Effect of contrast material osmolality on the electrocardiogram during intrauterine injection

RATIONALE AND OBJECTIVES

In a previous study, intrauterine injection of meglumine-sodium diatrizoate (high osmolar contrast media) during hysterosalpingography was found to induce lengthening of the QTc interval on electrocardiography. To evaluate the relationship between high osmolality and electrocardiographic changes during intrauterine injection, the authors evaluated the effect on QTc of two ionic contrast agents with different osmolality during routine hysterosalpingography.

METHODS

Forty-eight women undergoing routine hysterosalpingography were included in the study. Thirty-two women received meglumine-sodium diatrizoate (1500 mOsm/kg) and 16 received meglumine-sodium ioxaglate (600 mOsm/kg). QTc changes were evaluated using a 12 lead computerized electrocardiogram system during all the stages of the procedure.

RESULTS

In the meglumine-sodium diatrizoate group, QTc interval was prolonged significantly from 419 +/- 19 msec at baseline to 447 +/- 30 msec during injection of contrast material, P < .001, and returned to baseline values in late phase (416 +/- 18 msec). The meglumine-sodium ioxaglate group showed no change in the QTc interval.

CONCLUSION

As the single major difference between the two ionic agents is osmolality, we believe that QTc interval prolongation in the meglumine-sodium diatrizoate group is related to increased osmolality.

Axillary vein thrombosis during pregnancy: a case report

A 32-year-old multiparous woman had progressive swelling of the right arm at 32 weeks' gestation, accompanied by cyanosis and a preserved radial pulse. Phlebography demonstrated a 5-cm thrombus in the axillary vein. No known etiologic factors were found. Intravenous heparin administration resulted in rapid resolution of the clinical findings. Subcutaneous heparin 10,000 U/day was administered for secondary prophylaxis until cesarean at 39 weeks, during which a full dose was administered without complications. Axillary vein thrombosis during pregnancy may be diagnosed by either phlebography or duplex scanning, and preferably should be treated by heparin. Thrombolytic therapy is justified mainly for life-threatening complications such as pulmonary embolism.

Spontaneous nonfistulous barium reflux into the biliary tract: association with duodenal ulcer disease. A report of four cases

Reflux of barium into the bile duct system during a barium study of the upper gastrointestinal tract is rare in the absence of spontaneous or postoperative fistula. We report four patients, three men and one woman, who had such reflux, associated with active duodenal ulcer disease, shown at radiologic and endoscopic investigation. Reflux of gastrointestinal contents into the biliary tract can result from peptic ulcer disease with duodenal involvement. The finding does not necessarily imply fistulous communication, ulcer perforation, or surgical emergency.

Renal scintigraphy in initial evaluation of renal colic

To determine the role of renal scintigraphy (RS) in patients with suspected acute urinary tract obstruction, a prospective study was performed comparing RS with emergency intravenous excretory urography (IVU) in 36 examinations. Thirty patients were diagnosed as having renal colic: 28 had dilation of the urinary tracts with (89%) or without (11%) visualized stone; 2 patients with stones did not have stasis at the IVU. An abnormal RS was found in 28 patients with abnormal IVU, while it was normal in the 2 nonobstructed patients (sensitivity = 93%). The radiopaque stones in these 2 patients were seen on plain x-ray film of the abdomen. The results of this study support the use of RS combined with a plain film of the abdomen in the initial evaluation of renal colic.

Electrocardiogram changes during intrauterine injection of ionic contrast medium

The effect of intrauterine injection of meglumine-sodium diatrizoate 60% on the electrocardiogram was studied in 28 young, healthy women during routine hysterosalpingography. The most important single finding observed was significant QTc prolongation in 25 (90%) out of the 28 women examined. QTc increased from 417 +/- 18 mseconds to 451 +/- 30 mseconds (P less than .001). This effect disappeared rapidly within 2 to 3 minutes. Saline was injected in ten women prior to contrast medium injection in order to exclude direct mechanical dilatatory effect of the injected material. The QTc did not change significantly after saline (418 +/- 18 mseconds). The mechanism involved in the QTc prolongation is not known.

[A rare cause of subcutaneous emphysema]

A rare cause of subcutaneous emphysema is described which developed in two patients after epidural anaesthesia. Only two case reports could be found in literature describing similar conditions. The anaesthesia is performed using the "loss of resistance" technique with injection of air for the identification of the epidural space. Possible explanations for the development of the emphysema are discussed.

[Radiology and cytogenetic (author's transl)]

One of the major advances in medicine where Radiology is able to be of considerable aid is in the field of Cytogenetics. Parallel with the development of Cytogenetics a group of radiologists described radiological signs associated with chromosomal abnormalities, which became the basis of Radio Cytogenetics. In the last few years radiocytogenetics has provided a list of various signs commonly noted in diseases with chromosomal abnormalities. In spite of the adjuvant and secondary role of radiology, its techniques help in the early diagnosis and genetic counseling. In the final assessment the diagnosis of any chromosomal anomaly needs to depend on a combination of clinical, radiological and genetic features.