Reactions Associated with Intravenous Urography: Historical and Statistical Review

Abstract

While intravenous contrast studies, especially intravenous urography, have become one of our most valuable diagnostic measures, it is true, unfortunately, that the injection of any foreign substance into the human body always presents some hazard. As has been documented by previous surveys conducted by the members of the Department of Radiology of the Hospital of the University of Pennsylvania, both mild and severe reactions may follow the intravenous use of urographic media (8, 9). With the introduction of newer formulas for such contrast materials, it has seemed pertinent to evaluate again these unfavorable sidereactions. This report will deal primarily with the fatal reactions associated with intravenous urography. Historically, it is interesting to note that, although retrograde pyelography was introduced early in the first decade of the twentieth century, it was not until 1923 that excretory urography was first attempted in animals. Osborne, Sutherland, Scholl, and Rowntree (6) obtained faint urograms employing a 10 per cent solution of sodium iodide either intravenously or orally. During the next five years other contrast media were developed, providing better shadows of the renal collecting systems without causing such symptoms as headache, nausea, and vomiting in almost every patient. In 1929, Uroselectan, discovered by Professor Binz and Doctor Räth (1), was introduced for intravenous urography by Swick of New York City, working in the laboratories of Professor Lichtwitz in Germany (11, 12). Work with this new medium was continued on the urologic service of Professor von Lichtenberg (Berlin), who reported its use in 84 cases with no unusual sideeffects (4). In 1932 another compound, per-abrodil (Diodrast), manufactured by the T. G. Farbenindustrie (13) was introduced, and by 1933 the Schering Corporation was producing Uroselectan B (NeoIopax) commercially. These two latter compounds were employed in the majority of urographic procedures performed in the United States over the next twenty years. In previous publications (8, 9) we have documented 70 urographic deaths from 1930 through 1952, including 13 reported by other authors. Our most recent survey of the membership list of the American College of Radiology, as well as of the various interested pharmaceutical companies, has disclosed another 86 fatalities associated with intravenous urography. Sixty-nine of these occurred after 1952 (Jan. 1, 1953, to April 6, 1957), while 17 belonged in the years 1942 through 1952 but had not been included in our survey for that period. Four of the 69 more recent deaths reported to us have been published elsewhere (5, 7, 15) but are included in our study for completeness and for statistical purposes. Table I shows the classification of 156 intravenous urographic fatalities since 1930, including the 86 discovered in our present survey. As in our previous surveys, the deaths are classified as immediate, delayed, and indeterminate.