatic than in any other sport. From 1995-2003 a few players hit home runs at rates 20-50% higher than the best sluggers of the preceding century. Could steroids really increase home-run performance that much? I will describe a model that combines estimates of the physiological effects of steroids, known baseball physics, and reasonable models of batting effectiveness for highly skilled hitters. A 10% increase in muscle mass, which can reasonably be expected from steroid use, increases the speed of a batted ball by 3%. Because home runs are relatively rare events on the tail of a batter's range distribution, even this modest change in ball speed can increase the proportion of batted balls that result in home runs by 30 -- 70%, enough to account for the record-shattering performances of the recent past. I will also describe some of the attention -- both welcome and not -- that comes to the unsuspecting physicist who wades into such emotionally troubled waters.

  11. Sex Steroid Actions in Male Bone

    PubMed Central

    Laurent, Michaël R.; Claessens, Frank; Gielen, Evelien; Lagerquist, Marie K.; Vandenput, Liesbeth; Börjesson, Anna E.; Ohlsson, Claes

    2014-01-01

    Sex steroids are chief regulators of gender differences in the skeleton, and male gender is one of the strongest protective factors against osteoporotic fractures. This advantage in bone strength relies mainly on greater cortical bone expansion during pubertal peak bone mass acquisition and superior skeletal maintenance during aging. During both these phases, estrogens acting via estrogen receptor-α in osteoblast lineage cells are crucial for male cortical and trabecular bone, as evident from conditional genetic mouse models, epidemiological studies, rare genetic conditions, genome-wide meta-analyses, and recent interventional trials. Genetic mouse models have also demonstrated a direct role for androgens independent of aromatization on trabecular bone via the androgen receptor in osteoblasts and osteocytes, although the target cell for their key effects on periosteal bone formation remains elusive. Low serum estradiol predicts incident fractures, but the highest risk occurs in men with additionally low T and high SHBG. Still, the possible clinical utility of serum sex steroids for fracture prediction is unknown. It is likely that sex steroid actions on male bone metabolism rely also on extraskeletal mechanisms and cross talk with other signaling pathways. We propose that estrogens influence fracture risk in aging men via direct effects on bone, whereas androgens exert an additional antifracture effect mainly via extraskeletal parameters such as muscle mass and propensity to fall. Given the demographic trends of increased longevity and consequent rise of osteoporosis, an increased understanding of how sex steroids influence male bone health remains a high research priority. PMID:25202834

  12. Neurology of sex steroids and oral contraceptives.

    PubMed

    Schipper, H M

    1986-11-01

    Under normal circumstances, sex steroids interact with diverse neural substrates to modulate a host of activities essential to the preservation of the individual and the species. In addition, sex hormones play an important role in various human neurologic conditions including strokes, migraine, certain movement disorders and peripheral neuropathies, and possibly even the behavior of CNS neoplasms. PMID:3025581

  13. Steroids for intubated croup masking airway haemangioma.

    PubMed Central

    Kiff, K M; Mok, Q; Dunne, J; Tasker, R C

    1996-01-01

    Recently, the beneficial role of steroids for acute laryngotracheobronchitis has been more clearly defined for both intubated and unintubated patients. However, corticosteroids also improve the clinical signs of airway haemangiomata. Two patients are described who illustrate how this can be a source of diagnostic confusion. PMID:8660054

  14. Effects of steroids on the morphology and proliferation of canine and equine mesenchymal stem cells of adipose origin - in vitro research.

    PubMed

    Marycz, Krzysztof; Smieszek, Agnieszka; Grzesiak, Jakub; Nicpoń, Jakub E

    2014-09-01

    Disorders of the locomotive system, especially those occurring due to degenerative changes of the joints, are serious problems in daily veterinary medical practice. Steroid injections are the main way of treating these disorders. However, this approach brings usually only temporary effects of pain relief, and may cause many side effects. Alternative therapies focus on regeneration of damaged tissue using adult mesenchymal stem cells (MSCs). Since 2002, the great plasticity and immunomodulatory properties of MSCs isolated from adipose tissue (AdMSCs) have been used successfully in the treatment of degenerative joint diseases (DJD) of both dogs and horses. Possible simultaneous application of steroid therapy and stem cell transplantation could improve the commonly used clinical procedure. In this paper, the influence of the two steroid drugs (betamethasone and methylprednisolone) on AdMSCs was evaluated on the basis of morphology and proliferation rate. Both steroids positively influenced the viability and proliferation state of cells in a concentration of 0.01 mg/ml and 0.1 mg/ml, respectively. However, the concentration of 1 mg/ml had a cytotoxic effect. Moreover, the lower dosage of steroid drugs used in the experiment did not affect the morphology of cells and significantly increased cellular activity. In conclusion, our data demonstrate the stimulating effect of steroid drugs on cell morphology, proliferation rate and cytophysiological activity. These findings may influence the use of stem cells and steroids in applied regenerative veterinary medical practice in the future. PMID:24659718

  15. 76 FR 72355 - Classification of Two Steroids, Prostanozol and Methasterone, as Schedule III Anabolic Steroids...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-23

    ...This Notice of Proposed Rulemaking (NPRM) proposes to classify the following two steroids as ``anabolic steroids'' under the Controlled Substances Act (CSA): prostanozol (17[beta]-hydroxy- 5[alpha]-androstano[3,2-c]pyrazole) and methasterone (2[alpha],17[alpha]-dimethyl-5[alpha]-androstan-17[beta]-ol-3-one). The Drug Enforcement Administration (DEA) believes that this action is necessary to......

  16. Steroid and steroid glucuronide profiles in urine during pregnancy determined by liquid chromatography-electrospray ionization-tandem mass spectrometry.

    PubMed

    Jäntti, Sirkku E; Hartonen, Minna; Hilvo, Mika; Nygren, Heli; Hyötyläinen, Tuulia; Ketola, Raimo A; Kostiainen, Risto

    2013-11-13

    An ultra performance liquid chromatography-electrospray ionization-tandem mass spectrometry (UPLC-MS/MS) method was developed for the analysis of steroids and their glucuronides in urine samples. The method provides high sensitivity and fast analysis, as both steroids and their glucuronides can be analyzed directly without hydrolysis or complex sample preparation. The method was applied in profiling of targeted and nontargeted steroids and steroid glucuronides during pregnancy. The concentrations of 11 of 27 targeted steroids and steroid glucuronides and the concentrations of 25 nontargeted steroid glucuronides increased about 10-400 fold during the pregnancy. The concentrations of most of these 36 compounds began to increase in the first days of the pregnancy, increased gradually during the pregnancy, achieved a maximum in late pregnancy, and decreased sharply after delivery. Exceptionally, the concentrations of allopregnanolone and 17-hydroxypregnenolone started to increase later than those of the other steroids. Moreover, the concentrations of E2 glucuronides began to decrease one week before the delivery, in contrast to most of the steroids and steroid glucuronides, whose concentrations dropped sharply during the delivery. Concentrations of 34 compounds decreased noticeably when the subject was on sick leave owing a series of painful contractions. The results suggest that steroids and especially steroid glucuronides may provide a valuable diagnostic tool to follow the course of pregnancy. PMID:24176505

  17. Effectiveness of Blind & Ultrasound Guided Corticosteroid Injection in Impingement Syndrome

    PubMed Central

    Haghighat, Shila; Taheri, Parisa; Banimehdi, Mohsen; Taghavi, Arash

    2016-01-01

    Local steroid injections are common for treatment of impingement syndrome. Corticosteroid injections methods are basically in two formats, blind or with image guidance. The aim of this study is to compare the effect of ultrasound-guided in comparison with blind corticosteroid injections in patients with impingement syndrome. This study is a randomized clinical trial study undertaken in patients with diagnosis of impingement syndrome done in Isfahan University of Medical Science clinics from February 2014 to February 2015. The number of all patients registered in the study is 48; and then 40 patients were allocated to either control group randomly which received blind steroid injection or case group that underwent ultrasound-guided steroid injection. The clinical symptoms were assessed using Shoulder Pain and Disability Index (SPADI) questionnaire, Visual Analogue Scale (VAS) and shoulder range of motion (ROM) using goniometer at baseline and six weeks after the injection. Data analysis revealed a significant difference in the mean of the VAS, SPADI and shoulder ROM in both groups 6 weeks after intervention (P < 0.05). Patients with ultrasound guided corticosteroid injection had statistically significant improvements in function and shoulder ROM (abduction, flexion) compared to blind injection group after 6 weeks (P<0.05). There was not significant differences in pain (VAS) and internal and external rotation between these two groups (p>0.05). Our findings suggest that US image guided can improve the shoulder function of patients with impingement syndrome, and thus can be considered in comprehensive care programs of these patients for fast speed of rehabilitation.

  18. Anabolic-androgenic steroid use among 133 prisoners.

    PubMed

    Pope, H G; Kouri, E M; Powell, K F; Campbell, C; Katz, D L

    1996-01-01

    We performed a forensic evaluation of a 16-year-old boy convicted of murdering his 14-year-old girlfriend while he was taking anabolic steroids. Prior to steroid use, he had displayed no features of antisocial personality disorder and no criminal record. Prompted by this index case, we interviewed 133 consecutive male convicts at the same facility where this boy was incarcerated to assess whether steroid use frequently contributed to criminal acts. Two other cases of apparent steroid-induced crimes were found in this cohort, suggesting that steroid use is an uncommon, though occasionally significant, factor in criminal behavior. PMID:8879906

  19. TeBG- and CBG-bound steroid hormones in rabbits are available for influx into uterus in vivo

    SciTech Connect

    Chaudhuri, G.; Steingold, K.A.; Pardridge, W.M.; Judd, H.L. )

    1988-01-01

    The metabolic clearance rate (MCR) of gonadal or adrenal steroid hormones in rabbits often does not bear the expected inverse relationship with hormone binding to testosterone-binding globulin (TeBG) or corticosteroid-binding globulin (CBG). This suggests TeBG or CBG may not impede steroid hormone delivery to tissues. The effects of rabbit plasma proteins on the influxes of {sup 3}H-labeled steroids from the circulation into the rabbit uterus were measured in vivo using a tissue sampling single-injection technique. In the absence of plasma proteins, estradiol (E{sub 2}) and testosterone (T) were freely diffusible through the uterine microvasculature (i.e., extraction >80%). The extractions of dihydrostestosterone (DHT) and corticosterone (B) ranged from 60 to 72%, while that of cortisol (F) was reduced at 40%. Rabbit serum exerted no inhibition of the influxes of the steroids tested. The influxes of T and B greatly exceeded the rates that would be expected if only the free and albumin-bound fractions estimated in vitro were diffusible in vivo. However, the extraction of ({sup 3}H)corticosteroid-binding globulin or bovine ({sup 3}H)albumin were low, consistent with little, if any, extravascular uptake of the plasma proteins. The results indicate both albumin-bound and globulin-bound steroid hormone are available for transport into the uterus in the rabbit in vivo without significant exodus of the plasma protein, per se.

  20. Comparison of synthesis of 15α-hydroxylated steroids in males of four North American lamprey species

    USGS Publications Warehouse

    Bryan, Mara B.; Young, Bradley A.; Close, David A.; Semeyn, Jesse; Robinson, T. Craig; Bayer, Jennifer M.; Li, Weiming

    2006-01-01

    Recent studies have provided evidence that 15α-hydroxytestosterone (15α-T) and 15α-hydroxyprogesterone (15α-P) are produced in vitro and in vivo in adult male sea lampreys (Petromyzonmarinus), and that circulatory levels increase in response to injections with gonadotropin-releasing hormone (GnRH). We examined four species from the Petromyzontidae family including silver lampreys (Ichthyomyzon unicuspis), chestnut lampreys (I. castaneus), American brook lampreys (Lethenteron appendix), and Pacific lampreys (Entosphenus tridentatus) to determine if these unusual steroids were unique to sea lampreys or a common feature in lamprey species. In vitro production was examined through incubations of testis with tritiated precursors, and 15α-T and 15α-P production was confirmed in all species through co-elution with standards on both high performance liquid chromatography (HPLC) and thin layerchromatography. In vivo production was proven by demonstrating that HPLC-fractionated plasma had peaks of immunoreactive 15α-T and 15α-P that co-eluted with standards through using previously developed radioimmunoassays for 15α-T and 15α-P. The possible functionality of 15α-T and 15α-P was further examined in silver and Pacific lampreys by investigating the effect of injection of either type of lamprey GnRH on plasma concentrations of 15α-T and 15α-P. Injections with exogenous GnRH did not affect circulatory levels of either steroid in silver lampreys, and only GnRH III elicited higher levels of both steroids in Pacific lampreys. The 15α-hydroxylase enzyme(s) for steroids appeared to present in adult males of all species examined, but the question of whether 15α-hydroxylated steroids are functional in these lamprey species, and the significance of the 15-hydroxyl group, requires further research.

  1. Steroid atrophy scarring treated with fat grafting in a patient with complex regional pain syndrome: A case report.

    PubMed

    Strickland, Leah R; Collawn, Sherry S

    2016-06-01

    Subcutaneous atrophy is a known complication of steroid injections. Excellent results with fat grafting for the treatment of steroid atrophy have been documented. However, the benefit of treating steroid-induced subcutaneous atrophy in an extremity diagnosed with complex regional pain syndrome (CRPS) has not been described. CRPS, known formerly as reflex sympathetic dystrophy or RSD, causalgia, or reflex neurovascular dystrophy, is a severe, progressive musculoskeletal pain syndrome characterized by pain which is disproportionate to the severity of the inciting event, edema, or skin changes. Common treatment modalities include pharmacotherapy, physical therapy, and nerve blocks-each therapy producing varying results. We present a literature review of CRPS and the case of a 15-year-old female who developed CRPS of the left lower leg after arthroscopic debridement with retrograde drilling of an osteochondral lesion. Steroid atrophy of the involved area following a saphenous nerve block complicated the patient's treatment course. The area of atrophy was treated with autologous fat grafting. Following the adipose injection procedure, the patient experienced almost complete resolution of her CPRS-associated pain symptoms, along with improved cosmetic appearance of the area. PMID:26735938

  2. Therapeutic Potential of Steroidal Alkaloids in Cancer and Other Diseases.

    PubMed

    Jiang, Qi-Wei; Chen, Mei-Wan; Cheng, Ke-Jun; Yu, Pei-Zhong; Wei, Xing; Shi, Zhi

    2016-01-01

    Steroidal alkaloids are a class of secondary metabolites isolated from plants, amphibians, and marine invertebrates. Evidence accumulated in the recent two decades demonstrates that steroidal alkaloids have a wide range of bioactivities including anticancer, antimicrobial, anti-inflammatory, antinociceptive, etc., suggesting their great potential for application. It is therefore necessary to comprehensively summarize the bioactivities, especially anticancer activities and mechanisms of steroidal alkaloids. Here we systematically highlight the anticancer profiles both in vitro and in vivo of steroidal alkaloids such as dendrogenin, solanidine, solasodine, tomatidine, cyclopamine, and their derivatives. Furthermore, other bioactivities of steroidal alkaloids are also discussed. The integrated molecular mechanisms in this review can increase our understanding on the utilization of steroidal alkaloids and contribute to the development of new drug candidates. Although the therapeutic potentials of steroidal alkaloids look promising in the preclinical and clinical studies, further pharmacokinetic and clinical studies are mandated to define their efficacy and safety in cancer and other diseases. PMID:25820039

  3. Synergistic Effects of Calcineurin Inhibitors and Steroids on Steroid Sensitivity of Peripheral Blood Mononuclear Cells.

    PubMed

    Takeuchi, Hironori; Iwamoto, Hitoshi; Nakamura, Yuki; Hirano, Toshihiko; Konno, Osamu; Kihara, Yu; Chiba, Naokazu; Yokoyama, Takayoshi; Takano, Kiminori; Toraishi, Tatsunori; Okuyama, Kiyoshi; Ikeda, Chie; Tanaka, Sachiko; Onda, Kenji; Soga, Akiko; Kikuchi, Yukiko; Kawaguchi, Takashi; Kawachi, Shigeyuki; Unezaki, Sakae; Shimazu, Motohide

    2015-02-01

    The steroid receptor (SR) complex contains FKBP51 and FKBP52, which bind to tacrolimus (TAC) and cyclophilin 40, which, in turn, bind to cyclosporine (CYA); these influence the intranuclear mobility of steroid-SR complexes. Pharmacodynamic interactions are thought to exist between steroids and calcineurin inhibitors (CNIs) on the SR complex. We examined the effect of CNIs on steroid sensitivity. Methylprednisolone (MPSL) sensitivity was estimated as the concentration inhibiting mitosis in 50% (IC50) of peripheral blood mononuclear cells and as the area under the MPSL concentration-proliferation suppressive rate curves (CPS-AUC) in 30 healthy subjects. MPSL sensitivity was compared between the additive group (AG) as the MPSL sensitivity that was a result of addition of the proliferation suppressive rate of CNIs to that of MPSL and the mixed culture group (MCG) as MPSL sensitivity of mixed culture with both MPSL and CNIs in identical patients. IC50 values of MPSL and cortisol sensitivity were examined before and 2 months after CNI administration in 23 renal transplant recipients. IC50 and CPS-AUC values of MPSL were lower in the MCG than in the AG with administration of TAC and CYA. The CPS-AUC ratio of MCG and AG was lower in the TAC group. IC50 values of MPSL and cortisol tended to be lower after administration of TAC and CYA, and a significant difference was observed in the IC50 of cortisol after TAC administration. Steroid sensitivity increased with both TAC and CYA. Furthermore, TAC had a greater effect on increasing sensitivity. Thus, concomitant administration of CNIs and steroids can increase steroid sensitivity. PMID:26858893

  4. Acute bile nephropathy secondary to anabolic steroids.

    PubMed

    Alkhunaizi, Ahmed M; ElTigani, Mohamed A; Rabah, Rola S; Nasr, Samih H

    2016-02-01

    Renal dysfunction in cholestatic liver disease is multifactorial. Acute kidney injury may develop secondary to renal vasoconstriction in the setting of peripheral vasodilation and relative hypovolemia, tubular obstruction by bile casts, and direct tubular toxicity from bile. Anabolic steroids are frequently used by athletes to boost endurance and increase muscle mass. These agents are a recently recognized cause of hepatotoxicity and jaundice and may lead to acute kidney injury. To increase awareness about this growing problem and to characterize the pathology of acute kidney injury in this setting, we report on a young male who developed acute kidney injury in the setting of severe cholestatic jaundice related to ingestion of anabolic steroids used for bodybuilding. Kidney biopsy showed bile casts within distal tubular lumina, filamentous bile inclusions within tubular cells, and signs of acute tubular injury. This report supports the recently re-emerged concept of bile nephropathy cholemic nephrosis. PMID:26587777

  5. Steroid hormone sulphation in lead workers.

    PubMed Central

    Apostoli, P; Romeo, L; Peroni, E; Ferioli, A; Ferrari, S; Pasini, F; Aprili, F

    1989-01-01

    The metabolism of steroid hormones has been investigated in 10 workers exposed to lead and in 10 non-exposed subjects to determine whether lead interferes with the first or second phase reactions of steroid hormone biotransformation, or both. In the exposed workers blood lead concentrations (PbB) ranged from 45 to 69 micrograms/100 ml; in the controls PbB was less than 25 micrograms/100 ml. No statistical differences were found for the total amount of the urinary hormone metabolites, but a drop of about 50% was observed for the sulphated portion. It is suggested that lead interferes with the mechanisms of sulphoconjugation through an effect on the cytosol enzymes sulphotransferase and sulphokinase. PMID:2930732

  6. Cytotoxic steroidal saponins from Agave sisalana.

    PubMed

    Chen, Pi-Yu; Chen, Chin-Hui; Kuo, Ching-Chuan; Lee, Tzong-Huei; Kuo, Yueh-Hsiung; Lee, Ching-Kuo

    2011-06-01

    Two new steroidal saponins, 8 and 10, along with 7 known steroidal sapogenins and saponins (1-7) and a furostanol saponin (9) were isolated from Agave sisalana Perrine ex Engelm. The structures of these two new compounds were identified and characterized by 1D and 2D NMR spectroscopy and mass spectrometry. In addition, acid hydrolysis and GC-FID were used to confirm the sugar moieties of 8 and 10. The cytotoxic effects of 1-10 on MCF-7, NCI-H460, and SF-268 cancer cells were evaluated, and among them, compound 10 proved to be the most cytotoxic with IC₅₀ values of 1.2, 3.8, and 1.5 µM, respectively. PMID:21243587

  7. Non-steroidal drug-induced glaucoma

    PubMed Central

    Razeghinejad, M R; Pro, M J; Katz, L J

    2011-01-01

    Numerous systemically used drugs are involved in drug-induced glaucoma. Most reported cases of non-steroidal drug-induced glaucoma are closed-angle glaucoma (CAG). Indeed, many routinely used drugs that have sympathomimetic or parasympatholytic properties can cause pupillary block CAG in individuals with narrow iridocorneal angle. The resulting acute glaucoma occurs much more commonly unilaterally and only rarely bilaterally. CAG secondary to sulfa drugs is a bilateral non-pupillary block type and is due to forward movement of iris–lens diaphragm, which occurs in individuals with narrow or open iridocorneal angle. A few agents, including antineoplastics, may induce open-angle glaucoma. In conclusion, the majority of cases with glaucoma secondary to non-steroidal medications are of the pupillary block closed-angle type and preventable if the at-risk patients are recognized and treated prophylactically. PMID:21637303

  8. Anabolic steroids abuse and male infertility.

    PubMed

    El Osta, Rabih; Almont, Thierry; Diligent, Catherine; Hubert, Nicolas; Eschwège, Pascal; Hubert, Jacques

    2016-01-01

    For several decades, testosterone and its synthetic derivatives have been used with anabolic and androgenic purposes. These substances were first restricted to professional bodybuilders, but become more and more popular among recreational athletes. Up to date, 3,000,000 anabolic-androgenic steroids (AAS) users have been reported in the United States with an increasing prevalence, making AAS consumption a major public health growing concern. Infertility is defined by the WHO as the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse and a male factor is present in up to 50 % of all infertile couples. Several conditions may be related to male infertility. Substance abuse, including AAS, is commonly associated to transient or persistent impairment on male reproductive function, through different pathways. Herein, a brief overview on AAS is offered. Steroids biochemistry, patterns of use, physiological and clinical issues are enlightened. A further review about fertility outcomes among male AAS abusers is also presented, including the classic reports on transient anabolic steroid-induced hypogonadism (ASIH), and the more recent experimental reports on structural and genetic sperm damage. PMID:26855782

  9. Hypochlorite oxidation of select androgenic steroids.

    PubMed

    Mash, Heath; Schenck, Kathleen; Rosenblum, Laura

    2010-03-01

    Steroid hormones are vital for regulation of various biological functions including sexual development. Elevated concentrations of natural and synthetic androgenic steroids have been shown to adversely affect normal development in indigenous aqueous species. Androgens and their synthetic analogs released from agricultural activities and wastewater discharge may be introduced into drinking water sources. The fate of androgenic steroids during drinking water treatment, specifically the use of chlorine for biological control, has not been extensively studied. As such, this study focuses on the hypochlorite oxidation of a select number of androgenic compounds that vary in their structural composition. Where a favorable reaction is observed, we also attempt to describe the product distribution. The results show compounds that possess a ketonic functional group conjugated with a double bond inhibit oxidation by hypochlorite in the absence of biological or indirect oxidative pathways. Oxidative reactivity in the presence of hypochlorite was favorably correlated with the presence of isolated unsaturated carbon bonds and resulted in various transformation products. PMID:20031185

  10. Steroidal Compounds in Commercial Parenteral Lipid Emulsions

    PubMed Central

    Xu, Zhidong; Harvey, Kevin A.; Pavlina, Thomas; Dutot, Guy; Hise, Mary; Zaloga, Gary P.; Siddiqui, Rafat A.

    2012-01-01

    Parenteral nutrition lipid emulsions made from various plant oils contain steroidal compounds, called phytosterols. During parenteral administration of lipid emulsions, phytosterols can reach levels in the blood that are many fold higher than during enteral administration. The elevated phytosterol levels have been associated with the development of liver dysfunction and the rare development of liver failure. There is limited information available in the literature related to phytosterol concentrations in lipid emulsions. The objective of the current study was to validate an assay for steroidal compounds found in lipid emulsions and to compare their concentrations in the most commonly used parenteral nutrition lipid emulsions: Liposyn® II, Liposyn® III, Lipofundin® MCT, Lipofundin® N, Structolipid®, Intralipid®, Ivelip® and ClinOleic®. Our data demonstrates that concentrations of the various steroidal compounds varied greatly between the eight lipid emulsions, with the olive oil-based lipid emulsion containing the lowest levels of phytosterols and cholesterol, and the highest concentration of squalene. The clinical impression of greater incidences of liver dysfunction with soybean versus MCT/LCT and olive/soy lipid emulsions may be reflective of the levels of phytosterols in these emulsions. This information may help guide future studies and clinical care of patients with lipid emulsion-associated liver dysfunction. PMID:23016123

  11. Effect of oxidizing adulterants on human urinary steroid profiles.

    PubMed

    Kuzhiumparambil, Unnikrishnan; Fu, Shanlin

    2013-02-01

    Steroid profiling is the most versatile and informative technique adapted by doping control laboratories for detection of steroid abuse. The absolute concentrations and ratios of endogenous steroids including testosterone, epitestosterone, androsterone, etiocholanolone, 5α-androstane-3α,17β-diol and 5β-androstane-3α,17β-diol constitute the significant characteristics of a steroid profile. In the present study we report the influence of various oxidizing adulterants on the steroid profile of human urine. Gas chromatography-mass spectrometry analysis was carried out to develop the steroid profile of human male and female urine. Oxidants potassium nitrite, sodium hypochlorite, potassium permanganate, cerium ammonium nitrate, sodium metaperiodate, pyridinium chlorochromate, potassium dichromate and potassium perchlorate were reacted with urine at various concentrations and conditions and the effect of these oxidants on the steroid profile were analyzed. Most of the oxidizing chemicals led to significant changes in endogenous steroid profile parameters which were considered stable under normal conditions. These oxidizing chemicals can cause serious problems regarding the interpretation of steroid profiles and have the potential to act as masking agents that can complicate or prevent the detection of the steroid abuse. PMID:23238517

  12. Puberty, steroids and GABAA receptor plasticity

    PubMed Central

    Smith, Sheryl S.; Aoki, Chiye; Shen, Hui

    2009-01-01

    Summary GABAA receptors (GABAR) mediate most inhibition in the CNS and are also a target for neuroactive steroids such as 3α,5[α]β-THP (3αOH-5[α]β-OH-pregnan-20-one or [allo]pregnanolone). Although these steroids robustly enhance current gated by α1β2δ GABAR, we have shown that 3α,5[α]β-THP effects at recombinant α4β2δ GABAR depend on the direction of Cl- flux, where the steroid increases outward flux, but decreases inward flux through the receptor. This polarity-dependent inhibition of α4β2δ GABAR resulted from an increase in the rate and extent of rapid desensitization of the receptor, recorded from recombinant receptors expressed in HEK-293 cells with whole cell voltage clamp techniques. This inhibitory effect of 3α,5[α]β-THP was not observed at other receptor subtypes, suggesting it was selective for α4β2δ GABAR. Furthermore, it was prevented by a selective mutation of basic residue arginine 353 in the intracellular loop of the receptor, suggesting that this might be a putative chloride modulatory site. Expression of α4βδ GABAR increases markedly at extrasynaptic sites at the onset of puberty in female mice. At this time, 3α,5[α]β–THP decreased the inhibitory tonic current, recorded with perforated patch techniques to maintain the physiological Cl- gradient. By decreasing this shunting inhibition, 3α,5[α]β–THP increased the excitability of CA1 hippocampal pyramidal cells at puberty: These effects of the steroid were opposite to those observed before puberty when 3α,5[α]β–THP reduced neuronal excitability as a pre-synaptic effect. Behaviorally, the excitatory effect of 3α,5[α]β–THP was reflected as an increase in anxiety at the onset of puberty in female mice. Taken together, these findings suggest that the emergence of α4β2δ GABAR at the onset of puberty reverses the effect of a stress steroid. These findings may be relevant for the mood swings and increased response to stressful events reported in adolescence

  13. An improved micro-method for the measurement of steroid profiles by APPI-LC-MS/MS and its use in assessing diurnal effects on steroid concentrations and optimizing the diagnosis and treatment of adrenal insufficiency and CAH.

    PubMed

    Stolze, Brian R; Gounden, Verena; Gu, Jianghong; Elliott, Elizabeth A; Masika, Likhona S; Abel, Brent S; Merke, Deborah P; Skarulis, Monica C; Soldin, Steven J

    2016-09-01

    Our goals were to (1) develop an improved micro-method usable for neonates for steroid profile measurements and a method to measure androsterone, a key steroid in the recently described androgen backdoor pathway together, with dehydroepiandrosterone and (2) to assess if dehydroepiandrosterone diurnal concentration fluctuations exist potentially necessitating strict adherence to time of blood sample draw and requirement of separate time-dependent reference intervals. Liquid chromatography-tandem mass spectrometry was performed with an atmospheric pressure photoionization source [1]. For each sample 50μL (100μL for the backdoor pathway) of serum was deproteinized by adding 75μL (150μL for the backdoor pathway) of acetonitrile containing the internal standards. After centrifugation, 75μL (150μL for the backdoor pathway) of supernatant was diluted with 250μL of water and injected onto a Poroshell 120 EC-C8 column (SB-C8 column for the backdoor pathway). Within-run coefficients of variation ranged from 2.4 to 10.4% and between-day coefficients of variation from 2.9 to 11.2%. Comparison studies yielded correlation coefficient between 0.97 and 1.00 with recoveries of 90% or greater. Our methods analyze a 9 steroid profile and an additional 2 steroid profile (backdoor pathway) with minimal sample volume (usable in neonates optimizing early diagnosis of endocrinopathies and genetic diseases). Low limits of quantitation make these methods ideal for steroid measurement in women and prepubertal children. As diurnal variations of dehydroepiandrosterone and other steroids [2] concentrations are clinically significant we recommend that separate reference intervals be developed for 8 am, 8 pm, and midnight sample draws. The use of this approach in improving the diagnosis of patients with adrenal insufficiency and congenital adrenal hyperplasia is discussed. PMID:26721696

  14. Ultra high performance liquid chromatography/tandem mass spectrometry based identification of steroid esters in serum and plasma: an efficient strategy to detect natural steroids abuse in breeding and racing animals.

    PubMed

    Kaabia, Z; Dervilly-Pinel, G; Hanganu, F; Cesbron, N; Bichon, E; Popot, M A; Bonnaire, Y; Le Bizec, B

    2013-04-01

    During last decades, the use of natural steroids in racing and food producing animals for doping purposes has been flourishing. The endogenous or exogenous origin of these naturally occurring steroids has since remained a challenge for the different anti-doping laboratories. The administration of these substances to animals is usually made through an intra-muscular pathway with the steroid under its ester form for a higher bioavailability and a longer lasting effect. Detecting these steroid esters would provide an unequivocal proof of an exogenous administration of the considered naturally occurring steroids. A quick analytical method able to detect at trace level (below 50 pg/mL) a large panel of more than 20 steroid esters in serum and plasma potentially used for doping purposes in bovine and equine has been developed. Following a pre-treatment step, the sample is submitted to a solid phase extraction (SPE) before analysis with UPLC-MS/MS. The analytical method's efficiency has been probed through three different in vivo experiments involving testosterone propionate intra-muscular administration to three heifers, 17-estradiol benzoate intra-muscular administration to a bull and a heifer and nandrolone laurate intra-muscular administration to a stallion. The results enabled detecting the injected testosterone propionate and 17-estradiol benzoate 2 and 17 days, respectively, post-administration in bovine and nandrolone laurate up to 14 days post-administration in equine. The corresponding elimination profiles in bovine serum and equine plasma have been established. The first bovine experiment exhibited a maximal testosterone propionate concentration of 400 pg/mL in one of the three heifer serum within 5h post-administration. The second bovine experiment reported a maximal 17-estradiol benzoate concentration of 480 pg/mL in the same matrix recorded 9 days after its administration. The last equine experiment resulted in a maximal nandrolone laurate concentration of

  15. Progesterone stimulates respiration through a central nervous system steroid receptor-mediated mechanism in cat.

    PubMed Central

    Bayliss, D A; Millhorn, D E; Gallman, E A; Cidlowski, J A

    1987-01-01

    We have examined the effect on respiration of the steroid hormone progesterone, administered either intravenously or directly into the medulla oblongata in anesthetized and paralyzed male and female cats. The carotid sinus and vagus nerves were cut, and end-tidal PCO2 and temperature were kept constant with servo-controllers. Phrenic nerve activity was used to quantitate central respiratory activity. Repeated doses of progesterone (from 0.1 to 2.0 micrograms/kg, cumulative) caused a sustained (greater than 45 min) facilitation of phrenic nerve activity in female and male cats; however, the response was much more variable in females. Progesterone injected into the region of nucleus tractus solitarii, a respiratory-related area in the medulla oblongata, also caused a prolonged stimulation of respiration. Progesterone administration at high concentration by both routes also caused a substantial hypotension. Identical i.v. doses of other classes of steroid hormones (17 beta-estradiol, testosterone, and cortisol) did not elicit the same respiratory effect. Pretreatment with RU 486, a progesterone-receptor antagonist, blocked the facilitatory effect of progesterone. We conclude that progesterone acts centrally through a steroid receptor-mediated mechanism to facilitate respiration. PMID:3478727

  16. PYOMYOSITIS IN ATHLETES AFTER THE USE OF ANABOLIC STEROIDS - CASE REPORTS

    PubMed Central

    Filho, Nivaldo Souza Cardozo; Gaspar, Eric Figueirido; Siqueira, Karina Levy; Monteiro, Gustavo Cará; Andreoli, Carlos Vicente; Ejnisman, Benno; Cohen, Moisés

    2015-01-01

    Objective: To report on the management of five cases of pyomyositis in athletes after the use of anabolic steroids. Method: Over the past 10 years, five cases of athletes who developed pyomyositis after using anabolic steroids were attended at the Sports Trauma Center (CETE), EPM-UNIFESP. Results: All the patients were diagnosed clinically and through laboratory and imaging tests. Surgical treatment was carried out (with collection of material for culturing) and antibiotic therapy was administered. In four cases, the injection sites were in the upper limbs and in one case, in the gluteus muscles bilaterally as well as in the upper limbs. In all five cases, occurrences of leukocytosis and neutrophilia were observed in the hemogram. After debridement, the germs of normal skin (S. aureus and S. viridans) were found in cultures on the secretions. Demarcation of the abscess and examination of the muscle plane in which the abscess was located were performed using ultrasound and magnetic resonance imaging. All the patients responded to broad-spectrum antibiotic therapy. Two cases required more than one surgical procedure because of the appearance of more than one abscess site with different evolution times. Conclusion: The use of anabolic steroids by some athletes may have grave consequences. Rapid, energetic and multidisciplinary intervention is necessary in such cases in order to avoid undesirable results. The right treatment healed the athletes completely, and they returned to their sports at the same level. PMID:27026995

  17. Progesterone stimulates respiration through a central nervous system steroid receptor-mediated mechanism in cat.

    PubMed

    Bayliss, D A; Millhorn, D E; Gallman, E A; Cidlowski, J A

    1987-11-01

    We have examined the effect on respiration of the steroid hormone progesterone, administered either intravenously or directly into the medulla oblongata in anesthetized and paralyzed male and female cats. The carotid sinus and vagus nerves were cut, and end-tidal PCO2 and temperature were kept constant with servo-controllers. Phrenic nerve activity was used to quantitate central respiratory activity. Repeated doses of progesterone (from 0.1 to 2.0 micrograms/kg, cumulative) caused a sustained (greater than 45 min) facilitation of phrenic nerve activity in female and male cats; however, the response was much more variable in females. Progesterone injected into the region of nucleus tractus solitarii, a respiratory-related area in the medulla oblongata, also caused a prolonged stimulation of respiration. Progesterone administration at high concentration by both routes also caused a substantial hypotension. Identical i.v. doses of other classes of steroid hormones (17 beta-estradiol, testosterone, and cortisol) did not elicit the same respiratory effect. Pretreatment with RU 486, a progesterone-receptor antagonist, blocked the facilitatory effect of progesterone. We conclude that progesterone acts centrally through a steroid receptor-mediated mechanism to facilitate respiration. PMID:3478727

  18. 3D model of amphioxus steroid receptor complexed with estradiol

    SciTech Connect

    Baker, Michael E.; Chang, David J.

    2009-08-28

    The origins of signaling by vertebrate steroids are not fully understood. An important advance was the report that an estrogen-binding steroid receptor [SR] is present in amphioxus, a basal chordate with a similar body plan as vertebrates. To investigate the evolution of estrogen-binding to steroid receptors, we constructed a 3D model of amphioxus SR complexed with estradiol. This 3D model indicates that although the SR is activated by estradiol, some interactions between estradiol and human ER{alpha} are not conserved in the SR, which can explain the low affinity of estradiol for the SR. These differences between the SR and ER{alpha} in the steroid-binding domain are sufficient to suggest that another steroid is the physiological regulator of the SR. The 3D model predicts that mutation of Glu-346 to Gln will increase the affinity of testosterone for amphioxus SR and elucidate the evolution of steroid-binding to nuclear receptors.

  19. Activity, toxicity and analysis of resistance of essential oil from Chenopodium ambrosioides after intraperitoneal, oral and intralesional administration in BALB/c mice infected with Leishmania amazonensis: a preliminary study.

    PubMed

    Monzote, Lianet; Montalvo, Ana M; Scull, Ramón; Miranda, Migdalia; Abreu, Juan

    2007-01-01

    The World Health Organization has classified the leishmaniasis as a major tropical disease. Current therapy is toxic, expensive and cause several adverse effects. The majority of people in endemic areas of leishmaniasis depend of natural and traditional medicine. This study was developed to examine the activity of the essential oil from Chenopodium ambrosioides in BALB/c mice infected with Leishmania amazonensis. The infected animals received two cycle of treatment by different routes (intraperitoneal, oral or intralesional route). The intraperitoneal administration of the essential oil at dose of 30 mg/Kg prevented lesion development and decrease the parasite burden. Oral administration retarded the infection in the experimental model compared with untreated mice, although it was less effective that the intraperitoneal route. The administration by intralesional route did not show activity. Intraperitoneal and oral treatment at 30 mg/Kg with the essential oil had better antileishmanial effect that treatment with the reference drug, amphotericin B at 1 mg/Kg. Preliminarily, we examined the toxicity and the resistance after treatment. Signs of toxicity were evident only in the animals treated by intraperitoneal route. No resistance was detected in L. amazonensis isolates obtained from treated mice. These data clearly demonstrated that this natural product could be an alternative for the development of a new drug against cutaneous leishmaniasis based in the ethnomedical information. PMID:17254746

  20. Oral-steroid sparing effect of inhaled fluticasone propionate in children with steroid-dependent asthma

    PubMed Central

    Sheikh, Shahid; Goldsmith, Linda J; Eid, Nemr

    2000-01-01

    OBJECTIVE: To evaluate the oral steroid-sparing effect of inhaled fluticasone propionate (FP) in eight children with steroid-dependent asthma. DESIGN AND SETTING : Treatment protocol study at a tertiary pulmonary care centre at a children’s hospital. PATIENTS: Eight children with severe persistent steroid dependent asthma (mean age 11.6 years [range 10 to 13 years], mean duration of asthma 8.37 years [range three to 11 years]) were enrolled in the study. MEASUREMENTS: Inhaled FP 880 μg/day (two puffs of 220 μg/puff, two times a day) was added to the children’s asthma treatment, and attempts were made to reduce the dose of oral steroids by 20% every two weeks over a six-month period. After this six-month period, in the patients responding to inhaled FP, the dose of inhaled FP was reduced to 440 μg/day (two puffs of 110 μg/puff, two times a day) for the next six months. The mean percentage predicted values for forced expiratory volume in 1 s (FEV1) and maximal mid-expiratory flow rate (FEF25%–75%) were compared during the first month, at two to six months, and at seven to 12 month intervals before and after starting FP. The number of asthma exacerbations, emergency room visits, hospital admissions and number of school days lost were also compared. RESULTS: Within three months of starting inhaled FP, the mean alternate-day oral steroid dose decreased from 38 mg to 2.5 mg. In addition, six patients (66%) were able to discontinue the use of oral steroids. There was significant improvement in the number of mean emergency room visits per patient (P=0.016), mean asthma exacerbations per patient (P=0.016), mean hospital admissions per patient (P=0.016) and mean number of school days lost per patient (P=0.004) while patients were receiving high dose inhaled FP compared with oral steroids. There was no deterioration of any of the above mentioned parameters during the six month period when the dose of inhaled FP was reduced. The mean FEV1 and FEF25%–75% during the

  1. Separation of steroid isomers by ion mobility mass spectrometry.

    PubMed

    Ahonen, Linda; Fasciotti, Maíra; Gennäs, Gustav Boije Af; Kotiaho, Tapio; Daroda, Romeu J; Eberlin, Marcos; Kostiainen, Risto

    2013-10-01

    Ion mobility mass spectrometry performed in a compact traveling wave cell (TWIM-MS) is shown to provide a reliable, fast and repeatable method to separate derivatized steroid isomers. Three steroid isomer pairs were analyzed in their native form and as their p-toluenesulfonyl isocyanate derivatives. The native steroids were separated from each other, but no separation could be attained for the isomers. The derivatized steroid isomers were, however, properly separated by TWIM-MS with peak-to-peak resolutions close to or as high as baseline resolution (Rp-p=0.77-1.08). PMID:23992881

  2. Delineation of Steroid-Degrading Microorganisms through Comparative Genomic Analysis

    PubMed Central

    Bergstrand, Lee H.; Cardenas, Erick; Holert, Johannes; Van Hamme, Jonathan D.

    2016-01-01

    ABSTRACT Steroids are ubiquitous in natural environments and are a significant growth substrate for microorganisms. Microbial steroid metabolism is also important for some pathogens and for biotechnical applications. This study delineated the distribution of aerobic steroid catabolism pathways among over 8,000 microorganisms whose genomes are available in the NCBI RefSeq database. Combined analysis of bacterial, archaeal, and fungal genomes with both hidden Markov models and reciprocal BLAST identified 265 putative steroid degraders within only Actinobacteria and Proteobacteria, which mainly originated from soil, eukaryotic host, and aquatic environments. These bacteria include members of 17 genera not previously known to contain steroid degraders. A pathway for cholesterol degradation was conserved in many actinobacterial genera, particularly in members of the Corynebacterineae, and a pathway for cholate degradation was conserved in members of the genus Rhodococcus. A pathway for testosterone and, sometimes, cholate degradation had a patchy distribution among Proteobacteria. The steroid degradation genes tended to occur within large gene clusters. Growth experiments confirmed bioinformatic predictions of steroid metabolism capacity in nine bacterial strains. The results indicate there was a single ancestral 9,10-seco-steroid degradation pathway. Gene duplication, likely in a progenitor of Rhodococcus, later gave rise to a cholate degradation pathway. Proteobacteria and additional Actinobacteria subsequently obtained a cholate degradation pathway via horizontal gene transfer, in some cases facilitated by plasmids. Catabolism of steroids appears to be an important component of the ecological niches of broad groups of Actinobacteria and individual species of Proteobacteria. PMID:26956583

  3. [Steroid-responsive sensorineural hearing loss with low tone loss].

    PubMed

    Toriya, R; Yamashita, H; Hisashi, K; Komune, S; Komiyama, S

    1995-11-01

    Five cases of sensorineural hearing loss of sudden onset were reviewed. They were not responsive to administration of ATP and Vit. B12, but very responsive to steroid administration. All the patients were male and showed hearing loss in low frequencies in pure tone audiogram. Administration of steroid recovered hearing impairment immediately. However, cessation of steroid aggravated the recovered hearing. Serological and immunological examinations did not show any abnormal findings on all the patients. It was considered that these five patients had characteristics of both steroid-sensitive and low tone-loss type sensorineural hearing losses. PMID:8566929

  4. Developmental programming: exposure to testosterone excess disrupts steroidal and metabolic environment in pregnant sheep.

    PubMed

    Abi Salloum, B; Veiga-Lopez, A; Abbott, D H; Burant, C F; Padmanabhan, V

    2015-06-01

    Gestational exposure to excess T leads to intrauterine growth restriction, low birth weight, and adult metabolic/reproductive disorders in female sheep. We hypothesized that as early mediators of such disruptions, gestational T disrupts steroidal and metabolic homeostasis in both the mother and fetus by both androgenic and metabolic pathways. Maternal blood samples were measured weekly for levels of insulin, glucose, and progesterone from four groups of animals: control; gestational T (twice weekly im injections of 100 mg of T propionate from d 30 to d 90 of gestation); T plus an androgen antagonist, flutamide (15 mg/kg·d oral; T-Flutamide); and T plus the insulin sensitizer, rosiglitazone (0.11 mg/kg·d oral; T-Rosi) (n = 10-12/group). On day 90 of gestation, maternal and umbilical cord samples were collected after a 48-hour fast from a subset (n = 6/group) for the measurement of steroids, free fatty acids, amino acids, and acylcarnitines. Gestational T decreased maternal progesterone levels by 36.5% (P < .05), which was prevented by flutamide showing direct androgenic mediation. Gestational T also augmented maternal insulin levels and decreased medium chained acylcarnitines, suggesting increased mitochondrial fatty acid oxidation. These changes were prevented by rosiglitazone, suggesting alterations in maternal fuel use. Gestational T-induced increases in fetal estradiol were not prevented by either cotreatment. Gestational T disrupted associations of steroids with metabolites and progesterone with acylcarnitines, which was prevented either by androgen antagonist or insulin sensitizer cotreatment. These findings suggest a future combination of these treatments might be required to prevent alteration in maternal/fetal steroidal and metabolic milieu(s). PMID:25763641

  5. Developmental Programming: Exposure to Testosterone Excess Disrupts Steroidal and Metabolic Environment in Pregnant Sheep

    PubMed Central

    Abi Salloum, B.; Veiga-Lopez, A.; Abbott, D. H.; Burant, C. F.

    2015-01-01

    Gestational exposure to excess T leads to intrauterine growth restriction, low birth weight, and adult metabolic/reproductive disorders in female sheep. We hypothesized that as early mediators of such disruptions, gestational T disrupts steroidal and metabolic homeostasis in both the mother and fetus by both androgenic and metabolic pathways. Maternal blood samples were measured weekly for levels of insulin, glucose, and progesterone from four groups of animals: control; gestational T (twice weekly im injections of 100 mg of T propionate from d 30 to d 90 of gestation); T plus an androgen antagonist, flutamide (15 mg/kg·d oral; T-Flutamide); and T plus the insulin sensitizer, rosiglitazone (0.11 mg/kg·d oral; T-Rosi) (n = 10–12/group). On day 90 of gestation, maternal and umbilical cord samples were collected after a 48-hour fast from a subset (n = 6/group) for the measurement of steroids, free fatty acids, amino acids, and acylcarnitines. Gestational T decreased maternal progesterone levels by 36.5% (P < .05), which was prevented by flutamide showing direct androgenic mediation. Gestational T also augmented maternal insulin levels and decreased medium chained acylcarnitines, suggesting increased mitochondrial fatty acid oxidation. These changes were prevented by rosiglitazone, suggesting alterations in maternal fuel use. Gestational T-induced increases in fetal estradiol were not prevented by either cotreatment. Gestational T disrupted associations of steroids with metabolites and progesterone with acylcarnitines, which was prevented either by androgen antagonist or insulin sensitizer cotreatment. These findings suggest a future combination of these treatments might be required to prevent alteration in maternal/fetal steroidal and metabolic milieu(s). PMID:25763641

  6. Steroids and genes related to steroid biosynthesis in the female giant freshwater prawn, Macrobrachium rosenbergii.

    PubMed

    Thongbuakaew, Tipsuda; Siangcham, Tanapan; Suwansa-ard, Saowaros; Elizur, Abigail; Cummins, Scott F; Sobhon, Prasert; Sretarugsa, Prapee

    2016-03-01

    The giant freshwater prawn, Macrobrachium rosenbergii, is important to many Asian countries due to its high economic value as an aquaculture product. With demand increasing, there is requirement for a better understanding of the biosynthetic components that regulate its growth and reproduction, including steroids, in order to help increase production. Vertebrate-type steroids and their receptors were identified in crustaceans and implicated in reproduction. In this study, we presented the sex steroids estradiol and progesterone by LC-MS/MS in female M. rosenbergii, and reveal steroidogenic-related genes by in silico analysis of de novo assembled transcriptomes. Comparative analysis with other species was performed to confirm their putative role, as well as tissue-specific and quantitative gene expression. We reveal 29 transcripts that encode for steroidogenic-related proteins, including steroidogenic enzymes, a nuclear steroid hormone receptors, and a steroidogenic factor. Moreover, we identified for the first time the presence of steroidogenic factor 1, StAR-related lipid transfer protein, estradiol receptor- and progesterone-like protein in M. rosenbergii. Those targeted for gene expression analysis (3 beta-hydroxysteroid dehydrogenase, 17 beta-hydroxysteroid dehydrogenase, estrogen sulfotransferase and progesterone receptor-like) showed widespread expression within many tissues, and at relatively high levels in the central nervous system (CNS) during ovarian maturation. In summary, we provide further evidence for the existence of steroidogenic pathways in crustaceans, which may be useful for advancing prawn aquaculture. PMID:26774430

  7. Sex steroids and bone: current perspectives.

    PubMed

    Balasch, Juan

    2003-01-01

    Although the process of bone remodelling or its control has not yet been fully elucidated there is, at present, sufficient information available to conclude that ovarian steroids (estrogens, androgens, progesterone) play an essential role in skeletal homeostasis. The mechanism of action of sex steroids on the skeleton is still not entirely clear, but it has traditionally included indirect effects on systemic hormones that regulate calcium balance and a direct receptor-mediated action. More recently, changes in cytokine production within the bone marrow, as well as pro-apoptotic and anti-apoptotic effects in the osteoblastic cells, have been proposed as new perspectives on the cellular and molecular mechanisms by which sex steroids influence adult bone homeostasis. Mechanical loading, when combined with estrogens or androgens, results in a greater osteogenic response than either condition separately. Women are especially at risk for osteoporosis if they have had a premature or surgical menopause and have not received hormone replacement therapy (HRT). Other reproductive factors that can help to identify women with osteopenia and emphasize the role of sex steroids in preserving bone mass in premenopausal women include: age at menarche, menstrual history and irregularities (including those associated with excessive exercise), age at menopause, previous hysterectomy, hyperprolactinaemia, anorexia nervosa, scoliosis, ovarian dysgenesis, pregnancy and lactation, and pharmacological ovarian suppression. The prevention of osteoporosis starts with the onset of the menarche. A combination of exercise, appropriate nutrition and a healthy lifestyle all maximize bone mineral accrual and result in optimal peak bone mass; normal ovarian function is essential to this process. Unfortunately, many women actually become aware of the need for osteoporosis prevention much later in life, usually after they have already become menopausal. HRT, however, has important limitations for

  8. [Effect of anabolic steroid on immune response].

    PubMed

    Yamagishi, H; Kobayashi, M; Konosu, H; Kurioka, H; Naito, K; Sonoyama, T; Nishimoto, T; Hashimoto, I

    1984-03-01

    Using lymphocyte, monocyte and eosinophil counts of the peripheral blood, PHA-blastoid transformation, immunoglobulin and beta 2-microglobulin, the influence of anabolic steroid on the immune reactivity of the host was dissected by administration of Deca-Durabolin ( nandrolone decanoate) to both tumor-bearing host and tumor-free host after operation for alimentary tract. The number of peripheral lymphocytes and monocytes, the PHA-blastoid transformation of peripheral lymphocytes and the IgG level were increased, and the beta 2-microglobulin level showed the tendency of decrease after the administration of Deca-Durabolin. PMID:6367663

  9. Steroid Resistant Nephrotic Syndrome-Genetic Consideration.

    PubMed

    Tasic, Velibor; Gucev, Zoran; Polenakovic, Momir

    2015-01-01

    Nephrotic syndrome is defined as the association of massive proteinuria, hypoalbuminaemia, edema, and hyperlipidemia. It is separated to steroid-sensitive or steroid-resistant (SRNS) forms in respect to the response to intensive steroid therapy. SRNS usually progresses to end-stage renal failure. According to the North American Pediatric Renal Trials and Collaborative Studies SRNS constitutes the second most frequent cause of ESRD in the first two decades of life. Unfortunately, there is no curative treatment for majority of patients. Majority of the SRNS patients have the histologic picture of focal segmental glomerulosclerosis. Interestingly, the risk of recurrence in the kidney graft in patients with hereditary SRNS is lower than in those who do not have genetic background. The etiology and pathogenesis of SRSN has remained enigma for decades. The discovery of 39 dominant or recessive SRNS genes enabled better understanding of the function of the glomerular podocytes and slit membrane. Hildebrandt's group has shown that 85% of the SRNS cases with onset by 3 months of age and 66% with onset by 1 year of age can be explained by recessive mutations in one of four genes only (NPHS1, NPHS2, LAMB2, or WT1). The same group used modern diagnostic techniques such as the next generation sequencing and tested a large international cohort of SRNS patients (n = 1783 families). The diagnostic panel included 21 genes with a recessive mode of inheritance and 6 genes with a dominant mode of inheritance. Single-gene cause was detected in 29.5% (526 of 1783) of the families with SRNS that manifested before 25 years of age. The identification of causative single-gene mutations may have important therapeutic consequences in some cases. This is very important for patients who carry mutations in a gene of coenzyme Q10 biosynthesis (COQ2, COQ6, ADCK4, or PDSS2). In these patients the treatment with coenzyme Q10 may be indicated. Also, patients with recessive mutations in PLCE1 may

  10. Abuse of supraphysiologic doses of anabolic steroids.

    PubMed

    Hall, Ryan C W; Hall, Richard C W

    2005-05-01

    The following article is a literature review of supraphysiologic doses of anabolic-androgenic steroids (AAS). This article contains a brief review of the history of AAS, the chemistry of the varying forms of AAS, and proposed mechanisms of action. The article then focuses on how AAS are used in an illicit manner by the general population. Terms such as "stacking" and "pyramiding" are discussed. The article concludes by looking at the major detrimental side effects, such as liver damage and cardiovascular changes, which physicians may encounter when treating AAS abusers. PMID:15954512

  11. Role of a Disordered Steroid Metabolome in the Elucidation of Sterol and Steroid Biosynthesis

    PubMed Central

    2013-01-01

    In 1937 Butler and Marrian found large amounts of the steroid pregnanetriol in urine from a patient with the adrenogenital syndrome, a virilizing condition known to be caused by compromised adrenal secretion even in this pre-cortisol era. This introduced the concept of the study of altered excretion of metabolites as an in vivo tool for understanding sterol and steroid biosynthesis. This approach is still viable and has experienced renewed significance as the field of metabolomics. From the first cyclized sterol lanosterol to the most downstream product estradiol, there are probably greater than 30 steps. Based on a distinctive metabolome clinical disorders have now been attributed to about seven post-squalene cholesterol (C) biosynthetic steps and around 15 en-route to steroid hormones or needed for further metabolism of such hormones. Forty years ago it was widely perceived that the principal steroid biosynthetic defects were known but interest rekindled as novel metabolomes were documented. In his career this investigator has been involved in the study of many steroid disorders, the two most recent being P450 oxidoreductase deficiency and apparent cortisone reductase deficiency. These are of interest as they are due not to mutations in the primary catalytic enzymes of steroidogenesis but in ancillary enzymes needed for co-factor oxido-reduction A third focus of this researcher is Smith-Lemli-Opitz syndrome (SLOS), a cholesterol synthesis disorder caused by 7-dehydrocholesterol reductase mutations. The late George Schroepfer, in whose honor this article has been written, contributed greatly to defining the sterol metabolome of this condition. Defining the cause of clinically severe disorders can lead to improved treatment options. We are now involved in murine gene therapy studies for SLOS which, if successful could in the future offer an alternative therapy for this severe condition. PMID:21874273

  12. Vasovagal Rates in Flouroscopically Guided Interventional Procedures: A Study of Over 8,000 Injections

    PubMed Central

    Kennedy, David J.; Schneider, Byron; Casey, Ellen; Rittenberg, Joshua; Conrad, Bryan; Smuck, Matthew; Plastaras, Christopher T.

    2014-01-01

    Objective To determine the rate of vasovagal (vv) complications in fluoroscopically guided interventional procedures. Design Retrospective case series analysis of prospectively collected data from March 8, 2004 to January 30, 2009. Setting A single academic medical center. Subjects Four thousand one hundred eighty-three subjects undergoing 8,010 consecutive injections. Outcome Measures Pearson's chi-square test was used to determine the relationship between categorical variables. Results A total of 8,010 injections, including epidural steroid injections, radiofrequency nerve ablations, medial branch blocks, hip injections, knee injections, and glenohumeral injections were performed. Overall vv reaction rate was 2.6%, with 0.8% of procedures resulting in early terminated due to vv reaction. Peripheral joint injections had a vv rate of 0.2%, all occurring in hip injections. Transforaminal epidural steroid injections had a vv rate of 3.5%. Diagnostic blocks of the medial branches had the highest rate of vv (5.1%). Other predictors of vv reactions were identified including preprocedure pain score visual analog scale <5 (P = 0.004), male gender (P < 0.001), and age less than 65 years old (P < 0.001). Conclusions vv reactions have an overall low occurrence rate (2.6%) in interventional procedures ranging from 0% in peripheral knee and shoulder injections to 5.1% in medial branch blocks. Conservative treatment of vv reaction and willingness to terminate procedures resulted in no serious adverse events related to vv reaction in 8,010 procedures. PMID:24118835

  13. Rate of intraoperative complications during cataract surgery following intravitreal injections.

    PubMed

    Hahn, P; Jiramongkolchai, K; Stinnett, S; Daluvoy, M; Kim, T

    2016-08-01

    PurposeTo investigate the effect of prior intravitreal injections on intraoperative and postoperative complication rates associated with cataract surgery.MethodsA retrospective cohort analysis reviewed 10 105 cataract surgery procedures performed by experienced surgeons at the Duke Eye Center from 1 January 2005 to 10 December 2012. A group of 197 eyes with prior intravitreal injections was compared with an equal number of matched control eyes without prior injection using the Fisher's exact test of difference in proportions and the Wilcoxon rank-sum test of difference in means. Outcomes analyzed included baseline demographic information, preoperative clinical characteristics, prevalence of intraoperative complications, and postoperative intraocular pressure, glaucoma surgery, and glaucoma medication requirement through 1 year following cataract surgery.ResultsAn increased rate of intraoperative complications was identified during cataract surgery in eyes with prior intravitreal injections compared with control eyes (3 vs 0%, P=0.030). Injection eyes required more glaucoma medications at 1 year, but no difference was identified if steroid injections were excluded. No difference in postoperative IOP or glaucoma surgery was identified. No cases of endophthalmitis were reported.ConclusionsA history of intravitreal injections may be a risk factor for cataract surgery-related intraoperative complications. We hypothesize this may be due to unidentified iatrogenic lens trauma during intravitreal injections. Particular attention to the posterior capsule during preoperative assessment and intraoperatively is recommended in eyes undergoing cataract surgery with a prior history of intravitreal injections. PMID:27229705

  14. Blocking the mineralocorticoid receptor improves effectiveness of steroid treatment for low back pain in rats

    PubMed Central

    Ye, Ling; Xie, Wenrui; Strong, Judith A.; Zhang, Jun-Ming

    2014-01-01

    Background Localized inflammation of lumbar dorsal root ganglia (DRG) may contribute to low back pain. Local injections of corticosteroids used for low back pain are sometimes ineffective. Many corticosteroids activate not only the target glucocorticoid receptor (GR) but also the mineralocorticoid receptor (MR), which may have pro-inflammatory effects countering the effects of GR activation. Methods A low back pain model was implemented in rats (n = 6 -10 per group) by locally inflaming the L5 DRG. Sensory neuron excitability and mechanical hypersensitivity of the hind paws were measured. Tested steroids were applied locally to the inflamed DRG or orally. Results The selective MR blocker eplerenone reduced pain behaviors when given orally starting at the time of surgery, or starting 7 days later. The highly GR-selective agonist fluticasone, applied locally to the inflamed DRG, was much more effective in reducing mechanical hypersensitivity. The MR/GR agonist 6-α methylprednisolone, commonly injected for low back pain, reduced mechanical hypersensitivity when applied locally to the DRG, but was less effective than fluticasone. Its effectiveness was improved by combining it with local eplerenone. All tested steroids reduced hyperexcitability of myelinated sensory neurons (n = 71 – 220 cells per group) after inflammation, particularly abnormal spontaneous activity. Conclusions This preclinical study indicates the MR may play an important role in low back pain involving inflammation. Some MR effects may occur at the level of the sensory neuron. It may be useful to consider the action of clinically used steroids at the MR as well as at the GR. PMID:24781496

  15. Rapid test by liquid chromatography/tandem mass spectrometry to evaluate equine urine reactivity towards 17beta-OH steroids.

    PubMed

    Fidani, Marco; Casagni, Eleonora; Montana, Marco; Pasello, Emanuela; Pecoraro, Chiara; Gambaro, Veniero

    2006-01-01

    Bacteria frequently found in equine urine samples may cause degradation of 17beta-OH steroids. A simple liquid chromatography/tandem mass spectrometry (LC/MS/MS) method has been developed to evaluate the microbiological contamination of equine urine as a marker of poor storage conditions. Norethandrolone was used as the internal standard, and the linearity, sensitivity, precision and accuracy of the method were evaluated. 17beta-OH oxidation was demonstrated for testosterone, nandrolone, trenbolone and boldenone, but did not occur in alpha-epimers such as alpha-boldenone and epitestosterone, demonstrating the stereoselectivity of the reaction. A rapid test was performed by spiking one of the four 17beta-OH steroids in samples of diluted equine urine. The steroids were transformed into their respective ketones in the presence of bacterial activity. The test allows direct injection of diluted samples into the LC/MS system, without the need for prior extraction. Results show that the best method of storage is freezing at -18 degrees C. Urine specimens should be analyzed as soon as possible after thawing. This allows bacterial degradation of equine urine to be arrested temporarily, so that the urine can be used for qualitative or quantitative analysis of 17beta-OH steroids. PMID:16862626

  16. Anabolic-androgenic steroid interaction with rat androgen receptor in vivo and in vitro: a comparative study.

    PubMed

    Feldkoren, Boris I; Andersson, Stefan

    2005-04-01

    Anabolic steroids are synthetic derivatives of testosterone and are characterized by their ability to cause nitrogen retention and positive protein metabolism, thereby leading to increased protein synthesis and muscle mass. There are disagreements in the literature in regards to the interaction of anabolic steroids with the androgen receptor (AR) as revealed by competitive ligand binding assays in vitro using cytosolic preparations from prostate and skeletal muscle. By use of tissue extracts, it has been shown that some anabolic steroids have binding affinities for the AR that are higher than that of the natural androgen testosterone, while others such as stanozolol and methanedienone have significantly lower affinities as compared with testosterone. In this study we show that stanozolol and methanedienone are low affinity ligands of the rat recombinant AR as revealed by a ligand binding assay in vitro, however, based on a cell-based AR-dependent transactivation assay, they are potent activators of the AR. We also show that a single injection of stanozolol and methanedienone causes a rapid cytosolic depletion of AR in rat skeletal muscle. Based on these results, we conclude that anabolic steroids with low affinity to AR in vitro, can in fact in vivo act on the AR to cause biological responses. PMID:15876413

  17. Rapid steroid influences on visually guided sexual behavior in male goldfish

    PubMed Central

    Lord, Louis-David; Bond, Julia; Thompson, Richmond R.

    2013-01-01

    The ability of steroid hormones to rapidly influence cell physiology through nongenomic mechanisms raises the possibility that these molecules may play a role in the dynamic regulation of social behavior, particularly in species in which social stimuli can rapidly influence circulating steroid levels. We therefore tested if testosterone (T), which increases in male goldfish in response to sexual stimuli, can rapidly influence approach responses towards females. Injections of T stimulated approach responses towards the visual cues of females 30–45 min after the injection but did not stimulate approach responses towards stimulus males or affect general activity, indicating that the effect is stimulus-specific and not a secondary consequence of increased arousal. Estradiol produced the same effect 30–45 min and even 10–25 min after administration, and treatment with the aromatase inhibitor fadrozole blocked exogenous T’s behavioral effect, indicating that T’s rapid stimulation of visual approach responses depends on aromatization. We suggest that T surges induced by sexual stimuli, including preovulatory pheromones, rapidly prime males to mate by increasing sensitivity within visual pathways that guide approach responses towards females and/or by increasing the motivation to approach potential mates through actions within traditional limbic circuits. PMID:19751737

  18. In vivo absorption of steroidal hormones from smart polymer based delivery systems.

    PubMed

    Chen, Sibao; Pederson, Daniel; Oak, Mayura; Singh, Jagdish

    2010-08-01

    The purpose of this study was to develop smart polymer based controlled delivery systems to deliver steroidal hormones after single subcutaneous (s.c.) injection at predetermined rates over extended period of time. In vivo absorption and pharmacokinetics of levonorgestrel (LNG) and testosterone (TSN) were investigated from the thermosensitive and phase sensitive polymeric controlled delivery systems. A selective, reliable, and rapid method for determination of serum LNG concentration was developed using high-performance liquid chromatography-tandom mass spectrometry with atmospheric pressure chemical ionization interface (HPLC-MS-MS with APCI), while TSN in serum samples was detected and quantified by a competitive immunoassay. The delivery systems controlled the absorption of LNG in rabbits up to 6 weeks from thermosensitive and approximately 4 weeks from phase sensitive polymeric delivery systems. In vivo study of TSN delivery systems in castrated rabbits controlled the release of TSN for at least 2 months from both thermosensitive and phase sensitive polymers. Thermosensitive and phase sensitive polymer formulations significantly (p < 0.05) increased relative bioavailability of steroidal hormones compared to control. In conclusion, thermosensitive and phase sensitive polymer based delivery systems controlled the release in vivo in rabbits for longer duration after single s.c. injection. PMID:20213838

  19. Control of ovulation in mares in the early breeding season with ovarian steroids and prostaglandin.

    PubMed

    Taylor, T B; Pemstein, R; Loy, R G

    1982-01-01

    Two trials were conducted to (1) determine the degree of control of ovulation achieved by treating mares in late winter with progesterone and oestradiol-17 beta combined after prior exposure to an artificially increased photoperiod, and (2) to examine the effectiveness of such a procedure incorporated into equine breeding farm management systems. Following a 15-day treatment of 150 mg progesterone and 10 mg oestradiol-17 beta daily with 10 mg PGF-2 alpha on the last day of steroid treatment, 27 of 31 mares ovulated on Days 8-14 after the last injection in one trial. Conception rate for mares mated during that period was 77%, compared with 50% in untreated mares mated at first oestrus following the treatment period. In a second, larger field trial involving the same treatment for a 10-day period, 103 of 128 mares ovulated on Days 9-16 after the last injection and 62% of the mares mated on those days conceived. These results indicate that the combined steroid treatment provided reasonably precise and practical control of ovulation time in mares adequately stimulated by increased photoperiod without detrimental effect on fertility. PMID:6962856

  20. Detection and effects on serum and urine steroid and LH of repeated GnRH analog (leuprolide) stimulation.

    PubMed

    Handelsman, David J; Idan, Amanda; Grainger, Janelle; Goebel, Catrin; Turner, Leo; Conway, Ann J

    2014-05-01

    Non-steroidal drugs that increase endogenous testosterone (T) may be used to exploit ergogenic effects of androgens in power sports. While superactive GnRH analog use is suspected, neither screening nor detection tests are developed. This study aimed to determine if (a) stimulation for 5 days by leuprolide (a superactive GnRH analog) of serum and urine steroids and urine LH is reproducible at a 2 week interval, (b) nandrolone decanoate (ND) co-administration masks responses to leuprolide administration, (c) performance of urine measurement of leuprolide and M1, its major metabolite, as a detection test. Healthy men were randomized into a 4 week parallel group, open label clinical study in which all men had daily sc injections of leuprolide (1mg) for 4 days in the 1st and 3rd weeks with hormone-free 2nd and 4th weeks. In the 3rd week, men were randomized to either ND injections or no extra treatment. Serum steroids were determined by liquid chromatography, tandem mass spectrometry (LC-MS), urine steroids by gas chromatography, mass spectrometry (GC-MS), urine leuprolide and M1 by high resolution LC-MS and urine LH by immunoassay. Leuprolide stimulated striking, reproducible increases in serum and urine LH and steroids (serum T, dihydroT (DHT), 3α diol; urine T, epitestosterone (E) and androsterone (A). ND suppressed basal serum T, E2, 3α diol, and urinary E but did not mask or change the magnitude of responses to leuprolide. Urine leuprolide and M1 measurement had 100% sensitivity and specificity in detecting leuprolide administration up to one day after cessation of injections with the detection window between 1 and 3 days after last dose. Screening using urine steroid and LH measurements, optimally by urinary log10(LHxT), correctly classified 82% of urine samples. It is concluded that leuprolide stimulation of endogenous testosterone is reproducible after a 10-day interval, is not masked by ND and is reliably detected by urine leuprolide or M1 measurement for at