[Clinical efficacy and safety of acupuncture combined with western medicine in treatment of children with abdominal Henoch-Schonlein purpura with spleen-stomach damp-heat syndrome].

OBJECTIVE: To investigate the clinical effect of acupuncture combined with western medicine in the treatment of children with abdominal Henoch-Schonlein purpura with spleen-stomach damp-heat syndrome. METHODS: A total of 60 children with abdominal Henoch-Schonlein purpura with spleen-stomach damp-heat syndrome were randomly divided into treatment group and control group, with 30 patients in each group. The patients in the control group were given Hydroprednisone 2 mg•kg-1•d-1, and in addition to the treatment in the control group, those in the treatment group were given acupuncture at Tianshu (ST25), Neiguan (PC6), Zusanli (ST36), Zhongwan (CV12), Qihai (CV6), and Sanyinjiao (SP6) once a day, with a needle retaining time of 15 minutes. Both groups were treated for 7 days. The scores of abdominal pain, hematochezia, hematemesis, vomiting, poor appetite, abdominal distension, purpura, occult blood in stool, and abdominal ultrasound were determined before and after treatment, and the time to the disappearance of abdominal pain was observed. Clinical outcome was evaluated. RESULTS: The treatment group had a significantly higher effective rate than the control group ［96.7% (29/30) vs 80.0% (24/30), P<0.05］. Both groups had significant reductions in the scores of abdominal pain, hematochezia, hematemesis, poor appetite, abdominal distension, purpura, occult blood and abdominal ultrasound and the total score after treatment (P<0.05), and compared with the control group after treatment, the treatment group had significantly lower scores of abdominal pain, poor appetite, abdominal distension, and abdominal ultrasound and total score (P<0.05). The treatment group had a significantly shorter time to disappea-rance of abdominal pain than the control group (P<0.05). CONCLUSION: Acupuncture combined with western medicine has a better clinical effect than western medicine alone in the treatment of abdominal Henoch-Schonlein purpura with spleen-stomach damp-heat syndrome and can significantly improve clinical symptoms and signs and shorten the time to disappearance of abdominal pain.

Cord-derived mesenchymal stem cells therapy for liver cirrhosis in children with refractory Henoch-Schonlein purpura: A case report.

RATIONALE: To explore the curative effect of human umbilical cord-derived mesenchymal stem cell (ucMSC) therapy for patients with liver cirrhosis complicated with immune thrombocytopenia and refractory Henoch-Schonlein purpura (HSP). PATIENT CONCERNS: A 12-year-old boy presented to our hospital with an 11-month history of purpura on the skin of both lower limbs accompanied by thrombocytopenia. The patient had a history of repeated swelling and painful dorsum pedis, followed by skin redness. DIAGNOSIS: Bone marrow slides showed megakaryocyte maturation disorder. Based on the pathology and drug abuse history, he was diagnosed with nodular cirrhosis, secondary allergic purpura, and thrombocytopenia, etiologies related to his drugs and an immune dysfunction. INTERVENTIONS: ucMSC transplantation was performed, the liver damaging drugs were discontinued, and the appropriate liver immunosuppressive drugs were administered. ucMSCs were injected 8 times/wk in 2 months, with a median cell count of 5.65 × 10/L, ranging from 5.48 to 5.98 × 10/L. OUTCOMES: As the patient's skin rash resolved, his platelets gradually increased to >150 × 10/L and liver transaminase levels gradually decreased to a normal level. Ultrasonography of the abdomen indicated that the round nodules in the liver decreased in size and that the spleen thickness also decreased. LESSONS: This is a unique case of significant HSP with associated thrombocytopenia in a patient with liver cirrhosis. Long-term oral administration of excessive herbal medicine may cause liver damage. We believe that ucMSCs provide a novel approach for the treatment of liver cirrhosis.

[Controlled study on therapeutic effect of vessel pricking therapy and western medication for treatment of Henoch-Schonlein purpura nephritis].

OBJECTIVE: To compare the difference of therapeutic effects between vessel pricking therapy and Prednisone for treatment of Henoch-Schonlein purpura nephritis. METHODS: Seventy cases of acute purpura nephritis syndrome were randomly divided into an observation group (40 cases) and a control group (30 cases). Patients in observation group were differentiated into sthenia and asthenia syndromes. Vessel pricking therapy was applied at Hegu (LI 4), Quchi (LI 11), Xuehai (SP 10) etc. by triangular needle for sthenia symptom; shallow needling was used at Pishu (BL 20), Shenshu (BL 23), Zusanli (ST 36) etc. by filiform needle. The control group was treated with oral admi-nidtration of Prednisone. The symptom score of TCM, 24 h urinary protein, red blood cell count of urinary sediment of both groups were observed before and after treatment and therapeutic effects were compared. RESULTS: The total effective rate of 92.5% (37/40) in observation group was superior to that of 80.0% (24/30) in control group, and there was a significant difference between two groups (P < 0.05); the symptom score of TCM, 24 h urinary protein, red blood cell count of urinary sediment were all improved in both groups after treatment (all P < 0.05), and moreover, the improvement in observation group was superior to that of control group (all P < 0.05); after treatment, the symptom score of TCM of sthenia syndrome was lower than that of asthenia syndrome in observation group (P < 0.05). CONCLUSION: Vessel pricking therapy has a significant therapeutic effect for treatment of Henoch-Schonlein purpura nephritis, superior to that of oral administration of Prednisone, and the therapeutic effect is better for treating sthenia syndrome than for asthenia syndrome.

Meningococcal purpura fulminans treated with medicinal leeches.

INTRODUCTION: Meningococcal septicemia remains one of the most common infectious causes of admission to a pediatric intensive care unit. Numerous treatment strategies aimed at the thromboembolic complications inducing purpura fulminans and limb/digital ischemia have been attempted, with variable results. The successful use of medicinal leeches for pneumococcal purpura fulminans has been described, and we present a similar case of meningococcal purpura fulminans. PATIENT AND INTERVENTION: A 5-wk-old female infant with meningococcal meningitis and septicemia and progressive purpura fulminans of the left hand was treated with medicinal leeches. Medicinal leeches were applied to the left dorsal hand on a daily basis for 4 consecutive days. RESULT: The swelling and limited functionality visibly improved after 48 hrs, and by 120 hrs, perfusion in the distal phalanges of the thumb and middle finger was evident. Reperfusion of the distal phalanges was not fully sustained, and at 6 wks the plastic surgery department debrided the distal phalanges of her left hand, excluding the thumb. She fully recovered from the meningococcal septicemic shock; the functionality of her left thumb was preserved, and she has limited functionality of her left hand. CONCLUSION: The unique combination of salivary products in leech therapy has theoretical benefits and requires future study.

Managing Henoch-Schonlein purpura in children with fish oil and ACE inhibitor therapy.

BACKGROUND: Henoch-Schonlein purpura (HSP) is a vasculitic syndrome with palpable purpura and renal involvement. The treatment for HSP with persistent renal disease remains controversial. The kidney biopsy in HSP shows IgA deposits and fish-oil therapy has proven to be promising in halting the progression of IgA nephropathy. METHODS: Five children with biopsy-proven HSP with repeated episodes of haematuria and proteinuria were treated with fish oil (1 g orally twice daily). In three of the five patients an angiotensin-converting enzyme inhibitor (ACEI) was added for hypertension. RESULTS: The mean duration of follow up after starting fish-oil therapy was 49.2 weeks. The protein excretion rate prior to starting fish oil was 1041 mg/day and on the last follow-up visit the rate had decreased to 104 mg/day (P <0.05). The average blood pressure (BP) prior to therapy was 135/82. On the last follow-up visit the average BP off ACEI had decreased to 100/54 (P <0.05). After a year of follow up serum creatinine and glomerular filtration rates have remained stable at 51.2 micromol/L and 128 mL/min/1.73 m2, respectively. CONCLUSION: This is the first report of abatement of HSP with fish oil and ACEI in children. There is a need for randomized prospective trials to confirm this observation.

[Scanning electron microscopy of peripheral blood erythrocytes in the diagnosis and treatment of hemorrhagic vasculitis in children]. / Metod skaniruiushchei élektronnoi mikroskopii éritrotsitov perifericheskoi krovi v diagnostike i lechenii gemorragicheskogo vaskulita u detei.

Twenty-four children aged 3-15 years were examined, 16 of these with cutaneous and articulo-cutaneous hemorrhagic vasculitis (HV) and 8 normal controls. The patients were divided into 2 groups: 10 patients treated by basic therapy and 6 children whose treatment protocols were supplemented by membranoprotector locheine. The children were repeatedly examined 1 month after discharge from hospital. Scanning electron microscopy of peripheral blood erythrocytes provides valuable diagnostic data on erythrocyte membrane morphology and function in children with HV and can serve as a method for monitoring the efficiency of new approaches to therapy of this disease.

Hyperbaric oxygen therapy in the pediatric patient: the experience of the Israel Naval Medical Institute.

UNLABELLED: The pediatric patient is to be found in hyperbaric facilities throughout the world, receiving hyperbaric oxygen (HBO) therapy for both life-threatening and chronic diseases. OBJECTIVE: To review the experience accumulated at the Israel Naval Medical Institute in the treatment of pediatric patients. DESIGN: A retrospective analysis and review of all records of patients younger than age 18 years. RESULTS: Between 1980 and 1997, 139 pediatric patients age 2 months to 18 years (mean, 7.7 years) received HBO treatment at the Israel Naval Medical Institute. Of the children, 111 (79%) suffered from acute carbon monoxide (CO) poisoning; 13 (9.2%) were treated after crush injury, traumatic ischemia, or compartment syndrome; 4 (2.8%) had clostridial myonecrosis; 1 (0.7%) had necrotizing fasciitis; 5 (3.6%) had refractory osteomyelitis; 2 (1.4%) had suffered massive air embolism; 2 (1.4%) had purpura fulminans; and 1 (0.7%) suffered from decompression sickness. Outcome, judged by neurologic sequelae, mortality, and extent of soft tissue loss and limb amputation, was favorable in 129 patients (93%). Two patients (1.4%) died, 1 as a result of CO poisoning and the other, gas gangrene; 2 of the patients in the CO group (1.4%) remained with neurologic sequelae, and 6 patients in the acute traumatic ischemia group (4.3%) underwent limb amputation. CONCLUSIONS: We had a favorable experience with 129 of a total 139 pediatric patients treated at our facility for the indications listed. A basic knowledge of HBO therapy is needed to refer the pediatric patient for treatment when indicated. The needs of the pediatric patient, especially the critically ill, require specific skills and equipment inside the hyperbaric chamber. Close collaboration between the pediatrician and the hyperbaric medicine physician is essential to ensure adequate care for infants and children.

Haemophilus influenzae type b purpura fulminans treated with hyperbaric oxygen.

We report the case of a 4-month-old child with purpura fulminans caused by Haemophilus influenzae type b. In addition to conventional therapy, she was treated with hyperbaric oxygen, and made a full recovery. Hyperbaric oxygen as an adjunct to other therapy in purpura fulminans is discussed.

Anaphylactoid reactions in Barbados: incidence, prevention and treatment

A retrospective study was done of anaphylactoid reactions occurring in Barbados up to the end of 1962. Ninety-two reactions were reported by 42 doctors, and nearly 50 percent of those reported occurred in the 5 year ending in 1962. There were 5 fatal reactions. Penicillin was the commonest cause followed by ATS and other antisera. For the established anaphylactoid reaction. Adrenalin appears to be still by far the most effective remedy. The initial dose od Adrenalin by any route should be not more than 0.3 mgm. When by the mouth to mouth method with or without oxygen, combined with prompt external cardiac massage may prevent a fatal outcome (AU)