BACKGROUND: Plasma clearance of iohexol (Omnipaque(r)) which used widely in radiologic procedure is considered as useful method for estimation of GFR because iohexol is neither reabsorbed nor secreted from tubule after filtered as inulin and its extrarenal clearance is negligible. Plasma clearance of iohexol can be calculated from two compartment model or one compartment model with Brochner-Mortensen (B-M) modification which convenient and reliable. But there were controversies about sufficient sampling numbers and times for B-M modification of iohexol clearance. METHODS: Nineteen healthy Korean without renal disease underwent measurement of iohexol clearance. Iohexol was given as a single iv dose, and 14 blood sample were drawn up to 300 min. A reference GFR was iohexol clearance calculated from two-compartment model using 14 samples (CL-T). From 8, 3 and 2 samples clearances were calculated by B-M modification (CL-M8, 3 and 2 respectively). The accuracy of estimates was evaluated as percent of estimates falling within 10% above or below the reference GFR. Accuracy of CCr and equations for GFR estimation were also compared. RESULTS: CL-T, CL-M8, CL-M3 and CL-M2 were not different (101.9+/-24.0, 101.9+/-18.7, 101.7+/-18.6, 101.9+/-19.5 mL/min/1.73 m2 respectively). Accuracy of CL-M8, 3 and 2 were not different (74%, 84% and 79% respectively, p>0.05). MDRD equation had higher accuracy (47%) compared with other equations. CONCIUSION: These results indicate that sampling number for measuring iohexol plasma clearance using simplified method might be reduced to only two without accuracy loss in Korean without renal disease.
Inulin ; Iohexol* ; Plasma*

Iohexol has been widely used in extensive clinical evaluation of spinal problem. We report a 46-year-old man with generalized tonic-clonic status epilepticus which began with spreading myoclonus after iohexol injection for cervical myelography. The status epilepticus which started with spreading myoclonus followed by encephalopaty has controlled 8 hours after the initiation of treatment. The encephalopathy improved completely 8 days after treatment with glucocorticoids and anticonvulsant.
Glucocorticoids ; Humans ; Iohexol* ; Middle Aged ; Myelography* ; Myoclonus ; Status Epilepticus*

We report a case of severe chemical meningitis complicating iohexol myelography. Cerebrospinal fluid findings include a white blood cell count of 1700(94% polymorphouse cell, 6% lymphocyte ), sugar 20mg/dl and p rotein 170mg/dl. Chemical meningitis can not be distinguished from acute bacterial meningitis on the basis of the clinical findings and cerebrospinal fluid examination. A cerebrospinal fluid gram stain and culture were the only reliable test in deciding the etiology of the meningitis. The authors report this rare complication from iohexol myelography with review of pe rtinent literature.
Cerebrospinal Fluid ; Iohexol* ; Leukocyte Count ; Lymphocytes ; Meningitis* ; Meningitis, Bacterial ; Myelography

PURPOSE: We wanted to evaluate the clinical efficacy of an increased computed tomography attenuation coefficient (CTAC) of urine after the oral administration of iohexol in neonates who are suspected of suffering with neonatal necrotizing enterocolitis (NEC). MATERIALS AND METHODS: During a recent 1 year-period, seventeen neonates were admitted for suspected NEC, and they were divided into the suspected and definite groups based on their clinical signs and radiographic findings; we also included ten normal neonates as the control group. Diluted iohexol was administered and the CTACs of collected urine samples at 8-12 hour intervals were measured. Comparative analysis of the three groups was done and statistical significance was determined by the Scheffe test. RESULTS: Among 17 neonates, there were 13 neonates in the suspect group and 4 neonates in the definite group. The mean CTACs of urine in each group were 2711 HU (control group), 3411 HU (suspected group), and 7625 HU (definite group), respectively. There was a significant difference between the mean CTAC of the definite group and that of the control or suspected groups (Scheffe t >2.65). However, no statistically significant difference was seen between the suspected and control groups (Scheffe t=1.14). CONCLUSION: Although measurements of the CTAC of urine showed no significant diagnostic efficacy in the suspected group, the CTAC of urine, which reflects the correlated degree of bowel mucosal injury, can be a useful aid for determining the severity and progression of NEC.
Administration, Oral ; Colitis ; Enterocolitis, Necrotizing ; Humans ; Infant, Newborn* ; Iohexol ; Water*

BACKGROUND: The aim of this study was to compare the accuracy of the position of the epidural catheter inserted from three different lumbar intervertebral spaces, L2-3, L3-4, and L4-5, in infants and children. METHODS: Seventy-five children were randomly allocated to 3 groups according to the epidural catheter insertion site (L2-3, L3-4, and L4-5). The epidural catheter tip was identified using 50% diluted Iohexol and fluoroscopy. The incidence of correct position was compared among the groups and between infants and children. RESULTS: The incidence of correct position was significantly higher in the L2-3 group as compared to the L3-4 and L4-5 groups (P = 0.023 and P = 0.046 respectively). The incidence of correct position was higher in infants compared to children (P = 0.017). CONCLUSIONS: The L2-3 intervertebral space is preferable during epidural catheter insertion in children older than 1 year, but a low lumbar level should be considered in infants because they have a higher risk of neural damage.
Analgesia, Epidural ; Catheters ; Child ; Fluoroscopy ; Humans ; Incidence ; Infant ; Iohexol ; Pediatrics

We encountered a patient who had a rare occurrence of a seizure after lumbar myelography from the beginning of this untoward side effect. Clinical trials with iohexol in myelography have demonstrated a good tolerability of this water-soluble contrast medium. However, there have been a few reports that have shown acute adverse reactions such as headaches, vomiting, psychosis, confusion and generalized tonic-clonic seizures. Despite the reports on the safety of iohexol use, it may cause a generalized seizure attack without an epileptogenic history. Therefore, thorough attention and the preparation for emergency treatments for the seizure are essential in every myelography using iohexol as a contrast medium. Moreover, in order to avoid unwanted legal problems, the patients and their family need to be informed of the necessity and possible side effects associated with myelography.
Emergency Treatment ; Headache ; Humans ; Iohexol* ; Myelography* ; Psychotic Disorders ; Seizures* ; Vomiting

One of the most common mechanisms of failure of epidural anesthesia is the misplacement of a catheter. We present two cases of transforaminal escape of catheter which occurred accidentally during lumbar epidural anesthesia. Epidural catheter was inserted to a depth of 4.5 cm and 3.5 cm respectively, then 2% lidocaine 25 ml were injected slowly into the catheter. No analgesia was found except anterior knee area, so Iohexol dye was injected through the catheter for X-ray determination. The epidurogram showed the catheter, which passed through the intervertebral foramen, was to lie outside the epidural space in the paravertebral tissue. Because of the random direction and migration of epidural catheter, we suggest an epidural catheter should be inserted 3cm into the epidural space. Epidurogram with a small dose of contrast material is advisable in the cases of unsatisfactory effect of epidural block, or when some adverse reactions are noted after block.
Analgesia ; Anesthesia ; Anesthesia, Epidural* ; Catheters* ; Epidural Space ; Iohexol ; Knee ; Lidocaine ; United Nations*

BACKGROUND: Cervical epidural injection, performed via the interlaminar approach, represents a useful interventional pain management procedure indicated in patients with a cervical herniated disk. Due to thedecreased epidural space in the cervical region, cervical epidural injections may result in potentially serious complications, especially during a large volume injection. METHODS: Thirty-four patients with neck pain due to a cervical herniated disk that were referred to the pain clinic for cervical epidural steroid injection were randomized into two groups. One group received a cervical epidural injection of 4 ml drug and the other group received 2 ml drug. The injected mixture included triamcinolon, ropivacaine and omnipaque. Spread levels of the drug after injection were estimated with the use of C-arm fluoroscopy. RESULTS: Spread levels to the cephalad for patients in the two groups were 4.88 +/- 0.78 segments and 4.53 +/- 0.49 segments, respectively. Spread levels to the caudad for patients in the two groups were 4.59 +/- 0.93 segments and 4.47 +/- 0.51 segments, respectively. The results showed no significant difference in the spread level between the two groups. CONCLUSIONS: Use of a small volume of drug (2 ml) can provide a sufficient spread level of the injected drug that is desirable for patients with a cervical herniated disk.
Epidural Space ; Fluoroscopy ; Humans ; Injections, Epidural ; Intervertebral Disc Displacement ; Iohexol ; Neck Pain ; Pain Clinics ; Pain Management

A 69-year-old male presented with several painful erythematous patches on both palms and trunk several days after receiving iopromide (Ultravist(R), Shering, Berlin, Germany). A fixed drug eruption (FDE) due to iopromide was suspected clinically. However, at that time, the patch test with iopromide at the lesion site gave negative results. Three years later, the patient was mistakenly administered iopromide again and patches with vesicles recurred on the same sites as well as on the genitalia. This episode was repeated once again after 1 year. In all episodes, the skin lesion resolved after application of topical steroids. Although a patch test with iopromide was negative in our case, we made a diagnosis of FDE due to iopromide because the skin lesions occurred again at the previously involved area after re-exposure to iopromide. To date, only three cases of FDE caused by non-ionic monomers have been documented in the English literature. Herein, we report on an interesting case of FDE caused by iopromide.
Aged ; Berlin ; Contrast Media ; Drug Eruptions ; Genitalia ; Humans ; Iohexol ; Male ; Patch Tests ; Skin ; Steroids

OBJECTIVETo investigate the distribution of hyaluronic acid (HA) with iohexol tracing in the knee joint cavity of rabbits using CT plain scan, three-dimensional reconstruction and Χ-ray and observe how different injection sites affect HA distribution.

METHODSMixtures of HA and iohexol (tracer) were prepared that contained final iohexol concentrations of 2.5%, 5%, 10%, 20%, or 40%. The HA-iohexol mixtures (0.5 ml) were injected into rabbit knee joints, and the optimal iohexol concentration that allowed clear differentiation of the injected agents from the surrounding tissues was determined using dual-source CT plain scan and three-dimensional reconstruction technique. The HA-iohexol mixture (0.5 ml) containing the optimal concentration of iohexol was then injected into the knees of the rabbits either through the patella medial approach or the medial joint line approach, and HA distribution in the knee joint cavity was observed using CT scan and Χ-ray.

RESULTSThe CT value of HA-iohexol mixture increased progressively with the tracer concentration. After injection of the mixture containing 2.5%, 5%, 10%, 20%, and 40% iohexol, the CT value ratios of the soft tissue, HA-iohexol mixture and bone cortex were 2:7:46, 2:14:44, 2:28:44, 2:60:46, and 2:98:45, respectively, and a iohexol concentration of 5% was determined as optimal for differntiating the injected agents from the surrounding tissues. The HA-iohexol mixutre containing 5% iohexol injected through the medial-patellar approach was distributed mainly over the patello-femoral joint, and that injected through the joint line approach was found mainly over the tibio-femoral joint.

CONCLUSIONHA-iohexol mixture containing 5% iohexol allows clear differentiation of bone cortex and soft tissues in rabit knee joint from the injected agents on CT scan and Χ-ray, and the injection approach can influence HA distribution in the knee joint cavity.