ABSTRACT
The major pathogenesis of acute respiratory distress syndrome (ARDS) is an inflammatory process that results from a diversity of injuries to the body. Due to the various cytokines and vasoactive peptides released from the endothelium, the vascular permeability is increased; the migration of inflammatory cells and the leakage of plasma proteins then occur and edema develops in the alveolus. There is a hypothesis that the impairment of alveolar recruitment in ARDS is caused by a defect of the surfactant system and the resultant increase of alveolar surface tension. This has been studied in pediatric patients in ARDS; after the administration of surfactant, hypoxia, respiratory symptoms and survival chances were improved. To alleviate the major pathogenic mechanism in this disease, that is to say, inflammation of the lung, steroids have been used and studied as another treatment modality for ARDS, and it has been concluded that the administration of low dose methylprednisolone may improve patients' symptoms and survival rates. We report here on a case of a young infant admitted with ARDS, who, after the intratracheal administration of 120 mg/kg surfactant, on PaO(2)/FiO(2) was elevated. Subsequent low doses of methylprednisolone were given, and the symptoms did not recur, and no fibrotic change was shown during the follow-up period of 2 months.
Subject(s)
Humans , Infant , Hypoxia , Blood Proteins , Capillary Permeability , Cytokines , Edema , Endothelium , Follow-Up Studies , Inflammation , Lung , Methylprednisolone , Peptides , Respiratory Distress Syndrome , Steroids , Surface Tension , Survival RateABSTRACT
PURPOSE: The aim of this study was to review the clinical characteristics and treatment outcome of pancreatitis developed in 19 children with leukemia and lymphoma in Asan Medical Center. METHODS: Hospital and outpatient records of 19 children either with leukemia or lymphoma who developed acute pancreatitis were reviewed. Clinical characteristics of these patients along with serologic data were analysed. RESULTS: 1. Median age at diagnosis of pancreatitis in 19 patients was 11 years of age. 2. Patients had acute lymphocytic leukemia (12 cases; 53%), acute myelocytic leukemia (4 cases; 21%), non-Hodgkins lymphoma (3 cases; 16%). 3. The etiologies of pancreatitis were L-asparaginase (16 cases) therapy, continuous Ara-C therapy (2 cases) and gallbladder stone (1 case). 5. L-asparaginase realated pancreatitis developed during the course of CCG 1882 induction (7 cases), CCG 1901 onsolidation (4 cases), CCG 1901 induction (1 case), and ADCOMP induction (1 case). 6. All patients experienced abdomial pain. Nausea, fever, vomiting, abdominal distention and diarrhea were also manifested clinically. 7. Hypocalcemia, sepsis, ascites, hyperglycemia, diabetic ketoacidosis, pancreatic pseudocysts and fistula were complicating events. 8. 6 patients were dead. The causes of death were from progression of lymphoma/ leukemia itself in 5 cases. One patient died of regimen related toxicity. The period of follow-up ranged from 2 months to 6.6 years with median follow-up of 28 months. CONCLUSION: 1. It is neccessary to monitor the level of serum amylase and lipase or to perform radiologic evaluation in patients who develop abdominal pain during L-asparaginase and Ara-C therapy especially in the course of CCG 1882 induction and CCG 1901 consolidation. 2. The outcome of chemotherapy induced pancreatitis is favorable in most instances but in some patients chronic pancreatitis may remain. The delay of chemotherapy due to pancreatitis may be responsible for the relapse of cancer. Therefore, prompt diagnosis and aggressive supportive therapy are important.
Subject(s)
Child , Humans , Abdominal Pain , Amylases , Ascites , Cause of Death , Cytarabine , Diabetic Ketoacidosis , Diagnosis , Diarrhea , Drug Therapy , Fever , Fistula , Follow-Up Studies , Gallbladder , Hyperglycemia , Hypocalcemia , Leukemia , Leukemia, Myeloid, Acute , Lipase , Lymphoma , Lymphoma, Non-Hodgkin , Nausea , Outpatients , Pancreatic Pseudocyst , Pancreatitis , Pancreatitis, Chronic , Precursor Cell Lymphoblastic Leukemia-Lymphoma , Recurrence , Sepsis , Treatment Outcome , VomitingABSTRACT
PURPOSE: Childhood pancreatitis has more various and somewhat different etiology than adult. Until now the analysis of severity in childhood pancreatitis were not well-known, although several studies have been made. Therefore, we studied the etiology and complications in childhood pancreatitis and analyzed whether Ranson and CT criteria could be applicated to evaluate the severity of childhood pancreatitis patients. METHODS: The records of 30 patients with pancreatitis under 15 years of ages who were diagnosed in Asan medical center were reviewed. Age, sex, history, etiology, clinical features and treatment was reviewed in all patients but complications, Ranson and CT criteria were available in only 12 patients. Correlation between the number of complications and both Ranson and CT criteria were calculated with Spearman correlation coefficient. RESULTS: 1. Median age at diagnosis was 7.3 years of age. 28 cases were acute pancreatitis and 2 cases were chronic pancreatitis. 2. Etiology: choledochal cyst(8 cases), drug (7 cases), trauma (4 cases), infection (3 cases), biliary stone or bile sludge (3 cases), idiopathic (2 cases) Hemolytic uremic syndrome, pancreatic duct obstruction, iatrogenic (1 case). 3. Local complications were ascites (5 cases), pseudocyts (4 cases) and systemic complications were hyperglycemia (4 cases), hypocalcemia (3 cases), pleural effusion (3 cases), etc. 4. Positive correlation was found between the number of complication and Ranson creteria (r=0.78, P=0.0016) and between the number of complication and CT criteria (r=0.65, P=0.015) in 13 cases. CONCLUSION: A trial to search the biliary duct anomaly may help to find the causes of childhood idiopathic pancreatitis, and both Ranson and CT criteria can be applicated to pediatric patients to evaluate the severity of childhood pancreatitis.