Prevention and management of drug-induced peripheral neuropathy.

When symptoms of peripheral neuropathy appear, the possibility that they have been induced by drugs should be considered. A large number of drugs of all kinds, several of which are considered indispensable, have been implicated in peripheral neuropathy. A list of some of these drugs is provided. Neuropathy is a universal and dose-limiting factor during treatment with vinca alkaloids, but is otherwise a rare complication of drug therapy. Drug-induced peripheral neuropathy is almost always due to a dose-dependent primary axonal degeneration caused either by toxic reactions or by metabolic changes in neurons or their surroundings. The use of drugs should be restricted, especially in patients with a risk for development of neuropathy or with already existing neuropathy, e.g. patients with hepatic or renal failure, diabetes mellitus, or malnutrition. Patients should be given vitamins, prophylactically or therapeutically, which will sometimes allow a treatment to be continued. In other cases of drug-induced neuropathy the drug should be stopped. Reversal depends on the severity of the neuropathy, intensity and duration of the treatment and existence of causative cofactors, but generally the prognosis is good. While waiting for recovery physiotherapy is of importance, and when paraesthesia and pain are troublesome the patient should be treated with carbamazepine, imipramine or lidocaine (lignocaine).

[Poisoning with the brown roll-rim mushroom, Paxillus involutus]. / Forgiftning med svampen almindelig netbladhat, Paxillus involutus.

Brown Roll-Rim (Paxillus involutus) is a dangerous poisonous mushroom with symptoms of poisoning which occur a few hours after consumption. Repeated consumption may cause sensitization to a heat-stable toxin, resulting in haemolysis which may be of all degrees. In addition, severe gastrointestinal symptoms may be due to a heat-instable toxin. In cases with immune haemolysis, treatment consists of corticosteroid and possibly plasmapheresis and symptomatic therapy.

[Malignant T-cell neoplasia during treatment with azathioprine and prednisone after kidney transplantation]. / Malign T-celle neoplasi under azatioprin- og prednisonbehandling efter nyretransplantation.

Patients receiving immunosuppressive treatment show an increased incidence of malignant lymphoproliferative disease, mainly in the form of B-lymphomata, on account of constant antigen stimulation from an implanted organ and/or impaired immunological defense which permit cells which have undergone mutation or have been transformed by viruses to proliferate. Malignant T-proliferative disease is rare in this patient category. The authors present a case in which a man treated with azathioprin and prednisone who had been well and without symptoms of rejection during a total of seven years after renal transplantation, which suggests that the T-cell neoplasia was due to the immunosuppressive treatment.

[Obstruction of the larynx caused by an oncocytic papillary cystadenoma]. / Larynxobstruktion forårsaget af et onkocytaert papillaert cystadenom.

A case of oncocytic papillary cystadenoma in the larynx in an elderly woman forms the basis for a discussion of the causes of, the symptoms and diagnosis of chronic obstructive conditions of the upper respiratory tract.

[Laryngeal oncocytoid changes--hyperplasia or neoplasia?]. / Onkocytoide forandringer i larynx--hyperplasi eller neoplasi?

It is suggested that oncocytoid changes in glandular tissue represent a continuum in the development from metaplasia via increasing hyperplasia to neoplasia. This theory, which is supported in the literature, is based on three of the authors' own cases of oncocytoid changes in the larynx. The significance of differentiating between hyperplasia and neoplasia is emphasized as the neoplastic changes such as the oncocytoid papillary cystadenoma should be extirpated radically in order to avoid recurrence.

[Lactic acidosis associated with metformin]. / Metforminassocieret laktatacidose.

Lactic acidosis is an extremely rare but serious complication of treatment with metformin. In order to avoid lactate acidosis, it is important to select patients correctly and to ensure that contraindications such as cases of renal involvement, advanced age and chronic alcoholism are observed prior to treatment with metformin. In addition, it is necessary to carry out meticulous follow-up control of the patients with annual investigations of renal and hepatic functions and clinical assessment approximately four times per annum with the object of revealing commencing symptoms of diabetes and ischaemic conditions. In this manner, the majority of cases of lactate acidosis can be avoided.

[The post-thrombotic syndrome. A review]. / Det posttrombotiske syndrom. En oversigt.

The post-thrombotic syndrome which is caused by deep venous thrombosis and characterized by pain, oedema, pigmentation, eczema, lipodermatosis, varices and ulceration, is due to deficient function of the venous valves and/or obstruction of the deep veins with venous hypertension. The diagnosis may be established by investigation of the investigation of the muscular-venous pump by pletysmography or dynamic phlebography and invasive measurement of the venous pressure is not employed to any great extent. The results of valvuloplasty have, by and large, been negative. The main form of treatment is, therefore, conservative compressive bandaging which can reduce the symptoms, facilitate healing of venous ulcers and prevent recurrence of ulcers. It is emphasized, however, that this treatment must be continued consequently during the remainder of the patient's life, regardless of other treatment.

[Hepatocellular adenoma after oral contraception]. / Hepatocellulaert adenom efter peroral kontraception.

Raised serum basic phosphatase was found incidentally in a woman aged 43 years. Investigation with biopsy revealed a hepatocellular adenoma. The tumour regressed after withdrawal of Neogentrol oral contraception which the patient had consumed for 17 years. The patient did not desire invasive treatment. Employment of oral contraceptive steroids for more than two years is associated with increased occurrence of hepatocellular adenomata. The hepatocellular adenoma is a clearly delimited, most frequently solitary, benign tumour with limited malignant potential but with a considerable risk of rupture with haemorrhage even after withdrawal of oral contraception. The hepatocellular adenoma has no malignant tumour vessels (in contrast to hepatocellular carcinoma) and it appears as a cold region on scintigraphy (in contrast to focal nodular hyperplasia), but the diagnosis can only be established with certainty by histological examination. The hepatocellular adenoma consists most frequently of large pale hepatocytes in trabeculae surrounded by a net of reticulin and separated by sinusoids. Biliary passage and portal spaces do not occur. The best treatment consists of excision of the tumour or embolisation. If invasive treatment is postponed, regular scanning should be performed to observe regression or progression of the tumour and oral contraception and pregnancy should be advised against on account of the risk of growth of the tumour.

[Abscess of the omental bursa (lesser sac)]. / Bursa omentalis (lille saek) absces.

Subphrenic omental bursa abscess is frequently overlooked and the overall mortality is 70%. Early diagnosis and drainage improve the prognosis considerably. In cases with abdominal symptoms followed by pyrexia, possibly with signs of sepsis, and pleural effusion but with no or only slight findings on objective clinical examination, subphrenic abscess should be suspected and a scanning of the abdomen should be performed.

[Secondary aorto-enteric fistula]. / Den sekundaere aorto-enteriske fistel.

On the basis of five case histories, the causes, symptoms, investigations, diagnosis and treatment of secondary aorto-enteric fistulae are reviewed. In a patient in whom reconstruction in the aortoiliac segment has been undertaken, recurrent haematemesis and melaena, pyrexia and septicaemia and abdominal pain should lead to investigation for aorto-enteric fistula by means of oesophagogastro-duodenoscopy and radiological investigations if the condition permits this. Otherwise, emergency laporotomy with thorough examination of the intestine should be undertaken. The condition is associated with a considerable mortality but the prognosis is improved by rapid intervention. In cases where aorto-enteric fistula is suspected, the patient should be referred to a department for vascular surgery.

[Glycosylated hemoglobin (HbA1c) and acute hemolytic anemia]. / Glykosyleret haemoglobin (HbA1c) og akut haemolytisk anaemi.

The concentrations of glycosylated haemoglobin (HbA1c) were determined in eight patients with acute haemolytic anaemia and were found to be significantly lower than in a control group of 16 patients. A case history is presented in which HbA1c was employed as longitudinal parameter of haemolysis. It is concluded that in haemolytic anaemia in non-diabetic patients, HbA1c is a specific parameter of haemolysis which may be employed as a supplement to the traditional parameters of haemolysis.

[The post-thrombotic syndrome. Description and comparison of diagnostic methods: clinical examination, venous return time, phlebography and ultrasonography]. / Det posttrombotiske syndrom. Beskrivelse og sammenligning af diagnostiske undersøgelsesmetoder: Klinisk undersøgelse, venøs returtid, flebografi og ultralyd.

Thirty-one patients with deep vein thrombosis (DVT) confirmed by phlebography 5-11 years previously were examined for the post-thrombotic syndrome (PTS). Where all of the patients were concerned, the examination included crossing-off of their symptoms of PTS on a special chart and clinical examination carried out by four doctors independently of one another, for 29 patients also determination of the venous return time by strain gauge pletysmography and for 29 patients also secondary phlebography (SF) and B-method ultrasonic scanning (UL). The degree of severity of PTS was determined by means of a scoring value which was calculated on the bases of four observers assessment of the clinical symptoms and findings. Significant differences were found for the clinical scores for legs with and without previous DVT, which shows that the method is of value despite a not inconsiderable interobserver variation. In the form employed here, pletysmography was found unsuitable for quantitating of PTS. In 60% of the patients, agreement was present between the clinical assessment, SF and UL. The necessity of agreement both as regards the diagnostic clinical criteria and as a measure for the degree of severity of PTS is emphasized. UL is recommended as a screening investigation for changes after DVT. Phlebography is only considered to be indicated in cases where detailed knowledge of the anatomical conditions is desired e.g. prior to venous surgery.