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Biomedical subjects

M Turpeinen

Publications and source records attributed to M Turpeinen.

52 records · Page 3Linked to original sources
PubMed1995

Quantifying systemic absorption of topical hydrocortisone in erythroderma.

The systemic absorption of topical hydrocortisone (HC) was quantified in seven patients with erythroderma, using the ratio of the areas under the curves for plasma concentration vs. time, following topical and intravenous administration. Over a period of 24 h, 19-93 mg of HC was absorbed systemically, corresponding to 4-19% of the total topical dose of 500 mg. Thus, topical HC therapy of erythroderma is accompanied by a pharmacologically significant systemic dose.

Administration, Cutaneous↗
PubMed1993

Transepidermal water loss and absorption of hydrocortisone in widespread dermatitis.

Percutaneous absorption of hydrocortisone was measured in three children and six adults with widespread dermatitis, after the application of 1% hydrocortisone cream. Before application of the cream, the transepidermal water loss (TEWL) was measured on six skin areas. A highly significant correlation was found between the post-application rise in plasma cortisol level and the mean transepidermal water loss. Thus, measurement of TEWL affords a simple, non-invasive method for assessing the systemic effect of hydrocortisone applied to widespread dermatitis.

Adult↗
PubMed1993

Effect of eight months of inhaled beclomethasone dipropionate and budesonide on carbohydrate metabolism in adults with asthma.

BACKGROUND: The safety of high dose inhaled steroids has been a subject of debate. The efficacy and safety of beclomethasone dipropionate and budesonide inhalations were evaluated by measuring their effects on pulmonary function, on the hypothalamic-pituitary-adrenocortical axis, and on carbohydrate metabolism in adults with unstable asthma. METHODS: Fifteen adults with unstable asthma and 15 healthy controls were studied. Eight patients were treated with beclomethasone dipropionate in initially high (2 mg/day for five months) and subsequently lower (1 mg/day for three months) doses. Seven patients were treated with budesonide at doses of 1.6 mg/day for five months followed by 0.8 mg/day for three months. Blood glucose and serum insulin were measured in an oral glucose tolerance test and plasma cortisol in an adrenocorticotrophic hormone test. The antiasthmatic effect of treatment was evaluated by measuring peak morning expiratory flow rates and forced expiratory volume in one second (FEV1). RESULTS: The FEV1 increased significantly after one month of treatment (medians 88% v 96%, p < 0.01), and nocturnal symptoms disappeared within two weeks of treatment in both groups. At one month, the high dose significantly decreased serum insulin concentrations as calculated from the areas under the incremental two hours curves in the glucose tolerance test. The decrease was 59% for beclomethasone dipropionate (medians 76 v 31 mU/l/h, p < 0.005) and 42% for budesonide (medians 79 v 46 mU/l/h, p < 0.01). The median areas at five and eight months were intermediate for both drugs. No significant differences were found when the five and eight month values were compared either with the baseline or with one month values. The difference between the baseline values of both groups and the respective values in healthy controls was significant (medians 79 v 49 mU/l/h, p < 0.01). The one month values for the patients and control subjects were similar. Paralleling the changes for insulin, the area under the incremental two hour blood glucose curve decreased significantly (medians 1.4 v 0.4 mmol/l/h, p < 0.05) during the first month of treatment. The five and eight month values were intermediate (medians 0.8 and 0.7 mmol/l/h, respectively). These changes were not significant compared with the baseline or the one month areas. Similar changes were seen in both treatment groups. Neither treatment had any significant effect on plasma cortisol in the one hour adrenocorticotrophic hormone test. CONCLUSIONS: In patients stressed by uncontrolled asthma, the antiasthmatic effect of high dose beclomethasone dipropionate and budesonide was accompanied by a significant initial decrease in insulin resistance with a parallel improvement in glucose tolerance. During prolonged treatment a small increase in insulin sensitivity was found. The overall effect of beclomethasone dipropionate and budesonide inhalations on carbohydrate metabolism may be beneficial in patients with uncontrolled asthma.

Administration, Inhalation↗
PubMed1992

Effects of inhaled budesonide on serum markers of bone metabolism in children with asthma.

The effects of inhaled glucocorticoids on serum markers of bone formation were evaluated in asthmatic children. Serum total alkaline phosphatase (AP), bone alkaline phosphatase (BAP), osteocalcin, and the novel marker of bone formation, carboxypropeptide of type I procollagen (PICP), were measured. In the cross-sectional part, long-term glucocorticoid users were compared with sodium cromoglycate (SCG) users. In the boys (n = 16), but not in the girls (n = 11), PICP was significantly lower in the glucocorticoid users than in the SCG users. PICP correlated positively with BAP (n = 54; groups combined, r = 0.29, p < 0.05). In the longitudinal part, the effects of inhaled budesonide or SCG, both used for the first time, were evaluated before and after 1 and 5 months of treatment. The budesonide dose was 800 micrograms/m2/day for 1 month and thereafter half of that. The SCG dose was 30 mg/day throughout the study. Only during budesonide use did osteocalcin and PICP decrease, the median osteocalcin by 8% at 1 month (p < 0.05) and by 6% at 5 months (n = 15), and PICP by 5% at 1 month (p < 0.05) and by 28% at 5 months (n = 7, p < 0.01). AP and BAP did not change significantly. Decreased PICP suggests decreased bone formation rate. PICP might be clinically useful as a marker of early adverse effects of glucocorticoids on bone.

Administration, Inhalation↗
PubMed1991

Changes in carbohydrate and lipid metabolism in children with asthma inhaling budesonide.

In a longitudinal study, antiasthmatic and metabolic effects of budesonide inhalations in initially high (800 micrograms/m2/day for 1 month) and subsequently lower (400 micrograms/m2/day for 4 months) dosage were evaluated in nine children with asthma, aged 5 to 10 years. The FEV1 increased significantly after high dosage (median, 96.5% versus 105.5%; p = 0.0339). After lower dosage, FEV1 was still higher than at the baseline (106% versus 96.5%; p = 0.0339). Clinically, no additional beta2-agonist was needed after 2 weeks of treatment. Serum high-density lipoprotein cholesterol increased significantly by 22% after high dosage (medians, 1.18 versus 1.44 mmol/L). A significant decline to 1.31 mmol/L was observed when the dose was reduced (overall, p = 0.0319). The treatment had no significant effect on serum total cholesterol, on serum triglycerides, on the ratio of high-density lipoprotein to total cholesterol, on the body mass index, or on glucose tolerance. The high dosage increased significantly the ratio of serum insulin to blood glucose, calculated from the areas under the incremental 2-hour curves in the glucose tolerance test (medians, 17.3 versus 23.2 mU/mmol). After lower dosage, the ratio declined significantly to 13.5 mU/mmol (overall, p = 0.0164). No significant changes were observed in plasma cortisol in the 2-hour adrenocorticotropic hormone test. The antiasthmatic effect of budesonide inhalations in a dose of 800 micrograms/m2/day for 1 month was accompanied by detectable changes in lipid and carbohydrate metabolism. These metabolic changes were reversible, and the antiasthmatic effect could be maintained by a dose of 400 micrograms/m2 for 4 months without significant systemic effects. This dose is safe and efficient in the maintenance treatment of childhood asthma.

Administration, Inhalation↗
PubMed1991

Absorption of hydrocortisone from the skin reservoir in atopic dermatitis.

Percutaneous absorption of hydrocortisone was measured in four children and three adults with atopic dermatitis after the application of 1% hydrocortisone cream and again 12 h after the application of a moisturizer containing 80% water and 5% propylene glycol to the same areas. A significant increase in the level of the plasma cortisol was observed after both applications and these levels were still elevated at 24 h. Topically applied hydrocortisone, stored in eczematous skin, could be released from this reservoir by a moisturizer containing propylene glycol.

Administration, Topical↗
PubMed1989

Adrenocortical response to adrenocorticotropic hormone in relation to duration of topical therapy and percutaneous absorption of hydrocortisone in children with dermatitis.

To evaluate the effect of topical hydrocortisone therapy on cortisol secretion, the plasma cortisol response to a 2 h adrenocorticotropic hormone (ACTH) test was determined in 17 children with dermatitis. Percutaneous absorption of hydrocortisone was measured in the acute phase of dermatitis by a 4 h absorption test. Two-hour plasma cortisol in the ACTH test correlated inversely with the increment of plasma cortisol in the absorption test. The duration of topical hydrocortisone therapy had no significant influence on the adrenocortical response to ACTH. A moderately or severely subnormal 2 h plasma cortisol level was observed in three infants after 3-5 months' topical therapy with hydrocortisone.

Acute Disease↗
PubMed1988

Influence of age and severity of dermatitis on the percutaneous absorption of hydrocortisone in children.

The results of 55 4-h hydrocortisone absorption tests in 38 children with atopic or seborrhoeic dermatitis were analysed to evaluate the effect of age and severity of the dermatitis on percutaneous absorption of hydrocortisone. The children were divided into three groups on the basis of the severity of the dermatitis. The absorption of hydrocortisone caused a significantly higher mean rise of serum cortisol in 20 children with severe dermatitis (Group A) than in 17 children with moderate dermatitis (Group B). The mean post-application rise of serum cortisol in 18 children with mild dermatitis (Group C) was significantly lower than in the children with moderate dermatitis. There was a significant negative linear correlation between age and the post-application rise of serum cortisol in Groups A and C. In these groups the mean post-application rise of serum cortisol was significantly higher in children aged under 18 months than in children aged 18 months or over. Severe widespread dermatitis and an age under 18 months are two relevant risk factors in the topical use of hydrocortisone.

Administration, Topical↗
PubMed1988

Percutaneous absorption of hydrocortisone during and after the acute phase of dermatitis in children.

Percutaneous absorption of hydrocortisone was measured by a four-hour absorption test in 16 children during and after the acute phase of dermatitis. In the acute phase, after the application of 1% hydrocortisone cream the increment in plasma cortisol ranged from 47 to 961 nmol per liter (median 248 nmol/L). After the acute phase the increment was significantly (P less than 0.01) lower: range 18 to 241 nmol per liter (median 95 nmol/L). In addition to local effect, topical hydrocortisone therapy of childhood dermatitis is accompanied by a systemic effect that may be pronounced in the acute phase of disease. Convalescence is connected with a diminished systemic effect due to the restoration of the skin barrier to hydrocortisone.

Acute Disease↗
PubMed1988

Percutaneous absorption of hydrocortisone during exacerbation and remission of atopic dermatitis in adults.

Percutaneous absorption of hydrocortisone was studied in 18 young adults during and after the acute phase of atopic dermatitis using the direct hydrocortisone absorption test. In the acute phase the post-application increase in serum cortisol concentration ranged between 18 and 711 nmol/l (median 125 nmol/l). In remission the increase in serum cortisol ranged between 0 and 114 nmol/l (median 16 nmol/l), which was significantly lower than the rise in the acute phase. In the acute phase of dermatitis, topical hydrocortisone treatment has both a local and a systemic effect, due to percutaneous absorption.

Acute Disease↗
PubMed1986

Effect of percutaneous absorption of hydrocortisone on adrenocortical responsiveness in infants with severe skin disease.

Percutaneous absorption of hydrocortisone was studied in 18 children (aged from 6 weeks to 14 1/2 years) with atopic or seborrhoeic dermatitis, by measuring their serum cortisol before and after application of 1% hydrocortisone cream. Endogenous secretion of cortisol was suppressed with dexamethasone. A 24 h absorption test was performed on nine children. In six, percutaneous absorption was detected. The highest serum cortisol level was reached within the first 6 h. A 4 h absorption test was developed on the basis of the 24 h test. This short absorption test was performed on nine children, and in eight of them absorption of hydrocortisone was detected. The rise of serum cortisol ranged from 98 to 2669 nmol/l. The 2 h ACTH test was performed to evaluate the effect of previous treatment with topical glucocorticoids. Suppressed adrenocortical function was found in five of 13 children, and was associated significantly with high post-application serum cortisol levels. This occurred more often in infants with a severe skin disorder than in older children or in those with mild or moderate skin disease.

Adolescent↗
PubMed1986

An infant with simultaneous beta-lactamase-positive Haemophilus influenzae meningitis and beta-lactamase-negative H. influenzae septicemia, Escherichia coli pyelonephritis and herpes encephalitis.

We describe an infant with meningitis and septicemia due to infection with two different strains of Haemophilus influenzae, with a urinary tract infection due to Escherichia coli and in whom herpes virus encephalitis was diagnosed within three days. Acinetobacter calcoaceticus septicemia developed three weeks later. No immunological deficiency could be demonstrated in the patient who recovered finally, albeit with sequelae due to encephalitis.

Acinetobacter Infections↗
PubMed1984

Adrenaline and nebulized salbutamol in acute asthma.

The effects of injected adrenaline and nebulized salbutamol on acute asthma were compared in 46 children. The results showed that salbutamol had a significantly better bronchodilatory effect than adrenaline. Nebulized salbutamol is recommended as a primary method of treatment of asthmatic attacks in childhood.

Acute Disease↗