High-dose corticosteroids in a parenteral pulse form were first used in renal transplant patients to prevent graft rejection. (2) Since then, pulsed high-dose corticosteroids have been used successfully for many systemic and cutaneous disorders. (3-13) A novel approach to minimize the side effects of corticosteroids has been suggested to give corticosteroids in a weekly pulse form (giving 5 mg betamethasone in a single morning dose after breakfast on 2 consecutive days every week) till the arrest (stoppage of progression) of the disease as well as amelioration of the signs and symptoms. (14) The weekly dose of the oral corticosteroids is reduced by mg every 2 to 4 weeks depending upon the severity of the condition. This form of weekly pulse therapy with CS has been called oral mini-pulse therapy (OMP) (14) to differentiate it from the parenteral corticosteroid pulse therapy successfully used for many autoimmune systemic as well as cutaneous diseases for more than 30 years now. (3-13) OMP has been successfully used in many steroid responsive dermatoses such as vitiligo, (14-15) alopecia areata, (16-18) myositis, (19) and even infantile hemangioma. (20) Most of these studies report a rapid arrest of progression of the condition and a low incidence of corticosteroid-related minor side effects in these patients. No acute or clinical side effects were noted in our patient. Hematological and clinical chemistry followed at monthly intervals did not reveal any abnormality in this patient. There was no weight gain or any other clinical side effect noted in this patient. OMP with corticosteroids has many advantages over daily or alternate day steroids such as less frequent dosing thus ensuring compliance and decreased risk of short- and long-term side effects associated with corticosteroid therapy. Controlled studies with corticosteroid OMP in a larger number of patients having LP and other steroid responsive dermatoses are required.
In fact, the anatomical studies have demonstrated that after the radicular medullary arteries enter the neuroforamen in the anterior aspect of exiting nerve root and dorsal root ganglion, they often travel a distance superiorly and laterally in the lateral epidural space to join the anterior spinal artery supplying the anterior two thirds of the spinal cord. Additionally, in about 63% of cases of cadaver studies, there is a posterior branch of the radicular medullary artery going to the dorsal aspect of the cauda equina. It is conceivable that the epidural needle in the interlaminar lumbar epidural steroid injection will very likely encounter the radicular medullar artery in the lateral aspect of the epidural space or midline posterior epidural space.
About 1/1000 people
will develop a serious eye infection. The day after the injection your eye should be comfortable, there should
be very little pain. If your eye starts to get red, with misty vision
may be no pain ), perhaps 2-5 days after the injection, you should
suspect an infection and attend your eye department urgently. In Birmingham
this is the Birmingham
and Midland Eye Centre Casualty at the
Birmingham & Midland Eye Centre, City Hospital, Dudley Road, Birmingham B18 7QH
Tel: 0121-554 3801. Avastin , infection..preventing .