PubMed · 14055237
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J H WYATT. 1963. ENDOGENOUS UVEITIS.. https://pubmed.ncbi.nlm.nih.gov/14055237/
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Melkersson-Rosenthal syndrome is a rare disorder characterized by a triad of recurrent orofacial swelling, recurrent paralysis of the facial nerve and lingua plicata. The complete triad only occurs in 25% of MRS cases. Monosymptomatic or oligosymptomatic variants are more frequent; other findings include granulomas in other facial sites, regional lymphadenopathy, fever, psychotic disorders and hyperplastic gingivitis are associated with MRS. This can be a diagnostic challenge. The etiology and pathogenesis of MRS are unknown. Corticosteroids or clofazimine appear the best therapeutic options.
The LC-MS characteristics of budesonide and a series of structurally related corticosteroids were reviewed to commence the construction of a library of chromatographic and mass spectral information to aid identification of budesonide degradation products during formulation stabilization investigations. The LC-ESI(+)-MS technique employing a Hypersil C18 column with a mobile phase of ethanol-acetonitrile-formic acid (pH 3.8; 0.14 mM) (2:30:68, v/v/v) was then used to characterize 23 corticosteroids. Based on their structures, the corticosteroids were classified into three groups: (I) 4-pregnene-3-one steroids; (II) 1,4-pregnadien-3-one steroids with no fluorine substituents; and (III) 1,4-pregnadiene-3-one steroids with fluorine substituents. Chromatographic (retention time and UV absorbance) and mass spectral properties were correlated with the known chemical structures of these corticosteroids. Base peak and mass spectral fragmentation patterns were related to steroid structural characteristics.
BACKGROUND: The tendency of chemotherapeutic regimens to cause vomiting is dependent on the individual drugs in the regimen. The authors analyzed data combined from 2 Phase III trials to assess the effect of the neurokinin-1 (NK(1)) antagonist aprepitant combined with a 5HT(3) antagonist plus a corticosteroid in a subpopulation receiving > 1 emetogenic chemotherapeutic agent. METHODS: In the current study, 1043 cisplatin-naive patients (42% were women) receiving cisplatin-based (> or = 70 mg/m(2)) chemotherapy were assigned randomly to a control regimen (ondansetron [O] 32 mg intravenously and dexamethasone [D] 20 mg orally on Day 1; D 8 mg twice daily on Days 2-4) or an aprepitant (A) regimen (A 125 mg orally plus O 32 mg and D 12 mg on Day 1; A 80 mg and D 8 mg once daily on Days 2-3; and D 8 mg on Day 4). Randomization was stratified for use of concomitant chemotherapy and female gender. The primary end point was complete response (no vomiting and no rescue therapy) on Days 1-5 (0-120 hours). Data were analyzed by a modified intent-to-treat approach, and logistic regression was used to make treatment comparisons among patients receiving the most frequently coadministered emetogenic concomitant chemotherapy (Hesketh level > or = 3). RESULTS: Among the approximately 13% of patients (n = 81 for A; n = 80 for control) who received additional emetogenic chemotherapy (doxorubicin or cyclophosphamide), the aprepitant regimen provided a 33 percentage-point improvement in the complete response rate compared with the control regimen. Among the general population, the advantage with aprepitant was 20 percentage points. CONCLUSIONS: The current analysis of > 1000 patients from 2 large randomized trials showed that in the subpopulation at increased risk of chemotherapy-induced nausea and vomiting due to concomitant emetogenic chemotherapy, the addition of aprepitant to standard antiemetics improved protection to an even greater extent than in the general study population.