The safety and cost-effectiveness of low osmolar contrast media.
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Biomedical subjects
Publications and source records attributed to G T Benness.
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Audited cost data from two public hospital installations participating in a trial of the utilisation and efficacy of magnetic resonance imaging are presented. The data cover the period July 1987 to June 1988 when both installations had attained stable patterns of operation. One hospital operated a superconductive system and the other a resistive magnetic resonance imaging unit. Depreciation and salaries represented the major components of cost.
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The x-ray attenuation of the renal cortex of dogs, as determined by computed tomographic (CT) scanning, was measured over a three-day period after an intravenous bolus of 600 mg I/kg of iotrol or iopamidol. A slightly higher density observed 24 hours after injection of iotrol was not considered significant, and was not considered sufficient to warrant clinical application of iotrol for specific, prolonged renal enhancement.
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The sodium and methylglucamine salts of iothalamic acid were compared as urographic agents. The two drugs were administered intravenously to dogs at a dose of 600 mgI/kg. The outputs and concentrations of the major urinary solutes and the injected solutes were measured to define the differences in renal excretion of sodium and methylglucamine iothalamates. The action of methylglucamine as a relatively inert osmotic diuretic was reconfirmed. When sodium iothalamte was adminstered the tubular reabsorption of sodium and chloride was greater than when methylglucamine iothalamate was used. It is suggested that this reabsorption explains the advantage of sodium-linked agents over methylglucamine-linked agents in urography.
Sodium iothalamate and sodium iocarmate (iothalamate dimer) were compared as urographic agents. The two agents were administered intravenously to dogs at a dose level of 600 mg I/kg. The concentrations and outputs of major urinary solutes and injected solutes were measured to define the differences in diuretic effect of the two agents. The urinary output and concentration of iodine with each agent were also compared. The diuresis with iocarmate was lower. It was apparent that the lower diuresis and higher urinary iodine concentration with iocarmate was due to the lower osmotic activity per iodine atom obtained with this agent.
Metrizamide, a new non-ionic, triodinated contrast agent has been considerable for intravenous urography. Theory predicts that lower osmotic diuresis with this agent should lead to higher urinary iodine concentrations than with ionic agents, at equivalent iodine doses. However, a distinct advantage with metrizamide has not been observed with doses of 175 mgI/kg or less. In this study metrizamide and sodium locarmate were given intravenously to dehydrated dogs at a dose level of 600 mgI/kg. During the studies the concentrations and outputs of major urinary solutes were compared. Comparisons of urinary iodine concentrations and outputs showed that at this dose the predicted advantage with metrizamide can be observed.
Preliminary results of comparative studies with a new water-soluble contrast agent are described. The new agent, with the code P.286, is a molecule with 6 iodine atoms attached and only one ionizing group. The sodium salt of the new agent has been compared with sodium iothalamate and metrizamide in dogs. The results suggest that the sodium salt of P.286 is superior in terms of urinary iodine concentration to both sodium iothalamate and metrizamide.
The biliary concentration and output of two cholangiographic agents, Solu-Biloptin (calcium ipodate) and Biligrafin (meglumine iodipamide), were compared in labrador dogs. The maximum output of ipodate was approximately 20 mumol/min compared with 16 mumol/min for iodipamide. The maximum bile iodine concentration with both ipodate and iodipamide was similar (18-20 mgI/Ml) but the molar concentration of ipodate was almost twice that of iodipamide. Iodipamide was found to be much more choleretic, producing 0.025 ml of bile/mumole excreted compared with 0.009 ml/mumole for ipodate. Compared with iodipamide the lower choleretic effect and higher molar concentration of ipodate suggests that hepatic conjugation of the oral agent may permit its excretion in bile salt micelles.
Iodoxamic acid is a new hexaiodinated cholegraphic contrast agent. The methylglucamine salts of iodoxamate and iodipamide were administered to labrador dogs as an intravenous infusion. Bile salts were also infused. The biliary concentration and output of the two agents were compared. Bile flow rate, bile salt concentration and bile salt output with the two agents were also compared. The biliary output of iodoxamate (0.70-0.78 mumol/min/kg) was more than 50% higher than the iodipamide output (0.46 mumol/min/kg). Bile salt output and concentration with iodoxamate infusion were lower than with iodipamide infusion. The bile flow rate was higher with the new agent. The complementary effects of increased contrast output and decreased bile salt output with the new agent led to a significantly higher biliary iodine concentration compared with iodipamide. The results of this study support the suggestion that iodoxamate represents a significant advance in the cholegraphic contrast media field.