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Residual dilatation of the upper urinary tract following pregnancy
Volume 58 Number 6
SELECTED
ABSTRACTS
1227
Puerperium Nor&h, R. E.: Practitioner
Residual Dilatation 161: 47, 1948.
of the Upper
Urinary
Tract
Following
Pregnancy,
It has long been recognized that there are changes in the form of the renal pelvis and ureter during pregnancy, although the cause of these changes is still a matter of discussion. These changes are associated with urinary stasis and predisposition to infection, as shown by the frequent occurrence of pyelitis in pregnancy. In uncomplicated cases return to normal form and tonus of the ureter and bladder occurs about the sixth wwlc after delivery. This may be delayed by the presence of infection, and there may be some degree of residual dilatation. This residual dilatation may be maintained by subsequent pregnancies until the ureter becomes stiffened by fibrosis and the pelvis atonic, a condition that may persist after the childbearing period. Four illustrative cases are presented (with pyelograms). In the first case, the ureters and renal pelvis returned to normal by the eighth week after delivery. In the second case only the right ureter was dilated during pregnancy and there was no infection; the condition cleared up completely. In lhe third case the patient was 52 years of age; she had had six children; pyelitis had occurred in her first pregnancy and recurred in each subsequent pregnancy. For many years after her last pregnancy she continued to have backache, dysuria, and increased frequency; and examination showed a coliform urinary infection. Intravenous pyelograph) showed the right ureter and pelvis dilated, with kinking and twisting of the ureter, as is often found in pregnancy. In the fourth case the patient had had two pregnancies, with the urinary infection during the first pregnancy, which had persisted intermittently. During an exacerbation of symptoms, intravenous pyelography showed the right renal pelvis and ureter to be much dilated. When she became pregnant again a few months later, pyelograms showed dilatation of the ureter and pelvis on both sides. Four months after delivery the left ureter and pelvis were normal, but dilatation persisted on the right side and urinary infection was still present. HARVEY B.MATTHEWS. Boy&
David .A., Jr., and Brown, De Witt W.: Electric Convulsive Therapy Disorders Associated With Childbearing, J. Missouri M. A. 45: 573, 1945.
in Mental
Most mental diserders associated with childbearing occur after delivery and are characterized by manic-depressive and schizophrenic reactions. Experience with electroshock in major psychoses (nonpuerperal) indicate that it is most effective in cases with a strong depressive trend, less effective in manic patients, and least beneficial in schizophrenia. A review of the cases reported in literature of puerperal psychoses treated with electroshock, and the authors’ own experience indicate that the same is true in the puerperal psychoses. The fact that electroshock has proved effective in a large percentage of cases of puerperal psychosis may be attributed to the fact that many of these psychoses show a strong depressive trend. While some therapists consider that ‘electroshock treatment should not be given during the first month after delivery, other therapists have found that the prompt use of electroshock therapy is markedly effective and shortens the duration of the illness. In the authors’ cases of postpartum psychosis, psychiatric indications for electroshock therapy have been the deciding factors as to whether it is to be used and when it is to be given. As soon as routine psychiatric and physical examinations have been completed, and electroshock has been found to be definitely indicated, this treatment is begun. In the authors’ cases, therapy was instituted on the twenty-second, twentyfourth, and fourteenth days after delivery, respectively. Two cases of puerperal psychosis are reported in which good results were obtained. Manic-depressive and schizophrenic psychosis occurring during pregnancy are dangerous to both the mother and the child; delay of treatment of the psychosis until after the termination of the pregnancy may render the psychosis irreversible. Electroshock
SELECTED
ABSTRACTS
1227
Puerperium Nor&h, R. E.: Practitioner
Residual Dilatation 161: 47, 1948.
of the Upper
Urinary
Tract
Following
Pregnancy,
It has long been recognized that there are changes in the form of the renal pelvis and ureter during pregnancy, although the cause of these changes is still a matter of discussion. These changes are associated with urinary stasis and predisposition to infection, as shown by the frequent occurrence of pyelitis in pregnancy. In uncomplicated cases return to normal form and tonus of the ureter and bladder occurs about the sixth wwlc after delivery. This may be delayed by the presence of infection, and there may be some degree of residual dilatation. This residual dilatation may be maintained by subsequent pregnancies until the ureter becomes stiffened by fibrosis and the pelvis atonic, a condition that may persist after the childbearing period. Four illustrative cases are presented (with pyelograms). In the first case, the ureters and renal pelvis returned to normal by the eighth week after delivery. In the second case only the right ureter was dilated during pregnancy and there was no infection; the condition cleared up completely. In lhe third case the patient was 52 years of age; she had had six children; pyelitis had occurred in her first pregnancy and recurred in each subsequent pregnancy. For many years after her last pregnancy she continued to have backache, dysuria, and increased frequency; and examination showed a coliform urinary infection. Intravenous pyelograph) showed the right ureter and pelvis dilated, with kinking and twisting of the ureter, as is often found in pregnancy. In the fourth case the patient had had two pregnancies, with the urinary infection during the first pregnancy, which had persisted intermittently. During an exacerbation of symptoms, intravenous pyelography showed the right renal pelvis and ureter to be much dilated. When she became pregnant again a few months later, pyelograms showed dilatation of the ureter and pelvis on both sides. Four months after delivery the left ureter and pelvis were normal, but dilatation persisted on the right side and urinary infection was still present. HARVEY B.MATTHEWS. Boy&
David .A., Jr., and Brown, De Witt W.: Electric Convulsive Therapy Disorders Associated With Childbearing, J. Missouri M. A. 45: 573, 1945.
in Mental
Most mental diserders associated with childbearing occur after delivery and are characterized by manic-depressive and schizophrenic reactions. Experience with electroshock in major psychoses (nonpuerperal) indicate that it is most effective in cases with a strong depressive trend, less effective in manic patients, and least beneficial in schizophrenia. A review of the cases reported in literature of puerperal psychoses treated with electroshock, and the authors’ own experience indicate that the same is true in the puerperal psychoses. The fact that electroshock has proved effective in a large percentage of cases of puerperal psychosis may be attributed to the fact that many of these psychoses show a strong depressive trend. While some therapists consider that ‘electroshock treatment should not be given during the first month after delivery, other therapists have found that the prompt use of electroshock therapy is markedly effective and shortens the duration of the illness. In the authors’ cases of postpartum psychosis, psychiatric indications for electroshock therapy have been the deciding factors as to whether it is to be used and when it is to be given. As soon as routine psychiatric and physical examinations have been completed, and electroshock has been found to be definitely indicated, this treatment is begun. In the authors’ cases, therapy was instituted on the twenty-second, twentyfourth, and fourteenth days after delivery, respectively. Two cases of puerperal psychosis are reported in which good results were obtained. Manic-depressive and schizophrenic psychosis occurring during pregnancy are dangerous to both the mother and the child; delay of treatment of the psychosis until after the termination of the pregnancy may render the psychosis irreversible. Electroshock