ABSTRACT
Thiopurine S-methyltransferase (TPMT) deficient patients develop life threatening haematotoxicity (for example, pancytopenia) when treated with a standard dose of azathioprine (AZA) and 6-mercaptopurine (6-MP) due to excessive accumulation of cytotoxic metabolites. At present, it is generally recommended that these patients should not receive AZA or 6-MP treatment for inflammatory bowel disease. We report for the first time that Crohn's disease patients with TPMT deficiency can be successfully treated with AZA. We illustrate this with three cases where treatment has been successful and toxicity has been avoided by carefully titrating the drug dose. Thus very low TPMT activity demands pharmacogenetically guided dosing.
Subject(s)
Azathioprine/administration & dosage , Crohn Disease/drug therapy , Crohn Disease/enzymology , Immunosuppressive Agents/administration & dosage , Methyltransferases/deficiency , Adult , Drug Administration Schedule , Female , Humans , Male , Treatment OutcomeSubject(s)
Behcet Syndrome/drug therapy , Herpesvirus 8, Human/isolation & purification , Immunosuppressive Agents/adverse effects , Opportunistic Infections/immunology , Sarcoma, Kaposi/immunology , Adult , Antiviral Agents/therapeutic use , Humans , Immunocompromised Host , Interferon alpha-2 , Interferon-alpha/therapeutic use , Male , Opportunistic Infections/drug therapy , Recombinant Proteins , Sarcoma, Kaposi/drug therapyABSTRACT
The chimeric anti-TNF antibody Remicade (Infliximab) has recently been approved for human use by the FDA and is now available on the market. Since there is considerable interest in this kind of treatment among patients with Crohn's disease, an international working group has summarized the presently available information about efficacy, side effects and possible problems of this treatment. Studies show that Remicade is effective in the treatment of active Crohn's disease, maintaining remission and fistulae. The working group does not see Infliximab as a first-line treatment for Crohn's disease. It may be used in active phase recurrent disease, chronic active disease and fistulae if standard treatment was not successful. For the surveillance special attention has to be given to the unknown malignancy rate of Infliximab. Infusion should be performed in an institution, routinely performing intravenous infusions and a two-hour surveillance of the patients should be guaranteed to recognize anaphylactic reactions or acute side effects. There is presently no information indication that the combination with immunosuppressants might increase risks or side effects of this treatment. Due to the limited information available the working group would prefer to use Remicade in studies only and recommends central collection and documentation of all data on efficacy and side effects for the next year.
Subject(s)
Antibodies, Monoclonal/therapeutic use , Crohn Disease/therapy , Tumor Necrosis Factor-alpha/immunology , Antibodies, Monoclonal/administration & dosage , Antibodies, Monoclonal/adverse effects , Double-Blind Method , Drug Approval , Europe , Humans , Immunosuppressive Agents/administration & dosage , Infliximab , Monitoring, Physiologic , United States , United States Food and Drug AdministrationABSTRACT
We report a 30-year-old man who developed painful swelling of his right leg and complete sciatic nerve palsy after an i.v. injection of heroin. Excessive elevation of serum creatine phosphokinase indicated the presence of rhabdomyolysis. Fasciotomy of the gluteus maximus led to rapid and complete recovery from sciatic nerve palsy. Nontraumatic rhabdomyolysis may cause a gluteal compartment syndrome that requires immediate fasciotomy.
Subject(s)
Heroin , Inflammation/chemically induced , Leg , Paralysis/chemically induced , Rhabdomyolysis/chemically induced , Sciatic Nerve , Substance-Related Disorders/complications , Adult , Buttocks , Humans , Injections, Intravenous , Male , Peripheral Nervous System Diseases/chemically induced , SyndromeABSTRACT
BACKGROUND: Positron emission tomography (PET) has been shown capable of identifying malignant tissues. PATIENTS AND METHODS: WB-PET imaging in two women with metastatic choriocarcinoma is described. RESULTS: In a woman with tumor emboli secondary to a choriocarcinoma, WB-PET was the only noninvasive investigation to differentiate between tumor and blood clots. Moreover, PET helped to localize residual tumor tissue in another woman with persisting high beta-HCG serum levels after chemotherapy. CONCLUSIONS: WB-PET helps to localize tumor tissue in patients suffering from choriocarcinoma.
