Requiring Steroid Therapy Research Articles

Past and future prospects of orthoptic liver transplantation.

The hopes for liver transplantation have been increased by experience with the new immunosuppressive drug cyclosporin A. Optimal therapy with cyclosporin A has required steroid therapy, but the amounts of prednisone used have been a small fraction of those used in the past.

Prognosis in children with Crohn's disease

The course of 86 children with Crohn's disease was examined during a 10-year period between 1966 and 1976. Patients were classified according to the initial site of disease. Ileocolitis was the most (52%) and colitis the least (9%) common form of disease with diffuse small bowel or ileal disease each comprising nearly 20% of the study group. These figures show a reversal from those of a previous decade when 42% of the patients had only terminal ileal disease and 17% had ileocolitis. Children with ileocolitis had the highest number of extracolonic manifestations and operations and required steroid therapy the longest. Those with only small bowel disease (with the exception of duodenal involvement) had fewer extraintestinal symptoms and operations and showed a consistently good response to medical treatment.

Seasonal nephrotic syndrome. Description and immunological findings.

Three cases are described showing a seasonal exacerbation of their nephrotic syndrome in association with an atopic trait and grass pollen allergy. The first patient has a history of four consecutive seasonal relapses each requiring steroid therapy. Following a course of desensitization injections he has now been free of relapse for 3 consecutive years. The second patient has also had a recurrent steroid-sensitive nephrotic syndrome often associated with the pollen season and allergic rhinitis. In this patient a course of cyclophosphamide has reduced his tendency to relapse. The third patient who has been on continuous prednisone therapy shows a seasonal increase in proteinuria. Serum changes in the first two patients include: a seasonal rise in total and grass pollen specific IgE; the continued presence of grass pollen specific IgG throughout the year but with a reduction during the pollen season in association with a more pronounced fall in the total IgG level; a depression in the C3 level in association with each major relapse; a mild rise in the I-K titre and a positive result in the Clq test for circulating complexes. A renal biopsy performed on the first patient when in relapse showed minor histological changes only and IgG, IgM, IgA, IgD, IgE, C3 and fibrinogen were undetectable by immunofluorescent examination. The probable mechanism for the development of proteinuria in these patients is discussed.

Long-term immunosuppressive therapy of ulcerative colitis. Continuation of a personal series.

Twenty-five patients with ulcerative colitis considered “failures of therapy with adrenal steroids and salicylazosulfapyridine” but without absolute indication for surgical intervention were treated with 6-mercaptopurine. The dose ranged from 50 to 200 mg daily and the period of treatment from 10 to 52 months. At followup 15 were completely well and 8 improved; 2 required definitive surgery. Twelve had not required steroid therapy for 1 to 4 years and 8 received some form of maintenance therapy intermittently or a small sustained dose. On barium enema examination the colon was improved in 13 of 18. Transient vomiting complicated therapy in 9, and leukopenia occurred 38 times in 24 patients. There were no serious complications. The results still suggest that responses to 6-mercaptopurine are not as dramatic as those observed with steroids, but the former drug has a sustaining or supplementary role. It serves to decrease the frequency and severity of recurrences and eliminates or remain the need for steroids. Objections to 6-mercaptopurine therapy remain theoretic, and the drug seems sufficiently safe to use for periods as long as 4 years. Sufficient controlled studies are still lacking and should be encouraged.

Long term therapy of ulcerative colitis with 6-mercaptopurine: A personal series

Fourteen patients with ulcerative colitis who were considered “failures of therapy with adrenal steroids and salicylazosulfapyridine” but who did not have an absolute indication for surgical intervention were treated with 6-mercaptopurine. The dose ranged from 50 to 150 mg daily and the mean period of treatment was 2 years. The current status is excellent or good in 11, fair in 2 and one patient has had elective surgery. In 8 patients the sigmoidoscopic appearance was recently normal, 6 have not required steroid therapy for many months and in the other 7, maintenance doses have been very small. Transient vomiting complicated therapy in 6 and leukopenia occurred 19 times in 10 patients. No serious complications occurred. The results suggest that responses to 6-mercaptopurine are not as dramatic as those observed with steroids but the former drug has a sustaining or supplementary role. It serves to decrease the frequency and severity of recurrences and eliminates or reduces the need for steroids. Complications are infrequent, not severe, and occur early in the course of therapy so that the drug may be used for long periods. The favorable results justify undertaking long-term, double-blind controlled studies of 6-mercaptopurine therapy in patients with ulcerative colitis when other forms of medical treatment have failed.