Kenalog
Pathologic changes after inferior oblique marginal myotomy in rabbits.

Kim JY, Chang BL.

Department of Ophthalmology, Korea Veterans Hospital, Seoul.

To evaluate the histopathologic changes after an inferior oblique marginal myotomy with local injection of triamcinolone, an inferior oblique marginal myotomy was performed in 14 white rabbits and they were divided into 2 groups, one group with a local injection of triamcinolone and the other group without triamcinolone injection after a myotomy. At the postoperative one month, an edema of the muscle fibers and an infiltration of the inflammatory cells were observed and at postoperative three months, a fibrous tissue ingrowth around the muscle fibers and an atrophy of the muscle fibers were found and those changes were less prominant in the group with triamcinolone injection. The local injection of triamcinolone after the inferior oblique marginal myotomy would help in decreasing the fibrous tissue ingrowth and the formation of the scar tissue, thus it could be used in augmenting the effect of the inferior oblique marginal myotomy.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7933628&dopt=Abstract triamcinolone Kenalog



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Nasal mucosal inflammation has no effect on the absorption of intranasal triamcinolone acetonide.

Argenti D, Colligon I, Heald D, Ziemniak J.

Rhone-Poulenc Rorer Drug Disposition Department, Collegeville, Pennsylvania 19146.

The potential for enhanced systemic absorption of intranasal triamcinolone acetonide was explored in patients with inflamed nasal mucosa. Twelve allergic rhinitis patients with documented nasal inflammation, and 12 healthy volunteers, each received a single, therapeutic, 400-micrograms dose of triamcinolone acetonide in each nostril. Blood was obtained at fixed time points after the dose, and plasma concentrations of triamcinolone acetonide were determined by radioimmunoassay. There were no statistically significant differences in any of the derived pharmacokinetic parameters (maximum plasma triamcinolone acetonide concentrations [Cmax], time to maximum plasma triamcinolone concentrations [Tmax], elimination half-life [t1/2], and area under the plasma concentration-time curve [AUC0-12] from 0 to 12 hours) between treatment groups. A once-a-day, chronic regimen (6 weeks) of triamcinolone acetonide was also administered to five patients with allergic rhinitis. Pharmacokinetic parameters were similar to the parameters derived from healthy volunteers after acute administration. There was no evidence of drug accumulation. The results of this study indicate that acute and chronic intranasal administration. The results of this study indicate that acute and chronic intranasal administration of therapeutic doses of triamcinolone acetonide to patients with inflamed nasal mucosa does not result in enhanced systemic drug absorption or accumulation.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7962675&dopt=Abstract triamcinolone Kenalog



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Analgesic and neurotoxic effects of intrathecal corticosteroids in rats.

Abram SE, Marsala M, Yaksh TL.

Department of Anesthesiology, University of California, San Diego, La Jolla.

BACKGROUND: Despite the widespread use of epidurally administered corticosteroids in the treatment of sciatica and the failure of animal studies to demonstrate neurotoxicity from epidermally administered corticosteroids, controversy remains regarding the mechanism of action as well as the safety of this treatment. The goal of this study was to determine whether spinally administered corticosteroids have any analgesic effects, and whether repeated intrathecal administration causes any neuronal damage to the spinal cord. METHODS: Chronic lumbar intrathecal catheters were implanted in rats. Formalin testing was carried out 1 h after the intrathecal administration of 400 micrograms methylprednisolone sodium succinate, 48 h after intrathecal administration of triamcinolone diacetate 250 micrograms, or 24 h after the last of a series of four injections of triamcinolone diacetate 250 micrograms given at 5-day intervals. Histologic sections of multiple levels of spinal cord from the animals receiving repeat intrathecal steroid injections were compared to those from animals that received intrathecal saline at the same intervals. RESULTS: The animals receiving repeated intrathecal triamcinolone diacetate demonstrated mild, statistically significant reduction of pain behavior (hindlimb flinching) during the second but not the first phase of the formalin test when compared to controls. No analgesic effects were demonstrated after methylprednisolone sodium succinate or a single injection of triamicinolone diacetate. Animals that received methylprednisolone sodium succinate demonstrated transient segmental allodynia. No behavioral or neurologic abnormalities were seen in any other group. Some histologic evidence neuronal damage (the presence of argyrophilic neurons was seen in the chronically implanted animals in areas of the cord adjacent to the spinal catheters, but there was no difference in incidence of these changes between the steroid and control groups. CONCLUSIONS: Intrathecal steroid injections have no analgesic effect and do not suppress spinal sensitization when administered acutely. After chronic administration, there is a mild effect on nociceptor-driven spinal sensitization (phase 2 of the formalin test), but no analgesic effect on an acute noxious stimulus (phase 1 of the formalin test). Repeated intrathecal administration of triamcinolone diacetate (0.8 mg/kg) is not associated with spinal neurotoxic effects during the time period studied.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7978478&dopt=Abstract triamcinolone Kenalog



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Stimulation of proteoglycan synthesis by triamcinolone acetonide and insulin-like growth factor 1 in normal and arthritic murine articular cartilage.

Verschure PJ, van der Kraan PM, Vitters EL, van den Berg WB.

Department of Rheumatology, University Hospital Nijmegen, The Netherlands.

OBJECTIVE. During experimentally induced arthritis, inhibition of proteoglycan synthesis is one of the mechanisms leading to cartilage destruction. Disturbed anabolic signalling might contribute to this impaired chondrocyte proteoglycan synthesis. We investigated the effects of insulin-like growth factor 1 (IGF-1) and the glucocorticoid, triamcinolone acetonide, on in vitro chondrocyte proteoglycan synthesis of articular cartilage obtained from normal and arthritic mouse knee joints. METHODS. Proteoglycan synthesis was measured by 35S sulfate incorporation and the hydrodynamic volume of newly synthesized proteoglycans was analyzed with gel chromatography. RESULTS. Culturing normal cartilage with IGF-1 resulted in significant enhancement of chondrocyte proteoglycan synthesis. Concerning the hydrodynamic volume of newly synthesized proteoglycans after culture with IGF-1, proteoglycan monomers with large hydrodynamic size, similar to those synthesized immediately after dissection were observed. In arthritic cartilage, IGF-1 failed to stimulate proteoglycan synthesis and only proteoglycans with relatively small dimensions were produced. However, in the presence of the steroid triamcinolone acetonide, synthesis of hydrodynamically large proteoglycans were found in arthritic as well as normal cartilage. CONCLUSION. Our observations indicate that steroids may play a critical role in maintaining cartilage integrity in both normal and arthritic cartilage.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8064735&dopt=Abstract triamcinolone Kenalog



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Trans-Tenon's retrobulbar triamcinolone infusion for the treatment of uveitis.

Okada AA, Wakabayashi T, Morimura Y, Kawahara S, Kojima E, Asano Y, Hida T.

Kyorin Eye Center, Kyorin University School of Medicine, Tokyo, Japan. aokada po.iijnet.or.jp

AIM: To assess efficacy and complications of trans-Tenon's retrobulbar infusion of triamcinolone acetonide for posterior uveitic inflammation. METHODS: Non-randomised, uncontrolled, retrospective study of 51 eyes of 37 patients who underwent triamcinolone infusion for vitritis, cystoid macular oedema (CMO), or posterior retinal vasculitis using a long blunt cannula via an incision made through conjunctiva and Tenon's capsule. RESULTS: Overall clinical efficacy was 86%; 96% for vitritis, 82% for CMO, and 33% for posterior retinal vasculitis. Mean visual acuity improved within 1 month after triamcinolone infusion (p <0.05). Cataract progression and intraocular pressure elevation were observed in 31% and 27% of eyes, respectively. CONCLUSION: Trans-Tenon's retrobulbar triamcinolone infusion may be a safe and effective treatment for posterior uveitic inflammation.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12881336&dopt=Abstract triamcinolone Kenalog



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Treatment of rheumatoid joint inflammation with intrasynovial triamcinolone hexacetonide.

McCarty DJ, Harman JG, Grassanovich JL, Qian C.

Department of Medicine, Medical College of Wisconsin, Milwaukee 53226, USA.

OBJECTIVE. To determine the effectiveness of intrasynovial triamcinolone hexacetonide coupled with joint rest (3 weeks upper extremity; 6 weeks lower extremity) in the treatment of joint and tendon sheath inflammation in patients with seropositive rheumatoid arthritis (RA). METHODS. The medical records of 169 patients with seropositive RA treated by a single rheumatologist for at least one year between 1974 and 1992 were abstracted. RESULTS. Nine hundred fifty-six injections were given to 140 patients; approximately 75% of injected synovial structures remained in remission during a mean followup 7 years; 218 injections were given into previously treated structures. The injection rate was about 2 per patient in the first year, half of which were given at the time of the first visit. The rate then approximated 0.6 injections per patient-year for the next 15 years. Joints in the right upper extremity were injected significantly (p = 0.01) more frequently than those on the left. CONCLUSION. Intrasynovial triamcinolone hexacetonide followed by rest is a very useful adjunctive modality in the treatment of seropositive rheumatoid arthritis.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8523335&dopt=Abstract triamcinolone Kenalog