Kenalog
Mechanical properties of keloids in vivo during treatment with intralesional triamcinolone acetonide.

Krusche T, Worret WI.

Dermatologische Klinik, Technischen Universitat Munchen, Germany.

The mechanical properties of 17 keloids in 9 patients before and during treatment with intralesional triamcinolone acetonide were studied using a recently developed noninvasive suction device for measuring skin elasticity in vivo. Each keloid was treated with intralesional injections of 10 mg/ml triamcinolone acetonide without local anaesthetic at intervals of 3 weeks. A total of four measurements per keloid were performed, before treatment and 3 weeks after the first, second and third treatments. The parameters used were: immediate distension (Ue), delayed distension (Uv), immediate retraction (Ur) and final distension (Uf). Relative parameters independent of skin thickness were calculated: Uv/Ue, the ratio between the viscous and the elastic deformation of the skin, and Ur/Uf, representing the ability of the skin to return to its initial position after deformation (biological elasticity). After three injections of triamcinolone acetonide a marked decrease in Uv/Ue and a less-pronounced increase in Ur/Uf compared with baseline values was observed. These findings indicate that the main effect of intralesional steroids on the connective tissue of keloids is a decrease in viscosity due to a loss of ground substance. This method provides a noninvasive quantitative assessment of the mechanical properties of scars and is well suited to comparative studies on the efficacy of various scar therapies.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7598534&dopt=Abstract triamcinolone Kenalog



Kenalog
Biochemical quantification of triamcinolone in subconjunctival depots.

Kalina PH, Erie JC, Rosenbaum L.

Department of Ophthalmology, Mayo Clinic Scottsdale, Ariz, USA.

OBJECTIVE: To biochemically quantify the amount of active triamcinolone acetonide remaining after subconjunctival administration and to assess the effectiveness of surgical management for glaucoma induced by triamcinolone. DESIGN: Case series. PARTICIPANTS: Seven eyes of seven patients whose ages ranged from 47 to 84 years underwent excision of depot triamcinolone. Six of seven eyes required surgical intervention for medically unresponsive intraocular pressure (IOP) elevation. RESULTS: Pharmacologically active triamcinolone was identified up to 13 months following injection (range, 3 to 13 months). The mean amount in the excised sample was 5.4 mg (range, 2.0 to 8.8 mg), and the mean percentage of the original sample remaining was 20% (range, 4.2% to 44%). Glaucoma was diagnosed a mean of 3 months after injection (range, 1 to 6 months). Mean IOP was 37 mm Hg before excision and 16 mm Hg after removal. Surgical excision of visible triamcinolone normalized IOP in six of seven patients without need for glaucoma medications. CONCLUSIONS: Periocular injection of triamcinolone necessitates careful monitoring of IOP. Medically unresponsive IOP elevation may occur as late as 6 months following periocular triamcinolone injection. Surgical excision of remaining triamcinolone depot is an effective therapy for IOP elevation. Guidelines for safely using triamcinolone are discussed.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7605276&dopt=Abstract triamcinolone Kenalog



Kenalog
The effects of posterior subtenon injection of triamcinolone acetonide in patients with intermediate uveitis.

Helm CJ, Holland GN.

UCLA Ocular Inflammatory Disease Center, Jules Stein Eye Institute 90024-7003, USA.

PURPOSE: Periocular injection of corticosteroids is a common treatment for vision loss in patients with intermediate uveitis. However, this treatment has the potential for serious side effects. We sought to determine the effects of such injections in a series of patients. METHODS: We reviewed charts of 20 consecutive patients (20 eyes, 43 injections) who had received posterior subtenon injections of triamcinolone acetonide for treatment of intermediate uveitis. We collected data on visual outcome and side effects. RESULTS: Median follow-up was 23.5 months (range, one to 50 months). Snellen visual acuity improved by at least two lines in 12 (67%) of 18 patients who were examined after initial injection. Median time to improvement was three weeks. Patients with visual improvement had a median age of 29.0 years, compared with 41.5 years for nonresponders (P = .024). There was a weak association between response to treatment and a history of not smoking (P = .073) after correction for patient age. Increase of intraocular pressure (> 21 mm Hg) occurred in six patients (30%), with onset at a median of three weeks after initial injection; the median interval to peak increase (median, 32 mm Hg; range, 25 to 40 mm Hg) was 14 weeks after the injection. CONCLUSIONS: A subtenon injection of triamcinolone acetonide appears to be an effective treatment for decreased vision associated with intermediate uveitis but may contribute to increase of intraocular pressure in some patients with this disorder.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7611330&dopt=Abstract triamcinolone Kenalog



Kenalog
Delivery of glucocorticoids by jet nebulization: aerosol characteristics and output.

Leflein J, Brown E, Hill M, Kelly HW, Loffert DT, Nelson HS, Szefler SJ.

Department of Pediatrics, National Jewish Center for Immunology and Respiratory Medicine, Denver, CO 80206, USA.

BACKGROUND: Since inflammation has been identified as a critical factor in the pathogenesis of asthma, use of inhaled glucocorticoids has increased. Because young children are often unable to coordinate properly the use of metered-dose inhalers and no glucocorticoids preparations for nebulization have been approved in the United States, parenteral and intranasal glucocorticoids preparations are occasionally administered by nebulization. METHODS: We examined whether a parenteral preparation (triamcinolone acetonide [TAA]; Kenalog) could be delivered by nebulization. TAA, 1000 micrograms (0.1 ml), was placed in the nebulizer bowl (MB5 [MeFar, Brescia, Italy] or Pari-Jet [Dura Pharmaceuticals, San Diego, Calif.]), then diluted with 2.9 ml normal saline solution for a total volume fill of 3 ml. Using a laser particle analyzer, high-performance liquid chromatography, and cascade impactor, we examined the percentage of aerosol volume produced with particles in the respirable range of 1 to 5 microns in diameter, actual TAA output (in micrograms) and concentration of TAA contained in the particles within the respirable range. RESULTS: Laser particle analysis indicated that 34% +/- 3% (mean +/- SEM) (MB5) and 47 +/- 3% (Pari-Jet) of the total aerosol volume produced were within the respirable range of 1 to 5 microns in diameter, and this remained consistent throughout nebulization. The nebulizer was stopped serially for determination of TAA output with high-performance liquid chromatography. TAA output (1000 micrograms less the amount in micrograms remaining after nebulization) was essentially complete after 2 minutes with the Pari-Jet and within 4 minutes with the MB5 and totaled 352 +/- 19 micrograms and 367 +/- 9 micrograms, respectively. Finally, cascade impactor studies confirmed that 33.4% of the TAA aerosol generated by the MB5 nebulizer was contained in particles in the respirable range. CONCLUSION: Approximately 35% (Pari-Jet) and 37% (MB5) of the initial 1000 micrograms of TAA was delivered with the two nebulizers tested. The particles generated within the respirable range were limited to 34% (MB5) and 47% (Pari-Jet) of the amount delivered. TAA was equally distributed in the particles generated. The theoretic amount delivered in the respirable range was approximately 12.5% for the MB5 nebulizer on the basis of the cascade impactor and 16.5% for the Pari-Jet (assuming TAA distribution equivalence) of the TAA placed in each of the nebulizers. Additional clinical studies are needed to define efficacy and safety in view of the excipients used in preparing the parenteral preparation.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7751514&dopt=Abstract triamcinolone Kenalog



Kenalog
Association between reported use of inhaled triamcinolone and differential short-term responses to aerosolized albuterol in asthmatics in an emergency department setting.

Lin RY, Newman TG, Sauter D, Sirleaf J, Walters J, Fox S, Tavakol M.

Department of Medicine and Emergency Medicine, Metropolitan Hospital Center, New York City, USA.

Forty-four adult patients with acute asthma were treated with albuterol at a rate of 15 mg/h over 2 h. Analysis of covariance showed a significantly higher baseline adjusted mean for both percent predicted forced expiratory volume in 1 s (PFEV1) (p = 0.045) and percent predicted forced vital capacity (PFVC) (p = 0.022) at 50 and 110 min for the patients who reported triamcinolone use. Although heart rates decreased overall during the first hour of albuterol treatment, a rise in mean heart rate occurred during the second hour of treatment only in patients reporting triamcinolone use (p = 0.005). After accounting for the effects of parenteral corticosteroids, the effect of reported triamcinolone use remained significant. These data suggest that use of inhaled corticosteroids in this context may be associated with enhanced local and systemic beta-responsiveness, and if a causal relationship could be confirmed, this may constitute yet another advantage of early inhaled corticosteroid treatment in asthma. These data also suggest that chronotropic effects of high-dose albuterol should be monitored in patients using inhaled triamcinolone.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7774319&dopt=Abstract triamcinolone Kenalog



Kenalog
Inhibition of human keloid fibroblast growth by isotretinoin and triamcinolone acetonide in vitro.

Cruz NI, Korchin L.

Division of Plastic Surgery, University of Puerto Rico Medical School.

In this study, we evaluated the effects of isotretinoin and triamcinolone acetonide on the growth of keloid and embryonal human skin fibroblasts in vitro. Culture bottles were plated with 2 x 10(5) cells and after 3 days of growth in Eagle's minimum essential medium, the medium was changed to one containing the drug being evaluated. Five groups were established: (1) regular medium as the control; (2) the medium containing 0.1% ethyl alcohol (the vehicle in which isotretinoin is dissolved); (3) the medium containing isotretinoin; (4) the medium containing triamcinolone acetonide; (5) the medium containing both drugs. Our study demonstrated that isotretinoin and triamcinolone acetonide each significantly inhibited the growth of the cells, and the effect of the combination was greater than that of either drug used alone.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7810956&dopt=Abstract triamcinolone Kenalog