A comparison of a new cholecystographic medium, teridax, with telepaque.

Abstract

Following completion of a study of Telepaque by Dunne, Jensen, and Hughes (1) in December 1952, that medium has been used routinely for oral cholecystography at the Cleveland Clinic. As has been reported by others—in up to 96 per cent of the cases examined—the excretion of this compound into the gastrointestinal tract results in the formation of opaque material in the colon (2, 3). In our experience this has frequently necessitated repeat films in order to obtain a view of the gallbladder area free from obscuring shadows. Because of this shortcoming, a clinical trial of Teridax was undertaken, the results of which are presented here. Teridax is a white, odorless, crystalline powder, containing 66.5 per cent iodine by weight, whose principal route of excretion is the urinary tract. With its use, opaque material rarely has been noted in the bowel. The chemical and physical properties, as well as the toxicology, have been reported elsewhere (3, 4). Teridax was given to 472 patients (254 men and 218 women), while a control series of 57 patients (20 men and 37 women) received Telepaque. No attempt was made at selection on any basis. The compound was given daily to from 5 to 20 patients in minimum doses of 4 tablets (3.0 gm.) for women and 5 tablets (3.75 gm.) for men. An additional tablet (0.75 gm.) was given for each 25 pounds of body weight over 150 pounds, up to a maximum of 8 tablets for men weighing over 200. Each patient was interviewed immediately after postero-anterior and decubitus films had been taken and was questioned in detail concerning nausea, vomiting, diarrhea, dysuria, headache, and itching. Any symptoms present prior to taking the tablets were critically assessed to determine whether they were in any way aggravated by ingestion of the compound. In order to classify the complaints as to degree of severity, and to secure findings comparable to those of Dunne et al. with Telepaque, we utilized the definitions of mild and severe nausea and diarrhea from their study (1). The films were interpreted later without review of the recorded reactions, and evaluation was based upon the definitions of Hoppe (1). The reactions encountered following Teridax and Telepaque in this series of 529 patients are tabulated in Columns 3 and 4 of Table I. Those reported by Dunne et al. with Priodax and Telepaque in 3.0-gm. doses are given in Columns 1 and 2, and those in a larger series of patients given Telepaque (1) in 2.0-gm. (for those weighing under 160 pounds) and 2.5-gm. doses (for those over 160 pounds) in Column 5. In Column 6 are recorded the complaints noted by Shapiro (3) in 204 patients examined after receiving 3.0-gm. doses of Teridax. The latter are recorded in a form different from the original to conform to our definitions. In our study, the most common complaints, in order of frequency, were diarrhea, dysuria, and nausea. Mild diarrhea occurred after Teridax somewhat less than one-half as often as after Priodax, but approximately twice as often as after the smaller dose of Telepaque.