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PubMed1993

Safety profile of ranitidine. A review.

Ranitidine has been used for the treatment of millions of patients during the past 10 years. A small proportion of patients have developed a reaction to the drug shortly after the start of treatment, usually as a result of 'individual idiosyncrasy'. Reactions during continuous, long term treatment with ranitidine are uncommon, so that maintenance treatment of the chronic peptic diseases with ranitidine for more than 10 years has not been associated with significant iatrogenic disease.

Diarrhea↗
PubMed1983

Chylothorax. Clinical experience in nine cases.

Clinical experience in nine cases of chylothorax is presented. In five cases the cause was iatrogenic, in two cases idiopathic and in two cases the chylothorax was secondary to an advanced malignant disease. Iatrogenic chylothorax occurred after mediastinoscopy, thoracic sympathectomy, pneumonectomy, resection of an aneurysm of the thoracic aorta and closure of a patent ductus arteriosus. Only one of these patients needed an operative closure of the thoracic duct. In one of the two cases of a neoplastic origin the chylothorax was caused by a malignant mesothelioma and thoracic duct ligation was needed while in the other case it was due to an inoperable pancreatic carcinoma and was treated by thoracocentesis. In one of the idiopathic cases supradiaphragmatic ligation of the thoracic duct was necessary. It is concluded that in most iatrogenic or traumatic cases chylothorax can be cured by conservative therapy (diet, thoracocentesis); in other cases the operative therapy should be adjusted to the primary disease, and the ligation of the thoracic duct should be performed at a level where it is able to prevent the chylous leak without unnecessarily interfering with the collateral lymphatic circulation. Abundant and prolonged chylous leakage should be always treated operatively to prevent disastrous nutritional and immunological deficiencies.

Adult↗
PubMed1982

Changing epidemiological characteristics of acute viral hepatitis in Greece.

We have studied the epidemiological characteristics of acute viral hepatitis (AVH) in adult patients admitted to the Infectious Diseases Hospital of Athens in 1980. Commercially available radioimmunoassays were used for the detection of the hepatitis B surface antigen, its antibody, the antibody to the core of the hepatitis B virus (HBV) and the IgG and IgM antibody to the hepatitis A virus (HAV). HBV was responsible for 59.9%, HAV for 20.4% and hepatitis non-A, non-B virus for the remaining 19.7% of the cases studied. The results show that the relative frequency of AVH type B has declined considerably in the last four years (from 80.6% to 59.9%). In contrast, AVH type A (from 10.8% to 20.4%) and non-A, non-B (from 8.6% to 19.7%) have increased substantially. The incidence of AVH type A declined rapidly with age; the incidence of type B was higher in the 20-29 year-old group, while non-A, non-B continued to occur in older people. Seasonal variation was not observed, except for a slight increase during the winter months. These changes in the epidemiological characteristics of AVH can be attributed to the improvements in socioeconomic, sanitary and hygienic conditions, as well as to the obligatory screening of blood donors for HBsAg and the increased awareness of medical and paramedical personnel regarding the risk of transmitting the disease iatrogenically.

Acute Disease↗
PubMed1981

[Electrocardiographic changes in acute abdomen].

We have examined the electrocardiograms of 516 patients hospitalized for acute abdomen. We have excluded from this research the younger patients than 14 years, those with shock, those with clinical signs of cardiopathy, those with electrolytic alterations and those executing anti-arythmic or anti-depressing therapy. We have found changes of repolarization and of rhythm. The changes of regularization consisted in flottening-inversion of T wave in the precordial and/or limb leads associated sometimes at negative deflection of the ST tract in the same leads. The changes of rhythm consisted in atrial or ventricular extrasystoles, paroxismal atrial tachycardia, paroxysmal atrial fibrillation. Sometimes the changes of repolarization and rhythm were associated. We have discussed the possible pathogenetic mechanisms answerable for these changes; sympathetic adrenergic activation mediate or no from a parasympathetic reflex, reduction of intra-cellular potassium, activation of enzymatic systems, reabsorption of toxic substaces. The Authors have underlined the benignity of these ECG changes, disappearing after resolution of abdominal disease, and the necessity of a correct interpretation of those, to avoid the arising of a iatrogenic disease.

Abdomen, Acute↗
PubMed2005

[Contribution of bronchoalveolar lavage to the management of interstitial lung disease].

Bronchoalveolar lavage (BAL) is a minimally invasive method for exploring the distal lung. It enables collection of free cellular and acellular material present in the alveoli. Over the last two decades BAL has become a fundamental tool for positive diagnosis of interstitial lung disease and even more for differential diagnosis. It has contributed greatly to the diagnosis of lung infections, particularly in immunosuppressed patients. In the context of non-infectious infiltrative disease, the diagnostic contribution of BAL is limited due to the lack of a specific cell profile. It remains a fundamental tool for the differential diagnosis of idiopathic interstitial pneumonia. With BAL, a number of infectious or tumoral diseases can be ruled out with precision. It is also an important element for the evaluation of possible iatrogenic disease. BAL has transformed the diagnosis of interstitial lung disease and considerably reduced the indications for surgical biopsy.

Bronchoalveolar Lavage↗
PubMed1987

Arrhythmias, electrolytes, and ACE inhibitor therapy in the elderly.

Elderly patients have a higher incidence of symptomatic cardiac arrhythmias and greater management problems than younger patients. This is due to the frequency of occult and overt cardiovascular disease, reduction in cardiac reserve as a consequence of the aging process, and coexistence of other disorders which provide a substrate for iatrogenic disease. The last problem is largely due to electrolyte disturbances induced by diuretic therapy for hypertension and heart failure. The major electrolyte disturbance implicated in arrhythmogenesis is diuretic-induced hypokalemia. There is no doubt that arrhythmias are caused by severe hypokalemia (less than 2.5 mEq/l), or by a milder degree of hypokalemia in digitalis-treated patients or those with left ventricular hypertrophy, but the literature contains conflicting data regarding the importance of milder hypokalemia. The most compelling study in support of its importance used a crossover study design in hypertensive patients with coronary disease and showed that mild degrees of hypokalemia induced by thiazide diuretics increased the tendency to arrhythmia when compared with normokalemia on a potassium-sparing diuretic. Diuretic-induced magnesium deficiency is also regarded by some to be as important as hypokalemia, but the evidence is less extensive. Thus, it appears reasonable to avoid hypokalemia and hypomagnesemia. The optimum therapeutic approach in using diuretics is to keep the dose as low as possible, restrict dietary sodium, and add potassium supplements. Since, in many cases of hypertension, hypokalemia is due to secondary hyperaldosteronism, the use of angiotensin-converting enzyme inhibitors is another therapeutic approach that is effective in hypertension and heart failure.

Aged↗
PubMed1990

Renovascular disease and renal complications of angiotensin-converting enzyme inhibitor therapy.

Renal complications of angiotensin-converting enzyme (ACE) inhibitor therapy are widely recognized, but few authors have documented the incidence or spectrum of these conditions. In a retrospective study of 530 consecutive patients presenting to our unit as acute uraemic emergencies over a six-year period, 85 (16 per cent) had renovascular disease that was considered to be responsible for their loss of renal function. Twenty-one (4 per cent) patients had uraemia which could be clearly attributable to ACE inhibitor treatment; 18 of these cases were shown to have significant renovascular pathology. Following withdrawal of the ACE inhibitor the renal failure reversed in the majority of patients. We also examined 400 consecutive hypertensive patients referred over a similar period and, although vascular imaging was performed only when it was considered to be clinically indicated, 58 (14.5 per cent) of these patients were shown to have renovascular pathology. A further five patients with stable chronic renal disease were seen to have a deterioration in their glomerular filtration rate coincident with commencement of ACE inhibitor therapy; this reversed when the agents were withdrawn. These observations indicate that significant renovascular disease may be more common than has been hitherto recognized and that injudicious use of ACE inhibitors may result in serious complications. Methods which may minimize such iatrogenic disease are suggested.

Acute Disease↗
PubMed1984

A reexamination of the role of oxygen in retrolental fibroplasia.

A critical review of the literature of retrolental fibroplasia indicates that the cause of this disease is not yet known. Oxygen is certainly a critical factor but it is still not possible to make precise recommendations as to the amount or the duration of therapy that is safe. We have overemphasized the role of oxygen in the past, and as a result of this the false impression has been created that RLF is a disease that can be prevented. This gross oversimplification of a complex disease with multiple causes has resulted in many unjustified malpractice claims. A study of the present epidemic indicates that excessive oxygen administration probably plays a minor role, in contrast to the first epidemic in which prolonged oxygen administration was clearly a major factor. A reasonable working hypothesis is that the developing retina is highly sensitive to any disturbance in its oxygen supply, either hyperoxemic or hypoxemic. The retinal circulation is subject to the same wide fluctuations as the cerebral circulation in newborn infants. The very low-birth-weight, sick premature infant suffers from a number of conditions, many of which can seriously disturb the retinal circulation, resulting in hypoperfusion and ischemia. These factors (immaturity, hyperoxia, hypoxia, blood transfusions, intraventricular hemorrhage, apnea, infection, hypercarbia, hypocarbia, patent ductus arteriosus, prostaglandin synthetase inhibitors, vitamin E deficiency, lactic acidosis, prenatal complications, genetic factors) may all be present in an infant. They may interact to produce various degrees of retinal damage. Nearly all of these factors cannot be prevented or controlled by our present methods of care. Unfortunately, this means that RLF is an extremely difficult disease to prevent, treat, or investigate. A disease of this complexity with multiple causes will require very large numbers of infants in any controlled study of a therapy. Retrolental fibroplasia should not be considered an avoidable iatrogenic disease in very low-birth-weight infants. Its cause in these infants is not known.

Anencephaly↗
PubMed1990

New perspectives in the management of Alzheimer's disease.

Alzheimer's disease is the most common cause of progressive dementia in older adults. Diagnosis is based on a careful history, a thorough physical examination and appropriate laboratory studies. Although the pathology of Alzheimer's disease is well described, the etiology remains unknown. The only well-established risk factors are advanced age and family history. Management problems frequently include depression, delirium, wandering, urinary incontinence and iatrogenic disease.

Aged↗
PubMed1990

[The medical care of newborn infants in Switzerland].

Switzerland has one of the lowest neonatal mortalities in the world (5%) which has barely decreased during the last 10 years. The aim of care for newborn infants has therefore shifted from reducing mortality to reducing morbidity and increasing quality of life. Diseases which were frequent and severe some twenty years ago, such as rubella embryopathy and rhesus incompatibility, have almost disappeared today due to general prophylaxis. On the other hand, new, partly iatrogenic diseases, such as retinopathy of prematurity and bronchopulmonary dysplasia, considerably affect present morbidity of newborn infants. Due to newly developed imaging techniques and genetic, biochemical and immunological methods for screening of risk groups or all pregnant women or newborns, more and more diseases are detected earlier. Therefore the optimal procedure has to be settled early and on an interdisciplinary basis, and include prenatal investigation and possibly treatment, planning of delivery, and early and late postnatal diagnostic and therapeutic measures. The consequence of this development is close cooperation between obstetricians, neonatologists, and pediatric specialists, and a rapidly increasing need for neonatal beds, especially for intensive care. In spite of identification and centralization of women with high risk pregnancy before delivery, every newborn may develop sudden, unpredictable problems of adaptation which need immediate action. Therefore, at every delivery in a clinic or at home the necessary equipment and skilled staff must be available in order to cope with acute problems during adaptation from intrauterine to extrauterine life.

Congenital Abnormalities↗
PubMed1993

Prevention of health problems in later life.

The areas of health promotion and disease prevention for older people have been neglected in medical practice. Many doctors, as well as the general community, believe that for people over 65 years of age it is too late for preventive care. This assumption is incorrect. However, there are a number of issues that are unique to prevention of health problems in later life. The goals of preventive care are broader than the issues of illness and life expectancy. Quality of life, autonomy and maintaining optimal function are equally important concerns for older people. Practising prevention involves not only reducing primary risk factors or screening for disease, but also encompasses psychological, environmental and social issues as these affect health and well-being. In addition, special medical problems require consideration; these include falls, incontinence, confusion, poor mobility and iatrogenic disease which are not the result of one disease process, but have many inter-related causes. Greater prominence should be given to patient education and counselling on these medical, social and psychological issues. General practitioners are ideally placed to initiate prevention as 87% of older Australians visit their GP once a year. While clear recommendations can be given on the effectiveness of some interventions, for others the doctor involved will have to make an informed decision based on individual clinical circumstances. Preventive care in later life is an integral part of good geriatric medicine.

Aged↗
PubMed1984

Potentials and limitations of angiotensin converting enzyme inhibition in the treatment of hypertension.

To appreciate the advantages of inhibiting the renin-angiotensin system in the treatment of hypertension it is necessary to be aware of four major failures in today's therapy of the disease: The theoretical blood pressure target (supine diastolic blood pressure of 90 to 95 mmHg) is not reached in every patient. The number of adverse effects affecting the quality of life is not acceptable. Today's antihypertensive medications have no basic physiological rationale. Although the mechanical risks of blood pressure elevation are avoided with today's therapy, coronary heart disease, the most common cardiac complication, is not significantly reduced. Converting enzyme inhibition could theoretically provide a solution to each of these failures but its advantages will have to be balanced against the potential risks. The risk of iatrogenic disease with any compound introduced chronically into a living organism for therapeutic reasons. The lack of substrate specificity and the unknown overall physiological effect of angiotensin converting enzyme.

Angiotensin-Converting Enzyme Inhibitors↗