methyl-prednisolonate and Chronic-Disease

Chronic ITP rarely presents with severe bleeding episodes (SBE). Number and duration of SBE were evaluated in relation to the cost of management. Out of 157 chronic ITP patients attending our institution from 1994 to 2003, 37 patients, <16 years with persistent thrombocytopenia (>6 months), suffering from SBE or platelet count<10x10(9)/L were prospectively randomized to receive either intravenous immunoglobulins (IVIG), anti-D immunoglobulin (anti-D) or high-dose methyl prednisolone (HDMP). Sixty-one patient-years were followed, during which 351 SBE were documented. The high-cost management (IVIG and anti-D) showed insignificantly better platelet recovery, less frequent SBE with shorter duration per patient, higher rate of CR, and less splenectomy in contrast to the steroid groups. The effectiveness of high-cost management compared with methyl prednisolone could not be documented in this study.

Topics: Adolescent; Child; Chronic Disease; Cost of Illness; Disease Management; Drug Administration Schedule; Egypt; Follow-Up Studies; Health Care Costs; Humans; Immunoglobulins, Intravenous; Isoantibodies; Platelet Count; Prednisolone; Prospective Studies; Purpura, Thrombocytopenic, Idiopathic; Rho(D) Immune Globulin; Severity of Illness Index; Treatment Outcome

Pediatricians are often faced with both bad temper and decreased daily activity in children with persistent nephrotic syndrome. These problems, which might affect both mental and physical development, have been explained as a consequence of general fatigue due to systemic edema and/or long-term hospitalization. However, other factors, such as cerebral hypoperfusion, may be involved. We experienced a case of a boy with steroid-resistant nephrotic syndrome who showed diffuse cerebral hypoperfusion on single photon emission computed tomography. Diffuse cerebral hypoperfusion dramatically resolved as the nephrotic syndrome remitted. His bad temper, decreased daily activity, and delay of speech and motor development also improved. In our patient, cerebral hypoperfusion might have been associated with his mental problems, physical problems, and delayed development of speech.

Topics: Cerebral Cortex; Cerebrovascular Circulation; Child, Preschool; Chronic Disease; Cyclosporine; Developmental Disabilities; Electroencephalography; Humans; Hypoxia-Ischemia, Brain; Magnetic Resonance Imaging; Male; Mood Disorders; Nephrotic Syndrome; Prednisolone; Recovery of Function; Tomography, Emission-Computed, Single-Photon; Treatment Outcome