Nonrenal Complications of Contrast Media.

Injection of contrast media is the foundation of invasive and interventional cardiovascular practice. Iodine-based contrast was first used in the 1920s for urologic procedures and examinations. The initially used agents had high ionic and osmolar concentrations, which led to significant side effects, namely nausea, vomiting, and hypotension. Newer contrast agents had lower ionic concentrations and lower osmolarity. Modifications to the ionic structure and iodine content led to the development of ionic low-osmolar, nonionic low-osmolar, and nonionic iso-osmolar contrast media. Contemporary contrast agents are better tolerated and produce fewer major side effects.

Presence of external carotid artery plaque independently predicts mortality in patients without internal carotid artery atherosclerosis.

BACKGROUND: The presence of plaque in the external carotid artery (ECA) detected on carotid duplex ultrasound (CDU) is of unknown clinical significance and may not be reported in routine clinical practice. We hypothesize that ECA plaque in the absence of plaque in the other cervical vessels is a risk factor for increased all-cause mortality. OBJECTIVES: To determine the significance of ECA plaque on all-cause mortality in the absence of internal carotid artery (ICA) or common carotid artery (CCA) plaque. METHODS: We queried the Non-Invasive Vascular Laboratory database for all CDUs performed between 1 January 2005 and 31 December 2005. All images were reviewed for the presence of plaque. Studies were included if plaque was absent in both the CCA and the ICA. Chart review was performed to obtain demographic and clinical information. All-cause mortality was determined using the Social Security Death Index. RESULTS: A total of 500 patient studies met the inclusion criteria; 64 patients (12.8%) had plaque in one or both ECAs. There was no significant difference in age (mean 58.1 ± 14.8 years), race (82.5% white), or sex (64.4% male) between those with and without ECA plaque. There was a significant difference in all-cause mortality between patients with and without isolated ECA plaque after adjustment for age, sex, low-density lipoprotein cholesterol, smoking, hypertension, body mass index, and surgery within 30 days of CDU (adjusted hazard ratio 2.60, 95% CI 1.46-4.66, p<0.001). CONCLUSIONS: The presence of plaque isolated to the ECA is an independent predictor of all-cause mortality and may impart important prognostic information for patients referred for CDU.

Nonrenal Complications of Contrast Media.

Nonrenal complications of contrast media are caused by chemotoxic or anaphylactoid reactions related to the contrast agent used. Chemotoxicity is mainly attributed to ionic concentration and osmolality. Anaphylactoid reactions are typically caused by direct activation of basophils, mast cells, and complement rather than an observable antigen-antibody interaction, and may be acute or delayed. History of an adverse reaction following prior exposure is the strongest predictor of a subsequent adverse reaction to contrast. Premedication regimens of corticosteroids or antihistamines can lower the risk of repeat adverse reactions. Treatment of anaphylactoid reactions depends on the severity of symptoms.

A detailed observation of variations of the facial artery, with emphasis on the superior labial artery.

The reconstruction of lip defects through the use of the Abbe flap and other lip flap procedures involves surgical manipulation of one of the major branches of the facial artery, specifically the superior labial artery (SLA). We examined 284 hemifaces derived from 142 formalin fixed cadavers. Observations regarding the distribution patterns of the facial artery were recognized and categorized into five Types, labeled "A" through "E". Type A (135, 47.5%): facial artery bifurcates into SLA and lateral nasal (the latter gives off inferior and superior alar and ends as angular); Type B (110, 38.7%): similar to Type A, except lateral nasal terminates as superior alar (angular artery is absent); Type C (24, 8.4%): facial artery terminates as SLA; Type D (11, 3.8%): angular artery arises directly from facial arterial trunk rather than as the termination of lateral nasal, with the facial artery ending as superior alar; Type E (4, 1.4%): facial artery terminates as a rudimentary twig without providing any significant branches. Furthermore, we were able to categorize variations within each Type. Sub-Type variations were examined in Types A through C (A: 1-7; B: 1-4; C: 1-3). Our aim was to equip both the anatomist and surgeon with a more thorough understanding of the vasculature of the face, as well as to enable plastic surgeons to have a more confident approach to reconstructive procedures in this region.