Anaphylaxis following intralesional triamcinolone acetonide (Kenacort) injection

Intralesional triamcinolone acetonide injection is indicated for multiple skin conditions such as keloid scars, alopecia areata, and hypertrophic lichen planus. Immediate hypersensitivity reaction remains uncommon. We report on a 24-year-old woman who had received multiple intralesional injections with triamcinolone acetonide (Kenacort) plus lidocaine for keloid scar treatment without any reaction for the previous 10 years. The immediate reaction occurred 15 minutes after injection, with numbness on her face and 5 minutes later with urticaria on her chest wall and upper extremities, together with hypotension (blood pressure of 90/60 mmHg). Allergology workup revealed positive skin prick test for triamcinolone acetonide (Kenacort). Skin tests for other corticosteroids (hydrocortisone, methylprednisolone, and dexamethasone), excipients (carboxymethylcellulose, benzyl alcohol, and polysorbate 80) and lidocaine were negative, including subcutaneous challenge for lidocaine and oral challenge for carboxymethylcellulose. IgE-mediated hypersensitivity reaction must be considered in cases of multiple applications of triamcinolone acetonide injection.

Avaliação da atividade biológica de adutos derivados da reação morita-baylis-hillman sobre Trypanosoma cruzi: uma abordagem molecular, citoquímica e ultraestrutural / Biological activity evaluation of morita-baylis-hillman adducts against Trypanosoma cruzi: a molecular, cytochemical and ultrastructural approach

A doença de Chagas, causada pelo protozoário Trypanosoma cruzi, é um importante problema de saúde pública na América Latina, com cerca de 7,6 milhões de pessoas infectadas. O benznidazol e o nifurtimox são os únicos fármacos disponíveis para o tratamento, e além de apresentarem sérios efeitos colaterais, a sua eficácia na fase crônica da doença ainda é controversa. Neste sentido, nós sintetizamos o aduto Morita-Baylis-Hillman 3-hidroxi-2-metileno-3-(4-nitrofenilpropanonitrilo) (MBHA 3) e avaliamos sua atividade biológica sobre o T. cruzi. O MBHA 3 inibiu fortemente o crescimento das formas epimastigotas, com IC(50) / 72h de 28,5 µM e causou intensa lise de tripomastigotas, com IC(50)/ 24h de 25,5 µM. A análise ultraestrutural mostrou alterações morfológicas significantes, como arredondamento do corpo celular e desorganização intracelular. Alterações indicativas de apoptose, autofagia ou necrose também foram observadas nas células mais afetadas. A fim de melhor compreender o mecanismo envolvido na morte celular induzida pelo composto, nós utilizamos a microscopia confocal e a citometria de fluxo aliadas a sondas fluorescentes, como anexina-V (AV)/ iodeto de propídio (IP); Calceína-AM (CA)/ homodímero de etídio (HE); laranja de acridina (LA) e rodamina 123. O tratamento com 6 e 12 µg/ mL revelou uma alta porcentagem de células viáveis pela CA/ HE, mas também induziu alterações mitocondriais e aumento da marcação com a LA, sugerindo que um processo de morte celular programada (MCP) por autofagia poderia estar ocorrendo. Por outro lado, o tratamento com 24 µg/ mL levou à perda de viabilidade celular com danos excessivos sobre a membrana plasmática e mitocondrial e fragmentação inespecífica do DNA. Em conclusão, nossos achados sugerem que o MBHA 3, em alta concentração, induz MCP por necrose em T. cruzi.

Retinal Hemorrhage Induced by Triamcinolone Acetonide Left After Vitrectomy for Macular Epiretinal Membrane

PURPOSE: To report retinal hemorrhage and retinal edema induced by the remaining triamcinolone acetonide (TA) used in vitrectomy for dyeing of vitreous and epiretinal membranes. CASE SUMMARY: The authors performed 23 gauze vitrectomies for macular epiretinal membranes. TA was used during the operation to enhance visualization of the vitreous and epiretinal membrane. At the end of the surgery, an amount of TA was left on the retinal surface. One day after the operation, the patient was maintained a semi-sitting position because of the floating TA particles in the vitreous cavity. The following day, the TA settled onto the inferior retina and retinal edema and hemorrhage occurred unexpectedly in the inferior retina. Vitrectomy was performed again and the fluid of the vitreous cavity was replaced with a fresh balanced salt solution and the settled TA was removed from retinal surface. Finally, argon laser photocoagulation was performed at the area where the retinal edema and hemorrhage had occurred. The retinal edema and hemorrhage disappeared after a few days, normal visual acuity was recovered in seven days, and a normal condition with no further ocular complications was maintained at six months. CONCLUSIONS: When a TA vehicle, such as benzyl alcohol, and TA particles contained in the vehicle are left in the vitreous cavity and contact the retinal surface of a vitrectomized eye, retinal toxicity can be induced due to retinal edema and hemorrhage. The safest use of TA in vitrectomy would involve at least two rounds of sedimentation or filtration through a micofilter needle.

Estudo comparativo experimental da injeção perineural do álcool benzílico 0, 75 e do álcool etílico absoluto nos nervos palmares de eqüinos / Experimental comparative study of perineural injection of benzyl alcohol 0, 75 and absolute ethyl alcohol in equine palmar nerves

Foi estudada a neurólise química dos nervos Palmares em 10 eqüinos. Usando-se uma ferradura especial para induzir claudicação, a locomoção avaliada ao passo e trote e os graus foram registrados antes e após a injeção perineural do álcool benzílico 0,75% (Grupo A) e o álcool etílico absoluto (Grupo B). Os testes mostraram que ambos os neurolíticos dessensibilizaram completamente a sola dos animais a partir de 30 dias, assim permanecendo até o 150º dia nos animais do Grupo A, quando ocorreu retorno progressivo da sensibilidade. Jáno Grupo B, aos 180 dias, a sensibilidade permanecia ausente. A análise histopatológica revelou que nos nervos infiltrados com álcool benzílico 0,75% prevaleceram lesões próprias de axonotemese,sugerindo tendência de regeneração e restabelecimento da condução nervosa, enquanto que nos nervos infiltrados com álcool etílico absoluto, prevaleceram lesões simuladoras de neurotemese, com degeneração nervosa permanente. Concluiu-se que os álcoois utilizados foram eficientes bloqueadores temporários ou permanentes dos nervos Palmares em eqüinos.

The clinical and histopathological effects of two alcoholic neurolytics were studied in horses. Normal horses were shod with a designed shoe adaptted with 5 screws to produce solar pain. After gait and lameness score analysis, the palmar nerve of 5 horses was injected with 5 ml of 0,75% benzyl alcohol (Group A) and 5 horses were injected with 5 ml of absolute ethyl alcohol (Group B). The animals were submitted to regular lameness evaluation and solar sensibility tests during next six months. The solar sensitivity returned 5 months latter in the group injected with benzyl alcohol 0,75%, while in the group injected with absolute ethyl alcohol, the sole was still desensitized 6 months latter. The histopathological findings showed that the nerve injected with benzyl alcohol 0,75%, resulted inaxonotmesis, characterized by axonal nerve degeneration, with possibilities for the nerve conduction recovery. The perineural injectionof ethyl alcohol absolute, resulted in neurotmesis with difficult nerve regeneration. It was concluded that chemical neurolysis with alcoholis an option for temporary or permanent nerve blocks in horses.

Effect of benzyl alcohol on trehalose-loading red blood cells before lyophilization / 中国实验血液学杂志

This study was aimed to evaluate the effect of benzyl alcohol on trehalose-loading red blood cells (RBCs). The RBCs were incubated in 10, 30, 50 and 100 mmol/L concentrations of benzyl alcohol-trehaloe solution at 4 degrees C for 24 hours. The hemolysis rate of loaded RBCs was detected by using cyanohemoglobin kit, the intracellular trehalose level were assayed by sulfate anthrone method. The results showed that the intracellular trehalose concentration in group with 100 mmol/L benzyl alcohol was 72 +/- 12.98 mmol/L, compared with that in groups of 10, 30 and 50 mmol/L, the statistical difference were significant (p = 0.000); the hemolysis rate of loaded RBCs in group with 100 mmol/L of benzyl alcohol was 17.99 +/- 3.75%, as compared with groups of 10, 30 and 50 mmol/L, the statistical difference was significant (p = 0.000). It is concluded that benzyl alcohol can enhance the intracellular trehalose concentration. As concentration of benzyl alcohol ascends, the intracellular trehalose concentration increases. 100 mmol/L benzyl alcohol may be proper for loading RBCs.