Biomedical subjects
R G Grainger
Publications and source records attributed to R G Grainger.
Low osmolar contrast media: an appraisal.
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Radiological contrast media.
1. This author believes that the present evidence (water shifts and vasodilatation) strongly indicates that low osmolality is probably the main advantage of the new contrast media. 2. Arteriographic adverse reactions (pain, vasodilatation) are less marked with the contrast medium of the lowest osmolality--i.e. ionic ioxaglate salts. 3. Minor adverse reactions (nausea and vomiting) are less marked with some non-ionic media (e.g. iohexol, iopamidol) than with ioxaglate but there are no data concerning the relative incidence of severe reactions or fatalities. 4. Dr. Lasser's suggestion in 1987, that 12 hours of corticosteroid prophylaxis reduces the adverse reaction rate of intravenous HOCM to the rate of LOCM reactions, awaits confirmation. However, corticosteroid prophylaxis will not reduce the side effects due to hyperosmolality, e.g. vasodilation, hypervolemia, and pain (on arterial injection). 5. Unless and until the necessary finances are available, I suggest LOCM (costing 12 times the price of HOCM in Canada and America) be used on a selective and discriminatory basis in three groups of patients: those undergoing painful procedures (e.g. peripheral arteriography), those undergoing potentially dangerous procedures (e.g. spinal angiography, coronary angioplasty) for patients considered on account of their previous medical history (e.g. asthma, allergy, previous adverse reactions, cardiac failure) to be at greater risk than the normal population.
Radiological contrast media. Ethical and financial considerations.
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Radiological contrast media.
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The optimal concentration of contrast medium for aortography and femoral arteriography: a comparison of Hexabrix 320 and Hexabrix 250.
A prospective double-blind randomised clinical trial of aortography and iliofemoral arteriography in 89 patients demonstrates that there is no difference in the diagnostic quality of the studies when Hexabrix 250 replaces Hexabrix 320. There is a minor reduction in patient subjective reaction, and the lower viscosity permits the use of smaller bore catheters. The major gain is that the cost of the contrast medium should be reduced by 22%.
Fistula and sinus formation in xanthogranulomatous pyelonephritis. A clinicopathological review and report of four cases.
Fistula or deep sinus formation as a complication of xanthogranulomatous pyelonephritis (XPN) has not been described previously in the British literature. We present the clinicopathological features of one case of a nephrodiaphragmatic sinus complicating XPN, and three cases of nephrocolic fistula, including the first recorded case of fistula in childhood XPN. The detailed clinical, radiological and pathological features of XPN and its complications are reviewed. Total nephrectomy, together with primary excision of sinuses or fistulae, is the treatment of choice.
Bilateral adrenal metastases from renal carcinoma treated surgically with prolonged survival.
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The pulmonary circulation: the radiology of adaptation.
In this George Simon Lecture, I have tried to present a simplistic yet philosophical approach to the physiological processes of adaptation of circulatory and respiratory function in response to pathophysiological challenge. The objective of the body is to achieve a normal ventilation-perfusion ratio of 1 in order to optimise blood-gas exchange in a wide variety of pathological conditions. It is all a question of the right ingredients (oxygen in atmospheric air and reduced haemoglobin in desaturated blood), in the right copious amounts (100 ml/s), in the right proportion (1:1) and in the right place (alveolar capillary membrane). In order to demonstrate the above concepts, a variety of well known conditions, congenital and acquired, have been discussed in the developing infant lung and the adult mature lung; some primarily cardiovascular, others primarily respiratory; some conditions resulting in permanent and others resulting in temporary and reversible major readjustments of the blood supply to the lung. The emphasis has been to illustrate that simple, unsophisticated radiological techniques may provide a substantial amount of valuable information concerning the remarkable capacity of the pulmonary circulation to adapt to varying physiological or pathological demands in order to conserve our precious respiratory resources. George Simon, like all good doctors, had a tremendous respect for the ability of the body to respond to these challenges. He always emphasised the important basic principles rather than fine minutiae. It is hoped that this lecture in his honour follows these principles which he preached so well.
Low osmolar contrast media.
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The clinical and financial implications of the low-osmolar radiological contrast media.
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The new low-osmolar contrast media: a simple guide.
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Xanthogranulomatous pyelonephritis: a reappraisal.
A survey was undertaken of the clinical, radiological, ultrasonic, and pathological features of 80 patients with xanthogranulomatous pyelonephritis (XPN). The condition is a progressive granulomatous reaction to chronic renal inflammation which is often suppurative and usually caused by calculous urinary tract obstruction. The characteristic pathological features are large numbers of foam cells containing lipid, and the presence of inflammatory destruction of neighbouring renal tissue. XPN, which is commoner than generally recognised, may often be diagnosed preoperatively--the patient is usually a middle-aged female who presents with severe toxaemia, tender loin mass, and mild lower urinary tract symptoms. The diagnosis is confirmed by radiology and ultrasonography. Nephrectomy is curative.
The effect of ionic and nonionic contrast media on the sickling phenomenon.
The effects of an ionic contrast agent (meglumine iothalamate) and a nonionic contrast medium (iopamidol) on the sickling phenomenon were studied in vitro. The findings indicate that, at the same concentration of contrast agent in the blood, iopamidol causes significantly less sickling than meglumine iothalamate. This indicates that nonionic contrast agents are preferable for diagnostic studies in patients with sickle cell anemia.
Intravascular contrast media--the past, the present and the future. Mackenzie Davidson Memorial Lecture, April 1981.
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Intravascular contrast media.
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Terminology for radiographic projections.
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A study of the effect of sodium/meglumine ioxaglate (Hexabrix) on thyroid function.
The effect of thyroid function was investigated in 22 patients undergoing arteriography with a new low osmolality contrast medium--sodium and meglumine ioxaglate (Hexabrix). Plasma thyroxine (T4), thyroxine resin uptake (TRU) and free thyroxine index (FTI) were measured before and at varying intervals up to 56 days after the arteriogram. Despite the large doses of Hexabrix used (up to 89.6 g of iodine), these tests of thyroid function did not reveal any significant change from pre-angiographic levels. It is concluded that Hexabrix as used for arteriography does not affect thyroid function.