Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0338671 (Steroids)
 9,479 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We have presented an illustrative case of thrombocytopenic purpura complicating infectious mononucleosis. Steroid therapy appeared to be beneficial although spontaneous recovery cannot be excluded. The use of the Paul-Bunnell heterophil agglutination test is recommended for patients having idiopathic thrombocytopenic purpura to rule out subclinical infectious mononucleosis. It is suggested that this syndrome be treated with the expectancy of long-term remissions. Steroids appear to be of benefit. Platelet recovery is usually complete in less than 60 days. Splenectomy should not be considered until at least two months have passed. Chronic thrombocytopenia is an unlikely complication.
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PMID:Thrombocytopenic purpura in infectious mononucleosis-- A rare complication? 117 25

HIV-related chronic ITP is caused by an accelerated platelet destruction due to adsorption of circulating immune complexes and to specific anti-platelet antibodies, but perhaps also by a defective thrombopoiesis resulting from invasion of the megakaryocytes by the retrovirus. Treatment is needed when platelet numbers drop beneath 20.10(9)/L or when severe bleeding symptoms occur. Steroids, commercially available immunoglobulins for IV use, AZT and anti-Rh immunoglobulins can be administered, although relapses are frequent after withdrawal of the drugs. Recurrences after splenectomy are far less common, but the progression towards AIDS might be accelerated.
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PMID:HIV-related thrombocytopenia. 132 36

A 40-year-old woman of atrial septal defect associated with idiopathic thrombocytopenic purpura (ITP) was successfully operated upon under cardio-pulmonary bypass. Steroids had been given preoperatively, resulting in an increase of the platelet count from 0.7 X 10(4)/mm3 to 20.6 X 10(4)/mm3. Steroids could be withdrawn before the operation. No bleeding tendency was encountered during and after surgery. This is the 6th case of open-heart surgery associated with ITP in the literature.
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PMID:[Atrial septal defect with idiopathic thrombocytopenic purpura: a case of open-heart surgery]. 219 74

Between 1975 and 1992 450 children with idiopathic thrombocytopenic purpura (ITP) were diagnosed, and of those 100 (22%) developed the chronic form of the disease. Approximately half the patients with chronic ITP presented with mild to moderate hemorrhagic manifestations at the onset of purpura (30 cases) and/or later during the course of the disease (25 cases). The incidence of intracranial hemorrhage was 1%, and the mortality rate due to overwhelming septicemia after splenectomy was also 1%. Overall one-third of the patients received no therapy; two-thirds of them went into spontaneous remission within 8 months to 8 years from the onset of ITP. Steroids given in conventional or high doses (51 cases) achieved a transient (if any) rise in platelet count, but in no case were steroids curative. Remission related to intravenous immune globulin (IVIG) therapy was noticed in 38.5% of the children (10 of 26) after variable courses. The response rate to splenectomy was 95.0%. Ultimately the long-term outcome in children with chronic ITP was as follows: remission, 58 cases (spontaneous, 30; after IVIG therapy, 10; after splenectomy, 18); hemostatic platelet values, 22 cases (spontaneous, 16; after IVIG, 5; after splenectomy, 1). Thirteen children were lost in follow-up, and 7 remain thrombocytopenic but asymptomatic. These data indicate that chronic ITP in childhood runs a benign course in most cases and may remit with or without therapy even several years from onset. Therefore, therapeutic intervention has to be individualized, and splenectomy, which is not always safe, should be reserved for problematic cases that fail to respond to conventional therapeutic modalities.
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PMID:Seventeen years of experience with chronic idiopathic thrombocytopenic purpura in childhood. Is therapy always better? 757 95

Idiopathic thrombocytopenic purpura (ITP) is a relatively common hematologic disorder. Steroids and splenectomy constitute the main modalities of treatment. Although the indications for these therapies are well established in the literature, the timing of splenectomy remains controversial. This report retrospectively reviews 712 consecutive patients with ITP hospitalised in 9 medical centers in Israel between the years 1977 and 1987. The clinical presentations, the time required for a response to steroids and the remission rate following splenectomy were all similar in children with ITP who were hospitalised and adults. There were however marked differences in associated conditions, predominantly viral infections in children, and autoimmune disorders, neoplasia or infections in adults. The overall response to initial steroid therapy was 82% in children and 74% in adults. Ninety-three percent of those responding did so within 60 days of starting treatment. One hundred and seventy-three patients underwent splenectomy; 123 (71%) achieved a prolonged complete remission. We recommend early splenectomy in patients not responding rapidly to corticosteroid treatment. This study demonstrates that chronic, more severe ITP in children requiring hospitalisation has a marked similarity to the disease in adults. Many children, however, present with mild transient thrombocytopenia that does not necessitate hospitalisation or a specific therapy.
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PMID:Clinical and therapeutic experience in 712 Israeli patients with idiopathic thrombocytopenic purpura. Israeli ITP Study Group. 798 88

Idiopathic thrombocytopenic purpura (ITP) and thrombotic thrombocytopenic purpura (TTP), are distinct entities. ITP is a relatively common autoimmune disorder typically manifesting with isolated thrombocytopenia. The acute form, more common in children, is a self-limiting, often post-viral disease. Therapy, if indicated, usually consists of a brief course of steroids or intravenous IgG. Chronic ITP, more common in adults, rarely remits spontaneously. Most patients respond initially to steroids, but generally the disease relapses when steroids are tapered. Splenectomy offers a 70% chance of cure. A variety of treatment options exist for patients not responding to splenectomy. The treating physician must choose the most effective and least toxic treatment for the individual patient. TTP is a rare, often life-threatening, multisystem disease of unknown aetiology. Its hallmark is widespread occlusion of the microcirculation by platelet aggregates. The clinical symptoms usually respond dramatically to plasma exchange therapy. Steroids, antiplatelet agents and vincristine may also be useful. Splenectomy should be considered in patients with multiple relapses. More specific therapy awaits a fuller understanding of the pathogenesis of this disease.
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PMID:The thrombocytopenic purpuras. Recognition and management. 873 16

Autoimmune thrombocytopenic purpura (AITP) is a common hematological problem. Steroids are the usual first-line treatment but give long-term remission in less than 20% of adults. High doses of human intravenous immunoglobulin G (IVIg) can increase the platelet count in 70 to 80% of patients, but the treatment is expensive and the platelet response usually only transient. Seventy to 80% of the adults have the chronic form of AITP (ie, disease duration of more than 6 months) that only improves on specific treatment. Splenoctomy is the treatment of choice when thrombocytopenia is severe and/or associated with life threatening bleeding, as it cures 60-80% of patients. The best treatment for patients with severe chronic AITP in whom splenectomy is ineffective or contra-indicated is a difficult challenge. In this situation, spontaneous remission is rare and 5% of patients will die from hemmorrhage. However, the treatments so far proposed in refractory chronic AITP (danazol, vinca alcaloids, azathioprine, cyclophosphamide, dapsone, etc) are inconsistently and transiently effective. The aim of the treatments in AITP are thus different in the acute and chronic forms of the disease. In the acute phase, the treatment should quickly increase the platelet count, even if the effect in transient, and aggressive treatments (ie, splenectomy, immunosuppressive drugs) must be avoided since spontaneous remission is possible. On the contrary, splenectomy is the treatment of choice for chronic AITP since it obtains complete persistent recovery in nearly 80% of patients. In the case of unsuccessfullness, treatments should then be administered with the aim to maintain a "safe" platelet count (> 20 to 30 x 10(9)/L).
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PMID:[Treatment of autoimmune thrombopenic purpura in adults]. 888 Nov 94

The frequency and treatment of children with chronic idiopathic thrombocytopenic purpura in Sweden were characterized using a national enquiry based on a questionnaire. Seventy-five children diagnosed as having chronic idiopathic thrombocytopenic purpura on 1 September 1993 were identified. The prevalence in children between 0.5 and 15.5 years of age was calculated to be 4.6/100,000. The median age at the time of diagnosis was 5 years and the male/female ratio was 1:1.2. Almost half of the patients (43%) were not treated at all during the disease. Steroids (43%) and intravenous immunoglobulin (25%) were most commonly used. Only two children were splenectomized.
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PMID:Prevalence and treatment of chronic idiopathic thrombocytopenic purpura of childhood in Sweden. 905

We retrospectively analyzed the clinical characteristics and management of 472 Chinese children (age 1~14 years) with chronic idiopathic thrombocytopenic purpura (ITP). The distribution of cases by age showed a maximum at 4 years and more patients below 7 years old than between 7 and 14 years old had ITP (337, 71.4% vs. 135, 28.6%). Variable bleeding signs occurred in this series of patients. Steroids therapy was effective for Chinese children with chronic ITP whether as first- or second-line therapy. Traditional Chinese medicine was less effective than steroids.
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PMID:Retrospective analysis of 472 Chinese children with chronic idiopathic thrombocytopenic purpura: a single center experience. 1595 5

Idiopathic thrombocytopenic purpura is a relatively common but unrecognised auto-immune disorder among women of child bearing age. Nearly one-third of patients present with bleeding tendency in pregnancy. Management necessitates care of mother during pregnancy and delivery and care of the baby. Steroids remain the chief, economical and effective method of raising platelet counts, but platelet transfusion and human intravenous high dose alpha-globulin may be required. Neonatal thrombocytopenia must be expected and managed. Management of patient, since it concerns two lives, should be individualised and carefully planned in consultation with haematologist and paediatrician.
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PMID:Idiopathic thrombocytopenic purpura complicating pregnancy. 1649 61


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