Iodinated Contrast Media Substitution to Prevent Recurrent Hypersensitivity Reactions: A Systematic Review and Meta-Analysis.

Background Changing iodinated contrast media (ICM) may reduce the risk of recurrent ICM-induced hypersensitivity reactions in patients with a prior reaction. Purpose To perform a systematic review on the effectiveness of ICM change in comparison with no change to prevent recurrent ICM immediate hypersensitivity reactions. Materials and methods Multiple data bases were searched without language restriction between January 1990 and August 2021 to identify comparative studies of any design that included patients with a prior ICM hypersensitivity reaction to low-osmolality ICM and re-exposure to intravascular ICM. The methods used included a duplicate assessment of eligibility, double extraction of quantitative data, validity assessment, and random-effects meta-analysis. The primary outcome was the incidence of all-grade immediate recurrent hypersensitivity reactions. Secondary outcomes were the incidence of severe immediate recurrent hypersensitivity reactions and other adverse events associated with ICM change. Results Six retrospective observational studies at moderate to severe risk of bias assessed 7155 adult patients (4329 in the ICM change group and 2826 in the no-change group). Studies adopted nonstandardized switching methods, and the proportions of the ICM change group ranged between 19% (five of 27 examinations) and 80% (3104 of 3880 examinations). A Bayesian meta-analysis revealed that changing ICM was associated with a reduced risk of recurrent hypersensitivity reaction by 61% (risk ratio = 0.39; 95% credible interval [CrI]: 0.24, 0.58). The wide-ranging estimates of risk reduction were not explained by the risk of bias ratings, the event rates in the no-change group, the index-reaction severity, or the co-administered nonstandard premedication. Rare severe recurrent reactions (five studies with five events) precluded a conclusion (risk ratio = 0.34, favoring ICM change; CrI: 0.01, 3.74). Adverse events associated with ICM change were not reported. Conclusion In observational evidence of limited quality, iodinated contrast media (ICM)-change was associated with a reduced risk of recurrent immediate hypersensitivity reaction in patients with a prior ICM-induced hypersensitivity reaction. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by McDonald in this issue.

Allergic-like Hypersensitivity Reactions to Gadolinium-based Contrast Agents: An 8-year Cohort Study of 154 539 Patients.

Background With the widespread use of gadolinium-based contrast agents (GBCAs), the incidence of allergic-like hypersensitivity reactions (HSRs) to GBCAs is increasing. Research on the incidence and risk factors for HSRs to GBCAs is needed for their safe use. Purpose To determine the incidence of acute and delayed reactions to GBCAs and to discuss the risk factors and strategies for the prevention of HSRs to GBCAs. Materials and Methods All cases of HSRs to contrast media that occurred at the Seoul National University Hospital from July 1, 2012, to June 30, 2020, were assessed. Information including age, sex, GBCA type, onset, and severity of HSRs was retrospectively analyzed. Results Among the 331070 cases of GBCA exposure in 154539 patients, 1304 cases of HSRs (0.4%) were reported. Acute HSRs accounted for 1178 cases (0.4%), while 126 cases (0.04%) were delayed HSRs. While both premedication (odds ratio [OR] = 0.7, P = .041) and changing the type of GBCA (OR = 0.2, P < .001) showed preventative effects in patients with a history of acute HSRs, only premedication (OR = 0.2, P = .016) significantly reduced the incidence of HSRs in patients with a history of delayed reactions. The risk of an HSR to GBCA was higher in those with a history of an HSR to iodinated contrast media (OR = 4.6, P < .001). Conclusion The rate of hypersensitivity reactions (HSRs) to gadolinium-based contrast agents (GBCAs) was 0.4%. The absence of premedication, repeated exposures to the culprit GBCA, and a history of HSRs to iodinated contrast media and GBCAs were risk factors for HSRs to GBCAs. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Kallmes and McDonald in this issue.

Relationship between Lower Dose and Injection Speed of Iodinated Contrast Material for CT and Acute Hypersensitivity Reactions: An Observational Study.

BackgroundThere are few data on the relationship between acute hypersensitivity reactions and the dose and injection rate of iodinated contrast material for CT.PurposeTo determine the relationship between lower dose and injection speed of iodinated contrast material for CT and the rate of acute hypersensitivity reactions.Materials and MethodsThis retrospective study included adults (age ≥18 years) undergoing nonionic iodinated contrast material-enhanced abdominal CT between August 2016 and January 2017 (control period) and between August 2017 and January 2018 (intervention period); all examinations were conducted in an outpatient setting. Compared with CT during the control period, CT during the intervention period involved a reduced dose of contrast material achieved by lowering the CT tube voltage. CT examinations in the control period were performed with 120 kVp, a contrast material dose of 2 mL/kg (maximum, 150 mL), and an injection speed of 3 or 4 mL/sec. CT examinations in the intervention period were performed with 100 kVp, a contrast material dose of 1.5 mL/kg (maximum, 130 mL), and an injection speed of 2.5 or 3 mL/sec. Per-examination rates of acute hypersensitivity reactions to iodinated contrast material were compared between the control and intervention periods with use of a multivariable Poisson regression model, the parameters of which were estimated by using generalized estimating equations with an independence correlation structure.ResultsA total of 21947 adults (mean age ± standard deviation, 59 years ± 12; 8797 women [40%]) underwent 25119 CT examinations during the control period; 23019 adults (mean age, 59 years ± 12; 9538 women [41%]) underwent 26491 CT examinations during the intervention period. The rate of acute hypersensitivity reactions was 1.42% (376 of 26491 examinations; 95% confidence interval [CI]: 1.28%, 1.57%) in the intervention period and 1.86% (468 of 25119 examinations; 95% CI: 1.70%, 2.04%) in the control period, with a multivariable-adjusted relative risk of 0.85 (95% CI: 0.74, 0.99; P = .03).ConclusionReduction in the dose and injection speed of iodinated contrast material for CT was associated with a lower rate of acute hypersensitivity reactions to iodinated contrast material.© RSNA, 2019Online supplemental material is available for this article.

Hypersensitivity Reactions to Iodinated Contrast Media: A Multicenter Study of 196 081 Patients.

Background Multicenter studies may be required for establishing guidelines for safe usage of iodinated contrast media (ICM). Purpose To identify the prevalence, patterns, risk factors, and preventive measures for ICM-related hypersensitivity reactions (HSRs). Materials and Methods Between March 2017 and October 2017, a total of 196 081 patients who underwent ICM administration were enrolled from seven participating institutions. The occurrence of HSRs and baseline patient information were recorded. χ2 and Student t test were performed, and logistic regression analyses were used to identify risk factors that predict occurrence and recurrence of HSR. Results Among 196 081 patients (mean age ± standard deviation, 59.1 years ± 16.0; 105 014 men and 91 067 women) who underwent ICM administration, the overall prevalence of HSRs was 0.73% (1433 of 196 081), and severe reactions occurred in 0.01% (17 of 196 081). Conditional logistic regression for patients with HSR (n = 1433) and a control group (1:1 matched group for age, sex, ICM product, and institution) demonstrated that a patient's previous individual history of an ICM-related HSR (adjusted odds ratio [OR], 198.8; P < .001), hyperthyroidism (adjusted OR, 3.6; P = .04), drug allergy (adjusted OR, 3.5; P < .001), and other allergic diseases (adjusted OR, 6.8; P < .001) and a family history of ICM-related HSRs (adjusted OR, 14.0; P = .01) were predictors of HSR occurrence. Logistic regression analysis showed that use of premedication with antihistamine (OR, 0.5; P = .01) and change in the generic profile of ICM (OR, 0.5; P < .001) were preventive against recurrent HSR. Conclusion Family history as well as previous individual history of hypersensitivity reactions (HSRs) to iodinated contrast media (ICM) were risk factors for HSR occurrence, suggesting a potential genetic predisposition. A change in the culprit ICM and premedication with antihistamine are useful for reducing the recurrence of HSRs. © RSNA, 2019 Online supplemental material is available for this article.

Iodinated Contrast Agents and Risk of Hypothyroidism in Young Children in the United States.

BACKGROUND: Although it is generally acknowledged that exposure to iodine contrast agents can interfere with thyroid function, little is known about the incidence of iodine-induced hypothyroidism in young children (younger than the age of 4 years). STUDY OBJECTIVES: This was a retrospective cohort study to estimate the incidence rate of detected hypothyroidism in a US-based general population of pediatric patients exposed to an iodinated contrast agent. SETTING: The study was conducted in Kaiser Permanente Northern California, an integrated health care delivery system. STUDY POPULATION: This study included 2320 pediatric patients younger than 4 years of age who had a diagnostic procedure with an iodinated contrast agent during years 2008 to 2016. RESULTS: Among 2320 young children who met our study criteria, we identified 34 who met the initial criteria to be a case of hypothyroidism. The incidence density ratio for all hypothyroidism in iodine contrast agent-exposed patients was 1.33 per 1000 person months (95% confidence interval, 0.9-1.8). Most cases appeared to have subclinical hypothyroidism. The rate was higher for the probably iodine-induced cases (0.90 per 1000 person months) compared with cases with a possible alternate etiology (0.43 per 1000 person months), for males compared with females, and among children who had a heart catheterization compared with those with a computed tomography scan. It was also highest among the youngest children (younger than 3 months old), and decreased with increasing age. DISCUSSION: Our finding of hypothyroidism in young children exposed to iodine contrast agents (1.33 per 1000 person months [95% confidence interval, 0.9-1.8]) is broadly consistent with the sparse literature on this outcome.

Types of antiseptics, presentations and rules of use. / Tipos de antisépticos, presentaciones y normas de uso.

Antiseptics are chemical substances that when applied topically onto intact skin, mucous membranes or wounds partially or completely reduces the population of living microorganisms in those tissues. Different types of antiseptics are available - those most commonly used in clinical practice being alcohols, iodinated compounds and chlorhexidine. When using an antiseptic, consideration is required of its spectrum of antimicrobial activity, latency, residual effects, possible interferences of the presence of organic material with the activity of the antiseptic, its side effects, compatibility with other antiseptics, and cost. This article is part of a supplement entitled "Antisepsis in the critical patient", which is sponsored by Becton Dickinson.

Staining for viability testing, germination and maturation of Sambucus nigra L. pollen in vitro.

Freshly released pollen of black elderberry (Sambucus nigra L.) was incubated under various culture conditions until germination was achieved. Optimal conditions for germination were determined and used for maturation of unicellular microspores in vitro. Staining with 5-diphenyltetrazolium bromide, propidium iodide and iodine potassium iodide was used to assess pollen viability, nuclear phase and maturation, respectively. The germination rate was highest when fresh pollen was agitated at 40 rpm in Petri dishes containing a liquid medium consisting of Brewbaker and Kwack salts, 15% (w/v) sucrose, 500 mg/l MES sodium salt, at pH 5.0; germination reached nearly 70% after only 1 h in culture. Under these conditions, and with addition of 200 mg/l glutamine, 260 mg/l cytidine and 500 mg/l uridine, uninucleate microspores developed into mature pollen at a 12% germination rate. Our report is the first demonstration of maturation of S. nigra microspores in vitro.

In vitro comparative cytotoxicity study of a novel biocidal iodo-thiocyanate complex.

Novel biocides, which avoid the induction of cross-resistance to antibiotics, are an urgent societal requirement. Here, we compared the cytotoxic and bactericidal effects of a new antimicrobial agent, the iodo-thiocyanate complex (ITC), with those of the common antiseptics, hydrogen peroxide (H2O2), povidone iodine (PVP-I) and Lugol's iodine (Lugol). The antimicrobials were co-incubated for 10 min with HeLa and Escherichia coli cells in the presence and absence of organic matter (Dulbecco's modified Eagle's medium, supplemented with 10% fetal bovine serum). The cytotoxic concentrations of ITC were equivalent to its bactericidal concentrations (7.8 µg ml-1). By contrast, cytotoxic effects of H2O2, PVP-I and Lugol were apparent at concentrations lower than their bactericidal concentrations (250, 250 and 125 µg ml-1, respectively). The cellular effects of ITC were not quenched by organic matter, unlike the other antiseptics. ITC, PVP-I and Lugol had hemolytic effect on horse erythrocytes at high concentrations, while H2O2 showed no hemolysis. ITC, at 30 or 300 µg ml-1, did not cause DNA breakage in HeLa cells as assessed by an in vitro comet assay in the absence of S9 metabolic activation, whereas H2O2 caused extensive single-strand DNA breaks. The pronounced antimicrobial potency of ITC and its favorable cytotoxicity profile suggests that ITC should be considered for antiseptic applications.

The Effect of Contrast Material on Radiation Dose at CT: Part II. A Systematic Evaluation across 58 Patient Models.

Purpose To estimate the radiation dose as a result of contrast medium administration in a typical abdominal computed tomographic (CT) examination across a library of contrast material-enhanced computational patient models. Materials and Methods In part II of this study, first, the technique described in part I of this study was applied to enhance the extended cardiac-torso models with patient-specific iodine-time profiles reflecting the administration of contrast material. Second, the patient models were deployed to assess the patient-specific organ dose as a function of time in a typical abdominal CT examination using Monte Carlo simulation. In this hypothesis-generating study, organ dose refers to the total energy deposited in the unit mass of the tissue inclusive of iodine. Third, a study was performed as a strategy to anticipate the biologically relevant dose (absorbed dose to tissue) in highly perfused organs such as the liver and kidney. The time-varying organ-dose increment values relative to those for unenhanced CT examinations were reported. Results The results from the patient models subjected to the injection protocol indicated up to a total 53%, 30%, 35%, 54%, 27%, 18%, 17%, and 24% increase in radiation dose delivered to the heart, spleen, liver, kidneys, stomach, colon, small intestine, and pancreas, respectively. The biologically relevant dose increase with respect to the dose at an unenhanced CT examination was in the range of 0%-18% increase for the liver and 27% for the kidney across 58 patient models. Conclusion The administration of contrast medium increases the total radiation dose. However, radiation dose, while relevant to be included in estimating the risk associated with contrast-enhanced CT, may still not fully characterize the total biologic effects. Therefore, given the fact that many CT diagnostic decisions would be impossible without the use of iodine, this study suggests the need to consider the effect of iodinated contrast material on the organ doses to patients undergoing CT studies when designing CT protocols. © RSNA, 2017 Online supplemental material is available for this article.

Effects and Effectiveness of Cavity Disinfectants in Operative Dentistry: A Literature Review.

The degree of success in the elimination of bacteria during cavity preparation and prior to the insertion of a restoration may increase the longevity of the restoration and therefore the success of the restorative procedure. The complete eradication of bacteria in a caries-affected tooth, during cavity preparation, is considered a difficult clinical task. In addition to weakening the tooth structure, attempts to excavate extensive carious tissue completely, by only mechanical procedures, may affect the vitality of the pulp. Therefore, disinfection of the cavity preparation after caries excavation can aid in the elimination of bacterial remnants that can be responsible for recurrent caries, postoperative sensitivity, and failure of the restoration. However, the effects of disinfectants on the restorative treatment have been a major concern for dental clinicians and researchers. This review aims to explore existing literature and provide information about different materials and techniques that have been used for disinfecting cavity preparations and their effects and effectiveness in operative dentistry and, therefore, helps dental practitioners with clinical decision to use cavity disinfectants during restorative procedures. Antimicrobial effectiveness and effects on the pulp and dental restorations, in addition to possible side effects, were all reviewed in this paper.

Carbon dioxide contrast medium for endovascular treatment of ilio-femoral occlusive disease.

OBJECTIVES: Compare the use of carbon dioxide contrast medium with iodine contrast medium for the endovascular treatment of ilio-femoral occlusive disease in patients without contraindications to iodine. MATERIALS AND METHODS: From August 2012 to August 2014, 21 consecutive patients with ilio-femoral occlusive disease who were eligible for endovascular treatment and lacked contraindications to either iodine contrast or carbon dioxide were randomized into the carbon dioxide or iodine groups and subjected to ilio-femoral angioplasty.We analyzed the feasibility of the procedures, the surgical and clinical outcomes, the procedure lengths, the endovascular material costs, the contrast costs and the quality of the angiographic images in each group. RESULTS: No conversions to open surgery and no contrast media related complications were noted in either group. A post-operative femoral pulse was present in 88.9% of the iodine group and 80% of the carbon dioxide group. No differences in procedure length, endovascular material cost or renal function variation were noted between the groups. Four patients in the carbon dioxide group required iodine supplementation to complete the procedure. Contrast media expenses were reduced in the carbon dioxide group. Regarding angiographic image quality, 82% of the carbon dioxide images were graded as either good or fair by observers. CONCLUSIONS: The use of carbon dioxide contrast medium is a good option for ilio-femoral angioplasty in patients without contraindications to iodine and is not characterized by differences in endovascular material costs, procedure duration and surgical outcomes. In addition, carbon dioxide has lower contrast expenses compared with iodine.

Carbon dioxide contrast medium for endovascular treatment of ilio-femoral occlusive disease

OBJECTIVES:Compare the use of carbon dioxide contrast medium with iodine contrast medium for the endovascular treatment of ilio-femoral occlusive disease in patients without contraindications to iodine.MATERIALS AND METHODS:From August 2012 to August 2014, 21 consecutive patients with ilio-femoral occlusive disease who were eligible for endovascular treatment and lacked contraindications to either iodine contrast or carbon dioxide were randomized into the carbon dioxide or iodine groups and subjected to ilio-femoral angioplasty.We analyzed the feasibility of the procedures, the surgical and clinical outcomes, the procedure lengths, the endovascular material costs, the contrast costs and the quality of the angiographic images in each group.RESULTS:No conversions to open surgery and no contrast media related complications were noted in either group. A post-operative femoral pulse was present in 88.9% of the iodine group and 80% of the carbon dioxide group. No differences in procedure length, endovascular material cost or renal function variation were noted between the groups. Four patients in the carbon dioxide group required iodine supplementation to complete the procedure. Contrast media expenses were reduced in the carbon dioxide group. Regarding angiographic image quality, 82% of the carbon dioxide images were graded as either good or fair by observers.CONCLUSIONS:The use of carbon dioxide contrast medium is a good option for ilio-femoral angioplasty in patients without contraindications to iodine and is not characterized by differences in endovascular material costs, procedure duration and surgical outcomes. In addition, carbon dioxide has lower contrast expenses compared with iodine.

In vitro pollen viability and pollen germination in cherry laurel (Prunus laurocerasus L.).

Pollen quality is important for growers and breeders. This study was carried out to determine in vitro pollen viability and pollen germination in seven genotypes of cherry laurel (Prunus laurocerasus L.). Two pollen viability tests, TTC (2,3,5-triphenyl tetrazolium chloride) and IKI (iodine potassium iodide), were used. Pollen traits of genotypes were studied using an in vitro medium containing 0%, 5%, 10%, 15%, and 20% sucrose to determine the best sucrose concentrations for germination. In the second step, the germinated pollen was counted 1, 4, 6, 10, 12, 24, and 48 hours later until there was no further germination. The viability rates were different according to genotypes and tests used. The IKI and TTC staining tests and pollen germination had low correlation (r(2) = 0.0614 and r(2) = 0.0015, resp.). Painted pollen rate was higher and pollen was well-stained with IKI test and pollen viability estimated with TTC staining test was better than that estimated with the IKI staining test. 15% sucrose gave the best germination rates in most of the genotypes. Pollen germination rates were recorded periodically from one hour to 48 hours in 15% sucrose and the results showed that pollen germination rates increased after 6 hours of being placed in culture media.

Removal of the iodinated X-ray contrast medium diatrizoate by anaerobic transformation.

The iodinated X-ray contrast medium diatrizoate is known to be very persistent in current wastewater treatment as well as in environmental compartments. In this study, the potential of anaerobic processes in soils, sediments, and during wastewater treatment to remove and transform diatrizoate was investigated. In anaerobic batch experiments with soil and sediment seven biologically formed transformation products (TPs) as well as the corresponding transformation pathway were identified. The TPs resulted from successive deiodinations and deacetylations. The final TP 3,5-diaminobenzoic acid (DABA) was stable under anaerobic conditions. However, DABA was further transformed under air atmosphere, indicating the potential for the mineralization of diatrizoate by combining anaerobic and aerobic conditions. With the development of a methodology using complementary liquid chromatography-electrospray ionization-tandem mass spectrometry and liquid chromatography-inductively coupled plasma-mass spectrometry techniques, all identified TPs were quantified and the mass balance could be closed without having authentic standards for four of the TPs available. The detection and quantification of diatrizoate TPs in groundwater, in technical wetlands with anaerobic zones, and in a pilot wastewater treatment plant established for anaerobic treatment highlights the transferability and up-scaling of the results attained by laboratory experiments to environmental conditions.

¿Hay que ofrecer suplementos de yodo a madres que dan el pecho? / Do we have to give iodine supplementation to breastfeeding mothers?

No disponible

Iodine supplementation during pregnancy and lactation. Position statement of the working group on disorders related to iodine deficiency and thyroid dysfunction of the Spanish Society of Endocrinology and Nutrition.

Severe and mild iodine deficiency during pregnancy and lactation affects thyroid function of the mother and neonate as well as the infant's neuropsychological development. Studies performed in Spain confirm that most women are iodine deficient during pregnancy and lactation. Pregnant and breast feeding women and women planning to become pregnant should take iodine supplements.

Involvement of α7 nAChR subtype in rat oxaliplatin-induced neuropathy: effects of selective activation.

Oxaliplatin, unlike other platinum anticancer agents, has only mild toxic effects on the hematopoietic, urinary and gastrointestinal systems. Its dose-limiting side effect is neurotoxicity that may evolve to a neuropathic syndrome which is difficult to treat. In this study we treated rats with oxaliplatin (2.4 mg/kg/day intraperitoneally, for 3 weeks), and observed that expression levels of the α7 nicotinic acetylcholine receptor (nAChR) subunit were dramatically decreased both in the peripheral and central nervous system. The repeated administration (30 mg/kg/day per os, for 3 weeks) of (R)-ICH3, the most active enantiomer of a novel α7 nAChR agonist, and of PNU-282987 prevented the receptor down-regulation. On the other hand, both agonists per se up-regulated the α7 nAChR subunit compared to control. (R)-ICH3 and PNU-282987 significantly reduced oxaliplatin-dependent alterations of the pain threshold when noxious or non-noxious stimuli were used. Further ex vivo analysis highlighted their neuroprotective effects in dorsal root ganglia and peripheral nerves. The two agonists did not prevent the increase in microglia cell number induced by oxaliplatin in the central nervous system. Astrocyte density was enhanced by the agonist treatment in the spinal cord, thalamus and somatosensory area 1 as opposed to the effects of oxaliplatin treatment. (R)-ICH3 and PNU-282987 per se increased glial cell number in a region-specific manner. In summary, α7 nAChR is involved in oxaliplatin-dependent neuropathology and the agonists (R)-ICH3 and PNU-282987 reduce pain and protect nervous tissue with concomitant glial activation. Since glial cells play a role both in pain and in neuroprotection, an α7 AChR-dependent modulation of glial functions is suggested to distinguish rescue signals from the pathological pain-mediating pathway.

The antimicrobial effect of apical box versus apical cone preparation using iodine potassium iodide as root canal dressing: a pilot study.

PURPOSE: The purpose was to study the reduction of intra-canal microflora in premolars with apical periodontitis instrumented with either apical box or apical cone preparation and to provide measurements of intervention effects to allow proper power calculation in future clinical trials. METHODS: Twenty-four patients were centrally randomized to apical box preparation (size #60) or cone preparation (apical size #25). The groups were comparable regarding the presence of primary caries and type of coronal restoration. In the course of canal preparation each tooth was irrigated with 2.5% NaOCl (12 ml). Lastly, the canals were filled with 17% EDTA (2 × 30 s) and 5% iodine potassium iodide (IKI) for 10 min. The canals were sampled for micro-organisms on four occasions: before instrumentation, after instrumentation, after application of IKI dressing and at the beginning of the second appointment 1 week later. Between the treatment sessions, the root canals were sealed with IRM cement. In the laboratory, culture techniques were used to measure microbial growth, which was classified as: none, very sparse, sparse, moderate, heavy or very heavy. RESULTS: Initially, microbes were recovered in 88% of the teeth. Growth was classified as none in 35% of the teeth after instrumentation and in 50% after the application of IKI. Irrespective of the time of sampling, no significant difference in microbial growth reduction was observed between the two types of apical preparation. Based on the 1-week post-sampling, a power calculation revealed that over 900 patients are needed to show a difference of 9% between the two protocols tested. CONCLUSIONS: Future trials should be conducted using stringent protocols and as multi-centre trials for reaching the required information size.

One month is sufficient for urinary iodine to return to its baseline value after the use of water-soluble iodinated contrast agents in post-thyroidectomy patients requiring radioiodine therapy.

BACKGROUND: There is a concern regarding the use of iodinated contrast agents (ICA) for chest and neck computed tomography (CT) to localize metastatases in patients with differentiated thyroid cancer (DTC). This is because the iodine in ICA can compete with (131)I and interfere with subsequent whole scans or radioactive iodine treatment. The required period for patients to eliminate the excess iodine is not clear. Therefore, knowing the period for iodine levels to return to baseline after the injection of ICA would permit a more reliable indication of CT for DTC patients. The most widely used marker to assess the plasmatic iodine pool is the urinary iodine (UI) concentration, which can be collected over a period of 24 hours (24U) or as a single-spot urinary sample (sU). As 24U collections are more difficult to perform, sU samples are preferable. It has not been established, however, if the measurement of iodine in sU is accurate for situations of excess iodine. METHODS: We evaluated 25 patients with DTC who received ICA to perform chest or neck CT. They collected 24U and sU urinary samples before the CT scan and 1 week and 1, 2, and 3 months after the test. UI was quantified by a semiautomated colorimetric method. RESULTS: Baseline median UI levels were 21.8 µg/dL for 24U and 26 µg/dL for sU. One week after ICA, UI median levels were very high for all patients, 800 µg/dL. One month after ICA, however, UI median levels returned to baseline in all patients, 19.0 µg/dL for 24U and 20 µg/dL for sU. Although the values of median UI obtained from sU and 24U samples were signicantly different, we observed a significant correlation between samples collected in 24U and sU in all evaluated periods. CONCLUSION: One month is required for UI to return to its baseline value after the use of ICA and for patients (after total thyroidectomy and radioiodine therapy) to eliminate the excess of iodine. In addition, sU samples, although not statistically similar to 24U values, can be used as a good marker to evaluate patients suspected of contamination with iodine.

Contrast-induced kidney injury: mechanisms, risk factors, and prevention.

In general, iodinated contrast media (CM) are tolerated well, and CM use is steadily increasing. Acute kidney injury is the leading life-threatening side effect of CM. Here, we highlight endpoints used to assess CM-induced acute kidney injury (CIAKI), CM types, risk factors, and CIAKI prevention. Moreover, we put forward a unifying theory as to how CIAKI comes about; the kidney medulla's unique hyperosmolar environment concentrates CM in the tubules and vasculature. Highly concentrated CM in the tubules and vessels increases fluid viscosity. Thus, flow through medullary tubules and vessels decreases. Reducing the flow rate will increase the contact time of cytotoxic CM with the tubular epithelial cells and vascular endothelium, and thereby damage cells and generate oxygen radicals. As a result, medullary vasoconstriction takes place, causing hypoxia. Moreover, the glomerular filtration rate declines due to congestion of highly viscous tubular fluid. Effective prevention aims at reducing the medullary concentration of CM, thereby diminishing fluid viscosity. This is achieved by generous hydration using isotonic electrolyte solutions. Even forced diuresis may prove efficient if accompanied by adequate volume supplementation. Limiting the CM dose is the most effective measure to diminish fluid viscosity and to reduce cytotoxic effects.