Renal failure after cholangiography.

Abstract

Pregnancy in Young Primigravidae-Utian MEDBRITJISOURNA of pre-eclampsia. Only prompt and active treatment prevented a higher incidence of eclampsia. The single case of eclampsia occurred in a 16-year-old unbooked patient who presented at term with a blood pressure of 200/150 mm. Hg, no significant increase in weight, and no albumin in the urine. It became apparent in the management of these young patients that proteinuria was not a constant feature and its absence should not lull one into a false sense of complacency. Increase in Prematurity Rate.-It has been shown in this study that young primigravidae have an increased tendency to begin spontaneous labour before term. These findings are in marked contrast to those of Clough (1958), who reported on 175 young primigravidae and stated that these patients went beyond the expected date of confinement more often than older primigravidae. Both Bochner (1962) and Stearn (1963) found that the birth weights were much the same as in the control groups. Of more significance was the finding of a corrected prematurity rate of 7% in young primigravidae and of 2% in the controls. Of nine studies included in Table II, a prematurity rate of 10% or greater is demonstrated in five (Aznar and Bennett, 1961 ; Bochner, 1962;Hassan and Falls, 1964;Jarvinen and Katila, 1959;Poliakoff, 1958). This prematurity rate is to some extent reflected in a higher perinatal mortality rate in the younger patients.Increased Frequency of Prolonged Labour.-There is no uniformity of opinion on what constitutes prolonged labour. In the reported studies on young primigravidae the upper limit for labour varies from 24 hours (Poliakoff, 1958 ;Aznar and Bennett, 1961) to 48 hours (Sinclair, 1952). The reported average duration for normal labour varies from 9 hours and 42 minutes to 16 hours and 32 minutes (Clough, 1958 ; Hassan and Falls, 1954 experienced. In the present study the definite tendency to conservatism in view of the high illegitimacy rate probably accounted to a certain extent for the increased incidence of prolonged labour. ConclusionsPregnant adolescents demonstrate an increased tendency to at least two major complications in pregnancy-namely, toxaemia of pregnancy and prematurity-which should be avoided by more adequate antenatal care; these patients should therefore be seen at least weekly after the 32nd week.From the standpoint of pure physical ability the young primigravida does very well-in many respects better than the slightly older patient. A high incidence of spontaneous vaginal delivery can be expected and operative intervention thereby avoided. SummaryA series of 100 consecutive white primigravid patients aged 13 to 16 years was analysed and compared with a control group of 100 consecutive white 22-year-old primigravid patients.In the former there was a high incidence of hypertension and toxaemia. The prematurity rate was higher than in the control group, as was the perinatal mortality. There was also a greater incidence of prolonged labour. Though the foetal head was not engag...

Contrast media and the kidney.

“…The toxity of those given by mouth is well documented,2-4 though the agent principally to blame-bunamiodyl-has been withdrawn. Even a widely used oral medium such as iopanoic acid can occasionally cause mild renal damage when given in standard dosage,4 and the likelihood of renal injury increases with double dosage.5 Though less often encountered, renal failure due to intravenous cholangiography has also been reported.1 6 Whichever type of medium is given, renal injury is more likely if the patient is jaundiced, since impairment of hepatic elimination of contrast medium leads to increased excretion by the kidneys. A similar effect has been observed when iodipamide is given shortly after oral cholecystography.7 The oral medium may partly block the excretion of the iodipamide, and this too would increase the chances of renal injury.…”

Intravenous cholangiography in the CT era

“…However, problems inherent in the technique, including a signifcant incidence of adverse reactions to the contrast material (up to 4-10%) [1][2][3] and poor opacification of the biliary system, particularly when biliary disease is present, have largely precluded its use. Alternative methods of imaging the hepatobiliary system currently utilized include ultrasound (US), computed tomography (CT), percutaneous transhepatic cholangiography (PTC), and endoscopic retrograde cholangiopancreatography (ERCP).…”