Nelson S. Irey

Anaphylactic Deaths: A Clinicopathologic Study of 43 Cases

The concept of anaphylaxis originates from the observations by the French physiologist Charles Richet in 1902 of the effects of actinotoxins on the blood pressure of dogs [1]. Anaphylactic shock is the classic example of the immediate type of hypersensitivity reaction; it may be defined as the failure of the peripheral circulation induced by an antigen-antibody reaction [2]. The circulatory collapse may be primary, if the circulatory reaction is the primary event, or secondary, if the circulatory collapse is the consequence of an initial respiratory insufficiency.

Oral contraceptives and stroke in young women: A clinicopathologic correlation

Pathologic studies of women with fatal cerebrovascular disease who have received oral contraceptives are infrequently found in the literature. Three cases of this type are reported here. The pathologic findings included an intrinsic vascular lesion in the form of intimal hyperplasia with and without associated thrombosis, found in arteries supplying the brain. Similar vascular lesions have been reported previously in other sites of the vascular system in association with exogenous or endogenous steroids. They have also been found in other species under the influence of steroids. This hyperplasia of vessel intima may be found in association with other clinicopathologic entities, but stigmata of other diseases were not found in these three patients.

Adverse reactions to drugs: A clinicopathologic survey of 200 infants and children

Observations on the first 200 pediatric cases in the Registry of Tissue Reactions to Drugs are reported. Autopsy material was available for 181 of these cases: About 50 per cent of the patients were less than 5 years of age, 4 per cent were stillborn, and three fourths were Caucasian girls. Therapeutic exposure to a drug occurred in 63 per cent of the patients and nontherapeutic exposure in 23.5 per cent; in 13.5 per cent the type of exposure was not stated. The most frequent routes of administration, in decreasing order, were: oral, placental transfer, injection, and inhalation. The more common drugs were analgesics, antineoplastic agents, heavy metals, and corticosteroids. The liver was the organ most frequently affected. The relationship of drug to disease, evaluated by a method developed at the Registry, was considered to be “positive” in 47 per cent of the cases, “possible” in 37 per cent, and “coincidental” or “negative” in 16 per cent.

Sickle Cell Crisis Associated With Drugs

Drug overdose precipitated sickle cell crisis leading to death in four cases. Toxicologic studies in life and postmortem examinations showed the deaths to be caused by a combination of the ingested drugs and associated sickle cell crisis. Both the homozygous and heterozygous states in sickle cell disease are susceptible to sickle cell crisis induced by drug overdose.

CASE REPORT METHODS FOR ASSESSING CAUSALITY

The evaluation of cases of alleged adverse reactions to drugs is usually complex, and requires detailed time-related information on drug administration and on the markers of the adverse reaction. Many cases remain in the anecdotal category because of the lack of critically needed details. This presentation is built around two groups of diagnostic criteria that constitute guidelines in assessing causality in drug-related illnesses. Examples of the use of these criteria are given in a series of illustrative cases.

A Review of “Narcotics and Narcotic Addiction”

For the many persons who have an interest in current drug abuse problems, this fourth edition of Narcotics and Narcotic Addiction, by Maurer and Vogel, is a clearly written and comprehensive presentation of this vitally important problem in our modern times and society. The treatment of the multifaceted subject of drug abuse in this book is sufficiently broad that a wide variety of interested persons may gainfully turn to it.