Bromocriptine in systemic lupus erythematosus: a double-blind, randomized, placebo-controlled study.

The objective of this study was to investigate the efficacy and safety of bromocriptine (BRC) as an adjunct to conventional treatment in systemic lupus erythematosus (SLE). A prospective, double-blind, randomized, placebo-controlled study compared BRC at a fixed daily dosage of 2.5 mg with placebo. Patients were followed for 2-17 months (mean 12.5 months). Disease activity was assessed using the SLE Disease Activity Index (SLEDAI), numbers of flares were recorded, and serum prolactin (PRL) levels were obtained at intervals during the study. Patients were allowed to take prednisone and immunosuppressive drugs. Sixty-six patients with SLE entered the study. Thirty-six were treated with BRC, and 30 controls received placebo. Sixteen patients were removed from the study during the treatment period: five in each group left the study because of adverse effects, five became pregnant, and one patient who took placebo died with central nervous system lupus. Four patients in the BRC treatment group and three patients in the placebo group moved away or stopped coming for study visits for unknown reasons, and were lost to follow-up during the course. At entry, serum PRL was (mean+/-s.d.) 24.8 ng/ml+/-18.4 in the BRC treatment group. This value fell to 5.8+/-9.0 after 12 months of treatment. Corresponding PRL values in controls were 23.7+/-22.1 pretreatment and 20.3+/-14 after 12 months. PRL levels in BRC-treated subjects were significantly lower than levels in control subjects after 3, 6, 9, and 12 months of treatment. The SLEDAI score on the fifth protocol visit was decreased significantly in the BRC group vs controls: 0.9+/-1.4 vs 2.6+/-4.5 (P < 0.05). Although the absolute number of flares in each group was similar, the mean number of flares/patient/month was decreased significantly in the BRC group compared to the control group (0.08+/-0.1 vs 0.18+/-0.2, P = 0.03). Long term treatment with a low dose of BRC appears to be a safe and effective means of decreasing SLE flares in SLE patients.

[Natural history of paroxysmal nocturnal hemoglobinuria in adolescents,adults, and children: the Mexican experience]. / Historia natural de la hemoglobinuria paroxística nocturna en adolescentes, adultos y en la edad pediátrica: la experiencia mexicana.

PURPOSE: To compare the clinical patterns and survival of young and adult (AP) versus paediatric (PP) patients with paroxysmal nocturnal haemoglobinuria (PNH). PATIENTS AND METHODS: The clinical records of 117 patients (82% AP, 18% PP) seen in four cities of the Mexican Republic were analysed, the clinical course and survival of both groups being compared. RESULTS: No sex difference was found in the two patient-groups: 51% and 52% males, 49% and 48% females in AP and PP, respectively. The onset of PNH had similar distribution for the two groups of patients: aplastic form, 45% in AP and 62% in PP; cytopenias, 24% in AP versus 27% in PP; haemolysis, 28% in AP and 9% in PP, and thrombosis, 3% in AP versus 0% in PP. The clinical features with significant difference were: anaemic+haemorrhagic syndrome (39 AP (40%) vs 14 PP (67%), p = 0.02), initial diagnosis of immunologic thrombocytopenic purpura (7 AP (7%) vs 7 PP (33%), p = 0.003), and death rate (17 AP (18%) vs 8 PP (38%), p = 0.04). The actuarial survival curves showed significant differences between both groups (p = 0.045, Cox-Mantel), with estimated 10-year survival of 81% for AP and 55% for PP, and 15-year survivals of 64% for AP and 55% for PP. CONCLUSIONS: Seemingly, PNH in paediatric age has poorer prognosis than in adults, which is associated to higher incidence of fatal haemorrhages due to thrombocytopenia.

[A case of autoimmune thrombocytopenic purpura and dengue]. / Caso de púrpura trombocitopénica autoinmune y dengue.

Dengue fever was detected in Yucatan in 1979. Since then, about 17,000 clinical cases have been reported, of which 1169 were confirmed by the presence of specific antibodies (IgM and IgG) and/or virologic studies; 10 of the cases were classified as dengue haemorrhagic fever and four died. The disease is endemic in the region and serotypes 1, 2 and 4 have been observed. This paper describes a patient with chronic autoimmune thrombocytopenic purpura who developed a primary dengue infection with hemorrhagic manifestations and responded to corticosteroids. We discuss the physiopathogeny of thrombocytopenia and analyze the utility of treatment with corticosteroids in patients with autoimmune disease.

Leucemia aguda y embarazo. / Acute leukemia and pregnancy

Los casos de leucemia aguda em cuya evolucion se presenta un embarazo no han sido frecuentes hasta el momento. Se informan 2 casos con leucemia aguda mieloblastica y uno con linfoblastica que se embarazon estando en remision completa y en tratamiento de mantenimiento con 6-mercaptopurina, ciclofosfamida y methotrexate. En dos casos el producto murio en utero; uno de ellos con grandes malformaciones. El tercero tuvo gemelos univitelinos, uno con minimas malformaciones, pero estudios de medula osea y cromosomico normales y ambos en buenas condiciones despues de 2 anos.El embarazo no influyo en la evolucion de la leucemia. Se propone utilizar metodos anticonceptivos en las pacientes leucemicas en edad fertil