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PubMed1983

Comparison of computed tomography and aortography in abdominal aortic aneurysms.

In a prospectively designed study of 13 consecutive patients with proven abdominal aortic aneurysm, the diagnostic accuracy of computed tomography (CT) was compared with aortography. Computed tomography was found to be a highly informative diagnostic test providing clear delineation of lesions and extent of aneurysm and its relationship to renal and iliac arteries. Furthermore one case of retroperitoneal fibrosis and one case of hydronephrosis were demonstrated by CT. The diagnosis of aneurysm by aortography was uncertain in six cases and in another three cases the relation of the aneurysm to the renal arteries was uncertain. Thus CT was found superior to aortography in examining patients for abdominal aortic aneurysm.

Aorta, Abdominal↗
PubMedDate not supplied

Delayed contrast enhancement in acute focal bacterial nephritis: CT features.

Computed tomography was performed in seven patients with acute pyelonephritis 6 h after the administration of contrast medium. Four patients revealed patchy wedge-shaped areas of contrast enhancement. The scans immediately after contrast medium administration showed decreased attenuation in these wedge-shaped areas. These results suggest that CT performed hours after contrast medium administration may reveal delayed enhancement in a significant number of patients with acute pyelonephritis.

Acute Disease↗
PubMedDate not supplied

Computed tomography of the stomach with water as an oral contrast agent: technique and preliminary results.

Computed tomography of the gastric wall after ingestion of 500-700 ml of pure tap water, followed by rapid intravenous injection of contrast medium, was performed on 24 patients with known gastric tumors. Computed tomography detected the wall abnormality in 22 of 24 cases (91%). Local gastric involvement was correctly predicted in 20 of these patients. Tumoral ulceration was only diagnosed in two of 13 proven ulcerated tumors. General acceptance and tolerance of tap water as a gastric contrast medium was good in all patients. No side effects occurred.

Contrast Media↗
PubMedDate not supplied

Renal arteriovenous malformations: CT features.

The CT and clinical features of six patients with congenital renal arteriovenous malformation (RAVM) were reviewed to determine the characteristics of this condition. The most common symptom was hematuria. The CT images were characterized by masses of vascular density located in the renal sinus and surrounding the pelvicaliceal system with or without dilated renal veins. The exact size of the RAVM and the relation to the pelvicaliceal system were well demonstrated by delayed images or drip infusion technique, whereas the bolus injection technique was essential to document the vascular nature. The potential pitfalls in diagnosis that can occur if only an infusion study is performed are discussed.

Adult↗
PubMedDate not supplied

Lung cancer in patients with idiopathic pulmonary fibrosis: CT findings.

PURPOSE: The frequency of lung cancer in patients with idiopathic pulmonary fibrosis (IPF) is higher than that of general population. To evaluate CT findings of lung cancer associated with IPF, we analyzed 32 patients with lung cancer associated with IPF. METHOD: We analyzed retrospectively 32 patients with histologically confirmed lung cancer out of 244 consecutive cases diagnosed as IPF by either CT and clinical findings (n = 220) or histologically (n = 24). The patients were 40-85 years old (mean 66 years, M/F = 31/1). Scanning techniques were conventional CT in 24 patients, high-resolution CT (HRCT) in 2 patients, and both conventional CT and HRCT in 6 patients. We analyzed the CT patterns, locations, and histologic types of lung cancer. RESULTS: The frequency of lung cancer in patients with IPF was 13.1% (32/244). In 17 of 32 patients, the CT findings of lung cancer were ill defined lesions mimicking air-space consolidation. Lung cancer was located mainly in the lower lobes (21/32) and peripheral portion (21/32). Histologically, squamous cell carcinoma was the most common type (18/32). CONCLUSION: Typical CT findings of lung cancer were ill defined consolidation-like masses at the peripheral portion where the most advanced fibrosis was located.

Adenocarcinoma↗
PubMedDate not supplied

Acute macular neuroretinopathy following adverse reaction to intravenous contrast media.

Two young women noted acutely altered vision while suffering an adverse reaction to an intravenous injection of contrast agent for computerized tomography. One patient initially showed swollen maculas with subtle opacification of the parafoveal retina. Deep retinal lesions typical of acute macular neuroretinopathy were present later in both cases. Paracentral scotomas corresponding to the fundus lesions were present in both patients but subsequently improved. The temporal relationship of the onset of symptoms and the retinal abnormalities to the adverse reaction suggests that acute macular neuroretinopathy in these patients was caused either by the adverse reaction or its treatment.

Acute Disease↗
PubMed1980

Fixed eruption and fever after urography.

We have described a patient with fixed bullous eruption, usually associated with severe fever, occurring on five occasions after a series of seven intravenous urograms between 1974 and 1979. Diagnosis was initially obscured because the onset of fever and dermatitis was delayed as long as 72 hours. This is only the second report of true ioderma ascribed to urographic contrast media.

Fever↗
PubMedDate not supplied

The effect of diagnostic radiopaque fluids used in discography on chymopapain activity.

It has been thought that intradiscal injection of radioopaque fluids prior to intradiscal chymopapain therapy might have some inhibitory effect on its enzyme activity and, thus, disc nuclear dissolution. This raised the question--what interval should elapse between discography and injection of the chymopapain to avoid this possible effect? The effects of Hypaque (Conray), metrizamide, and Urografin on chymopapain activity were measured. The most suitable substrate was N. Benzoyl-DL-arginine paranitroanilide (BAPNA). The yellow p-nitro aniline liberated (a measure of the enzymic activity of chymopapain) was determined by absorption spectrometry. Controlled series using 1) Hypaque plus substrate plus no enzyme, 2) Hypaque, enzyme, no substrate, and 3) Hypaque plus substrate plus enzyme showed no action. Hypaque (Conray) and Urografin are seen to enhance enzymic action of chymopapain. Metrizamide has slight inhibitory action. Effects of Dimerex were variable. Weak Hypaque increases activity (20%); 100% solution doubles activity. Thus, there is no necessity to delay injection of enzyme after Hypaque, Conray, Urografin, especially as disc radioopacity can persist up to 24 hours. Prior injection of 95% alcohol (as used by Trosier) abolishes chymopapain activity.

Chymopapain↗
PubMed1988

A nonradioactive iothalamate method for measuring glomerular filtration rate and its use to study the renal handling of cibenzoline.

A high-pressure liquid chromatographic method was developed to measure nonradioactive iothalamate in serum and urine for use in estimating glomerular filtration rate (GFR). This method was used to study the renal handling of cibenzoline, an experimental antiarrhythmic drug. The mean cibenzoline clearance was 3.5 +/- 2.5 (SD) times the glomerular filtration rate. The clearance of non-protein-bound cibenzoline was seven times GFR, indicating excretion by the renal tubular secretory pathway for organic bases. This drug, at the doses used, did not lower creatinine clearance, indicating that the effect of basic drugs competing with creatinine for the base secretory pathway appears to be dose and drug dependent.

Adult↗
PubMed1993

Glomerular filtration rates in persons evaluated as living-related donors--are our standards too high?

We have retrospectively analyzed the glomerular filtration rate by 125-I iothalamate clearance and creatinine clearance in a group of 661 persons evaluated as potential kidney donors. The average GFR in this population is lower than that reported in previous studies and ranges from 102 +/- 15 and 114 +/- 17 ml/min for males and females age 21-30 to 84 +/- 13 and 79 +/- 15 ml/min for males and females age 51-60. Furthermore, there has been a gradual decrease in GFR in this population from 1970 to 1990 in both the entire population and in those under the age of 40. The cause of this drop is not apparent. These data can be utilized to determine the appropriateness of a potential donor for donation, and may indicate that our current standards are too high.

Adult↗
PubMed2000

Transplantation and 2-year follow-up of kidneys procured from a cadaver donor with a history of lupus nephritis.

BACKGROUND: Two patients underwent cadaver transplantation with kidneys from a donor with a history of World Health Organization Class IV/V lupus nephritis, and we report their clinical and pathological outcome. METHODS: The donor had a diagnosis of lupus nephritis made by renal biopsy 5 years before donation. At the time of donation, a biopsy was performed on the donor and on one of the recipients at 2 months and 1 year after the transplant. RESULTS: Both recipients underwent uneventful renal transplantation. On the first postoperative day, the donor's final pathological results became available. Although the frozen section seemed to be quite benign, the permanent sections revealed World Health Organization Class II/V lupus nephritis, with full house immunofluorescence and multiple electron dense deposits. Biopsies were performed on recipient #2 at 8 weeks and 1 year after the transplant. These revealed marked diminution followed by complete resolution of all tubular reticular structures and deposits as well as immunofluorescent activity. Both recipients remain with normal renal function and urinalysis at 3 years after the transplant. CONCLUSION: Although a history of clinically significant renal disease has been considered an absolute contraindication to kidney donation, with appropriate workup and caution, select patients may still be considered, which would increase the potential donor pool.

Adult↗
PubMed1995

Iothalamate clearance and its use in large-scale clinical trials.

Several recently completed or ongoing large-scale clinical trials, including the Modification of Diet in Renal Disease Study, the Diabetes Control and Complications Trial, and the African-American Study of Kidney Disease and Hypertension, have all chosen the renal clearance of sodium 125I-iothalmate to monitor renal disease progression. The need for accurate and precise renal testing at multiple clinical sites, with centralized renal sample processing, clearly exceeds the limited scope of most other glomerular filtration rate methods. Analysis of 3580 studies combined from the Modification of Diet in Renal Disease Study and Diabetes Control and Complications Trial demonstrates that trained clinical personnel can successfully perform the 125I-iothalamate clearance glomerular filtration rate method in large-scale studies. Overall, intratest and interest glomerular filtration rate coefficients of variation of approximately 10 and 6% are acceptable for such studies. Strict standardization of glomerular filtration rate protocol with respect to water loading, equilibration time after injection, and pre-study fasting is of crucial importance. Other confounding phenomena, including regression to the mean of progression slopes, must be considered before renal results of an intervention can be assessed. The 125I-iothalamate clearance glomerular filtration rate method offers good accuracy and precision, reasonable clinical convenience, straightforward and efficient central laboratory analysis, and reasonable cost and safety for large-scale clinical trials.

Clinical Trials as Topic↗
PubMed1998

Application of newer clearance techniques for the determination of glomerular filtration rate.

Glomerular filtration rate (GFR) is the standard measure of renal function and is critical for the management of renal diseases. Rigorous assessment of GFR requires the measurement of renal clearance of a filtration marker, such as inulin. This method, however, is not suitable for routine clinical practice. Labelled compounds as alternative filtration markers provide accurate and precise GFR measurement, but their use may be limited for safety reasons. Thus investigators have proposed clearance procedures using minute doses of non-radioactive contrast agents, including iothalamate and iohexol. Their renal clearance provides similar accuracy as inulin clearance in GFR estimation, but the need of urine collection again poses certain limitations to the procedure. Thus, plasma clearance of suitable exogenous markers, such X-ray contrast media, has been suggested for measuring renal function, in which the elimination rate of the tracer after a single intravenous injection is evaluated. Plasma clearance of these markers estimated by multiple blood samples provides precise information, but repeated sampling makes this method cumbersome. Abbreviated kinetic profiles have been proposed to predict GFR from the plasma disappearance curve. The simplified method that uses a one-compartment model corrected by the Bröchner-Mortensen formula gives an excellent correlation with inulin clearance and is currently employed for measuring GFR in multi-centre clinical trials.

Contrast Media↗
PubMed2004

A comparison of iothalamate-GFR and serum creatinine-based outcomes: acceleration in the rate of GFR decline in the African American Study of Kidney Disease and Hypertension.

In renal clinical trials, both slope-based and time-to-event renal outcomes have been used. These outcomes are typically based on estimates of GFR obtained using creatinine or iothalamate GFR (iGFR). The African American Study of Kidney Disease and Hypertension (AASK) was a trial in 1094 African Americans with hypertensive nephrosclerosis, which examined the effects of two levels of BP control and three antihypertensive regimens. This study compared the effects of the AASK interventions on outcomes based on serum creatinine with corresponding outcomes based on iGFR using 9742 matched pairs of iGFR and serum creatinine measurements. The iGFR-based outcomes included (1) a time-to-event composite outcome including a 50% GFR decline, ESRD, or death; (2) a composite outcome including a 50% GFR decline or ESRD; (3) mean decline in GFR in the first 3 mo after randomization (acute slope); (4) mean decline in GFR starting 3 mo after randomization (chronic slope); and (5) mean decline in GFR from baseline (total slope). The corresponding creatinine-based outcomes were (1) a composite of doubling of serum creatinine, ESRD, or death and (2) a composite of doubling of serum creatinine or ESRD and acute, chronic, and total slopes defined by the mean change in estimated GFR (eGFR), where eGFR was estimated from a regression equation for GFR depending primarily on serum creatinine and developed in AASK enrollees. Mean changes in iGFR and eGFR were also compared under extended models that allowed for the possibility that the rate of GFR decline may change over time during the chronic phase. an apparent acceleration in rate of decline of renal function over time was found. Subtle differences were observed between effects of the interventions on some of the creatinine and iGFR slope-based outcomes, but the main conclusions of the trial were similar for the serum creatinine and iothalamate-based measurements. This has important implications for the design of clinical trials with renal outcomes.

Adolescent↗
PubMed2004

Decline in native renal function early after bladder-drained pancreas transplantation alone.

BACKGROUND: Pancreas transplant alone (PTA) has become accepted therapy for select nonuremic patients with type 1 diabetes mellitus. However, PTA may lead to significant complications including a decline in native renal function. This study examines trends in native renal function during the first posttransplant year in PTA recipients with a spectrum of pretransplant glomerular filtration rates (GFR). METHODS: Renal function was studied in 23 recipients of bladder-drained PTA who underwent transplantation from April 1998 through September 2001. GFR was measured by corrected iothalamate clearance at the time of transplant evaluation and 1 year posttransplant and also calculated using the Cockcroft-Gault method at the transplant evaluation; at the day of transplantation; and at 1, 6, and 12 months posttransplant. RESULTS: Iothalamate clearance decreased in the first year in 96% of patients (22 of 23). The mean measured GFR decreased from 84 +/- 33 mL/min/1.73 m2 pretransplant to 52 +/- 26 mL/min/1.73 m2 at 1 year (P <0.001). Calculated creatinine clearance declined in the majority of patients at both 1 and 12 months after PTA, but some patients, including a few with low GFR, maintained stable renal function. Calculated GFR generally correlated well with measured GFR in most patients, with a few notable exceptions. One patient (baseline GFR, 42 mL/min/1.73 m2) developed renal failure in the first year after transplant and required kidney transplantation. CONCLUSIONS: Bladder-drained PTA results in a decline in native renal function in the majority of patients regardless of the pretransplant GFR. These data suggest the need for strategies to prevent or minimize the decline in renal function after PTA.

Adult↗