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At least 775 records · Page 43Linked to original sources
PubMed2003

Inhaled corticosteroids: past lessons and future issues.

Inhaled corticosteroids play a pivotal role in the treatment of asthma. Inhalation permits effective delivery of the corticosteroid in high concentration to target sites within the lung while minimizing systemic exposure. Consequently, the safety profile of inhaled corticosteroids is markedly better than that of oral corticosteroid therapy. However, although it was first thought that direct delivery might eliminate systemic adverse effects, this has not been confirmed by clinical trials and experience. Inhaled corticosteroids are absorbed from the lungs into the systemic circulation, in which they can acutely decrease growth velocity in children, an effect that fortunately appears to be temporary and might have no effect on final adult height. In sufficient dosages, they also produce bone mineral loss leading to osteoporosis and might increase the risk of cataracts, glaucoma, skin atrophy, and vascular changes that increase the risk of ecchymoses. Effective evaluation of the severity and significance of these complications is challenging because highly sensitive tests do not reliably predict clinically significant events, and short-term observations do not predict long-term consequences. Also, compliance wanes with long-term treatment, and susceptibility to a particular adverse event can vary over time, even in the same individual, because of developmental or hormonal changes. This journal supplement will review what has been learned about the safety of inhaled cortico-steroids during the past decade, discussing some of the questions that remain and considering the characteristics of an "ideal" inhaled corticosteroid: one with high local activity in the lung and minimal or no adverse systemic effects.

Administration, Inhalation↗
PubMedDate not supplied

Alpha2-plasmin-inhibitor deficiency (Miyasato disease).

A 25-year-old man, born in Okinawa, Japan, had a haemorrhagic diathesis characterised by prolonged bleeding and ecchymoses after minor trauma and spontaneous joint haemorrhage. The frequency and severity of these episodes were reduced by an antiplasminic drug. Routine coagulation studies revealed no abnormalities except for significantly sshortened euglobulin-lysis time and whole-blood clot lysis time. Activities of all known clotting and fibrinolytic factors were within normal ranges but no circulating alpha2-plasmin inhibitor was found in the plasma. alpha2-plasmin inhibitor is a potent and fast-acting protease inhibitor. Studies of family members indicated that this abnormality was inherited as an autosomal and recessive gene.

Adult↗
PubMed1981

Clinical evaluation of the patient with bruising and bleeding.

Abnormal bleeding or bruising is frequently encountered in the clinical practice of dermatology. A working knowledge of mechanisms of normal hemostasis, a complete history (general, bleeding, familial), a thorough physical examination, and an appropriate laboratory evaluation are the integral steps in the diagnostic process. Cutaneous bruising and/or bleeding may be a manifestation of a previously unrecognized hereditary coagulation deficiency such as mild hemophilia or von Willebrand's disease (vWD), hereditary or acquired qualitative or quantitative platelet disorder, disturbance of the vascular or supporting structure, or it may be due to one of several acquired systemic disorders.

Blood Coagulation↗
PubMed1981

Cutaneous signs of child abuse.

Child abuse is a well-established clinical entity affecting over one million children each year in this country. All physicians are responsible for the recognition of this syndrome and for the initiation of prompt treatment. Presented are some of the classical cutaneous signs of child abuse, including physical abuse, neglect, and sexual assault. The abusive pattern is described and the need for physician awareness noted.

Alopecia↗
PubMedDate not supplied

Ophthalmic complications of endoscopic ethmoid surgery and their management.

PURPOSE: The proximity of the paranasal sinuses to the orbit puts the anterior visual pathways at risk during sinus surgery. Although the ophthalmic complications of sinus surgery are well known to the otolaryngologist, they are rarely encountered in clinical practice. Several recommendations will help the surgeon performing intranasal sinus surgery. MATERIALS AND METHODS: To study the incidence of orbital complications of intranasal ethmoid surgery, a retrospective review of 372 cases, most of them bilateral, was performed. RESULTS: Our series of 372 patients who underwent endoscopic sinus surgery showed five orbital complications. CONCLUSION: several recommendations may help the surgeon to avoid any ophthalmic complication. When orbital wall dehiscence is suspected, either by CT scan or at surgery, especially in a previously operated case, extreme care should be taken not to penetrate the periorbita. If orbital fat protrudes into the operative field, it should not be pulled or twisted in an attempt to remove it. The surgeon should seek the cooperation of the anesthesiologist working the case. A knowledge of the variable anatomy is essential to avoid iatrogenic injury. The surgeon should be aware of the different complications for early recognition and management.

Adult↗
PubMed1995

Thresholds for hemorrhages in mouse skin and intestine induced by lithotripter shock waves.

In vivo biological effects of ultrasound should be characterized as thermal or cavitational to understand their etiology and significance. A spark-gap shock-wave lithotripter was built and used to compare cavitation-induced hemorrhages to the heat-induced petechial hemorrhages caused by continuous-wave ultrasound in mouse intestine. Intestinal hemorrhages induced in anesthetized hairless mice by the lithotripter pulses involved tissue destruction with bleeding into the lumen of the intestine, and were associated with intestinal gas bubbles. Skin hemorrhages were also observed, which appeared to be contusions, with no actual breakage of the skin. Administration of 100 shock waves with peak positive amplitude of 18.5 MPa produced an average of 7.6 (standard error [SE] 3.1, n = 6) intestinal hemorrhages and 45 (SE 11) skin hemorrhages. The counts and severity of hemorrhages increased with increasing numbers (3 to 300) of shock waves. Absorbers of varying thickness were used to reduce the pressure amplitude of the shock waves, which were thereby modified into low frequency ultrasound pulses. For 100 pulse exposures, apparent thresholds for effects occurred between 1.6 and 4.0 MPa for the intestinal hemorrhages and between 0.6 and 1.6 MPa for the skin hemorrhages. The low 1-Hz pulse repetition frequency precluded significant heating, and so these effects were the result of cavitation, which probably occurred inside the intestines or in the surrounding water. Compared to the previously observed thermal petechia, the cavitation-induced hemorrhages could be distinguished on the basis of their appearance upon histological examination, and also by the relative values of the thermal and mechanical exposure indices associated with the two different exposure modes.

Animals↗
PubMed1998

Colposcopy in evaluation of the adult sexual assault victim.

The purpose of this study was to determine if the colposcope improves detection of genital trauma in adult women who are victims of sexual assault compared with gross visual examination alone. A prospective, 1-month pilot study was conducted of 17 women patients who presented consecutively to Charity Hospital New Orleans during April 1994 requesting sexual assault examinations. Use of the colposcope allowed documentation of trauma in 9 of the 17 sexual assault victims (53%), compared with 1 of 17 (6%) by gross visualization alone (statistically significant: chi2 = 0.64, P = .0114). The colposcope improved detection of genital trauma in adult female sexual assault victims as compared with gross visual examination alone at a statistically significant level.

Adolescent↗
PubMed2004

[Skin allergy to hydrocortisone hemisuccinate in a patient with asthma].

INTRODUCTION: Corticosteroids are the basis of treatment of asthma; they interrupt the development of inflammation. However, corticosteroids can also be at the origin of severe allergical reactions. CASE REPORT: A 40 Year-old woman, during hospitalisation for severe acute asthma, presented with an allergy to hydrocortisone hemisuccinate (HCHS) in the form of generalised pruritus with, on examination, cutaneous mucosal lesions in the form of purpura and ecchymoses on the abdomen and the upper and lower limbs. The substitution of HCHS led to the return to normal. COMMENTS: Allergic reactions to corticosteroids, generally paradoxical, were for many Years ignored and their existence was controversial. They were usually secondary to the administration of injectable substances containing hydrocortisone hemisuccinate or methylprednisolone. Their physiopathology remains a mystery. Their management requires the immediate and permanent withdrawal of the product implied, antihistamine and adrenalin in the case of shock and symptomatic treatment.

Acute Disease↗