Treatment of urethral syndrome with triamcinolone acetonide

A new method for the treatment of the urethral syndrome is presented. Therapy involves the submucosal injection of triamcinolone acetonide around Skene's glands to decrease inflammation and scarring. It is a simple office procedure, while all other therapeutic modalities are surgical.     

Intramuscular high-dose triamcinolone acetonide in the treatment of severe chronic asthma

We describe our experience with administering intramuscular triamcinolone acetonide to 22 steroid-dependent patients with asthma. These patients represent the minority of those with asthma whose disease is characterized by frequent emergency department visits, hospital admissions, and long-term dependency on oral corticosteroid therapy. The participants were randomly assigned to 2 treatment groups, one group receiving 120 mg of intramuscular triamcinolone acetonide, the second receiving 360 mg as a series of three 120-mg daily doses. We determined relative efficacy by comparing peak expiratory flow rates and incidents of emergency department visits, hospital admissions, and ventilatory failure of the study and during the 12 months before enrollment. Peak expiratory flow rates improved significantly in both groups. The mean (+/- standard deviation [SD]) monthly percentage of predicted peak expiratory flow on the study was 88.6 +/- 3.7% and 91.2 +/- 3.9% compared with 63 +/- 15.1% and 64 +/- 14.5% at entry in patients receiving 120 and 360 mg, respectively (P < 0.02). Patients receiving 120 mg required 8 hospital stays and 8 emergency department visits compared with 27 hospital stays and 72 emergency department visits in the previous year (P < 0.05). Patients receiving 360 mg required 5 hospital stays and 5 emergency department visits compared with 33 hospital stays and 34 emergency department visits in the previous year (P < 0.05). The average monthly interval (+/- SD) between exacerbations was 2.7 +/- 2.3 and 7.8 +/- 3.5 for patients receiving 120 mg and 360 mg, respectively. A total of 25 intubations was required in the previous year and only 1 during the study. The incidence of cushingoid facies, weight gain, and hypertension was reduced in both groups (P < 0.05). Total steroid use was reduced in both groups (P < 0.02). A dose of 360 mg produced a longer exacerbation-free period than 120 mg (P < 0.02).     

An in-vitro study of the effect of hydrocolloid patch occlusion on the penetration of triamcinolone acetonide through skin in man

The aim of this study was to evaluate the effect of occlusion using hydrocolloid-containing patches on in-vitro triamcinolone acetonide (TACA) penetration of the epidermis while monitoring the uptake of water by the patches as a result of transepidermal water loss. The hydrocolloid patches were a laminate of a pressure-sensitive hydrophobic adhesive (containing a dispersion of 39% of either pectin or carmellose sodium) and a polyethylene film. The diffusion of a representative corticosteroid (TACA) through isolated epidermal sheet was shown to depend on the site from which the skin was removed. The two patch-types exhibited markedly different hydration rates when applied to the membranes. For example, after 96 h the carmellose sodium patch showed ten times the weight increase of the pectin patch. Epidermal diffusion rates were, however, similar, both showing a 3-4-fold enhancement over unoccluded conditions. The increase in TACA diffusion with the patches can be explained by the increase in skin hydration that occurs during occlusion. Despite the large differences in transepidermal water transfer through the epidermal membranes with the two types of hydrocolloid patch, however, this level of stratum corneum hydration was apparently similar. As the rate of diffusion was also independent of hydrocolloid patch component, it seems possible that the hydrophobic component of the patch matrix may also influence the level of skin hydration and consequent drug diffusion.     

Pain relief in the rheumatoid knee after steroid injection. A single-blind comparison of hydrocortisone succinate, and triamcinolone acetonide or hexacetonide

A case of a 58 year old woman with a chronic lymphoproliferative disorder of unusual clinical presentation, disease course, and immunophenotype is presented. At diagnosis she had severe anaemia, moderate lymphocytosis with some cells having prolymphocytoid features and a normal platelet count. A clinical examination yielded negative results. Only anaemia related symptoms were found and the patient became blood transfusion dependent. Both the lymphocytosis and the proportion of prolymphocytoid cells rose insidiously and thrombocytopenia developed later during the course of the disease. Three years later, the patient had a white cell count of 269 x 10(9)/l almost exclusively of prolymphocytoid cells and the bone marrow was diffusely infiltrated. She was refractory to chemotherapy and the anaemia did not improve after treatment with cyclosporine. Lymphoid cells were positive for cytoplasmatic CD3, HLA-Dr, CD34, CD38, CD7, CD56, CD13, CD33 and CD65. Membrane alpha beta and gamma delta T cell receptors (TCRs) were not expressed and the beta chain TCR gene was in germline configuration. Other membrane T, B, natural killer, and myelomonocytic markers were negative. Karyotype analysis was tried several times but metaphases were not obtained, even after stimulation with T cell mitogens.     

Clinical use of percutaneous intramuscular electrodes for functional electrical stimulation

OBJECTIVE: To evaluate the clinical use of the percutaneous intramuscular electrode in functional electrical stimulation (FES). DESIGN: Randomized and controlled study. SETTING: A referral center and institutional practice providing outpatient care. PATIENTS: Seventeen patients (12 men, 5 women) who had implanted percutaneous intramuscular electrodes for more than 1 year were examined. The average follow-up time after implantation of electrodes was 2.2 years (range, 1yr to 4yr 10mo). Overall, there were 327 electrodes (83 upper extremities and 244 lower extremities). INTERVENTION: The indwelling electrode was composed of helically coiled Teflon-coated rope stranded from 19 hard drawn wires of SUS 316L stainless steel (SES 114). MAIN OUTCOME MEASURES: The rates of breakage, movement, and infection, and the number of electrodes that needed reimplantation were evaluated. RESULTS: Only one electrode broke (0.3%) in the iliopsoas muscle at 12 weeks after implantation. Eight electrodes (2.4%) were removed because of loss of sufficient contraction force caused by movement of the electrodes. Movements occurred at 9 weeks in 6 electrodes and at 5 months in two. The failure rate of electrodes in the lower extremities was 3.7%. No failures occurred in the upper extremities. Ten electrodes (3.1%) required reimplantation. Although ten superficial infections (3.1%) were seen around the site of electrode insertion, no removals of electrode were needed. All electrodes in one patient were removed, however, because of generalized methicillin-resistant Staphylococcus aureus infection complicated with renal disease. Electrodes were reimplanted after improvement of the infection. CONCLUSIONS: The ultrafine percutaneous intramuscular electrode was considered practical for long-term FES use.     

Role of radiology in the diagnosis of joint chondrocalcinosis. Calcium pseudogout

Chondrocalcinosis is a really frequent clinicopathologic entity, which is caused by the penetration of calcium pyrophosphate dihydrate microcrystals into the structures of the joint, including hyaline cartilages and fibrocartilages--hense its name--as well as the synovial fluid and membrane. Calcium gout, which preferentially appears in the knees, is the most spectacular and characteristic symptom of chondrocalcinosis, expressing a crisis of acute microcrystal synovitis, of which it has all the usual clinical features, and thus simulating uratic gout. The positive diagnosis is based on: a) the radiologic demonstration of articular calcifications in the lining cartilages, forming a continuous or fragmented opaque border on the subchondral bone, from which it is separated by a light space, and/or in the fibrocartilaginous structures (most often the menisci, the symphysis pubis, the disk of the inferior radioulnar joint) where they appear as small, irregular clusters with blurred or cloudy margins. The knee is the most frequent site of calcium impregnation images, both in hyaline cartilages and in fibrocartilages. b) the presence of calcium pyrophosphate microcrystals in the synovial fluid; their nature is usually demonstrated convincingly enough with a conventional light microscope; c) needle biopsy findings of microcrystalline clusters embedded in the synovial membrane, that can be easily identified with routine staining. In practice, demonstrating radiologic signs, when these are characteristic and can be detected in their preferred sites, allows recognizing diffuse chondrocalcinosis in satisfactory safety conditions after a calcium gout crisis, as well as in the presence of the many atypical or misleading symptomatic aspects of this microcystal arthropathy, that will be the subject of a further paper.     

Prospective study of beverage use and the risk of kidney stones

We have analysed the replication of the heterochromatic megachromosome that was formed de novo by a large-scale amplification process initiated in the centromeric region of mouse chromosome 7. The megachromosome is organized into amplicons approximately 30 Mb in size, and each amplicon consists of two large inverted repeats delimited by a primary replication initiation site. Our results suggest that these segments represent a higher order replication unit (megareplicon) of the centromeric region of mouse chromosomes. Analysis of the replication of the megareplicons indicates that the pericentric heterochromatin and the centromere of mouse chromosomes begin to replicate early, and that their replication continues through approximately three-quarters of the S-phase. We suggest that a replication-directed mechanism may account for the initiation of large-scale amplification in the centromeric regions of mouse chromosomes, and may also explain the formation of new, stable chromosome segments and chromosomes.     

Prospective analysis of comorbidity: Tobacco and alcohol use disorders.

Alcohol use disorders (AUD) and tobacco use disorders (TD) frequently co-occur. The authors examined AUD–TD comorbidity over time using a state–trait (ST) model. The ST model represents variance in AUD/TD as a traitlike factor that spans measurement occasion and identifies distinct sources of variance in AUD/TD comorbidity. The ST model was evaluated on 450 young adults (baseline age?=?18.5 yrs; 51% with family history of alcoholism) assessed 5 times over 7 yrs. The ST model demonstrated superior fit over a first-order autoregressive model. The tendency to diagnose with AUD and TD was partially explained by family history of alcoholism; this relationship was mediated by childhood stressors, alcohol expectancies, and behavioral undercontrol. Results supported a common third-variable influence (vs. directional) model of comorbidity. The ST model is an important conceptual and methodological approach to the prospective study of comorbidity in general. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prospective differential prediction of adolescent alcohol use and problem use: Examining the mechanisms of effect.

This prospective study tested the assertion that psychopathology would predict both adolescent alcohol use and problem use, whereas socialization factors would predict only use, and explored mechanisms by which predictors led to problem use in a community sample of families (N?=?216). Externalizing symptoms, parental alcoholism, peer influences, and parental support were indirectly related to negative consequences through their effects on use level. Externalizing symptoms, internalizing symptoms, peer influences, and parental approval of use directly predicted consequences, controlling for the indirect effects through use level. Internalizing pathology potentiated the relation between consumption and consequences, whereas parental support and control mitigated this relation. Collectively, findings provided mixed support for the assertion that psychopathology would predict both use and problem use, whereas socialization factors would predict only use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prospective use of glycoprotein IIb/IIIa receptor blockers in the emergency department setting

OBJECTIVE: We examined whether alcohol consumption and problem drinking decreased with age or if the reported declines were actually cohort and/or period effects. METHOD: We utilized data from the Normative Aging Study, assessing 1,267 men three times over an 18-year period (1973, 1982, 1991). Men were divided into five 9-year birth cohorts; age ranged from 46 to 72. RESULTS: Sequential analyses using repeated measures ANOVAs showed significant age, cohort and period effects. Although there was a tendency for alcohol consumption to decline with age, this was not true for all cohorts. Men born between 1910 and 1918 increased from an average of 350 to 440 drinks per year from their fifties to their sixties. The younger cohorts tended to report both more consumption and more problems. However, period had the most consistent effect in this study. There was an increase in problems and in consumption during the 1970s but a decrease in the 1980s, with the exception of the youngest cohort (1937-1945) who reported more problems in the 1991 assessment despite lower consumption. CONCLUSIONS: Age-related change in both consumption and problems varied depending upon which cohort or time period was assessed. Thus, drinking patterns are a complex amalgam of individual aging and societal change.     

Prospective association of smoking and alcohol use with cognitive function in an elderly cohort

Cross-sectional studies of the associations of alcohol and tobacco use with cognitive function do not take into account behavior change after memory loss or differential survival. This prospective study examines the association of cigarette smoking and alcohol consumption at baseline with risk of poor cognitive function 13-18 years later. Between 1973 and 1975, 1469 relatively well-educated, noninstitutionalized men and women from Rancho Bernardo, California, answered standardized questions about smoking and alcohol consumption. Between 1988 and 1991, 511 of these men and women completed five standardized cognitive function tests. At baseline, 20.4% of the men and 23.0% of the women were cigarette smokers. Smoking was associated with increased mortality in men but not in women. In surviving male participants, cognitive function test scores did not significantly differ by baseline smoking status. Among female participants, smoking was associated with categorically defined poorer function on two of five tests. At baseline, 16% of the men and 29% of the women were nondrinkers. Drinking more than two drinks per day was associated with decreased mortality in both sexes. Among women, increasing consumption of alcohol predicted a significant decline in the long-term recall and savings scores of the visual reproduction test. Moderate drinking, approximately two drinks per day, predicted categorically defined poor performance on the Buschke long-term recall task in women. Alcohol consumption was not associated with cognitive function in men. Overall, the observed associations were weak, and no clear pattern was observed. Although there were some gender differences in observed associations and a survivor effect cannot be excluded, data from these healthy, educated, noninstitutionalized people offer no compelling evidence that social drinking or cigarette smoking causes or prevents impaired cognitive function in old age. The large number of comparisons and inconsistent results suggest that the few statistically significant findings may be spurious. Additional long-term prospective studies are needed to determine the generalizability of these findings to individuals in less healthy or less well-educated cohorts.     

Prospective use of platelet glycoprotein IIb/IIIa receptor blockers in the emergency department setting

Platelets play a pivotal role in the pathophysiology of acute coronary syndromes (ACS) and thus are logical therapeutic targets for treatment of this disease process. Platelet glycoprotein (GP IIb/IIIa receptor antagonists, which interrupt the final common pathway of platelet aggregation, have been proven to reduce the 30-day incidence of death, acute myocardial infarction (MI), and urgent revascularization in both high-risk and low-risk patients undergoing percutaneous intervention procedures. Three-year follow-up has indicated that these benefits appear durable. Recent large-scale randomized trials have demonstrated the value of GP IIb/IIIa receptor inhibitors in reducing the risk of death and MI in unstable angina/non-Q-wave MI patients receiving pharmacologic management. And, emerging evidence suggests a future role for GP IIb/IIIa receptor inhibitors as an adjunct to low-dose fibrinolytic therapy in patients with acute MI. As the list of indications for GP IIb/IIIa receptor antagonists expands to encompass the full spectrum of ACS, there is increasing interest in the potential use of these agents in the emergency department setting. The integration of GP IIb/IIIa receptor inhibitors into emergency department protocols will ultimately depend largely on whether these drugs prove to be safe and effective regardless of the direction of ST-segment deviation, and irrespective of whether definitive therapy will be invasive or conservative.