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PubMedDate not supplied

Chronic laryngeal stenosis.

The results of treatment of 82 patients with chronic laryngeal stenosis during a 20-year period are presented. Road traffic accidents accounted for 30% of the cases and iatrogenic disease for 40%. Of the stenoses 10% were supraglottic, 20% glottic, 50% subglottic, and 15% combined. Virtually all patients with supraglottic stenosis had a good result as regards voice and airway, and we describe the use of a laryngeal widening operation for this group of patients. Over 80% of patients with glottic stenosis achieved good results. However, patients with a subglottic stenosis did badly, and only 60% were relieved of their tracheostomies. Patients with stenosis due to previous tracheostomy or to systemic disease such as Wegener's granuloma did badly.

Adolescent↗
PubMed1987

Haemophilia, blood products and HIV infection.

Between 1979 and 1984, many haemophiliacs in the UK were exposed to the human immunodeficiency virus (HIV) by transfusion of blood products, in particular clotting factor concentrates, especially those imported from the USA. In the UK 1025 haemophiliacs are HIV-antibody-positive, of whom 75 are in Scotland. Thirty-one UK haemophiliacs have developed the Acquired Immune Deficiency Syndrome (AIDS), of whom 23 have died. The clinical progress of HIV infection appears similar in haemophiliacs and in other risk groups, except that Kaposi's sarcoma is rare. There is evidence that transfusion of blood products is immunosuppressive in the absence of HIV antibody. Blood donor selection and heat treatment of clotting factor concentrates were introduced from 1985, and so far these measures appear to have largely prevented new HIV infection in haemophiliacs. Meanwhile a tragic toll of iatrogenic disease and death continues to increase.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Drug-induced metabolic disorders and parenteral nutrition in the intensive care unit: a pharmaceutical and metabolic perspective.

Since its inception, the field of parenteral nutrition has continued to evolve requiring the expertise of several health care disciplines. This feature has made nutrition support unique among clinical subspecialties. As a member of this team, the pharmacist plays a critical role in the provision of sterile admixtures, compatible nutritional formulations, and cost-effective, therapeutically equivalent strategies. The pharmacist has become more involved in the clinical care of the patient, with particular emphasis on the development of drug-induced metabolic disorders. The multitude of drugs prescribed to hospitalized patients increases the potential for serious metabolic disturbances. This is especially true in the critical care setting where sudden changes in metabolism (e.g., acid-base homeostasis, fluid and electrolyte balance) may result in profoundly negative effects. The critical care setting also represents the most sensitive period of hospitalization where even subtle changes in metabolic homeostasis may assume major clinical significance. Early recognition of offending agents and the institution of appropriate intervention may avert serious iatrogenic diseases. The nutrition support team is in a unique position to address many such disorders through selective manipulation of the various components in the parenteral nutrient admixture. The ability of the pharmacist to recognize the development of drug-induced metabolic disorders lends further support for clinical pharmacy in nutrition support services.

Enteral Nutrition↗
PubMed1995

Prescription drug and healthcare use among Swedish patients treated with antidepressants.

OBJECTIVE: To analyze healthcare and prescription drug use among patients taking and those not taking antidepressant drugs in a Swedish community. DESIGN: Cross-sectional study. SETTING: General population of the rural Swedish municipality Tierp of approximately 20,000 inhabitants. PARTICIPANTS: All residents of Tierp aged 25 years or older during 1988. MAIN OUTCOME MEASURES: Mean number of ambulatory care visits, hospital bed days, and prescriptions per person; proportion of those taking prescription drugs in different pharmacologic classes. RESULTS: Patients treated with antidepressant drugs had a significantly (p < 0.05) greater use of ambulatory care, hospital care, and prescription drugs than those who did not take antidepressants in the study population. They also had an increased frequency of use of prescription drugs from virtually all pharmacologic classes. Furthermore, the risk for polypharmacy was high in patients treated with antidepressant medications. CONCLUSIONS: Those who took antidepressant drugs consumed more health services and prescription drugs than did those not taking an antidepressant. Patients receiving antidepressant treatment may be at serious risk for iatrogenic disease and should be evaluated carefully with respect to concomitant drug use.

Adult↗
PubMed2005

T-cell immunotherapy for adenoviral infections of stem-cell transplant recipients.

Human adenoviruses are ubiquitous lytic DNA viruses that can be divided into 51 different serotypes, grouped from A to F on the basis of genome size, composition, homology, and organization. Adenovirus infections, although frequent, are rarely fatal in immunocompetent individuals, due to potent innate and adaptive immune responses. By contrast, adenoviruses are a significant cause of morbidity and mortality in immunosuppressed individuals, for whom there are limited treatment options. Since antiviral drugs have variable efficacy in the treatment of severe adenovirus disease, iatrogenic reconstitution with in vitro expanded virus-specific cytotoxic T lymphocytes (CTLs) is an attractive option for prophylaxis and treatment, particularly because the endogenous recovery of adenovirus-specific T cells has proved important in controlling infection in vivo. Thus, we have characterized human T-cell responses to adenovirus in vitro and explored the potential of adoptive T-cell immunotherapy as a prophylactic or therapeutic strategy for adenovirus infections posttransplant.

Adenoviridae Infections↗
PubMed1998

Saccharated ferric oxide-induced osteomalacia in Japan: iron-induced osteopathy due to nephropathy.

Saccharaed ferric oxide (SFO)-induced osteomalacia develops when excessive SFO infusions are administrated to patients with anemia for prolonged periods for a few years. The small particles and almost neutral saccharide of SFO filter through the glomerular tufts into the renal tubules, resulting in impairment of proximal renal tubular function, particularly renal reabsorption of phosphate and 1alpha-hydroxylase activity, resulting in decreased serum levels of phosphorus and active vitamin D, both of which lead to development of hypophosphatemic osteomalacia. Furthermore, SFO, at concentrations attainable in serum, exacerbates the osteomalacia by inhibiting bone formation directly. In contrast to itai-itai disease, another iatrogenic osteomalacia due to cadmium nephropathy [44], the proximal renal tubular function impairment induced by SFO is reversible simply by discontinuing the nephrotoxin, which is followed by improvement of all the clinical manifestations, except bone deformities. So far, SFO-induced osteomalacia, that is, SFO-induced osteopathy due to nephropathy, has been reported only in Japan, probably due to the lax surveillance system of the health insurance scheme. All physicians who prescribe SFO should be aware of its severe adverse effects. We hope that such iatrogenic osteomalacia caused by abusive infusion of SFO will never again be reported in our country.

Aged↗
PubMedDate not supplied

The discovery of retrolental fibroplasia and the role of oxygen: a historical review, 1942-1956.

Nearly 50 years after it was thought to be conquered, retinopathy of prematurity (ROP) continues to cause vision disturbances and blindness among prematurely born infants. During the 1940s and early 1950s, researchers and caregivers first identified and struggled to eliminate this problem, which seemed to come from nowhere and was concentrated among the most advanced premature nurseries in the U.S. Research studies initially identified many potential causes, none of which could be proved conclusively. By the mid 1950s, oxygen was identified as the culprit, and its use was immediately restricted. The rate of blindness among premature infants decreased significantly. ROP was not cured, however. By the 1960s, it had reappeared. The history of ROP serves to remind us that, despite our best intentions, the care and treatment of premature newborns will always carry with it the possibility of iatrogenic disease. This caution is worth remembering as we work to expand the quality and quantity of clinical research.

History, 20th Century↗
PubMed1980

The epidemic of endometrial cancer: a commentary.

Vital statistics show that a rise in incidence of endometrial cancer began in the mid-1960s on the West Coast of the United States. This rise was continuous and reached a peak in 1975. Elsewhere, incidence rates for endometrial cancer rose during the 1970s. It now seems evident that much of the rise in all areas of the country was due to replacement estrogen treatment. We estimated from data obtained from the Commission on Professional and Hospital Activities-Professional Activity Study of Ann Arbor, Michigan, that over 15,000 cases of endometrial cancer were caused by replacement estrogens during the five-year period 1971--1975 alone. This represents one of the largest epidemics of serious iatrogenic disease that has ever occurred in this country. With the substantial fall in estrogen sales starting in January 1976, there has been an associated decline in the incidence rates of endometrial cancer nationwide.

Aged↗
PubMed1995

Cephalosporin utilisation review and evaluation.

The clinical misuse of drugs may result in preventable patient morbidity and mortality, costly remedial care, additional costs for diagnosis and management of iatrogenic disease and unnecessary wastage of healthcare resources. In recognition of this problem, drug utilisation evaluation (DUE) has been recommended as a method for identifying inappropriate or unnecessary drug use and for promoting rational therapy. Growing concern over the widespread misuse of antibiotics, together with the emergence of antimicrobial resistance and escalating expenditures, has resulted in antibiotics being the drugs most frequently chosen for DUE projects. Cephalosporin DUE is well documented as being successful for modifying cephalosporin use and for containing drug expenditure. Studies range from isolated projects to ongoing programmes that comprehensively evaluate cephalosporin use and the impact of corrective strategies. Sensible use of antibiotics requires a clear understanding of the infectious process, the clinical pharmacology of anti-infective agents and an appreciation of clinical and microbiological monitoring and assessment. Audit criteria that incorporate the above principles, and which are described in the studies reviewed in this article, will be useful for other investigators. Through its DUE programme, the Royal Adelaide Hospital has investigated the use of cephalosporins, including ceftriaxone, ceftazidime and cefoxitin. These reviews have resulted in improvements in cephalosporin use and significant cost savings. Alterations to cephalosporin use that were recommended following these reviews have not resulted in adverse changes to post-operative infection rates, clinical outcomes or adverse drug reactions. This experience, combined with that of other investigators, serves as a useful model for the promotion of rational and economical therapy with cephalosporins and other drug groups.

Bacterial Infections↗
PubMed1992

The perinatal autopsy: a contemporary approach.

As autopsy rates in general hospitals decline, interest in the perinatal autopsy continues to rise, reflecting the emergence of a vigorous specialty growing in parallel with fetal medicine, prenatal diagnosis and clinical genetics. Perinatal autopsies are best carried out in tertiary centres which provide these services. Meticulous documentation, flexibility of technique, intelligent use of laboratory tests and wide systematic histopathologic sampling are emphasized. Microbiologic examination is of particular value when carried out by a laboratory having a special interest in genital tract and perinatal pathogens. Karyotyping must be selective if resources are to be conserved and is most productive when there are multiple malformations. Perinatal autopsy is not complete without examination of the placenta and significant lesions should be clearly distinguished from curiosities and from changes secondary to fetal death. The pathologist's wider contribution to perinatal medicine includes providing high quality data to epidemiology units and auditing committees, contributing to the multidisciplinary management of prenatally diagnosed fetal abnormalities, monitoring iatrogenic disease patterns and supporting the process of perinatal grief management. Special problems and diagnostic challenges are to be found when investigating sudden, unexplained intrauterine fetal death, hydrops, bone dysplasias and complicated multiple pregnancies.

Autopsy↗
PubMed1994

Studies on the mechanisms of glucocorticoid hypertension in humans.

Hypertension is a common feature of both Cushing's syndrome, which is relatively rare, and iatrogenic steroid administration, which is much more common. Cardiovascular mortality and morbidity are very significant in patients with both naturally occurring and iatrogenic disease. The mechanism of glucocorticoid induced hypertension in man remains undefined. Contrary to previous notions, it does not reflect urinary sodium retention or volume expansion. Increased pressor responsiveness may be an important contributor to the rise in blood pressure.

Animals↗
PubMed1976

Coronary ostial stenosis complicating coronary arteriography.

Coronary ostial stenosis is a cause of angina pectoris and sudden death. It is due mainly to atherosclerosis, syphilis, and iatrogenic disease. The last is of growing importance because of the frequency of coronary arteriography and surgical procedures on the aortic valve. Since both may cause stenosis of the coronary ostia, these procedures raise the topic from an obscure morphologic entity to an important consideration in the treatment of cardiac disease. We describe a case of ostial stenosis that was complicated by coronary arteriography.

Adult↗
PubMed2000

[Steroid therapy and adrenal function].

Glucocorticoids are frequently used for both diagnostic and therapeutic purposes. Their action mimics endogenous glucocorticoid actions by altering the activity of the hypothalamic-pituitary-adrenal (HPA) axis. Therefore, they can be responsible for iatrogenic diseases, particularly if used at high doses and for a long time. The aim of this brief review is to show the main pharmacological characteristics and the endocrine effects of glucocorticoids. The HPA axis insufficiency, related to acute glucocorticoid withdrawal, is also discussed.

Adrenal Insufficiency↗
PubMed2000

[Diffuse infiltrative lung diseases due to allergy and iatrogenic causes].

Iatrogenic and hypersensitivity infiltrative pneumonias comprise 3 distinct entities: extrinsic allergic alveolitis, drug-induced pneumonia and radiation-induced pneumonia. The diagnosis of the latter is usually easy, except for the recently identified postradiation bronchiolitis obliterans organizing pneumonia. Diagnosis of extrinsic allergic alveolitis is based on the association of clinical, radiological, functional, immunological criteria and bronchoalveolar lavage fluid analysis. The polymorphous presentation of drug-induced pneumonia makes its diagnosis critical except for a few causes such as amiodarone pneumonia or lipoid pneumonia.

Alveolitis, Extrinsic Allergic↗
PubMedDate not supplied

[Oncologic treatment of oto-neuro-ophthalmological metastases and their complications].

INTRODUCTION: Cerebral metastases and the sequelae of their treatment are the major cause of neurological symptoms in patients with cancer. OBJECTIVE: In this article we review the oto-neuro-ophthalmological complications of the treatment of metastases with radiotherapy and/or chemotherapy. DEVELOPMENT: When speaking of the iatrogenic diseases caused by radiotherapy treatment of metastases, it is important to emphasize that the major complications of this form of treatment are seen in the long term, in general, months or years later. When dealing with incurable diseases, such as most metastatic cancers, the benefit/risk balance of each therapeutic option has to be taken into account. Thus we have a population of patients with symptoms secondary to metastatic involvement, and with an overall life expectancy which may be measured in months. The oto-neuro-ophthalmological toxicity of the chemotherapy may present as an infrequent and unexpected complication or as a usual, expected secondary effect of the drug used. A large variety of drugs are used for the systemic control of cancer (cystostatic drugs, hormones and modifiers of the biological response) which, in one way or another, may cause neurological signs. CONCLUSION: The increasingly frequent use of high dose chemotherapy and of the combined use of chemotherapy and radiotherapy mean that these types of toxicity have become common clinical syndromes in current oncological practices.

Adrenal Cortex Hormones↗
PubMed1975

[Proceedings: Long-term therapy with steroids].

All glucocorticosteroids available at the present time exert a wide range of actions in every single cell of every organ. It is still not possible to dissociate the therapeutically desirable effects from the undesirable side effects, and whether this goal will ever be achieved is more than questionable. Thus, chronic treatment with steroids is invariably associated with side effects, but there are a number of therapeutic rules whose strict observance may prevent a patient in chronic need of steroid treatment from developing a second, iatrogenic disease. For example, there is strong evidence that spacing the administration or oral steroids, even without changing the 24 h dosage, may substantially decrease the steroid induced side effects without loss of therapeutic action. Another promising approach has been reported in the case of steroid dependent asthmatics, many of whom may be treated by inhalations of steroid esters with strong topical but low systemic effects.

Administration, Oral↗
PubMedDate not supplied

[Hyperprolactinemia and pregnancy].

Prolactin is a polipeptidic hormone secreted by the anterior pituitary gland, whose main role consists in the stimulation of lactation in the postpartum period. The increasing of prolactin secretion can be physiological (pregnancy and lactation) or pathological (hypothalamic and pituitary diseases, iatrogenic, etc.). The suppression of the hypothalamic-pituitary-gonadal axis and the resistivity of the ovary and gonadotropin action are induced in hyperprolactinemia, the amenorrhea and lack of ovulation being the result. Infertility associated with hyperprolactinemia is reversible with treatment, irrespectively to the type of treatment (radical or medical). Lowering of prolactin levels to normal or near normal is often necessary to permit ovulation. Dopamine-like drogs, as bromocriptine, appear to be safe for the developing fetus, at lest when the treatment is interrupted in the first trimester of pregnancy.

Bromocriptine↗