SINCE 1921, when we showed the possibilities of an iodized oil, called lipiodol (Lafay), as an opaque mediun, for roentgenologic exploration, we have extended the use of the preparation to a great many cavities of the body. At the same time, French and foreign investigators, taking advantage of our initial work, succeeded in enlarging the field of our general method. Besides the two principal roentgenological uses of lipiodol—exploration of the central nervous system (spinal subarachnoid space and cerebral ventricles) and exploration of bronchial tubes—there have occurred a great many uses of minor importance, but still quite promising. We shall review here the exploration of the different cavities, except those of the bronchial tree concerning which we have written already in Radiology.2 The Substance.—First, we must say a few words about the substance itself. Lipiodol is a definite chemical compound in which 40 per cent iodine is bound to a fat body—poppy-seed oil. It is not a solution: this is most important, and explains why, in spite of its high percentage of iodine, lipiodol is tolerated by human tissues and cavities as any ordinary oil. The injection of lipiodol, up to very high doses, hardly gives any reaction and generally no iodism, because there is no free iodine. Lipiodol is a clear, transparent, yellow oil, of high density and much thicker than olive oil. All samples of brownish color or dim appearance, containing free iodine, must be strictly avoided. The best lipiodol is delivered in small aluminum flasks, and, being antiseptic, does not require any sterilization. Lipiodol is much heavier than water and all body fluids. When injected into a duct or cavity it progresses generally to the lowest part, according to the action of gravity, in very small ducts or tubes the action of capillarity stops this progress. Epidural Space.—The exploration of this region, between the spinal theca and the spine itself, is of great interest in all bony diseases of the spine, for early modifications here are frequently apparent. Lipiodol may be injected through the lower method “Sicard's sacrococcygeal,” or through the lumbar or cervical regions. In the latter case, the technic is the same as for a lumbar puncture, but it is important that the point of the needle, after penetrating the ligamentum flava, should not perforate the theca.3 Four to six c.c. of lipiodol may be injected, which, by its specific gravity, will slide slowly down the space toward the coccyx, leaving a deposit resembling, in the film, irregular and elongated splotches of ink. If, after the injection, the patient is put in Trendelenburg's position, it is clear that the lipiodol will slide down toward the thoracic vertebrzæ, the length of the track being determined by the quantity injected (Fig. 1).
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