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Thyroid function after bronchography with propyliodone.

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

Adult

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

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

Adult

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.

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