Disposable operative cholangiogram cannula.
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Cholangiography was performed in 442 patients using four dosage regimens of Cholografin: (a) a single-dose, full-strength injection in 10 minutes (150 examinations), (b) two dilute (76 examinations) or very dilute single doses (71 examinations) infused in 30 minutes, and (c) one dilute double dose infused in 30 minutes (145 examinations). Results showed that the double-dose infusion gave maximum visualization, followed by the single-dose injection and the two single-dose infusions. With the double-dose method, both the reaction rate and the incidence of SGOT elevation were twice that seen with any single-dose method, making the single-dose injection the procedure of choice despite slightly lower opacification.
Retrograde infusion of large amounts of water-soluble contrast agents into the biliary system results in only a brief hepatogram. A dense hepatogram lasting for several weeks and visualization of hepatic and celiac lymph nodes equal to that in direct lymphography can be obtained after retrograde biliary infusion of Ethiodol. In serching for metastasis from tumor in the liver, gall-bladder, bile ducts, pancreas, stomach, and duodenum, radiographic visualization of these nodes may help. If proved safe, the procedure can be performed by endocopic cannulation of the common bile duct.
Cholografin and Renografin 76 were studied to determine their effects on platelet function. In vitro platelet aggregation was significantly inhibited by at least 3.4 micron/ml Cholografin and 19.5 micron/ml Renografin 76. Patients who received Cholografin for intravenous cholangiography, and Renografin 76 for non-cardiac angiography, had low levels of plasma contrast agent, and hemostasis was clinically unimpaired. Patients who received Renografin 76 for cardiac angiography had inhibition of platelet aggregation at high levels of plasma contrast agent; there was no correlation with prolonged bleeding times, or with bleeding complications. High levels of plasma contrast agent may inhibit platelet aggregation in vitro and in vivo, although this may not be associated with clinically significant bleeding.
Histamine concentration in plasma was measured and the microvasculature studied after injections of radiographic contrast materials and hypertonic NaCl solutions. Only 8 ml/kg of contrast material caused a prolonged decrease in systemic and microvascular pressure and a drop in erythrocyte velocity. Concomitantly, a significant increase in plasma histamine concentration was observed after two minutes. Signs of cellular defects and constriction of arterioles were noted after several minutes. These findings suggest that the hyperosmolality of the radiopaque materials tested could initiate the microhemodynamic reactions but is not responsible for cellular and endothelial damage in the microcirculation of the rabbit omentum.
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