ABSTRACT
INTRODUCTION: Eye-drops can provoke various systemic side effects and diagnosis of an iatrogenic pathology can made difficult. Observation For 4 months, and 80 year-old man had experienced severe recurrent episodes of sweating concomitant with shaking of the legs. Alpha stimulating eye-drops, prescribed for his glaucoma, were at the origin of these problems. On withdrawal of the latter, the symptoms regressed. DISCUSSION: Diagnosis of an iatrogenic pathology was made after 3 months of medical explorations. The delay in diagnosis was prolonged because the patient had not mentioned the use of an active ingredient, since it was in the form of eye-drops. CONCLUSION: The search for drug-induced causes must be systematic when faced with any unexplained symptom and must include all the active ingredients, whatever their form of administration.
Subject(s)
Diagnostic Errors , Ophthalmic Solutions/adverse effects , Sweating , Aged , Aged, 80 and over , Glaucoma/drug therapy , Humans , Iatrogenic Disease , Leg/pathology , Male , Peripheral Nervous System Diseases/chemically inducedABSTRACT
OBJECTIVE: The prognostic value of nocturnal blood pressure (BP) in hemodialysis patients has been well established. The aim of this study was to evaluate the long-term outcome of ambulatory BP in hypertensive hemodialysis patients. DESIGN AND METHODS: Medical records of all hemodialysis patients seen for uncontrolled hypertension between 1993 and 1999 and who underwent an ambulatory blood pressure measurements (ABPM) were retrospectively studied. Uncontrolled hypertension was defined as office BP = 140/90 mmHg and 24 h ABP = 125/80 mmHg. Patients who underwent a second ABPM after an interval of at least 1 year were included in the study. Demographic characteristics, medical history, cardiovascular risk factors and treatments were recorded for each patient. A t-test (bilateral) was used to compare BP. RESULTS: 26 patients were included (545 +/- 18.9 years; 14 men). 7 had previous history of cardiovascular disease and 2 were diabetic. At the end of the follow-up (29 +/- 12.8 months), 9 patients (36%) had 24 h BP < 125/80 mmHg. A significant decrease in diurnal and nocturnal BP was observed (p < 0.05). No significant change was observed for office systolic BP and predialytic BP. CONCLUSION: Our data show that a long-term decrease in nocturnal BP can be obtained in hypertensive patients on hemodialysis. With respect to the prognostic value of this criteria, randomised trials could be carried out to determine whether nocturnal BP is superior to office BP as a target for antihypertensive therapy in this population.
