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At least 991 records · Page 55Linked to original sources
PubMed2003

Implications of anastomotic leakage after total gastrectomy for gastric carcinoma.

BACKGROUND/OBJECTIVES: Oesophagojejunal anastomotic leakage is a serious complication following total gastrectomy, and is reported to be decreasing in frequency. This study was an audit of the radiological and clinical frequency of such leakage and its consequences. METHODS: A retrospective (1983-2000) cohort study was undertaken in a tertiary institution where 175 patients had undergone a total gastrectomy for gastric carcinoma with oesophagojejunal reconstruction using a stapling device and a 50 cm J-loop. Anastomotic leakage was sought 3-9 days postoperatively using a Gastrograffin (diatrizoate meglumine) swallow. RESULTS: Leakage was demonstrated in 7 patients (4%), being subclinical in 2, minor in 4, and fatal in 1. There was no correlation between leakage and patient factors (age, medical risk, haemoglobin, albumin), surgical factors (surgical seniority, approach, reconstruction, splenectomy, lymph node dissection) or tumour factors (stage, nodes examined, and margin positivity). However, intraoperative difficulties or mishaps were recorded in most cases of leakage. Subclinical leakage was marked by an uneventful postoperative course, and low-volume enterocutaneous fistulas were self-limiting. One patient developed a subphrenic abscess that required drainage. One patient suffered an intrathoracic leak which proved fatal. CONCLUSIONS: Anastomotic leakage was an infrequent complication of total gastrectomy when using a stapling device and a 50 cm J-loop. It was related to intraoperative surgical difficulty and mishap rather than conventional patient and tumour factors. It was subclinical or self-limiting, if occurring in the abdomen, but fatal if in the chest.

Adult↗
PubMed1992

A retrospective survey of delayed adverse reactions to ionic and nonionic contrast media.

A comparative survey of delayed adverse reactions (DARs) to ionic and nonionic contrast media (CM) was carried out. In Japan high osmolar CM have mostly been replaced by new low osmolar CM. Therefore, a retrospective survey was performed limited to inpatients who had received an enhanced CT examination in our hospital. The material consists of 715 consecutive cases given ionic CM (iothalamate and diatrizoate) and 902 given nonionic CM (iopamidol and iohexol). DARs were picked up based on descriptions in the medical record up to 5 days after the examination. Most DARs had occurred within two days after the examination. Overall DARs were noted in 36 cases (5.0%) of the ionic group, and 44 cases (4.9%) of the nonionic group. Skin rash as well as other symptoms revealed no significant difference in incidence between the ionic and the nonionic group. There were no significant associations with immediate reactions, allergy, previous adverse reactions to CM. One patient given an ionic CM developed hypotension (60 mmHg) after return to the ward. It should be emphasized that a delayed shock had been recorded.

Aged↗
PubMed2005

Calcium binding by gadolinium-based MR contrast agents.

PURPOSE: This study was conducted to characterize the alterations in ionic sodium, potassium, and calcium by gadolinium-based MR contrast agents. MATERIALS AND METHODS: An electrolyte solution (ES) containing 1.2 mM/L calcium ions,120 mM/L sodium, and 4.0 mM/L potassium were diluted with various gadolinium compounds and alterations in ionized electrolytes were measured using an ion-specific electrometer. Gadolinium compounds including Gd-DTPA, Gd-DOTA, gadoteridol, gadodiamide, meglumine/sodium diatrizoate (76% Urografin), and isotonic saline as a control were investigated. The dilution ranged from 5% (ES/test solution = 100/5) to 100%. Alterations of ionic electrolytes were measured. Calcium-binding capacities caused by each gadolinium compound also were measured. RESULTS: The alterations of ionic sodium and potassium by gadolinium compound were similar to those of isotonic saline. A significant reduction in ionized calcium was observed with Gd-DTPA and Gd-DOTA in comparison with gadoteridol and gadodiamide. CONCLUSION: Ionic gadolinium compounds induced significant reductions of calcium ions in vitro compared with non-ionic gadolinium compounds.

Calcium↗
PubMed1991

Altered urinary beta 2-microglobulin excretion as an index of nephrotoxicity.

The experimental and clinical evidence indicate that beta 2-microglobulin (beta 2m) is actively reabsorbed from the glomerular filtrate by receptors on the brush border located in the proximal third of the proximal tubule. Increased beta 2m excretion in the absence of increased filtered load of beta 2m is indicative of nephrotoxicity. The data presented show that urine beta 2m increases and creatinine concentrations decrease within four hours of administration of diatrizoate megalumine (DMG). In 9 of the 20 patients, the urinary excretion of beta 2m (U beta 2m) increased to clearly abnormal values. In 12 of the 20 patients, the beta 2m excretion expressed as mg per g creatinine (Cr), increased from normal (less than 0.30) to an abnormal beta 2m excretion rate. The increased beta 2m excretion per g Cr occurring immediately after DMG administration lead us to conclude that this effect occurs when the nephrotoxic agent is present in the kidney. Based on these data we believe that the onset of abnormal urinary beta 2m excretion coincides with the presence of the causative agent. This criterion therefore, should prove to be useful in determining the time to conduct studies designed to search for the causative agent(s) in Balkan endemic nephropathy.

Adult↗
PubMed1991

[Rhabdomyolysis associated with an iodinated contrast media].

A case of rhabdomyolysis associated with an iodinated contrast medium (sodium diatrizoate) in a patient with chronic renal failure is presented for the purpose of discussing this association. Clinical manifestations were: diffuse myalgias, proximal muscular weakness and an acute reversible deterioration of the renal function. Muscle biopsy showed the typical pattern found in rhabdomyolysis, that is, cellular necrosis with no inflammation signs and myolytic areas. The temporal association between the rhabdomyolysis and the use of the contrast medium suggests a causal relationship. The present case allows us to postulate that the skeletal muscle injury was secondary to direct toxicity and/or the compromise of muscle blood perfusion by the contrast medium in a susceptible muscle due to previous renal failure. It is suggested that this group of substances should be incorporated to the list of agents capable of causing non traumatic rhabdomyolysis.

Adult↗
PubMed1991

Direct effects of contrast media on rat lungs.

Despite the widespread use and the assumed safety of Omnipaque (iohexol) and 3% Gastrografin (meglumine diatrizoate) as contrast media for esophagography and computed tomography respectively, their effects on the lung if they are aspirated have never been studied. This information is important because such compounds may inadvertently enter the lungs during the diagnostic procedures. Twenty-four rats were injected intratracheally with 0.15 mL of one of three contrast agents (omnipaque, full-strength Gastrografin and 3% Gastrografin) or normal saline, which was used as a control. Radiographs were then obtained. Equal numbers from each experimental group were sacrificed after 5 minutes, 1 hour and 24 hours, and their lungs were examined pathologically. The rats injected with full-strength Gastrografin all died immediately of gross pulmonary edema. Neither Omnipaque nor 3% Gastrografin was fatal, but Omnipaque produced more edema and alveolar hemorrhage than either normal saline or 3% Gastrografin. Iohexol is, therefore, more irritating to the airways and the lung parenchyma than previously believed.

Animals↗
PubMed1991

Transfemoral digital subtraction aortography. Are diluted high osmolar contrast media acceptable?

The ionic monomer, sodium diatrizoate at 150 mg I/ml (726 mosmol/kg) and the non-ionic monomer, iopamidol, diluted to the same iodine concentration but at 324.3 mosmol/kg, were randomly allocated to patients undergoing transfemoral intra-arterial digital subtraction angiography for lower limb peripheral vascular disease. The agents produced images of comparable quality and diagnostic efficacy. There were no significant differences between the media regarding sensations of pain and warmth. Minor neurological symptoms (headache and dizziness) occurred 7 times more frequently with the ionic monomer. There was a slight but temporary rise in plasma potassium one hour after injection of the ionic monomer but no evidence of appreciable intravascular haemolysis. The non-ionic monomer caused a slight fall in haemoglobin and haematocrit one hour after injection which is attributed to osmotic haemodilution. It is concluded that a diluted high osmolar contrast agent is an acceptable alternative to a low osmolar agent in transfemoral digital subtraction lower limb aortography.

Adult↗
PubMed1991

Telebrix: a better-tasting oral contrast agent for abdominal computed tomography.

In a randomized, controlled, double-blind trial, Telebrix 38 (ioxithalamate) and Gastrografin (diatrizoate) were compared with respect to taste and degree of opacification of the alimentary canal when used in computed tomography of the abdomen and pelvis. Bowel opacification was excellent with both contrast agents. Patients rated the 2% solution of Telebrix in water significantly better in taste than the control contrast medium, a 2% solution of Gastrografin in water. Of the patients in the Telebrix group 89% judged the taste to be excellent or good, compared with 59% in the Gastrografin group (p = 0.012, Fisher's exact test). Only 1 of 28 patients in the Telebrix group was unwilling to drink Telebrix again, compared with 6 of 27 patients in the Gastrografin group (p = 0.045, Fisher's exact test). There were no significant side effects. Dilute Telebrix 38 is preferable to dilute Gastrografin, in terms of taste and patient tolerance, for bowel opacification on computed tomography, and produces equivalent, excellent bowel opacification.

Administration, Oral↗
PubMed1990

Blood-brain barrier injury following intracarotid injection of radiographic contrast media. In vivo quantification using magnetic resonance imaging and Gd-DTPA.

Changes in signal intensity of the brain at magnetic resonance (MR) imaging before and after Gd-DTPA were used for in vivo quantification of injury to the blood-brain barrier (BBB). Immediately following intracarotid injection of 2 ml/kg of radiographic contrast medium (CM) 0.4 mmol/kg of Gd-DTPA was injected intravenously. MR imaging was performed with a 400/25 partial saturation pulse sequence. The maximum percentage changes (mean +/- SD) in signal intensity of the brain after CM and Gd-DTPA were 1.6 +/- 1.6% with saline, 3.2 +/- 2.0% with iotrolan, 4.3 +/- 1.7% with iohexol, 6.6 +/- 3.6% with ioxaglate and 8.2 +/- 3.6% with diatrizoate. Not only the osmolality but also the ionicity and chemotoxicity seemed to influence Gd-DTPA leakage. A subtle BBB injury had a stronger tendency to occur in the basal ganglia than in the cerebral cortex. MR enhancement is proposed as a sensitive method for in vivo quantification of the BBB injury caused by intracarotid CM injection.

Animals↗
PubMedDate not supplied

Opening of the blood-brain barrier by intravenous contrast media in euvolemic and dehydrated rabbits.

It has been suggested that intravenous injections of hypertonic contrast media when used in computed tomography and digital subtraction angiography might raise plasma osmolality sufficiently to open the blood-brain barrier (BBB). The current investigation establishes the threshold of plasma osmolality that causes the the opening of the BBB in euvolemic and dehydrated rabbits. Euvolemic rabbits were allowed food and water ad libitum. Dehydrated rabbits received 4.0 mg/kg of furosemide intramuscularly and were deprived of water for 72 hours. Meglumine/sodium diatrizoate 76 per cent (n = 28) or mannitol 20 per cent (n = 12) was administrated intravenously, at a rate of 25 mmol/kg body weight/hour for 2, 3 or 4 hours. Plasma osmolality, blood iodine concentration, blood pressure, heart rate and hematocrit were assessed at regular intervals. Evans blue and 99Tcm-DTPA were used simultaneously as tracers for BBB opening. Rating of BBB opening with 99Tcm-DTPA correlated well with Evans blue staining (r = 0.863, p less than 0.001; n = 42). BBB opening was related to plasma osmolality and was similar for both contrast media and mannitol. Widespread BBB opening occurred above 400 mmol/kg while focal BBB opening occurred above 370 mmol/kg. Dehydration per se increased plasma osmolality but did not reduce the threshold for BBB opening.

Animals↗
PubMed1989

[Excretory urography: comparison of the ionic contrast medium amidotrezoic acid with the non-ionic contrast medium iohexol].

The contrast media diatrizoic acid and iohexol were compared in a randomized double-blind study on the basis of 100 excretory urograms. It was found that side effects are less frequent under the non ionic contrast medium than under the ionic agent, the difference being statistically significant at the level alpha = 0.05. No statistically significant difference was recognizable concerning the overall quality of the urograms.

Clinical Trials as Topic↗
PubMed1989

Evaluation of contrast dose reduction for excretory urography using computed radiography.

We prospectively investigated whether performing excretory urography by computed radiography (CR) - with CR's broader dynamic range and potential for post-processing - would permit lower contrast dose while maintaining usual image quality. The rationale for this experiment was to evaluate whether CR had potential in reducing the risks and costs associated with urography. Sixty sequential patients were randomly assigned to undergo computed urography with either our full (282 mg I/kg body weight) or half our usual dose (141 mg I/kg body weight) of intravenous 60% diatrizoate meglumine. Three blinded observers judged automatically post-processed full dose tomograms and KUBs as qualitatively superior to both automatically post-processed and individually, interactively post-processed half dose images. Thus, post-acquisition image manipulation could not fully compensate for diminished image quality due to contrast dose reduction.

Diatrizoate Meglumine↗
PubMed1989

[Comparison of intravenous drip infusion excretory urography using ionic and non-ionic contrast media].

Ionic and non-ionic contrast media were compared for use in intravenous drip infusion excretory urography. Sixty consecutive cases were classified alternately into two groups, ionic and non-ionic, excluding cases which were known to have factors affecting contrast ability adversely, such as hydronephrosis, renal failure and so on. Each group consisted of 30 cases. A hundred ml of the ionic contrast medium (Diatrizoate--60% Urografin) or non-ionic contrast medium (Iopamidol--Iopamiron 300) was administered I.V. by drip infusion, each infusion taking less than 10 minutes, using a 18 G needle, and 0-minute, 10-minute and 20-minute films were obtained. Visibility of nephrogram, calyceal system, renal pelvis, ureters and bladder were evaluated, ranging from 0 to 3, by six radiologists who were not informed of the contrast medium used. Some detailed factors such as radiographic contrast and fullness of the collecting system and of the bladder were also analyzed. Visualization rate of the ureters was defined as the length of visualized ureters divided by the distance between the renal pelvis and the ureteral orifice of the bladder. There was no significant difference in visualization of nephrogram between the two groups. However, the non-ionic group was superior to the ionic group in visualization of the calyceal system and ureters with statistical significance, probably due to higher radiographic contrast of non-ionic medium. There was no statistical significance between the two groups, in fullness of the calyceal system and visualization rate of the ureters, whereas the ionic group was superior to the non-ionic group in fullness of the bladder.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Local blood-brain barrier penetration following systemic contrast medium administration. A case report and an experimental study.

The present study was initiated by a severe complication in a patient with renal dysfunction who developed cortical blindness and weakness of her left extremities 30 hours following renal and abdominal angiography. To evaluate the impact of prolonged high serum concentrations of contrast medium (CM) this clinical situation was simulated in a laboratory model using sheep with elevated serum levels of contrast medium maintained for 48 hours. The experimental data did not support the theory that the prolonged exposure to high circulating levels of contrast medium (4 ml/kg body weight of meglumine diatrizoate 60%) is sufficient alone to cause penetration of the blood-brain barrier.

Aged↗
PubMedDate not supplied

Addition of local anesthetics to contrast media. II. Increase of acute mortality in mice with intravenous contrast administration.

The acute intravenous toxicity (i.v. LD50) of solutions of the ratio 1.5 contrast media metrizoate or diatrizoate and the ratio 3.0 contrast medium metrizamide was determined in mice with and without the addition of local anesthetics to the solutions. The two local anesthetics mepivacaine or lidocaine were added to final concentrations up to 2.0 mg/ml of the contrast medium solutions. This corresponds to clinically used concentrations. All additions of local anesthetics to the solutions increased the mortalities caused by the contrast medium solutions. Addition of local anesthetics to a final concentration of 2 mg/ml approximately doubled the acute intravenous toxicity of the contrast media. The ratio 3 contrast media produce less hypertonic solutions than the ratio 1.5 contrast media and should be preferred for angiography because they cause less pain and do not require the addition of local anesthetics which increase the acute toxicity of the solutions.

Anesthetics, Local↗
PubMedDate not supplied

Contrast medium induced changes in granulocyte adherence in vitro and during angiography.

The effect of ioxaglate and diatrizoate on per cent granulocyte adherence to nylon fibers was investigated in blood to which contrast medium was added in vitro and in blood from patients undergoing angiography. Very high concentrations of contrast medium, added to blood in vitro, directly abolished granulocyte adherence to nylon fibers. Intraaortic bolus injections of ioxaglate, but not of saline, transiently increased granulocyte concentrations in the femoral vein. Fractional granulocyte adherence to nylon fibers increased significantly above the baseline when angiographic dosages of contrast medium were diluted by circulation within the human body. On the other hand, dilute concentrations of contrast medium had no effect on per cent granulocyte adherence when added to whole blood in vitro. This indicates that the increased adherence produced in vivo is an indirect effect, which, usually, cannot be simulated in vitro.

Adult↗
PubMed1987

[Clinical course and CT findings in patients with contrast media-associated seizures].

It is well known that convulsion is one of serious adverse reactions of x-ray contrast media. The occurrence of the convulsion seems to be very rare in general population. However, a few reports noticed recently that patients with brain metastases or gliomas developed this complication relatively frequently and the terms, as contrast-induced convulsion or contrast media-associated (induced) seizure, were used. We performed 12,479 cranial CT examinations with contrast enhancement during the last nine years. The amount of 100 ml in adult or 2 ml/kg in children of 65% Angiografin (methylglucamine diatrizoate) was given intravenously and five patients had contrast media-associated seizures. Case 1: A 37-year-old man with right frontal anaplastic glioma was treated surgically and with radiochemotherapy and hyperthermia. In spite of anticonvulsant therapy, general or left hemiconvulsions occurred sometimes. The patient had contrast-induced general convulsion at 16th CT examination which revealed enhancement in the wall of surgical tissue defect. At 26th CT study, he developed general convulsion again. Case 2: A 47-year-old man with anterior callosal anaplastic glioma was treated surgically and with radiochemotherapy and hyperthermia. After then, he had contrast media-associated general convulsion at 10th CT examination which showed enhanced lesions. Case 3: A 63-year-old woman had been treated surgically for lung cancer. Five years later, CT revealed a ring enhancement in the left frontal lobe. Radiation reduced the lesion gradually.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Meconium ileus: a fifteen-year experience with forty-two neonates.

From 1969 to 1984, 42 neonates were managed for meconium ileus caused by cystic fibrosis. Simple, uncomplicated meconium ileus occurred in 24 infants (57%) and complicated meconium ileus occurred in 18 (43%). Meglumine diatrizoate (Gastrografin) enema completely relieved the obstruction in 13 patients with simple meconium ileus (54%) and caused colonic and rectal perforations in three (13%). Six operative procedures were used in 29 patients: double enterostomy (seven), resection with primary anastomosis (seven), Bishop-Koop enterostomy (seven), intraluminal lavage (four), colostomy (three), and Mikulicz enterostomy (one). Postoperative complications included malabsorptive diarrhea (nine), pneumonia (three), intestinal obstruction (two), total parenteral nutrition-catheter sepsis (two), and anastomotic leak (one). Infants managed nonoperatively by Gastrografin enema had a significantly shorter hospitalization (average, 15 days) than those undergoing operation for simple meconium ileus (54 days) and complicated meconium ileus (111 days). Postoperative survival rate was 100% with a late survival rate of 86%.

Cystic Fibrosis↗