Goals: To report the 10- year experience of a single center in treating pati ents with refractory inflammatory bowel disease (IBD) with relatively lower dose of 6- mercaptopurine (6- MP). Study: The charts of 285 pati...Goals: To report the 10- year experience of a single center in treating pati ents with refractory inflammatory bowel disease (IBD) with relatively lower dose of 6- mercaptopurine (6- MP). Study: The charts of 285 patients with IBD (Cro hn’ s disease 160 and ulcerative colitis 125) receiving 6- MP were reviewed. C linical response, subsequent breakthrough while taking 6- MP, and relapse rates when 6- MP was discontinued and side effects were assessed. Results: Ninety- three percent of the patients were taking 50 to 75 mg/day of 6- MP. Complete re mission was achieved in 62% , partial remission in 14.5% , and failure to achi eve remission in 23.5% of the patients. Of complete responders, 27.5% had br eakthrough while continuing 6- MP. Nine percent of those that achieved a comple te remission experienced a relapse after 6- MP was discontinued. Side effects i ncluded leukopenia (11.2% ), abnormal liver function tests (3.8% ), various in fections, including pneumonia (3.1% ), pancreatitis (2.5% ), nausea (2.1% ), headache (2.8% ), fever (1.4% ), hair loss (1% ), and rash (0.7% ). Two canc ers occurred while taking 6- MP: melanoma on the finger and a fatal colonic lym phoma. Four patients continued 6- MP throughout pregnancies and had normal outc omes. Conclusions: In our experience 6- MP is relatively safe and appears to be as effective at a lower dosage (0.84 mg/kg per day) compared with the recommend ed higher dosage (1- 1.5 mg/kg per day), when leukopenia was more frequent. Ser ious side effects, although rare, need to be monitored.展开更多
The purpose of this study was to determine the feasibility of noninvasive fetal pulse oximetry in the human fetus with transabdominal continuous- wave near- infrared spectroscopy. The instrument has 3 wavelength light...The purpose of this study was to determine the feasibility of noninvasive fetal pulse oximetry in the human fetus with transabdominal continuous- wave near- infrared spectroscopy. The instrument has 3 wavelength light- emitting diodes (735, 805, and 850 nm) as light sources and a photomultiplier tube as a detector. This instrument was used in 6 pregnant women (>36 weeks of gestation). First, a fetal heart rate was obtained with a fetal heart rate monitor. Then, the depth of fetal tissue (head) from the maternal abdomen was determined by ultrasound examination; the distance between the optodes (light source and the detector) was set to be approximately twice the depth of the fetus (7- 11 cm). The data analysis was based on the modified Beer- Lambert law and the use of optical densities at 735 and 850 nm to obtain the concentration changes of the oxyhemoglobin and deoxyhemoglobin. The saturation was expressed as the percent of oxygen saturation equal to 100× oxyhemoglobin/ (oxyhemoglobin + deoxyhemoglo- bin). We recorded the spectroscopy data and the fetal heart rate for approximately 3 to 10 minutes in each patient. The mean oxygen saturation values of each of the 6 individual fetuses ranged from 50% to 74% (overall mean saturation, 61% ± 14.8% [SD]). This preliminary data indicate that transabdominal fetal pulse oximetry is feasible for human patient application. The measured values were similar to those that are obtained with transvaginal pulse oximetry. Future studies should correlate transabdominally obtained measurements with those measurements that are obtained by transvaginal fetal pulse oximetry.展开更多
文摘Goals: To report the 10- year experience of a single center in treating pati ents with refractory inflammatory bowel disease (IBD) with relatively lower dose of 6- mercaptopurine (6- MP). Study: The charts of 285 patients with IBD (Cro hn’ s disease 160 and ulcerative colitis 125) receiving 6- MP were reviewed. C linical response, subsequent breakthrough while taking 6- MP, and relapse rates when 6- MP was discontinued and side effects were assessed. Results: Ninety- three percent of the patients were taking 50 to 75 mg/day of 6- MP. Complete re mission was achieved in 62% , partial remission in 14.5% , and failure to achi eve remission in 23.5% of the patients. Of complete responders, 27.5% had br eakthrough while continuing 6- MP. Nine percent of those that achieved a comple te remission experienced a relapse after 6- MP was discontinued. Side effects i ncluded leukopenia (11.2% ), abnormal liver function tests (3.8% ), various in fections, including pneumonia (3.1% ), pancreatitis (2.5% ), nausea (2.1% ), headache (2.8% ), fever (1.4% ), hair loss (1% ), and rash (0.7% ). Two canc ers occurred while taking 6- MP: melanoma on the finger and a fatal colonic lym phoma. Four patients continued 6- MP throughout pregnancies and had normal outc omes. Conclusions: In our experience 6- MP is relatively safe and appears to be as effective at a lower dosage (0.84 mg/kg per day) compared with the recommend ed higher dosage (1- 1.5 mg/kg per day), when leukopenia was more frequent. Ser ious side effects, although rare, need to be monitored.
文摘The purpose of this study was to determine the feasibility of noninvasive fetal pulse oximetry in the human fetus with transabdominal continuous- wave near- infrared spectroscopy. The instrument has 3 wavelength light- emitting diodes (735, 805, and 850 nm) as light sources and a photomultiplier tube as a detector. This instrument was used in 6 pregnant women (>36 weeks of gestation). First, a fetal heart rate was obtained with a fetal heart rate monitor. Then, the depth of fetal tissue (head) from the maternal abdomen was determined by ultrasound examination; the distance between the optodes (light source and the detector) was set to be approximately twice the depth of the fetus (7- 11 cm). The data analysis was based on the modified Beer- Lambert law and the use of optical densities at 735 and 850 nm to obtain the concentration changes of the oxyhemoglobin and deoxyhemoglobin. The saturation was expressed as the percent of oxygen saturation equal to 100× oxyhemoglobin/ (oxyhemoglobin + deoxyhemoglo- bin). We recorded the spectroscopy data and the fetal heart rate for approximately 3 to 10 minutes in each patient. The mean oxygen saturation values of each of the 6 individual fetuses ranged from 50% to 74% (overall mean saturation, 61% ± 14.8% [SD]). This preliminary data indicate that transabdominal fetal pulse oximetry is feasible for human patient application. The measured values were similar to those that are obtained with transvaginal pulse oximetry. Future studies should correlate transabdominally obtained measurements with those measurements that are obtained by transvaginal fetal pulse oximetry.
