唾液腺造影剤の検討
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Iodized oils have been extensively used as contrast media in sialography. In recent years, however, various types of new media have been tried by different workers in an attempt to overcome the drawbacks presented by iodized oils. In order to compare the advantages of various contrast media, the author experimented with 40 % Moljodol, that has long been used in our clinic, oily Dionsil, aqueous Dionsil, oily Urokolin, Pyraceton C, 70 % Pyraceton and 70 % Urokolin in dogs and humans. Experiments in dogs. Oily Dionsil gave clear demonstration of the ductal system, but no visualization of the gland was obtained in many cases. The main duct or its branches often leaked; the gland tissue in the region were the leakage occurred underwent degeneration and necrosis with subsequent formation of granulomas. The medium that seeped through the duct wall persisted for,a long time, and there were still remains of it 8 weeks after injections. There was a severe destruction of the interlobular connective tissue of the submaxillary gland. The results of experiments with aqueous Dionsil were more or less similar to those with oily Dionsil. The use of the former was marked by infiltration of the giant cells in the granulomas formed in the region where a leakage occurred. Clear demonstration of the ductal system was obtained but the gland was not visualized in experiments with oily Urokolin. There was an extensive leakage in the interlobular connective tissue, where a diffuse cell infiltration occurred. The medium that had seeped through the duct wall was, however, absorbed quickly, radiological and histologic examinations showing no trace of leakage 1 week after injections. The shadow of the duct obtained with PyracetonC was low in density; the gland was not demonstrated at all in some cases, and it appeared as a homogeneous or dappled shadow of low density if it appeared at all. A leakage occurred when it was used for visualization of the parotid gland. The region where the leakage occurred was marked by the/formation of granulomas, disintegration of the gland cells and severe destruction of the tissue. The use of Pyraceton C for visualization of the submaxillary gland resulted in comparatively moderate histologic changes in the tissue. Faint shadow of the duct and poor delineation of the branches of the duct were the results obtained with 70 % Urokolin. The medium filled the gland unevenly, which appeared as a dappled and unsegmented shadow. It caused the formation of granulomas in the parotid gland. The shadow disappeared 1 week after injections. The results obtained with 70 % Pyraceton were almost similar to those obtained with 70 % Urokolin, except that it caused the formation of no granuloma and comparatively moderate histologic changes in the tissue. Sialograms made with 40 % Moljodol were characterized by clear demonstration of both the duct and gland. The parotid and submaxillary glands with all their anatomical details appeared distinctly. An increase in the amount injected resulted in an increase in density of the gland. Injections of about 0.3cc and 0.4cc into the parotid and submaxillary glands, respectively, gave a homogeneous or lobulated shadow. Further increase in the amount injected caused the gland to appear still more lobulated. The fact that an injection of comparatively great amounts of 40 % Moljodol was not associated with a distorted picture of the gland may indicate that a permissible dose is quite high. The adequate amounts in dogs would, however, be about 0.3 cc and 0.4cc for the parotid and submaxillary glands, respectively. The histologic changes encountered in experiments in which these amounts were used consisted of dilatation of the duct and acini, cell infiltration of slight degree around the duct and the disorderly arrangement of the gland cells (in. the parotid gland only). Foreign body reactions and destruction of the tissue produced by 40 % Moljodol were moderate in severity in comparison with those caused by other media. Histologic sections revealed even distribution of the medium when the gland appeared as a homogeneous or lobulated shadow. The medium cleared completely from the acini in 3 weeks in the case of the parotid gland and 3 in days in the case of the submaxillary gland, but it persisted for a considerably long time as small drops in the epithelium of the striated tubules, the lymphatic sinuses surrounding them and the interstitial tissue of the gland. Poppy seed oil and 40 % Moljodol caused similar histologic changes in the tissue; iodine combined with poppy seed oil had no special effect on the tissue. It would not be too much to saythat the effects of 40% Moljodol on the tissue could be attributed to poppy seed oil. It may be said that the mediumis chemically stable. Experiments in humans. The experiments with aqueous Dionsil (a water-suspension medium) and 70 % Pyraceton (a water-soluble medium) for visualization of the parotid gland in man produced no satisfactory results with regard to opacity and side effects. The author's attention was drawn to the fact that the side effects 40 % Moljodol were only local, not involving the whole body. There was no marked difference in side effects produced in persons with normal and morbid parotid glands. It seems that sialography with 40% Moljodol is a safe and simple diagnostic aid to which there are no known contra-indications.
- 千葉大学の論文
- 1959-01-28
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