Non-ionic Water-soluble Contrast Medium Research Articles

PROSEDUR PEMERIKSAAN LOPOGRAFI DENGAN KLINIS SUSPECT COLON CARCINOMA

ABSTRACT
 Background :The lopographic examination according to Lampignano and Kendrick (2018) uses barium sulfate contrast media which is inserted through the stoma, using plain photos, AP/PA, Lateral, Oblique, post evacuation. Installation of Radiology Hospital Prof. Dr. Margono Soekarjo Purwokerto using a non-ionic water soluble contrast media mixed with NaCl, inserted into the proximal stoma and anus with plain photos, AP, Lateral. The purpose of the study was to determine the lopographic examination procedure, the reasons for using water soluble contrast media, to find out anatomical information from the AP and Lateral.
 Methods :This research used qualitative approach with a case study. Data collection were used observation, interviews, documentation. Research respondents were patients, radiographers, radiologist, and dispatching doctors. Data analysis with interactive analysis model.
 Result : Showed that the lopographic examination was aimed at evaluating the colon after colostomy and chemotherapy. Patients undergo special preparation. The water soluble contrast medium was mixed with NaCl in a ratio of 1: 4 because it was safer than barium sulfate. The reason for insertion of contrast media through the proximal stoma and anus is the absence of a stoma to the distal colon. Anatomical information from the plain photo is the distribution of air in the colon, the AP projection looks contrast to fill the ascending colon, transverse colon, descending colon and superpositioned sigmoid colon. Laterally, the sigmoid colon and rectum are seen. Diagnostic information was not found in colonic carcinoma residif cells.

Comparison of Two Methods of Stent Placement in Esophageal Malignant Strictures: With Fluoroscopy and Without Fluoroscopy Take in Consideration the Safe and Efficacy

Background: Expandable metal stents are used increasingly as a non-surgical alternative for the palliation of luminal gastrointestinal neoplasms, particularly esophageal cancer. Fluoroscopy is normaly used to guide the placement of self-expanding metallic stents for the palliative treatment of patients with esophageal malignant strictures. This is a description of a comparison of two methods of stent placement: With fluoroscopy and without fluoroscopy by direct endoscopic view, take inconsideration the safe and efficacy. Methods: The technique without fluoroscopy relies on a clear endoscopic view of the proximal radiopaque marker on the stent. A gastroscope was passed, allowing guidewire deployment. The Endoscope was reinserted giving direct visualization of the proximal margin of the stricture during the deployment. The technique with fluoroscopy, a metallic marker strip was placed on the patient's back as a landmark during fluoroscopyAn initial esophagogram was performedwith nonionic water-soluble contrast medium to evaluate the location and length of the stricture. The stent was carefully positioned in relation to the metallic markers and other bony landmarks to cover the entire stricture. Results: Thirty seven consecutive patients with inoperable esophageal malignancy underwent stent placement. Eighteen with fluoroscopy and nineteen underwent endoscopic placement without fluoroscopy. Deployment in satisfactory position without fluoroscopy was successful in 18 of 19 (94.74%) and there was only one important complication. Deployment using fluoroscopy was successful in 16 of 18 (88.89%); there were no important complications. Patient's characteristics and prior treatments like chemotherapy and/or radiotherapy didn't show statistical difference. Conclusions: The majority of esophageal stents can be accurately positionedwithout fluoroscopy as safe and effectiveness as with fluoroscopy, and less cost.

Preoperative portal vein embolization with a new liquid embolic agent.

To evaluate the effectiveness and safety of a new liquid embolic agent in preoperative portal vein embolization. Embol-78 was obtained by means of hydrolysis of polyvinyl acetate and was dissolved in a mixture of ethanol and nonionic water-soluble contrast medium. After percutaneous puncture of the portal vein, embolization of the right portal vein was performed in 22 patients with hepatocellular carcinoma and in 29 patients with nonhepatocellular carcinoma. In each group, changes in volume of the future liver remnant, portal venous pressure, and liver enzymes were evaluated both before and after embolization. Complications were also evaluated. Portal vein embolization was successful in all patients, without major complications. The mean volumes of the future liver remnant before and 2 weeks after embolization were 385 mL +/- 138 and 533 mL +/- 140, respectively, in the hepatocellular carcinoma group and 517 mL +/- 348 and 755 mL +/- 197, respectively, in the nonhepatocellular carcinoma group. There were only transient elevations in liver enzyme levels after embolization. Mean portal venous pressures before and after the procedure were 16.7 mm Hg +/- 3.8 and 20.3 mm Hg +/- 3.6, respectively, in the hepatocellular carcinoma group and 11.7 mm Hg +/- 3.5 and 14.6 mm Hg +/- 3.6, respectively, in the nonhepatocellular carcinoma group. In each group, changes in volume of the future liver remnant and portal venous pressure were statistically significant (P <.001). The liquid embolic material Embol-78 seems to be effective and safe for preoperative portal vein embolization.

Balloon dilation of congenital and acquired stenosis of the trachea and bronchi.

To document the results of balloon dilation of the trachea and bronchi in infants and children with congenital and acquired stenosis. Balloon dilation of congenital and acquired tracheal and bronchial stenosis was performed in six patients aged 5 weeks to 2 years 8 months (mean, 12.5 months). Bronchography with nonionic water-soluble contrast medium was performed initially through an endotracheal or tracheostomy tube with the patient sedated or under general anesthesia. Balloon size (2-8 mm) was determined on the basis of diameter of the airway lumen distal to the stenosis measured at bronchoscopy. Twenty-three incremental balloon dilation procedures were performed in these six patients at time intervals from 3 days to 2 years. Usually, three balloon insufflations were performed for 20-45 seconds at 4-6 atm during each procedure. Symptomatic improvement or increased lumen diameter occurred in four of six patients after balloon dilation. No improvement was seen in two patients: One had unrecognized vascular compression of the proximal left bronchus and distal trachea, and the other, of the left upper lobe bronchus. There were no complications. Balloon dilation was a safe and effective palliative procedure for treatment of congenital and acquired stenosis of the trachea and bronchi. Symptomatic improvement and increased lumen diameter occurred but may be temporary. Performance of serial dilation procedures was necessary to effect a long-term cure.

Pattern of anesthetic diffusion during peribulbar infiltration: a CT evaluation.

The aim of this study was to evaluate the changes undergone by orbital structures during peribulbar anesthesia. CT-thin slices were acquired and 8-9 ml of anesthetic, with a small part of low-density non-ionic water-soluble contrast medium were injected under CT guide once to follow extraconal spreading and diffusion to intraconal structures and above all, the surgically important structures such as recti muscles, orbicular and optic nerve sheath. Conjunctival sack involvement was assessed and conjunctival chemosis was rated. Induced ptosis was evaluated, verifying change before and after eyepressure. The results help in optimizing anesthetic technique, above all concerning the site, materials and quantity, and suggest the amount of anesthesia could be reduced. The peribulbar anesthetic technique proved effective and safe for patients.

Dynamic Documentation of Digital Dacryocystography

Digital dacryocystography has proved to be the optimum method of x-ray diagnostics in connection with managing obstructions of the lacrimal pathways. We present 50 patients in whom digital dacryocystography was performed with a computer-controlled x-ray unit and a C-arc coupled to an image intensifier TV-system. A nonionic water soluble contrast medium was used. The bilateral contrast medium filling process appearing on the monitor was simultaneously recorded on videotape. Videocassettes, with patient data attached, were stored in a videotape library, providing repeatable diagnostic documentation and an excellent base for scientific analyses.

Clearance of iopamidol, a non-ionic contrast medium, by CAPD in patients with end-stage renal failure.

In normal healthy subjects radiographic contrast media are cleared by the kidneys with a half-life of approximately 2 h and a total body clearance of 8 l/h. The mechanism of contrast clearance has not been previously investigated in chronic renal failure patients undergoing continuous ambulatory peritoneal dialysis (CAPD). A study was undertaken to investigate the pharmacokinetics of a non-ionic water soluble radiographic contrast medium (iopamidol) in 10 patients stabilized on CAPD. All patients (eight male, two female) aged 22-68 years (median 53 years) had injection of 30 ml of iopamidol 300 via a forearm vein to investigate subclavian vein patency following previous cannulation for haemodialysis. Venous blood samples, CAPD dialysate and urine were collected for seven days post injection. The mean plasma half-life was 37.9 h (SD 10.6) (range 24.1-57.2 h) for the CAPD patients and was greatly prolonged in comparison to healthy subjects. The total body clearance of iopamidol was also greatly reduced (0.377 l/h). CAPD removed an average of 53.6% of the administered dose (range 36.3-80.8%) whilst an average of 26.9% was excreted in the urine (range 1.3-56.3%). The combined renal and dialysate clearance was up to 93% of the administered dose over the period of the study. There is therefore some evidence for a small extra renal clearance of iopamidol in end-stage renal failure patients. This study has shown for the first time that patients with end-stage renal failure undergoing CAPD have significantly delayed elimination of contrast medium. This should be taken into consideration when extensive or prolonged investigations using contrast medium are proposed.

Videodocumentation in digital dacryocystography

The digital dacryocystography proved to be the optimum method of X-ray diagnostics in obstructions of the lacrimal pathways. The examination was performed with a computer controlled X-ray unit with a C-arc coupled to an image intensifier tv-system. In the study the advantages of this technique were combined with the advantages of modern videotechnique. A nonionic water soluble contrast medium was used. The bilateral contrast medium filling process was registrated and the findings were recorded on videotape concurrently. The videocassettes, marked with the data of the patients and the date of examination, are stored in a video-tape library. This provides an always repeatable diagnostic documentation and it is also an excellent base for scientific analyses. The technique and the results of the examinations, performed with 18 patients, are described.

Lack of Peritoneal Reactivity

The ideal contrast agent in patients suspected of having gastrointestinal perforation is an iso-osmolar, or nearly iso-osmolar substance, that causes no peritoneal reaction. Iopamidol is a nonionic water-soluble contrast medium that may be considered in such situations. Intraperitoneal injections of ionic and nonionic contrast agents were compared in rats to study potentially harmful peritoneal inflammation. Only intraperitoneal barium injection produced any significant tissue reaction, such as adhesions and ascites. There was no difference between iopamidol and the other water-soluble contrast agents. Iopamidol may satisfy the need for nonreactive and nearly iso-osmolar contrast agents for evaluating patients with possible bowel perforation. However, the high cost of this agent may make its clinical application impractical.

Pharmacokinetics and excretion of iohexol after lumbar myelography in man.

Pharmacokinetics and excretion of iohexol, a new nonionic water-soluble contrast medium, were determined after lumbar myelography. Peak plasma concentrations were obtained 2 to 6 hours after injection and ranged from 29 to 177 microgram/ml. Terminal elimination half-life was 4.0 hours, and over 90% of the dose was recovered in the urine within 24 hours. In one patient with a large lumbar cauda equina tumor, absorption and excretion were delayed; but eventually 99% was recovered indicating a large capacity for reabsorption via the lumbar subarachnoid space. One mild headache of 5 minutes' duration was reported in a 73-year-old woman. No significant changes in vital signs, neurologic examinations, or serum chemistries were observed.

Outpatient Lumbar Myelography

Over a 2-year period, 92 patients were submitted as outpatients to lumbar myelography using lopamidol, a new nonionic water-soluble contrast medium. The incidence and severity of adverse reactions associated with myelography in these cases were compared with those in 116 patients who underwent lopamidol myelography as inpatients. The hospitalized patients received 10 ml, and the outpatients 8 or 10 ml of contrast medium (300 mg l/ml). The severity of complications was graded as very mild, mild, moderate, or severe. The complication rate was 37% in the hospitalized patients and 40% in the outpatients. Adverse reactions, mostly in the form of headache, were very mild in approximately two thirds of cases in each group, and moderate or severe in 15% of the inpatients and 24% of the outpatients presenting complications. The incidence of moderate or severe reactions was lower in the outpatients receiving 8 ml of contrast medium compared with those given 10 ml. lopamidol lumbar myelography performed on an outpatient basis is a safe procedure. The outpatient regimen considerably reduces the cost of myelography and indirectly increases the availability of beds in orthopaedic and neurologic units.

Pleurography in encapsulated effusion.

Encapsulated pleural effusion was investigated radiographically in 4 patients by injection of a non-ionic water-soluble contrast medium (Amipaque) into the encapsulated site. Demonstration of the presence and extent of the cavities and their size and form was thereby achieved.

The toxicity of non-ionic water-soluble monomeric and dimeric contrast media in selective vertebral angiography. An experimental study in rabbits.

Selective vertebral angiography was performed in 29 rabbits in order to compare the adverse effects of three monomeric (iopamidol, iopromide, metrizamide) and one dimeric (iodecol) non-ionic water-soluble contrast medium. The dose was 10 ml and the iodine concentration 350 mg/ml. Marked, but transitory changes were seen in the electrocardiographic and blood pressure recordings with all the contrast media. The monomers seemed to have a higher tendency than the dimer to cause spasm in the intracranial arteries, while the changes in the cardiovascular recordings were more marked with the dimer. One animal died and one animal developed a permanent neurological deficit following the injection of the dimer. All the other animals recovered completely and seemed quite unaffected within half an hour after completion of the experiment.

Adverse side effects of metrizamide and iopamidolo in myelography.

Nonionic water-soluble contrast medium, at first metrizamide and later Iopamidolo was used for lumbar myelography. Three serious neurological complications were noted: one case of total aphasia, one case of generalized seizures, and one of myoclonic jerking of the legs.

Cervical myelography with iopamidolo.

A new non-ionic water-soluble contrast medium was used for cervical myelography in 65 patients. The contrast medium was injected suboccipitally or by the latent C1-C2 approach. The films were of equally good quality as those obtained with other contrast media and tolerance has been superior. The contrast medium is Iopamidolo and is available in ampoules which is further positive quality.

Clinical cardiovascular experiences with iopamidol: A new non-ionic contrast medium

Iopamidol, a new non-ionic water-soluble contrast medium, has been compared with standard ionic media in a number of cardiovascular applications. It is stable in aqueous solution, is much less viscous and only slightly more osmolar than metrizamide. Compared to sodium meglumine diatrizoate in a series of 40 coronary arteriograms, it produced a consistent and highly significant decrease in the incidence and severity of hypotension and bradycardia following intracoronary injection. In the same group and in 62 children undergoing ventricular or great vessel angiocardiography, a subjective assessment of patient reaction showed that iopamidol was better tolerated than the ionic medium. There was a very strong patient preference for iopamidol in a group of 20 of the adult patients who had also consented to femoral artery injections of both media. Throughout these series there was no detectable difference in arterial image quality between the media. Venous phase opacification during arterioportography was assessed in 11 cases comparing iopamidol with sodium meglumine iothalamate. No significant difference was found. We conclude that iopamidol is clearly preferable to ionic media for routine cardiovascular applications.

Experience from 10 Years of Development of Water-soluble Nonionic Contrast Media

Some experiences are presented from 11 years of work within a group trying to develop better water-soluble contrast media for myelography, urography, and angiography. The group consisted of chemists, pharmacologists, neurophysiologists, and radiologists interested in research. The first nonionic water-soluble contrast medium in clinical use, metrizamide (Amipaque), was developed within the group. Some data obtained within the group are presented. Interest is focused on effects of clinical and experimental contrast media on the central nervous system, arachnoid membrane, and blood-brain barrier.

Pediatric metrizamide ventriculography.

Although computerized cranial tomography (CT) is useful for the diagnosis of hydrocephalus and various fluid-containing intracranial cysts. CT cannot always define the functional relationship of the cyst to the normal CSF pathways. In such cases, ventriculography may be necessary to determine proper treatment. Metrizamide, a nonionic water-soluble contrast medium, has been used for myelography and ventriculography in adults and for myelography in children. Eleven children have been ventriculograms using metrizamide with conventional roentgenographic techniques. Diagnostic information was obtained in all but one study. No major complications occurred.

Metrizamide in High-Dose Urography

The non-ionic water-soluble contrast medium metrizamide (Amipaque) was used for high-dose urography in 11 patients with apparently normal renal function. Films of good quality were obtained. Adverse reactions and the effect on pulse and blood pressure as well as a large number of blood and urine laboratory parameters were recorded. Only clinically insignificant effects occurred, and the medium is recommended for further use in urography.

Clinical evaluation of metrizamide for neuroradiology in children

Metrizamide is a nonionic water-soluble contrast medium for neuroradiological studies that is less irritating to the nervous system than other water-soluble agents. Studies in adults have shown that metrizamide has advantages over currently available media, but experience with children has been limited. Sixty-two children have had myelography or ventriculography using metrizamide. The children ranged in age from 11 days to 22 years. Technically satisfactory studies were obtained in every patient. No major complications were encountered. Minor side-effects included headache in 11 children (18%), mild nausea or vomiting in 16 children (26%), and fever in 4 children (6%). Seizures did not occur. One infant in the study subsequently died of unrelated problems; there was no evidence of arachnoiditis at postmortem examination. Metrizamide is a safe, effective contrast medium for neuroradiological use in children.