Transfer of Injected Triamcinolone into Human Milk of a Lactating Patient Suffering from Idiopathic Granulomatous Mastitis.

Background: Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory condition of the mammary gland that presents as a painful mass, and it must be distinguished from both infectious mastitis and breast cancer. When diagnosed during lactation, it can result in significant distress and early weaning. Injection of triamcinolone has been used as a successful treatment method, but safety in breastfed infants has not been established. Methods: We present a case of a lactating patient who received a direct injection of triamcinolone (dosage 40 mg) in her breast to treat IGM after failure of oral corticosteroids. Breastmilk samples were expressed by the patient 0, 1, 4, and 24 hours after the procedure, and then daily for 1 week. All the samples were analyzed using liquid chromatography mass spectrometry. The patient was supported by a breastfeeding and lactation medicine clinic. Results: After injection of triamcinolone into the granulomatous mass, breast milk samples were collected and analyzed. No samples were found to contain triamcinolone. A temporary but significant decrease in milk production was noted after injection, though only a slight decrease had been noted with 6 weeks of systemic corticosteroids. With support, the patient rebuilt milk production and continued to breastfeed from both breasts. Conclusion: Triamcinolone was not found in any milk samples (≥0.78 ng/mL) following therapeutic injection of the affected breast. The patient was able to continue breastfeeding from the affected breast with intermittent symptoms.

Estudo comparativo entre pentoxifilina e triancinolona no tratamento das cicatrizes hipertróficas pós-queimadura quanto à remodelação do colágeno e das fibras do sistema elástico / Comparative study of pentoxifylline and triamcinolone in the treatment of post-burn hypertrophic scars on the collagen remodeling and elastic system fibers

Introdução: O tratamento das sequelas cicatriciais permanece um desafio na prática diária. Corticosteroides injetáveis são amplamente utilizados no combate a queloides e cicatrizes hipertróficas, mas substâncias como a pentoxifilina (PTF) também têm demonstrado eficácia clínica na modulação dessas cicatrizes. Objetivos: No presente estudo, propusemos a comparação dos efeitos da PTF e do corticosteroide triancinolona nas cicatrizes hipertróficas de pacientes vítimas de queimaduras por meio de análise histológica da organização das fibras que contêm colágeno e das fibras do sistema elástico. Métodos: Foram estudadas amostras de pele cicatricial de 10 pacientes, entre 20 e 40 anos, com história de queimaduras em tronco, com até 24 meses de evolução, não tratadas cirurgicamente. Cada paciente teve duas áreas cicatriciais tratadas, uma com Hexacetonido de Triancinolona 20 mg/ml e outra com Pentoxifilina 1 mg/ ml; tendo sido realizadas três aplicações intracicatriciais com intervalos mensais. Uma biópsia de cada área tratada foi colhida após 30 dias de cada aplicação. Resultados: Os resultados clínicos foram evidentes e semelhantes para as duas drogas: diminuição da espessura, do prurido, da hiperemia e da consistência da cicatriz. Não se observaram diferenças arquiteturais no tecido conjuntivo subepidérmico quando comparadas a cicatriz original com as cicatrizes após cada tipo de tratamento (grandes feixes de fibras colágenas em todas as direções, com ausência de fibras do sistema elástico). Estudos subsequentes envolvendo a análise da espessura total da cicatriz e o grau de vascularização/ inflamação presentes se fazem necessários na investigação da justificativa da eficácia clínica dos tratamentos. Conclusão: Concluímos que a PTF teve uma resposta clínica e morfológica similar à triancinolona nos casos tratados.

Introduction: The treatment of scarring sequelae remains challenge in daily practice. Injecting corticosteroids are widely used to combat keloids and hypertrophic scars, but substances such as pentoxifylline (PTF) have also demonstrated clinical efficacy in modulating these scars. Objectives: This study set out to compare the effects of TFP and corticosteroid triamcinolone in hypertrophic scars of burn victims by histological analysis of the organization of the fibers containing collagen and elastic system fibers. Methods: Scar skin samples from 10patients were studied between 20 and 40 years, with a history of burns on the trunk, up to 24 months of evolution, not surgically treated. Each patient had two treated scar areas, one with triamcinolone hexacetonide 20 mg/ml and the other with pentoxifylline 1 mg/ml; having been held three intracicatriciais applications at monthly intervals. A biopsy of each treated area was harvested after 30 days of each application. Results: The clinical results were evident and similar for the two drugs: thinning, itching, hyperemia and scar consistency. There were no differences in architectural subepidermal connective tissue when compared with the original scar scars after each treatment (large bundles of collagen fibers in all directions with no elastic system fibers). Subsequent studies involving the analysis of the total thickness of the scar and the extent of vascularization/inflammation gifts are needed to investigate the reasons of clinical efficacy of treatments. Conclusion: We conclude that TFP had a clinical and morphological response similar to triamcinolone in treated cases.

A rapid screen for four corticosteroids in equine synovial fluid.

Most antidoping method development in the equine industry has been for plasma and urine, though there has been recent interest in the analysis of synovial fluid for evidence of doping by intra-articular corticosteroid injection. Published methods for corticosteroid analysis in synovial fluid are primarily singleplex methods, do not screen for all corticosteroids of interest and are not adequately sensitive. The purpose of this study is to develop a rapid and sensitive liquid chromatography-tandem mass spectrometry (LC-MS-MS) screening method for the detection of four of the most common intra-articularly administered corticosteroids--betamethasone, methylprednisolone, methylprednisolone acetate and triamcinolone acetonide. Sample preparation consisted of protein precipitation followed by a basified liquid-liquid extraction. LC-MS-MS experiments consisted of a six-min isocratic separation using a Phenomenex Polar-RP stationary phase and a mobile phase consisting of 35% acetonitrile, 5 mM ammonium acetate and 0.1% formic acid in nanopure water. The detection system used was a triple quadrupole mass analyzer with thermospray ionization, and compounds were identified using selective reaction monitoring. The method was validated to the ISO/IEC 17025 standard, and real synovial fluid samples were analyzed to demonstrate the application of the method in an antidoping context. The method was highly selective for the four corticosteroids with limits of detection of 1-3 ng/mL. The extraction efficiency was 50-101%, and the matrix effects were 14-31%. These results indicate that the method is a rapid and sensitive screen for the four corticosteroids in equine synovial fluid, fit for purpose for equine antidoping assays.

Validation of a recombinant cell bioassay for the detection of (gluco)corticosteroids in feed.

Use of hormones for fattening purposes is forbidden in the animal production in Europe (European Commission. 1996. Council Directive EC/96/22 (replacement of 88/146/EC). Off J Eur Commun. L125:3-9; European Commission. 1996. Council Directive EC/96/23. Off J Eur Commun. L125:10-32). Moreover, Regulation (EC) 178/2002 (European Commission. 2002. Regulation EC No 178/2002. Off J Eur Commun. L31:1-24) and Regulation (EC) 882/2004 (European Commission. 2004. Regulation EC No 882/2004. Off J Eur Commun. L165:1-135) oblige the member states to identify emerging risks and use validated and accredited methods for control analysis. Only combinations of bioassay activity screening with chemical identification are suited to uphold all laws. No such combination is described for the detection of (gluco)corticoids. In the present study, the GR-CALUX bioassay was validated as a qualitative screening method for the determination of glucocorticoid activity in feed. This validation was performed according to EC Decision 2002/657/EC (European Commission. 2002. Commission Decision 2002/657/EC from Directive 96/23. Off J Eur Commun. L221:8-36). Twenty-two representative blank feed samples were selected and spiked with 50 ng g(-1) of dexamethasone, 100 ng g(-1) of betamethasone or 500 ng g(-1) of triamcinolone. All blank and spiked feed samples fulfilled the CCα and CCß criteria; the method was specific and robust and glucocorticoids in feed were stable for at least 88 days.

Quelóide: fatores de influência prognóstica / Keloids: prognostic factors

Introdução: Quelóides são um dos maiores problemas relacionados ao processo de cicatrização. O tratamento pode ser difícil e envolver uma variedade de possibilidades terapêuticas, com resultados muitas vezes frustrantes. Considerando-se estas informações, este trabalho objetivaestudar variáveis que poderiam estar correlacionadas à recidiva dos quelóides tratados. Método: Foram analisados, retrospectivamente, 48 quelóides tratados em um período de cincoanos, que mantiveram seguimento mínimo de 18 meses após término do tratamento. Os resultados obtidos com várias modalidades terapêuticas foram correlacionados com outras variáveis. Foram considerados para análise a regressão completa e o tratamento sem resposta favorável. Resultados: Das 48 lesões analisadas (45% do sexo masculino e 55% do feminino),a idade média foi de 24 anos (8-69 anos), a melhora completa, considerando-se os diversostratamentos adotados no serviço, foi alcançada em 64,5% dos quelóides. O tamanho da lesão mostrou-se significativo (t-Student; p< 0,04 e ANOVA; p= 0,042) em recidiva para lesões > 40 mm e cura para as menores que 20 mm. A terapêutica nas lesões > 20 mm com exérese associadaà betaterapia foi significativamente superior à associação com corticóide injetável (quiquadrado; p < 0,04). Conclusão: A exérese associada à betaterapia é significativamente superiorà associação com corticóide injetável nas lesões maiores que 20 mm. Quanto à resposta terapêutica, o tamanho da lesão foi o principal fator prognóstico.

Introduction: Keloids are a challenging problem related to the wound healing process. The treatment can be difficult and includes a variety of therapeutical possibilities that sometimes show frustrating outcomes. Considering that information, the present study aimed to analyze the features that could be correlated to the recurrence of treated keloids. Methods: Forty eight lesions were analyzed retrospectively in a period of five years, with a follow-up of at least 18 months. The therapeutical response was correlated with other keloids variables. It was considered for analysis the complete regression and the treatment without favorable response. Results: Considering 48 analyzed keloids (45% male and 55% female). The average age was24 year-old (8-69 year-old). The complete regression obtained with diverse treatments was 64.5%. The keloid size was statistically significant (t-Student; p< 0.04 e ANOVA; p= 0.042) for recurrence in lesions > 40 mm and for cure in lesions < 20 mm. Keloids bigger than 20 mm reachedstatistically significant favorable outcomes with excision and superficial radiation than those treated with excision and steroid injections (chi-square; p < 0.04). Conclusions: The excision associated to the betatherapy is significantly better than the excision with steroid injections in lesions bigger than 20 mm. The size of the keloid was the main prognostic factor for cure.

Micellar electrokinetic chromatography for simultaneous determination of six corticosteroids in commercial pharmaceuticals.

We have developed a micellar electrokinetic chromatography (MEKC) method using bile salts for the simultaneous determination of six corticosteroids, including betamethasone, cortisone, prednisolone, 6alpha-methylprednisolone, triamcinolone, and prednisone. The separation was performed using borate buffer containing sodium cholate and sodium deoxycholate. Several parameters were studied, including bile salt concentrations, concentrations and pH of borate buffer, and analytical voltages. In method validation, calibration curves were linear over a range of 10-100 microM for each corticosteroid. The RSD (relative standard deviation) and RE (relative error) were all less than 5% for intra- and interday assays. The limit of detection of each analyte was 5 microM. The recoveries were greater than 95%. Application of this method for quality control of commercial tablets also proved to be feasible. All analytical values fall within the labeled amount of 90-110% for betamethasone and prednisolone, and of the labeled amount of 92.5-107.5% for 6alpha-methylprednisolone, as required by the United State Pharmacopeia 25 (USP 25).

Detection and quantitation of fatty acid acyl conjugates of triamcinolone acetonide via gas chromatography-electron-capture negative-ion mass spectrometry.

The inherent electron-capture properties of triamcinolone acetonide (TAA) fatty acid conjugates were exploited for development of a GC-MS technique for quantitation of C21 long-chain fatty esters of TAA synthesized in BEAS-2B cells, an immortalized airway epithelium cell line. TAA esters extracted from BEAS-2B cells were purified and detected via selected ion monitoring of the molecular anions generated from the TAA esters under electron-capture negative-ion mass spectrometric conditions. Standard curves were linear over a range of 0.0 to >4.5 ng/mg protein with r(2) values = 1. Levels of TAA conjugates extracted from BEAS-2B treated with 10(-5)M TAA for 24h ranged from 0.024 to 0.301 ng/mg protein. Further evidence for confirmation of the identity of TAA fatty esters formed in BEAS-2B cells was obtained via selected reaction monitoring. The transition monitored was formation of the carboxy anion generated from each of the respective molecular anions of the TAA esters during collision-induced decomposition. These findings indicate that the GC-MS analysis is suitable for studies of the kinetics of the TAA fatty acid conjugates formation in vitro and may be directly applicable to determination of the kinetics of TAA fatty acid conjugation in vivo.

Determination of methylparaben, propylparaben, triamcinolone acetonide and its degradation product in a topical cream by RP-HPLC.

A novel reversed-phase high-performance liquid chromatographic (RP-HPLC) method was developed and validated for the determination of active component triamcinolone acetonide, its degradation product triamcinolone (occurring in formulation after long-term stability tests) and two preservatives presented in the cream-methylparaben and propylparaben, using hydrocortisone as an internal standard. The chromatographic separation was performed on a Supelco Discovery C18 column; the mobile phase for separation of all compounds consists of a mixture of acetonitrile and water (40:60 v/v). The analysis time was less than 9 min, at a flow rate of 0.6 mL min(-1) and detection at 240 nm. The method was found to be applicable for routine analysis (stability tests, homogeneity) in the pharmaceutical product topical cream Triamcinolon cream 0.1%.

Automated coupling of capillary-HPLC to matrix-assisted laser desorption/ionization mass spectrometry for the analysis of small molecules utilizing a reactive matrix.

This study describes the application of a novel, reactive matrix for the mass spectral analysis of steroids by capillary-high performance liquid chromatography (capillary-HPLC) coupled to matrix-assisted laser desorption/ionization (MALDI). The mass spectral analysis of steroids was accomplished after fully automated peak deposition of chromatographic peaks onto MALDI targets. The seven corticosteroids used as test compounds were: triamcinolone, prednisone, cortisone, fludrocortisone, dexamethasone, deoxycorticosterone, and budesonide. They were separated using a PepMap C(18) (3 microm particle size, 100 A pore width) column at five different concentration levels of 25, 15, 7.5, 2.5 and 1 ng/microL, and the peaks were detected at a wavelength of 237 nm. The column effluent was mixed with 2,4-dinitrophenylhydrazine (DNPH) directly following the UV detector. The chromatographic peaks were then deposited onto the MALDI target with a robotic micro-fraction collector triggered by the UV detector signals. A special hydrophobic surface coating allowed the deposition of up to 4 microL (up to 90 % of the chromatographic peak volume) onto one sample spot. The compounds were then identified by MALDI mass spectrometry. Depending on the nature of the analyte, radical cations ([M](+.)) and sodium adduct ions ([M+Na](+)) of the steroids as well as protonated steroid-dinitrophenylhydrazone derivatives ([M(D)+H](+)) were detected in positive ion mode. The detection limits were between 0.5 and 15 ng injected with capillary-HPLC-MALDI-TOF-MS and between 0.3 and 3 ng on target with MALDI-TOF when deposited manually.

A high-performance liquid chromatography/tandem mass spectrometric screening method for eight synthetic corticosteroids in bovine feces and the simultaneous differentiation between dexamethasone and betamethasone.

A screening method was developed to monitor the illegal use of synthetic corticosteroids in cattle. Diethyl ether extracts from spiked feces samples were cleaned-up by solid phase extraction followed by semipreparative reversed-phase chromatography (RPC). The fraction containing the corticosteroids was derivatized with ethoxyamine hydrochloride. The corresponding ethoximes were separated using silica-based C18 RPC and analyzed on-line in an ion trap mass spectrometer using atmospheric pressure positive chemical ionization. Ethoxime derivatives of dexamethasone and betamethasone were baseline resolved, allowing for the simultaneous mass spectrometric differentiation of both epimers in bovine feces by conventional non-chiral chromatography. At the lowest level tested (1 micro g/kg), corticosteroids (except triamcinolone) could be identified in compliance with the recent European criteria for residue identification. The quantitative performance of the method was best at residue levels > or = 2 micro g/kg.

Collision-induced dissociation of corticosteroids in electrospray tandem mass spectrometry and development of a screening method by high performance liquid chromatography/tandem mass spectrometry.

A screening method based on liquid chromatography/electrospray tandem mass spectrometry was developed in order to control the illegal use of corticosteroids as growth promoters in cattle. The objective was the detection of low residue levels of corticosteroids or metabolites in biological matrices. Relative to other studies published on this subject, the present work focused on enhancing specificity and sensitivity. Firstly, fragmentation of corticosteroids by collision-induced dissociation was studied. In positive mode, the losses of H(2)O for each hydroxyl group fixed on the molecule, as well as the loss of HF or HCl for halogenated compounds, were observed. For higher collision energy, fragmentations in the B, C and D rings were induced. The negative mode was found to be more specific, inducing a cleavage of the C(20)-C(21) bond with concomitant loss of formaldehyde (CH(2)O). Secondly, three acquisition methods in the negative mode were studied and evaluated, recorded signals being the parent ion [M + acetate](-) and the two daughter ions, [M - H](-) and [M - H - CH(2)O](-). For dexamethasone, MS/MS instrumental detection limits of fragment ion and neutral loss scans, and of multiple reaction monitoring (MRM), were 250, 20 and 5 pg injected, respectively. The MRM method was then evaluated with the objective of use for the detection of corticosteroid residues in biological samples (urine, hair, muscle) and for a metabolism study.

Influência da limpeza cirúrgica, irrigação e/ou aplicação tópica de triancinolona e antimicrobianos em alveolites: estudo histológicos em ratos / Influence of surgical clean triancinolone and antibiotics association on dry socket treatment in rats: histological study

Foi estudada a ação da associação triancinolona e antimicrobianos (Omcilon-A M) no tratamento das alveolites provocadas experimentalmente em ratos. Concluiu-se que a aplicação intra-alveolar da pasta provocou acentuado atraso no reparo alveolar e que a limpeza cirúrgica e irrigação são procedimentos aconselháveis no tratamento da alveolite

Synovial and serum levels of triamcinolone following intra-articular administration of triamcinolone acetonide in the horse.

Seven mature thoroughbred horses, weighing between 400 and 541 kg, were each injected intra-articularly into three joints with 6 mg/joint of triamcinolone acetonide (Vetalog). The fourth joint, the control, was injected with saline. Synovial fluid was taken from all four legs of the horses on days 1, 2, 3, 4, 5, 6, 7, 8, 11, and 15 following the injections. Triamcinolone acetonide was assayed by a radioimmunoassay. Blood was collected at 1, 2, 4, 6, 12 h and on days 1, 2, 3, 4, 5, 6, 7, 8, 11, and 15 following injection of either triamcinolone or saline. Both cortisol and triamcinolone were assayed. The results show that the synovial fluid level of triamcinolone was 7.5 micrograms/ml 1 day following treatment and decreased to 10 ng/ml by the 4th day. These low levels were maintained for approximately 14 days. By the 15th day, the triamcinolone was below a detectable level. Serum levels of triamcinolone increased to 3 ng/ml within 1 h and further increased to a peak of 4.3 ng/ml at 4th h. The level then decreased to 2 ng/ml at 24 h and to nearly an undetectable level in 48 h. The mean level of serum cortisol, on the other hand, gradually decreased as the serum level of triamcinolone increased. As the serum level of triamcinolone reached an undetectable level on the 2nd day, the serum cortisol level gradually increased and returned to the pre-administration level by the 5th day. These results showed that the intra-articular administration of triamcinolone maintained triamcinolone in the synovial fluid for 4-14 days and that the triamcinolone reached the blood within 1 h. The serum level of triamcinolone was maintained for 2 days and resulted in the inhibition of adrenal function for 4 days.

Mapping of intracellular halogenous molecules by low and high resolution SIMS microscopy.

The subcellular distribution of halogenous molecules has been studied by SIMS microscopy in cultured cells of a human breast carcinoma (MCF-7 cell line). Two instruments of microanalysis were used. A low lateral resolution ion microscope (SMI 300 CAMECA) and a prototype scanning ion microscope equipped with a cesium gun that gives high lateral resolution images. This apparatus has been developed by G Slodzian, in Onera Laboratories (Office National d'Etudes et de Recherches Aérospatiales). Molecules studied by low lateral resolution ion microscope were halogenous steroids: fluorometholone, triamcinolone, bromocriptine and bromoandrosterone. Analytical images show that the first two compounds are mainly localized in the nuclear structure of MCF-7 cells whereas the last two molecules are localized in cytoplasm of these cells. Images were obtained with a resolution of 1 micron. With the scanning ion microscope, it is now possible to obtain images at the ultrastructural level. Four analytical images can be simultaneously obtained by a single scan of the imaged area, corresponding to a depth of erosion of the section of ten nm. The intranuclear distributions of three pyrimidine analogs, 5-bromo-2'-deoxyuridine, 5-iodo-2'-deoxyuridine and 5-fluorouracil have been studied in phase S and M of MCF-7 cells and these images have been compared to the distribution of sulfur, nitrogen and phosphorus. All these images have been obtained with a lateral resolution better than 100 nm.

Determination of triamcinolone, triamcinolone acetonide and fluocinonide in dosage forms.

The colorimetric method for determination of triamcinolone, triamcinolone acetonide and fluocinonide in tablets, ointments and cream using isonicotinic acid hydrazide is proposed. This method provides a precise and reproducible results (recovery ranged within 97.42-101.75%, variation coefficient ranged within 0.99-2.56%).

The release and diffusion through human coronal dentine in vitro of triamcinolone and demeclocycline from Ledermix paste.

Crowns from freshly extracted human third molar teeth were used to quantify the release and diffusion of corticosteroid and antibiotic tracer molecules from Ledermix paste used as an indirect pulp-capping agent. These molecules readily diffused through dentine and reached a peak rate of diffusion at 2 h. The rate then decreased exponentially with time. The concentrations of the drugs in the dentine were calculated; this showed that a gradient existed from the cavity floor to the pulp space. The data obtained appeared to have clinical relevance and helped explain the therapeutic benefits of this medicament when used as an indirect pulp-capping agent.