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Severe Systemic Reactions Following Administration of Different Ureotonic Drugs
618
METABOLISM, ENDOCRINOLOGY AND IMMUNOLOGY
gonorrhea it is believed to be rare to date. All children with gonorrhea should be suspected of being victims of sexual abuse until proved otherwise. While gonorrhea vaginitis or urethritis usually is symptomatic, gonorrhea infections of the pharynx and rectum are almost always asymptomatic. Since syphilis infections in children usually are asymptomatic a serologic test for syphilis should be a routine part of the diagnostic studies of sexually abused children. The authors note that the number of cases of alleged sexual abuse in children is increasing. A complete history may be difficult to obtain from young children and physical examination may not always substantiate the history, especially in cases of molestation without vaginal penetration. Physicians who examine children for sexual abuse should obtain appropriate microbiologic studies for sexually transmitted diseases. This is a potential means of documenting sexual abuse. Gonorrhea was found to be the most common sexually transmitted disease in prepubertal children. It is recommended that routine cultures for gonorrhea from the mouth, genitals and anus be a standard part of the investigation of potential sexual abuse in children. P. M. H. 5 tables, 25 references
In an editorial the author comments on the recent publicity given to the nephrotoxic effects and hazards of intravenous contrast medium, particularly in patients with reduced renal function. However, the author notes that an equally grave hazard may lie in the failure to diagnose properly obstructive uropathy because of fear of using intravenous contrast material. In the United States this conservative attitude is justified partly because of the ready availability of sophisticated alternative diagnostic modalities but even these do not provide adequate diagnostic information on some occasions, and in many areas of the world these alternatives do not exist at all. Thus, the need for contrast studies still exists but care should be taken to minimize potential problems by careful hydration of the patient as well as other precautions that might be dictated by the clinical status. T. D. A. 9 references
The Usefulness of Percutaneous Fine-Needle Aspiration Biopsy in Infants and Children
A.
R. T.
SCHALLER, JR., J. KIVIAT, Departments
F. SCHALLER, C. BUSCHMANN AND N. of Surgery and Pathology, Children's Orthopedic Hospital and Medical Center, and the University of Washington School of Medicine, Seattle, Washington
J. Ped. Surg., 18: 398-405 (Aug.) 1983 The authors report their 2-year experience with percutaneous fine needle aspiration biopsy in 32 infants and children. Patient age ranged from 1 week to 15 years, with a mean of 6.3 years. A 22 gauge spinal needle was used to aspirate the lesions. Aspiration of superficial lesions was guided by palpation. Aspiration of visceral lesions was guided by ultrasound, fluoroscopy or computerized tomography (CT). Of the 32 patients 19 had malignant disease (neuroblastoma, lymphoma and rhabdomyosarcoma were the most common types). In 4 patients the appearance of metastatic or recurrent malignancy was confirmed without the need for open biopsy. There were no false negative or false positive needle aspirations and no complications related directly to the procedure. G. W. K. 11 figures, 1 table, 25 references
Editorial comment. This technique seems to have come of age. There are almost no reports of tumor seeding the needle tract in children in whom malignancies are biopsied in this manner. Since the needle can be directed with the help of ultrasound, fluoroscopy or CT scan, diagnostic accuracy is high. However, obviously any needle biopsy may not be reprepresentative of the tumor so negative biopsies are best regarded as inconclusive. L. R. K.
RADIOLOGY, NUCLEAR MEDICINE AND SONOGRAPHY Renal Failure After Contrast Radiography M. S. KNAPP, Queen's Medical Centre, Nottingham, England
Brit. Med. J., 287: 3-4 (July 2) 1983
METABOLISM, ENDOCRINOLOGY AND IMMUNOLOGY Metabolic Alkalosis Following Relief of Urinary Tract Obstruction SPITAL AND E. W. CHIDECKEL, Section of Nephrology, Rochester General Hospital, and the University of Rochester School of Medicine, Rochester, New York, and Section of Metabolism, West Virginia University, Morgantown, West Virginia
N. Y. State J. Med., 83: 1058-1060 (July, Aug., Sept.) 1983 A 76-year-old man with long-standing chronic obstructive pulmonary disease was hospitalized in urinary retention and renal failure secondary to benign prostatic hypertrophy. A urethral Foley catheter was placed and 131. urine were obtained during the first 24 hours. In this setting severe metabolic alkalosis developed. There was no nasogastric suction or vomiting, diuretics were not administered and the patient was not given any source of alkali. The authors believe that this is the first reported case of metabolic alkalosis developing after relief of urinary tract obstruction. They suggest that a variety of acid-based disturbances may occur in patients undergoing post-obstructive diuresis, particularly if underlying chronic obstructive pulmonary disease is present. D. K. M. 1 table, 16 references
Severe Systemic Reactions Following Administration of Different Ureotonic Drugs
J. L. MITCHELL AND G. F. MARX, Departments of Anesthesiology, and Gynecology and Obstetrics, Albert Einstein College of Medicine, Bronx, New York
S. COHEN,
N. Y. State J. Med., 83: 1060-1061 (July, Aug., Sept.) 1983 After cesarean section, an 18-year-old woman was given oxytocin, methylergonovine and prostaglandin F2-a to stop uterine bleeding. The patient experienced vomiting, diaphoresis, hypertension and bronchoconstriction but recovered promptly with treatment. The authors emphasize that all 3 of these drugs may cause hypertension and this has resulted in cerebrovascular accidents in other cases. They recommend that uterine fundal massage should precede administration of a second or third uterotonic drug. D. K. M. 7 references
METABOLISM, ENDOCRINOLOGY AND IMMUNOLOGY
gonorrhea it is believed to be rare to date. All children with gonorrhea should be suspected of being victims of sexual abuse until proved otherwise. While gonorrhea vaginitis or urethritis usually is symptomatic, gonorrhea infections of the pharynx and rectum are almost always asymptomatic. Since syphilis infections in children usually are asymptomatic a serologic test for syphilis should be a routine part of the diagnostic studies of sexually abused children. The authors note that the number of cases of alleged sexual abuse in children is increasing. A complete history may be difficult to obtain from young children and physical examination may not always substantiate the history, especially in cases of molestation without vaginal penetration. Physicians who examine children for sexual abuse should obtain appropriate microbiologic studies for sexually transmitted diseases. This is a potential means of documenting sexual abuse. Gonorrhea was found to be the most common sexually transmitted disease in prepubertal children. It is recommended that routine cultures for gonorrhea from the mouth, genitals and anus be a standard part of the investigation of potential sexual abuse in children. P. M. H. 5 tables, 25 references
In an editorial the author comments on the recent publicity given to the nephrotoxic effects and hazards of intravenous contrast medium, particularly in patients with reduced renal function. However, the author notes that an equally grave hazard may lie in the failure to diagnose properly obstructive uropathy because of fear of using intravenous contrast material. In the United States this conservative attitude is justified partly because of the ready availability of sophisticated alternative diagnostic modalities but even these do not provide adequate diagnostic information on some occasions, and in many areas of the world these alternatives do not exist at all. Thus, the need for contrast studies still exists but care should be taken to minimize potential problems by careful hydration of the patient as well as other precautions that might be dictated by the clinical status. T. D. A. 9 references
The Usefulness of Percutaneous Fine-Needle Aspiration Biopsy in Infants and Children
A.
R. T.
SCHALLER, JR., J. KIVIAT, Departments
F. SCHALLER, C. BUSCHMANN AND N. of Surgery and Pathology, Children's Orthopedic Hospital and Medical Center, and the University of Washington School of Medicine, Seattle, Washington
J. Ped. Surg., 18: 398-405 (Aug.) 1983 The authors report their 2-year experience with percutaneous fine needle aspiration biopsy in 32 infants and children. Patient age ranged from 1 week to 15 years, with a mean of 6.3 years. A 22 gauge spinal needle was used to aspirate the lesions. Aspiration of superficial lesions was guided by palpation. Aspiration of visceral lesions was guided by ultrasound, fluoroscopy or computerized tomography (CT). Of the 32 patients 19 had malignant disease (neuroblastoma, lymphoma and rhabdomyosarcoma were the most common types). In 4 patients the appearance of metastatic or recurrent malignancy was confirmed without the need for open biopsy. There were no false negative or false positive needle aspirations and no complications related directly to the procedure. G. W. K. 11 figures, 1 table, 25 references
Editorial comment. This technique seems to have come of age. There are almost no reports of tumor seeding the needle tract in children in whom malignancies are biopsied in this manner. Since the needle can be directed with the help of ultrasound, fluoroscopy or CT scan, diagnostic accuracy is high. However, obviously any needle biopsy may not be reprepresentative of the tumor so negative biopsies are best regarded as inconclusive. L. R. K.
RADIOLOGY, NUCLEAR MEDICINE AND SONOGRAPHY Renal Failure After Contrast Radiography M. S. KNAPP, Queen's Medical Centre, Nottingham, England
Brit. Med. J., 287: 3-4 (July 2) 1983
METABOLISM, ENDOCRINOLOGY AND IMMUNOLOGY Metabolic Alkalosis Following Relief of Urinary Tract Obstruction SPITAL AND E. W. CHIDECKEL, Section of Nephrology, Rochester General Hospital, and the University of Rochester School of Medicine, Rochester, New York, and Section of Metabolism, West Virginia University, Morgantown, West Virginia
N. Y. State J. Med., 83: 1058-1060 (July, Aug., Sept.) 1983 A 76-year-old man with long-standing chronic obstructive pulmonary disease was hospitalized in urinary retention and renal failure secondary to benign prostatic hypertrophy. A urethral Foley catheter was placed and 131. urine were obtained during the first 24 hours. In this setting severe metabolic alkalosis developed. There was no nasogastric suction or vomiting, diuretics were not administered and the patient was not given any source of alkali. The authors believe that this is the first reported case of metabolic alkalosis developing after relief of urinary tract obstruction. They suggest that a variety of acid-based disturbances may occur in patients undergoing post-obstructive diuresis, particularly if underlying chronic obstructive pulmonary disease is present. D. K. M. 1 table, 16 references
Severe Systemic Reactions Following Administration of Different Ureotonic Drugs
J. L. MITCHELL AND G. F. MARX, Departments of Anesthesiology, and Gynecology and Obstetrics, Albert Einstein College of Medicine, Bronx, New York
S. COHEN,
N. Y. State J. Med., 83: 1060-1061 (July, Aug., Sept.) 1983 After cesarean section, an 18-year-old woman was given oxytocin, methylergonovine and prostaglandin F2-a to stop uterine bleeding. The patient experienced vomiting, diaphoresis, hypertension and bronchoconstriction but recovered promptly with treatment. The authors emphasize that all 3 of these drugs may cause hypertension and this has resulted in cerebrovascular accidents in other cases. They recommend that uterine fundal massage should precede administration of a second or third uterotonic drug. D. K. M. 7 references