Reports Of Serious Complications Research Articles

Jaundice associated with amitriptyline.

Reports of serious complications arising from the administration of amitriptyline have been very few, particularly when account is taken of the widespread prescription of this drug in recent years for depressive illness. This is a report of three cases of jaundice, one mild, one fatal, and the third severe, but leading to a good recovery, occurring following the administration of amitriptyline, though in two cases other drugs were being given concurrendy. The makers of amitriptyline do include in their literature a caution about the very occasional link with jaundice, but only two cases have so far been reported (Cunningham, 1965; Biagi and Bapat, 1967). In a recent article (Sherlock, 1968), no specific mention was made of amitriptyline in particular, or of tricyclic antidepressant drugs in general, as liable to produce hepatic disorder.

IS THIS SHOT NECESSARY

To the Editor: I read with so much dismay the two reports of serious complications from injection of penicillin (Amer J Dis Child 111 :548-557, 1966) that I am compelled to react in writing, first to speak out against the use of parenteral injections of antibiotics whenever possible and second, to offer explanations of the pathogenesis of the adverse reactions. Every physician should be aware of certain facts: (1) All antibiotics must be considered as necrotizing agents, capable of destroying any structure they reach in concentrated form. (2) In addition to being toxic per se, some are dispensed in solvent vehicles which themselves are highly toxic, for example, propylene glycol. (3) Except for the critically ill individual with obvious gastrointestinal dysfunction or reactive vomiting, a therapeutic blood stream level will be reached as quickly after oral medication as after intramuscular injection in any child able to swallow the tasty antibiotic

Renal angiography.

HomeRadiologyVol. 78, No. 6 PreviousNext EditorialRenal AngiographyJohn A. Evans, Peter M. TillotsonJohn A. Evans, Peter M. TillotsonAuthor Affiliations New York HospitalJohn A. EvansPeter M. TillotsonPublished Online:Jun 1 1962https://doi.org/10.1148/78.6.975MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractRenal angiography had its beginning in 1929 with the first direct needle puncture of the aorta by dos Santos (4). Translumbar aortography is still widely used today, but it has a number of serious disadvantages: In a significant percentage of cases it fails to provide adequate visualization of the renal arteries, and reports of serious complications and death continue to appear.A percutaneous method of arterial catheterization was suggested by Peirce (2) in 1951, modified by Seldinger (5) in 1953, and further modified in basic technic by Prioton (3) and Ödman (1). With the Seldinger technic of renal arteriography, a needle is inserted into the lumen of a femoral artery via percutaneous puncture. A flexible guide wire is introduced into the artery through the needle, which is then removed. Finally a catheter, usually opaque or non-opaque polyethylene, is threaded into the artery over the wire, which is withdrawn, leaving the tubing in place within the aorta at the level of the renal arteries. Contrast material is injected, in most instances with a pressure device, and serial films are exposed to delineate the arterial, capillary, and venous phases of the renal circulation. By reversing the above steps as desired, catheters with tips of various curvatures can be interchanged, thus enabling the examiner to study selectively a single renal artery by placing the tip within the orifice of that artery under fluoroscopic control. Small amounts of contrast material are injected by hand, and the anatomy and vascular pathology of a renal artery and its intrarenal branches are defined in exquisite detail. The renal parenchyma and venous return of the kidney may also be studied. Similarly, the renal veins can be selectively studied via the femoral vein in patients with suspected renal vein thrombosis or tumor invasion. Swedish radiologists deserve the major credit for developing selective renal arteriography as a precise clinical procedure.An alternative method is the intravenous technic described by Steinberg (6) in 1959. While this often fails to give adequate renal arterial definition, it can be useful in individual cases, particularly as a screening procedure. Its principal value is in establishing the degree and extent of degenerative disease of the aorta and its branches to the lower extremities.The percutaneous femoral technic is, in our opinion, the one of choice for the radiological study of the renal vasculature, since it has many important advantages over translumbar aortography and other methods. The procedure is not complicated, and the basic equipment is inexpensive and easily obtained. The study is usually done with the full co-operation of the patient, since general anesthesia is not required, as is frequently the case with translumbar aortography. In fact, the examination can be performed on an ambulatory basis if the patient can be relied upon to rest for a few hours at home with a heavy pressure dressing over the puncture site.Minor adjustments and manipulations of the catheter allow a great degree of flexibility in the manner whereby the renal vessels are visualized. The fact that this procedure permits selective study of the vessels of a single kidney without the superimposition of other contrast-filled branches of the aorta, unavoidably visualized in regular aortography, is invaluable in difficult diagnostic cases.Article HistoryPublished in print: June 1962 FiguresReferencesRelatedDetailsRecommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 78, No. 6 Metrics Altmetric Score PDF download