[Hysterosalpingography using iotrolan--a new contrast medium]

Iotrolan was investigated as a new contrast medium for hysterosalpingography. Fertility rates and side-effects were registered in a series of 108 consecutive patients. The results indicate a higher fertility rate after hysterosalpingography with iotrolan than after the use of other water-soluble contrast media but a lower fertility rate when compared to lipiodol. As for side-effects, the study indicates that the frequencies of low abdominal pain and vaginal bleeding after hysterosalpingography are equal for iotrolan and lipiodol but higher for other, water-soluble contrast media. A prospective, randomized study is recommended for the clarification of these aspects.

Tissue tolerance to pelvic intraarterial chemoembolization with cisplatin-lipiodol suspension

Tissue tolerance to pelvic intraarterial chemoembolization with cisplatin-lipiodol suspension was studied in rabbits. Cisplatin (3 mg/kg) was used with different doses of lipiodol (0.0, 0.1, 0.2, and 0.3 ml/kg). Cisplatin-lipiodol suspension was injected into the umbilical artery through a long polyethylene catheter. Local tissue concentration of platinum was increased with lipiodol, while that in the liver, heart, and kidneys was reduced. Tissue retention of platinum was linearly related to the dosage of lipiodol. With a single dose of 0.2 ml/kg lipiodol, only slight degeneration and sparse hemorrhage were observed without necrosis.

Pulmonary oil embolism after transcatheter oily chemoembolization of hepatocellular carcinoma

The medical records of 336 patients with hepatocellular carcinoma who underwent transcatheter oily chemoembolization (TOCE) performed via the hepatic artery were retrospectively reviewed to ascertain the occurrence of symptomatic pulmonary oil embolism. In 14 patients, more than 20 mL of iodized oil was administered. In six of these 14 patients, respiratory symptoms of cough, hemoptysis, and dyspnea developed 2-5 days after TOCE, and their chest radiographs showed diffuse bilateral pulmonary parenchymal infiltrate. Their arterial partial pressure of oxygen while they breathed room air ranged from 39 to 60 mm Hg during maximum hypoxemia. The symptoms, arterial hypoxemia, and chest radiographic abnormalities completely cleared 10-28 days after TOCE in the five patients who survived. One patient died 10 days after TOCE because of respiratory arrest with a progression of pulmonary infiltrate. Although histopathologic proof is lacking, it is concluded that massive pulmonary embolization of iodized oil was the primary cause of the clinical and radiographic manifestations in these six patients.

Treatment of inoperable hepatocellular carcinoma by transcatheter arterial chemoembolization using an emulsion of cisplatin in iodized oil and gelfoam

Eighty patients with inoperable hepatocellular carcinoma (HCC) were treated by transcatheter arterial chemoembolization using an emulsion of Lipiodol and Cisplatin. In 59 patients, gelfoam embolization was also given. The tumour size ranged from 0.5 cm to 33 cm in maximum diameter with the median diameter being 8 cm. The chemoembolization sessions were repeated every 1 1/2 to 3 months. The number of sessions the patients underwent varied from 1 to 11, with the mean number of sessions being 3.7. The HCC either disappeared completely or decreased in size in 44 patients (55%). In patients having an HCC of 12 cm or less in size, 31 out of 41 (75.6%) who had the addition of gelfoam demonstrated decrease in tumour size, while seven out of 11 (63.6%) without the addition of gelfoam demonstrated decrease in tumour size. In patients having an HCC of more than 12 cm in size, only six out of 18 (33.3%) who had the addition of gelfoam demonstrated reduction in tumour size and none of the 10 patients without the addition of gelfoam responded. Thus, HCCs of 12 cm or less in size responded better than larger ones to chemoembolization (P < 0.0001) while the addition of gelfoam enhanced the response (P = 0.039). The 1 year survival rate for the 80 patients was 53% and the 2 years survival rate was 38%. The median survival was 13 months. For patients having an HCC of 12 cm or less in size, the 1 year and 2 year survival rates were 69% and 47% respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Transarterial internal radiation therapy with I-131 Lipiodol for multifocal hepatocellular carcinoma: immediate and long-term results

Transarterial internal radiation with I-131 Lipiodol (TAIR) was performed in 21 patients with multifocal hepatic carcinoma. Eight patients were treated by TAIR alone and 13 by combination of TAIR and intraarterial infusion of cis-diamminedichloroplatinum (CDDP) and/or adriamycin mitomycin C oil suspension (ADMOS). TAIR was found effective immediately and long-term. Serum alpha-feto-protein (AFP) levels dropped to 50% or less in 7 of 14 patients. Eleven of 21 patients (52%) showed 50% or greater decrease in tumor size. The overall 1-year survival rate was 43% and 67% in patients who received 50 Gy or greater tumor dose. Lipiodol distribution pattern of the tumor indicated some difference in the prognosis between the scattered pattern and solid pattern. The solid pattern showed a statistically significant better survival rate. Patients treated with TAIR alone versus those treated with TAIR and chemotherapy showed no difference in their survival rate.

Diagnostic iodised oil embolisation of liver tumours--the Hammersmith experience

Oily embolisation of the liver as a diagnostic technique in the management of liver tumours has not proved reliable in our hands. In our study of 20 patients we found: (1) The technique was not risk-free, with complications in four patients, one of whom required emergency surgery. (2) The Bruneton classification is far too simplistic to be relied upon. (3) Residual Lipiodol, particularly in the left lobe of the liver is problematic, making it difficult to distinguish normal from diseased liver. (4) The technique did not contribute to decisions about surgical management in any one of our 20 cases though we accept it might occasionally do so. Our experience was disappointing and in marked contradistinction to enthusiastic reports by some other authors.

Distribution and effect of iodized poppyseed oil in the liver after hepatic artery embolization: experimental study in several animal species

To define the intrahepatic distribution of iodized poppyseed oil and its effect on the liver, hepatic artery embolization (HAE) was performed in five mice, 12 rats, four rabbits, and 21 pigs with the iodized oil alone or in combination with gelatin sponge powder (GSPow) in three rats or gelatin sponge particles (GSPs) in nine pigs. All mice, rats, and rabbits underwent radiography of the upper abdomen and in vivo microscopy of the hepatic periphery during and immediately after injection and 1, 4, and 24 hours later. All pigs underwent angiography before and after HAE as well as measurement of portal venous pressure before HAE and 15, 30, 45, and 60 minutes and 4 weeks after HAE. Follow-up radiographs were obtained in 18 pigs. HAE performed with the iodized oil only was well tolerated by the liver, even when high doses were used, likely because of continuous flushing of the sinusoids by high blood flow from peripheral arterioles. When HAE was performed with the iodized oil and GSPow, this blood flow ceased and necrosis developed. The degree of necrosis after HAE with the iodized oil in combination with GSPs was directly associated with the dose of iodized oil. HAE performed with GSPs only did not cause damage.

[Digital subtraction angiography with carbon dioxide in severe arterial ischemia and allergy to iodinated compounds]

When in some selected patients, a direct arterial surgery (DAS) procedure or an endoluminal surgery (ES) are required for a chronic arterial ischemia (III or IV degrees), and an arteriography with contrast is absolutely contraindicated (because of severe renal failure without hemodialysis program or a severe congestive heart failure or a hyperthyroidism or a seriously demonstrated hypersensibility against the contrast agents); an angiography by digital subtraction with carbon dioxide (DIVAS-CO2) is indicated. This technique provides good quality images with minimal risks for the patient and an adequate study for ulterior treatment. We report a case of a 67-years-old woman, with diabetes-II, ischemic cardiopathy, arterial hypertension and a demonstrated hypersensibility against the iodide compounds. The patient was admitted because of a chronic ischemia (IV degree) with ischemic ulcerations on some fingers from the left foot. High doses of analgesic drugs were needed. Because the hypersensibility against the iodide compounds, an angiography with CO2 was carried out. The good quality images provided by this technique showed the factibility of a revascularization.

Hepatic parenchymal changes after the intraarterial injection of lipiodol in tumor-bearing rabbits

RATIONALE AND OBJECTIVES

The influence of lipiodol injection on hepatic morphology and function was investigated in 119 rabbits with hepatic VX2 tumors.

METHODS

The rabbits were divided into the following three groups, according to the materials injected via the proper hepatic artery: group 1 received doxorubicin (Adriamycin [ADM]); group 2 received lipiodol (LPD); and group 3 received LPD plus ADM. Groups 2 and 3 were each divided into three subgroups, according to the dose of LPD injected (0.3, 0.6, and 1.2 mL). Non-tumorous regions in the tumor-bearing lobe and the tumor-free lobe were examined histologically; low-kilovolt x-ray studies and computed tomography (CT) also were performed in 84 rabbits. Liver function tests were performed in 35 rabbits.

RESULTS

Elevation of the serum aminotransferase levels was observed after the administration of LPD. Hepatocellular degeneration was marked in the tumor-free lobe, but was much more severe in the tumor-bearing lobe in groups 2 and 3. The degree of degeneration depended on the dose of LPD. Both low-kilovolt x-ray studies and CT showed the heavy accumulation of LPD in the tumor-bearing lobe.

CONCLUSIONS

The current study shows that the histologic and functional adverse effects of oily chemoembolization depend on the dose of LPD administered to the liver.

[A case of chronic thyroiditis with transient painful thyroiditis occurring after the administration of lipiodol]

We reported a female case of painful thyroiditis occurring after hysterosalpingography and investigated whether the destructive thyroiditis was iodine-induced. The patient, aged 28, had TBG deficiency and the previous episode of thyrotoxicosis caused by Graves' disease. Lipiodol (containing 4.8g of iodide in 10ml solution) was administered via vagina for hysterosalpingography. One month after the radiography, serum inorganic iodide and Tg were elevated abnormally, but she was asymptomatic. After the subsequent 3 months she developed a painful and 3rd grade-sized goiter with concomitant marked elevation of thyroid hormones and inorganic iodide and also high titer of MCHA (320(2)X). A dramatic response was obtained with steroid. Thereafter she was treated with acupuncture on the thyroid gland, resulting in a sudden reappearance of tender goiter. This traumatic thyroiditis disappeared successfully in 2 weeks with steroid treatment. The painful thyroiditis subsided in 5 months throughout the course and she remained euthyroid for the ensuing 2 years. Aspiration biopsy was performed twice and revealed lymphocytic thyroiditis. Values of serum Tg varied in good correlation with those of serum inorganic iodide or rT3 throughout the course, respectively (P < 0.01, P < 0.05). Significant correlations between FT4 and FT3, and also T4 and T3 were observed, respectively (P < 0.01, P < 0.05). Serum inorganic iodide was elevated to 316 micrograms/dl at the symptomatic stage of the thyroiditis and decreased to 170 micrograms/dl at the resolving phase 2 months after the inflammation. Iodide disappearance curve showed a diphasic slope. The BHL was calculated as 60.3 days during the symptomatic stage and 6.9 months in euthyroid state.(ABSTRACT TRUNCATED AT 250 WORDS)

[Two cases of esophageal varices complication after hepatic arterial infusion chemotherapy (HAI) for metastatic liver tumor]

Mild liver dysfunction is a well-known complication of HAI, but it has been thought to be transient and reversible in most cases. In the case, of metastatic liver disease, in particular, HAI has been performed safely because liver function is normal for the most part. We encountered 2 cases of irreversible severe liver dysfunction and esophageal varices after hepatectomy for metastatic liver tumor from colorectal cancer. They were treated with postoperative adjuvant HAI. Biliary enzyme as alkaline phosphatase elevated, and dilated intrahepatic bile ducts were observed in both patients. Fibrosis of Glissonean sheath, dilatation of intrahepatic bile ducts and intrahepatic biliary stones were observed at autopsy in both patients. One of the patients had obstruction of portal trunk. It must not be forgotten that such complications can occur even in a case with non-cirrhotic liver.

[Causes and incidence of short-life keratitis caused by dacryography. Optimization of protective parameters]

This study was aimed at investigating the changes occurring in superficial corneal epithelium (localized or diffuse, dotted or linear) as observed in 300 eyes after macrodacryography with iodate contrast media (iodized oil and water soluble non-ionic agents). In our opinion, the causes of iatrogenic short-life keratitis are: needle injury, the deposition of iodate contrast medium on the cornea and the reduction of palpebral winking, favoring dry eye, due to superficial anesthesia. The pharmacologic protection of the cornea by means of high-viscosity drugs allows both the number and the degree of keratitis to be markedly reduced. Therefore, contrast media must be chosen on the basis of anamnestic and clinical data, as well as of patient's symptoms, focusing mainly on the characteristics of the various agents--i.e., density, concentration, viscosity.

Evaluation of oil-soluble FUdR ester for transcatheter arterial treatment of hepatomas

From January 1987 to December 1989, we performed a prospective study of transcatheter arterial chemoembolization therapy with iodized oil (Lipiodol) mixed with an anticancer agent. A new oil-soluble modification of FUdR, FUdR-C8 ester, was developed and dissolved in Lipiodol as an embolic material, which was administered to 36 patients with hepatomas. Water-soluble adriamycin emulsified in Lipiodol was used as control in 67 patients with hepatomas. Initial effects on tumors were observed as decrease of tumor size in 25.0% for the FUdR group and 17.9% for the control group. Alpha-fetoprotein decreased more than half in 41.9% of the FUdR group, and 16.1% of the ADM group. Six-month and one-year survivals were 74.2% and 46.8% for the FUdR group (median survival 317 days), whereas the control group yielded 61.0% and 28.3% survivals, respectively (median survival 191 days).

Targeting chemotherapy for hepatoma: arterial administration of anticancer drugs dissolved in Lipiodol

In targeted cancer chemotherapy, Lipiodol Ultrafluid (Lipiodol) was used as a carrier of anticancer drugs, these drugs were termed as "oily anticancer agents". This arterial injection therapy with oily anticancer agents was performed for 323 patients with hepatoma. Serum alpha-fetoprotein (AFP) levels decreased in 165 (93%) of 177 AFP-positive patients. Reduced tumour size was observed in 210 (regression over 50% in 96 and less than 50% in 114) of 222 evaluable patients with unresectable hepatoma. In patients who preoperatively received a dose of styrene maleic acid neocarzinostatin (SMANCS)/Lipiodol of more than 0.7 mg/cm2 of maximal cut surface area of the tumour, complete necrosis or necrosis of almost the entire area of tumour was found, and non-cancerous liver tissue and the gallbladder remained unaffected. The survival period of 277 patients with unresectable hepatoma who were treated with oily anticancer agents is thought to be prolonged, especially of 147 patients, excluding those with Child C liver cirrhosis, with tumour occupying all segments of the liver, or with extrahepatic spread. The 1-, 2-, 3-, and 5-year survival rates were 84, 47, 37, and 34%, respectively.

Intraarterial injection therapy of newly developed cisplatin-phosphatidyl choline-lipiodol suspension for hepatocellular carcinoma

Twenty-seven patients with hepatocellular carcinoma were treated by intraarterial injection of a suspension of cisplatin powder and iodized oil using phosphatidyl choline as a dispersing stabilizer. A reduction in tumor size of over 25% was obtained in 23 patients (85%) and a reduction of more than 50% was obtained in 17 patients (63%). In all of 14 patients with a high serum alpha-fetoprotein level (more than 200 ng/ml), 27% to 99% reduction in the level was obtained. The one-, two-, and three-year survival rates were 74%, 50%, and 35%, respectively. As for side effects, digestive symptoms were rather frequently observed. Liver abscess and cholangitis were observed in one patient each in patients combined with embolization using gelatin sponge particles. Injection of the suspension with embolization was superior to injection only in therapeutic effect, but was associated with a higher frequency of side effects. The therapeutic effect was better in cases of higher Lipiodol retention in the tumor on follow-up CT.

Evaluation of transcatheter arterial embolization with epirubicin-lipiodol emulsion for hepatocellular carcinoma

A total of 18 patients with hepatocellular carcinoma (HCC) were treated by transcatheter arterial embolization (TAE) with a 4'-epi-doxorubicin (EDX)-lipiodol emulsion. Infusion of the EDX-lipiodol emulsion (EDX-L) via the hepatic artery was followed by the injection of gelatin sponge in 12 cases. The response and survival of these 12 patients following EDX-L treatment were compared with those of 42 subjects treated with a doxorubicin-lipiodol emulsion (DX-L) and those of 23 patients treated by TAE with gelatin sponge (GS) only. In the group treated with EDX-L, nine cases were AFP-positive in sera and four showed a decrease in serum AFP values to less than 10% of the pretreatment level. Seven cases showed a partial response, and nine cases showed no change in the size of the tumor. In the group treated with EDX-L, nine cases are alive, and the oldest has survived for more than 431 days since the treatment. The half-year survival value was 57%, and the 1-year survival value was 49%. These values did not differ significantly from those calculated for the group treated with DX-L. The 1-year survival value determined for patients treated with a lipiodol emulsion (EDX-L or DX-L) followed by GS was 65%, and the 2-year survival value was 39%. These results rates are significantly better than those obtained in patients treated with GS only (1-year survival, 39%; 2-year survival, 13%.

Treatment of inoperable hepatocellular carcinoma by intra-arterial lipiodol and 4'-epidoxorubicin

A total of 30 patients presenting with inoperable hepatocellular carcinoma (HCC) were treated with intrahepatic arterial Lipiodol (5 ml) and 4'-epidoxorubicin (90 mg/m2) once every 4 weeks. The treatment results included no complete response, 2 partial responses, 6 cases of static disease and 19 cases of progressive disease. The median survival was 18.9 weeks. All patients had died by the time of this writing, with survival duration ranging from 4.1 to 87.3 weeks. Toxicities were minimal and included anaemia and alopecia. As compared with a historic control group that had received the same dose of intravenous 4'-epidoxorubicin, the treatment group showed similar response rates but developed fewer toxicities. There was no significant survival benefit over the control group. We concluded that although this form of treatment had comparable activity and produced fewer side effects, it provided no survival benefit over intravenous treatment. The slight prolongation of survival achieved in the treatment group as compared with the control arm might have been due to case selection.

Adverse reactions to lipiodol ultra fluid: report of an accidental case

A 25-year-old Japanese woman experienced pulmonary edema, shock, encephalopathy and silent pancreatitis after hysterosalpingography using lipiodol ultra fluid, because the contrast media flowed directly into the blood stream from endometrium injured by several curettages for termination of pregnancy. Total iodine concentrations in plasma and urine decreased exponentially and their half-life was 16.12 and 13.04 days, respectively. Clear correlations were observed between the iodine concentration in plasma and the amelioration of both electroencephalogram and neuropsychic abnormalities. Adverse reactions of oil-soluble contrast media are also discussed.

Biloma following transcatheter oily chemoembolization

Hepatic biloma (bile cyst) developed in a patient after transcatheter oily chemoembolization (TOCE) with Lipiodol for hepatocellular carcinoma. The patient was treated conservatively and underwent the next TOCE uneventfully. An inappropriately large dose of Lipiodol, anticancer agent, and Gelfoam can induce biloma; however, it is not reasonable to abstain from TOCE for hepatocellular carcinoma in fear of biloma.

Contrast media in sialography: a comparison of Lipiodol Ultra Fluid and Urografin 290

A prospective, randomized study of 60 patients undergoing sialography was conducted to compare Lipiodol Ultra Fluid (UF) (Ethyl diiodostearate, May & Baker Ltd), with Urografin 290 (meglumine diatrizoate 52.1% w/v and sodium diatrizoate 7.9% w/v, Schering). The quality of the images, the clinical tolerance and the side-effects of contrast were compared. Both agents produced adequate opacification of ducts but poor intra-gland duct filling was seen in two patients examined with Lipiodol UF. There were significantly more side-effects (which were also more severe) in the Lipiodol group. It is concluded that Urografin 290 is the better contrast agent for sialography because of better filling of intra-gland ducts and greater clinical tolerance.

Targeting cancer chemotherapeutic agents by use of lipiodol contrast medium

Arterially administered Lipiodol Ultrafluid contrast medium selectively remained in various malignant solid tumors because of the difference in time required for the removal of Lipiodol contrast medium from normal capillaries and tumor neovasculature. Although blood flow was maintained in the tumor, even immediately after injection Lipiodol contrast medium remained in the neovasculature of the tumor. To target anti-cancer agents to tumors by using Lipiodol contrast medium as a carrier, the characteristics of the agents were examined. Anti-cancer agents had to be soluble in Lipiodol, be stable in it, and separate gradually from it so that the anti-cancer agents would selectively remain in the tumor. These conditions were found to be necessary on the basis of the measurement of radioactivity in VX2 tumors implanted in the liver of 16 rabbits that received arterial injections of 14C-labeled doxorubicin. Antitumor activities and side effects of arterial injections of two types of anti-cancer agents were compared in 76 rabbits with VX2 tumors. Oily anti-cancer agents that had characteristics essential for targeting were compared with simple mixtures of anti-cancer agents with Lipiodol contrast medium that did not have these essential characteristics. Groups of rabbits that received oily anti-cancer agents responded significantly better than groups that received simple mixtures, and side effects were observed more frequently in the groups that received the simple mixtures. These results suggest that targeting of the anti-cancer agent to the tumor is important for treatment of solid malignant tumors.

[A case of interstitial pneumonia after hepatic arterial infusion of lipiodol-anticancer drug emulsion for hepatocellular carcinoma]

We reported a case of interstitial pneumonia immediately after hepatic arterial infusion of Lipiodol anticancer drug emulsion for hepatocellular carcinoma. The reason was considered that Lipiodol-anticancer drug emulsion ran through an A-V shunt to alveolar septum resulting in alveolitis.

[Effect of intraarterially injected lipiodol on rat liver with cirrhosis]

The serial histological changes of the liver following the intrahepatic arterial injection of Lipiodol in the rat with cirrhosis were investigated. The hepatocytes showed acidophilic degeneration and focal necrosis after 12 hours and restoration of focal necrosis was seen after 72 hours. Necrosis and infarction were resolved after 120 hours. We concluded that the intrahepatic arterial injection of 0.1 ml Lipiodol in the rat with cirrhosis was safely performed.