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PubMed1978

Renal cyst puncture: utilization of pediatric guide wire technique and upright radiographic changers.

After puncture of a renal cyst with a polytetrafluoroethylene needle a pediatric 0.021-inch guide wire is inserted through a polytetrafluoroethylene sheath needle. The sheath is then advanced over the wire. The technique is controlled by fluoroscopy or performed under ultrasonography. Aspiration of the contrast material is performed, and then air and diatrizoate meglumine and diatrizoate sodium are injected to outline the borders of the cyst. The patient is then taken to an upright and lateral radiographic changer for routine radiography in the upright and decubitus positions.

Humans↗
PubMed1975

Continuous infusion urography in unilateral hydronephrosis.

In cases of unilateral hydronephrosis the urine concentration of contrast medium, for example diatrizoate, depends on the remaining renal function, the rate of turnover in the obstructed renal pelvis and the function of the contralateral kidney. Contrast medium for a single injection or a short infusion time is rapidly excreted by the normal contraleteral kidney, without allowing high enough plasma levels long enough for sufficient urine concentrations in the hydronephrotic kidney. This excretion rate can be compensated for by continuous infusion urography for several hours with large doses of contrast medium (up to 1,250 ml. 30 per cent diatrizoate). This method was theoretically computerized, tested in animals experiments and clinically used in 11 patients. It can improve the diagnostic possibilites of excretory urography, especially in cases of unilateral obstruction, and can minimize the need for retrograde pyelography with its known complications.

Aged↗
PubMedDate not supplied

Effect of iodinated contrast media on neutrophil adhesion to cultured endothelial cells.

PURPOSE: To investigate the influence of contrast media (CM) on endothelial cells (ECs) with respect to cytotoxicity and to neutrophil adhesion. MATERIALS AND METHODS: Human umbilical vein ECs were incubated with chromium-51-labeled human neutrophils in the presence of CM (diatrizoate, ioxaglate, iopamidol, and iodixanol) in three concentrations: 2, 20, and 50 mg I/mL. CM was compared with glucose solutions prepared from plain, buffered glucose solutions, iso-osmolar to the corresponding CM solution. Neutrophil adhesion to the EC monolayer, EC morphology, and cytotoxicity were evaluated. RESULTS: The effect of CM on neutrophil adhesion was dependent on dose, with increased adhesion at low CM concentrations (2 and 20 mg I/mL) and decreased adhesion at high CM concentration (50 mg I/mL). The response was observed only if ECs and neutrophils were exposed to CM simultaneously in a shared environment. Glucose solutions with the same osmolarity did not show similar effect. Both diatrizoate and ioxaglate had a greater cytotoxic effect on ECs and neutrophils than did iodixanol and iopamidol. CONCLUSION: The altered neutrophil adhesion to ECs may be due to CM-induced cytotoxicity or CM-induced EC activation because the glucose solutions did not cause a similar change at equal osmolality. The lack of cell death, combined with altered neutrophil adhesion implies modulation of cell adhesion molecules by CM. The results could be pertinent to the pathogenesis of peripheral vascular lesions and the endothelial response in immunosuppressed or septic patients receiving CM during imaging studies.

Cell Adhesion↗
PubMed1996

Effects of contrast media and mannitol on renal medullary blood flow and red cell aggregation in the rat kidney.

Hemodynamic factors may play a role in the development of acute renal failure following administration of contrast media (CM). In this study the effect of intravenous injection of contrast media and mannitol on red blood cell velocity (VRBC) and red blood cell aggregation in renal medullary vessels was studied in 58 rats. Renal medullary blood flow was investigated by a cross-correlation technique and by a visual aggregation score. The CM, namely diatrizoate, iopromide, iohexol, ioxaglate, iotrolan, were given in iodine equivalent doses (1600 mg/kg body wt). Mannitol (950 mOsm/liter) and Ringer's solution were used as controls. The same vessels were studied 30 minutes before and 30 minutes after injections. VRBC decreased significantly after injection of diatrizoate, iopromide, iohexol, iotrolan and mannitol. Ringer's solution and ioxaglate did not significantly alter medullary blood flow, while iotrolan and mannitol caused the largest decreases in VRBC. All CM and mannitol caused both red cell aggregation and cessation of blood flow. The decrease in blood flow and increase in red blood cell aggregation after injection of CM and mannitol may partly explain the occurrence of contrast medium-induced acute renal failure.

Acute Kidney Injury↗
PubMed2004

Computed tomographic colonography without cathartic preparation for the detection of colorectal polyps.

BACKGROUND AND AIMS: We prospectively compared the performance of low-dose multidetector computed tomographic colonography (CTC) without cathartic preparation with that of colonoscopy for the detection of colorectal polyps. METHODS: A total of 203 patients underwent low-dose CTC without cathartic preparation followed by colonoscopy. Before CTC, fecal tagging was achieved by adding diatrizoate meglumine and diatrizoate sodium to regular meals. No subtraction of tagged feces was performed. Colonoscopy was performed 3-7 days after CTC. Three readers interpreted the CTC examinations separately and independently using a primary 2-dimensional approach using multiplanar reconstructions and 3-dimensional images for further characterization. Colonoscopy with segmental unblinding was used as reference standard. The sensitivity of CTC was calculated both on a per-polyp and a per-patient basis. For the latter, specificity, positive predictive values, and negative predictive values were also calculated. RESULTS: CTC had an average sensitivity of 95.5% (95% confidence interval [CI], 92.1%-99%) for the identification of colorectal polyps > or =8 mm. With regard to per-patient analysis, CTC yielded an average sensitivity of 89.9% (95% CI, 86%-93.7%), an average specificity of 92.2% (95% CI, 89.5%-94.9%), an average positive predictive value of 88% (95% CI, 83.3%-91.5%), and an average negative predictive value of 93.5% (95% CI, 90.9%-96%). Interobserver agreement was high on a per-polyp basis (kappa statistic range, .61-.74) and high to excellent on a per-patient basis (kappa statistic range, .79-.91). CONCLUSIONS: Low-dose multidetector CTC without cathartic preparation compares favorably with colonoscopy for the detection of colorectal polyps.

Adult↗
PubMed1983

[Effect of x-ray contrast media on the vena cava endothelium of rats].

A study comparing the effects of diatrizoate, ioxitalamate, metrizamide, ioxaglate, iopamidol and a hyperosmotic sorbitol and sodium chloride solution on the endothelium of the vena cava of the rat was performed. In each case 1 ml. of the respective solution was injected intravenously. Endothelial damage was seen after injection of metrizamide, diatrizoate and ioxitalamate. After injection of ioxaglate only minor endothelial changes were observed, whereas after administration of both hyperosmotic solution no endothelial damage could be observed.

Animals↗
PubMedDate not supplied

The determination of commonly used iodinated contrast media in postmortem samples using HPLC and TLC.

A rapid micro method is described for the determination of diatrizoic, iothalamic, ioxaglic, and iopanoic acids in postmortem liver and blood. The compounds were extracted with methanol and analyzed by high performance liquid chromatography using a C18 column. The mobile phase consisted of methanol:PIC A with ultraviolet detection at 232 and 242 nm. Recoveries of about 85% were obtained. A thin layer chromatographic system is described which separates the four compounds. The spots were hydrolyzed and sprayed with a diazonium coupling reagent to produce colored spots with sensitivities of 0.02 to 0.1 micrograms. Postmortem levels are given for two deaths involving diatrizoic acid.

Chromatography, High Pressure Liquid↗
PubMed1989

Effect of iodinated contrast media on blood clotting.

Recently, blood clot formation in catheters used for the injection of nonionic contrast media (CM) during angiography has been reported as being due to activation of hemostasis in the catheter. However, CM exhibit inhibitory properties regarding coagulation and platelet functions. The effect on blood clotting of iohexol, iopamidol, ioxaglate, diatrizoate, and ioxitalamate at a ratio of 10% v/v with nonanticoagulated human whole blood was evaluated using the kinetics of fibrinopeptide A (FpA) generation. Blood aliquots were taken every 2 minutes until blood clot occurred. Two groups of contrast media were identified: (1) iohexol and iopamidol, which increased the clotting time, and (2) ioxaglate, diatrizoate, and ioxitalamate, for which all clotting times were over 30 minutes and no FpA generation occurred.

Blood Coagulation↗
PubMed1990

Production and characterization of improved liposomes containing radiographic contrast media.

The authors have investigated liposomes prepared by the reverse-phase evaporation method (REVs) and a modification of this technique that employs a microemulsifier (MREVs), for the delivery of radiographic contrast media (RCM) to the liver and spleen. The modification entailed substituting a Microfluidizer (Microfluidics Inc., Newton, MA) for the sonication step of the REV technique. The MREV procedure is amenable to large-scale production and continuous-flow operation and yields products with high RCM encapsulation. Efficiently entrapped are ionic, high-osmolar diatrizoate (24.38 +/- 2.62% versus 8.35 +/- 0.55%; MREV versus REV), and nonionic, low osmolar Iotrolan (Schering AG, Berlin, FRG) (24.84 +/- 2.13% versus 7.25 +/- 1.19%) RCM with iodine-to-lipid ratio of 1.5:1. The MREV procedure, therefore, has practical advantages over the REV method. High liver and spleen uptakes of Iotrolan-containing vesicles were noted in normal rats. The diatrizoate MREVs lost their contents on contact with serum, resulting in urinary excretion of this agent. Computed tomography values of splenic and hepatic sections, 1 hour after intravenous injection of Iotrolan MREV (500 mgI/kg), are 0.78, and 0.08 Hounsfield Units (HU)/mgI/kg, respectively (versus 0.01, and 0.006 HU/mgI/kg for free Iotrolan).

Animals↗
PubMed1994

Physicochemical parameters of x-ray contrast media.

RATIONALE AND OBJECTIVES: Osmolality, including "dynamic osmolality," which is observed during dilution in the plasma, viscosity, density, and partition coefficient of 11 commercially available contrast media and two new nonionic monomers were determined. METHODS: Osmolality was measured by vapor pressure osmometry, viscosity by determining flow in microcapillaries, and partition coefficient in n-octanol or n-butanol/water mixtures by inductively coupled plasma mass spectroscopy or x-ray fluorescence analysis of iodine concentrations. RESULTS: For the commercially available contrast media, the following statistically significant ranking of osmolality was obtained at 300 mg iodine/mL: iotrolan << ioxaglate < iopromide < iopamidol < ioversol = iohexol < iopentol << meglumine diatrizoate. The novel nonionic monomers, ZK 119095 and ZK 139129, had very low osmolalities, and ZK 139129 was isotonic to blood. The partition coefficient for the system n-octanol/water was lowest for the ionic compounds ioxaglate and diatrizoate followed by the nonionic dimer iotrolan. In n-butanol, iotrolan showed the lowest partition coefficient. CONCLUSION: "Dynamic osmolalities" of contrast media may differ from static values possibly because of the formation of "quasi-oligomers." Especially for ZK 139129, disaggregation occurred during dilution and the osmolality increased slightly. However, osmolality was lower than for any other monomer during the whole dilution process.

Animals↗
PubMed2002

Local tissue toxicity in response to extravascular extravasation of magnetic resonance contrast media.

RATIONALE AND OBJECTIVES: The relative toxicities of the gadolinium chelates currently available in the United States were compared when extravasated in soft tissue. The increasing use of these contrast agents in higher volumes and at faster injection rates, often with a power injector, was a principal motivation for this research. METHODS: Gadopentetate dimeglumine (Magnevist), gadoteridol (ProHance), gadodiamide (Omniscan), and gadoversetamide (Optimark) were evaluated at standard concentration and compared with a control (physiologic saline) and the conventional ionic radiographic contrast medium meglumine diatrizoate (Renografin 60). Each mouse received a subcutaneous injection in the hindlimb of 0.3 mL of contrast or saline. There were 6 experimental groups, with 15 animals in each group. The individual performing the injection was blinded to the identity of the contrast agent used in each mouse. After 48 hours, the mice were killed and tissue samples obtained for histopathology. A veterinary pathologist, also blinded to the agent injected, graded the degree of damage seen on microscopic examination. RESULTS: Of the four MR contrast agents, gadopentetate dimeglumine caused the greatest tissue damage, and gadoteridol and gadodiamide-the two lowest osmolar agents-the least. The difference was statistically significant in terms of both inflammation (P = 0.0008 for gadoteridol, and P = 0.006 for gadodiamide) and necrosis (P = 0.0067 for gadoteridol, and P = 0.031 for gadodiamide), when these agents were compared with gadopentetate dimeglumine. In regard to the control experiments, for all three variables (necrosis, edema, and inflammation), there was no statistically significant difference between the results with gadoteridol or gadodiamide and those with saline. In terms of both edema and inflammation, the effect of gadopentetate dimeglumine, although less, could not be differentiated with any statistical significance from that of meglumine diatrizoate. Gadoversetamide, which has an osmolality between the ionic agent (gadopentetate dimeglumine) and the other two nonionic agents, caused a reaction that could not be differentiated from that seen with gadopentetate dimeglumine for both necrosis and edema. Only in the scoring of inflammation was the effect less using gadoversetamide compared to gadopentetate dimeglumine with any statistical significance (P = 0.021). CONCLUSIONS: The risk of tissue damage due to extravasation is not widely appreciated for the gadolinium chelates. Care should be exercised during contrast injection, to avoid inadvertent extravasation and its deleterious consequences, in particular with the two higher osmolar agents (gadopentetate dimeglumine and gadoversetamide).

Animals↗
PubMed2001

Nephrotoxicants induce endothelin release and signaling in renal proximal tubules: effect on drug efflux.

We previously used killifish proximal tubules, fluorescent substrates, and confocal microscopy to demonstrate that transport mediated by the multidrug resistance protein (Mrp2) and by P-glycoprotein was reduced by nanomolar concentrations of endothelin-1 (ET), acting through a basolateral B-type ET receptor and protein kinase C (PKC). Here we show that representatives of two classes of nephrotoxicants decrease transport by activating the endothelin-PKC signaling pathway. Exposing tubules to radiocontrast agents (iohexol, diatrizoate) or aminoglycoside antibiotics (gentamicin, amikacin) reduced Mrp2-mediated fluorescein methotrexate (FL-MTX) transport from cell to tubular lumen. Pretreating the tubules with an ET(B)-receptor antagonist or with PKC-selective inhibitors abolished these effects. The nephrotoxicants activated signaling by inducing release of ET from the tubules, because adding of an antibody against ET to the medium abolished the effects. Elevating medium Ca(2+) also reduced FL-MTX transport; this reduction was abolished when tubules were pretreated with an ET antibody, an ET(B)-receptor antagonist, PKC-selective inhibitors, or the Ca(2+) channel blocker, nifedipine. None of these drugs by themselves affected FL-MTX transport. Importantly, nifedipine also blocked the ET(B)-receptor/PKC-dependent reduction in FL-MTX transport caused by gentamicin and diatrizoate. These results for two classes of structurally unrelated nephrotoxicants suggest that Ca(2+)-dependent ET release and subsequent action through an autocrine mechanism may be an early response to tubular injury.

Animals↗
PubMed1982

Prolonged visualization of the gastrointestinal tract with metrizamide.

Excellent images of the bowel can be obtained for many days, and sometimes weeks, after oral administration of metrizamide unless it is evacuated via the rectum or a bowel perforation; the quality of images obtained with barium or hypertonic contrast agents (such as diatrizoate meglumine and diatrizoate sodium) begins to deteriorate after several hours. The reasons for prolonged visualization of the bowel with metrizamide and its clinical applications are discussed.

Administration, Oral↗
PubMed1984

Myocardial ischemia during intravenous DSA in patients with cardiac disease.

A prospective study was performed for 48 patients who had histories of angina and were referred for digital subtraction angiography (DSA). Cardiac disease was graded according to the American Heart Association (AHA) functional classification system. Each patient received 2-5 injections of 40-ml diatrizoate meglumine and diatrizoate sodium (Renografin-76, Angiovist-370, or MD-76) at 15 ml per second in the superior vena cava. Of the 28 patients in functional Classes I or II (no or slight limitation of activity), 11% had angina and 32% had definite ischemic ECG changes after the DSA injections. Of the 19 patients in functional Class III (marked limitation of activity), 63% had angina, and 58% had definite ischemic ECG changes after the injections. One patient in functional Class IV (total disability) developed ventricular fibrillation after the second injection. These observed cardiac effects following bolus injections of hypertonic ionic contrast media indicate that special precautions are necessary when performing intravenous DSA examinations on this group of high risk patients.

Aged↗
PubMed1988

Esophageal disruption: evaluation with iohexol esophagography.

Twenty-six patients with possible esophageal disruption who were also at risk for aspiration or direct communication of the esophagus with the tracheobronchial tree were examined with iohexol esophagography. Fifteen patients had normal studies confirmed by findings at a barium examination performed immediately after. In 11 patients abnormalities were diagnosed on the basis of iohexol esophagograms; the abnormalities included extraluminal extravasation of contrast material (n = 7), aspiration (n = 1), esophageal stricture with intramural diverticulosis (n = 1), edema of the gastroesophageal junction (n = 1), and epiphrenic diverticulum (n = 1). Eight of these patients were immediately reexamined with barium esophagography, which yielded no additional information. Low-osmolality, water-soluble contrast agents are a safe alternative for patients in whom barium esophagography poses a risk of mediastinitis and esophagography with diatrizoate meglumine and diatrizoate sodium (Gastrografin) poses a risk of pulmonary edema.

Adult↗
PubMed1995

Tissue reaction follwing intratracheal application of roentgen contrast media in rats.

Contrast media (CM) given orally for roentgen examination of the upper gastrointestinal tract may inadvertently enter the lungs. The present paper describes the local effects on the lungs of rats after a single intratracheal instillation of the nonionic, iso-osmolar, dimer CM iodixanol and iotrolan, and the ionic hyperosmolar, monomeric CM diatrizoate. Hydrochloric acid (HCl) and saline were included as positive and negative controls, respectively. The test compounds were given by intratracheal instillation to anesthetized rats at low dose volumes of 0.5 ml/kg b.w. The animals were killed 6 hours, 24 hours or 7 days after dosing, and the trachea and lungs subjected to histopathological examination. Acute signs of dyspnea were observed in 7 out of 15 animals that received HCl. No clinical signs could be related to treatment with any of the CM. Histomorphological assessment of the respiratory tract did not reveal any CM-related adverse effects, whereas animals treated with HCl showed marked histopathological changes. The results indicate that accidental exposure of the respiratory system to iodixanol, iotrolan or diatrizoate is unlikely to cause any significant tissue damage or lead to respiratory complications.

Animals↗
PubMed2002

Iodinated contrast media induce neutrophil apoptosis through a mitochondrial and caspase mediated pathway.

Iodinated contrast media (ICM) can induce apoptosis (programmed cell death) in renal, myocardial and endothelial cells. Following intravascular injection, circulating immune cells are exposed to high concentrations of ICM. As neutrophils constitutively undergo apoptosis we hypothesized that ICM may adversely affect neutrophil survival. Our aim was to investigate the effect of ICM on neutrophil apoptosis. Neutrophils were isolated from healthy subjects and cultured in vitro with ionic (diatrizoate and ioxaglate) and non-ionic (iohexol and iotrolan) ICM. The effect of ICM on neutrophil apoptosis in both unstimulated and lipopolysaccharide-stimulated neutrophils was determined by annexin V flow cytometry. The influence of physicochemical properties of the different ICM on apoptosis of neutrophils was also studied. We further investigated the effects of ICM on key intracellular signal pathways, including p38 mitogen-activated protein kinase (MAPK) by Western blotting, and mitochondrial depolarization and caspase activity by flow cytometry. Isoiodine concentrations (20 mg ml(-1)) of ionic (diatrizoate 69.6+/-2.9%; ioxaglate 58.9+/-2.0%) and non-ionic (iohexol 57.3+/-2.9%; iotrolan 57.1+/-2.6%) ICM significantly induced neutrophil apoptosis over control levels (47.7+/-1.4%). The apoptotic effect of ICM was influenced by their chemical structure, with ionic ICM having a more significant (p<0.01) apoptotic effect than non-ionic ICM (p<0.05). Furthermore, ICM reversed the anti-apoptotic effect of lipopolysaccharide (1000 ng ml(-1)) treated neutrophils to control levels (23.0+/-3.5% to 61.2+/-5.3%; n=4; p<0.05). These agents induce apoptosis through a p38 MAPK independent pathway that results in mitochondrial depolarization, and is dependent on caspase activation. As neutrophils play a central role in host response to infection and injury, ICM, through induction of neutrophil apoptosis, could have a significant deleterious effect on host immune defence and resolution of an inflammatory response.

Adult↗
PubMed1999

Effect of contrast media on coronary vascular resistance: contrast-induced coronary vasodilation.

STUDY OBJECTIVES: To determine if the vasodilatory response to the intracoronary injection of ionic and nonionic contrast media in intact pigs is dependent on nitric oxide (NO). The mechanisms responsible for inducing the increase in coronary blood flow in response to the intracoronary injection of contrast media during angiography are still not entirely understood. There is evidence to suggest that the response could be partially mediated by NO. PARTICIPANTS: We studied 14 anesthetized, open-chested pigs receiving ventilation. MEASUREMENTS AND RESULTS: Changes in coronary blood flow and coronary vascular resistance were measured in response to the coronary artery injection of saline solution (0.5 mol/L, isosmolar with plasma) and three different contrast agents: meglumine sodium ioxaglate (Hexabrix; Mallinckrodt Medical; Point-Claire, Quebec, Canada), a low osmolar ionic contrast agent; iohexol (Omnipaque 300; Sanofi Winthrop; Markham, Ontario, Canada), a nonionic contrast agent; and diatrizoate meglumine 66%, diatrizoate sodium 10% (MD-76; Mallinckrodt Medical), an ionic contrast agent. Measurements were made during three experimental conditions: the coronary artery infusion of (1) saline solution, control; (2) L-nitro-arginine (LNNA; 10(-3) mol/L and 10(-2) mol/L), a competitive inhibitor of NO synthase; and (3)L-arginine 10(-1) mol/L, a substrate for NO synthase. The infusion of LNNA produced an increase in baseline coronary vascular resistance (p < 0.001), but it did not attenuate the vasodilatory response to the infusion of the contrast agents. Both the high and low osmolar ionic and nonionic contrast media caused a decrease in baseline coronary vascular resistance. For all three conditions, MD-76, which has the highest osmolality, produced the greatest decrease in coronary vascular resistance. CONCLUSION: The vasodilatory response of the coronary vasculature to contrast agents is directly related to osmolality and is not mediated by NO.

Animals↗