[Three (3) cases of advanced hepatocellular carcinoma (HCC) treated successfully by transcatheter arterial chemoembolization (TACE) using lipiodol and a fine- powder formulated cisplatin (DH)]

Although great advances have been made in therapies for patients with hepatocellular carcinoma(HCC), the prognosis for advanced HCC remains poor because liver transplantation is not applicable. We report three(3)cases of HCC treated successfully by transcatheter arterial chemoembolization(TACE)using a suspension of Lipiodol and a fine powder formulation of cisplatin(DDPH). Case No. 1 was a 64-year-old man with multiple HCCs who had undergone several sessions of TACE using doxorubicin(ADM). During the course of the treatment, the HCC became intractable and residual tumors were observed repeatedly within a short period. He was then treated by TACE using DDPH instead of ADM. The tumor marker levels decreased in response to this treatment and no recurrence of HCC has been observed. Case No. 2 was a 71-year-old man who had been diagnosed with multiple HCCs in 2004. He was treated by TACE with ADM, but the procedure had to be repeated more than three(3)times due to residual tumors. Despite the treatment, the tumor grew gradually and a formation of tumor thrombus was observed in the inferior vena cava. Both the tumor and tumor thrombus reduced in size after TACE with DDPH. Case No. 3 was a 52-year-old man who had been monitored diabetes mellitus and chronic hepatitis at our hospital. Multiple HCCs were diagnosed in 2006. TACE with DDPH was performed as an initial therapy. The tumors shrank or disappeared in response to this treatment. These results propose that TACE with DDHP against advanced HCC is effective.

Liquid embolisation material reduces the delivered radiation dose: a physical experiment

OBJECTIVE

To test a new hypothesis that the glue/contrast admixture used for embolisation reduces the dose delivered to AVMs using an experimental model.

METHOD

A model was created using a block of "solid water" (6 x 5 x 2 cm) with twelve wells of different depths. Different concentrations of the glue admixture (Enbucrilate + Lipiodol) were used. The model was irradiated using a 5MV beam with a clinical LINAC system and the dose was checked upstream and downstream. Dose was measured using Kodak XV film, a Vidar 16 bit film scanner and software for therapeutic film dosimetry measurements (RIT software).

RESULTS

The radiation dose varied with the distance beyond the glue solid water interface. For distances of 0, 2 and 5 mm to the film, the mean reduction was 13.65% (SD = 2.94), 6.87% (SD = 1.95) and 1.75% (SD = 1.14), respectively. There was also correlation with the Lipiodol concentration in the mixture. The maximum reductions for 80, 50 and 20% Lipiodol concentrations were 16.1% (SD = 1.32), 14.85% (SD = 0.98) and 10% (SD = 1.21), respectively. There was no correlation between the glue depth and the dose delivered.

CONCLUSION

The hypothesis that the glue mixture used for embolisation reduces the radiation dose delivered was experimentally confirmed with this study.

Radiofrequency ablation in a porcine liver model: Effects of transcatheter arterial embolization with iodized oil on ablation time, maximum output, and coagulation diameter as well as angiographic characteristics

AIM: To evaluate the effects of combined radiofrequency ablation and transcatheter arterial embolization with iodized oil on ablation time, maximum output, coagulation diameter, and portal angiography in a porcine liver model.

METHODS: Radiofrequency ablation (RFA) was applied to in vivo livers of 10 normal pigs using a 17-gauge 3.0 cm expandable LeVeen RF needle electrode with or without transcatheter arterial embolization (TAE) with iodized oil (n = 5). In each animal, 2 areas in the liver were ablated. Direct portography was performed before and after RFA. Ablation was initiated at an output of 30 W, and continued with an increase of 10 W per minute until roll-off occurred. Ablation time and maximum output until roll-off, and coagulated tissue diameter were compared between the 2 groups. Angiographic changes on portography before and after ablation were also reviewed.

RESULTS: For groups with and without TAE with iodized oil, the ablation times until roll-off were 320.6 ± 30.9 seconds and 445.1 ± 35.9 seconds, respectively, maximum outputs were 69.0 ± 7.38 W and 87.0 ± 4.83 W and maximal diameters of coagulation were 41.7 ± 3.85 mm and 33.2 ± 2.28 mm. Significant reductions of ablation time and maximum output, and significantly larger coagulation diameter were obtained with RFA following TAE with iodized oil compared to RFA alone. Portography after RFA following TAE with iodized oil revealed more occlusion of the larger portal branches than with RFA alone.

CONCLUSION: RFA following TAE with iodized oil can increase the volume of coagulation necrosis with lower output and shorter ablation time than RFA alone in normal pig liver tissue.

Temporal evolution of spinal cord infarction in an in vivo experimental study of canine models characterized by diffusion-weighted imaging

PURPOSE

To determine the temporal evolution of diffusion abnormalities of in vivo experimental spinal cord infarction.

MATERIALS AND METHODS

Guided by a digital subtract angiography (DSA) monitor, an agent of 1:1 match of lipiodol and diatrizoate meglumine was injected into bilateral T9-11 intercostal arteries of six dogs to embolize the spinal branches of intercostal arteries and establish the canine spinal cord infarction models. The progression of experimental spinal cord infarction was followed by dynamic MRI, including diffusion-weighted imaging (DWI) on a 1.5 Tesla MR system from one hour to 168 hours postembolization. Apparent diffusion coefficient (ADC) values were calculated and analyzed. At the end of the MRI experiments, the spinal cords of the animals were fixed for histology.

RESULTS

A total of six experimental models were successfully established. In all cases, DWI images showed slight hyperintensity within one hour postembolization, whereas only four cases presented slight hyperintensity on T2-weighted images. ADC values of spinal cord infarction lesions decreased rapidly at early stage (several hours to 24 hours) and then increased gradually.

CONCLUSION

The temporal evolution of diffusion abnormality of experimental spinal cord infarction may help us better understand various DWI signals in the process of spinal cord infarction.

Docetaxel labeled with iodine 131 radionuclide--a possible new anticancer drug? (The pilot study)

The cytotoxic potentials of the lipiodol emulsion with dissolved 131I-docetaxel, the 131I-lipiodol emulsion and non-labeled docetaxel were tested on the HeLa Hep2 cell line during 24 hours. The pilot study confirmed that the radio-labeled docetaxel was significantly more toxic than the radionuclide or docetaxel alone.

Lipiodol alters murine uterine dendritic cell populations: A potential mechanism for the fertility-enhancing effect of lipiodol

OBJECTIVE

To determine whether treatment with lipiodol alters the leukocyte population in the uterus.

DESIGN

Randomized controlled animal study.

SETTING

University research laboratory.

ANIMAL(S)

Sixty female Swiss white mice at proestrous.

INTERVENTION(S)

Infusion of the female reproductive tract with lipiodol versus infusion with saline versus sham treatment.

MAIN OUTCOME MEASURE(S)

Counts of uterine macrophages, dendritic cells, and total leukocytes assessed by immunohistochemistry.

RESULT(S)

No statistically significant differences were found in the mean number of total leukocytes or macrophages between the three treatment groups. The mean number of CD205+ dendritic cells showed a statistically significant decrease following lipiodol treatment compared with the sham treatment and saline treatment. The mean number of CD1+ dendritic cells showed a statistically significant increase following lipiodol treatment compared with the sham treatment.

CONCLUSION(S)

Intrauterine lipiodol infusion is associated with a change in the uterine dendritic cell populations in mice. This change may alter the uterine immune response to the fetus, leading to improved fertility.

Regression of Novikoff rat hepatocellular carcinoma following locoregional administration of a novel formulation of clofazimine in lipiodol

We report here that, clofazimine (CFZ) treatment (0.1-10 microM) led to inhibition of in vitro proliferation of hepatocellular carcinoma (HCC) cell lines Hep3-beta, HuH-7, HepG2, SKHEP-1, PLC/PRF-5 and Novikoff. A 24 h exposure of human HuH-7 cells to various concentrations of CFZ dissolved in lipiodol (CFZ-L 10-160 microM), followed by 4 days treatment with medium alone, also led to dose-dependant inhibition of post-treatment cell growth. In vivo, direct intratumoural and intrahepatic arterial injection (IHA) of CFZ-L led to profound inhibition of orthotopic growth of rat Novikoff liver tumours (P < 0.0001 and P < 0.005, respectively). On the contrary, daily oral administration of 150 mg/kg CFZ for 7 days, did not influence the rate of Novikoff tumour growth. Histological examination of rat tumours, revealed the presence of lipiodol in tumour cells, 7 days after treatment with a single IHA dose. Histopathology did not show any abnormality in liver, lung or bowel sections taken from animals 1 week after IHA administration of CFZ-L. Similarly, liver function tests were all normal compared to saline treated animals. Deoxynucleotidyl transferase-mediated deoxyuridinetriphosphate nick end-labelling revealed the presence of large numbers of apoptotic cells in the CFZ-L treated tumours. Thus, intraarterial administration of the highly lipophilic antiproliferative agent CFZ in lipiodol solution may represent an effective and yet safe strategy for the regional treatment of HCCs.

Synthesis and in vitro evaluation of the phenylboric acid derivative entrapped lipiodol in boron neutron capture therapy for hepatoma

BACKGROUND

Hepatoma, a common cancer in Taiwan, responds poorly to conventional therapies. Boron neutron capture therapy (BNCT) may provide a promising approach for hepatoma therapy. In this study, a pharmaceutical composition, phenylboric acid derivative entrapped lipiodol (PBAD-lipiodol), was synthesized and characterized. In vitro study was used for evaluation of PBAD-lipiodol for the BNCT of hepatoma.

MATERIALS AND METHODS

alpha Track observation was used to identify the boron compound in the TLC plate and to evidence the uniform distribution of boron in the PBAD-lipiodol. Inductively coupled plasma-atomic emission spectroscopy and neutron activation analysis were used to determine the concentrations of boron and lipiodol, respectively. Human hepatoma HepG2 cells were used for in vitro experiments. A Nomarski optical microscope was used to investigate the uptake of PBAD-lipiodol globules in individual hepatoma cells.

RESULTS

PBAD-lipiodol was stable in human serum. The boron source, PBAD, was uniformly distributed in PBAD-lipiodol. Many of the PBAD-lipiodol globules were internalized and retained in HepG2 cells, and the boron concentration of HepG2 cells reached 269 ppm after 72 hours of PBAD-lipiodol treatment.

CONCLUSION

In vitro studies revealed that PBAD-lipiodol could deliver a therapeutically effective amount of PBAD as a boron source for the BNCT of hepatoma. PBAD-lipiodol is a potential new boron drug for the BNCT of hepatoma.

Boron-lipiodol: a potential new drug for the treatment of liver tumors

BACKGROUND

Boron neutron capture therapy (BNCT) is a form of radiation therapy and has been proposed for the treatment of some malignancies with encouraging results. However, none of them has ever been applied to liver malignancy. The purpose of this study was to evaluate the potential of boron-lipiodol (B-lipiodol) for the treatment of VX2 liver tumor via BNCT.

MATERIALS AND METHODS

Twelve New Zealand rabbits were randomly separated into two groups: lipiodol and boron-lipiodol groups. The rabbits were anesthetized, a midline incision was made and the left lobe of the liver was injected with 0.1 ml of VX2 tumor cells. After the tumor reached 2-3 cm in diameter, the rabbits were anesthetized and 0.5 ml of boron-lipiodol was injected into the hepatic artery via an angiocatheter. Liver function tests and renal function tests were performed before, at 12 hours, 24 hours, 48 hours and 7 days after injection of drugs in both groups. The concentration of boron in various tissues was determined on the 7th day after injection.

RESULTS

Liver function was abnormal at 12 hours after injection, and then gradually returned to normal at 7 days, indicative of acute temporary hepatic damage. As for the renal function, no significant change was noted in either group. The boron level was 49.7 ppm in tumor and 6.31 ppm in the healthy liver 7 days after injection of B-lipiodol. The ratio of boron concentrations between the tumor and the normal liver tissue was 7.87. As for blood and other organs including spleen, heart and kidney, the concentration of boron was low. In the lipiodol group, the boron concentrations in tumor and various organs were low.

CONCLUSION

The high concentration of boron after intra-arterial injection of B-lipiodol can be used for neutron capture therapy. B-lipiodol has potential for the treatment of liver malignancy.

Hepatic intra-arterial injection of 1,25-dihydroxyvitamin D3 in lipiodol: Pilot study in patients with hepatocellular carcinoma

1,25-dihydroxycholecalciferol [1,25-(OH)2 D3] has been shown to have antiproliferative effects in a wide variety of cancer cell lines. In vivo studies, although often limited by the development of hypercalcemia, have also shown the potential usefulness of 1,25-(OH)2 D3 in inhibiting tumor growth. The potential usefulness of the drug has been hampered by the development of hypercalcemia. This pilot clinical study was designed to evaluate the preclinical results that have shown, locoregional administration of 1,25-(OH)2 D3 in lipiodol can prevent the development of hypercalcemia. Eight patients with refractory HCC were given a single intrahepatic arterial dose (50, 75 or 100 microg) of 1,25-(OH)2 D3 dissolved in 5 ml of lipiodol. Following this, for 4 weeks serum calcium, 1,25-(OH)2 D3, alpha-fetoprotein and a range of biochemical indices were monitored. While, in 3 patients the calcium levels exceeded the normal range, even at these extremely high doses, non of the patients developed grade 3 hypercalcemia. 1,25-(OH)2 D3 administration also led to transient stabilization of serum alpha-fetoprotein in these patients. The data obtained support the hypothesis that, in patients with HCC, locoregional delivery of 1,25-(OH)2 D3 in lipiodol can allow administration of supra-pharmacological doses of the drug without the development of hypercalcemia.

Changes in the microvascular architecture of colorectal liver metastases following the administration of SMANCS/lipiodol

BACKGROUND

Liver metastases are the major cause of death for patients with colorectal cancer. Surgical resection is at present the only curative option. Styrene maleic acid neocarzinostatin [SMANCS/Lipiodol (S/L)] targets the unique vascular architecture of tumor blood vessels, which are hyperpermeable and lack a well-developed lymphatic system. Here we report changes in the microvascular architecture of liver metastases by scanning electron microscopy (SEM) following the administration of S/L.

MATERIALS AND METHODS

Liver metastases were induced by the intrasplenic injection of dimethylhydrazine induced colon cancer cells in mice. In this model tumor angiogenesis occurs at day 10, while exponential tumor growth occurs at day 16. Changes in the tumor microvasculature were observed at 3 weeks following treatment with S/L at these time points by SEM of corrosion casts.

RESULTS

Tumors treated with S/L at day 10 appear similar to day 10 controls. Tumor vessels, 50 +/- 18 microm in diameter, are easily identified from hepatic vessels. Within the hepatic sinusoids are avascular spaces, 144 +/- 60 microm in diameter, which correspond to tumor cell aggregates at the initial stages of growth. Similarly, day 16 treated tumors appear comparable to day 16 controls. These vessels are narrower (84 +/- 32 microm vs. 150 +/- 70 microm) than their control counterparts. This is in contrast to vessels (216 +/- 36 microm in diameter) of a complex nature at 3 weeks.

CONCLUSIONS

S/L exerts a marked and immediate effect on the tumor microvessels at both the angiogenic and the exponential phases of tumor growth. This agent is effective at the microvascular level during inhibition of metastatic growth.

Increased cytotoxicity and stability of Lipiodol-pirarubicin emulsion compared to classical doxorubicin-Lipiodol: potential advantage for chemoembolization of unresectable hepatocellular carcinoma

There is no well-defined curative treatment for advanced and unresectable hepatocellular carcinoma. The widely used transarterial chemoembolization (TACE) with a doxorubicin-Lipiodol emulsion has not been shown to improve survival in randomized studies. Further, obstruction of the hepatic artery used in the procedure is badly tolerated in patients with cirrhosis. Drugs with a more rapid penetration into the cancer cells are likely to eliminate the need for obstruction of the hepatic artery. We therefore compared the cytotoxicity of another anthracycline pirarubicin with that of the commonly used doxorubicin. In this report, we show that pirarubicin has a greater in vitro cytotoxic effect than doxorubicin on the HepG2 and Hu-H7 human hepatoma cell lines. Pirarubicin emulsion with Lipiodol is more stable at 37 degrees C than doxorubicin-Lipiodol. Moreover, pirarubicin accumulates at a greater extent in the oil phase, permitting Lipiodol to act as a slow-releasing vector for the anthracycline. Further, amiodarone, a multidrug resistance inhibitor, was shown to decrease the intrinsic resistance of HepG2 and Hu-H7 cells to both anthracyclines, and the presence of polysorbate 80 in the amiodarone preparation increased the stability of the anthracycline-Lipiodol emulsions. We therefore conclude that pirarubicin is a better candidate for TACE than doxorubicin. The rapid and increased cytotoxicity of pirarubicin on hepatoma cancer cells and the stability of the pirarubicin-Lipiodol amiodarone emulsion could avoid the complete obstruction of the hepatic artery by Gelfoam sponges, and provide a better tolerated method of TACE in patients with latent liver insufficiency.

Simulation model based on non-newtonian fluid mechanics applied to the evaluation of the embolic effect of emulsions of iodized oil and anticancer drug

PURPOSE

To verify the difference in embolic effect between oil-in-water (O-W) and water-in-oil (W-O) emulsions composed of iodized oil and an anticancer drug, epirubicin, using a simulation model based on non-Newtonian fluid mechanics.

METHODS

Flow curves of pure iodized oil and two types of O-W and W-O emulsions immediately and 1 hr after preparation were examined with a viscometer. Using the yield stress data obtained, we simulated the stagnation of each fluid with steady flow in a rigid tube.

RESULTS

The W-O emulsions were observed to stagnate in the thin tube at a low pressure gradient. However, the embolic effect of the W-O emulsions decreased 1 hr after preparation. The O-W emulsions were stable and did not stagnate under the conditions in which the W-O emulsions stagnated.

CONCLUSION

The simulation model showed that the embolic effect of the W-O emulsions was superior to that of the O-W emulsions.

1,25-dihydroxyvitamin D3 dissolved in lipiodol produces a sustained antiproliferative effect in the human hepatoblastoma cell line HepG2

The steroid hormone 1,25-dihydroxyvitamin D3 [1,25-(OH)2D3] has potential to be used as an anti-tumor agent, but its clinical application has been restricted by the strong systemic calcemic activity. Regional administration of the drug dissolved in lipiodol, might be a way of selectively delivering high concentrations of the drug to lipiodol avid tumor cells without causing systemic side effects. In acute (1 day treatment) and chronic (5 days treatment) experiments, efficacy of the drug dissolved in ethanol (control) or lipiodol and subsequently diluted in the culture medium was tested in vitro against the hepatoblastoma cell line HepG2. Using [3H]thymidine incorporation and cell count, antiproliferative effects of 1,25-(OH)2D3 dissolved in the two different solvents was compared. Microscopic examination of cells exposed to the lipiodol containing media revealed intra-cellular presence of the oil in abundance. Chronic treatment of cells with either formulation of 1,25-(OH)2D3 resulted in profound inhibition of cell proliferation. However, exposure of cells to 1,25-(OH)2D3 in lipiodol was followed by significantly greater and lasting inhibition of cell proliferation in both acute and chronic studies. These results indicate that, 1,25-(OH)2D3 dissolved in lipiodol probably acts as a sustained release drug depot formulation, in which case it could have some potential for the regional treatment of liver tumors.

In vitro antitumor activity, intracellular accumulation, and DNA adduct formation of cis-[((1R,2R)-1,2-cyclohexanediamine-N,N')bis(myristato)] platinum (II) suspended in lipiodol

SM-11355, cis-[((1R,2R)-1,2-cyclohexanediamine-N,N')bis(myristato)] platinum (II), is a lipophilic platinum complex under clinical development that targets primary hepatocellular carcinoma using Lipiodol as a carrier. SM-11355 was compared with cisplatin (CDDP) using an in vitro evaluation system capable of examining the release characteristics and the cytotoxicity of drugs suspended in Lipiodol. SM-11355 suspended in Lipiodol (SM-11355/Lipiodol) and CDDP suspended in Lipiodol (CDDP/Lipiodol) showed cytotoxic activity against rat ascites hepatoma AH-109A cells in a dose-dependent manner. Their IC50 values following 7-day exposure were 22.3 and 0.40 microg/ml, respectively. Following the subsequent 7-day exposure, from day 7 to day 14 after preparation of the suspension, SM-11355/Lipiodol showed an almost equivalent activity, but CDDP/Lipiodol did not show any activity at all. SM-11355/Lipiodol showed a sustained release into the culture medium over the course of a 14-day exposure. Following the exposure to CDDP/Lipiodol, the platinum concentration in the medium was at its maximum on the first day and remained constant thereafter. Intracellular platinum uptake and formation of platinum-DNA adducts were dependent on the release characteristics of each drug suspension. For SM-11355/Lipiodol, the drug release, intracellular drug uptake, and formation of platinum-DNA adducts over the course of the subsequent 7-day exposure were similar to those observed during the first 7 days. DPC, one of the compounds released from SM-11355/Lipiodol, was taken up by cells and showed formation of platinum-DNA adducts. Thus, this study suggests that SM-11355/Lipiodol may release active platinum compound(s) that bind to nuclear DNA and mediate the cytotoxic activity of SM-11355/Lipiodol.

Lipiodol ultra-fluid: an antitumor agent-in vitro study

Lipiodol Ultra-Fluid (LUF), a contrast medium for the diagnosis and treatment of hepatocellular carcinoma (HCC), is used by hepatic intra-arterial infusion. Hepatoma cells are capable of active uptake of LUF and retaining it for prolonged periods of time. These characteristics have important therapeutic potential for the targeting of anticancer drugs and have lead us to form an intratumoral diffuser. But, before in vivo studies, we have investigated in vitro LUF effects on various cell species in order to explain and refine the lipiodol chemotherapy. The antiproliferative and cytotoxic effects of LUF on HepG2 (human hepatoma cells), MCF-7 (human breast cancer cells) murine macrophages and human hepatocytes, were assessed by Trypan blue exclusion and lactico-dehydrogenase extracellular tests. We demonstrated the dose and time-dependent antiproliferative and cytotoxic activities of LUF on cells. Cytotoxicity was different according to cells species, whether or not they had cancerous characteristics and phagocytosis function: this cytotoxicity was very significant on macrophages and was greater for cancerous cells than for human hepatocytes in primary culture. We showed in vitro, for the first time, that LUF was an antiproliferative and cytotoxic agent, because of its active uptake and selective retention which lead to cellular death due to necrosis by lipoperoxidation increase.

Retinoic acid-induced apoptosis is prevented by serum albumin and enhanced by Lipiodol in human hepatoma Hep3B cells

The effects of retinoic acid (RA) on the cell growth and viability of human hepatoma Hep3B cells were examined. We showed that removal of serum in the presence of RA results in cell death in a dose-dependent manner in human hepatoma Hep3B cells. Time-course cell death analysis showed that RA at a dose of 10 microM induces a rapid (48-72 h) fall in cell viability (>95%). The drug-induced cell death was RA-specific, since three RA analogs (retinol, retinal and retinol acetate) did not show any cytocidal activity at an equimolar dose. Fluorescence microscopy and DNA fragmentation analysis showed that Hep3B cells treated with RA underwent a death process highly reminiscent of apoptosis, with chromatin condensation, nuclear fragmentation and the presence of a 180-200 bp DNA fragment ladder. Additionally, we found that RA-induced apoptosis was reduced by 70-80% when the medium was supplemented with serum albumin (human and bovine) at a concentration of 0.05%. However, a variety of known growth factors were ineffective in preventing RA-induced apoptosis. Preincubating serum and serum albumin with Lipiodol restored the apoptotic effects of RA demonstrated in serum-free systems. These data suggest that the binding of RA by serum albumin may have reduced the bioavailability of RA, restricting its apoptotic effects on Hep3B cells. Blocking RA-albumin interactions with a lipid lymphographic contrast medium (Lipiodol) may improve the bioavailability of RA and significantly enhance its apoptotic effect on human hepatoma Hep3B cells.

Effect of arterial administration of a high molecular weight anti-tumor agent, styrene maleic acid neocarzinostatin, for multiple small liver cancer--a pilot study

To assess the efficacy of the zinostatin derivative, the anti-tumor agent, styrene-maleic acid neocarzinostatin, in treating multiple small liver cancers, 29 patients with multiple hepatocellular carcinoma of 3 cm or less in diameter were treated with intraarterial injections of this high molecular weight agent, mixed with Lipiodol. Computed tomography 3 months after the first therapy showed complete deposition of Lipiodol in the entire area of the original tumor in 8 patients (27.6%), 50%-99% deposition in 4 (13.8%), 10%-49% in 10 (34.5%), and less than 10% in 7 (24.1%). After repeated injections, Lipiodol deposition in the entire area of the original tumor was found in 11 patients (37.9%). The degree of Lipiodol deposition depended on the angiographic vascularity of the tumor and on the images of the computed tomogram during arterial portography. Although complete deposition of Lipiodol was found in all tumors in 10 (58.8%) of the 17 patients with well demarcated round hypervascularity, only 1 (8.3%) of 12 patients with ill demarcated tumors showed complete deposition of Lipiodol in the tumors. Taking into account that hypervascularity on angiograms was closely correlated with the degree of Lipiodol accumulation on computed tomograms taken later, it appears that well demarcated round-shaped liver cancer is the best candidate for styrene-maleic acid neocarzinostatin therapy.

Antitumor activity of zinostatin stimalamer (YM881) in human hepatoma cell lines and VX2 liver tumor-bearing rabbits

Antitumor activities of zinostatin stimalamer (YM881) were examined in human hepatoma cell lines (SK-Hep1 and HuH2) and VX2 liver tumor-bearing rabbits. YM881 inhibited the growth of human hepatoma cells in a dose-dependent manner. The IC50 values of YM881 causing a 50% inhibition of growth of SK-Hep1 and HuH2 cells were 6.7 and 27 nM, respectively. In VX2 tumor-bearing rabbits, administration of YM881 suspended in Lipiodol, an iodinated fatty acid ethylester of poppyseed oil, (YM881/Lipiodol suspension, 0.2 mg/0.2 ml/body) into the hepatic artery showed significant (p < 0.01, vs. sham-operated and Lipiodol-treated groups) inhibitory effects on tumor growth and histopathological changes at 1 and 2 weeks after administration. In contrast, Lipiodol (0.2 ml/body) tended to inhibit the growth of VX2 tumor (p < 0.1, vs. sham-operated group) at 1 week after administration, but showed only moderate effects at 2 weeks after administration. Minimal necrosis was observed at 1 and 2 weeks after administration of Lipiodol, and histopathological findings were similar to those in the sham-operated group. From the present study, it is suggested that YM881/Lipiodol suspension showed antitumor activity in VX2 tumor-bearing rabbits presumably due to the inhibition of the growth of hepatoma cells by YM881 itself. Lipiodol, on the other hand, is considered to augment the antitumor activity of YM881 by maintaining high YM881 concentrations in tumor tissue.

Human liver cancer cells and endothelial cells incorporate iodised oil

Iodised oil (lipiodol) administered via the hepatic artery localises selectively in primary liver cell cancers (hepatocellular carcinomas or HCCs) for prolonged periods and has been used as a vehicle for cytotoxic agents. Despite clinical use, the mechanism of lipiodol retention by tumours has remained unclear, embolisation of oil droplets in the tumour vasculature being the prevailing hypothesis. We have investigated the role of tumour and endothelial cells in lipiodol retention. Human liver tumour (Hep G2) cells and human umbilical vein endothelial cells in culture were exposed to lipiodol. Light microscopy using selective silver impregnation stains and transmission electron microscopy revealed lipiodol incorporation by both cell types, probably by pinocytosis. This was not associated with cellular injury in terms of cell lysis, cell replication or radio-labelled leucine uptake. Histological analysis of 24 HCCs either surgically resected or discovered incidentally at liver transplantation (with prior arterial injection of lipiodol) revealed vesicles of lipiodol in the cytoplasm of tumour cells and endothelial cells lining tumour vessels. Thus, lipiodol is likely to deliver cytotoxic agents directly into tumour cells and endothelial cells, both in vitro and in vivo. This may also apply to other lipids and to other human tumours. These findings have significant therapeutic implications.

Study on hepatic artery chemoembolization using temperature-sensitive liposome or lipiodol emulsion

As a novel method for the medical application of liposomes, we have tried hepatic artery chemoembolization using temperature-sensitive liposomes with hyperthermia for the treatment of hepatic tumors. In this study, the effect of temperature-sensitive liposomes was compared with that of Lipiodol emulsion, which has been used clinically. The temperature-sensitive liposomes, consisting of dipalmitoylphosphatidylcholine or Lipiodol emulsions entrapping doxorubicin, were administered into the hepatic artery of hepatic tumor-bearing rats via a cannula. Doxorubicin administered in a liposomal form showed a high accumulative property toward tumors, with heating, while that in the emulsion form showed a slow release property toward tumors. Not only was tumor growth inhibited, but also, an actual diminishing of the tumor was observed in each form. Side effects were also examined: an abnormal rise in GPT, or necrosis of the normal tissues in liver, which was often observed in hepatic artery chemoembolization using Lipiodol emulsion, was remarkably reduced in the liposomal chemoembolization.

Circulatory alterations induced by intra-arterial injection of iodized oil and emulsions of iodized oil and doxorubicin: experimental study

PURPOSE

To evaluate circulatory alterations induced by intra-arterial injection of iodized oil and emulsions of iodized oil with an anticancer drug.

MATERIALS AND METHODS

The viscosities and stability were evaluated in arterial flow of iodized oil and the emulsions. Doppler ultrasound was used to quantify the embolic effect in the arteries of rabbits. The behavior of doxorubicin and iodized oil in the rat cremaster muscle was studied with videomicroscopy.

RESULTS

The emulsions did not break up after injection, and the size of discontinuous-phase droplets did not change. The embolic effect did not correlate with viscosity. The thinnest water-in-oil emulsion had the lowest embolic effect and induced homogeneous distribution of iodized oil droplets in the arterial tree.

CONCLUSION

Changes in the formulation of emulsions obtained with the same proportions of drug and iodized oil change the distribution of iodized oil in the arterial tree, the location at which the drug is released, and the embolic effect.

Role of Kupffer cells in iodized oil embolization

RATIONALE AND OBJECTIVES

Iodized oil is a common oily embolic agent used in chemoembolization for treating hepatic tumors. However, how the iodized oil is cleared from the liver has been an unsettled and controversial issue. In this study, the authors attempt to clarify whether Kupffer cells are involved in the clearance of iodized oil and to evaluate the effect of hepatic arterial injection of iodized oil on the functional status of Kupffer cells.

METHODS

Iodized oil was injected into the proper hepatic artery in 42 Fischer 344 rats. In vivo microscopy was performed immediately after and 1, 3, 7, 15, 30, and 60 days after injection. Electron microscopy was performed after in vivo microscopy.

RESULTS

Kupffer cells actively captured and phagocytosed iodized oil droplets in the hepatic circulation. The number and functional status of Kupffer cells in the liver were significantly increased after the injection of the iodized oil and returned to normal when the liver was cleared of the oil.

CONCLUSIONS

Kupffer cells play an important role in clearing iodized oil from the liver. Iodized oil activates the immune defense system in the liver, which may have a synergistic effect in tumor treatment.

I-131-lipiodol cytotoxicity in hepatoma cells

Hepatoma is a common cancer in Taiwan. New effective treatment for hepatoma patients is urgently needed. Encouraging results of I-131-lipiodol treatment for hepatoma with minimal toxicity have been recently reported. The mechanism of lipiodol targeting and retention by hepatoma are not well understood. The cellular interaction of lipiodol and the cytotoxic effects of I-131-lipiodol on hepatoma cells were investigated in this study. HepG2 cells were cultured with lipiodol, and untreated HepG2 cells were used as the control. Changes of cellular morphology were accessed by light and electron microscopy. The uptake and retention of lipiodol by HepG2 cells were studied by phase contrast microscopy and neutron activation analysis. HepG2 cells were cultured with I-131-lipiodol varying from 0.12 microCi to 120 microCi. The cytotoxic effect of I-131-lipiodol was evaluated by the surviving fraction of HepG2 cells. Changes in cellular morphology was examined by light microscopy. Results indicated that HepG2 cells were capable of active uptake of large amounts of lipiodol by endocytosis and prolonged intra-cellular retention associated with the formation of many bulging cytoplasmic extensions. I-131-lipiodol was highly cytotoxic to HepG2 cells. There was a steep dose response relationship, and the effective dose (LD50) was 1.2 microCi (480 rads). The cytotoxic effects of I-131-lipiodol were associated with pleomorphism of HepG2 cells, an increase in cell size and nuclear-cytoplasmic ratio, an increase in the size and number of nuclei, and vacuolation of the cytoplasm around the nuclear regions. Multiple nucleoli, fragmentation and segregation and ring shaped changes of nucleoli were also observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of an oil contrast medium on fertilization in the oviduct in rabbits

The influence of an oil contrast medium on fertilization in rabbit oviducts was investigated. The oil contrast medium (Lipiodol-UF) was injected into the catheterized oviducts of anaesthetized animals, and they were mated 1, 3, 5 or 7 days later. When mating took place 1 day after injection, none of the ova that were subsequently recovered were fertilized; the fertilization rates when mating occurred 3, 5 or 7 days after injection of the medium were 78.9, 90 and 100%. Fertilization within the oviduct was, thus, impaired by the injection of oil contrast medium, but appeared to be fully recovered 7 days later.

Morphology of in vitro sperm phagocytosis by rat peritoneal macrophages under influence of oily contrast medium (Lipiodol)

Morphology of sperm phagocytosing rat peritoneal macrophages (PM) in control and Lipiodol added cultures was evaluated under light as well as scanning electron and transmission electron microscopes. The spermiophagic index (SPI) was assessed to estimate an inhibitory effect of Lipiodol on sperm phagocytosis to be compared with the outcome of morphological studies. Lipiodol inhibits in vitro sperm phagocytosis as indicated by SPI and evaluation under light, scanning electron and transmission electron microscopes. The highest SPI was seen in control cultures (14.44), declined in cultures with 0.25% and 0.5% Lipiodol (3.3 and 3.02 respectively) to reach the lowest value with 1% Lipiodol (1.60). The macrophages in cultures with Lipiodol were covered by a thin layer of oily contrast medium. The layer produced changes in the macrophages' shape and the cytoplasmic surface configuration. Lipiodol hinders both sperm phagocytosis and movement of PM by altering their shape and impairing pseudopodia and protrusions formation. Morphological studies of sperm phagocytosis by PM can help explain therapeutic effects of oily contrast media used in hysterosalpingography. Number of studies have suggested therapeutic effects of hysterosalpingography (HSG). These studies have demonstrated an increase in pregnancy rates after HSG in previously infertile women (Fullenlove, 1969; Palmer, 1960). Pregnancies were even more numerous after applying oil, than water based contrast media (DeCharney et al., 1980; Schwabe, 1983). Sawatari et al., 1993 have lately shown, that Lipiodol significantly increases pregnancy rates in animals. Hypothesis has been put forward as to the possibility of modulating activity of these agents exerted upon the peritoneal and oviductal macrophages (Boyer et al., 1986; Schwabe et al., 1983).(ABSTRACT TRUNCATED AT 250 WORDS)

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.

Segmental transcatheter hepatic artery chemoembolization with iodized oil for hepatocellular carcinoma: antitumor effect and influence on normal tissue

PURPOSE

Segmental transcatheter arterial embolization (TAE) with use of iodized oil mixed with an anticancer drug, followed by injection of gelatin sponge particles, was undertaken to evaluate its antitumor effect and its influence on normal tissue in patients with hepatocellular carcinoma (HCC).

PATIENTS AND METHODS

Histologic findings in 12 patients who underwent hepatectomy after segmental TAE were compared with findings on plain radiographs and computed tomographic (CT) scans. Visualization of the portal veins contiguous to the tumor on radiographs and the pattern of iodized oil accumulation in the tumor and vicinity on CT scans after TAE were assessed.

RESULTS

Complete necrosis of the tumor was achieved in 10 cases (83%), while complete necrosis of daughter nodules and capsular invasion was observed histologically in eight of these 10 patients (80%). The degree of tumor necrosis correlated with the pattern of iodized oil accumulation in and near the tumor. Partial necrosis of normal tissue near the tumor correlated with accumulation of iodized oil.

CONCLUSION

Segmental TAE may be an excellent therapeutic method for treatment of HCC that is localized in one or a few segmental or subsegmental regions.

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.

[Experimental study on the effect of injection with anticancer agent-oil suspension]

Local injection of an anticancer agent guided by endoscopy is thought to be effective for cancerous lesion associated with lymph node metastasis, if the anticancer drugs are drained into the lymph nodes. In the experimental study, anticancer drug-oil (nimustine-Lipiodol) (N-L) suspension (5 mg/ml) was injected into the tumor (Lewis lung cancer) that had been implanted sub dorsally in mice (57 black/6 mice) for the purpose of finding out the antitumor effect on the primary lesion. Then it was injected into sarcoma-180 that had been implanted into hind feet of mice (ICR mice) for the purpose of finding out the antitumor effect on metastatic lymph nodes. The results showed that the N-L suspension was effective for the primary cancerous lesion and metastatic lesions.

[Enhancement of selective drug accumulation and retention in normal and regenerating liver by the use of lipiodol in portal venous infusion in rats]

We studied selective accumulation and retention of lipiodol (LP) and anticancer agents in normal and regenerating liver tissue following portal infusion in rats. Total concentration of Aclarubicin (ACR) and its metabolites in liver tissue was higher in ACR + LP portal infusion group than in ACR portal infusion group both in normal and regenerating liver, concentration of active metabolites of ACR was higher in ACR portal infusion group than in ACR peripheral infusion group. Much higher concentration was found in ACR + LP portal infusion group. Histologic examination revealed more toxic effect on regenerating liver in ACR portal infusion group than in ACR + LP portal infusion group. Oil red staining demonstrated the retention of lipiodol more than 7 days following intraportal infusion in regenerating liver tissue. This study confirms that the ACR + LP portal infusion induces selective accumulation and long-term retention in normal and regenerating liver tissue, and may enhance the antitumor effect of drugs.

Mitomycin C and lipiodol do not improve the effect of intermittent hepatic artery occlusion on liver tumour growth. An experimental study in the rat

The effect of Mitomycin C (MMC 2.0 mg/kg bw), lipiodol (0.2 ml/kg bw) and intermittent hepatic artery occlusion on liver tumour growth, as well as their possible interrelation, were studied in 29 rats. An adenocarcinoma was inoculated in the left liver lobe. After one week, the tumour size was measured and the rats then divided into five different groups of treatment. Intermittent hepatic artery occlusion was performed during five days for 1 hour daily alone, of initially in combination with MMC and lipiodol. One group was treated with MMC and lipiodol in combination and one group with lipiodol only. The tumour growth six days later was compared between the groups and with control rats. It was found that intermittent arterial occlusion significantly reduced the tumour growth (P = 0.01). However, the retarding effect of intermittent arterial occlusion on tumour growth was not significantly improved with additional treatment of MMC and lipiodol.

Pharmacokinetics and toxicity of intraarterial adriamycin for hepatocellular carcinoma: effect of coadministration of lipiodol

To determine the effect of coadministration of lipiodol on the pharmacokinetics and systemic toxicity of intraarterial Adriamycin in patients with hepatocellular carcinoma, nine patients were studied in detail. Each received two courses of a bolus injection of Adriamycin (60 mg/m2), in one of which the Adriamycin was mixed with 10 ml of lipiodol. Analysis of the paired data, and additional 'non-paired' data from a further seven patients, showed that there was no significant difference in the area under the concentration-time curve for Adriamycin or adriamycinol or, in the case of Adriamycin, the terminal half-life. Likewise the fall in haemoglobin concentration, white cell count and platelet count following treatment, and the degree of nausea and vomiting were not significantly different. Comparison with a series of 12 patients receiving intravenous Adriamycin, in the same dose schedule, revealed no difference in terms of pharmacokinetic parameters or toxicity with intraarterial administration of Adriamycin, with or without lipiodol.

Irresectable hepatoma treated by intrahepatic iodized oil doxorubicin hydrochloride: initial results

In this study we describe the investigation and treatment of 14 patients with primary hepatocellular carcinoma. Patients were treated with intra-arterial infusion of iodized oil and doxorubicin hydrochloride. Five of these patients were alive after 1 year. Twelve patients showed a fall in alpha-fetoprotein, and in seven of these patients, the fall in alpha-fetoprotein was greater than 50%.

Effects of iodinated fatty acid ester on human hepatocellular carcinoma cells

The interaction between Lipiodol and cells was studied by treating Lipiodol in a human hepatocellular carcinoma cell line(Hep) and mouse fibroblast cell line (L929). Irregular, sustained radioactivity was released from both cell lines shortly after incubation in the radioiodinated Lipiodol mixed media. Lipiodol droplets were found to be firmly attached to the cells following the incubation and these cells were strongly positive for fat stains. The radioiodinated Lipiodol demonstrated the same behavior of accumulation within the cell and on the cell membrane. Although the amount of Lipiodol attached was almost equal in both of the cell lines, the final amount accumulated in the cells was larger in the Hep cells. The accumulation of Lipiodol within the cell and on the cell membrane may play a significant role for its selective targeting and its prolonged retention in the solid tumor.

Effects of intra-arterial chemotherapy with a new lipophilic anticancer agent, estradiol-chlorambucil (KM2210), dissolved in lipiodol on experimental liver tumor in rats

Anticancer effects and biodistribution of a new lipophilic anticancer agent, estradiol-chlorambucil (KM2210), dissolved in lipiodol (LPD) were investigated as an intra-arterial chemotherapy (IAC) on Walker 256 carcinosarcoma grown in the liver of 136 Wistar rats. All rats treated with KM2210 (10 mg)-LPD survived for 90 days after administration, whereas none of the rats with LPD alone were alive for more than 19 days. Histological examination revealed that there was no viable tumor cell in the encapsulated necrotic tumor at 21 days after administration. There was no significant liver dysfunction or leukopenia due to KM2210. The biodistribution study using [14C, 3H]KM2210-LPD solution showed that KM2210 accumulated selectively in tumor and that the tumor-to-normal-liver and tumor-to-blood ratios were 10 and 1,000, respectively, at 21 days after administration. These results suggest that KM2210 has potential clinical application in the treatment of human liver cancer.

[Effect of the portal vein injection of cisplatin and lipiodol on rat liver]

The purpose of this study was to elucidate the efficacy and safety of cisplatin powder, suspended in lipiodol, as a means for the treatment of liver cancer by injection into the portal vein. The effects of lipiodol (0.1 ml. 0.2 ml. 0.3 ml. 0.4 ml) alone, as well as that of cisplatin powder (1.0 mg) suspended in lipiodol or saline (0.1 ml), on the liver, was investigated by administration of them into the portal vein in 100 normal Wistar rats. The results revealed that the hepatic cells were moderately affected by a small amount of lipiodol alone, but a large amount of lipiodol caused multiple anemic infarctions in the peripheral area of the liver. And, also the injection of cisplatin powder suspended in lipiodol, compared to that suspended in saline, resulted in higher concentration of platinum in the liver. Histologically severe degenerative changes were also perceived in the liver, but these changes were reversible. These results suggest that cisplatin powder suspended in lipiodol is to be used for the treatment of liver cancer.

Experimental investigation of a new iodinated lipid emulsion for computed tomography of the liver

Iodinated lipid emulsions are highly efficient macrophage imaging agents. Nevertheless, none of them has been accepted for clinical use because of adverse reactions. We have tested a new iodinated lipid emulsion, Intraiodol. The size and surface properties of the particles of this emulsion are similar to those of Intralipid which in turn closely resemble the naturally occurring chylomicrons. Using computed tomography (CT) of the rabbit liver as well as vital microscopy and electron microscopy of the rat liver we found that Intraiodol has low efficiency as a liver-specific contrast medium because its particles are predominantly taken up by the hepatocytes and to a less extent by the Kupffer cells, as is Intralipid. The low efficiency of Intraiodol could be fully compensated by an increase in dosage without any significant effect on sinusoidal blood flow. This in turn suggests that the likelihood of release of toxic mediators (and thereby related adverse reactions from activated macrophages) is reduced. We believe that this new way of delivering iodinated lipid particles to the liver represents an important advance in the search for a non-toxic lipid emulsion for CT of the liver.

Adriamycin-lipiodol suspension for i.a. chemotherapy of hepatocellular carcinoma

Physicochemical properties of two types of adriamycin preparation, suspensions and emulsions prepared for i.a. chemotherapy of hepatocellular carcinoma, were investigated. A suspension was prepared by dispersing adriamycin directly into the lipid contrast medium, Lipiodol, whereas an emulsion was obtained by emulsifying an aqueous solution of adriamycin into Lipiodol. The dispersibility of the drug in each preparation was examined microscopically. The chemical stability of and drug release from the preparation were determined by high-performance liquid chromatography and spectrophotometry, respectively. The suspension was then given to ten patients with primary hepatocellular carcinoma. The suspension maintained good dispersibility without coagulation of drug particles, whereas coalescence of aqueous droplets and the resultant phase separation occurred 4 h after preparation of the emulsion. Both preparations maintained the initial drug content for at least 1 week at room temperature. The release of adriamycin was more prolonged in the suspension than in the emulsion. After i.a. administration of the suspension, a selective accumulation of Lipiodol in the tumor and decrease in serum alpha-fetoprotein (AFP) levels were found in most patients. A significant amount of adriamycin was still detected in hepatic specimens resected from two patients 1 and 2 months after treatment. These findings suggest that the adriamycin-Lipiodol suspension may be a useful preparation for targeting chemotherapy to hepatocellular carcinoma.

[Effect of lipiodol emulsion and local hyperthermia on hepatic tissue blood flow in rabbits with VX-2 liver tumor]

The effect of intra-arterial infusion of lipiodol-emulsion and local hyperthermia on tissue blood flow was examined in experimental hepatic tumor and normal liver of rabbits. VX-2 tumor was implanted in liver of rabbit. The tissue blood flow was estimated by hydrogen gas clearance method when the tumor grew to about 2 cm. Tissue blood flow in tumor (64.5 ml/min/100 g) was significantly less than in normal liver (90.8 ml/min/100 g) (p less than 0.005). The intra-arterial infusion of lipiodol-emulsion did not alter the flow in either tissue. However, the addition of hyperthermia induced a substantial rise of tissue blood flow in normal liver (35% increase, from 93.8 to 127 ml/min/100 g) when compared with in VX-2 tumor (8.9% increase, from 65.1 to 71.8 ml/min/100 g). These were accompanied by a selective heating of liver tumor; the tumor temperature rose to 43 degrees C, although that of normal liver remained at 38 degrees C. Our results suggested that a specific temperature rise of liver tumor after infusion of lipiodol-emulsion and local heating might be related to a different response of microcirculation in tumor and normal liver to the hyperthermia.

Experimental sialography: the effects of retrograde infusion of radiographic contrast media on salivary gland morphology and function. A review article

An experimental model for sialography, involving retrograde infusion of contrast medium into the rat submandibular gland under continuous pressure monitoring, was developed. Morphologic alterations induced during infusion of water- and lipid-soluble radiographic contrast media and the distribution of the media were examined with light and electron microscopy. An uneven distribution of the media throughout the tissue and variations in the degree of the alterations in different parts of the gland were seen at all stages of filling. The changes primarily consisted of dilation of the luminal system, which successively became more pronounced as infusion continued. Infusion of the lipid-based medium consistently resulted in more severe alterations, including changes in the acini. Tracer studies showed that the water-soluble medium leaked out through the intercellular spaces and to the surrounding tissue, whereas the lipid-based medium appeared to be confined to the luminal space. Ductal filling with either medium resulted in a relatively fast recovery; after prolonged infusion, recovery was slower and additional alterations occurred. The acini showed confluence of secretory granules and vacuole formation. After infusion of the lipid-based compound, autophagic vacuoles and granulomatous alterations developed. Prolonged infusion with either medium resulted in atrophy of the parenchyma and connective tissue proliferation in some glands. An inflammatory infiltrate was present in all glands during the recovery period. Functional alterations, primarily consisting of a decrease in flow rate, were noted after prolonged infusion. The increase in intraluminal pressure induced during infusion was most likely the primary cause of the alterations. In addition, the presence of contrast medium contributed to the long-term effects of the procedure.

The iodine status of grazing sheep as monitored by concentrations of iodine in milk

The iodine nutrition of grazing ewes was assessed from milk iodine concentrations. In 54 flocks sampled throughout Victoria, the mean milk iodine concentrations in ewes ranged from 79 to 1831 micrograms/l. In 2 flocks where newborn lambs had goitre the concentrations in ewes ranged from 45 to 98 micrograms/l. A marked seasonal variation was apparent when ewes in a flock were sampled at monthly intervals over 2 years. Milk iodine concentrations were highest at the end of summer, and were lowest in spring. In grazing ewes the milk iodine concentrations remained relatively constant throughout the day. In ewes given single oral doses of up to 2 mg iodine, milk iodine concentrations increased to maximum within 5 h, the increment being related to the dose administered, and decreased to pretreatment concentrations within 24 h. Milk iodine concentrations in ewes given 1 ml iodised oil intramuscularly remained significantly higher than untreated ewes in the same flock for 16 months after treatment. The effectiveness of the single injection was still apparent after 2 consecutive pregnancies in the ewes.

Saliva secretion from the rat submandibular gland after retrograde infusion of radiographic contrast media

Rat submandibular saliva was collected at various times after retrograde infusion of water-soluble (Renografin 60%) or lipid-soluble (Lipiodol UF) radiographic contrast medium. Significant alterations in flow rate occurred following heavy parenchymal filling with both types of contrast media. Occasional changes in protein concentration, lactoperoxidase activity, and K+ levels were also noted. These changes were relatively mild and transient, and gland function had generally returned to normal by one wk after infusion. No alterations in glandular function were detected after infusion of contrast medium to a degree (ductal filling) comparable to that usually employed in clinical sialography.

[Effect of x-ray contrast media on the blood coagulation and fibrinolysis systems]

The intravenous application of x-ray contrast media during arteriographies resulted in a small, statistically significant, however clinically and biologically not relevant prolongation of the thromboplastin time and of the thrombincoagulase time. Contrast media applied for the examination of the kidneys and of the gall bladder did not induce any comparable changes of coagulation parameters. In vitro addition of iodinated contrast media to citrated plasmas was inhibitory to the coagulation process. Further analysis demonstrated that contrast media did not influence coagulation by enzyme inhibition but by inhibition of fibrin polymerization. Euglobulin lysis time was not only shortened by diagnostic applications of contrast media but also by other diagnostic procedures (gastroscopies, rectoscopies, laparoscopies) which involved physical exercise and thereby activation of the fibrinolytic system. Finally it is discussed that thrombotic complications following angiographies might be induced by the punction and injury of the vessel with the liberation of thrombokinase and subendothelial collagen.

Hypothyroidism in an area of endemic goiter and cretinism in Central Java, Indonesia

In an area of severe endemic goiter in Central Java, Indonesia, clinical overt or mild hypothyroidism appeared to be present in 7 out of 20 cretins and also in 12 out of 94 non-cretinous subjects, all 5-20 years of age, living in the village of Sengi. Hypothyroidism was not found in a control group of 70 subjects of the same age living in Londjong just outside the edemia. In hypothyroid subjects the plasma PBI-concentration was 0.98+/-0.32 mug/100 ml (mean+/-SD) vs. 2.72+/-1.24 mug/100 ml in euthyroid subjects from Sengi and 4.86+/-0.80 mug/100 ml in controls from Londjong. Values for T3 were 56.3+/-3.17 ng/100 ml in hypothyroids, 140.5+/-38.5 ng/100 ml in euthyroids from Sengi and 121.6+/-27.4 ng/100 ml in controls. The TSH levels (geometric mean and range) in these 3 groups were, respectively, 210.1 (108.0-342), 15.6 (3.0-372) and 4.1 (0.8-7.0) muU/ml. The differences between the mean concentration of PBI, T3 and TSH in the hypothyroid and euthyroid groups were highly significant (P less than 0.001). These data strengthen the clinical diagnosis of hypothyroidism in cretins as well as in non-cretinous subjects. All hypothyroid subjects had a PBI less than 1.8 mug/100 ml and T3 less than 120 ng/100 ml and TSH greater than 100 muU/ml. In 8 hypothyroid subjects, restudied 18 months after iodized oil injection, hypothyroidism was either corrected or markedly improved. It therefore appears that iodine deficiency per se in postnatal life may lead to (juvenile) hypothyroidism, which can be corrected by iodine therapy. Our findings have implications for the definition and diagnosis of endemic cretinism. Not all hypothyroid subjects in an area of endemic iodine deficiency should be classified as cretins.

The effect of iodized oil on the TSH response to TRH in endemic goiter patients

The TSH and T3 response to synthetic TRH was evaluated in 4 groups of patients: normal controls and goitrous subjects from the urban area of Sao Paulo (urinary iodine excretion: 172.2 +/- 48.3 mug I/g creatinine) and nongoitrous and goitrous subjects from the endemic areas of Sao Bento (urinary iodine excretion: 53.8 +/- 17.1 mug I/g). Plasma T4 and T3 were within our normal range in all groups of patients. The mean plasma TSH was significantly higher (5.2 +/- 3.3 muU/ml) in goitrous subjects living in Sao Bento as compared to normal control groups both in urban or endemic areas, and after TRH these patients had an exaggerated and sustained TSH response with a significantly higher peak level (21.1 +/- 7.9 muU/ml). T3 concentration rose in all subjects following TRH and all patients from the Sao Bento endemic areas had a significantly higher proportionate increase in plasma T3 at 120 min. After an injection of iodized oil basal plasma TSH returned to the normal range in the goitrous subjects from Sao Bento. The mean peak TSH response to TRH was 9.1 +/- 3.8 muU/ml at 3 months after the iodized oil injection, and only at 6 months after the iodized oil TSH response was significantly reduced (peak level: 6.1 +/- 2.4 muU/ml). It is confirmed that plasma TSH levels are increased in endemic goitrous patients but not in normal controls living in the same endemic area and it is suggested that the pituitary threshold for inhibition of secretion of TSH by T4 and T3 has been reset in these goitrous subjects to achieve a persistently higher secretion rate of TSH.

Immunosuppressive effect of intra-lymphatic irradiation

The effect of intra-lymphatic administration of Lipiodol-l131 on the number of T and B lymphocytes, and on the in vivo response to common antigens and to DNCB, was investigated in uremic patients in the pre-transplant period. T lymphocytes have been detected by rosette formation with sheep erythrocytes (E) and B lymphocytes by rosette formation with erythrocytes sensitized with antibody and complement (EAC). After irradiation it was observed a lymphopenia due to a statistically significant decrease in the number of both T and B peripheral blood lymphocytes and a depletion of these cells in the irradiated lymph nodes. Their ability to give delayed hypersensitivity response to common antigens in vivo was lost after intralymphatic irradiation. Two patients were able to develop sensitization to DNCB and this reaction was supressed in one of them by irradiation. These effects of intralymphatic irradiation on the immune system favours further study of this method in clinical renal transplantation.