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In the treatment of 38 patients with urethral stricture, 21 received intralesional corticosteroid injections, combined in 17 cases with internal urethrotomy. The aetiology of the lesion is discussed, together with a review of the pertaining literature, and the results of the treatment are evaluated.
Intralesional therapy is a less invasive method for the treatment of Peyronie's disease. The objective of this study was to evaluate intralesional injections of interferon alpha 2B (IFN-alpha-2B) as an effective alternative to the surgical treatment of Peyronie's disease. Twenty-one patients with Peyronie's disease were evaluated by use of penile duplex Doppler ultrasonography for cavernosal blood flows, degree of penile curvature, and plaque size. A questionnaire was given to all patients to assess sexual function. Each patient then received biweekly intralesional injections of 1 x 10(6) units of IFN-alpha-2B in 10 ml of normal saline over a period of 6 months. There was no placebo control group in this study. At the conclusion of the study, penile duplex Doppler imaging was repeated. A questionnaire was completed by all patients to assess changes in sexual function after treatment. Twenty patients completed the study, with all men reporting subjective softening of their plaques. Nine of 10 patients initially reporting penile pain with erection (90%) had resolution of their phallalgia while on study protocol. Thirteen patients (65%) had significant improvement in curvature, ranging from 20 to 90%. Seventeen patients (85%) demonstrated an objective 10 to 80% decrease in plaque size. Biweekly intralesional injections of Peyronie's plaques with IFN-alpha-2B resulted in a significant improvement in penile curvature, diminished pain, and reduced plaque size, and resulted in a subjective improvement in sexual function.
I clinically studied 905 patients with alopecia areata (AA) who visited the Department of Dermatology, College of Medicine, Chung Ang University, from January of 1982 to February of 1994. The purpose of the study was to evaluate the clinical manifestations and compare the effects of treatment with intralesional injection of triamcinolone acetonide suspension and immunotherapy with dinitrochlorobenzene (DNCB) or diphenylcyclopropenone (DPCP). The results were as follows: 1) The incidence of AA among all out-patients (59,970) was 1.5% (905 cases), and the ratio of males to females was 1.3:1 (512:393). 2) The age distribution showed high incidences in the third (41.8%) and fourth decades (20.0%). 3) The family history was contributory in 104 cases (11.5%). 4) The relapse rate was 17.5% (158 cases). 5) Almost half of the patients had a solitary lesion (408 cases, 46.7%). 6) The most common site of predilection was the occipital region of the scalp in both male and female patients. 7) Associated diseases were seborrheic dermatitis, atopic dermatitis, hepatitis, hypertension, open heart surgery, thyroid disease, pulmonary disease, and vitiligo in order of frequency. 8) The effect of treatment on the patients who had bald patches less than 50 cm2 was not significantly statistically different between intralesional injection of triamcinolone acetonide and immunotherapy with DNCB or DPCP. 9) In cases with bald areas more than 50 cm2, including alopecia totalis and universalis, DNCB or DPCP immunotherapy showed better therapeutic effects than did intralesional injection of triamcinolone acetonide.
OBJECTIVE: To study the efficacy of subconjunctival 5-fluorouracil (5-FU) and triamcinolone injection in halting the progression of impending recurrent pterygium. DESIGN: Randomized, prospective, controlled clinical trial. PARTICIPANTS: One hundred nine patients who had undergone pterygium excision within the previous 6 months and developed grade 3 characteristics (impending recurrent pterygium). METHODS: A total of 109 eyes with impending recurrent pterygium were stratified randomly into 3 groups by treatment: 35 eyes served as the control group, 39 eyes received a 5-mg intralesional injection of 5-FU weekly for 2 weeks, and 35 eyes received one 20-mg intralesional injection of triamcinolone. All groups received 1% prednisolone acetate eye drops 4 times daily for 8 weeks. MAIN OUTCOME MEASURES: Recurrence rate, success rate, and survival analysis were compared among the groups. RESULTS: With a mean follow-up time of 10.9+/-5.5 months (range, 6-26 months), the success rates of the 5-fluorouracil and triamcinolone groups were higher than the control group (87.2%, 71.4%, and 48.6%, respectively). 5-fluorouracil was significantly (P = 0.001) more effective in inhibiting the recurrence of pterygium compared with the control group at all time points during follow-up. Kaplan-Meier survival analysis showed that the recurrence-free period of pterygium in the 5-FU group was significantly (P = 0.005) longer than that of the control group but not in the triamcinolone group compared with the controls (P = 0.063). There was no significant difference between the 5-FU group and the triamcinolone group (P = 0.362). Minimal reversible complications such as steroid-induced glaucoma and superficial punctate epitheliopathy developed during the study. CONCLUSIONS: Intralesional injection of 5-FU and triamcinolone was more effective in inhibiting the recurrence of pterygium than topical steroid alone, with the results in the 5-FU group reaching statistical significance.
It would be very useful to have a more effective and more rapid method available for the treatment of cutaneous leishmaniasis (CL). The main aim of the present, Iranian study, was to see if the combination of cryotherapy and intralesional injections with meglumine antimoniate (C + MA) would be more effective than the injections given alone (MA) or the combination of cryotherapy plus intralesional sodium stibogluconate (C + SS). Forty patients (with 67 lesions) were treated with C + MA, another 40 (with 65 lesions) were treated with C + SS and 100 patients (with 180 lesions) were treated with MA. Follow-up for 6 months after the final treatment indicated that 89.5% of the lesions treated with C + MA, 92.3% of those treated with C + SS but only 50% of the lesions treated with MA only were completely cured. The frequencies of cure in the two cryotherapy groups were similar, both being significantly higher than that in the MA group (P < 0.05). The combination of cryotherapy with intralesional injections of meglumine antimoniate or sodium stibogluconate, which is much more effective than the use of intralesional meglumine antimoniate alone, should be promoted.
Five cows bearing bovine ocular squamous cell carcinoma (BOSCC) were treated with low doses of recombinant human interleukin-2 (rhIL-2). A dose of 2500 U rhIL-2 was injected intralesionally and another 2500 U were injected into the subparotid regional lymph node once a day during a period of 5 consecutive days. This cycle of 5 days was repeated after an interval of 2 days. Total regression of the tumor was observed in three out of five animals. One cow showed tumor regression (greater than 80%) accompanied by metastases to the regional lymph node that were observed from the fifth week after the beginning of the treatment. Growth of the tumor of the fifth animal was retarded after treatment. In vitro proliferation of peripheral blood lymphocytes was investigated in two animals and tumor-infiltrating lymphocytes in one animal during incubation in various rhIL-2 concentrations. Cytotoxic activity of both cell populations against P815, Yac-1 and BOSCC-derived cell lines increased during incubation with rhIL-2. Cultured BOSCC-infiltrating lymphocytes showed predominant killing of the BOSCC-derived autologous cell line after 4 weeks of culture. Preliminary phenotype analysis did not give conclusive results with respect to the types of cells responsible for killing.
BACKGROUND AND DESIGN: A new intralesional sustained-release chemotherapy is under development as a treatment for condylomata acuminata; it is administered as an injectable gel that consists of fluorouracil and epinephrine with a purified bovine collagen as the gellant (fluorouracil/epinephrine gel). In this randomized, double-blind study, we evaluated the safety and efficacy of this intralesional treatment in 401 patients, using 2 active drug formulations (fluorouracil/epinephrine gel and fluorouracil gel alone) and a placebo. Each lesion was injected once a week for up to 6 weeks, and patients were followed up for 3 months. RESULTS: A total of 359 patients with 1926 condylomata underwent evaluation. For all lesions treated with fluorouracil/epinephrine gel, the complete response (CR) rate was 77%. For all patients treated with fluorouracil/epinephrine gel, the CR rate was 61%. The fluorouracil/epinephrine gel was significantly more effective (P < .002) in treating condylomata than the fluorouracil gel without epinephrine (CR rate, 43%); both were superior to placebo (CR rate, 5%). At 3 months after completion of treatment, recurrence rates in patients with CRs were as follows: fluorouracil/epinephrine gel group, 50%; fluorouracil gel group, 58%. No clinically significant drug-related systemic reactions occurred. Finally, the type and severity of local tissue reactions of patients with a positive pretreatment collagen skin test result (6/401 [1.5%]) were similar to those of patients with a negative collagen skin test result. CONCLUSION: The fluorouracil/epinephrine injectable gel is a safe and effective treatment for condylomata acuminata.
Infants with capillary hemangiomas of the eyelid are at risk for amblyopia and strabismus. Several methods of treating these tumors have been associated with complications and limitations. The use of intralesional corticosteroid injections has been demonstrated to be a simple, safe, and effective method of treating capillary hemangiomas of the eyelid.
It is well documented that drug delivery into experimental and human brain tumors is limited by the variably intact blood-brain barrier (BBB) at the growing edge. The aim of the present investigation was to examine the histopathological changes that occur after a single intralesional injection of human recombinant interleukin-2 (rIL-2) into a growing glioma and determine whether the injection improved delivery of cytotoxic drug into the neuropil surrounding the site of lymphokine injection. Because an intracerebral injection of rIL-2 causes a temporary breakdown in the BBB, we hoped to enhance drug penetration into peritumoral areas of brain with an intact BBB by using the novel biomodulating effect of rIL-2 on the cerebral endothelial cells. The results demonstrated that an intralesional injection of 7.2 x 10(4) National Units rIL-2 on Day 7 after tumor inoculation did not accentuate the already increased cerebrovascular permeability produced by the glioma nor did rIL-2 trigger additional or aggravate neurological deficits in glioma-bearing rats. Before the administration of chemotherapy in vivo, the RT-2 glioma cells were tested for in vitro sensitivity by colorimetric assay. At 24 hours after exposure to either methotrexate (MTX), vincristine (VIN), or doxorubicin (DOX), no significant inhibition of metabolic activity was observed. In contrast, a timed pulsed of any drug for 5 minutes caused significant dose-dependent inhibition of RT-2 glioma cells at 48 hours to 5 days after drug administration. Animal models receiving an intralesional injection of rIL-2 followed 3 days later by an intravenous dose of 30 mg/kg MTX, 0.23 mg/kg VIN, or 10 mg/kg DOX demonstrated that only MTX combined with intralesional rIL-2 significantly inhibited intracranial proliferation of RT-2 glioma cells. Use of intralesional rIL-2 and intravenous chemotherapy, however, did not significantly increase survival in this animal model of glioma. These results show that the combination of cytotoxic drugs with intralesional rIL-2 can be safely applied in the management of glioma and may form a rational basis for additional pharmacological investigations of a wider assortment of chemotherapies in combination with rIL-2 for intracranial malignancies.
OBJECTIVES: We assessed the intermediate-term and long-term efficacy of intralesional injection of cidofovir used with surgical excision in juvenile-onset recurrent respiratory papillomatosis. METHODS: The protocol was revised during the study, from endoscopy at 4-week intervals with intralesional injection of cidofovir at 5 mg/mL, to a 2-week interval and a 7.5-mg/mL dosage. Partial surgical excision of hypertrophic papillomas was performed before the initiation of injection. Further injections at 4-week (or 2-week) intervals were performed until complete remission. RESULTS: Sixteen patients received a mean 8.9 injections. Complete remission was obtained in 12 patients (75%) after a mean 7.2 endoscopic treatments. Remission was stable at a mean 33.6 months' follow-up. Five of these 12 patients received 5.2 injections and remained disease-free at a mean 39.3 months' follow-up. Seven of the 12 had 1 relapse; they needed complementary treatment to become disease-free, and remained so thereafter over a mean 27.3 months' follow-up. The other 4 of the 16 patients (25%) continued to present active disease. CONCLUSIONS: Active endoscopic treatment until complete remission led to a higher-than-expected complete remission rate on intermediate-term to long-term follow-up, with or without relapse. Transient relapse was associated with a long delay in initiating cidofovir treatment.
Recurrent laryngeal papillomatosis is a benign disease of the larynx often leading to organic and functional restrictions. The therapeutic treatment of choice in larynx-obstructing papillomatosis is at present surgical laser ablation. The effectiveness of adjuvant intralesional injection of the virustaticum Cidofovir has been investigated recently in a variety of therapeutic models. The present case study deals with the treatment of recurrent laryngeal papillomatosis by means of surgical laser ablation of the laryngeal papillomas with adjuvant local injection of the virustaticum Cidofovir (dose of 5 mg/1 ml). Within the period from October 2001 to August 2004, ten patients aged between 5- and 70 years were treated with intralesional injections of Cidofovir. Papillomatosis was confirmed histologically in all cases, and the virus types were defined in part. Each of the patients underwent clinical-phoniatric examinations and was photographed for documentation. After 2-7 treatments with surgical laser papilloma ablation and intralesional Cidofovir injections, all patients showed a definite papilloma reduction, while in six cases complete remission was achieved. During the follow-up period of 8-30 months, not a single recurrence of the laryngeal papillomatosis occurred. In the majority of patients, a clear improvement in the voice was achieved. There were no local or systemic side effects caused by the virustaticum. Intralesional injection of Cidofovir is an adjuvant, but not a curative therapeutic option in recurrent laryngeal papillomatosis. Remission of previously frequently recurrent laryngeal papillomas can be achieved, but recurrence after longer treatment-free intervals is also possible.
REASONS FOR PERFORMING STUDY: There is a lack of long-term follow-up data for outcome of medical treatment of superficial digital flexor (SDF) tendonitis. OBJECTIVES: To determine whether intralesional injection of hyaluronan, beta aminoproprionitrile fumarate (BAPN) or polysulphated glycosaminoglycans (PSGAG) or systemic administration of PSGAG yielded better results than a controlled exercise programme alone in the management of SDF tendonitis, with a minimum follow-up period of 2 years after resumption of full work; and to determine whether reinjury rate was related to sports discipline and whether fibre alignment score (FAS) at 4 months could predict outcome. METHODS: In Study 1, 50 horses were managed by controlled exercise alone (Group A), 50 were treated with intralesional injection of hyaluronan (Group B), 20 received intralesional and systemic treatment with PSGAG (Group Ci) and 30 received systemic treatment with PSGAG (Group Cii). Horses in Groups B, Ci and Cii followed the same controlled exercise programme as Group A. In Study 2, 69 horses (Group D) were treated by intralesional injection of BAPN and followed a modified controlled exercise programme. Horses were re-examined clinically and ultrasonographically at intervals. Follow-up data were obtained for horses 2 years after resuming full work and for up to 6 years. RESULTS: There was no significant difference in reinjury rate of the treated limb(s) between Groups A, B, Ci and Cii (42.5-44.4%) (P>0.9). The reinjury rate (16%) in the treated limb(s) in Group D was significantly lower than in the other groups (P<0.001). However, when injury rate of the uninjured limb was considered, the results were similar to Study 1. In Study 2, the FAS at 4 months after treatment was a good predictor of outcome (P<0.001). Reinjury rates for different disciplines were similar in the 2 studies, with the risk of reinjury ascending from showjumpers to event horses to National Hunt and flat racehorses. CONCLUSIONS: Treatment with BAPN reduced the risk of reinjury in the treated limb, although the overall rate of subsequent injury was not affected. FAS at 4 months after treatment is a good predictor of outcome in the treated limb(s). POTENTIAL RELEVANCE: This study provides long-term follow-up data in horses from a variety of sports disciplines that can be used to provide prognostic information.
BACKGROUND: Kaposi sarcoma (KS) is an acquired immune deficiency syndrome-defining condition in human immunodeficiency virus infection. Oral KS may produce local symptoms and require treatment. Palliation of oral lesions may be achieved with radiation therapy and chemotherapy. This review was conducted to assess the effect of intralesional vinblastine in the management of oral KS. METHODS: Patients were referred because of oral KS. Intralesional injection of vinblastine (0.2 mg/ml) was conducted under local anesthesia, and patients were observed to determine the effect of treatment. RESULTS: Forty-two patients with oral KS were treated with intralesional vinblastine. A greater than 50% reduction in the lesions was seen in 74% of patients. The mean duration of response was 3.52 months for all patients. For patients not lost to follow-up and observed until recurrence of the oral lesions, palliation was achieved for a mean of 4.25 months. CONCLUSIONS: Effective local palliation of oral KS can be achieved with intralesional injection of vinblastine.
We retrospectively studied the outcome of percutaneous needle biopsy and intralesional injection of a corticosteroid (methylprednisolone) in thirty-nine patients who had localized Langerhans-cell histiocytosis (eosinophilic granuloma of bone). All thirty-nine patients had a solitary symptomatic lesion at presentation; a second lesion developed in two patients, two and four months after the first lesion was diagnosed. Therefore, there were forty-one lesions in thirty-nine patients. Fine-needle aspiration with or without core-needle biopsy was performed for all forty-one lesions, and the diagnosis of Langerhans-cell histiocytosis was established for thirty-seven (90 per cent). A corticosteroid was injected into thirty-five lesions. Twenty-nine received the injection at the time of the fine-needle aspiration on the basis of the cytological findings in the aspirate. Six patients who had a solitary lesion had a two-stage procedure because the injection was delayed until the diagnosis was confirmed with histological evaluation of specimens obtained by core-needle biopsy. Thirty-four (97 per cent) of the thirty-five lesions healed. The clinical symptoms associated with thirty-one lesions resolved within two weeks after a single injection of the corticosteroid. There were no complications associated with either the biopsy or the injection. At a median of ninety months (range, twenty-four to 199 months), no patient had recurrence of symptoms or of radiographic evidence of the lesion. All patients who had been managed with an intralesional injection of the corticosteroid had full range of motion of the affected extremity and had resumed unlimited activities. Although the mechanism of action of intralesional injection of a corticosteroid has not been defined, use of percutaneous needle biopsy to diagnose localized Langerhans-cell histiocytosis and treatment with intralesional administration of methylprednisolone relieved pain expeditiously, enabled the patient to avoid an operative procedure, and resulted in osseous healing. The specific role of corticosteroid therapy remains to be determined by prospective, randomized studies.
STUDY DESIGN: This report describes Brown-Sequard syndrome after intralesional injection of absolute alcohol into vertebral hemangioma. OBJECTIVE: To discuss whether the described technique is safe in the management of vertebral hemangiomas. SUMMARY OF BACKGROUND DATA: The management of vertebral hemangiomas remains controversial. There have been reports of successful management using intralesional absolute alcohol. METHODS: The clinical and radiologic features of the reported complication are detailed. RESULTS: Intralesional injection of absolute alcohol caused Brown-Sequard syndrome. CONCLUSION: This case shows that intralesional alcohol injection cannot be considered a safe technique for management of vertebral hemangiomas with spinal cord compression.
Laryngeal sarcoidosis presents with hoarseness, cough, and dysphagia. Shortness of breath due to upper airway obstruction may occur. Indirect laryngoscopy reveals mucosal edema and erythema, granulomas, and nodules. The supraglottic larynx is the most frequently affected area. Systemic corticosteroids can be used initially; however, with persistent symptoms and/or severe airway problems, intralesional steroid injections may be more effective, as in the six patients presented.
Treatment of palatal Kaposi's sarcoma (KS) with intralesional injection of vinblastine was seen to provide effective palliation. Of the ten patients studied, four had a 25% to 50% response, two 50% to 75% response, and four had 75% to 100% response with one or two intralesional injections of vinblastine. Response to treatment was followed for a mean of 3.6 months, with recurrence of lesions in two of ten patients.
OBJECTIVE: To provide some representative examples of sonographically guided arthrocentesis and intralesional injection therapy. METHODS: Sonographic evaluation was performed with high-frequency linear (13 MHz) and mechanical sector (20 MHz) transducers. The images were obtained in representative patients with rheumatoid arthritis and posttraumatic subacromial bursitis. RESULTS: Sonographically guided intralesional injection is a rapid and reliable procedure, especially in patients with arthritis, tenosynovitis, and bursitis. After target localization, needle placement can be performed under continuous sonographic monitoring. Sonographic guidance is particularly useful when fluid collections are small (less than 5 mm) and deep or when the inflammatory process is adjacent to anatomic structures that could be seriously damaged by the injection. CONCLUSIONS: Over the last few years, the rapid technologic advancements in ultrasonography have dramatically increased the potential applications of sonographically guided procedures. The simplicity and reliability of the technique might warrant rheumatologists to undergo sonographic training.