Iopamidol, a new non-ionic hydrosoluble contrast medium for neuroradiology.
The side effects associated with the use of Iopamidol for myelography were determined in 100 patients and compared with metrizamide in a double-blind study.
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The side effects associated with the use of Iopamidol for myelography were determined in 100 patients and compared with metrizamide in a double-blind study.
Groups each consisting of ten patients underwent lumbar and cervical myelography with metrizamide and iopamidol, together with a control group of ten patients who underwent lumbar punctures only. These groups were studied with a psychopathometric test procedure in order to demonstrate and quantify mental disturbances. It was shown that in contrast to myelography with iopamidol, mild mental disturbances are common after myelography with metrizamide. The severity of the mental disturbances after myelography with metrizamide was dependent on the quantity of contrast medium which diffused into the intracranial space after myelography, suggesting a dose-related neurotoxic effect of this substance. Such a correlation was not found with iopamidol.
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A new non-ionic water-soluble contrast medium was used for cervical myelography in 65 patients. The contrast medium was injected suboccipitally or by the latent C1-C2 approach. The films were of equally good quality as those obtained with other contrast media and tolerance has been superior. The contrast medium is Iopamidolo and is available in ampoules which is further positive quality.
Arterial blood pressure and heart rate were recorded for 5 to 7 h during myelography with iothalamate meglumine and metrizamide in 23 rabbits. After 0.6 ml iothalamate meglumine containing 280 mg I/ml a significant decrease in blood pressure and signs of circulatory failure were found. After identical doses of metrizamide and after reduction of the dose of iothalamate meglumine to 0.4 ml containing 140 mg I/ml no significant fall in blood pressure was recorded. A decrease of blood pressure was always accompanied by a decrease of heart rate. Arterial blood pressure and heart rate during experimental myelography are suggested as useful variables in the evaluation and comparison of new contrast media for myelography.
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After undergoing myelography with iopamidol by either direct puncture (n = 120) or lumbar puncture and run up of the contrast medium (n = 232), the patients were randomly allocated into one of two groups, one group being confined to bed for 24h and the other allowed to be fully ambulant. Questionnaires recording the occurrence and severity of side effects were completed at specific intervals after the myelogram. Adverse reactions experienced were significantly fewer than in our previous direct puncture study using metrizamide. Neither in the direct puncture nor in the run up group were side effects adversely affected by allowing the patients to remain ambulant after the examination. There is, therefore, no necessity to confine patients to bed following cervical myelography.
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Although Dimer X is said to be a low toxic water soluble contrast medium, epileptic seizures sometimes occur during or after Dimer X ventriculography. The toxicity of this dye was examined in rats and possible prophylactic measures were evaluated. From the results of our experiment it was concluded that Dimer X of low concentration should be used with premedication of Valium and Decadron.
In a comparative study between Dimer X and Amipaque (metrizamide) for lumbar myelography it was found that there is a little higher frequency of monor, but unimportant side effects after Amipaque. Amipaque has also been used for thoracocervical myelography with excellent results and without greater discomfort than after myelography in the lumbar region. A new puncture technique was used for the eximation of the cervical region alone: lateral puncture on the neck between the laminae of C1 and C2 under TV control. In more than 75 reinvestigations no arachnoid changes were observed.
Hexabrix (ioxaglate), a new low osmolality contrast agent, has been compared with Télébrix (ioxitalamate) in a series of 50 lumbar epidural venograms. The intensity of the pain and heat sensation experienced by the patient was significantly lower following the injection of Hexabrix. For this reason Hexabrix may be considered the contrast medium of choice for epidural venography. In 15 additional cases Hexabrix was compared with Amipaque (metrizamide) in the same iodine concentration (320 mg/ml). In these patients hardly any difference in pain and heat sensation was observed after the injection of both contrast agents. Frequently only a slight feeling of warmth was noticed. A minimal sensation of pain was occasionally observed to the same degree with both contrast agents.
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After studying the histograms of 87 supratentorial brain tumors and 4 abscesses before and after contrast medium injection and analyzing the results, we attempt to determine characteristic signs of the various kinds of tumors in order to improve their pathologic definition. The meningiomas, astrocytomas, and abscesses seem to show the most standard signs. The metastases are the most variable kind of tumors.
The attenuation coefficients of cerebral parenchyma and systemic blood were simultaneously measured at varying times after injection of two contrast agents with differing osmolarities. Cerebral parenchyma was in fact denser than the theory would predict. The osmolarity of the iodinated contrast agents seems to play only a very minor part. However, liposolubility could perhaps explain the leakage of iodine across the BBB and thus the increase in the attenuation coefficient of cerebral parenchyma.
A randomised blind trial comparing Iopamidol (Niopam) and Metrizamide (Amipaque) for lumbar radiculography was performed in 100 patients. Significantly more patients receiving Metrizamide complained of having severe headaches (P less than 0.05) and vomiting (P less than 0.05). There was no difference in quality of the radiculograms.