mercaptopurine and Intestinal-Perforation

To review the optimal strategy to prevent recurrence of Crohn's disease (CD) after surgery, with particular emphasis on the risk factors that predict postoperative recurrence, methods of monitoring for recurrence and medications used to prevent postoperative recurrence.. MEDLINE and the Cochrane Library were searched for clinical trials and meta-analyses that studied postoperative recurrence and prophylactic medications in CD.. The most significant factor that predicted postoperative recurrence was patient smoking status. Smokers had an increased risk of recurrence (odds ratio = 2.15; 95% confidence interval (CI) = 1.42-3.27). Similarly, perforating CD appeared to be associated with a higher recurrence rate compared with nonperforating CD (hazard ratio = 1.50; 95% CI = 1.16-1.93). The optimal monitoring strategy for postoperative recurrence has yet to be established. Nonetheless, ileocolonoscopy is considered to be the gold standard. Noninvasive imaging techniques including contrast ultrasonography and capsule endoscopy appear to be useful for postoperative monitoring. A number of meta-analyses found that mesalazine, nitroimidazole antibiotics and purine analogues (azathioprine/6-mercaptopurine) significantly reduced the risk of postoperative recurrence when compared with placebo. Additionally, recent randomized controlled trials have suggested that an early intervention with infliximab is likely to prevent recurrence after ileocolonic resection. Likewise, in prospective studies, biological therapy (infliximab/adalimumab) reduced clinical and endoscopic CD activity in patients with early endoscopic recurrence after surgery.. Although additional evidence is necessary, endoscopic monitoring and treatment step-up should be used to prevent postoperative recurrence of CD.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Antibodies, Monoclonal; Azathioprine; Colectomy; Colon; Colonoscopy; Crohn Disease; Humans; Ileum; Immunosuppressive Agents; Infliximab; Intestinal Perforation; Mercaptopurine; Mesalamine; Nitroimidazoles; Odds Ratio; Proportional Hazards Models; Risk Factors; Secondary Prevention; Smoking; Treatment Outcome

Topics: Adult; Azathioprine; Child; Child, Preschool; Cyclophosphamide; Glucocorticoids; Humans; Hydrocortisone; Intestinal Perforation; Intussusception; Kidney Diseases; Laparotomy; Mercaptopurine; Prednisone; Purpura

The histological diagnosis of non-Hodgkin's lymphoma (Burkitt's lymphoma excluded) in 147 children was reviewed. The most common site of presentation was in the abdomen (32.6%). The most frequent site of metastatic disease at diagnosis was the bone marrow (27.2%). The most common histology was diffuse undifferentiated non-Burkitt type (37.4%). According to the Murphy staging system, 40.1% were stage III and 27.2% were stage IV. In a nonrandomized prospective study, 121 patients were submitted to a treatment regimen (protocol 8001) and compared with 26 historical controls treated with the COP regimen, consisting of cyclophosphamide, vincristine, and prednisone. Of those patients treated with protocol 8001, nine had intestinal perforation at the site of primary disease. All patients in this group were malnourished at the time of perforation. The overall rate of initial complete remission in those patients treated with protocol 8001 was 90.7%. The duration of remission was from 16 to 108 months, with a median of 39 months. The actuarial rate of disease-free survival was 69% at 2 years and 63% at 6 years, compared with 36% at 6 years of the control group (COP) (p less than 0.01). None of the patients have relapsed after 4 years.

Topics: Adolescent; Antineoplastic Combined Chemotherapy Protocols; Asparaginase; Child; Child, Preschool; Clinical Trials as Topic; Cyclophosphamide; Cytarabine; Female; Humans; Hydrocortisone; Intestinal Perforation; Lymphoma, Non-Hodgkin; Male; Mercaptopurine; Methotrexate; Nutrition Disorders; Prednisone; Vincristine

Crohn's disease (CD) is a chronic inflammatory bowel disease (IBD) with uncertain etiopathogenesis. CD can involve any site of gastrointestinal tract from the mouth to anus and is associated with serious complications such as bowel strictures, perforations, and fistula formation. The incidence and prevalence rates of CD in Korea are still lower than those of Western countries, but have been rapidly increasing during the past decades. Although there are no definitive curative modalities for CD, various medical and surgical therapies are currently applied for diverse clinical situations of CD. However, a lot of decisions on the management of CD are made depending on the personal experiences and choices of physicians. To suggest preferable approaches to diverse problems of CD and to minimize the variations according to physicians, guidelines for the management of CD are needed. Therefore, IBD Study Group of the Korean Association for the Study of the Intestinal Diseases has set out to develop the guidelines for the management of CD in Korea. These guidelines were developed using the adaptation methods and encompass the treatment of inflammatory disease, stricturing disease, and penetrating disease. The guidelines also cover the indication of surgery, prevention of recurrence after surgery, and CD in pregnancy and lactation. These are the first Korean guidelines for the management of CD and the update with further scientific data and evidences is needed.

Topics: Anti-Inflammatory Agents; Antibodies, Monoclonal; Antimetabolites, Antineoplastic; Budesonide; Crohn Disease; Databases, Factual; Female; Fistula; Humans; Infliximab; Intestinal Perforation; Male; Mercaptopurine; Mesalamine; Methotrexate; Prednisolone; Pregnancy; Recurrence; Risk Factors; Severity of Illness Index; Sulfasalazine

We report a case of 53-year-old man with acute myelogenous leukemia (M2) showing a karyotype of t(7;11) (p15;p15), del(10) (q11;q12), who was complicated with perforation of a duodenal ulcer during the antileukemic chemotherapy using behenoyl ara-C, daunorubicin, 6-mercaptopurine and prednisolone. As his bone marrow still showed high cell density and leukemic proliferation at the time of intestinal perforation, the therapeutic regimen was changed to a combination of behenoyl are-C and mitoxantrone, and daily rhG-CSF was concurrently administered for the purpose of early establishment of bone marrow hypoplasia. On the 8th day after the therapeutic regimen had been changed, his bone marrow became nearly aplastic, and complete remission was obtained on the 24th day. This case may indicate that the concurrent administration of cell-cycle specific antileukemic drugs and rhG-CSF is available for AML patients with emergent need of leukemic cell reduction.

Topics: Antineoplastic Combined Chemotherapy Protocols; Bone Marrow; Cytarabine; Daunorubicin; Duodenal Diseases; Granulocyte Colony-Stimulating Factor; Humans; Intestinal Perforation; Karyotyping; Leukemia, Myeloid, Acute; Male; Mercaptopurine; Middle Aged; Prednisolone; Recombinant Proteins; Remission Induction

Topics: Adult; Asparaginase; Breast Neoplasms; Cecal Diseases; Child; Cytarabine; Daunorubicin; Female; Fluorouracil; Humans; Intestinal Perforation; Leukemia; Male; Mercaptopurine; Methotrexate; Middle Aged; Necrosis; Prednisone; Thioguanine; Vincristine

Topics: Humans; Infant; Intestinal Perforation; Leukemia; Mercaptopurine; Methotrexate; Pathology; Stomach; Toxicology; Triamcinolone