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Drip infusion urography in patients with renal disease
580
ABSTRACTS
mortality rate from 80 to 9.1 per cent.George Holcomb, Jr. ABDOMEN GALLBLADDERDISEASE IN CHILDHOOD.H. N. Bars. Clin. Ped. 9:229 (April), 1970.
Four patients under 15 years of age with gallbladder disease are reported. Two of these patients had associated hematologic diseases.-h&he1 Gilbert THE ROLE OF RADIATION THERAPY IN THE MANAGEMENT OF HEMANGIOMAS OF THE LIVER. W. C. Park and R. Phillips.
JAMA 212: 1496-1498
(June 1), 1970.
Five cases of nonresectable hemangioma of the liver were treated with radiation therapy. Four of the five patients had good results with control of the disease and preservation of normal liver function. One patient was 4 months old. Although 2000 rads delivered in 10 days is recommended in adults, 400 to 600 rads is recommended in infants.-.I. Eugene Lewis, Jr. LIVER TRANSPLANTATION IN MAN. THE SIGNIFICANCE,PATTERNS AND CONTROL OF INFECTION. I. M. Murray-Lyon, D. B. Evans, W. D. Forter, R. J. Holden, H. 0. Rake, H. Stern, R. Y. Caine and R. Williams. Brit. .I. Surg. 57:280-284 (April),
1970. In spite of strict precautions, including barrier nursing, infection is a major problem in all transplant operations including hepatic transplantation mainly due to the use of immunosuppressive drugs. Only one out of nine patients who survived the immediate postoperative period did not develop a serious infection, and six died as a result of it. Pulmonary infection was the most serious problem occurring in all but one case. Staphylococcus aureus was the organism in three cases who were also nasal carriers. Five out of six cases where bile specimens could be obtained had positive cultures with the usual intestinal organisms, and in all five patients these organisms appeared in blood cultures. Not all cases with positive bile or blood cultures were necessarily ill. Cytomegalovirus infection occurred in six patients but in none was there evidence that the virus did any harm.
Prophylactic antibiotics were not used and were thought to encourage resistant organisms and fungal infection. Broad-spectrum antibiotics were used freely even in minor infections and with little success to clear the bile of organisms. This was often followed by superinfection with resistant organisms and fungi. The present policy is to use antibiotics sparingly and to rely on narrow spectrum drugs wherever possible.-./. _L~J+
GENITOURINARY
TRACT
DRIP INFUSION UROGRAPHY IN PATIENTS WITH RENAL DISEASE. R. D. Ensor, E. Anderson and R. R. Robinson. J. Urol.
103:267-271
(March),
1970.
This is a report based on 188 studies performed in 174 patients whose blood urea nitrogen was 40 mg. per 100 ml. or higher, plasma creatinine concentration was 1.5 mg. per 100 ml. or more whose endogenous creatinine clearance was less than 80 ml. per minute per 1.73 sq. meters body surface. Fifty per cent Sodium Diatrizoate (1 ml. per lb. of body weight) was given with an equal volume of 5 per cent Dextrose and water IV rapidly. Films were exposed at 2 minutes after starting the infusion and 2 minutes and 10 minutes after its completion. Occasionally, delayed films were obtained at 24 hours. As there is little tubular reabsorption of Sodium Diatrizoate, its concentration increases allowing visualization by X ray. In patients with diminished renal function, the filtered load of contrast medium is limited due to marked filtration rate reduction. There may also be an endogenous osmotic diuresis and a decrease in the rate of water absorption further minimizing intratubular concentration of the dye. Drip infusion urography allows greater volumes of dye to be used making visualization of the kidney even when its functions are depressed. When the creatinine clearance was more than 10 ml. per minute, the plasma creatinine concentration was less than 8 mg. per 100 ml. or the BUN concentration was less than 80 mg. per 100 ml., 75 per cent of the urograms were satisfactory. There were only a few adverse reactions all of which were transient. In no case was there evidence of adverse effects of the dye on renal functions.-Bruce M. Henderson
ABSTRACTS
mortality rate from 80 to 9.1 per cent.George Holcomb, Jr. ABDOMEN GALLBLADDERDISEASE IN CHILDHOOD.H. N. Bars. Clin. Ped. 9:229 (April), 1970.
Four patients under 15 years of age with gallbladder disease are reported. Two of these patients had associated hematologic diseases.-h&he1 Gilbert THE ROLE OF RADIATION THERAPY IN THE MANAGEMENT OF HEMANGIOMAS OF THE LIVER. W. C. Park and R. Phillips.
JAMA 212: 1496-1498
(June 1), 1970.
Five cases of nonresectable hemangioma of the liver were treated with radiation therapy. Four of the five patients had good results with control of the disease and preservation of normal liver function. One patient was 4 months old. Although 2000 rads delivered in 10 days is recommended in adults, 400 to 600 rads is recommended in infants.-.I. Eugene Lewis, Jr. LIVER TRANSPLANTATION IN MAN. THE SIGNIFICANCE,PATTERNS AND CONTROL OF INFECTION. I. M. Murray-Lyon, D. B. Evans, W. D. Forter, R. J. Holden, H. 0. Rake, H. Stern, R. Y. Caine and R. Williams. Brit. .I. Surg. 57:280-284 (April),
1970. In spite of strict precautions, including barrier nursing, infection is a major problem in all transplant operations including hepatic transplantation mainly due to the use of immunosuppressive drugs. Only one out of nine patients who survived the immediate postoperative period did not develop a serious infection, and six died as a result of it. Pulmonary infection was the most serious problem occurring in all but one case. Staphylococcus aureus was the organism in three cases who were also nasal carriers. Five out of six cases where bile specimens could be obtained had positive cultures with the usual intestinal organisms, and in all five patients these organisms appeared in blood cultures. Not all cases with positive bile or blood cultures were necessarily ill. Cytomegalovirus infection occurred in six patients but in none was there evidence that the virus did any harm.
Prophylactic antibiotics were not used and were thought to encourage resistant organisms and fungal infection. Broad-spectrum antibiotics were used freely even in minor infections and with little success to clear the bile of organisms. This was often followed by superinfection with resistant organisms and fungi. The present policy is to use antibiotics sparingly and to rely on narrow spectrum drugs wherever possible.-./. _L~J+
GENITOURINARY
TRACT
DRIP INFUSION UROGRAPHY IN PATIENTS WITH RENAL DISEASE. R. D. Ensor, E. Anderson and R. R. Robinson. J. Urol.
103:267-271
(March),
1970.
This is a report based on 188 studies performed in 174 patients whose blood urea nitrogen was 40 mg. per 100 ml. or higher, plasma creatinine concentration was 1.5 mg. per 100 ml. or more whose endogenous creatinine clearance was less than 80 ml. per minute per 1.73 sq. meters body surface. Fifty per cent Sodium Diatrizoate (1 ml. per lb. of body weight) was given with an equal volume of 5 per cent Dextrose and water IV rapidly. Films were exposed at 2 minutes after starting the infusion and 2 minutes and 10 minutes after its completion. Occasionally, delayed films were obtained at 24 hours. As there is little tubular reabsorption of Sodium Diatrizoate, its concentration increases allowing visualization by X ray. In patients with diminished renal function, the filtered load of contrast medium is limited due to marked filtration rate reduction. There may also be an endogenous osmotic diuresis and a decrease in the rate of water absorption further minimizing intratubular concentration of the dye. Drip infusion urography allows greater volumes of dye to be used making visualization of the kidney even when its functions are depressed. When the creatinine clearance was more than 10 ml. per minute, the plasma creatinine concentration was less than 8 mg. per 100 ml. or the BUN concentration was less than 80 mg. per 100 ml., 75 per cent of the urograms were satisfactory. There were only a few adverse reactions all of which were transient. In no case was there evidence of adverse effects of the dye on renal functions.-Bruce M. Henderson