Kenalog
Quantitative, highly sensitive liquid chromatography-tandem mass spectrometry method for detection of synthetic corticosteroids.

Taylor RL, Grebe SK, Singh RJ.

Department of Laboratory Medicine and Pathology, Mayo Clinic and Foundation, Rochester, MN 55905, USA.

BACKGROUND: Measurements of serum or urine concentrations of synthetic glucocorticoids are useful for assessing suspected iatrogenic hypothalamic-pituitary-adrenal axis suppression and Cushing syndrome. We have developed a liquid chromatography-tandem mass spectrometry (LC-MS/MS) assay for the simultaneous quantitative analysis of beclomethasone dipropionate, betamethasone, budesonide, dexamethasone, fludrocortisone, flunisolide, fluorometholone, fluticasone propionate, megestrol acetate, methylprednisolone, prednisolone, prednisone, triamcinolone, and triamcinolone acetonide. METHODS: Stable isotopes of cortisol-9,11,12,12-d(4) and triamcinolone-d(1) acetonide-d(6) were added as internal standards to calibrators, controls, and unknown samples. After acetonitrile precipitation, these samples were extracted with methylene chloride, and the extracts were washed and dried. Reconstituted extract (15 muL) was injected on a reversed-phase column and analyzed by LC-MS/MS in positive-ion mode. Assay precision, accuracy, linearity, and sample stability were determined by use of enriched samples. Clinical validation included analysis of 8 serum and 20 urine samples from patients with undetectable cortisol concentrations and analysis of different types of tablets. RESULTS: Functional assay sensitivity was as low as 0.6-1.6 nmol/L for all compounds except for triamcinolone (7.6 nmol/L). Interassay CVs were 3.0-20% for concentrations of 0.6-364 nmol/L for all analytes. Recoveries of all analytes (except triamcinolone in serum) were 82-138% at 19.2-693 nmol/L. All but one of the serum and urine samples from patients who were tested because of suppressed cortisol concentrations contained at least one synthetic steroid. Tablet analysis recovered 75% of the synthetic steroids in suspected drugs. CONCLUSIONS: LC-MS/MS allows simultaneous quantitative detection of various synthetic steroids in serum, plasma, urine, and tablets. This provides a valuable tool for evaluating the clinical effects of topical and systemic synthetic corticosteroids.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15486026&dopt=Abstract triamcinolone Kenalog



Kenalog
Intracameral triamcinolone helps to visualize and remove the vitreous body in anterior chamber in cataract surgery.

Yamakiri K, Uchino E, Kimura K, Sakamoto T.

Department of Ophthalmology Faculty of Medicine, Kagoshima University Graduate School of Medicine and Dental Sciences, Kagoshima, Japan.

AIM: To study the effects of intracameral injection of triamcinolone acetonide on visualizing and removing the vitreous body from the anterior chamber in cataract surgery. DESIGN: Observational case series. METHODS: Six eyes of six patients had the posterior capsule ruptured and the vitreous body prolapsed or incarcerated into the anterior chamber during cataract surgery. To visualize vitreous body, triamcinolone acetonide solution was injected into the anterior chamber and the vitreous body was resected. The intraoperative findings, results, and complications were evaluated. RESULTS: Vitreous body was well observed under surgical microscopy and was resected safely and completely. Minimum inflammation was observed postoperatively, and the patients obtained good visual acuity. No serious complications were found. One eye showed increased intraocular pressure (40 mm Hg), which was normalized by additional washing of the anterior chamber. CONCLUSIONS: Appropriate use of intracameral triamcinolone acetonide is beneficial to visualize and remove the vitreous body from the anterior chamber during cataract surgery, and sufficient washing of the anterior chamber is necessary to avoid complications.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15488797&dopt=Abstract triamcinolone Kenalog



Kenalog
Decreases in glucocorticoid sensitivity as a factor of stress-producing changes in the activity of monoamine oxidase, lipid peroxidation, and behavior in rats.

Volchegorskii IA, Tseilikman VE, Smirnov DS, Ship SA, Borisenkov AV.

Department of General and Bioorganic Chemistry, Chelyabinsk State Medical Academy.

Four episodes of immobilization stress induced a decrease in the sensitivity of rats to glucocorticoid hormones, which was accompanied by anxiogenic behavior, increased MAO-B activity, and a parallel increase in lipid peroxidation (LPO) in brain tissues. There was a simultaneous increase in MAO-B activity in the kidneys and accumulation of LPO products in the liver and kidneys. Administration of Kenalog (2 mg/kg), a pharmacological analog of glucocorticoid hormones, prevented the poststress activation of MAO-B and LPO and decreased the extent of anxiogenic behavioral abnormalities in rats.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15526425&dopt=Abstract triamcinolone Kenalog



Kenalog
Intravitreal triamcinolone acetonide and intraocular pressure.

Smithen LM, Ober MD, Maranan L, Spaide RF.

Vitreous, Retina, Macula Consultants of New York, and the LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York, USA.

PURPOSE: To analyze the incidence of intraocular pressure (IOP) elevation following intravitreal triamcinolone injection. DESIGN: Retrospective observational case series. METHODS: Charts of patients undergoing intravitreal triamcinolone injection in one clinical practice were reviewed. A pressure elevation was defined as a pressure of 24 mm Hg or higher during follow-up. RESULTS: There were 89 patients with a mean age of 76.4 years. The mean baseline IOP was 14.9 mm Hg with a mean change of 8.0 mm Hg. Thirty-six patients (40.4%) experienced a pressure elevation to 24 mm Hg or higher at a mean of 100.6 days (SD = 83.1 day) after treatment. Of nonglaucomatous patients with baseline IOP of 15 mm Hg or above, 60.0% experienced a pressure elevation, compared with only 22.7% of those with baseline pressures below 15 mm Hg (relative risk = 2.1, P < .01). In glaucoma patients, 6 of 12 (50%) experienced a pressure elevation, and this elevation was not correlated with baseline pressure. Thirty-two patients (36.0%) received repeat injections, and there was no difference in the incidence of procedure elevation in patients receiving multiple injections versus those receiving a single injection. Pressure elevation was controlled with topical medications in all patients. CONCLUSIONS: IOP elevation after intravitreal triamcinolone injection is common and may take an extended period of time to manifest. The proportion of patients who developed a pressure elevation to at least 24 mm Hg was much higher for those with baseline IOP 15 mm Hg or greater.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15531307&dopt=Abstract triamcinolone Kenalog



Kenalog
Factors influencing visual acuity after intravitreal triamcinolone acetonide as treatment of exudative age related macular degeneration.

Jonas JB, Kreissig I, Degenring RF.

Universitats-Augenklinik, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany. Jost.Jonas ma.augen.uni-heidelberg.de

AIM: To evaluate factors influencing change in visual acuity (VA) after intravitreal injection of triamcinolone acetonide as treatment of exudative age related macular degeneration (AMD). METHODS: This prospective, interventional, comparative non-randomised clinical case series study included 94 patients (99 eyes) showing progressive exudative AMD with occult (n = 61 eyes), minimally classic (n = 18), predominantly classic (n = 1), or totally classic (n = 8) subfoveal neovascularisation. Mean follow up was 8.5 (SD 4.7) months (median, 7.3 months; range 3.1-24.5 months). All patients received an intravitreal injection of 20-25 mg of triamcinolone acetonide. RESULTS: An increase in best VA of at least one line on the Snellen charts was found in 63 (63.1%) eyes. Correspondingly, mean VA increased significantly (p<0.001) from 0.17 (SD 0.13) to 0.22 (SD 0.17) after the injection. Postoperative increase in VA was significantly (p<0.001) and negatively correlated with preoperative VA (correlation coefficient, -0.49). Gain in visual acuity was significantly (p = 0.009) higher if preoperative visual acuity was less than 0.08 (gain: 3.2 (SD 2.9) Snellen lines) than if preoperative VA ranged between 0.08 and 0.20 (gain: 1.2 (SD 2.2) Snellen lines). Change in VA was significantly (p = 0.016) less if preoperative VA was higher than 0.20 (change: -0.8 (SD 3.4) Snellen lines). Maximal gain in VA was significantly (p = 0.035) larger in eyes with retinal pigment epithelium detachment than in eyes with minimally classic subfoveal neovascularisation. This was statistically independent of age (p = 0.99), refractive error (p = 0.88), sex (p = 0.92), and duration of follow up (p = 0.46). CONCLUSIONS: Gain in VA after intravitreal injection of 20-25 mg of triamcinolone acetonide is significantly and negatively correlated with preoperative VA. It is significantly larger in eyes with retinal pigment epithelium detachment than in eyes with minimally classic subfoveal neovascularisation.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15548812&dopt=Abstract triamcinolone Kenalog



Kenalog
Comparison of the intraarticular effectiveness of triamcinolone hexacetonide and triamcinolone acetonide in treatment of juvenile rheumatoid arthritis.

Eberhard BA, Sison MC, Gottlieb BS, Ilowite NT.

Division of Rheumatology, Schneider Children's Hospital, 269-01 76th Avenue, New Hyde Park, NY 11040, USA. aeberhard lij.ed

OBJECTIVE: To compare patients with juvenile rheumatoid arthritis (JRA) injected with triamcinolone hexacetonide (TH) or triamcinolone acetonide (TA) with respect to time to relapse. METHODS: This was a retrospective chart review of 85 patients: 51 patients with JRA who had received a joint injection with TH during the period June 2000-April 2001 and 48 patients who had received a joint injection with TA during the period May 2001-March 2002 who were followed for a minimum of 15 months, after an intraarticular steroid injection. RESULTS: The primary endpoint variable for the study was the time to relapse of the arthritis in the affected joint following an intraarticular injection. A total of 227 joints were injected, 114 with TH and 113 with TA. In the TH group the mean time to relapse (+/- SE) was 10.14 +/- 0.49 months compared to the TA group at 7.75 +/- 0.49 months (p < 0.0001) using the log-rank test. A proportional hazards (Cox) regression analysis revealed no statistical association between sex, duration of illness, or type of arthritis and relapse time. An analysis was performed on the first intraarticular injection for each patient, with the average time to relapse for all joints injected of 10.36 +/- 0.72 months for TH compared to 8.45 +/- 0.78 months for TA (p < 0.02). A further analysis of the first knee injections showed a relapse time in the TH group of 11.11 +/- 0.81 months compared to 7.95 +/- 0.95 months for TA (p < 0.008). CONCLUSION: TH offers an advantage to TA, as there is a longer duration of action leading to an improved prolonged response rate in weight-bearing joints, particularly the knees. The results suggest that TH should be the intraarticular steroid of choice, particularly for the knee joint, in patients with JRA.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15570659&dopt=Abstract triamcinolone Kenalog