RESUMO
OBJECTIVE: To evaluate the efficacy of oral tacrolimus as an induction agent in steroid-refractory severe colitis. STUDY DESIGN: Open-label, multicenter trial of oral tacrolimus in patients with severe colitis. Patients not responding to conventional therapy received tacrolimus, 0.1 mg/kg/dose given twice a day, and the dosage was adjusted to achieve blood levels between 10 and 15 ng/mL. Response was defined as improvement in a number of clinical parameters (including abdominal pain, diarrhea, rectal bleeding, and cessation of transfusions). Patients who responded by 14 days continued to receive tacrolimus, and 6-mercaptopurine or azathioprine was added as a steroid-sparing agent 4 to 6 weeks after the tacrolimus was instituted. RESULTS: Fourteen patients were enrolled in the study. One patient elected to withdraw after 48 hours. Of the 13 remaining, 9 (69%) responded and were discharged. Tacrolimus was continued for 2 to 3 months in the responders, except for 1 patient who was given tacrolimus for 11 months. After 1 year of follow-up, only 5 (38%) patients were receiving maintenance therapy; the other 4 responders had undergone colectomy. CONCLUSION: Although tacrolimus is effective induction therapy for severe ulcerative or Crohn's colitis, fewer than 50% of patients treated will successfully achieve a long-term remission.
Assuntos
Colite Ulcerativa/tratamento farmacológico , Doença de Crohn/tratamento farmacológico , Imunossupressores/uso terapêutico , Tacrolimo/uso terapêutico , Adolescente , Adulto , Azatioprina/administração & dosagem , Azatioprina/uso terapêutico , Criança , Pré-Escolar , Quimioterapia Combinada , Feminino , Humanos , Imunossupressores/administração & dosagem , Lactente , Masculino , Mercaptopurina/administração & dosagem , Mercaptopurina/uso terapêutico , Estudos Prospectivos , Indução de Remissão , Índice de Gravidade de Doença , Tacrolimo/administração & dosagemRESUMO
Hepatotoxity associated with amoxicillin/clavulanic acid is usually a self-limited disease with complete recovery. We report a rapidly progressing liver disease with ductopenia and portal fibrosis in a 3-year-old boy treated with Augmentin.
Assuntos
Combinação Amoxicilina e Clavulanato de Potássio/efeitos adversos , Antibacterianos/efeitos adversos , Colestase/induzido quimicamente , Quimioterapia Combinada/efeitos adversos , Doenças dos Ductos Biliares/induzido quimicamente , Ductos Biliares Intra-Hepáticos/efeitos dos fármacos , Pré-Escolar , Toxidermias/etiologia , Humanos , Icterícia/induzido quimicamente , Fígado/efeitos dos fármacos , Cirrose Hepática/induzido quimicamente , MasculinoRESUMO
Sixty-three children with seizure disorders receiving phenobarbital and/or diphenylhydantoin for more than 12 months had liver function tests evaluated. All 56 whose serum anticonvulsant concentrations were in the therapeutic range had elevations of their serum gamma glutamyl transpeptidase activity. Of the 11 who had elevated SGOT and SGPT concentrations initially, six had persistent transaminase abnormalities for more than 20 weeks. Liver tissue from these six patients revealed by light microscopy uniform swelling of the hepatocytes without cell necrosis, inflammation, fibrosis, or disturbance of hepatic architecture. Electron microscopy demonstrated proliferation of the smooth endoplasmic reticulum without other ultrastructural alterations. All six patients were maintained on the same dosages of PB and/or DPH, and their transaminase activities returned to normal within eight to 14 months. The clinical well being of these patients, the transient nature of their SGOT and SGPT elevations, and the absence of specific histopathology suggest that chronic treatment with PB and/or DPH does not result in hepatotoxicity but rather in enzyme induction. The data indicate that liver biopsies are not warranted in such children and that PB and DPH may be continued despite mild elevations of SGOT and SGPT, without concern for hepatic damage.
Assuntos
Fígado/efeitos dos fármacos , Fenobarbital/efeitos adversos , Fenitoína/efeitos adversos , Convulsões/tratamento farmacológico , Adolescente , Adulto , Alanina Transaminase/biossíntese , Aspartato Aminotransferases/biossíntese , Criança , Pré-Escolar , Indução Enzimática/efeitos dos fármacos , Feminino , Humanos , Lactente , Fígado/enzimologia , Masculino , Nucleotidases/biossíntese , gama-Glutamiltransferase/biossínteseAssuntos
Detergentes/efeitos adversos , Icterícia Neonatal/induzido quimicamente , Fenóis/efeitos adversos , Animais , Bilirrubina/análise , Detergentes/farmacologia , Detergentes/toxicidade , Glucuronatos , Humanos , Recém-Nascido , Fenóis/farmacologia , Fenóis/toxicidade , Ratos , Ratos Endogâmicos , Transferases/análise , Transferases/antagonistas & inibidoresRESUMO
In children with extrahepatic biliary atresia, impaired hydroxylation and defective intestinal absorption of cholecalciferol may lead to a deficiency of vitamin D and rickets. The data presented herein demonstrate that in such patients serum levels of vitamin D measured as 25-hydroxycalciferol are reduced. A moderate therapeutic oral dose of 25-hydroxycholecalciferol, by circumventing the hepatic conversion of cholecalciferol to 25-hydroxycholecalciferol, will replete vitamin D stores and maintain the serum concentration of 25-hydroxycalciferol required to prevent or heal rickets in these patients.