No abstract

Azathioprine leads to changes in mean corpuscular volume (MCV) and white blood cell (WBC) indices reflecting efficacy or toxicity. Understanding the interactions between bone marrow stem cells and azathioprine could highlight abnormal response patterns as forerunners for hematologic malignancies. This study gives a statistical description of factors influencing the relationship between MCV and WBC in children with inflammatory bowel disease treated with azathioprine. We found that leukopenia preceded macrocytosis. Macrocytosis is therefore not a good predictor of leukopenia. Further studies will be necessary to determine the subgroup of patients at increased risk of malignancies based on bone marrow response.

A bdominal pain is reported by a third of school-aged children 1 and accounts for several visits daily in most emergency departments. 2-5 Although the use of analgesia to treat acute abdominal pain is well-supported, 6,7 there is little evidence to guide the management of nonspecific abdominal pain in the emergency department, 8 which accounts for two-thirds of cases of abdominal pain presenting to the emergency department. 8,9 Acetaminophen is the most commonly used World Health Organization Step 1 analgesic. 10 In children, it is effective for many painful conditions, 11,12 but data supporting its use for abdominal pain are lacking. 13,14 Despite strong advocacy by the American Academy of Pediatrics 15 for adequate pain management, less than two-thirds of children with abdominal pain in the emergency department receive analgesia, 16,17 and roughly half experience ongoing pain after discharge. 18 Children with nonspecific abdominal pain are less likely than those with a specific cause to receive analgesia. 5 Available analgesic options for children with nonspecific abdominal pain in the emergency department may result in greater adherence to the American Academy of Pediatrics recommendations. Hyoscine butylbromide is orally administered and available in most Canadian emergency departments. We surmised that it may be effective for colicky abdominal pain owing to its antispasmodic properties. 19 Ten placebo-controlled studies involving 3699 adults with functional abdominal pain showed hyoscine butylbromide to be beneficial, without serious adverse effects. 20-29 In the only pediatric study, hyoscine butylbromide, 10 mg given orally, was found