The Topical and Systemic Use of Corticosteroids in the Treatment of Skin Disease

Branhamella catarrhalis, one of the normal respiratory tract flora, has been increasingly recognized as a lower respiratory tract pathogen, particularly affecting immunocompromised patients and patients with chronic lung disease. The authors trace the history of this pathogen and discuss when to suspect B catarrhalis infection, how to identify the organism, and which antibiotics to choose for treatment.     

用EDSS系统评价多发性硬化急性期糖皮质激素疗效

目的 :采用EDSS评分系统评价多发性硬化急性期糖皮质激素治疗的疗效。方法 :采用Kurtzke的EDSS评分标准 ,对 1 2 1例多发性硬化急性期患者 ,分别用甲基强的松龙和地塞米松进行治疗 ,用EDSS评分标准对不同治疗组治疗前后患者的锥体、小脑、脑干、感觉、膀胱及直肠、大脑 6项神经功能进行EDSS评分 ,同时比较了两组病人住院治疗的时间及治疗经费。结果 :采用EDSS评价 ,甲基强的松龙在改善神经功能、缩短病程方面 ,明显优于地塞米松 (P <0 0 5 )。而在治疗经费方面 ,两组间无显著性差异 (P >0 0 5 )。结论 :甲基强的松龙能较快地促进神经功能恢复 ,缩短病程 ,减少病人住院时间 ,同时也就相应地节约了患者的治疗费用 ,疗效明显优于地塞米松     

Corticosteroids in asthma

The use of corticosteroids in the treatment of asthma has significantly decreased the morbidity and mortality from this disease. However, corticosteroids have devastating side effects when given frequently or for prolonged periods. High doses of systemic corticosteroid preparations should be used only during bouts of acute bronchospasm, whereas the lowest possible dose needed to control symptoms is recommended for the treatment of chronic asthma. Aerosolized steroids offer an alternative to systemic preparations and have less associated morbidity. Various corticosteroid preparations have various potencies and durations of action that need to be considered. Patients with coexisting liver disease require preparations that do not need hepatic hydroxylation, whereas patients with congestive heart failure require preparations that minimize salt retention. When asthma and pregnancy coexist, it is vital that symptoms of bronchospasm are controlled to protect the fetus. During stressful situations, such as surgery, it is important to consider the possibility of hypothalamic-pituitary-adrenal axis suppression if the asthmatic patient has been previously treated with corticosteroids.     

Corticosteroids in organ transplantation

This chapter presents an organ-by-organ review of immunosuppression use, especially focuses on corticosteroids use. In response to concerns about the adverse effects associated with steroid-based regimen increases, many transplant recipients are being taken off corticosteroids as a maintenance therapy or not being given it in the first place. Corticosteroids were still administered to the majority of patients, though regimens of steroid avoidance and steroid withdrawal have been increasing in use. As the number of available choices expands, the mosaic of the practice of immunosuppression in transplantation becomes more textured. This chapter reviews and describes a number of these trends, including the increased application of corticosteroid avoidance and withdrawal, the evolution towards tacrolimus-centered immunosuppression, and the emerging use of basiliximab.     

Corticosteroids in the treatment of asthma

Corticosteroid medications have been regularly used in the management of asthma for more than 30 years. Review of the published literature suggests that steroids may enhance sensitivity to beta-adrenergic agonists and reduce local inflammation. These effects may not be clinically evident for six to 12 hours after steroid administration. Optimum dose, dose forms, and the role of plasma levels remain to be determined. Iatrogenic side effects, notably cushingoid features and hypothalamic-pituitary-related adrenal suppression, are dose-related and may be minimized with alternate-day regimens or the use of inhaled beclomethasone dipropionate. Beclomethasone may facilitate weaning from systemic corticosteroid therapy but usually cannot replace systemic therapy unless the daily dose is less than 20 mg of prednisone or its equivalent. Weaning should be undertaken cautiously, using objective measurements of pulmonary function, to reach a goal of the lowest daily dose consonant with control of symptoms, rather than complete withdrawal.     

Experimental Prescribed Burn In Radiata Pine

A prescribed burn of low intensity was carried out in a 23-year-old plantation of radiata pine (Pinus radiata D. Don). The burn reduced the fine fuel from 3.6 to 2.6 tons per acre, and it was a satisfactory hazard-reduction measure.

Infiltration rates were determined before and after the fire by applying artificial rainfall, at the rate of 80 points in 15 minutes, to run-off plots which were 60 square feet in area.

The infiltration rates were not significantly altered by the fire, and no soil loss occurred before or after burning.

Losses of calcium, potassium and sodium in the run-off water from the first artificial rainfall after the fire were significantly increased by the burning. Nutrient losses in the run-off water from a second artificial rainfall after the fire were significantly lower than from the first.

These results are considered in relation to prescribed burning of plantation areas.     

Topical analgesics

Our knowledge and understanding of the pathophysiology and treatment of pain is increasing; however, we should not lose sight of the simple opportunities that exist for intercepting pain at peripheral targets. Although systemic medication often has peripheral and central modes of action, the appeal for provision of medication close to where these peripheral targets exist should be high. If these sites can be attacked with relatively high concentrations of active drug while keeping systemic levels of that drug below the level at which systemic side effects become apparent, then this should lead to desirable outcomes. Even though the number of true topical agents with an indication for this use is small, a number of other topical agents are available that evidence suggests have the possibility of being effective. Given the increased understanding of pain, the likelihood of further topical agents becoming available is high.