Intravenous pyelography: the case against its routine use

Article Abstract:

Intravenous pyelography is used to examine the function of the urinary system. It entails the intravenous injection of a contrast medium and the X-ray examination of the elimination of the medium from the body. The use of intravenous pyelography has declined because of the advancement in other imaging techniques such as computed tomography and ultrasonography. It is however, still routinely used in four common clinical situations: before prostatectomy, the surgical removal of part or all of the prostate gland; before hysterectomy, the surgical removal of the uterus; for evaluating anatomical abnormalities in women who have symptomatic lower urinary tract infection; and for the evaluation of patients who have high blood pressure due to kidney disease. The use of intravenous pyelography was assessed in these four clinical situations. Intravenous pyelography revealed only small numbers of obstructions in the prostate gland. It did not specifically show obstruction of the ureter and was not very sensitive or specific in detecting urinary tract malignancies. When used before hysterectomy, intravenous pyelography does not reduce injury to the ureter and detects very few unexpected abnormalities. It did not improve the outcome or prevent impaired renal function of women who had urinary tract infections. Intravenous pyelography was not accurate in detecting the narrowing of the openings of the arteries in the kidney or predicting favorable outcomes of renal artery surgery. It is felt that because of its high false-positive rates, few benefits and significant costs, pyelography should not be performed routinely in these clinical situations but should be used only when there is a specific question for which this test could provide an answer that would affect the course of treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Diagnosis, Medical examination, Kidneys, Uterus, Kidney, Radiography, Medical, Medical radiography, Urinary tract infections, Prostate, Renal hypertension

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Digitalis-induced visual disturbances with therapeutic serum digitalis concentrations

Article Abstract:

Normal doses of digitalis may cause visual complications in older people. High doses of this heart medicine are associated with abnormal color vision and other visual symptoms. Researchers evaluated the vision problems of six elderly patients who took digitalis. Five patients reported photopsia, or seeing bright lights, and one man reported seeing less clearly. The patients were between 66 to 85 years old. According to blood tests, all digitalis concentrations were appropriate for the doses taken. Electroretinographic testing revealed a longer b-wave implicit time during digitalis therapy and a corresponding shortening after digitalis withdrawal. This change in eye reaction time apparently varied with the presence and absence of digitalis. Visual symptoms improved in five of the patients soon after digitalis was discontinued. Close monitoring of patients taking digitalis may be necessary to avoid visual and cardiac side effects.

Causes of, Complications and side effects, Vision disorders, Digitalis, Digitalis glycosides

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Intravenous phenytoin: a loading scheme for desired concentrations

Article Abstract:

Intravenous phenytoin is given to treat patients with status epilepticus (a multiple seizure disorder) or to prevent seizures after neurological surgery. Effective seizure control is established by increasing the dose of phenytoin gradually over a two- to six-week period. However, there are some instances where a therapeutic dose is needed rapidly. The safety and reliability of a higher loading dose of phenytoin were studied in 40 patients. The effectiveness of a new loading dose, based on the Monte Carlo computer simulations, was compared with that of standard dosage regimens. Although the blood pressures in four out of 21 patients were lowered by 20 percent, none required blood pressure-correcting medication. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drug therapy, Dosage and administration, Status epilepticus, Phenytoin

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