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tompat
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06/30/07 - 04:33 AM             #1

10 yr old kid comes with complains of fever bone pain and epistaxis.he has a history of dystonias,choreoathetosis and hyperreflexia with tendency for inflicting self injuries.he is on kidney stone prevention medications.on physical exam he has hepato-spleenomegaly.lab test shows normocytic anaemia, thrombocytopenia and marrow packed with lymphoblasts.he is given routine chemotherapy and the new disease goes into remisson. what could be the prob with is further treatment with conventional drugs

A.frequent remissions
B.increased stone formation
C.increased toxicity of the drugs prescribed
D.ineffective treatment of mets in the sanctuaries
E.nothing if we adjust the dose of drugs he was taking previously
(this is hypothetical q,hope no one in this forum is from sicily)

arlete
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06/30/07 - 08:24 AM             #2

B?raised eyebrow

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jean robert
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06/30/07 - 01:06 PM             #3

C increased toxicity of the drugs prescribed.

It seems this kid suffers from Lesch Nyhan Syndrome. He s put on Allopurinol treatment in order to diminish his risk to develop renal uric acid stones. But for some unfortunate reason,now he develops leukemia which is most likely treated with 6 mercaptopurine, whose inactivation is obtained by XANTHINE OXIDASE, the same enzyme blocked by Allopurinol.

It seems that is the scenario or i ve too much imagination!!!!!!

please correct me if i m wrong.

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tompat
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06/30/07 - 02:16 PM             #4

hey i dont know why the new options i posted last night aint showing up.
any way jean is wrongdisapproval

tompat
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06/30/07 - 07:29 PM             #5

hey come on guys , 37 views and 2 replies. this q covers many a topics

jean robert
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06/30/07 - 07:55 PM             #6

E???

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tompat
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06/30/07 - 09:05 PM             #7

no jean when i said u r wrong i meant u r wrong in thinking that u thought too much . yes the ans is C.
look this kid has got lesch nyhan syn. pt with this disease has no hypoxanthine-guanine phosphoribosyl transferase activity. this enz. is critical in salvaging purines. if it is absent there is impaired salvaging of purines leading to excess demand for production of purines and increased by products of metabolism. this leads to high uric acid production which freqently results in uric acid stones.thats why this pt are put on xathine oxidase inhibitors like allopurinol.

tompat
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06/30/07 - 09:11 PM             #8

unfortunately this kid has now got ALL. to treat it we will be giving prednisol, vincristine and asparginase for remission induction. and for maintenance we will give him 6-mercaptopurin and methotrexate. this is conventional treatment for ALL.
for activation of 6-MP we require hypoxanthine-gua.phospho.transferase enz. into its active form. but if we dont have this enz then 6-MP accumulates and this leads to its toxicity.to reduce its toxicity we have to stop this drug , because its of no use if its not getting activated!!

tompat
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06/30/07 - 09:16 PM             #9

if some 1 is on allopurinol doses of 6-MP has to be adjusted and not that of allopurinol, to reduce toxicity of 6-MP.to treat themets in sanctuaries like CNS we give intrathecal methotrexate, no role of 6-MP there so no ineffective treatment.
thanks to both of u,
keep the good work up guysnod

silver
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06/30/07 - 11:01 PM             #10

don't your last 3 posts say in a long drawn out way what jean said precisely in one post

raised eyebrow

anyways, good question


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tompat
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07/01/07 - 12:25 AM             #11

yes he does, n thats very smart of him.
i respect knowledge BUT I WORSHIP APPLICATION!
i have learn many a things by reading detailed posts of forum seniors , in a way that helped me to think n apply.
i think the BELL'S palsy is very common now a days-----look--->raised eyebrow


arlete
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07/01/07 - 07:47 AM             #12

Bell's palsy! LOL!grin

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SmokyWaters
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07/02/07 - 05:54 AM             #13

hehe...good work tompat

Idlehands
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07/03/07 - 04:41 PM             #14

silver wrote:
don't your last 3 posts say in a long drawn out way what jean said precisely in one post

raised eyebrow

anyways, good question

Well I m Sorry Tompat, Silver is Right!!

Wht u have Elaborated in 3 Long Posts Jean has done it in couple of Lines. Essential U r Also saying the Same Thing but taking a long route to the point.


Idlehands
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07/03/07 - 04:47 PM             #15

tompat wrote:
yes he does, n thats very smart of him.
i respect knowledge BUT I WORSHIP APPLICATION!
i have learn many a things by reading detailed posts of forum seniors , in a way that helped me to think n apply.
i think the BELL'S palsy is very common now a days-----look--->raised eyebrow

Hmmmm........ Somebody Doesnt Like to Wrong ( or told as such).

We all do repect Knowledge Tompat but the Point is of Application and u r also right abt it. But that Doesnt necessarily mean that ur way of application is right. U can be wrong So take it lightly.

Secondly U of all ppl cant say that this emotion raised eyebrow is depictive of Bell's Palsy Cos that is not surely a SAD face as depicted in Bell's. Thats a Total Suprise coming from u and i m pretty sure that u meant the spasm of the Corrugator Supercilli.


SmokyWaters
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07/04/07 - 03:18 AM             #16

incerased drug toxicity...very adequately explained... smiling face

drduck
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07/07/07 - 08:28 AM             #17

hey TOMPAT ur bells palsy is really creating lot of problem to me....u know i laughed for atleast 10 mins after reading that post....
man!!!what a finding.....
now when ever i see that smilie i laugh for atleast a min and then read the concerned post..

u know what.....I AM STILL LAUGHING.... gringringrin

how about parkinsons disease....check this smilienodnodnod

really relieved much of my stress....thank u tompat

tompat
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07/07/07 - 10:50 PM             #18

hey drduck thats really cool man that dint occur to me,gringrin

drduck
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07/08/07 - 07:27 AM             #19

by this tell me MCC of unilateral bells palsy..
also tell me MCC of B/L bells palsy....

good revision....ha.....grin

tompat
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07/08/07 - 11:02 AM             #20

as far as i know mcc of unilateral bell's palsy is idiopathic and bilateral is lyme's disease.
unilateral is also seen in herpes infection

drduck
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07/10/07 - 10:27 PM             #21

nodnod







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