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Background Systemic lupus erythematosus (SLE) is a chronic, multisystem, autoimmune disease. Untreated SLE often become progressive and lead to increased risk of mortality. Corticosteroid and cyclophosphamide remain the treatment of choice for severe SLE. Disease activity assessed with SLE Daily Activity Index (SLEDAI). Objective To compare the disease activity of childhood-onset severe SLE at the time of diagnosis, after completion of high dose methylprednisolone, and after three month of cyclophosphamide by using SLEDAI. Methods This study was conducted in the Division of Pediatric Allergy and Immunology, Department of Child Health, Udayana University/Sanglah Hospital, Denpasar, Bali. Subjects were SLE patient aged 0-18 years who had severe clinical manifestations. Subject received therapy combination of high dose methylprednisolone and cyclophosphamide every 2 weeks for six doses. SLEDAI score was assessed at the time of diagnosis, after completion of high dose methylprednisolone, and after three month of cyclophosphamide. Results During the study period, 51 children were diagnosed as SLE. Twenty-one subjects were included for analysis. Median SLEDAI score at the time of diagnosis was 23 (range 13-39). SLEDAI score after three months of cyclophosphamide was decreased to 2 (range 0-14). Post hoc analysis with Wilcoxon signed-rank test showed the improvement of SLEDAI score at the time of diagnosis and after three months of cyclophosphamide was statistically significant (Z=-4.016, P

Introduction Nivolumab is a programmed death 1 (PD-1) inhibitor approved by the Food and Drug Administration (FDA) for the treatment of eight different cancers including metastatic melanoma. Immune checkpoint blockade may lead to a range of neurologic immune-related adverse events (irAEs) with severity varying from mild to life-threatening, including encephalitis. Case report We describe a case of a 68-year-old man who developed alteration in mental status, physical weakness and fatigue after nine cycles of nivolumab 3 mg/kg every two weeks. These symptoms were compatible with a clinical diagnosis of autoimmune limbic encephalitis, although no specific antibodies were detected and the initial MRI was normal. Management and outcome The patient received intravenous methylprednisolone 1 g daily for 5 days, which was then converted to a maintenance dose of oral prednisone. The patient made a full clinical recovery but relapsed clinically upon steroid tapering, while hypersignal in the left mesial temporal suggestive of limbic encephalitis was observed on repeated MRI. Discussion Because of the prevailing usage of nivolumab in many cancer protocols, this case highlights the importance of rapidly recognising neurological impairment in patients treated with nivolumab and of initiating very high doses of corticosteroids.

Introduction: To investigate the effect of ozone (O3) therapy on cornea subjected to systemically used high dose methylprednisolone (MP) in a rabbit model. Methods: Twenty-four New Zealand White adult male rabbits were randomly divided into three equal groups as containing eight animals. The first group (n = 8) was used as the control group and nothing was applied to them, whereas the other 2 groups named as steroid groups were subjected to IM methylprednisolone injection at a dose of 20 mg/kg/day for three days. After three days of MP administration, only the third group was treated with 50-µg/mL O3 (20 mL O3) through the rectal insufflation for 14 sessions. The histopathological examination of corneas of three groups were made, and they were also assessed regarding the expression of hypoxia-inducible factor-1 α (HIF-1α). Results: It was determined that systemically administered high dose MP caused erosion and necrosis in corneal epithelium and stromal disintegrations in corneal stroma in steroid groups (Group 2 and Group 3). In the MP + O3 group (Group 3), the histopathological findings were mild. The expression of HIF1-α in the cornea of Group1 (control group), Group 2 (MP), and Group 3 (MP-O3) was measured as, 17.9±9.6%, 3.1±1.0% and 6.4±1.9% respectively. Conclusions: MP and MP-O3 therapy decreased HIF-1a expression in rabbit cornea in both intervention groups. Between these two groups, HIF-1α expression remained relatively high in the MP-O3 group than in the MP group alone.

BACKGROUND AND OBJECTIVES: Corticosteroids are often empirically used to treat idiosyncratic hepatotoxicity with severe features. Interestingly, intravenous methylprednisolone (MP) is increasingly being recognized as being responsible for liver injury. We aimed to characterize MP-induced liver injury by analyzing demographical, clinical, laboratory and outcome data of three MP-induced hepatotoxicity cases and compared this information with that of previously published cases. CASE SERIES: Three females with multiple sclerosis (MS) were treated intravenously with MP, mean daily dose 767 mg. Liver damage occurred 2 to 6 weeks after exposure. Severity was mild to moderate. Two patients suffered positive rechallenge. LITERATURE REVIEW: We identified 50 published cases of MP hepatotoxicity. Most of these cases were female (86%) and main treatment indications were MS (29 cases) and Graves' ophthalmopathy (13 cases). Hepatocellular damage predominated and mean time to onset was 6 weeks. Four patients died and rechallenge occurred in 19 cases. CONCLUSION: MP pulses can induce severe liver injury, often with an autoimmune phenotype, particularly in patients with MS and Graves' ophthalmopathy. Consequently, these patient groups should have liver tests monitored when treated with MP to provide safer patient care.

Alopecia areata (AA) is a chronic autoimmune skin disease with hair loss, which often results in a poor prognosis. Although the high-dose intravenous methylprednisolone pulse therapy (IVMP) is used for AA, predictive factors affecting efficacies of IVMP are not fully elucidated. Thus, we conducted a retrospective study reviewing IVMP for AA during January 2009 and December 2018. The study was approved by the ethical committee of the Tohoku University Graduate School of Medicine.

Methylprednisolone is a corticosteroid medication used in acute traumatic spinal cord injury (SCI) to tackle secondary injury cascades. Its use in acute SCI has been the subject of controversy for over 30 years. The second National Acute Spinal Cord Injury Study (NASCIS-2) demonstrated a small benefit of methylprednisolone,1 though this conclusion was derived from a post hoc subgroup analysis.2 Studies that followed did not reach the same conclusion and reported potential adverse effects of the drug.3 However, the 2017 AOSpine guideline continues to recommend high-dose methylprednisolone within 8 hours postinjury,4 based on a meta-analysis with rigid inclusion criteria.5 This Journal Club article reports on a study from Liu et al.,6 who have attempted to resolve this controversy. The study provides an elegant example of meta-analytic methods and has important implications for neurologic clinical practice.

To evaluate the effect of a single preoperative dose of 125 mg methylprednisolone (MP) on glycemic homeostasis early after fast-track total hip and knee arthroplasty.One-hundred thirty-four patients undergoing elective unilateral total hip arthroplasty and total knee arthroplasty were randomized (1:1) to preoperative intravenous MP 125 mg (group MP) or isotonic saline intravenous (group C). All procedures were performed under spinal anesthesia, using a standardized multimodal analgesic regime. The primary outcome was the change in plasma glucose 2 hours postoperatively, and secondary outcomes included plasma C-peptide concentrations, homeostatic model assessment (HOMA), HOMA-IR (insulin resistance), and HOMA-B (β-cell function). Fasting blood samples were collected at baseline and 2, 6 (nonfasting), 24, and 48 hours after surgery with complete samples from 122 patients (group MP = 62, group C = 60) for analyses.MP patients had increased plasma glucose levels at 2 hours (adjusted mean [95% CI], 7.4 mmol·L [7.2-7.5] vs 6.0 mmol·L [5.9-6.2]; P = .023) and 6 hours (13.9 mmol·L [13.3-14.5] vs 8.4 mmol·L [7.8-9.0]; P.001), and in plasma C-peptide 24 hours postoperatively (1675 pmol·L [1573-1778] vs 1248 pmol·L [1145-1351]; P.001). An impaired insulin response was also observed in group MP as reflected by HOMA-B (P.001). Additionally, HOMA-IR increased 24 hours postoperatively in group MP compared to group C (P.001). Parameters were normalized 48 hours postoperatively.Preoperative administration of MP 125 mg resulted in a transient postoperative increase in plasma glucose and insulin resistance and impaired insulin secretion in response to hyperglycemia.

The standard therapy of multiple sclerosis (MS) relapse is high-dose pulse corticosteroid therapy. Although commonly applied and usually well tolerated it may as well carry certain risks for people with MS, the more severe of them being hepatotoxicity. This report describes three cases of acute liver injury following pulse corticosteroid therapy with reference to other possible causative factors. Caution should be exercised when applying high-dose methylprednisolone given the potential liver related adverse events it may cause.

Background and Objectives: BTK and BCL2 inhibitors have changed the treatment paradigms of high-risk and elderly patients with chronic lymphocytic leukemia (CLL), but their long-term efficacy and toxicity are still unknown and the costs are considerable. Our previous data showed that Rituximab (Rtx) and high-dose methylprednisolone (HDMP) can be an effective and safe treatment option for relapsed high-risk CLL patients. Materials and Methods: We explored the efficacy and safety of a higher Rtx dose in combination with a shorter (3-day) schedule of HDMP in relapsed elderly or unfit CLL patients. Results: Twenty-five patients were included in the phase-two, single-arm trial. The median progression free survival (PFS) was 11 months (range 10&ndash, 12). Median OS was 68 (range 47&ndash, 89) months. Adverse events (AE) were mainly grade I&ndash, II&deg, (77%) and no deaths occurred during the treatment period. Conclusions: 3-day HDMP and Rtx was associated with clinically meaningful improvement in most patients. The median PFS in 3-day and 5-day HDMP studies was similar and the toxicity of the 3-day HDMP schedule proved to be lower. The HDMP and Rtx combination can still be applied in some relapsed high-risk and elderly or unfit CLL patients if new targeted therapies are contraindicated or unavailable. (ClinicalTrials.gov identifier: NCT01576588).

To evaluate the sensitivity of the balance sway index (SI) to drug-induced functional changes during acute relapse in patients with MS.Dynamic posturography was used to derive the SI in 11 healthy subjects and 13 MS patients before and after intravenous high dose methylprednisolone (HDMP).In both groups, SI was lower in the least demanding task and increased with test complexity. Compared to the healthy group, patients were distinguished by a higher SI both prior to and following administration of HDMP (p 0.008). However, the effect of the drug on patients' SI was unremarkable. Total Expanded Disability Status Scale score was lower after treatment compared to pre-treatment values (p 0.001), with significantly lower mean score recorded in patients with pyramidal and cerebellar abnormalities (p = 0.017 and p = 0.011, respectively).The SI measure of dynamic posturography is not sensitive to short-term HDMP-induced functional changes during acute relapse in patients with MS. Further studies are needed to evaluate modified balance protocols and the possible long-term treatment effects of HDMP on SI.

We describe the case of a 6-year-old boy who developed myelin oligodendrocyte glycoprotein antibody (MOG-Ab) associated demyelinating syndrome, after initially presenting with aseptic meningitis. Magnetic resonance imaging showed cerebral and spinal lesions consistent with acute disseminating encephalomyelitis. Rapid clinical improvement occurred after intravenous high dose methylprednisolone. A small number of cases with MOG-Ab associated demyelinating syndrome presenting as aseptic meningitis have previously been reported in adults, but to our knowledge, this is the first pediatric case of this new clinical phenotype.

Multiple sclerosis (MS) is an inflammatory, demyelinating disease of the central nervous system (CNS) and is the most common cause of non-traumatic neurologic disability in young adults. Multiple s...

We present a case of a boy with recurrent left-sided hemiparesis. Early magnetic resonance imaging showed features suggesting acute disseminated encephalomyelitis (ADEM). However, he deteriorated neurologically on high dose methylprednisolone. A follow-up cerebral magnetic resonance imaging showed an extensive infarction due to carotid artery dissection. Distinguishing features between ADEM and acute stroke in childhood are described, but at early stage, it might be difficult to distinguish ADEM from acute stroke.

Acute spinal cord injury is a devastating condition typically affecting young people, mostly males. High-Dose Methylprednisolone treatment in the early hours after the injury is aimed at reducing the extent of permanent paralysis during the rest of the patient’s life. The aim To review randomized trials of High-Dose Methylprednisolone in Acute Spinal Cord Injuries. All randomized controlled trials of steroid treatment for acute spinal cord injury in any language. Data have been extracted from original trial reports. For the NASCIS, Japanese and French trials, additional data (e.g. SDs) have been obtained from the original authors. The evidence produced by this systematic review support the use of high dose methylprednisolone in acute spinal cord injury to improve neurological recovery. Patients who received high-dose methylprednisolone therapy should be observed with intensive in order to reduce complications from such therapy.

Although many literatures have shown that prolonged high-dose administration of corticosteroids is hazardous and not indicated to therapy acute lung injury (ALI), there is little information on the harmful effect of prolonged high-dose corticosteroids in acute lung injury. In this study, we aimed to investigate the effect of prolonged high-dose methylprednisolone (MPL) on ALI and improve knowledge regarding the appropriate use of corticosteroids in ALI. The different doses of MPL (3, 30, 180 mg·kg − 1 ) were given via tail vein injection 1 h after the first time LPS administration and were daily administrated for 14 days. Lung tissues and lavage samples were isolated for biochemical determinations and histological measurements at 12 h, 7 days and 14 days after LPS administration. Single administration of 180 mg·kg − 1 MPL decreased the lung injury score, wet-to-dry ratio, the total cell numbers and level of procollagen type III in BALF at 12 h after LPS challenge. However, prolonged therapy with 180 mg·kg − 1 MPL for 7 days and 14 days decreased the number of AMs in BALF and increased the above-mentioned indexes. These results suggested that the prolonged high-dose MPL has harmful effects to treat LPS-induced ALI in rats.

Not available

Corticosteroids are used widely to treat many types of disease. In general, these drugs are considered safe for the liver; however, recent reports have demonstrated that high- dose methylprednisolone (MT) may cause severe liver injury. Here, we report a case of a 24-year-old female who was given pulsed MT therapy for multiple sclerosis. MT induced icteric hepatitis and impaired liver synthetic function. Hepatotoxicity devel- oped several weeks after drug exposure, and the causal association with MT was con- firmed by unintentional rechallenge test. A brief review of the literature on corticos- teroid-induced hepatotoxicity is presented.

The effect of corticosteroids on spinal fusion healing has not yet been determined. To evaluate the effect of corticosteroids on lumbar spinal fusion we designed a randomized, placebo-controlled animal study using high-dose methylprednisolone sodium succinate, which is widely used in patients with spinal cord injury who are undergoing spinal fusion.Two groups of 18 rabbits underwent a postero-lateral fusion at L5-L6 with autologous bone graft. After surgery, the animals were assigned to receive: (a) methylprednisolone sodium succinate 30 mg/kg over 15 min, followed by an intravenous infusion of 5.4 mg/kg/h for 23 h, or (b) normal saline in the same volume. Animals were killed 8 weeks after surgery; the presence of fusion was analyzed by use of two different methods: a manual palpation test and an antero-posterior radiograph.Both groups of animals were comparable in weight. Fusion was achieved in 5/18 rabbits (27.8%) in the methylprednisolone group and in 9/18 animals (50%) in the control group (p = 0.17).In a lumbar posterolateral fusion rabbit model, high-dose methylprednisolone sodium succinate reduced the success of lumbar fusion; however, our data did not reach statistical significance.

Administration after spinal cord injury (SCI) of methylprednisolone (MP) for 24-48 h has been suggested to improve functional outcome. The safety of this approach has been questioned because of the known adverse effects of glucocorticoids on skeletal muscle and the immune system. The purpose of this study was to explicitly test adverse effects of regimen of MP administration on skeletal muscle.Male rats underwent spinal cord transection at T9-T10, followed by an intravenous injection of MP and subsequent infusion of MP for 24 h.MP significantly reduced the weight of the triceps, soleus, plantaris and gastrocnemius muscles, with the greatest effect being a 63% decrease in triceps weight (for example, muscle above the level of lesion) at 7 days; below the level of lesion, gastrocnemius weight was reduced by 33% by SCI alone, and by 45% by SCI and MP. Centralized nuclei were found in myofibers of the gastrocnemius and triceps from the MP-SCI group, but not other groups. MP increased expression in the triceps, soleus and plantaris of FOXO1, MAFbx, MuRF1 and REDD1 at 1 day, and, in plantaris, at 7 days.Thus, 1 day of MP at a dose comparable to those routinely employed in clinical practice immediately after SCI resulted in marked atrophy of functionally intact muscle above the level of lesion, and worsened atrophy of paralyzed muscle below the level of lesion, associated with elevations in expression of four genes involved in pathways associated with muscle atrophy.

High dose corticosteroid therapy is widely used as attack therapy of inflammatory central nervous system disorders and can induce several adverse reactions. Bradycardia is an infrequent event after corticosteroids administration and is often asymptomatic. We report a case of a woman admitted to the neurological department of our hospital for paraesthesias of the lower limbs. She received adiagnosis of inflammatory myelitis and high dose corticosteroid therapy was prescribed. During the therapy she complained of chest tightness, dyspnoea, weakness and malaise. An electrocardiogram revealed sinus bradycardia. A significant increase in body weight, probably due to plasma volume expansion, was detected. Bradycardia and high blood pressure spontaneously resolved in few days. We provide a collection and a statistical analysis of literature data about steroid induced bradycardia. We found that higher total doses are associated with lower pulse rate and symptomatic bradycardia. Bradycardia is more frequent in older patients and those with underlying cardiac disease or with autonomic disturbance. However clinicians must be aware about the occurrence of symptomatic bradycardia in all patients who undergo high dose corticosteroid therapy, not only in those at risk, to early detect and treat this potentially dangerous condition.

OBJECTIVES: To study the prevalence and the risk factors for surgical site infection in patients who underwent posterior instrumented surgery for thoracolumbar burst fractures. METHODOLOGY: Retrospective review of cases operated between year 2006 and 2007. The final end point is the detection of surgical site infection within one year. RESULTS: A total of 38 cases were reviewed. Surgical site infection occurred in 5 cases. Only one had deep infection. The onset of infection occurred within one month in all cases. The risk factors studied were smoking, timing of surgery, duration of surgery, neurological deficit, associated injuries and high dose methylprednisolone administration. None of them were statistically significant as risk factors for surgical site infection. CONCLUSION: The prevalence of surgical site infection in patients who underwent posterior instrumented surgery for thoracolumbar burst fractures was 13%.

The optimal salvage treatment for patients with chronic lymphocytic leukemia (CLL) who have failed or relapsed shortly after treatment with purine-analogue based treatment remains undefined. This i...

The pharmacological armamentarium for the treatment of SLE is expanding and a number of novel therapies are currently under investigation. In spite of this, steroid therapy remains the cornerstone of treatment and intravenous methylprednisolone (IVMP) is still widely used in clinical practice. There is however surprisingly little evidence on which to define its precise role. The objective of this review was to consider the published evidence relating to the use of IVMP in SLE patients and also to identify open questions that still need to be answered with regard to its use.In acute flares, IVMP induces rapid suppression of acute inflammation. There is not however a strong evidence base to support the use of high doses compared to low IVMP doses or oral prednisolone. In maintenance regimes, secondary analyses suggest that IVMP may confer additional long-term renal survival over oral steroids as part of a cyclophosphamide regime. Therefore, in addition to the evaluation of novel therapies for SLE, better evidence to define the precise role of IVMP in SLE is still required. ( Lupus (2007) 16, 387—393)

非体外循環下冠動脈バイパス術(off-pump coronary-artery bypass grafting, off-pump CABG)術後に原因不明の強い全身性炎症を示し多臓器障害を呈したが,大量のコルチコステロイド投与により劇的に改善した症例を経験したので報告する。症例は72歳男性,既往症は高血圧,59歳時にCABG,70歳時に腹部大動脈瘤に対して人工血管置換術を受けた。今回増悪する狭心症に対してoff-pump CABGを受けたが,術後3日目より高熱,白血球増多,CRP高値を呈し,ショック,腎不全,高ビリルビン血症を合併した。アレルギー性疾患,感染症は否定的であった。術後12日目に,炎症の治療目的で,メチルプレドニゾロン500mgを3日間投与したところ,発熱,高炎症,多臓器障害は速やかに改善した。メチルプレドニゾロンの投与期間は25日間,その後,術後42日目に無事転棟となった。敗血症,ARDSなどの重症患者に対する高用量ステロイド投与による予後改善は現在否定されているが,今回のように全身性炎症状態のみが病態をなしている場合には有効でありうると考えた。

We read with great interest the recent study by Michallet et al. [1] who treated autoimmune cytopenias in 48 patients with chronic lymphocytic leukemia (CLL) with a combination of rituximab, cyclop...

Spinal epidural hematoma (SEH) is rare and not without serious sequelae. We report a patient who developed Brown-Séquard syndrome from SEH after fluoroscopic-guided cervical steroid injection and favorable response to methylprednisolone (MP). A 56-year-old man reported immediate sharp shooting pain to the upper extremities on introduction of epidural toughy needle. A total of 5 mL of 0.2% ropivacaine and 120 mg methylprednisolone acetate suspension was administered at the C6-7 interspace. Within half an hour, a neurologic deficit occurred at C7-8 and right Brown-Séquard syndrome developed. Once SEH was suspected (3 hours after onset of neurologic deficit), a protocol of high-dose MP intravenous infusion was initiated. Immediate incomplete recovery of motor, sensory, and sphincteric functions was noted within 30 minutes of infusion. Emergency spinal C6-T2 bilateral decompressive laminectomies and evacuation SEH were performed within an expected delay (10 hours from the onset of neurologic deficit). Fluoroscopic guidance does not take the place of adherence to meticulous technique. An unexplained neurologic deficit after invasive spinal procedures should raise the concern for SEH. Early recognition and emergent evacuation remain the mainstay management for SEH. This case suggests some neuroprotection from MP in cases of cervicothoracic cord compression secondary to traumatic SEH. When potential risks for SEH exist, it is advisable not to administer local anesthetic so as not to interfere with neurologic assessment and delaying the diagnosis.

Spinal cord injury (SCI) is a devastating neurological disorder that affects thousands of individuals each year. Over the past decades an enormous progress has been made in our understanding of the molecular and cellular events generated by SCI, providing insights into crucial mechanisms that contribute to tissue damage and regenerative failure of injured neurons. Current treatment options for SCI include the use of high dose methylprednisolone, surgical interventions to stabilize and decompress the spinal cord, and rehabilitative care. Nonetheless, SCI is still a harmful condition for which there is yet no cure. Cellular, molecular, rehabilitative training and combinatorial therapies have shown promising results in animal models. Nevertheless, work remains to be done to ascertain whether any of these therapies can safely improve patient's condition after human SCI. This review provides an extensive overview of SCI research, as well as its clinical component. It starts covering areas from physiology and anatomy of the spinal cord, neuropathology of the SCI, current clinical options, neuronal plasticity after SCI, animal models and techniques to assess recovery, focusing the subsequent discussion on a variety of promising neuroprotective, cell-based and combinatorial therapeutic approaches that have recently moved, or are close, to clinical testing., The authors would like to acknowledge the Portuguese Foundation for Science and Technology (grant no. PTDC/SAU-BMA/114059/2009; pre-doctoral fellowship to Nuno Silva - SFRH/BD/40684/2007); the Foundation Calouste de Gulbenkian for funds attributed to A.J. Salgado under the scope of the Gulbenkian Program to Support Research in the Life Sciences; co-funded by Programa Operacional Regional do Norte (ON.2-0 Novo Norte), ao abrigo do Quadro de Referencia Estrategico Nacional (QREN), atraves do Fundo Europeu de Desenvolvimento Regional (FEDER).

Serum granulocyte colony-stimulating factor (G-CSF) level were measured for 24 h in 6 patients with hematological disorders and two patients with Graves' disease associated with malignant exophthalmos after iv infusion of high-dose methylprednisolone (HDMP) (20 mg/kg BW) for 2 h starting at 0900 h. Saline solution (500 ml) was infused iv for 2 h as a control on two days before starting the HDMP therapy. Serum G-CSF levels increased with the mean peak values at 4 h after the HDMP therapy (mean +/- SD: 488.1 +/- 125.8 pg/ml vs. saline control 74.4 +/- 21.9 pg/ml, P0.01). Circulating absolute neutrophil counts (ANC) also increased with the mean peak values at 24 h after the HDMP (6,057 +/- 1,460 / microliters vs. saline control 2,007 +/- 390 / microliters, P0.025). These findings indicate that glucocorticoid has a stimulating effect on G-CSF release and that the increased G-CSF release could be involved, at least partly, in neutrophilia induced by glucocorticoid.

Objective—To determine whether parenteral l-alanyl-l-glutamine (Ala-Gln) administration modulated phagocytic responses of polymorphonuclear neutrophilic leukocytes (PMNs) from dogs undergoing high-dose methylprednisolone sodium succinate (MPSS) treatment. Animals—15 healthy Beagles. Procedures—Dogs were randomly assigned to 3 treatment groups (n = 5/group): 38-hour IV infusion of saline (0.9% NaCl) solution (control group), saline solution with 8.5% amino acids (2.3 g/kg/d), or saline solution with 8.5% amino acids (1.8 g/kg/d) and 20% l-alanyl-l-glutamine (Ala-Gln; 0.5 g/kg/d). High-dose MPSS treatment was initiated at the same time that IV infusions began, such that a total dose of 85 mg of MPSS/kg was administered through multiple IV injections over a 26-hour period. The infusions were maintained until 12 hours after the last MPSS injection. Blood samples collected before MPSS injections began and 2, 12, and 24 hours after injections ceased were used to evaluate PMN function. Results—MPSS injections resulted in an increase in the total number of circulating leukocytes and increases in neutrophil and monocyte counts but did not affect lymphocyte, eosinophil, or basophil counts. Lymphocyte counts in the Ala-Gln group were higher than in the control group 12 hours after MPSS injections finished. Relative to preinfusion values, phagocytic capacity, oxidative burst activity, and filamentous actin polymerization of PMNs were suppressed in all dogs except those that received Ala-Gln. Conclusions and Clinical Relevance—Parenteral Ala-Gln administration in dogs resulted in an increase in PMN phagocytic responses that were suppressed by high-dose MPSS treatment.

Background: To report a successful treatment case of endogenous fungal endophthalmitis caused by corticosteroid impulse therapy and the cultures are always negative for fungi. Methods: Systemic antifungal treatment and full ophthalmic examination including B-scan ultrasonography, fundus photograph and indocyanine green angiography. Results: The visual acuity recovered from 0.2 to 0.8. B-scan ultrasonography revealed the largest irregular apophysis which disappeared finally. Both fundus photograph and indocyanine green angiography showed the chorioretinal lesions disappearing. Conclusion: Endogenous fungal endophthalmitis caused by corticosteroid impulse therapy is noteworthy and under this situation antifungal treatment should be considered even if the culture is negative for fungi.

The spinal cord-injured patient has presented a dilemma for nursing care since the earliest survivor of such an injury. Recent research has identified a means of improving neurologic recovery for these patients. Proper administration of high-dose MP within 8 hours after injury provides the patient with the best potential for improvement. Ensuring immobilization and prevention of the complications of immobility are the next most significant actions the nurse can undertake to assist such a patient through a devastating injury toward optimal functional outcome. With continued research and education of caregivers, the residual effects of spinal cord injury may be further abated.