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Query: UMLS:C0338671 (Steroids)
 9,479 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The Cooperative Statistical Program was initiated in 1963, the 1st effort to evaluate a method of contraception by using pooled data from several clinics and a systematic statistical method. Progress reports were issued from 1963 through 1970. The reports provided epidemiological evidence that Lippes Loop D has the best overall performance of all the IUDs studied. Expulsion, pregnancy, and removal rates for bleeding and pain were measured. Performance rates for all these indices are better with the duration of the device. Since 1970, numbers of new IUDs have been designed and tested clinically. The aim was to improve efficacy, to make IUDs suitable for women who had never been pregnant, and to reduce the incidence of pain and bleeding. The T-shaped IUD has been found to cause lowered rates of removal for pain and bleeding. To counteract the higher pregnancy rate with this device, an antifertility agent can be added to the IUD for timed release. Steroids and copper have both been used. Clinics differ in their performance rates due to differing patient populations, differing physician experience, and differing clinic attitudes. The insertion technique is important to long-term performance.
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PMID:Historical considerations in the development of modern IUD's: patient and device selection and the importance of insertion techniques. 34 70

In a recent survey that the author conducted among podiatrists, the typical therapeutic injection for inflammatory lesions consisted of 2.25 or 2.5 mL of 1% lidocaine or plain bupivicaine (or, rarely, with epinephrine 1:200,000), 0.5 mL of hexadrol, and 0.25 mL of an insoluble cortisone such as triamcinolone acetonide (Kenalog). It is clear that variation exists and that each doctor has his or her own "cocktail" for therapeusis. The author finds that 1% lidocaine with epinephrine 1:200,000 therapeutic injections alone have a profound clinical effect when used in concert with biomechanic control. These injections are given as a series once a week and then the interphase is stretched out as needed. Because no steroids are used, there is no limit to the number of injections, and so, for chronic entities such as metatarsophalangeal (MTP) joint osteoarthritis, the author has been giving certain patients 6 to 10 therapeutic injections a year for 15 to 18 years, while controlling pain. Because all "cocktails" usually contain some amount of local anesthetic, maybe the podiatric community is using added medications such as steroids unnecessarily. Steroids mask poor diagnostic and technical skills and also infections. Clinicians also should spend time controlling the pedal sympathetics through "chemical sympathectomy." This posterior tibial nerve and artery therapeutic block was developed by Dr. Marvin Steinberg in the 1940s. Treatments are given in 1-week intervals with the first treatment giving 3 to 5 days' relief, the second 5 to 7 days, the third 7 to 10 days, and then 2- and 4-week intervals. Eventually, a comfortable interphase is selected, if necessary. In order for the blocks to work in summation, a vasoconstrictor such as epinephrine is mandatory. Lidocaine is the active ingredient of chemical sympathectomy; it blocks the artery and nerve, including the posterior tibial sympathetics. The posterior tibial sympathetics control 85% of the sympathetics to the foot, including all four muscle layers and the vital structures of the sole of the foot. Epinephrine works at the vasovasorum, nervonervorum, vasonervorum, and nervovasorum to maintain the active medication longer and make the block more effective. This chemical sympathectomy works even better than a lumbar paravertebral sympathectomy.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Preoperative and therapeutic local anesthetics and steroids. 158 7

A retrospective study is presented of 83 athletes with tendo Achillis pain (TAP) treated conservatively over a 12-year period from 1976 to 1988. Local steroid injections did not contribute to an earlier return to sport, though many individuals were improved symptomatically. Local steroids were not found to have a deleterious effect on outcome. Steroids were used most frequently in the chronic cases that presented late and had been treated previously: this group had most recurrences and surgical intervention. One case of Achilles rupture (3%) occurred in the group treated with steroids. Early presentation for treatment led to an earlier return to sport and avoidance of recurrences. Recurrences were most frequent in athletes with bilateral Achilles tendinopathy. The tendo Achillis lesion may range from peritendinitis through a mixed lesion of the tendon and paratenon, to complete rupture. The management depends upon accurate diagnosis, its chronicity and the age and aspirations of the patient. Steroids are safe to use and further prospective trials should note presentation time and disease staging accurately.
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PMID:Tendo Achillis pain: steroids and outcome. 160 Apr 48

Intra-articular injections with steroids may offer additional help in the treatment of inflammatory joint diseases. The major side effects are the systemic effects of steroids, infectious arthritis and cartilage damage. These are infrequent, however, and to a great extent preventable. Steroids are of little effect in radiological progression and function, and this is the most important limitation on liberal use. On the other hand, they powerfully suppress inflammation and pain, for a varying length of time which depends on the preparation used.
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PMID:Intra-articular steroid injection. A risk-benefit assessment. 219 May 96

Between January 1982 and March 1987, 23 patients (26 orbits) were treated for orbital pseudotumor with radiation therapy at the Department of Radiation Oncology, Hospital of the University of Pennsylvania. The patients were referred for clinical relapse after steroid taper in 70%, no response to steroids in 17%, and no steroid treatment (refused or contraindicated) in 13%. Presenting symptoms/signs included soft tissue swelling in 92% of orbits, pain in 92%, proptosis in 85%, and extraocular muscle dysfunction or ptosis in 69%. Decreased visual acuity was seen in only 19% of orbits. Biopsy was performed in nine patients. Treatment consisted of 2000 cGy in 2 weeks in 10 fractions for all patients. Median follow-up was 41 months, with a mean of 53 months, and a range of 21-92 months. Complete response was documented in 87% of orbits with soft tissue swelling, 82% with proptosis, 78% with extraocular muscle dysfunction, and 75% with pain. Of the five patients with visual acuity defects, three experienced complete recovery. There was no difference in complete response in patients biopsied versus those not biopsied. Overall, 17 orbits have remained in complete orbital response with no further steroid requirement (66%). Three orbits suffered local relapse at some point following radiation therapy and were retreated with steroids. These three orbits had durable local control off steroids at last follow-up (11%). Therefore, 77% of orbits attained durable local control and were steroid independent with radiation therapy alone or radiation therapy followed by steroids for relapse. Only one patient developed systemic lymphoma with follow-up. No pretreatment clinical factor reached statistical significance with respect to prognosis following radiation therapy at the less than or equal to .05 level. There were no significant acute or chronic side effects secondary to treatment. Steroids should continue to be first line treatment for orbital pseudotumor, but radiation therapy has a well-defined role in cases of steroid failure or in patients unable to tolerate steroid therapy.
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PMID:The results of radiotherapy for orbital pseudotumor. 240 29

An animal experimental study was performed to investigate the prevention of scar formation after laminectomy by applying Gelfoam, a free-fat graft and steroids as interposing material between the dura and muscles. There were 52 adult guinea pigs equally divided into four groups. They were sacrificed 2 weeks, 4 weeks and 12 weeks respectively after surgery. In the control group, there was young fibrous tissue at 2 weeks, which became more mature at 4 weeks. At 12 weeks, it became mature with varying thickness and canal extension. In the steroid group, it showed the same picture as the control group. In the Gelfoam group, there was foreign body reaction with disintegration of Gelfoam at 2 to 4 weeks. At 12 weeks, however in the free-fat graft group, viable fat graft could be seen at the laminectomy site with little fibrous tissue overlying the dura. In the clinical part, from September 1981 to September 1984, one of the authors (PQC) performed 100 laminectomies on patients with various causes of low back pain. A piece of free subcutaneous fat was laid on dura before wound closure. At follow-up, there was no adverse effect pertaining to its application. Most patients had considerable pain relief after the surgery. From the above observation, we believe that a free-fat graft is a simple and effective way to prevent postlaminectomy membrane. Steroids and Gelfoam do not have such advantage.
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PMID:Prevention of postlaminectomy membrane: experimental and clinical observations. 275 20

Of 333 duodenal ulcer (DU) patients 75 (22.5%) were aged 65-93 years (study group). Ninety-two percent (306 patients) of the entire group were diagnosed endoscopically, and all were followed prospectively. In the study group of the older patients there were fewer smokers, but more patients used steroids and other nonsteroidal antiinflammatory drugs (NSAIDs) and had more arteriosclerotic heart disease than the younger control group. Presenting signs and symptoms were similar in both age groups, although painless upper gastrointestinal bleeding was more common in the elderly, and pain, when present, tended to be milder. Bleeding episodes were more prevalent in the older age group. Another difference between the groups was the larger incidence of concurrent gastric ulcer and DU observed endoscopically in the study population. Steroids and NSAIDs could be etiologically connected to bleeding in the older patients, as well as to their relative lack of pain. We conclude that DU in the elderly tended to present atypically and that pain was not the major symptom of activity. This places a different emphasis on diagnostic and therapeutic criteria.
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PMID:Duodenal ulcer in the elderly. 279 28

We report two patients who underwent orbital exploration yielding the diagnosis of sclerosing orbital pseudotumor. The presenting symptoms were exophthalmos, visual loss, abnormal ocular mobility, and ocular pain. Computed tomographic (CT) scans showed masses in the orbital apex. Steroids were ineffective. Orbital pseudotumor is a heterogeneous diagnostic category of lymphoid infiltrations of the orbit with a wide spectrum of pathological conditions and intraorbital locations. The clinical presentation typically includes the sudden onset of pain, diplopia, lid edema, and exophthalmos. Visual loss is uncommon. Most cases resolve spontaneously or respond to steroid treatment. Although fibrosis may be a prominent histological finding, the literature contains little information concerning its significance. We discuss the evidence for considering the sclerosing pseudotumors to be a significant variant with unique clinical behavior. Although features suggestive of pseudotumor were present in our case, the presence of visual loss and an apical mass shown on the CT scan led to the presumptive diagnosis of tumor and exploratory operation. Neurosurgeons should be aware of this entity as a cause of visual loss and orbital mass. Proper suspicion may in some cases permit transorbital biopsy and avoid craniotomy, inasmuch as operation is of no therapeutic benefit in this disease.
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PMID:Sclerosing orbital pseudotumor. 685 74

The favorable spontaneous course of TMA indicates a conservation approach to treatment. One-half of the percent 119 patients were either not treated or treated by physiatric measures only. One-third of the patients were treated by pivotation, whereby TMJ pain was relieved within an average of 2 months. Pivotation seemed to prolong the spontaneous course of TMA. Steroids were injected intraarticularly in one-fifth of the patients, whereby TMJ pain was relieved within an average of 5 d. There were, however, symptoms other than pain that tended to persist after steroid injection. The various treatments did not result in any lasting differences in mandibular mobility. Pivotation and steroid injection seemed to result in a higher frequency of irregularity of the mandibular condyle as seem in transpharyngeal radiographs.
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PMID:Treatment of temporomandibular arthropathy. 695 47

Retroperitoneal fibrosis may be classified as either primary or idiopathic, probably of autoimmune origin or secondary to a malignant process. Both classes are usually presented identically, and it is the responsibility of the physician to exclude a malignant process. The disease should be especially suspected in patients with signs and symptoms of irritation of the retroperitoneal space, such as pain in the lower part of the back or in the flank, a distribution of pain down the legs and, at times, a positive Patrick's sign. Gray scale ultrasonography and computerized axial tomography may now be used to help in the diagnosis of this entity and also in the follow-up management. Operation is recommended for diagnosis and correction of any ureteral impairment. Steroids may be an invaluable aid for the treatment of this disease.
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PMID:Retroperitoneal fibrosis. 736 54


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