Oral cyclic megadose methylprednisolone therapy for chronic immune thrombocytopenic purpura in childhood.

The objectives of this study were to investigate the effectiveness of oral megadose methylprednisolone (OMMP) therapy in children with chronic immune thrombocytopenic purpura (ITP). Twenty-two patients were given oral methylprednisolone daily for 7 d (30 mg/kg for 3 d and then 20 mg/kg for 4 d). OMMP therapy was repeated once per month if the platelet count was less than 20,000/mm3 at the 30th day of therapy, for up to six courses. The number of platelets of all patients increased gradually during the OMMP therapy, with a peak number at the 7th day, then decreased until the 14th day, and remained relatively stable until 12 months. During the study no patient had a platelet count less than 20,000/mm3 at the 3rd day and 50,000/mm3 at the 7th day. Although the number of platelets was gradually decreased between the 7th and 14th days, it remained above 100,000/mm3 for at least 12 months in the nine patients, and above 20,000/mm3 in the four patients. None of these 13 patients required hospitalization or therapy during the follow-up period. All of the patients tolerated the medication well. None of them reported side-effects that were severe enough to discontinue therapy. We conclude that OMMP therapy is a safe, easy and effective therapy in children with refractory chronic ITP, and it may provide long-term remission in about two thirds of the patients.

Insulin secretion and insulin resistance determined by euglycemic clamp.

Obesity among children is increasingly recognized and linked to several metabolic problems. In this study, 47 children, aged 5-14 yr, with exogenous obesity were compared to 20 normal (non-obese) children to show alterations in glucose metabolism. All the obese children had body mass index > 95th percentile and weight for age > 120%. Basal and stimulated insulin and C-peptide levels were obtained during oral glucose tolerance test (OGTT). Seven children from the obese group had impaired OGTT according to WHO criteria. Mean fasting insulin levels were 26.7 +/- 14.6 microIU/ml in obese and 10.99 +/- 4.36 microIU/ml in controls; postprandial insulin levels were 70.4 +/- 56.4 microIU/ml and 22.23 +/- 6.55 microIU/ml, respectively (p < 0.001). The euglycemic glucose clamp technique was applied to 8 normal and 22 obese children. The amount of metabolized glucose (M) during clamp test is measured to identify glucose sensitivity. Mean M values were 3.24 +/- 1.35 mg/kg/min in obese and 6.525 +/- 0.770 mg/kg/min in control children (p < 0.001). As a result of this study, it seems reasonable to consider all obese children and adults as being at risk for hyperinsulinism and insulin resistance.