Sodium Meglumine Diatrizoate Research Articles

Retrograde Urethrography with Diatrizoate Meglumine Sodium for Detection of Xanthine Urethrolithiasis in Dalmatian: A Case Report

Retrograde Urethrography with Diatrizoate Meglumine Sodium for Detection of Xanthine Urethrolithiasis in Dalmatian: A Case Report

Adverse reactions to intravenous iodinated contrast media: a prospective study

Background: Adverse reactions to intravenous iodinated contrast media may be classified as general and organ-specific, such as contrast-induced nephrotoxicity. General adverse reactions may be sub classified into acute and delayed types. Acute general adverse reactions can range from transient minor reactions to life-threatening severe reactions. This study was done to determine clinical adverse effects of the iodinated contrast media. Methods: Data of 899 consecutive patients at C.U. Shah Medical College and Hospital, Surendranagar, who received sodium meglumine diatrizoate intravenous iodinated contrast media during the period of May 2011 to April 2012, were collected for any adverse drug reactions. Results: Out of 899, 189 patients developed adverse contrast reactions. The incidences of mild, moderate and severe adverse reactions were 19.47%, 1.33% and 0.28%, respectively. There were no differences in the incidence of adverse reactions according to gender (males 21.1%; females 20.7%; p = >0.05) or age ( p = >0.05). The incidence of adverse reactions was significantly higher in patients with a history of previous reactions (50%) than in those with no history (21.25%; p = <0.05). Conclusions: The skin was the most commonly affected site of reactions. In reactions, mild forms were more common compared to moderate and severe.

Prospective Randomized Trial of Iohexol 350 Versus Meglumine Sodium Diatrizoate as an Oral Contrast Agent for Abdominopelvic Computed Tomography

To compare the efficacy and patient tolerance of iohexol and meglumine sodium diatrizoate as oral contrast agents for computed tomography (CT). One hundred patients were randomly assigned to drink 1000 mL of either meglumine sodium diatrizoate or iohexol 350 before their abdominopelvic CT examination. The images were evaluated independently and in a blinded fashion by 2 radiologists who scored the extent and density of bowel opacification. Attenuation value measurements were obtained in representative areas of each gastrointestinal tract segment (stomach, duodenum, jejunum, ileum, and colon) by a research technologist. Patients' tolerance of the oral contrast agent was assessed through a questionnaire administered immediately after the CT and with a follow-up phone call 2 to 3 days later. For most of the bowel, there was no statistically significant difference in the extent or degree of opacification between the 2 contrast agents. Opacification of the ileum was better with iohexol. There was no statistically significant difference between the 2 agents in adverse effects. Patients had a small but statistically significant preference for the taste of iohexol. Iohexol 350 is a satisfactory oral contrast agent for abdominopelvic CT. It opacifies the gastrointestinal tract as well as meglumine sodium diatrizoate does, and patients prefer the taste of iohexol to that of diatrizoate.

The effect of &lt;i&gt;In Vivo&lt;/i&gt; intravenous administration of Sodium meglumine diatrizoate on some haematological parameters

To investigate the in-vivo effects of intravenous administration of sodium meglumine diatrizoate on some haematological parameters in a Nigerian population. Blood samples were collected before and one hour after intravenous injection of sodium-meglumine diatrizoate from 50 subjects undergoing intravenous urography examinations who had no history of and laboratory confirmed diseases that may affect haematological parameters. Standard laboratory methods were used to assay the haemoglobin concentration (Hb), packed cell volume (PCV), total white blood cell (WBC) count and differentials and blood film for any morphological changes in the red blood cells (RBC). Comparisons were made between the mean values of these haematological parameters before and one hour post injection using paired t-test for any statistically significant differences. There were statistically significant reductions in the mean values of Hb concentration and the neutrophil count one hour post injection compared with their pretest values (p < 0.05). The lymphocytes were also significantly increased post injection compared to the pretest values whereas 70% of the erythrocytes were morphologically altered from their approximately 100% normocytic shape at pre-test. Intravenous administration of sodium-meglumine diatrizoate causes in-vivo reduction in Hb concentration and neutrophil count in humans as well as poikilocytosis of the erythrocytes. Some of these effects have the potential of triggering or exacerbating crisis in a sickle cell anaemia subject which is endemic in our locality. Caution should therefore be exercised in the choice and administration of radiological contrast agents to sickle cell subjects. Preparations that are iso-osmolar with plasma and have less probability in precipitating crises should be preferred instead.

Adverse reactions to radiocontrast media in an Indian population.

This study was conducted to determine the epidemiological characteristics and clinical presentation of adverse reactions to intravenous radiocontrast media (CM) in patients of Indian origin. 379 of 1798 patients who received either sodium iothalamate or sodium meglumine diatrizoate developed adverse reactions (i.e. 21.08% of patients). The incidence of mild, moderate and severe adverse reactions were 19.47%, 1.33% and 0.28%, respectively. One patient who developed a severe reaction expired. There were no differences in the incidence of adverse reactions according to gender (males 21.2%; females 20.8%; p = 0.907) or age (p = 0.876). The incidence of adverse reactions was significantly higher in patients with a history of previous reactions (45.5%) than in those with no history (20.9%; p = 0.046). The incidence of reactions was also significantly higher in patients with a history of predisposing factors such as bronchial asthma (69.2%) and diabetes mellitus (60.0%) than in those without such a history (20.6%; p = 0). The incidence of adverse reactions in patients who received premedication prior to CM administration because of a history of predisposing factors (21.4%) was not significantly different from that in patients who were not premedicated (21.2%; p = 0.974), a result probably due to inadequate premedication used in the study. The skin was the most commonly affected site of reaction.

Similar cytogenetic effects of sodium-meglumine diatrizoate and sodium-meglumine ioxithalamate in lymphocytes of patients undergoing brain CT scan

Cytogenetic effects of two ionic contrast media (CM), Urografin 76% a sodium-meglumine diatrizoate, and Telebrix 38, a sodium-meglumine ioxythalamate, were tested on lymphocytes of patients undergoing brain CT Scan. Both compounds have approximately similar iodine concentrations. Chromosomal aberrations were scored in peripheral lymphocytes obtained from 15 patients undergoing brain CT with either urografin 76% or telebrix 38 before and after examination. Results showed no difference in aberration frequency for patients who underwent brain CT without contrast materials compared to controls. However, injection of CM resulted in a high frequency of chromosomal aberrations which significantly differed from controls ( P<0.05). The effect of urografin 76% appeared to be similar to telebrix 38. Therefore, both CM exhibited clastogenic effects on peripheral lymphocytes in vivo. An increase in chromosomal aberrations due to CM used in this study were similar to that reported for other ionic and non-ionic compounds.

Intussusception Associated with Yersinia enterocolitica O:3 Infection: Two Case Reports

We report 2 patients with intussusception due to infection byYersinia enterocolitica. A 3-year-old girl was reduced by a meglumine sodium diatrizoate enema andY. enterocolitica (serotype O:3) was isolated from her stool. Although she was treated with fosfomycin for 3 days, the organism was not eradicated from the bowel. She experienced repeated intussusception on hospital days 10 and 11. A colonoscopy examination on hospital day 13 found many polypoid lesions from the terminal ileum to the ascending colon. The histopathology of a biopsied lesion demonstrated nonspecific lymphoid follicular hyperplasia and gramnegative bacilli surrounded by an infiltration of inflammatory cells in the lamina propria. The child was treated with cefotaxime which eradicated theY. enterocolitica. No other organisms were isolated from stool samples and she has not had further intussusception. The second patient was a 2-year-old girl who was similarly reduced by a meglumine sodium diatrizoate enema, andY. enterocolitica (serotype O:3) was isolated from her stool. The patient was treated with cefotaxime which eradicated the organism. After treatment,Y. enterocolitica was not isolated from stool samples and she did not have intussusception.

The SHR as a Small Animal Model for Radiocontrast Renal Failure. Relation of Nephrotoxicity to Animal's Age, Gender, Strain, and Dose of Radiocontrast

The male spontaneously hypertensive rat (SHR), as it ages, suffers many of the renal and cardiovascular complications that are recognized in humans as risk factors for radiocontrast (RC) agent induced renal failure (RF). Knowledge of this led us to test this strain of rats as a small animal model for RC-induced renal failure (RC-RF). Functional studies demonstrated a significant fall in GFR in the recovery period after RC administration. In addition, histopathologic evaluation of the kidneys was done in this study. Our results are based on assigning separate scale values to the histopathological evaluation of the (a) glomeruli, (b) tubules, (c) interstitium, and (d) arteries and arterioles of the kidneys. Saline (S) was administered to one group and the RC agent Hypaque-76 (diatrizoate meglumine sodium) to paired groups of 5-, 8-, 10-, 12-, and 14-month-old male SHR. The results indicated that younger animals (5 and 8 months old) were resistant to the nephrotoxic effects of the RC, but developed susceptibility at 10 months of age, when spontaneous renal pathology became manifest. Both spontaneous renal pathology and RC-induced renal damage (RC-RD) increased as the animals aged. In addition, when the administered dose of RC was repeated after a short interval of only 6 h, the degree of RC-RD increased greatly. In parallel control studies of the influence of gender and strain on the response to RC in 12-month-old rats, neither hypertensive female SHR nor male normotensive Wistar-Kyoto (WKY) rats demonstrated significant spontaneous renal pathology or the marked susceptibility to RC nephrotoxicity shown by their male SHR counterparts.This small animal model for RC-RD, the mature male SHR, has the distinct advantage that risk factors for RC-RD, similar to those characterized in humans for RC-RF, develop spontaneously without requiring any special treatment or surgical intervention.

Local and Systemic Effects of Water-Soluble Contrast Media and Barium in Rats with Chronic Small Bowel Obstruction

The local effects on the small intestine and systemic changes produced by different contrast media in small bowel obstruction, with time courses of 4 days, were evaluated. Four groups, each with 10 normal rats and another four groups (also each with 10 rats) that had ligation of the terminal ileum (obstructed rats) for 4 days were given 3 mL of barium, meglumine sodium diatrizoate, iohexol, or saline (control animals). Radiographs were taken immediately, 1 and 4 hours after administration of contrast media. Immediately before sacrifice, blood samples were taken to determine the hematocrit (Hct), hemoglobin (Hb), white blood cell count (WBC), red blood cell count (RBC), and serum sodium, and potassium and chloride concentrations. Specimens of small bowel were taken for histologic and morphometric analysis. In obstructed rats, the image quality with iohexol improved on final radiographs despite being diluted in the great intestinal contents. There was an improvement in the serum electrolyte concentrations in the obstructed animals that were given any one of the contrast media, the best improvement being in the iohexol groups. A shortening of the length of epithelial cells when any one of the contrast media was administered was observed, as was an increase in the lymphatic space area in the diatrizoate group in normal rats. In the bowel proximal to the obstruction, the lymphatic space area was increased in the diatrizoate group and the size of the epithelial cells was higher in the diatrizoate and iohexol groups compared to the barium and saline groups. Our results suggest that iohexol offers good radiologic efficacy and excellent systemic and local tolerance in small bowel obstruction.

Intravascular Contrast Media and Thrombin Generation

This study focuses on the effect of contrast media (CM) on thrombin generation. In vitro studies consisted of incubating nonanticoagulated whole blood with ionic CM (sodium meglumine diatrizoate, ioxaglate), nonionic CM (iohexol, iopamidol) or glucose in plastic tubes. Thrombin generation was assessed by measuring F1 + 2, ATM and FpA levels in plasma using ELISA assay kits. In a separate protocol, the procoagulant activity of 3 nonionic CM (iohexol, iopamidol, and iopromide) was investigated by one-stage plasma recalcification time method. Rabbit brain tissue thromboplastin and physiologic saline were used as standard and experimental controls. Incubation of ionic and nonionic CM with whole blood did not enhance thrombin generation compared to glucose control. Similarly, the plasma recalcification times were not significantly shortened by either of the 3 nonionic CM tested. These studies suggest that ionic and nonionic CM exhibit different levels of anticoagulant properties in vitro and the latter are not procoagulant materials.

Interaction between Beta-Blockers and Contrast Media during Intracoronary Administration in Rabbit Heart

The effects of ionic, meglumine sodium diatrizoate (Urografin 76) and nonionic, iohexol contrast media were examined in the absence and presence of propranolol, a beta-blocker having nonspecific membrane stabilizing action and atenolol, a beta-blocker lacking nonspecific membrane stabilizing action on Langendorff-perfused rabbit hearts. Contrast medium, 0.7 ml, was injected into the aortic root in the absence and presence of 10(-7) and 10(-5) M beta-blocker to observe the changes in resting tension, force of contraction, rate of contraction, heart rate and PR interval. Beta-blockers and contrast media interact in affecting myocardial contractility, heart rate and atrioventricular conduction. The interaction is milder when the beta-blocker lacks membrane stabilizing activity and the contrast medium is nonionic.

Intravascular contrast media and thrombin generation

This study focuses on the effect of contrast media (CM) on thrombin generation. In vitro studies consisted of incubating nonanticoagulated whole blood with ionic CM (sodium meglumine diatrizoate, ioxaglate), nonionic CM (iohexol, iopamidol) or glucose in plastic tubes. Thrombin generation was assessed by measuring F1 + 2, ATM and FpA levels in plasma using ELISA assay kits. In a separate protocol, the procoagulant activity of 3 nonionic CM (iohexol, iopamidol, and iopromide) was investigated by one-stage plasma recalcification time method. Rabbit brain tissue thromboplastin and physiologic saline were used as standard and experimental controls. Incubation of ionic and nonionic CM with whole blood did not enhance thrombin generation compared to glucose control. Similarly, the plasma recalcification times were not significantly shortened by either of the 3 nonionic CM tested. These studies suggest that ionic and nonionic CM exhibit different levels of anticoagulant properties in vitro and the latter are not procoagulant materials.

Contrast Bolus Dynamic Computed Tomography for the Measurement of Solid Organ Perfusion

The authors have investigated the aortic responses to various intravenous bolus injections of nonionic and ionic contrast media and have presented data illustrating the potential of ultrafast computed tomography (CT) to quantify perfusion in the kidney, liver, and spleen. Bolus Dynamics Study: Performed in 3 healthy dogs (weight: 35 kg to 36 kg). In 2 dogs, 15 mL of the nonionic agent iohexol and the ionic agent sodium-meglumine diatrizoate were injected at 5, 10 and 20 mL/sec via a venous catheter placed in the superior vena cava; the order of injection was alternated between the 2 dogs. In the third dog, 25 mL of iohexol 300 mg I/mL was compared with diatrizoate 370 mg I/mL with injection rates of 10 and 20 mL/sec. Computed tomography scanning at the level of the midabdominal aorta was performed using an ultrafast CT scanner. Time-density curves were drawn for regions of interest over the aorta, and gamma-variate fits performed. Perfusion Studies: Dynamic perfusion scans of the upper abdomen were performed in more than 50 patients. A dose of 25 mL of iohexol 300 mg I/mL was injected at 10 mL/sec via an intravenous cannula in the antecubital fossa, followed immediately by 25 mL of saline, at the same rate. Scanning was performed at a single level using an ultrafast CT scanner. Regions of interest were drawn and gamma-variate fits were applied to the vascular time-density curves. Bolus Dynamics: Excellent curve fits for aortic time-density curves were obtained. A 10-mL/sec versus a 5-mL/sec bolus produced an 8% higher peak density. Nonionic contrast increased the peak density by a mean of 6%, increased the area under the corrected time-density curve by a mean of 22%, and lengthened the increase time by a mean of 21%. Perfusion Studies: Values obtained were reproducible and correlated well with values predicted from inert gas washout techniques. Changes in the CT number in a region after an intravenous injection of contrast medium may be used to calculate blood flow per unit volume of tissue. Ultrafast CT offers sufficient data points for accurate calculation. The quality of the aortic bolus is of great importance. Nonionic media offer several important advantages: hemodynamic perturbation is minimized, and they are better tolerated at the high injection rates needed. Low-osmolality nonionic agents produce "better" curves than conventional high-osmolality ionic agents, all other factors being equal. The resulting data are relevant to intravenous digital subtraction angiography and indirect portography as well as to perfusion measurement. The technique of quantitative dynamic CT is theoretically applicable to any cross-sectional modality, notably magnetic resonance.

Repeated intracoronary injections of contrast media. Additive hemodynamic and electrophysiologic effects in a dog model.

Coronary arteriography in patients implies several selective injections into the coronary arteries. The authors investigate whether repeated injections cause additive cardiac hemodynamic and electrophysiologic effects in dogs. Five repeated injections of 5 mL iohexol (Omnipaque 350 mgI/mL, Nycomed Imaging AS, Oslo, Norway), ioxaglate (Hexabrix 320 mgI/mL, Laboratory Guerbet, Cedex, France), and sodium meglumine-diatrizoate (Renografin-76 370 mgI/mL, Squibb Diagnostics, Princeton, NJ) were given into the left coronary artery in 7 anesthetized dogs and were compared with the effects after a 5 mL single injection of the same medium. Left ventricular (LV) pressures, LV dP/dtmax (inotropy) and epicardial monophasic action potential were recorded, from which monophasic action potential duration (MAPD) was measured. Repeated injections of ioxaglate and sodium meglumine-diatrizoate did not potentiate initial decrease in LV pressures and inotropy, but the secondary increase in LV inotropy increased more after repeated injections than after a single injection. Repeated injections of iohexol increased LV inotropy more than a single injection. All contrast media prolonged MAPD more after repeated injections than after single injections. MAPD was prolonged 30 sec after the last injection. Repeated injections of contrast media cause greater cardiac hemodynamic and electrophysiologic effects than a single injection during selective coronary arteriography.

Multicenter trial of ionic versus nonionic contrast media for cardiac angiography

Contrast agents used for cardiac anglography are different in regard to ionicity, osmolality and physiologic effects. The nonionic contrast media have been shown to have less toxic effects and a better safety profile than do higher osmolar agents. To better assess this risk, clinically stable patients undergoing cardiac anglography were stratified according to the presence of diabetes mellitus, and level of serum creatinine, and then randomized to receive either iohexol (Omnipaque 350 TM) or sodium meglumine diatrizoate (Renogratin 76 TM). All adverse events that occurred during and immediately after anglography were tabulated. A multivariate model was used to identify patients at increased risk for adverse outcome. The 1,390 patients were randomized to iohexol (n = 696) or diatrizoate (n = 694). Significant differences were found in the number of patients with contrast media-related adverse (iohexol vs diatrizoate:10.2 vs 31.6%; p <0.001) and cardiac adverse (7.2 vs 24.5%; p <0.001) events. Severe reactions and the need for treatment were more frequent with diatrizoate than with iohexol, but there was no difference in the incidence of death. The presence of New York Heart Association classification 3 or 4 and serum creatinine ⩾1.5 mg/dl predicted a higher incidence of adverse events as a result of contrast media alone. Use of iohexol is associated with a lower incidence of all types of adverse events during cardiac anglography than is diatrizoate.

Assay of radiographic contrast agents in mice plasma and testes by high-performance liquid chromatography

A new buffer system is reported for the analysis of radiographic contrast agents (RCAs) sodium meglumine diatrizoate, iohexol, and iopamidol in mice plasma and testes, on a reversed-phase HPLC with UV detection. The buffer consisting of 0.1 M NaH2PO4, 0.2 mM Na2EDTA adjusted to pH 3.1 with orthophosphoric acid and 2.5-5.0% acetonitrile (v/v) resolved RCA peaks for clear quantitation. The main advantages of this system are the ambient temperature of operation and direct sample injection without prior sample purification as required in the earlier procedures. Using this procedure, uptake and clearance kinetics of these RCAs were studied in mice plasma and testes, following iv injections via tail veins. The plasma levels of all the RCAs reached maxima between 5 and 15 min and dropped down sharply. At the end of 12 h they were virtually undetected (detection limits 0.64-0.71 micrograms/mL). The testicular levels also showed a similar trend and reached undetectable levels after 4 h. There were no signs of metabolism of these RCAs in plasma or testes. The present clearance kinetics in plasma compares very well with earlier reports of non-HPLC methods of assay.

Injection Characteristics and Downstream Contrast Material Distribution of Flush Aortography Catheters: In Vitro Study

Performance of 11 commercially available 4- and 5-F aortic flush catheters was evaluated with respect to the extent of upstream injection, catheter motion, and downstream homogeneity of a 10-, 15-, and 20-mL/sec bolus of 76% meglumine sodium diatrizoate at room temperature. Tests were made in a pulsatile aortic flow model containing circulating fluid isoviscous to blood. The injection process was recorded on videotape. Homogeneity of the contrast material bolus was determined spectrophotometrically from samples collected from the center and each of the four quadrants of the vessel lumen. Upstream contrast material injection between 1.5 and 7 cm in length emerged from all catheters; it was lowest with one of the "tennis racket" designs from one and a new spiral end-loop design (Halo) from another manufacturer. All catheters, except the most rigid and largest-caliber catheter (5.8 F) showed considerable shaft motion at the higher injection rates. Downstream contrast material mixing homogeneity was always best at the highest injection rate but altogether was better for the Halo catheter than for any other catheter tested. It is concluded that all tested 4- and 5-F aortic flush catheters show some undesirable features, but certain design modifications improve performance and comparative testing is helpful to distinguish such features.

Ionized calcium levels in coronary sinus blood during coronary angiography: effects of four contrast media.

The changes in ionized calcium level in the coronary sinus during coronary angiography were compared for four contrast media (meglumine sodium diatrizoate, iohexol, iopamidol, and meglumine sodium ioxaglate) in 44 subjects. Blood samples were collected before and 5, 15, and 30 seconds after injection of contrast medium into the left coronary artery. The hematocrit and ionized calcium level of each specimen were measured. Meglumine sodium diatrizoate produced the largest changes in hematocrit and ionized calcium level. The time-concentration curve of the hematocrit was similar for all four contrast media, but diatrizoate and ioxaglate produced a prolonged decrease of ionized calcium. The cause of this is not clear, but the phenomenon may be related to differences of ionic status among the contrast media. With respect to maintenance of the ionized calcium level, nonionic low-osmolality contrast medium with added calcium may be preferable for coronary angiography.

A Comparison of Sodium Meglumine Diatrizoate and Iohexol

Hwang Mil, Piao ZE, Malinowska K, Sheu SH, Loeb HS, Scanlon PJ. Effects of intracoronary administration of contrast media on myocardial high-energy phosphate: a comparison of sodium meglumine diatrizoate and iohexol. Invest Radiol 1992;27:35–39. Myocardial ATP, ADP, and AMP were measured from cardiac biopsy in 11 dogs after iniracoronary injection of 6 mL of sodium-meglumine diatrizoate (SMD), iohexol (IOH), or 0.9% sodium chloride (NaCI), and in three of the dogs at baseline before any injection. The ATP at baseline and after SMD, IOH, and 0.9% NaCI were 5.39 ± 0.41, 3.72 ± 0.70, 5.52 ± 0.82, and 5.44 ± 1.40 μmol/g wet weight, respectively. There were significant differences between SMD and IOH (P < .02), and between SMI) and 0.9% NaCI {P < .05). The energy charge of SMD was 0.82 ± 0.08, which differed from 0.89 ± 0.02 for NaCI or 0.9 ± 0.05 for baseline (P < .05), but not from 0.85 ± 0.04 for IOH. In conclusion, diatrizoate caused significant depletions In ATP stores in comparison with iohexol, but there was no significant difference with respect to energy charge. Nonionic contrast media would be preferable for coronary arteriography in patients whose high-energy stores might be depleted from severe ischemia.

Use of Perfluorooctylbromide (PFOB) to Detect Liver Abscesses with Computed Tomography

Although perfluorooctylbromide (PFOB) is known to stimulate macrophages, particulates given intravenously (IV) can inhibit the body's response to infection by blocking the reticuloendothelial system. Since PFOB enhances abscesses on computed tomography (CT), the authors evaluated its safety and efficacy by assessing the mortality and abscess volume in 104 rabbits with intrahepatic abscesses given either PFOB or lactated Ringer's (LR), and by comparing its efficacy to that of 76% meglumine sodium diatrizoate (MSD76). Abscesses were produced by injecting a virulent strain of E. coli into the liver. Two days later, five of the rabbits had died. Of the remaining rabbits, 50 were given 5 g/kg PFOB IV, and 49 were given an equal volume of LR. All rabbits had a CT scan at four and at ten days after infusion. They were killed before the second CT scan. Thirty seconds before being killed, 28 rabbits given LR were given a bolus of 2 ml/kg MSD76 IV. Following CT, rabbits were frozen, sliced, and photographed. Abscess volumes were calculated by digitizing the photographs of the anatomic sections and the CT images. MSD76 enhanced the liver by 105 Hounsfield units (HU) more than the liquefied abscess center. The abscess wall enhanced to the same degree as liver, resulting in nonvisualization of three of six abscesses less than 3 mm in size, and a 30% underestimation of true abscess volume.(ABSTRACT TRUNCATED AT 250 WORDS)