Reactions to contrast media. The A.M.A. registry on adverse reactions.
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Two hundred and twenty-eight deaths due to the use of contrast media are reported, including 15 from intravenous cholangiography, 69 from angiography, 140 from urography and four other. The causes are analyzed and the various explanations for reactions to contrast media are considered. Data concerning the high incidence of cardiac death, the large number of deaths due to pulmonary edema, and the known transgression of the blood-brain barrier by contrast media are used to construct a theory that bases all reactions on the effect of contrast media on the central nervous system.
Iosefamate meglumine was evaluated for potential use as a contrast agent for hepatic computed tomography (CT) in rhesus monkeys. Iosefamate meglumine in doses of 150, 300, and 450 mg I/kg was injected into four rhesus monkeys and hepatic CT attenuation values, blood iodine levels, serum enzyme levels, and hepatic histology were monitored. The hepatic CT number increased by 19 to 30 HU following a 150 mg I/kg dose and remained elevated for 15 to 45 minutes. Peak blood iodine values occurred 2 minutes postinjection but fell rapidly to less than 40% of the peak value by 45 minutes and less than 20% of peak by 4 hours. Transient elevations in serum enzyme levels were found but no histologic abnormalities were detected. Iosefamate meglumine is a potentially valuable hepatic CT contrast agent, as it produces a significant, prolonged increase in hepatic attenuation values and selectively opacifies functioning hepatocytes.
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Inhibitors of prostaglandin (PG) transport (probenecid, indomethacin, or bromcresol green) were found to eliminate the difference between the pulmonary transit time of 3H and 14C when [3H]PGF2alpha and E114C]sucrose were injected as a single intra-arterial bolus into the isolated perfused rat lung. Similar results were obtained with PGE1. The transit time of [3H]PGA1 was not significantly different from that of [14C]sucrose even in the absence of an inhibitor. These inhibitors increased the amount of [3H]PGF2alpha or [3H]PGE1 and decreased the amount of [3H]PG metabolites found in the venous effluent: these agents also inhibited the pulmonary metabolism of continously infused, nonradioactive PGF2alpha. One of the three inhibitors, bromcresol green, was shown not to be an effective inhibitor of PG metabolism in cell-free preparations of rat lung homogenates. These results indicated that under normal conditions, PG's are rapidly transported into intracellular compartment(s) where they are metabolized. Inhibition of this transport process prevents rapid access of PG's to the cytoplasmic enzymes and therefore inhibits pulmonary PG metabolism. This implies that inhibitors of PG transport, including anti-inflammatory organic acids, and some PG antagonists, metabolites, and analogues, can be expected to inhibit the pulmonary metabolism of PG's and thus could potentiate the systemic effects endogenous or exogenous PG's.
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Ischemic renal failure was produced in rabbits by occluding the renal arteries for 90 min. Group 1 (n = 8) received radiocontrast media at the time of occlusion, group 2 (n = 8) 24 h after occlusion, and group 3 (n = 8) 3 days after occlusion. Group 4 (n = 12) was subjected to ischemic injury alone, group 5 (n = 4) served as sham-operated controls and group 6 (n = 4) did not undergo surgery but received radiocontrast media. Serum creatinine concentration in group 1 increased to a greater degree (p less than 0.001) than all other groups and did not return to normal during the 8-day observation period. Creatinine concentration in groups 2, 3, 4, and 6 were comparable and significantly increased compared to sham-operated group (p less than 0.05). Urinary excretion of alanine aminopeptidase and N-acetyl-beta-glucosaminidase in group 1 was significantly greater than all other groups (p less than 0.05). Microscopic analysis indicated tubular necrosis was more prominent in group 1. Radiocontrast media is nephrotoxic and in the setting of ischemic injury may prevent recovery of renal function. Toxicity was dependent on the time of administration since functional impairment was not increased if dye was given 1 or 3 days after ischemic injury.
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The nonionic radiographic contrast material (RCM) metrizamide causes consumption of total complement activity in normal human serum (NHS) in vitro in the absence and to a lesser extent also in the presence of EDTA. The depression of titers of total complement is related to an inactivating effect of metrizamide on component C2. Furthermore, metrizamide induces activation of the alternative pathway as evidenced by the appearance of C3 and factor B cleavage products in NHS, dependent on the presence of divalent cations. Alternative pathway activation is probably mediated by an antagonizing effect of metrizamide on the inactivation of C3b. Unlike ionic RCM, the nonionic substance metrizamide does not lead to cleavage of the internal thiolester bond present in native C3 and C4, at concentrations that produce potent consumption of C3 activity in NHS.
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A simple phantom experiment indicates that the enhancement of abdominal organs should be twice the SD of noise in a CT image. The enhancement of liver tissue by urographic and biligraphic contrast media is analysed in clinical series and animal experiments. Various substances, applied alone and in combination, were investigated. At present, only the infusion technique of urographic media provides a sufficient enhancement of liver tissue.
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