Hepatocellular carcinoma associated with anabolic steroid therapy: report of a case and review of the Japanese literature

J Gastroenterol. 1996 Jun;31(3):450-4.

Hepatocellular carcinoma associated with anabolic steroid therapy: report of a
case and review of the Japanese literature.

Kosaka A, Takahashi H, Yajima Y, Tanaka M, Okamura K, Mizumoto R, Katsuta K.

Department of Surgery, Matsusaka City Hospital, Mie, Japan.

We report herein the case of a 35-year-old woman with aplastic anemia who
developed hepatocellular carcinoma after long-term therapy with oxymetholone. She
was treated with 60 mg/day of oxymetholone for 3 years (total dose 64.8 g).
Alpha-fetoprotein, hepatitis B surface antigen, and hepatitis C antibody were all
negative, but serum titers of carcinoembryonic antigen and carbohydrate antigen
were elevated. Lateral segmentectomy of the liver was performed. The
histopathological findings were compatible with those of multiple hepatocellular
carcinoma without liver cirrhosis. Three years since the operation, the patient
is doing well and no signs of tumor recurrence have been detected. According to
our review of Japanese cases of hepatocellular carcinoma associated with anabolic
steroid therapy, in all instances the tumors developed after long-term
administration of anabolic steroids for hematologic diseases. In patients under
long-term anabolic steroid therapy, routine screening of the liver by
ultrasonography and computed tomography should be performed to detect liver
tumors in the early stages.

Oxymetholone promotes weight gain in patients with advanced human immunodeficiency virus (HIV-1) infection

Br J Nutr. 1996 Jan;75(1):129-38.

Oxymetholone promotes weight gain in patients with advanced human
immunodeficiency virus (HIV-1) infection.

Hengge UR, Baumann M, Maleba R, Brockmeyer NH, Goos M.

Department of Dermatology, University of Essen, Germany.

The effect of the testosterone derivative oxymetholone alone or in combination
with the H1-receptor antagonist ketotifen, which has recently been shown to block
tumour necrosis factor alpha (TNF alpha), on weight gain and performance status
in human immunodeficiency virus (HIV) patients with chronic cachexia was
evaluated in a 30-week prospective pilot study. Thirty patients were randomly
assigned to either oxymetholone monotherapy (n 14) or oxymetholone plus ketotifen
(n 16). Patients receiving treatment were compared with a group of thirty
untreated matched controls, who met the same inclusion criteria. Body weight and
the Karnofsky index, which assesses the ability to perform activities of daily
life, and several quality-of-life variables were measured to evaluate response to
therapy. The average weight gain at peak was 8.2 (SD 6.2) kg (+ 14.5% of body
weight at study entry) in the oxymetholone group (P < 0.001), and 6.1 (SD 4.6) kg
(+10.9%) in the combination group (P < 0.005), compared with an average weight
loss of 1.8 (SD 0.7) kg in the untreated controls. The mean time to peak weight
was 19.6 weeks in the monotherapy group and 20.8 weeks in the combination group.
The Karnofsky index improved equally in both groups from 56% before to 67% after
20 weeks of treatment (P < 0.05). The quality of life variables (activities of
daily life, and appetite/nutrition) improved in 68% (P < 0.05) and 91% (P < 0.01)
of the treated patients respectively. Oxymetholone was safe and promoted weight
gain in cachectic patients with advanced HIV-1 infection. The addition of
ketotifen did not further support weight gain. These results suggest the need for
a randomized, double-blind, placebo-controlled multicentre trial.

Other therapies for wasting

GMHC Treat Issues. 1995 May;9(5):7-8, 12.

Other therapies for wasting.

Smart T.

AIDS: Individuals with wasting syndrome lose muscle or lean body mass rather than
body fat. Several possible alternatives to the approved drugs for AIDS-related
wasting are discussed. Ketotifen, an antihistamine approved in Europe, is a TNF
inhibitor. Anabolic steroids are testosterone derivatives designed to increase
strength and muscle. Although there are anecdotal reports of success with these
steroids, their long-term safety and efficacy have yet to be established in
placebo-controlled studies. An ongoing study at Mt. Sinai shows a statistically
significant effect on lean body mass in the first twelve men to complete the
study. Dehydroepiandrosterone (DHEA) is a hormone produced by the adrenal gland.
Although its role in the body is poorly understood; it may have immunologic
effects, and appears to influence metabolism. There have been no studies of
DHEA's effect on weight or body composition in people with AIDS-related wasting.
A study combining ketotifen and oxymetholone, the oral anabolic steroid, was
presented at the Ninth International AIDS Conference. Preliminary data from a
study combining ketotifen and oxymetholone showed that 18 out of 22 patients
gained an average of 11.4 pounds after treatment of an average of 3.9 weeks.
Finally, a trial of smoked marijuana versus the oral drug marinol for
AIDS-related wasting syndrome may be canceled. The Drug Enforcement
Administration (DEA) and the National Institute of Drug Abuse (NIDA) rejected the
Community Consortium of San Francisco's proposal to obtain officially sanctioned
cannabis.

Assessment of attentional bias and mood in users and non-users of anabolic-androgenic steroids

Drug Alcohol Depend. 1995 Mar;37(3):241-5.

Assessment of attentional bias and mood in users and non-users of
anabolic-androgenic steroids.

Bond AJ, Choi PY, Pope HG Jr.

Department of Psychiatry, Institute of Psychiatry, University of London, UK.

Forty-six male strength athletes took part in a study to measure the effects of
anabolic-androgenic steroids on attentional bias to aggressive cues. They were 16
current users of anabolic steroids, 16 former users and 14 non-users.
Testosterone, deca-durabolin and anadrol were the three most commonly taken
steroids during the last cycle. Users generally took 2-3 drugs during each cycle;
the average cycle lasted 8-11 weeks and they had completed 3-4 cycles. The
subjects completed visual analogue scales of current feelings and were presented
with a modified Stroop Colour Word Conflict Task containing sets of neutral,
verbally aggressive and physically aggressive words. Current users tended to rate
themselves more negatively. Users took longer than former users to name the
colours of all word sets but there were no significant differences between word
sets. Therefore, attentional bias did not differ between groups but current
steroid use produced subtle mood changes and slowed performance compared to users
not currently taking steroids.

Rupture of the triceps tendon associated with steroid injections.

Am J Sports Med. 1993 May-Jun;21(3):482-5.

Comment in:
    Am J Sports Med. 1995 Nov-Dec;23(6):778.

Rupture of the triceps tendon associated with steroid injections.

Stannard JP, Bucknell AL.

Orthopaedic Surgery Service, Brook Army Medical Center, Fort Sam Houston, Texas.

Rupture of the triceps mechanism is an uncommon injury that has been recognized
with increasing frequency in recent years. It has been proposed that such
injuries commonly accompany fractures of the radial head and must be actively
evaluated in the presence of such a fracture. We present a unique case of
isolated rupture of the triceps tendon in an athlete who was lifting weights.
This case was complicated by a history of olecranon bursitis that had been
treated with numerous local steroid injections, as well as a history of anabolic
steroid abuse. Both systemic steroids and local injections may predispose tendons
to rupture. Triceps tendon ruptures may result in uniformly good to excellent
results if recognized and treated surgically. This case also serves as a reminder
of the risks of treating inflamed tissues with local steroid injections,
especially in strength athletes who place high demands on their musculoskeletal
structures. Finally, this case documents a second case of triceps mechanism
rupture in an athlete who has abused anabolic steroids. A study by Hunter et al.
suggests that oral steroid abuse may be associated with detrimental effects on
the mechanical properties of connective tissue, demonstrating another negative
effect of anabolic steroid use in athletes.

A familial case of hereditary angioneurotic edema in Japan

Intern Med. 1992 Mar;31(3):353-6.

A familial case of hereditary angioneurotic edema in Japan.

Yamato H, Nakashima Y, Ninomiya K, Sakurai S, Kuroiwa A.

Second Department of Internal Medicine, University of Occupational and
Environmental Health, School of Medicine, Kitakyushu, Japan.

A 53-year-old man was admitted with impairment of breathing following laryngeal
edema. Serum levels of CH50 (22 U/ml), C4 (3 mg/dl), C1-INH protein (10.6 mg/dl)
and C1-INH activity (LT 25%) were low. Complement study of the patient's family
members revealed that he was one of 5 patients in 3 generations with hereditary
angioneurotic edema (HANE). Administration of the androgen derivatives Danazol
(600 mg/day) and Oxymetholone (30 mg/day) effectively increased serum levels of
C1-INH activity and C4. Though eruption and hepatic dysfunction attributable to
administration of the drugs appeared, these side effects improved after
withdrawal of the drugs. Subsequently, the treatment with Danazol at a low dose
(100 mg/day) was resumed, and the patient has had no episodes of edema for the
past 3 years. Regarding the familial cases of HANE, fewer than 20 have been
reported in Japan.

A clinico-haematologic profile of paroxysmal nocturnal haemoglobinuria

J Assoc Physicians India. 1991 Oct;39(10):741-3.

Comment in:
    J Assoc Physicians India. 1991 Oct;39(10):735-6.

A clinico-haematologic profile of paroxysmal nocturnal haemoglobinuria.

Saxena R, Malhotra OP, Saraya AK.

Department of Medicine, All India Institute of Medical Sciences, New Delhi.

Clinico-haematological parameters in sixteen patients of paroxysmal nocturnal
haemoglobinuria (PNH) are presented. Their modes of presentation included
recurrent episodes of cola-coloured urine (6/16), refractory anaemia (9/16) and
predominant thrombotic manifestations (1/16). Laboratory investigations revealed
the presence of anaemia (16/16), reticulocytosis (14/16), thrombocytopenia
(11/16), leucopenia (5/16) and cellular bone marrow (14/16). Two patients had
hypoplastic bone marrow initially but subsequently developed PNH. The patients
were treated with haematinics, prednisolone (16/16) and oxymethalone (2).
Prednisone was effective in suppressing haemolytic episodes. Oxymethalone given
to the 2 patients with hypoplastic bone marrow resulted in amelioration of
anaemia in one but no effect in the other patient.