Selective injection of contrast media: inflammatory effects on rabbit fallopian tubes.

The inflammatory effects of fallopian tube catheterization and selective injection of seven contrast agents (ethiodized oil, diatrizoate meglumine 52%, diatrizoate meglumine 66%, iothalamate meglumine 60%, iopamidol, ioxitol, and ioxaglate) were evaluated in 88 rabbits. The contrast agent used was randomly selected and selectively injected after unilateral catheterization; the contralateral side was used for control. Pathologic inspection of right and left uteri with attached fallopian tubes and ovaries was done without knowledge of side of catheterization or duration of time since catheterization. The degree and location of inflammation were noted. Inflammation disappeared by 4 days in five of seven contrast agents. Iothalamate meglumine 60% and iopamidol required 2 weeks for disappearance of inflammation. Essentially no inflammation was associated at any time with ioxaglate. These findings suggest that all of these contrast agents would be clinically acceptable for direct injection into the human fallopian tube.     

Peritoneal reaction resulting from iodinated contrast material: comparative study

A consensus does not exist as to the optimal contrast agent for hysterosalpingography. This study was undertaken to evaluate the early and delayed inflammatory responses of the peritoneal surfaces to various types of iodinated contrast media. Guinea pigs received intraperitoneal injections of lactated Ringer solution, iothalamate meglumine, diatrizoate sodium, ioxilan, or ethiodized oil. The inflammatory response of the peritoneal surfaces was assessed at 1,7, and 30 days. Five animals were studied at each time point for each agent. No animals that received Ringer lactate or iothalamate meglumine had inflammation at any time. Ioxilan produced inflammation in two of five animals at 7 days and no inflammation at 1 or 30 days. Ethiodized oil produced no inflammation at 1 day; however, three animals had inflammation at 7 days, and all five had inflammation at 30 days. The 30-day group showed striking inflammatory response with granulomatous features. The authors recommend the continued use of meglumine-based water-soluble ionic contrast material for hysterosalpingography.     

Cutaneous ulceration due to contrast extravasation. Experimental assessment of injury and potential antidotes

Severe cutaneous ulceration may occur as a result of contrast media extravasation. We established a definitive animal model for assessing the cutaneous toxicity of commonly employed agents and used this model to evaluate possible antidotes to the effects of contrast media extravasation. The contrast agents studied were: meglumine/sodium diatrizoate 76%, meglumine iothalamate 60% and 43%, meglumine/sodium ioxaglate 60%, iohexol 350, and iopamidol 370, in varying volumes and osmolalities. Hypertonic saline (950 and 1900 mOsm/kg) also was injected. Agents were injected intradermally into BALB/c mice. The higher osmolality agents produced dose-dependent skin ulcerations. The lower osmolality agents failed to produce any skin lesions after the same volume doses. Hypertonic saline produced skin toxicity in a dose-dependent fashion similar to hyperosmolar contrast agents. Three antidotes were tested: hyaluronidase, topical heat, and topical cold. Hyaluronidase significantly reduced skin toxicity when injected immediately following contrast injection. Cold also significantly reduced skin toxicity, while heat caused no improvement.     

Neuroangiography with iohexol

Iohexol is a new, nonionic water-soluble contrast agent undergoing early clinical trials in the United States. Using a double-blind, parallel format, iohexol was compared with meglumine iothalamate (60 patients) for selective cerebral angiography, and with sodium meglumine diatrizoate (40 patients) for arch aortography. Iohexol produced significantly less pain than meglumine iothalamate or sodium meglumine diatrizoate. There were no significant differences in terms of heart rate, blood pressure, or electrocardiogram (ECG) changes. Both produced a transient tachycardia and hypotension after arch aortography, but significantly less so with iohexol. No significant complications occurred. Film quality was comparable between contrast agents except for diminished motion artifacts with iohexol. Iohexol appears to be a superior neuroangiographic contrast agent to current ionic drugs.     

Diagnostic quality and complications of hysterosalpingography: oil- versus water-soluble contrast media--a randomized prospective study.

In a prospective randomized study of 417 patients, side effects and complications of contrast media and the diagnostic quality of images obtained after hysterosalpingography (HSG) were evaluated after use of diatrizoate meglumine (104 patients), ioxaglate (105 patients), iohexol (105 patients), or ethiodized poppy-seed oil (103 patients). The authors detected no differences among these groups in the prevalence of pain during HSG. The prevalence of lower abdominal pain and vaginal bleeding after HSG was significantly lower in the group that received ethiodized poppy-seed oil than in the three other groups. The prevalence of pelvic infection or inflammation was significantly lower with ethiodized poppy-seed oil than with water-soluble media. All contrast media provided acceptable diagnostic image quality with regard to fallopian tubes, peritoneal spill, and intraperitoneal distribution. Visualization of the uterine cavity and ampullary rugae was significantly better with water-soluble media than with ethiodized poppy-seed oil, which was associated with a high conception rate and which the authors consider preferable for HSG.     

The toxicity of the non-ionic watersoluble contrast medium metrizamide (Amipaque) in selective vertebral angiography

Summary Selective left vertebral angiography was carried out in 21 rabbits comparing the toxic effects of meglumine iothalamate (Conray meglumine), meglumine metrizoate (Isopaque Cerebral) and metrizamide (Amipaque). The iodine concentration for all 3 media was 280 mg/ml. General convulsions were seen in many of the animals with all 3 media. The convulsions occurred at higher doses and were milder with metrizamide than with the 2 other contrast agents. Bradycardia was also seen with all 3 media and there was no statistical significant difference between them in this respect. The mortality was approximately 50% with both meglumine iothalamate and meglumine metrizoate, while no animals died following angiography with metrizamide.     

Pregnancy outcomes after fallopian tube recanalization: oil-based versus water-soluble contrast agents

PURPOSE: To determine the pregnancy outcomes in patients undergoing fallopian tube recanalization (FTR) with use of oil-based versus water-soluble contrast agents. MATERIALS AND METHODS: Ninety-three patients with unilateral or bilateral proximal tubal occlusion confirmed by hysterosalpingography or laparoscopy underwent FTR with use of water-soluble contrast material alone (n = 50) or also had an oil-based agent injected into each tube after recanalization (n = 43). Pregnancy rates and outcomes of the two groups were studied retrospectively. RESULTS: With respect to differences between groups, only the body mass index proved to be a significant predictor (oil, 28.4; water, 24.7; P =.008). Mean age, duration of infertility, type of infertility, and initial diagnosis were comparable. There was a weak trend toward a higher pregnancy rate in the oil-based contrast material group, but it was not significant (P =.64). The average time to pregnancy was 4.4 months with use of oil-based contrast material, compared to 7.7 months with use of only water-soluble contrast material (P =.03). CONCLUSION: The use of an oil-based agent had little effect on the rate of conception, but time to conception was reduced by more than 3 months.     

Fallopian tube occlusion with use of a small intestine submucosa device: evaluation in a rabbit model

PURPOSE: The present study evaluates the short- and midterm efficacy of a small intestinal submucosa (SIS) device for fallopian tube occlusion in rabbits. MATERIALS AND METHODS: In a pilot study, several SIS device designs were tested for positional stability (absence of migration). The design selected for further testing consisted of a center of spongy SIS surrounded by an SIS sheet and held together by a 0.006-inch wire helix with two barbs. It was delivered on the tip of a short coaxial 3-F/5-F catheter set. Using this design, bilateral transuterine fallopian tube occlusion was performed in eight New Zealand White rabbits. Follow-up consisted of plain radiography at 2 weeks and hysterosalpingography at 6 weeks (n = 4 animals; eight tubes), 12 weeks (n = 2 animals; four tubes), or 24 weeks (n = 2 animals; four tubes). Thereafter, the animals were killed and the fallopian tubes were harvested for histologic evaluation. RESULTS: A single device was placed successfully in each fallopian tube. Fifteen of 16 devices (94%) remained in place throughout follow-up. One device migrated into the vagina at 2-week follow-up. Hysterosalpingography of the 15 tubes with occluders in place showed occlusion in seven of seven (100%) at 6 weeks, three of four (75%) at 12 weeks, and two of four (50%) at 24 weeks. Histologic evaluation revealed luminal occlusion by reorganized SIS containing macrophages, fibrocytes, and scant foreign-body giant cells. Only a mild inflammatory reaction was observed around the tube. In the animals with recanalization at 12 and 24 weeks, new channels were found alongside the original still-occluded fallopian tube lumen. CONCLUSIONS: The original lumen of the fallopian tube was effectively occluded by the SIS occluder, which was remodeled within the fallopian tubes of rabbits. Partial peripheral recanalization was observed over time.     

Use of ethylene vinyl alcohol copolymer for tubal sterilization by selective catheterization in rabbits

PURPOSE: To assess the efficacy of ethylene vinyl alcohol copolymer (Uryx) in nonsurgically occluding the fallopian tube and achieving tubal sterilization in the rabbit model. MATERIALS AND METHODS: Ten mature virgin female New England rabbits underwent transvaginal selective bilateral fallopian tube cannulation with use of a coaxial catheter system under general anesthesia. Selective salpingography was performed bilaterally to assess patency of the fallopian tubes. Ethylene vinyl alcohol copolymer was injected unilaterally through a microcatheter to completely fill the middle portion of the tube. Three to seven days after injection, each animal was bred. Conception was determined by ultrasonography (US) 7-19 days after effective breeding. If pregnant, the rabbit was killed. Otherwise, it was permitted to rebreed until pregnancy was achieved. Histologic specimens of the fallopian tubes were prepared and analyzed. RESULTS: Patency of the fallopian tubes was demonstrated bilaterally in all animals by the free spillage of contrast material into the peritoneum. The delivery of ethylene vinyl alcohol copolymer into the fallopian tubes was successful in all animals but one, in which most of the plug almost immediately extruded into the uterus. Pregnancy was detected by US in the untreated fallopian tube in the nine rabbits that were receptive to breeding. No pregnancies were detected in the injected side. Histologic analysis demonstrated variable degrees of occlusion, fibrosis, and inflammation, with the majority of specimens demonstrating mild to moderate inflammation and moderate to marked fibrosis. CONCLUSION: Ethylene vinyl alcohol copolymer can reliably be placed nonsurgically via the transvaginal approach into the fallopian tubes with use of a coaxial catheter system. Ethylene vinyl alcohol copolymer appears to result in less fibrosis than previously investigated agents and demonstrates a 100% early sterilization rate in the rabbit model.     

Incompatibility of water-soluble contrast media and intravascular pharmacologic agents. An in vitro study.

In vitro incompatibilities between nine water-soluble contrast media and 21 intravascular pharmacologic agents were investigated using naked-eye observation and a centrifuge. Most of the previously reported incompatibilities were verified, and a few new incompatibilities were discovered: phentolamine mesylate with diatrizoate sodium, diatrizoate meglumine, ioxaglate, and iothalamate; diatrizoate meglumine with diazepam and meperidine hydrochloride; and diatrizoate sodium with meperidine hydrochloride. There were no incompatibilities when the pharmacologic agents investigated were mixed with ioxithalamate, iopromide, iopamidol, and iohexol.     

球囊导管加压注射法子宫输卵管造影对不孕症的应用价值

目的探讨利用球囊导管加压注射泛影葡胺行子宫输卵管造影的应用价值。方法对219例不孕症用76%泛影葡胺采用球囊导管加压注射法作子宫输卵管造影检查,并在透视下实时点片。结果普通注射时双侧输卵管显示185例(84.47%),单侧显示24例;加压注射后203例(92.69%)双侧输卵管显示,单侧显示14例,成功率100%。子宫畸形见于9例,输卵管异常131例,造影剂弥散与吸收异常104例。结论利用球囊导管加压注射水溶性造影剂,可以明显提高子宫输卵管造影质量及输卵管再通效果,有重要的临床价值。     

Inhibition of platelet function by contrast media: iopamidol and ioxaglate versus iothalamate. Work in progress

The effects of an ionic contrast agent, meglumine iothalamate (Conray-60), and two newer low-osmolality radiographic contrast media, sodium meglumine ioxaglate (Hexabrix) and iopamidol (B-15,000), on platelet aggregation and secretion responses were studied. All three agents inhibited platelet responses during stimulation with adenosine diphosphate (ADP), epinephrine, and collagen. Platelet function was inhibited by iothalamate at concentrations of 11 mg iodine/ml and above, and by the newer agents at concentrations above 30 mg iodine/ml. Addition of exogenous calcium decreased the iothalamate-induced inhibition of aggregation but did not improve dense granule secretion. There was no consistent effect of exogenous calcium on platelet inhibition by iopamidol and ioxaglate. These studies indicate that the newer agents inhibit platelet function less than iothalamate does, and that chelation of Ca2+ may not be the major mechanism of platelet inhibition by contrast agents.     

Occlusion of the fallopian tube by selective transcatheter radiofrequency electrocoagulation: an experimental study in rabbits

PURPOSE: To test the feasibility of performing transcervical fallopian tube occlusion in a rabbit model with use of unipolar radiofrequency (RF) electrocoagulation. MATERIALS AND METHODS: Under fluoroscopic guidance, transvaginal catheterization of the right or left fallopian tube was first performed with use of a coaxial technique in 20 rabbits. With a metal guide wire protruding from the catheter serving as the active electrode, RF electrocoagulation was performed. The power output was set to 200 W and the current was applied for 20 seconds. The fallopian tube on the contralateral side and the uterus were used as controls. Rabbits were randomly designated to be killed either 2 days (group I, n = 10) or 30 days (group II, n = 10) after the procedure, and tubal patency and histologic changes were evaluated. RESULTS: In group I, significant necrosis of the endosalpinx caused by RF electrocoagulation was found in all 10 rabbits. In group II, the occluded fallopian tube showed fibrosis of the wall in all 10 rabbits, but there was no tissue damage to adjacent organs. Histologic findings in the contralateral fallopian tubes were normal in all 20 rabbits. CONCLUSION: Transcatheter RF electrocoagulation proved to be a safe nonsurgical alternative for occlusion of the fallopian tubes in rabbits.     

Peritubal adhesions in infertile women: diagnosis with hysterosalpingography

We studied the efficacy of hysterosalpingography in the detection of peritubal adhesions without tubal occlusion by using laparoscopy as the gold standard for the diagnosis. Peritubal adhesions were diagnosed on hysterosalpingography by using the following radiographic criteria alone or in combination: (1) convoluted fallopian tube, (2) loculation of spillage of contrast medium into the peritoneal cavity, (3) ampullary dilatation, (4) peritubal halo effect (double-contour appearance of the tubal wall), and (5) vertical fallopian tube. The first 100 patients with the diagnosis of adhesions on hysterosalpingography who also had laparoscopy were included in the study. Seventy-five patients had the diagnosis confirmed on laparoscopy, resulting in a 25% false-positive diagnosis of adhesions with hysterosalpingography. Thirty-nine (52%) of these 75 patients had one radiographic finding alone, and 20 of these patients had loculation of spillage of contrast medium. Although the patients with adhesions tended to have two or more of the radiographic findings, the difference was not statistically significant. The most frequent radiographic findings found in combination were convoluted fallopian tube and loculation of spillage of contrast medium. These findings suggest that hysterosalpingography can be the diagnostic procedure of choice in the initial investigation of infertility due to peritubal adhesions.     

Relative uptake of low- and high-osmolality contrast media in CT of brain tumors

The magnitude and time course of contrast enhancement in spontaneous canine brain tumors was determined for two contrast agents: meglumine iothalamate and sodium meglumine ioxaglate. Tumor enhancement during contrast infusion and at 5, 10, 15, 30, and 45 min was measured using quantitative computed tomography. Blood iodine was measured using x-ray fluorescence. Peak contrast enhancement occurred during the infusion, and the magnitude was the same for both agents. Per gram of iodine infused, blood iodine was 12.4% higher with ioxaglate than iothalamate. The monoionic dimer ioxaglate is as effective as iothalamate for enhancement of canine brain tumors.     

Hepatic dynamic sequential CT: section enhancement profiles with a bolus of ionic and nonionic contrast agents

The enhancement characteristics in different portions of the liver during dynamic sequential bolus computed tomography (CT) with iodinated contrast material (DSBCT) were prospectively evaluated in 75 patients by using iothalamate meglumine, iopamidol, and iohexol (25 patients received each agent). After baseline noncontrast CT was performed, DSBCT was performed with a 180-mL intravenous bolus administered at 2 mL/sec. Scanning was started 25 seconds after the bolus was initiated, by using a 3-second scan time and rapid cephalocaudal table incrementation, yielding contiguous 8-mm-thick sections at a rate of nine sections per minute. On postcontrast images, peak enhancement was 115% for iopamidol and 117% for iohexol, both of which were superior to iothalamate meglumine at 95% (P less than .05). After peaking, enhancement then decreased for all three contrast agents, although the decline was more precipitous for iothalamate meglumine. Enhancement on the more caudal sections with both iopamidol and iohexol was superior to that with iothalamate meglumine (P less than .05). The data suggest that the enhancement characteristics for the two nonionic agents may be more optimal for detection of focal hepatic lesions than the ionic agent.     

Epileptogenic effects of radiographic contrast agents: experimental study

Electrical activity in cells directly exposed to water-soluble radiographic contrast agents was investigated by intracellular recordings from neurons of the abdominal ganglia of Aplysia. Measurements of membrane resting potential, membrane conductance, synaptic and action potential configuration, and spontaneous electrical activity were performed. Test solutions included sodium diatrizoate, meglumine iothalamate, metrizamide, and control solutions. Solutions (100 and 200 mOsm) of these agents did not significantly alter resting membrane potential, membrane conductance, action potential frequency or configuration, or excitatory postsynaptic potentials. Inhibitory postsynaptic potentials were suppressed by contrast agents. These results suggest that contrast agents affect at least some neurons by disinhibition.     

新型可复性输卵管避孕栓避孕效果实验研究

 目的 观察输卵管避孕栓的避孕效果和安全性.方法 采用成年新西兰兔20只,随机分为3组(实验组10只、自身对照组5只和空白对照组5只).经腹暴露子宫后,于子宫角处切开将输卵管避孕栓放置入输卵管内.术后1个月开始与雄兔合笼,每周交配2～3次,观察避孕效果.结果 栓子放置术后3个月内,实验组10只雌兔均未见妊娠,自身对照组5只雌兔有1例妊娠,空白对照组5只雌兔均已妊娠.有2只栓子有移位,但无掉出输卵管.实验组、自身对照组和空白对照组,经统计学分析差异有显著性(P＜0.01).结论 可复性输卵管避孕栓是一种新型、有效、安全的输卵管避孕装置.     

Cardiovascular reactions to myelography with watersoluble contrast media

Summary Arterial blood pressure and heart rate were recorded for 5 to 7 h during myelography with iothalamate meglumine and metrizamide in 23 rabbits. After 0.6 ml iothalamate meglumine containing 280 mg I/ml a significant decrease in blood pressure and signs of circulatory failure were found. After identical doses of iothalamate meglumine to 0.4 ml containing 140 mg I/ml no significant fall in blood pressure was recorded. A decrease of blood pressure was always accompanied by a decrease of heart rate. Arterial blood pressure and heart rate during experimental myelography are suggested as useful variables in the evaluation and comparison of new contrast media for myelography.     

Arthrography with Amipaque (metrizamide) and other contrast media. A roentgenographic and histologic evaluation in rabbits.

Arthrography of the knee joint was performed in 30 rabbits for comparison of Amipaque (metrizamide) with Urografin 60% (meglumine-sodium diatrizoate), Isopaque Amin (meglumine-calcium metrizoate), Conray Meglumin 282 (meglumine iothalamate) and Dimer-X (meglumine iocarmate). Films taken at regular intervals show longer contrast duration, and less hydrarthrosis after injection of Amipaque. Minimal focal inflammatory reaction in the synovial membrane is found in many cases when the animals are sacrificed 1 day or 7 days after the injections. No significant difference can be found between the contrast media, and similar changes are also seen after injection of physiologic saline.