[Coagulation disorder following angiography with a nonionic tri-iodized contrast medium? Effect due to contrast medium or to heparin?].
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Aortography↗
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[Anatomic resolution of intra-arterial digital subtraction angiography of the kidney using different concentrations of contrast media].
In 40 patients in whom intra-arterial DSA of the kidney was carried out, the appearance of the vessels was compared between group A (20 patients) in whom 5 ml. of Iopamidol 300 mg. I./ml. and 5 ml. Iopamidol 150 mg. I./ml. were used, with group B (20 patients) in whom 5 ml. Iopamidol 300 mg. I./ml. and 10 ml. Iopamidol 150 mg. I./ml. were used. Apart from the well known advantages of intra-arterial DSA, no improvement was brought about by using lower concentration of contrast.
Angiography↗
[Comparison of the electrocardiographic changes resulting from Urografin 76 and Iopamidol (Solutrast 370) during coronary angiography].
The electrocardiographic changes during, and immediately after, 410 injections in 50 patients were studied and related to the findings on coronary angiography and to the type of contrast medium used; the contrast media were Urografin 76 and the non-ionic Iopamidol 370. The results showed that 1.E.C.G. changes are much less marked if there is a stenosis of the coronary vessels. 2. Iopamidol 370 showed much less electrocardiographic change than was produced by Urografin 76.
Adult↗
[Adverse reactions following high-dose intravenous injection of urographic contrast media].
The frequency and type of side effects from high-dose renographic contrast media correspond with those quoted in the literature for injections of small doses of contrast. In addition to the usual contra-indications against injection of renographic contrast, one should also consider the effect of short-lived increase in circulating volume in patients with left heart insufficiency.
Adolescent↗
[Transabdominal CT-guided sympathectomy].
A new technique for lumbar sympathectomy is described. It consists of CT-guided trans-abdominal fine needle puncture and injection of alcohol. The technique is simple and well tolerated by the patient, and it permits accurate application of the alcohol. Complications have so far not been observed.
Aged↗
[Chymopapain allergy. Diagnostic value of a skin test before and after chemonucleolysis].
Chemonucleolysis with Chymopapain (Chymodiactin, Disease) bears the risk of unpredictable anaphylactic reactions. The rate of anaphylaxis is reported to be between 0.35 and 1.5%. Serological in vitro tests such as RAST (Radio Allergo Sorbent Test) or ChymoFAST (Fluorescent Allergo Sorbent Test) are used to determine increased specific IgE antibody titres against chymopapain in patients submitted to chemonucleolysis for lumbar disc disease. Alternatively skin prick tests have also been applied in clinical trials. A skin prick test including Discase, Chymodiactin and Solutrast 250 M, which is a radiopaque dye used for discography, has been performed in a total of 208 patients. One-hundred and seventy-seven patients were tested before, 31 patients were tested after chemonucleolysis with chymopapain. From the group tested before chemonucleolysis, 2.3-3.5% had positive skin testes. After chemonucleolysis, the overall allergy rate to chymopapain increased to 41.9%. Positive skin reactions seem to be time-dependent: Between the 3rd and 12th week after chemonucleolysis more than 70% of the patients had positive skin tests. There was no correlation between a history of previous allergy and the skin test result. Patients with positive skin tests should be excluded from chemonucleolysis. This procedure increases the safety for patients submitted to chemonucleolysis. No anaphylactic reaction has been observed hitherto in nearly 350 patients who were treated with the intradiscal injection of chymopapain following a negative skin prick test.
Adult↗
[Radiculomyelography with a water-soluble contrast medium in root evulsion of the lumbosacral plexus].
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Adolescent↗
[Late meningeal changes after dimer-X-myelography in the absence of surgery (author's transl)].
Myelography with Amipaque was carried out in a group of 28 patients who had had previous Dimer-X-myelography, but no surgery. In 12 cases there was radiological evidence of a meningeal reaction. In all these cases there were chronic changes in the lumbar subarachnoid space. The original myelograms showed no evidence of adhesive changes in the root pouches. It was not possible to correlate the radiological findings of the meningeal changes with the severity or type of neurological diseases.
Adult↗
[Hyperosmolality of radiographic contrast media - a factor in endothelial damage? (author's transl)].
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Animals↗
[Iopromide, a new contrast medium for angiography. Clinical study and comparison with other low-osmolar contrast media].
In a multi-centre randomized double-blind study the ionic dimer ioxaglate was compared with the nonionic monomer iopromide. In a second randomized double-blind study iopamidol was included in the trial. It was shown that with low-osmolar substances sensitivity to pain and warmth occurred to only a slight extent, whether the contrast medium was ionic or non-ionic. An advantage of the non-ionic preparation was the definitely lower incidence of skin-rash, dizziness, nausea and vomiting.
Angiography↗
Increased glomerular filtration rate in patients with major burns and its effect on the pharmacokinetics of tobramycin.
The clearance of endogenous creatinine in 20 burned patients, measured between the fourth and the 35th post-burn day, was a mean (+/- S.D.) of 172.1 p 48.4 ml per minute per 1.73 m2; in eight normal subjects the mean value was 125.4 g- 10.4 (P less than 0.02). Thirteen patients had values more than 2 S.D. above the normal mean. We confirmed this rise in glomerular filtration rate by measuring inulin or iothalamate clearance in nine patients. The pharmacokinetics of tobramycin were studied in 11 of the 20 patients and in eight normal subjects receiving continuous intravenous infusions of the drug. An inverse correlation was found between plasma half-life of the drug and creatinine clearance (r = 0.68, P less than 0.01). Increased creatinine clearances and shortened half-life of tobramycin occurred mainly in younger patients. Glomerular filtration rates in burned patients may rise to very high values and can be validly measured by creatinine clearance. The plasma half-lives of drugs with predominantly urinary excretion may decrease in patients with burns.
Adult↗
Membranoproliferative glomerulonephritis. A prospective clinical trial of platelet-inhibitor therapy.
Forty patients with Type I membranoproliferative glomerulonephritis were treated for one year with dipyridamole, 225 mg per day, and aspirin, 975 mg per day, in a prospective, randomized, double-blind, placebo-controlled study. At the base line, the half-life of 51Cr-labeled platelets was reduced in 12 of 17 patients. The platelet half-life became longer and renal function stabilized in the treated group, as compared with the placebo group, suggesting a relation between platelet consumption and the glomerulopathy. The glomerular filtration rate, determined by iothalamate clearance, was better maintained in the treated group (average decrease, 1.3 ml per minute per 1.73 m2 of body-surface area per 12 months) than in the placebo group (average decrease, 19.6). Fewer patients in the treated group than in the placebo group had progression to end-stage renal disease (3 of 21 after 62 months as compared with 9 of 19 after 33 months). The data suggest that dipyridamole and aspirin slowed the deterioration of renal function and the development of end-stage renal disease.
Adolescent↗
Effect of restricting dietary protein on the progression of renal failure in patients with insulin-dependent diabetes mellitus.
BACKGROUND: Restriction of dietary protein may slow the progression of renal failure in diverse renal diseases, but the extent to which such a diet is beneficial in patients with diabetic nephropathy is uncertain. METHODS: We studied the effect of reduced intake of protein and phosphorus on the progression of renal disease in 35 patients with insulin-dependent (Type I) diabetes mellitus and clinically evident nephropathy. The low-protein, low-phosphorus diet contained 0.6 g of protein per kilogram of ideal body weight per day, 500 to 1000 mg of phosphorus, and 2000 mg of sodium. The control diet consisted of the patient's prestudy diet with the stipulation that it contain 2000 mg of sodium and at least 1 g of protein per kilogram per day and 1000 mg of phosphorus. Renal function was assessed by measurement of iothalamate and creatinine clearances at intervals of 3 to 6 months, and the patients were followed for a minimum of 12 months (mean, 34.7). The declines in mean glomerular filtration rates were compared between groups by linear-regression analysis of the glomerular filtration rate as a function of time. RESULTS: The patients who followed the study diet for a mean of 37.1 months had declines in iothalamate clearance of 0.0043 ml per second per month and in creatinine clearance of 0.0055 ml per second per month. The comparable values in the control group were 0.0168 and 0.0135, respectively (P less than 0.05). Blood pressure was well controlled, and the degree of glycemic control was comparable in both groups. CONCLUSION: Dietary restriction of protein and phosphorus can retard the progression of renal failure in patients with Type I diabetes mellitus who have nephropathy. We believe that wider use of this treatment is indicated.
Adult↗
Low- versus high-osmolality contrast media.
PURPOSE: To evaluate the effects of contrast media pharmokinetic differences on aortic enhancement at abdominal CT angiography and to determine whether these effects are of clinical relevance. MATERIAL AND METHODS: Two hundred and twelve patients referred for abdominal CT angiography were included in the study. All abdominal CT angiograms were performed with the same parameters (collimation 3 mm, pitch ratio 1.7, scan delay 30 s) after i.v. injection of 120 ml of contrast medium at 3 ml/s. After randomization, patients received either iobitridol 300 (low-osmolar, 300 mg I/ml), iobitridol 350 (low-osmolar, 350 mg I/ml) or ioxithalamate 350 (high-osmolar, 350 mg I/ml). The time attenuation curves obtained with the three contrast media were compared. RESULTS: The time attenuation curve obtained with ioxithalamate 350 was not parallel to those obtained with iobitridol 300 and iobitridol 350. Mean peak enhancements obtained with iobitridol 350 and ioxithalamate 350 were not significantly different but iobitridol 350 provided higher mean peak enhancement than iobitridol 300. Mean delays of the peak enhancements were the same with the three contrast media. After peak enhancement, the decrease of aortic opacification under a selected threshold of 200 HU was significantly slower with iobitridol 350 than with iobitridol 300 and ioxithalamate 350, whereas iobitridol 300 and ioxithalamate 350 showed no significant differences. CONCLUSION: For a given iodine concentration, low-osmolality contrast media provide longer aortic opacification and may be recommended for CT angiography when long acquisition times are needed.
Adult↗
Effect of contrast media on vascular smooth muscle cells.
PURPOSE: In order to alleviate the adverse effects of contrast media (CMs) on the vascular system, the role of Ca2+ in the viability of vascular smooth muscle cells (VSMCs) was investigated. MATERIAL AND METHODS: VSMCs were obtained from swine thoracic aorta. The number of VSMCs was counted under a microscope using the trypan blue dye-exclusion method 24 h after culture in RPMI containing physiological saline (SAL) as control, iothalamate (IOT), or iohexol (IOH) at 10% by volume with CaCl2 added at 0 to 2.0 mmol/l. Free Ca2+ in the above media was measured using an ion-selective electrode. RESULTS: Free Ca2+ was 0.4 to 1.5 mmol/l with ionic IOT and 0.4 to 1.8 mmol/l with non-ionic IOH as well as with control. The ratio of viable cells grown in the presence of CMs to those grown in the control was optimal at approximately 0.60 near 1 mmol/l Ca2+ and decreased markedly to 0.00 at 1.5 mmol/l Ca2+ in the presence of IOT and to 0.39 at 1.8 mmol/l Ca2+ in the presence of IOH, while the ratios decreased gradually to 0.28 in the presence of IOT and 0.53 in the presence of IOH at 0.4 mmol/l Ca2+. CONCLUSION: Ionic IOT is more cytotoxic to VSMCs than non-ionic IOH. However, the cytotoxicity was minimal and similar between both CMs at 1 mmol/l Ca2+ in accordance with the sodium-calcium balance.
Animals↗
Influence of iothalamate on renal medullary perfusion and oxygenation in the rat.
PURPOSE: To evaluate controversial results regarding the effect of the contrast medium (CM) iothalamate on renal medullary blood flow by applying two different methods simultaneously. MATERIAL AND METHODS: The outer medullary blood flow (OMBF) response was estimated using laser-Doppler flowmetry and hydrogen gas wash-out (microelectrodes) simultaneously. Outer medullary oxygen tension (PO2) was measured using Clark type microelectrodes. Iothalamate was injected i.v. at 1600 mg I/kg body weight for 2 min. RESULTS: CM induced a transient 28% decrease in OMBF as measured with the laser Doppler. The hydrogen gas wash-out rate was reduced by 50%, indicating a reduced perfusion. CM induced a transient 60% reduction in PO2, while renal fluid and electrolyte excretion increased several fold. CONCLUSION: The CM iothalamate reduces outer medullary perfusion as estimated by two different techniques applied simultaneously. The PO2 in the same region was also reduced. Previous controversies regarding the effect of iothalamate on OMBF can be explained by extreme dosage and injection rates greatly exceeding clinical relevance.
Animals↗
Functioning islet cell tumor of the pancreas. Localization with dynamic spiral CT.
PURPOSE: The purpose of this study was to evaluate the usefulness of dynamic spiral CT, including multidimensional reformation, in the detection and localization of islet cell tumors of the pancreas. MATERIAL AND METHODS: Seven patients with histopathologically proven functioning islet cell tumors of the pancreas were studied with 2-phase contrast-enhanced spiral CT. Scanning of the arterial phase and late phase was started 30 s and 180 s, respectively, after injection of 100 ml of contrast medium at a rate of 3 ml/s. RESULTS: Axial images in the arterial phase depicted the lesions in 5 patients, but in the late phase in only one patient. Multiplanar reformatted images of the arterial phase depicted the lesions in all 7 patients. Maximal intensity projection images demonstrated all lesions with information of their relationship to the vascular structure. CONCLUSION: Dynamic spiral CT with scanning during the arterial phase and retrospective multidimensional reformation is useful for preoperative detection and localization of small islet cell tumors of the pancreas.
Adenoma, Islet Cell↗
Simultaneous voiding cystourethrography and voiding urosonography reveals utility of sonographic diagnosis of vesicoureteral reflux in children.
AIM: To evaluate the diagnostic potential of voiding urosonography (VUS) compared with fluoroscopic voiding cystourethrography (VCUG) under identical conditions and to evaluate potential reasons for false-negative VUS results, particularly regarding bladder concentrations of the US contrast agent, Levovist. METHODS: Fifty-six paediatric patients (M/F 34/22, mean age 2.3 y, age range 1 mo-14 y) underwent simultaneous VUS and VCUG under identical conditions. The bladder was filled by simultaneous administration of Levovist and the X-ray contrast medium, DIP Conray. Levovist concentrations in bladders were calculated using amounts of Levovist injected and total DIP Conray infused when reflux was first observed in either procedure. RESULTS: Sensitivities of VUS and VCUG for detection of vesicoureteral reflux (VUR) were both 86%, assuming that VUR detected by either method represented a true-positive, and no reflux by either method represented a true-negative. Patients under 24-mo of age displayed a better VUS sensitivity, of 94%. Levovist concentrations in bladders ranged from 1.8% to 23%, with older children tending to demonstrate increased bladder capacity and lower concentration. All VUS false-negative units displayed Levovist bladder concentrations of less than 5%. CONCLUSION: The present simultaneous study suggests that: 1) the two techniques demonstrate similar sensitivity for detection of reflux; 2) sustained Levovist bladder concentrations of below 5% may not allow detection of reflux on VUS; and 3) VUS represents a suitable technique, particularly for small children whose bladder capacity is not so large.
Adolescent↗