High-dose short-course oral corticosteroid protocol for treatment of primary frozen shoulder: a retrospective cohort study

Objective To evaluate the effect of high-dose prednisolone on the functional outcome of patients with early-stage primary frozen shoulder. Methods Eighteen patients treated with oral prednisolone at an initial dose of 1 mg/kg/day for primary frozen shoulder were retrospectively evaluated. The patients’ range of motion, Disabilities of the Arm, Shoulder, and Hand (DASH) score, Constant–Murley score, American Shoulder and Elbow Surgeons (ASES) score, and visual analog scale score were recorded at baseline and at 4 weeks and 6 months after treatment. Results Rapid recovery of shoulder motion was noted at 4 weeks with the exception of abduction, which was maintained at 6 months. Significant improvement in pain perception and the Constant–Murley score was evident at 4 weeks and extended to 6 months. The DASH and ASES scores did not show significant improvement in the first 4 weeks but were significantly improved at 6 months. Conclusion High-dose oral prednisolone treatment provides rapid symptom resolution that persists long after drug discontinuation. The early treatment period is characterized by marked reduction in pain and rapid recovery of shoulder motion. Improvements in functional outcomes and disability indices tend to be more subtle in the early period but significantly improve during late treatment.

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Comparison of functional outcome of ultrasound guided glenohumeral and subacromial methylprednisolone acetate injections in frozen shoulder

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20184378 ◽

2018 ◽

Vol 4 (6) ◽

pp. 876

Author(s):

Mayur Chopra ◽

Attique Vasdev

Keyword(s):

Functional Outcome ◽

Early Stage ◽

Constant Score ◽

Adhesive Capsulitis ◽

Frozen Shoulder ◽

Dash Score ◽

Methylprednisolone Acetate ◽

Ultrasound Guided ◽

Group Constant

Background: Frozen shoulder also known as adhesive capsulitis is a common cause for limitation of motion and pain of the shoulder joint with an incidence of 2-5% in the general population. The aim of the study was to assess the functional outcome of ultrasound guided glenohumeral and subacromial methylprednisolone acetate steroid injection in patients with frozen shoulder.Methods: 120 patients with frozen shoulder were randomly divided into 2 groups according to site i.e. glenohumeral and subacromial. Ultrasound-guided methylprednisolone acetate (80 mg) injection was administered. At follow up pain was being measured using VAS scale and functional outcome was measured using the DASH score and Constant score at day 0, 1 followed by 1, 3, 6 weeks and at 3 months.Results: The VAS score of glenohumeral decreased from 6.5±0.95 to 2.25±0.86 at 3 months and in subacromial it decreased from 6.37±1.07 to 2.3±0.72. DASH score in glenohumeral group decreased from 66.95±9.9 to 27.45±9.31 at 3 months and in the subacromial group it decreased from 67.52±10.65 to 26.81±11.14 at 3 months. In glenohumeral group Constant score increased from 46.63±7.18 to 72.66±7.38 at 3 months and in the subacromial group it increased from 47.92±6.91 to 70.28±6.97 at 3 months.Conclusions: Spontaneous recovery does not necessarily occur even after a long period, so we recommend that these modalities should be offered to all patients with frozen shoulder and it would be of more value if carried out at an early stage of the disorder.

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Relapse After Early-Stage, Favorable Hodgkin Lymphoma: Disease Characteristics and Outcomes With Conventional or High-Dose Chemotherapy

Journal of Clinical Oncology ◽

10.1200/jco.20.00947 ◽

2021 ◽

Vol 39 (2) ◽

pp. 107-115

Author(s):

Paul J. Bröckelmann ◽

Horst Müller ◽

Teresa Guhl ◽

Karolin Behringer ◽

Michael Fuchs ◽

...

Keyword(s):

Hodgkin Lymphoma ◽

Early Stage ◽

High Dose Chemotherapy ◽

Sensitivity Analyses ◽

High Dose ◽

Second Line ◽

Second Line Therapy ◽

Line Therapy ◽

Significant Difference ◽

First Diagnosis

PURPOSE We evaluated disease and treatment characteristics of patients with relapse after risk-adapted first-line treatment of early-stage, favorable, classic Hodgkin lymphoma (ES-HL). We compared second-line therapy with high-dose chemotherapy and autologous stem cell transplantation (ASCT) or conventional chemotherapy (CTx). METHODS We analyzed patients with relapse after ES-HL treated within the German Hodgkin Study Group HD10+HD13 trials. We compared, by Cox proportional hazards regression, progression-free survival (PFS) after relapse (second PFS) treated with either ASCT or CTx and performed sensitivity analyses with overall survival (OS) from relapse and Kaplan-Meier statistics. RESULTS A total of 174 patients’ disease relapsed after treatment in the HD10 (n = 53) and HD13 (n = 121) trials. Relapse mostly occurred > 12 months after first diagnosis, predominantly with stage I-II disease. Of 172 patients with known second-line therapy, 85 received CTx (49%); 70, ASCT (41%); 11, radiotherapy only (6%); and 4, palliative single agent therapies (2%). CTx was predominantly bleomycin, etoposide, doxorubicin cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP [68%]), followed by the combination regimen of doxorubicin, bleomycin, vinblastine, and dacarbazine (19%), or other regimens (13%). Patients aged > 60 years at relapse had shorter second PFS (hazard ratio [HR], 3.0; P = .0029) and were mostly treated with CTx (n = 33 of 49; 67%) and rarely with ASCT (n = 8; 16%). After adjustment for age and a disadvantage of ASCT after the more historic HD10 trial, we did not observe a significant difference in the efficacy of CTx versus ASCT for second PFS (HR, 0.7; 95% CI, 0.3 to 1.6; P = .39). In patients in the HD13 trial who were aged ≤ 60 years, the 2-year, second PFS rate was 94.0% with CTx (95% CI, 85.7% to 100%) versus 83.3% with ASCT (95% CI, 71.8% to 94.8%). Additional sensitivity analyses including OS confirmed these observations. CONCLUSION After contemporary treatment of ES-HL, relapse mostly occurred > 12 months after first diagnosis. Polychemotherapy regimens such as BEACOPP are frequently administered and may constitute a reasonable treatment option for selected patients with relapse after ES-HL.

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Adjuvant brachytherapy for FIGO stage I serous or clear cell endometrial cancer

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-002217 ◽

2021 ◽

pp. ijgc-2020-002217

Author(s):

Elizabeth B Jeans ◽

William G Breen ◽

Trey C Mullikin ◽

Brittany A Looker ◽

Andrea Mariani ◽

...

Keyword(s):

Endometrial Cancer ◽

Clear Cell ◽

Early Stage ◽

Figo Stage ◽

Stage I ◽

High Dose ◽

Vaginal Cuff ◽

Locoregional Failure ◽

Platinum Based Chemotherapy ◽

Increased Risk

ObjectivesOptimal adjuvant treatment for early-stage clear cell and serous endometrial cancer remains unclear. We report outcomes for women with surgically staged International Federation of Gynecology and Obstetrics (FIGO) stage I clear cell, serous, and mixed endometrial cancers following adjuvant vaginal cuff brachytherapy with or without chemotherapy.MethodsFrom April 1998 to January 2020, women with FIGO stage IA–IB clear cell, serous, and mixed endometrial cancer underwent surgery and adjuvant vaginal cuff brachytherapy. Seventy-six patients received chemotherapy. High-dose rate vaginal cuff brachytherapy was planned to a total dose of 21 gray in three fractions using a multichannel vaginal cylinder. The primary objective was to determine the effectiveness of adjuvant vaginal cuff brachytherapy and to identify surgicopathological risk factors that could portend towards worse oncological outcomes.ResultsA total of 182 patients were included in the analysis. Median follow-up was 5.3 years (2.3–12.2). Ten-year survival was 73.3%. Five-year cumulative incidence (CI) of vaginal, pelvic, and para-aortic relapse was 1.4%, 2.1%, and 0.9%, respectively. Five-year locoregional failure, any recurrence, peritoneal relapse, and other distant recurrence was 4.4%, 11.6%, 5.3%, and 6.7%, respectively. On univariate analysis, locoregional failure was worse for larger tumors (per 1 cm) (HR 1.9, 95% CI 1.2 to 3.0, p≤0.01). Any recurrence was worse for tumors of at least 3.5 cm (HR 3.8, 95% CI 1.3 to 11.7, p=0.02) and patients with positive/suspicious cytology (HR 4.4, 95% CI 1.5 to 12.4, p≤0.01). Ten-year survival for tumors of at least 3.5 cm was 56.9% versus 86.6% for those with smaller tumors (HR 2.9, 95% CI 1.4 to 5.8, p≤0.01). Ten-year survival for positive/suspicious cytology was 50.9% versus 77.4% (HR 2.2, 95% CI 0.9 to 5.4, p=0.09). Multivariate modeling demonstrated worse locoregional failure, any recurrence, and survival with larger tumors, as well as any recurrence with positive/suspicious cytology. Subgroup analysis demonstrated improved outcomes with the use of adjuvant chemotherapy in patients with large tumors or positive/suspicious cytology.ConclusionAdjuvant vaginal cuff brachytherapy alone without chemotherapy is an appropriate treatment for women with negative peritoneal cytology and small, early-stage clear cell, serous, and mixed endometrial cancer. Larger tumors or positive/suspicious cytology are at increased risk for relapse and worse survival, and should be considered for additional upfront adjuvant treatments, such as platinum-based chemotherapy.

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Novel perspectives of super-high dose sulfonylurea and high-dose oral prednisolone in an infant with DEND syndrome due to V64M heterozygote KCNJ11 mutation

Acta Diabetologica ◽

10.1007/s00592-021-01763-1 ◽

2021 ◽

Author(s):

Galia Barash ◽

Haim Bassan ◽

Ayelet Livne ◽

Lilach Benyamini ◽

Eli Heyman ◽

...

Keyword(s):

Oral Prednisolone ◽

High Dose ◽

Dose Oral

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Atypical Granulomatosis with Polyangiitis Presenting with Meibomitis, Scleritis, Uveitis and Papillary Bladder Tumor: A Case Report and Literature Review

Diagnostics ◽

10.3390/diagnostics11040680 ◽

2021 ◽

Vol 11 (4) ◽

pp. 680

Author(s):

Takashi Kojima ◽

Murat Dogru ◽

Eisuke Shimizu ◽

Hiroyuki Yazu ◽

Aya Takahashi ◽

...

Keyword(s):

Granulomatosis With Polyangiitis ◽

Early Stage ◽

Topical Steroid ◽

Granulomatous Inflammation ◽

Oral Prednisolone ◽

Meibomian Gland ◽

Clinical Findings ◽

Meibomian Gland Dysfunction ◽

Oral Steroids ◽

Atypical Cells

Granulomatosis with polyangiitis (GPA) presents with a variety of systemic findings, sometimes with ocular findings initially, but is often difficult to diagnose at an early stage. An 85-year-old male had complaints of ocular dryness and redness and was diagnosed with meibomian gland dysfunction with meibomitis. Despite an initial treatment with topical steroid and antibiotics, the meibomitis did not improve and the left eye developed scleritis and iridocyclitis. The patient was administered topical mydriatics and oral steroids. During follow-up, the patient developed left hearing difficulty and reported a darker urine. Urinalysis revealed microscopic hematuria. A blood test showed an elevated erythrocyte sedimentation rate, positivity for perinuclear anti-neutorophil cytoplasmic antibody, and elevations in blood urea nitrogen and serum creatinine. Nasal mucosal biopsy showed a non-necrotizing granulomatous inflammation. Renal biopsy revealed focal glomerulosclerosis. Cystoscopy and bladder wash followed by a planned transurethral resection revealed atypical cells and apical papillary tumors which were resected. Iridocyclitis and scleritis responded well to oral prednisolone with 0.1% topical betamethasone and prednisolone ointment. The patient is tumor free with no recurrences 24 months after resection. GPA may present atypically with meibomian gland dysfunction without showing representative clinical findings. Early detection and treatment are essential for visual recovery.

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Understanding the Processes Causing the Early Intensification of Hurricane Dorian through an Ensemble of the Hurricane Analysis and Forecast System (HAFS)

Atmosphere ◽

10.3390/atmos12010093 ◽

2021 ◽

Vol 12 (1) ◽

pp. 93

Author(s):

Andrew Hazelton ◽

Ghassan J. Alaka ◽

Levi Cowan ◽

Michael Fischer ◽

Sundararaman Gopalakrishnan

Keyword(s):

Tropical Cyclone ◽

Large Scale ◽

Early Stage ◽

Early Period ◽

Storm Track ◽

Key Factors ◽

Complex Interplay ◽

Forecast System ◽

Model Initialization

The early stages of a tropical cyclone can be a challenge to forecast, as a storm consolidates and begins to grow based on the local and environmental conditions. A high-resolution ensemble of the Hurricane Analysis and Forecast System (HAFS) is used to study the early intensification of Hurricane Dorian, a catastrophic 2019 storm in which the early period proved challenging for forecasters. There was a clear connection in the ensemble between early storm track and intensity: stronger members moved more northeast initially, although this result did not have much impact on the long-term track. The ensemble results show several key factors determining the early evolution of Dorian. Large-scale divergence northeast of the tropical cyclone (TC) appeared to favor intensification, and this structure was present at model initialization. There was also greater moisture northeast of the TC for stronger members at initialization, favoring more intensification and downshear development of the circulation as these members evolved. This study highlights the complex interplay between synoptic and storm scale processes in the development and intensification of early-stage tropical cyclones.

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A CONTROLLED STUDY OF ORAL PREDNISOLONE IN FROZEN SHOULDER

Rheumatology ◽

10.1093/rheumatology/25.3.288 ◽

1986 ◽

Vol 25 (3) ◽

pp. 288-292 ◽

Cited By ~ 75

Author(s):

A. BINDER ◽

B. L. HAZLEMAN ◽

G. PARR ◽

S. ROBERTS

Keyword(s):

Frozen Shoulder ◽

Oral Prednisolone ◽

Controlled Study

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A study on the outcome of displaced midshaft non-comminuted clavicle fractures treated with anatomical locking plate versus titanium elastic nail

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1177/2210491720975189 ◽

2020 ◽

pp. 221049172097518

Author(s):

Vineet Thomas Abraham ◽

Chandrasekaran Marimuthu

Keyword(s):

Functional Outcome ◽

Locking Plate ◽

Plate Versus ◽

Dash Score ◽

Titanium Elastic Nail ◽

Constant Murley Score ◽

Elastic Nail ◽

Clavicle Fractures ◽

The Mean ◽

Quick Dash

Purpose: Fixation of displaced midshaft clavicle is well known to decrease nonunion, malunion and shoulder disability as compared to nonoperative treatment. This study was done to compare the clinical and functional outcome of group 1 clavicle fractures treated with anatomic locking plates (ALP) versus Titanium elastic nail (TEN). Methods: We studied patients presenting with displaced midshaft clavicle fractures treated with ALP or TEN. The study period was from Jan 2013 to Dec 2016. Patients were reviewed and at each visit clinical and radiological progress of union was noted, complications if any were noted, functional assessment was done using the quick Dash score and Constant Murley score. Results: A total of 116 patients met our inclusion criteria. 62 patients were treated with TEN and 54 with ALP. Bony union was achieved at an average of 11.8 weeks in the TENS group and 12.8 weeks in the ALP group post operatively and this was found to be significant. The mean postoperative Constant Murley score in the ALP and the TEN groups were 92.8 (range 80–97), and 93.7 (82–97) respectively. The mean postoperative quick dash score in the ALP and TEN groups were 2.48(range from 0 to 6.8) and 2.1 (range 0–9.1) respectively. Conclusion: Both Anatomical locking plate and TEN are good options for the treatment of non-comminuted mid clavicular fractures as they have a similar functional outcome. TEN nail insertion has the advantage of being minimally invasive, having a faster union time and may be recommended in midshaft clavicle fractures without comminution.

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