Intravenous urography: injection of contrast agents by radiographers.
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In a comparative urographic study of the methylglucamine salts of iodamide (Uromiro 300) and iothalamate (Conray 280) the following conclusions have been made: (i) In subjects with radiologically normal kidneys and a creatinine clearance greater than 70 ml/min total urogram scores and nephrogram scores were higher with iodamide (not statistically significant). The improvement in performance was more marked in the nephrographic phase. (ii) In patients with radiologically normal kidneys and a spectrum of normal and abnormal renal function, total urogram scores and nephrogram scores showed no significant dependance on creatinine clearance. (iii) No correlations of note were observed between urographic performance and physical or biochemical parameters for either contrast medium. (iv) Side effects encountered in the study were mild and there were no significant differences between the contrast media in either the incidence or severity of the side effects. (v) Post-injection blood pressure profiles showed no significant differences between the media. (vi) Induced electrocardiographic abnormalities were uncommon and mild occurring in seven patients following iothalamate and three patients following iodamide.
In a comparative urographic study of the sodium salts of iodamide (Uromiro 300 Sodium) and iothalamate (Conray 420) the following conclusions have been made. (i) In subjects with radiologically normal kidneys and a creatinine clearance greater than 70 ml/min, nephrogram scores were significantly higher with iodamide (P less than 0.02). There were differences between the media in respect of total urogram scores and pyelogram scores but they were not statistically significant. (ii) In patients with radiologically normal kidneys and a spectrum of normal and abnormal renal function, performance scores for iothalamate showed no significant relationship with creatinine clearance. Results for iodamide, however, showed some relationship with creatinine clearance (nephrogram score r = 0.46, pyelogram score r = 0.38, total urogram score r = 0.49). A possible mechanism for this is proposed. (iii) Side-effects encountered in the study were mild and there were no significant differences between the contrast media in either the incidence or severity of the side-effects. (iv) Blood-pressure and pulse-rate profiles following iodamide were not significantly different from those following iothalamate. (v) Cardiac arrhythmias were mild and uncommon.
The electrocardiographic changes induced during a rapid bolus intravenous injection of both a conventional ionic agent (sodium iothalamate) and a new, low-osmolality non-ionic agent (iohexol) have been studied. Multiple abnormalities were observed but in every category significantly less frequently, or not at all, with iohexol. The most common abnormality was an increase in sinus rate of 15 beats/min over the rate during needle insertion. Other abnormalities observed included T-wave flattening and premature atrial and ventricular contractions. Contrary to some previous studies, we did not find that age, known heart disease or an abnormal base-line ECG were statistically significant determinants of subsequent ECG changes on contrast administration. There was, however, a significant correlation between ECG changes and more severe subjective side-effects experienced after the contrast injection. This offers support for the theories suggesting a psychogenic basis for some contrast reactions, since low-osmolality contrast media are known to produce less marked subjective side-effects. The new agents are known to be less cardiotoxic and to produce less profound haemodynamic changes. These factors may also play a part in the observed reduction in ECG disturbance.
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PURPOSE: A prospective, randomized, single blind, controlled trial was performed to determine whether routine bowel preparations are necessary for satisfactory visualization of the urinary system during IVP and compare the side effects of several bowel preparation methods. MATERIALS AND METHODS: A total of 200 patients between 17 and 70 years old at the outpatient department who were prescribed IVP were enrolled in this prospective study. Patients were divided into 4 groups and randomly received liquid supper, senna, magnesium sulfate solution and PEG-ELS as bowel preparation before IVP. Control and contrast images were assessed by a radiologist and a urologist blinded to the bowel preparation. IVP was given a visualization score, a fecal residue score, a bowel gas score and an overall quality score. Images were also divided into anatomical sections to assess visualization, and the effect of fecal residue and bowel gas. Questionnaires were prepared about the side effects of bowel preparation. RESULTS: For contrast images there was no significant difference in terms of visualization,, fecal residue, bowel gas and overall quality scores among the 4 groups. The same result was seen on the control image except for fecal residue scores, when the senna and PEG-ELS groups had a lower fecal residue score than the liquid supper group (p = 0.001). Interestingly when considering sectional images, the right renal region of the control image showed that the senna and PEG-ELS groups had better visualization scores with less bowel gas and fecal residue than the liquid supper only group. Patients in all 3 laxative bowel preparation groups except the liquid supper group reported side effects. There was no statistically significant difference among these 3 groups in the attitude toward ingesting laxatives again. CONCLUSIONS: Our results suggest that routine bowel preparation prior to IVP does not improve the visibility or overall quality of control or contrast images, while patients experience certain side effects due to the bowel preparation. The laxative bowel preparation may be helpful only when visualizing the right renal region on the control image.
Benign parapelvic cysts are a common finding on radiology studies. Rarely, a parapelvic cyst may enlarge enough to obstruct the renal calices. We report a case in which computerized tomography following an excretory urogram and ultrasound proved to be especially helpful in the noninvasive evaluation of an obstructing parapelvic cyst.
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