Drug Stability ; Methylprednisolone Hemisuccinate ; administration & dosage

Recent clinical trials have reported that methylprednisolone sodium succinate administered within 8 hours improves neurological recovery in human spinal cord injury (SCI). Methylprednisolone, however, was ineffective and possibly even deleterious when given more than 8 hours after injury. This finding suggests that a therapeutic time window exists in spinal cord injury. In order to determine the doses, durations and timing of methylprednisolone treatment for optimal neuroprotection, a single or two bolus dose of methylprednisolone (30 mg/kg) was administered at 10, 30, 120, 150 and 240 min. after three graded spinal cord injury. The primary outcome measure was 24-hour spinal cord lesion volumes estimated from spinal cord Na+ and K+ shifts. A single 30 mg/kg dose of methylprednisolone at 10 min. after injury significantly reduced 24-hour lesion volumes in injured rat spinal cords. However, any other methylprednisolone treatment starting 30 min. or more after injury had no effect on 24-hour lesion volumes compared to the vehicle control group. Moreover, delayed treatment increased lesion volumes in some cases. These results suggest that the NYU SCI model has a very short therapeutic window.
Animal ; Drug Administration Schedule ; Male ; Methylprednisolone Hemisuccinate/therapeutic use ; Methylprednisolone Hemisuccinate/administration & dosage* ; Neuroprotective Agents/therapeutic use ; Neuroprotective Agents/administration & dosage* ; Rats ; Rats, Long-Evans ; Spinal Cord/pathology ; Spinal Cord Injuries/pathology ; Spinal Cord Injuries/drug therapy*

BACKGROUND: This study evaluated the benefits and safety of a multimodal pain control protocol, which included a periarticular injection of local anesthetics, in patients undergoing total hip arthroplasty. METHODS: Between March 2006 and March 2007, 60 patients undergoing unilateral total hip arthroplasty were randomized to undergo either a multimodal pain control protocol or a conventional pain control protocol. The following parameters were compared: the preoperative and postoperative visual analogue scales (VAS), hospital stay, operative time, postoperative rehabilitation, additional painkiller consumption, and complication rates. RESULTS: There was no difference between the groups in terms of diagnosis, age, gender, and BMI. Although both groups had similar VAS scores in the preoperative period and on the fifth postoperative day, there was a significant difference between the groups over the four-day period after surgery. There were no differences in the hospital stay, operative time, additional painkiller consumption, or complication rate between the groups. The average time for comfortable crutch ambulation was 2.8 days in the multimodal pain control protocol group and 5.3 days in the control group. CONCLUSIONS: The multimodal pain control protocol can significantly reduce the level of postoperative pain and improve patients' satisfaction, with no apparent risks, after total hip arthroplasty.
Adult ; Aged ; Amides/administration & dosage ; Analgesia/*methods ; *Arthroplasty, Replacement, Hip ; Clinical Protocols ; Female ; Humans ; Injections, Intra-Articular ; Length of Stay ; Male ; Methylprednisolone/administration & dosage ; Middle Aged ; Morphine/administration & dosage ; Narcotics/administration & dosage ; Pain/prevention & control ; Pain Measurement ; Pain, Postoperative/prevention & control

AIMTo investigate the effect of intratunical instillation of bupivacaine and methylprednisolone for scrotal pain, swelling and peritesticular fibrosis due to testicular sperm retrieval procedures.

METHODSA total of 65 patients were randomly divided into two groups. In the instillation group (GI), 34 patients were administered 2.5 mL of 0.5 % bupivacaine combined with 10 mg/ml methylprednisolone before closure of the tunica vaginalis. In the control group (GC), 31 patients only received analgesics postoperatively by intramuscular route. The pain (by visual analogue scale, VAS) and duration of pain-free period after surgery between the two groups were evaluated at 2 and 4 h and at days 2 and 7 postoperatively.

RESULTSThe mean pain scores were significantly lower in the GI than in the GC group at 2 and 4 h after surgery (P<0.05 and P<0.01, respectively). The mean duration of pain free interval after the procedure was 47.8 +/-16.9 (12-72) h in GI, which was significantly longer than that in GC [(9.9 +/-3.6; 4-20) h]. Besides, in the GI, 29 % of patients were completely free from pain and 67 % had no scrotal swelling, but in the GC, all the patients required additional NSAID injection due to pain and only 3 % had no scrotal swelling.

CONCLUSIONThis study confirms that direct intratunical instillation of bupivacaine and methylprednisolone around the testis reduces the postoperative pain, scrotal swelling and peritesticular fibrosis.

Adult ; Anesthetics, Local ; administration & dosage ; Anti-Inflammatory Agents ; administration & dosage ; Bupivacaine ; administration & dosage ; Humans ; Male ; Methylprednisolone ; administration & dosage ; Oligospermia ; surgery ; Pain, Postoperative ; drug therapy ; Scrotum ; Spermatozoa ; cytology ; Treatment Outcome

Most of the interstitial lung diseases are rare, chronic, progressive and fatal disorders, especially in familial form. The etiology of the majority of interstitial lung disease is still unknown. Host susceptibility, genetic and environmental factors may influence clinical expression of each disease. With familial interstitial lung diseases, mutations of surfactant protein B and surfactant protein C or other additional genetic mechanisms (e.g. mutation of the gene for ATP-binding cassette transporter A3) could be associated. We found a 21 month-old girl with respiratory symptoms, abnormal radiographic findings and abnormal open lung biopsy findings compatible with nonspecific interstitial pneumonitis that is similar to those of her older sister died from this disease. We performed genetic studies of the patient and her parents, but we could not find any mutation in our case. High-dose intravenous methylprednisolone and oral hydroxychloroquine were administered and she is still alive without progression during 21 months of follow-up.
Child, Preschool ; Female ; Humans ; Hydroxychloroquine/administration and dosage ; Infant ; Korea ; Lung Diseases, Interstitial/drug therapy/*genetics/pathology/physiopathology ; Methylprednisolone/administration and dosage ; Siblings ; Tomography, X-Ray Computed

Internal hernia is defined as the herniation of viscera through an anatomic or pathologic opening within the boundaries of peritoneal cavity. Transmesocolic hernia, a subtype of internal hernia, has a herniated sac through the transverse mesocolon. Transmesocolic hernia has been rarely described in the literature, and most of reported cases were associated with a history of operation or congenital anormaly. A 72-year-old female with chronic intermittent abdominal pain and bloating was admitted. Small bowel series showed multiple jejunal loops confined to the left upper quadrant of abdomen. Abdomen spiral computed tomography (CT) showed a cluster of mildly dilated small bowel loops with mesenteries on the same area. On the three-dimensional reconstruction CT scan, a herniated sac through the transverse mesocolon was identified. She was diagnosed as transmesocolic hernia by using the three-dimensional reconstruction CT and small bowel series, without surgical exploration. The symptoms were managed with conservative measures.
Colitis, Ulcerative/*drug therapy ; Cyclosporine/*therapeutic use ; Drug Tolerance ; Humans ; Hydrocortisone/administration & dosage/*therapeutic use ; Injections, Intravenous ; Methylprednisolone/administration & dosage/*therapeutic use

Graft-versus-host disease (GVHD) is an uncommon but fatal complication of orthotopic liver transplantation (OLT). The pathogenesis and mechanism of GVHD after OLT remains unclear and the treatment is therefore largely empirical. The prevention of GVHD including avoidance of closely matched human leukocyte antigen donors and old-age recipients is of particular importance because effective treatment is lacking. To reduce immunosuppressants combined with high dose of methylprednisolone and IL-2 receptor antibodies can be applied as a reasonable regime.
Autoantibodies ; therapeutic use ; Graft vs Host Disease ; drug therapy ; prevention & control ; Humans ; Immunosuppressive Agents ; administration & dosage ; Liver Transplantation ; adverse effects ; Methylprednisolone ; administration & dosage ; Receptors, Interleukin-2 ; immunology

BACKGROUNDOur previous study had demonstrated that ulinastatin (UTI) had a neuroprotective effect in experimental autoimmune encephalomyelitis (EAE). Methylprednisolone has been recommended to be a standard drug in multiple sclerosis (MS) therapies. The present study was to investigate the protective effects of UTI combined methylprednisolone in EAE.

METHODSMice were divided into a UTI treatment group, a methylprednisolone treatment group, a combined treatment group with UTI and methylprednisolone, a normal saline treatment group, and a normal control group. EAE mice were induced in groups receiving different combined treatments, or respective monotherapies. Demyelination was evaluated by Solochrome cyanin staining. 2',3'-cyclic nucleotide 3'-phosphodiesterase (CNP)/ myelin basic protein (MBP)/ the precursor form of nerve growth factor (proNGF)/p75/ inducible nitric oxide synthase (iNOS) proteins in cerebral cortex of EAE were detected by Western blotting.

RESULTSThe combined treatment group had a lower clinical score (0.61 ± 0.06) and demyelinating score (1.33 ± 0.33) than the groups with normal saline (clinical score: 1.39 ± 0.08, P < 0.001; demyelinating score: 2.75 ± 0.49, P < 0.05) or monotheraphies. Compared with the saline treated EAE group, UTI combined methylprednisolone significantly increased expressions of CNP (1.14 ± 0.06 vs. 0.65 ± 0.04, P < 0.001), MBP (1.28 ± 0.14 vs. 0.44 ± 0.17, P < 0.001), and decreased expressions of proNGF (1.08 ± 0.10 vs. 2.32 ± 0.12, P < 0.001), p75 (1.13 ± 0.13 vs. 2.33 ± 0.17, P < 0.001), and iNOS (1.05 ± 0.31 vs. 2.17 ± 0.13, P < 0.001) proteins in EAE. Furthermore, UTI combined methylprednisolone could significantly upregulate MBP (1.28 ± 0.14 vs. 1.01 ± 0.15, P < 0.05) expression and downregulate iNOS (1.05 ± 0.31 vs. 1.35 ± 0.14, P < 0.05) expression compared to methylprednisolone treatment EAE group. And proNGF expression was significantly lower in combined treatment (1.08 ± 0.10) than that in UTI (1.51 ± 0.24, P < 0.05) or methylprednisolone (1.31 ± 0.04, P < 0.05) treatment group.

CONCLUSIONCombination treatment of UTI with methylprednisolone was shown to protect EAE, suggesting that combination therapy is a potential novel treatment in MS.

Animals ; Drug Combinations ; Encephalomyelitis, Autoimmune, Experimental ; drug therapy ; Female ; Glycoproteins ; administration & dosage ; therapeutic use ; Methylprednisolone ; administration & dosage ; therapeutic use ; Mice ; Mice, Inbred C57BL ; Multiple Sclerosis ; drug therapy

OBJECTIVE: To investigate the effect of intratympanic dexamethasone or methylprednisolone on treatment of sudden sensorineural hearing loss. METHOD: Forty-seven subjects received an at least 7-day dexamethasone(5 g/L/d) or methylprednisolone (40 g/L/d) course. Pure-tone averages (PTA) of pre-injection and post-injection at 4-frequency (500, 1,000, 2,000, 4,000 Hz) were compared. More than 10 dB HL of improvement in PTA was considered to be clinically significant. RESULT: PTA of pre-injection and post-injection were (71.59 +/- 27.66) dB HL and (53.44 +/- 30.10) dB HL respectively in 24 patients with intratympanic dexamethasone. There was significant improvement in PTA (P<0.01), 1.67% of patients showed improvement in hearing. PTA of preinjection and post-injection were (68.64 +/- 25.21) dB HL and (55.76 +/- 26.42) dB HL respectively in 23 patients with intratympanic methylprednisolone. There was significant improvement in PTA (P<0.01), 43% of patients showed improvement in hearing. There was no significant difference in PTA between intratympanic dexamethasone and methylprednisolone. After dexamethasone injection, evident improvement was accomplished in 11 cases who underwent treatment with other therapy (systemic steroids, vasodilator agent, or high-pressure-oxygen therapy) (P<0.05); PTA showed significant improvement in 13 cases with only intratympanic dexamethasone(P< 0.05). After methylprednisolone injection, evident improvement was accomplished in 17 cases who underwent treatment with other therapy (P<0.01); PTA decreased but had no significance in 6 cases with only intratympanic methyl-prednisolone(P>0.05). No unexpected adverse events such as otitis media, perforated tympanic membrane and worsening in hearing occurred during the injection or follow-up period. CONCLUSION Intratympanic dexamethasone or methylprednisolone can be beneficial in treatment on patient with sudden sensorineural hearing loss, however, there was no significant difference in the effect between dexamethasone and methylprednisolone. Dexamethasone is recommended to use as favorable drug for intratympanic application that could be primary therapy in treatment on sudden sensorineural hearing loss.
Adult ; Aged ; Dexamethasone ; administration & dosage ; therapeutic use ; Ear, Middle ; Female ; Hearing Loss, Sudden ; drug therapy ; Humans ; Male ; Methylprednisolone ; administration & dosage ; therapeutic use ; Middle Aged ; Treatment Outcome

A young woman who had a delivery history 3 months previously presented with dyspnea and orthopnea. Initial findings of physical examination, chest radiography, and echocardiogram showed typical congestive heart failure with severe left ventricular (LV) dysfunction. At first, we considered peripartum cardiomyopathy because she had given birth to a baby 3 months previously. However, even though we massively tried conventional drug therapy for 10 days, the patient still remained with refractory heart failure. We performed additional laboratory studies such as complement level and autoantibodies, of which the results supported systemic lupus erythematosus. We could make the diagnosis of acute lupus myocarditis and treated her with corticosteroid. The symptoms were dramatically disappeared and LV function also improved.
Acute Disease ; Administration, Oral ; Adult ; Echocardiography ; Female ; Glucocorticoids/administration & dosage ; Heart Failure/*diagnosis ; Humans ; Lupus Erythematosus, Systemic/complications/*diagnosis/radiography ; Methylprednisolone/administration & dosage ; Myocarditis/*diagnosis/etiology/radiography ; Prednisolone/administration & dosage