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Distension arthrography of the shoulder joint.
Pain and stiffness resulting from degenerative disease of the rotator cuff of the glenohumeral joint is not always self-limiting. In a few patients, the symptoms persist despite medication and physiotherapy. Distension arthrography, a method of hydrostatic manipulation, has been used in six such patients; five recovered full range of abduction and rotation and the sixth was improved. It is concluded that distension arthrography should be part of the treatment of intractable pain stiffness of the shoulder joint.
Contrast media and regional renal blood flow. A study of the effects of ionic and non-ionic monomeric and dimeric contrast media in the rat.
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Experimental evaluation of renal and spinal cord tolerance to a new angiographic agent, Angio-Conray.
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A new angiographic contrast medium, sodium iothalamate 80 percent. A clinical and experimental evaluation.
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Iothalamate (Conray, Angio-Conray), a new cardiovascular contrast agent of low toxicity, low viscosity and high opacity.
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[ON NEW CONTRAST MEDIA FOR INTRAVENOUS INJECTION; CONRAY AND ANGIO-CONRAY].
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CLINICAL EVALUATION OF SODIUM IOTHALAMATE 66.8 PER CENT (CONRAY-400).
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[CLINICAL EVALUATION OF TWO NEW CONTRAST MEDIA: CONRAY AND ANGIO-CONRAY; APPLICATION TO THE RAPID-SEQUENCE INTRAVENOUS PYELOGRAPHY AND THE TRANSLUMBAR AORTOGRAPHY].
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[Effects of a non-ionic low osmolar contrast medium on thyroidal radioiodine uptake in rats].
Recently non ionic low osmolar contrast media (NILOCM) have been widely used in radiographic contrast studies. These new agents have a great advantage over conventional ionic high osmolar contrast media (IHOCM) in low chemical toxicity and good X-ray absorption. However, their effects on thyroid function, especially on thyroidal radioiodine uptake (TRIU), are still unknown and it is not clear how long NILOCM interfere with TRIU. Therefore, the extent of the interference with TRIU caused by previous NILOCM injection was examined using rat thyroid. Male WKA rats were divided into four groups and fed under different dietary conditions, A) routine diet for rats; B) low iodine diet (LID) for 1 week, C) LID for 2 weeks, and D) LID for 8 weeks. Iopamidol was used as NILOCM, and iothalmate, one of IHOCM, was also employed for comparative study. After feeding, some rats in each group were injected with 300 mgI/kg. b.w. of iopamidol or iothalmate. The remaining rats in each group received saline injection as the control. At day 1, 2, 3, 7, and 14 following injection, I-131 was administered intravenously and a 24 hour TRIU (% dose/mg tissue) was measured in each group. Thyroidal iodine content (TIC: micrograms I/mg tissue) at day 1, 7, and 14 was also measured in group A, C, and D. Until day 3, severe suppression on TRIU was observed in all groups, and TIC elevated at day 1 in iothalmate-injected rats. In iopamidol-injected rats, TRIU and TIC recovered after then, and reached the same levels as those in control rats until day 14 except for group D. However, TRIU was still significantly lower and TIC levels in group D was higher at day 14 in iothalmate-injected rats. It is concluded that iopamidol has less effects on TRIU and TIC with a shorter period of recovery than iothalmate. This results maybe beneficial to the patients who were injected NILOCM prior to radioiodine scintigraphy.
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.
[Key note comment on the determination of glomerular filtration rate].
Glomerular filtration rate (GRF) is the most fundamental renal function. Determination of GFR is the most important examination in clinical nephrology. Cin is accepted as the gold standard of GFR, but, continuous infusion and the determination method of inulin (method of anthrone) are very troublesome. Interference of glucose in the serum and urine of patients with diabetes mellitus on the determination of inulin should be avoided. Ccr is widely used in the clinical field. Recently, the dynamics of creatinine in the body have been clarified. Variation of pool, generation rate, extrarenal excretion and tubular excretion of creatinine are found to change daily in the patient. Additionally, classical Jaffé's reaction involves non creatinine chromogen particularly in the serum. Though Jaffé's reaction with kinetic analysis improves the reliability of this reaction, the result is still unsatisfactory. There are several methods of enzyme assay are now using an autoanalyser, but, if we use many enzymes and reagents, the reliability of this method could not exceed that of Jaffé's method. Recently, HPLC is recommended as the standard method. 24-hr urine collection is also troublesome in the measurement of Ccr. I have found a good correlation between the estimated Ccr using Cockcroft and Gault's formula and Cin. Such prediction using serum creatinine concentration and few parameters should be developed. Radiolabelled agents have been widely used for the determination of GFR. However, in Japan, the methods of clearance of non radiolabelled contrast agents should be developed. Furthermore, a physical determination of GFR is necessary. In this workshop, these issues will be discussed by each speaker.
[A new analytical method for simultaneous measurement of iothalamate and iohexol].
Glomerular filtration rate (GFR) is believed to be the overall index of renal function, and the renal clearance of inulin (Cin) obtained during constant intravenous infusion has long been accepted as the gold standard of GFR measurement. Because of a number of technical difficulties inherent in the assay of inulin concentration in urine and plasma, its utility in clinical practice is limited. Iothalamate, urographic contrast medium, which behaves and is excreted in a fashion similar to inulin, has been accepted as a good filtration marker. We examined whether GFR could be estimated by ionic contrast media, "iothalamate" and non-ionic contrast media, "iohexol", when the high-performance liquid chromatography (HPLC) system was used as the analytic method. In our HPLC system, iothalamate and iohexol could be simultaneously determined. The assay results gave linearity within the wide range of concentrations tested. In seventeen subjects, the renal clearances of creatinine, iothalamate, and iohexol (Ccr, Ciot, and Cioh) were compared with that of inulin. The slopes with zero intercept of Ccr vs Cin, Ciot vs Cin, and Cioh vs Cin were 1.24 +/- 0.02, 1.06 +/- 0.02, and 0.83 +/- 0.02, respectively. In conclusion, an excellent correlation of renal clearance of iothalamate with that of inulin was obtained in patients with a wide range of renal function and normal volunteers. This justifies the use of the single injection of iothalamate and HPLC system as the analytic method in the measurement of GFR.
Dynamic catheterography in the early diagnosis of peritoneal catheter malfunction.
The dynamic catheterography is an image technique that allows to study the peritoneal solution inflow and outflow phases in case of catheter malfunction. The examination is carried out in three subsequent steps: 1) direct examination without contrast media in order to define the position of the catheter inside the abdomen; 2) low speed catheterography by normal injection of 10 ml of hydrosoluble contrast medium to verify the patency of the cannula; 3) high speed catheterography by 30 ml hydrosoluble dye injected with an automateds high pressure system to study the inflow phase, the fluid distribution in the peritoneal cavity and the patency of the catheter holes. Different radiographic patterns can be found: dislocation of the catheter tip, KinKing, one way obstruction, inner lumen obstruction. The procedure is simple, safe and reliable for a correct diagnosis and for the choice of a successful therapeutic approach to peritoneal catheter malfunction.
[Methods for the quantification of left ventricular volumes assessed by radionuclide ventriculography (first part)].
The purpose of this study was to point out the existing methods and to describe and evaluate the accuracy of new, original, "Geometric-count-based" (GCB) method, based on radionuclide ventriculography, for the measurement of left ventricular volumes compaired to the contrast ventriculography. By having done this, the aim was to compare the accuracy of GCB method and other two radionuclide methods available for left ventricular volume measurements: Count-bases Massardo method and gated blood pool SPECT method. In GCB method count based data from radionuclide ventriculography were combined with geometric ones assuming a prolate ellipsoid left ventricular's shape with identical short axes. The following equation for computing left ventricular end-diastolic volume was developed: EDV = 2 x c x M x C(tot)/C(max), (1) where: 2c--manually drown short axis of prolate ellipsoid (left ventricle) at end-diastolic frame, M-calibrated pixel size, C(tot)--total counts in left ventricular's region of interest at end-diastolic frame, C(max)--maximum pixel counts in left ventricular's region of interest. Physical experiments with two different heart shaped phantoms were used to compare volumes assessed by all three radionuclide methods with the true volumes. The true volumes of cylindrical and ellipsoid phantoms of 112.5 ml and 190.5 ml, were computed to be 114 ml and 196 ml by our GCB method, 168 ml and 180 ml by Massardo method and 142 ml and 222 ml by gated blood pool SPECT methods, respectively. In clinical study, in 65 patients volumes assessed by radionuclide methods were compared to volumes measured using single plane contrast ventriculography as a gold standard. A good correlation of our original method was obtained with a contrast ventriculography for both EDV/m2 and ESV/m2 (r = 0.94, r = 0.92), slightly lower for Massardo method (EDV/m2: r = 0.90, ESV/m2 : r = 0.89) and significantly lower for gated blood pool SPECT (EDV/m2: r = 0.85, ESV/m2: r = 0.81, p < 0.01). In conclusion, both, phantom and clinical studies indicate that GCB radionuclide method is accurate, noninvasive for left ventricular volumes' measurement and should be widely used in everyday clinical practice.
Nephropathy in critically Ill patients without preexisting renal disease.
Contrast-induced nephropathy (CIN) remains a common complication of radiographic procedures. Isovue (lopamidol) is a low-osmolality nonionic monomeric tri-iodinated water soluble agent widely used as a contrast medium in radiographic procedures for intravascular, intrathecal, and body cavity administration. The purpose of this study was to evaluate the effect of lopamidol on renal function in patients without any preexisting renal condition who were undergoing radiographic imaging with the iodine contrast. Seventy-five patients admitted to the Intensive Care Unit (ICU) had CT-scans with intravenous lopamidol contrast. All the patients had a normal serum creatinine before administration of the contrast media. Serum creatinine was recorded for three consecutive days after the CT-scan. The control group consisted of medical ICU patients that were not administered iodine contrast during their stay in the unit. There was no change from the baseline in the control group. A significant increase in serum creatinine was recorded in patients undergoing CT-scan with lopamidol contrast. In 18% of the patients, creatinine was elevated more than 25% from the baseline. This level of creatinine elevation indicated a significant decrease in glomerular filtration, and thus fulfilled the criteria for contrast-induced nephropathy. Our data demonstrates that iodine contrast media for CT in ICU patients without preexisting kidney disease can precipitate clearly measurable nephropathic changes.
Variable effects of radiological contrast media on thrombus growth in a rabbit jugular vein thrombosis model.
We studied the effect of an ionic high osmolar contrast medium (Ioxitalamate), an ionic low osmolar contrast medium (Ioxaglate) and various nonionic low osmolar contrast media (Iopamidol, Iopromide and Iohexol) on thrombus growth in a rabbit jugular vein thrombosis model. Thrombus growth was determined by the accretion of 125I-labeled fibrinogen onto autologous preformed thrombi in rabbit jugular veins at various time-intervals from 15 min up to 10 h after infusion of the study solution. The ionic low osmolar contrast medium markedly inhibited thrombus growth whereas all nonionic low osmolar contrast media promoted thrombus growth. The ionic high osmolar, contrast medium inhibited thrombus growth, but less than the ionic low osmolar contrast medium. Within the group of nonionic contrast media, the Iopamidol associated promotion of thrombus growth was significantly higher than the Iopromide or Iohexol associated effects. The simultaneous administration of the apparently most potent thrombus growth promoting contrast medium (i.e. Iopamidol) and heparin resulted in complete abolishment of the increase in thrombus growth. These results support the claims of prothrombotic properties of nonionic as compared to ionic contrast media and could explain the clinically encountered thromboembolic complications after the use of nonionic low osmolar contrast media.
Renal function and metabolism during endotoxemia in rats: role of hypoperfusion.
Renal failure often complicates endotoxin shock. This might be due to renal hypoperfusion, but endotoxemia could also have additional effects. We studied in anesthetized rats renal plasma flow (RPF), glomerular filtration rate (GFR), and metabolism (ATP, CrP = creatine phosphate, energy charge = [ATP + 0.5 ADP]/[ATP + ADP + AMP], lactate, glucose) during endotoxin shock (Escherichia coli endotoxin, 10 mg/kg for 60 min; n = 10) and "balloon shock" (balloon inflated in vena cava below renal vein to cause comparable decreases in cardiac output and RPF as in endotoxin-treated rats; n = 10). A third group of rats served as controls (n = 10). At t = 0 infusion of endotoxin was started. At t = 90 min, when cardiac output was low and serum lactate was high (indicating shock), GFR and RPF were obtained from plasma disappearance rates (from t = 90 to t = 135 min) of 125I-thalamate and 131I-hippurate, respectively. Experiments ended at t = 135 min. In both shock groups RPF decreased (by ca. - 75% compared with control rats), but filtration fraction only increased (by 72%) in the "balloon shock" rats. In renal biopsies lactate concentration increased more (by 407 vs. 167%) and ATP decreased more (by -63 vs. - 35%) during endotoxin shock than during "balloon shock"; the endotoxin-treated rats also showed a significant decrease in CrP (by - 58%), energy charge (by - 31%), and glucose concentration (by - 34%), and an increase in the number of leukocytes in the glomeruli (by 730%). Renal function and metabolism thus was more affected in this hypodynamic form of endotoxin shock than in "balloon shock." This may be caused by the effects of endotoxin on sticking of leukocytes and renal metabolism.