Successful use of intravenous clomipramine in depressive–catatonic state associated with corticosteroid treatment

We report two female patients who deteriorated to depressive–catatonic state after interepisode recovery from a hypomanic episode induced by corticosteroid treatment. Their symptoms developed during maintenance treatment with a low dose of prednisolone in Case 1 and after discontinuation of betamethasone in Case 2. Intravenous clomipramine successfully relieved their symptoms including reduction in contact and reactivity, immobility and mutism. These two patients showed no schizophrenic symptoms such as hallucinations and delusions. Corticosteroid-induced mood disorder can deteriorate into depressive stupor, severe depressive episode with catatonic features in DSM-IV. Clomipramine, a tricyclic antidepressant with relatively stronger serotonin reuptake inhibition, is one of the useful treatment options for corticosteroid-induced depression even in severe cases.     

Benign Mucinous Cystadenoma of the Appendix Report of 3 Cases. Review of the Literature

Backgrounds/Aims: Inflammation during the early phase of anastomotic wound healing is an essential cellular response and is suppressed by corticosteroids. The anti-inflammatory effect of corticosteroids is largely responsible for its impairment of wound healing in bowel anastomosis. Beta-D-glucan, a commonly used macrophage activator, has been shown to improve anastomotic wound healing under normal conditions. In the present study, we have investigated the effects of beta-D-glucan on anastomotic wound healing in rats treated with long-term corticosteroid. Methodology: 92 male Sprague-Dawley rats were randomized into four groups. 1: control, 2: control + beta-D-glu-can, 3: steroid, 4: steroid + beta-D-glucan. Methylprednisolone (5mg/kg) was injected IM daily for 14 days in groups 3 and 4. After 14 days, following anaesthesia and laparotomy, colonic anastomosis was performed 3 cm away from the peritoneal reflection of rectum. In groups 2 and 4, 100mg/kg beta-D-glucan was administered orally for 7 days before laparotomy. On postoperative day 3, relaparotomies were performed and bursting pressures, hydroxyproline levels and histopathological specimens were studied.

Results: The mean values of bursting pressures groups were 50.8 (95% CI 46.99-56.50), 58.2 (95% CI 54.49-61.90), 32.0 (95% CI 29.21-34.98), 45.9 (95% CI 43.09-48.80) respectively. The differences of the mean values of the groups between group 1 and 2 and also 3 were significant (p = 0.002, p < 0.001). The mean values of hydroxyproline of the groups were 3.8 (95% CI 3.56-4.06), 4.7 (95% CI 4.50-5.04), 2.9 (95% CI 2.73-3.20), 3.9 (95% CI 3.65-4.22) respectively. The differences of the values of the groups between control (group1) and group 2 and also group 3 were significant (p = 0.001, p < 0.001). In histopathological examination, increased macrophages and fibroblast population were observed in specimens from beta-D-glucan-treated animals.

Conclusion: The results indicate that in rat model, oral administration of beta-D-glucan causes a significant improvement in the healing of anastomotic wound impaired by long-term corticosteroid administration.     

Effects of Neurotensin on the Healing of Experimental Anastomosis of the Colon

The leakage of colonic anastomoses increases perioperative morbidity significantly. The purpose of the study was to investigate the influence of neurotensin, an intestinal trophic peptide, on the healing of colonic anastomosis. Forty-two Wistar-albino rats were separated into three equal groups: Group 1 (control group) — segmental resection of the left colon and end-to-end anastomosis; Group 2 (dexamethasone group) — resection and anastomosis, plus 0.1 mg/kg/day of dexamethasone; Group 3 (neurotensin group) — same surgical procedure plus 300 pg/kg/day of neurotensin. Bursting pressure and tissue hydroxyproline content were determined as parameters of the anastomosis strength and healing on the 3^rd and 7^th days postoperatively. On the 3^rd day, mean bursting pressures were 141.4, 146.7 and 73.1 (p = 0.0001) cm of water in the control group, dexamethasone and neurotensin groups respectively. On the 7^th day, bursting pressures were measured as 237.4, 100.6 (p = 0.0001) and 72.7(p = 10^-6) cm of water, in the control group, dexamethasone and neurotensin groups respectively. Between the 3^rd and 7^th days, bursting pressures were increased significantly in the control group (p = 0.0001), decreased in the dexamethasone (p = 0.048), and maintained their lowest values in the neurotensin (p = 0.96) groups. On the 7^th day, mean hydroxyproline levels were measured as 9.20, 3.30 (p = 0.007), 2.86 (p = 0.007) pg, in the control group, dexamethasone, and neurotensin groups respectively. Between the 3^rd and 7^th days, tissue hydroxyproline levels were increased significantly in the control group (p = 0.004), decreased in the dexamethasone (p = 0.03), and maintained their lowest values in the neurotensin (p = 0.87) groups. The anastomosis resistance to intraluminal pressure was weak, tissue collagen content was insufficient, and healing was inadequate in the dexamethasone and neurotensin groups in respect to the control group. We concluded that neurotensin impaired the healing, and affected the strength of the colonic anastomosis.     

Budesonide in the treatment of inflammatory bowel disease

Inflammatory bowel disease, including Crohn’s disease and ulcerative colitis, features recurrent episodes of inflammation of the GI tract. The treatment of inflammatory bowel disease is aimed at breaking the cycle of relapsing and remitting inflammation by inducing and maintaining remission. Systemically active conventional corticosteroids have long played a role in the induction of remission in both Crohn’s disease and ulcerative colitis, however, their long-term use can lead to adverse systemic effects. Budesonide, a synthetic steroid, has potent local anti-inflammatory effects and limited systemic bioavailability making it an appealing therapeutic option. Ulcerative colitis with predominantly distal disease may be treated with topical budesonide, however, novel oral controlled-release formulations have also been developed to allow for treatment of the entire colon. This article summarizes the use of budesonide in the management of inflammatory bowel disease.     

Oral beclomethasone dipropionate in gastrointestinal graft-versus-host disease

Beclomethasone dipropionate is a corticosteroid with topical activity for inflammatory disorders at mucosal surfaces. Oral beclomethasone dipropionate (orBec^®) has demonstrated activity in gastrointestinal acute graft-versus-host disease (aGVHD) associated with hematopoietic cell transplantation. Since the GI tract is the dominant aGVHD target in many patients, oral beclomethasone dipropionate reduces the requirement for systemic immunosuppressive drugs in treating aGVHD. In this patient population, reduced exposure to systemic corticosteroids is associated with fewer infections and, possibly, preserved graft-versus-tumor effects, yielding a statistically significant improvement in survival in a randomized, multicenter clinical trial.     

Effect of propranolol vs prednisolone vs propranolol with prednisolone in the management of infantile hemangioma: A randomized controlled study

Aims and Objectives

The purpose of this study was to compare the efficacy of orally administered propranolol versus prednisolone versus both in the treatment of potentially disfiguring or functionally threatening infantile hemangiomas.

Material and Methods

A prospective study of 30 patients aged 1 week–8 months was randomized into three equal groups. These were as follows: A, propranolol (2–3 mg/kg/d); B, prednisolone (1–4 mg/kg/d); and C, receiving both for a minimum duration of 3 months. Dimensions, color, consistency, ultrasonography, photographic documentation based on Visual Analogue Scale (VAS) were recorded before and periodically after starting treatment. A minimum 75% improvement was considered as success with no regrowth up to 1 month of stopping treatment.

Results

Mean initial response time (days) in A (4.1 ± 3.3 SD) and C (4.7 ± 3.4SD) was significantly lower than B (9.78 ± 7.8SD) (p < 0.047). Significant change in consistency was noted very early in A (24 hours) compared to B and C (8 days). VAS results are as follows: (a) color fading—significant reduction in A within 48 hours compared to B and C (p = 0.025), (b) flattening—more significant and earlier in A and C than B (p < 0.05), and (c) mean reduction in size: significant in A and C at 3 months (p = 0.005, p = 0.005), 6 months (p = 0.005, p = 0.008), 12 months (p = 0.005, p = 0.008), and 18 months (p = 0.02, p = 0.04), whereas in B, it was seen only at 6 months (p = 0.008).

Conclusions

Propranolol had a consistent, rapid therapeutic effect compared to prednisolone. A combination of the two had a comparable but not higher efficacy than propranolol alone. Prednisolone was associated with a higher number of complications, thereby decreasing patient compliance.     

Interventricular septal mass in a patient with cardiac sarcoidosis

Sarcoidosis is a granulomatous disease that may involve multiple organ systems. The prognosis of sarcoidosis is influenced by the presence and severity of cardiac lesions. Thinning of the wall in the ventricular septum has often been reported, whereas an interventricular septal mass is rare. We describe a case of cardiac sarcoidosis resulting in a myocardial mass in the basal portion of the interventricular septum that was sensitive to corticosteroid treatment.     

中西医结合治疗面部糖皮质激素依赖性皮炎疗效观察

目的:观察中西医结合治疗面部糖皮质激素依赖性皮炎的疗效。方法:98例患者,随机分成治疗组49例与对照组49例,治疗组口服百癣夏塔热片4片,3次/天,他克莫司软膏和湿润烧伤膏适量混匀,2次/天外搽患处;对照组仅给予他克莫司软膏外搽患处,2次/天。结果:两组痊愈率分别为68.89%,12.24%,有显著性差异;两组有效率分别为93.88%,40.81%,经比较有显著性差异。结论:中西医结合治疗面部糖皮质激素依赖性皮炎疗效显著。     

Efficacy of Corticosteroid Injection for Treatment of Trigger Finger: A Meta-Analysis of Randomized Controlled Trials

ABSTRACT

Purpose: To determine the efficacy and safety of corticosteroid injection for trigger finger by performing a meta-analysis of all relevant studies. Methods: PubMed, EMBASE, and Cochrane Library databases were searched for randomized controlled trials (RCTs) comparing corticosteroid injection with other treatments for trigger finger. Pooled summary estimates for outcomes, including success rate, relapse rate, visual analogue score (VAS) and complications, were calculated as standardized mean difference (SMD) or relative risk (RR) either on a fixed- or random-effect model via Stata 12.0 software. Results: Ten literatures involving 806 patients (387 in corticosteroid injection group and 419 in control group) were included. Pooled analysis showed there were no differences in the success rate, VAS and complications between patients undergoing corticosteroid injection and others. However, the relapse rate was significantly higher in patients treated with corticosteroid injection than that of other treatments (RR = 19.53, 95% CI = 6.23–61.19). Subgroup analysis indicated the efficacy of corticosteroid injection was superior to other non-surgical treatments (success rate: RR = 1.54, 95% CI = 1.01–2.35), but inferior to surgery (success rate: RR = 0.55, 95% CI = 0.48–0.63; relapse rate: RR = 21.15, 95% CI = 6.06–73.85; VAS: SMD = 3.49, 95% CI = 2.84–4.14). Conclusions: Corticosteroid injection may be an effective strategy for management of trigger finger, although surgery may be needed for some patients due to recurrence.     

Managing COVID-19 in Renal Transplant Recipients: A Review of Recent Literature and Case Supporting Corticosteroid-sparing Immunosuppression

Novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome virus (SARS-CoV-2) has become a global health care crisis. The Centers for Disease Control and Prevention (CDC) lists immunocompromised patients, including those requiring immunosuppression following renal transplantation, as high risk for severe disease from SARS-CoV-2. Treatment for other viral infections in renal transplant recipients often includes a reduction in immunosuppression; however, no current guidelines are available recommending the optimal approach to managing immunosuppression in the patients who are infected with SARS-CoV-2. It is currently advised to avoid corticosteroids in the treatment of SARS-CoV-2 outside of critically ill patients. Recently published cases describing inpatient care of COVID-19 in renal transplant recipients differ widely in disease severity, time from transplantation, baseline immunosuppressive therapy, and the modifications made to immunosuppression during COVID-19 treatment. This review summarizes and compares inpatient immunosuppressant management strategies of recently published reports in the renal transplant population infected with SARS-CoV-2 and discusses the limitations of corticosteroids in managing immunosuppression in this patient population.