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 & dosagemAssuntos
Anemia Falciforme/complicações , Bile , Colelitíase/etiologia , Criança , Pré-Escolar , Colelitíase/terapia , Humanos , Jamaica , Estados UnidosAssuntos
Humanos , Criança , Pré-Escolar , Anemia Falciforme/complicações , Bile , Colelitíase/etiologia , Colelitíase/terapia , Jamaica , Estados UnidosRESUMO
We measured serum glucose and insulin levels in 15 children older than 2 years of age for 30 minutes after abrupt discontinuation of total parenteral nutrition. Initially high insulin levels rapidly became normal, and glucose levels were stable after 15 minutes. No patient had biochemical or symptomatic hypoglycemia. Glucose infusion rate, age, or use of steroid therapy had no apparent influence. Abrupt discontinuation of total parenteral nutrition is safe in most children older than 2 years of age.
Assuntos
Glicemia/análise , Glucose/administração & dosagem , Insulina/sangue , Nutrição Parenteral Total , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Nutrição Parenteral Total/efeitos adversosRESUMO
Endoscopic retrograde cholangiopancreatography (ERCP) is a universally used diagnostic and therapeutic modality in adults with pancreaticobiliary tract disease; its use in children with similar problems has been limited. We have performed ERCP procedures in 39 children and adolescents (aged 6 months to 18 years; mean 12.5 years), using the standard adult and pediatric side-viewing endoscopes. In selected cases, ERCP manometric study of the sphincter of Oddi, endoscopic sphincterotomy, or balloon extraction of common bile duct stones was performed. Nineteen patients had significant or abnormal structural findings, including pancreas divisum (four patients); sclerosing cholangitis (three); and choledochal cyst, chronic pancreatitis, choledochocele, pancreatic pseudocyst, common bile duct stone, and sphincter of Oddi motor dysfunction (two each). In all instances in which patients required operation, ERCP examination provided specific anatomic detail that was useful for planning appropriate intervention. The only significant complication after ERCP was mild pancreatitis, which occurred in four patients and responded to supportive, short-term measures.
Assuntos
Doenças Biliares/diagnóstico por imagem , Colangiopancreatografia Retrógrada Endoscópica , Pancreatite/diagnóstico por imagem , Adolescente , Doenças Biliares/terapia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pancreatite/terapiaRESUMO
We studied the lower esophageal sphincter in 29 children with known or suspected gastroesophageal reflux using a sleeve sensor and micro pH electrode. Mean lower esophageal sphincter pressure for a ten-minute monitoring period was 19 +/- 13 mm Hg; however, considerable temporal variation occurred in each child. Gastroesophageal reflex was infrequently associated with a low basal sphincter pressure (< 5 mm Hg) but usually associated with an increase in intra-abdominal pressure or with transient inappropriate relaxation of the lower esophageal sphincter.
Assuntos
Esôfago/fisiopatologia , Refluxo Gastroesofágico/fisiopatologia , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Relaxamento Muscular , PressãoRESUMO
Two new pediatric examples of Caroli disease are reported; one was diagnosed by operative cholangiography and one by percutaneous transhepatic cholangiography. Although a variety of approaches may lead one to suspect the diagnosis, percutaneous transhepatic cholangiography is now the method of choice to establish the diagnosis.
Assuntos
Ductos Biliares Intra-Hepáticos/anormalidades , Discinesia Biliar/diagnóstico , Doenças da Vesícula Biliar/diagnóstico , Pré-Escolar , Colangiografia , Humanos , Masculino , SíndromeRESUMO
The accuracy of the serum ceruloplasmin level in distinguishing chronic active hepatitis from Wilson disease was compared to the 24-hour urinary copper excretion and hepatic copper content in 20 untreated patients with chronic active hepatitis and 25 with Wilson disease. Serum ceruloplasmin levels were decreased in five patients (25%) with chronic active hepatitis and were normal in seven patients (28%) with Wilson disease at the time of diagnosis. The 24-hour urinary copper excretion failed to provide accurate discrimination between the two groups, being elevated in all patients with Wilson disease and in five of eight patients with chronic active hepatitis studied. All patients with Wilson disease had hepatic copper levels greater than 400 microgram/gm dry weight, whereas patients with chronic active hepatitis had levels less than 300 microgram/gm dry weight. The discriminatory value of hepatic copper concentration makes this the most reliable test for differentiating chronic active hepatitis and Wilson disease in children and adolescents. The serum ceruloplasmin level may not be significantly accurate for definitive diagnosis in this age group.