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A retrospective survey was made of 57 consecutive patients referred for myelography by one neurological team. Reactions occurred in patients with multiple sclerosis significantly more often than in all other patients (P=0.01). This finding appears to support the belief that demyelination may be associated with more severe reactions to iophendylate myelography.
60 cases of bilateral cerebellopontine angle pantopaque cisternography done between May, 1972, and April, 1974, are reported. Of these, 9 showed a unilateral acoustic neurinoma of different sizes, 1 showed a bilateral acoustic neurinoma all confirmed by operation. Technical details and advantages of the procedure are discussed. There were no complications related to the procedure.
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A study of repeat myelograms carried out in 93 patients revealed that the incidence of thecal scarring following Conray lumbar radiculography is high (61% of all cases), and only slightly lower than that found after Myodil myelography (74%). Possible factors affecting the incidence of arachnoiditis and the radiological and clinical significance of this condition are considered.
Hepatography with a 75% iodophendylate emulsion was carried out in 21 rabbits to which the contrast medium had been introduced after laparotomy in a dose of 0.84-1.9 g/kg. The roentogenological and histological dynamics and the liver contrasting was studied in its continuity. In experimental hepatography the emulsification of iodophendylate does not cause any damaging effect on the liver and the lungs. In the mechanism of the emulsified iodophendylate elimination of prime importance are phagocytic cellular reactions on the part of lympho- and histocytic elements.
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An experimental lymphography was effected in 41 rabbits which were given the contrast medium intralymphatically in a dose of 0.3--0.5 ml/kg. The roentgenological dynamics of contrasting the lymphatic structures of the hind limbs and pelvis of the animals was studied. Iodophendylate was found in experimental lymphography to cause no damage to the lymph nodes, lungs, liver, spleen and the kidneys. In the mechanism of the contrast medium elimination of major importance are phagocytic cellular reactions.
Accumulated experience with triple contrast percutaneous nephrocystography (water-soluble contrast, iophendylate [Pantopaque], and air) in 42 patients with avascular lesions is presented. Diagnostic studies were accomplished in 40 with surgical correlation in 11. Of the 35 patients with intracystic iophendylate, progressive cyst shrinkage was observed in the 29 with adequate x-ray follow up. The reduction in cyst size was attributed to a marked reactive inflammatory proliferative response with fibrosis of the cyst wall which was found in 6 patients after introduction of iophendylate when compared with a control group of 13 others with surgically proved cysts. Intracystic iophendylate may be especially therapeutic in the nonsurgical management of renal cysts associated with pain, calyceal obstruction, and hypertension. The cyst aspirate was analyzed for appearance, culture, cytology, fat content, and multichannel chemistries (SMA). The index accuracy of these combined tests is high although instances of false positives and negatives for tumor are stressed. The nonsurgical diagnosis of renal cystic lesions is incomplete without percutaneous cyst puncture, contrast study, and analysis of cyst aspirate.
In a case of chronic, severe urticaria and intermittent episodes of anaphylaxis due to an iophendylate injection (Pantopaque) given in the course of myelography, almost complete relief was obtained from the removal of approximately 8 ml of residual iophendylate from the spinal canal. Data obtained from direct skin testing, Prausnitz-Küstner testing, peptide inhibition of Prausnitz-Küstner testing, and IgE levels quantitated before and after removal of iophendylate indicate that these symptoms were mediated via an IgE anti-iophendylate reaction.
Cyanoacrylate is a satisfactory material for therapeutic embolization, but it has the disadvantage of not being radiopaque and polymerizing within 1 sec after contact with ionic materials. Its behavior was modified with varying concentrations of iophendylate and were able to satisfactorily control its polymerization from 1 to 30 sec. This control should allow penetration of arteriovenous malformations, which is necessary if cure is to result. The iophendylate adds radiopacity and seems to enhance the suspension of tentalum, another opacifying agent. Preliminary experience in dogs is encouraging, but too few humans have been treated with this method to recommend it as more than an experimental procedure at this time.
This study reports an investigation of the canine arachnoid membrane using the scanning electronmicroscope (SEM) regarding the effects of contrast material on these structures. In the normal arachnoid membrane, two basic surface patterns were observed; one fenestrated and the other embossed with parallel fibers. Ventriculography was performed on 30 mongrel dogs divided into five groups: control, air, iophendylate, meglumine iothalamate, and Metrizamide. SEM study of the arachnoid membrane from basal cisterns showed no change after air ventriculography. After contrast agents were used, macrophages appeared and fenestrations became closed with fibrin-like substance.
A technique for internal auditory cisternography is described. A small volume of Iophendylate is used and coronal hypocycloid tomographic sections of the dependent internal auditory canal and adjacent cerebellopontine angle cistern performed.
Myelographic changes after spinal operation are often difficult to interpret especially with regard to the differentiation between arachnoiditis and recurrent disc prolapse. The radiological appearances using iophendylate (Myodil) and the distinguishing features are discussed and illustrated.
Computer tomography (CT) was used in 53 consecutive patients with a working diagnosis of cerebellopontine angle tumor. The CT was performed with the 160 X 160 matrix scanner, height of sections was 13 mm. Metrizoate sodium (1.5 ml/kg of body weight) was used for tumor enhancement. Seventeen CT scans revealed tumors; one patient proved at operation to be false-positive. Thirty-six CT scans revealed no tumors; two examinations may prove to be false-negative, but surgical verification has so far not been obtained. The smallest tumor demonstrated by CT extended 7 mm into the angle, while one of the possible false-negative CT scans after iophendylate injection cisternography showed a tumor extending 5 mm into the angle. It is concluded that CT is a harmless, noninvasive neuroradiological procedure, and should precede invasive procedures. It can be used safely in patients with increased intracranial pressure.
Post-operative myelograms in patients with renewed or persistant pain in the back or sciatica after lumbar disc surgery were reviewed in an attempt to differentiate between recurrent disc prolapse and other changes, particularly scarring and inflammation of the meninges. The most useful sign of recurrent disc prolapse was anterior indentation of the iophendylate (Myodil) column opposite a disc space. Inflammatory changes in the meninges were indicated by loculation of the subarachnoid space, matting or marked swelling of the nerve roots, irregularity of the theca, and by the absence of a posterior bulge of the subarachnoid space at the level of the operation. Waisting of the contrast medium column, non-filling of nerve root sheaths, complete myelographic block and posteriorly placed indentations were confirmatory evidence of the presence of disease, but not helpful in determining its nature.
One month after having a right upper lobectomy to remove a squamous cell carcinoma, a 43-year-old man presented with a 4-day history of postural headache, worsened by standing and relieved by lying. Skull films showed prominent ventricular pneumocephalus. Iophendylate myelography was unrewarding, but isotope cisternography revealed a CSF fistula at the T4 level, extending into the thoracic cavity. Thoracoplastic removal of the first four ribs successfully prevented air passage and the patient had a rapid uneventful recovery.
Myelography with gas or iophendylate is difficult in patients with spinal anomalies. Metrizamide (Amipaque) has been used to evaluate 20 patients with Chiari malformations, achondroplasia, and conditions related to scoliosis. Lateral cervical puncture was uncomplicated in 10 patients with Chiari malformations. Definition of spinal subarachnoid space was adequate to demonstrate or exclude associated intraspinal tumors or diastematomyelia.