cerebral
damage
returning
to
such
as
paresis
consciousness.
or
The
paralysis severe
on
and
pain in the chest with signs of collapse suggested embolism of the coronary artery; but the absence of pallor, vomiting and, later, signsof pericarditis were against such a diagnosis. Cyanosis, blood-tinged sputum, pleural friction and crepitations indicated pulmonary infarction. The acute pain in the left loin with haematuria can only be explained by assuming infarction of the left kidney. Another explanation which is less satisfactory is that the renal symptoms are caused by acute nephritis produced by
sudden
chemical irritant introduced in the blood with
INFARCTION FOLLOWING THE USE OF AN ABORTIFACIENT By P. L. DESHMUKH,
m.d.,
d.t.m.&h.,
f.c.p.s.
Poona City A married lady, aged 25, was 3 months' pregnant. She had five living children and was advised abortion because it was thought that frequently repeated pregnancies were likely to endanger her health. Her doctor undertook to do the operation by using one of the abortifacient pastes (Aeratus), which he believed to be safe. After the preparation of the patient, the paste was injected very slowly between the membranes and the uterine wall. There was slight bleeding and suddenly the patient had a severe fit of cough and became cyanosed. She complained of severe pain in the chest and the loins. The next moment she was and pulseless perspiring unconscious, profusely. Coramine 4 c.cm. and adrenaline i c.cm. were given subcutaneously, and artificial respiration was started. Gradually the patient came round, and when I saw her, within 20 minutes of the collapse, she was conscious and able to recognize and talk. She still complained of severe pain in the left side of her chest and in the left loin. After a while she had a bout of coughing and the sputum was blood-tinged. About the same time she passed scanty urine with a fair amount of blood in it. One hour later, pleural friction and crepitations could be heard in a localized Her cyanosis gradually area in the left axillary region. disappeared after oxygen inhalations, but the pulse remained weak and rapid. The urine contained obvious blood for the next 48 hours, and gradually it cleared up. After 12 hours' abortion occurred. She was then treated as a case of pneumonia with M&B 693 tablets and occasional stimulants. The patient made an uneventful recovery.
Discussion.?The symptoms appear to be clue to the occurrence of pulmonary and renal infarction. Cerebral embolism was suggestecj/fbv the unconsciousness that supervened, but it could be excluded by the absence of evidence of
the paste. The points against such an assumption are the suddenness of symptoms, the absence of cedema, the absence of casts in the urinary deposit and the rapid clearing of the urine that followed. It is doubtful whether the minute amount of the irritant injected with the paste can produce a fulminant irritation of the kidney such as to give rise to marked haematuria. The loin pain was unilateral while an irritant carried in circulation would give rise to bilateral symptoms. Thus, renal infarction appears to be a more feasible explanation of the clinical picture. It is difficult to account for the embolism in the systemic circuit after aspiration of the foreign material by the uterine veins, except as a paradoxical embolism. The heart did not show any evidence of valvular disease or of a congenital anomaly that is likely to give rise to paradoxical embolism. In the latter condition it is usually the cerebral vessels that are affected. Here it has given rise to renal infarction. The symptoms obviously appeared after the accidental injection of the paste in the vascular channels. The disaster that followed could, perhaps, have been avoided if the injection had been stopped as soon as the bleeding was noticed. The interest of the case lies in the following
points
:?
1. Dangerous complication such as pulmonary and renal infarction appeared during a compara0 tively trivial operation. 2. Embolism appeared simultaneously in the pulmonary and the systemic circulation. 3. The systemic embolism, if it has occurred, has evad.ed the cerebral vessels and occurred in the renal vessels, which is unusual. The mechanism of the embolism has remained un-
"
explained. 4.
The administration of M&B 693 in the of a renal infarction produced no
presence
apparent harm. 5.
to
The
pulmonary
infarction
*
chemotherapy. 6. The injection
responded well
paste after the bleeding appeared to produce dangerous symptoms seen in this patient; of
the
occurrence of the
the
[Note.?There is
of tration I. M. G.h
no
apparent reason for the adminiscase.?Editor, this in
sulphapyridine
damage
returning
to
such
as
paresis
consciousness.
or
The
paralysis severe
on
and
pain in the chest with signs of collapse suggested embolism of the coronary artery; but the absence of pallor, vomiting and, later, signsof pericarditis were against such a diagnosis. Cyanosis, blood-tinged sputum, pleural friction and crepitations indicated pulmonary infarction. The acute pain in the left loin with haematuria can only be explained by assuming infarction of the left kidney. Another explanation which is less satisfactory is that the renal symptoms are caused by acute nephritis produced by
sudden
chemical irritant introduced in the blood with
INFARCTION FOLLOWING THE USE OF AN ABORTIFACIENT By P. L. DESHMUKH,
m.d.,
d.t.m.&h.,
f.c.p.s.
Poona City A married lady, aged 25, was 3 months' pregnant. She had five living children and was advised abortion because it was thought that frequently repeated pregnancies were likely to endanger her health. Her doctor undertook to do the operation by using one of the abortifacient pastes (Aeratus), which he believed to be safe. After the preparation of the patient, the paste was injected very slowly between the membranes and the uterine wall. There was slight bleeding and suddenly the patient had a severe fit of cough and became cyanosed. She complained of severe pain in the chest and the loins. The next moment she was and pulseless perspiring unconscious, profusely. Coramine 4 c.cm. and adrenaline i c.cm. were given subcutaneously, and artificial respiration was started. Gradually the patient came round, and when I saw her, within 20 minutes of the collapse, she was conscious and able to recognize and talk. She still complained of severe pain in the left side of her chest and in the left loin. After a while she had a bout of coughing and the sputum was blood-tinged. About the same time she passed scanty urine with a fair amount of blood in it. One hour later, pleural friction and crepitations could be heard in a localized Her cyanosis gradually area in the left axillary region. disappeared after oxygen inhalations, but the pulse remained weak and rapid. The urine contained obvious blood for the next 48 hours, and gradually it cleared up. After 12 hours' abortion occurred. She was then treated as a case of pneumonia with M&B 693 tablets and occasional stimulants. The patient made an uneventful recovery.
Discussion.?The symptoms appear to be clue to the occurrence of pulmonary and renal infarction. Cerebral embolism was suggestecj/fbv the unconsciousness that supervened, but it could be excluded by the absence of evidence of
the paste. The points against such an assumption are the suddenness of symptoms, the absence of cedema, the absence of casts in the urinary deposit and the rapid clearing of the urine that followed. It is doubtful whether the minute amount of the irritant injected with the paste can produce a fulminant irritation of the kidney such as to give rise to marked haematuria. The loin pain was unilateral while an irritant carried in circulation would give rise to bilateral symptoms. Thus, renal infarction appears to be a more feasible explanation of the clinical picture. It is difficult to account for the embolism in the systemic circuit after aspiration of the foreign material by the uterine veins, except as a paradoxical embolism. The heart did not show any evidence of valvular disease or of a congenital anomaly that is likely to give rise to paradoxical embolism. In the latter condition it is usually the cerebral vessels that are affected. Here it has given rise to renal infarction. The symptoms obviously appeared after the accidental injection of the paste in the vascular channels. The disaster that followed could, perhaps, have been avoided if the injection had been stopped as soon as the bleeding was noticed. The interest of the case lies in the following
points
:?
1. Dangerous complication such as pulmonary and renal infarction appeared during a compara0 tively trivial operation. 2. Embolism appeared simultaneously in the pulmonary and the systemic circulation. 3. The systemic embolism, if it has occurred, has evad.ed the cerebral vessels and occurred in the renal vessels, which is unusual. The mechanism of the embolism has remained un-
"
explained. 4.
The administration of M&B 693 in the of a renal infarction produced no
presence
apparent harm. 5.
to
The
pulmonary
infarction
*
chemotherapy. 6. The injection
responded well
paste after the bleeding appeared to produce dangerous symptoms seen in this patient; of
the
occurrence of the
the
[Note.?There is
of tration I. M. G.h
no
apparent reason for the adminiscase.?Editor, this in
sulphapyridine
