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At least 217 records · Page 12Linked to original sources

OK-432 therapy for recalcitrant warts.

Twelve patients with warts recalcitrant to various treatment, including cryotherapy, were treated with OK-432 injection therapy. Six patients received only subcutaneous injection, three received only intralesional injection, and the other three received both subcutaneous and intralesional injections. Complete clearing of the warts occurred in nine (75%) of 12 patients, while the other three patients were not cured. Grouping the patients by the method of injection, the success rate of subcutaneous injection was 5/9 (55.6%), and that of intralesional injection was 4/6 (66.7%). Although five patients complained of mild fever and malaise, these side effects gradually disappeared during the repeated injections. OK-432 injection is considered as a hopeful therapy for recalcitrant warts.

Adolescent↗

Intralesional vinblastine injections for the treatment of oral Kaposi's sarcoma: report of 10 patients with 2-year follow-up.

PURPOSE: This study evaluated the use of intralesional vinblastine injections for the treatment of the intraoral lesions of Kaposi's sarcoma. PATIENTS AND METHODS: Eighteen patients were treated with up to three intralesional injections of 0.1 mg/cc vinblastine. RESULTS: All lesions responded to the local injections; 40% required one injection; 31%, two injections; and 29%, three injections. Large, exophytic lesions usually required the multiple injections. No complications were encountered, and the patients tolerated the protocol well. Ten patients were followed for 24 months. Eight died of their general disease during this period. Four patients developed new intraoral lesions, which were treated with, and responded favorably to, the three-injection protocol. CONCLUSION: Intralesional vinblastine injections are an effective and useful treatment alternative for human immunodeficiency virus (HIV)-associated intraoral Kaposi's sarcoma.

AIDS-Related Opportunistic Infections↗

Intralesional bleomycin injections for the palliation of epistaxis in hereditary hemorrhagic telangiectasia.

Epistaxis is a common complication in patients with hereditary hemorrhagic telangiectasia. Its treatment is generally aimed at controlling the frequency and severity of nasal hemorrhage and involves surgery, transcatheter embolization, topical treatment, or a combination. Despite this multitude of treatment methods, the long-term prognosis for many patients remains poor. We describe a patient in whom direct intralesional injections of bleomycin successfully palliated severe recurrent epistaxis for almost 2 years without the need for adjuvant therapy.

Anesthesia, General↗

[Intralesional cidofovir injections for recurrent laryngeal papillomatosis: first results].

BACKGROUND: The treatment of recurrent laryngeal papillomatosis still presents an important therapeutic problem. This primarily benign disease of the larynx is caused by an infection with the human papilloma virus (HPV) and forms epithelial neoplastic papillomas. Therapy in larynx obstructing papillomatosis usually requires laser ablation. Cidofovir acts virustatically as an nucleosidanalogon. Currently pilot studies investigate the effectiveness of intralesional Cidofovir injection. PATIENTS AND METHODS: The present study covers the period from October 2001 to March 2003. Seven patients, age of five to 70 years, were treated with intralesional injections of Cidofovir after microlaryngoscopic ablation of laryngeal papillomas. In all patients papillomatosis was confirmed histologically and a clinical-phoniatric examination and a photo documentation pre- and postoperatively was carried out. We treated patients to a maximum of six sessions. RESULTS AND CONCLUSIONS: After three to six sessions of laser ablation of the papillomas and intralesional injections with Cidofovir a distinct papilloma reduction could be observed in all patients and in two cases a complete remission was achieved. The follow-up period of seven to 15 months revealed no recurrent laryngeal papillomatosis. The majority of patients showed a defined voice improvement. There were no local or systemic side-effects caused by the virustatic drug. Intralesional injection of Cidofovir appears to develop into a promising adjuvant therapy option in recurrent laryngeal papillomatosis. First results of the study seem to achieve a considerable reduction of the previously high rate of recurrence of laryngeal papillomatosis.

Adolescent↗

Treatment of palmoplantar pustulosis with intralesional triamcinolone injections.

Five patients with chronic intermittent palmoplantar pustulosis were treated with intralesional injections of 3.3 to 5.0 mg/mL of triamcinolone acetonide. Prompt clearing of symptoms and lesions ensued, lasting three to six months. Despite the discomfort experienced from the injections, patients preferred this treatment modality over others. Minor side effects included hypopigmentation, cutaneous atrophy, and, in one case, exacerbation of a latent dermatophyte infection.

Administration, Topical↗

Office-based intralesional cidofovir injections for nasal septal papilloma: a pilot study.

OBJECTIVES: To determine if nasal septal papilloma is responsive to intralesional cidofovir injections. METHODS: Five adult males, ages 37 to 57, presented with nasal septal or columellar papilloma. Three lesions had been previously excised with the laser and recurred. The lesions were injected with cidofovir on a monthly basis until complete resolution or any residual lesion was excised afterwards with the laser. RESULTS: All patients achieved disease remission sustained over 10 to 24 months. Overall doses were much lower than those described for laryngeal papillomatosis and no toxic effects were observed. CONCLUSIONS: Office-based intralesional injections of cidofovir may show benefit in the treatment of nasal septal papilloma. EBM RATING: C-4.

Adult↗

Local bacillus Calmette-Guérin therapy for bovine vulval papilloma and carcinoma.

Thirty cows from a pedigree Friesian dairy herd with bovine vulva papilloma and carcinoma were treated by intralesional injections of live bacillus Calmette-Guérin (BCG). This treatment induced total regression of all of six carcinomas. Whilst, after treatment, limited regression was also observed in advanced papillomas, BCG has little or no effect on the early stages of papillomas. This is the first study of BCG therapy in this type of cancer.

Animals↗

Use of intralesional interferon-alpha for the treatment of recalcitrant oral warts in patients with AIDS: a report of 4 cases.

Four human immunodeficiency virus-positive homosexual men with 2- to 4.5-year histories of recurrent oral warts that had failed to respond to conventional surgical and other treatment modalities were offered treatment with interferon-alpha. All had multiple or large oral warts, 3 had skin warts, 2 had a history of anal warts, and 1 had penile lesions. All 4 patients were treated with a combination of intralesional and subcutaneous interferon-alpha. Adverse side effects were dose-related, mild, and transient; they included flulike symptoms (3 patients), hair loss and tachycardia (1 patient), and transient changes in the white blood cell count. All patients responded to therapy and remained free of disease up to 42 months. Intralesional injection with interferon-alpha appears to provide excellent clinical control for recurrent, multiple, and extensive oral warts in the human immunodeficiency virus-positive population, and is a useful adjunct to initial surgical removal of oral warts.

Acquired Immunodeficiency Syndrome↗

Chronic idiopathic esophageal ulceration in the acquired immunodeficiency syndrome. Characterization and treatment with corticosteroids.

Study objectives were to characterize the clinical syndrome of chronic idiopathic esophageal ulceration in patients with acquired immunodeficiency syndrome (AIDS), to determine the extent of local human immunodeficiency virus (HIV) infection, and to evaluate the effect of corticosteroid therapy upon symptoms and healing. Twelve AIDS patients with chronic esophageal ulcers whose etiology remained unknown after clinical evaluation were the subjects. All patients complained of severe odynophagia, chest pain, and weight loss. Barium radiography and endoscopy demonstrated large, undermined ulcers with severe acute inflammation. No evidence of herpes simplex viruses I or II, cytomegalovirus, fungi, or tumors were found histologically. Evidence of HIV was found in all ulcers using a combination of RNA in situ hybridization, immunohistochemistry, and quantitative antigen capture enzyme-linked immunosorbent assay of tissue homogenates. Steroid therapy by the oral or intravenous routes or by direct intralesional injection resulted in pain relief, weight gain in 10 patients, and ulcer healing in five patients. A characteristic clinical syndrome of chronic idiopathic esophageal ulceration may occur in patients with AIDS, related to local HIV infection in the esophagus. Corticosteroids relieve symptoms and may promote healing of the ulcer.

Acquired Immunodeficiency Syndrome↗

Ocular complication of intralesional corticosteroid injection of a chalazion.

PURPOSE: To report a major complication of intralesional corticosteroid injection for the treatment of a chalazion. METHODS: A 28-year-old woman presented with a 4-day history of decreased vision in her left eye that developed after corticosteroid injection to her upper eyelid for the treatment of chalazion. The visual acuity was 20/20 in her right and finger counting in her left eye. Anterior segment examination showed an inferior corneal opacity with positive Seidel test and cataract. RESULTS: A soft contact lens was applied to cornea and antibiotic therapy was given to prevent endophthalmitis. Cataract was removed by lens aspiration and a posterior chamber intraocular lens was implanted. After surgery, the visual acuity increased to 20/20 in her left eye. CONCLUSIONS: Inadvertent corneal penetration and traumatic cataract are possible and serious complications of intralesional corticosteroid injection.

Adult↗

Intralesional bleomycin injection in treatment of condyloma acuminatum.

The antitumoral antibiotic, bleomycin, was given by intralesional injection to ten patients with condyloma acuminatum. Our 70 per cent success rate suggests this is a reasonable alternative treatment in the management of anal warts which prove unresponsive to other modalities.

Adolescent↗

Bilateral retinal embolization associated with intralesional corticosteroid injection for capillary hemangioma of infancy.

A 2-month-old female infant underwent intralesional corticosteroid injection for a capillary hemangioma that was causing amblyopia of the right eye from ptosis, globe displacement, and astigmatism. Forty-eight hours after the injection, the infant's parents noted that she was visually inattentive. On examination, she could not fixate or follow with either eye, and an afferent pupillary defect was present in the left eye. Ophthalmoscopy showed scattered areas of intraretinal hemorrhage in the right eye and extensive preretinal and intraretinal hemorrhages in the left eye. Ten months after injection, the hemangioma had greatly regressed, and visual acuity in the right eye was felt to be normal. The left eye had unsteady fixation with a persistent afferent pupillary defect and macular scarring. Retrograde flow of the corticosteroid suspension through the hemangioma's feeder vessels, probably originating from both ophthalmic arteries, is the most likely explanation for this complication.

Betamethasone↗

Intralesional corticosteroid injection vs surgical treatment of chalazia in pigmented patients.

OBJECTIVE: To compare the outcome of intralesional corticosteroid injection and surgical treatment of chalazia. DESIGN: An interventional comparative study. PLACE AND DURATION OF STUDY: PNS Shifa, Naval Hospital, Karachi from 1st September 2002 to 31st August 2003. PATIENTS AND METHODS: During a 9-month recruitment period all patients attending PNS Shifa, Naval Hospital, Karachi, for treatment of chalazia were inducted in the study. A 141 patients with chalazia completed the study. Patients received either incision-curettage (surgical treatment/ ST group) or intralesional corticosteroid injection treatment (steroid injection/ SI group). The same procedure was repeated in unsuccessful cases only once. Z-test of proportion was used as appropriate statistical test of significance at p <0.05 for the comparison of the results between the two groups. RESULTS: The success was achieved in 59 out of 75 patients (79%) in ST group and 41 of 66 patients (62%) in SI group at first visit after two weeks (p-value <0.01). The success in ST group improved to 89% (67 out of 75 patients) after second operation and to 80% (53 out of 66 patients) in SI group after second injection of the steroid given at second week (p-value < 0.14). CONCLUSION: Intralesional steroid injection is an effective and safe alternative procedure for the treatment of chalazia. The results are comparable to surgical treatment especially after second injection. It is not associated with any serious complications although skin depigmentation is relatively common in coloured population.

Adolescent↗

OK-432 therapy for cervical lymphangioma.

OBJECTIVE: To describe our experience with sclerosing treatment of lymphangiomas in the head and neck region by intralesional injections of OK-432. STUDY DESIGN: Case series. METHODS: Patients with the diagnosis of a macrocystic-type cervical lymphangioma were treated by one to three intralesional injections of OK-432 (0.01 mg of OK-432/1 mL of lymphangioma fluid, up to a maximum of 0.2 mg in the first injection and 0.3 mg in the second or third injections). All injections were performed under ultrasound guidance. Children were injected under sedation. RESULTS: Eleven patients were treated with injections of OK-432: 7 children and 4 adults. They were followed up for a period of 5 to 68 (mean 30) months. Eight (73%) patients had complete or subcomplete resolution of the lymphangioma after one or two injections. In three (27%) cases, no response was obtained (2 cases) or the lymphangioma recurred (1 case) after two to three injections. In two cases, surgical excision was performed. There was no evidence of fibrosis around the cysts. There were no complications to OK-432 injections. CONCLUSION: Intralesional injection of OK-432 is an effective treatment modality for macrocystic-type lymphangiomas in the head and neck region. It has no complications, and surgical excision in case of failure is not compromised by fibrosis. Sclerosing of macrocystic-type lymphangiomas with OK-432 should therefore be considered before surgical excision.

Adult↗

Pharmacokinetic study of intralesional cisplatin for the treatment of hepatocellular carcinoma.

BACKGROUND: In the current study the authors examined the pharmacokinetics of direct intralesional injection of cisplatin/epinephrine/bovine collagen gel in patients with hepatocellular carcinoma and cirrhosis. METHODS: Six patients with cirrhosis and unresectable hepatocellular carcinoma received a direct intralesional injection (range, 6.7-26.7 mg) into their tumors under ultrasonographic guidance. The authors determined the total cisplatin (Pt) concentration in the plasma and urine and nonprotein-bound free Pt in plasma ultrafiltrate using flameless atomic absorption spectrometry. Data from individual patients were analyzed to calculate the pharmacokinetic parameters via a noncompartmental method for constant infusion. To demonstrate that the changes in pharmacokinetics are not related to the underlying cirrhosis, a similar methodology was applied to measure the pharmacokinetic parameters of four similar patients who were treated with cisplatin, 75 mg/m(2), as a 1-hour intravenous infusion. RESULTS: The time to attain maximum concentration of total Pt after intralesional injection was dose-dependent and ranged from 2-13 hours. The concentration-time curve was biphasic in nature. The initial half-life of total Pt in patients who received an intralesional injection varied with the cisplatin dose. The initial half-life for cisplatin doses < 15 mg was approximately 9 hours and the initial half-life at higher cisplatin doses (> 15 mg) was approximately 25 hours. The area under the curve (AUC) was dose-dependent with values ranging from 38-150 microm/mL x hour. Pharmacokinetic parameters for free Pt (ultrafiltrate) were significantly different. The time to attain maximum concentration (t-max) and terminal half-life were shorter and the average AUC was approximately 100-fold lower than total Pt. After the intravenous infusion of cisplatin, the t-max for total and free Pt was 1.3 hours and 1.1 hours, respectively. The terminal half-life and average AUC for total Pt was 194 hours and 247 microg/mL per hour, respectively, and its corresponding parameters for free Pt after intravenous infusion were much lower, similar to the findings for the intralesional injection. CONCLUSIONS: The prolonged t-max and initial half-life noted with the intralesional injection of cisplatin/epinephrine/collagen gel are consistent with its proclaimed ability to retain cisplatin at the tumor and delay its release in systemic circulation. The kinetics of intralesional cisplatin injection also suggest local sequestration of the drug in the injected site. Parameters of intravenous cisplatin infusion in cirrhotic patients are similar to those of patients from the historic control group.

Aged↗

Intralesional corticosteroid injection versus extracorporeal shock wave therapy for plantar fasciopathy.

OBJECTIVE: To compare the efficacy of low-energy extracorporeal shock wave therapy (ESWT) and intralesional corticosteroid injection (CSI) for the treatment of plantar fasciopathy present for at least 6 weeks. DESIGN: A prospective, randomized, controlled, observer-blinded study over a period of 12 months. SETTING: Primary care and hospital setting. PATIENTS: A total of 132 patients were enrolled in the study, and 125 completed the study. Nineteen nonrandomized patients acted as a surrogate control group. INTERVENTIONS: All patients performed a standardized Achilles tendon and plantar fascia stretching program. The patients were randomly allocated to either treatment group A or B. Group A received a single CSI, while group B were referred for a course of low-dose ESWT comprising 3 treatments over a period of 3 weeks. Group C consisted of 19 nonrandomized patients who performed the standardized stretching program only. MAIN OUTCOME MEASUREMENTS: The worst daily pain recorded on a visual analogue scale (VAS), and the tenderness at the plantar fascia insertion as determined by an algometer. These measures were recorded immediately prior to the commencement of treatment and 3 months and 12 months posttreatment. RESULTS: With regard to VAS pain scores, values for the CSI (1.48; 0-7) were significantly lower than both ESWT (3.69; 0-8), and controls (3.58; 2-5) at 3 months. At 12 months, VAS scores for CSI (0.84; 0-7) and ESWT (0.84; 0-4) were both significantly lower than controls (2.42; 1-4). The tenderness values at 3 months were significantly higher for CSI (9.42; 7-11) than both ESWT (6.72; 4-11) and controls (7.63; 6-9). P < 0.05 was used throughout. CONCLUSIONS: Corticosteroid injection is more efficacious and multiple times more cost-effective than ESWT in the treatment of plantar fasciopathy that has been symptomatic for more than 6 weeks.

Adolescent↗