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PubMedDate not supplied

Colopathies of the old adults.

The increase of life-time together with the improvement of the social, sanitary and medical cares lead to the apparition of a cohort of "very old" subjects. The prevalence of symptoms compatible with colopathies among the olders is impressive. The spectrum of large bowel disease in the elderly is essentially similar to that found at a younger age but the incidence of some diseases increases with age. This review presents the specificity of colopathies of the olders and focuses on the following medical topics: irritable bowel disease (IBS), clostridium colitis, ischemic disease, iatrogenic disorders. The specificity of the "geriatric" patients should be integrated into diagnosis and clinical management.

Aged↗

PubMed1990

[An investigation on injectional gluteal muscle contracture in childhood in Mianyang City].

An investigation of 9845 healthy children with age of 3-12 years in Mianyang urban area has been made by us. One hundred and twenty-two cases of injectional gluteal muscle contracture were diagnosed. The morbidity is 1.36% and it is more common in boys than in girls (OR: 3.71). The prevalence rate of the age group from 4 to 7 is highest and it decreases markedly with aging. This is probably due to self-recovery of some mild cases. Repeating injections of diluted penicillin by 1.5-2% Benzyl alcohol are the predominant causative factor of the disease. If Benzyl alcohol as a solvent for penicillin in children was no longer using, it would possibly reduce the morbidity. Up to now, this is a common iatrogenic disease in pediatric population and special attention should be paid to it.

Benzyl Alcohols↗

PubMed1994

Human spongiform encephalopathy: the National Institutes of Health series of 300 cases of experimentally transmitted disease.

We present a synthesis of clinical, neuropathological, and biological details of the National Institutes of Health series of 300 experimentally transmitted cases of spongiform encephalopathy from among more than 1,000 cases of various neurological disorders inoculated into nonhuman primates during the past 30 years. The series comprises 278 subjects with Creutzfeldt-Jakob disease, of whom 234 had sporadic, 36 familial, and 8 iatrogenic disease; 18 patients with kuru; and 4 patients with Gerstmann-Strüssler-Scheinker syndrome. Sporadic Creutzfeldt-Jakob disease, numerically by far the most important representative, showed an average age at onset of 60 years, with the frequent early appearance of cerebellar and visual/oculomotor signs, and a broad spectrum of clinical features during the subsequent course of illness, which was usually fatal in less than 6 months. Characteristic spongiform neuropathology was present in all but 2 subjects. Microscopically visible kuru-type amyloid plaques were found in 5% of patients with Creutzfeldt-Jakob disease, 75% of those with kuru, and 100% of those with Gerstmann-Sträussler-Scheinker syndrome; brain biopsy was diagnostic in 95% of cases later confirmed at autopsy, and proteinase-resistant amyloid protein was identified in Western blots of brain extracts from 88% of tested subjects. Experimental transmission rates were highest for iatrogenic Creutzfeldt-Jakob disease (100%), kuru (95%), and sporadic Creutzfeldt-Jakob disease (90%), and considerably lower for most familial forms of disease (68%). Incubation periods as well as the durations and character of illness showed great variability, even in animals receiving the same inoculum, mirroring the spectrum of clinical profiles seen in human disease. Infectivity reached average levels of nearly 10(5) median lethal doses/gm of brain tissue, but was only irregularly present (and at much lower levels) in tissues outside the brain, and, except for cerebrospinal fluid, was never detected in bodily secretions or excretions.

Adolescent↗

PubMed2001

History of surgical approaches to the frontal sinus.

Despite the enormous number of external and endonasal surgical techniques described for the treatment of frontal sinus disease, a single time-proven technique has yet to be obtained. The purpose of this article is to critically evaluate the lessons of more than a century of endonasal and external procedures. The past has taught us a cautionary lesson for the surgical management of chronic frontal sinus disease, respect for the severity of iatrogenic disease caused by surgical trauma, and the need for long-term follow-up before embracing any new technique to treat this notoriously difficult clinical problem.

Frontal Sinus↗

PubMed1998

Cholestatic hepatocellular injury with azathioprine: a case report and review of the mechanisms of hepatotoxicity.

Azathioprine is a drug commonly used for the treatment of inflammatory bowel disease, organ transplantation and various autoimmune diseases. Hepatotoxicity is a rare, but important complication of this drug. The cases reported to date can be grouped into three syndromes: hypersensitivity; idiosyncratic cholestatic reaction; and presumed endothelial cell injury with resultant raised portal pressures, venoocclusive disease or peliosis hepatis. The components of azathioprine, 6-mercaptopurine and the imidazole group, may play different roles in the pathogenesis of hepatotoxicity. The strong association with male sex, and perhaps with human leukocyte antigen type, suggests a genetic predisposition of unknown type. Many of the symptoms of hepatotoxicity, such as nausea, abdominal pain and diarrhea, can be nonspecific and can be confused with a flare-up of inflammatory bowel disease. As well, the subtype resulting in portal hypertension can occur without biochemical abnormalities. A 63-year-old man with Crohn's disease who is presented developed the rare idiosyncratic form of azathioprine hepatotoxicity, but also had a severe disabling steroid myopathy, peripheral neuropathy, resultant deep venous thrombosis and pulmonary embolism related to immobility, and a nosocomial pneumonia. His jaundice and liver enzyme levels improved markedly on withdrawal of the drug, returning to almost normal in five weeks. Treating inflammatory bowel disease effectively while trying to limit iatrogenic disease is a continuous struggle. Understanding the risks of treatment is the first important step. There must be a low threshold for obtaining liver function tests, especially in men, and alertness to the need to discontinue the drug or perform a liver biopsy should patients on azathioprine develop liver biochemical abnormalities, unexplained hepatomegaly or signs of portal hypertension.

Azathioprine↗

PubMed1988

Iatrogenic Buschke's disease (Michelin man syndrome)

Scleredema [corrected] adultorum as originally described by Buschke in 1900, is cutaneous thickening of unknown aetiology. Since then several cases have been reported which have illustrated different aspects of the disease but the exact aetiology, pathogenesis and prognosis remain uncertain. Disease of possible iatrogenic origin appears not to have been described previously.

Blood Protein Electrophoresis↗

PubMed1982

[Modification of psychosocial adjustment by terminal disease].

Psychosocial adaption during or after somatic illness is relatively little studied--quite in difference to the better known psychosocial predictors of somatic illness. This study is concerned with a group of 31 female patients who suffered from a terminal vascular disease (primary vascular pulmonary hypertension)--an iatrogenic disease which with high probability is the consequence of a drug for weight reducing (Menocil), prescribed by their family doctors to these moderate overweight middle aged women. Psychosocial adaptions was assessed on a 5-point-scale, including the following dimensions: work-situation, socio-economic conditions, family adaption, social activities. Psychosocial adaption before illness was very good (just 10% below maximal values). Two or three years after illness started, however, there was a highly significant drop in all dimensions (most significant in "work" and "social activities"). To some extent success or failure of psychosocial adaption had a predictive power for the terminal course of this illness. Possible interaction between course of illness and psychosocial adaption is discussed and illustrated. There was also a significant correlation between psychosocial adaption and defense-processes.

Adult↗

PubMed1975

[Testing of granulocyte function].

Recent work on the in-vitro analysis of granulocyte functions is reviewed. Various forms of granulocyte functions defect have been observed in association with increased susceptibility to infectious diseases. Intrinsic cellular defects can be distinguished from secondary impairment of granulocyte functions due to other diseases, iatrogenic causes or humoral defects. In such cases the in-vitro methods for evaluation of granulocyte functions have become an indispensable diagnostic aid.

Blood Bactericidal Activity↗

PubMed1998

Contribution of magnetic resonance imaging for the diagnosis of median nerve lesion after endoscopic carpal tunnel release.

Deterioration of pre-existing signs or appearance of a nerve deficit raise difficult problems during the complicated course following endoscopic carpal tunnel release. One possible explanation is transient aggravation of nerve compression by passage of the endoscopy material, but these signs may also be due to incomplete section of the flexor retinaculum or an iatrogenic nerve lesion. Each case raises the problem of surgical revision. The authors report three cases of open revision in which MRI allowed a very precise preoperative diagnosis of the lesions and all of the MR findings were confirmed during surgical revision. In the first case, MRI showed section of the most radial branches of the median nerve (collateral nerves of the thumb, index finger and radial collateral nerve of the middle finger). The proximal origin of the nerve of the 3rd web space, above the retinaculum, an anatomical variant, was also identified. Section of 2/3 of the nerve of the 3rd web space, proximal to the superficial palmar arch, was observed in the second case. Simple thickening of the nerve of the 3rd web space, without disruption after opening of the perineurium, was observed in the third case. MRI therefore appears to be an examination allowing early and precise definition of indications for surgical revision in this new iatrogenic disease.

Carpal Tunnel Syndrome↗

PubMed1976

Pattern and quality of recording pre-admission drug treatment in paediatric patients.

The pattern and quality of recording drug use before admission was examined in children admitted to a paediatric unit over eight months. The preadmission drug intake (1-7 drugs/patient) was lower than that of adults. Antibiotics were the most frequently prescribed drugs, but mild analgesics and antihistamine preparations were commonly used, often without medical advice. The simultaneous administration of prescribed and non-prescribed drugs appeared to be as common in children as in adults. The number of drugs taken was related to the number of domicilary consultation received and the number of doctors seen as as to confirm that most doctors' visits result in the prescription of medicine. The transfer and recording of drug information was poor, owing principally to lack of communication between doctors and failure to detect self-medication, but the modern practices of self-referral to hospital and use of multiple prescribers have further reduced the information available. The use of a "current treatment card" is required if the full significance of iatrogenic disease in childhood is to be investigated.

Adolescent↗

PubMed1976

[Gastroenterology yesterday and today].

In the 40 years since the foundation of the "Schweizerische Gesellschaft fur Gastroenterologie", medicine - and with it gastroenterology - have markedly changed. New diseases and syndromes have been discovered and others have disappeared. New knowledge in basic sciences influences progress in diagnosis and therapy. In diagnostic methods the most evident advances are fiberendoscopy, endophotography and biopsy, and progress in roentgenology and immunology. New drugs, new surgical methods and controlled trials have improved treatment. However, each advance has its drawbacks: the growing incidence of iatrogenic diseases, the overwhelming literature, the flood of congresses, the record-breaking mentality of many clinicians and the hunting and collecting instinct for "interesting cases". "Medical art", a notion difficult to define, is in danger of disappearing. It means a harmony of knowledge, skill experience, intuition and the predominant desire to help the patient. This means individualized medicine, which is only possible by sympathetic dialogue with the patient - not only by specialists in psychiatry or psychosomatics, but by every doctor. will be able to preserve medicine from inhumanity in spite of technology, rationalization and the computer?

Congresses as Topic↗

PubMed1990

Myospherulosis of the mastoid antrum: a case report.

Myospherulosis is a recently discovered iatrogenic disease caused by the implantation during surgery of mineral oil- or petrolatum-based products into various tissues. The condition results from the action of lipid substances on extravasated erythrocytes. The case report presented is the first detailed description of this uncommon, unique inflammatory lesion occurring in the mastoid and is the second otitic case reported in the literature. The lesion mimicked recurrent cholesteatoma 6 years following an intact canal wall mastoidectomy. As in myospherulosis of the paranasal sinuses, the symptoms and findings of otitic myospherulosis are those of the preceding disease.

Bacitracin↗

PubMed1994

Avoiding polypharmacy and iatrogenesis in the nursing home.

The vast majority of nursing home patients over age 65 take at least one prescription medicine, and, on average, seven drugs are concurrently prescribed for each of these patients. One result of this polypharmacy is an increased risk of iatrogenic disease. The authors discuss traditional prescribing patterns in nursing homes and how these patterns contribute to drug-drug and drug-disease interactions in nursing home patients, as well as strategies to reduce polypharmacy and iatrogenesis.

Aged↗

PubMed1989

Cervical esophageal perforation diagnosed by endoscopy in a premature infant: review of recent literature.

A case of cervical esophageal perforation in a premature infant by an orogastric polyvinyl chloride (PVC) tube is reported. Perforation appeared as an esophageal atresia, suspected because of the inability to aspirate gastric secretions. Initially, atresia was confirmed by an esophagogram, but endoscopy revealed a "double esophagus" with a normally located and developed esophagus and a blind mediastinal fistula starting at the opposite side of the glottis. The "double esophagus" was confirmed by an esophagogram, followed by a contrast study in the pharynx. Esophageal perforation in the neonate is an iatrogenic disease that may mimic esophageal atresia. We recommend endoscopy instead of contrast studies for suspected esophageal atresia.

Diagnosis, Differential↗

PubMed2002

Physician-induced torsade de pointes--therapeutic implications.

"Torsade de pointes" (TdP) is a clinico-electrocardiographic syndrome characterized by an abnormally prolonged QT interval and the occurrence of potentially life-threatening ventricular tachyarrhythmias. Two mayor causes can be distinguished: congenital and acquired long QT syndrome. Whereas the former has recently been identified as an ion channelopathy, the mechanisms underlying acquired long QT syndrome are far from being understood. It has been suggested that patients with the acquired form of the disease may suffer from a clinically hidden form of the congenital variant. However, recent studies have yielded only a small number of individual cases in whom genetic analyses revealed the presence of an ion channel gene mutation. Since acquired long QT syndrome is most often induced by drugs prolonging myocardial repolarization, it is largely an iatrogenic disease. In order to prevent unwitting exposure to risk, physicians prescribing agents that may prolong repolarization need to be aware of the typical clinico-electrocardiographic characteristics of drug-induced TdP, and its diagnosis and management. A clearer delineation of the risk factors predisposing to abnormal prolongation of repolarization, and a more precise quantification of the torsadogenic potency of individual drugs appear mandatory in order to prevent or at least minimize the occurrence of this potentially fatal adverse effect of certain drugs.

Cardiovascular Agents↗

PubMed2004

[Preliminary study of the drug consumption in hospitalized elders].

BACKGROUND: The absence of studies that evaluate the effect of the medical acts is an example of "mala praxis". The irrational use of medications is one of these cases. This study shows the characteristics of the drugs consumption in elders. MATERIAL AND METHODS: We include 53 elders hospitalized between 1/02/02 and the 31/05/02. RESULTS: The elders received an average of 6.45 medicaments/day. The factors of more consumption are the origin from nursing home residents and the number of previous surgeries. The adverse effects were related in 25% of the hospitalizations. CONCLUSIONS: The basis of this situation is in the loss of the global perspective of the patients and in the abuse of the sanitary resources. Each drug is the result of an isolated medical act, determining the appearance of iatrogenic disease.

Aged↗

PubMed1978

[Hypophenylalaninemia in dietary treatment of phenylketonuria (author's transl)].

One case of hypophenylalaninemia during the dietary low phenylalanine treatment is presented. The general problem of dietary treatment from early ages is reviewed. The appearance of this iatrogenic disease despite adequate supply of this essential aminoacid is stressed. Authors recommend follow-up of these patients in a regional reference center with adecuate technology.

Diet Therapy↗

PubMed2006

Illness-related stigma, mood and adjustment to illness in persons with hepatitis C.

We examined stigma in persons with hepatitis C and its relationship with mood and adjustment to illness. We studied 87 persons awaiting interferon treatment for hepatitis C at St James's Hospital, Dublin. Stigma was assessed using Fife's Experience of Illness scale. A structured clinical interview was used to establish DSM-IV diagnosis. The Hospital Anxiety and Depression Scale (HADS) and Beck Depression Inventory (BDI) were also used as measures of mood. Factor analysis and clustering around latent variables analysis were used to assess scale structure and reliability. The stigma scale had an overall reliability of 0.94. A strong dimension of fear of disclosure emerged, from item analysis, together with dimensions of social isolation and social rejection. Stigma was higher in those in manual occupations and the unemployed than in those in non-manual occupation. There were high levels in those with disease associated with injecting drug use and iatrogenic disease caused by transfusion or anti-D blood products, and low levels in those who had been treated for haemophilia with contaminated products or whose hepatitis was of unknown origin. Adjusted for confounders, a 1-decile increase in stigma score had an odds ratio of 1.4 for DSM-IV depression and similar associations with depression on the HADS and BDI. Stigma was also associated with poorer work and social adjustment, lower acceptance of illness, higher subjective levels of symptoms and greater subjective impairment of memory and concentration. These associations were replicated in the non-depressed subsample. The results underline the strong link between stigma and well-being in hepatitis C. However, they also suggest that stigma is a complex construct that will require further research to elucidate.

Adaptation, Psychological↗