Ionic Contrast Media Research Articles

Assessment of Hepato-Renal Functions and Markers of Oxidative Stress in Animals Exposed to Ionic Contrast Media

Assessment of Hepato-Renal Functions and Markers of Oxidative Stress in Animals Exposed to Ionic Contrast Media

Effect of contrast media on the enzyme activity of condoliase: In vitro assessment.

BackgroundCondoliase has been used in Japan to treat patients with lumbar disc herniation by its injection into the nucleus pulposus. The injection of condoliase together with contrast media is prohibited; because there are no data whether contrast media have any effect on condoliase activity. This study aimed to elucidate the effects of contrast media on condoliase activity.MethodsCondoliase with chondroitin sulfate (CS) and without CS were mixed with various contrast media (nonionic [iohexol or iotrolan]; ionic [amidotrizoic acid]). (i) The mixtures with CS were incubated at 37°C; (ii) the mixtures without CS were stored at 24°C for 60 min, followed by addition of CS to assess condoliase activity by measuring the amount of N‐acetylhexosamines enzymatically cleaved from CS using Morgan–Elson method.Results(i) In the presence of CS, the ionic contrast media reduced condoliase activity within 10 min in a dose‐dependent manner, and the nonionic contrast media had no effect on condoliase activity for at least 120 min. (ii) In the absence of CS, the ionic contrast media almost completely inactivated condoliase within 15 min, and the nonionic contrast media also reduced condoliase activity; the residual activity was 65% with iotrolan and 35% with iohexol at 60 min.ConclusionsThe ionic contrast media significantly reduced condoliase activity regardless of presence or absence of CS. Although the nonionic contrast media did not affect condoliase activity in the presence of CS, it reduced activity in the absence of CS. Mixing condoliase with contrast media, especially ionic type contrast media, should be avoided.

Ionic and non-ionic intravenous X-ray contrast media: antibacterial agents?

X-ray contrast media have been reported to have inhibitory effects on bacterial growth. Despite its potentially beneficial effect on patients, these features of contrast media have received relatively little attention in the medical literature in the past decades. The aim of this review is to evaluate the literature concerning the bactericidal and bacteriostatic effects of X-ray contrast media, specifically if there is a known difference concerning these effects between ionic and non-ionic contrast media. Systematic literature review was performed for the years of publication between 1911 and 2019. Since the publication of Grossich in 1911, the effect of iodine on the treatment of superficial infections in surgical procedures has been established clinical knowledge. Bacteriostatic and bactericidal effects of ionic X-ray contrast media are well established. However, non-ionic contrast agents have been the subject of little research in this respect. In past decades, the hypothesis emerged in the literature that mainly the concentration of free iodine might be responsible for any bacteriostatic or bactericidal effect of ionic X-ray contrast media. Nowadays, however, only non-ionic contrast media are used. The question regarding the mechanism and magnitude of bacteriostatic or bactericidal effects of these, non-ionic contrast media, could not be answered conclusively from this review. Non-ionic contrast media could be used intentionally when a local antibacterial effect is intended (e.g. in percutaneous abscess drainage), as well as to reduce the overall dose of antibiotics administered to a patient. Thus, this question remains relevant and might constitute the area of future research.

30 years of Katayama's article on ionic and non-ionic contrast media: appreciation of well and less known facts of a milestone paper.

30 years of Katayama's article on ionic and non-ionic contrast media: appreciation of well and less known facts of a milestone paper.

Nephrotoxicity in cancer treatment: An overview.

Anticancer drug nephrotoxicity is an important and increasing adverse drug event that limits the efficacy of cancer treatment. The kidney is an important elimination pathway for many antineoplastic drugs and their metabolites, which occurs by glomerular filtration and tubular secretion. Chemotherapeutic agents, both conventional cytotoxic agents and molecularly targeted agents, can affect any segment of the nephron including its microvasculature, leading to many clinical manifestations such as proteinuria, hypertension, electrolyte disturbances, glomerulopathy, acute and chronic interstitial nephritis, acute kidney injury and at times chronic kidney disease. The clinician should be alert to recognize several factors that may maximize renal dysfunction and contribute to the increased incidence of nephrotoxicity associated with these drugs, such as intravascular volume depletion, the associated use of nonchemotherapeutic nephrotoxic drugs (analgesics, antibiotics, proton pump inhibitors, and bone-targeted therapies), radiographic ionic contrast media or radiation therapy, urinary tract obstruction, and intrinsic renal disease. Identification of patients at higher risk for nephrotoxicity may allow the prevention or at least reduction in the development and severity of this adverse effect. Therefore, the aim of this brief review is to provide currently available evidences on oncologic drug-related nephrotoxicity.

Imaging of coronary arteries using ionic versus non-ionic radiographic contrast media: Intraindividual comparison study.

Imaging of coronary arteries using ionic versus non-ionic radiographic contrast media: Intraindividual comparison study.

THE INCIDENCE AND RISK FACTORS OF CONTRAST INDUCED NEPHROPATHY IN PATIENTS UNDERGOING CORONARY ANGIOPLASTY.

Background: Contrast induced nephropathy remains important cause of hospital-acquired acute kidney injury and affects between 2% of the general population to 50% of high-risk subgroups following coronary intervention.
 Objectives: To determine the incidence and to study the various risk factors associated with CIN.
 Patients and Methods: In our study, total of 212 patients (154 males and 58 females) who received non ionic iso osmolar contrast media during percutaneous transluminal coronary intervention (PCI) were included. We diagnosed CIN by a relative increase of >25% or an absolute increase of >0.5 mg/dl in serum creatinine levels two days after procedure.
 Results: The incidence of CIN in our study was 15.1%. In univariate analysis: age >75 years, hypertention diabetes mellitus (DM), heart failure, hypotension, CKD [creatinine >1.5mg/dl] and increased contrast volume were associated with increased risk of CIN whereas, gender, anemia and use of IABP failed to reach statistical significance. As the number of risk factor and/or volume of contrast increases, the incidence of CIN increases exponentially. Conclusion: Since there is no established treatment for CIN, all possible efforts should be taken to prevent it from occurring by identifying patients at risk. CIN is related with many risk factors, so whenever multiple risk factors are present in an individual patient, lowest dose of contrast should be used and adequate hydration should be given.
 Key Words: Contrast-induced nephropathy, Non ionic iso-osmolar contrast media, percutaneous coronary intervention.

Comparison of nephrotoxicity between two gadolinium-contrasts, gadodiamide and gadopentetate in patients with mildly diminished renal failure.

Although gadolinium (Gd)-based contrast media have been found to be nephrotoxic, their nephrotoxicity, and the dependence of nephrotoxicity on chelate types, have not been assessed in patients with normal or mildly diminished renal failure. This prospective, randomized study compared the nephrotoxicity of low doses of the nonionic Gd-based contrast medium gadodiamide (Omniscan®) and the ionic Gd-based contrast medium gadopentetate (Magnevist®) in patients with serum creatinine < 1.6 mg/dL. Patients aged 20 to 80 years, weighing 45 to 70 kg and with normal or < 1.6 mg/dL Serum-creatinine in the 3 months prior to undergoing magnetic resonance imaging (MRI) of brain, were enrolled. Patients were randomized to receive 0.1 mol/kg gadodiamide or gadopentetate. Serum-creatinine, serum cystatin-C, estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) formula, and estimated creatinine clearance rate (eCCr) using the Cockcroft-Gault formula were measured just before and 16-80 hr after MRI. Groups were compared statistically by Mann-Whitney U-tests and Wilcoxon signed-rank tests. There were no significant differences in clinical characteristics between the gadodiamide (n = 43) and gadopentetate (n = 59) groups. Serum-creatinine, eGFR and eCCr before and 16-80 hr after MRI did not differ significantly within either group or between the two groups. Serum cystatin-C was significantly higher 16-80 hr after than before MRI only in the gadodiamide group (0.79 ± 0.21 vs. 0.74 ± 0.14 mg/L, p = 0.028). The ionic contrast medium, gadopentetate, did not affect renal function during MRI, whereas the nonionic contrast medium, gadodiamide, affected renal function transiently.

Nephrotoxicity of anticancer treatment.

Severe adverse systemic drug events occur commonly as a result of treatment of cancer patients. Nephrotoxicity of chemotherapeutic agents remains a significant complication limiting the efficacy of the treatment. A variety of renal disease and electrolyte disorders can result from the drugs that are used to treat malignant disease. The kidneys are a major elimination pathway for many antineoplastic drugs and their metabolites. Tumour lysis syndrome, an emergency in haematooncology, occurs most often after the initiation of cytotoxic therapy in patients with high-grade lymphomas and acute lymphoblastic leukaemia. Chemotherapeutic agents can affect the glomerulus, tubules, interstitium and renal microvasculature, with clinical manifestations that range from asymptomatic elevation of serum creatinine to acute renal failure requiring dialysis. Some factors such as intravascular volume depletion, as well as concomitant use of other drugs or radiographic ionic contrast media, can potentiate or contribute to the nephrotoxicity. Cytotoxic agents can cause nephrotoxicity by a variety of mechanisms. The most nephrotoxic chemotherapeutic drug is cisplatin, which is often associated with acute kidney injury. Many other drugs such as alkylating agents, antimetabolites, vascular endothelial growth factor pathway inhibitors and epidermal growth factor receptor pathway inhibitors may have toxic effects on the kidneys. The aim of this review is to discuss the issue of nephrotoxicity associated with chemotherapy. In routine clinical practice, monitoring of kidney function is mandatory in order to identify nephrotoxicity early, allowing dosage adjustments or withdrawal of the offending drug.

Should patients with risk factors be tested for hypersensitivity to contrast media: a prospective study.

Previous hypersensitivity reactions to contrast media (CM), atopy, atopic disease, drug allergy, and age (20-29 or>55) are risk factors for CM hypersensitivity reactions. Our aim was to evaluate whether these risk factors should prompt skin testing for diagnosing CM allergy. The study was conducted among patients referred for allergy testing with CM. Skin tests were performed with non ionic or gadolinium CM, recommended by a radiologist. After completion of tests patients were telephonically queried on their symptoms of reactions. 151 risk patients (53 men, 98 women; mean age 55.2) were included in the study. Only 13 (9%) had a history of hypersensitivity reaction to CM. Compared with the other patients, atopy was significantly more common in patients with a history of CM hypersensitivity reactions. Female gender and mean age were also higher, but not significant. All of the tests with CMs were negative. Only one patient reported urticaria within 1-2min after administration of CM (telephonically). Atopy can increase the risk of CM allergy. However, skin tests with CMs may be inefficient, unnecessary, and time-consuming, except in cases with a history of CM allergy. Premedication protocols appear to be beneficial in patients with a history of CM allergy and cannot be recommended for patients with well-controlled asthma, rhinitis, atopic dermatitis or history of drug allergy.

The assessment of thrombotic markers utilizing ionic versus non-ionic contrast during coronary angiography and intervention trial.

To determine how two different types of iodinated contrast media (CM), low-osmolar ionic dimer ioxaglate (Hexabrix) and iso-osmolar non-ionic dimer iodixanol (Visipaque), affect multiple indices of hemostasis. In vitro models demonstrate differential effects of ionic and non-ionic CM on markers of hemostasis. This blinded endpoint trial randomized 100 patients to ioxaglate or iodixanol. The primary endpoint was change in endogenous thrombin potential (ETP) following diagnostic angiography. Secondary endpoints included change in markers of fibrinolysis [tissue plasminogen activator (tPA) and plasminogen activator inhibitor 1 (PAI-1)] and platelet aggregation following diagnostic angiography and percutaneous coronary intervention (PCI) with bivalirudin. Data are presented as median [interquartile range]. ETP significantly decreased after diagnostic angiography in both ioxaglate (baseline 1810 nM*minute [1540-2089] to post-angiography 649 nM*minute [314-1347], p < 0.001) and iodixanol groups (baseline 1682 nM*minute [1534-2147] to post-angiography 681 nM*minute [229-1237], p < 0.001), but the decrease was not different between CM (p = 0.70). There was a significant increase in ETP during PCI (n = 45), despite the use of bivalirudin, suggesting a prothrombotic effect of PCI (post-angiography 764 nM*minute [286-1283] to post-PCI 1081 nM*minute [668-1552], p = 0.02). There were no significant differential effects on tPA, PAI-1, and markers of platelet activity. There were no significant differential effects between ioxaglate and iodixanol. Both CM led to significant reductions in thrombin generation and no significant effects on fibrinolytic activity or platelet activity, thereby contributing to a favorable antithrombotic milieu. © 2016 Wiley Periodicals, Inc.

The Use of Heparin during Endovascular Peripheral Arterial Interventions: A Synopsis.

A large variety exists for many aspects of the use of heparin as periprocedural prophylactic antithrombotics (PPAT) during peripheral arterial interventions (PAI). This variation is present, not only within countries, but also between them. Due to a lack of (robust) data, no systematic review on the use of heparin during PAI could be justified. A synopsis of all available literature on heparin during PAI describes that heparin is used on technical equipment to reduce the thrombogenicity and in the flushing solution with saline. Heparin could have a cumulative anticoagulant effect when used in combination with ionic contrast medium. No level-1 evidence exists on the use of heparin. A measurement of actual anticoagulation status by means of an activated clotting time should be mandatory.

Oxidation of diatrizoate in aqueous phase by advanced oxidation processes based on solar radiation

Abstract The aim of this study was to investigate the use of solar radiation to treat recalcitrant pollutants, using sodium diatrizoate (DTZ), an ionic X-ray contrast media, as reference compound. The effectiveness in DTZ removal was compared among solar radiation, H2O2, solar radiation/H2O2, K2S2O8, solar radiation/K2S2O8, Fenton, solar radiation/Fenton, Fenton-Like, and solar radiation/Fenton-Like systems. Using direct DTZ photolysis, the percentage DTZ degradation is low and independent of the medium pH, but not of the irradiance level. However, in the presence of radical-promoting species, 100% DTZ degradation is achieved. Results obtained with solar radiation/Fenton and solar radiation/Fenton-like systems suggest that the formation of peroxo and iron hydroperoxy complexes susceptible of absorbing radiation in the solar radiation area represents a new source of OH and/or OH2 radicals in the medium, favoring DTZ degradation. The byproducts formed in each process and the post-treatment medium toxicity were studied, observing an increased toxicity after all oxidation treatments, indicating that the degradation products generated are more toxic than DTZ. Moreover, a direct relationship was found between percentage DTZ degradation and aqueous medium toxicity.

Brain Computerized Tomography Scan Findings in a Man After Inadvertent Intrathecal Ionic Contrast Agent Injection

Here is described a serial brain computerized tomography (CT) scan findings in a patient with inadvertent intrathecal injection of Meglumine Diatrizoate 76% for myelography. Intrathecal administration of ionic contrast media may cause severe and lethal neurotoxic reactions owing to their hyperosmolarity. This patient recovered from disease with only minor neurological sequel after 40 days of hospitalization and supportive care. To perform myelography, only non-ionic water soluble contrast agent for intrathecal injection can be used. Here is reported the findings of a serial brain CT scan in a patient with inadvertent intrathecal injection of Meglumine Diatrizoate (an ionic contrast agent not permitted for intrathecal use) for myelography. A 55-year-old man who was a victim of war shell fragment injury and had surgical history of lumbar laminectomy referred with chronic low back pain. He underwent myelography and was unintentionally injected Meglumine Diatrizoate. After a few minutes, he started complaining of severe headache, inability to walk, followed by a decrease in his level of consciousness and myoclonic seizure. His Glascow Coma Scale (GCS) declined to 3 in less than two hours. He was intubated and admitted in the intensive care unit. His initial brain CT scan showed hyperdensity of subarachnoid space consistent with the presence of high density contrast medium as well as diffused white matter hypodensity and increased gray-white matter differentiation compatible with those of cerebral edema Figure 1. After preliminary supportive care a ventricular shunt was introduced to assist faster cerebrospinal fluid turnover. In the second brain CT scan, one day after the event, only the ventriculostomy tube was visible and decrease in brightness of contrast agent in cerebral cortical sulci and decrease in hypodensity of white matter was observed Figure 2. Follow up CT scan after 3 days of continuous medical treatment showed almost complete washout of the contrast medium from subarachnoid space. Although to a lesser extent, white matter hypodensity consistent with cerebral edema still persisted. The patient’s GCS was calculated to be 10 at the time of this follow up CT scan, Figure 3. After 10 days of hospitalization and supportive care, the patient regained full consciousness showing GCS of 15 and only complained of difficulty in walking. CT scan at the time of discharge demonstrated complete resolution of cerebral edema, Figure 4.

Which iodinated contrast media is the least cytotoxic to human disc cells?

BackgroundIodinated contrast media (CM) is commonly used for various intradiscal injections such as in discography and endoscopic spinal surgery. However, CM has been shown to be toxic to renal tissue due to its ionic strength and osmolarity and as a result of iodine-induced cytotoxicity, which has raised concern over whether there are similar negative effects on disc cells. PurposeThis in vitro study was designed to identify the least cytotoxic iodinated CM to the human disc cell among four different physiochemical iodinated contrast dyes. Study designIn vitro laboratory study. MethodsIntervertebral disc tissue was obtained by discectomy from a total of 10 lumbar disc patients undergoing surgery and disc cells were isolated. The human disc cells were grown in 3D alginate bead culture with 0, 0.1, 10, and 100 mg/mL CM solutions (ionic dimer, ionic monomer, non-ionic dimer, and non-ionic monomer) and mannitol as a control for 2 days. The living cells were analyzed with trypan blue staining. Fluorescence-activated cell sorting analysis was performed using Annexin V and propidium iodide (PI) and 3D alginate bead immunostaining to identify live, apoptotic, and necrotic cells. ResultsHuman disc cell death was time- and dose-dependent in response to CM and more necrosis was observed than apoptosis. In addition, non-ionic dimeric CM (iodixanol) showed the least toxic effect on human disc cells, followed by non-ionic monomeric (iopromide), ionic dimeric (ioxaglate), and ionic monomeric CM (ioxithalamate). ConclusionsContrast media is cytotoxic to human disc cells in a dose- and time-dependent manner. This in vitro study revealed that, among four different CM preparations, non-ionic dimeric CM is the least detrimental to human disc cell viability. Careful attention should be paid to the type of CM chosen for discography and endoscopic spinal surgery. It is also necessary to investigate the detrimental effects of CM on disc cells and disc degeneration in further in vivo studies.

Successful use of an older ionic contrast media in a patient with systemic hypersensitivity to ioxilan

Results A 78-year-old female with end stage renal disease on hemodialysis via arteriovenous fistula, diabetes mellitus, hypertension, and hyperlipidemia was evaluated for recurrent fever and rash after receiving CM for a fistulogram. She had received prednisone prophylactically for reactions associated with ioxilan administration on two prior fistulograms. These reactions consisted of diffuse erythematous rash preceded by fever that started 2-4 hours after contrast administration and lasted several days. After receiving pretreatment with prednisone and diphenhydramine, she received her most recent dose of ioxilan (70 mL) for a fistulogram and developed fever and diffuse erythematous rash (2 and 4 hours post injection, respectively). The fever lasted 3 days and the rash subsequently desquamated involving the arms, trunk, neck and face. Her skin fully re-epithelialized 2 weeks later. She had negative skin prick tests and negative patch tests to ioxilan, iothalamate, and iohexol. She subsequently underwent challenge with 10 mL of intravenous iothalamate and was observed for 4 hours without incident. Later, she underwent fistulogram with iothalamate and tolerated it without adverse reactions. Conclusions Hypersensitivity reactions are generally much less common with non-ionic CM compared to older ionic CM. However, for DHRs, reaction rates between ionic CM and non-ionic CM are similar. Successful administration of different CM selected based on skin tests has been reported for patients with previous DHRs to specific CM. In our case, skin testing was non-diagnostic, and we hypothesized that the distinct chemical structures of these agents would make immunological cross-reactivity unlikely. Indeed this patient who was repeatedly reactive to the non-ionic lowosmolal CM ioxilan, subsequently tolerated the ionic hyperosmolal CM iothalamate. We conclude that different epitopes involved in DHRs to CM may be suggested based on differing chemical structure and ionicity. Further research is needed regarding both the cross-reactivity and cross-tolerance of various CM in DHRs, especially in CM skin-test negative patients.

Management of Intravenous Contrast Extravasations with Ultrasonography: A Case Report

Extravasation of ionic and nonionic contrast materials is a well-recognized complication of contrast-enhanced imaging studies. Complications vary from minimal swelling to severe skin and subcutaneous ulceration, necrosis, and compartment syndrome. We report a case of Omnipaque (iohexol) extravasation in a 50-year-old man with erythema, blistering, and compartment syndrome who was treated medically but was not cured. Using gray scale ultrasonography, we determined the characteristics of the lesion, its distance from the skin, and its proximity to the vessels. We then determined the depth of the lesion, and then inserted the tip of the needle into the lesion. We also used ultrasonography in locations where extravasation was near an artery. After aspiration, the diameter of the lesion decreased significantly. The patient was cured by ultrasonography-guided aspiration from the extravasated site.

Time- and Dose-dependent Cytotoxicities of Ioxitalamate and Indigocarmine in Human Nucleus Pulposus Cells

Introduction Ioxitalamate (Telebrix 300) is an ionic iodinated contrast medium (CM) commonly used for discography or PELD (percutaneous endoscopic lumbar discectomy), though it has side effects such as anaphylactic shock and renal toxicity. Indigocarmine is an organic compound dye with a distinctive blue color that is commonly used during PELD to stain the acidic, degenerated nucleus pulposus. Although ioxitalamate and indigocarmine are widely used in spinal surgery, there have been no reports on their effects on nucleus pulposus (NP) cells. We studied the toxicity of both ioxitalamate and indigocarmine to NP cells. Materials and Methods NP cells were obtained via discectomy from lumbar disc patients and isolated. NP cells were cultured in three-dimensional (3D) alginate beads with 0.001, 0.1, 10, and 100 mg/mL ioxitalamate, 0.00001, 0.001, 0.1 and 10 mg/mL indigocarmine, or a mixture of both for 1, 2, or 3 days. The living cells were analyzed with trypan blue staining. FACS analysis using Annexin V and propidium iodide (PI) and 3D alginate bead immunostaining was performed to identify live, apoptotic, and necrotic cells. Results Ioxitalamate, indigocarmine, and their combination induced statistically significant NP cell injury that was both time and dose dependent ( p &lt; 0.05). Also, at the same concentration, ioxitalamate was more cytotoxic than was indigocarmine or the combination ( p &lt; 0.05). All three treatments also showed dose-dependent cytotoxicity according to flow cytometry and immunostaining. Conclusion Ioxitalamate and indigocarmine are toxic to human NP cells in vitro in a time- and dose-dependent manner. We assume that ioxitalamate and indigocarmine may have similar effects in patients undergoing discography and PELD. Thus, we suggest that ioxitalamate and indigocarmine should be used carefully at low concentrations. Disclosure of Interest None declared References Stout A. Discography. Phys Med Rehabil Clin N Am 2010;21(4):859–867 Manchikanti L, Glaser SE, Wolfer L, Derby R, Cohen SP. Systematic review of lumbar discography as a diagnostic test for chronic low back pain. Pain Physician 2009;12(3):541–559 Carragee EJ, Tanner CM, Yang B, Brito JL, Truong T. False-positive findings on lumbar discography. Reliability of subjective concordance assessment during provocative disc injection. Spine 1999;24(23):2542–2547 Laslett M, Oberg B, Aprill CN, McDonald B. Centralization as a predictor of provocation discography results in chronic low back pain, and the influence of disability and distress on diagnostic power. Spine J 2005;5(4):370–380 Kim D, Wadley R. Variability in techniques and patient safety protocols in discography: a national multispecialty survey of International Spine Intervention Society members. J Spinal Disord Tech 2010;23(6):431–438 Carragee EJ, Tanner CM, Khurana S, et al. The rates of false-positive lumbar discography in select patients without low back symptoms. Spine 2000;25(11):1373-1380, discussion 1381 Paul MD, Tsou M. Posterolateral percutaneous endoscopic lumbar discectomy. Oper Tech Orthop 2003;13:207-213 Yeung AT. Selective endoscopic discectomy. In: Kambin P, ed. Arthroscopic and Endoscopic Spinal Surgery. Totowa, NJ: Humana Press; 2005:205–225 Mayer HM, Brock M. Percutaneous endoscopic discectomy: surgical technique and preliminary results compared to microsurgical discectomy. J Neurosurg 1993;78(2):216–225 Yeung AT, Tsou PM. Posterolateral endoscopic excision for lumbar disc herniation: Surgical technique, outcome, and complications in 307 consecutive cases. Spine 2002;27(7):722–731 Lee H, Sowa G, Vo N, et al. Effect of bupivacaine on intervertebral disc cell viability. Spine J 2010;10(2):159–166 Hsu SP, Tsai TJ, Chien CT. Ioxitalamate induces renal tubular apoptosis via activation of renal efferent nerve-mediated adrenergic signaling, renin activity, and reactive oxygen species production in rats. Toxicol Sci 2010;114(1):149–158 Lee HC, Chang JG, Yen HW, Liu IH, Lai WT, Sheu SH. Ionic contrast media induced more apoptosis in diabetic kidney than nonionic contrast media. J Nephrol 2011;24(3):376–380 Belhadjali H, Bouzgarrou L, Youssef M, Njim L, Zili J. DRESS syndrome induced by sodium meglumine ioxitalamate. Allergy 2008;63(6):786–787 Lacour B, Lacroix C, Jungers P, Bailly M. [Effects of intravenous urography using sodium and meglumine ioxitalamate (Telebrix 38) on blood creatinine and urinary excretion of N-acetyl-beta-D-glucosaminidase]. Ann Biol Clin (Paris) 1984;42(6):407–411

L’imagerie médicale diagnostique est-elle iatrogène ?

Imaging is an indispensable element of modern medicine but is not without risk. Low-dose irradiation due to spinal, abdominal, pelvic or cardiac radiography, and the increasing use of CT carries an additional, albeit moderate risk of cancer. Iodinated and gadolinium-containing contrast media, besides their direct toxicity, can trigger hypersensitivity and allergic-like reactions. Spinal and articular diagnostic injections can also lead to complications. This article reviews the direct iatrogenicity of diagnostic imaging and current efforts to limit it through the use of new radiological systems, lower-dose CT non ionic contrast media, and alternative imaging techniques. The authors also examine the less known but more frequent problem of indirect iatrogenesis, which is highly dependent on the quality of the imaging personnel and technique. Finally, we propose some legislative solutions to this problem.

Parkinsonian tremor-induced electrocardiographic artifacts mimicking atrial flutter/fibrillation or ventricular tachycardia

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