Reactions Associated with Intravenous Urography: Historical and Statistical Review

Pendergrass, Henry P.; Tondreau, Roderick L.; Pendergrass, Eugene P.; Ritchie, David J.; Hildreth, Eugene A.; Askovitz, S. I.

doi:10.1148/71.1.1

Cited by 105 publications

(10 citation statements)

References 9 publications

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Low-Molecular-Weight Dextran

Bernstein¹,

Evans²

1960

JAMA

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Toxic reactions to currently employed iodinated water-soluble radiopaque media have been responsible for the occurrence of considerable morbidity and some deaths after such diagnostic procedures as cardioangiography, aortography, arteriography, and pyelography.7, 12,23 The mechanism of these reactions has been the subject of intense clinical interest for some time. However, until quite recently, no satisfactory explanation for many of the observed clinical and experimental reactions had been advanced.21 The role of allergic phenomena has been seriously challenged by Sandstrom,26 who clearly indicates that there is no evidence for the value of pretesting or prophylaxis, history of previous contact, or proof of antigen-antibody reaction. Other authors agree that pretesting and prophylactic antihistaminics are of little value in predicting or preventing these reactions.12Recent studies by Read 24 have demonstrated that the phenomenon of diffuse intravascular red-blood\x=req-\ cell sludging occurs after the intravenous injection of a number of hypertonic solutions, including the more concentrated iodinated radiopaque media. These red-blood-cell aggregates were directly visualized in the pia mater, the small bowel mesentery, and the subcutaneous tissue. Isolated perfusion studies indicated that pulmonary vascular resistance and pulmonary artery pressure increased markedly after the injection of hypertonic media but only did so in the presence of red blood cells.Observations of the corneoscleral blood vessels in 24 human patients by Sobin and his associates 27 have identified similar changes in the microcirculation and the development of red-blood-cell masses in these vessels after the intravenous injection of diatrizoate (Hypaque) sodium and sodium diprotrizoate (Miokon). These vascular alterations occurred within minutes after injection and, in general, spontaneously resolved 20 minutes after the administration of the radiopaque material. Similar observations of the conjunctival blood vessels made in this laboratory confirmed the rapid development of red-blood-cell aggregates after the intravenous administration of diatrizoate sodium in the dog.:'Observations of the microcirculation in the conjunctival vessels with development of intravascular aggregation or agglutination of red cells has been described for a number of other conditions. In 1942, Knisely 18 described this phenomenon in association with malaria and later, in 1945, its occurrence after traumatic shock.19 These studies were confirmed by Bigelow and his associates,4' 15 who observed intravascular agglutination of erythrocytes in conjunctival, omental, and mesenteric vessels.Bigelow's studies indicated that the sludging was more severe with traumatic shock. More recently, Swedish investigators reconfirmed these findings. Gelin ,s' 14 and others5'28 found that prophylaxis or treatment with a low-molecular-weight fraction of dextran will prevent or reverse the development of red-blood-cell aggregations and the accompanying decrease in hemoglobin level, ce...

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Low-Molecular-Weight Dextran

Bernstein¹,

Evans²

1960

JAMA

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“…The results of several surveys (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12) mostly on urography are at variance regarding fatalities secondary to intravascular injection of contrast media.…”

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confidence: 99%

Death following Intravascular Administration of Contrast Media

Shehadi¹

1985

Acta Radiologica. Diagnosis

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Adverse reactions to intravascularly administered contrast media preceding death and the autopsy findings in 44 patients are presented. There is a wide scatter of the age distribution of fatal reactions. The highest incidence is in the 50-70 year age group. Similar observations were obtained from the 405 deaths due to contrast media reported to the Food and Drug Administration of the United States. In the same age group the number of reactions is highest, likewise the autopsy findings. The predominant autopsy findings are pulmonary edema, congestion and hemorrhage; arteriosclerosis, both general and coronary. In the younger age group the autopsy findings are limited mostly to the respiratory tract. Fatal reactions to contrast media occur often without warning and most deaths occur within 15 min to 6 hours. Reactions to contrast media occur without relation to sex or age.

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“…In der Mehrzahl der Fälle handelt es sich jedoch um leichte * 1 Stokes = 1 X 10 m2 s Reaktionen, die sich als Hauterscheinung (Flush, Urticaria, angioneurotisches Odem), Nausea und Tachykardie äußern (Schweregrade I und II nach der früher veröffent-lichten Skala zur Klassifizierung anaphylaktoider Reaktionen [46] Pendergrass und Mitarbeiter (44) beschrieben 99 Fälle von letalen Komplikationen nach intravenöser Urographie unter rund 11 546 000 Patienten. Im großen und ganzen ähnliche Zahlen finden sich bei den anderen in Tabelle 2 aufgeführten Autoren (1, 9,11,13,16,18,24,38,42,44,45,51,55,57,62,64,65,66 Herzrhythmusstörungen sind keineswegs selten, insbesondere nach Koronarangiographie (64). Sie können sich als Sinustachykardie (58), Bradykardie (22) oder Extrasystolen manifestieren (58,59) Urographie (57) Mediatorsubstanzen hervorgerufen werden, wie im folgenden diskutiert werden wird.…”

Section: Häufigkeit Und Symptomatik Der Kontrastmittelunverträglichkeitunclassified

Die Problematik der Kontrastmittelüberempfindlichkeit

Ring¹

1979

Dtsch med Wochenschr

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Die moderne klinische Diagnostik ist ohne Röntgenkon-trastmittel nicht mehr denkbar. Seit der ersten Applikation dieser Substanzen in den zwanziger Jahren sind jedoch die Probleme der Nebenwirkungen der Kontrastmittelinfusion bekannt. Röntgenkontrastmittel sind keine Pharmaka im klassischen Sinne; ihre erwünschte Wirkung selbst ist eine »Nebenwirkung«, ihre Effekte sind unerwünscht. Das ideale Kontrastmittel wäre eine absolut inerte Substanz. Trotz vieler Verbesserungen durch Einführung neuer Produkte ist dieses Ziel jedoch noch nicht erreicht.

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Reactions Associated with Intravenous Urography: Historical and Statistical Review

Cited by 105 publications

References 9 publications

Low-Molecular-Weight Dextran

Low-Molecular-Weight Dextran

Death following Intravascular Administration of Contrast Media

Die Problematik der Kontrastmittelüberempfindlichkeit

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