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Double blind comparison of meglumine iotroxate (Biliscopin), meglumine iodoxamate (Endobil), and meglumine ioglycamate (Biligram).

Two new intravenous cholegraphic agents, iotroxate and iodoxamate, hold a lower general toxicity, lower protein binding, and claim a higher rate of biliary excretion. Both compounds proved to be equally effective in opacifying the gallbladder and the bile ducts in a double-blind clinical study comprising 400 cases. Iotroxate gave significantly earlier good or adequate visualization as a result of its higher excretion rate by the liver (P less than 0.05). Side effects were observed in fewer patients in the iotroxate group (11.6%) compared with the iodoxamate group (16.4%, P greater than 0.05). In a second double-blind study, an iotroxage group of 97 patients who received two thirds of the overall content of iodine (3.6 g) was compared with a group of 98 patients, who received ioglycamate (5.3 g). Visualization was equal in the two groups, while side effects were significantly reduced to 10.3% in the iotroxate group against 20.4% (P less than 0.05). The higher biliary clearance of iotroxate permits a reduction of the amount of iodine.

Adult↗

Complement and coagulation: causative considerations in contrast catastrophies.

Earlier studies suggest that adverse reactions to injected radiographic contrast media are idiosyncratic. In an attempt to gain a better understanding of pathophysiologic events underlying these reactions, rabbit models injected with lethal dose ranges of a cholangiographic contrast material were studied. These animals showed activation of both the complement and coagulation systems. Externally applied heat potentiated complement consumption and increased mortality. Depleting complement components C3-C9 by cobra venom factor did not prevent activation of coagulation or diminish mortality. However, depleting fibrinogen diminished complement activation and markedly diminished mortality. Heparin, administered at several hourly intervals after contrast challenge, also diminished mortality. These studies suggest that the adverse effects of contrast media in this model system are mediated chiefly by the coagulation system, and that complement, if it participates deleteriously, must involve components up to, but not including, C3. A logical role for the inhibitor of C1 esterase in adverse contrast reactions is considered.

Ancrod↗

Hysterosalpingography: comparison of Conray 60 and Sinografin.

Conray 60 and Sinografin were compared as contrast agents for hysterosalpingography in 40 consecutive patients in a double-blind protocol. Emphasis was centered on the incidence and severity of symptoms during and after the procedure. Of patients receiving Conray, 36% suffered moderate or severe discomfort compared with 78% of the patients receiving Sinografin, and 13% of patients receiving Conray complained of moderate delayed discomfort compared with 28% of those receiving Sinografin. Both agents produced excellent diagnostic studies. Conray was clearly superior to Sinografin in terms of patient comfort.

Diatrizoate↗

Contrast-medium-induced electrocardiographic abnormalities: comparison of bolus and infusion of methylglucamine iodamide and methylglucamine/sodium diatrizoate.

A double-blind study comparing electrocardiographic (ECG) abnormalities induced by methyglucamine iodamide and methylglucamine/sodium diatrizoate was conducted in 189 patients. The media were each administered by both bolus and infusion. Iodamide caused fewer ECG changes both by injection and infusion. This contrast medium also resulted in fewer ECG changes in the patient groups with known prior ECG abnormalities, cardiovascular disease, arrhythmias, ischemia, or renal impairment and in those over 50 years of age. Digitalis did not increase the frequency of ECG abnormalities with either medium. With diatrizoate, the lower bolus dose produced as many major ECG changes in the presence of preexisting ECG abnormalities (arrhythmias, ischemia) or prior cardiovascular disease as the three-times-larger infusion dose more slowly administered; conversely, the opposite was found when renal insufficiency or older age existed. The conclusion is that iodamide media caused fewer ECG abnormalities and may be less hazardous.

Arrhythmias, Cardiac↗

Usefulness of liposomes carrying losefamate for CT opacification of liver and spleen.

Losefamate, a hepatobiliary contrast agent, was encapsulated into liposomes to increase its ability to opacify the liver and spleen on computed tomographic (CT) images. Multilamellar lipid vesicles (lecithin, cholesterol, and stearylamine, in 4:1:1 molar ratio) containing iosefamate in their aqueous phase were prepared. Seven dogs received intravenous injections of 100-300 mg I/kg in one of three forms: encapsulated, unencapsulated, or a mixture of the two in equal parts. Animals that received the opaque vesicles had marked opacification of their livers, bile ducts, gallbladders, spleens (maximum 106 H enhancement), and gastrointestinal tracts. Spleen CT values (an indicator of encapsulated material uptake) were always higher in these dogs than in the animals receiving equivalent amounts of unencapsulated iosefamate alone. At the high-dose level, liver uptake of the encapsulated materials was also greater. Liposome-encapsulated hepatobiliary contrast agents are effective liver and spleen opacifiers for CT imaging in the dog.

Animals↗

Experimental evaluation of iosefamate meglumine and its derivatives as hepatobiliary CT contrast agents.

Iosefamate meglumine has attracted attention as a possible hepatobiliary contrast agent for CT scanning. However, its limited hepatic opacification has prevented clinical acceptance. To find a more efficient agent, the efficacy and toxicity of six derivatives of iosefamate were compared with those of the parent compound in dogs. Twenty dogs received intravenous doses ranging from 150 to 600 mg I/kg of one of these seven water-soluble, ionic, dimeric agents. Three control animals received equivalent amounts of physiologic saline. The CT densities of liver, biliary tract, kidneys, and blood were then measured for up to 3 hr. Toxicity tests of liver and kidney function were performed for up to 3 days. Among the new agents, only MI-294, a previously unreported compound, proved to be a slightly more efficient hepatic opacifier than iosefamate (0.40 vs. 0.34 H per mg I/kg, respectively). MI-294 was also the least toxic. However, transient abnormalities in at least one liver function test were observed with every agent at some dose level. One animal died with hepatic necrosis after receiving iosefamate. No renal impairment was noted in any case. MI-294 has advantages over iosefamate as a CT liver and biliary opacifier in dogs. Potential hepatotoxicity of this class of agents needs to be more fully evaluated.

Animals↗

Helical CT cholangiography for the detection and localization of bile duct leakage.

OBJECTIVE: We describe the use of helical CT cholangiography or helical CT after administration of biliary i.v. contrast material to verify and localize bile duct leakage. CONCLUSION: Helical CT cholangiography revealed bile leaks in seven patients after penetrating trauma or liver or gallbladder surgery and excluded bile leaks in two patients with blunt liver trauma. Endoscopic retrograde cholangiography was performed in only one of seven patients with bile leakage and was avoided in an additional two patients in whom CT cholangiography excluded leakage. The method is a feasible, noninvasive tool for the detection and localization of bile leaks and may help avoid endoscopic retrograde cholangiography.

Adult↗

Concordance of second-order portal venous and biliary tract anatomies on MDCT angiography and MDCT cholangiography.

OBJECTIVE: We sought to investigate the concordance between second-order portal venous and biliary tract anatomies using MDCT angiography and MDCT cholangiography. MATERIALS AND METHODS: We retrospectively identified 56 living related potential liver donors who underwent both MDCT angiography and MDCT cholangiography. Two reviewers independently rated axial images and 3D reconstructions of MDCT angiograms and cholangiograms as diagnostic or nondiagnostic with respect to depiction of second-order portal venous and biliary tract anatomies. In images rated as diagnostic, second-order portal venous and biliary tract anatomies were categorized as conventional or variant. The concordance between portal venous and biliary tract anatomies was analyzed using McNemar exact chi-square test. RESULTS: All examinations were diagnostic. Second-order portal venous variants were seen in 10 (18%) and biliary branch variants were seen in 23 (41%) of the 56 patients. Patients with variant portal venous anatomy (6/10, 60%) were more likely to have variant biliary tract anatomy than patients with conventional portal venous anatomy (17/46, 37%; p < 0.01). The sensitivity of variant portal venous anatomy as a marker for variant biliary anatomy was 26% (6/23 patients). CONCLUSION: Concordance between second-order portal venous and biliary tract anatomies is statistically significant. However, in our series, a number of patients with conventional portal venous anatomy had variant biliary anatomy; therefore, the finding of conventional portal venous anatomy does not obviate preoperative biliary tract imaging in patients before liver donation.

Adolescent↗