Assuntos
Injúria Renal Aguda/induzido quimicamente , Anti-Inflamatórios não Esteroides/efeitos adversos , Rim/efeitos dos fármacos , Dor/tratamento farmacológico , Adolescente , Anti-Inflamatórios não Esteroides/uso terapêutico , Criança , Feminino , Humanos , Rim/diagnóstico por imagem , Testes de Função Renal , Masculino , Cintilografia , Pentetato de Tecnécio Tc 99m , UltrassonografiaRESUMO
Lymphoproliferative disease (LPD) is a well-recognized complication of both solid organ and bone marrow transplantations. The occurrence of LPD in these settings is related in part to the use of the immunosuppressive agent cyclosporine. We report 12 cases of LPD after orthotopic liver transplantations in 132 pediatric patients. Lymphoproliferative disease occurred as one of three clinical syndromes: (1) lymphadenopathic, (2) systemic, and (3) lymphomatous. Effective management of LPD with excisional therapy or reduction of immunosuppressive medications or both resulted in the survival of 7 of 12 patients. In an alarming and increasing percentage of patients after orthotopic liver transplantation, progressive LPD develops with lethal outcome (5/12 patients). Early recognition of LPD and aggressive intervention may improve outcome in this group.
Assuntos
Ciclosporinas/efeitos adversos , Infecções por Herpesviridae/etiologia , Herpesvirus Humano 4 , Transplante de Fígado/efeitos adversos , Transtornos Linfoproliferativos/etiologia , Complicações Pós-Operatórias/etiologia , Criança , Pré-Escolar , Infecções por Herpesviridae/diagnóstico , Infecções por Herpesviridae/epidemiologia , Infecções por Herpesviridae/mortalidade , Humanos , Lactente , Transplante de Fígado/mortalidade , Transplante de Fígado/estatística & dados numéricos , Transtornos Linfoproliferativos/diagnóstico , Transtornos Linfoproliferativos/epidemiologia , Transtornos Linfoproliferativos/mortalidade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/mortalidade , Fatores de RiscoRESUMO
During the past several years, we treated seven children with Kawasaki disease who developed a distinctive but rarely described perineal rash. This rash began three to four days from onset of the illness and desquamated in all instances by days 5 to 7. The presence of this rash may facilitate early diagnosis of Kawasaki disease and, hence, may influence the initiation of early treatment.
Assuntos
Exantema/etiologia , Síndrome de Linfonodos Mucocutâneos/complicações , Períneo , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Síndrome de Linfonodos Mucocutâneos/patologiaAssuntos
Centros Médicos Acadêmicos , Pediatria , Encaminhamento e Consulta , Criança , Humanos , Pennsylvania , Papel do MédicoRESUMO
Between March 3, 1981, and June 1, 1984, 216 children were evaluated for orthotopic liver transplantation. Of the 216 patients, 117 (55%) had received at least one liver transplant by June 1, 1985. Fifty-five (25%) died before transplantation. The 117 patients who received transplants were grouped according to severity of disease and degree of general decompensation at the time of transplantation. The severity of a patient's medical condition with the possible exception of deep hepatic coma, did not predict outcome following orthotopic liver transplantation. Seventy variables were assessed at the time of the evaluation. Twenty-three of the 70 variables were found to have prognostic significance with regard to death from progressive liver disease before transplantation. These 23 variables were incorporated into a multivariate model to provide a means of determining the relative risk of death among pediatric patients with end-stage liver disease. This information may allow more informed selection of candidates awaiting liver transplantation.
Assuntos
Transplante de Fígado , Assistência Ambulatorial , Pré-Escolar , Feminino , Seguimentos , Encefalopatia Hepática/etiologia , Hospitalização , Humanos , Lactente , Unidades de Terapia Intensiva , Hepatopatias/mortalidade , Hepatopatias/fisiopatologia , Hepatopatias/cirurgia , Hepatopatias/terapia , Masculino , Modelos Biológicos , Prognóstico , Fatores de RiscoRESUMO
The new immunosuppressive agent, cyclosporin A, was used with low doses of steroids to treat eight patients undergoing hepatic transplantation and three patients undergoing cadaveric renal transplantation. Seven of the eight liver recipients are well, including one who was given two livers. The three kidney recipients who had developed cytotoxic antibodies after previously rejecting grafts with conventional immunosuppressive therapy, have had good results despite conditions which usually preclude attempts at transplantation. The ability to control rejection effectively and safely without chronic high-dose steroid therapy may make the described therapeutic regimen valuable for pediatric recipients of whole organs.
Assuntos
Ciclosporinas/uso terapêutico , Hidrocortisona/administração & dosagem , Transplante de Rim , Transplante de Fígado , Prednisona/administração & dosagem , Adolescente , Procedimentos Cirúrgicos do Sistema Biliar , Criança , Pré-Escolar , Feminino , Humanos , Tempo de Internação , Testes de Função Hepática , Masculino , Complicações Pós-Operatórias , ReoperaçãoRESUMO
In order to evaluate the role of lactose malabsorption in children with recurrent abdominal pain, we performed a prospective controlled double-blinded study in 40 children with RAP of at least three months' duration. Children were studied for lactose malabsorption by breath hydrogen determinations after ingestion of lactose (2 gm/kg of body weight; maximum 50 gm). Lactose malabsorbers were retested with 12.5 gm lactose; lactose absorbers were retested with lactose for ability to produce hydrogen. All children underwent a dietary trial which included two lactose elimination periods. Although 12 children (30%) were lactose malabsorbers, only three malabsorbed part of the smaller, more physiologic, lactose load. Improvement rates of lactose malabsorbers and absorbers during lactose elimination were not significantly different as judged by their physicians and as determined by a 50% or more decrease in pain frequency. These results suggest that lactose malabsorption is of little importance in children with RAP.