Cardiac complications of intravenous digital subtraction angiography.

In a prospective study of 103 patients the incidence of cardiac events during intravenous digital subtraction angiography (i. v. DSA) was investigated. Of 103 patients 17 had known ischaemic heart disease. The examination was performed with an ionic contrast medium, Urografin 76% (sodium megluminediatrizoate), administered by bolus injection into the right atrium. Patients with severe cardiac disease were examined only if the procedure was considered of vital importance. Cardiac events were defined as ST-segment changes of more than 0.1 mV, changes in heart rate of more than 20%, arrhythmias and such symptoms as chest pain and dyspnoea. Ischaemic ST-segment changes during i. v. DSA were observed in approximately 20% of the patients and were not related to the presence of known ischaemic heart disease. Three patients developed angina during the procedure. Among 12 patients with known angina only one patient developed angina during the procedure. In this study chest pain was infrequent (3%), but there was a relative high frequency of ECG changes (20%) not related to patients with ischaemic heart disease only. It is concluded that there is a risk of cardiac events during i. v. DSA, but the risk is not increased in patients with known ischaemic heart disease (if they do not suffer from congestive heart failure) as compared with other patients without known ischaemic heart disease.

[Inadequate configurational stability of a DSA pigtail catheter as a cause of complications. Case report and study of the mechanism]. / Unzureichende Formstabilität eines DSA-Pigtailkatheters als Komplikationsursache. Fallbeobachtung und Untersuchung zum Mechanismus.

There have been few descriptions extravasation into the superior vena cava and right atrium during intravenous DSA. This is seen almost exclusively when using straight catheters. The configuration of pigtail DSA catheters should reduce or prevent damage to vessel wall due to extravasation. Following an extravasation into the right atrium, which we ascribed to inadequate stability of the distal end of the pigtail catheter, we carried out in vitro experiments with seven DSA catheters from a variety of manufacturers, using an atrial model. Three of these catheters behaved in a manner that would be liable to produce extravasation.

Radiation exposure during dynamic hip screw operation.

Exposure to radiation by surgeon and patient was measured in ten cases during insertion of a dynamic hip screw, using image intensified screening. There were low levels of irradiation of the thyroid and eyes of the surgeon. However, the dominant hand of the surgeon was often exposed to higher levels. The use of a memory during screening significantly reduced the level of radiation measured (P less than 0.05). Recommendations are made for reducing radiation exposure by the surgeon, and a method is described to measure the irradiation of surgeons' hands.

Five patients with iodine-induced hyperthyroidism.

Iodine-induced hyperthyroidism has been frequently described when iodine is introduced into an iodine-deficient area. However, it may also occur in patients with and without previous thyroid disease residing in iodine-sufficient areas. Five patients with iodine-induced hyperthyroidism seen in a 12-month period are described. All were exposed to iodine in the form of commonly used drugs (Betadine, Iodo-Niacin, amiodarone, and radiographic contrast dyes). The cause of iodine-induced hyperthyroidism is unclear, but it is probably more common in patients with goiters containing previously existing areas of autonomous function or iodine-poor thyroglobulin. Iodine-induced hyperthyroidism usually abates after iodine withdrawal in patients with multinodular goiters or normal thyroid glands. The hyperthyroidism is usually treated with beta-blockers and antithyroid thionamide drugs, although reinstitution of iodine to block thyroid hormone release or corticosteroids occasionally may be necessary. Iodine-containing drugs should be given with caution to patients with underlying thyroid disease.

[A comparison of radiation exposure of angiographers using an above-table or below-table image intensifier (author's transl)]. / Vergleich der Strahlenexposition des Untersuchers bei Angiographiearbeitsplätzen mit Obertischund-und Untertischbildverstärker.

Phantom measurements in the vicinity of an angiographic installation with the image intensifier below the table and subsequently with the intensifier above the table have shown that the former arrangement produces three times as much radiation to the head, gonads and leg during screening than when the intensifier is above the table. This has been confirmed in clinical practice during angioplastic procedures in other units. There is also a factor of 2.6 in favour of the above table intensifier applied to the lens of the eye of the investigator Radiation to the hand of the investigator is at least half with the above table arrangement.

[Image intensifiers in Osteosynthesis a danger for the team? (author's transl)]. / Röntgenbildverstärker bei Osteosynthesen, eine Gefahr für das Personal?

Three years' examination of X-ray load when working with the X-ray image intensifier have led to the conclusion that with a tolerance basis of 100 mrem per week a fluoroscoping time of about 1 hour is tolerable without lead protection with an average fluoroscoping time of 5 minutes for one osteosynthesis. The operating surgeon can carry out about 10 osteosyntheses per week. For the other members of the operating team the X-ray load is significantly lower and, therefore, there are no limits in practice. It must be noted that an exact record of the fluoroscoping time and dose measurements is absolutely necessary.