Evaluation of contrast media for bronchography.

BACKGROUND: Bronchography is occasionally needed for the evaluation and management of some congenital pulmonary anomalies as well as some acquired diseases, usually of the tracheo- bronchial tree. There is currently no effective, approved contrast agent for this imaging techniq ue. OBJECTIVE: We evaluated five agents (barium sulfate, iohexol, propyliodone oily, propyliodone aqueous, and perflubron) in terms of image quality, histologic changes, and effects on hemodynamics, blood gases, and standard laboratory tests in New Zealand White rabbits. MATERIALS AND METHODS: Animals were anesthetized and intubated. Each contrast agent (0.25 ml/kg) was administered intratracheally. Three animals in each group had intravenous lines placed for blood sampling and blood pressure monitoring and were sacrificed at 1 h. An additional three animals for each agent were sacrificed at 24 h and 1 week after imaging. Blood samples were taken immediately before contrast instillation and at 1 h postbronchography. Fluoroscopic images were recorded on standard VHS video tape and evaluated in blind fashion. Segments of lung tissue and bronchi were obtained for histologic examination. RESULTS: Necrosis and/or inflammatory infiltrates were noted in 78 % of the bronchograms performed with propyliodone aqueous, 67 % with propyliodone oily, 55 % with perflubron, and 33 % with iohexol 120, 240 and 350. No histologic damage was observed with barium. The propyliodones gave the best-quality imaging results and the most histologic changes. Iohexol, in any concentration, gave the least acceptable images and a moderate number of histologic changes. Barium sulfate demonstrated acceptable images with virtually no histologic changes. CONCLUSION: From the histologic and imaging results, barium is the best available contrast material for bronchography.

[Double contrast retrograde urethrography using viscous and gaseous contrast media in men]. / Retrogradnaia uretrografiia s dvoinym kontrastirovaniem viazkimi i gazoobraznymi kontrastnymi veshchestvami u muzhchin.

The authors present the literature and their own data on the use of a double contrast study of the urethra in 38 male patients with dysuria of various etiology. The investigations were performed with roentgeno-television control using viscid contrast substances (propyliodone) and gel-like triiodinated liquid contrast media (verografin, urografin, triombrast, etc.). A high informative value of the method in the detection of pathological changes in the urethra and the neck of the urinary bladder, lesser risk of the development and lesser severity of urethro-venous refluxes were noted.

The effects of water soluble contrast agents on the respiratory tract.

The water soluble contrast agents Gastrografin (Sodium diatrizoate and meglumine diatrizoate, Schering, Berlin), Iopamiro 300 (Iopamidol, Schering, Berlin), and Dionosil Aqueous (propyliodone BP, Glaxo, England) were instilled into the tracheobronchial tree of rats in doses of either 0.1 ml and 0.25 ml. Rats being used as controls, underwent sham operations with the instillation of air instead of contrast agent. In all, 85 rats were used. All rats that had not already died from the effects of contrast agent were sacrificed 30 minutes after instillation. The relative effects of the contrast agents were measured by comparing: 1. survival time; 2. radiographic effects of the contrast agents on the lungs and; 3. pathological changes as estimated by post mortem lung section and microscopy. The least toxic agent was the one with the lowest osmotic activity, namely Aqueous Dionosil. It is therefore recommended that Aqueous Dionosil be used in preference to Gastrografin or Iopamidol for studies of the oesophagus whenever there is a danger of aspiration of contrast agent into the tracheobronchial tree.

Cord/spine motion in experimental spinal cord injury.

We examined cord motion and cord-spine coupling associated with the axial tension and dorsal impact models of spinal cord injury. In 20 cats, distraction forces up to 15 kg were applied. Five microliters of radiopaque agent was injected into the central cord at C4-C7 (14 cats) and T6-L1 (6 cats) at 2-mm intervals. In 20 cats, 300 g/cm impacts were delivered after injection of contrast at 2-mm intervals from the impact point. Trials were conducted under fluoroscopy. At 5-kg distraction, vertebral motion averaged 2.12 mm and cord motion averaged 1.03 mm (coupling ratio = .49). At 10-kg coupling increased to .75. Between 10 and 15-kg distraction, the amount of increase in cord length slowed, as did the ratio (.59). Differences in length between load groups were significant at most levels, and motion corresponded with histologic injury reported previously. In the thoracolumbar region, minimal spine motion and no cord motion occurred. Spine motion was not seen with dorsal impact although cord motion at 2 mm from impact averaged 1.3 mm/300 g/cm, which decreased away from the impact point. The spinal cord has limited elasticity, which may be related to injury. Because spine and cord motion occur in clinical injury, experimental models need to incorporate this element.

Death associated with bronchography. Question role of heating the contrast agent.

A young woman died following bronchography. The bilateral bronchogram done under general anesthesia without fluoroscopic control was associated with extensive small airway filling or "alveolarization" of the contrast medium. The oily Dionosil used had been heated in an autoclave. Experiments showed that the viscosity of oily Dionosil decreases with heating. The lowered viscosity could have contributed to the increased "alveolarization" of the contrast agent and death of the patient.

Comparison of deep and shallow endotracheal administration of dionosil in dogs and effect of manual hyperventilation.

The endotracheal route has been used as a second route of choice for administration of emergency drugs for several years; however, the optimal technique for administration of drugs by this route has not been clearly defined. One important aspect of technique involves the question of how distribution to the distal-most endobronchial tree is influenced by initial depth of endotracheally administered drug instillation and use of forced manual hyperventilation. This study demonstrates that depth of instillation of drugs administered by the endotracheal route may not be an important factor in the delivery of medications to absorptive sites in the lung. It appears, however, that forced manual hyperventilation is essential to assure bilateral and optimal distal delivery of endotracheally administered medications.

Experimental evaluation of various available contrast agents for use in the upper gastrointestinal tract in case of suspected leakage. Effects on lungs.

The reactions of seven contrast agents--pure barium sulphate, Micropaque, Gastrografin, Dionosil, Hytrast, Amipaque and Hexabrix--on the bronchi and lungs of rats were studied. This work was undertaken to find a safe gastrointestinal contrast agent for use in post-operative patients where aspiration may be an accompanying risk. Amipaque and Hexabrix produced no significant histological reaction in the lungs and would, therefore, appear to be suitable for use in such cases.

Thyroid function after bronchography with propyliodone.

Thyroid function was studied in 27 subjects who underwent bronchography with propyliodone (18-70 ml, containing 30% of organic iodine). Sustained elevations of serum non-hormonal iodine were observed, indicating that significant amounts of propyliodone were absorbed from the bronchial tree and also that elimination may take several weeks. During the period of anaesthesia, there was an increase in thyroxine-binding globulin and all thyroid hormones which was transient and probably reflected vascular response to the anaesthetic. T4-T3 conversion was inhibited with a nadir of T3 and a peak of rT3 occurring on the 2nd day after propyliodone exposure. FT4 increased gradually during the 2 weeks after bronchography, but remained within the normal range. 6 out of the 27 patients developed pathologic T4 levels, 3 elevated T3 levels, and 2 an abnormal response to thyrotropin-releasing hormone; these changes might have been confused with hyperthyroidism. None of the patients developed clinical thyrotoxicosis; however, in patients with autonomous thyroid tissue, the same precautions should be taken with propyliodone as with other iodine-containing agents which are known to induce hyperthyroidism in this situation.

Unusual pulmonary reactions to oily propyliodone (Dionosil) in bronchography.

Severe reactions to oily propyliodone are rare. Side-effects are usually mild and self-limiting. Three cases are reported of early pulmonary reactions, the cause of which may be a chemical pneumonitis or possibly an allergic response to one of the components of the contrast medium. There was a good response to corticosteroid therapy in all three patients.

[The diagnostic value of double-contrast-technique cystography in the evaluation of benign and malignant lesions of the urinary bladder (author's transl)]. / Wertigkeit der Doppelkontrastcystographie in der Diagnostik benigner und maligner Blasenprozesse.

Cystography by double-contrast-technique as a simple and quick method of evaluating benign and malignant lesions of the urinary bladder is being described. 301 examinations were reviewed and are being discussed in regard to diagnostic value, indication, complication and radiation exposure of this method. A few typical cases are being demonstrated to illustrate the value of this method in the spectrum of other diagnostic methods in the work-up of urinary bladder lesions.