Splenomegaly, Analgesic Ingestion and Renal Disease

Fordham, Christopher C.; Huffines, William D.

doi:10.1056/nejm196710052771407

Cited by 12 publications

(5 citation statements)

References 3 publications

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“…Finally a recent water load (Almen and Andren, 1961), and chronic ingestion of toxins such as alcohol (Holzbach et af., 1962) or analgesic drugs (Azen and Schilling, 1963;Fordham and Huffines, 1967;Duggan, 1970) are known to increase spleen size. Table 1: L'im is the distance between the level of the most cranial part of the diaphragmatic arch and the lower pole of the spleen in a radiograph defined as in Figure I b (Bergstrand and Ekman, 1957).…”

Section: Radiological and Radionuclide Studiesmentioning

confidence: 99%

“…Finally a recent water load (Almen and Andren, 1961), and chronic ingestion of toxins such as alcohol (Holzbach et af., 1962) or analgesic drugs (Azen and Schilling, 1963;Fordham and Huffines, 1967;Duggan, 1970) are known to increase spleen size. the area of the frontal splenic projection, is readily estimated planimetrically or by point grid counting (von Behrens.…”

Section: Radiological and Radionuclide Studiesmentioning

confidence: 99%

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Assessment Of Spleen Size In Vivo

Behrens

1973

Australas Radiol

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Summary Definitions from the radiologic and radionuclide literature on “spleen sizing” are reviewed and summarized. Some established relationships are confirmed and the data are extended in a study based on measurements made on abdominal radiographs from 40 healthy adult volunteers, 15 patients with known splenomegaly and 12 patients in whom diagnostic radionuclide images of the spleen were recorded; measurements were also made on 17 spleens at autopsy. The principles of organ sizing (namely dimensional analysis and similarity theory) are applied to derive a number of equations, a nomogram, and convenient spleen size indices for assessing both the absolute spleen weight and the allometric size of the spleen (namely the size of the spleen relative to the size of the subject) in health and disease. It is shown that occult splenomegaly can be diagnosed with confidence in nuclear medicine before spleen weight is increased 1.3‐fold (on average); in radiology, if the whole spleen projection is visible, splenomegaly can be diagnosed at that value. If only the tip of the spleen is visible as in most plain abdominal radiographs then latent splenomegaly can be diagnosed when, on average, spleen weight is increased 2‐fold. Palpable splenomegaly usually corresponds to a 3.4‐fold increase in spleen weight above the normal value in health.

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Section: Radiological and Radionuclide Studiesmentioning

confidence: 99%

“…Finally a recent water load (Almen and Andren, 1961), and chronic ingestion of toxins such as alcohol (Holzbach et af., 1962) or analgesic drugs (Azen and Schilling, 1963;Fordham and Huffines, 1967;Duggan, 1970) are known to increase spleen size. the area of the frontal splenic projection, is readily estimated planimetrically or by point grid counting (von Behrens.…”

Section: Radiological and Radionuclide Studiesmentioning

confidence: 99%

Assessment Of Spleen Size In Vivo

Behrens

1973

Australas Radiol

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“…Methaemoglobinaemia and sulphaemoglobinaemia have become uncommon in recent years with the withdrawal of phenacetin from analgesic mixtures. Splenomegaly has been reported in about 10% of patients (Fordham & Huffines, 1967).…”

Section: Clinical Aspectsmentioning

confidence: 99%

Clinical and pathological aspects of analgesic nephropathy.

Rs¹

1980

Brit J Clinical Pharma

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1 Analgesic nephropathy is part of the analgesic syndrome which has gastrointestinal, haematological, cardiovascular, psychological and psychiatric, and pregnancy and gonadal manifestations; premature ageing may also be a feature. 2 Analgesic nephropathy is a form of renal disease characterized by renal papillary necrosis, secondary chronic interstitial nephritis and renal failure with features of predominant tubulointerstitial dysfunction. 3 The percentage of patients with analgesic nephropathy who present with terminal renal failure is 12%. With appropriate management, 17% of analgesic nephropathy patients improve, 50% remain stable and 23% deteriorate. The 6 year cumulative survival is 70%. The major factors influencing deterioration are malignant hypertension, persistent proteinuria and small initial renal size. 4 The risk of renal papillary carcinoma in patients who regularly take analgesics is 8 per 100,000 patients per year. 5 Renal papillary necrosis is a consequence of the chronic toxicity of all non‐steroidal anti‐inflammatory drugs and results from medullary ischaemia secondary to suppression of prostaglandin E2 synthesis and from direct cellular toxicity. 6 Analgesic nephropathy is a preventable form of renal disease and renal failure. It can be prevented by limiting the abuse potential of analgesics rather than by making minor modifications in the composition of analgesic mixtures.

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“…Repeated studies by responsible observers (10, 15–18) can regularly reproduce the following in animals and man given high or prolonged dosages of phenacetin or its metabolite, acetyl‐paraminophenol: Methemoglobinemia. Chronic anemia. Renal medullary anoxia with eventual necrosis. Decreased erythrocyte survival. Splenomegaly. Abnormal serum electrophoretic pattern. …”

Section: Pathophysiology and Pathologymentioning

confidence: 99%

The Phenacetin Enigma

Pribe

1970

J American Geriatrics Society

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The unregulated sale of phenacetin-containing anodynes frequently has led to abuse of this drug by consumers. The demonstration of renal papillary necrosis in persons who habitually use excessive amounts (3.5 kg or more as the enmulative lifetime dose) has been corroborated in extensive animal studies. It is not known whether phenacetin itself or one of its metabolites causes the damage. The mechanism of damage is probably inhibition of cellular enzymes and direct anoxia induced by interference with hemoglobin metabolism. The clinical diagnosis is difficult, but is aided by alertness for a history of phenacetin ingestion, even in the remote past. Further study can be expected to demonstrate an association between phenacetin ingestion and several renal disease processes of obscure etiology.

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Splenomegaly, Analgesic Ingestion and Renal Disease

Cited by 12 publications

References 3 publications

Assessment Of Spleen Size In Vivo

Assessment Of Spleen Size In Vivo

Clinical and pathological aspects of analgesic nephropathy.

The Phenacetin Enigma

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