Meglumine iodipamide (Cholografin) hepatotoxicity

Severe liver and renal injuries following cerebral angiography: late life-threatening complications of non-ionic contrast medium administration

INTRODUCTION

Contrast-induced nephropathy requiring dialysis support is rarely reported, whereas severe liver injury after contrast agent administration has not been described in children yet.

CLINICAL CASE

A previously healthy 10-year-old boy with diagnosis of cerebral arteriovenous malformation underwent a cerebral angiogram study with iohexol (3 mL/kg). After 4 days, he developed vomiting and abdominal pain. Laboratory results showed abnormal liver function tests, including marked elevation of transaminases. In the next day, he evolved with oliguria and blood arterial hypertension. At this time, he presented with worsening renal function tests. Peritoneal dialysis was required for 13 days. The patient had a self-limiting course and received only supportive treatment.

CLINICAL PRESENTATION

This report highlights delayed complications related to low non-ionic contrast media with a rare presentation that can be neglected or unrecognized by pediatric specialties.

Role of magnetic resonance cholangiography in assessing biliary anatomy in right lobe living donors

BACKGROUND

The value of magnetic resonance cholangiography (MRC) in assessing potential adult-to-adult living liver transplant (ALDLT) donors remains poorly defined. The purpose of this study is to determine the accuracy of MRC in assessing biliary anatomy with intraoperative confirmation.

METHODS

A prospective cohort of 30 ALDLT donors who underwent right hepatectomy from October 2000 to July 2003 was evaluated. MRC was performed using a heavily T2 weighted radial slab technique. MRC was interpreted preoperatively by a radiologist and a surgeon and compared with the intraoperative biliary findings in all patients derived from cholangiography (IOC) and bile duct exploration. The sensitivity, specificity, and positive and negative predictive values of MRC for aberrant biliary anatomy were calculated.

RESULTS

MRC suggested normal, aberrant, and indeterminate biliary anatomy in 16, 12, and 2 donors, respectively. IOC revealed normal and aberrant biliary anatomy in 17 and 13 patients, respectively. MRC demonstrated biliary anatomy accurately in 27 of 30 patients. The sensitivity, specificity, positive predictive, and negative predictive values of MRC in detecting aberrant biliary anatomy were 92%, 100%, 100%, and 94%, respectively.

CONCLUSIONS

Preoperative MRC accurately depicts biliary anatomy in potential ALDLT donors and may guide the intraoperative management of the biliary tract.

Drug effects on the liver. An updated tabular compilation of drugs and drug-related hepatic diseases

Generic and chemical names of drugs and the possible adverse effects of these drugs on the human liver are tabulated. Most drugs compiled in these tables have been approved by the Federal Drug Administration. They are currently available in the United States, and they are listed in the 1983 Physicians' Desk Reference. Some important investigational drugs are listed also. The tables include: (1) generic names of drugs that have caused a characteristic morphologic change, such as granulomatous hepatitis; (2) morphologic diagnoses that have been documented after administration of each drug; and (3) references that can be matched to each drug and to its effects on the liver.

Elevation of serum lactate dehydrogenase-5 following methylglucamine iodipamide (Cholografin/Biligrafin) infusion for intravenous cholangiography

Methylglucamine iodipamide (Cholografin-North America; Biligrafin-Europe, Squibb) is the only contrast medium in clinical usage for opacification of the biliary tree in intravenous cholangiography. We report two cases of elevation of serum lactate dehydrogenase-5 activity following infusion of 40 ml of Cholografin. This occurred without overt clinical signs of adverse reaction to contrast medium. This elevation was 65% of serum LD-5 activity in case one, 91% in case two. The elevation peaked at 12 h after administration of contrast medium in both cases and persisted for at least 24 h. These findings suggest that methylglucamine iodipamide causes transient hepatocellular toxicity, the mechanism of which is not known.

Drugs and liver disease: a tabular compilation of drugs and the histopathological changes that can occur in the liver

A compilation of drugs and the histopathological changes that can occur in the liver is presented. The purpose of this review is to provide the reader with a comprehensive and reliable source of information on various drugs that have been documented by liver biopsy to cause hepatocellular damage. The morphologic terms used in the tables have been chosen based on past publications dealing with this subject. This review is intended as a concise guide to aid in the identification of drug-induced liver diseases.