ABSTRACT
Since introduce of antithyroid drugs (ATDs) in 1941, they have been widely used for treatment of Graves' disease and other hyperthyroid disorders. However, agranulocytosis, the most serious adverse effect of ATD treatment, has been occasionally reported. Agranulocytosis should be diagnosed and be treated promptly due to possible fatality.We have experienced a 17 year-old girl with PTU (propylthiouracil)-induced agranulocytosis. Initial graulocyte count was 400/mm2, and presenting symtoms were fever and sore throat. She has recovered from agranulocytosis without complications after use of G-CSF (granulocyte-colony stimulating factor). We reviewed and analyzed additional 7 cases of ATD-induced agranulocytosis in Yonsei University Hospital (From 1988 to 1998). We found that ATD-induced agranulocytosis, of which incidence is known to be ranged from 0.1 to 1 per cent, does not seem to have a distinct correlation with sex, age, dosage, and the kind of ATD. Event of agranulocytosis has a tendency to occur within 3 months, and in a few case it has been occasionally detected in asymptomatic patients, routine monitoring of the white blood cell count within 3 months after the start of ATD medication can be helpful in predicting and in detecting agranulocytosis. The treatment of ATD-induced agranulocytosis has been mainly composed of conservative care, but according to introduction and popular application of G-CSF, the use of G-CSF seems to be a promise of a reduction in morbidity and mortality.
Subject(s)
Adolescent , Female , Humans , Agranulocytosis , Antithyroid Agents , Fever , Granulocyte Colony-Stimulating Factor , Graves Disease , Incidence , Leukocyte Count , Mortality , PharyngitisABSTRACT
The blood sugar control has been a significant problem after transplantation. Cyclosporine is partly responsible for post-transplantation diabetes mellitus (PTDM), but steroid has been well known to have diabetogenic effect and mainly responsible for glucose intolerance after transplantation. Deflazacort, a new steroid, has been introduced as a substitute of conventional steroid to prevent glucose intolerance after transplantation. We performed prospective study of deflazacort conversion from conventional steroid in kidney transplant patients with pre-transplantation diabetes mellitus(pre-Tx DM) or PTDM. A total of 82 kidney transplant patients was included for this study. Forty two patients were converted to deflazacort as a conversion group and 40 patients were remained on conventional steroid as a control group. In conversion group, the patients were converted from steroid to deflazacort with ratio of 5:6 in dosage. Nine patients developed severe anorexia with nausea/vomiting and three patients among them went back on steroid within 3 months after conversion(conversion failure 7.1%). After minimal 6 months of follow-up, there was neither episodes of graft dysfunction nor rejection. There was a significant improvement of glucose control in conversion group. In 12 patients(30.8%), more than 50% dose reduction of insulin or oral hypoglycemics requirement was possible. In control group, however, only 2 patients showed greater than 50% of insulin or oral hypoglycemics dose reduction. We could find that deflazacort conversion had a significant impact on blood sugar control in PTDM patients(11/26) but not in pre-Tx DM patients(1/13). In conclusion, conversion to deflazacort in PTDM patients with stable graft function was safe and blood sugar control was readily possible without an increment of risks of rejection and infection. We propose to use deflazacort as a substitute for prednisone in PTDM patients with stable graft function.
Subject(s)
Humans , Anorexia , Blood Glucose , Cyclosporine , Diabetes Mellitus , Follow-Up Studies , Glucose , Glucose Intolerance , Hypoglycemic Agents , Insulin , Kidney , Prednisone , Prospective Studies , TransplantsABSTRACT
No abstract available.
ABSTRACT
No abstract available.
Subject(s)
Humans , Diabetic Retinopathy , Follow-Up Studies , PhotographyABSTRACT
This is a case report of the familial olivo-ponto-cerebellar atrophy (Menzel type OPCA, OPCA III with retinal degeneration). The patient is a 37 year-old male with 5 years history of slowly progressive cerebellar ataxia, dysarthria, visual change, horizontal nystagmus and signs of pyramidal dysfunction. The CT brain scan shows significant atrophy of brain stem and cerebellum with dilatation of cisterns. His younger sister, also, has similar clinical manifestations and radiological abnormalities, but mild. By history, his mother who died at 47 years of her age looked like to have same kind of chronic disease.