Combined glucocorticoid and antiviral therapy of hepatitis B virus-related liver failure

Acute hepatic failure due to hepatitis B virus(HBV)can occur both during primary infection as well as after reactivation of chronic infection.Guidelines recommend considering antiviral therapy in both situations,although evidence supporting this recommendation is weak.Since HBV is not directly cytopathic,the mechanism leading to fulminant hepatitis B is thought to be primarily immunemediated.Therefore,immunosuppression combined with antiviral therapy might be a preferred therapeutic intervention in acute liver failure in hepatitis B.Here wereport our favourable experience in three hepatitis B patients with fulminant hepatic failure who were treated by combining high-dose steroid therapy with standard antiviral treatment,which resulted in a rapid improvement of clinical and liver parameters.     

Steroid-induced recurrent myocardial ischemia

We report the case of a female patient under oral prednisolone therapy due to a diagnosis of idiopathic intracranial hypertension with papilledema. Unfortunately, short-term treatment with prednisolone caused an unusual complication in the patient, i.e., recurrent myocardial ischemia. Possible mechanisms leading to this complication were evaluated in the light of current knowledge.     

扁桃体切除术联合激素对IgA肾病的疗效评价

目的评价扁桃体切除术联合激素对IgA肾病的疗效。方法选取42例经肾活检诊断为IgA肾病患者,分为扁桃体切除术联合激素治疗组24例和单用激素治疗组18例。经12个月治疗后,评估扁桃体切除联合激素治疗方法对IgA肾病的疗效。结果经过12个月的治疗,尿蛋白转阴率联合治疗组为79.2%,高于单用激素治疗组的44.4%(P=0.020),尿潜血转阴率联合治疗组为75.0%,高于单用激素治疗组的16.7%(P0.001),尿异常转阴率联合治疗组为62.5%,高于单用激素组的16.7%(P=0.003)。结论扁桃体切除联合激素治疗对IgA肾病具一定疗效。     

泼尼松龙联合氯己定对口腔溃疡大鼠黏膜活性氧水平的影响

目的探讨泼尼松龙联合氯己定对口腔溃疡大鼠症状的改善作用及黏膜活性氧水平的影响。方法口腔溃疡大鼠模型通过石碳酸烧灼口腔黏膜制备,并随机分为对照组和研究组,两组均给予氯己定治疗,仅研究组加用泼尼松龙,分析两组治疗后2周的症状改善情况并检测治疗1 d、3 d、7 d及14 d的黏膜活性氧水平。结果①研究组的治疗总有效率高于对照组(P<0.05),显效例数多于对照组(P<0.01),无效例数少于对照组(P<0.05);②研究组的进食量、体重多于对照组,红肿和溃疡消失时间均低于对照组;③研究组在治疗后7 d和14 d黏膜的活性氧水平低于对照组(P<0.01)。结论泼尼松龙联合氯己定对口腔溃疡大鼠症状的改善作用较好,同时可降低黏膜的活性氧水平。     

泼尼松龙联合熊去氧胆酸治疗原发性胆汁性肝硬化患者疗效初步研究

目的 评价泼尼松龙联合熊去氧胆酸（UDCA）治疗原发性胆汁肝硬化（PBC）患者的疗效,寻找治疗PBC的有效方案。方法 2010年1月~2015年12月我院治疗的106例PBC患者,随机分为观察组和对照组,每组53例。给予对照组患者UDCA 13~15 mg·kg^-1·d^-1口服,观察组在对照组治疗的基础上再给予泼尼松龙口服并逐步减少激素剂量。在治疗前和治疗后3个月、6个月和12个月,观察患者临床表现和检测血清主要生化指标和免疫球蛋白IgM、IgG、IgA。结果 在治疗后,观察组和对照组患者临床症状均有所改善,观察组患者的乏力、皮肤瘙痒症状明显改善（P<0.05）;在治疗后,两组患者血清ALP、GGT和TBIL水平较治疗前均有明显改善（P<0.05）,且两组患者在治疗3个月时上述指标下降较快,观察组改善程度明显优于对照组（P<0.05）,在治疗6个月和12个月时,两组上述指标改善程度不明显（P>0.05）,两组患者血清ALB水平在治疗前后无明显变化（P>0.05）,且在不同治疗时段亦无显著性差异（P>0.05）;治疗后,两组患者血清IgM水平明显下降（P<0.05）,并且在治疗3个月时观察组较对照组下降程度较大,差异显著（P<0.05）,在6个月和12个月时,两组免疫球蛋白水平改善程度差异不明显（P>0.05）,两组患者血清IgA和IgG水平在治疗前后无显著性差异（P>0.05）。结论 泼尼松龙联合UDCA在短期内可以改善PBC患者临床表现、主要生化指标以及IgM水平,但其远期疗效还有待观察。     

Antiemetic efficacy of combination therapy with granisetron plus prednisolone plus the dopamine D2 antagonist metopimazine during multiple cycles of moderately emetogenic chemotherapy in patients refractory to previous antiemetic therapy

 Effective antiemetic treatment of patients who have previously experienced chemotherapy-induced nausea and vomiting is difficult. The aim of this study was to evaluate the antiemetic efficacy of a single intravenous dose of granisetron plus a 3-day oral treatment with prednisolone 25 mg once a day plus metopimazine 30 mg four times a day in patients refractory to previous antiemetic treatment with granisetron or with prednisolone plus metopimazine. The study population was made up of 25 consecutive women with stage I or II breast cancer, who were treated with multiple cycles of adjuvant cyclophosphamide, fluorouracil plus methotrexate or cyclophosphamide, epirubicin plus fluorouracil given i.v. every 3 weeks. Patients received the three-drug combination of antiemetics during a total of 113 cycles of chemotherapy. No emetic episodes were reported in 88.9% cycles on day 1, in 94.7% cycles on days 2 through 5 and in 85.8% cycles on days 1 through 5 after chemotherapy. No nausea was reported in 43.4% cycles on day 1, in 49.6% cycles on days 2 through 5 and in 34.5% cycles on days 1 through 5. Nineteen patients (76.0%) completed the scheduled nine cycles of chemotherapy, 1 being withdrawn because of ≥5 emetic episodes and 5, because they were not satisfied with the antiemetic treatment. The treatment was well tolerated. In conclusion, granisetron plus prednisolone plus metopimazine is a highly effective antiemetic treatment in patients receiving moderately emetogenic chemotherapy refractory to antiemetic therapy with granisetron or prednisolone plus metopimazine. Published online: 25 February 2000     

The rheumatoid knee before and after arthrocentesis and Prednisolone injection: Evaluation by Gd-enhanced MRI

Summary In patients with rheumatoid arthritis, intraarticular injection of corticosteroids is an accepted means of treating a symptomatic joint. It has previously been impossible to precisely quantitate the effects of these injections on synovial effusion and pannus. Magnetic resonance imaging (MRI) is a safe, effective means of evaluating joint anatomy, and the use of intravenous gadolinium (Gd)-containing contrast allows clear differentiation of fluid from abnormal synovial tissue. The current study utilized MRI with Gd-labeled diethylene-triamene pentacetic acid (Gd-DTPA) contrast to evaluate serial changes in 6 knees of 6 patients with rheumatoid arthritis, following arthrocentesis and intraarticular injection of prednisolone. One week after the corticosteroid was injected, 2 patients had reduction of pannus width to 20% and 68% of baseline measurements. In these same individuals, follow-up sagittal views showed decreases of total effusion and fluid-plus-pannus width. The other 4 patients, who were followed for 4 weeks, had minimal changes in fluid and synovium. Gd-DTPA-enhanced MRI permits precise assessment of effects of intraarticular injections on synovial fluid and pannus in the rheumatoid knee.     

Einfluß der Prednisolonbehandlung auf die Insulinsekretion der Ratte

Zusammenfassung Bei mit Prednisolon behandelten Ratten wurde das Verhalten von Blutzucker und immunologisch meßbarem Insulin (IMI) im Serum nach i. v. Glucosebelastung (50 mg/100 g Körpergewicht) untersucht. Drei Tiergruppen erhielten über einen Zeitraum von 3, 7 bzw. 18 Tage 10 mg/die Ultracorten-H subcutan. Im Vergleich zu einer Gruppe unbehandelter Kontrolltiere zeigten nur die Ratten des 7-Tage-Versuchs eine signifikante Erhöhung des Nüchternblutzuckers. Der Glucoseassimilations-Koefflzient (K) blieb bei allen drei behandelten Gruppen im Normbereich. Jedoch war bei allen drei Gruppen der Prednisolon-behandelten Tiere im Vergleich zur Kontrollgruppe sowohl ein erhöhter Nüehterninsulinspiegel als auch eine vermehrte Insulinsekretion nach der Glucosebelastung zu beobachten. Dieser Hyperinsulinismus scheint keine Folge einer Hyperglykämie zu sein und wird weder von einer Verminderung der Gmcoseassimilation noch von einer verstärkten Reaktivität des endokrinen tankreas gegenüber Glucose begleitet. Unsere Befunde sprechen für einen peripheren Antagonismus zwischen den Glucocorticoiden und Insulin, der, um den Kohlenhydratstoffwechsel im Gleichgewicht zu halten, zu einer vermehrten Insulinsekretion fuhrt.

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Effect of treatment with prednisolone on the secretion of insulin in rats

Summary The relationship between immunologically measurable insulin (IMI) in serum and the blood sugar was studied in the fasting state as well as after i.v. injection of glucose (50 mg / 100 g rat), in a group of untreated rats and in three groups of rats treated subcutaneously with 10 mg Prednisolone daily for 3, 7 and 18 days, resp. Only in the group of rats treated with Prednisolone for 7 days was there a significant increase in the fasting blood sugar; in all of the treated groups the glucose assimilation coefficient (K) remained within the normal range. The fasting insulin levels, however, showed a significant rise compared with the control group. After glucose loading in all the treated groups comparatively higher insulin values in blood were also observed. — This hyperinsulinism does not seem to be a result of hyperglycaemia, and is accompanied by neither a decreased assimilation of glucose nor an increase in the reactivity of the endocrine pancreas to glucose. Our findings are an indication of the existence of a peripheral antagonism between glucocorticoids and insulin, which leads to an increased secretion of insulin in order to maintain the equilibrium of the carbohydrate metabolism.

Durchgeführt mit Unterstützung der Deutschen Forschungsgemeinschaft, Bad Godesberg.     

An unusual cause of paraparesis in a patient on chronic steroid therapy

BACKGROUND/OBJECTIVE: Spinal epidural lipomatosis is the excessive deposition of unencapsulated fat in the epidural space. This is a rare disorder often associated with high levels of endogenous steroids or the administration of exogenous steroids. CASE DESCRIPTION: A 32-year-old man with congenital kyphosis treated with prednisolone daily for 5 months for interstitial lung disease developed compressive myelopathy. FINDINGS: Magnetic resonance imaging showed congenital kyphosis along with epidural lipomatosis compressing the cord. Cessation of steroid therapy was associated with improvement in the symptoms. CONCLUSIONS: Spinal epidural lipomatosis is a rare side effect of chronic steroid therapy that may occur with relatively short-term, low-dose regimens. In patients with congenital vertebral anomalies, spinal fat deposition may worsen the neurological status in an already compromised cord. Discontinuation of steroid therapy is beneficial; some patients may require surgical intervention for decompression.     

Mizoribine for renal sarcoidosis: effective steroid tapering and prevention of recurrence

Sarcoidosis is a systemic disease of unknown etiology that is characterized by chronic non-caseating granulomatous inflammation with tissue destruction. It is an uncommon disease in children, and renal sarcoidosis in particular is very rare in adults and children. A 17-year-old boy with renal sarcoidosis was referred to our hospital with an initial diagnosis of pyelonephritis. Prior treatment with various antibiotics had not been effective, but tentative oral daily prednisolone (PSL) had partially ameliorated his symptoms, although the symptoms recurred during steroid tapering. We detected non-caseating granulomatous interstitial nephritis and numerous sclerotic glomeruli in a second biopsy specimen, compatible with the diagnosis of renal sarcoidosis. The patient was treated with pulsed methyl-prednisolone and oral daily doses of PSL and mizoribine (MZR). During the treatment with MZR, the PSL was successfully tapered, and the patient has since presented no signs of recurrence. Our treatment of this patient shows that treatment with MZR can allow steroid sparing and prevent recurrence in a patient with sarcoidosis.