The effect of intra-arterial contrast media on the small intestine of rabbits. An electron-microscopic study.
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Conray, Renografin-60, and Reno-M-60 were compared in 40 patients undergoing cerebral angiography. Pain during injection, as evidenced by head motion, was documented using subtraction. Conray produced less had head motion and therefore a superior subtraction study than either Renografin-60 or Reno-M-60 and was also subjectively the least painful of the three.
Renal biopsies were performed in 211 patients which 10 days of excretory urography or renal arteriogrpahy in which diatrizoate, iothalamate or ioxithalamate had been used. In 47 renal specimens, osmotic nephrosis of the proximal tubular cells was found. Previous renal function had been normal in 10 patients, moderately impaired in 19, and severely impaired in 18. Tubular atrophy and/or necrosis was associated with histological features in 29 of 47 patients. Diffuse osmotic nephrosis was more often found in patients biopsied soon after roentgenography and also with severe renal insufficiency, but was not necessarily associated with declining renal function. The mechanism(s) by which contrast media may induce osmotic nephrosis remains unclear.
Lumbar radiculographs were obtained in 252 patients with suspected disk herniation. Fifteen patients who underwent previous radiculography with Dimer-X plus Depo-Medrol exhibited adhesive arachnoiditis. This was not observed in 6 patients who received Dimer-X alone. No positive correlation between radiological diagnosis of adhesive arachnoiditis and clinical symptoms can be demonstrated. The authors suggest that steroids not be used intrathecally in combination with water-soluble contrast media.
A laboratory dog exhibited an altered response to injections of sodium iothalamate. This idiosyncratic response may have been predicated on an earlier series of iothalamate injections. The overt manifestations of the reactions in this dog were vomiting, hypotension, and hyperreflexia. Significant changes in several electrolyte components and serum complement levels were noted when the dog reacted to the contrast material.
Computed tomography (CT) is a safe and reliable technique for the study of children with increased head circumference. Hydrocephalic children requiring drainage of cerebrospinal fluid may be shunted on the basis of the CT scan alone and their postsurgical course followed by serial CT scans thereafter. Any additional pneumographic studies required may be performed via the existing shunt tube, eliminating transcerebral catheterization and its attendant complications.
The effect of dexamethasone on the accumulation of iothalamate and 99mTc pertechnetate in cerebral tumors was investigated in 6 patients over a five-month period. Patients were examined by x-ray (transmission) computed tomography (CT) and by radionuclide (emission) computed tomography (RCT) prior to and during a course of dexamethasone therapy. Stenosis diminished the degree of accumulation of both agents but did not change the boundaries of their distribution.
Reliable, large, nonobstructive thrombi were produced by electrical stimulation of the wall of the inferior caval veins in dogs, thus avoiding surgical trauma or introduction of chemical substances. Metrizamide was found to adhere longer to the thrombi than an ionic medium (iothalamate) at comparable iodine concentrations. This may be due to the much higher viscosity of metrizamide.
The effects of isotonic solutions of three contrast agents, administered intrathecally, were studied in cats. A pronounced increase in the electrically evoked cortico-spinal responses and segmental spinal polysynaptic reflexes was recorded after administration of methylglucamine diatrizoate. Injection of methylglucamine iothalamate resulted in an increase of the amplitudes of these reflexes, while metrizamide did not show any consistent effect. The data suggest that water-soluble media have direct effects upon spinal gray matter.
Accurate glomerular filtration rates (GFR) can be calculated based on the infusion of small amounts of nonradioactive iothalamate and collection of plasma samples for assay by x-ray fluorescence. This innovation permits frequent clearance determinations in patients without the hazard of repeated radiation exposure and without the necessity of catheterization of the bladder for urine samples. Thus, the technique becomes feasible in children, transplant patients, and other needing accurate and frequent GFR determinations.
After myelography with either metrizamide (300mg l/ml) or meglumine iocarmate (280 mg l/ml), mild to severe arachnoid fibrosis was demonstrated radiographically and histologically in primates. Intrathecal injections of metrizamide (170 mg l/ml) or autologous cerebrospinal fluid produced less arachnoiditis. The risk of arachnoiditis is probably minimized by the use of reduced volumes and concentrations of water-soluble media. Controlled studies of arachnoiditis following myelography are probably more reliable in the primate model than in other experimental animals.
In vitro and in vivo studies were done to examine the effects of methylprednisolone on the adverse reactions induced by contrast media. At very high concentrations, the steroid potentiated the complement-activating effect produced in vitro by iodipamide, but inhibited the immune and nonimmune mechanisms of hemolysis. Rabbits pretreated for 3 days with intramuscular methylprednisolone (at high or low dosages) were significantly protected against an LD47 challenging dose of iodipamide. Those treated once with a low intravenous dose immediately prior to iodipamide challenge were protected to a lesser degree. Rabbits treated once with a very high intravenous dose of steroid evidenced no protection. A hyper-responsive dog was consistently protected against adverse reactions to injected sodium iothalamate by a 3-day steroid pretreatment.
Acute pulmonary edema developed in two young, previously healthy women immediately after the intravenous administration of contrast media. The pulmonary edema, rare in young persons, could not be explained by classical anaphylaxis, contrast media overdose, sodium and fluid overload, or acute myocardial infarction. A nonimmunologic osmotic mechanism causing reversible pulmonary capillary leak might explain the clinical events observed in both patients. Both responded to continuous positive airway pressure (CPAP), indicating the possible utility of CPAP in treating pulmonary capillary-leak contrast reactions.
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