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PubMed1987

Occult spontaneous esophageal perforation. Unusual clinical and radiographic presentation.

We report a unique presentation of spontaneous esophageal perforation or Boerhaave's syndrome. Our patient had no risk factors predisposing her to barogenic rupture of the esophagus, and she had none of the "classic" presenting signs. She was asymptomatic, and her clinical course appeared to be chronic. Her chest roentgenogram demonstrated bilateral thick-walled cavities with air-fluid levels. Computerized axial tomography of the chest and swallow of meglumine diatrizoate (Gastrografin) showed the cavities and esophagus to communicate. This patient's presentation and radiographic studies extend the reported description of Boerhaave's syndrome.

Diatrizoate Meglumine↗
PubMed1978

Tween 80/diatrizoate enemas in bowel obstruction.

Although successful treatment of meconium ileus with Gastrografin enema has been attributed to the hypertonicity of this material, Tween 80, present in a 0.75% concentration, may be its most effective component. Tween 80 acts as a surface-active substance and stool emulsifier. An enema solution of 1%-2% Tween 80 and isotonic sodium diatrizoate has been effective in the relief of meconium or fecal mass obstruction in infants and children.

Adolescent↗
PubMed1984

Iopamidol: new, nonionic contrast agent for excretory urography.

Iopamidol, a new, nonionic contrast agent, was evaluated in 18 patients undergoing excretory urography. None of the 18 patients experienced any side effects or adverse reactions. No abnormalities were noted in serum chemistries, complete blood cell counts, urinalyses, or electrocardiograms. The half-life of iopamidol in 17 patients with normal renal function was 2.5 hr. The urograms were judged to be of good or excellent quality in 15 of 16 patients using doses of 200 and 250 mg l/kg of iopamidol. Two patients who were studied using a dose of only 120 mg l/kg had urograms rated poor. Fifteen iopamidol urograms (mean iodine dose, 17.4 g) were compared in a blind fashion with 15 meglumine diatrizoate studies (iodine dose, 29 g). No qualitative difference could be detected between the two groups of urograms. Iopamidol may provide equal-quality diagnostic studies with a lower iodine dose and perhaps greater safety than the currently used ionic agents.

Adult↗
PubMed1987

Contrast agent nephrotoxicity: comparison of ionic and nonionic contrast agents.

The effects on glomerular and proximal tubular function of an ionic contrast agent (sodium meglumine diatrizoate) and a nonionic agent (iopamidol) were compared in 34 patients with normal renal function. The patients received large doses (2.5 ml/kg body weight) of contrast material for IV digital subtraction angiography. Urine samples, collected before, immediately after, and on the first and third days after digital subtraction angiography, were analyzed for albumin, alanil-aminopeptidase, alpha-glucosidase, and beta-2-microglobulin. The changes noted were mild and of short duration with both contrast agents, despite the high dose given. These results suggest that, at least as far as renal toxicity is measured by these tests is concerned, ionic monomers can be safely used instead of more expensive nonionic media in procedures, such as digital subtraction angiography, that require high doses of contrast material.

Adult↗
PubMed1988

ECG abnormalities during excretory urography: the effect of stress.

ECG alterations occurring during IV infusion of contrast agents have been well documented, although the specific causes of these alterations are unknown. Stress and anxiety have been considered important factors, but no prospective evaluation of their impact on ECG alterations has been reported. In order to separate ECG changes resulting from anxiety associated with the procedure itself from those caused by the contrast agent, ECG monitoring was done during IV urography, first when patients were given saline and then again during and after contrast infusion. In both circumstances, the patients were told that they were being given contrast material. One hundred fifty patients undergoing infusion excretory urography with meglumine diatrizoate were studied. Preliminary 12-lead ECGs identified those with initially normal (71) and abnormal (79) tracings. Lead II rhythm strip ECGs were then obtained at 1 and 3 min during a saline infusion and again during contrast infusion; final 12-lead ECGs were done after the contrast infusion. During contrast infusion, PR prolongation (greater than 0.02 sec) occurred in 44% of patients, a change in heart rate (greater than +/- 10 beats/min) occurred in 26%, and benign arrhythmias (premature atrial and ventricular contractions, less than 5/min) occurred in 9%. Saline alone caused no statistically significant ECG alterations (only a single instance of premature atrial contractions). The hypothesis that stress or anxiety may adversely affect ECG reactivity in IV urography is unproved. Although we do not offer proof that it cannot occur, we found no evidence in a study of 150 patients to confirm that stress is an important factor. Only the contrast agent, not saline, produced measurable ECG changes during urography.

Adult↗
PubMed1989

Comparison of omnipaque with hypaque in temporomandibular arthrography.

Decreasing or alleviating pain experienced by some patients during or after temporomandibular arthrography would make this relatively inexpensive and highly accurate technique more attractive. This is particularly true for those patients without access to MR or those whose referring physicians prefer arthrography to other techniques for diagnosing internal derangements. Ionic and nonionic contrast agents were compared in a randomized, double-blind trial to determine if pain could be decreased by using a nonionic contrast material. Forty patients received either Omnipaque 300 (nonionic, iohexol) or Hypaque 60 (ionic, diatrizoate meglumine). Radiographs were assessed for diagnostic quality, and patients were asked to note their level of discomfort. No significant differences between the agents were detected. Maximal discomfort was noted at 24 hr. Discomfort was classified as none, mild, or moderate, with no patients describing marked discomfort. This study does not support the use of nonionic contrast agents over the less expensive ionic agents for decreasing pain or improving film quality in temporomandibular joint arthrography.

Adult↗
PubMed2002

Renal excretion of ingested gastrografin: clinical relevance in early postoperative treatment of patients who have undergone gastric surgery.

OBJECTIVE: We performed this study to evaluate the clinical relevance of renal excretion of ingested Gastrografin (methylglucamine diatrizoate) revealed on CT in the early treatment of patients who have undergone gastric surgery. SUBJECTS AND METHODS: Unenhanced abdominal CT was performed before and then 1 hr to 1 hr 30 min after Gastrografin ingestion in 30 patients 7 days after gastric surgery and in 19 healthy adults who served as the control group. CT scans were reviewed for the opacification of the renal collecting system or urinary bladder after Gastrografin ingestion, a finding that represents renal excretion of the ingested contrast medium. RESULTS: In the control group, four (21 %) of the 19 healthy adults showed renal excretion of ingested Gastrografin visualized as opacification of the urinary tract on CT scans obtained 1 hr to 1 hr 30 min after ingestion of the substance. Renal excretion of the ingested Gastrografin was seen in 19 (63%) of the 30 patients, a significantly larger percentage than in the control group (z score, p < 0.01). No patient showed either radiologic or clinical evidence of leakage from the anastomotic site. CONCLUSION: Renal excretion of ingested Gastrografin is frequently visualized on CT in patients without anastomotic leakage during the early postoperative period after gastric surgery, and this phenomenon is not rare, even in healthy adults. Therefore, renal excretion seen on CT should not be regarded as a sign of anastomotic leakage in early postoperative patients.

Administration, Oral↗
PubMed2003

Is administration of enteric contrast material safe before abdominal CT in children who require sedation? Experience with chloral hydrate and pentobarbital.

OBJECTIVE: It has been common practice to administer enteric contrast material in preparation for abdominal CT in children who require sedation to be examined. At some institutions, the practice of administering an anesthetic or enteric contrast material before sedation is being challenged because it violates the "nothing by mouth" status that is otherwise strictly enforced before sedation. Our purpose was to review our safety record in administering enteric contrast material for CT before sedation. MATERIALS AND METHODS: Radiology reports, medical records, and department incident reports were reviewed for the past 5 years from all patients who required sedation for abdominal CT. Patient age and sex, type of sedation, and complications (defined as vomiting with aspiration) related to enteric contrast material before the sedation were recorded. For routine oral contrast material, diluted Hypaque (meglumine diatrizoate) was administered in an age-based amount 1-2 hr before scanning. For sedation, depending on the patient's age, either oral chloral hydrate (70-100 mg/kg) or IV pentobarbital (3 mg/kg with repeated doses of up to 7 mg/kg) was used. RESULTS: Three hundred sixty-seven patients who received oral contrast material before sedation for abdominal CT were identified (200 boys, 167 girls; age range, 1 month-19 years; mean age, 2.9 years). Chloral hydrate was used in 30 patients and IV pentobarbital in 337 patients. No complications related to the administration of oral contrast material before sedation were identified. CONCLUSION: The practice of administering oral contrast material in children before sedation for abdominal CT appears to be safe when using the sedation drugs and protocols in place at our institution. Further study of the safety of this practice should be undertaken.

Administration, Oral↗
PubMed1988

Acute hypomagnesaemia complicating the treatment of meconium ileus equivalent in cystic fibrosis.

Meconium ileus equivalent (MIE) is a common and often recurrent complication in adolescent and adult patients with cystic fibrosis (CF). MIE is characterized by partial or complete bowel obstruction, resulting from abnormally viscid mucofaeculant material in the terminal ileum and right colon. Patients present with recurrent abdominal pain, intestinal obstruction, and/or a palpable faecal mass. Conventional treatment consists of the oral and rectal administration of the mucolytic agent N-acetylcysteine, and hypertonic solutions of sodium diatrizoate. We describe the occurrence of acute decreases in plasma magnesium in all of seven patients treated with this regimen with marked hypomagnesaemia (less than 0.70 mmol/l) in four of the seven patients. No changes in plasma sodium, potassium, or calcium were observed.

Acetylcysteine↗
PubMedDate not supplied

Lyophilized liposomes: a new method for long-term vesicular storage.

To facilitate acceptance and use of radiopaque liposomes as novel CT contrast agents, we developed a technique that permits their long-term storage at room temperature. This study compares standard storage procedures with the new method. Multilamellar vesicles were prepared with egg lecithin, cholesterol and stearylamine (4:1:1 molar ratio) as well as diatrizoate. After synthesis, the vesicles were separated into batches: one portion was kept frozen (FRO), another was lyophilized and stored at room temperature (LYO-RT), and a third was thawed and stored at room temperature (RT). Size, structure and biodistribution of vesicles in all three groups were assessed over a 6-month period. Freeze-drying the vesicles caused no apparent damage to their membranes The RT group showed marked aggregation after 1 month, while the LYO-RT and FRO vesicles showed only a slight shift to larger particles after 6 months. At this time, there was no significant change in the biodistribution of the LYO-RT vesicles compared to FRO. Uptakes in the reticuloendothelial tissues were 15 per cent and 19 per cent respectively. The LYO-RT materials showed additional advantages in that they were always easy to resuspend. This technique appears to be the most successful and convenient procedure for the long-term storage of liposomes.

Animals↗
PubMed1994

Gallbladder size: is it affected by the oral intake of water or dilute contrast medium?

Examinations of the gallbladder are performed by ultrasonography while patients are in a fasting state. In contrast, computed tomography of the abdomen is carried out in fasting patients who were given 2% meglumine diatrizoate (Urografin) solution to opacify the gut. Sonographic examination was performed to establish whether the weight of fluids given to patients had any effect on the volume of the gallbladder. Gallbladder size was measured in subjects with a normal gallbladder. The gallbladder also was measured in 117 people in the fasting state, and 10 and 30 minutes later, it was measured again after an intake of 500 ml of water or a dilute solution of contrast medium. Both groups showed evidence of gallbladder contraction, but no significant statistical difference between them was apparent. It appears, therefore, that the contrast medium solution given before abdominal computed tomography may cause some gallbladder contraction.

Adolescent↗
PubMed1998

Cellular activity of murine phagocytes isolated from peripheral blood by a discontinuous gradient.

A mixture of Ficoll 400 and sodium diatrizoate (Hypaque) at a density of 1.077 g/ml has been used to isolate the mononuclear cells from the remaining haematic cells. A simple, inexpensive and classical method was established to obtain substantially erythrocyte-free polymorphonuclear cell preparations from mouse peripheral blood, using a mixture of the same substances but at a density of 1.119 g/ml. This method along with that at a density of 1.077 g/ml allows two cellular bands to appear which contain mononuclear and polymorphonuclear (PMN) cells, respectively. Using this method, the counts of monocytes isolated from peripheral blood are significantly greater than those obtained by a one-step Ficoll-Hypaque procedure. On the contrary, the counts of PMN cells are significantly smaller than when sedimentation in dextran (6% solution) is used after gradient centrifugation. In this paper, chemiluminescence assay has been used to analyze the possible variations in phagocytic activity of cells isolated by both procedures, since it appears to be one of the most sensitive methods available for this purpose. The results obtained show a slightly greater activation in monocytes and PMN cells isolated by one-step Ficoll-Hypaque procedure, in comparison with another method which uses both Ficoll-Hypaque 1077 and Ficoll-Hypaque 1119, although statistical differences were not significant.

Animals↗
PubMedDate not supplied

Vasocilators in the canine mesenteric circulation. Evaluation of a potential aid in the diagnosis of gastrointestinal bleeding.

Radiodiagnostic potential of intra-arterially injected vasodialting agents was investigated by their effect on total and segmenal resistances (VR) of mesenteric vasculature, blood flow in superior mesenteric artery and its bleeding branch; heart rate and ventricular and systemic blood pressure. Dipyridamole, isoxsuprine, protricular and systemic blood pressure. Dipyridamole, isoxsuprine, prochlorperazine, lidocaine, meglumine diatrizoate and carbon dioxide were poor dilators. Phentolamine produced hypotension; glucagon and serpasil an extremely long dilation. A large and short vasodilation was produced with tolazoline and nylidrin, but both agents increased VR of the postcapillary segment and caused transient hypotension and arrhythmias, nylidrin's side effects were smaller. Oxygen produced large and long vasodilation and minimal systemic effects. It is concluded that oxygen or possibly nylidrin are suitable agents should an intermittently bleeding mesenteric artery be dilated for diagnostic purposes prior to angiography.

Animals↗
PubMedDate not supplied

Renal arteriography. The choice of contrast material.

Angiographers responding to a questionnaire disagreed on the agent of choice for selective renal arteriography. Opinion differed regarding the advantages of sodium versus meglumine salts, diatrizoate versus iothalamate, and 50-60 percent concentration agents versus those in the 70-76 percent range. Although an increasing number of angiographers are using more concentrated agents for renal arteriography, there is little information available to indicate their safety for this purpose. Dog experiments were done to see whether Renografin 76 percent (R-76), at a reasonable dose, caused more severe changes than the lower concentration agents. The studies failed to demonstrate significant differences between R-76 and the less concentrated agents indicating that R-76 can be used for selective renal arteriography if the additional iodine is deemed necessary. Factors affecting nephrotoxicity of contrast media in patients with normal and abnormal kidneys are discussed.

Aminohippuric Acids↗
PubMed1975

Barium or gastrografin: which contrast media for diagnosis of esophageal tears?

In order to study the effects of the commonly employed contrast media alone and in combination with bacteria in the mediastinum, various mixtures of barium and meglamine diatrizoate (Gastrografin) with and without flora were instilled in the mediastinum of 29 domestic cats. The animals were killed for pathological studies at serial time intervals following mediastina injection. These data demonstrate that water-soluble contrast media cause no significant histological reaction. Barium causes granuloma formation but has no additional deleterious effects when mixed with flora. Barium has superior physical properties of mucosal coating and radiographic density. It should be employed as the contrast agent of choice in difficult clinical problems with regard to esophageal tears. A water-soluble contrast study of the esophagus may be utilized as the initial diagnostic procedure, but if this is normal a follow-up barium esophagram is recommended.

Animals↗
PubMed1976

An evaluation of Urovist S in urography.

In 200 adult patients, urography with Urovist S (50 ml sodium diatrizoate 50%) achieved good or satisfactory visualisation of the urinary tract in 80-90%. The medium was generally well tolerated. Reactions, which were mostly mild, occurred in 13% of patients.

Adult↗
PubMedDate not supplied

High performance liquid chromatography with multiwavelength detection: a technique for identification of iodinated x-ray contrast agents in human body fluids and brain tissue.

PURPOSE: Several cases of a severe adverse reaction, referred to as "ascending tonic-clonic seizure syndrome," have been reported after administration of water-soluble iodinated x-ray contrast agents for myelographic examinations. Because of the bizarre reactions, the identities of the causative contrast media were questioned. METHODS: Analyses of biologic materials from four of these patients were performed by using reverse-phase high-performance liquid chromatography. The chromatographic system was equipped with a fast-scanning UV-visible detector for the analysis of the UV-spectra of the chromatographic peaks. RESULTS: The analyses revealed that the nonionic contrast agents iohexol or ioversol were not present in detectable amounts in any of the samples. On the other hand, the chromatographic analyses revealed peaks that cochromatographed with and showed the same UV-spectra as the ionic agents diatrizoate, metrizoate, and ioxitalamate. CONCLUSION: The results indicate inadvertent injection of ionic contrast medium in all four cases.

Body Fluids↗
PubMed1992

Viscosity of some contemporary contrast media before and after mixing with whole blood.

The viscosity of 7 contrast media was measured using a rotational viscometer. When solutions with similar iodine concentrations were compared, the highest viscosities were found for the nonionic dimers iodixanol and iotrolan, the lowest for diatrizoate, iopamidol, and iopromide, and intermediate values for iohexol and ioxaglate. The viscosity of iohexol and ioxaglate was found to vary linearly with temperature and quadratically with concentration. Whole-blood viscosity was measured for 5 subjects at high and low shear rates before and after mixing with contrast media in various proportions. Low-shear viscosity was found to decrease and high-shear viscosity to increase with contrast medium concentration. It is concluded that the contrast media currently used may affect blood rheology less than previous agents, despite their higher viscosity.

Adult↗