Tympanoplasty graft preparation using ear drops containing polyethylene glycol, flumethasone and clioquinol.

The aim of tympanoplasty graft preparation is to stiffen the fascia or perichondrium and thereby to optimise ease of manipulation. We report 39 cases utilising a novel technique in which the graft is prepared in ear drops containing polyethylene glycol, flumetasone pivalate (0.02 per cent) and clioquinol (1 per cent). This technique is useful in reducing the risk of desiccation if placement is delayed, and may pose less risk of infection and mechanical damage than alternative methods.

Medical treatment of vulvar squamous cell hyperplasia.

OBJECTIVE: To evaluate symptomatic response and recurrence rates of graduated topical fluorinated corticosteroid in patients with vulvar squamous cell hyperplasia. METHODS: Nine hundred seventy-six patients with biopsy-proven vulvar squamous cell hyperplasia from 1990 to 2003 were reviewed in this retrospective study. All patients were treated with graduated topical fluorinated corticosteroid. Data were obtained from hospital records. Symptomatic remission and recurrence rates were noted following six months local therapy. RESULTS: The mean age was 42.55+/-10.93 (15-85). The remission rate was 93.8% in six months. The remission rate was non-significantly higher in postmenopausal patients than that in their premenopausal counterpart (94.9% vs 93.0%, p=0.15). The disease recurred in 6.9% of patients. Of the patients that suffered recurrence 47.5% had persistent disease initially. The patients with following factors older ages (>40 years), postmenopausal period had significantly higher recurrence rates. Four patients with recurrent disease and six patients with persistent disease in the form of vulvar intraepithelial neoplasia I-II or atypical squamous hyperplasia, were treated with skinning vulvectomy. CONCLUSION: Corticosteroid in the treatment of vulvar squamous cell hyperplasia yielded excellent response rates. In the evaluation of patients without symptomatic relief, the first step should be a vulvar biopsy to exclude the presence of atypical components.

Regression of subcorneal pustular dermatosis type of IgA pemphigus lesions with azithromycin.

We present our experience with a 56-year-old man who complained for generalized dermatopathy, manifested by skin lesions with diameter from 0.5 to 5 cm. The lesions did not respond to a 20-day systemic steroid regimen. The results of biopsies of three excised lesions, in combination with the clinical manifestations, led to the diagnosis of subcorneal pustular dermatosis type of IgA pemphigus. An unexpected improvement was noted after treatment with azithromycin (which was provided for management of concurrent non-specific urethritis) and local non-potent steroid plus keratolytic agent ointment.

Otic drops used to clear a blocked grommet: an in vitro prospective randomized controlled study with blinded assessment.

Clinicians often prescribe otic drops anecdotally to try and clear grommets blocked with blood. We carried out an in vitro double-blind randomized controlled study comparing the efficacy of sodium bicarbonate, Locorten Vioform and olive oil drops in clearing Shah grommets placed in 'artificial ears' and blocked with blood in a standardized fashion. There were 33 grommets in each group, and drops were inserted three times a day for 7 days. Olive oil drops cleared 17 of 33 (51.51%), Locorten Vioform cleared one of 33 (3%) and sodium bicarbonate cleared zero of 33 (0%) blocked grommets. Statistical comparison between pairs indicates that olive oil was significantly better than both Locorten Vioform (P < 0.001) and sodium bicarbonate drops (P < 0.001) at clearing grommets blocked with blood.

Effect of steroidal and non-steroidal anti-inflammatory drugs in combination with long-acting oxytetracycline on non-specific immunity of calves suffering from enzootic bronchopneumonia.

The aim of this paper was to compare the effect of flumethasone and meloxicam in combination with oxytetracycline on clinical and immunological parameters of calves suffering from enzootic bronchopneumonia. The study was performed on 30 Black-and-White Lowland Breed calves with clinical signs of enzootic bronchopneumonia divided randomly into three equal groups and, respectively, treated with-Group I: oxytetracycline and meloxicam; Group II: oxytetracycline and flumethasone; Group III (control): oxytetracycline only. Treatment of calves with the combination of oxytetracycline and meloxicam (Group I) caused a significantly faster, in comparison to other groups, improvement in the clinical illness index score (CIIS: cough, nasal discharge, dyspnea, depression and anorexia) and a faster normalization of body temperature. A slow decrease in white blood cell (WBC) count, the number of neutrophils, MID (mixed number of monocytes, eosinophils and basophils) and in the individual number of monocytes (CD14/CD45 positive cells) was observed in Groups I and III. In the blood of the calves which received oxytetracycline and flumethasone (Group II), leukocytosis, neutrophilia and monocytosis with concomitant lymphopenia and a low number of T cells (CD2+) was observed. Moreover, the calves treated with flumethasone exhibited a decrease in gamma-globulin concentration, and phagocytic parameters. Both drugs, flumethasone and meloxicam slightly decreased tumor necrosis factor (TNF) but meloxicam slightly increased the levels of interferon (IFN) in sera and in bronchoalveolar lavages (BALs). These results suggest that the combination of meloxicam with an antibiotic in calves suffering from enzootic bronchopneumonia is superior to the antibiotic alone and also to the combination of the antibiotic with flumethasone.

The effect of steroidal and non-steroidal anti-inflammatory drugs on the cellular immunity of calves with experimentally-induced local lung inflammation.

We examined the effect of a single intravenous dose of flumetasone (SAID) and meloxicam (NSAID) treatment of calves with experimentally-induced localized lung inflammation on immunological and hematological variables such as total protein, gamma globulin, hemoglobin (Hb) concentrations, alkaline phosphatase activity, packed red cell volume (PCV), red blood cell (RBC) and white blood cell (WBC) counts. The influence of drug treatment on the phagocytic activity of WBC and bronchoalveolar lavage (BAL) cells and their ex vivo ability to produce interferon (IFN) and tumor necrosis factor (TNF) after induction with Newcastle disease virus (NDV), as well as on the development of PHA-induced skin delayed hypersensitivity reaction was also determined. Two days after the treatment of calves with experimentally-induced local lung inflammation with flumetasone (5 mg per calf), we observed a significant increase in WBC count, especially neutrophils, and a decrease in gamma globulin concentration, in the percent of blood phagocytic cells and their random migration. Flumetasone treatment also inhibited the development of skin delayed hypersensitivity reaction. In contrast, the treatment of calves with meloxicam (50 mg per calf) did not influence any hematological parameters or skin reactivity. Both drugs, flumetasone and meloxicam, influenced TNF production in ex vivo cultures of blood and BAL cells, inhibiting excessive TNF production induced by local lung inflammation. Contrary to TNF, the treatment of calves with meloxicam and flumetasone enhanced ex vivo IFN production in blood and BAL cells. Histological examination of lung tissue revealed that in control calves (those not treated with anti-inflammatory drugs) and in calves treated with flumetasone, symptoms of stromo-purulent inflammation of pulmonary tissue developed. However, in calves treated with meloxicam, only interstitial inflammation with a slight thickening of interalveolar septa and infiltration of lymphoid cells was observed. These results suggest that in this model of pneumonia, it is more appropriate to use a single dose of meloxicam, rather than flumetasone, to modulate lung inflammation.

Dexamethasone and flumethasone residues in milk of intramuscularly dosed cows.

A field study was performed to assess the level of drug residues in milk after therapeutic application of highly potent synthetic glucocorticoids. Dexamethasone was tested either as a crystalline suspension or as a combination of sodium phosphate and phenylpropionate esters. Intramuscular injection of these preparations in lactating dairy cows (60 micrograms dexamethasone/kg body wt) yielded drug residues in milk of up to 8.4 ng/mL 12 h after treatment. These dexamethasone residues fell to below 1.0 ng/mL within 3 days after treatment. Intramuscular injection of an aqueous flumethasone preparation (13.5 micrograms/kg body wt) produced drug residues in milk in the range of 0.7-1.2 ng/mL 12 h after treatment, whereas flumethasone was below the detection limit of 0.23 ng/mL 2 days after administration. These results indicate that toxicologically significant residues may arise transiently in the milk during the first 2-3 days after intramuscular injection of synthetic glucocorticoids. Urine from the same animals contained 5- to 50-fold higher glucocorticoid concentrations than the corresponding milk samples. Thus, urine analysis appears to be an effective method to monitor the use of synthetic glucocorticoids in food producing animals.

Efficacy of the combination sodium ceftiofur-flumethasone in the treatment of experimental Pasteurella haemolytica bronchopneumonia in calves.

Severe acute bronchopneumonia was induced in 18 conventional Friesian-Holstein calves by inoculating them intratracheally with Pasteurella haemolytica type A1. Six of the calves received no treatment and served as controls. Six of the calves were treated with sodium ceftiofur and six were treated with sodium ceftiofur and flumethasone. The mortality rate in the group of calves treated with sodium ceftiofur and flumethasone was significantly lower and their clinical and haematological parameters returned to normal significantly faster than in the control calves and the calves treated with sodium ceftiofur alone.

Prophylaxis of respiratory distress syndrome in premature calves by administration of dexamethasone or a prostaglandin F2 alpha analogue to their dams before parturition.

OBJECTIVE: To investigate effects of preterm induction of calving by administration of flumethasone and dinoprost on the lecithin-to-sphingomyelin ratio in amniotic fluid and on neonatal respiratory distress after birth. ANIMALS: 45 dairy cows and their newborn calves. PROCEDURE: Amniotic fluid from 45 cows was obtained and tested between days 258 and 270 of gestation. Cows were then given flumethasone (10 mg; n = 15), dinoprost (25 mg; n = 15), or saline solution (n = 15). Thirty hours later, left flank cesarean section was performed, amniotic fluid was collected, and the calf was delivered. Blood for determination of progesterone was withdrawn at amniotic fluid sample collections and before induction of calving. Blood for analysis of pH and base deficit was collected from calves during cesarean section and repeatedly after birth. Phospholipids in amniotic fluid were measured by thin-layer chromatography, and progesterone was determined by radioimmunoassay. Base deficit and pH were measured, using a blood gas analyzer. RESULTS: Before treatments, a corpus luteum was present in all cows and the lecithin-to-sphingomyelin ratio in amniotic fluid did not differ between groups. Thirty hours after injections of flumethasone and dinoprost, progesterone concentration had decreased (P < 0.05) and the lecithin-to-sphingomyelin ratio was significantly (P < 0.05) higher than values in controls. In calves delivered after flumethasone or dinoprost treatments, the degree of acidosis was significantly (P < 0.05) less than that in controls. CONCLUSIONS: Flumethasone and dinoprost, given to pregnant cows, accelerate fetal lung maturation and improve respiratory function after birth.

Use of corticosteroids alone or combined with glucose to treat ketosis in dairy cows.

OBJECTIVE: To compare relative efficacy of dexamethasone and flumethasone alone or in combination with rapid IV infusion of glucose for treatment of ketosis in cattle. DESIGN: Clinical trial. ANIMALS: 127 cows with urine acetoacetate concentration > or = 60 mg/dl. PROCEDURE: Cows were treated with 500 ml of 50% glucose solution. IV, and 40 mg of dexamethasone, IM (group 1), 40 mg of dexamethasone, IM (group 2), 5 mg of flumethasone (group 3), or 500 ml of 50% glucose solution, IV, and 5 mg of flumethasone (group 4). Treatment success was defined as recovery after a single treatment without relapse during the same lactation. Uterine disease (retained placenta or metritis), parity, and pretreatment plasma glucose, serum beta-hydroxybutyric acid, and urine acetoacetate concentrations were evaluated as possible confounding factors affecting recovery. RESULTS: Only uterine disease was found to have a significant effect on recovery. Treatments 1 and 4 were significantly more efficacious than was treatment 2, but efficacy of treatment 2 was not significantly different from that of treatment 3. Regardless of treatment, cows with uterine disease were less likely to have a successful outcome than were cows without uterine disease. In all treatment groups, plasma glucose concentration increased and serum beta-hydroxybutyric acid and urine acetoacetate concentrations decreased following treatment. CLINICAL IMPLICATIONS: In this study, treatment of ketosis in dairy cattle with a corticosteriod alone was less efficacious than treatment with glucose and a corticosteroid.

[The effectiveness of cholecalciferol and flumethasone for the prevention of hypocalcemic parturient paresis in dairy cows]. / Untersuchungen über die Wirksamkeit von Cholekalziferol und Flumethason zur Prophylaxe der hypokalzämischen Gebärparese bei Milchkühen.

Investigations on the efficacy of high doses of cholecalciferol and flumethasone for prophylaxis of hypocalcemic milk fever were performed in dairy cows. Only one cow in the group of 25 treated animals diseased by milk fever, but 5 of 25 control animals showed signs of hypocalcemia. A placenta retention was observed in three treated animals and in four control animals. The results show that the additional application of flumethasone for birth induction after the injection of vitamin D3 was unchanged.

Vulvar dystrophies: an evaluation.

Of 86 patients diagnosed as having vulvar dystrophy in a 10-year period 56 (65.1%) had hyperplastic dystrophy, 23 (26.7%) had lichen sclerosus and 7 (26.7%) had mixed vulvar dystrophy. The diagnoses were made by colposcopic or toluidine blue directed biopsies. Fluorinated corticosteroids were given to patients with hyperplastic dystrophy with a response rate of 90.1%. Patients with lichen sclerosus received topical testosterone propionate and the response rate was 87.7%. Topical fluorinated corticosteroids followed by testosterone propionate was given to patients with mixed dystrophy and 85.8% of the patients responded. Surgical therapy was reserved for patients with failed medical treatment.

Effect of steroidal anti-inflammatory drugs on Escherichia coli endotoxin-induced mastitis in the cow.

Effects of intramammary infusion of prednisolone (40 mg) or intramuscular injection of dexamethasone (30 mg) or flumethasone (5 mg) on local and systemic signs in Escherichia coli endotoxin-induced mastitis were studied. The effect of varying intervals (0, 2, and 4 h) between intramammary infusion of endotoxin and prednisolone in the same quarter was determined. Intramammary infusion of endotoxin (.01 mg lipopolysaccharide of E. coli) produced inflammation of the infused quarter, fever, tachycardia, and leukopenia followed by a neutrophilic leukocytosis in the blood and a decrease in plasma zinc and iron concentrations. All corticosteroid treatments, except intramammary administration of prednisolone 4 h after endotoxin infusion, enhanced leukocytosis and diminished local signs of inflammation. Intramuscular injection of dexamethasone or flumethasone together with intramammary infusion of endotoxin and intramammary administration of prednisolone 2 h after lipopolysaccharide infusion completely abolished the febrile response. Abolishment of fever and attenuation of several hematologic and blood biochemical changes may be explained by diminished synthesis of endogenous mediators within the inflamed quarters due to glucocorticosteroid action.

Effects of induced parturition and early obstetrical assistance in beef cattle.

Pregnant crossbred beef females (33 second-calf cows and 73 primiparous heifers) bred to a single Hereford sire were assigned to a 2(3) factorial study involving age of dam, natural (NP) or induced (IP) parturition and late emergency (LA) or forced early (EA) obstetrical assistance. Parturition was induced with 10 mg flumethazone given i.m. between 1400 and 1600 on d 272 of gestation; EA was given when the cervix and birth canal were fully dilated. Average IP occurred 39.6 h postinjection, and 95.3% of the treated dams responded within 60 h postinjection; gestation was shortened 2.9 d (P approximately equal to .07). Dystocia score (from 1 = no assist to 4 = major traction required and 5 = abnormal presentation) was 1.12 vs 2.40 for LA and EA, respectively (P less than .01), and 11% of LA vs 84% of EA were assisted. Calf vigor score (1 = normal to 3 = severely depressed or dying) at birth was 1.3 for NP and 1.1 for IP (P approximately equal to .06) and 1.3 for EA and 1.1 for LA (P less than .05). This effect of EA was due to reduced vigor of calves experiencing abnormal presentation. Birth weights (BW) and weaning weights (WW) of calves from cows exceeded those from heifers (32.6 vs 30.8 kg, P less than .05; 210.9 vs 156.3 kg, P less than .01, respectively). Differences due to IP and EA in BW, WW, postpartum interval and conception rate were not significant, but weight gain of calves from EA dams tended (P approximately equal to .09) to be greater than weight gain of calves from LA dams.(ABSTRACT TRUNCATED AT 250 WORDS)

Combination dermatological products: a comparison of betamethasone dipropionate/clotrimazole/gentamicin sulphate and flumethasone pivalate/clioquinol creams.

The combination creams, betamethasone dipropionate/clotrimazole/gentamicin sulphate and flumethasone pivalate/clioquinol, were compared in patients with corticosteroid responsive dermatoses and/or cutaneous fungal and/or bacterial infections. Medication was applied to affected areas twice daily for 28 days. Of 67 patients enrolled, 31 treated with betamethasone/clotrimazole/gentamicin and 33 given flumethasone pivalate/clioquinol were evaluated for efficacy and safety each week during therapy and once 14 days post-therapy. Disease signs and symptoms were less severe in the group given betamethasone/clotrimazole/gentamicin than in the comparative group at days 7 (P = 0.04), 21 (P = 0.02), 28 (P = 0.09), and 42 (P = 0.09) and at patients' last valid visit (P = 0.06). By the last valid visit, signs/symptoms had improved by 82% for patients treated with betamethasone/clotrimazole/gentamicin versus 68% for those treated with flumethasone pivalate/clioquinol. Patients given betamethasone/clotrimazole/gentamicin had statistically significantly better therapeutic responses than those given flumethasone pivalate/clioquinol at day 7 and, by the last valid visit, 19/31 (61%) patients given betamethasone/clotrimazole/gentamicin compared to 15/33 (45%) given flumethasone pivalate/clioquinol had a complete cure or an excellent therapeutic response. Median time of onset of relief of erythema and pruritus was approximately 2 days, regardless of treatment. No adverse reactions were reported.

Efficacy of topical application of glucocorticosteroids compared with eosin in infants with seborrheic dermatitis.

Two therapeutic regimens for seborrheic dermatitis in infancy were compared. Fifteen infants were treated with topical glucocorticosteroid (flumethasone pivalate 0.02 percent) and fifteen with aqueous solution of the staining agent eosin 2 percent. Following two days of treatment a similar degree of healing was noted in both groups, and after ten days almost complete healing of the lesions was observed in all of the infants.