The symptomatic complications of iopamidol (Niopam) and metrizamide (Amipaque) following lumbar radiculography.
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Contrast Media↗
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The role of the distal nephron mechanisms in the concentration of contrast medium in the urine.
The concentrating mechanisms affecting contrast medium in the distal nephron have been studied using three contrast media of differing osmolality (monomer, dimer and non-ionic compounds) in antidiuretic dogs with three different basal solute excretion rates. Evidence has been obtained that, under conditions of contrast medium osmotic diuresis, the loop of Henle generates more free water. If the free water generated in response to the contrast medium solute load is reabsorbed in the collecting ducts, this can in part mask the different proximal tubular effects of contrast media of different osmolality. However, as basal solute excretion increases, the compensatory mechanism is overwhelmed and urine osmolality falls exponentially. At the higher basal solute excretion rates, different osmolar loads of contrast medium no longer produce different urine osmolalities and different urine contrast medium concentrations. It is therefore considered unlikely that contrast media of reduced osmolality will produce significant increases in urine contrast medium concentration under the conditions of solute diuresis which occur in renal failure.
Animals↗
The effect of intravenous contrast medium on glomerular filtration rate.
The changes in glomerular filtration rate (GFR) after intravenous contrast medium have been investigated with three contrast media of differing osmolality (monomer, dimer and non-ionic agent) in antidiuretic dogs with three different basal solute excretion rates. A transient increase in GFR after contrast medium was attributed to the wash-out of medullary creatinine at the onset of diuresis. The subsequent fall in GFR was greatest with the contrast media of higher osmolality and in those dogs without an underlying solute diuresis. With the monomer, the decrease in GFR produced a significant decrease in the amount of contrast medium excreted in the first few minutes after contrast injection. It is suggested that an important factor in the decrease in GFR is the rise in pressure in the renal tubules at the start of a diuresis, before they have had time to dilate. An underlying solute diuresis is considered to protect against the fall in GFR because tubular dilatation has already occurred in response to the basal solute load. The decrease in blood pressure during and after contrast medium injection did not correlate with the fall in GFR.
Animals↗
Effect of X-ray contrast media on the action of chymopapain on the intervertebral disc: an in vitro study of cartilage degradation.
A representative selection of X-ray contrast media was tested for their effects on the action of chymopapain on cartilage proteoglycan in an in-vitro test system. Inhibition of the action of chymopapain was detected only at high concentrations of contrast media, and was more marked with ionic contrast media than with non-ionic media. A dose-response curve for the release of glycosaminoglycan by chymopapain was linear when the amount of enzyme was plotted on a logarithmic scale against glycosaminoglycan release. In view of our results, we suggest that there is no need for a delay between injection of contrast medium and enzyme, contrary to the instructions of the distributors of chymopapain, if small amounts of a non-ionic contrast medium are used.
Animals↗
Guidelines for cervical myelography: lumbar versus cervical puncture technique.
Cervical myelography may be performed with non-ionic contrast media either by direct cervical puncture or by lumbar puncture with run-up of the contrast medium. In this prospective study of 300 cervical myelograms using iopamidol (130 by direct puncture and 170 by lumbar puncture), we have shown that the run-up technique causes no more side effects than direct puncture technique and films of equivalent diagnostic quality are obtained. A sub-group of 80 patients had EEG examinations before and after myelography, plus a lateral skull film taken at the end of the myelogram to assess the amount of contrast medium that had entered the skull. More EEG abnormalities were found in those patients examined by direct puncture and significantly more contrast medium had entered the skull in this group. Run-up myelography therefore results in less intracranial spill and so less potential for cortical irritation. In view of the EEG abnormalities, anticonvulsant premedication is discussed, and we now give phenytoin to all patients having cervical myelography with iopamidol. We consider that cervical myelography can be adequately and more safely performed by lumbar puncture technique but, to optimise patient safety, should be performed by a radiologist experienced in neuroradiology.
Anticonvulsants↗
A comparison of iopamidol and iohexol in peripheral angiography.
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Angiography↗
The old and the new: a study of five contrast media for urography.
Five contrast media, Conray 280 and 420, Urografin 370, Uromiro Sodium 300 and Niopam 370, were compared in a randomised trial involving a total of 482 patients. The best urographic agent was Conray 420 and the worst Conray 280, these control agents defining the ends of the scoring system. Uromiro Sodium 300 was very nearly as good as Conray 420. A non-ionic agent, Niopam 370, scored nearly equal with Urografin 370; both were rather better than Conray 280. There was little difference in minor reactions between the media. No reason was found to prefer non-ionic to ionic agents for general use in urography; indeed for a diagnostic examination the sodium salt of an ionic agent is preferable.
Adult↗
Contrast agents and enzyme inhibition. II. Mechanisms.
The inhibition of enzymes by radiological contrast agents has been invoked to explain some of their clinical effects. In a previous paper, in-vitro studies of the inhibition of the enzyme acetylcholinesterase were presented and some clinical correlations were discussed. More detailed studies, described here, have now shed new light on the mechanisms involved in this important phenomenon. Because the findings restore the iodine atoms to a central role, they have important general implications for contrast agent pharmacology.
Cholinesterase Inhibitors↗
Plasma leukotriene C4 and reactions to contrast media.
Forty-five patients were randomly divided into three groups of 15 and within each group patients were given iothalamate, iopamidol or ioxaglate intravenously during radiological investigations. The plasma leukotriene C4 level was measured before and 30 s and 3 min after the administration of the respective contrast media. In patients demonstrating non-idiosyncratic contrast reactions, a consistent decrease in plasma leukotriene concentration was noted at both 30 s and 3 min following the administration of all three contrast media. A statistically significant decrease in plasma leukotriene occurred at 30 s with ioxaglate, but not with the other two agents. In the limited number of patients who experienced idiosyncratic reactions, the decrease in plasma leukotriene concentration was less apparent. This decrease in plasma leukotriene concentration has been attributed to changes in plasma volume following administration of hyperosmolar contrast media. The inability to demonstrate an increase in plasma leukotriene levels following the administration of both conventional and new, low-osmolar radiographic contrast media supports the cumulative evidence against an allergic mechanism in the majority of non-idiosyncratic and some idiosyncratic contrast reactions.
Female↗
A large trial of intravenous Conray 325 and Niopam 300 to assess immediate and delayed reactions.
The trial was designed as an investigation into the incidence of both immediate and delayed reactions to the intravenous administration of Conray 325 (sodium iothalamate) (844 patients) and Niopam 300 (iopamidol) (855 patients) for urographic examination. Information was obtained from questionnaires returned by patients about a week after their examination, with a response rate of 81%. Significant differences were found in the incidences of both types of reactions to the two media with respect to nausea and vomiting, arm pain, and taste in the mouth, which was commoner in patients receiving Conray 325, whereas the incidence of delayed skin rashes and parotid swelling was commoner with Niopam 300. The occurrence of a flu-like illness, so-called "iodism", was found to be equal for the two contrast media.
Clinical Trials as Topic↗
The effect of sodium iothalamate on the vascular resistance of the isolated perfused rat kidney.
The direct effects of sodium iothalamate on renal vascular resistance (RVR) were examined using the isolated perfused rat kidney experimental model. A concentration-dependent biphasic change in RVR was produced with the hyperosmolar solution of sodium iothalamate [(Conray 420), 420 mgI/ml, 2500 mOsmol/kg/H2O]. The response characterized by an initial fall followed by a prolonged increase in RVR on discontinuation of the iothalamate infusion. No significant change in RVR was observed when iothalamate was infused as an iso-osmotic solution (60 mgI/ml, 280 mOsmol/kg/H2O) at a rate of 0.525 ml/min. to produce a concentration of 4.2 mgI/ml in the renal perfusate. We conclude that sodium iothalamate can exert direct biphasic effects on RVR which are mediated by its hyperosmolality rather than its chemical content.
Animals↗
Effect of radiological iodinated contrast media on acetylcholinesterase activity.
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Acetylcholinesterase↗
Case report: mobile fatty globules in benign cystic teratoma of the mediastinum.
Benign cystic teratoma is a well recognized cause of an anterior mediastinal mass. The presence of fat, found in approximately half the cases, suggests the diagnosis. We report a new feature, which consists of components of the tumour drifting upwards (anteriorly) during the course of a computed tomography examination. The appearance is compared with a popular light fitting.
Adipose Tissue↗
Radiographic quality and patient discomfort in sialography: comparison of iohexol with iothalamate.
We have compared the usefulness of a newly developed, low osmolality contrast medium, Omnipaque 350 (75.49% iohexol, 350 mgI ml-1), for sialography with one of the established, Angioconray (80% sodium iothalamate, 480 mgI ml-1), in a double-blind, prospective randomized clinical trial in 80 patients. The diagnostic quality of the sialograms, pain during the procedure and discomfort subsequently were investigated. There was no difference in either group between the number of sialograms judged as diagnostically useful, although those of excellent quality were significantly more frequent in the Angioconray group. The level of pain on injection of the medium was significantly lower in the Omnipaque group. Eighteen per cent of the patients with Omnipaque had severe or moderate pain on injection of the contrast medium, while 63% had such pain with Angioconray. There was no difference in postprocedural discomfort between the two contrast media. We concluded that the low osmolality contrast medium is more favourable for sialography despite its lower iodine content.
Adult↗
The iothalamate clearance in cats with experimentally induced renal failure.
Plasma iothalamate (IOT) disappearance rates were measured after a single-injection of IOT (113.8 mg/kg, IV) in cats with experimentally induced renal failure. The disappearance rates especially fitted into the one compartment model. The mean value of plasma disappearance rates of IOT in these cats with induced renal failure (2.16 +/- 0.240 x 10(-3) micrograms/ml/min) was markedly lower than that of clinically healthy cats (4.10 +/- 1.00 x 10(-3) micrograms/ml/min). These results demonstrate that IOT clearance is available for evaluation of renal function in cats.
Animals↗
Facet joint injection for low back pain. A clinical study.
Therapeutic injection of facet joints is now widely practised, but British experience has been infrequently reported. We studied the results of injecting facet joints with a corticosteroid preparation in 50 patients suffering from the "facet syndrome". Our series included a number of extra-articular injections and these "failed injections" provide a useful control group. Results indicate that only intra-articular injections are effective; certainty of joint penetration can be ensured only by the routine use of joint arthrography.
Adult↗
Electrocardiogram of the month. Pattern of infarction produced by sodium iothalamate 80 per cent (angioconray) invasion of myocardium.
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Angiocardiography↗
Simple method for the collection of pancreatic islets by the use of Ficoll-Conray gradient.
Simple method for the collection of large numbers of viable pancreatic islets from normal rats is described. This method involves collagenase digestion of the pancreas, followed by the use of Ficoll-Conray discontinuous gradient for the separation of isolated islets from unwanted acinal debris. Ficoll-Conray A solution was prepared by mixing undialyzed 12.5% Ficoll and 33.4% Conray in the ratio 2 : 1, to make a specific gravity of 1.095 and osmolarity of 396 mOsm/l. The solution B, C, and D, with specific gravities 1.084, 1.072, and 1.048, respectively were obtained by diluting A solution with distilled water. Using Ficoll-Conray gradient, about 200 viable islets which maintained excellently their morphology and function, were collected consistently from a young adult rat pancreas.
Animals↗