[Comparative study of Hexabrix and Lipiodol UF in sialography]

Many new lipid- and water-soluble contrast media can be used in sialography, the three main criteria of choice being the cost, the quality of filling, particularly of the parenchyma, and its evacuation and clinical tolerance. Duroliopaque possesses very similar physicochemical properties to those of Lipiodol UF, but a sufficiently satisfactory filling of the parenchyma is not obtained. Comparison of Lipiodol UF and Hexabrix in parotid and submaxillary contrast imaging showed good clinical tolerance for both products, but improved parenchymatous filling with Lipiodol UF. However, the more effective glandular evacuation with Hexabrix makes this the product most suitable at the present time for morphologic exploration of salivary glands.

[Acute adult respiratory distress syndrome after lymphography]

Pulmonary complications of lymphography are usually described as radiological infiltrates without clinical symptoms. However, a case is here reported of an adult respiratory distress syndrome occurring after lymphography in a 60 year old female lymphoma patient. Pulmonary oedema developed within 48 h; haemodynamic study showed a normal capillary wedge pressure. The patient died from intractable low cardiac output within 24 h. Post-mortem examination showed pulmonary lymphocytic infiltration and multiple fat emboli. The lack of lymphatic drainage was probably responsible for the intravascular passage of lipid-soluble contrast medium, this giving endothelial lesions. In such patients with preexisting lung disease or pulmonary involvement in haematological disease, lymphography has to be considered carefully.

Mineral oil (follicular) lipidosis: II. Histologic studies of spleen, liver, lymph nodes, and bone marrow

Tissues obtained from 600 routine autopsies were studied. Mineral oil lipidosis was present in the spleen (76 per cent), liver (45 per cent), bone marrow (26 per cent), and lymph nodes; more than 50 per cent of the lymph nodes from the mesentery, porta hepatis, and mediastinum were affected. Mineral oil and its metabolic products produce a nonfibrogenic reaction in these tissues. The differential diagnosis of mineral oil lipidosis in lymph nodes with reaction to radiopaque oils and Whipple's disease is discussed. The presence of mineral oil in para-aortic (42 per cent) and internal iliac (15 per cent) lymph nodes could result in false-positive readings after lymphangiography.

[Drug-induced changes in the lungs]

The author reviews changes in the lung induced by pharmacotherapy. Attention is drawn to the differences in mode of reaction of the individual drug noxae. Roentgenological changes are demonstrated by means of x-ray film examples and the various roentgenological signs are pointed out. In accordance with the classification by v. Wichert, the drugs are tabulated according to the pathogenetic mechanisms triggered by them at the lung parenchyma, the tabulation being arranged in groups. Wrong interpretations of the changes in the lung can be avoided by means of intensive co-operation between the clinician and the radiologist and by including the possibility of lung damage caused by drugs in the diagnostic deliberations.

Thyroid hormone and immunological studies in endemic goiter

Iodized oil (1 ml im) was given to 58 goitrous patients from a mildly iodine-deficient area in Greece. Goiter size, urinary iodine, and serum T4, T3RU, T3, rT3, TSH, thyroxine-binding globulin (TBG), and thyroid autoantibodies were measured before and 1, 3, and 6 months after the injection. Goiter size decreased. Serum T4 remained relatively constant, but TBG decreased and therefore T3RU and FTI increased. Serum T3 and rT3 initially decreased (P less than 0.001) and then increased at the sixth month (P less than 0.001), both showing roughly parallel changes. Serum TSH, initially normal (1.42 +/- 0.11 (SEM) mU/liter), decreased to 0.65 +/- 0.01 and 0.76 +/- 0.05 mU/liter at the third and sixth month (difference from baseline P less than 0.001). Thyroid autoantibodies, both against thyroglobulin and the microsomal antigen, were undetectable before treatment, but became positive in 42.8% of the patients 3 and 6 months later. Three patients developed transient hyperthyroidism. This occurred 3 or 6 months after treatment, and was associated with high titers of thyroid autoantibodies. These results indicate that: 1) transient hyperthyroidism may occur after the administration of iodized oil, possibly because of thyroid tissue necrosis and leakage of hormones, and 2) serum TBG decreases after iodized oil, a finding not previously reported and one whose cause is not known.

Anaphylaxis: pathophysiology, clinical presentations and treatment

Anaphylaxis and anaphylactoid reactions are abrupt, often life-threatening episodes, secondary to the liberation of certain chemical mediators, and their effects on target organs. The number of agents known to trigger such reactions is expanding, with the most common fatal reactions secondary to penicillins, iodinated contrast material (ICM), and hymenoptera stings. Limited studies point to upper airway obstruction and circulatory collapse as the causes of death in man. It is felt that the frequency of cardiovascular involvement is not widely appreciated, and that hypotensive patients can be markedly hypovolemic. The primary goals of treatment should be aimed at preventing or reversing complications, and include immediate attention to the airway, cardiac monitoring, and establishment of intravenous access. The cornerstone of pharmacologic therapy is epinephrine. A comprehensive review of the pathophysiology, symptomatology, and treatment is presented.

Hepatic oil embolization following lymphangiography. A report of 12 cases

The authors report on 12 personal observations of lymphoportal fistulas, which represented 0.24% of their series of lymphographies. This rare complication of lymphography has no clinical or biological liver manifestations. Review of 71 cases in the literature confirmed that hepatic oil embolization only occurs when there are lymphatic masses, with or without associated thrombosis of the inferior vena cava.

Iodine-induced hypothyroidism and goiter following lipiodolTM lymphography

Hypothyroid goiter is a rare but well recognized complication following long term administration of iodine containing expectorants and disinfectants in children. Only few reports exist on iodine-induced hypothyroidism after a single injection of the iodized radiopaque dye Lipiodol. A 15-year-old boy with previously normal thyroid function is described who developed hypothyroid goiter within six weeks following bipedal lymphography. Urinary iodine excretion was extremely elevated up to 18 mg/day while serum concentrations of total thyroxine were below the euthyroid range and thyrotropin levels were elevated. After oral L-thyroxine treatment the goiter disappeared. Thyroid function remained normal when treatment was discontinued after five months although iodine excretion was still 50 times higher (2.5 mg/day) than in normal age matched children. The observed alterations of the thyroid gland were caused by a long lasting Wolff-Chaikoff effect with a delayed adaptation to high iodide concentrations.

Effect of lymphangiography on lymphedema

Lymphangiography, using oily radiopaque Lipiodol Ultra Fluid has been shown to increase lymphedema in one-third of the patients with obstructive lymphedema and to cause lymphatic obliteration (demonstrated histologically). No effective element has been observed, although subclinical infection could not be ruled out. Allergy is another possible contributor, but the evidence from this series suggests that Lipiodol may act as a direct irritant when it is not rapidly cleared, as in the case of obstructive lymphedema, and proceed to obliteration of the residual lymphatics. On the basis of these findings, elective routine preoperative lymphangiography for lymphedema is considered strongly inadvisable.

Fetal thyroid hyperplasia, rhesus isoimmunisation, and amniography

Thyroid hyperplasia was identified at necropsy in 16 of 70 cases of haemolytic disease of the newborn due to rhesus isoimmunisation dying in the years 1959--76. No hyperplasia was found in the thyroids from 140 nonrhesus-affected infants matched for date of birth, bodyweight and length, and gestation, or in cases of haemolytic disease born before 1966. All 16 infants with thyroid hyperplasia had received intrauterine transfusions and the iodine-containing contrast media used for preliminary amniography were the only goitrogenic factors identified. Lipiodol, first used in 1966, was considered to have the greatest effect. The 16 infants with hyperplastic thyroids were less mature and smaller than 22 infants with normal thyroids who had been similarly exposed to contrast media. The high incidence of hyperplasia may be due to immaturity of the adaptive mechanisms which allow most normal individuals to escape the goitrogenic effects of iodine compounds.

[Changes following splenoportography or lymphography, respectively]

Lipidol deposits remaining in lymph nodes following lymphography evoke a tissue reaction of various degree. Most probably, the material injected during splenoportography may lead to storage phenomena in the reticuloendothelium of the liver.

[ECG signs of pulmonary embolism caused by lymphography injected contrast oil (author's transl)]

Authors have reported ECG signs of pulmonary embolism caused by lymphography injected contrast oil. Signs indicative of transitory right ventricular strain were observed in the ECG in 17 of 30 clinically symptom-free patients.