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[The immune defense system in gastric cancer tissue, regional lymph node and spleen--aspects from subsets and functions of lymphocytes].

Tumor infiltrating lymphocytes (TIL) and lymph node lymphocytes (LNL) were thought to play an important role in local immunity against cancer. But the natural cytotoxicity (NC) of TIL and LNL was very weak, and was not augmented by beta-IFN. This low cytotoxicity was augmented by IL-2, and especially LNL were activated to have higher lymphokine activated killer (LAK) activity than that of PBL. So it was proven that TIL and LNL had an potential of immunological defence system. In order to bring out these potential, immunomodulators (OK-432, PSK) were injected intralesionally under endoscopy one week prior to surgery. The cytotoxicity of TIL and LNL was augmented by the intralesional injection of OK-432 or PSK. There was no significant difference in LAK activity of LNL among the OK-432-, PSK-injected group, and the control. The 2-year survival rate of the OK-432-injected group was much longer than that of the control. From above results, intralesional injection of immunomodulators was thought to be a promising candidate for the immunotherapy of gastric cancer.

Humans↗

Treatment of recurrent respiratory papillomatosis with microsurgery in combination with intralesional cidofovir--a prospective study.

Recurrent respiratory papillomatosis (RRP) is an uncommon disease that may cause symptoms ranging from hoarseness to severe obstruction of the airway. Several treatment modalities have been tried, all with varying success. The goal of this study is to assess the benefit of the intralesional injection of cidofovir as an adjunct to microsurgical excision in treatment of laryngeal papillomatosis. All patients with RRP who presented between 1999 and 2004 at the University Medical Center Groningen were prospectively analyzed, regardless of the patients' age at presentation or duration of the disease. Not all patients were treated with cidofovir. To be included, all patients required a history of repeated microsurgery because of severe recurrence of RRP or because of severe technical difficulties in excising or vaporizing the lesion. Local microsurgery was performed, and then cidofovir, 2.5 mg/ml, was injected intralesionally. Treatment was repeated after 6, 12, 18, 24 and 30 weeks. Six male and three female patients were treated with cidofovir. Localization was the glottis in seven and the technically inaccessible dorsum epiglottidis and subglottis in one case each. The seven patients with glottic localization were cured. The two other patients showed recurrences, but at a lower rate than previously. Several times, however, more than six procedures were necessary. Cumulative doses of cidofovir ranged from 10.5 to 128 mg per patient. Cidofovir is a promising and powerful therapeutic approach for the treatment of RRP. Currently, the combination of microsurgery with intralesional cidofovir seems to be the treatment of choice for RRP.

Antineoplastic Agents↗

Intralesional administration of formalin for treatment of epidermal inclusion cysts in five horses.

Five horses with unilateral epidermal inclusion cysts located in the nasal diverticula were sedated and treated with intralesional injection of neutral-buffered 10% formalin (volume range, 2 to 4.5 mL). After aspiration of the cyst, formalin was injected intralesionally until leakage of fluid around the needle was observed. After several weeks, desiccation of the cyst was evident; it was excised 2 weeks after treatment in 3 horses, digitally removed by the owner of 1 horse, and never removed in 1 horse, because the owner declined further treatment after resolution of the original swelling of the nasal diverticulum. Swelling of the cyst after treatment was observed in all horses; nasal discharge (2 horses) and a mild episode of epistaxis (1 horse) were the only other complications of the treatment. Intralesional administration of formalin appears to be a simple and effective treatment for epidermal inclusion cysts in the nasal diverticula of horses.

Animals↗

Increased plasma kallikrein activity and tumour growth suppression associated with intralesional bradykinin injections in hamsters.

Daily intralesional injections of bradykinin (250 microgram) into syngeneic SV40 virus-induced fibrosarcomas in inbred hamsters for 21 days produced marked inhibition of tumour growth, marked lymphoid cell infiltration of tumours, and significant elevations in plasma kallikrein and prekallikrein activity, compared with intralesional saline injections. All tumours were of comparable size and growth rates before injections were begun. Plasma kallikrein levels of animals which received the standard tumour cell inoculum subcutaneously and did not develop tumours were elevated significantly above normal levels and above levels of animals with large tumours. Kallikrein inhibitor activity of animals which did not develop tumours was depressed below normal levels. Intralesional injections of saline produced a significantly lesser response in plasma kallikrein and plasma prekallikrein activity than was encountered with subcutaneous saline injections in normal animals. Intralesional injections of bradykinin produced a response equivalent to that encountered with subcutaneous bradykinin injections in normal animals.

Animals↗

Bacillus Calmette-Guérin and dinitrochlorobenzene immunotherapy of chemically induced bladder tumors.

Immunologic incompetence is correlated with increased susceptibility to malignacy. Immunostimulation with such agents as Bacillus Calmette-Guérin (BCG) and dinitrochlorobenzene (DNCB) have resulted in regression of cutaneous maligancies. An evaluation of the effect of BCG and dinitrochlorobenzene sensitization and bladder irrigation in Fischer rats revealed no decrease in the incidence of bladder tumors induced by 2-formylamino-4-(5-nitro-2-furyl) thiazole (FANFT). However, direct intralesional injection of BCG into early bladder tumors was effective in preventing the progression of such tumors in seven of ten BCG-sensitized rats (P less than 0.005). No effect was seen when BCG was injected intralesionally in unsensitized rats or when control solutions were injected.

Animals↗

Eyelid necrosis following intralesional corticosteroid injection for capillary hemangioma.

The intralesional injection of corticosteroids has been employed successfully in treatment of adnexal neonatal hemangiomas since 1979. This form of treatment is easily administered, is repeatable and free from serious complications. We present an exceptional case in which full-thickness eyelid necrosis ensued following intralesional injection of corticosteroids in a capillary hemangioma. After eyelid reconstruction the patient's visual axis has remained unobstructed, and amblyopia has been thus far averted.

Betamethasone↗

Benefits and risks of intralesional corticosteroid injection in the treatment of dermatological diseases.

Intralesional corticosteroid (CS) injections have been used to treat a variety of dermatological and non-dermatological diseases with variable results. The purpose of the injection is to attain a high concentration of the drug at the diseased site, with minimal systemic absorption. Several CS preparations are available for intralesional injection, although triamcinolone derivatives have gained the widest usage in dermatology. The dose and the interval between injections depend on the type, size and severity of the lesion as well as the response to the previous injections. The most critical issue in the efficacy and also in the development of complications of the injections, is the method of injection. Several local and systemic side-effects have been reported following intralesional injections, but most of them are rare or acceptable. Thus intralesional CS injection is an integral part of the clinical practice of dermatology. Since their introduction in 1951, intralesional CS injections have become an integral part of clinical practice in dermatology. They are used alone or in combination with other therapeutic modalities in the treatment of many skin diseases. The purpose of the injection is to attain a high local concentration of the CS at the diseased site, without significant systemic absorption, thus avoiding the numerous side-effects associated with systemic administration. Intralesional CS injection may be a valuable therapeutic modality in situations where topical CS are not suitable for use, either because of low potency and inefficient epidermal barrier penetration or in clinical conditions associated with epidermal atrophy.

Adrenal Cortex Hormones↗

Cutaneous leishmaniasis. Treatment with combined cryotherapy and intralesional stibogluconate injection.

A combination of both intralesional stibogluconate injection and superficial cryotherapy (not including the base of the lesion nor the 1-2 mm rim of the surrounding normal skin) was performed in an attempt to improve the therapeutic efficacy of either of the two modalities when used separately in the treatment of cutaneous leishmaniasis. This combined therapy resulted in a 100% cure rate in 15 patients with 23 lesions of cutaneous leishmaniasis. Two control groups, one treated with superficial cryo and the other treated with intralesional stibogluconate injection alone were included in the study for evaluation. The results obtained by combined superficial freezing and intralesional stibogluconate injection were much more impressive than those obtained by each of the two modalities when used alone.

Adult↗

[Treatment of keloids and hypertrophic scars. Pilot study with intralesional Lipotalon injections].

A pilot study was conducted to establish whether intralesional injection of a microsomal corticoid, Lipotalon, would reduce the development of keloids and hypertrophic scars. Thirteen patients with 17 scars and keloids were admitted to the study. In all the patients investigated, injection of Lipotalon into the lesion led to a moderate to appreciable improvement in the hypertrophic scars and keloids. Injections of 0.5 to 4 mg Lipotalon were given, for the most part, at intervals of 4 to 6 weeks, and were oriented to the respective findings. No side effects were observed. Some of the patients received topical application of Lipotalon as adjuvant treatment to surgical scar resection. Here, too, a trend towards positive results was observed, although in one case, disordered wound healing was seen.

Adolescent↗

Intralesional steroid injection for management of acute idiopathic dacryoadenitis: a preliminary result.

PURPOSE: To evaluate the efficacy of intralesional injection of steroid as a new line of therapy in treatment of the acute form of an isolated idiopathic dacryoadenitis. METHODS: Five patients with unilateral isolated acute idiopathic dacryoadenitis were included in the study. In 2 patients, the pathology was recurrent. Intralesional injection of 2 to 4 ml betamethasone suspension (1 ml contains 2 mg betamethasone sodium phosphate and 5 mg betamethasone dipropionate) was followed by cold compression for 6 hours. Systemic nonsteroidal anti-inflammatory drugs were given for 2 weeks after the injection. RESULTS: Dramatic response was achieved within 7 days after injection in all cases. No patient had recurrence during the follow-up period of 8 to 19 months. CONCLUSIONS: The excellent preliminary results make this new line of therapy highly promising. However, more study and long-term follow-up are recommended.

Acute Disease↗

The diagnosis and treatment of periorbital sarcoid in the horse: 445 cases from 1974 to 1999.

OBJECTIVE: Diagnosis and management of periorbital sarcoids in horses is a significant clinical challenge for the practicing veterinary surgeon and pathologist. The purpose of this study was to investigate the response of various types of sarcoids to different therapeutic methods. Animals studied Medical records of 445 clinical patients. Procedures This paper retrospectively examines the clinical and histological features of periorbital sarcoids and the treatment of 445 cases. Treatment by surgical excision, cryosurgery, Bacillus-Calmette-Gaérin (BCG) immunomodulation, topical cytotoxic applications, and radiation are described. RESULTS: Six types of sarcoid can be found in the immediate periorbital region and each has some characteristics of other disorders of the skin with which they can be confused. The diagnosis of sarcoids is, however, relatively simple in most cases. The lesions are not necessarily restricted to the dermis and epidermis, but commonly invade into the subcutis and the deeper muscular structures around the eye. Treatment with radiation is expensive and difficult to manage but resulted in the best outcome with almost 100% resolution in 66 cases. By contrast, surgical excision has serious potential complications that arise primarily as a result of the infiltrative nature of periorbital sarcoids. The value of BCG immunomodulation therapy for fibroblastic and nodular lesions described by previous workers is confirmed in this paper, with a good overall response (69%), provided that the material was injected intralesionally. Perilesional injection did not appear to carry a significant benefit. However, treatment of verrucose or occult lesions by this method gave generally poor results. The results of intralesional injection of cisplatin emulsions suggest that this may be an effective method of treatment in cases where other modalities are not feasible. In common with previous reports, failure to resolve the lesions frequently resulted in regrowth of the tumor, and in most cases this recurrence appeared to be more aggressive, with extensive local infiltration and faster growth. Conclusion The periorbital tissues are less tolerant of damage than those at many other sites and therefore certain treatment methods may be contraindicated. This suggests that it is important to select the best possible treatment at the first opportunity. It is a wise precaution to warn owners of horses with periorbital sarcoids of the dangers of leaving them and the particular risks associated with the currently available treatments.

Journal Article↗

Normalisation of asymmetric astigmatism after intralesional steroid injection for upper eye lid hemangioma in childhood.

Infantile hemangiomas affect about 5% (3%-8%) of the population, showing a predilection for the face. After a phase of rapid enlargement between the 3rd and the 9th month of life, 70% regress by the age of six after a period of stability. 43%-60% of the children with eye lid hemangiomas develop strabismic, anisometropic, or deprivation amblyopia. Previous studies found the majority of cases resulting from anisometropia (especially asymmetric astigmatism) rather than strabism or occlusion of the visual axis. Several methods of treatment--surgical excision, irradiation, sclerosing agents, systemic steroids, ligation, cryotherapy--have been used but all with a risk of local or systemic complications. Local injections of steroids are a simple method of therapy with a high rate of resolution of hemangiomas, but still with a high degree of bad visual output because of persistent astigmatism. In four children with asymmetric astigmatism (axis of astigmatism towards the hemangioma) in which the injection was given at the beginning of the phase of enlargement, amblyopia could be avoided by preventing corneal steepening from becoming permanent.

Anti-Inflammatory Agents↗

Intralesional Ethibloc injections in primary aneurysmal bone cysts: an efficient and safe treatment.

OBJECTIVE: Ethibloc is a fibrogenic and thrombogenic agent recently proposed for the treatment of bone cysts. The purpose of this study is to report the results of direct Ethibloc injection in primary aneurysmal bone cyst (ABC) in children. DESIGN AND PATIENTS: Seventeen patients, aged from 2 to 18 years (mean 8 years), were treated with either a single injection (14 patients) or supplementary injections (3 patients) of Ethibloc. The histological diagnosis was assessed following surgical biopsy and was retrospectively reviewed. The mean follow-up was 5 years (range 18 months to 11 years). RESULTS: At 5 year follow-up, 14 of 17 patients demonstrated complete healing manifest by increased cortical and septal thickening. Surgical excision was required in three patients, in two of whom the ABC increased rapidly in size despite the injection, and in one of whom the healing was incomplete. We observed inflammatory reactions in 16 of 17 patients with local pain and fever. Three patients developed a small cutaneous fistula which resolved spontaneously in a few weeks. No major complications such as deep infection, pulmonary embolism, epiphyseal necrosis or malignant degeneration were observed. CONCLUSION: Percutaneous direct Ethibloc injection is a safe, efficient and noninvasive treatment for ABC. The authors highlight the frequent local reactions.

Adolescent↗

Capillary haemangioma of the nasal cavity in a 7-week-old baby--successful treatment using intralesional steroid injection.

A case of a seven-week-old baby who presented with a capillary haemangioma of the nasal cavity is presented. We describe a novel treatment modality and provide a literature review of head and neck capillary haemangioma in the paediatric population. Capillary haemangioma of the nasal cavity and our treatment option has not previously been described in the literature at such an early age.

Female↗