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Lactate dehydrogenase isozymes in and intralesional steroid injection therapy for pseudocyst of the auricle.

BACKGROUND: Various treatments for pseudocyst of the auricle have been reported. Recently, several patients have been treated successfully with steroid injections. The lactate dehydrogenase (LDH) levels of cystic fluid have been reported to be high, and the LDH-4 and LDH-5 isozymes were found to predominate, although the serum LDH levels and LDH isozyme patterns were normal. OBJECTIVE: To find a way of preventing auricular pseudocyst recurrences after steroid injection therapy and to examine the relationships between recurrences and the LDH level and isozyme pattern of the cystic fluid. METHODS: Steroid injection therapy was given to nine Japanese patients with pseudocyst of the auricle at our clinic between 1994 and 1999. We determined the LDH level and isozyme pattern of the cystic fluid and sera of seven patients. RESULTS: All nine patients in this series were treated successfully with steroid injections, although three suffered recurrences. Although the serum LDH levels of seven patients were almost normal, their cystic fluid LDH levels were very high. LDH-4 and LDH-5 predominated in the cystic fluid of all seven, although their serum LDH isozyme patterns were virtually normal. CONCLUSIONS: Auricular pseudocyst recurrences show no relationship with either the LDH levels or isozyme pattern. An undiluted solution of steroid fluid should be used in order to prevent recurrences.

Adult↗

Sonographically guided intralesional antibiotic injection for treatment of a recalcitrant pelvic abscess: a case report.

A pelvic abscess occurred in an infertile woman with an endocervical gonococcal infection after hysterosalpingographical examination. The pelvic abscess was not cured despite rigorous antimicrobial chemotherapy until two intra-abscess ceftriaxone injections were administered. This shows that antibiotics administered systemically may not reach therapeutic concentration in an abscess and an intra-abscess antibiotic injection may help to cure it.

Abscess↗

Treatment of chalazia with intralesional triamcinolone injection.

Chalazia are commonly encountered lesions of the eyelids. They often resolve spontaneously or respond to a conservative therapeutic regimen. Chalazia not responding to this type of treatment are often referred for surgical extirpation. This article presents an alternative to surgery, namely intralesional injection of a synthetic glucocorticoid. Reports show a high success rate with few complications using this procedure. A patient with chronic bilateral chalazia was given intralesional injections after conservative therapy was unsuccessful. Two corticosteroid injections produced complete resolution of the lesions.

Follow-Up Studies↗

Phase II trial of intralesional therapy with interleukin-2 in soft-tissue melanoma metastases.

The objective of the present study was to validate the use of intralesional injection of interleukin-2 (IL-2) in patients with skin and soft-tissue melanoma metastases. A total of 24 patients with AJCC stage III or IV melanoma and single or multiple skin and soft-tissue metastases were included. Interleukin-2 injections were administered intralesionally into the total number of cutaneous and soft-tissue metastases accessible from the skin, 2-3 times weekly, over 1-57 weeks. Single doses varied from 0.6 to 6 x 10(6) IU, depending on lesion size. The clinical response was monitored by sonography and confirmed by histopathology; response evaluation was confined to the intralesionally treated tumours. Complete response (CR) of the treated metastases was achieved in 15 patients (62.5%), the longest remission lasting 38 months to date. In five patients, partial response (PR) was achieved (21%) and in another three patients, progressive disease was observed (one patient not assessable). A total of 245 metastases were treated with CR in 209 (85%), and PR in 21 (6%). The therapy was generally well tolerated; the observed adverse events were mainly of grade 1-2 severity. Immunohistochemical studies showed the tumour cells undergoing apoptosis and revealed a mixed character of the inflammatory infiltrate. The unusual high CR rate in metastatic melanoma of 62.5% and the limited toxicity suggest that treatment of skin and soft-tissue melanoma metastases with intralesional injection of IL-2 may be a safe and effective alternative to conventional therapies. The optimal dosage and duration of this therapy still remain to be defined in larger prospective multicentre trials.

Adult↗

Linear lymphatic hypopigmentation after intralesional corticosteroid injection: report of two cases.

Perilesional and linear hypopigmentation, extending cephalad along the lymphatics, occurred in one patient following intralesional injection of corticosteroid suspension for treatment of a hypertrophic scar, and in a second patient following sub-lesional injection of a soft toe-web corn. Atrophy did not occur. Repigmentation in both patients was complete without specific treatment. Review of the literature and evaluation of these patients suggest that the linear hypopigmentation in these two cases was caused by lymphogenous uptake of the corticosteroid crystals.

Adult↗

Granuloma faciale: successful treatment of nine cases with a combination of cryotherapy and intralesional corticosteroid injection.

BACKGROUND: Granuloma faciale is a rare disorder characterized by asymptomatic papules, nodules, and plaques on the face. Although the exact pathogenesis of this disease in unclear, it is considered a variant of leukocytoclastic vasculitis confined to the skin. Several medical and surgical methods have been used to treat it with variable results. CASE REPORTS: We report nine cases of granuloma faciale treated with a combination of cryotherapy with liquid nitrogen and intralesional injection of corticosteroids. RESULTS: The lesions cleared completely in all of the patients without any side-effects. No recurrences have been observed. CONCLUSIONS: Cryotherapy with liquid nitrogen, followed by intralesional injection of corticosteroids, is a safe and effective method to treat granuloma faciale.

Adrenal Cortex Hormones↗

Treatment of Peyronie's disease with intralesional verapamil injection.

PURPOSE: In a previous study, 83% of 14 patients noted that their symptoms of Peyronie's disease had arrested or improved after intralesional injection of verapamil. This nonrandomized, prospective study further investigates the use of verapamil in a larger, thoroughly characterized patient population. MATERIALS AND METHODS: Forty-six men began treatment; 38 completed the study. Using a multiple puncture technique, 10 mg. of verapamil diluted to 10 cc were distributed throughout the plaque every 2 weeks for a total of 12 injections. Response to treatment was evaluated through subjective and objective measurements of pain, plaque size, deformity, duration of disease and sexual function, and with the Kelami classification system based on plaque size and curvature. RESULTS: Pain resolved in 97% of the patients who presented with pain after a mean of 2.5 injections. After therapy, 76% reported a subjective decrease in curvature, 9.5% noted an increase and 14.5% remained unchanged. Of the treated patients 72% reported an improvement in the ability to engage in coitus. Objective measurements demonstrated that curvature was decreased in 54% of the patients, increased in 11% and remained unchanged in 34%. There were no substantial differences in response to treatment based on duration of disease or within the 3 Kelami classification groups. Other than transient post-injection ecchymosis, there were no significant acute or chronic side effects. CONCLUSIONS: Verapamil injection therapy resulted in a reduction of pain in 97% of the patients, an improvement in sexual function in 72%, a reduction of deformity in 86%, an improvement in distal rigidity in 93% and an objective reduction of curvature in 54%. Further studies are required to determine the effectiveness of this nontoxic, inexpensive, nonsurgical approach to Peyronie's disease.

Adult↗

Intralesional bleomycin injection (IBI) treatment for haemangiomas and congenital vascular malformations.

Successful treatment of vascular anomalies has eluded the physician until now, despite various treatments utilised. Bleomycin has been successfully used in intralesional injection treatment of cystic hygromas and haemangiomas, based specifically on a high sclerosing effect on vascular endothelium. In a prospective study of 95 patients, the effectiveness of intralesional bleomycin injection (IBI) treatment in haemangiomas and vascular malformations was evaluated and documented. Complete resolution or significant improvement occurred in 80% of all patients treated. Complete resolution occurred in 49% of haemangiomas, 32% of venous malformations, and 80% of cystic hygromas. Significant improvement occurred in 38% of haemangiomas, 52% of venous malformations, 13% of cystic hygromas and 50% of lymphatic malformations. Of the six patients who presented with a painful lesion, four experienced complete resolution and two had significant improvement to treatment. Local complications encountered were superficial ulceration occurring in 2 patients, and cellulitis in 1 of the 95 patients. Systemic complications were flu-like symptoms in three patients and partial, transient hair loss in two patients. None of the patients presented with haematological toxic effects or signs of pulmonary involvement (fibrosis, hypertension). IBI is an effective treatment in haemangiomas and vascular malformation lesions, obviating the need for invasive primary surgery or systemic treatment regimens in 80% of cases, and allowing for limited need of secondary surgical or adjunctive procedures in cases with a moderate result.

Adult↗

Intralesional corticosteroid injection for infantile adnexal hemangioma.

I treated ten patients who had adnexal hemangioma with intralesional injections of corticosteroid. A marked and lasting regression of the hemangioma occurred in eight of the patients and one had a moderate response. This treatment also proved effective in preventing amblyopia in infants who had large hemangiomas that occluded the visual axis, and often resulted in a reversal of the astigmatism induced by these tumors. There were no complications. The advantages of intralesional corticosteroid injection include ease of administration, speed of action, apparent freedom from adverse side effects, and repeatability.

Adrenal Cortex Hormones↗

[Intralesional corticosteroid injection in the treatment of chalazion].

OBJECTIVE: To evaluate the efficacy of intralesional corticosteroid injection in the treatment of chalazia in black African patients. METHODS: In a prospective study conducted between February 1999 and February 2000, 25 black African patients with chalazion (25 eyes, 29 chalazia), ranging in age from 15 to 54 years (mean age +/- SD, 30.6+/-9 years), were treated with intralesional triamcinolone (injection of 0.075 - 0.5 ml triamcinolone acetate at a 5-mg/ml concentration). RESULTS: Success was achieved in 18 (72%) of 25 patients [20 (74%) out of 27 eyes, 22 (76%) out of 29 chalazia)]. In 11 of 25 patients, two intralesional injections were necessary to obtain these results. Recurrence occurred in five eyes (five chalazia, 17%) after 5-6 weeks. During a mean +/- SD of 4.68 months (range, 3.5-12 months) of follow-up, no postinjection ocular complication occurred. CONCLUSION: Intralesional corticosteroid injection appears to be effective in managing chalazion in black African patients, as reported in previous studies in Caucasian patients. This treatment can be used when curettage is contraindicated.

Adolescent↗

[Intralesional methotrexate injection: an effective time and cost saving therapy alternative in keratoacanthomas that are difficult to treat surgically].

A 53 year old female patient developed a keratoacanthoma, present on the left side of her nose for two months. After repeated unsuccessful trials with cryotherapy, she was treated with intralesional injection of methotrexate performed twice with a weekly internal. This led to complete resolution within 5 weeks. Although controlled studies on the effect of methotrexate in keratoacanthoma are not available, the rapid regression and the good cosmetic result suggest that this therapy may play a beneficial role in treating these lesions especially in problem locations.

Dermatologic Agents↗