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Cerebrovascular complications were registered in 11 patients (0.21%) of 5,339, consecutively submitted to coronary angiography with the nonionic contrast medium iohexol (Omnipaque). Six of the patients had diseases predisposing them to thromboembolic complications, 3 of whom earlier had symptoms of cerebral stroke. Excluding these 6, the incidence of cerebral thromboembolic events was 0.10% in patients with no predisposing diseases. Precise catheterization technique and some anticoagulation and antiplatelet activity therapy are definite precautions against these complications, while the role of the contrast medium is still debated.

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The possible association between heart size measured during a cardiovascular screening examination and cardiovascular mortality was studied in 1984 healthy men aged 40-59 years. At the 16-year follow-up 278 had died, 150 from cardiovascular diseases. Cardiovascular mortality was 2.2 times higher among the 122 men with heart size > or = 500 ml.m-2 than among those with heart size < 500 ml.m-2. This association was, however, exclusively confined to men with physical fitness below median in whom the corresponding mortality ratio was 4.6 (95% confidence interval 2.5-8.4; P < 0.001) after adjustment for age, smoking, cholesterol, blood pressure and heart rate. Heart size measurements from routine chest X-rays is fast, easy, inexpensive and appears to provide valuable, independent screening information in healthy, middle-aged men.

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In this phase I study, safety, tolerance and pharmacokinetics of iodixanol 300 mg I/ml, were evaluated in 40 healthy male volunteers using four dose levels. No clinically important influences on renal function parameters, hemodynamics, ECG or clinical-chemical parameters in blood and urine were observed. 17 adverse events including discomfort were reported, but only three of them (sensation of warmth) were classified as related to iodixanol. CT-investigations revealed a dose-related, reversible increase in kidney cortex density. However, iodixanol caused no changes in glomerular function, and the increase in excretion of tubular enzymes was less than caused by other nonionic x-ray contrast media. Further investigations will focus on the safety and efficacy of iodixanol in patients.

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The justified campaign against child abuse has unfortunately had a side effect. It has ruined the lives of some innocent parents of children with undiagnosed osteogenesis imperfecta. For 15 years, Colin Paterson and co-workers have studied a large number of patients with type IV of osteogenesis imperfecta, and have found that more than 50 per cent of them have normal radiographs of the bones at the time of the first fracture. Paterson and co-workers have also found that fractures of the ribs and skull are by no means uncommon in osteogenesis imperfecta type IV. These important observations should help, in the future, to prevent prosecution of innocent parents of children with osteogenesis imperfecta type IV, provided that the observations are not overlooked by pediatricians.

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The safety and toleration of iopentol, a new non-ionic contrast medium for intravascular use, were evaluated. In the intravenous phase I study, 24 volunteers were allocated to 3 dose groups corresponding to 0.3, 0.6 or 1.2 g I/kg body weight, respectively. Injection of saline was used as control in the highest dose group. Adverse events, hemodynamic parameters, and clinical chemical parameters in the blood and urine were recorded. No severe or unexpected adverse events occurred. All findings were transient and included a sensation of warmth, a small increase in heart rate, a dilution effect on blood parameters, and enzymuria. The deviations in clinical chemical parameters fell mostly within reference ranges and were clinically insignificant. Thus, iopentol may safely be advanced to clinical trials in patients for comparative studies.

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The low osmolar nonionic contrast medium Omnipaque was used in 5,339 consecutive coronary angiographies and serious complications were registered. Myocardial infarction occurred in 4 patients, of whom 2 died, and ventricular fibrillation in 1. Cerebral embolism occurred in 11 patients, all of whom survived. The results are compared with those of previous series of coronary angiography with high osmolar ionic media. It is concluded that use of the nonionic medium Omnipaque resulted in a significant reduction of the frequency of serious complications.

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Adverse events occur in 5-7 per cent of patients after intravenous injection of a traditional contrast medium. Some diseases and procedures are associated with a higher frequency and more serious reactions. In recent years, contrast media with less adverse reactions have been marketed. From a pharmacologic point of view, these are preferable to the traditional media. However their prices are relatively high. In spite of this, use of the newer agents is steadily increasing.

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A study of the diagnostic utility of both intravenous digital subtraction angiography (IV-DSA) and conventional angiography of precerebral and cerebral arteries is presented. The series comprised 60 patients with TIA, who underwent the two procedures with a mean interval of 16 days. Conventional angiography was generally superior to IV-DSA, and this was particularly marked in the siphons and cerebral arteries. Only the excellent IV-DSA examinations obtained in a few patients with TIA could be accepted as final pre-operative procedures. Accurate imaging of the lesions and collateral flow pattern usually required intra-arterial injections, and intra-arterial DSA is now usually preferred.

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During the 10-year period from 1 January 1975 to 31 December 1984, primary sclerosing cholangitis (PSC) was diagnosed in 45 patients. Twelve of the patients have died (26.7%), 10 of them of causes related to PSC. Inflammatory bowel disease was found in all patients; ulcerative colitis was found in 37, Crohn's disease in 6, and unclassified colitis in 2 patients. Of the patients alive, 27 were submitted to a follow-up study in 1985. At the follow-up examination no general progression of the liver disease, as measured on the basis of clinical examination and levels of transaminases, alkaline phosphatases, and bilirubin, was found. Cholangiographic evaluation in 24 patients showed that the stage of ductal changes progressed from mild to moderate in 3 patients; in the other patients the stage was not altered. Morphologic examination of liver biopsy specimens in patients with a benign clinical course usually showed portal inflammation, fibrosis, and minor signs of piecemeal necrosis, whereas widespread piecemeal necrosis was found in patients who deteriorated and died. The 50% survival since diagnosis of liver disease was calculated to be 17 years in patients with PSC and 50 years in a comparable group among the general population. The estimated survival curve in PSC was displaced to the left, indicating a reduced life expectancy of about 30 years.

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The effects of the first injections in humans of iopentol, a new non-ionic contrast medium, are briefly reported. Detailed descriptions will be published elsewhere. Iopentol was well tolerated when injected intravenously into 24 healthy male volunteers in doses of 300 to 1,200 mg I/kg body weight and was excreted almost entirely in the urine in unchanged form. The results indicate that iopentol may be used in clinical trials in patients.

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The heart volume was followed over a 7-year period in 819 healthy men aged 40 to 59 years. The subjects were selected on the basis of unremarkable clinical findings and technically satisfactory films on two occasions 7 years apart. On both occasions the mean heart volume in the upright position was 390 ml/m2 (96.6% below 500), uninfluenced by age, and moderately larger in subjects with high physical fitness. Inclusion of subjects who were healthy during the baseline examination, but who developed heart disease or other diseases during the follow-up period, would have increased the mean heart volume by 15 ml/m2. Latent coronary heart disease did not influence the heart volume, but intercurrent myocardial infection increased the follow-up volumes significantly.

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Ultrasonography (US) was performed in a prospective study of 48 patients with uncharacteristic abdominal symptoms. All patients had been examined in other hospitals, but no diagnosis had been established. Pathologic US findings were encountered in five patients: fatty liver in two patients, gallstones in one patient, ovarian cyst in one, and liver metastases in another patient. US may be used as a diagnostic approach in patients with uncharacteristic abdominal complaints when conventional X-ray examinations are negative. In patients with psychosomatic disease a negative US result may be of importance in the psychiatric approach to these patients' disease.

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Computer tomography (CT) was performed on 48 patients with uncharacteristic abdominal disturbances. Pathological CT findings were encountered in five patients, namely hepatic steatosis in three patients, liver metastases in one, and occlusion of the inferior vena cava in one. CT may be indicated in patients with uncharacteristic abdominal disorders when other investigations are negative. In some patients the negative result of the CT examination for organic disease was of great importance for the psychiatric approach to these patients' psychosomatic disease. In spite of this, the positive yield of abdominal CT seems to be highest when other less expensive examinations or tests have suggested abnormality of abdominal organs.

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Fifteen patients with carcinoid metastases in the liver were examined with computed tomography (CT). In 13 patients, liver metastases were demonstrated, while 2 patients had a normal liver at CT. The attenuation of the metastases was lower than that of the liver parenchyma in 12 patients, higher in one. Angiography was performed on 10 patients, and liver metastases were diagnosed in 9. Eight patients had hypervascular metastases with dense accumulation of contrast medium. In one patient, displacement of the intrahepatic arteries was the only sign of an expansive process. In one patient, previously treated with ligation of the common hepatic artery, no signs of liver metastases could be revealed at angiography but were evident at CT.

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Injections of iohexol in two series of volunteers, 20 in 1980 and 16 in 1982 are briefly reported. Intravenous injections of iohexol in doses from 125 to 1500 mg I/kg body weight were well tolerated. Iohexol was completely excreted in unchanged form. The results indicate that iohexol may safely be used in clinical trials.

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