[The effect of the dispersion medium on the stability of an aqueous suspension of propyliodone].
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Contrast Media↗
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Evaluation of contrast media for bronchography.
BACKGROUND: Bronchography is occasionally needed for the evaluation and management of some congenital pulmonary anomalies as well as some acquired diseases, usually of the tracheo- bronchial tree. There is currently no effective, approved contrast agent for this imaging techniq ue. OBJECTIVE: We evaluated five agents (barium sulfate, iohexol, propyliodone oily, propyliodone aqueous, and perflubron) in terms of image quality, histologic changes, and effects on hemodynamics, blood gases, and standard laboratory tests in New Zealand White rabbits. MATERIALS AND METHODS: Animals were anesthetized and intubated. Each contrast agent (0.25 ml/kg) was administered intratracheally. Three animals in each group had intravenous lines placed for blood sampling and blood pressure monitoring and were sacrificed at 1 h. An additional three animals for each agent were sacrificed at 24 h and 1 week after imaging. Blood samples were taken immediately before contrast instillation and at 1 h postbronchography. Fluoroscopic images were recorded on standard VHS video tape and evaluated in blind fashion. Segments of lung tissue and bronchi were obtained for histologic examination. RESULTS: Necrosis and/or inflammatory infiltrates were noted in 78 % of the bronchograms performed with propyliodone aqueous, 67 % with propyliodone oily, 55 % with perflubron, and 33 % with iohexol 120, 240 and 350. No histologic damage was observed with barium. The propyliodones gave the best-quality imaging results and the most histologic changes. Iohexol, in any concentration, gave the least acceptable images and a moderate number of histologic changes. Barium sulfate demonstrated acceptable images with virtually no histologic changes. CONCLUSION: From the histologic and imaging results, barium is the best available contrast material for bronchography.
Animals↗
Interference of bronchographic agents with lung surfactant.
Dionosil Oily (a suspension of propyliodone crystals in peanut oil and powdered tantalum were introduced into the right principal bronchi of rabbit lungs. The left lungs were used as controls. Pressure-volume characteristics of excised lungs with Dionosil Oily or peanut oil demonstrated significantly reduced compliance on inflation at a pressure of 3-4 cm H2O. These lungs also retained less air on deflation and therefore demonstrated a significantly reduced stability index. Histological sections revealed microatelectasis closely associated with crystals and/or peanut oil. Lungs with tantalum powder were not measurably influenced by the bronchographic agents. Surface balance experiments with lung surfactant and synthetic dipalmitoyl phosphatidylcholine (DPPC) demonstrated an increased minimum surface tension due to the oil suspension of propyliodone, peanut oil and particles (propyliodone and tantalum). There is good evidence that the oil suspension of propyliodone reduced the surface activity of lung surfactant in situ. Particles also may prevent the minimum surface tension from reaching relatively low values if they enter the alveoli in sufficient quantities.
Animals↗
[Survey of the state of bronchography in Japan].
Bronchography is not routinely done. We analyzed the state of bronchography with questionnaires returned from 57 hospitals. Bronchography is now done at 30 hospitals. The number done in 1992 ranged from 1 to 27 (median 3). Peripheral lung cancer and bronchiectasis were the two most frequent diseases for which bronchography was done. In other hospitals, bronchography was once done, but had been stopped. Two reasons for discontinuation of bronchography are: recent progress in radiographic diagnostic techniques such as high resolution CT, and discomfort of the patient. Now that propyliodone is no longer available, some hospitals may use iopydol-iopydone or iopamidol instead. It is necessary to elucidate the true need for bronchography and for an appropriate contrast medium to take the place of propyliodone.
Bronchography↗
The effects of water soluble contrast agents on the respiratory tract.
The water soluble contrast agents Gastrografin (Sodium diatrizoate and meglumine diatrizoate, Schering, Berlin), Iopamiro 300 (Iopamidol, Schering, Berlin), and Dionosil Aqueous (propyliodone BP, Glaxo, England) were instilled into the tracheobronchial tree of rats in doses of either 0.1 ml and 0.25 ml. Rats being used as controls, underwent sham operations with the instillation of air instead of contrast agent. In all, 85 rats were used. All rats that had not already died from the effects of contrast agent were sacrificed 30 minutes after instillation. The relative effects of the contrast agents were measured by comparing: 1. survival time; 2. radiographic effects of the contrast agents on the lungs and; 3. pathological changes as estimated by post mortem lung section and microscopy. The least toxic agent was the one with the lowest osmotic activity, namely Aqueous Dionosil. It is therefore recommended that Aqueous Dionosil be used in preference to Gastrografin or Iopamidol for studies of the oesophagus whenever there is a danger of aspiration of contrast agent into the tracheobronchial tree.
Animals↗
Peripheral pooling of bronchographic contrast material: evidence of its relationship to smoking and emphysema.
Sixty-six subjects, mainly derived from various occupational groups and one-third of whom admitted to dyspnoea on exertion, have been grouped according to the appearance of their peripheral airways at bronchography with oily propyliodone. Eleven subjects showed marked peripheral pooling of radiographic contrast material, 22 showed mild or moderate pooling, and in 33 peripheral pools were absent. Pooling was not seen in non-smoking subjects. In the group of subjects without pooling, pulmonary function in non-smokers and subjects with a history of smoking was similar. Subjects with marked pooling had a significantly lower pulmonary diffusing capacity (transfer factor) and evidence of loss of pulmonary elastic recoil when compared with subjects with absent peripheral pooling. These results indicate that bronchographic peripheral pooling is associated with the physiological changes of panacinar pulmonary emphysema and suggest that a causal relationship may exist between the organic bronchiolar lesion of pooling and the peripheral parenchymal lesion of panacinar emphysema.
Adult↗
Cerebral dye embolus: a complication of selective bronchography following transbronchial biopsy.
Cerebral embolization of an aqueous solution of propyliodone (Dionosil) occurred during selective bronchographic studies following a fiberoptic bronchoscopic procedure with transbronchial biopsy in a patient undergoing investigation of a pulmonary lesion. The embolization resulted in a grand mal seizure and transient neurologic deficits. This potential complication has not been previously reported. We suggest that selective bronchographic studies be avoided when the transbronchial biopsy is associated with endobronchial bleeding.
Aged↗
[Double contrast retrograde urethrography using viscous and gaseous contrast media in men].
The authors present the literature and their own data on the use of a double contrast study of the urethra in 38 male patients with dysuria of various etiology. The investigations were performed with roentgeno-television control using viscid contrast substances (propyliodone) and gel-like triiodinated liquid contrast media (verografin, urografin, triombrast, etc.). A high informative value of the method in the detection of pathological changes in the urethra and the neck of the urinary bladder, lesser risk of the development and lesser severity of urethro-venous refluxes were noted.
Aged↗
[Kidney cyst puncture for diagnosis and therapy].
It is reported on 38 punctures of avascular space occupying lesions of the kidney. The method is little stressing and poor of risk. It is recommended above all for older patients for the exclusion of an avascular tumour or a tumour within a cyst. The demonstration of the cyst in the double contrast may be performed following the angiography. The simultaneous therapeutic effect of the obliteration of a benign cyst be instillation of Propyliodon and Vistarin is desirable. A positive effect (complete obliteration including essential shrinking) was observed in 91%. Roentgenograms without contrast medium are not sufficient for course control. When the results of the demonstration of the hollow space, the cytology and the arteriography are unclear, operation is recommended.
Adult↗
Iatrogenic perforation of the bronchus intermedius in a 1,100-g neonate.
A 1,100-g infant was found to have a right tension pneumothorax following multiple attempts at endotracheal intubation. Despite the use of high-frequency ventilation, adequate oxygenation was not possible. Bronchoscopy was hazardous, and bronchography of the right lung using propyliodone oil suspension confirmed perforation of the bronchus intermedius. At thoracotomy, while on high-frequency ventilation, the size of the perforation precluded suture repair, and right middle and lower lobectomies were performed. Follow-up at 1 year showed a small, though healthy infant. Review of the surgical literature has not documented successful operative management of bronchial perforation in a neonate. Selective bronchography was precise in identifying the site of perforation and was well tolerated.
Bronchi↗
Barium sulfate bronchography. Report of a complication.
Alveolarization of the barium sulfate and subsequent retention of barium sulfate for years was demonstrated in three patients in whom dilute suspension of barium sulfate in water was used for bronchography. Pathologic examination in one patient showed barium sulfate within macrophages in the alveolar spaces and walls and in the perivascular and peribronchial interstitium. Since the residual barium sulfate interferes with imaging procedures of the lungs, it represents an unwanted event in patients with pulmonary disease. High-resolution computed tomography is the preferred method of evaluating for bronchiectasis. If bronchogram is performed, it should be performed after bronchoscopy using oily propyliodone (Dionosil).
Adult↗
Radiographically guided percutaneous catheter drainage of pleural fluid collections.
We reviewed the outcome of guided percutaneous catheter drainage of pleural fluid collections in 18 patients over a 5-year period. Catheter positioning was guided by fluoroscopy in 10 (56%) cases, CT in seven (39%), and sonography in one (6%). Included were 16 patients with empyemas and one each with a sterile hematoma and transudate. In nine of the patients, previous surgical chest tube drainage had been unsuccessful. The majority of collections were treated with a 12- or 14-French catheter and closed underwater seal drainage. Twelve (80%) of the 15 patients who had an adequate trial of guided drainage were cured. Propyliodone oil suspension contrast sinography after catheter placement showed two clinically unsuspected bronchopleural fistulas. Although an extensive multilocular pleural collection was a contraindication to percutaneous catheter drainage, the thick fibrous peel of a chronic empyema was not. Drainage of pleural fluid collections with radiographic guidance ensures proper catheter placement and is successful in a high percentage of cases.
Adult↗
[Clinical and roentgenological aspects of toxic megacolon (author's transl)].
Ulcerative colitis may occur on several forms. Toxic megacolon is roentgenologically characterized by dilatation usually in the area of transverse colon and toxic symptoms. At the first appearance of these symptoms the patient should be treated or operated upon. Under normal circumstances the roentgenological diagnosis may be obtained only by a full erect or a left lateral decubitus film of the abdomen. A barium enema could lead to performation of the colon, peritonitis or provocation of toxic megacolon. In doubtful cases the examination should be performed with water-solubel contrast media (i. e. Gastrografin, Propyliodon etc.) The therapeutical internal and surgical possibilities are discussed.
Colitis, Ulcerative↗
Bronchography in children aged 3 years and under. Anaesthetic techniques and results.
Bilateral bronchography was performed on 89 children aged between 3 months and 3 years. The bronchographic technique involves instillation of oily propyliodone into the tracheobronchial tree by positive pressure ventilation, and the procedure is carried out under general anaesthesia. Technically adequate bronchograms were obtained in 84 of the children, and with a solitary exception the complications of bronchography were few and trivial. In bronchiectatic children bronchography is a valuable and accurate investigation, which should in general be restricted to those patients who on clinical grounds are thought to have surgically manageable bronchiectasis.
Anesthesia, Inhalation↗
[Method of colpo-urethrocystography. Part II: Physico-technical conditions for optimum colpo-urethrocystography (author's transl)].
The method of colpo-urethrocystography is now increasingly used in hospitals which admit women for treatment of functional urinary incontinence. Both the quality of examination and the resulting value of the method were found to depend decisively on the techniques used. The results of a systematic purpose-oriented methodological study, with 40 cases of colpo-urethro-cystography included, were evaluated, and a resulting examination programme is described which can be out with the facilities available in the GDR. Here are the most important requirements: 1. Availability of fluoroscope with image intensifier, TV connection, and high-voltage generator; 2. Use of hard rays, X-ray exposure system, HS 11 or HS 90 X-ray film, 18 X 24 in format (vertical), in conjunction with highly amplifying sheet; 3. Marking of urinary bladder by means of 250 ml of contrast fluid (20 ml Propyliodon, 40 ml Visotrast 290, 190 ml physiological salt solution) and marking of urethra, using a lipiodol-UF soaked textile wick.
Contrast Media↗
[A new technique for evaluating the respiratory tract--digital subtraction bronchography (DSBG)].
Bronchography is essential for evaluation of morphological changes in the bronchial tree. However, conventional bronchography using Propyliodone (Dionosil) is extremely invasive, especially to those with pulmonary infections. In the present study, we developed a new less invasive method of bronchography with the aid of digital subtraction technique (DSBG), and evaluated its clinical benefits. Bronchography was performed by injecting contrast medium (Iopamidol: Iopamiron 300) via the lumen of the bronchoscope (Olympus Type 20), and image processing of the respiratory tract was performed using digital subtraction technique. From 1991 to 1992, DSBG was performed in 15 cases (8 bronchiectasis, 1 diffuse panbronchiolitis, 1 lung cancer, 1 pulmonary emphysema, and 4 others). DSBG clearly demonstrated the morphological changes of large and segmental bronchial lesions in cases of bronchiectasis and lung cancer, as well as conventional bronchography using Dionosil. In addition, it was possible to image the morphological changes of bronchiolar lesions in diffuse panbronchiolitis and pulmonary emphysema to the same detail as obtained using classical selective alveolo-bronchography (SAB). Since DSBG can provide enhanced images the bronchial tree without being affected by cardiac and respiratory movements, we could obtain detailed information on bronchial and/or bronchiolar lesions. With respect to side effects, Iopamiron was quickly drained and/or absorbed within 2 hours after injection. Pulmonary infection and bronchial bleeding, which are well known primary complications of classical bronchography using Dionosil, were not observed. We conclude that 1) DSBG is useful new technique for examining morphological changes of the respiratory tract, and 2) DSBG is less invasive than conventional bronchography.
Adult↗
Death associated with bronchography. Question role of heating the contrast agent.
A young woman died following bronchography. The bilateral bronchogram done under general anesthesia without fluoroscopic control was associated with extensive small airway filling or "alveolarization" of the contrast medium. The oily Dionosil used had been heated in an autoclave. Experiments showed that the viscosity of oily Dionosil decreases with heating. The lowered viscosity could have contributed to the increased "alveolarization" of the contrast agent and death of the patient.
Adult↗
Bronchography in pulmonary tuberculosis; a report of a year's experience with dionosil.
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Bronchography↗