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PubMed1988

Assessment of myocardial perfusion in humans by contrast echocardiography. I. Evaluation of regional coronary reserve by peak contrast intensity.

Myocardial contrast echocardiography was performed during coronary angiography with 2 ml of sonicated meglumine diatrizoate sodium 76% (meglumine) in 40 patients (ranging in age from 25 to 79 years) before and 10 to 15 s after intracoronary injection of papaverine, 8 mg into the right coronary artery (n = 43) and 10 mg into the left (n = 46). The same protocol was repeated in 17 patients 5 to 10 min after completion of coronary angioplasty. In 13 patients with normal coronary angiograms, peak contrast intensity corrected for background myocardial intensity was measured in 36 regions and was found to increase after papaverine from 36 +/- 16 to 55 +/- 22 U (p less than 0.001). In contrast, in the 27 patients with angiographic evidence of coronary artery disease, peak intensity in 64 regions remained unchanged after papaverine (35 +/- 22 versus 36 +/- 23 U). An increase in peak intensity greater than or equal to 10 U was 80% sensitive and 92% specific for coronary artery disease. After successful coronary angioplasty, peak intensity in the involved regions improved significantly (p less than 0.001) during baseline contrast injections (from 32 +/- 16 to 50 +/- 25 U) as well as in the postpapaverine contrast injections (from 30 +/- 12 to 60 +/- 26 U). In conclusion, measurement of peak contrast intensity after intracoronary injections of sonicated meglumine provides a relative index of myocardial perfusion that allows assessment of regional coronary reserve in patients with coronary artery disease. This may be of particular value in evaluating the immediate effects of coronary angioplasty on myocardial perfusion.

Adult↗
PubMed1988

Myocardial contrast two-dimensional echocardiography: dose-myocardial effect relations of intracoronary microbubbles.

It is controversial whether echocardiographic contrast agents prepared by sonication cause transient myocardial depression beyond that known to occur with contrast agents alone. In nine open chest dogs, contrast injections were made into the left anterior descending coronary artery during two-dimensional echocardiography. One hundred forty-four recordings were analyzed subsequently, by an observer who was unaware of other data, for percent depression of systolic wall thickening, duration of regional wall motion abnormalities, peak contrast enhancement and contrast washout. Two microbubble sizes were obtained by sonicating Renografin-76 (meglumine sodium diatrizoate): mean diameter 12 +/- 3 (SEE) and 20 +/- 6 micron. Four doses (range 0.5 to 3 ml) of each of four agents (12 and 20 micron bubbles in Renografin, nonsonicated Renografin and saline solution) were injected in random order. Significant relations were found between percent depression of systolic wall thickening, duration of regional wall motion abnormalities and contrast washout time versus microbubble size (p less than 0.001) and microbubble dose (p less than 0.01). Little increased contrast effect was found at larger doses or with larger microbubbles compared with the smaller doses and size studied. Injections of nonsonicated Renografin caused less depression of systolic wall thickening (p less than 0.05), faster resolution of wall motion abnormalities (p less than 0.05), less contrast (p less than 0.001) and more rapid contrast washout (p less than 0.001) than did 12 micron bubbles in Renografin. A significant correlation was found between the duration of regional wall motion abnormalities and contrast washout time (r = 0.93, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

In vivo effects of nonionic and ionic contrast media on beta-thromboglobulin and fibrinopeptide levels.

Nonionic contrast media are suggested to cause increased thromboembolism (in vivo), platelet aggregation and procoagulant effect (in vitro) as compared with ionic contrast media. To study these effects in vivo, 30 consecutive patients undergoing routine angiography were prospectively randomized to three groups of 10 patients each. Group A received diatrizoate (ionic, high osmolality), Group B ioxaglate (ionic, low osmolality) and Group C iohexol (nonionic, low osmolality). In vivo platelet alpha-granule release and fibrin-1 formation were measured by radioimmunoassay of beta-thromboglobulin and fibrinopeptide A in peripheral venous samples. Levels were estimated at three stages during the procedure: before and after left ventriculography and after coronary angiography. No differences were noted (p = NS) when the ratios of beta-thromboglobulin and fibrinopeptide A were compared among the three groups. These data suggest that the newer nonionic contrast media do not demonstrate enhanced systemic platelet activation or fibrin formation as compared with standard ionic contrast media. However, larger randomized clinical studies are necessary to conclusively establish the suggested thromboembolic potential of nonionic contrast media.

Angiography↗
PubMed2006

Monitoring of iodinated X-ray contrast media in surface water.

A monitoring programme was carried out in order to determine iodinated X-ray contrast media (ICM) in the River Danube and to investigate the raw water quality for drinking water production at Langenau waterworks. The study revealed that the maximum concentrations of ICM (over 500 ng l(-1) for diatrizoic acid and iopamidol) were found in 2h-composite samples taken from the downstream of the Ulm/Neu-Ulm metropolitan area. By means of a concentration profile over one month the highest ICM concentrations were observed on weekdays. The extended data evaluation with principal component analysis shows that the upstream and downstream samples had different pattern of variations in ICM concentration and also demonstrates a clear change in ICM composition by the discharge of municipal wastewater. In addition to load profiles of ICM, time-dependent plots of principal component 1 exhibited peaks, indicating a short-term discharge of ICM between the two sampling sites. In conclusion, a point source for ICM contamination between the sampling sites in Ulm upstream and Leipheim downstream seems to be the reasonable explanation for peak ICM concentrations. Due to the observed high variations of ICM concentrations in river, the evaluation of natural waters by means of a single analysis is not representative.

Contrast Media↗
PubMed1990

Effect of intracoronary contrast medium on left ventricular diastolic pressure-volume relationships.

The purpose of this study was to investigate the effect of intracoronary injection of the contrast medium sodium-meglumine diatrizoate (CM) on left ventricular (LV) diastolic pressure-volume relationships. Seven closed-chest dogs were instrumented with pressure catheters in the left ventricle and aorta, a balloon transducer to measure pericardial pressure, and an aortic flow meter to determine stroke volume. We estimated LV volume from two diameters by sonomicrometry. Six milliliters of CM was injected into the left main coronary artery. Transmural LV end-diastolic pressure increased from 3.3 +/- 1.1 to 7.2 +/- 0.9 mm Hg and LV end-diastolic volume index from 40.8 +/- 6.8 to 44.7 +/- 7.4 ml. There was only a minor increase in pericardial pressure. Stroke volume decreased by 31 +/- 7%. There was no change in the intracavitary or transmural diastolic pressure-volume relationship, indicating unchanged LV "compliance." Increased LV filling pressure by CM reflected reduced systolic function.

Animals↗
PubMed1984

Effects of angiocardiographic contrast media on the pulmonary circulation in pigs.

In 12 open-chest pigs, mean weight 18 kg, simultaneous beat-to-beat measurements of pressure in the right and left atria and right and left ventricles, and of pressure and flow in the pulmonary artery, were performed before, during and after the injection of 0.8 ml/kg with 10 to 15 ml/s of diatrizoate, ioxaglate and iopamidol as well as mannitol, normal saline solution and own blood into the right atrium, right ventricle and pulmonary artery. Within 5 beats after injection, all determined hemodynamic values reached their maxima of change independent of site of injection and kind of injectate. After 10 to 20 beats, pulmonary resistance diminished, and the reduction was more pronounced and longer lasting the higher the osmolality of the injectate. Hemodynamic changes during the first beats were a result of the rapidly injected volume; longer lasting hemodynamic changes were associated with an osmolality-dependent decrease in pulmonary resistance.

Angiocardiography↗
PubMed1990

Renal excretion of enteral gastrografin in the absence of free intestinal perforation.

The renal excretion of orally administered water-soluble contrast medium has been described in intestinal perforation (Mori and Barret, 1962). We present a case in which orally administered Diatrizoate methylglucamine (Gastrografin, Schering) was detected in the renal collecting system on computed tomography in a man with an ischaemic segment of small bowel associated with abscess formation but no evidence of intra-peritoneal perforation.

Adult↗
PubMed1980

Angiocardiography with metrizamide in the neonate and infant.

The non-ionic contrast medium metrizamide was compared with a routine ionic medium (sodium methyl-glucamine diatrizoate) in a series of 16 patients with congenital heart disease, all under 11 kg body weight, undergoing angiocardiography. Despite a higher viscosity, metrizamide yielded images of equal quality to those of the ionic medium, and was clinically better tolerated. Metrizamide produced a significantly lesser effect on plasma osmolality, a parameter closely related to contrast medium toxicity. Other biochemical parameters showed insignificant changes. Metrizamide is therefore a more suitable contrast medium for angiocardiography and despite its cost should be considered for patients with serious congenital heart disease who are in poor clinical condition.

Angiocardiography↗
PubMed1981

Clinical cardiovascular experiences with iopamidol: a new non-ionic contrast medium.

Iopamidol, a new non-ionic water-soluble contrast medium, has been compared with standard ionic media in a number of cardiovascular applications. It is stable in aqueous solution, is much less viscous and only slightly more osmolar than metrizamide. Compared to sodium meglumine diatrizoate in a series of 40 coronary arteriograms, it produced a consistent and highly significant decrease in the incidence and severity of hypotension and bradycardia following intracoronary injection. In the same group and in 62 children undergoing ventricular or great vessel angiocardiography, a subjective assessment of patient reaction showed that iopamidol was better tolerated than the ionic medium. There was a very strong patient preference for iopamidol in a group of 20 of the adult patients who had also consented to femoral artery injections of both media. Throughout these series there was no detectable difference in arterial image quality between the media. Venous phase opacification during arterioportography was assessed in 11 cases comparing iopamidol with sodium meglumine iothalamate. No significant difference was found. We conclude that iopamidol is clearly preferable to ionic media for routine cardiovascular applications.

Angiocardiography↗
PubMed1982

Metrizamide as contrast medium in endoscopic retrograde cholangio-pancreatography.

Endoscopic retrograde cholangio-pancreatography (ERCP) has been performed in 17 patients using metrizamide (Amipaque) as contrast medium, and in 33 using meglumine diatrizoate (Urografin). The quality of pancreatograms obtained has been compared, using a specially developed scoring system, an any clinical and biochemical evidence of (acute) pancreatitis following ERCP observed. The mean pancreatogram score was slightly higher when Amipaque was used but there was no difference in the frequency or extent of hyperamylasaemia between the two groups. The slight advantage of Amipaque is not sufficient to overcome the disadvantages of its relatively high cost and inconvenience in use.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed2001

The selective adenosine A1 receptor antagonist KW-3902 prevents radiocontrast media-induced nephropathy in rats with chronic nitric oxide deficiency.

Several studies have recently suggested a principal role of adenosine in the pathogenesis of radiocontrast media-induced nephropathy. In the present experiments, we therefore investigated the renal protective effects of 8-(noradamantan-3-yl)-1,3-dipropylxanthine (KW-3902), a potent and selective adenosine A1 receptor antagonist, on radiocontrast media-induced nephropathy in the model of the N-pi-nitro-L-arginine methyl ester (L-NAME) hypertensive, chronic nitric oxide (NO)-depleted rat. Chronic NO depletion was induced by pretreatment with L-NAME, 50 mg/ml, added to drinking water for 8 weeks. Clearance experiments were performed in anesthetized rats and glomerular filtration rate was assessed prior to and following the application of high osmolar radiocontrast media (sodium diatrizoate, 3 ml/kg, i.v.) or an equivalent volume of isoosmolar mannitol to examine the role of hyperosmolarity in radiocontrast media-induced nephropathy. Subgroups received KW-3902 (0.1 mg/kg, i.v.), 20 min prior to radiocontrast media administration. Age-matched, untreated rats served as controls. Radiocontrast media application induced a significant decline in glomerular filtration rate in L-NAME hypertensive animals, whereas no effects were observed in control rats. KW-3902 fully prevented the drop in glomerular filtration rate in response to radiocontrast media in L-NAME hypertensive rats. No renal hemodynamic alterations were observed in mannitol-infused animals. The present experiments demonstrate that the decrease in glomerular filtration rate following radiocontrast media occurred independently of the osmotic load, and that KW-3902 effectively prevented the radiocontrast media-induced deterioration in renal function. KW-3902 may be especially beneficial in patients at high risk for developing acute renal failure following radiocontrast media application or in patients in which extracellular fluid volume expansion is limited by clinical conditions such as congestive heart failure.

Animals↗
PubMed1987

Neurotoxic complications of contrast computed tomography in children.

Four children with brain tumors had marked alterations in levels of consciousness and vital signs after contrast-enhanced cranial computed tomography (CT). Each had clinical evidence of increased intracranial pressure but was alert and coherent before CT. During the procedure, 2 to 2.5 mL/kg 60% diatrizoate meglumine was administered intravenously, and within hours the patients became progressively lethargic and disoriented and bradycardia and hypertension developed; two had generalized seizures. Two children died immediately after the CT procedure. Contrast-enhanced CT may produce grave neurologic complications in children with brain tumors, and this study should be reserved for those patients in whom the probability of obtaining additional information is high. Use of low-osmolality agents or nonionic contrast agents may decrease the morbidity and mortality associated with the procedure.

Brain Neoplasms↗
PubMed2000

Occurrence of triiodinated X-ray contrast agents in the aquatic environment.

High concentrations of adsorbable organic iodine (AOI) are found in municipal treatment plant effluents and surface waters by specific organic halogen determination. The high AOI is caused by widely used triiodinated X-ray contrast agents, which are very stable and hydrophilic. We have analysed specifically surface water influenced by a municipal treatment plant effluent, the surface water after bank filtration and raw drinking water. The X-ray contrast agents were determined by liquid chromatography-mass spectrometry with positive electrospray ionization after enrichment by solid phase extraction. Diatrizoate and iopromide, two triiodinated contrast agents are detectable in all samples, whereby the less polar component iopromide seems to be reduced during bank filtration. Just a trace of iopromide is identified in surface water after bank filtration and in the raw drinking water. Approximately 60% of the initial AOI is extractable and approximately 25% of the extractable AOI can be identified as specific triiodinated contrast agents.

Chromatography, High Pressure Liquid↗
PubMed2002

Do clinically relevant circulating concentrations of radiographic contrast agents inhibit platelet-dependent arterial thrombosis?

OBJECTIVES: The purpose of this study was to determine if radiographic contrast agents (RCAs) inhibit thrombosis in a rat carotid artery injury model. BACKGROUND: Whether ionic and nonionic RCAs differentially affect thrombus formation during coronary artery angioplasty is controversial. Although there are numerous in vitro studies and clinical trials addressing this issue, it is unknown whether clinically relevant plasma concentrations of RCA inhibit platelet-dependent thrombosis after injury of medium-sized arteries. METHODS: Rats received RCA or control solution by bolus (0.7 ml/kg) and constant (0.04 ml/kg/min) intravenous infusion. Carotid arteries were injured with ferric chloride. Blood flow was monitored for 1 h. In vitro platelet aggregation and plasma clotting were studied. RESULTS: After injury, mean times free from formation of an occlusive, platelet-rich thrombus were 16.2+/-2.3, 49.6+/-18.9, 47.9+/-21.0, and 37.1+/-22.8 min for rats (n=5/group) that received saline, diatrizoate (P<.002 vs. saline), ioxaglate (P<.002 vs. saline), and iohexol (P=.06 vs. saline), respectively. Reperfusion after initial occlusion did not occur in saline-treated animals, but was common in rats that received RCA. The antithrombotic properties of RCA were not explained by their high osmolarities or by detectable effects on in vitro platelet aggregation and plasma clotting. Plasma concentrations of RCA were <1%. CONCLUSIONS: Systemic administration of RCA at doses that achieve low, clinically relevant plasma concentrations can inhibit platelet-rich thrombus formation after arterial injury. Antithrombotic properties of ionic RCA appear to be greater than those of nonionic RCA.

Animals↗
PubMed1998

Aspirin and fraxiparine in the prevention of laser induced thrombosis in the presence of iodinated contrast media.

The purpose of this study was to investigate the thromboembolic properties of ionic and nonionic contrast media in rats pretreated with aspirin and/or fraxiparine using an experimental model of laser induced thrombosis in the mesenteric microvessels of 17 groups of five male Wistar rats each. Two ionic (ioxaglate and diatrizoate) and two nonionic contrast media (iopamidol and iohexol), alone or associated with antithrombotic drugs (aspirin and/or fraxiparine) were studied. To evaluate the effects of these substances in this model, the number of laser beams needed to induce platelet thrombus formation, the number of emboli detached from the thrombus and the duration of embolization were quantified. Platelet aggregation induced by ADP, induced hemorrhagic time (IHT) and haemoglobin loss level were also determined. Both contrast media injected at 3 ml/kg caused a significant increase in the number of emboli and the duration of embolization (p<0.05). Pretreatment with aspirin and/or fraxiparine in the presence of ionic contrast media showed antithrombotic activities equal to those obtained when they were tested alone (p<0.05), while in the presence of nonionic contrast media, these drugs only neutralised the prothrombotic effects. There were no differences with the NaCl treated group (p>0.05). The ionic contrast media, and to a lesser extent the nonionic contrast medium: iohexol, inhibited platelet aggregation, while iopamidol behaved as an activator. The antithrombotic drugs tested in this study prevent the prothrombotic activities of contrast media therefore suggesting their use before radiographic procedures.

Animals↗
PubMed1997

Inadvertent intraoperative myelography with Hypaque: case report and discussion.

BACKGROUND: Myelography is routinely performed safely using nonionic water-soluble radiographic contrast media. However, inadvertent introduction of ionic contrast media into the thecal space can result in a syndrome of spasms and convulsions, which can lead to death if not recognized and dealt with in a timely manner. METHODS: We report a case of inadvertent use of the ionic diatrizoate meglumine, an ionic contrast agent, instead of a nonionic contrast agent during intraoperative myelography. RESULTS: The patient developed a sterotypical syndrome of ascending myoclonic spasms, resulting in rhabdomyolysis. Treatment included elevation of the head, removal of cerebrospinal fluid, administration of anticonvulsants, diuresis and sedation, and neuromuscular blockade. The patient recovered well, and there were no long-term sequelae. CONCLUSIONS: Intrathecal introduction of ionic contrast media and the resultant syndrome must be recognized promptly and treated with aggressive medical management to address rhabdomyolysis and seizures. Ionic contrast media should be stored and marked in such a way as to avoid inadvertent use in myelography.

Aged↗
PubMed1983

Urinary sodium and chloride during renal salt retention.

One hundred ten episodes of renal salt retention (urinary sodium and/or chloride less than 10 mEq/L) were studied retrospectively to determine the significance of discordance of urinary sodium from chloride. In 16 episodes the urinary sodium exceeded chloride by at least 15 mEq/L. This disparity was associated with the necessity for urinary excretion of substantial quantities of poorly reabsorbed anions (penicillin, ketones, or diatrizoate), a rapidly falling serum bicarbonate level (due to resolving metabolic or developing respiratory alkalosis), or substantial renal insufficiency (serum creatinine greater than 3 mg/dL). In 14 of 110 episodes, urinary chloride exceeded urinary sodium by at least 15 mEq/L. These patients were more often oliguric and had a higher mean serum chloride than patients without this dissociation. In patients with oliguria, hyponatremia, or metabolic alkalosis, measurement of urinary sodium or chloride alone will, in a substantial number of cases, fail to detect renal salt retention. When evidence is sought for renal salt retention, both urinary sodium and chloride should be determined.

Aged↗