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1.
Acta Neurol Scand ; 102(5): 337-9, 2000 Nov.
Article in English | MEDLINE | ID: mdl-11083513

ABSTRACT

We describe a 77-year-old woman who developed a confusional state, cognitive impairment, behavioural abnormalities and dysphasia after treatment of hypercalcaemia. Repeated EEG recording revealed rhythmic sharp-wave activity over the right parietal-occipital lobe. Magnetic resonance imaging (MRI) showed marked hyperintense signal changes bilaterally. The diagnosis of a non-convulsive status epilepticus (NCSE) was made. With antiepileptic treatment the patient improved and MRI as well as EEG changes were almost all reversible. NCSE is an important differential diagnosis of patients with neuropsychiatric symptoms and can develop after rapid lowering of serum calcium levels in hypercalcaemia.


Subject(s)
Brain/metabolism , Calcium/metabolism , Hypercalcemia/complications , Status Epilepticus/diagnosis , Status Epilepticus/etiology , Aged , Anticonvulsants/therapeutic use , Aphasia/etiology , Brain/pathology , Brain/physiopathology , Calcium/blood , Cognition , Delirium/etiology , Electroencephalography , Female , Humans , Magnetic Resonance Imaging , Status Epilepticus/physiopathology , Treatment Outcome
2.
Eur Heart J ; 20(23): 1752-6, 1999 Dec.
Article in English | MEDLINE | ID: mdl-10562484

ABSTRACT

AIM: To prospectively study the relationship between blood pressure levels and subsequent cardiovascular morbidity and mortality in a population aged 65 years and older. METHODS: Participants of the 1992 baseline survey of the population-based Starnberg Study on Epidemiology of Parkinsonism and Hypertension in the Elderly (STEPHY, 394 men and 588 women above age 65) were followed up for 3 years. Total mortality was assessed by official death data. Cardiovascular morbidity, that is, the occurrence of non-fatal events (new cases of acute myocardial infarction, angina pectoris, stroke, and heart failure) could be assessed in 681 of the 863 survivors by a second interview and analysis of general practitioners' records. The mortality and morbidity risks were compared for hypertensives (baseline blood pressure > or = 160/95 mmHg or antihypertensive treatment) and non-hypertensives. RESULTS: During follow-up a total of 55 men and 64 women died resulting in a 2.7-year cumulative mortality in this population of 12%. Mortality was higher in men (14%) than in women (11%). Hypertensives had no increased risk of death compared to non-hypertensives (adjusted relative risk (RR)=0. 92; 95% CI: 0.48-1.76 for men and RR=1.36; 95% CI 0.67-2.78 for women). This was confirmed in age-stratified analyses. However, among survivors hypertension was associated with a significantly higher occurrence of non-fatal cardiovascular events. After controlling for potentially confounding baseline conditions, the relative risk for any event (RR=1.44; 95% CI: 1.04-2.0) and, in particular, of acute myocardial infarction (RR=5.5; 95% CI: 1.6-18. 7) was raised among hypertensives. Higher rates for angina pectoris (RR=1.4; 95% CI: 0.9-2.4) and heart failure (RR 1.7; 95% CI: 0.9-2. 9) were of borderline significance. Positive risk associations were confined to the age group 65 to 75 years and not detected at higher ages. CONCLUSION: This study demonstrates for a Central European population older than 65 years the impact of hypertension as a risk factor for cardiovascular and cerebrovascular morbidity. To address the issue that risk of death showed no significant relationship to blood pressure, a longer follow-up period might be necessary.


Subject(s)
Cerebrovascular Disorders/mortality , Heart Diseases/mortality , Hypertension/complications , Aged , Aged, 80 and over , Blood Pressure , Cause of Death , Cerebrovascular Disorders/etiology , Female , Germany/epidemiology , Heart Diseases/etiology , Humans , Hypertension/epidemiology , Incidence , Male , Prospective Studies , Risk Factors , Rural Population , Surveys and Questionnaires , Survival Rate
5.
Dtsch Med Wochenschr ; 123(31-32): 930-5, 1998 Jul 31.
Article in German | MEDLINE | ID: mdl-9721568

ABSTRACT

HISTORY AND CLINICAL FINDINGS: Two women, both aged 54 years, were admitted because of supraventricular arrhythmias of recent onset. Patient 2 was also in heart failure. Male family members of both patients were known to have Duchenne's muscular dystrophy, of which one had died. INVESTIGATIONS: The electrocardiogram of patient 1 demonstrated atrial fibrillation. Patient 2 had a raised serum creatine kinase concentration and increased pulmonary marking in the chest radiogram. Patient 1 had normal findings on left heart catheterization, but immunohistochemical analysis of a myocardial biopsy revealed dystrophin mosaic with 20% dystrophin-negative fibres. Patient 2 had a reduced ejection fraction and 80% dystrophin-negative fibres. DIAGNOSIS, TREATMENT AND COURSE: Myocardial involvement in the carrier state for Duchenne's muscular dystrophy having been demonstrated in both women, patient 1 received antihypertensive treatment while patient 2, who was in cardiac failure, was given diuretics, ACE-inhibitor and beta-receptor blockers. CONCLUSION: Cardiomyopathy in carriers of Duchenne's muscular dystrophy is a rare cause of supraventricular arrhythmias. The cause can be confirmed by immunochemical analysis of an endomyocardial biopsy.


Subject(s)
Heterozygote , Muscular Dystrophies/genetics , Myocardium/pathology , Tachycardia, Supraventricular/etiology , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Anti-Arrhythmia Agents/therapeutic use , Antihypertensive Agents/therapeutic use , Atrial Fibrillation/etiology , Creatine Kinase/blood , Diuretics/therapeutic use , Drug Therapy, Combination , Dystrophin/analysis , Electrocardiography , Enalapril/therapeutic use , Female , Heart/physiopathology , Heart Failure/etiology , Humans , Immunohistochemistry , Male , Metoprolol/therapeutic use , Middle Aged , Muscular Dystrophies/complications , Nicardipine/therapeutic use , Pedigree , Tachycardia, Supraventricular/drug therapy
8.
Bildgebung ; 63(2): 130-2, 1996 Jun.
Article in German | MEDLINE | ID: mdl-8756157

ABSTRACT

Sonographic evidence of a cystic adrenal tumour was found in a 73-year-old female patient with a 6-month history of chest pain and dyspnoea. A computed tomogram of the abdomen revealed, in addition to the 5-cm lesion, a contrast medium-free area in the vena cava inferior, leading to an initial diagnosis of recurrent pulmonary emboli due to a thrombosis of the vena cava inferior. Further diagnostic procedures excluded emboli and indicated a dilating cardiomyopathy with mitral and tricuspid regurgitation. The contrast medium-free area in the vena cava inferior was caused by the influx and regurgitation of contrast medium-free blood from the renal and hepatic veins in addition to blood from the right atrium due to the tricuspid valve regurgitation. A thrombosis was excluded by means of a color-duplex investigation. The patient declined any further diagnostic procedures concerning the lesion.


Subject(s)
Thrombosis/diagnostic imaging , Tomography, X-Ray Computed , Tricuspid Valve Insufficiency/diagnostic imaging , Vena Cava, Inferior/diagnostic imaging , Aged , Diagnostic Errors , Echocardiography, Doppler , Female , Humans , Pulmonary Embolism/diagnostic imaging
9.
Blood Press ; 5(3): 154-63, 1996 May.
Article in English | MEDLINE | ID: mdl-8790926

ABSTRACT

The aim of the study was to compare the antihypertensive efficacy of either felodipine or the diuretic combination hydrochlorothiazide/triamterene in a group (n = 65) of elderly (> or = 70 years) hypertensives (office blood pressure > or = 160/95 mmHg) with special regard to ambulatory blood pressure monitoring, hypertensive heart disease and metabolic parameters. This was a randomized, double-blind study with a treatment period of 6 months. Reduction of office and 24-hr ambulatory blood pressure was comparable with both treatment regimens; after 6 months. 18 of 29 patients in the felodipine group (62%) and 20 of 27 patients in the diuretic group (74%; p = 0.4) were controlled. While episodes of ischemic type ST-segment depression were significantly reduced in the felodipine group (from 49 to 9 episodes), there was no significant change in the diuretic group (from 24 to 21 episodes). Both regimens decreased left ventricular wall thickness, but the decline in left ventricular muscle mass index was significant only for felodipine. Felodipine did not induce any change in metabolic or hormonal parameters; the diuretic combination significantly increased serum creatinine, uric acid, plasma renin activity, and plasma prorenin. Thus, the antihypertensive efficacy of felodipine and the diuretic combination was comparable in elderly hypertensives; only felodipine, however, improved parameters of hypertensive heart disease and showed a neutral metabolic and hormonal profile.


Subject(s)
Blood Pressure/drug effects , Calcium Channel Blockers/therapeutic use , Diuretics/administration & dosage , Felodipine/therapeutic use , Heart Diseases/physiopathology , Hypertension/drug therapy , Aged , Aged, 80 and over , Double-Blind Method , Drug Therapy, Combination , Electrocardiography/drug effects , Felodipine/adverse effects , Female , Heart Rate/drug effects , Hormones/blood , Humans , Hydrochlorothiazide/administration & dosage , Hydrochlorothiazide/adverse effects , Hypertension/physiopathology , Male , Triamterene/administration & dosage , Triamterene/adverse effects
10.
Dtsch Med Wochenschr ; 120(18): 641-5, 1995 May 05.
Article in German | MEDLINE | ID: mdl-7750431

ABSTRACT

A 50-year-old man with an IgG-chi light chain multiple myeloma stage IIIA, developed--in a phase of low disease activity, after 18 months of an uncomplicated course--marked malabsorption syndrome with 20 kg weight loss, diarrhoea and meteorism. Although the H2-breath test indicated intestinal bacterial colonisation, neither antibacterial treatment with trimethoprim/sulphamethoxazole and metronidazole nor prokinetic treatment with cisapride (30 mg daily) and erythromycin (1 g twice daily) improved the symptoms. Suspected amyloidosis was not demonstrable at first, despite repeated step biopsies of stomach, duodenum and rectum. Amyloidosis of the entire gastrointestinal tract was proven only by repeated biopsies deep into the submucosa. Despite treatment of the underlying disease with melphalan and prednisone (Alexanian's scheme) the amyloidosis advanced further to involve liver, spleen, lung, kidneys and heart. The patient died, 2 years after diagnosis of the multiple myeloma, from recurrent pulmonary emboli due to atrial fibrillation.


Subject(s)
Amyloidosis/complications , Gastrointestinal Diseases/complications , Immunoglobulin G , Immunoglobulin Light Chains , Multiple Myeloma/complications , Amyloidosis/diagnosis , Amyloidosis/pathology , Autopsy , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/pathology , Humans , Male , Middle Aged , Paraproteinemias
11.
Eur Heart J ; 15(12): 1673-80, 1994 Dec.
Article in English | MEDLINE | ID: mdl-7698138

ABSTRACT

Episodes of transient myocardial ischaemia can frequently be observed in hypertensive patients. To assess the effects of antihypertensive treatment with the calcium antagonist felodipine or the diuretic combination hydrochlorothiazidel triamterene on episodes of ischaemic-type ST-segment depression (ST-D), simultaneous ambulatory electrocardiographic and blood pressure (BP) monitoring was performed in 42 elderly hypertensives without manifest coronary artery disease. All patients (mean age 79 +/- 6 years, office BP > or = 160/95 mmHg) were evaluated off any antihypertensive or anti-ischaemic therapy and after 3 months treatment with either felodipine or the diuretic (randomized, double-blind study) for episodes of significant ST-D (> or = 0.1 mV, duration > or = 1 min, interval > or = 1 min). The reduction in office BP and daytime ambulatory BP was similar for both agents, as was a significant reduction in the heart rate x systolic BP product (DP) over 24 h (felodipine: 12,441 +/- 2076 vs 11,643 +/- 1953 mmHg.min-1; P = 0.048; diuretic: 12,366 +/- 2782 vs 11,062 +/- 2012 mmHg.min-1; P = 0.003). While felodipine significantly decreased the total number of ST-D (from 40 to six episodes; P = 0.03), the total number of ST-D remained unchanged with the diuretic (non-significant increase from 31 to 45 episodes; P = 0.24). The same trend was observed for the number of patients with ST-D.(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Felodipine/therapeutic use , Hydrochlorothiazide/therapeutic use , Hypertension/complications , Hypertension/drug therapy , Myocardial Ischemia/complications , Myocardial Ischemia/prevention & control , Triamterene/therapeutic use , Aged , Aged, 80 and over , Double-Blind Method , Drug Therapy, Combination , Female , Hemodynamics/drug effects , Humans , Hypertension/physiopathology , Male , Myocardial Ischemia/physiopathology
12.
Z Kardiol ; 83(11): 830-9, 1994 Nov.
Article in German | MEDLINE | ID: mdl-7825373

ABSTRACT

The aim of the study was to assess the current cardiovascular risk factor profile including data on treatment of a representative population over the age of 65 in Germany. From a total of 1190 inhabitants > or = 65 years living in two Bavarian villages near Munich, 982 could be visited at home ("door-to-door" survey), where a questionnaire and the measurement section were performed (response rate 82.5%). Blood pressure was measured three times in the sitting position with a standard sphygmomanometer, ("actual") hypertension was defined as systolic blood pressure > or = 160 mm Hg and/or diastolic blood pressure > or = 95 mm Hg or effective antihypertensive treatment. Obesity was defined as body mass index > or = 27.8 kg/m2 for men or > or = 27.3 kg/m2 for women, hypercholesterolemia as total cholesterol > or = 250 mg/dl (6.5 mmol/l), diabetes as fasting serum glucose > 120 mg/dl, glucosuria or treatment with insulin or oral antidiabetics. With a prevalence of 53% hypertension was the leading risk factor, followed by obesity with 35% and hypercholesterolemia with 21%; smoking and diabetes were observed in < 10%. Hypertension and obesity tended to be more prevalent in women, diabetes in men; hypercholesterolemia was significantly more prevalent in women. While the prevalence of hypertension increased up to the age groups "75-79 years" in men and "80-84 years" in women, there was a constant decrease with age for obesity, hypercholesterolemia and smoking. Three-quarters of the participants showed a minimum of one cardiovascular risk factor, the risk factor combination "hypertension/hypercholesterolemia/smoking" was observed however only in 1%.(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Cardiovascular Diseases/epidemiology , Hypertension/epidemiology , Mass Screening , Parkinson Disease/epidemiology , Aged , Aged, 80 and over , Antihypertensive Agents/therapeutic use , Cardiovascular Diseases/etiology , Cross-Sectional Studies , Diabetic Angiopathies/complications , Diabetic Angiopathies/epidemiology , Drug Therapy, Combination , Female , Germany/epidemiology , Humans , Hypercholesterolemia/complications , Hypercholesterolemia/epidemiology , Hypertension/etiology , Incidence , Male , Obesity/complications , Obesity/epidemiology , Parkinson Disease/etiology , Risk Factors
13.
J Hypertens ; 12(6): 709-16, 1994 Jun.
Article in English | MEDLINE | ID: mdl-7963497

ABSTRACT

OBJECTIVE: To assess the prevalence of hypertension and isolated systolic hypertension and the level of awareness, treatment and control of hypertension, in a population aged over 65 years. DESIGN: Cross-sectional survey of the total population aged > or = 65 years of two Bavarian villages with a representative age distribution. PATIENTS: From a total of 1190 inhabitants aged > or = 65 years, 982 (394 male, 588 female) participated (response rate 82.5%). METHODS: All of the participants were visited at home by physician observers. After a standardized questionnaire, blood pressure was measured three times on one occasion with the subject in the sitting position, using a standard mercury sphygmomanometer. 'Actual' hypertension was defined as systolic blood pressure (SBP) > or = 160 or diastolic blood pressure (DBP) > or = 95 mmHg, or both, or current use of antihypertensive drugs given for the indication hypertension in patients with blood pressure < 160/95 mmHg. Isolated systolic hypertension was defined as SBP > or = 160 and DBP < 90 mmHg. All 'actual' hypertensives were further classified as 'unaware' of hypertension, 'aware' (but not treated), 'treated' (current use of antihypertensive drugs for the indication hypertension and blood pressure > or = 160/95 mmHg) or 'controlled' (treated and blood pressure < 160/95 mmHg). RESULTS: Mean +/- SD blood pressure was 154.5 +/- 24.4/84.9 +/- 11.6 mmHg (when 52 institutionalized participants were excluded, 155.6 +/- 24.4/85.3 +/- 11.6 mmHg). The SBP was significantly higher in females than in males and increased up to the age group 80-84 years both in males and in females. The DBP decreased with age. The prevalence of 'actual' hypertension was 53% and increased up to the age group 75-79 years in males and 80-84 years in females. The prevalence of isolated systolic hypertension was 17% (with patients currently using antihypertensive drugs excluded). Of the patients with 'actual' hypertension, 34% were 'unaware' of the diagnosis, 12% 'aware', 32% 'treated' and 22% 'controlled'. CONCLUSIONS: In central Europe hypertension, with a prevalence of > 50%, remains the most common cardiovascular risk factor in the elderly. Although most elderly hypertensives are currently treated with antihypertensive agents, less than one-quarter are controlled, and more than one-third are still unaware of the diagnosis. These levels of awareness and control call for better strategies in the diagnosis and treatment of hypertension in the elderly.


Subject(s)
Hypertension/epidemiology , Age Factors , Aged , Aged, 80 and over , Antihypertensive Agents/therapeutic use , Awareness , Cross-Sectional Studies , Female , Germany , Humans , Hypertension/prevention & control , Hypertension/therapy , Male , Prevalence
15.
Blood Press ; 2(4): 262-71, 1993 Dec.
Article in English | MEDLINE | ID: mdl-8173694

ABSTRACT

"White coat" hypertension can be demonstrated in 20-25% of younger patients with mild-to-moderate hypertension. In a population of 50 untreated hypertensive patients > or = 70 years (mean age 79 +/- 6 years, office blood pressure > or = 160 mmHg systolic and > or = 95 mmHg diastolic) ambulatory blood pressure monitoring, ECG and echocardiography were performed to assess the frequency of "white coat" hypertension and the alerting reaction ("white coat" effect). "White coat" hypertension was diagnosed, if mean daytime ambulatory blood pressure was < or = 146/87 mmHg (taken as upper "normal" limit), "definite" hypertension, if > 146/87 mmHg. Nine patients (18%) were classified as "white coat", 28(56%) as "definite" hypertensives, 13(26%) as an "intermediate" group. There were no differences in gender, weight, concomitant diseases, pre-study treatment, and systolic or diastolic left ventricular function between the groups. Patients with "white coat" hypertension showed lower office blood pressure (178 +/- 13/98 +/- 3 vs 201 +/- 19/104 +/- 7 mmHg; p < 0.004), lower left ventricular mass index (131 +/- 9 vs 139 +/- 26 g/m2, p < 0.5), no left ventricular hypertrophy (ECG-criteria; p < 0.05), a more pronounced alerting reaction (39 +/- 13/22 +/- 5 vs 27 +/- 17/8 +/- 9; p < 0.01) and no correlation between office blood pressure and left ventricular mass compared to the "definite" hypertension group. The total group showed an average alerting reaction of 30 +/- 19/12 +/- 8 mmHg. It is concluded that "white coat" hypertension and an alerting reaction can be demonstrated in untreated elderly and very elderly hypertensive patients. Patients with "white coat" hypertension are characterized by a milder degree of hypertension, less cardiac target organ damage and a more pronounced alerting reaction. The prognostic significance of "white coat" hypertension in the elderly needs to be reevaluated in a larger population.


Subject(s)
Aging/physiology , Anxiety/physiopathology , Hypertension/physiopathology , Aged , Aged, 80 and over , Blood Pressure/physiology , Blood Pressure Monitors , Echocardiography , Electrocardiography , Female , Humans , Hypertension/psychology , Male , Ventricular Function, Left
16.
Am J Cardiol ; 72(12): 927-31, 1993 Oct 15.
Article in English | MEDLINE | ID: mdl-7692716

ABSTRACT

Ischemic-type ST-segment depression is frequently observed in younger hypertensive patients. To assess the frequency of ST-segment depression in elderly hypertensive patients and to determine the influence of heart rate (HR) and blood pressure (BP) on the episodes of transient myocardial ischemia, ambulatory electrocardiographic and BP monitoring was simultaneously performed in 41 untreated hypertensive patients > 70 years of age (mean age 79 +/- 6 years; office BP > or = 160/95 mm Hg). A total of 66 episodes of significant ST-segment depression (> or = 0.1 mV, duration > or = 1 minute, interval > or = 1 minute) could be demonstrated in 15 patients (37%); 26 patients (63%) had no ST-segment changes. The 2 groups did not differ in age, gender, office or ambulatory BP, diurnal BP profile, concomitant diseases, ventricular arrhythmias, or in left ventricular (LV) mass or function. In 11 patients with ST-segment depression (73%), an increase in HR of > 15% preceded the episodes of ST-segment depression; 2 of these patients (13%) had an additional increase in BP of > 20/10 mm Hg. The extent of ST-segment depression was correlated significantly to BP, HR and HR x systolic BP product during the ischemic events, to office BP, and to LV mass. In conclusion, transient myocardial ischemia is a frequent phenomenon in elderly hypertensive patients with and without LV hypertrophy. Whereas most episodes of ischemia are preceded by an increase in HR, the extent of ST-segment depression is dependent on HR, BP and LV mass.


Subject(s)
Blood Pressure Monitors , Electrocardiography, Ambulatory , Hypertension/complications , Myocardial Ischemia/diagnosis , Age Factors , Aged , Aged, 80 and over , Blood Pressure/physiology , Cardiac Complexes, Premature/diagnosis , Cardiac Complexes, Premature/physiopathology , Echocardiography , Electrocardiography , Electrocardiography, Ambulatory/instrumentation , Electrocardiography, Ambulatory/methods , Female , Heart Rate/physiology , Heart Ventricles/diagnostic imaging , Humans , Hypertension/diagnostic imaging , Hypertension/physiopathology , Male , Myocardial Ischemia/diagnostic imaging , Myocardial Ischemia/physiopathology , Tachycardia, Ventricular/diagnosis , Tachycardia, Ventricular/physiopathology , Ventricular Function, Left/physiology
17.
Z Gerontol ; 26(4): 297-301, 1993.
Article in German | MEDLINE | ID: mdl-8212801

ABSTRACT

In 12 of 32 elderly (> 65 years) hypertensives admitted with syncope, a diagnosis of orthostatic hypotension was made after a positive orthostatic tolerance test and extensive diagnostic evaluation with exclusion of other causes of syncope. Blood pressure of these 12 patients (pts.) after admission was 145 +/- 16/83 +/- 6 mmHg; at that time the pts. were treated with 2.6 +/- 1.6 different antihypertensive agents, and 67% of the pts. received a combination therapy. After reevaluation of treatment the pts. could be discharged with 1.3 +/- 0.7 different antihypertensive agents (significant difference, p < 0.02); in 25% of pts. (p < 0.05) combination therapy was still necessary. Before discharge casual blood pressure was 156 +/- 17/85 +/- mmHg (with the patient in the sitting position); average daytime ambulatory blood pressure was 145 +/- 18/80 +/- 5 mmHg. Three months after discharge 91% of pts. remained free of a new syncope. Orthostatic hypotension is a frequent cause of syncope in the hypertensive elderly; thus, their blood pressure should be checked more often in the sitting and standing position and by ambulatory monitoring.


Subject(s)
Antihypertensive Agents/adverse effects , Hypertension/drug therapy , Hypotension, Orthostatic/chemically induced , Syncope/chemically induced , Aged , Aged, 80 and over , Antihypertensive Agents/therapeutic use , Blood Pressure/drug effects , Diagnosis, Differential , Drug Therapy, Combination , Electrocardiography/drug effects , Female , Humans , Male
19.
Clin Investig ; 70(10): 951-5, 1992 Oct.
Article in English | MEDLINE | ID: mdl-1450620

ABSTRACT

A 77-year-old man with chronic obstructive pulmonary disease was treated with low-dose methotrexate (7.5-15 mg per week). After 15 months a diagnosis of urothelial carcinoma of the bladder was made; after a further 6 months pneumonitis and pancytopenia developed. The patient died due to massive pulmonary hemorrhage. A malignant teratoma was diagnosed in a 65-year-old asthmatic man 16 months after initiation of methotrexate therapy (15 mg per week). The patient died 4 months later due to fulminant progression of the neoplasm. A third malignant neoplasm (dermal squamous cell carcinoma) was seen in a 64-year-old woman with rheumatoid arthritis after 13 months treatment with 7.5 mg methotrexate per week. These three cases, while obviously not proving a causal relationship between long-term treatment with low-dose methotrexate and development of malignant neoplasm, do call for stringent treatment criteria, close surveillance, and prospective studies.


Subject(s)
Lung Diseases, Obstructive/drug therapy , Methotrexate/adverse effects , Neoplasms/chemically induced , Pancytopenia/chemically induced , Pneumonia/chemically induced , Aged , Carcinoma, Squamous Cell/chemically induced , Female , Humans , Lung Diseases, Obstructive/complications , Male , Methotrexate/administration & dosage , Middle Aged , Skin Neoplasms/chemically induced , Teratoma/chemically induced , Urinary Bladder Neoplasms/chemically induced
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