MedWorm: Steroid Therapy

Patients' knowledge and perception on optic neuritis management before and after an information session.

BioMed Central — Sun, 21 Mar 2010 00:00:00 +0100

Conclusions: In this study, patients have shown good understanding of the symptoms and signs of optic neuritis. The finding that significant increases in the likelihood of patients engaging in best practice can be achieved with an information session is very important. This suggests that patient knowledge of available treatments and outcomes can play an important role and aid in implementing and adopting guideline recommendations. (Source: BioMed Central)

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Polymyalgia rheumatica and vertebral fractures: a 1-year pilot controlled study

Rheumatology International — Thu, 18 Mar 2010 19:24:38 +0100

Abstract No data exist about the possibility that vertebral fracture in PMR patients could be independent of steroid therapy. For this reason, we aimed to investigate this topic by a case cohort study with a 1-year follow-up for each patient. We selected ten consecutive patients who experienced vertebral fractures (VF-group) during the first month of 1-year follow-up period and without any other significant associated condition. As a control group we studied ten control patients, without vertebral fractures and with a follow-up of 1 year, randomly selected among a larger group of patients affected by polymyalgia rheumatica. The following data were analysed: eritrosedimention rate (ESR), visual analogical scale score (VAS), methyprednisolone daily dosage. Each patient ...

Can the prognosis of polymyalgia rheumatica be predicted at disease onset? Results from a 5-year prospective study

Rheumatology — Mon, 15 Mar 2010 13:35:46 +0100

Conclusion. A higher PV in PMR increases the risk of prolonged steroid therapy and late GCA. Female sex and particular HLA alleles may increase the risk of late GCA. Starting patients on >15 mg prednisolone is associated with a prolonged steroid duration. (Source: Rheumatology)

Reply: Rituximab-induced pneumonitis: Steroid therapy or not?

Pediatric Pulmonology — Mon, 15 Mar 2010 00:00:00 +0100

No Abstract. (Source: Pediatric Pulmonology)

Rituximab-induced pneumonitis: Steroid therapy or not?

Pediatric Pulmonology — Mon, 15 Mar 2010 00:00:00 +0100

No Abstract. (Source: Pediatric Pulmonology)

A case of pulmonary sarcoidosis preceding polycythemia vera with literature review

Rheumatology International — Sun, 14 Mar 2010 11:26:19 +0100

We present a case in which a patient with pulmonary sarcoidosis developed polycythemia vera few months later. A review of literature shows that sarcoidosis precedes neoplasms and tends to be a chronic active variety. Our case, by contrast, has been responsive to steroid therapy. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00296-010-1378-5Authors Daniela Tirotta, Medicina Interna, Ospedale Cervesi di Cattolica (ASL Rimini) via Beethoven 1 47841 Cattolica RN ItalyVittorio Durante, Medicina Interna, Ospedale Cervesi di Cattolica (ASL Rimini) via Beethoven 1 47841 Cattolica RN Italy Journal Rheumatology InternationalOnline ISSN 1437-160XPrint ISSN 0172-8172 (Source: Rheumatology International)

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Japanese consensus guidelines for management of autoimmune pancreatitis: III. Treatment and prognosis of AIP

Journal of Gastroenterology — Wed, 10 Mar 2010 15:32:02 +0100

Abstract Steroid therapy appeared to be a standard treatment for autoimmune pancreatitis (AIP), although some AIP patients improve spontaneously. The indications for steroid therapy in AIP patients are symptoms such as obstructive jaundice, abdominal pain, and back pain, and the presence of symptomatic extrapancreatic lesions. Before steroid therapy, jaundice should be managed by biliary drainage in patients with obstructive jaundice, and blood glucose levels should be controlled in patients with diabetes mellitus. For the initial oral prednisolone dose for induction of remission, 0.6 mg/kg/day is recommended. The initial dose is administered for 2–4 weeks, and the dose is tapered by 5 mg every 1–2 weeks, based on changes in the clinical manifestatio...

The probability of and factors influencing tooth survival following non-surgical root canal treatment – a prospective study

International Endodontic Journal — Tue, 02 Mar 2010 00:00:00 +0100

Conclusions The 4-year tooth survival following primary or secondary root canal treatment was 95%; with fourteen prognostic factors common to both. (Source: International Endodontic Journal)

Urolithiasis in patients suffering from malignant hematologic diseases.

Yonsei Medical Journal — Mon, 01 Mar 2010 00:00:00 +0100

CONCLUSION: The incidence of urolithiasis for malignant hematologic patients was significantly higher than that for the control group. PMID: 20191017 [PubMed - in process] (Source: Yonsei Medical Journal)

Bone density in renal transplant recipients and in patients with chronic kidney disease: a follow-up study in children and adolescents.

Clinical Nephrology — Fri, 26 Feb 2010 08:00:36 +0100

Conclusions: The results showed that bone density in children and adolescents, even several years after kidney transplantation, did not significantly change over time comparing to patients with chronic kidney disease. Hyperparathyroidism and steroid therapy were the most important risk factors for the slow increase of bone density. PMID: 20178718 [PubMed - in process] (Source: Clinical Nephrology)

Relapsing tubulointerstitial nephritis in an adolescent with inflammatory bowel disease without aminosalicylate exposure.

Clinical Nephrology — Fri, 26 Feb 2010 08:00:06 +0100

We describe a rare case of a 5-aminosalicylic acid (5-ASA)-naïve patient who developed interstitial nephritis in association with CD with no evidence of other primary glomerulopathy. A unique feature of the case being a profound systemic inflammatory response at the time of diagnosis and a relapse in nephritis 2 months after cessation of mesalazine in the absence of any macroscopic colitis. PMID: 20178728 [PubMed - in process] (Source: Clinical Nephrology)

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The natural history of adult Crohn's disease in population-based cohorts

Thu, 25 Feb 2010 14:25:36 +0100

This article is not available freely or via NHS Athens username and password. NHS professionals are advised to check their local library to access the fulltext of this journal. Note: This article has been included in the Specialist Collection as it is a systematic review published in a reputable journal in the field. It has not been appraised for quality by NHS Evidence staff. (Source: Gastroenterology and Liver Diseases Specialist Library - Inflammatory bowel disease)

Poor catch-up growth after proctocolectomy in pediatric patients with ulcerative colitis receiving prolonged steroid therapy

Pediatric Surgery International — Thu, 25 Feb 2010 06:51:42 +0100

Conclusion Preoperative prolonged high steroid therapy may disturb growth recovery of pediatric patients with UC, while early induction of colectomy allowed pediatric patients with PSL dependency to become free of steroids and get normal growth. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-010-2577-6Authors Keiichi Uchida, Mie University Department of Gastrointestinal and Pediatric Surgery, Graduate School of Medicine 2-174 Edobashi Tsu Mie 514-8507 JapanToshimitsu Araki, Mie University Department of Gastrointestinal and Pediatric Surgery, Graduate School of Medicine 2-174 Edobashi Tsu Mie 514-8507 JapanMikihiro Inoue, Mie University Department of Gastrointestinal and Pediatric Surgery, Graduate School of Medicine 2-174 Edobashi Tsu Mie 514...

High-mobility group box-1 protein in tracheal aspirates from premature infants: relationship with bronchopulmonary dysplasia and steroid therapy

Journal of Perinatology — Thu, 25 Feb 2010 00:00:00 +0100

Authors: Z H Aghai, J G Saslow, C Meniru, C Porter, R Eydelman, V Bhat, G Stahl, S Sannoh, K Pyon, C Hewitt & V Bhandari (Source: Journal of Perinatology)

Angioimmunoblastic T-cell lymphoma and membranous nephropathy: a still unreported association

Clinical and Experimental Nephrology — Tue, 23 Feb 2010 07:44:04 +0100

Abstract A 21-year-old man with lymphadenopathy and Coombs-positive hemolytic anemia had been treated with steroid maintenance therapy. He developed nephrotic syndrome with size increase of lymphadenopathy. Lymph node examination disclosed angioimmunoblastic T-cell lymphoma (AITL). Light microscopy of a renal biopsy specimen showed typical features of membranous nephropathy (MN), such as bubbling appearance and spike formation. Immunofluorescence studies revealed no significant deposition of immunoglobulins. Electron microscopy showed sparse degenerative materials on the epithelial side of the glomerular basement membranes, with intervening spikes. These unique histological findings suggested secondary MN. High-dose steroid therapy followed by six courses of cyclophosphami...

Long-term steroid treatment and growth: a study in steroid-dependent nephrotic syndrome

Archives of Disease in Childhood — Fri, 19 Feb 2010 09:09:56 +0100

Conclusions Overall, prednisolone treatment in these children was not shown to adversely affect their height SDS. This was true even at doses of prednisolone up to 0.5–0.75 mg/kg/day. There was some decline in height SDS seen during periods of higher steroid use (over 0.75 mg/kg/day), but periods on lower doses allowed for adequate catch up growth. (Source: Archives of Disease in Childhood)

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Pseudotumor Cerebri after Surgical Remission of Cushing's Disease.

The Journal of Clinical Endocrinology and Metabolism — Wed, 17 Feb 2010 00:00:00 +0100

Conclusions: This series demonstrates a 3% occurrence of pseudotumor cerebri in children after successful surgery for CD, but the absence of the syndrome in adults. Pseudotumor cerebri manifests itself within 1 yr of surgery, often while patients are still undergoing replacement steroid therapy. A patient exhibiting signs of intracranial hypertension after surgery for CD should undergo an evaluation for pseudotumor cerebri. Recognition of the symptoms and treatment should correct and/or prevent ophthalmological sequelae. PMID: 20164289 [PubMed - as supplied by publisher] (Source: The Journal of Clinical Endocrinology and Metabolism)

Relapsing Autoimmune Pancreatitis in a 14-Year-Old Girl.

Journal of Nippon Medical School — Tue, 16 Feb 2010 22:14:03 +0100

We present a case of acute pancreatitis in a 14-year-old girl which fulfilled the diagnostic criteria of autoimmune pancreatitis (AIP) and responded to corticosteroid therapy. Imaging studies revealed that the main pancreatic duct was narrow in the head of the pancreas but had been dilated in the body at an earlier stage. The pancreatitis recurred twice when the prednisolone dose was reduced to 10 mg or less but responded each time to an increased dose and has been kept under control with low-dose prednisolone therapy for 3 years since onset. Repeated magnetic resonance cholangiopancreatography during steroid therapy revealed an improvement of the narrowing of the main pancreatic duct in the head and dilation of the duct in the body. AIP in younger patients has distinct clinical features, ...

Pediatric Idiopathic Nephrotic Syndrome: Treatment Strategies in Steroid Dependent and Steroid Resistant Forms.

Current Medicinal Chemistry — Tue, 16 Feb 2010 00:00:00 +0100

Authors: Ulinski T, Aoun B Idiopathic nephrotic syndrome (INS) is defined as massive proteinuria and hypoalbuminemia associated with dyslipidemia and generalized oedema in most cases. It is thought to be due to a plasma factor of immunologic origin. Most cases are steroid responsive. However, a considerable proportion of children run a steroid dependent course. Calcineurin inhibitors and alkylating agents have been classical treatment strategies for such cases, but specific toxicity limits the use of these drugs. Mycophenolate mofetil (MMF) is an inhibitor of inosine monophosphate dehydrogenase and thus de novo purine synthesis. Several uncontrolled clinical trials have demonstrated the efficacy of MMF in steroid dependent NS with or without prior use of CyP and in children with nephro...

T(H)17 Cells in Asthma and COPD.

Annual Review of Physiology — Sat, 13 Feb 2010 15:56:31 +0100

Authors: Alcorn JF, Crowe CR, Kolls JK Asthma and chronic obstructive pulmonary disease (COPD) represent two classes of chronic obstructive lung disorders that may share some similar immunologic mechanisms of disease. Asthma is a complex human disease characterized by airway hyperresponsiveness (AHR) and inflammation, whereas COPD is marked by progressive emphysematic changes in the lung. Recently it has been shown that advanced COPD is characterized by lymphoid follicles, drawing attention to immunological mechanisms in COPD. Despite numerous studies in mice to elucidate the immunologic mechanisms of asthma, sufficient current treatment options are limited. Clinically, many asthma patients fail to satisfactorily respond to standard steroid therapy, and this type of steroid-resistant, ...

Dexamethasone-suppression-test predicts later development of an impaired adrenal function after a 14 days' course of prednisone in healthy volunteers.

European Journal of Endocrinology — Mon, 08 Feb 2010 00:00:00 +0100

Conclusion: Circulating cortisol levels after a dexamethasone-suppression-test and a pre-intervention stimulated cortisol level are predictive of later development of a suppressed adrenal function after a 14 days; course of prednisone and superior to a clinical score or basal cortisol levels. This may allow a more targeted concept for the need of stress prophylaxis after cessation of steroid therapy. PMID: 20142368 [PubMed - as supplied by publisher] (Source: European Journal of Endocrinology)

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Eosinophilic myocarditis mimicking acute coronary syndrome secondary to idiopathic hypereosinophilic syndrome: a case report

BioMed Central — Sat, 06 Feb 2010 00:00:00 +0100

Conclusion: Eosinophilic myocarditis can present like an acute myocardial infarction and should be considered in the differential diagnosis of acute coronary syndrome in patients with a history of allergy, asthma or acute reduction of the left ventricular function with or without peripheral eosinophilia. (Source: BioMed Central)

BSR and BHPR guidelines for management of polymyalgia rheumatica

NeLM - News — Fri, 05 Feb 2010 00:00:00 +0100

Source: Rheumatology, BMJ Area: News The British Society for Rheumatology (BSR) and the British Health Professionals in Rheumatology (BHPR) have published guidelines on management of polymyalgia rheumatica, the most common inflammatory rheumatic disease in the elderly, and one of the biggest indications for long-term steroid therapy. There are difficulties in diagnosis, with heterogeneity in presentation, response to steroids and disease course. These guidelines cover diagnosis, management and monitoring of disease activity, complications and relapse. An editorial in the BMJ points out that "the current guidelines simplify the approach to the diagnosis and management of patients presenting with polymyalgic symptoms, although they are not supported by good scientific evidence-most of the r...

Periodic lateralized epileptiform discharges in neuropsychiatric lupus: association with cerebritis in magnetic resonance imaging and resolution after intravenous immunoglobulin.

Lupus — Thu, 04 Feb 2010 00:00:00 +0100

Authors: Lim KS, Cheong KL, Tan CT A 13-year-old girl with a known diagnosis of systemic lupus erythematosus presented with seizures and psychosis. An electroencephalogram (EEG) revealed continuous, non-evolving periodic lateralized epileptiform discharges (PLEDs) in the left temporal region, which did not resolve with benzodiazepine. A magnetic resonance imaging (MRI) brain scan demonstrated a focal hyperintensity in the left medial temporal and left occipital lobes, left thalamus and bilateral cerebellar white matter, with evidence of vasculitis in the magnetic resonance angiography. Intravenous immunoglobulin was given because of failed steroid therapy, which resulted in a full resolution of clinical, EEG and MRI abnormalities. Lupus cerebritis should be considered as a possible aet...

Pulmonary toxicity after a quick course of combinatorial vincristine, bleomycin, and Cisplatin neoadjuvant chemotherapy in cervical cancer.

J Korean Med Sci — Mon, 01 Feb 2010 00:00:00 +0100

In conclusion, these patients require special monitoring for bleomycin-induced pulmonary toxicity. PMID: 20119577 [PubMed - in process] (Source: J Korean Med Sci)

Radio-induced bullous pemphigoid

Clinical and Translational Oncology — Fri, 29 Jan 2010 17:53:01 +0100

We report on the appearance of two new cases of radio-induced bullous pemphigoid (BP), a rare complication of radiotherapy. Both were elderly women, were treated for breast cancer and suffered (BP) during the irradiation, the evolution was favorable with steroid therapy. Content Type Journal ArticleCategory Case ReportsDOI 10.1007/s12094-010-0469-9Authors Joaquín J. Cabrera-Rodríguez, Hospital Universitario Infanta Cristina Radiation Oncology Department Avenida de Elvas, s/n ES-06080 Badajoz SpainJulia L. Muñoz-García, Hospital Universitario Infanta Cristina Radiation Oncology Department Avenida de Elvas, s/n ES-06080 Badajoz SpainJuan Quirós Rivero, Hospital Universitario Infanta Cristina Radiation Oncology Department Avenida de Elvas, s/n ES-06080 Badajoz SpainFrancisca Roper...

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Med Sci Monit 2010; 16(2):PI1-6 "Early onset steroid-dependent ulcerative colitis is a predictor of Azathioprine response: A longitudinal 12-month follow-up study"

Medical Science Monitor — Fri, 29 Jan 2010 15:18:38 +0100

Conclusions: AZA demonstrated sustained efficacy for maintenance of clinical remission without steroids and steroid sparing through 12 months of therapy in steroid-dependent UC. Patients with early onset UC are those who most probably will achieve sustained steroid-free remission while on AZA. (Source: Medical Science Monitor)

Progressive multifocal leukoencephalopathy developed in incomplete Heerfordt syndrome, a rare manifestation of sarcoidosis, without steroid therapy responding to cidofovir

Clinical Neurology and Neurosurgery — Thu, 21 Jan 2010 16:36:25 +0100

We describe a 34-year-old PML patient with incomplete Heerfordt syndrome, a rare type of sarcoidosis, who had not received any immunosuppressants, including steroids, at the onset and who was clinically and radiologically responsive to the antiviral drug cidofovir. (Source: Clinical Neurology and Neurosurgery)

Differential Effect of Corticosteroids on Serum Cystatin C in Thrombocytopenic Purpura and Leukemia.

Pathology Oncology Research — Tue, 19 Jan 2010 00:00:00 +0100

Authors: Bardi E, Dobos E, Kappelmayer J, Kiss C The aim of our study was to evaluate the influence of steroid therapy on serum cystatin C (cysC) concentrations in patients with acute lymphoblastic leukemia (ALL) and idiopthiás thrombocytopenias purpura (ITP). We studied 17 patients with ITP (girls: boys = 5:12, mean age: 7.6 yrs, range between 1 to 17 years) and 18 patients with ALL (girls: boys = 6:12, mean age: 6.3 yrs, range between 2 to 17 years). CysC and white blood cell count (WBC) in both group of patients were determined before and after 300 mg/m(2) cumulative dose of steroid therapy. Corticosteroids increased the level of cysC in both groups of patients, however significant increase was found only in ITP patients between pre- and posttreatment values (0,96 +/- 0,27 mg/L...

Efficacy and Safety of Pulse Steroid Therapy in Japanese Pediatric Patients with Ulcerative Colitis: A Survey of the Japanese Society for Pediatric Inflammatory Bowel Disease

Karger Publishers — Mon, 18 Jan 2010 23:00:00 +0100

Digestion 2010;81:188192 (DOI:10.1159/000255379) (Source: Karger Publishers)

Bilateral uveitis with hypopyon as a presenting symptom of metastatic peritoneal carcinomatosis.

European Journal of Ophthalmology — Thu, 14 Jan 2010 00:00:00 +0100

Conclusions. Excluding a masquerade syndrome and a paraneoplastic syndrome on the basis of clinical features, uveitis represents an immune response to the concurrent tumor. The good response to steroid therapy is in accordance with this hypothesis. This is the first case of uveitis with hypopyon as presenting symptom of a metastatic peritoneal carcinomatosis developing 20 years after the removal of primitive breast cancer. PMID: 20099238 [PubMed - as supplied by publisher] (Source: European Journal of Ophthalmology)

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A case of advanced-stage sclerosing cholangitis with autoimmune pancreatitis not responsive to steroid therapy.

JOP — Wed, 13 Jan 2010 19:32:03 +0100

CONCLUSION: Advanced-stage sclerosing cholangitis with autoimmune pancreatitis may sometimes be unresponsive to steroid therapy, and this should be borne in mind when attempting a steroid trial for the diagnosis of sclerosing cholangitis with autoimmune pancreatitis. Early administration of steroid is important for the prevention of disease progression. PMID: 20065555 [PubMed - in process] (Source: JOP)

Systemic and Local Management at the Onset of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis with Ocular Complications

American Journal of Ophthalmology — Tue, 12 Jan 2010 16:10:28 +0100

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal necrolysis (TEN) are recognized as two of the most devastating ocular surface disorders and are extremely difficult to treat both at the acute and later stages. Massive inflammation on the ocular surface at the acute stage often is uncontrollable. Even after the acute-stage impairments subside, ocular complications such as serious visual impairment with dry eye and keratinization remain at the later stage. Recently, we reported in our retrospective analysis that visual outcomes at the later stage were significantly better in the group receiving topical steroids at the acute stage compared with the no-treatment group (P < .00001). Furthermore, using a prospective study, we confirmed the therapeutic importance of steroid therapy at disease o...

The laparoscopically harvested omental flap for deep sternal wound infection [Original articles]

European Journal of Cardio-Thoracic Surgery — Mon, 04 Jan 2010 16:40:24 +0100

Conclusion: The laparoscopically harvested omental flap can contribute to a successful outcome following deep sternal wound infection and deserves serious consideration in type IV mediastinitis in particular, regardless of the co-morbidity or previous abdominal surgery. (Source: European Journal of Cardio-Thoracic Surgery)

Case report Acute drug eruption as a result of therapy with the new generation anticonvulsant drug lamotrigine – case report

Articles of Advances in Dermatology and Allergology - TERMEDIA publishing house — Mon, 04 Jan 2010 12:04:24 +0100

We describe an 18-year old woman with generalized eruption which started 14 days after initiation of the new anticonvulsant drug lamotrigine. The patient was observed for mononucleosis, virus throat infection and angina before hospitalization. She was admitted to the Dermatology Clinic in Kraków in general good condition on the 4th day of steroid therapy with dexamethasone in a dose of 24 mg per day. On physical examination generalized erythema and inflammatory skin lesions were seen with colliquative tendency and positive Nikolsky sign. Laboratory tests (morphology, coagulation parameters, liver and kidney testes) were correct. Due to multi-aetiological and still unknown mechanisms of drug eruption, recommended therapy is inconsistent. We decided to stop lamotrigine therapy and to start ...

Diagnosis and Management of Cardiac Sarcoidosis

Progress in Cardiovascular Diseases — Fri, 01 Jan 2010 00:00:00 +0100

This article reviews the clinical manifestations, diagnosis and treatment of sarcoidosis, with an emphasis on new imaging techniques and therapies. (Source: Progress in Cardiovascular Diseases)

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Nephrotic syndrome and Guillan-barre syndrome: A rare association in child.

Saudi Journal of Kidney Diseases and Transplantation — Fri, 01 Jan 2010 00:00:00 +0100

Authors: Bouyahia O, Khelifi I, Gharsallah L, Harzallah K, Mrad SM, Ghargah T, Boukthir S, Azza Sel G Only few cases of nephrotic syndrome associated with Guillain-Barre Syndrome (GBS) have been reported in the adult and pediatric literature. A 3-year-old boy was initially admitted to our hospital following five days of progressive weakness of his extremities, fatigue, right leg pain and numbness. There was no past history of renal or neurological disease. Cerebro-spinal fluid studies showed a protein level of 92 mg/dL and a white cell count of 1 per high-power field. The diagnosis of GBS was verified with a nerve conduction velocity test as well as. The GBS symptoms improved gradually on intravenous immunoglobulin. Three weeks later, he deve-loped severe proteinuria and edema; laborat...

The long-term results of pediatric patients with primary focal and segmental glomerulosclerosis.

Saudi Journal of Kidney Diseases and Transplantation — Fri, 01 Jan 2010 00:00:00 +0100

Authors: Sozeri B, Mir S, Mutlubas F, Sen S Focal and segmental glomerulosclerosis (FSGS) is a major cause of idiopathic steroid-resistant nephrotic syndrome (SRNS) and end-stage renal disease (ESRD). In this retrospective study, we report on 34 pediatric patients with FSGS who were diagnosed and treated from 1992 to 2006. The mean age at onset was 6.3 +/- 4.3 years. All patients had nephrotic-range proteinuria. Micros-copic hematuria was seen in three patients and hypertension was seen in 15 patients at presentation. All patients were treated with steroids (oral and/or methylprednisolone), while 23 patients received cytotoxic therapy in addition. The mean follow-up period was 8.6 +/- 3.3 years at the end of which, 59% of patients achieved complete or partial remission, 20.5% continued...

The Impact of Anti-Inflammatory Therapy on Intraocular Pressure Reduction Following Selective Laser Trabeculoplasty.

Fri, 01 Jan 2010 00:00:00 +0100

CONCLUSION:A 1-week course of topical prednisolone acetate 1% four times daily did not affect the IOP-lowering effect of selective laser trabeculoplasty in eyes with primary open-angle glaucoma. PMID: 20128578 [PubMed - as supplied by publisher] (Source: Ophthalmic Surgery, Lasers and Imaging : the Official Journal of the International Society for Imaging in the Eye)

Preliminary Experience With Alemtuzumab Induction Therapy Combined With Maintenance Low-Dose Tacrolimus Monotherapy in Small-Bowel Transplantation in China

Transplantation Proceedings — Fri, 01 Jan 2010 00:00:00 +0100

Conclusions: Our preliminary experience in these 5 cases showed that the protocol combining alemtuzumab induction therapy with low-dose tacrolimus monotherapy without maintenance steroid therapy past-SBTx can effectively control rejection with excellent graft function. Nevertheless, close surveillance of ACR should be still performed after 6 months. (Source: Transplantation Proceedings)

Daclizumab and Alemtuzumab as Induction Agents in Adult Intestinal and Multivisceral Transplantation: Rejection and Infection Rates in 40 Recipients During the Early Postoperative Period

Transplantation Proceedings — Fri, 01 Jan 2010 00:00:00 +0100

Conclusions: The infection rate is considerably high with both protocols. Alemtuzumab seems to offer better immunosuppression against ACRs during the first month posttransplantation. (Source: Transplantation Proceedings)

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Introducing high dose steroid therapy for MS relapses into the community.

British Journal of Community Nursing — Fri, 01 Jan 2010 00:00:00 +0100

Authors: Cassia B, Ranford-Mills M South Staffordshire primary care trust (PCT) has seen a rise in the number of specialist nurses working in the community and the development of a wide range of intermediate care services. The Community Intervention Team (CIT) has offered the patients of East Staffordshire the choice to receive intravenous antibiotics, blood transfusions (Pott, 2009), and other intravenous therapies in their own homes rather than as hospital in-patients, for over five years. The local multiple sclerosis clinical nurse specialist (MS CNS) has worked closely with CIT when any MS patients have needed extra support at home to manage a crisis and this led the authors to consider how they could work together to prevent some of these crises occurring. In this article they aut...

Case report Efficacy of cyclosporin A in the treatment of acute posterior multifocal placoid pigment epitheliopathy

Articles of Archives of Medical Science - TERMEDIA publishing house — Wed, 30 Dec 2009 14:06:03 +0100

Aim of the study is report a case of a female patient with acute posterior multifocal placoid pigment epitheliopathy (APMPPE) in whom remission was obtained after systemic cyclosporin A treatment had been applied. The presented case confirms the efficacy of oral cyclosporin A (Sandimmun Neoral) treatment in selected types of choroiditis including patients with APMPPE resistant to steroid therapy. (Source: Articles of Archives of Medical Science - TERMEDIA publishing house)

Original paper Secondary (AA) amyloidosis in systemic onset juvenile idiopathic arthritis - a long-term follow-up study

Articles of Rheumatology - TERMEDIA publishing house — Tue, 29 Dec 2009 07:32:56 +0100

The aim of this study was to determine the clinical outcome and survival of children with long-standing systemic onset juvenile idiopathic arthritis (SOJIA) and amyloidosis. 27 patients (11 male, 16 female) with SOJIA and amyloidosis had an average SOJIA duration of 17.3 yrs. The past and current status were assessed from hospital records, through a questionnaire and a personal interview of all living patients. Amyloidosis was diagnosed (histopathological methods) 1.7-20 yrs after the onset of SOJIA (mean 5.3 ±4.6 yrs). The mean follow-up from the diagnosis of amyloidosis was 11.1 ±7.0 yrs. 24 of 27 patients are currently alive (3 of 27 (11.1%) died). Infection was the cause of death in 2 patients with renal failure. One patient had undergone successful renal transplantation, a...

Role of steroids in septic shock: Assessment of knowledge, attitudes and practices among intensivists practising in Hyderabad

Indian Journal of Critical Care Medicine — Sat, 26 Dec 2009 15:31:17 +0100

Conclusion:</b> There is a lot of ambiguity in the knowledge, attitudes or practices regarding role of steroids in septic shock among intensivists in Hyderabad. Uniform policies and protocols need to be devised at institutional level, with multispecialty inputs, and doctors need to be familiarized accordingly. (Source: Indian Journal of Critical Care Medicine)

FeNO helps identify responders to steroid therapy

MedWire News - Respiratory — Wed, 16 Dec 2009 15:13:43 +0100

Exhaled nitric oxide (FeNO) can identify patients with difficult-to-treat asthma and potential responders to high doses of inhaled corticosteroids or systemic steroids, research shows. (Source: MedWire News - Respiratory)

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Granulomatous Mastitis: Clinical, Pathological Features, and Management

The Breast Journal — Wed, 16 Dec 2009 00:00:00 +0100

Abstract: This clinical study was conducted to present clinical, radiologic, and histopathologic features of Granulomatous Mastitis (GM) and evaluate the result of surgical and steroid treatment. Sixteen cases diagnosed histologically as GM were reviewed. Patient characteristics, clinical presentation, radiologic imaging, microbiologic, histopathologic assessment, treatment modalities, recurrence, morbidity, and follow-up data were analyzed. Majority of the patients were child bearing age and all of the patients had a history of breast feeding. Radiologic findings were nonspecific. Histopathology showed the characteristic distribution of granulomatous inflammation in all cases. In 12 cases, surgical excision of the lesion with negative margins was performed. Four cases required quadranecto...

Sudden paraplegia following epidural lipomatosis and thoracal compression fracture after long-term steroid therapy: a case report

Rheumatology International — Sat, 12 Dec 2009 14:16:00 +0100

Abstract Sudden paraplegia secondary to the posterior spinal epidural compression and vertebral compression fracture as a complication in corticosteroid treatment is extremely rare. The authors presented a case 49-year-old man with chronic relapsing attack of Still’s disease. After the identification of pathology, the surgical evacuation of lipid tissue and pedicle-based instrumentation showed therapeutic success. To the authors’ knowledge, this is the first case showing both vertebral fracture and paraplegia that required urgent surgery in the follow-up Still’s disease. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00296-009-1271-2Authors Suat Erol Çelik, Ümraniye Training and Research Hospital Istanbul TurkeySait B. Erer, Ümraniye Training and ...

Choroidal granuloma as an initial manifestation of systemic sarcoidosis

International Ophthalmology — Wed, 09 Dec 2009 06:48:37 +0100

We present a case of systemic sarcoidosis in a young adult male presenting as a solitary choroidal mass. The diagnosis was made based on elevated serum lysozyme, serum angiotensin-converting enzyme, negative Mantoux, and computed tomography (CT) scan of the chest. Ultrasound examination and fundus fluorescein angiography helped us to differentiate this lesion from choroidal melanoma. Magnetic resonance imaging (MRI) of brain was done to rule out neurosarcoidosis. Patient responded well to systemic steroid therapy, with marked resolution of the choroidal granuloma, and reduced size of mediastinal lymph nodes on repeat CT scan of the chest. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s10792-009-9328-5Authors Aditya Verma, Sankara Nethralaya Department of Ocular Pat...

[Bronchopulmonary dysplasia and prematurity. Short-and long-term respiratory changes.]

Anales de Pediatria — Mon, 07 Dec 2009 00:00:00 +0100

In this study, different aspects of chronic respiratory disease associated with prematurity will be analysed, drawing special attention to clinical symptoms, respiratory function changes, BHR and exercise capacity. All these aspects will be reviewed from early childhood until adolescence and young adult age. Similarities and differences between BPD and asthma will also be discussed. PMID: 20004153 [PubMed - as supplied by publisher] (Source: Anales de Pediatria)

Treatment With Intravenous Immunoglobulin and Steroids May Correct Severe Anemia in Hyperhemolytic Transfusion Reactions: Case Report and Literature Review

Transfusion Medicine Reviews — Sat, 05 Dec 2009 14:20:56 +0100

We report a patient with SCD presented with severe HHTR whose serum contained multiple RBC alloantibodies. On day 2 of admission, the hemoglobin level dropped to 47 g/L. Intravenous immunoglobulin and steroid therapy was commenced. The patient responded and further transfusion was avoided. Review of the literature identified 5 HHTR cases in which transfusion was withheld and IVIG/steroids prescribed. In all of these cases, anemia was corrected and hemolysis resolved without blood transfusion. The reasons why transfusion was withheld and IVIG/steroids treatment prescribed were explored. There is no indication for IVIG in the routine treatment of hemolytic transfusion reactions, but IVIG should be considered as an option for treatment of serious, life-threatening HHTR both in SCD and non-SCD...

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MRI Evidence of Early Muscle Atrophy in MuSK Positive Myasthenia Gravis

Journal of Neuroimaging — Sat, 05 Dec 2009 00:00:00 +0100

Muscle atrophy, particularly of facial and bulbar muscles, seems to be a relatively common long-term consequence of musclespecific tyrosine kinase-myasthenia gravis (MuSK-MG), perhaps reflecting the chronic state of disease or long-term therapy with corticosteroids. We performed magnetic resonance imaging (MRI) to assess muscle wasting in the facial and bulbar muscles in two female MuSK-MG patients, with short duration of symptoms prior to diagnosis and prior to commencement of steroid therapy. The study revealed marked atrophy of temporalis, masseters, and lingual muscles with fatty replacement. MRI evidence of early muscle atrophy in MuSK-MG may indicate that MuSK antibodies per se may predispose to muscle atrophy. J Neuroimaging 2009;XX:1[ndash]4. (Source: Journal of Neuroimaging)

The role of steroids in the management of brain metastases: a systematic review and evidence-based clinical practice guideline

Journal of Neuro-Oncology — Wed, 02 Dec 2009 18:44:13 +0100

Discussion” and “Summary” section for additional details. Content Type Journal ArticleCategory Invited ManuscriptDOI 10.1007/s11060-009-0057-4Authors Timothy C. Ryken, Iowa Spine and Brain Institute Department of Neurosurgery Iowa City IA USAMichael McDermott, University of California San Francisco Department of Neurosurgery San Francisco CA USAPaula D. Robinson, McMaster University Evidence-Based Practice Centre Hamilton ON CanadaMario Ammirati, Ohio State University Medical Center Department of Neurosurgery Columbus OH USADavid W. Andrews, Thomas Jefferson University Department of Neurosurgery Philadelphia PA USAAnthony L. Asher, Carolina Neurosurgery and Spine Associates Department of Neurosurgery Charlotte NC USAStuart H. Burri, Carolinas Medical Center Department of...

A Case of Drug-Induced Hypersensitivity Syndrome-Like Symptoms Following HHV-6 Encephalopathy.

Herpes — Wed, 02 Dec 2009 04:36:08 +0100

We report on a case with DIHS-like symptoms following human herpes virus 6 (HHV-6) infection complicated with encephalopathy. Case Summary: An 11-month-old girl suffered from a human herpes virus 6 (HHV-6) infection (exanthema subitum) complicated with encephalopathy. We treated the patient with continuous infusion of thiopental, assisted mechanical ventilation, methylprednisolone pulse therapy, and gamma-globulin infusion therapy starting on the fifth day of the illness and started phenobarbital administration on the eleventh day. The patient developed a fever, systemic erythematous exanthema, lymphadenopathy, and eosinophilia two weeks after the start of phenobarbital administration. Steroid therapy, methylprednisolone (4mg/kg/day) followed by oral prednisolone (1mg/kg/day), was started ...

Sex steroids and the thyroid

Best Practice & Research. Clinical Endocrinology & Metabolism — Fri, 27 Nov 2009 14:11:43 +0100

Thyroid function is modulated by genetic and environmental causes as well as other illnesses and medications such as gonadal or sex steroids. The latter class of drugs (sex steroids) modulates thyroid function. Gonadal steroids exert their influence on thyroid function primarily by altering the clearance of thyroxine-binding globulin (TBG). While oestrogen administration causes an increase in serum TBG concentration, androgen therapy results in a decrease in this binding protein. These effects of gonadal steroids on TBG clearance and concentration are modulated by the chemical structure of the steroid being used, its dose and the route of administration. Despite the gonadal steroids-induced changes in serum TBG concentrations, subjects with normal thyroid glands maintain clinical and bioch...

Coccidioidal meningitis and brain abscesses: Analysis of 71 cases at a referral center

Neurology — Mon, 23 Nov 2009 21:01:51 +0100

Conclusions: Coccidioidal meningitis remains a diagnostic challenge, but the diagnosis can usually be made successfully when coccidioidal serum and CSF antibodies and cultures are combined with appropriate imaging studies. (Source: Neurology)

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Flexible bronchoscopy as a valuable tool in the evaluation of persistent wheezing in children

International Journal of Pediatric Otorhinolaryngology — Fri, 20 Nov 2009 14:12:42 +0100

Conclusion: Flexible bronchoscopy provided rapid and definitive diagnosis for our patients with persistent wheezing without any major complications. This study is one of the largest studies concerning persistent wheezing. Early bronchoscopic evaluation can reduce cost by providing rapid and accurate diagnosis and preventing unnecessary investigations and drug administration. Flexible bronchoscopy is a safe procedure and should be considered in the evaluation of children with persistent wheezing. (Source: International Journal of Pediatric Otorhinolaryngology)

Recent advances in autoimmune pancreatitis

Gut — Wed, 18 Nov 2009 18:02:43 +0100

Autoimmune pancreatitis (AIP) is distinct from calcifying and obstructive forms of chronic pancreatitis. Clinically and histologically it has two distinct subsets: (i) lymphoplasmacytic sclerosing pancreatitis or type 1 AIP which appears to be a systemic disease characterised by abundant infiltration of affected organs with immunoglobulin G4 (IgG4)-positive plasma cells and (2) duct-centric or type 2 AIP characterised by granulocyte epithelial lesions in the pancreas without systemic involvement. In AIP a marked lymphoplasmacytic infiltrate that responds dramatically to steroid therapy suggests an autoimmune aetiology. However, the target autoantigen(s) and the effector cells in AIP remain speculative. Despite the consistent elevation in serum IgG4 levels and tissue infiltration with IgG4-...

Toxic anterior segment syndrome after uncomplicated cataract surgery.

European Journal of Ophthalmology — Tue, 17 Nov 2009 00:00:00 +0100

Discussion. After uncomplicated cataract surgery, toxic anterior segment may occur in the early postoperative period, which is treated successfully with steroids. More studies are needed to understand the multifactorial risk factors affecting the etiopathogenesis of this syndrome. PMID: 19927269 [PubMed - as supplied by publisher] (Source: European Journal of Ophthalmology)

Combination therapy with steroids and mizoribine in juvenile SLE: a randomized controlled trial

Pediatric Nephrology — Mon, 09 Nov 2009 19:15:01 +0100

In conclusion, our combined steroid and MZB drug therapeutic regimen was not shown to be significantly better than the steroid-only therapy as initial treatment for juvenile SLE. Whether MZB administered in a higher dose would be therapeutically advantageous can only be answered by further studies. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00467-009-1341-4Authors Yuriko Tanaka, Dokkyo Medical University Koshigaya Hospital Department of Pediatrics 2-1-50 Minamikoshigaya Koshigaya City Saitama Japan 343-8555Norishige Yoshikawa, Wakayama Medical University Department of Pediatrics Wakayama JapanShinzaburo Hattori, Kumamoto Health Science University Fundamental Medicine Kumamoto JapanSatoshi Sasaki, Hokkaido University Department of Pediatrics Beijing ChinaTakas...

Treatment of erythrodermic psoriasis in HCV+ patient with adalimumab

Dermatologic Therapy — Tue, 03 Nov 2009 00:00:00 +0100

Erythrodermic psoriasis is a severe and disabling variant of psoriasis. The authors present the case of a 48-year-old man with psoriasis and hemophilia presented with a history of hepatitis C virus (HCV) infection treated with pegylated interferon alpha-2a and ribavirin therapy. At the end of antiviral therapy, skin manifestation progressively worsened, becoming erythrodermic, with lack of efficacy of steroid therapy. The authors decided to start biological therapy with induction dose of adalimumab (Humira, Abbott Laboratories, Abbott Park, Chicago, IL) 80 mg at Week 0 and 40 mg weekly. In our case, this resulted in a highly effective and safe treatment. (Source: Dermatologic Therapy)

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Regional Changes in Bone Area and Bone Mineral Content in Boys with Duchenne Muscular Dystrophy Receiving Corticosteroid Therapy

The Journal of Pediatrics — Mon, 02 Nov 2009 00:00:00 +0100

Conclusion: At baseline reduced mechanical load from diminished muscle function results in narrow light bones more noticeable in the subcranial region than the lumbar spine. Increases observed in subcranial bone area at 30 months suggest a gradual adaptation to increased gravitational load whereas at the spine there were no apparent detrimental effects on bone after 30 months of steroid therapy. (Source: The Journal of Pediatrics)

Drug-induced interstitial nephritis in a child with idiopathic nephrotic syndrome.

Saudi Journal of Kidney Diseases and Transplantation — Fri, 30 Oct 2009 10:08:38 +0100

We present a case of drug-induced acute interstitial nephritis (AIN), complicated with ARF, in a 2(1/2) -year-old girl with active INS. The child was referred to the Hippokration General Hospital, Thessaloniki, Greece hospital with steroid-resistant NS; renal biopsy was performed, which did not show any remarkable findings and cyclosporine was admi-nistered in addition to steroid therapy. The first day after biopsy, the child developed gross hematuria and abdominal pain and an antibiotic was added to her treatment. In the following days, fever, vomiting, hypertension and ARF occurred. Ultrasound study revealed enlarged kidneys with increased echogenity and loss of corticomedullary differentiation. The antibiotic and cyclos-porine were stopped and the child was managed with furosemide, nife...

Anticyclic Citrullinated Peptide Antibody-Positive Paraneoplastic Polyarthritis in a Patient With Metastatic Pancreatic Cancer.

The American Journal of the Medical Sciences — Fri, 30 Oct 2009 00:00:00 +0100

We report the case of a patient who initially presented with an asymmetrical, rapid onset polyarthritis. It resembled atypical RA with positive rheumatoid factor and anticyclic citrullinated peptide (CCP) antibodies. A good response to steroid therapy was noted. A few weeks later, he was diagnosed with metastatic pancreatic cancer that resulted in his mortality. His clinical course suggested that his rheumatic symptoms were a paraneoplastic manifestation of his underlying malignancy. Anticyclic citrullinated peptide antibodies have not been previously described in cancer polyarthritis. Awareness of this atypical, seropositive RA-like syndrome may prompt clinicians to investigate for an underlying malignancy. PMID: 19884819 [PubMed - as supplied by publisher] (Source: The American Journ...

Bevacizumab as Therapy for Radiation Necrosis in Four Children With Pontine Gliomas

International Journal of Radiation Oncology * Biology * Physics — Mon, 26 Oct 2009 15:43:42 +0100

Conclusions: In children with pontine gliomas, bevacizumab may provide both therapeutic benefit and diagnostic information. More formal evaluation of bevacizumab in these children is needed. (Source: International Journal of Radiation Oncology * Biology * Physics)

Emerging Prevalence of Microsporidial Keratitis in Singapore: Epidemiology, Clinical Features, and Management

Ophthalmology — Wed, 07 Oct 2009 00:00:00 +0100

Conclusions: This study identifies an increasing incidence of microsporidial keratitis in Singapore with a strong correlation with prior soil exposure. Diffuse endotheliitis and limbitis have not been described and resolves with topical steroid therapy. Topical fluoroquinolone monotherapy is a valid treatment option.Financial Disclosure(s): Proprietary or commercial disclosure maybe found after the references. (Source: Ophthalmology)

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A case report of cranial polyneuropathy in Behcet’s disease

Neurological Sciences — Tue, 06 Oct 2009 12:53:10 +0100

We report a 19-year-old man with BD who presented with cranial polyneuropathy secondary to aseptic meningitis. He made a gradual though incomplete recovery with steroid therapy. Cranial polyneuropathy secondary to meningeal involvement can be a presentation of n-BD, and Behcet’s disease should be a consideration in patients with idiopathic cranial polyneuropathy. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s10072-009-0162-3Authors Ali Alrefai, Jordan University of Science and Technology (JUST) Department of Neuroscience PO Box 3030 Irbid 22110 JordanKhalid El-Salem, Jordan University of Science and Technology (JUST) Department of Neuroscience PO Box 3030 Irbid 22110 JordanRuba Saadeh, Jordan University of Science and Technology (JUST) Department of Neuroscience PO...

Autoimmune pancreatitis: A challenging diagnostic puzzle for clinicians

Digestive and Liver Disease — Mon, 05 Oct 2009 00:00:00 +0100

This article briefly reviews clinical aspects of autoimmune pancreatitis with a focus on its diagnostic imaging and management. (Source: Digestive and Liver Disease)

Matrix metalloproteinases-7, -8, -9 and TIMP-1 in the follow-up of diisocyanate-induced asthma

Allergy — Sun, 04 Oct 2009 23:00:00 +0100

Conclusions: Our data suggest that reduced TH-2 type inflammation in DIA after inhaled steroid medication is reflected as elevated MMP-9 and MMP-9/TIMP-1 levels in BAL. MIF may be the inducer of MMP-9. This might point to some protective role for MMP-9 in DIA. (Source: Allergy)

Safety and Efficacy of Steroid-Free Immunosuppression with Tacrolimus and Daclizumab in Liver Transplant Recipients: 6-Year Follow-up in a Single Center

Transplantation Proceedings — Thu, 01 Oct 2009 00:00:00 +0100

Conclusions: A CS-free regimen of Tac/Dac is as effective as Tac/Cs in achieving good patient and graft survival. However, no substantial benefits insofar as the safety of Tac/Dac therapy were evident during long-term follow-up. (Source: Transplantation Proceedings)

Steroid Therapy of Septic Shock

Critical Care Clinics — Thu, 01 Oct 2009 00:00:00 +0100

This article reviews the subject of steroid treatment of patients with septic shock and weighs the advantages and disadvantages of steroid treatment. It reviews and contrasts several low- and high-dose steroid studies, and makes recommendations for future practice. (Source: Critical Care Clinics)

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S100A8/A9: a mediator of severe asthma pathogenesis and morbidity?

Canadian Journal of Physiology and Pharmacology — Thu, 01 Oct 2009 00:00:00 +0100

Authors: Halayko AJ, Ghavami S Nearly 12% of children and 6% of adults in Canada have been diagnosed with asthma. Although in most patients symptoms are controlled by inhaled steroids, a subpopulation (~10%) characterized by excessive airway neutrophilia, is refractory to treatment; these patients exhibit severe disease, and account for more than 50% of asthma health care costs. These numbers underscore the need to better understand the biology of severe asthma and identify pro-asthma mediators released by cells, such as neutrophils, that are unresponsive to common steroid therapy. This review focuses on a unique protein complex consisting of S100A8 and S100A9. These subunits belong to the large Ca2+-binding S100 protein family and are some of the most abundant proteins in neutrophils ...

[The support of the ultrasonography of the shoulder in the diagnosis of polymyalgia rheumatica with normal erythrocyte sedimentation rate.]

Reumatismo — Thu, 01 Oct 2009 00:00:00 +0100

Authors: Zaccaria A, Latinakis G, Oliveri M, Maio T, Frisone G, Versace F Polymyalgia rheumatica (PMR) is a chronic inflammatory syndrome that affects the elderly population and whose diagnosis is mainly based on clinical criteria taking little advantage of the latest innovatory methods of diagnostic imaging, for instance ultrasonography. Although it is generally characterised by increasing of inflammation values as well as pain and stiffness on the shoulder and pelvic girdles, there is a significant percentage of patients with PMR whose erythrocyte sedimentation rate (ESR) is normal; in this case to make a diagnosis is difficult. The purpose of our study is to demonstrate how useful ultrasound investigations on the shoulders joints could be in order to make a diagnosis of PMR, especia...

New insights into the pathophysiology of idiopathic nephrotic syndrome.

Clinical Immunology — Wed, 30 Sep 2009 23:00:00 +0100

Authors: Bruneau S, Dantal J Corticoresistant idiopathic nephrotic syndrome (INS) is a glomerulopathy of unknown etiology whose original aspect is its recurrence after kidney transplantation in 30 to 50% of patients with end-stage renal disease. This suggests the involvement of circulating factors that would alter the glomerular filtration barrier, but whose nature remains elusive. Although a T cell immune origin has been suggested, the actual role of these cells in INS recurrence is still unclear. Here we present an 8-year-old patient with corticoresistant INS who developed a recurrence of her initial disease after kidney transplantation. Rituximab therapy was proposed 11 months after transplantation; although no immediate effect was induced, a slow but persistent decrease in proteinu...

Gallium-67 citrate imaging for the assessment of radiation pneumonitis

Annals of Nuclear Medicine — Tue, 29 Sep 2009 03:59:30 +0100

Abstract In order to evaluate its usefulness in the assessment of radiation pneumonitis, gallium-67 citrate (67Ga) imaging was performed before and after radiation therapy (RT) on 103 patients with lung cancer. In 23 patients with radiation pneumonitis detected radiographically, abnormal67Ga uptake in sites other than tumors was found in all post-RT67Ga lung images. Three patterns of uptake were found: (A), focal uptake corresponding to the RT field (n= 10); (B), diffuse uptake including the RT field (n=4), and (C), diffuse uptake outside the RT field (n=9). The area of67Ga uptake was consistent with that of interstitial pneumonitis as revealed histopathologically in 7 cases.67Ga uptake in pattern (C) was an indicator of poor prognosis for the patients with radiation pneumonit...

Clinical Application of Exhaled Breath Condensate Analysis in Asthma: Prediction of FEV 1 Improvement by Steroid Therapy

Respiration — Mon, 28 Sep 2009 23:00:00 +0100

Respiration (DOI:10.1159/000243551) (Source: Respiration)

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[Sub-acute encephalopathy that responds to steroids without any evidence of autoimmune thyroid disease: a case of non-vasculitic autoimmune meningoencephalitis.]

Revista de Neurologia — Thu, 24 Sep 2009 15:34:28 +0100

CONCLUSIONS. With no evidence of autoimmune thyroid disease, although non-specific autoimmunity was present, the patient was diagnosed as having non-vasculitic autoimmune meningoencephalitis. PMID: 19774530 [PubMed - in process] (Source: Revista de Neurologia)

A new cold autoagglutinin specificity: the third external loop of band 3.

Transfusion — Mon, 21 Sep 2009 23:00:00 +0100

CONCLUSION: This is to our knowledge the first observation of a CA specific for band 3. The coexistence of IgM and IgG molecules, a very unusual feature for a CA, may be related to the peptidic nature of the target antigen. PMID: 19778339 [PubMed - as supplied by publisher] (Source: Transfusion)

Free perforation of the small intestine in collagenous sprue.

World Journal of Gastroenterology : WJG — Sun, 20 Sep 2009 21:30:23 +0100

Authors: Freeman HJ, Webber DL A 67-year-old man with celiac disease developed recurrent diarrhea, profound weakness and weight loss, with evidence of marked protein depletion. His clinical course was refractory to a strict gluten-free diet and steroid therapy. Postmortem studies led to definition of unrecognized collagenous sprue that caused ulceration and small intestinal perforation. Although PCR showed identical monoclonal T-cell populations in antemortem duodenal biopsies and postmortem jejunum, careful pathological evaluation demonstrated no frank lymphoma. Rarely, overt or even cryptic T-cell lymphoma may complicate collagenous sprue, however, small intestinal ulcers and perforation may also develop independently. The dramatic findings here may reflect an underlying or early mol...

Primary sclerosing cholangitis with elevated serum IgG4 levels and/or infiltration of abundant IgG4-positive plasma cells

Journal of Gastroenterology — Thu, 17 Sep 2009 12:47:07 +0100

Abstract Immunoglobin G4-related sclerosing cholangitis (IgG4-SC) is recognized as one of the systemic sclerosing diseases characterized by abundant IgG4-positive plasma cells with effective steroid therapy. On the other hand, primary sclerosing cholangitis (PSC), recognized as a sclerosing cholangitis of unknown origin without steroid efficacy, has been often clinically confused with IgG4-SC. To date, the prognosis of IgG4-SC is unclear, while the prognosis of PSC is well known to be poor. Therefore, it is clinically very important to be able to distinguish IgG4-SC from PSC. However, at the present time it still remains unclear whether PSC may sometimes be misdiagnosed as IgG4-SC or not. Herein, we report three rare cases of PSC with elevated serum IgG4 levels and/or an i...

Blood Pressure in Children with Minimal Change Nephrotic Syndrome during Oedema and after Steroid Therapy: The Influence of Familial Essential Hypertension

Karger Publishers — Mon, 14 Sep 2009 23:00:00 +0100

Kidney Blood Press Res 2009;32:258-262 (DOI:10.1159/000238823) (Source: Karger Publishers)

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Community acquired influenza requiring hospitalization: Vaccine status is unrelated to morbidity in children with cancer

Pediatric Blood and Cancer — Tue, 08 Sep 2009 23:00:00 +0100

Community acquired influenza can be severe and there are few data regarding hospitalization for children with cancer and influenza. Association between prior vaccination and infection severity has not been studied, although vaccination is standard practice.Patients with malignancy or prior stem cell transplant (SCT) were identified using a database of children with laboratory confirmed influenza (2000-2005). Other data collected included receipt of vaccine, absolute neutrophil count (ANC) and absolute lymphocyte count (ALC). These were compared with intensive care unit (ICU) stay, respiratory complications and hospital days.There were 39 patients with laboratory-confirmed influenza with a median age of 6.9 years. Twenty-four (62%) were on cancer therapy at time of infection and 18 (46%) ha...

Is 18F-fluorodeoxyglucose positron emission tomography meaningful for estimating the efficacy of corticosteroid therapy in patients with autoimmune pancreatitis?

Journal of Hepato-Biliary-Pancreatic Surgery — Thu, 03 Sep 2009 06:11:01 +0100

Conclusions FDG-PET pattern at baseline, and a decrease in FDG uptake after a short steroid trial can be useful for discriminating AIP from PC. Content Type Journal ArticleCategory Original articleDOI 10.1007/s00534-009-0172-9Authors Minoru Shigekawa, Aichi Cancer Center Hospital Department of Gastroenterology Nagoya JapanKenji Yamao, Aichi Cancer Center Hospital Department of Gastroenterology Nagoya JapanAkira Sawaki, Aichi Cancer Center Hospital Department of Gastroenterology Nagoya JapanKazuo Hara, Aichi Cancer Center Hospital Department of Gastroenterology Nagoya JapanTadayuki Takagi, Aichi Cancer Center Hospital Department of Gastroenterology Nagoya JapanVikram Bhatia, Institute of Liver and Biliary Sciences (ILBS) Department of Medical Hepatology Delhi IndiaMasam...

Consistency of sputum eosinophilia in difficult-to-treat asthma: A 5-year follow-up study

Journal of Allergy and Clinical Immunology — Mon, 31 Aug 2009 23:00:00 +0100

To the Editor: Several inflammatory phenotypes have been described in patients with difficult-to-treat asthma, including the eosinophilic and noneosinophilic phenotypes. Eosinophilic airway inflammation that persists despite vigorous anti-inflammatory treatment has been associated with more severe asthma, frequent exacerbations, and loss of lung function. Notably, persistent sputum eosinophilia has therapeutic consequences, because it allows tailored steroid therapy as well as targeted treatment with new biologicals in severe refractory asthma. (Source: Journal of Allergy and Clinical Immunology)

Early Sirolimus Therapy in Renal Transplant Recipients at High Risk: Is It Justified?

Transplantation Proceedings — Mon, 31 Aug 2009 23:00:00 +0100

Conclusion: Early treatment with combined SRL-MMF-steroid may be effective as a CNI-free immunosuppression regimen in patients at high risk; however, there is a high rate of adverse effects during long-term follow-up. (Source: Transplantation Proceedings)

Cord blood transplantation with a reduced-intensity conditioning regimen for patients with relapsed aggressive multiple myeloma after cytoreduction with bortezomib.

International Journal of Hematology — Fri, 28 Aug 2009 23:00:00 +0100

Authors: Kasahara I, Nishio M, Yamamoto S, Endo T, Fujimoto K, Yamaguchi K, Takeda Y, Goto H, Sato N, Koike T Two multiple myeloma patients relapsed after autologous stem cell transplantation (ASCT). Conventional chemotherapy, including thalidomide, showed very little effect, but both patients responded well to a standard dose of bortezomib. One patient was treated with two additional cycles of bortezomib, but his clinical course suddenly deteriorated. Unrelated cord blood transplantation (CBT) with reduced-intensity conditioning regimen (RIC) was performed in refractory disease. After CBT, the clinical course was aggravated by tumor lysis syndrome and other conditions, thus resulting in patient death on day 34. Thereafter, we administered CBT with RIC on the second patient after just ...

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Cyclosporine and steroid therapy in children with steroid-resistant nephrotic syndrome

Pediatric Nephrology — Fri, 28 Aug 2009 16:58:57 +0100

In conclusion, a high remission rate was achieved in our patient cohort using a combined cyclosporine/prednisolone treatment regimen in children with SRNS who had MC/DMP and a combined cyclosporine/prednisolone plus MPT regimen in children who had FSGS. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00467-009-1264-0Authors Yuko Hamasaki, Tokyo Metropolitan Kiyose Children’s Hospital Department of Pediatric Nephrology 1-3-1 Umezono Kiyose-city, Tokyo 204-8567 JapanNorishige Yoshikawa, Wakayama Medical University Department of Pediatrics Wakayama JapanShinzaburo Hattori, Kumamoto Health Science University Department of Fundamental Medicine Kumamoto JapanSatoshi Sasaki, Hokkaido University Graduate School of Medicine Department of Pediatrics Sapporo JapanKazumoto I...

A prospective, randomised, placebo-controlled trial of postoperative oral steroid in allergic fungal sinusitis

European Archives of Oto-Rhino-Laryngology — Fri, 28 Aug 2009 16:58:14 +0100

In conclusion, postoperative oral steroid in a tapering dose produces significant subjective and objective improvement of patients with AFS. It is also effective in preventing early recurrence. Inclusion of postoperative oral steroid therapy for at least 12 weeks is recommended in all patients who undergo excisive surgery for AFS. Content Type Journal ArticleCategory RhinologyDOI 10.1007/s00405-009-1075-8Authors V. Rupa, Christian Medical College and Hospital Department of ENT Vellore 632004 IndiaMary Jacob, Christian Medical College and Hospital Department of Pathology Vellore IndiaMary Somini Mathews, Christian Medical College and Hospital Department of Microbiology Vellore IndiaMandalam S. Seshadri, Christian Medical College and Hospital Department of Endocrinology Vellore I...

Delayed Recovery of Accelerated Acute Rejection

Dialysis and Transplantation — Thu, 27 Aug 2009 23:00:00 +0100

We report the case of a 49-year-old female, under chronic hemodialysis therapy who received a living transplant from her husband. Both of them had the same blood type and the result of the mixed lymphocyte culture test was acceptable before transplantation. The operation was smooth and a combination therapy with cyclosporine, prednisolone, and mycophenolate mofetil (MMF) was given. However, oliguria developed on the second day after transplantation. After excluding the possibility of occlusive lesion, the first course of pulse steroid therapy was given under the impression of AAR, supported by renal biopsy. After the second course of pulse steroid and OKT3 therapy, her renal function did not recover. Thereafter, she received regular hemodialysis therapy and cyclosporine was replaced by tac...

Glucocorticoid bioactivity does not predict response to steroid therapy in severe pediatric ulcerative colitis

Inflammatory Bowel Diseases — Wed, 26 Aug 2009 23:00:00 +0100

The pathophysiological basis for corticosteroid (CS) failure in ulcerative colitis (UC) is unknown. A transactivation glucocorticoid bioassay (GBA) was developed to measure the biological activity of CS by quantifying glucocorticoid response elements. This approach eliminates differences in bioavailability, chemistry, affinity, and other potential differences between the various steroids regarding their ability to activate the glucocorticoid receptor. In this multicenter prospective study, we aimed to evaluate whether CS bioavailability plays a role in CS refractoriness in severe pediatric UC.GBA (using COS-1 transfected cells) was measured in the serum of 50 children (52% males, age 13.4 ± 3.5 years) admitted for acute severe UC on the third day of CS treatment. Demographic, clinical, an...

Disturbances of Esophageal Motility in Eosinophilic Esophagitis: A Case Series

Dysphagia — Wed, 26 Aug 2009 08:45:00 +0100

Abstract Esophageal manometry (EM) findings were reviewed in 14 (13 male) adults diagnosed with eosinophilic esophagitis (EE). One had complete nonperistaltic contractions (amplitude range = 30–180 mmHg) and incomplete relaxation of the lower esophageal sphincter (LES), suggesting vigorous achalasia. After 6 months of steroid therapy the repeat EM showed near-normal findings. One had total aperistalsis with contraction amplitudes less than 10 mmHg and a weak LES pressure (8 mmHg), criteria suggesting scleroderma. Two had low-amplitude (<30 mmHg) nonperistaltic contractions limited to the mid-esophagus. Criteria for nutcracker esophagus were met in two patients. Isolated low LES pressure (<15 mmHg) was observed in four patients...

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Azathioprine maintains long-term steroid-free remission through 3 years in patients with steroid-dependent ulcerative colitis

Inflammatory Bowel Diseases — Sun, 23 Aug 2009 23:00:00 +0100

Studies assessing the efficacy of azathioprine (AZA) in steroid-dependent ulcerative colitis (SD-UC) are scarce. The purpose of this trial was to explore the efficacy of AZA in maintaining steroid-free remission in SD-UC patients and the factors associated with sustained response.In this observational cohort study, 42 subjects with SD-UC were recruited for AZA therapy during a 3-year period. AZA was adjusted for a target dose of 2-3 mg/kg/day. Steroid therapy was tapered off following a standardized regimen. The primary endpoint was the annual rate of steroid-free response to AZA. Secondary endpoints included clinical recurrence, yearly steroid dose, and safety of treatment.On an intention-to-treat basis, the proportion of patients remaining in steroid-free remission at 12, 24, and 36 mont...

Acute eosinophilic myocarditis mimicking myocardial infarction.

Texas Heart Institute Journal — Sat, 22 Aug 2009 09:08:03 +0100

Authors: Thambidorai SK, Korlakunta HL, Arouni AJ, Hunter WJ, Holmberg MJ Eosinophilic myocarditis is characterized by progressive myocardial damage that results in heart failure and death. Herein, we present the case of a 54-year-old man who presented with symptoms of acute myocardial infarction. Normal coronary angiographic results and the presence of elevated levels of peripheral-blood eosinophilia prompted an endomyocardial biopsy that revealed acute eosinophilic myocarditis. The early initiation of steroid therapy resulted in the patient's substantial clinical improvement and survival. Early diagnosis of eosinophilic myocarditis and its treatment with steroid agents in some patients can lead to a favorable outcome. We discuss the challenge of diagnosing and identifying the charact...

Early CT Findings of Tomotherapy-Induced Radiation Pneumonitis After Treatment of Lung Malignancy

American Journal of Roentgenology — Wed, 19 Aug 2009 23:00:00 +0100

CONCLUSION. Radiation pneumonitis commonly developed with minimal clinical findings within 3 months after tomotherapy. The CT findings were nonspecific: focal, irregular-shaped ground-glass opacities with minimal fibrosis. However, the location of the radiation pneumonitis tended not to correspond to the planned target volume and had a centrifugal distribution. In addition, the immediate area around the target tended to be spared. (Source: American Journal of Roentgenology)

Acute inflammatory demyelinating polyneuropathy as the initial presentation of lupus

The American Journal of Emergency Medicine — Tue, 18 Aug 2009 10:22:33 +0100

A 28-year-old woman presented at the emergency department (ED) with acute bilateral leg weakness and lost the ability to walk 1 day after noticing bilateral leg numbness and intermittent pleuritic pain for 3 weeks. Physical examination revealed bilateral decreased muscle strength with score 4 symmetrically in the legs and decreased deep tendon reflex. Laboratory tests indicated lymphopenia but no other grossly remarkable findings. Cerebrospinal fluid analysis demonstrated albuminocytologic dissociation. Electrophysiologic survey also indicated sensory-motor demyelinating polyneuropathy. The clinical picture was compatible with acute inflammatory demyelinating polyneuropathy (AIDP), the most prevalent form of Guillain-Barré syndrome (GBS). Plasma exchange was immediately arranged. After se...

Growth in boys with idiopathic nephrotic syndrome on long-term cyclosporin and steroid treatment

Pediatric Nephrology — Tue, 11 Aug 2009 00:07:00 +0100

Abstract Although steroid-free remission can usually be achieved with cyclosporin A (CsA) in patients with steroid-dependent nephrotic syndrome (SDNS), some CsA-treated patients require long-term steroid therapy. Data on growth in these patients are scarce. Sixty-four boys with SDNS receiving long-term CsA and steroid therapy were retrospectively analyzed. During the 10-year follow-up period, height standard deviation score (HSDS) remained in the normal range in 47 patients but was below −2 SD in 17 patients. The occurrence of growth retardation was influenced by height at diagnosis and the number of relapses. Thirty patients were followed for at least 3 years before and after age 12. The decrease in HSDS per year of disease in patients older than 12 years was twice ...

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Cellulitis: Infectious or Non-Infectious?

The Journal of Emergency Medicine — Mon, 10 Aug 2009 00:00:00 +0100

We report a case of a rare non-infectious cause of cellulitis that was resistant to antibiotics and improved by steroid therapy. (Source: The Journal of Emergency Medicine)

M.P.5.06 Steroids and T2 relaxation time mapping of the gluteal muscles in patients with Duchenne muscular dystrophy (DMD): Longitudinal and quantitative assessment

Neuromuscular Disorders — Fri, 07 Aug 2009 11:14:13 +0100

Background: DMD is a fatal disease characterized by progressive muscle weakness and eventual early death. Steroid therapy can transiently improve weakness. T2 relaxation time mapping (T2 mapping), used primarily for articular cartilage, has infrequently been used for soft tissues. There are no longitudinal studies using T2 mapping of muscle, particularly in children. Objective: To determine the feasibility of T2 mapping as a quantitative method to longitudinally follow disease activity in children with DMD treated with steroids. Methods: Eleven boys with DMD ages 5–14 (mean age 7.2 years) underwent evaluation with Clinical Functional Score (CFS), conventional pelvic MRI and T2 mapping before and during steroid therapy. Gluteus muscle inflammation and fatty infiltration were evaluated on ...

T.P.3.03 Long-term, low-dosage, early steroid therapy in Duchenne muscular dystrophy prolongs ambulation and preserves respiratory and cardiac function. 13 years follow-up

Neuromuscular Disorders — Fri, 07 Aug 2009 11:14:03 +0100

Duchenne muscular dystrophy (DMD) is an incurable disease of childhood. In the natural history course of DMD, loss of walking ability at the mean age of 9.5 years (range 6–13) is followed by restrictive respiratory syndrome, cardiomyopathy, and eventually death. The major aim of steroids in the ambulant phase of DMD is to prolong the ability to walk. RCT have shown that steroids improved muscle strength and function for six months to two years, but the overall long-term benefit remains unclear, and has to be weighed against the long-term side effects of steroids. In 1996 we started a prospective long-term open, parallel group, double consent trial of low-dosage prednisone in five early cases of DMD. Prednisone was given 0.75mg/kg for 2 weeks, then, 1.25mg/kg on alternate days. Ability to...

T.P.2.07 Attenuation of adverse effects of prednisolone on δ-sarcoglycan-deficient cardiomyopathy by mineralocorticoid-receptor-antagonism

Neuromuscular Disorders — Fri, 07 Aug 2009 11:13:41 +0100

An inflammatory component to Duchenne muscular dystrophy (DMD), Limb-girdle muscular dystrophy (LGMD) and other dystrophin–glycoprotein complex-associated muscular dystrophies has been well documented, and steroid therapy increases respiratory and skeletal muscle strength in DMD and sarcoglycan-deficient LGMD patients. In addition, retrospective studies in patients with DMD have suggested that steroids have beneficial effects on left ventricular function when assessed by echocardiography. We have however recently reported severe adverse myocardial effects of steroid treatment in the δ-sarcoglycan-deficient (Sgcd-null) mouse, a well characterised model of LGMD2F. We have therefore investigated the hypothesis that cross reactivity of prednisolone to cardiac mineralocorticoid receptors (MR...

Acute Vogt–Koyanagi–Harada Disease in Enhanced Spectral-Domain Optical Coherence Tomography

Ophthalmology — Wed, 29 Jul 2009 23:00:00 +0100

Conclusions: The membranous structure that can be seen in eyes with acute VKH disease seems to represent a portion of the outer segment layer that has become separated from the inner segment layer by cystoid spaces. We hypothesize that the membranous form of the outer segment is bound with the action of inflammatory products, such as fibrin, and this membranous structure changes to a granular structure as steroid therapy “dissolves” the fibrin holding the outer segments together.Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article. (Source: Ophthalmology)

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Vacuum-assisted biopsy and steroid therapy for granulomatous lobular mastitis: Report of three cases

Surgery Today — Tue, 28 Jul 2009 18:46:46 +0100

We report the cases of three patients with granulomatous lobular mastitis (GLM), who were treated successfully with low-dose steroid therapy. Furthermore, the findings of our review of 271 patients reported in the literature suggest that steroid therapy is the treatment of choice for GLM. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00595-008-3891-7Authors Sayaka Kuba, National Hospital Organization Department of Surgery Saga JapanJunzo Yamaguchi, National Hospital Organization Department of Surgery Saga JapanHiroshi Ohtani, Nagasaki University Department of Investigative Pathology, Graduate School of Biomedical Sciences 1-7-1 Sakamotomachi Nagasaki 852-8501 JapanIsao Shimokawa, Nagasaki University Department of Investigative Pathology, Graduate School of Biomedical ...

Identification and characterization of IgG4-associated autoimmune hepatitis

Liver International — Fri, 24 Jul 2009 23:00:00 +0100

In this study, we examined whether the IgG4 response contributes to the histopathological and clinical findings in AIH. Liver sections from 26 patients with AIH, 10 patients with primary biliary cirrhosis (PBC), three patients with primary sclerosing cholangitis (PSC) and 20 chronic hepatitis patients with hepatitis C virus (HCV) infection were immunostained for IgG4. We investigated the relationship among the histopathology, the responses to steroid therapy and the IgG4 staining. Nine of the 26 liver specimens from patients with AIH showed positive staining for IgG4 whereas none of the 10 samples from patients with PBC, the three samples from patients with PSC or the 20 samples from patients with HCV hepatitis were positive. Patients with IgG4-positive AIH also showed increased serum leve...

Comparing hydrocortisone and methylprednisolone in patients with septic shock.

Advances in Therapy — Wed, 22 Jul 2009 23:00:00 +0100

CONCLUSIONS: Low-dose methylprednisolone and hydrocortisone might have a similar effect for the treatment of patients with septic shock. PMID: 19629409 [PubMed - as supplied by publisher] (Source: Advances in Therapy)

Utility of 18F-FDG PET/CT for Differentiation of Autoimmune Pancreatitis With Atypical Pancreatic Imaging Findings From Pancreatic Cancer

American Journal of Roentgenology — Sun, 19 Jul 2009 23:00:00 +0100

CONCLUSION. In difficult cases, at PET/CT the presence of diffuse uptake of FDG by the pancreas or concomitant extrapancreatic uptake by the salivary glands can be used to aid in differentiation of autoimmune pancreatitis and pancreatic cancer. (Source: American Journal of Roentgenology)

Autoimmune pancreatitis: An underdiagnosed autoimmune disease with clinical, imaging and serological features.

Autoimmunity Reviews — Fri, 17 Jul 2009 23:00:00 +0100

Authors: Sánchez-Castañón M, de Las Heras-Castaño G, López-Hoyos M Since Sarles et al reported a case of pancreatitis associated with hypergammaglobulinemia, many cases have been described, which led to the current concept of "autoimmune pancreatitis (AIP)". Lymphoplasmacytic infiltration and fibrosis on histology together with elevated IgG levels or the presence of autoantibodies on laboratory examinations supported the concept of AIP. In recent years, based on histological and immunohistochemical examination of various organs of patients with AIP, a novel clinicopathological entity, IgG4-related slerosing disease, has been proposed. AIP is a systemic disease that is characterized by dense infiltration of IgG4-positive plasma cells and T lymphocytes in various...

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Isolated diffuse invasive renal aspergillosis in an immunocompromized patient due to longstanding steroid treatment: a case report

Cases Journal — Wed, 15 Jul 2009 23:00:00 +0100

A 53-year-old Indian lady suffered from type 2 diabetes and hypothyroidism and was on longstanding steroid therapy. She was urgently admitted to the hospital with a high white cell count and high creatinine. On imaging no space occupying lesions were shown. In spite of intensive therapy the patient died a week after admission. Post mortem examination revealed markedly enlarged kidneys with areas of necrosis, hemorrhagic infarction, inflammatory response and granulomas related to the widespread glomerular, tubulo-interstitial and vascular involvement by aspergillus. Renal disease may present as bilateral diffuse parenchymal involvement with blood vessel invasion causing organ failure. (Source: Cases Journal)

[Intermittent elevation deficiency.]

Der Ophthalmologe — Sat, 11 Jul 2009 23:00:00 +0100

Authors: van Waveren M, Jägle H A 7-year-old boy presented with vertical double images. A paediatric examination and magnetic resonance imaging of the head did not show any pathological findings. The diagnosis was an acquired click syndrome of the superior oblique muscle. In cases with inflammatory and systemic origin the underlying disease should be treated. Local steroid therapy can be carried out for improvement of inflammation in the region of the superior oblique muscle with a high degree of suffering. PMID: 19593572 [PubMed - as supplied by publisher] (Source: Der Ophthalmologe)

IgG4-related retroperitoneal fibrosis and sclerosing cholangitis independent of autoimmune pancreatitis. A recurrent case after a 5-year history of spontaneous remission.

JOP — Thu, 09 Jul 2009 06:34:02 +0100

CONCLUSION: When we encounter fibrotic diseases of unknown etiology, we should measure serum IgG4 concentrations and monitor the disease activity over long periods even after achieving clinical remission. PMID: 19581751 [PubMed - in process] (Source: JOP)

Ulcerative colitis associated with IgG4 cholangitis: Similar features in two HLA identical siblings

Journal of Hepatology — Tue, 07 Jul 2009 23:00:00 +0100

Conclusion: Appropriate investigation for IBD-associated cholangitis is mandatory to identify IAC, the recognition of which has particular therapeutic and prognostic implications. (Source: Journal of Hepatology)

Chronic Fatigue Syndrome After Infectious Mononucleosis in Adolescents

PEDIATRICS — Sun, 28 Jun 2009 23:00:00 +0100

CONCLUSIONS: Infectious mononucleosis may be a risk factor for chronic fatigue syndrome in adolescents. Female gender and greater fatigue severity, but not reported steroid use during the acute illness, were associated with the development of chronic fatigue syndrome in adolescents. Additional research is needed to determine other predictors of persistent fatigue after infectious mononucleosis. (Source: PEDIATRICS)

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Host‐Related Risk Factors and Clinical Features of Community‐Acquired Legionnaires Disease Due to the Paris and Lorraine Endemic Strains, 1998–2007, France

Clinical Infectious Diseases Latest Issue — Fri, 19 Jun 2009 15:43:25 +0100

Conclusion. Several host characteristics were associated with the risk of infection by endemic strains of L. pneumophila serogroup 1. These findings may help to guide preventive measures. Factors predisposing patients to infection by specific strains need to be explored further. (Source: Clinical Infectious Diseases Latest Issue)

Non-invasive assessment of coronary flow reserve and ADMA levels: a case-control study of early rheumatoid arthritis patients

Rheumatology — Mon, 15 Jun 2009 04:00:00 +0100

Conclusions. Plasma ADMA levels were significantly higher in the ERA patients. A statistically significant negative effect of ADMA levels on CFR value was observed. The effect of ADMA levels on IMT is not significant. (Source: Rheumatology)

[PostScript] Are all pancreatic lesions responsive to steroid therapy in autoimmune pancreatitis?

Gut — Thu, 11 Jun 2009 04:00:00 +0100

(Source: Gut)

Forty Years of Publication of Transplantation Proceedings—The Second Decade: The Cyclosporine Revolution

Transplantation Proceedings — Sun, 31 May 2009 23:00:00 +0100

Abstract: With surgical tools in place, increased knowledge concerning immunogenetics and alloimmunity as well as improved management of immunocompromised patients, the foundations were lain for the rapid development of the transplantation enterprise. In contrast to pre-transplant conditioning by thoracic duct drainage or total lymphoid irradiation, which were too cumbersome for routine execution among the burgeoning recipient pool, cyclosporine was a facile method to produce immunosuppression de novo after transplantation. On the one hand, clinical data confirmed the potency of cyclosporine in a variety of clinical settings. On the other hand, a pleiotropic array of side effects, particularly nephrotoxicity, beclouded the regimens, even when used in reduced doses in combination with azath...

Delayed Onset of Contralateral Pulmonary Edema Following Reexpansion Pulmonary Edema of a Collapsed Lung After Video-assisted Thoracoscopic Surgery.

Acta Anaesthesiologica Taiwanica — Sun, 31 May 2009 23:00:00 +0100

Authors: Chang CY, Hung MH, Chang HC, Chan KC, Chen HY, Fan SZ, Lin TY This case report describes a 61-year-old man who developed reexpansion pulmonary edema (RPE) of the collapsed left lung after video-assisted thoracoscopic surgery because of left thoracic empyema, complicated with secondary contralateral pulmonary edema later. The left lung was gently reexpanded after surgery under one-lung ventilation anesthesia for 2.5 hours. The patient developed RPE of the left lung immediately after surgery, and required mechanical ventilation with positive end-expiratory pressure support. RPE was resolved within 24 hours. Nevertheless, delayed onset of contralateral pulmonary edema manifested on chest radiography 4 days later without clinical symptoms such as tachypnea or dyspnea. There was no...

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[A case of autoimmune pancreatitis combined with extensive involvement of biliary tract.]

Korean J Gastroenter... — Sun, 31 May 2009 23:00:00 +0100

We report a case of the patient with autoimmune pancreatitis combined with extensive involvement of extrahepatic and intrahepatic bile duct, which had a favorable response to steroid therapy. PMID: 19556847 [PubMed - in process] (Source: Korean J Gastroenter...)

Lupus nephritis.

The American Journal of the Medical Sciences — Sun, 31 May 2009 23:00:00 +0100

Authors: Singh S, Saxena R Lupus nephritis (LN) is one of the common manifestations of systemic lupus erythematosus. Kidney biopsy remains a mainstay of LN diagnosis, which is usually prompted by abnormal urinary sediment, proteinuria, or elevated creatinine. New International Society of Nephrology/Renal Pathology Society classification of LN tends to remove some of the ambiguities of World Health Organization classification and results in better categorization of patients. Although prognosis of LN has improved with the combined use of cytotoxic and steroid therapy, up to 20% of these patients progress to renal failure. Moreover, toxicity of the current regimens remains a major concern. Last few decades have seen a tremendous progress being made in understanding the pathogenesis of LN,...

Osteonecrosis of the jaw induced by oral administration of bisphosphonates in Asian population: five cases

Osteoporosis International — Sat, 30 May 2009 08:15:37 +0100

Conclusion Irrespective of race, elderly women undergoing steroid therapy have an increased incidence of BRONJ even with oral administration of bisphosphonate. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00198-009-0973-3Authors W. Park, Yonsei University Department of Oral and Maxillofacial Surgery and Human Identification Center, College of Dentistry 134 Shinchondong, Seodaemun-Gu 120-752 Seoul South KoreaN.-K. Kim, Yonsei University Department of Oral and Maxillofacial Surgery, College of Dentistry 134 Shinchondong, Seodaemun-Gu 120-752 Seoul South KoreaM.-Y. Kim, Yonsei University Department of General Dentistry, Dental Hospital Seoul South KoreaY.-M. Rhee, Yonsei University Department of Endocrinology, College of Medicine Seoul South KoreaH. J. Kim...

Fatal acute pancreatitis complicated by pancreatic pseudocysts in a patient with systemic lupus erythematosus

Rheumatology International — Sun, 24 May 2009 06:08:49 +0100

We report a case of a 39-year-old woman with previous SLE diagnose treated with prednisone and mycophenolate mofetil who developed an acute pancreatitis complicated by pancreatic pseudocysts within the context of a severe lupus flare. Elevated serum amylase and computerized tomography confirmed the diagnosis and mechanical obstruction or toxic-metabolic etiologies were ruled out. In the present case, we opted for the clinical surveillance of pancreatic pseudocyst and not perform invasive medical procedures to drainage. A steroid therapy was started in order to achieve SLE and pancreatitis remission, however, it was unable to avoid the development of multiorgan failure and patient died a few days after diagnosis was made. Content Type Journal ArticleCategory Case ReportDOI 10.1007/...

Serial Neuroimaging in Tolosa-Hunt Syndrome with Acute Bilateral Complete Ophthalmoplegia

Journal of Neuroimaging — Tue, 19 May 2009 04:00:00 +0100

We describe the first such patient with bilateral THS that responded quickly to corticosteroid therapy. A 54-year-old man presented with a periorbital and frontal headache with acute bilateral severe blepharoptosis and fixed eyes, which dramatically responded to corticosteroid therapy. He had diabetes mellitus type II. Brain MRI showed granulomatous inflammation in both cavernous sinuses and thickening of the surrounding dura mater of the cranial base, suggesting the coexistence of focal hypertrophic cranial pachymeningitis. Our experience indicates that steroid therapy with strict control of blood sugar should be considered in patients with THS complicated by diabetes. MRI is a valuable tool for serially monitoring the response of lesions to treatment in THS. J Neuroimaging 2009;XX:1[ndas...

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Is steroid therapy enough to reverse complete atrioventricular block after percutaneous perimembranous ventricular septal defect closure?.

Journal of Cardiovascular Medicine — Fri, 15 May 2009 06:57:53 +0100

Page: 412DOI: 10.2459/JCM.0b013e32832401c2Authors: Butera, Gianfranco; Gaio, Gianpiero; Carminati, Mario (Source: Journal of Cardiovascular Medicine)

Low-density lipoprotein apheresis in a pediatric patient with refractory nephrotic syndrome due to focal segmental glomerulosclerosis

Journal of Anesthesia — Fri, 15 May 2009 06:10:57 +0100

Abstract Focal segmental glomerulosclerosis (FSGS) often leads to refractory nephrotic syndrome (NS). A high level of low-density lipoprotein (LDL) is a risk factor for the progression of NS. An 8-year-old girl presented with severe proteinuria refractory to steroid therapy. She was diagnosed with non-IgA diffuse mesangial proliferative glomerulonephritis. Oral prednisolone, methylprednisolone (mPL) pulse therapy, and cyclosporine and cyclophosphamide therapy failed to achieve remission. Follow-up renal biopsy revealed FSGS. Her serum level of LDL was high, and LDL-apheresis (LDL-A) was performed five times, followed by mPL pulse therapy. Urinary protein decreased from 2–4 g·day− to 0.5–1.0 g·day−. LDL-A may be beneficial in the treatment of multidrug-resistant FS...

Maintenance Steroid Therapy for Kidney Recipients—Not Ready for Relegation

American Journal of Transplantation — Wed, 13 May 2009 04:00:00 +0100

(Source: American Journal of Transplantation)

Autoimmune pancreatitis/IgG4-associated cholangitis and primary sclerosing cholangitis – Overlapping or separate diseases?

Journal of Hepatology — Mon, 11 May 2009 23:00:00 +0100

Autoimmune pancreatitis is a recently described fibroinflammatory disease which is characterised by raised serum levels of IgG4 (in >70% of cases), and an IgG4-positive lymphoplasmacytic tissue infiltrate. A favourable and rapid clinical response to oral steroid therapy is often seen. Biliary involvement is common, and the term IgG4-associated cholangitis has recently been coined. The cholangiographic appearances of IgG4-associated cholangitis and primary sclerosing cholangitis can be difficult to differentiate. Moreover, raised levels of serum IgG4 have been recently found in 9% of patients with primary sclerosing cholangitis (a much higher frequency than for other gastrointestinal diseases), and those with raised levels appear to progress more rapidly to liver failure. Here we review the...

Stroke in an adult with HIV infection due to carotid artery stenosis successfully treated with steroids: HIV-associated arteritis?

Journal of Neurology — Wed, 06 May 2009 05:56:44 +0100

Abstract A 33-year-old Caucasian man with a 17-year history of HIV infection developed sudden right-sided hemiplegia, with the arm more affected than the leg, and aphasia. Magnetic resonance imaging of the brain showed hemodynamic watershed stroke between the anterior and middle cerebral artery territories and an ischemic stroke within the left posterior middle cerebral artery territory. Color-coded Duplex sonography and Doppler sonography revealed hypoechogenic stenosis of the left common carotid artery, the left internal carotid artery, left external carotid artery and right internal carotid artery. An extensive diagnostic workup led us to hypothesize that HIV-associated arteritis was the cause of the stroke, and following intravenous steroid therapy, the carotid artery ...

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Steroid utilization in eosinophilic jejunitis: beneficial or harmful?

Langenbeck's Archives of Surgery — Wed, 06 May 2009 05:52:51 +0100

Conclusion Recent data suggest that eosinophils may directly damage the gastrointestinal tract wall in eosinophilic gastroenteritis. A few limited literatures about this disease strongly recommends steroid therapy for treatment. Furthermore, beneficial or harmful effects of steroids in eosinophilic jejunitis and its treatment details are discussed and reviewed. Content Type Journal ArticleCategory Case Management and Clinical ConsequencesDOI 10.1007/s00423-009-0501-0Authors Cemil Caliskan, Ege University School of Medicine Department of General Surgery, Division of Proctology Bornova 35100 Izmir TurkeyOzgur Fırat, Ege University School of Medicine Department of General Surgery, Division of Proctology Bornova 35100 Izmir TurkeyAvni Can Karaca, Ege University School of...

Reversible Loss of Pre-excitation as a Sign of Acute Cardiac Rejection

The Journal of Heart and Lung Transplantation — Thu, 30 Apr 2009 23:00:00 +0100

A 50-year-old woman presented with signs of mild heart failure 16 months after orthotopic heart transplantation. Cardiac biopsy revealed ISHLT Grade 2R rejection, which was treated with corticosteroids. Electrocardiograms (ECGs) after transplantation showed a pre-excitation pattern; the presenting ECG showed complete loss of pre-excitation, which returned fully within 7 days of steroid therapy. Intermittent pre-excitation had been present for 4 weeks prior to any other clinical sign of rejection. Accessory pathways can display reversible loss of function during acute cellular rejection, and this may precede other clinical signs. This rare but significant finding may have clinical relevance to other transplanted patients with pre-excitation. (Source: The Journal of Heart and Lung Transplant...

Tracheal amyloidosis-an unusual cause of stridor.

Ear, Nose and Throat Journal — Thu, 30 Apr 2009 23:00:00 +0100

We describe the case of a 63-year-old man who presented with a history of dysphonia and stridor. Rigid bronchoscopy revealed a segment of abnormal tissue at the midtracheal level, resembling granulation tissue. A stent was placed in an attempt to secure the patient's airway, which was >50% narrowed. Although the patient's stridor disappeared completely, 5 days postoperatively it recurred, worsening within hours. Emergency bronchoscopy revealed that the tracheal stent was almost completely obstructed with amyloid and granulation tissue, despite high-dose steroid therapy, and had to be removed. Tracheostomy was performed to bypass the diseased trachea. We also highlight some of the problems encountered with tracheal stenting in benign tracheal disease. PMID: 19444779 [PubMed - in proc...

Hip fracture in a patient affected by transient osteoporosis of the femoral head during the last trimester of pregnancy.

Orthopedics — Thu, 30 Apr 2009 23:00:00 +0100

This article describes the case of a 35-year-old woman with a sudden onset of bilateral hip pain during the last trimester of her first pregnancy; she had neither history of steroid therapy nor alcohol abuse; her body temperature and serological parameters were normal. Bilateral transient osteoporosis of the femoral heads was suspected and confirmed by magnetic resonance imaging. Fifteen days postpartum, she was admitted to our clinic with a displaced femoral neck fracture. A cementless total hip arthroplasty was performed to quickly begin a rehabilitative program. She underwent antiresorptive therapy with alendronic acid 70 mg/week and vitamin D for 3 months. Three months after the fracture, a dual-energy x-ray absorptiometry scan showed osteopenia (T-score, -1.5). Risedronic acid 35 mg/w...

Quality of Care for Common Pediatric Respiratory Illness in United States Emergency Departments: Analysis of 2005 National Hospital Ambulatory Medical Care Survey Data: Knapp JF, Simon SD, Sharma V. Pediatrics 2008;122:1165–70

The Journal of Emergency Medicine — Wed, 29 Apr 2009 01:10:28 +0100

This study from Children's Mercy Hospitals in Kansas City, Missouri retrospectively measured United States (US) Emergency Department (ED) performance in the care of pediatric asthma, bronchiolitis, and croup (based on adherence to published guidelines for all three conditions) at a representative sample of hospitals using 2005 National Hospital Ambulatory Medical Care Survey data. The database employs standardized survey forms to collect data from patient visit records from 352 eligible EDs. For this study, 950,000 cases of asthma, bronchiolitis, or croup were evaluated. Of the 405,000 visits for asthma, 69% received steroids in the ED, 29% received antibiotics or a prescription for antibiotics, and 48% received radiographs in the ED. Steroid prescriptions were issued in 46% of patients wi...

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Pr03steroid therapy for problematic proliferating haemangioma

ANZ Journal of Surgery — Mon, 27 Apr 2009 04:00:00 +0100

Conclusion: Intralesional and systemic steroid are relatively safe and effective in treating problematic proliferating haemangioma. Systemic steroid therapy is associated with few short-term side effects, hence a multidisciplinary management is essential. (Source: ANZ Journal of Surgery)

Pr53ptreatment of problematic proliferating haemangioma with propranolol

ANZ Journal of Surgery — Mon, 27 Apr 2009 04:00:00 +0100

Conclusion: Accelerated regression is observed in 2 infants with problematic haemangioma following Propranolol therapy with no observed side effect. The possible mechanism of action of beta-blocker on cell proliferation is discussed. (Source: ANZ Journal of Surgery)

Management of conjunctival chemosis secondary to imatinib treatment for chronic myelogenous leukemia

Leukemia Research — Fri, 24 Apr 2009 13:41:15 +0100

Ocular side effects are very common complaints among patients receiving imatinib therapy, with up to 70% of patients experiencing mild to moderate periorbital edema at the doses of 400mg or higher. But the conjunctiva chemosis associated with imatinib mesylate is relatively rare . Here we report that severe conjunctival chemosis secondary to imatinib treatment can be managed by concomitant oral short-term steroid therapy without discontinuation of imatinib. (Source: Leukemia Research)

Med Sci Monit 2009; 15(5):PI19-26 "Azathioprine therapy in steroid-dependent patients with Crohn disease: Results of a 10-year longitudinal follow-up study"

Medical Science Monitor — Thu, 23 Apr 2009 13:55:00 +0100

Conclusions: Azathioprine therapy offers a meaningful option in the management of steroid-dependent Crohn’s disease for up to 10 years. A persistent decrease in leukocyte count may provide a surrogate marker of sustained steroid-free response. (Source: Medical Science Monitor)

Immune-mediated liver dysfunction after antiviral treatment in liver transplanted patients with hepatitis c: Allo or autoimmune de novo hepatitis?

Digestive and Liver Disease — Tue, 21 Apr 2009 08:47:49 +0100

Conclusions: Following liver transplantation, antiviral therapy with pegylated-interferon α-2a and ribavirin for recurrent hepatitis C may be associated, in a few patients, with severe immune-mediated graft dysfunction similar to autoimmune hepatitis. (Source: Digestive and Liver Disease)

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Psoriasis Associated with Diabetes and High Blood Pressure in Women

Diabetes News from dLife.com — Mon, 20 Apr 2009 04:00:00 +0100

April 20, 2009 (EurekAlert) - Women with psoriasis appear to have an increased risk for developing diabetes and hypertension (high blood pressure), according to a report in the April issue of Archives of Dermatology, one of the JAMA/Archives journals. Psoriasis, a chronic inflammatory skin disease, affects between 1 percent and 3 percent of the population, according to background information in the article. Recent studies indicate that psoriasis is associated with an increased risk of other illnesses and death. "Systemic inflammation in psoriasis and an increased prevalence of unhealthy lifestyle factors have been independently associated with obesity, insulin resistance and an unfavorable cardiovascular risk profile," the authors write. Abrar A. Qureshi, M.D., M.P.H., of Brigham and ...

Single Incision Laparoscopic Splenectomy: The First Two Cases

Journal of Gastrointestinal Surgery — Tue, 14 Apr 2009 05:48:45 +0100

Conclusion Although there were some procedures performed with single incision technique like cholecystectomy, prostatectomy, and partial nephrectomy, as far as we are concerned this is the first report about laparoscopic splenectomy performed with single incision surgery technique. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s11605-009-0869-8Authors Umut Barbaros, Istanbul University Department of General Surgery, Istanbul Faculty of Medicine Capa Istanbul TurkeyAhmet Dinççağ, Istanbul University Department of General Surgery, Istanbul Faculty of Medicine Capa Istanbul Turkey Journal Journal of Gastrointestinal SurgeryOnline ISSN 1873-4626Print ISSN 1091-255X (Source: Journal of Gastrointestinal Surgery)

In ataxia-teleangiectasia betamethasone response is inversely correlated to cerebellar atrophy and directly to antioxidative capacity

European Journal of Neurology — Thu, 02 Apr 2009 04:00:00 +0100

Conclusion: We suggest that antioxidative mechanisms play a role in favouring the improvement of cerebellar functions observed in A-T patients receiving a short-term betamethasone trial. (Source: European Journal of Neurology)

Treatment of osteoporosis/osteopenia in pediatric leukemia and lymphoma.

The Annals of Pharmacotherapy — Wed, 01 Apr 2009 04:00:00 +0100

CONCLUSIONS: The clinical trials published to date are limited to only a few conducted in small populations of patients diagnosed with lymphoblastic leukemia or non-Hodgkin's lymphoma. However, alendronate and pamidronate both appeared to be effective options in improving bone mineral density scores with minimal adverse effects. PMID: 19336653 [PubMed - in process] (Source: The Annals of Pharmacotherapy)

Twenty years' experience of steroids in infantile hemangioma—a developing country's perspective

Journal of Pediatric Surgery — Wed, 01 Apr 2009 04:00:00 +0100

Conclusion: Steroid therapy either oral or intralesional as per the requirement is an easy and safe modality. Results are good to satisfactory in most patients. The complications are minimal. If treatment is needed, it should be used as a first-line therapy, especially when cost is an important concern. (Source: Journal of Pediatric Surgery)

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Management of allergic fungal sinusitis with postoperative oral and nasal steroids: a controlled study.

Ear, Nose and Throat Journal — Tue, 31 Mar 2009 23:00:00 +0100

Authors: Ikram M, Abbas A, Suhail A, Onali MA, Akhtar S, Iqbal M In patients with allergic fungal sinusitis, the mainstay of treatment remains surgical removal of allergic mucin and fungal debris. But as a single modality, surgery is associated with high rates of recurrence, so a number of adjunctive medical modalities have been tried, including postoperative corticosteroid therapy. We conducted a study of 63 patients with allergic fungal sinusitis who underwent endoscopic sinus surgery with or without postoperative steroid therapy. A group of 30 patients who had been treated prior to January 2000 had undergone surgery only; their cases were reviewed retrospectively, and they served as historical controls. Another 33 patients who were treated after June 2000 underwent surgery plus oral...

[A patient diagnosed as autoimmune pancreatitis 6 years after onset of jaundice]

Korean J Gastroenter... — Tue, 31 Mar 2009 23:00:00 +0100

In this report, we describe a 62-year-old woman diagnosed as autoimmune pancreatitis six years after onset of jaundice, who presented with uncontrolled blood glucose levels. The laboratory tests revealed obstructive jaundice, and the computed tomography of the pancreas showed pancreatic swelling. After six years of onset, she was diagnosed with AIP and successfully treated with steroid treatment. PMID: 19381060 [PubMed - in process] (Source: Korean J Gastroenter...)

[Churg-Strauss syndrome presenting with cutaneous vasculitis]

Acta Reumatologica Portuguesa — Tue, 31 Mar 2009 23:00:00 +0100

Authors: Lestre S, Serrão V, João A, Pinheiro S, Lobo L Churg-Strauss syndrome (CSS), also known as allergic granulomatous angiitis, is a rare disorder characterized by the presence of asthma, eosinophilia and small-to-medium sized vessels vasculitis. Vasculitis commonly affects lung, heart, skin and peripheral nerves. The authors report a case of a 47-year-old woman that was admitted with a 1-week history of painful purpuric lesions affecting extensor surfaces of lower extremities. She had a 7 years-long medical history of asthma, paranasal sinusitis and allergic rhinitis. Laboratorial tests revealed leucocytosis, peripheral blood eosinophilia and elevated inflammatory parameters. Antineutrophil cytoplasmic antibodies were negative. Skin biopsy was consistent with necrotizin...

Thiopurines, a previously unrecognised cause for fatigue in patients with inflammatory bowel disease

Journal of Critical Care — Mon, 30 Mar 2009 23:00:00 +0100

Conclusions: Marked fatigue is a previously unrecognized adverse effect of thiopurines. It does not appear to be drug-specific. Its onset might be masked by concurrent steroid therapy. (Source: Journal of Critical Care)

Quiz Page April 2009: Kidney Failure, Gross Hematuria, and Hemoptysis in a Diabetic Man Undergoing Treatment for Non-Hodgkin Lymphoma

American Journal of Kidney Diseases — Sat, 28 Mar 2009 04:09:08 +0100

A 57-year-old man presented with a 1-week history of coughing up blood and darkening of the urine. The patient developed a dry hacking cough 1 month before the current presentation. He denied fever, chills, night sweats, or weight loss. His medical history was significant for rheumatoid arthritis treated with prednisone, 5 mg/d; non-Hodgkin lymphoma, for which he was recently treated with 5 cycles of cyclophosphamide, hydroxydaunorubicin, vincristine, prednisone, and rituximab; hypothyroidism; type 1 diabetes mellitus with insulin therapy; and vitiligo. Vital signs were normal, and physical examination was significant for bilateral dependent pulmonary crackles. Urinalysis showed blood, but no protein, and sediment evaluation showed numerous red blood cells (RBCs) without casts. Blood work ...

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Fatal Aspergillus brain abscess in immunocompetent patient

Neurological Sciences — Fri, 27 Mar 2009 06:52:23 +0100

We report a case of fatal brain abscess in an immunocompetent patient with a previous diagnosis of acute disseminated encephalomyelitis (ADEM) in whom a high-dose steroid course has probably contributed to the development of the fungal infection. Despite steroids’ relative safety, clinicians must remain alert to potential fatal complication that could arise from their use. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s10072-009-0049-3Authors Marcella Curone, Neurological Institute Foundation C. Besta Neuroscience Department 20133 Milan ItalyDomenico D’Amico, Neurological Institute Foundation C. Besta Neuroscience Department 20133 Milan ItalyElio Maccagnano, Neurological Institute Foundation C. Besta Neuroscience Department 20133 Milan ItalyGennaro Bussone, Neurol...

Bisphosphonates are not associated with vertebral osteonecrosis

Journal of Bone and Mineral Metabolism — Fri, 27 Mar 2009 06:49:50 +0100

Abstract Intravertebral clefts are considered markers for osteonecrosis. We tested the hypothesis that bisphosphonate therapy was associated with vertebral osteonecrosis. A retrospective review of a vertebroplasty database was performed. Exposure to, duration of, and type of bisphosphonate therapy was documented. Radiographs were reviewed to identify intravertebral gas-filled or fluid-filled clefts, which are considered a marker for vertebral osteonecrosis. Proportion of patients with and without clefts was compared between the group exposed to bisphosphonates and the unexposed group using Chi-squared test. Duration of bisphosphonate exposure was compared between patients with and without clefts using Student's t-test. After exclusion of 16 patients with malignancy and 21 w...

Systemic Lupus Erythematosus Presenting with Leukocytoclastic Vasculitis and Seizure during Pregnancy

American Journal of Perinatology — Fri, 27 Mar 2009 02:42:32 +0100

Amer J PerinatolDOI: 10.1055/s-0029-1214241ABSTRACTSystemic lupus erythematosus (SLE) is a rare multisystem disease with a wide array of presentation and is a diagnostic challenge during pregnancy. A 20-year-old gravida 1 at 39 weeks' gestation was referred to our hospital for elevated blood pressure, headache, and history of seizure. She was admitted with the impression of severe preeclampsia. Intravenous magnesium sulfate for seizure prophylaxis and oxytocin for induction of labor were started. Primary lower-segment cesarean section was performed for nonreassuring fetal heart tracing. The postoperative course was complicated with fever requiring prolonged intravenous antibiotic therapy, appearance of violaceous skin lesions on the periungual areas of fingers and toes, recurrent seizures,...

Relationship between free T4 levels and postnatal steroid therapy in preterm infants

Pediatrics International — Fri, 20 Mar 2009 00:00:00 +0100

Background: Transient hypothyroxinemia is the most common thyroid dysfunction in preterm infants. Hypothalamic[ndash]pituitary[ndash]thyroid immaturity and non-thyroidal illness contribute to its etiology. The aim of the present study was therefore to determine the relationship between thyroid hormone status and early postnatal steroid therapy in preterm infants.Methods: A prospective study of premature infants born at (Source: Pediatrics International)