Psychiatric complications of corticosteroid therapy

Despite limited evidence, the general consensus is that corticosteroids can cause psychiatric complications, mainly depression. This is most noticeable in high doses or in medical conditions with neuropsychiatric sequelae. The prognosis is usually good if corticosteroids are discontinued, but further study of the prevalence of psychiatric reactions, their mechanism of action and appropriate treatment is necessary.     

Indications, adverse effects and complications of lithium therapy

The application of lithium preparations in the therapy and prophylaxis of recidivations of affective psychoses has essentially gathered in point in psychiatry during the last years. Apart from the discussion of the indication, the contraindication and efficacy especially concomitant appearances, side effects and dangers as well as their influencibility are demonstrated, the knowledge of which is of importance also for the physician not dealing with psychiatry.     

Topical corticosteroid therapy complicating congenital glaucoma

A 4-month-old infant with congenital glaucoma had been treated with a topical antibiotic-corticosteroid for three months. This fact complicated initial management, delaying definitive diagnosis and therapy. Topical steroid therapy in infants can produce a condition simulating congenital glaucoma. Since there is little rationale for using topical steroids to treat most infantile external disease processes, they are best avoided. When steroids are used for a prolonged period, some strategy for detecting glaucoma should be adopted.     

Systemic corticosteroid therapy--side effects and their management

True splenic cyst is a relatively rare disease, and the majority of the cases are classified as epidermoid cysts. Three cases of epidermoid cysts in the spleen or accessory spleen were studied using an immunohistochemical technique and staining for mucin. In case 1, serum carcinoembryonic antigen (CEA) and CA19-9, and in cases 2 and 3, serum CA19-9, before surgery were markedly elevated, and these levels decreased postoperatively. This strongly indicates the relationship between the increase of tumor marker levels and the presence of the epidermoid cyst. In addition, stratified squamous epithelium in the resected tissues of cases 1 and 2 was positive for anti-CEA antibody and anti-CA19-9 antibody, and that of case 3 was positive for anti-CA19-9 antibody. This strongly supports CEA or CA19-9 production in the squamous epithelium.     

Role of corticosteroid therapy in non-malignant diseases

The study assessed immunohistochemically the location and distribution of various non-collagenous matrix proteins (fibronectin, laminin, tenascin-C, osteocalcin, thrombospondin-1, vitronectin and undulin) in musculoskeletal tissues of rat. Fibronectin and thrombospondin-1 were found to be ubiquitous in the studied tissues. High immunoreactivity of these proteins was found in the extracellular matrix of the anatomical sites where firm bindings are needed, i.e. between muscle fibres and fibre bundles, between the collagen fibres of a tendon and at myotendinous junctions, osteotendinous junctions and articular cartilage. Tenascin-C was found in the extracellular matrix of regions where especially high forces are transmitted from one tissue component to the other, such as myotendinous junctions and osteotendinous junctions. Laminin was demonstrated in the basement membranes of the muscle cells and capillaries of the muscle-tendon units. Osteocalcin immunoreactivity concentrated in the extracellular matrix of areas of newly formed bone tissue, i.e. in the subperiosteal and subchondral regions, osteoid tissue and mineralized fibrocartilage zone of the osteotendinous junction. Mild vitronectin activity could be seen in the extracellular matrix of the osteotendinous and myotendinous junctions, and high activity around the bone marrow cells. Undulin could be demonstrated in the extracellular matrix (i.e. on the collagen fibres) of the tendon and epimysium only. However, it was co-distributed with fibronectin and tenascin-C. Together, these findings on the normal location and distribution of these non-collagenous proteins in the musculoskeletal tissues help to form the basis of knowledge against which the location and distribution of the these proteins in various pathological processes could be compared.     

Induction of glycosuria and hyperglycemia by topical corticosteroid therapy

A patient with psoriasis is described who had an abnormal response to the glucose tolerance test without other evidence of diabetes and then developed postprandial hyperglycemia and glycosuria during a period of topical administration of a corticosteroid cream, halcinonide cream 0.1%, under occlusion. A second patient with a similar glucose tolerance test result showed postprandial hyperglycemia when treated similarly with betamethasone valerate cream 0.1%. Two additional patients with midly abnormal responses to glucose tolerance tests showed no evidence of altered glucose metabolism when treated with halcinonide cream in a similar manner.     

Systemic corticosteroid therapy in rheumatology, advantages and risks

Apart from the therapy of autoimmune diseases, corticosteroids have an important position in the treatment of rheumatoid arthritis. Corticosteroids are used after the failure of non-steroidal antiinflammatory agents or of the basis therapies to control the illness. When the rheumatoid arthritis is accompanied by a systemic disease, they will be used earlier and in higher dosages. For polymyalgia rheumatica, independently of an association with temporal arteritis, corticosteroids are the therapy of choice. Risks of long-time corticosteroid therapy are a higher incidence of infection and bone demineralisation, especially in postmenopausal women. A careful prevention with Calcium and Vitamin D must be carried out systematically. The demineralisation can be limited by the use of Deflazacort, a corticosteroid, which decreases the loss of calcium.     

The late results of the combined therapy of patients in 2nd-stage lymphogranulomatosis

AIM: To define the scope of combined therapy according to prognostic factors in patients with Hodgkin's disease state II. MATERIALS AND METHODS: 98 patients with favorable and unfavorable Hodgkin's disease (HD) prognosis according to EORTC criteria (41 and 57 of group 1 and 2, respectively) entered the study. Unfavorable factors were: mixed HD variant and lymphoid depletion, ESR above 50 mm/h in stage A and 30 mm/h in stage B, involvement of more than 3 groups of lymph nodes, age over 40. Patients of group 1 received CVPP program: 2 courses before and after radiation of the primary disease zones in the total dose 40 Gy. Therapy of group 2 patients consisted of 3 CVPP courses before and 3 courses after irradiation of all the lymphatic collectors above the diaphragm in the total dose 35 Gy or radiation according to the extended program. Efficacy of therapy was assessed by EORTC criteria. The survival curves were calculated by Caplan and Meyer methods. RESULTS: In groups 1 and 2 a complete a complete remission was achieved in 98 and 93%, 6-year survival was 100 and 91%, recurrence-free survival--94 and 87%, respectively. Survival free of the treatment failure reached in group 1--88%, in group 2--81%. CONCLUSION: Reduced treatment in HD stage II in favourable prognosis did not worsen the results of treatment.