Drug Stability ; Methylprednisolone Hemisuccinate ; administration & dosage

Objective: To review current available evidence that addresses the question regarding the efficacy of intravenous methylprednisolone and oral-prednisone treatment regimens in improving vision among optic-neuritis patients. Methods: A literature search for randomized controlled trials on the treatment of optic neuritis in adults using steroids was conducted. A total of 23 studies were identified in the search. Of these, the Optic Neuritis Treatment Trial (ONTT) was identified as the largest multicenter, randomized controlled trial that evaluated the effect of steroids in the treatment of optic neuritis in adults. The initial article regarding the results of this landmark study published in 1992 and follow-up reports focusing on the five-year and ten-year visual outcomes published in 1997 and 2004 were appraised for this review. Results: Treatment with high dose intravenous methylprednisolone followed by oral prednisone produced short-term accelerated visual recovery but provided no long-term benefit to vision. Most patients retained good to excellent vision following an attack of optic neuritis regardless of treatment received. A significantly increased risk of recurrence of optic neuritis in either eye (19 percent) was noted in the oral-prednisone treatment group. There were no significant differences among the treatment groups in the risk of development of clinically definite multiple sclerosis. Conclusion: Intravenous methylprednisolone followed by oral prednisone may be considered as treatment for patients with acute optic neuritis in whom there is a need to speed up recovery of vision. Considering that the use of oral prednisone alone was associated with an increased risk of recurrence of optic neuritis in either eye, no treatment is an option.
INFUSIONS, INTRAVENOUS ; METHYLPREDNISOLONE ; ADMINISTRATION, ORAL ; PREDNISONE ; OPTIC NEURITIS

PURPOSE: Posterior scleritis is known to be a rare disease. The authors of the present study herein report a case of posterior scleritis, which occurred in a patient's eye, accompanied by hyperthyroidism and recurring in the other eye one year later. CASE SUMMARY: A 39-year-old female patient visited the hospital for ocular pain in the left eye and a headache. The patient was diagnosed with posterior scleritis through fundus examination, ultrasonography, CT and MRI, and an effective outcome of treatment was obtained by oral administration of methylprednisolone. Four months after discharge, the patient received left subtotal thyroidectomy for thyroid papillary cancer. Seven months after surgery she visited again, due to ocular pain that started 1 week earlier in the left eye, as well as a headache, and was diagnosed with posterior scleritis upon fundus examination, ultrasonography and MRI. Methylprednisolone was administered orally and an effective treatment result was obtained. After discharge, the patient was followed up for 5 months and did not show any signs of recurrence. CONCLUSIONS: When a hyperthyroidism patient has ocular pain or a headache, the possibility of posterior scleritis accompaniment should be considered, as well as the possibility that posterior scleritis, which already occurred in one eye, may recur in the other eye.
Administration, Oral ; Adult ; Eye ; Female ; Headache ; Humans ; Hyperthyroidism ; Methylprednisolone ; Rare Diseases ; Scleritis ; Thyroid Gland ; Thyroidectomy

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*

We report a case of patient with malignant thymoma, who developed nephrotic syndrome several years after thymectomy. This 38-year-old man was diagnosed as myasthenia gravis and malignant thymoma and underwent thymectomy in 2004. Tumor resection and systemic chemotherapy were performed after recurrence in pleura in 2006. He also took pyridostigmine to control his symptoms of myasthenia gravis after thymectomy. Four years later, even though there was no evidence of recurrence of thymoma, he developed a nephrotic syndrome and was diagnosed as a minimal change disease on renal biopsy. After pulse therapy with methylprednisolone followed by oral administration of prednisolone therapy, nephrotic syndrome was improved.
Administration, Oral ; Adult ; Biopsy ; Humans ; Methylprednisolone ; Myasthenia Gravis ; Nephrosis, Lipoid ; Nephrotic Syndrome ; Pleura ; Prednisolone ; Pyridostigmine Bromide ; Recurrence ; Thymectomy ; Thymoma

PURPOSE: To determine if intravenous aminophylline adds any efficacy to nebulized albuterol and intravenously administered corticosteroid in children who hospitalized with mild to moderate asthma. METHOD: Subjects were children between the ages of 5 and 15 years admitted of acute asthma attack to Department of Pediatrics, Kyung Hee University Hospital. All patient received therapy with albuterol delivered with nebulization at 4-6 hour interval and intravenously adminstered methylprednisolone in standardized doses. Thirty patients were recruited to receive either an intravenous aminophylline(n=15) or not(n=15). The outcome variables were:duration of hospitalization, percent of predicted peak expiratory flow rates recorded at 12-hour intervals and side effects. When intravenously administered medications were discontinued, therapy continued with oral administration of theophylline. Twice daily assessments of clinical asthma symptoms were made by using a scoring system consisting of respiratory rate, wheeze and accessory muscle use. RESULTS: 1) There were no significant differences at study entry in age, sex, race, number of previous hospital admission, clinical symptom scores, or initial peak flow rates for the two groups. 2) Fifteen patients in the aminophylline group were hospitalized for an mean duration of 5.1+/-1.0 days, whereas 15 patients in the control group required 5.3+/-1.2 days. There were no significant differences between the two groups. 3) There was no differences in the absolute changes in their scores two scoring intervals(at 24 hours) between the two groups. 4) The two groups showed no differences in measurements of peak expiratory flow rates at any time interval and at the end of treatment. 5) The mean theophylline level for aminophylline group was 10.2+/-1.7micorgram/mL. 6) In the aminophylline group, 6 of 15 patients who entered the study experienced adverse effects consisting of nausea/vomiting, abdominal pain, and irritability. Five of 15 patients in the control group had an adverse effects. There were no significant differences between the two groups for incidence of adverse effects. 7) There were no significant differences between the two groups for amount of albuterol therapy required. CONCLUSION: When the combination of systemically administered corticosteroid and inhaled albuterol is used in hospitalized asthmatic children with mild to moderate asthma, addition of theophylline provided no additional benefit. Further study will be needed to evaluate if patients with more severe asthma exacerbation benefit for the use of intraveously administered aminophylline.
Abdominal Pain ; Administration, Oral ; Albuterol ; Aminophylline* ; Asthma* ; Child ; Continental Population Groups ; Hospitalization ; Humans ; Incidence ; Methylprednisolone ; Pediatrics ; Respiratory Rate ; Theophylline

BACKGROUND: It is well known that topical and systemic corticosteroids can arrest the progress of vitiligo and lead to repigmentation. However, it may also produce unacceptable side effects. To minimize the side effects of systemic corticosteroids, there have been some reports of using high-dose methylprednisolone pulse therapy in vitiligo. But, there has been no report on the effectiveness of the combined treatment with phototherapy. OBJECTIVE: We evaluated the efficacy, safety, and tolerability of combination therapy of intravenous methylprednisolone pulse therapy and PUVA. METHODS: A study was performed on 31 patients with vitiligo who could undergo follow up study for at least 6 months. After intravenous administration of methylprednisolone 25 mg/kg/day for 3 consecutive days, PUVA phototherapy was given once or twice a week for the next 6 months. RESULTS: After 6 months, vitiligo lesions on the face showed 60.7% improvement, and the upper extremities showed 34.5% improvement. The trunk and lower extremities showed 25.1% and 25.8% improvement respectively. Compared with other sites, lesions on the feet (13.2%) and periungal area (0%) showed poor improvement. The overall improvement in 12 patients (38.7%) showed more than 50% repigmentation. Side effects occurred in a small number of patients and were transient. CONCLUSION: Combination treatment of high-dose methylprednisolone pulse therapy and PUVA may provide a therapeutic option for generalized vitiligo, with high effectiveness and low side effects.
Administration, Intravenous ; Adrenal Cortex Hormones ; Follow-Up Studies ; Foot ; Humans ; Lower Extremity ; Methylprednisolone* ; Phototherapy ; Upper Extremity ; Vitiligo*

Infantile hemangioendothelioma is a severe disease with a high mortality. It is characterized by multiple hemangioma affecting the skin and visceral organs. We report that high doses of methylprednisolone pulse therapy improved symptoms and signs of infantile hemangioendothelioma in a male neonate, and completely resolved the hepatic and cutaneous hemangioendothelioma on follow up.
Case Report ; Hemangioendothelioma/drug therapy* ; Human ; Infant, Newborn ; Liver Neoplasms/drug therapy* ; Male ; Methylprednisolone/administration & dosage* ; Skin Neoplasms/drug therapy*

OBJECTIVE: To evaluate the clinical efficacy of the intratympanic methylprednisolone perfusion for patients of intractable Meniere's disease (MD). METHOD: Ten cases (10 ears), collected from Janu 2008 to Janu 2010, of intractable MD were studied retrospectively. The micro-catheter was placed into the tympanum of the affected ear, then methylprednisolone was imported into the tympanum once a day for 10 days. The average followed-up duration was (15. 4 +/- 5. 4) months after the perfusion. The treatment effect of vertigo, hearing loss and activity capacity was evaluated with Diagnostic Criteria for MD set by the Guiyang Meeting in 2006. The efficacy of tinnitus was analyzed by comparing the score of tinnitus handicap inventory (THI) before and after treatment. RESULT: The vertigo was absolutely controlled in 7 patients (grade A), partially controlled in 2 patients (grade B) and no efficiency in 1 patient (grade C). The 2 patients in grade B had a vertigo again in 9 months and 11 months after intratympanic perfusion, respectively, while the frequency, severity and duration of their vertigo softened obviously. Puretone threshold average (PTA) at the affected frequencies was decreased to within the level of 20 dB in one patient and was improved more than 30 dB in another one (grade A), improved 15 dB to 30 dB in 4 patients (grade B), and improved less than 15 dB in the other 4 patients. The average score of THI was 48.80 +/- 7.25 and 41.9 +/- 7.78 before and after perfusion respectively. The ability capacity of all the 10 patients after treatment was as normal (grade A), i. e. All of them could lead an independent life. There was no irreversible tympanic perforation in the operated ear and there was no other complications left. CONCLUSION Intratympanic methylprednisolone perfusion through the micro-catheter is a safe and effective method for the intractable Meniere's disease.
Ear, Middle ; Female ; Humans ; Male ; Meniere Disease ; drug therapy ; Methylprednisolone ; administration & dosage ; therapeutic use ; Middle Aged ; Retrospective Studies ; Treatment Outcome

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