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Pharmacokinetics of a contraceptive patch (Evra/Ortho Evra) containing norelgestromin and ethinyloestradiol at four application sites.

AIMS: To determine the pharmacokinetic profile of norelgestromin (NGMN) and ethinyloestradiol (EE) following application of the contraceptive patch, Evra/Ortho Evra, at each of four anatomic sites (abdomen, buttock, arm, and torso). METHODS: Thirty-seven healthy, nonpregnant women aged 20-45 years participated in this open-label, four-period crossover study. Subjects were randomized to one of four treatment (site of application) sequences. Each patch was worn for 7 days, with a 1 month washout between treatments. Blood samples were collected before and at various times up to 240 h after application of each patch. Serum samples were assayed for NGMN and EE by validated methods. RESULTS: The serum concentration reference ranges for NGMN and EE are 0.6-1.2 ng ml-1 and 25-75 pg ml-1, respectively, based on studies of the mean Cave of oral norgestimate 250 microg and EE 35 microg. For all application sites, mean concentrations of NGMN and EE remained within these ranges during the 7 day wear period. Absorption of NGMN and EE during patch application on the buttock, arm, and torso was equivalent. Absorption of NGMN and EE during patch application on the abdomen was approximately 20% less than observed for the other three sites, although mean serum concentrations were still within reference ranges. A previous study demonstrated therapeutic equivalence of patches worn on the abdomen vs other sites. CONCLUSIONS: Serum concentrations of NGMN and EE from the contraceptive patch remain within the reference ranges throughout the 7 day wear period, regardless of the site of application (abdomen, buttock, arm, or torso).

Administration, Cutaneous↗

Facultative skin pigmentation in caucasians: an objective biological indicator of lifetime exposure to ultraviolet radiation?

To investigate age and gender trends in facultative and constitutive skin pigmentation we measured skin pigmentation non-invasively and objectively by skin reflectance spectroscopy in 653 caucasians (336 females and 317 males; mean age 38 years, range 0-85) who were not using artificial tanning devices. In all subjects, measurements were performed in the late winter and pre-spring period at five sites exposed to ultraviolet (UV) radiation: the forehead, the upper chest, the upper back and the lateral and medial aspects of the upper arm, and in UV-unexposed buttock skin. Constitutive pigmentation at the buttocks was highest in the first years of life and then decreased substantially during the first two decades of life (P < 0.01). After the age of 25 years, buttock pigmentation remained at a constant level (P = 0.20). There was no gender difference in constitutive pigmentation. Facultative skin pigmentation increased with age for all the measured sites with the highest levels found at the lateral aspect of the upper arm. Based on observations in this study we propose the idea of a 'sun exposure index' (SEI) for individuals, based on objective measurements of skin pigmentation. The SEI is calculated as the increase in facultative pigmentation above the constitutive level and is expressed as a percentage of the constitutive level. The SEI appeared to be related to cumulative lifetime UV exposure and may be used in epidemiological research as an objective estimate of UV exposure at different body sites in caucasians.

Adolescent↗

Urocanic acid isomers and photosensitivity in healthy children.

Episodes of intense sun exposure, particularly in childhood, seem to carry a risk for the development of malignant melanoma in later life. However, little is known about photosensitivity and natural photoprotection in children. In adult subjects, photoprotection is provided mainly by the epidermal content of melanin and the thickness of the stratum corneum, while the amount of urocanic acid (UCA), a major ultraviolet-absorbing component of the stratum corneum, is not thought to contribute significantly to photoprotection. The minimal erythema dose (MED) was determined in 22 healthy children aged 6-13 years and in 36 healthy adults (mean age 28.1 years). Pigmentation was measured at six body sites by use of reflectance spectroscopy and the concentration of UCA isomers was measured in a sun-exposed area (upper back) and in unexposed buttock skin. No significant differences between children and adults were found, either in pigmentation at exposed and unexposed body sites, or in MED. The concentration of total UCA was significantly higher in the children than in the adults on the buttock (median 22.2 vs. 13.6 nmol/cm2), but not on the back. On exposed back skin, the children had a significantly higher percentage of cis-UCA than the adults (median 60.1 vs. 28.3%), while no difference was found on the buttock. In both groups, a significant correlation was found between pigmentation and MED (children: Spearman correlation coefficient 0. 58, P = 0.006; adults: Spearman correlation coefficient 0.69, P < 0. 0001), indicating that pigmentation is of major importance in determining photosensitivity in children as well as in adults. The concentration of total UCA did not correlate with the MED in either group.

Adolescent↗

Quantitative evaluation of chronological ageing and photoageing in vivo: studies on skin echogenicity and thickness.

Skin ageing is divided into chronological ageing and photoageing due to the cumulative effects of solar ultraviolet radiation. It is, however, difficult to measure the degree of photoageing and chronological ageing in humans in vivo. Here, we have evaluated the usefulness of ultrasonography for measurement of chronological ageing and photoageing in vivo. Twenty megahertz ultrasonography was performed in 90 individuals (29 men, 61 women, age 18-94) to describe age-related changes in sun-exposed regions with different levels of sun exposure (dorsal and ventral forearm, forehead, ankle) and non-exposed buttock skin. Skin thickness and skin echogenicity in different layers of the dermis were measured in ultrasound images. Additionally, cutaneous photodamage was scored clinically. Age-related changes were dependent on body site as well as layer of the dermis. A progressive, age-related decrease in echogenicity of the upper dermis was found in sun-exposed regions (dorsal forearm, forehead), but not in moderately exposed regions (ventral forearm, ankle). In the buttock an increase in echogenicity was observed. The echogenicity of the lower dermis increased in all examined sites. Skin thickness increased with age in the forehead and buttock, but decreased in the extremity skin. Our findings show that photoageing causes a decrease in echogenicity in the upper dermis. In contrast, chronological ageing is associated with an increase in echogenicity in the lower dermis. Although both increases and decreases in skin thickness were observed in different anatomical regions, there was no general relationship between skin thickness and age. Dermal echogenicity was deemed valuable for in vivo study of chronological ageing and photoageing.

Adolescent↗

A broad spectrum of human papillomavirus types is present in the skin of Australian patients with non-melanoma skin cancers and solar keratosis.

BACKGROUND: Human papillomavirus (HPV) may play a role in the pathogenesis of non-melanoma skin cancer (NMSC) in epidermodysplasia verruciformis (EV) patients, but in the general population no specific HPV types have been associated with these lesions. Objectives To examine the spectrum of HPV types present in the skin and tumours of Australian patients with NMSC or solar keratosis (SK). METHODS: Biopsies from tumours, and cotton swab samples of perilesional skin and buttock skin from each of 59 Australian patients with basal cell carcinoma (BCC), squamous cell carcinoma (SCC) or SK were tested for HPV DNA by polymerase chain reaction (PCR) using HPV consensus (FAP) primers and by type-specific primers for HPV 38 and candidate HPV 92. The identification of HPV type from consensus PCR was performed by sequencing and comparison with GenBank. RESULTS: In total, 49 of 59 (83%) patients harboured HPV DNA, which was detected in 28 of 64 (44%) biopsies, 48 of 64 (75%; P < 0.001) perilesional swabs and 36 of 59 (61%; P = 0.04) buttock swabs. Forty-five different HPV types/putative types were detected: 15 were previously characterized HPV types, 17 were earlier described putative types and 13 were new putative types. In addition, six subtypes and four variants of HPV sequences were identified. HPV types within the B1 group (EV HPV types) were found in 26 of 64 (40%) lesions, 44 of 64 (69%) perilesional swabs and 35 of 59 (59%) buttock swabs. HPV 38 was detected in 23 of 59 (39%) patients, and was found in seven of 16 (43%) SKs, but was less common in SCCs [three of 23 (13%); P = 0.037] and BCCs [four of 25 (16%); P = 0.056]. Candidate HPV 92 was found in seven of 59 (12%) patients. CONCLUSIONS: A broad spectrum of HPV types, the majority from the B1 group, was found in skin of Australian patients with skin tumours. HPV 38 was found significantly more often in SK than in SCC. However, the role of cutaneous HPV infection in the pathogenesis of NMSC remains elusive.

Adult↗

Actinic degeneration and pigmentary change in association with psoralen and UVA treatment: a 20-year prospective study.

BACKGROUND: Changes in the appearance of the skin including actinic degeneration and pigmentary changes have been noted in patients treated with psoralen and UVA (PUVA). OBJECTIVE: Our purpose was to quantify risk factors for increased extent and progression of actinic degeneration and pigmentary changes in the skin of patients treated with PUVA. METHODS: On the basis of standardized dermatologic examination conducted in 1977 and 1998 of patients enrolled in the PUVA Follow Up Study, we assessed the prevalence of and changes in the extent of actinic degeneration and pigmentary abnormalities on the hands and buttocks. RESULTS: From 1977 to 1998, the prevalence of moderate or severe actinic degeneration increased from 15.6% to 60.5% on the hands and from 2.2% to 21.3% on the buttocks. During this same period, the prevalence of pigmentary changes of this degree increased from 15.6% to 58.6% on the hands and 12.6% to 24.7% on the buttocks. Extent of exposure to PUVA was the strongest predictor of an increased extent of clinical actinic degeneration or pigmentary change. CONCLUSION: Long-term exposure to PUVA is associated with persistent increases in actinic degeneration and pigmentary abnormalities of the skin on both usually sun-exposed and sun-protected sites.

Aged↗

Internal iliac occlusion without coil embolization during endovascular abdominal aortic aneurysm repair.

PURPOSE: When abdominal aortic aneurysms and common iliac artery (CIA) aneurysms undergo concomitant endovascular repair, endograft limb extension into the external iliac artery is often necessary. Usually, the internal iliac artery (IIA) is coil embolized in such a case to prevent endoleak. It has been our practice to coil embolize the IIA only in cases where there is not adequate stent graft seal in the CIA immediately proximal to the IIA origin (effectively sealing the entire IIA origin). In this study, we evaluated the outcomes of this approach. METHODS: We retrospectively reviewed 204 consecutive endovascular abdominal aortic aneurysm repairs at Dartmouth-Hitchcock Medical Center from 1996 to 2001. Computed tomographic angiography with three-dimensional reconstruction was the primary preoperative imaging modality, and the decision to cover the IIA without concomitant coil embolization was based before surgery on the presence of adequate graft oversizing (> or =10% to 15%) in the most distal 5 mm of CIA and 15 mm of proximal external iliac artery, respectively. RESULTS: The IIA was occluded 33 times in 31 patients. In 22 cases (67%), the IIA was covered without coil embolization (COVER group). The remaining 11 patients (33%) with inadequate graft oversizing in the CIA underwent IIA coil embolization (COIL group). The follow-up periods for the COVER and COIL groups were 19 +/- 2 months and 10 +/- 3 months, respectively. All operations in both groups were technically successful without evidence of endoleak at completion angiography. No endoleaks, graft migrations, or aneurysm enlargements were associated with the covered or coiled IIAs during the follow-up period. No clinical sequelae were seen in the COVER group, with the exception of buttock claudication in six patients (27%) that resolved completely in five patients. In the COIL group, five patients (45%) had buttock claudication. In addition, one case of buttock necrosis and one case of ischemic neuropathy occurred in the COIL group. CONCLUSION: Covering the IIA without coiling effectively excluded the CIA aneurysm in every case and was associated with a low incidence rate of complications compared with coil embolization. With detailed preoperative imaging and patient selection, IIA coil embolization may not be necessary in as many as two thirds of patients who need IIA occlusion.

Aged↗

Does weight-shifting exercise improve postural symmetry in sitting in people with hemiplegia?

BACKGROUND: Weight-shifting exercise was empirically practised in correcting the biased posture of people with stroke-induced hemiplegia. OBJECTIVES: (1) Evaluate the loading symmetry at the buttock-seat interface as a reflection of a postural defect in sitting. (2) Investigate if weight-shifting exercises could correct the postural problem of people with hemiplegia. DESIGN: Control group design. PARTICIPANTS: 16 subjects with hemiplegia after stroke and 14 healthy individuals. PROCEDURES: Subjects were assessed for buttock-seat interface loading while in erect sitting using a seat pressure mapping system. Subjects with stroke then practised one session of weight-shifting exercise followed by a reassessment. RESULTS: The subjects with hemiplegia, particularly those with right hemisphere lesion, had more load borne at the buttock ipsilateral to the side of stroke lesion. The weight-shifting exercise did not produce an immediate improvement on the loading asymmetry. CONCLUSION: The exercise would require further investigation to clarify its benefits in treating postural problems after stroke.

Adult↗

Design and development of a pressure relief seating apparatus for individuals with quadriplegia.

Persons with spinal cord injury above C7 lack the ability to extend their elbows and grip with their hands. Consequently, when seated, they are unable to press down to shift their weight to relieve pressure on the ischial tuberosities. This can ultimately cause serious pressure sores to develop on the buttocks. Those with adequate insurance coverage can eliminate this problem with an electric power recliner wheelchair. With the touch of a button, the backrest will fold down to a laying position, thus relieving the pressure on the ischial tuberosity. Unfortunately, not all individuals with quadriplegia possess this type of coverage. Therefore, the problem requires an alternate design that will utilize mechanical rather than electrical power to produce a cost-effective solution. The purpose of this project was thus to design and build an affordable apparatus adaptable to wheelchairs that allows individuals with quadriplegia to shift their weight from one side to the other thus relieving the pressure on the ischial tuberosities. A pneumatic system that utilizes two inflatable air bladders was employed. One cushion is placed under each buttock and inflated separately to tilt the user from one side to the other. The inflated cushion elevates one side of the buttock, which relieves the pressure from the other side. The power required to operate the system is generated using repetitions of elbow flexion. The system was evaluated on an individual with C6 quadriplegia. The subject demonstrated independent pressure relief without intrusion on cosmesis or independence.

Cost-Benefit Analysis↗

Subcutaneous adipose-tissue fatty acids and vitamin E in humans: relation to diet and sampling site.

The influence of diet and sampling site on subcutaneous adipose-tissue fatty acid composition and vitamin E content was examined in 20 healthy subjects. A dietary history and adipose-tissue biopsies from the buttock were obtained from 14 individuals. In another six individuals, samples were taken from both waist and buttock. The relative dietary intake of both polyunsaturated and saturated fatty acids correlated with the relative content in adipose tissue (r = 0.6, p = 0.02). Adipose-tissue vitamin E was strongly associated with dietary intake (r = 0.76, p = 0.004). The content of n - 3 (omega-3) fatty acids in adipose tissue was shown to influence adipose-tissue vitamin E negatively. Waist and buttock fat differed (p less than 0.05) with regard to fatty acid composition whereas no systematic variation was seen in the vitamin E content. The use of adipose-tissue biopsies in epidemiologic studies as measures of the habitual relative intake of fatty acids and vitamin E is suggested.

Adipose Tissue↗

Sacral stress fractures in athletes.

Low back and buttock pain in runners can be a source of frustration for the athlete and a diagnostic dilemma for the physician. The authors reported on 3 cases of sacral stress fractures in women athletes, all of which initially presented as low back and/or buttock pain. Sacral stress fractures have been increasingly recognized as a potential cause of these symptoms, especially in young athletes. Because plain radiograph findings are typically normal, the diagnosis is best made with bone scintigraphy. Computed tomography is indicated if there is concern about neoplasm and to evaluate healing of the fracture. If treated with rest, most of these fractures heal and the athlete can return to previous sports activity. The treating physician should be suspicious of this injury among running athletes reporting sacral and buttock pain that does not respond to treatment.

Adolescent↗

Neutrophil localization following reperfusion of ischemic skin flaps.

A swine model of island latissimus dorsi myocutaneous and buttock cutaneous flaps was used to examine neutrophil localization and flap survival after 6 hours of global ischemia followed by 24 hours of reperfusion. Radioactivity from autotransfused neutrophils labeled with indium-111 enabled their localization. Radioactivity in ischemic latissimus dorsi flaps was increased by 101 +/- 30 percent over contralateral control latissimus dorsi flaps (n = 6, p = 0.01). Radioactivity in ischemic buttock flaps was increased by 142 +/- 40 percent over contralateral control buttock flaps (n = 6, p = 0.008). Despite increased neutrophil localization to ischemic flaps, the magnitude of tissue radioactivity failed to provide sufficient information to predict ischemic injury as measured by flap survival and tissue water content.

Analysis of Variance↗

Arterial ischemia in skin flaps: microcirculatory intravascular thrombosis.

Although endothelial cell injury and microcirculatory intravascular thrombosis have been implicated in the pathophysiology of skin-flap failure, the basic underlying pathophysiology has not been documented previously. This study focuses on the morphologic changes and the alteration in platelet, fibrinogen, antithrombin III, and von Willebrand factor levels in flaps injured by arterial ischemia and reperfusion. A thrombogenic arterial anastomosis model is compared with simple arterial clamping as methods to achieve flap ischemia. Bilateral buttock skin flaps and latissimus dorsi island flaps were elevated in 12 pigs. All flaps had a primary ischemic insult of 2 hours' duration by simple clamp application. During this interval, a thrombus-generating, microvascular anastomosis was prepared, and during a 2-hour period of reperfusion, laser Doppler and transiluminator monitoring of the vascular pedicle allowed documentation of embolic events from the thrombus-generating anastomosis. In group 1 (n = 6), the flaps were then subjected to 7 (buttock skin) and 5 (latissimus dorsi) hours of complete arterial ischemia by clamping. During the secondary ischemic period, the poor microanastomosis was resected and repaired. Radioactively labeled autologous platelets (111In) and human fibrinogen (125I) were injected intravenously half an hour before secondary reperfusion. After 4 hours of reperfusion, flap biopsies and venous effluent were collected and prepared for electron microscopic analysis. The flaps and control tissue were harvested and the radioactivity was counted. In group 2 (n = 6), flaps were subjected to 6 hours of secondary ischemia by using the same technique as in group 1. Central venous and flap venous blood was sampled at baseline as well as upon immediate secondary reperfusion and after 4 and 8 hours of reperfusion. The hematocrit, platelet count, fibrinogen, antithrombin III, and von Willebrand factor levels were determined for these intervals. Platelets and fibrinogen accumulated significantly in buttock skin flaps and in the latissimus dorsi skin and muscle components as compared with similar control tissue (p < 0.05). There was no significant difference in platelet or fibrinogen accumulation after comparing the two ischemic models. Electron microscopic studies showed occluded capillaries with activated platelets in the flaps. Control tissue showed very little capillary occlusion. Platelet count was significantly decreased both in central venous (p < 0.05) and in adventitial infolding flap venous blood (p < 0.025) during immediate reperfusion as compared with baseline. These findings confirm that microcirculatory intravascular thrombosis is implicated in skin-flap ischemia-reperfusion injury. This study provides physiologic support for treatment modalities aimed at counteracting the various components in the coagulation pathways responsible for thrombus formation.

Anastomosis, Surgical↗

Orbital dermis-fat graft using periumbilical tissue.

Dermis-fat grafts are currently used in orbital reconstruction in a variety of procedures. The most frequent harvesting site is the gluteal area. However, we encountered some patients with anophthalmic socket who wished to avoid a visible scar on the buttock. In this article, we describe the effort to offer the patient an alternative donor site. Of the last 36 patients with anophthalmic socket who needed a dermal fat implant, 11 wished to avoid a visible scar on the buttock. To satisfy their requests we have endeavored to harvest the dermis graft from the periumbilical area. The rate of absorption, the motility, and the satisfaction of the patients were used as outcome measures and were analyzed carefully. Of 11 patients, 4 were women and 7 were men. The ages of these patients ranged from 24 to 56. The maximum follow-up was 137 months and the minimum 22 months, with a mean follow-up of 79 months. Some degree of absorption of the graft developed in one patient who had a severe absorption and required further operation. Of 11 cases, there were 7 with excellent motility, 3 with good motility, and 1 not evaluated. The motility was measured with the final prosthesis. The results for all patients were satisfactory. The periumbilical area has sufficient concentration of subdermal fat, and it is a relatively hair-free region as the lateral quadrant of the buttock. This area is a suitable alternative donor site of dermal fat implant for anophthalmic socket, especially in young women.

Adipose Tissue↗

Superior cluneal nerve entrapment eight years after decubitus surgery.

BACKGROUND AND OBJECTIVE: Superior cluneal nerve (SCN) entrapment is one of the infrequent etiologies of low back pain (LBP), which is rarely diagnosed. Few clinical reports have been published in the literature. We present a case of severe LBP radiating to the ipsilateral buttock after decubitus surgery. CASE REPORT: A 62-year-old man weighing 85 kg presented to the algology department, suffering from severe LBP of 6 months duration. The pain was in the right iliac crest region with radiation to the ipsilateral buttock. After admission, his history was taken, physical examination was performed, and further evaluations were made. He was suspected of having facet and right sacroiliac joint pain. Two tender points were found 6.5 and 7.5 cm to the right of the midline over the iliac crest. Local anesthetic with corticosteroid was injected at the tender points over the right iliac crest. Five minutes after the injection, the pain dissipated. CONCLUSION: SCN entrapment should be considered in patients who suffer from LBP radiating to the iliac crest and buttock after other causes of LBP have been excluded.

Journal Article↗

Influence of adipose tissue distribution on the biological activity of androgens.

To establish whether the conversion of androstenedione (A) to estrogens and 5 alpha-reduced metabolites in human adipose tissue was determined by the site of origin of the tissue, studies were carried out on adipose stromal cells from different body sites. Adipose tissue was obtained from the breast, omentum, abdomen, lower thigh, upper thigh, buttock, and flank from patients undergoing liposuction for cosmetic reasons or at surgery. Stromal cells were isolated after incubation of the adipose tissue with collagenase and were grown in culture using alpha-minimal essential medium (MEM) + 15% fetal calf serum. Studies of A metabolism were carried out when the cells were between days 4 and 12 in culture. After an 8-hour incubation with (3H)-A as substrate, estrone (E1), testosterone (T), 5 alpha-androstanedione (5 alpha-A-dione), androsterone (AND), and dihydrotestosterone (DHT) were isolated using thin layer and paper chromatography. The conversion per 1 x 10(6) cells of A of E1 was more than 10-fold greater in the upper thigh, buttock, and flank than in the breast, lower thigh, abdomen, or omentum (0.13-3.0 vs 0.01-0.09%). The formation of 5 alpha-reduced androgens varied from 0.86-10% and was similar in tissue from different body sites. Cortisol (10(-7) M) stimulated E1 formation 3- to 10-fold in cells from all sites, whereas 5 alpha-reductase activity was either unchanged or increased moderately (up to twofold). In cells from the abdomen, omentum, and lower thigh, the formation of 5 alpha-reduced androgens was more than 10-fold greater than the formation of E1. In cells from the upper thigh, buttock, and flank, E1 formation was comparable to 5 alpha-reduced androgen formation. These studies show marked differences in the relative conversion of A to estrogens and 5 alpha-reduced androgens in adipose stromal cells depending on their site of origin, and they suggest that the distribution of body fat may be a major factor in determining the biologic effects of secreted androgens.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗

Tendinosis and tears of gluteus medius and minimus muscles as a cause of hip pain: MR imaging findings.

OBJECTIVE: This study was conducted to determine the prevalence of tendinosis and tears of gluteus medius and minimus muscles in patients presenting with buttock, lateral hip, or groin pain; describe the MR imaging findings; and discuss their probable relationship to the greater trochanteric pain syndrome. SUBJECTS AND METHODS: Two hundred fifty MR imaging examinations of the hip were performed for the evaluation of buttock, lateral hip, or groin pain. The findings were reviewed for changes in the morphology or signal intensity of gluteus medius and minimus muscles and tendons and for any peritendinous abnormality including distention of regional bursae. RESULTS: Thirty-five studies met our criterion of showing either tendinosis or tears of gluteus medius and minimus muscles as the primary positive finding. Eight patients had complete retracted tears of the gluteus medius, and 14 patients had partial tears; in 13 patients, MR findings were consistent with tendinosis. The gluteus minimus muscle was also involved in 10 patients. MR imaging findings were the same as those described for tears and tendinosis of other regions of the body. Surgical proof of a tendon tear was obtained in six patients. CONCLUSION: Tendinopathy of the hip abductors and gluteus medius and minimus muscles was a common finding on MR imaging in our patients with buttock, lateral hip, or groin pain. Tendinopathy is probably a frequent cause of the greater trochanteric pain syndrome, a common regional pain syndrome that can mimic other important conditions causing hip pain including avascular necrosis and stress fracture. Moreover, it is likely that trochanteric bursitis is associated with tendinopathy.

Arthralgia↗

Efficacy of epidural injections of Kenalog and Celestone in the treatment of lower back pain.

OBJECTIVE: Epidural corticosteroid injections have been used extensively to treat lower back pain, but the relative effectiveness of one corticosteroid versus another has never been reported in a large patient series. We retrospectively reviewed 597 patients who had epidural corticosteroid injections to determine any difference in Kenalog or Celestone efficacy. MATERIALS AND METHODS: We reviewed charts and self-reported pain score evaluations of 597 patients who received either Kenalog or Celestone Soluspan as an epidural injection for the treatment of lower back pain from 1997 to 2002 at our university hospital and affiliated Veterans Affairs hospital. Kenalog was used for the initial 2 years and Celestone was used for the next 3 years. Fluoroscopic guidance was used to confirm epidural location, and each patient was injected with a mixture of 5 mL of 0.5% preservative-free lidocaine and 2 mL of either Kenalog 40 mg/mL (triamcinolone acetonide injectable suspension) or Celestone Soluspan 6 mg/mL (betamethasone sodium phosphate and betamethasone acetate injectable suspension). Each patient was given a standardized pain evaluation sheet that used an 11-point scale for initial pain severity. Scoring of pain compared with baseline during the following 14 days was based on a 5-point scale of pain improvement or worsening. RESULTS: On days 0-3 after the procedure, no statistical significance in improvement of lower back and buttock pain was seen between groups. On day 7, 59% of Celestone recipients and 73% of Kenalog recipients showed improvement in lower back pain (p = 0.002, Pearson's chi-square test), and 58% of Celestone recipients and 75% of Kenalog recipients had improvement in leg or buttock pain (p < 0.001). On day 14, 54% of Celestone recipients and 71% of Kenalog recipients showed improvement in lower back pain (p < 0.001), and 54% of Celestone recipients and 71% of Kenalog recipients had improvement in leg or buttock pain (p < 0.001). CONCLUSION: The epidural injection of Celestone Soluspan and Kenalog reduced lower back and radicular pain in more than half the patients, although Kenalog reduced pain in a significantly larger number of patients than Celestone Soluspan at 1 and 2 weeks after injection.

Anti-Inflammatory Agents↗