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In 50 patients with benign prostatic hyperplasia the preoperative diagnostical value of ultrasonography was compared with urography. The results show the sufficient efficacy of both methods in the case of bland history and normal urinary findings. In the estimation of adenoma weight the rectal ultrasonography is superior to other techniques.
The investigations were carried out in 30 persons subjected to the urography, in which influence of intravenous contrast media on coagulation and fibrinolysis system were studied (Part I). In venous blood collected before and in determined time intervals after injection of "Uropolinum" Polfa hemolytic activity of the complement system, concentration of its components (C3, C4) and total calcium level in blood were assayed. These parameters may contribute to the pathogenesis of side effects following injection of the contrast media. Disturbances in function of coagulation system were accompanied by a decrease in calcium level and activity of the complement. This phenomenon did not correlate with clinical symptoms.
In a controlled double-blind study the quality of the contrast produced by iopromide and iohexol was compared in two groups of 100 patients by excretory urography. The aim was to investigate whether iopromide or iohexol has any diagnostic advantages for the opacification of the kidneys, the renal pelves, and the ureters. The results show that there is no difference in contrast quality between the two substances (chi-square, p greater than 0.1). Moreover there is no difference in the frequency of concomitant symptoms (chi-square, p greater than 0.1). Both contrast media show the well-known excellent tolerance with only 1% side effects and the good contrast quality of the nonionic contrast media.
The radiographic findings and the hypotension patterns were reviewed in 19 patients having hypotensive reactions in routine excretory urography using ionic contrast medium. The lowest systolic blood pressure was above 80 mmHg in 10 patients while below 80 mmHg in remaining 9 patients. The urogram was unremarkable as long as the systolic blood pressure was preserved above 80 mmHg. In 2 patients, whose systolic blood pressure decreased quickly beyond 80 mmHg immediately after injection of contrast medium, the pyelogram was faint or non-visualized. On the other hand, in 4 patients, whose systolic blood pressure decreased beyond 80 mmHg in several minutes after injection of contrast medium and remained under 80 mmHg for more than 20 minutes, the nephrogram was dense and the pyelogram was faint or non-visualized. Although systolic blood pressure decreased beyond 80 mmHg, the urogram was unremarkable in 3 patients. This was due to the delayed hypotension or the short duration of hypotension.
We monitored the blood pressure and pulse rate during routine excretory urography in 3002 patients (4832 examinations) using high osmolality contrast medium. After injection of contrast medium, the blood pressure was changed more than 20% of the pre-injection blood pressure lasting for more than 1 minute in 27 patients (27 examinations, 0.56%), including 8 patients with a hypertensive reaction (0.17%) and 19 patients with a hypotensive reaction (0.39%). In all 27 patients, transient tachycardia was seen along with the progress of blood pressure change. Bradycardia was associated with a severe hypotensive reaction in 2 patients. In 19 patients with a hypotensive reaction, the blood pressure was progressively decreased beyond 60 mmHg in 9 patients (0.18%) while the blood pressure was remained above 60 mmHg in 10 patients (0.21%). Treatment was not necessary in 8 patients with a hypertensive reaction as well as in 10 patients with a mild hypotensive reaction (above 80 mmHg). In these 18 patients, the examination would have been finished without a suspicion of the blood pressure change unless the blood pressure was monitored. In 9 patients with a severe hypotensive reaction (below 60 mmHg), the subjective or objective symptoms were present during the examination in 7 patients. They should be considered to have had "severe adverse reaction". In remaining 2 patients, there was no subjective or objective symptoms. We discussed possible mechanisms regarding the change of blood pressure and pulse rate after injection of contrast medium.
The investigations were carried out in 30 persons subjected to the urography, in which influence of intravenous contrast media in coagulation and fibrinolysis system were studied (Part I). In venous blood collected before and in determined time intervals after injection of "uropolinum polfa" hemolytic activity of the complement system, concentration of its components (C3, C4) and total calcium level in blood were assayed. These parameters may contribute to the pathogenesis of side effects following injection of the contrast media. Disturbances in function of coagulation system were accompanied by a decrease in calcium level and activity of the complement. This phenomenon did not correlate with clinical symptoms.
The results of a 12-month prospective study of 113 patients show that intravenous urography has no place in the management of men with acute urinary retention without haematuria.
A prospective study was done on 20 adult patients to determine changes in the serum electrolytes and proteins produced by bolus administration of 100 ml of the nonionic contrast medium iohexol (Omnipaque 300) for intravenous urography. Blood samples were taken for analysis before injection and at five and 30 minutes after. Statistically significant decreases in serum sodium, potassium, total protein, albumin, calcium, and phosphate were noted at five minutes post-injection (p less than 0.001). The mean percentage decreases were sodium 2.4%, potassium 5.1%, total protein 13.7%, albumin 14.2%, calcium 8.6%, and phosphate 5.3%. These values were significantly decreased after 30 minutes (p less than 0.001) except for the serum potassium concentration which had almost returned to baseline level. The changes in sodium, potassium, and phosphate are small and thought to be secondary to hemodilution due to the osmolality of the contrast. The changes in total protein, albumin, and calcium were much greater and difficult to explain. Although we found significant changes in serum biochemistry and proteins, these did not appear to cause clinical abnormalities in this group of patients.
The prospective study was performed to reassess the necessity of water deprivation before excretory urography (IVP) with non-ionic contrast medium. 35 adults were deprived of water before IVP and divided into two groups. First group was received 250 ml 5% glucose solution and lopamidol-300 (1 ml/kg, maximum dose; 50 ml). Second group received contrast medium only. Image quality of IVP of the two groups were compared. In the first group the visualization of ureter and bladder were better than the second group. There was no significant difference in the caliceal and pelvic visualization between the two groups. Water deprivation was suggested to be unnecessary in IVP with non-ionic contrast medium.
Ionic and non-ionic contrast media were compared for use in intravenous drip infusion excretory urography. Sixty consecutive cases were classified alternately into two groups, ionic and non-ionic, excluding cases which were known to have factors affecting contrast ability adversely, such as hydronephrosis, renal failure and so on. Each group consisted of 30 cases. A hundred ml of the ionic contrast medium (Diatrizoate--60% Urografin) or non-ionic contrast medium (Iopamidol--Iopamiron 300) was administered I.V. by drip infusion, each infusion taking less than 10 minutes, using a 18 G needle, and 0-minute, 10-minute and 20-minute films were obtained. Visibility of nephrogram, calyceal system, renal pelvis, ureters and bladder were evaluated, ranging from 0 to 3, by six radiologists who were not informed of the contrast medium used. Some detailed factors such as radiographic contrast and fullness of the collecting system and of the bladder were also analyzed. Visualization rate of the ureters was defined as the length of visualized ureters divided by the distance between the renal pelvis and the ureteral orifice of the bladder. There was no significant difference in visualization of nephrogram between the two groups. However, the non-ionic group was superior to the ionic group in visualization of the calyceal system and ureters with statistical significance, probably due to higher radiographic contrast of non-ionic medium. There was no statistical significance between the two groups, in fullness of the calyceal system and visualization rate of the ureters, whereas the ionic group was superior to the non-ionic group in fullness of the bladder.(ABSTRACT TRUNCATED AT 250 WORDS)
The clinical utility was evaluated of a computed radiographic system in urography. The system (FCR 101, Philips Medical Systems, Inc., Shelton, CT) is based on a photo-stimulatable phosphor screen (imaging plate) for X-ray image detection and storage. The X-ray information recorded on the imaging plate is converted into digital from and processed by means of a computer. After processing is completed, the digitized image is reversed back to analogic signals, which modulate the intensity of a laser beam scanning the image on a single-emulsion film (Fuji CR 633). Two hundred IVP's were obtained in four groups, of 50 patients each, with normal azotemic values by rapid infusion of a low osmolality contrast medium (iopamidol 150 mgI/ml). While conventional radiographs were performed on the first group of patients with the injection of 0.6 gI/kg body weight of contrast medium, digital examinations were carried out, in the remaining three groups, with the injection of 0.6, 0.3 and 0.12 gI/kg, respectively. The digital images were processed with the "Abdomen-routine" program. A specific algorithm was implemented in order to reduce the excessive contrast resolution of the bladder, which is due to the characteristics of the nonionic contrast medium and enhanced by the reading program. The image details were evaluated by two observers and then statistically analyzed with nonparametric tests. Statistical analysis did not show any difference in the quality of digital and screen-film images. Image processing improved some inadequate images, by reducing the contrast resolution of the bladder, and allowed a better detection of some details. Low doses (0.3 gI/kg) of a low osmolality (150 mgI/kg) contrast medium were enough to obtain good images. Another biological advantage was obtained by a consistent radiation dose reduction (about 40%).
Urinary protein profiles (IgG, albumin, beta 2-microglobulin) following urography with iothalamate were investigated in 5 patients with functionally and morphologically normal kidneys. In 4 of 5 patients an increased clearance of at least one of the proteins was found indicating disturbance in both glomerular and tubular function and the change was transient (up to 6 days). Albustix was always negative.
Blood samples were taken from 21 subjects at 2 to 4 hours after simultaneous injection of contrast medium (metrizoate) for urography and 51Cr-EDTA. Clearance calculations were performed using the single injection (single slope) technique. The plasma concentrations of 51Cr-EDTA and contrast medium were measured by gamma counting and X-ray fluorescence analysis, respectively. A good correlation was found between the clearance of 51Cr-EDTA and clearance of contrast medium (r = 0.94).
The potential usefulness in urography of two new non-ionic dimeric ratio 6 contrast media (iodixanol and cpd. 2-5410-4A) and a new non-ionic monomeric ratio 3 contrast medium, iopentol, was investigated in a rabbit model and compared with iohexol. Urinary iodine concentrations, urine flow, estimated attenuation capacity and radiographic scoring by visual observation was determined at three dose levels in normally hydrated and at one dose level in dehydrated animals. At the high dose (500 mg I/kg) and in dehydrated animals at 200 mg I/kg the dimers yielded higher urinary iodine concentrations, an increased estimated attenuation capacity and a higher radiographic score than the monomers. Iopentol was as effective as iohexol in all the recorded parameters.
Medullary cystic disease (MCD) is an uncommon renal disease with adult onset and autosomal inheritance, eventually progressing to terminal renal failure. It may be difficult to identify because of insufficient diagnostic tools. At urography, the same ring-shaped accumulation of contrast medium at the corticomedullary junction was observed in two patients (mother and son) suffering from MCD. To our knowledge this observation has not been reported before.
The results obtained in four successive trials based on the analysis of urography performed on patients with normal kidney function are reported. The scores obtained with a non-ionic contrast (iopamidol) were compared with those produced after injecting the same contrast medium with the addition of various diuretics (furosemide, various quantities of 5% glucose solution, 20% mannitol). The results obtained by injecting the diuretic together with the iopamidol were usually unsatisfactory. Injection of diuretic 15 ms after the iopamidol gave better results in the lower urinary tract, particularly the bladder. The best results were obtained by injecting 250 ml, 20% mannitol, after 15 ms. However this technique is not applicable to patients requiring a voiding cystourethrogram due to the inadequate opacification of the urethra it provides.
Iopamidol (Iopamiron 370) was examined for use in intravenous urography in 37 patients who previously developed adverse reactions to conventional ionic contrast media or had a history of allergy. The patients were divided into three groups (group A1:22 patients with previous adverse reactions to contrast media, but without history of allergy, group A2:8 patients with previous adverse reactions to contrast media and with history of allergy, group B:7 patients with a history of allergy, but without experience of using contrast media. Adverse reactions to iopamidol were observed in 6 patients (one in group A1, four in group A2, one in group B) and there were no serious adverse reactions. In conclusion, iopamidol seems to be a safe contrast medium for the patients without history of allergy, but we should examine it carefully as in the case of conventional ionic contrast media.
Given the disagreements in the literature over the extent of cardiac complications during urography it was decided to assess any arrhythmias following the injection of ionic and non-ionic contrast media and a placebo by means of 24 hours dynamic Holter monitoring. The results were subjected to meticulous statistical analysis and showed no connection between electrocardiographic alterations and the substance injected. The absence of statistical significance and the variability of the results suggest that alterations in the physiological parameters and/or arrhythmias arising during the administration of contrast media should be assessed with extreme caution.