Kenalog
[Intravitreal injection of triamcinolone acetonide in non infectious uveitis]

[Article in Spanish]

Benitez Del Castillo Sanchez JM, Garcia Sanchez J.

Instituto Investigaciones Oftalmologicas Ramon Castroviejo, Facultad de Medicina, Universidad Complutense de Madrid, Espana. jbs00004 teleline.es

PURPOSE: Systemic immunosuppressants take more than two weeks before showing activity. Therefore corticosteroids remain the mainstay in the treatment of non infectious uveitis. The goal of this study is to assess results of the use of intravitreal triamcinolone acetonide in acute sight-threatening non-infectious uveitis. METHOD: Ten patients (4 idiopathic retinal vasculitis, 1 idiopathic panuveitis, 1 pars planitis and 4 Behcet disease) were treated. Triamcinolone acetonide 4 mg/0.1 ml was injected through pars plana. RESULTS: Pre-treatment visual acuity<0.1 and post-treatment visual acuity >0.6 after less than a week. Inflammation resolved completely in all cases. The only complications observed were transient ocular hypertension which was successfully treated in two patients with topical betablockers and a catact in one case. CONCLUSIONS: Intravitreal triamcinolone acetonide is effective in rapidly decreasing inflammation in acute sight threatening non infectious uveitis.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11715104&dopt=Abstract triamcinolone Kenalog



Kenalog
[Immunological regulations of dendritic cell in abnormal scarring tissue]

[Article in Chinese]

Chen D, Bao W, Wang Q.

Research Center of Plastic Surgery, 3rh Hospital, Beijing University, Beijing 100083.

OBJECTIVE: To investigate the relationship between dendritic cell(DC) and pathogenesis of abnormal scar. METHODS: The content of HLA-DR and CD1a molecules of DC, in 6 samples of hypertrophic scar (HS), keloid (K) and normal skin, were determined with the stain of avidin-biotin-peroxidase complex method (ABC). The effect of Triamcinolone Acetonide was evaluated with the measurement of the HLA-DR and CD1a molecules of DC in the epidermis of the HS. RESULTS: 1. The amounts of HLA-DR molecules of the positive DC were 806.67 +/- 101.72 and 870.00 +/- 134.24 in the HS and the K respectively, significantly higher than the controlled normal skin (510.01 +/- 45.17, P < 0.05). HLA-DR molecules showed an abnormal expression in the Kerationcytes and fibroblasts. 2. The amounts of CD1a molecules of the positive DC were 700.00 +/- 97.23 and 780.00 +/- 104.47 in the HS and the K respectively, significantly higher than the controlled normal skin (521.24 +/- 57.87)(P < 0.05). 3. The amounts of the HLA-DR molecules positive DC, in the positive kerationcytes and fibroblasts of hypertrophic scar, treated by Triamcinolone Acetonide, were 476.67 +/- 70.02 and 447.76 +/- 90.03 (P < 0.05) for 3 days and 7 days treatment respectively, significantly lower than the control. The amounts of CD1a molecules positive DC in the epidermis of hypertrophic scar with the injection of Triamcinolone Acetonide were significantly lower in 3 days and 7 days treatment (456.36 +/- 82.88 and 397.18 +/- 99.36, P < 0.05). CONCLUSION: 1. The results, with the high expression of HLA-DR and CD1a molecules, indicate that the HS and the K may have strong immune reactions. 2. Triamcinolone Acetonide may decrease the immune reactions of the HS, through the inhibition of the expressions of HLA-DR and CD1a molecules in the dendritric cell.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11767704&dopt=Abstract triamcinolone Kenalog



Kenalog
Intra-articular corticosteroid preparations: different characteristics and their effect during inflammation induced by monosodium urate crystals in the rat subcutaneous air pouch.

Rull M, Clayburne G, Sieck M, Schumacher HR.

Veterans Affairs Medical Center and University of Pennsylvania, Philadelphia, PA 19104, USA.

OBJECTIVE: To examine the effects of three commonly used intra-articular depot corticosteroid preparations tested in a rat air pouch model and their effect against monosodium urate (MSU) crystal-induced inflammation. Rheumatologists use intra-articular corticosteroid preparations to relieve pain and inflammation of acute monoarthritis without really knowing their effects on the synovial fluid and membrane or the differences between distinct preparations. This work compares the effect of three commonly used corticosteroid preparations in vivo, showing that they behave differently. METHODS: A subcutaneous air pouch was formed in male Sprague-Dawley rats. A first group of 6-day-old air pouches were injected with 10 ml of 6 mg/ml normal saline solution, 6 mg/ml betamethasone containing both depot betamethasone acetate and soluble betamethasone phosphate (Celestone) in 9 ml of normal saline solution, 20 mg/ml of prednisolone tebutate (Hydeltra) in 9 ml of normal saline solution or 20 mg/ml of triamcinolone hexacetonide (Aristospan) in 9 ml of normal saline solution. A second group (group 2) of air pouches were injected with 15 mg of synthetic MSU crystals and 24 h later they were reinjected with 1 ml of the same three corticosteroid suspensions. For each condition four rats were killed at 6, 24, 48 h and 7 days. Pouch fluid and tissue were analysed. RESULTS: In the first 6 h after normal saline solution or corticosteroid injection into the air pouch there were mildly increased leucocyte counts in the air pouch fluid. Betamethasone-injected pouches showed no cells in the fluid after 6 h and no crystals after 24 h, triamcinolone-injected pouches still showed rare cells at 7 days. Both triamcinolone and prednisolone crystals persisted in higher numbers and lasted longer in the fluid than did betamethasone (P<0.05). In group 2 MSU crystal phagocytosis in the fluid was decreased in the betamethasone- (P<0.01), prednisolone- (P<0.003) and triamcinolone- (P<0.006) injected pouches when compared with the MSU crystal-injected pouches alone. Pouches injected with MSU crystals alone showed the most intense tissue inflammation at all times. After MSU, betamethasone-injected pouches had a rapid but mild decrease in the number of lining cells and inflammation. In contrast, triamcinolone- and prednisolone-injected pouches showed a very thin tissue with few or no vessels and almost no inflammation at 7 days. The pouches injected with MSU crystals and any of the corticoid preparations had three times more tophus-like structures and persistent crystals identified than the ones injected with MSU crystals alone. CONCLUSION: Each of the corticosteroid preparations by themselves produced very mild transient inflammation. The betamethasone preparation with a soluble steroid component had a quicker but milder anti-inflammatory effect on MSU crystal-induced inflammation. In contrast to the doses used, prednisolone tebutate and triamcinolone hexacetonide preparations dramatically suppressed urate crystal-induced inflammation at 7 days, but both produced atrophy and necrosis of the membrane, yielding a very thin membrane with almost no vessels. When used for MSU crystal-induced inflammation these corticosteroid preparations suppressed some aspects of inflammation but may actually promote the persistence of MSU crystals and the formation of tophi.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12777646&dopt=Abstract triamcinolone Kenalog



Kenalog
Usefulness of intralesional triamcinolone in treatment of benign esophageal strictures.

Kochhar R, Makharia GK.

Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

INTRODUCTION: The cornerstone treatment for benign esophageal strictures is endoscopic dilation. There are reports suggesting that intralesional corticosteroid injection decreases the frequency of endoscopic dilation. METHODS: Seventy-one patients (mean age 42.39 [17.52] years; range, 13-78 years) with benign esophageal strictures (corrosive 29, peptic 14, anastomotic 19, radiation-induced 9) were recruited for this study. All were being managed with a program of intermittent endoscopic dilation by using over-the-wire polyvinyl dilators. All patients were treated by intralesional injections of triamcinolone acetonide (40 mg/mL diluted 1:1 with saline solution) by using a 23-gauge, 5-mm long sclerotherapy needle in aliquots of 0.5 mL. At each session, 4 injections (4 quadrants) were made at the proximal margin of the stricture with another 4 injections into the strictured segment itself whenever possible. The intervals between dilations and frequency of dilations were calculated before and after triamcinolone injections. A periodic dilation index (defined as number of dilations required per month) before and after the triamcinolone injections was calculated. RESULTS: The overall mean (SD) duration of treatment before intralesional injection was 10.9 (19.8) months (range, 1-120 months) and the mean number (SD) of esophageal dilations required was 9.67 (13.06) (range, 1-70). The mean number of sessions of intralesional injection was 1.4 (0.62). After initiation of intralesional injections mean follow-up was 8.1 (5.6) months (range 3-30 months) and the mean number of esophageal dilations was 3.8 (3.0) (range 0-16). The periodic dilation index decreased significantly from 1.24 (0.05) (range 0.13-3.16) before injection to 0.5 (0.33) (range, 0-2) after injection (p < 0.001). For each category of stricture, the periodic dilation index decreased significantly: corrosive, 1.24 (0.5) to 0.53 (0.34) (p < 0.001); peptic, 0.92 (0.44) to 0.42 (0.2) (p < 0.001); anastomotic, 1.24 (0.49) to 0.51 (0.4) (p < 0.001); and radiation-induced, 1.32 (0.6) to 0.6 (0.3) (p < 0.02). CONCLUSION: Intralesional injections of triamcinolone augment the effects of dilation in patients with benign esophageal strictures.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12447293&dopt=Abstract triamcinolone Kenalog



Kenalog
Correction of the soft tissue pollybeak using triamcinolone injection.

Hanasono MM, Kridel RW, Pastorek NJ, Glasgold MJ, Koch RJ.

Facial Plastic Surgery Associates, 6655 Travis St, Suite 900, Houston, TX 77030-1336, USA. rkridel todaysface.com

OBJECTIVE: To describe the technique for correction of the soft tissue pollybeak deformity using intralesional injection of triamcinolone acetonide. METHODS: We discuss our philosophy, regimen, and technique for treatment of the soft tissue pollybeak using triamcinolone injection. We include results from a series of 173 patients who underwent rhinoplasty performed by one of us (N.J.P.). RESULTS: Triamcinolone was injected at 1 week after surgery in 127 patients (73%). A second injection was performed in 92 (72%) of the 127 patients at 4 weeks after surgery. One hundred eight (85%) of the 127 patients had an acceptable result, as judged by the surgeon, with good supratip definition. Nineteen (15%) of the 127 patients had a less than optimal result, with residual supratip fullness, as judged by the surgeon. There were no complications caused by triamcinolone injection. CONCLUSIONS: Because revision surgery is difficult and may be associated with complications, intralesional triamcinolone injection is the first-line treatment for the soft tissue pollybeak deformities caused by subdermal scarring. Should intralesional steroid injection fail to satisfactorily treat the deformity, revision rhinoplasty can subsequently be performed.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11843673&dopt=Abstract triamcinolone Kenalog



Kenalog
Pituitary-adrenal function following topical triamcinolone acetonide and occlusion.

Taylor KS, Malkinson FD, Gak C.

Section of Dermatology, Department of Medicine, University of Chicago 60637, USA.

This study was undertaken to investigate the possible pituitary-adrenal suppressive effects of triamcinolone acetonide under occlusive dressings in six psoriatic patients. Forty-five grams of a cream containing 0.1% triamcinolone acetonide was applied daily to the psoriatic lesions of four patients and covered with an occlusive dressing. Two patients received daily applications of 45 gm of 0.01% triamcinolone acetonide cream and occlusive dressings. The four patients who received the 0.1% triamcinolone acetonide applications showed a marked decrease in the 24-hour urinary 17-hydroxycorticosteroids and no significant response to intravenous metyrapone testing. The two patients who were treated with 0.01% triamcinolone acetonide also showed a significant decrease in 24-hour urinary 17-hydroxycorticosteroids, but a partial response to metyrapone testing. Percutaneous absorption of as little as 1 to 2 mg of triamcinolone acetonide may affect pituitary-adrenal function.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11850923&dopt=Abstract triamcinolone Kenalog