Subject predisposing factors

There is no doubt that IL-6 is involved in the modulation of the HPA axis and increased availability of 11 6 in the hypothalamus is associated with increased HPA activity (Plata-Salaman, 1991). Ac tivation of the HPA axis is one of the best-documented changes in major depression (Roy et al., 1987). Stress acts as a predisposing factor for MD, an increased susceptibility to stress has repeatedly been described in patients with MD, even prior to their first exacerbation of the disorder and psychosocial stressors frequently precede the onset of MD. Additionally, an altered HPA axis physiology and dysfunctions of the extrahypo-thalamic CRH system have been consistently found in subjects with MD (Hasler et al., 2004). Several studies demonstrate that MD patients exhibit higher baseline cortisol levels or at least much higher cortisol levels during the recovery period after psychological stress (Burke et al., 2005). 

There have been several reports of impaired renal function in patients taking ketorolac (SEDA-17, 112) (SEDA-18, 105) (SEDA-22, 117). The severity varies from slight to severe forms of renal insufficiency, which may even occur after a single dose of 30 mg. Because recent major surgery is considered a risk factor for renal insufficiency, particularly in elderly patients, the use of ketorolac, or other NSAIDs, for postoperative pain management is warranted only in carefully selected patients. Furthermore, a case report confirmed that oral ketorolac can cause acute renal insufficiency in young subjects without any predisposing factors (SEDA-21,106). 

Sensory systems Eyes Tamsulosin and other alpha-1 antagonists have been associated with intraoperative floppy iris syndrome (IFIS). A recent review compared the incidence of IFK in patients using tamsulosin and other chronic medications [35 ]. In a review of 1530 subjects who xmderwent phacoemulsification, 80% of cxn-rent tamsulosin users, 60% of previous tamsulosin users, 1% of patients on other chronic medications including antihypertensives, antipsychotics, antidiabetics and 1.7% of those on no medications at all had IFCS. The authors concluded that while IFCS was most likely associated with tamsulosin, it was also observed among patients on other chronic drugs like metformin, lisinopril and aspirin. The predisposing factors to IFCS for patients on these medications need to be elucidated. 

Chlorpromazine has mild anticholinergic properties and may have contributed to the angle closure in this case. She also had hypermetropia which is an another risk factor for glaucoma. However, this case supports the view that potent blockade of serotonin re-uptake can cause glaucoma in predisposed subjects. 

Structural features predisposing compounds to react as monomers have been briefly treated in Chap. 2, Sec. 1. Chemical factors affecting polymerizations are, in fact, the subject of all parts of this volume. Therefore only certain aspects will be mentioned in this chapter. 

There is no vahd evidence that diuretics contribute to myocardial infarction, sudden death, or a failure of antihypertensive treatment or other risk factor interventions to prevent coronary deaths (50). An association between diuretics and sudden death has been suggested only in selected subset analyses, which allow no vahd conclusions. Even in subjects with electrocardiographic abnormalities before treatment, there is no sound or consistent evidence to support the suggestion that diuretics predispose to sudden death. 

Markou et aL, 2001), and this was the case in about 1% of our patients. Iodine excess inhibits iodine organification and T4andT3 synthesis (WoUf-Chaikoff effect). Normal subjects escape from this effect however, patients with abnormal thyroid gland do not and may develop thyroid hypofunction. Iodine also inhibits thyroid hormone release and decreases serum T4 and T3 levels (Woeber, 1991). Furthermore, iodine seems to be an important factor in thyroid autoimmunity in genetically predisposed individuals (Laurberg... 

Further analysis of 50 years of Framingham research showed that hypertension is a powerful risk factor accounting for about 35% of atherosclerotic cardiovascular disease. Hypertension was shown to predispose powerfully to all of the major atherosclerotic cardiovascular events including coronary artery disease, stroke, peripheral arterial disease, and heart failure. An analysis of risk of cardiovascular events in subjects with hypertension in persons aged 35-64 years in a 36-year follow-up of the Framingham study showed that the age-adjusted biennial rate per 1000 for peripheral arterial disease was 10 for men and 7 for women. The age-adjusted risk ratio was 2.0 for men and 3.7 for women, and the excess risk per 1000 was 5.0 for both men and women (17). 

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