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Sudden death after intravenous injection of a mercurial diuretic (“Neptal”)
SELECTED
Blumenthal, 44r372
L. (Oct.),
S.: Pathologic 1947.
843
ABSTRACTS
Significance
of
the
Ductus
Arteriosus.
Arch.
Path.
The author studied histologically the degenerative changes that precede the closure of the ductus arteriosus, from the special viewpoint of its correlation with arteriosclerosis in general pathology. Sections were from a series of 175 specimens obtained from fetuses and from persons of various ages. Various stains were employed to bring out changes in the elastic, muscular, and connective tissues. Sections from fetuses and from normal infants up to the age of twelve days showed little difference except that the media in the latter was more cellular, the lumen reduced in diameter, and the general appearance of a more active and contracting media, therefore, was presented. Degenerative changes made their first appearance in infants ranging from twelve days to two months of age. There seemed to be an ischemic appearance of the wall, fibrosis made its first appearance in the media, and the lumen of the ductus was compressed to a slit. Gradually the muscle cells had become paler, and fibrous tissue had infiltrated into the media. Elastic tissue increased, while smooth muscle tissue decreased. Actual necrosis was rare in very young infants, but gradually increased, together with calcium deposition, in infants ranging up to one year of age. The narrowed lumen continued to contain many red blood cells, and in some cases an attempt at recanalization was apparent. Fibrosis gradually increased. At the age of outer part of the persistent capillary The internal elastic of elastosis appeared the scarred remnants
one year or over, fibrosis was marked; it had replaced smooth muscle in the media. Small clusters of smooth muscle cells remained, in conjunction with processes. When the latter disappeared, iachemic fibrosis became dominant. lamina remained intact, even in the older specimens, and a degenerative type In elderly people, cartilage developed at times in with advancing years. of the ductus arteriosus.
A comparison of the muscular structure of the ductus in the fetal and in the postnatal states indicates that it is an active muscular structure, confirming physiologic studies showing active contraction to be present as a part of its function. But as early as twelve days after birth, and continuing thereafter, there is a progressive loss of muscular structure. The author works on the premise that the ischemic degeneration here observed, and noted in other organs after cessation of function (uterine arteries in the puerperium), is similar to the fundamental changes in arteriosclerosis throughout the body; all are dependent on anoxemia.
GOULEY. Oettle,
A. G.: (“Neptal”).
Sudden Death After Intravenous Brit. M. J. 530 (Oct. 4), 1947.
Injection
of
a Mercurial
Diuretic
The author presents the case of a patient, 31 years of age, who wasadmitted to the hospital complaining of swelling of the legs, reduction ip urinary output, dull backache, and dimness of vision. She had suffered from frequent sore throats for many years and four and one-half years prior to admission had had rheumatoid arthritis which responded poorly to treatment with gold injections. The patient was confined to bed and given a diet high in protein and low in salt, with iron tonics. On the fifth day after admission a mercurial diuretic (Neptal) was injected intramusBecause cularly. Within thirty-two days she received a total of 24.5 ml. of this preparation. the intramuscular injecrions were painful, the inrravenous route was adopted. After the fourth intravenous injection, she complained of giddiness and became pale for a few seconds shortly after the needle had been withdrawn. The next day she complained of a sore throat and generalized joint pains. Two days later 2.0 ml. of Neptal was injected into the right median antecubital vein. Immediately on withdrawal of the needle the patient turned pale and became unconscious. Cyanosis rapidly supervened and the breathing, which became gasping, ceased about two minutes after the onset of the attack. On clinical grounds, the authors believe that the injection of Nepal brought about a sudden cessation of the heart beat, presumably by ventricular fibrillation.
BELLET.
Blumenthal, 44r372
L. (Oct.),
S.: Pathologic 1947.
843
ABSTRACTS
Significance
of
the
Ductus
Arteriosus.
Arch.
Path.
The author studied histologically the degenerative changes that precede the closure of the ductus arteriosus, from the special viewpoint of its correlation with arteriosclerosis in general pathology. Sections were from a series of 175 specimens obtained from fetuses and from persons of various ages. Various stains were employed to bring out changes in the elastic, muscular, and connective tissues. Sections from fetuses and from normal infants up to the age of twelve days showed little difference except that the media in the latter was more cellular, the lumen reduced in diameter, and the general appearance of a more active and contracting media, therefore, was presented. Degenerative changes made their first appearance in infants ranging from twelve days to two months of age. There seemed to be an ischemic appearance of the wall, fibrosis made its first appearance in the media, and the lumen of the ductus was compressed to a slit. Gradually the muscle cells had become paler, and fibrous tissue had infiltrated into the media. Elastic tissue increased, while smooth muscle tissue decreased. Actual necrosis was rare in very young infants, but gradually increased, together with calcium deposition, in infants ranging up to one year of age. The narrowed lumen continued to contain many red blood cells, and in some cases an attempt at recanalization was apparent. Fibrosis gradually increased. At the age of outer part of the persistent capillary The internal elastic of elastosis appeared the scarred remnants
one year or over, fibrosis was marked; it had replaced smooth muscle in the media. Small clusters of smooth muscle cells remained, in conjunction with processes. When the latter disappeared, iachemic fibrosis became dominant. lamina remained intact, even in the older specimens, and a degenerative type In elderly people, cartilage developed at times in with advancing years. of the ductus arteriosus.
A comparison of the muscular structure of the ductus in the fetal and in the postnatal states indicates that it is an active muscular structure, confirming physiologic studies showing active contraction to be present as a part of its function. But as early as twelve days after birth, and continuing thereafter, there is a progressive loss of muscular structure. The author works on the premise that the ischemic degeneration here observed, and noted in other organs after cessation of function (uterine arteries in the puerperium), is similar to the fundamental changes in arteriosclerosis throughout the body; all are dependent on anoxemia.
GOULEY. Oettle,
A. G.: (“Neptal”).
Sudden Death After Intravenous Brit. M. J. 530 (Oct. 4), 1947.
Injection
of
a Mercurial
Diuretic
The author presents the case of a patient, 31 years of age, who wasadmitted to the hospital complaining of swelling of the legs, reduction ip urinary output, dull backache, and dimness of vision. She had suffered from frequent sore throats for many years and four and one-half years prior to admission had had rheumatoid arthritis which responded poorly to treatment with gold injections. The patient was confined to bed and given a diet high in protein and low in salt, with iron tonics. On the fifth day after admission a mercurial diuretic (Neptal) was injected intramusBecause cularly. Within thirty-two days she received a total of 24.5 ml. of this preparation. the intramuscular injecrions were painful, the inrravenous route was adopted. After the fourth intravenous injection, she complained of giddiness and became pale for a few seconds shortly after the needle had been withdrawn. The next day she complained of a sore throat and generalized joint pains. Two days later 2.0 ml. of Neptal was injected into the right median antecubital vein. Immediately on withdrawal of the needle the patient turned pale and became unconscious. Cyanosis rapidly supervened and the breathing, which became gasping, ceased about two minutes after the onset of the attack. On clinical grounds, the authors believe that the injection of Nepal brought about a sudden cessation of the heart beat, presumably by ventricular fibrillation.
BELLET.