曲安奈德注射加针刀松解治疗肩周炎

目的:探索治疗肩周炎的重要方法.方法:应用曲安奈德40 mg、2%利多卡因5ml行痛点注射,再利用针刀松解后手法活动肩关节.1～2周后可重复.结果:本组治疗157例,治愈126例(80.25%),显效27例(17.20%),好转4例(2.55%),无效0例(0),总有效率达到100.00%.结论:曲安奈德注射加针刀松解治疗肩周炎是一种特别有效的重要方法.安全可靠,临床操作方便.     

曲安奈德联合鼠神经生长因子治疗眶下壁骨折后眶下神经损伤

目的：评价局部应用曲安奈德联合鼠神经生长因子治疗眶下壁骨折后眶下神经损伤的临床疗效。

方法：前瞻性分析南昌大学附属眼科医院2020-04/2021-02接受眶下壁骨折整复术的眶下壁骨折患者43例43眼。患者随机分为两组,其中试验组20例20眼术中将浸润曲安奈德和鼠神经生长因子的明胶海绵放置于神经损伤处; 对照组23例23眼术中无特殊处理。术后随访6mo,通过定量感觉测试(两点定位觉、痛觉、触觉)比较患侧和健侧下睑区的测试结果,结果以不对称指数(AI)表示。

结果：基线结果显示,两组性别、年龄、受伤时间、术前两组间感觉测试无差异(均P>0.05)。两组患者术后1wk的两点定位觉、触觉、痛觉AI值均较术前升高(均P<0.05),感觉障碍症状加重; 术后1mo不同程度改善,术后3mo痛觉有差异(P<0.05); 术后6mo两点定位觉、触觉、痛觉均较治疗前明显改善(均P<0.01)。术后1mo,两组间两点定位觉、痛觉有差异(t=-2.082、-2.143,P=0.044、0.038); 术后3mo,两组间痛觉有差异(t=-2.118,P=0.04); 术后6mo,两组间定量感官测试无差异(P>0.05)。

结论：局部应用曲安奈德联合鼠神经生长因子治疗眶下壁骨折后的眶下神经损伤早期内恢复效果良好,优于术中无特殊处理组。     

The use of intraocular corticosteroids

Background: Diabetic macular edema (DME), cystoid macular edema (CME), age-related macular degeneration (AMD), retinal vascular occlusion (RVO) and uveitis are responsible for severe visual impairment worldwide. In some patients with these conditions, treatment with intraocular corticosteroids may be beneficial. Although off-label use of these agents has occurred for many years, novel agents including preservative-free and sustained-release intravitreal implants are currently being studied in clinical trials (CTs). Objective: To review the use of intraocular corticosteroids. Methods: Literature review. Results: Used alone, intravitreal corticosteroids may benefit disorders such as DME, RVO and uveitis compared with standard therapy or observation. Patients with AMD may benefit more from combination treatment with photodynamic therapy, intravitreal corticosteroid and intravitreal anti-VEGF injections. Intraoperative use of these agents may assist in visualization and manipulation of fine retinal structures. Sustained-release intraocular implants have been approved for severe posterior uveitis, and have shown benefits in ongoing CTs. Conclusion: Although intraocular corticosteroid injections have a limited duration of action requiring frequent re-treatment, and significant side effects including cataract and glaucoma development, intraocular injections may be of benefit in certain ocular disorders. Corticosteroid implants are emerging as potential treatments for macular edema due to uveitis, DME or RVO.     

Nocardia asteroides Necrotizing Scleritis Associated with Subtenon Triamcinolone Acetonide Injection

Purpose: To report a case of Nocardia asteroides infection after subtenon triamcinolone acetonide injection. Design: Case report. Results: An 80-year old female received a subtenon triamcinolone acetonide injection for postcataract surgery cystoid macular edema. Shortly after, the patient developed a chronic red eye that progressed to a fulminant necrotizing scleritis. Eventual scleral biopsy revealed Nocardia asteroides infection, which improved after 5 months of systemic antibiotic therapy. Conclusions: Subtenon triamcinolone acetonide injection should be recognized as a cause of serious infectious scleritis.     

Clinical behaviour and long‐term therapeutic response in orofacial granulomatosis patients treated with intralesional triamcinolone acetonide injections alone or in combination with topical pimecrolimus 1%

Background: Orofacial granulomatosis (OFG) is a relapsing inflammatory disorder of unknown aetiology and non‐standardized treatment protocols. The aim of this study was to assess the clinical behaviour and long‐term therapeutic response in OFG patients treated with intralesional triamcinolone acetonide (TA) injections alone or in combination with topical pimecrolimus 1%, as adjuvant, in those patients partially responders to TA. Methods: We analysed data from 19 OFG patients followed‐up for 7 years. Demographic characteristics, clinical behaviour and long‐term therapeutic response were investigated. Results: Eleven (57.9%) OFG patients treated with intralesional TA injections therapy reached first complete clinical remission in a mean time of 10 ± 2.2 (95% CI, 8.5–11.5) weeks, while eight (42.1%) patients, partially responders to intralesional TA injections, were treated with TA injections plus topical pimecrolimus 1%, as adjuvant, achieving complete clinical remission in a mean time of 29.8 ± 7.8 (95% CI, 23.2–36.3) weeks. Relapses occurred in four TA responder patients with a disease‐free time of 35.8 ± 8.7 (95% CI, 21.9–46.4) weeks and in five patients treated with TA and topical pimecrolimus 1% with a disease‐free time of 55.8 ± 18.5 (95% CI, 32.8–78.8) weeks. Patients were followed‐up for a mean time of 56.3 ± 18.2 (95% CI, 47.6–65.1) months. At last control, all 19 patients were in complete clinical remission. Conclusion: These preliminary data suggest that intralesional TA injections still represent a mainstay in the treatment of OFG. It is unclear the role of topical pimecrolimus, as adjuvant, in leading OFG patients, partly responders to intralesional TA injections, to a complete clinical remission.     

康宁克通局部注射治疗阴茎硬结症10例疗效分析

目的 探讨康宁克通（Triamcinolone Acetonide）及维生素E治疗阴茎硬结症的效果。方法 10例阴茎硬结患者应用康宁克通局部注射并口服维生素E。结果 10例阴茎硬结症8例完全治愈，2例多发性阴茎绵体硬结症经第一疗程注射治疗半年后复发，经第二疗程注射治疗治愈，随访半年无复发，2例多发性阴茎海绵体硬结治疗后变软，缩小，未完全消失，但有治疗效果。总有效率达100％，治愈率80％。结论 康宁克通局部注射加用维生素E口服治疗阴茎硬结症，效果满意，值得推广。     

Long-Term Safety of a Non-Chlorofluorocarbon- Containing Triamcinolone Acetonide Inhalation Aerosol in Patients with Asthma

In response to environmental concerns regarding chlorofluorocarbon (CFC), two new triamcinolone acetonide (TAA) inhalation aerosol (Azmacort Inhalation Aerosol) formulations have been developed using a more environmentally favorable propellant, HFA-134a (1,1,1,2-tetrafluoroethane). This multicenter, open-label study evaluated the safety of switching asthma patients from TAA-CFC to one of two TAA-HFA formulations. After a 2- or 4-week baseline period during which patients received only CFC-containing TAA Inhaler, 552 patients were randomized to receive TAA-HFA 75 or 225 μg for 6 or 12 months. A total of 493 patients completed treatment. Seven patients discontinued because of adverse events and two because of ineffective asthma control. The incidence of adverse events was similar in the two treatment groups, and most events were mild to moderate in severity and were not considered related to study medication. No clinically relevant suppression of the hypophyseal-pituitary-adrenal (HPA) axis was observed. Pulmonary function tests were not adversely affected by use of either study medication, and improvements were noted in forced expiratory volume in 1 sec (FEV₁) and forced expiratory flow between 25% and 75% of forced vital capacity (FEF_25%-75%) throughout the course of treatment. This study confirms that TAA-HFA provides effective, long-term asthma control and can safely be substituted for the currently marketed CFC-containing TAA product.     

Topical formulations of fluocinolone acetonide

The study was done in healthy volunteers to investigate the vasoconstrictor activity of three commercially available formulations of fluocinolone acetonide (Synalar gel, cream and ointment) and to determine whether they were bioequivalent. The influence of dilution of the cream formulation on activity was also examined.Twenty mg of each topical formulation was applied, followed by occlusion for 6 h, and the potency was evaluated by measuring the vasoconstrictor effect using tristimulus colour analysis.The cream formulation was more potent than the ointment, with the gel having intermediate strength. Dilution did not significantly reduce activity.While choice of an appropriate topical corticosteroid formulation largely depends on the nature of the lesions, this study has shown that different formulations of nominally the same concentration have different potencies; dilution up to 1 in 10 produced no significant reduction in potency. The potency classification in the British National Formulary for formulations of Synalar may need revision.     

神经阻滞与经皮电刺激治疗颈源性头痛的对照研究

目的 :评价神经阻滞和经皮中频电刺激治疗颈源性头痛 (cervicogenicheadache,CEH)的效果。方法 :42例CEH患者行枕神经 +颈椎旁神经曲安奈德阻滞治疗1～3次 ;45例经皮中频电刺激对同部位治疗7天。结果 :神经阻滞组平均治疗 (1 88±1 10)次 ,其中有33(78 57 % )例和中频电刺激组平均治疗 (7 76±2 47)次 ,其中有10(22 22 % )例头痛完全解除。视觉模拟评分 (VAS)分别平均为1 02±1 37和3 31±1 62。两组对比差异显著 (P<0.01)。结论 :用曲安奈德神经阻滞治疗CEH优于同部位经皮中频电刺激     

鼓室内注射康宁克通—A治疗分泌性中耳炎

目的 :探讨鼓室内注射康宁克通 -A治疗分泌性中耳炎的效果。方法 :回顾分析鼓室内注射康宁克通 -A治疗分泌性中耳炎 2 0例、2 1耳的疗效。结果 :治疗后症状消失 ,耳检查均示正常 ,随访 1～ 2年未见复发。结论 :鼓室内注射康宁克通 -A治疗分泌性中耳炎简便易行 ,效果好