Safety and effectiveness of additional triamcinolone acetonide with endoscopic radial incision and cutting for benign stenosis of the lower gastrointestinal tract: A pilot study.

Objectives: Radial incision and cutting (RIC) is being investigated as an alternative endoscopic dilation method for lower intestinal tract stenosis, providing a high technical success rate and improving subjective symptoms. However, several patients develop re-stenosis following RIC. In this pilot study, we aimed to evaluate the safety and efficacy of triamcinolone acetonide (TA) addition after RIC. Methods: RIC with TA was performed in 20 patients with lower gastrointestinal tract stenosis. We evaluated the rate of adverse events 2 months after RIC with TA. We investigated the short- and long-term prognoses, as well as the improvement in subjective symptoms, using a visual analog scale. Results: The delayed bleeding rate after RIC was 23.8%. Endoscopic hemostasis was achieved in all patients with delayed bleeding. No perforations were observed. The cumulative re-stenosis-free, re-intervention-free, and surgery-free rates 1 year after RIC were 52.9%, 63.7%, and 85.2%, respectively. Subjective symptoms, including abdominal pain, abdominal bloating, nausea, and dyschezia, significantly improved after RIC with TA. Conclusion: Although additional TA administration after RIC could be safe, additional TA may not be effective on luminal patency after dilation. Further investigation is warranted.

Predictors of stricture after endoscopic submucosal dissection of the esophagus and steroids application.

BACKGROUND: Endoscopic submucosal dissection (ESD) is a reliable method to resect early esophageal cancer. Esophageal stricture is one of the major complications after ESD of the esophagus. Steroid prophylaxis for esophageal strictures, particularly local injection of triamcinolone acetonide (TA), is a relatively effective method to prevent esophageal strictures. However, even with steroid prophylaxis, stenosis still occurs in up to 45% of patients. Predicting the risk of stenosis formation after local TA injection would enable additional interventions in risky patients. AIM: To identify the predictors of esophageal strictures after steroids application. METHODS: Patients who underwent esophageal ESD and steroid prophylaxis and who were comprehensively assessed for lesion- and ESD-related factors at Southeast University Affiliated Zhongda Hospital between February 2018 and March 2023 were included in the study. The univariate and multivariate regression analyses were conducted to identify the predictors of stricture among patients undergoing steroid prophylaxis. RESULTS: A total of 120 patients were included in the analysis. In the oral prednisone and oral prednisone combined with local tretinoin injection groups, the stenosis rates were 44/53 (83.0%) and 56/67 (83.6%), respectively. Among them, univariate analysis showed that the lesion circumference (P = 0.01) and submucosal injection solution (P = 0.04) showed significant correlation with the risk of stenosis formation. Logistic regression analyses were then performed using predictors that were significant in the univariate analyses and combined with known predictors from previous reports, such as additional chemoradiotherapy and tumor location. We identified a lesion circumference < 5/6 (OR = 0.19; P = 0.02) and submucosal injection of sodium hyaluronate (OR = 0.15; P = 0.03) as independent predictors of on esophageal stricture formation. CONCLUSION: Steroid prophylaxis effectively prevents stenosis. Moreover, the lesion circumference and submucosal injection of sodium hyaluronate were independent predictors of esophageal strictures. Additional interventions should be considered in high-risk patients.

Juvenile idiopathic arthritis management: insights into the utilization of intra-articular corticosteroid injections.

BACKGROUND: Juvenile idiopathic arthritis (JIA) is a common chronic rheumatic disease in children, requiring careful management to reduce both short- and long-term morbidity. In this study, our objective was to assess the clinical features of patients diagnosed with JIA who received intra-articular corticosteroid injections (IACI). METHODS: In this retrospective study, we evaluated the clinical and laboratory characteristics of 225 JIA patients monitored from January 2012 to October 2023 at a tertiary care center. We focused on patients who underwent intra-articular corticosteroid injections (IACI) as part of their treatment. Triamcinolone hexacetonide (TH) was used due to its demonstrated safety and efficacy. RESULTS: Our analysis revealed that IACI, particularly utilizing TH, was a widely employed and effective adjunct therapy, contributing to rapid symptom relief and local disease control. Patients receiving IACI exhibited earlier symptom onset, younger age at diagnosis, longer follow-up durations, and higher cumulative treatment burden (p < 0.001, p < 0.001, p < 0.01, p < 0.001 respectively). Despite inconclusive acute-phase reactants, a higher frequency of ANA positivity and elevated initial lymphocyte counts were associated with increased IACI use (p < 0.001, p < 0.001 respectively). Importantly, on a joint basis, a high percentage of arthritis remission following IACI underscores its efficacy and favorable safety profile. CONCLUSIONS: Notably, the high percentage of arthritis remission achieved with intra-articular corticosteroid injections (IACI) on a joint-specific basis highlights its efficacy and favorable safety profile. A lymphocyte count exceeding 5000/mm3 at the time of diagnosis may serve as an early indicator for considering intra-articular steroid administration. These findings emphasize the need for nuanced and individualized treatment strategies in JIA management to optimize outcomes for affected children.

A Comparative Study of Post Operative Pain Following Tonsillectomy with Local Infilteration of Dexamethasone vs Triamcinolone.

Tonsillectomy till date continues to be the most frequently performed surgery by ENT surgeons, and with that comes the most challenging complication of post-tonsillectomy pain and its management that affects the patient morbidity and alters the hospital course. Various methods and techniques have been implicated in the post-operative pain management in patients undergoing tonsillectomy. To compare the post operative pain following local infiltration of Dexamethasone and Triamcinolone in patients undergoing Tonsillectomy. Total of 50 patients were selected and randomized into two groups- Group 1 and Group 2, who underwent local infiltration of Dexamethasone and Triamcinolone respectively to maintain uniformity. Baseline scoring (0 h post operatively) and follow up scoring after 6 h and 24 h was done using the Visual Analogue Scale and were evaluated and documented as per their response to treatment. A significant reduction was observed in the severity of pain in both groups with an average reduction of mean score from 9.50 to 5.92 in Group 1 and from 9.04 to 3.90 in Group 2 at the end of 24 h post-operatively. The mean score of Group 2 was greater and showed better improvements in VAS pain score and was statistically significant (p < 0.001). Usage of steroidal preparations locally during tonsillectomy helps combat the post-operative pain. Usage of Triamcinolone locally has proved beneficial in reducing the post-operative tonsillectomy pain.

Efficacy of Nd:YAG Laser and Intralesional Triamcinolone Injection Combination Therapy in the Postoperative Management of Keloids.

BACKGROUND: Keloids, characterized by protruding scars that extend beyond the original skin damage site, cause significant emotional stress and reduced quality of life. Their exact pathogenesis remains unclear, with various hypotheses including growth factor imbalances and extracellular matrix changes. No single treatment is universally accepted, but multiple modalities like triamcinolone acetonide injection (TAC), laser therapies, and surgery are commonly used. METHODS: This retrospective study involved East Asian patients who underwent keloid scar excision between March 2019 and June 2022. Patients were divided into two groups: one receiving only TAC injections and the other a combination of TAC and Nd:YAG laser therapy. The efficacy of treatments was evaluated using the modified Vancouver Scar Scale (mVSS) and the Patient and Observer Scar Assessment Scale (POSAS), with follow-ups at six and twelve months after operation. RESULTS: The study involved 111 patients. Both treatment groups showed significant improvements in mVSS and POSAS scores, but the combination therapy group demonstrated a statistically significant improvement in POSAS scores and lower recurrence rates at 12 months compared to the TAC-only group. However, there was no significant difference in patient satisfaction between the groups. CONCLUSION: Dual therapy involving TAC injection and Nd:YAG laser treatment was more effective than TAC injection alone for managing keloid scars after surgery. This combination therapy showed better outcomes in preventing keloid recurrence and improving scar status at 12 months after operation, along with significant improvements in patient-reported outcomes. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Comparative Study of Triamcinolone and Sumac for Treating Minor Aphthous Lesions - A Triple-Blind Study.

BACKGROUND: Recurrent aphthous stomatitis (RAS) is a common oral mucosal lesion. Herbal medicine has been explored to treat this condition. This study compared the effectiveness of two oral pastes containing Triamcinolone and Sumac, for the healing, size, and symptomatology of RAS. METHODS: This triple-blind randomized clinical trial included 60 patients with minor aphthous ulcers. Participants were informed about the study and provided consent. Exclusion criteria consisted of specific medical conditions and medication use. The patients were divided into three groups and received either Sumac adhesive gel, Triadent oral paste, or a placebo. Ulcer size was measured before and after treatment. The medication was prepared using carboxymethylcellulose-based gel and Sumac powder extract. The study was triple-blinded, and the groups were labelled as A, B, and C. Data analysis was performed using SPSS version 22, employing repeated measurement, student t test, Kolmogorov-Smirnoff, and one-way ANOVA for quantitative data. Statistical significance was set at P ≤ .05. RESULTS: A clinical trial involving 59 participants compared the Sumac, Triadent, and placebo groups. The Sumac group exhibited the shortest healing time, significantly reduced lesion size, and lower Visual Analog Scale scores. Triadent took the longest time to heal ulcers. ANOVA test indicated no significant difference in age and gender distribution. CONCLUSION: This clinical trial evaluated two oral pastes for treating aphthous ulcers and found that the Sumac group achieved faster healing and reduced lesion size compared to the Triadent and control groups. Sumac shows promise as a treatment option, but further studies are necessary to confirm its efficacy and safety. These favourable results support the use of herbal treatments and suggest their potential for broader utilization in managing diseases such as RAS.

Carboxymethylcellulose: A hidden culprit in immediate hypersensitivity reactions after triamcinolone injections.

We aim to bring awareness of allergies to excipients such as carboxymethylcellulose as "hidden dangers" that can be easily missed in diagnosis, leading to severe effects on patient health, and falsely limit the drug treatments that a patient can receive.

A Comparison of Analgesic Efficacy of Triamcinolone vs Magnesium Sulfate as Adjuvants in Caudal Block in Patients with Low Back Pain: A Double-Blind Randomized Controlled Trial.

Background: Chronic low back pain (CLBP) is a common issue among older adults. Radicular pain syndromes are often managed with caudal epidural injections. Our study aimed to compare the effects of triamcinolone and magnesium sulfate, used as adjuvants to local anesthetics in caudal blocks, on pain levels and quality of life in patients with LBP. Methods: A total of 40 patients undergoing caudal block were randomized to two groups,received 10 mL caudal epidural injection of either injection 9 mL of ropivacaine 0.1% and 1 mL of triamcinolone; 40 mg (Group T, n = 20) or magnesium sulfate; 200 mg (group M, n = 20). Improvements in the pain score measured with the Visual Analog Scale (VAS) and functional ability measured with the Oswestry Disability Index (ODI) were the primary and secondary outcome measures, respectively. Before, one month and three months after the caudl block, the VAS and ODI scores were evaluated. Results: The VAS and ODI scores did not exhibit a significant difference between the 2 groups at all post-injection time points, except for the VAS score at 3 months, which showed a statistically lower value in group M compared to group T (P = 0.046). However, when comparing within the same group, both groups showed significantly improved VAS and ODI scores at all post-injection time points compared to the pre-injection scores (P < 0.0001). Conclusions: The addition of magnesium or triamcinolone to a local anesthetic in caudal epidural injections does not result in any discernible difference. However, this combination may lead to improvements in pain levels and quality of life, and these improvements can be sustained for up to 3 months.

Dysthyroid Optic Neuropathy Dramatically Improved by Sheath-Guided Triamcinolone Orbital Injection: A Case Report.

Thyroid eye disease is an autoimmune disorder caused by thyroid-stimulating hormone receptor autoantibodies stimulating the thyroid-stimulating hormone receptor, resulting in proptosis, extraocular muscle dysfunction, diplopia, retro-orbital pain, optic nerve compression, and visual impairment. Dysthyroid optic neuropathy (DON), believed to result from direct compression by enlarged extraocular muscles, represents a severe complication with the potential for irreversible vision loss. Currently, the treatment options for DON are limited to highly invasive procedures, such as orbital decompression surgery and systemic steroid pulse therapy. There are consequently significant challenges in the management of this condition. This report presents a case where a significant improvement in DON was achieved solely through the novel technique of sheath-guided orbital triamcinolone injection, which was utilized with the aim of reaching the deeper part of the orbit under sheath guidance. In this case, the best corrected visual acuity improved from 20/32 (decimal visual acuity: 0.7) to 20/20 (1.2) in the right eye and from 20/500 (0.04) to 20/20 (1.2) in the left eye. Critical flicker frequency values also improved, from 20.3 Hz to 35.0 Hz in the right eye and from 9.3 Hz to 31.5 Hz in the left eye. The cross-sectional areas of the extraocular muscles decreased by an average of 55.5%.

CFD-PK model for nasal suspension sprays: Validation with human adult in vivo data for triamcinolone acetonide.

The objectives of this study were to expand and implement a Computational Fluid Dynamics (CFD)-Dissolution, Absorption and Clearance (DAC)-Pharmacokinetics (PK) multi-physics modeling framework for simulating the transport of suspension-based nasal corticosteroid sprays. The mean CFD-predicted peak plasma concentration (Cmax) and area under the curve (AUC) of the plasma concentration-time profile, based on three representative nasal airway models (capturing low, medium and high posterior spray deposition), were within one standard deviation of available in vivo PK data for a representative corticosteroid drug (triamcinolone acetonide). The relative differences in mean Cmax between predictions and in vivo data for low dose (110 µg) and high dose (220 µg) cases were 27.8% and 10.1%, respectively. The models confirmed the dose-dependent dissolution-limited behavior of nasally delivered triamcinolone acetonide observed in available in vivo data. The total uptake from the nasal cavity decreased from 68.3% to 51.3% for the medium deposition model as dose was increased from 110 to 220 µg due to concentration-limited dissolution. The modeling framework is envisioned to facilitate faster development and testing of generic locally acting suspension nasal spray products due to its ability to predict the impact of differences in spray characteristics and patient use parameters on systemic PK.

Losartan in Situ Forming Gel as a New Treatment for Hypertrophic Scars.

Hypertrophic scars are defined as visible lesions formed by excessive wound healing that cause cosmetic and, in some cases, functional challenges in patients. This study aimed to assess the efficacy of intralesional injections of losartan-loaded in situ forming gel and compare it with the common treatment (triamcinolone) in preventing scar formation. The formulation was prepared using a thermosensitive PLGA-PEG-PLGA triblock copolymer. Ear scar tissue in rabbits represented the hypertrophic scar, and the animals were treated with three treatments in three groups. Nine weeks following the single treatment, images of the scars were obtained and quantitatively analyzed using ImageJ and light microscopy was used to evaluate the fibroblast cell number, vascularization, inflammation and collagen deposition and fibrosis in H&E-stained sample tissue. According to the results based on the ImageJ and the Vancouver criteria, the losartan in situ forming gel (F-LG) indicated significantly higher improving effects on decreased vascularity and pigmentation in comparison with triamcinolone (F-TA) and placebo as a control (F-Ctl), although the effect F-LG was almost similar to F-TA on pliability and scar height, and they were better than the control. Histological findings showed F-LG and F-TA have less inflammatory and fibroblast cells compared to F-Ctl. Also, results indicated the dermal layers of the F-TA and F-LG groups' scar were thinner, and the deposition of collagens was reduced compared to the control. Consequently, F-LG was found to be an effective treatment in reducing scarring and promoting wound healing.No Level Assigned This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Corticosteroids for the Management of Uveitic Macular Edema: A Comprehensive Review.

Uveitis, which refers to the inflammation of the uveal tract and surrounding structures in the eye, poses a significant risk of vision impairment, with macular edema (UME) being a prevalent complication. The current statement reviews UME's prevalence, pathogenesis, diagnosis, and management strategies, focusing on the utility of systemic and local corticosteroid therapy. Corticosteroids, with their multifaceted effects on inflammatory pathways, serve as the cornerstone of UME treatment. Various administration routes, including topical, periocular, intraocular, and systemic, are employed based on the anatomical type and severity of inflammation. The efficacy of different corticosteroid formulations, such as difluprednate, triamcinolone acetonide, dexamethasone implant, and fluocinolone acetonide implant, is evaluated through clinical trials and retrospective studies. Additionally, the role of corticosteroid-sparing treatments, including antimetabolites like methotrexate and mycophenolate mofetil, is explored. Emerging techniques, such as suprachoroidal space triamcinolone acetonide administration, offer promising alternatives for managing UME. Through a thorough examination of current evidence, this review provides valuable insights into optimizing the management of UME and improving visual outcomes in patients with uveitis.

A randomized controlled trial on triamcinolone versus saline impregnated merocel post endoscopic sinus surgery: Our experience in a tertiary care centre.

Purpose: To assess the potential benefit of impregnating Merocel (a non-absorbable nasal dressing) with a topical steroid solution, for use as a direct and slow local delivery system of steroids after sinus surgery to improve postoperative wound healing. Methods: In this randomized controlled trial, 40 patients with bilateral chronic rhinosinusitis with nasal polyposis were subjected to functional endoscopic sinus surgery. Following the completion of the surgery, Merocel packs were inserted in the bilateral nasal cavities and infiltrated with 4 mL triamcinolone (40 mg/mL) in one nasal cavity (treatment group) and 4 mL normal saline in the other (control group). Nasal packs were removed on the third postoperative day and postoperative healing assessment was done on postoperative Weeks 1, 2, 4, and 12. The findings were noted as per Lund Kennedy (LKES) and perioperative sinus endoscopy (POSE) scores and compared on both sides. Results: Significant (P < 0.05) improvement was noted in Lund Kennedy score for crusting and polyp at Week 12, for edema at Week 1, and nasal discharge at Weeks 1 and 12, but there was no significant improvement in scarring at any week. Overall, the difference between the treatment and control arms was statistically significant at all postoperative visits except at Week 4. Also, there was a significant improvement in POSE scores at Weeks 1, 2, and 12 but not at Week 4. Conclusion: This study positively concludes that the nasal cavity packed with drug-soaked packs had less scarring and edema in the postoperative period and the overall wound healing was much better as compared to saline-soaked packs.

A double-blinded randomised control study to compare the effectiveness and safety of intralesional vitamin D3 with intralesional triamcinolone and its correlation with tissue expression of vitamin D receptors in patients with keloid.

Intralesional steroids commonly used for keloid treatment have adverse effects like cutaneous atrophy and telangiectasias. Safer and more effective therapies are needed. Preliminary studies suggest intralesional vitamin D as a potential alternative treatment. The aim of this study was to compare efficacy and safety of intralesional vitamin D with triamcinolone for keloids, and correlate tissue expression of vitamin D receptors (VDRs) with treatment outcomes. Sixty patients were randomly assigned to two groups: Group A (intralesional vitamin D) and Group B (intralesional triamcinolone). Four injections were given at 4-week intervals, with an 8-week follow-up. Biopsies were taken pre- and post-treatment to examine VDR expression levels and treatment response correlation. The primary outcome of interest was the proportion of patients achieving a 50% reduction in Vancouver Scar Scale (VSS). Secondary outcomes included incidence of adverse effects, and changes in VDR expression before and after treatment. Baseline VSS scores were 9.73 ± 1.01 (vitamin D group) and 10.13 ± 1.07 (triamcinolone group). After treatment, mean VSS decreased to 5.17 ± 0.59 (vitamin D group, p < 0.001) and 4.77 ± 0.77 (triamcinolone group, p < 0.001), with significantly better response in latter (p = 0.03). More than 50% reduction in VSS score was higher in the triamcinolone group (76.7% vs. 50%, p = 0.032). No recurrences were noted during the 8-week follow-up. Hypopigmentation (80% vs. 36.7%, p < 0.001) and atrophy (73.3% vs. 40%, p = 0.009) were more common in the triamcinolone group. No significant difference in pre- and post-treatment VDR receptor expression was observed in either group. Both triamcinolone acetonide and vitamin D were effective for keloids. Triamcinolone was more efficacious, whereas vitamin D was safer, suggesting it as a viable alternative for keloid management.

Nonsurgical Treatment of Oral Mucocele With Intralesional Corticosteroid Injections: A Case Report.

Oral mucoceles are common lesions resulting from alterations in minor salivary glands due to mucus accumulation. Deleterious habits such as lip biting, sucking, or trauma from oral appliances can result in the occurrence of mucoceles. Although conventional surgical removal has been the preferred treatment option, it is associated with drawbacks, including the risk of damaging nearby ducts and the formation of satellite lesions. A 13-year-old male patient visited the department with a sessile, nodular, and exophytic lesion on the lower lip and a persistent history of traumatic lip biting. The treatment involved the administration of intralesional injections of triamcinolone acetonide at the base of the lesion. A significant reduction was noted after the first injection, with the lesion showing complete resolution within two weeks. No recurrence was observed during the six-month follow-up period. This case highlights the effectiveness of intralesional corticosteroid injections as a non-surgical treatment option for mucoceles. This treatment modality, due to its non-invasive nature, can be particularly considered as the primary treatment choice in the pediatric population, facilitating effective behavior management.

Efficacy and Systemic Effects of a Single Deep Orbital Triamcinolone Injection for Thyroid Eye Disease.

Purpose: Orbital steroid injections offer a potential therapeutic avenue for managing Thyroid Eye Disease (TED). This study aimed to assess the effectiveness and potential systemic impacts of a single deep orbital triamcinolone injection in TED patients. Methods: In a prospective investigation conducted from January 2021 to March 2023, patients diagnosed with TED were enrolled. Inclusion criteria encompassed a Clinical Activity Score (CAS) of ≥3, extraocular muscle inflammation, and upper eyelid retraction. A total of 1 mL of triamcinolone acetonide (40 mg/mL) was administered posterior to the orbital septum at both the medial and lateral aspects of both the upper and lower eyelids. Parameters, including CAS, margin-reflex distances (MRD1 and MRD2), intraocular pressure (IOP), ocular motility (Hess area ratio [HAR%]), exophthalmometry, extraocular muscle size, and blood and urinary indices, were evaluated before and at 2 and 4 weeks after a single injection. Results: Analysis included 28 patients (23 women, 5 men; mean age (SD): 38.7 (11.1) years), representing 56 eyes. Following the injection at 4 weeks, the mean CAS and MRD1 significantly decreased by 2 points and 0.8 mm, respectively. There was a 4.5% increase in HAR%, and extraocular muscle size decreased by 4 to 15.3 mm². Neutrophil count, C-reactive protein, and thyroid antibodies significantly decreased. No severe adverse ophthalmic or systemic effects, including IOP increases or liver damage, were observed. Conclusion: Bilateral single orbital triamcinolone injections provided relief from TED symptoms through both direct effects on orbital soft tissue and systemic effects by decreasing antibody reactions.

Tratamento cirúrgico de queloides: Ressecção total ou parcial? / Surgical treatment of keloids: Total or partial resection?

Introdução: Atualmente, a aplicação de triancinolona intralesional com a excisão cirúrgica é considerada o tratamento mais satisfatório para queloides, com baixa taxa de recorrência. Método: Realizado estudo de casos contemplando cirurgias reparadoras de pacientes com queloides em lóbulos de orelhas bilateralmente, operados pelo mesmo cirurgião plástico no período de julho de 2018 a janeiro de 2021 no Hospital Regional de Sobradinho em Brasília-DF. Ressecou-se parcialmente a cicatriz queloideana (intralesional), deixando margens de queloide na ferida operatória e comparou-se com a resposta após ressecção total (justalesional) de uma outra cicatriz em um mesmo paciente. Foi realizada aplicação de triancinolona no pré-operatório, com total de 4 aplicações a intervalos de 4 semanas entre cada sessão e no pós-operatório imediato, mantendo aplicação a cada 30 dias por 6 meses. Nenhum paciente havia realizado tratamentos prévios para queloides. As cicatrizes foram avaliadas no pós-operatório pelo cirurgião principal por um período de 12 meses. Resultados: Quatro de 11 pacientes tiveram algum tipo de recidiva, totalizando 36% de recidiva em nosso trabalho. A excisão total do queloide (orelha esquerda) teve mais recidivas do que o lado contralateral em que foi deixada margem de 1mm de queloide na cicatriz (orelha direita). Conclusão: No presente estudo observamos que, quando associada ao tratamento com triancinolona no pré, intra e pós-operatório, a excisão parcial do queloide apresentou menores taxas de recidiva local quando comparada à excisão total do queloide.

Introduction: Currently, the application of intralesional triamcinolone with surgical excision is considered the most satisfactory treatment for keloids, with a low recurrence rate. Method: A case study was carried out covering reconstructive surgeries for patients with bilateral earlobe keloids, operated by the same plastic surgeon from July 2018 to January 2021 at the Hospital Regional de Sobradinho in Brasília-DF. The keloid scar (intralesional) was partially resected, leaving keloid margins in the surgical wound, and compared with the response after total resection (juxtalesional) of another scar in the same patient. Triamcinolone was applied preoperatively, with a total of 4 applications at intervals of 4 weeks between each session and in the immediate postoperative period, maintaining application every 30 days for 6 months. No patient had undergone previous treatments for keloids. Scars were evaluated postoperatively by the primary surgeon over a period of 12 months. Results: Four of 11 patients had some type of recurrence, totaling 36% of recurrence in our study. Total excision of the keloid (left ear) had more recurrences than the contralateral side where a 1mm margin of keloid was left in the scar (right ear). Conclusion: In the present study, we observed that when associated with treatment with triamcinolone pre-, intra-, and postoperatively, partial excision of the keloid presented lower rates of local recurrence when compared to total excision of the keloid.

Suprachoroidal Drug Delivery for Macular Edema Associated With Noninfectious Uveitis.

Purpose: To evaluate clinical trials in the literature that focus on suprachoroidal drug delivery for the treatment of noninfectious uveitis and other posterior segment diseases. Methods: A synthesis of the literature was performed. Results: In 2021, suprachoroidal space triamcinolone acetonide, a corticosteroid delivery system used for the treatment of uveitic macular edema (ME), was approved by the US Food and Drug Administration. The drug-delivery system targets the suprachoroidal space using a microneedle-based device and has a favorable pharmacokinetic profile. Suprachoroidally administered investigational therapies have also been assessed in clinical trials for other posterior segment diseases, including diabetic ME, retinal vein occlusion, age-related macular degeneration, and choroidal melanoma. Conclusions: The safety and efficacy of suprachoroidal corticosteroid injections to treat uveitic ME have been shown in recent phase III clinical trials. Multiple programs are also investigating this modality of drug delivery for use in many other retinal and choroidal pathologies.

Comparative Efficacy of Fractional CO2 Laser Combined with Topical Steroid Cream versus Solution for Post-Thyroidectomy Scar Treatment: A Prospective Study.

BACKGROUNDS: Post-thyroidectomy scarring is a common illness impacting patient quality of life. Fractional carbon dioxide (CO2) lasers and topical steroids delivered via laser-assisted drug delivery (LADD) have shown potential for scar treatment. However, ideal steroid formulations (cream vs. solution) when combined with laser therapy remain unclear. METHODS: This study included 12 patients receiving fractional CO2 laser on post-thyroidectomy scars. After laser treatment, one scar half received topically applied steroid cream, while the other half received steroid solution. The Patient and Observer Scar Assessment Scale (POSAS) was used to measure the scar conditions at the time prior to the first treatment and one year later by the patients themselves and by the surgeon who did the laser treatment. Scar appearance was photographically assessed at baseline and 6 months post-treatment by four blinded evaluators using scales. RESULTS: This study discovered a modest improvement in the appearance of post-thyroidectomy scars when combining fractional CO2 laser treatment with either topical steroid cream or solution. Patients and treating physicians examined the POSAS scores one year after treatment found significant improvements in all aspects of the scar conditions, with high efficacy and satisfaction levels reported by patients. CONCLUSIONS: Fractional CO2 laser combined with topical steroid delivery, either cream or solution form, significantly enhanced post-thyroidectomy scar appearance with modest effect and high patient satisfaction. This approach may represent a promising scar management strategy along with current scar treatment for the post-thyroidectomy scar.

Injectable nanogels to improve triamcinolone acetonide delivery and toxicity on the treatment of eye diseases.

Triamcinolone acetonide (TA) is a corticosteroid, and widely used in the treatment of eye diseases such as macular edema, proliferative vitreoretinopathy, and chronic uveitis. It's also used in diseases such as osteoarthritis and rheumatoid arthritis. Despite the width of its usage, it has toxicity in the eye. Nanogels are advantageous in applying toxic and low bioavailability drugs thanks to their swelling ability and stability. In the presented study, to minimize the disadvantages of TA, and to reach the drug into the back segment of the eye, TA-loaded chitosan (CS) nanogel (CS-TA Nanogel) has been prepared, and in vitro characterized. CS-TA nanogels were prepared by ionic gelation and characterized by SEM, FTIR, and TGA. Drug release profile, and in vitro cytotoxicity was determined to evaluate the efficacy of nanogels for intravitreal eye applications. DNA damage, and oxidative stress caused by nanogels in eye endothelial cells were investigated. CS and CS-TA nanogels were synthesized in the sizes range 200-300 nm with an overall positive charge surface. The loading efficiency of TA on nanogels was determined as 50%. Cells exposed to 250 µg/ml free TA showed 74% viability, while this rate was 90% in cells exposed to CS-TA nanogels. 8-OHdG levels were determined as 54.93 ± 1.118 ng/mL in control cells and 92.47 ± 0.852 ng/mL in cells exposed to 250 µg/ml TA. TA both induces oxidative stress and causes DNA damage in HRMEC cells. However, administration of TA with carrier increased cell viability, total antioxidant capacity, and reduced oxidative DNA damage.