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Can the Dogs. Preliminary Partial Or Complete Curred Despite Functioning 426 CLUTE AND FITZGERALD: ELECTROSHOCK THERAPY [Canad.OM. A.J of thrombosis than is the suture method. REFERENCES 1. GRANT, J. C. B.: A Method of Anatomy, Wm. Wood Suture anastomosis is associated with more & Co., p. 404, 1939. 2. ROBERTS, J. T., BROWN, R. S. AND ROBERTS, G.: dissection and trauma which increases the Federation Proc., 2: 90, 1943. 3. ADRIO, M.: Medico-Chirurgicale, 15: 559, 1938. incidence of thrombosis. End-to-end right 4. BECK, C. S., STANTON, E., BATINCHOK, W. AND LEITER, E.: J. Am. M. Ass., 137: 436, 1948. common carotid to coronary sinus one week 5. BLUM, L. AND GROSS, L.: J. Thoracic Surg., 5: 522, 1937. after sinus ligation, at the moment, seems to be 6. SHANER, R. F.: Personal Communication. 7. BLALOCK, A. AND JOHNS, T.: Personal Communication. the most satisfactory method. 8. ROBERTSON, H. F.: Surgery, 9: 1, 1941. 9. OTTo, J. L.: Am. Heart J., 4: 64, 1928. 10. GROSS, L., BLUM, L. AND SILVERMAN, G.: J. Exper. The frequency and severity of left ventricu- Med., 65: 1, 91, 1937. 11. GREGG, D. E. AND SHIPLEY, R. E.: Am. J. Physiol., lar ecchymosis is a major obstacle if this pro- 151: 13, 1947. 12. ROBERTS, J. T., SPENCER, F. D. AND BROWNE, R. S.: cedure is to be applied to the human heart. It Federation Proc., 2: 90, 1943. may be that the human cardiac veins can 13. HALPERT, B.: Heart, 15: 129, 1930. tolerate sudden arterial pressure better than can the dogs. Preliminary partial or complete sinus occlusion may prepare the cardiac veins ANURIA FOLLOWING ELECTROSHOCK for blood under arterial pressure. End-to-side THERAPY anastomosis with incomplete occlusion of the F. coronary sinus ostium reduces the incidence of K. Clute, B.A., M.D.* and ecchymosis. There is evidence to suggest that G. W. FitzGerald, B.A., M..D.t such a systemic artery-right atrium fistula is Regina, Sask. not serious.'3 Acute rupture of cardiac veins frequently causes death and evidence is pre- pRIOR to the war, little was taught about sented which suggests that if survival occurs necrosis of renal tubules save that it occurred severe degeneration of heart muscle follows. in cases of mercury and arsenic poisoning. Dur- ing the Battle of Britain, the condition which The prevention and reduction of infaretion came to be called crush syndrome1 to 7 was recog- associated with a functioning stoma sugests nized. The characteristic picture consisted of that the area deprived of coronary arterial crushing of the limbs followed by the develop- blood is supplied with arterial blood through ment of oliguria or anuria and urwmia. At the veins. However,' the infarets which oc- autopsy, the findings were necrosis of curred skeletal despite functioning anastomoses are not muscle and large, pale kidneys with damage pre- so easily explained. dominantly of the distal convoluted tubules. SUMMARY Since these cases were reported, considerable interest has been shown in acute lesions of the Three hundred and fifty-six operations have been renal tubules. A review of the literature has done on 240 dogs. These operations con- revealed that sisted of anastomosis cases of fatal anuria following between a systemic artery crushing injuries were and the coronary sinus plus described by German coronary artery writerss' 9 during, and the war of ligation. Arterial blood can be delivered to after, 1914- the myoeardial capillary 1918 and that Dunn and Polson,10 in 1926, pro- bed through the duced a focal veins. Rupture of cardiac veins with resultant necrosis, limited to the distal acute left ventricular segments of the tubules, by the intravenous in- hwmnorrhage is a frequent into cause of death. Occlusion of the anastomotic jection rabbits of large doses of lithium stoma by thrombosis is a frequent complica- monourate. tion. The ventricular fibrillation death rate Following the recognition of crush syndrome as a result of ligation of the anterior deseend- with its characteristic renal lesions, there have ing branch of the left coronary artery has been been reports of numerous conditions which are reduced by this procedure. Infaretion has typified elinically by anuria, which is frequently been prevented in 14 hearts and the infaret has fatal, and pathologically by renal lesions which been reduced in size in 13 hearts by the differ in no essential from those of crush syn- anastomosis. drome. The group includes such widely diver- gent conditions as Blalock and Johns7 have done a number of anuria following transfusion with incompatible 12 similar anastomoses on dogs. Dr. Blalock has blood,11 acute paralytic reviewed this paper and states that his results * Department of Pathology, Regina General Hospital. in t Member of Neuropsychiatric Staff, Regina General general confirm the above. Hospital. Canad.M.A.J. 1 Nov. 1948, vol. 59i CLUTE AND FITZGERALD: ELECTROSHOCK THERAPY 427 myoheemoglobinuria,"3 renal failure after sul- Electroshock therapy was carried out on March 1, 1948. W'ith a dose of 110 volts and 450 milliamperes fonamide therapy,12 anuria due to heat stroke,'2 for 0.3 second, the patient had a typical grand mal Weil's disease,'2' 14 anuria due to excessive convulsion with no immediate complications. The fol- lowing morning, he stated that he had not passed any vomiting,'5 and poisoning by carbon tetra- urine since the shock therapy and complained of aching chloride.'6 For a more comprehensive list of in the lumbar region and nausea. Catheterization, on March 3, disclosed only one ounce of urine in the bladder. these conditions, the reader is referred to the The intravenous administration of 5% glucose in paper of Maegraith, Havard, and Parsons.'7 distilled water was instituted; but, although the pa- tient received 2,500 c.e. of this solution and 2 grams of The purpose of this paper is to report a case, aminophylline intravenously during the following twenty- with a similar clinical and pathological picture, four hours, his urinary output for this period was only one and a half ounces. The continued administration of which terminated fatally after electroshock glucose in distilled water and the application of hot therapy. Although a case of fatal anuria follow- packs thrice daily proved of no avail, as only one ounce of urine was found in the bladder on March 5, whereas ing electric shock from a high tension wire has the blood urea level was 123 mgm. %. The develop- been reported by Fischer, Fr6hlicher, and ment of subcutaneous cedema, severe cough, and short- ness of breath and the finding of dullness and rales Rossier18 and has been alluded to by Bywaters,19 at the base of the left lung dictated the discontinuance the writers have not encountered any report of of intravenous fluids. anuria following electroshock therapy, nor do On March 6, bilateral ureteral catheterization and lavage of both renal pelves were carried out. On the the Swiss workers include a description, either same day, sympathetic block by high spinal anwsthesia gross or microscopic, of the kidneys in their was performed with the purpose of combating any arterial spasm in the kidneys, if such were present. case. It is therefore felt that, in view of the These measures, however, failed to prevent the severe widespread use of electroshock therapy in the oliguria proceeding to anuria; only four ounces were voided that day and one and a half ounces on March 7. treatment of psychiatric disorders, attention Catheterization later on March 7 was non-productive, occurrence and the patient died suddenly on March 8, almost seven should be drawn to the possible of days after the electroshock therapy, without having this serious complication. passed any more urine. Urinalyses subsequent to the shock therapy showed CASE REPORT from a trace to a heavy cloud of albumen, up to 10 white cells high-power field, epithelial cells, amorph- A white farmer, 59 years of age, was admitted to per ous phosphates and urates, and, in the last urine on the Regina General Hospital on February 28, 1948, with March 7, frank blood. None of the specimens was a of nervousness and history fleeting pains, insomnia, darker than amber, except the last which contained sweating of the palms and the feet for several months, and of anorexia for two weeks. During the previous blood. There is no record of casts having been found, and the urine was not specially examined for pigment. year or more, he had noted a loss of libido. His rela- tives had observed during the preceding few weeks that he had become increasingly agitated, with episodes of PATHOLOGICAL FINDINGS depression during which he had stated, "Nothing can be done to help me. " (a) Gross.-Both pleural cavities contained The only previous illnesses reported were pneumonia fluid, whose volume could not be measured be- in 1939, with no sequelae, and a transurethral resection of the prostate in 1947, with no subsequent urinary cause of the fluidity of the blood and the copi- complaints except occasional burning on micturition. ous bleeding that occurred while the chest was The patient's family history was non-contributory. His personal history indicated that he had always been of a heig open-ed. The volume was judged to be in tense, energetic, overly conscientious nature. The the region of 200 c.c. in each pleural cavity. prostatectomy in 1947 and the fact that his wife had recently undergone a cholecystectomy were the only The left lung weighed 635 gm., the right lung facts elicited which might be considered to have caused 665 gm. The lower lobes were firm, non- psychological trauma. crepitant, and dark purplish. Sanguineous fluid Examination showed the patient to be a tense, ap- prehensive, thin, white male, who appeared five years flowed from their cut surfaces.
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