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This discussion reviews drugs that affect the eye, including antihyperglycemic agents; corticosteroids; antirheumatic drugs (quinolines, indomethacin, and allopurinol); psychiatric drugs (phenothiazine, thioridazine, and chlorpromazine); drugs used in cardiology (practolol, amiodarone, and digitalis gylcosides); drugs implicated in optic neuritis and atrophy, drugs with an anticholinergic action; oral contraceptives (OCs); and topical drugs and systemic effects. Refractive changes, either myopic or hypermetropic, can occur as a result of hyperglycemia, and variation in vision is sometimes a presenting symptom in diabetes mellitus. If it causes a change in the refraction, treatment of hyperglycemia almost always produces a temporary hypermetropia. A return to the original refractive state often takes weeks, sometimes months. There is some evidence that patients adequately treated with insulin improve more rapidly than those taking oral medication. Such patients always should be referred for opthalmological evaluation as other factors might be responsible, but it might not be possible to order the appropriate spectacle correction for some time. The most important ocular side effect of the systemic adiministration of corticosteroids is the formation of a posterior subcapsular cataract. Glaucoma also can result from corticosteroids, most often when they are applied topically. Corticosteroids have been implicated in the production of benign intracranial hypertension, which is paradoxical because they also are used in its treatment. The most important side effect of drugs such as chloroquine and hydroxychloroquine is an almost always irreversible maculopathy with resultant loss of central vision. Corneal and retinal changes similar to those caused by the quinolines have been reported with indomethacin, but there is some question about a cause and effect relationship. The National Registry of Drug Induced Ocular Side Effects in the US published 30 case histories of cataract suspected to be induced by allopurinol; numerous additional cases have been reported to the registry since. Phenothiazine, with an estimated 3% incidence of side effects, appears to be safer than other antipsychotic drugs, but the rate of ocular effects increases with the duration of therapy. Thioridazine and chlorpromazine are known to cause lens deposits and pigmentary retinopathy. There is a significantly high prevalence of thrombophlebitis and pseudotumor cerebri among women who use OCs and thrombotic retinal vascular disease, such as retinal vein occulsion, might be linked with them. It also is probable that, because of altered hydration of the cornea, there is a decreased tolerance to contact lenses.
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PMID:Drugs affecting the eye. 286 12

The efficacy and safety of ticarcillin plus clavulanic acid in the treatment of patients with infections of soft tissue, bone, and joint were evaluated in this open study. Clinical diagnoses included osteomyelitis, soft tissue abscess or ulcer, cellulitis, bite wound, traumatic or postoperative cellulitis, necrotizing fasciitis, septic arthritis, septic bursitis, and septic thrombophlebitis. Trauma or underlying disease such as diabetes mellitus or vascular insufficiency was common (more than 50 percent) in the patient population. Clinical efficacy was evaluable in 66 patients who received 3 g of ticarcillin and 0.1 g of clavulanic acid every four or six hours for a mean of 23.4 days. A satisfactory clinical response was observed in 92 percent of the patients. Major pathogens isolated were Enterobacteriaceae, anaerobic cocci, Staphylococcus aureus, and beta-hemolytic Streptococcus. Of the 143 isolates recovered from 55 bacteriologically evaluable cases, 87 percent were eradicated by therapy. Overall, a satisfactory bacteriologic outcome occurred in 93 percent of the patients, and the pathogen(s) persisted in 7 percent. More than 98 percent of the isolates were susceptible to ticarcillin plus clavulanic acid in vitro. Emergence of resistance during therapy occurred with three strains of Pseudomonas aeruginosa. Adverse drug-related reactions required discontinuation of treatment in two patients, although other minor abnormal laboratory findings were common. These results indicate that ticarcillin plus clavulanic acid offers safe and effective therapy for infections of soft tissue, bone, and joint.
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PMID:Safety and efficacy of ticarcillin plus clavulanic acid in the treatment of infections of soft tissue, bone, and joint. 407 81

Studies of blood clotting factors and prospective and retrospective studies on risk of thromboembolism are reviewed until 1969. Clotting factors 7, 8, 9, and 10, coagulation time, and platelet adhesiveness are increased during oral contraception. The significance, however, is unknown for developing thromboembolism. There are numerous publications on thromboemoblism in pill users, but most are statistically useless case reports. Risks of morbidity from this disorder in normal women are 1.2-2.9/1000 for nonpregnant, 3.1-10.4/1000 for postpartum, and .5/1000 for pregnant. A prospective study by the U.S. Food and Drug Administration found no increased risk, but 3 British retrospective studies found a 3-fold risk of phlebits, a 9-fold risk of hospitalization for thrombophlebitis, and an increased risk of death from pulmonary embolism or cerebral accident. Women at greater risk because of age, weight, or predisposing factors (diabetes, hyperlipidemia, surgery) should be meticulously eliminated by the clinician.
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PMID:[Statement on the thromboembolic risk while taking oral contraceptives]. 542 2

A retrospective analysis was undertaken of 365 consecutive patients, 75 women and 290 men with a mean age of 59.9 +/- 9.7 years, who had coronary artery bypass surgery during 1981. Complications classified as major were: mediastinal hemorrhage, pericardial tamponade, wound dehiscence, sternal osteomyelitis, myocardial infarction, bacterial endocarditis, dissecting aneurysm and diabetes insipidus. Complications classified as minor were: atrial fibrillation, postpericardiotomy syndrome, cellulitis, thrombophlebitis and phrenic nerve palsy. There were 48 patients (13%) with 52 major complications. Age more than 60 years, cardiopulmonary bypass time longer than 150 minutes, aortic cross-clamp time longer than 100 minutes, number of grafts greater than five and presence of diabetes mellitus were significantly associated with major complications. Complications tended to occur more frequently in women, obese patients and those with emergency operation or ejection fraction less than 30%, but the associations were not statistically significant. Physicians referring patients for coronary artery surgery should be cognizant of the incidence of morbidity along with the other risks and benefits when considering coronary artery bypass surgery.
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PMID:Coronary artery bypass surgery morbidity. 660 79

Oral contrceptives (OCs), usd by over 30% of reproductive aged women in Belgium, are by far the most widely used contraceptive in that country. The various types of OCs include monophasic, biphasic, and triphasic combinations of an estrogen and a progestin, sequentials containing estrogen only for 7-14 days followed by a progestin through the 21st day; macrodose or microdose progestin only formulations, 3-month injectable progestins, and the morning after pill. Side effects of OCs are mainly due to metabolic effects on coagulation factors, the renin-angiotensin system, glucose tolerance, or the lipid profile. Users of OCs face increased risks of cholelithiases, thrombophlebitis, thromboembolism, cerebrovascular accidents, myocardial infarcts (among smokers over 35 years of age), and hepatic adenomas. The most troubling secondary effect is the excess cardiovascular morbidity and mortality show by contraceptive users, not just those who are obese, hypertensive, or who have histories of vascular pathology, but also those over 40 years of age and smokers. Lenght of use of OCs does not increase vascular risks. Epidemiologic studies demonstrate that vascular risks are reduced in lower dose formulations. Absolute contraindications to OC use include serious cardiovascular problems, severe hepatic pathology, estrogen-dependent tumors, pregnancy and undiagnosed gynecologic problems, and significant hyperlipidemia. Relative contraindications include severe headaches, cholelithiase, previous cholestasis of pregnancy, severe renal disease, fibromyomas, benign breast disease, age over 40 years, smoking, surgery anticipated within 4 weeks, infectious mononucleosis, falciform anemia, and immediate postpartum and lactation. Epilepsy, diabetes, depression, and varicose veins are not strictly speaking contraindications but require additonal surveillance. Lower dose formulations should be prescribed if possible. OC users should be followed up every 6-12 months. Among other steroidal contraceptive methods, sequential OCs and high dose progestin-only formulations are used for short-term treatment of specific conditions. Progestin-only minipills are used when an OC is desired but estrogens are contraindicated. Injectable progestins should be reserved for patients who for cultural or medical reasons can use no other type of contraceptive. Morning-after pills should not be considered a regular form of contraception. If OCs are used in adolescents, a low dose pill is indicated. Low dose OCs may be indicated for diabetics because of the danger of infection with IUDs and the lesser efficacy of barrier methods. If OCs are used in epileptics, they should be regular dosed because of the danger of drug interactions. Only low-dose formulations and progestin-only minipills should be used by women over 40.
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PMID:[The choice of oral contraception in 1984: general indications and specific cases]. 672 93

A 12 year old female patient presenting non ketotic hyperosmolar hyperglycemic coma as initial sign of diabetes mellitus is presented. She was successfully treated with continuous infusion of low dose of insulin and saline and glycosaline isotonic sera. Potassium was precociously added to the hydrating solutions. During convalescence she suffered a left iliofemoral thrombophlebitis which remitted with appropriate treatment. In coma stage, C-peptide was close to normal, indicating active insulin production by the pancreas.
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PMID:[Hyperosmolar non-ketotic diabetic coma in children (author's transl)]. 700 66

OC (oral contraception) can cause hypertension in a small minority, about 5%, of users. There does not seem to be a relationship between estrogen dosage and hypertension, while a relationship between progesterone and hypertension seems more possible. Hypertensive reaction to OC has been primarily seen in patients over 30; length of use is another important factor; the incidence after the 5th year of use is reputed to be 2.5-3 times higher than for the first year. Almost all women who develop hypertension with OC use will return to normal levels after OC termination. Several studies indicate a 4-fold to 6-fold increase in the risk of thrombosis and of thrombophlebitis among OC users and especially among woman over 35. OCs containing 50 mcg or less of estrogen can decrease the incidence of thromboembolic diseases by as much as 25%. It has also been reported that OC use before a surgical procedure increases the risk of postsurgical thromboembolism. Frequency of cerebral thrombosis, however rare, also seems to be higher in OC users, especially smokers. Risk of myocardial infarction is also higher among OC users especially in relation to age and smoking. A British study found that mortality rates among smokers were 10.2/100,000 pill users, versus 2.6 in nonusers in the age group 30-39; rates were 62.0 and 15.9 respectively in women over 40; duration of OC use is also a relevant factor. Absolute contraindications to OC use include any precedent of history of cardiovascular or cerebrovascular disease, impaired liver functions, any known or suspected form of neoplasia, genital bleeding, congenital hyperlipidemia, and obviously pregnancy. Relative contraindications include hypertension, migraine, epilepsy, varicose veins, diabetes, uterine leiomyomas, age over 35, and elective surgery. Potential OC users should be carefully screened to minimize possible risks. Age, health history, and smoking are extremely important. Starting OC with a dose lower than 50 mcg of estrogen is also advisable. A woman on OC should be seen every 6 months. Despite side effects and complications, OCs are the most effective and safest method of contraception a physician can offer.
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PMID:Complications and contraindications of oral contraception. 702 10

In two large general populations of Yugoslav men from Tuzia, Bosnia, and Remetinec, Croatia, examined in 1964-1965, it was found that a greater alcohol consumption was accompanied by higher blood pressures, higher pulse rates, and higher concentrations of serum cholesterol and hematocrit. A greater consumption was also associated with an enlarged liver, as well as a higher prevalence rate of chronic bronchitis and thrombophlebitis. All these were statistically significant even after allowing for differences in cigarette smoking and demographic characteristics. Pulse rate, liver size, and varices appear to be specifically associated with a history of episodes of drunkenness. There were significant differences in drinking habits by place of residence, religious background, years of schooling, and kind of work. These were allowed for in evaluating the relationship of drinking to other characteristics. Two anomalous findings were low prevalence rates for diabetes and gastritis among those drinking most frequently.
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PMID:Drinking habits and other characteristics: the Yugoslavia Cardiovascular Disease Study. 711 39

It is stimulating to ascertain the comparative risk to the woman of hormonal contraceptives of the various kinds used today: combination preparations, which rely on blocking the secretion of gonadotropic hormones by the hypothesis; sequential preparations, which rearrange the physiological relationships of the menstrual cycle; gestagen preparations (minipills), which heighten the viscosity of the cervical mucus; longterm injectable preparations, which initially block ovulation and then act on the cervical mucus; postcoital preparations, which act by inducing abortion of the fertilized egg. Of these the most reliable are the fixed combinations, while sequential preparations are somewhat less so. The minipills are the least reliable. Interaction with other medications can reduce the reliability of these preparations; for instance, women on contraceptives have become pregnant after taking antiepileptic medications containing phenobarbitol and hydantoin. As far as risk is concerned, we must distinguish between those that merely harm the woman and those that pose a threat to life. Some of the former are: bleeding between cycles, failure of menses to appear after cessation of contraception, depression, breast-pains, hypertension, thrombophlebitis, and reduced libido. Hormonal contraceptives also have a series of beneficial effects, especially in women who ordinarily have menstrual difficulties. Among the more serious side effects are: risk of teratogenicity, carcinogenicity, liver problems, thromboses, and infarctions. To reduce the risks of these various side effects, the physician should observe carefully the contraindications: these are both absolute (cerebrovascular and retinal problems, thrombo-embolisms, hepatic disease, diabetes, porphyria, and sickle-cell anemia and relative (migraines, cardiac pains, hyperlipemia, epilepsy, and multiple sclerosis).
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PMID:[Safety and risks of hormonal contraceptives]. 712 52

The authors report the case of a 22-year-old Guatemalan in whom lupus was diagnosed 8 months after a second pregnancy. The diagnosis of lupus met the criteria of the ARA: Raynaud's syndrome, alopecia, arthralgia, thrombophlebitis, facial erythema, antinuclear factor at 1/100, Farr at 75 p. 100 and immunofluorescent demonstration of IgM binding in healthy skin. Two months after the beginning of the lupus, there was onset of insulin-resistant ketosic diabetes without overweight. The serum insulin was 1.140 mu U/ml. Acanthosis nigricans was noted and confirmed by a biopsy. Insulin-resistance can be attributed to anti-membrane receptor antibodies titrating at 1/200 (R. Khan). The short-term progress of the disease was favorable on corticosteroid treatment. Insulin could be stopped, but high insulin serum levels persisted. This case meets criteria for type B as defined by Flier, Khan and Roth, and is the first European case of lupus with a complete presentation. Short-term progress was favorable, and there is no evidence to affirm that there will be a tardive progression towards hypoglycemia which is, however, possible due to the persistence of elevated serum insulin levels.
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PMID:[Lupus, insulin-resistant diabetes and acanthosis nigricans (author's transl)]. 723 1


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