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PubMed1992

Oral ulceration and iatrogenic disease in HIV infection.

Ulcerative lesions of oropharyngeal mucous membranes are less commonly seen than other lesions in HIV infection and may be associated with mycotic, bacterial, and viral infection, as well as neoplasia. Differential diagnosis may be difficult because of the clinical similarity of ulcerations that can represent various causes. The term "atypical ulceration" has been suggested because it may be impossible to differentiate some of the oral ulcerations from each other. Iatrogenic ulceration is seen occasionally, as the consequence of chemotherapy or irradiation.

Antifungal Agents↗
PubMed1997

Prescribed drugs and iatrogenic disease.

Prescribed drugs can cause side-effects and adverse reactions and can interact with other medications. Factors such as age, disease and idiosyncratic responses can cause drug intolerance in some people. Nurses must be able to provide patients with appropriate information to ensure the safe administration of their drugs.

Drug Interactions↗
PubMed2003

[SMON--a model of the iatrogenic disease].

The subacute myelo-optico-neuropathy (SMON) was hazard caused by clioquinol, an antiseptic, prescribed for the treatment of diarrhea and other bowel symptoms. Its overdosing and long-term taking led to the occurrence of SMON, for which physicians should be responsible. Clioquinol, originally a disinfectant powder for external use, was diverted later to a drug for internal use to sterilize the bowel where no intestinal absorption or action after absorption was expected. An annotation on the 6th Revision of the Japan Pharmacopoeia (1954) allowed irregular increase in its dosage depending on the severity of illness. An annotation on the 7th Revision (1961) ignoring the 6 papers published in the 1930's, 1940's or 1950's claimed that its metabolism was poorly known, yet neglected significant side effect and substantial absorption from the intestine. Its characterization as a superficial disinfectant helped the annotators be less interested in its absorption and its internal actions and side effects. Attention paid by clinicians to a polyneuropathy-like syndrome that complicated an uncontrollable hemorrhagic diarrhea (1958) and an encephalomyelitis or a paralysis of the lower half of the body associated with diarrhea or other bowel symptoms (1960, 1961) started the recognition of a new disease. During the dispute induced by the mass occurrence of the disease in several instances postmortem examination with neuropathologic expertise, especially of T. Tsubaki, Y. Toyokura and H. Tsukagoshi (1964), characterized SMON as a non-inflammatory new disease of the spinal cord, optic nerve and peripheral nerve with a pseudo-systemic degeneration of posterior and lateral columns and, therefore played a decisive role in establishing the truth of SMON. The discovery of the green hairy tongue (the tongue coated with green hairs) of SMON by T. Takasu, A. Igata and Y. Toyokura (January 1970) aroused researchers' interest in the green color of SMON and thereby began solving the cause of SMON. The discovery of the green urine in SMON patients by A. Igata, M. Hasebe and T. Tsuji (May 1970) especially facilitated the identification of the green substance in SMON that was achieved by M. Yoshioka and Z. Tamura (June 1970). The green color was derived from a chelate compound of clioquinol with ferric iron. The early epidemiological analysis related clioquinol taking to the occurrence of SMON well enough for the Japanese Government to take an administrative measure for the temporary suspension of selling clioquinol containing drugs and the postponing of their use (September 1970). Extensive and intensive multidisciplinary investigations conducted for the subsequent 20 months led to the conclusion by the SMON Investigation and Research Committee (Head: R. Kono) that the neurological disorders of patients who were diagnosed as SMON for the most part were caused by taking clioquinol (March 1972). Close clinical observation of patients opened a way to recognize a new disease and elucidate its cause. Expert specialized technical knowledge and skills established the firm knowledge of the new disease. The study of SMON began as a personal research and after its achievement was exposed to the public a great many investigators in different fields concerted efforts to solve problems. Both steps were indispensable for completing the study.

Amebicides↗
PubMed1991

[Iatrogenic disease in pediatric dentistry. Report of a case].

The case history of a six-year-old girl who underwent endodontic treatment by a non recommended technique. It was decided to perform integral treatment anew, this time with techniques and materials adequate for the restoration and renewal of temporary dentition.

Child↗
PubMed1981

Acquired lobar emphysema in premature infants with bronchopulmonary dysplasia: an iatrogenic disease?

Five premature infants in whom bronchopulmonary dysplasia developed following prolonged neonatal respiratory support are presented. In all five patients, right middle and/or lower lobe emphysema related to focal obstructing endobronchial masses of granulation tissue subsequently developed. It is speculated that the granulation tissue formed in response to the repeated mechanical trauma of endotracheal tube suctioning.

Female↗
PubMed1990

Foreign body gingivitis: an iatrogenic disease?

Gingival biopsy specimens from eight patients exhibiting a localized, erythematous, or mixed erythematous/leukoplakic gingivitis that was refractory to conventional periodontal therapy were examined histologically and by energy-dispersive X-ray microanalysis. Histologic examination revealed variable numbers of small, usually subtle, sometimes equivocal, and occasionally obvious foci of granulomatous inflammation. Special stains for fungi and acid-fast bacilli were consistently negative. In all cases, the granulomatous foci contained particles of foreign material that were often inconspicuous and easily overlooked during routine histologic examination. Energy-dispersive X-ray microanalysis of these foreign particles disclosed Ca, Al, Si, Ti, and P in most lesions. However, other elements such as Zr, V, Ag, and Ni were found only in specific biopsy specimens. By comparing the elemental analyses, clinical features, and history of the lesions, strong evidence for an iatrogenic source of the foreign material was found in one case, and good evidence in five cases. In the remaining two patients, the source of the foreign particles remains unresolved.

Adult↗
PubMed1983

[Drug interactions as a cause for iatrogenic diseases in the aged. A tabulated presentation].

Drug interactions are found in elderly patients to a higher degree than in younger persons, because of the multimorbidity in the advanced age. The reasons are pharmacokinetic and/or pharmacodynamic mechanisms. At the first glance the amount of interactions seems puzzling but after regarding details more thoroughly it turns out that most of those interactions may be attributed to just a few drugs.

Aged↗
PubMed1998

[Iatrogenic disease and self-injury: significant factors in hospital admission?].

UNLABELLED: The frequency of adverse effects caused by doctors may serve as a quality control. We therefore assessed the number of adverse effects leading to a hospital admission and occurring during a six-month period in the medical department of a district hospital. We compared these figures with the number of admissions caused by substance-abuse by the patient himself. RESULTS: At admission to hospital 35 patients (6.4%) suffered from adverse effects. In 89% of these, the adverse effect was the leading factor to admit the patient; in the remaining 4 patients (11%) the adverse effect was detected by routine-screening upon admission. Further 8.6% developed adverse effects in the hospital which in 12.5% had consequences upon course and duration of the hospitalization. Self-afflicted hospital-admissions (substance-abuse, suicide-attempts) were found in 13%. Iatrogenic adverse effects brought 3.5% of the patients to the hospital. CONCLUSIONS: Adverse effects caused by diagnostic and therapeutic activities of doctors considerably contribute to hospital-admissions and course of hospital-stay, but even more often the patient himself is responsible by his self-damaging behavior.

Adult↗
PubMed1983

[Epidemiology and basic pathogenetic mechanisms of environmental and iatrogenic diseases].

In the first part environmental diseases by air pollution, water contamination and dietary factors are discussed. The important role of the combustion of coal and petrol and the increasing confrontation with carcinogenic substances, especially with those originated by smoking of tobacco are stressed and underlined by epidemiologic dates. Other epidemiologic evidences are mentioned concerning the development of cardiovascular diseases, neoplastic diseases of the colon or liver diseases by dietetic factors. In the second part epidemiologic facts of drug induced reactions and iatrogenic cases of death in hospitalized and out-patients are reported. The main responsible pathogenetic factors for such events, prevailing in elder persons, are seen in the reduced hepatic metabolic capacity, the decreasing tubular or glomerular function of the kidneys and above all the different and often unpredictable drug interactions. The most important pathogenetic mechanisms for drug interactions are changes of drug binding to albumin or competitive disturbance of renal excretion and particularly alterations of the biotransformation processes as enzyme induction or enzyme inhibition. The clinical relevance of these theoretical considerations is demonstrated by some practical examples referring to the importance of a solid knowledge of the many possible interactions in drug therapy especially in elder patients.

Aged↗
PubMed1988

[Iatrogenic diseases and scientific and technical progress].

Evolution of the term "iatrogenesis" and a widening range of the diseases varying in origin and clinical appearance covered with this term are considered. It is emphasized that such interpretation misrepresents the primary meaning aimed at orientation of the physicians to evaluation of the patient and doctor personality in view of its role in the genesis of psychic and somatic disturbances which tends to loom large with further scientific and technological progress. Iatrogenesis is supposed to be relevant to pathomorphosis of the borderline psychic conditions, prenosologic diagnosis and screening of population, drug addiction and alcoholism management. There is a tendency to further introduction of technical aspects into medical education.

Humans↗
PubMed2004

[An auto-iatrogenic disease].

A 55-year-old practitioner from an island in the northern sea felt an increasing hypersensitivity of his entire body to various ambient and nutritional allergens and toxics. He started to treat himself with increasing doses of glucocorticoids and moved to a southern climate in Lanzarote and later on to the Swiss mountains in the grisons. On admission to our hospital in December he was in a disastrous psychotic condition, trying to cool down his body by laying naked on his bed at ambient temperatures around the freezing point. He had consumed on average 250 mg prednisone daily over weeks. As we found out later his personal assistant travelling with him was giving him glucocorticoids through the infusion during his hospital stay. He developed a necrotizing septic phlebitis at the infusion site followed by a Pseudomonas aeruginosa sepsis with fatal multiorgan failure. This case illustrates the dangers of self-treatment by doctors and the difficulties in treating a physician.

Anti-Inflammatory Agents↗
PubMed1977

Iatrogenic disease, drug metabolism, and cell injury: lethal synthesis in man.

One important consideration to be appreciated from the examples of "lethal synthesis" presented in this paper is that the mechanisms of toxic substances must be further explored, a true understanding of the complex modalities of cellular injury achieved, and the significance of cellular changes determined before we can preestablish the hazards of chemical or environmental contaminants. The identification of compounds that may modify the intracellular milieu by adduction of marcromolecules and those that may be activated to produce proximate toxins could be accomplished on the basis of their distinguishing structure and metabolism. Assaying for the levels and functions of xenobiotic systems may help us to preduct the potential risk to individuals. It is incumbent upon us now to become more critical of the side-effects of "therapy", to weigh the jeopardy against the benefits involved. And to do so, we must attain a better comprehension of the complicated mechanisms of cellular injury.

Biotransformation↗
PubMed1982

[Iatrogenic disease in hemophilia and Von Willebrand's disease].

From a group of 115 children with hereditary haemorrhagic disease, nine suffered avoidable accidents or incidents during their treatment, these nine patients represent 8.6% of the cases. The observed complications included a giant cervical hematoma and hemomediastinum after a puncture of the internal jugular vein; an encephalic lesion associated with descompressive craneotomy; a hemophilic pseudo cyst associated with inappropriate treatment of a tibial fracture; acute bleeding and shock after surgery for tonsillectomy and circumcision; subdural hygroma after a subdural puncture; giant hematoma and acute anemia secondary to a venous dissection; permanent dyslexia after inappropriate puncture; giant hematoma and acute anemia secondary to a venous dissection; permanent dyslexia after inappropriate management of intracranial bleeding; bleeding and acute anemia after surgical drainage of a prepucial hematoma and a joint hematoma of the left knee after synovectomy and application of a prosthesis.

Adult↗
PubMed1985

[Psychologic iatrogenic disease in the postsurgical child].

In the present paper, we comment on the psychological and emotional disorders occurring after surgery. We surveyed 150 children that were admitted in several surgical units of our Children's Hospital. We used the Vernon's test in a questionaire. We reached a high level of comprehension. As a result, 121 valid questionaires were returned. The considerable amount of information was statistically studied with a computer, obtaining data on the following aspects: Filiation, frequency and percentage of every answer. Post-hospitalization behaviour evaluated by Vernon's test. Partial and total results under the 6 factors of the questionaire: General anxiety and regression, anxiety about separation, anxiety about sleeping, eating disturbances, agressiveness against authority, apathy and isolation. Previous results in connection with the diverse filiation variables. When we analyzed the results, we confirmed the findings of other investigators: A global damage in child behaviour, that is present in two main aspects: "Anxiety about separation" and "Agressiveness against authority". In conclusion, our results support the need for implementing prophylactic measures, of which "psychological presentation" is the most important, to children that are going to be operated upon.

Aggression↗
PubMed1987

Parenteral nutrition with associated cholelithiasis: another iatrogenic disease of infants and children.

During the past decade, 246 infants and children treated at the Columbus Children's Hospital have required more than 4 weeks of parenteral nutrition (PN). Of the 178 survivors, 70 returned for evaluation. Sixty-eight either had adequate visualization of the gallbladder by ultrasound or had previous gallbladder surgery (39%). Of 68 children who did not survive, complete postmortem examinations or ultrasound studies were available for 16 (24%). A diagnosis of cholelithiasis was established in 11 of the 84 studied patients (13%). Six of these children (55%) have required cholecystectomy for relief of chronic abdominal pain, pancreatitis, or empyema of the gallbladder. One additional infant underwent cholecystostomy. Two of the four remaining patients are asymptomatic, one has episodes of abdominal colic, and one child expired of chronic hepatic insufficiency as a result of PN-associated cholestasis. Risk factors that predisposed these children to cholelithiasis included short bowel syndrome, lack of an ileocecal valve, and an increased number of abdominal operative procedures (P less than .05). Patients with biliary calculi also had a longer duration of parenteral feeding, and a higher incidence of both PN-associated cholestasis and necrotizing enterocolitis. The intergroup differences for these characteristics, however, did not achieve statistical significance. On the basis of this information, routine ultrasound examinations of the gallbladder are recommended for children maintained on PN for longer than 30 days. All patients presenting with abdominal pain who previously received PN should also be evaluated. Early elective cholecystectomy is suggested for children who develop PN-associated cholelithiasis.

Adolescent↗
PubMed1990

[Clinico-morphological characteristics of the family of diseases: cytomegalic inclusion disease, iatrogenic thesaurismosis and septicemia].

The clinicomorphological manifestations of iatrogenic thesaurismosis that developed because of infusion therapy of patients with plasma substitutes were studied using autopsy and operative material from 44 deceased and 2 operated children aged 1 month to 3 years. An experimental disease was obtained in 16 rabbits. Cytomegalia was discovered in 23 deceased children with iatrogenic thesaurismosis and sepsis in 18 children. In 12 cases, sepsis was of iatrogenic nature. An assumption is worded about the three-member family of those diseases undergoing substantial pathomorphism.

Animals↗
PubMed1978

Intracerebral calcifications in childhood lymphoblastic leukemia. A new iatrogenic disease?

A 3-year-old child diagnosed as having acute lymphatic leukemia (ALL), developed meningeal leukemia 36 months after the onset of the disease. He was twice subjected to cranial irradiation plus intrathecal methotrexate (i.t. MTX). Skull radiology showed bilateral gyriform calcification of both cerebral hemispheres. Hematological relapse was first detected 5 years after diagnosis and the child died 5 months later. The most striking findings of a right frontal lobe biopsy and the postmortem examination were wide calcium deposits located in the cortex and in the adjacent white matter. Intense demyelination as well as areas of neuron poverty were apparent in the necropsy but in the biopsy specimen. The possible interrelationship between such deposition and cranial irradiation and/or i.t. MTX suggests a new iatrogenic disorder.

Brain↗
PubMed1999

[Ureteral iatrogenic disease of obstetric-gynecologic origin].

OBJECTIVE: To review our experience in the diagnosis and management of ureteral injuries secondary to obstetric and gynecologic procedures. METHODS: During the last 25 years, 42 patients were treated at our center for iatrogenic ureteral injuries (45 renal units) associated with obstetric and gynecologic procedures, principally hysterectomy via the abdominal approach (29 cases). The injury was diagnosed in the immediate postoperative period in 21 of the 42 cases. Surgical management was frequently by ureteroneocystostomy. Patient follow-up ranged from 3 months to 11 years. RESULTS: Good results were obtained in 83.3% of the cases. CONCLUSIONS: Ureteral injuries detected intraoperatively should be immediately repaired. For those diagnosed postoperatively, management by retrograde or antegrade catheterization and/or US or CT-guided percutaneous nephrostomy should be attempted before performing surgery.

Adult↗