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Suprapubic bladder puncture in furosemide diuresis
698
Letters to the Editor
REFERENCE
1. Pieroni, D. R., Park, S. C., Holbrook, P. R., and Houghton, P. B.: Echocardiographic diagnosis of septic pericarditis in infancy, J. PEDIATR. 82: 689, 1973.
Reply To the Editor: The only valid area representing blood in Fig. 1 (p. 690) of our paper that should be compared to the purulent effusion is just anterior to the mitral valve. If one compares this area to the posterior pericardial space it is self-evident that there are far more echoes emanating from the effusion than from the blood. The region posterior to the mitral valve is largely filled with echoes from the posterior left ventricular wall and mitral apparatus. Furthermore, one can hardly talk about blood within the right ventricular cavity since, as is often the case, the heavy trabeculations scatter echoes within this normally flattened chamber, thereby sonically obliterating the right ventricular space. Last, the statement concerning sensitivity and gain assumes that the major structures of the heart can still be identified. With specific reference to the echoes on the left in Fig. 1, the gain and sensitivity had already been turned to the m i n i m u m to include all necessary structures. Upon further reduction in gain, as is illustrated to the right of Fig. 1, the left ventricular wall echoes were eliminated. Therefore, one would not expect to see reflections from particulate matter within the effusion. Nonetheless , one is obligated to further reduce these settings in order to establish the diagnosis of any type of effusion.
Daniel R. Pieroni, M.D. The Johns Hopkins Hospital Baltimore, Md. 21205
Suprapubic bladder puncture in furosemide diuresi~ To the Editor: In the September, 1972, issue of the JOIJRZ~AL, Simon and Berdon 1 advise that, "It is
The ]ournal of Pediatrics October 1973
also wise to perform the suprapubic catheterization in a patient with a urine-filled bladder to to insure intravesical placement." This condition is usually achieved by producing water diuresis in the patient who has been given some fluid before the puncture, z, ~ In our experience the proper filling of the bladder was easily ensured by the use of diuretics. Furosemide (Lasix or Furantral) in a single dose of 1 mg. per kilogram of body weight intravenously or intramuscularly produces a urinefilled bladder suitable for bladder puncture in about 15 to 30 minutes, even in children under one year of age. Bladder puncture for bacteriologic examination, suprapubic catheterization, or micturition cystourethrography can be performed by this method without difficulty. If the urine obtained in this manner is to be used for bacteriologic culture, the dilution step must be omitted because of the effect of the furosemide upon urine flow. The waiting time for performing micturition cystourethrography is also considerahly shortened. Among our 20 patients, complications were not observed if the recommended dosage of furosemide was given to induce a short, intense diuretic period. Serum electrolytes and acid-base balance remained unchanged for 15 minutes to 6 hours. Sodium, potassium, calcium, magnesium, phosphate, and creatinine excretion was increased.
I. Marosvdri .4. G6rgdnyi Department o[ Pediatrics No. II Semmelweis University Medical School Budapest, Hungary REFERENCES
1. Simon, G., and Berdon, W. E.: Suprapubic bladder puncture for voiding cystourethrography, J. PEDIATR. 81: 555, 1972. 2. Abbot, G. D., and Shannon, F. T.: How to aspirate urine suprapubically in infants and children, Clin. Pediatr. 9: 277, 1970. 3. Wiebel, J. K., et al.: Suprapubische, perkutane Blasenpunktion bei Kindern mlt Harnwegsinkeft, Deutsch. Med. Wochenschr. 97: 1049, 1972.
Letters to the Editor
REFERENCE
1. Pieroni, D. R., Park, S. C., Holbrook, P. R., and Houghton, P. B.: Echocardiographic diagnosis of septic pericarditis in infancy, J. PEDIATR. 82: 689, 1973.
Reply To the Editor: The only valid area representing blood in Fig. 1 (p. 690) of our paper that should be compared to the purulent effusion is just anterior to the mitral valve. If one compares this area to the posterior pericardial space it is self-evident that there are far more echoes emanating from the effusion than from the blood. The region posterior to the mitral valve is largely filled with echoes from the posterior left ventricular wall and mitral apparatus. Furthermore, one can hardly talk about blood within the right ventricular cavity since, as is often the case, the heavy trabeculations scatter echoes within this normally flattened chamber, thereby sonically obliterating the right ventricular space. Last, the statement concerning sensitivity and gain assumes that the major structures of the heart can still be identified. With specific reference to the echoes on the left in Fig. 1, the gain and sensitivity had already been turned to the m i n i m u m to include all necessary structures. Upon further reduction in gain, as is illustrated to the right of Fig. 1, the left ventricular wall echoes were eliminated. Therefore, one would not expect to see reflections from particulate matter within the effusion. Nonetheless , one is obligated to further reduce these settings in order to establish the diagnosis of any type of effusion.
Daniel R. Pieroni, M.D. The Johns Hopkins Hospital Baltimore, Md. 21205
Suprapubic bladder puncture in furosemide diuresi~ To the Editor: In the September, 1972, issue of the JOIJRZ~AL, Simon and Berdon 1 advise that, "It is
The ]ournal of Pediatrics October 1973
also wise to perform the suprapubic catheterization in a patient with a urine-filled bladder to to insure intravesical placement." This condition is usually achieved by producing water diuresis in the patient who has been given some fluid before the puncture, z, ~ In our experience the proper filling of the bladder was easily ensured by the use of diuretics. Furosemide (Lasix or Furantral) in a single dose of 1 mg. per kilogram of body weight intravenously or intramuscularly produces a urinefilled bladder suitable for bladder puncture in about 15 to 30 minutes, even in children under one year of age. Bladder puncture for bacteriologic examination, suprapubic catheterization, or micturition cystourethrography can be performed by this method without difficulty. If the urine obtained in this manner is to be used for bacteriologic culture, the dilution step must be omitted because of the effect of the furosemide upon urine flow. The waiting time for performing micturition cystourethrography is also considerahly shortened. Among our 20 patients, complications were not observed if the recommended dosage of furosemide was given to induce a short, intense diuretic period. Serum electrolytes and acid-base balance remained unchanged for 15 minutes to 6 hours. Sodium, potassium, calcium, magnesium, phosphate, and creatinine excretion was increased.
I. Marosvdri .4. G6rgdnyi Department o[ Pediatrics No. II Semmelweis University Medical School Budapest, Hungary REFERENCES
1. Simon, G., and Berdon, W. E.: Suprapubic bladder puncture for voiding cystourethrography, J. PEDIATR. 81: 555, 1972. 2. Abbot, G. D., and Shannon, F. T.: How to aspirate urine suprapubically in infants and children, Clin. Pediatr. 9: 277, 1970. 3. Wiebel, J. K., et al.: Suprapubische, perkutane Blasenpunktion bei Kindern mlt Harnwegsinkeft, Deutsch. Med. Wochenschr. 97: 1049, 1972.