Hepatic artery aneurysm in corticosteroidtreated,adult Kawasaki's disease

We describe a single case of Kawasaki's disease (mucocutaneous lymph node syndrome) with the rare complication of a hepatic artery aneurysm which was surgically repaired. Unusual features include arterial aneurysmal formation in the hepatic arteries rather than in coronary arteries, the unusual morphology of the hepatic artery aneurysm, and the expansion of the aneurysm after corticosteroid therapy.     

New steroids and steroid–longacting β2agonist combinations

New, highly selective, glucocorticoid receptor agonists based on an androstane 17β-carbothioate ester scaffold are claimed. Combinations of these steroids with novel long-acting β₂ agonists are also claimed. This patent defines potential replacements for fluticasone propionate and the combination of salmeterol and fluticasone propionate (Advair?, Glaxo Wellcome, Inc.).     

吸入糖皮质激素治疗感染后咳嗽

目的研究吸入糖皮质激素对感染后咳嗽的治疗效果及对气道炎症细胞的影响。方法采取前瞻性随机对照研究,将60例年龄在18～65岁的感染后咳嗽患者(咳嗽持续3周以上)随机分为观察组和对照组接受1周的治疗。观察组每天吸入布地奈德800μg,同时口服马来酸氯苯那敏和右美沙芬;对照组口服马来酸氯苯那敏和右美沙芬治疗。在治疗前、治疗后1周分别记录患者咳嗽特异性生活质量评分(CQLQ评分表),查诱导痰炎症细胞分类。结果治疗1周后,观察组CQLQ评分(35.38±10.65)明显降低,比对照组(46.57±7.49)降低明显(P<0.05)。观察组诱导痰中性粒细胞百分数在治疗1周后为(42.35±7.82)%,比对照组(63.24±10.24)%低(P<0.05)。结论吸入糖皮质激素对感染后咳嗽有明显疗效,可显著改善患者生活质量;气道中性粒细胞减少可能是激素的作用机制之一。     

Intraarticular corticosteroid injection into rheumatoid arthritis knees improves extensor muscles strength

Summary Eleven arthritic knee joints in seven patients with rheumatoid arthritis were studied before and after intraarticular injection of a corticosteroid preparation. Extensor muscle torque and quantitative electromyography increased on days 7 and 14 after treatment, indicating that muscle function had been inhibited by synovitis. Clinical signs of synovitis, such as pain, range of motion and knee circumference, also improved. Synovial fluid withdrawal alone improved extensor muscle torque. Joints with instability and/or radiological cartilage involvement also improved.     

High-dose intravenous IgG therapy in a seven-week-old infant with chronic autoimmune hemolytic anemia

A 7-week-old male infant tested positive for autoimmune hemolytic anemia. Serological studies revealed a positive Coombs test and a strong antibody with relative anti-E specificity. Despite corticosteroid therapy, he frequently suffered severe hemolytic crises. During the course of the disease he had pneumonia, subcutaneous abscess, and sepsis, which were thought to be caused by his immunosuppressive state. His clinical course was chronic and refractory. Recently, high-dose intravenous IgG therapy for the treatment of chronic AIHA has been reported, but it has not been successful in the management of adult AIHA. We attempted this therapy in our patient, and successful management was obtained.     

Corticosteroid-induced exophthalmos

We describe twenty-one patients on sustained corticosteroid therapy who presented with exophthalmos. Each patient received a complete ophthalmologic examination and further tests were conducted to rule out other causes of exophthalmos. Our data suggest that corticosteroid-induced exophthalmos is an entity more common than has been previously recognized.     

Pneumatosis Cystoides Intestinalis Following Steriod Pulse Therapy in a Patient with Polyarteritis Nodosa

We present a case of a 67‐year‐old female with polyarteritis nodosa, complicated by pneumatosis cystoides intestinalis. The definite diagnosis of polyarteritis nodosa was obtained by histological findings on a biopsy specimen from her sural nerve. Following steroid pulse therapy, she developed gastrointestinal symptoms such as nausea, abdominal fullness and watery diarrhea. Abdominal X‐ray and computed tomography showed an abundance of gas contrast within the large intestinal wall. Colonoscopy revealed submucosal tumor‐like multiple elevated lesions from the sigmoid to transverse colon. These findings indicated pneumatosis cystoides intestinalis and the patient was accordingly treated with a high concentration of oxygen via a nasal catheter. One week later, her symptoms and the gas in the bowel wall completely disappeared. Pneumatosis cystoides intestinalis may be one of the complications of steroid pulse therapy.     

Asthma: Versatile Treatment for a Variable Disease

Objective. This review describes factors contributing to the variable nature of asthma and the versatile treatment strategies required for the clinical management of the disease. Data Sources. A comprehensive review of the literature using MEDLINE was conducted. Study Selection. Included articles were selected for their relevance to variability or severity of asthma. Bibliographies of selected articles served as additional sources of considered publications. Results. Asthma severity can vary substantially among patients and within individual patients because of physiologic, environmental, or behavioral factors. Inhaled corticosteroids are an effective and versatile treatment option for special populations with asthma and for patients with varying degrees of asthma severity. Inhaled corticosteroids are now the preferred treatment for all three severity levels of persistent asthma, especially in young children and pregnant women. Treatment regimens may be adjusted up or adjusted down when appropriate to maintain optimal symptom control and limit potential adverse systemic effects. Conclusions. The clinical management of asthma is challenging given the day-to-day variability of the disease. Variability in pulmonary function and asthma symptoms may be minimized through increased awareness of the factors contributing to asthma variability as well as the effective use of inhaled corticosteroid therapy. Flexible treatment strategies that consider the different severities of asthma and account for variability within individual patients may be particularly useful in improving adherence and patient outcomes.     

Corticosteroid toxicity in neuro-oncology patients

Summary Hospital charts from 59 patients with intracranial malignancy or epidural spinal cord compression were reviewed to establish the frequency of clinically important corticosteroid toxicities and to determine treatment or patient characteristics which were predictive for toxicity. Thirty patients (51%) developed at least one steroid toxicity and eleven (19%) required hospital admission for diagnosis and/or management of steroid-related complications. In this retrospective analysis the duration of steroid therapy and the total administered dose predicted for toxicity. Patients with toxicity also had a significant fall in the serum albumin level. Important corticosteroid toxicity occurs frequently in neuro-oncology patients. Further research should be directed at developing non-toxic alternatives to corticosteroids.