Severe corrosive oesophagitis: are high doses of methyl prednisolone efficient to prevent oesophageal caustic stricture in children?

Corrosive oesophagitis stricture is the long term complication of severe corrosive oesophagitis. The aim of our study was to evaluate the effect of a high doses of steroids on incidence and quality of oesophageal stricture. We reviewed the case histories of 28 children seen at children hospital from 31 December 1991 to 31 December 2001. These children has second and third degree oesophageal burns and they were treated by systemic Methylprednisolone [1000mg/l,73/m2 SC]. The frequency of stricture was 12/26 [46%]. Ten children required a mean of 6,7 [5,74] dilatation range [1 - 17].One patient required an oesocoloplasty. The frequency of stricture in the group treated early before the 24th hour and after the 24th hours was [9/21] [47,4%] versus [3/7] [42,9%]. This difference was not significant [P = 1]. The frequency of stricture in the group treated less than 21 days and more than 21 days was 6/17 [40%] versus 6/9 [66,7%]. This difference was not significant [P = 0,400]. High doses of methyl prednisolone seems to decrease the risk of oesophageal stricture. We found no difference between the children treated before the 24th hours and those treated after the 24 hours and those treated less than 21 days and those more than 21 days

Therapeutic time window for methylprednisolone in spinal cord injured rat

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.

Uso de esteroides intravenosos como tratamiento de la lumbociática aguda / Intravenous steroids for treatmente of acute lumbosciatic pain

Se realizó un estudio prospectivo de marzo de 1992 a junio de 1993 en 25 pacientes adultos, de 24 a 45 años, con cuadro de lumbociatalgia aguda secundaria a radiculopatía por hernia de disco intervertebral lumbar, que se trataron en forma intra-hospitalaria con un succinato sódico de metil-prednisolona en dosis de 500 mg por vía intravenosa, a intervalos de 8 a 12 horas durante un periodo de tres a cinco días. De los 25 pacientes tratados, en 14 desapareció del dolor y en 10 de esos 14 desaparecieron las alternaciones neurológicas. De los 11 restantes en tres hubo mejoría significativa con fisioterapia y reposo. Finalmente ocho no mejoraron, de los cuales solamente cinco aceptaron someterse a cirugía. El porcentaje de pacientes que mejoró en forma primaria con este tratamiento fue de 56 por ciento, el cual se considera de valor clínico

Pulsoterapia em buloses: relato de nove casos / Pulsotherapy in bullous disorders: report of nine cases

Os AA relatam os resultados obtidos com o uso intravenoso de doses suprafarmacológicas do succinato sódico de metilpredinisolona (1g/dia por três dias consecutivos) em nove casos e pentifigóide gestacional - um caso. A exceçäo de cinco pacientes virgens de tratamento, todos os demais apresentavam resistência ao tratamento oral com doses elevadas de corticosteróides ou alguma restriçäo ao seu uso prolongado. A pulsoterapia produziu remissäo completa das lesöes sem observaçäo de efeitos colaterais graves. O tratamento subseqüente consistiu do uso oral, de doses baixas de prednisona, isoladamente ou em associaçäo à azatioprina, ciclofosfamida, talidomida, ouro ou sufona. Durante o seguimento ambulatorial que variou de seis a 16 meses, foram registrados um abandono e duas recidivas