Use Of Radiocontrast Media Research Articles

Radiocontrast Media Hypersensitivity Reactions in Children.

Hypersensitivity reactions to radiocontrast media seem to be rare in children. Furthermore, the use of radiocontrast media in children remains quite safe in terms of the severity of reactions. Since pediatric guidelines are lacking, the diagnostic workup employed in adults could be adapted to children, taking into account that results have not yet been validated in this age group. Specific protocols for risk stratification and management of severe reactions have been proposed so far.

Re-exposure to iodinated contrast media in two patients with prior severe hypersensitivity reaction

Most allergic reactions to iodinated contrast media can be managed using a pre-treatment protocol involving corticosteroids and antihistamines. However, under certain circumstances, patients may experience severe allergic symptoms despite pre-treatment. Two Chinese men with a history of severe contrast allergy and unstable angina underwent a desensitization protocol that allowed for successful percutaneous coronary intervention. Rapid desensitization is an effective and safe strategy that may allow other patients with similar allergies to successfully undergo angiography that requires the use of radiocontrast media.

Efficacy of Atorvastatin in Prevention of Contrast induced Nephropathy in Patients Undergoing Coronary Angiography

Abstract Background The use of radiocontrast media has increased greatly from the past decades for diagnostic radiography and interventional procedures and it is estimated that approximately 60 million people in the world are used radiocontrast media each year. Objective The aim of this study was to evaluate the efficacy of atorvastatin (ATN) 80 mg in the prevention of CIN in patients undergoing angiography. Patients and Methods This study was a prospective, two‑arm, parallel group, controlled, clinical trial. This study has been performed on 100 Egyptian patients. Patients of either sex and aged between 21 and 65 years admitted for coronary angiography from January 2019 to June 2019, the patients had serum cretinine between 1 and 1.5 mg/dl or estimated glomerular filtration rate (eGFR > 60 ml/min/1.73m2) and suffering from controlled DM or HTN. Results As regard to prevalence of contrast nephropathy, in our study we found that the total prevalence was 13%. We have concluded a great effect of diabetes on development of contrast nephropathy. We have concluded a great effect of hypertension on development of contrast nephropathy. There was a great effect of number of vessels affected on development of contrast nephropathy. As regard FBS there was no significant difference between the two groups. Also, there was a highly significant positive correlation between and study markers of acute kidney injury (72 h- Serum creat Delta Serum creat, 72 h- GFR and Delta GFR) and FBS. As regard Contrast media dose there was no significant difference between the two groups. Also, there was a highly significant positive correlation between and study markers of acute kidney injury (72 h- Serum creat Delta Serum creat, 72 h- GFR and Delta GFR) and contrast media dose. In our study there was a highly significant difference between the two groups as regard study markers of evidence of contrast nephropathy (72 h- Serum creat Delta Serum creat, 72 h- GFR and Delta GFR).Also, there was a great effect of on development of contrast nephropathy. In our study there was a highly significant difference between the two groups as regard study markers of evidence of contrast nephropathy (72 h- Serum creat Delta Serum creat, 72 h- GFR and Delta GFR).Also, there was a great effect of on development of contrast nephropathy. Conclusion There was a beneficial significant effect of statin on prevention of contrast nephropathy, also we concluded that age, hypertension, DM, dyslipidaemia, FBS, hemoglobin level, serum uric acid and dose of contrast media are major risk factors for developing contrast nephropathy.

Three-Step Diagnostic Assessment Following Adverse Reaction due to X-ray Contrast Media: An 11-Year Study in 47 Patients

Background: The diagnostic evaluation of adverse reactions occurring after iodinated contrast media is still debated. Immediate, delayed-type immune reactions and non-immune adverse events have to be differentiated. Our aim was to assess a safe three-step routine procedure in a single-center teaching hospital 2010-2021 with a prospective “real- life” outlook. Methods: Forty-seven patients after mild intermediate and severe adverse events were tested in three consecutive days. Skin prick tests with 2 to 5 undiluted media were followed at 24 hours by intradermal testing of 2 different concentrations each (10-2m and 10-3m). The results were red after both 20 and 70 minutes and at 24 hours. On day three one negative medium selected was 1/3 diluted and given intravenously under close observation. Results: The suspected 32 immediate, 11 delayed hypersensitive and 4 non-immune mediated reactors showed 22.3% skin prick test and 62.7% intradermal test positivity, 11 patients were all negative. The 70 minutes reading of intradermal tests modified the results obtained by 20 minutes. In 44.1% of the cases more and more pronounced positivity was found. The highest response rate was achieved by 10-3m solution of contrast media alone or in combination with 10-2m concentration. The only higher (10-2m) revealed 21.2%, while the only late(24 hours) manifesting tests only 8.1% positivity. Intravenous provocation confirmed in 32/38(84.2%) cases the selected alternative. Six cases were mildly positive. After testing the “real-life” versatility was 85% within the next year. Conclusion: The three-step workup shown in a single-center based study was proven useful and enabled repeated use of radio contrast media in problem patients.

Choosing wisely recommendations in nephrology

The German Society of Internal Medicine ("Deutsche Gesellschaft für Innere Medizin", DGIM) founded the Choosing wisely initiative in order to address diagnostic and therapeutic procedures that are frequently inappropriately applied, whether this be in terms of over-, under-, or misuse of health services. The German Society of Nephrology ("Deutsche Gesellschaft für Nephrologie," DGfN) strongly supports the initiative and has contributed five positive and five negative recommendations. These ten recommendations are discussed in the current publication. The positive recommendations reflect the importance of early recognition of renal disease via simple blood and urine tests, the use of radiocontrast media in cases of impaired renal function, as well as the problems associated with low vaccination rates. Three of the negative recommendations are focused on hydration and diuretics. The remaining two negative recommendations concern angioplasty in cases of renal artery stenosis and the unconsidered use of nonsteroidal anti-inflammatory drugs.

Risk factors for contrast-induced nephropathy after coronary angiography.

Contrast-induced nephropathy (CIN) is of concern after the use of radiocontrast media for coronary angiography (CAG) and percutaneous coronary intervention (PCI). We studied the incidence of CIN and its risk factors in patients undergoing CAG. In this prospective study, we included all patients with normal renal parameters undergoing CAG with nonionic radiocontrast media. We excluded patients with known chronic kidney disease, baseline creatinine more than 1.5 mg/dL, significant hypotension, anemia, and patients with acute myocardial infarction undergoing emergency PCI. Serum creatinine was done at baseline and serially for seven days after the procedure. Appropriate statistical tests were used to analyze the results and P <0.05 was considered statistically significant. The study population (n = 500, 348 males and 152 females) had a mean age of 56.6 ± 12.5 years. Twelve patients (2.4%) developed CIN and were equally distributed irrespective of the age, diabetes, or PCI procedure. CIN was observed to be more common in patients with hypertension than in those without hypertension (P = 0.0158). The total volume of contrast administered to CIN group (175 ± 59.3) was not significant as compared to that of non-CIN (159.1 ± 56) group (P = 0.334). None of the patients in our study required renal replacement therapy, and there was no mortality. CIN is observed in 2.4% of patients undergoing CAG and had a self-limiting course. Hypertension is the only observed risk factor, and further large-scale studies are necessary to delineate the novel risk factors for CIN in the general population with normal kidney function.

Advances in technology are changing the future of medicine.

In this October, we are having the most important allergy festival in Asia-Pacific region - the Joint Congress of Asia Pacific Association of Allergy, Asthma, and Clinical Immunology (APAAACI) and Asia Pacific Association of Pediatric Allergy, Respiratory, and Immunology in Kuala Lumpur, Malaysia (October 17–20, 2016, http://www.apaaaci-kl2016.org). Joint Congress will be hosted by the Malaysian Society of Allergy and Immunology. The Era of Allergy: Local and Global Insights and Intervention is the main theme which will make the congress scientifically meaningful. There will be special sessions such as commemorating 50 years since discovery of IgE. It is remarkable that new International Classification of Diseases (ICD)-11 beta phase structure Allergic and hypersensitivity section has been constructed as a result of a detailed and careful action plan based on scientific evidences for the necessity of changes and collaboration with the World Health Organization ICD-11 revision governance [1]. APAAACI is supporting this international collaboration with the World Allergy Organization, the American Academy of Allergy Asthma and Immunology, the European Academy of Allergy and Clinical Immunology, the Latin American Society of Allergy, Asthma and Immunology, and the American College of Allergy Asthma and Immunology [2,3]. Readers of this issue will find an original article on the mapping of ICD-10 allergic and hypersensitivity conditions in the ICD-11 beta phase structure [1]. Readers of this issue will also find a review article on allergen-specific immunotherapy in pediatric allergic asthma [4] and an original article on the mixed house dust mite and weed pollen extract immunotherapy [5]. Immunotherapy with a history of more than 100 years still works for allergy patients. As radiocontrast media (RCM) media induced hypersensitivity is an unpredictable adverse drug reaction, prevention of the recurrence is one of the key components of the management [6]. Avoidance is the best if possible. When you order computed tomography scans using RCM, it is important to find out those who had a history of RCM induced hypersensitivity reactions. A clinical decision supporting system embedded in the electronic medical record system may help [7]. If it is impossible to avoid the use of RCM, the preventive measures are used, for example, 50 mg of oral prednisolone at 13 hours, 7 hours and an hour before injection of RCM, and 4 mg of chlorpheniramine at an hour before the injection if a patient has previous history of severe immediate type RCM hypersensitivity [6]. What about mild cases such as simple urticaria? In this issue, Lee et al. [8] report the efficacy of single premedication with antihistamines for RCM hypersensitivity. Advances in technology are changing the future of medicine. Clinical decision supporting systems have been developed to help clinicians make informed management decisions [7,9]. platform of the clinical decision supporting system has been evolved from simple algorithms to artificial intelligence with neural networking systems. Most recently Watson, the IBM supercomputer, has collaborated with several cancer care providers to help clinicians make informed treatment decisions [10]. In this issue, Kim et al. [11] from Korea report the feasibility of a smartphone application based action plan and monitoring in asthma. According to this article, the patients were satisfied with the information from the smartphone application that they've got right on time. It also showed some beneficial effects such as enhanced adherence. This application was developed by a university hospital. As described in the article [11], a study showed most of applications among 103 applications provided inaccurate information but only 32 applications provided strategies for asthma control. Thus the role of physicians is very important in the development of medical applications. Collaborations between medicine and computer or information science are essential. Readers will find an interesting study of a birth cohort from Singapore on the relationship between all fevers or fever after vaccination and atopy or atopic diseases at 18 and 36 months of age [12] and a study on the elderly asthma from Thailand [13]. This issue of Asia Pacific Allergy also contains an educational case report on allergic bronchopulmonary aspergillosis [14] and a unique case of marking nut anaphylaxis [15].

Intraoral hemangiomas in Sturge-Weber syndrome

Sturge-Weber syndrome is a rare congenital disease also called as encephalo-trigeminal-angiomatosis, caused by persistence of transitory primordial arterio-venous connections of fetal intracranial vasculature. It is characterized by vascular malformations with capillary venous angiomas that involve face, choroid of eye, and leptomeninges. The main clinical features of this syndrome are port-wine stains, glaucoma, convulsions and angiomas of the airway. Anesthesia management is directed towards keeping the intracranial and intraocular pressures normal, avoiding trauma to hemangiomas, and anticipating difficult airway. We discuss the case of a 13-year-old boy with intraoral hemangiomas resulting in difficulty in speech. Patient was scheduled for digital subtraction angiography (DSA) and sclerotherapy of hemangiomas under general anesthesia. The anesthetic considerations during the peri-operative management, including airway problems, multiple changes in patient position during DSA procedure, precautions during use of radio-contrast media and sclerosing agents are highlighted.

Clearance and Safety of the Radiocontrast Medium Iopamidol in Peritoneal Dialysis Patients

Although the characteristics and safety of radiocontrast media in peritoneal dialysis (PD) patients are not yet well defined, their use in PD patients is considered generally safe. In this study, we evaluated clearance and adverse events of iopamidol in PD patients. We measured the iopamidol concentration in the plasma, dialysate, and urine of 11 patients. Iopamidol clearance from patient plasma was delayed with a half-life of 33.3 h, and the elimination ratio was 83.6% for 96 h. We retrospectively investigated adverse events occurring in a total of 50 stable PD patients who underwent a total of 64 angiographic computed tomography (CT) scans. In 64 angiographic CT scans, two cases of adverse events were observed. Our results suggest that iopamidol can be eliminated by regular PD and careful observation for adverse events are necessary for the safe use of radiocontrast media.

Perceptions Of Radiologists On The Association Between Shellfish Allergy And Risk Of Anaphylaxis To Radiocontrast Media In Canada

RATIONALE: There is a pervasive myth in the medical community that shellfish allergy precludes the use of radiocontrast media in diagnostic procedures. A study by Beaty et al. in 2006 in the US demonstrated that 37.2% of polled radiologists and interventional cardiologists share this perception. We sought to determine the strength and or existence of this myth in Canada.

Acute renal impairment following use of intravenous contrast agent: A case report and reminder for increased awareness of the problem

Contrast-induced nephropathy is one of the adverse reactions to the use of radiocontrast media. Its incidence can be reduced if preventive measures are instituted. This report presents a case of acute renal impairment following use of radiocontrast media. We report a case of an elderly hypertensive diabetic who developed acute renal impairment within 24 hours of undergoing an intravenous urography. He was not a known asthmatic and had no previous history of allergy. His renal function improved subsequently with hydration, diuretics and strict input/output monitoring. He was discharged after 23 days in hospital and renal function returned to pre-morbid state 3 months after discharge. The report is a reminder of the possibility of nephropathy associated with the use of intravascular contrast media. There is need for extra care to be taken to identify risk factors in patients that are to undergo intravascular contrast studies and adequate attention paid to these.

Radiocontrast media cause dephosphorylation of Akt and downstream signaling targets in human renal proximal tubular cells

Radiocontrast medium induced nephrotoxicity is a major clinical problem. There is considerable interest in reducing the incidence of acute renal failure due to the use of radiocontrast media (RCM). Reduction of renal blood flow and direct toxic effect on renal tubular epithelial cells have been postulated as major causes of RCM nephropathy. Understanding the molecular mechanisms by which RCM cause cell damage may allow the development of pharmacological therapy to prevent their nephrotoxicity. In this work we have investigated the signaling pathways that may be affected by RCM. The incubation of human renal tubular proximal cells with sodium diatrizoate, iopromide and iomeprol caused a marked dephosphorylation of the kinase Akt on Ser473 within 5 min of incubation. RCM also caused a decrease in cell viability, which was substantially alleviated by transfecting the cells with a constitutively active form of Akt. Further downstream targets of Akt, including the Forkhead family of transcription factors FKHR and FKHRL1, were also dephosphorylated by RCM at Thr24 and Thr32, respectively. The P70S6 kinase was also dephosphorylated at Thr389 and Ser371 by RCM. However there was a more dramatic decrease in phosphorylation of the phosphorylated form of mammalian target of rapamycin (mTOR) and of the extracellular-signal regulated kinases (ERK) 1/2 caused by sodium diatrizoate than by iopromide. These results demonstrate the effect of RCM on some intracellular signaling pathways that may allow understanding of the mechanism of their toxicity and may allow the development of strategies to overcome their adverse effects.

Hypersensitivity reactions to radiocontrast media: The role of complement activation

Although intravenous use of radiocontrast media (RCM) for a variety of radiographic procedures is generally safe, clinically significant acute hypersensitivity reactions still occur in a significant percentage of patients. The mechanism of these anaphylactoid, or "pseudoallergic," reactions is complex, involving complement activation, direct degranulation of mast cells and basophils, and modulation of enzymes and proteolytic cascades in plasma. In this review, basic information on different RCMs and their reactogenicity is summarized and updated, and the prevalence, pathomechanism, prediction, prevention, treatment, and economic impact of hypersensitivity reactions are discussed. Particular attention is paid to the in vitro and in vivo evidence supporting complement activation as an underlying cause of RCM reactions.

Acute renal failure in diabetics.

Acute renal failure in diabetic patients occurs, as a result of certain specific conditions. The most common of these are hyperglycaemic hyperosmolar ‘coma’, diabetic ketoacidosis, the use of radiocontrast media, and renal papillary necrosis. The management of diabetics with acute renal failure is essentially the same as for non-diabetic patients but may be complicated by the problems of metabolic control, vascular access, and vascular instability. Prevention is important as the development of acute renal failure adds considerably to the morbidity and mortality of these conditions and is often avoidable.

Quantitation of some pancreatic juice exocrine proteins in the presence of radiocontrast medium used in endoscopic retrograde pancreatography (ERP).

The endoscopic collection of human pancreatic juice for chemical analysis is facilitated by the use of radiocontrast media. However, the effects of this material on pancreatic juice and the techniques used to analyze its proteins are unknown. This study has demonstrated no detrimental effects of a commonly used contrast medium on the pancreatic juice itself or on the analytic technique of radioimmunoassay and radial immunodiffusion. Likewise, the Phadebas enzymatic technique for amylase was not affected by this material. We conclude that techniques for the collection of pure pancreatic juice using radiocontrast material do not interfere with the analysis of pancreatic juice proteins using the techniques described.