Therapeutic effects of hysterosalpingography contrast media in infertile women: what do we know about the H2O in the H2Oil trial and why does it matter?

2020 ◽  
Author(s):  
Jane M Peart ◽  
Robert G Sim ◽  
Paul L Hofman
Keyword(s):  
Contrast Media ◽  
New England ◽  
Iodine Concentration ◽  
Water Soluble ◽  
Therapeutic Effects ◽  
Infertile Women ◽  
Randomized Controlled ◽  
Recent Interest ◽  
Radiographic Contrast ◽  
Physical And Chemical

ABSTRACT Recent interest in the use of oil-soluble contrast media (OSCM) for hysterosalpingography (HSG) and other tubal flushing procedures is largely the result of publication of the large, multicentre, randomized controlled H2Oil trial in the New England Journal of Medicine in 2017, addressing the long-held suspicion that pregnancy rates following HSG with OSCM are higher than if a water-soluble contrast media (WSCM) is used. However, the findings of this trial have been compromised by the WSCM selected for comparison with OSCM. The chosen WSCM belongs to a superceded class of ionic media, with an iodine concentration, osmolality and viscosity all lying at the extreme end of the range for water-soluble radiographic contrast. The requirement for safe, cheap, versatile WSCM for intravascular use during computerized tomography, angiography and interventional procedures has resulted in considerable refinement of WSCM, with current widespread use of non-ionic, low osmolality or iso-osmolar WSCM in radiology, including for HSG. However, the use of the earlier ionic, high osmolality agents such as that selected for the H2Oil trial persists for HSG in some centres, despite potential adverse effects on the endometrium and fallopian tubal epithelium compared with more modern, less toxic WSCM. Knowledge of the variety of physical and chemical characteristics of the available WSCM is essential for interpretation of the current literature and establishing the most effective and safe water-soluble agent to use for HSG. Design of future clinical trials to establish the potential superiority of OSCM over WSCM for fertility enhancement must include the use of the readily available, inexpensive modern WSCM. While the fertility rates following OSCM HSG have been shown to be high in women with idiopathic infertility, more robust trials are required before the widespread use of OSCM for HSG or other modalities such as ultrasound and laparoscopy should be adopted.

Lumbar Myelography with Metrizamide in Rabbits

1984 ◽  
Vol 25 (6) ◽  
pp. 517-522 ◽  
Author(s):  
S. E. Ekholm ◽  
M. Foley ◽  
D. K. Kido ◽  
T. W. Morris
Keyword(s):  
Cerebrospinal Fluid ◽  
Contrast Media ◽  
Contrast Medium ◽  
Contact Time ◽  
Extracellular Fluid ◽  
Neural Tissue ◽  
Iodine Concentration ◽  
Water Soluble ◽  
Simple Diffusion ◽  
Lumbar Cerebrospinal Fluid

Neurotoxicity from subarachnoid contrast media is probably related to their specific pharmacologic effects and to their penetration into the central nervous system. The lack of a barrier between the cerebrospinal fluid and the extracellular fluid of the brain and cord allows water-soluble contrast media to diffuse into the neural tissue. The aim of this investigation was to develop a method that allows one to quantify the neural tissue penetration for a given contrast medium in relation to the cerebrospinal fluid concentration and contact time and apply this to the use of metrizamide. The result shows a good correlation between iodine concentration in the lumbar cerebrospinal fluid and that in the lumbar cord suggestive of a simple diffusion. When time of sacrifice (contact time) is added as a covariant there is also some indication of retention of metrizamide in the neural tissue. The investigation also demonstrates that the resorption of the contrast medium in the rabbit in this experimental model is mainly in the lumbo-sacral region.

Effect of viscosity and iodine concentration of nonionic radiographic contrast media on coronary arteriography in patients

1992 ◽  
Vol 123 (1) ◽  
pp. 160-165 ◽  
Author(s):  
Morton J. Kern ◽  
Robert A. Roth ◽  
Frank V. Aguirre ◽  
Glen Beauman ◽  
Robert Vogel
Keyword(s):  
Contrast Media ◽  
Iodine Concentration ◽  
Coronary Arteriography ◽  
Radiographic Contrast ◽  
Radiographic Contrast Media

The haemodynamic effects of iodinated water soluble radiographic contrast media: a review

1998 ◽  
Vol 29 (1) ◽  
pp. 31-46 ◽  
Author(s):  
S.K Morcos ◽  
P Dawson ◽  
J.D Pearson ◽  
J.Y Jeremy ◽  
A.P Davenport ◽  
...  
Keyword(s):  
Contrast Media ◽  
Haemodynamic Effects ◽  
Water Soluble ◽  
Radiographic Contrast ◽  
Radiographic Contrast Media

Skin necrosis following extravasatin of water soluble contrast media-report of 2 cases

1987 ◽  
Vol 23 (4) ◽  
pp. 658
Author(s):  
J H Park ◽  
S H Kim ◽  
M J Shin ◽  
J C Kim ◽  
K W Minn ◽  
...  
Keyword(s):  
Contrast Media ◽  
Skin Necrosis ◽  
Water Soluble ◽  
Media Report ◽  
Water Soluble Contrast

Water-soluble contrast media compared with barium in enteric follow-through

1988 ◽  
Vol 29 (5) ◽  
pp. 603-610 ◽  
Author(s):  
F. Laerum ◽  
A. Stordahl ◽  
S. Aase
Keyword(s):  
Contrast Media ◽  
Water Soluble ◽  
Water Soluble Contrast

Adverse Drug Reactions to Radiographic Contrast Media in a Teaching Hospital in North India: An Observational Study

2019 ◽  
Vol 14 (2) ◽  
pp. 122-126
Author(s):  
Deepti Chopra ◽  
Abhinav Jain ◽  
Richa Garg ◽  
Shreya Dhingra
Keyword(s):  
Observational Study ◽  
Contrast Media ◽  
Adverse Drug Reactions ◽  
Teaching Hospital ◽  
Adverse Reactions ◽  
North India ◽  
Drug Reactions ◽  
Iodinated Contrast ◽  
Radiographic Contrast ◽  
Radiographic Contrast Media

Background: Radiocontrast media are used extensively nowadays to visualize internal organs. Currently, non-ionic iodinated contrast media are used which are generally considered to be safe but some adverse reactions have been reported. Thus, the present study was carried out to analyze the nature and incidence of adverse drug reactions (ADRs) to radiographic contrast media in a teaching hospital. Methods:An observational study carried out for a period of six months in a teaching hospital. Contrast media induced adverse reactions were analyzed in terms of affected organs, rate, causality assessment, severity and preventability. The treatment and outcomes of adverse events were also recorded. Naranjo Probability Scale was used to evaluate the relationship between the contrast agent used and the suspected ADR. The severity of the suspected ADRs was determined using Hartwig Scale and preventability was assessed using modified Schumock and Thornton criterion. Results:A total of 15 suspected ADRs occurred in 11 patients with an incidence of 1.4%. It included 5 (45.4%) males and 6 (54.5%) females (p < 05). The highest percentage (72.7 %) of ADRs was seen in adult patients, the mean age being 40.8 years. Vomiting (33.3%) was the most common ADR noted followed by severe nausea and rashes. 64.7 % of ADRs were categorized as probable and 35.3 % were possible. Adverse reactions required treatment in 46.6% patients. There was no fatality reported. Conclusion:The reactions observed were mild to moderate in severity and occurred within 30 minutes of the administration of the contrast.

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