Iatrogenic and idiopathic acute myelogenous leukemia: a comparison of clinical features and treatment complications.

We have compared the clinical and laboratory features as well as treatment complications observed in 6 patients with iatrogenic acute myelogenous leukemia (I-AML) with those of 26 patients with idiopathic acute myelogenous leukemia (AML). I-AML patients were significantly younger and their disease appeared less virulent on admission than in the AML patients. Following identical chemotherapy, hemorrhagic complications and the need for platelet support were found to be similar for both groups. Major infections, including systemic candidiasis and Gram-negative septicemias, occurred 3 times more frequently among I-AML than AML patients. More marked suppression and delayed regeneration of the bone marrow also occurred in I-AML patients. These observations and other factors, such as post-splenectomy state and inherent immune deficiency among surgically staged lymphoma patients as well as radiation induced immunologic impairment, may have contributed to the increased propensity to develop infection observed in this group of patients. Five of the 6 I-AML and 17 of the 26 AML patients achieved remission. We attribute the satisfactory outcome in our I-AML patients to treatment in a protective environment and availability of facilities for hematologic supportive care.

Iatrogenic neonatal and maternal hyponatraemia following oxytocin and aqueous glucose infusion during labour.

Maternal and umbilical cord serum sodium and osmolality were studied prospectively in 140 deliveries to investigate whether transplacental hyponatraemia, seen following oxytocin infusion during labour, was due to the antidiuretic effect of oxytocin or was secondary to the infusion of aqueous glucose used as a vehicle for oxytocin, or both. Forty-five women received oxytocin in aqueous glucose for induction or augmentation of labour (oxytocin group), 43 received aqueous glucose infusion alone (glucose group) and 52 did not receive any intravenous infusions (control group). Mean cord sodium levels were significantly lower in the oxytocin (131.4, SD 3.6 mmol/l) and glucose groups (132.5, SD 3.2 mmol/l) than in the control group (135.0, SD 3.0 mmol/l). Hyponatraemia (Na less than 130 mmol) was seen in 47% and 30% of the infants in the oxytocin and glucose groups respectively, in contrast to only 5.8% of the infants in the control group. Significant negative linear correlations were seen between serum sodium and the dose of oxytocin (P less than 0.01) and log of the volume of glucose solution infused (P less than 0.001). The hyponatraemic newborn infants had a significantly higher incidence of transient neonatal tachypnea (7/37, 19%) than the normonatraemic infants (2%). Our results strongly suggest that infusion of oxytocin and glucose both cause maternal and transplacental hyponatraemia, even in recommended doses. This should be taken in account while planning a safe dose of oxytocin and glucose for infusion during labour.

Iatrogenic ocular silver nitrate burn.

Two cases of silver nitrate burn occurred after treatment of superior limbic keratoconjunctivitis with a solid silver nitrate applicator. After medical treatment and several months of observation, visual acuity eventually returned to acceptable levels with minimal corneal scarring. These cases emphasize the fact that silver nitrate should be used very cautiously around the eye and only in a fresh 0.5-1% solution. The use of solid silver nitrate should be prohibited around the eye.

[Drug interactions as a cause for iatrogenic diseases in the aged. A tabulated presentation]. / Arzneimittelinteraktionen als Ursache für iatrogene Erkrankungen im Alter. Eine'tabellarische Zusammenstellung.

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.

[Survey of medical practice: therapeutic applications and iatrogenic implications]. / Inquérito sobre prática médica: aplicações terapêuticas e implicações iatrogênicas.

This survey sought to investigate and quantify the use of analgesics and the understanding of their therapeutic hazards. One hundred physicians from different fields and specialties practicing in São Paulo were queried as to the frequency of their use of these products and about their knowledge of the contraindications and the precautions to be taken, measured in percentages on the basis of information supplied by the producing laboratories themselves. The data were processed electronically, and the results bore out the immediate necessity of disseminating greater information on the side effects of these drugs among physicians, health authorities, and the general public.

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.

[Tardive Dyskinesia induced by neuroleptics: a survey of 3140 patients in a psychiatric hospital]. / Les dyskinésies tardives des neuroleptiques enquête chez 3140 malades d'hôpital psychiatrique.

Tardive dyskinesia constitute the most serious complications of long term treatment with neuroleptics. In this study e,140 patients (1,568 men, 1,572 women) were examined in 4 psychiatric hospitals. 258 (8.2%) patients were found to present such a syndrom. The frequency of tardive dyskinesia was higher among female patients (167 women; 10.6%) than among male patients (91; 5.8%). On the average dyskinetic women were older than men (64.9 versus 54 years old). In 59.3% of the cases, dyskinesia was limited to an oro-facial symptomatology, but in 40.6% of the cases, this was associated with a choreo-athetoïd syndrom. Most of these patients were chronic patients. On the average they had been in hospital for 20 years, and had received neuroleptic treatment for 15 years. In half of the patients, the treatment was undergone for schizophrenia and chronic delusion. Other syndroms encountered were mental retardation, dementia, affective disorders, epilepsy, alcoholism, character disorders, etc... The frequency of tardive dyskinesia that we observed is certainly a minimum since there exits a number of transient pathological forms. We discuss a few aspects of treatments of tardive dyskinesia with neuroleptics, lithium, diethylaminoethanol, choline... we insist particularly on the problem of prevention. In patients treated with neuroleptics, tardive dyskinesea might be stopped at an early stage: secondary prevention, consisting in an early detection of the first symptoms of lingual or facial dyskinesia, should lead, if possible, to the withdrawal of the treatment. Primary prevention appears to be very important: the risk of drug-induced dyskinesia appears to be higher among people above 50 of age, and neuroleptic treatment should be administered only for the most serious forms of mental illnesses.

Diagnostic problems in drug-induced diseases.

The evaluation of adverse drug reactions (ADR's) in clinical patients is usually a complex and multifactorial problem. A methodology for this evaluation has been derived from the experience with over 3,000 cases. Illustrative cases are presented to demonstrate in detail a variety of means of linking a drug with an ADR. Emphasis is placed on the frequent diagnostic utility of accurate time-related information, in addition to the use of historical, clinical-laboratory and morphologic findings.