Simultaneous roentgen examination of the urinary and biliary tracts with duografin.

Abstract

Intravenous pyelography and oral cholecystography are fully established radiologic procedures, dating back to the 1920's. The introduction of Biligrafin in Germany in 1953 (1) and its subsequent development in the United States as Cholografin, a 20 per cent solution of the disodium salt of N,N1 adipyl bis (3-amino-2; 4; 6 triiodobenzoic acid), opened a new era of intravenous cholecystography. This agent has been uniformly successful in demonstrating both the biliary tree and the gallbladder. More recently, a new product for the simultaneous visualization of the renal and biliary excretory tracts has been made available. This is Duografin, a radiopaque fluid mixture containing 40 per cent Renografin for urography and 20 per cent Cholografin for cholecystography and cholangiography. Both media are present as the methylglucamine salt in aqueous solution. Duografin is supplied in packages of two ampules, each containing 20 c.c, together with two 1.0 c.c. ampules for sensitivity testing. Duografin contains, in each cubic centimeter, 400 mg. of Renografin acid, 200 mg. of Cholografin acid, and 198 mg. of methylglucamine. Chemically, Renografin acid is 3,5-diacetylamino-2,4,6- triiodobenzoic acid; it contains 62.1 per cent of bound iodine. Cholografin acid contains 66.8 per cent bound iodine, and the solution supplied as Duografin, 38.2 per cent. This solution has a pH of 7.22 and a specific gravity of 1.430. Its viscosity at 20° C. is 28 centipoises (2). Indications The indications for the use of Duografin include all of the indications for pyelography and intravenous cholecystocholangiography. In addition, it is indicated in acute abdominal diagnostic problems, especially those pointing to the right upper abdomen, where time is an important factor in diagnosis and treatment. Duografin is also of value in routine examinations to save time and radiation exposure of the patient. Preparation and Administration Appropriate preparation of the patient aids greatly in obtaining diagnostic roentgenograms. Satisfactory results have been achieved, however, in emergency cases without any preliminary measures. The routine employed at the Newark Beth Israel Hospital has included a low-fat meal the night before the examination, as well as a laxative, usually castor oil. Breakfast is withheld the following morning. On arrival in the X-ray Department, the patient is given 1.0 c.c. of Duografin intravenously as a test of sensitivity. After half an hour, if no adverse reaction has been observed, 40 c.c. are given intravenously over a ten-minute period. Any mild allergic reaction, such as pruritus, urticaria, or gastrointestinal upset, is treated by the administration of 20 mg. of Benadryl intravenously. Benadryl and Duografin are not miscible in the same syringe.