RESUMO
Fifty-three children, aged 7 months to 14.4 years and with typical acute immune thrombocytopenic purpura and platelet counts < or = 20 10(9)/L, were randomly assigned to receive intravenously administered immune globulin G (IVIG), 1 gm/kg per day for 2 consecutive days (n = 19); orally administered prednisone, starting at a dose of 4 mg/kg per day, with tapering and discontinuation of corticosteroids by day 21 (n = 18); or no therapy (n = 16). Both IVIG and prednisone resulted in significantly fewer days with platelet counts < or = 20 x 10(9)/L in comparison with no therapy (median, 1 and 2 days vs 4 days; corresponding ranges, 1 to 20 and 1 to 11 days vs 1 to 132 days; p < 0.01). Reversal of clinically important thrombocytopenia assessed by the number of days taken to achieve a platelet count of > or = 50 x 10(9)/L was significantly faster in children randomly assigned to receive IVIG (median, 2 days; range, 1 to 34 days) than in those receiving prednisone (median, 4 days; range, 2 to 13 days; p < 0.001) or no therapy (median, 16 days; range, 2 to 132 days; p < 0.001). Because the risk of intracranial hemorrhage in children with acute immune thrombocytopenic purpura is highest in the group with severe thrombocytopenia, and appears to be restricted to children with platelet counts < or = 20 x 10(9)/L, these results support the use of IVIG or high doses of prednisone as initial therapy in children with acute immune thrombocytopenic purpura and severe thrombocytopenia (platelet counts < or = 20 x 10(9)/L).
Assuntos
Imunoglobulinas Intravenosas/uso terapêutico , Prednisona/uso terapêutico , Púrpura Trombocitopênica Idiopática/terapia , Administração Oral , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulinas Intravenosas/efeitos adversos , Lactente , Masculino , Contagem de Plaquetas , Prednisona/administração & dosagem , Prednisona/efeitos adversos , Estudos Prospectivos , Púrpura Trombocitopênica Idiopática/fisiopatologiaRESUMO
There is preliminary evidence that colchicine, an inhibitor of collagen synthesis, may be beneficial in the treatment of cirrhosis of the liver. To evaluate the use of colchicine (1 mg per day, five days per week) in the treatment of hepatic cirrhosis, we performed a randomized, double-blind, placebo-controlled trial in which 100 patients were followed for up to 14 years. Forty-five patients had alcoholic cirrhosis, 41 had posthepatitic cirrhosis, and the remaining 14 had cirrhosis with various other causes. Histologic studies were available for 92 percent of patients. Seventy-three patients were in Child-Turcotte class A, 26 were in class B, and one was in class C. Fifty-four patients received colchicine, and 46 received placebo. The overall survival in the colchicine group was markedly better than in the placebo group (median survival, 11 and 3.5 years, respectively; P less than 0.001). The cumulative 5-year survival rates were 75 percent in the colchicine group and 34 percent in the placebo group; the corresponding 10-year survival rates were 56 percent and 20 percent. Among the 30 patients treated with colchicine who underwent repeated liver biopsies, histologic improvement was seen in 9; the liver appeared normal in 2, and 7 had minimal portal fibrosis. No histologic improvement was observed in the 14 members of the placebo group who had two or more biopsies. Few side effects were observed in either group.
Assuntos
Colchicina/uso terapêutico , Cirrose Hepática/tratamento farmacológico , Ensaios Clínicos como Assunto , Colchicina/administração & dosagem , Colchicina/efeitos adversos , Método Duplo-Cego , Feminino , Seguimentos , Hepatite/complicações , Humanos , Cirrose Hepática/mortalidade , Cirrose Hepática Alcoólica/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Distribuição AleatóriaRESUMO
Administration of cyclosporine resulted in reduced insulin requirements and improved glycemic control in patients with insulin-dependent diabetes mellitus of recent onset, but the drug was less effective in young children. Renal toxic effects and other problems related to therapy resolved after discontinuation of the drug. Sustained remission seemed dependent on continued administration of cyclosporine. Although short-term control of diabetes may be achieved in some patients, more studies are needed to determine whether cyclosporine can be given safely as maintenance therapy to maintain glycemic control and prevent the long-term consequences of the disease.
Assuntos
Doenças Autoimunes/tratamento farmacológico , Ciclosporinas/uso terapêutico , Diabetes Mellitus Tipo 1/tratamento farmacológico , Adolescente , Adulto , Fatores Etários , Autoanticorpos/análise , Criança , Pré-Escolar , Ciclosporinas/efeitos adversos , Avaliação de Medicamentos , Teste de Tolerância a Glucose , Humanos , Lactente , Insulina/administração & dosagem , Ilhotas Pancreáticas/imunologia , Nefropatias/induzido quimicamente , Pessoa de Meia-Idade , Fatores de TempoRESUMO
A series of 1,704 infants of blood group O mothers have been studied to determine the relation between the degree of red cell sensitization and the cord hemoglobin and bilirubin concentrations. The infants with blood group A or B had significantly higher cord bilirubin and lower cord hemoglobin concentrations than the group O babies. Those infants whose red cells had the greatest evidence of sensitization had the highest bilirubin and lowest hemoglobin levels. The infants in whom no antibody was demonstrable on the red cells or in the red cell eluate also had significantly higher cord bilirubin and lower cord hemoglobin levels than the ABO compatible group; it is suggested that these infants had sufficient erythrocyte sensitization to produce mild hemolysis. ABO incompatibility represents a spectrum of hemolytic disease extending from those in which there is little laboratory evidence of erythrocyte sensitization, but evidence of hemolysis, to severe hemolytic disease in which erythrocyte sensitization is usually easily demonstrable.