Oral steroid therapy for frozen shoulder / Terapia de esteroides orales para el hombro congelado

BACKGROUND: Since frozen shoulder is characterized by spontaneous recovery, no precise treatment strategy exists. Both conservative therapy and arthroscopic surgery is available, but the time required for recovery varies considerably. This study looks at the possible early symptom relief with oral steroid therapy. SUBJECTS AND METHODS: The subjects were 76 patients aged 33 to 73 years at the beginning of the study. The duration of the frozen shoulder was one to 15 months (mean 5.7 months) and hypertension was noted in 13 patients as a complicated disorder. A single course of steroid therapy consisted of a total dose of 105 mg of prednisolone over approximately a three-week period by the dose-tapering method. The number of courses varied with the degree of symptom relief, but the rest period between courses was always approximately four weeks. The results were assessed on the basis of the Japanese Orthopaedic Association (JOA) score, but the principal evaluations were pain and range of motion. RESULTS: The average ranges of motion before treatment were 102.8º of forward flexion 11.3º of external rotation and internal, rotation was at the buttocks. However, after one course of treatment, forward flexion was 136º, external rotation was 33.7º, and internal rotation was limited to the buttocks in only six cases. CONCLUSION: The results of oral steroid therapy for frozen shoulder were highly satisfactory. However, sufficient care is required in explaining the method of administration and the adverse effects such as the osteonecrosis of the femoral head or osteoporosis.

ANTECEDENTES: Como que el hombro congelado se caracteriza por la recuperación espontánea, no existe una estrategia de tratamiento precisa. Tanto la terapia conservadora como la cirugía artroscópica se hallan a disposición, pero el tiempo requerido para la recuperación varía considerablemente. Este estudio echa una ojeada al posible alivio de los síntomas tempranos por medio de la terapia de esteroides orales. SUJETOS Y MÉTODO: Los sujetos fueron 76pacientes en edades de 33 a 73 años al comienzo del estudio. La duración del hombro congelado fue de 1 a 15 meses (promedio 5.7 meses), y se observó hipertensión en 13 pacientes como una condición co-mórbida. Un solo tratamiento con esteroides consistía en una dosis total de 105 mg de prednisolona por un período de aproximadamente tres semanas mediante el método de reducción gradual de la dosis. El número de tratamientos varió de acuerdo con el grado de alivio del síntoma, pero el período de descanso entre tratamientos fue aproximadamente de cuatro semanas. Los resultados fueron evaluados sobre la base de la puntuación establecida por la Asociación Ortopédica del Japón (JOA), y las evaluaciones principales fueron el dolor y el alcance del movimiento. RESULTADOS: El rango promedio del movimiento antes del tratamiento fue 102.8º deflexión delantera, y 11.3º de rotación externa y la rotación interna fue en las nalgas. Sin embargo, luego de un tratamiento, la flexión delantera fue 136º, la rotación externa fue 33.7º, y la rotación interna estuvo limitada a las nalgas en sólo seis casos. CONCLUSIÓN: Los resultados de la terapia de esteroides orales para el hombro congelado, fueron altamente satisfactorias. Sin embargo, se requiere suficiente cuidado al explicar el método de administración y los efectos adversos, tales como la osteonecrosis de la cabeza del fémur o la osteoporosis.

Renal Sarcoidosis Monitored with Gallium Scintigraphy: Report of a Case / General Medicine

A 60-year-old male was diagnosed as having sarcoidosis four months previously because of bilateral hilar lymphadenopathy seen on a chest X-ray, uveitis, and elevation of serum angiotensin converting enzyme. In summer, the patient suffered from hypercalcemia, hypercalciuria, and renal dysfunction. Renal biopsy showed interstitial nephritis with gallium scintigraphy demonstrating high uptake in the bilateral hilum, eyes, and kidneys. Corticosteroid treatment was effective in remarkably improving the renal disorder and radiographic abnormalities.<BR>The calcium metabolic abnormalities and the granulomatous interstitial nephritis showed a marked response to corticosteroid therapy, so that immediate administration of corticosteroid may be justified even in cases without histological evidences. Gallium scintigraphy is suggested to be useful in noninvasive examination in acute stage of sarcoidosis.

Gallium-67 Scintigraphy in Glomerular Disease / 대한내과학회지

OBJECTIVES: Gallium 67(Ga-67) scintigraphy has been used to diagnose inflammatory and neoplastic diseases. We undertook a study to determine the clinical value of Ga- 67 renal scan in patients with various glomerular diseases. METHODS: Ga-67 scintigraphy was performed in 48 patients with various biopsy proven forms of renal diseases. Renal uptake in 48 patients images was graded as follow: Grade 0 = not visualization at 48 hours: 1 = faintly visualize: 2 = equal to uptake in spine: 3 = greater than over the spine: 4 = greater than activity over the liver. RESULTS: 1) Of the 48 patients, 31 were male, and mean age was 32 years. 11 patients had hypertension and 29 patients had hematuria. 2) Positive scintigram were seen in 40 of 48(83%) cases. In results of renal biopsy, IgA nephropathy(IgAN) was 15 patients, minimal change disease(MCD) was 14, focal segmental glomerulosclerosis (FSGS) was 8, membranoproliferative glomerulonephritis (MPGN) was 3, lupus nephritis(LN) was 3, poststreptococcal glomerulonephritis(PSGN) was 3 and membranous glomerulonephritis(MGN) was 2. 3) In 26 patients (54%) with nephrotic-range proteinuria, Grade 2 or higher renal uptake was observed in 9 (75%) of MCD, 5(100%) of FSGS, 2(100%) of LN and 3(75%) of IgAN. 4) In comparision nephrotics with non-nephrotics at biopsy, renal Ga-67 uptake in who patients had nephrotic-range proteinuria was correlated with clinical severity determined by serum albumin, serum total cholesterol and 24 hours urine protein excretion. CONCLUSIONS: Renal Ga-67 scintigraphy may be able to be a predictor in the assessment for severity of nephrotic syndrome.