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1.
Plast Reconstr Surg ; 146(2): 177e-186e, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740586

RESUMO

BACKGROUND: Evidence-based practices in medicine are linked with a higher quality of care and lower health care cost. For trigger finger, identifying patient factors associated with nonadherence to evidence-based practices will aid physicians in treatment decisions. The objectives were to (1) determine patient factors associated with treatment nonadherence, (2) examine the success rates of steroid injections, and (3) evaluate the economic consequences of nonadherence to treatment recommendations. METHODS: The authors used data from the Clinformatics DataMart database from 2010 to 2017 to conduct a population-based analysis of patients with single-digit trigger finger. The authors calculated rates of steroid injection success and examined associations between injection success and patient factors using chi-square tests. In addition, the authors analyzed differences in the cost to the insurer, the cost to the patient, and total cost. RESULTS: A total of 29,722 patients were included in this analysis. Injection success rates were similar for diabetic (72 percent) and nondiabetic patients (73 percent), women (73 percent), and men (73 percent). Nonetheless, diabetics (OR, 1.4; 95 percent CI, 1.4 to 1.5; p < 0.001) and women (OR, 1.2; 95 percent CI, 1.1 to 1.2; p < 0.001) were significantly more likely to receive nonadherent treatment. In total, $23 million (U.S. dollars) were spent on nonadherent trigger finger care. CONCLUSIONS: Diabetics and women have increased odds of having surgery without a prior steroid injection, despite similar success rates of steroid injections compared to nondiabetics and men. Because performing surgical release before any steroid injections may represent a higher cost treatment option, providers should provide steroid injections before surgery for all patients regardless of diabetes status or sex to minimize overtreatment. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Diabetes Mellitus/epidemiologia , Glucocorticoides/administração & dosagem , Procedimentos Ortopédicos/economia , Cooperação do Paciente/estatística & dados numéricos , Dedo em Gatilho/terapia , Idoso , Custos e Análise de Custo/estatística & dados numéricos , Medicina Baseada em Evidências/economia , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/estatística & dados numéricos , Feminino , Seguimentos , Glucocorticoides/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Injeções Intralesionais/economia , Injeções Intralesionais/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/estatística & dados numéricos , Fatores de Risco , Fatores Sexuais , Resultado do Tratamento , Dedo em Gatilho/economia
2.
Dermatol Online J ; 26(6)2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32815688

RESUMO

Calcinosis cutis, although common in systemic sclerosis, has been rarely reported in patients with morphea. We describe four patients with calcinosis cutis arising within morphea plaques, discuss their treatments and outcomes, and review previously published cases. Current management recommendations for concomitant morphea and dystrophic calcinosis cutis are based on limited data and expert opinion, which has primarily focused on reduction of active inflammation and reduction of symptoms related to calcinosis or ulceration. In most cases, no improvement of calcinosis was noted. The use of intralesional corticosteroids to active lesions in conjunction with systemic treatment, including methotrexate when indicated, appear promising treatments to halt progression of the disease. Surgical excision seems to be the most definitive treatment for calcinosis affecting morphea plaques, but the current literature lacks details regarding disease recurrence following operative management.


Assuntos
Calcinose/etiologia , Esclerodermia Localizada/complicações , Dermatopatias/patologia , Pele/patologia , Corticosteroides/uso terapêutico , Calcinose/patologia , Calcinose/cirurgia , Criança , Feminino , Humanos , Injeções Intralesionais , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Esclerodermia Localizada/tratamento farmacológico , Esclerodermia Localizada/patologia , Dermatopatias/terapia
3.
J Am Acad Orthop Surg ; 28(15): e642-e650, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32732655

RESUMO

Trigger finger (TF) is one of the most common causes of hand disability. Immobilization of TF with a joint-blocking orthosis has been demonstrated to effectively relieve pain and improve function. The efficacy of steroid injections for TF varies based on the number of affected digits and the clinical severity of the condition. Up to three repeat steroid injections are effective in most patients. When conservative interventions are unsuccessful, open surgical release of the A1 pulley effectively alleviates the subjective and objective manifestations of TF and currently remains the benchmark procedure for addressing TF. Although several studies have emerged suggesting that a percutaneous approach may result in improved outcomes, this technique demands a learning curve that may predispose patients to higher risk of procedure-related complications. There is no role for preoperative antibiotics in patients who undergo elective soft-tissue procedures of the hand. WALANT anesthesia has gained popularity because it has been associated with improved patient outcomes and a clear cost savings; however, proper patient selection is critical. Similar to other soft-tissue hand procedures, TF surgery rarely necessitates a postoperative opioid prescription.


Assuntos
Procedimentos Ortopédicos/métodos , Dedo em Gatilho/cirurgia , Corticosteroides/administração & dosagem , Adulto , Anestesia Local/economia , Anestesia Local/métodos , Anti-Inflamatórios não Esteroides/uso terapêutico , Tratamento Conservador , Redução de Custos , Mãos/cirurgia , Humanos , Imobilização/métodos , Injeções Intralesionais , Curva de Aprendizado , Procedimentos Ortopédicos/economia , Procedimentos Ortopédicos/educação , Dedo em Gatilho/diagnóstico , Dedo em Gatilho/terapia
4.
Dermatol Online J ; 26(3)2020 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-32609439

RESUMO

BACKGROUND: New treatment options for warts include intralesional wart injection with agents such as vitamin D, measles, mumps, and rubella (MMR) vaccine antigen, Bacillus Calmette-Guerin (BCG) antigen, and candida antigen but there have been limited studies to compare their efficacies. OBJECTIVE: The purpose of this systematic review is to compare the efficacy and safety of injectable agents used for the treatment of warts. METHODS: A PubMed search included terms "intralesional wart therapy," "wart injection" and "verruca injection." Articles reviewed were published over 10 years. RESULTS: A total of 43 articles were reviewed; 30 covered studies with more than 10 participants and 13 were case reports, case series, and reviews. In comparison studies intralesional agents have equal or superior efficacy (66%-94.9%) compared to first-line salicylic acid or cryotherapy (65.5-76.5%). One advantage of intralesional injections is the rate of complete resolution of distant warts. LIMITATIONS: Each study varied in their agents, treatment interval, and treatment dose, making comparisons difficult. CONCLUSIONS: Intralesional wart injections are safe, affordable, and efficacious treatments for warts. Physicians should consider intralesional injections for patients with refractory warts, multiple warts, or warts in sensitive areas.


Assuntos
Injeções Intralesionais , Verrugas/tratamento farmacológico , Ácido Aminolevulínico/administração & dosagem , Antibacterianos/administração & dosagem , Antivirais/administração & dosagem , Vacina BCG/administração & dosagem , Vacinas Bacterianas/administração & dosagem , Humanos , Interferon-alfa/administração & dosagem , Mycobacterium , Tuberculina/administração & dosagem , Vitamina D/administração & dosagem
5.
Dermatol Online J ; 26(3)2020 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-32609455

RESUMO

Keratoacanthomas are rapidly growing neoplasms of squamous epithelium. Despite their benign nature, they are often difficult to distinguish from squamous cell carcinoma and require excision. In cases in which excision is not successful or not desired, intralesional treatments may be considered. However, limited research exists on individual therapeutic efficacy. We present a 68-year-old man who developed multiple eruptive keratoacanthomas around the wound edge of a previous keratoacanthoma excision. Considering previous excisional failure, intralesional 5-fluorouracil was used as a treatment modality. Injections every 3-4 weeks over a course of 12 weeks induced clinical keratoacanthoma clearance with excellent cosmetic results. This case showcases that weekly intralesional 5-fluorouracil injections, as was the standard mode of treatment in previous case reports, may not be necessary. This less frequent injection strategy is more convenient for the patient and may lead to fewer treatments and less medication necessary. Although a case-by-case basis is needed for any alternative approach to keratoacanthoma treatment, this report is useful for the practicing clinician in showing that 5-fluorouracil may be efficacious in these difficult-to-treat patients.


Assuntos
Antimetabólitos Antineoplásicos/administração & dosagem , Fluoruracila/administração & dosagem , Ceratoacantoma/tratamento farmacológico , Idoso , Braço/cirurgia , Humanos , Injeções Intralesionais , Ceratoacantoma/cirurgia , Masculino , Recidiva
6.
Hautarzt ; 71(10): 805-808, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32696202

RESUMO

Tattoos, including permanent makeup, may entail diverse complications like viral or bacterial infections and allergic and inflammatory reactions. In the latter case, besides exogenous pigment, histology shows an either lymphocytic or histiocytic-granulomatous infiltrate, depending on the predominant reaction pattern. We report successful treatment with intralesional triamcinolone acetonide injections in two individuals who developed granulomatous inflammation after tattooing.


Assuntos
Granuloma/induzido quimicamente , Hipersensibilidade/etiologia , Inflamação/induzido quimicamente , Tatuagem/efeitos adversos , Granuloma/complicações , Humanos , Inflamação/complicações , Injeções Intralesionais
7.
Aesthetic Plast Surg ; 44(5): 1869-1870, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32519038

RESUMO

Level of Evidence V 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 .


Assuntos
Cicatriz Hipertrófica , Queloide , Fluoruracila , Humanos , Injeções Intralesionais , Triancinolona
8.
Georgian Med News ; (301): 41-43, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32535560

RESUMO

In contrast to intra-urine wounds, extra-uterine wounds will heal with a scar. A number of conservative and surgical methods have been developed, aiming at improving unsightly and hypertrophic scars. The authors report on their experience with intralesional injection of the enzyme hyaluronidase to improve hypertrophic scars. Hyaluronidase produces low-molecular weight fragments during digestion of high-molecular weight hyaluronic acid. These fragments are known to stimulate angiogenesis and to activate mesenchymal stem cells. The manuscript presents a clinical review of series of patients with hypertrophic scars, mainly resulted from tumor resection, who were treated by this technique.


Assuntos
Cicatriz Hipertrófica/tratamento farmacológico , Hialuronoglucosaminidase/uso terapêutico , Queloide/tratamento farmacológico , Cicatrização , Humanos , Injeções Intralesionais , Cicatrização/efeitos dos fármacos
9.
Curr Gastroenterol Rep ; 22(6): 27, 2020 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-32350629

RESUMO

PURPOSE OF REVIEW: The aim of this review is to evaluate the emerging role of endoscopic ultrasound (EUS) in the guidance of tumor-targeted therapies for patients with pancreatic cancer (PC). RECENT FINDINGS: EUS-guided ablation, brachytherapy, fiducial marker placement, and antitumor agent injection have been described to date. EUS-guided fiducial placement for SBRT in pancreatic cancer has entered the clinical practice and is performed at many centers clinically without a research protocol. EUS-guided brachytherapy and RFA have been shown to be feasible and safe procedures, and potentially offer local disease control. Other potential techniques of EUS-guided treatment of pancreatic cancer are still considered experimental, with many of them appearing to be safe and reasonably well tolerated. However, their effectiveness and exact role in oncological treatment have yet to be established. Clinical trials with many of the techniques/agents described are underway and multicentric randomized trials with prospective design are eagerly awaited.


Assuntos
Carcinoma Ductal Pancreático/diagnóstico por imagem , Carcinoma Ductal Pancreático/terapia , Endossonografia/métodos , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/terapia , Técnicas de Ablação/métodos , Antineoplásicos/administração & dosagem , Braquiterapia , Marcadores Fiduciais , Humanos , Injeções Intralesionais , Ultrassonografia de Intervenção/métodos
10.
Zhonghua Shao Shang Za Zhi ; 36(5): 339-345, 2020 May 20.
Artigo em Chinês | MEDLINE | ID: mdl-32456370

RESUMO

Objective: To investigate the clinical effect of Zhang's super tension-relieving suture applied in high-tension wound closure. Methods: From January to August 2019, 19 eligible patients with scar or black hairy nevus were treated with Zhang's super tension-relieving suture for outpatient operation in the Department of Plastic and Reconstructive Surgery of Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. The patients were composed of 6 males and 13 females, aged 10-68 years, with 8 keloids, 3 hypertrophic scars, 5 atrophic scars, and 3 black hairy nevus. The operation sites included lower jaw in 2 cases, neck in 3 cases, chest in 4 cases, abdomen in 2 cases, and limbs in 8 cases. The size of scars and black hairy nevus before surgery ranged from 1.4 cm×1.1 cm to 10.0 cm×4.0 cm. All the lesions underwent excision alone with both sides of the incision undermined for 1 to 2 cm, and the wound size ranged from 2.6 cm×2.6 cm to 12.6 cm×6.8 cm. Zhang's super tension-relieving suture was applied with barbed suture, and the wound edges were naturally jointed with relaxation and low tension by pushing normal skin on both sides to the middle. Two patients with keloids underwent superficial radiotherapy within 24-hour interval after the surgery, with a total of 20 Gy delivered in 4 times, once a day. All the patients were followed up at outpatient clinics, with tension-relieving duration and adverse effects recorded. Six months after operation, the Vancouver Scar Scale (VSS) was used to evaluate scar appearance, while scar width and recurrence were recorded. Results: All the wounds of 19 patients healed completely after surgeries. Two patients experienced transient hyperpigmentation at puncture points and recovered without intervention, and one of them had hypertrophic scar at the puncture point, which was relieved after intralesional injections of corticosteroids. One patient underwent transient erythema, dry desquamation, and hyperpigmentation after radiotherapy, which recovered without intervention. Follow-up time ranged from 7.1 to 13.6 months, with an average of 9.6 months. Tension-relieving duration ranged from 4 to 26 weeks, with an average of 11.2 weeks. Two patients underwent Zhang's super tension-relieving suture again 8 weeks after operation due to their short tension-relieving duration which lasted for only 4 weeks after the first suture. Six months after operation, liner scars were achieved in all the patients with an average width of 2.2 mm (0.8 to 7.0 mm) and an average VSS score of 2.1 points (1.0 to 4.3 points). Three keloid patients had local recurrence 3 months after surgery for not receiving radiotherapy, which was obviously relieved following laser treatment in combination with intralesional injections of corticosteroids and 5-fluorouracil, etc. Conclusions: Zhang's super tension-relieving suture technique with barbed suture is able to effectively relieve the tension on wound edges, extend the tension-relieving duration, and reduce the hypertrophic scar risk when applied in high-tension wound.


Assuntos
Cicatriz Hipertrófica/cirurgia , Queloide/cirurgia , Técnicas de Sutura , Suturas , Adolescente , Adulto , Idoso , Criança , China , Feminino , Humanos , Injeções Intralesionais , Queloide/etiologia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
11.
Plast Reconstr Surg ; 145(6): 1464-1474, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32459776

RESUMO

BACKGROUND: This study compared the effectiveness of injectable collagenase clostridium histolyticum and percutaneous needle fasciotomy in the treatment of Dupuytren's contracture. METHODS: Patients with a total passive extension deficit of 30 degrees or more in a single digital ray were enrolled and assigned randomly to receive either collagenase clostridium histolyticum injections or percutaneous needle fasciotomy. Preoperative severity of proximal interphalangeal joint contracture for Dupuytren's disease was classified according to the British Society for Surgery of the Hand as less than 30 degrees (stage I) or 30 degrees or more (stage II). RESULTS: Of the 70 patients enrolled, 36 patients with 46 joints received collagenase clostridium histolyticum injections and 34 patients with 48 joints received percutaneous needle fasciotomy. At day 30, successful corrections were obtained in only 50 percent of the injection group and 67 percent of the fasciotomy group for stage II proximal interphalangeal joints. Recurrences were frequent among patients with stage II joint contractures. The mean Quick Disabilities of the Arm, Shoulder and Hand questionnaire score at day 30 was significantly higher in the injection group compared with the fasciotomy group (7.5 versus 4.2, respectively). In the injection group, adverse events were reported for all patients. In the fasciotomy group, complications were reported for 15 percent of patients. CONCLUSIONS: The collagenase clostridium histolyticum and percutaneous needle fasciotomy groups had similar outcomes for Dupuytren's contracture with 3 years' follow-up. Recurrences were frequent among patients with stage II proximal interphalangeal joint contractures. The Unité Rhumatologique des Affections de la Main scale and Quick Disabilities of the Arm, Shoulder and Hand questionnaire score decreased significantly for both groups at final follow-up. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.


Assuntos
Contratura de Dupuytren/terapia , Fasciotomia/instrumentação , Colagenase Microbiana/administração & dosagem , Complicações Pós-Operatórias/epidemiologia , Idoso , Contratura de Dupuytren/fisiopatologia , Fasciotomia/efeitos adversos , Feminino , Articulações dos Dedos/fisiopatologia , Seguimentos , Mãos , Humanos , Injeções Intralesionais/efeitos adversos , Masculino , Colagenase Microbiana/efeitos adversos , Agulhas , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Amplitude de Movimento Articular , Recidiva , Resultado do Tratamento
13.
PLoS One ; 15(4): e0231619, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32294117

RESUMO

BACKGROUND: Tendinopathy is a common musculoskeletal disorder and current treatment options show limited success. Genipin is an effective collagen crosslinker with low cytotoxicity and a promising therapeutic strategy for stabilizing an intratendinous lesion. PURPOSE: This study examined the mechanical effect and delivery of intratendinous genipin injection in healthy and degenerated tendons. STUDY DESIGN: Controlled laboratory study. METHODS: Bovine superficial digital flexor tendons were randomized into four groups: Healthy control (N = 25), healthy genipin (N = 25), degenerated control (N = 45) and degenerated genipin (N = 45). Degeneration was induced by Collagenase D injection. After 24h, degenerated tendons were subsequently injected with either 0.2ml of 80mM genipin or buffer only. 24h post-treatment, samples were cyclically loaded for 500 cycles and then ramp loaded to failure. Fluorescence and absorption assays were performed to analyze genipin crosslink distribution and estimate tissue concentration after injection. RESULTS: Compared to controls, genipin treatment increased ultimate force by 19% in degenerated tendons (median control 530 N vs. 633 N; p = 0.0078). No significant differences in mechanical properties were observed in healthy tendons, while degenerated tendons showed a significant difference in ultimate stress (+23%, p = 0.049), stiffness (+27%, p = 0.037), work to failure (+42%, p = 0.009), and relative stress relaxation (-11%, p < 0.001) after genipin injection. Fluorescence and absorption were significantly higher in genipin treated tendons compared to control groups. A higher degree of crosslinking (+45%, p < 0.001) and a more localized distribution were observed in the treated healthy compared to degenerated tendons, with higher genipin tissue concentrations in healthy (7.9 mM) than in degenerated tissue (2.3 mM). CONCLUSION: Using an ex-vivo tendinopathy model, intratendinous genipin injections recovered mechanical strength to the level of healthy tendons. Measured by genipin tissue distribution, injection is an effective method for local delivery. CLINICAL RELEVANCE: This study provides a proof of concept for the use of intratendinous genipin injection in the treatment of tendinopathy. The results demonstrate that a degenerated tendon can be mechanically augmented by a clinically viable method of local genipin delivery. This warrants further in vivo studies towards the development of a clinically applicable treatment based on genipin.


Assuntos
Adesivos/administração & dosagem , Colágeno/efeitos dos fármacos , Iridoides/administração & dosagem , Tendinopatia/tratamento farmacológico , Tendões/efeitos dos fármacos , Animais , Bovinos , Colágeno/metabolismo , Humanos , Injeções Intralesionais , Tendinopatia/patologia , Tendões/patologia , Resistência à Tração
14.
J Craniofac Surg ; 31(4): e393-e394, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32282473

RESUMO

Venous malformations (VMs) are congenital disorders that constitute about 40% of all vascular anomalies. These lesions do not regress spontaneously and may increase in size during childhood. The case of a 10-year-old girl with an extensive oral VM is reported. Intraoral examination revealed the presence of purplish nodules in the alveolar mucosa and gingiva from anterior maxilla. Doppler ultrasound showed a well-defined hypoechoic image and increased vascularization with low blood flow for the alveolar mucosa lesion. The patient was submitted to intralesional injections of the ethanolamine oleate/mepivacaine sclerosing solution. After four sessions, there was a significant reduction of the lesions. However, the patient abandoned the treatment and the oral VM grew progressively. After 1 year, sclerotherapy was resumed and performed weekly. After 10 session of sclerotherapy, the oral VM totally regressed. The childhood is a critical period for oral VM growth. Doppler ultrasound and sclerotherapy can be effective for the management of extensive lesions in children.


Assuntos
Malformações Vasculares/terapia , Angiografia , Criança , Feminino , Humanos , Injeções Intralesionais , Mepivacaína/uso terapêutico , Ácidos Oleicos/uso terapêutico , Soluções Esclerosantes/uso terapêutico , Escleroterapia , Malformações Vasculares/diagnóstico por imagem
15.
Clin Drug Investig ; 40(6): 583-588, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32342279

RESUMO

BACKGROUND AND OBJECTIVE: Plaque formation ordinarily takes place in the acute phase of Peyronie's disease. There is no unanimous consent regarding the management of the acute phase of Peyronie's disease. The objective of this study was to evaluate the advantages of using a single intralesional injection of collagenase Clostridium histolyticum in patients with the active phase of Peyronie's disease and to assess its effect on disease progression by reducing penile curvature and ameliorating pain during sexual intercourse. METHODS: Sexually active men aged older than 18 years with the acute phase of Peyronie's disease were enrolled. All patients received treatment with a single intralesional injection of collagenase Clostridium histolyticum. The primary outcome of the study was the change in penile curvature after treatment while secondary outcomes were the change in sexual function (International Index of Erectile Function [IIEF-5]) and in the Peyronie Disease Questionnaire (PDQ) and its sub-scores, PDQ-PS (psychological symptoms), PDQ-PP (penile pain) and PDQ-BD (bother disease). RESULTS: Overall, 74 patients were enrolled. Mean penile curvature at baseline was 41.1° ± 12.2°. The mean changes before and at the 3-month evaluation in terms of penile curvature, Visual Analog Scale score at rest, and Visual Analog Scale score during intercourse were - 19.3 ± 8.4 (p < 0.0001), - 0.8 ± 1.1 (p < 0.0001) and - 3.8 ± 0.9 (p < 0.0001) with the benefit persisting also after 6 months. Moreover, improvements of mean IIEF-5 score (1.1 ± 0.9, p = 0.03; 0.9 ± 0.5, p = 0.02), PDQ-PS (- 2.7 ± 2.2; - 2.5 ± 2.0, p = 0.01), PDQ-PP (- 1.2 ± 1.6; - 1.1 ± 1.2, p = 0.02) and PDQ-BD (- 3.8 ± 3.4; - 3.5 ± 3.1, p = 0.001) were observed 3 and 6 months after the end of treatment, respectively. At the multivariable regression analysis, the time since disease onset (modelled with non-linear terms) and baseline curvature were independently associated with the degree of curvature improvement (coefficient: 0.30; 95% confidence interval 0.16-0.44) after a single intralesional injection (all p < 0.03). CONCLUSIONS: Although intralesional therapy with collagenase Clostridium histolyticum is not yet indicated for the acute phase of Peyronie's disease, these preliminary results suggest the effectiveness of this minimally invasive option by improving penile curvature and IIEF-5 and PDQ scores.


Assuntos
Clostridium histolyticum/enzimologia , Colagenases/uso terapêutico , Induração Peniana/tratamento farmacológico , Doença Aguda , Adolescente , Adulto , Idoso , Colagenases/administração & dosagem , Progressão da Doença , Humanos , Injeções Intralesionais , Masculino , Pessoa de Meia-Idade , Dor , Inquéritos e Questionários , Resultado do Tratamento
16.
Dermatol Online J ; 26(1)2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-32155037

RESUMO

Intralesional corticosteroids are associated with various, uncommon, local adverse events [1]. Atrophy and hypopigmentation most commonlyremain localized to sites of injection. However, outward radiation in a linear, streaky pattern has been reported and is termed "perilesional/perilymphatic hypopigmentation or atrophy [2]." We report a case of this rare adverse event.


Assuntos
Glucocorticoides/efeitos adversos , Hipopigmentação/induzido quimicamente , Pele/patologia , Triancinolona Acetonida/efeitos adversos , Idoso , Atrofia/induzido quimicamente , Glucocorticoides/administração & dosagem , Humanos , Injeções Intralesionais/efeitos adversos , Masculino , Cotovelo de Tenista/tratamento farmacológico , Triancinolona Acetonida/administração & dosagem
19.
Yakugaku Zasshi ; 140(3): 345-354, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32115551

RESUMO

This study was designed to clarify the intrapulmonary pharmacokinetics and distribution characteristics of drugs in order to develop better therapies for respiratory diseases, including respiratory infections and pulmonary fibrosis. The distribution characteristics of three macrolide antimicrobial agents-clarithromycin, azithromycin, and telithromycin-in plasma, lung epithelial lining fluid (ELF), and alveolar macrophages (AMs), were examined for the optimization of antimicrobial therapy. The time course of the uptake of these agents in ELF and AMs, following oral administration to rats, resulted in markedly higher concentrations than that in plasma. The high concentration of the agents in AMs was due to their sustained distribution to ELF via multidrug resistance protein 1 and to high uptake by AMs themselves via active transport mechanisms and trapping and/or binding in acidic organelles. The intrapulmonary pharmacokinetics of aerosolized model compounds administered to animals with bleomycin-induced pulmonary fibrosis via aerosol formulations of model compounds (MicroSprayer) were then evaluated. The concentrations of these compounds in the plasma of pulmonary fibrotic rats were markedly higher than in that of control rats. The expression of epithelial tight junctions decreased in pulmonary fibrotic lesions. The accumulation of extracellular matrix inhibited the intrapulmonary distribution of aerosolized model compounds, indicating that aerosolized drugs are easily absorbed after leakage through damaged alveolar epithelia, but cannot become widely distributed in the lungs because of interruption by the extracellular matrix. This review provides useful findings for the development of therapies for respiratory infections and pulmonary fibrosis.


Assuntos
Antibacterianos/farmacocinética , Pulmão/metabolismo , Macrolídeos/farmacocinética , Doenças Respiratórias/tratamento farmacológico , Doenças Respiratórias/metabolismo , Administração Oral , Animais , Antibacterianos/administração & dosagem , Injeções Intralesionais , Macrolídeos/administração & dosagem , Macrófagos Alveolares/metabolismo , Camundongos , Ratos , Distribuição Tecidual
20.
Acta Orthop Traumatol Turc ; 54(1): 49-58, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32175897

RESUMO

OBJECTIVE: The aim of this study was to compare the outcome of intra-lesional autologous bone marrow concentrate (BMC) and equine derived demineralized bone matrix (EDDBM) injections with methylprednisolone acetate injections in patients with simple bone cyst. METHODS: Clinical records and radiographs of 53 consecutive patients (37 females,and 16 males; mean age: 10.6±1.53 years) treated between 2006 and 2016 were retrospectively reviewed. Healing was assessed by an independent radiologist according to Neer scoring system. Functional outcome was assessed with the Activity Scale for Kids (ASK). Thirty-four cysts were in the humerus, 13 in the femur and 6 in other locations. Twenty-nine patients were included in Steroid Group and treated with 3 cycles of injections of methylprednisolone acetate, while 24 patients were treated with injection of autologous bone marrow concentrate and equine derived demineralized bone matrix (BMC+ EDDBM Group). The two groups were homogenous for the mean age, sex distribution, cysts location and their clinical presentation. RESULTS: At a minimum follow-up of 24 months, success rate (Neer/Cole score 3 and 4) was higher in EDDBM+BMC group (83.3% vs 58.6%; p=0.047). Female patients had higher healing rates in both groups (p=0.002). No association was found between healing and age (p=0.839), cyst activity (p=0.599), cyst localization (p=0.099) and clinical presentation (p=0.207). BMC+EDDBM group showed higher ASK score (p=0.0007). CONCLUSION: Treatment with BMC+EDDBM injections may provide better results with a single procedure than 3 methylprednisolone acetate injections and represent an interesting alternative for the treatment of unicameral bone cysts. LEVEL OF EVIDENCE: Level III, Therapeutic Study.


Assuntos
Cistos Ósseos , Transplante de Medula Óssea/métodos , Acetato de Metilprednilosona/administração & dosagem , Materiais Biocompatíveis/administração & dosagem , Cistos Ósseos/diagnóstico por imagem , Cistos Ósseos/terapia , Matriz Óssea , Criança , Feminino , Glucocorticoides/administração & dosagem , Humanos , Injeções Intralesionais/métodos , Masculino , Radiografia/métodos , Estudos Retrospectivos , Resultado do Tratamento
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