RESUMO
OBJECTIVE: To examine the relationship between hepatotoxic risk factors and liver histopathology in patients with juvenile rheumatoid arthritis (JRA) treated with methotrexate (MTX). STUDY DESIGN: We graded the histology of 33 percutaneous liver biopsy specimens from 25 patients with JRA treated at Children's Hospital Medical Center, Cincinnati, Ohio, using the Roenigk Classification Scale. Stepwise linear and logistic regression analyses were performed to examine the relationship of the Roenigk grade and presence of liver fibrosis of biopsy specimens with potential risk factors. RESULTS: Twenty-seven biopsy specimens (82%) were classified as grade I, 4 (12%) as grade II, and 2 (6%) as grade IIIA; none demonstrated significant fibrosis. The frequency of biochemical abnormalities (P <.001) and body mass index (P =.05) were the only risk factors found to significantly relate to the Roenigk grade. The following factors were not significantly associated with the Roenigk grade: age, gender, disease duration, JRA subtype and course, duration of MTX administration, weekly MTX dose, cumulative dose of MTX, route of MTX administration, use of folic acid supplementation, concurrent use of other medications, and potential hepatotoxic comorbidities. CONCLUSIONS: Serial biochemical abnormalities are significantly associated with Roenigk grade and the presence of liver fibrosis. These findings concur with studies of patients with rheumatoid arthritis, suggesting that guidelines for monitoring MTX hepatotoxicity in rheumatoid arthritis may be applicable to patients with JRA.
Assuntos
Artrite Juvenil/tratamento farmacológico , Artrite Juvenil/patologia , Fígado/patologia , Metotrexato/efeitos adversos , Adolescente , Adulto , Artrite Juvenil/classificação , Índice de Massa Corporal , Criança , Feminino , Seguimentos , Humanos , Fígado/efeitos dos fármacos , Modelos Logísticos , Masculino , Fatores de RiscoAssuntos
Cardiomegalia/etiologia , Hipertensão/etiologia , Síndromes da Apneia do Sono/complicações , Cardiomegalia/diagnóstico , Cardiomegalia/genética , Cardiomegalia/patologia , Pré-Escolar , Diagnóstico Diferencial , Humanos , Hipertensão/diagnóstico , Hipertensão/genética , Hipertensão/patologia , Masculino , Miocárdio/patologia , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/genética , Síndromes da Apneia do Sono/patologiaRESUMO
Twenty-nine of 60 boys with acute lymphoblastic leukemia survived for more than 30 months and were potential candidates for discontinuation of therapy. Six patients developed overt clinical testicular leukemia: one at 34 months from diagnosis while receiving therapy and five at three to 17 months after therapy was stopped. Elective wedge biopsy of the testes has become part of the evaluation prior to discontinuation of therapy since 1977. Six of 18 boys had microscopic evidence of leukemic infiltration of the testes: four with diffuse involvement and two with focal clusters of leukemic cells. Testicular biopsy is recommended at the time of discontinuation of therapy and perhaps early in the course of the disease, although a negative biopsy does not exclude some focal lesions. The eventual outcome of those with occult testicular leukemia remains to be determined.
Assuntos
Leucemia Linfoide , Neoplasias Testiculares/secundário , Criança , Pré-Escolar , Humanos , Leucemia Linfoide/patologia , Leucemia Linfoide/terapia , Masculino , Neoplasias Testiculares/patologia , Neoplasias Testiculares/terapia , Testículo/patologiaRESUMO
Thirty-one neonates with early onset of serious group B streptococcal infections were observed in a four-year period. The mortality was 52%. Premature infants with clinical signs of respiratory distress syndrome were at highest risk of death; clinical signs of RDS were typical until apnea, shock, respiratory failure, and worsening of the radiographic pattern unexpectedly intervened. Pathologic material from infants with radiographic evidence either of RDS or of pneumonia showed both typical hyaline membrane disease and pneumonia in most instances. Factors which may be helpful in recognizing premature infants at risk for GBS disease in the much larger group of premature infants with uncomplicated RDS include: history of artificial, premature, or prolonged rupture of membranes; localized pulmonary infiltrates on chest roentgenogram; low absolute neutrophil count; and an unusually rapid progression of RDS.