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[Therapeutically induced immunodeficiency].

Therapeutically induced immundefects principally can be the result of pathophysiological influences on autoimmune diseases by immunomodulation on the one hand or loss of resistance against bacteria, fungi or viruses as a consequence of immunomodulation on the other hand. Further complications such as increasing incidence of neoplasms after long-term therapy, hypersensitivity reactions, especially damage of bone marrow, can be recognised after application of many different drugs. The immunesuppressive drugs are discussed in detail.

Autoimmune Diseases↗

Neurologic complications of systemic lymphoma.

Lymphoma denotes a heterogeneous group of neoplasms derived from lymphoreticular tissues. It can cause neurologic symptoms by infiltrating into the meninges or brain parenchyma. Alternatively, lymphomas may metastasize to bone or infiltrate into the epidural space via intervertebral foramina to cause neurologic dysfunction by compressing adjacent CNS structures. These direct effects can occur at any time during the disease process; most distressingly, meningeal infiltration may be the initial site of relapse after a complete remission. Diffuse and more undifferentiated lymphomas are much more likely to be responsible for producing either meningeal infiltration or intraparenchymal lesions. Direct CNS invasion by lymphoma is associated with significant patient morbidity and short survival despite intensive therapy; whether this manifestation of lymphoma can be prevented by prophylactic CNS treatment remains uncertain. CNS complications may also occur as a result of indirect effects of lymphoma. Therefore, CNS dysfunction may develop as a result of infections that occur secondary to immunosuppression, as a result of antineoplastic therapies, or as a result of true paraneoplastic syndromes. It is important to distinguish between these indirect effects and tumor progression because their recognition permits frequently available appropriate treatment modalities to be administered.

Brain Neoplasms↗

[Abducens paresis, a rare complication to spinal analgesia].

A case of paresis of the abducens nerve following spinal analgesia is described. Cranial nerve paresis is a rare complication of spinal analgesia although described for all cranial nerves except nos. 1, 9 and 10. It is very useful to know that cranial nerve paresis after spinal analgesia often occurs after a delay of several days, and that treatment is unnecessary because symptoms nearly always disappear spontaneously in about 2-4 months.

Abducens Nerve↗

[Ototoxicity].

Ototoxic drugs, the best known of which are aminoglucoside antibiotics, can cause irreversible lesions in the ciliate cells of the organ of Corti and the maculae and crests of the vestibular apparatus. The cellular lesion is linked to the formation of complex substances between the ototoxic drug and the polyphospho-inositides of the cellular membrane. Auditory and vestibular monitoring must be ensured permanently throughout the use of such drugs, especially in the presence of risk factors. The lesions induced experimentally in animals having studied by electrophysiological methods, with recordings of the cochlear and brainstem potentials, and by histological methods with the technique of surface preparation of the organ of Corti, and by electron microscopy.

Adult↗

[The epidemiological aspect of chronic kidney lesions of drug origin].

In order to establish the prevalence of the intake of the most widely used nephrotropic drugs (non-steroidal anti-inflammatory agents and analgesic-antipyretic drugs), the authors have carried out epidemiological studies among the urban population. 5996 persons living in Riga were examined according to the designed by the authors 4-staged system using computer at the final stage. All the examined underwent analysis of the morning portion of urine. The drugs indicated were discovered to be taken for a long time in 14% of cases (in 15.4 among women and in 11.8% among men). The use of the drugs was motivated by degenerative dystrophic alterations in the bones and joints (56.27%), complicated virus infections (9.68%), headache (2.99%), and by combination of the three enumerated causes (30.34%). In 0.72% of cases, the causes of drug intake could not be established. Depending on the presence of a concrete urinary symptom, a high relative and a high absolute risk of the development of chronic tubulointerstitial renal lesions provoked by drugs have been defined in cases of the prolonged use of the drugs under study.

Age Factors↗

Dissection of the thoracic aorta following partial clamping.

A case is reported in which an extensive dissection of the thoracic aorta was observed after partial clamping during surgery on that blood vessel. The unfavourable outcome of the operation and the accurate investigation of the post-mortem material suggest a lesion of the artery wall secondary to tangential clamping by Satinsky's clamp. The possible pathogenetic mechanisms of lesions induced by vascular clamping are also discussed.

Aged↗

Limits to medicine.

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Biological Evolution↗

[Iatrogenesis].

Iatrogenesis, earlier considered to be an unfavorable effect of the word on the patient has acquired a new essence. Iatrogenesis means an unintentional and often inevitable complication resulting from contact with the patients, the influence upon him or due to inaction of medical personnel during prophylactic, diagnostic and curative procedures. An analysis of clinical and social sources of iatrogenesis gives grounds to find out ways to make it less.

Classification↗

[Prevention of pyelonephritis].

The possibilities of the prophylaxis of pyelonephritis in the intrauterine life, in infancy and childhood, in internal medicine, gynaecology and urology are described. After explanation of the causes of pyelonephritis it is referred to the importance of the asymptomatic, significant bacteriuria and it is emphasized that there is no primary pyelonephritis, but every pyelonephritis is secondary.

Adolescent↗

[The "second disease" and "second nature"].

An idea about the second disease as a metamorphosis when the phenomenon of one nature is transformed into phenomenon of the second nature is proposed. There are three stages in the development of the second disease: origin, when clinical and morphological features of initial and new nosologic forms coexist; formation-distinct groups of features of a new nosologic form which preserved a link to the first disease; separation of this new nosologic form with its typical clinical and morphological features. The second disease is metamorphosis of the first disease which develops into a new nosologic entity under the influence of exogenous or endogenous factors.

Communism↗