Water-soluble Contrast Medium Research Articles

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.

Esophageal perforation: comparison of use of aqueous and barium-containing contrast media.

To assess the need for follow-up esophagography with barium-containing contrast medium after examination with a water-soluble contrast medium in the detection of esophageal perforation. Sixty-seven patients suspected of having esophageal perforation were examined prospectively with use of an aqueous contrast medium during a 1-year period. The examinations were performed with a digital fluoroscopy unit. Eighteen patients without proved extravasation at esophagography performed with aqueous contrast medium and without other contraindications underwent esophagography with barium-containing contrast medium. In four of 18 patients (22%) with unremarkable findings at esophagography performed with a water-soluble contrast medium, a perforation was detected subsequently with use of a barium-containing contrast medium. No complications related to barium extravasation occurred. Patients suspected of having esophageal perforation and who have unremarkable findings at esophagography with water-soluble contrast media need to undergo follow-up esophagography with a barium-containing contrast medium. The use of a digital fluoroscopy unit does not obviate the follow-up examination.

Assessment of the penile vascular system with color-coded duplex sonography and pharmacocavernosometry and -graphy in impotent men.

To examine the extent to which color-coded duplex sonography permits complete clarification of vessel-dependent erectile dysfunction (ED). A total of 215 patients with ED were examined. All patients underwent pharmacocolor-coded duplex sonography (PHCCDS; 20 micrograms of prostaglandin E1, PGE1, intracavernosally) as well as pharmacocavernosometry and -graphy (PHCM and PHCG; 20 micrograms of PGE1 intracavernosally). The penile vessels were visualized, i.e. the dorsal arteries, the cavernosal arteries, and the anastomoses between them, as well as the venous pathways. Peak flow and end-diastolic flow in all arteries and, when present, anastomoses were determined after stimulation. Induction flow to achieve maximal tumescence/rigidity as well as maintenance flow were determined during PHCM. Finally, for the morphological visualization of the cavenous body and possible venous insufficiencies, a radiography in 2 planes was produced with infusion of a water-soluble contrast medium. In 145 patients with a grade 0-III tumescence after stimulation with 20 micrograms of PGE1, PHCCDS revealed an end-diastolic flow of > 5 cm/s, with a peak flow velocity > 25 cm/s in the 2 cavernosal and 2 dorsal arteries. The deep dorsal vein of the penis was visualized in 110 of these 145 patients with a blood flow > 5 cm/s, and in 35 cases with a blood flow < 5 cm/s. Venous drainage to the corpus spongiosum was visualized in 80 patients with a blood flow > 10 cm/s. All patients had a pathologically increased induction (normal value < 100 ml/min) and maintenance venous flow (normal value < 10 ml/min) in the PHCM as well as venous drainage in the PHCG. Sixty patients with a tumescence grade of IV-V (rigidity) had a peak flow velocity clearly > 25 cm/s, an end-diastolic flow < 5 cm/s in the 2 cavernosal and 2 dorsal arteries in the PHCCDS, as well as induction values < 100 ml/min and maintenance flow values < 10 ml/min in the PHCM, without visible insufficient efferent venous pathways on the PHCG. In 29 patients (13.5%) hemodynamically active anastomoses perforating the tunica albuginea could be detected. Ten patients with a tumescence grade of III had a peak flow velocity < 25 cm/s and an end-diastolic flow < 5 cm/s without venous leakage in PHCM and PHCG. PHCCDS allows for the assessment of arterial flow disorder as well as of venous leakage in ED. PHCM and PHCG should only be carried out in patients in whom surgical or radiological interventional procedures at the efferent venous pathways are planned.

Peritoneocele: visualization with defecography and peritoneography performed simultaneously.

To evaluate the use of simultaneous defecography and peritoneography (defecoperitoneography) in patients with an unexplained widening of the rectovaginal space noted at defecography. Twenty-two patients with unexplained widening of the rectovaginal space noted at defecography were studied with defecoperitoneography. Defecoperitoneography was a combination of defecography and peritoneography with water-soluble contrast medium administered intraperitoneally. The outline and movements of the peritoneum and alterations in the pelvic peritoneal cavity could be visualized with defecoperitoneography during the dynamic act of defecation. Unexplained widening of the rectovaginal space was completely due to a peritoneocele in 14 patients and partially due to a peritoneocele in six patients. In two patients, there was no peritoneocele. Only nine of 22 patients had bowel in the unexplained widening (enterocele). Three patients had a rectal peritoneocele; six, a septal peritoneocele; one, a vaginal peritoneocele; and 10, a combination of these findings. Visualization of the pelvic floor with defecoperitoneography is improved compared with visualization with defecography alone.

Urinary Excretion of Iohexol as a Marker of Disease Activity in Patients with Inflammatory Bowel Disease

Background: Increased intestinal permeability of water-soluble contrast medium during an intestinal follow-through is found in patients with active Crohn's disease in the small bowel. Methods: Urinary excretion of the water-soluble X-ray contrast medium iohexol was measured after oral administration in patients with inflammatory bowel disease and in healthy controls. The patients were grouped on the basis of disease activity and location and extent of intestinal involvement. Results: Urinary excretion of iohexol was significantly higher in patients with active disease than in patients with quiescent disease or in healthy controls (P = 0.005), and it correlated positively with activity indices and with the extent of the disease. Conclusion: The intestinal permeability of iohexol is significantly increased in patients with active inflammatory bowel disease in the small bowel and in the colon, whereas the permeability of patients with inactive disease is similar to that in healthy controls. We suggest that urinary excretion of iohexol can be used as a marker of disease activity in patients with inflammatory bowel disease.

Preclinical Evaluation of an Iodinated Particulate Contrast Agent for Use during Angiography: Work in Progress

To study the feasibility of using an iodinated particulate contrast agent, iodipamide ethyl ester (IDE), for angiography. IDE at doses of 40-100 mg of iodine per kilogram was diluted to a total volume of 5-20 mL and used for digital subtraction angiography in nine dogs under general anesthesia. Equivalent images were obtained by using water-soluble contrast medium (WSCM) for comparison (iohexol) in seven animals. All images were reviewed by blinded reviewers and graded subjectively on a five-point scale. Angiographic studies of multiple vascular territories performed with IDE yielded images of slightly lower overall quality compared with images obtained with WSCM (P = .14, Mann-Whitney U test). Arterial phase images were subjectively superior with WSCM when compared with IDE (P < .0001, chi 2.) Depiction of the corresponding veins during the venous phase on the IDE angiograms was superior to that on WSCM angiograms in 12 of 21 cases, although this did not reach statistical significance (P > .05 chi 2). Images of the renal vein and portal vein achieved with IDE were graded as superior to those achieved with WSCM in eight of 10 reviews. Angiography is feasible with IDE. Compared with WSCM, IDE produced images of lesser quality during the arterial phase, but of equal or superior quality in the venous phase depending on the vessel studied. Because it is excreted slowly in bile and is isotonic, it may prove useful in patients with renal insufficiency, diabetes, multiple myeloma, or severe coronary disease.

Oil-soluble versus water-soluble media for assessing tubal patency with hysterosalpingography or laparoscopy in subfertile women.

There has been debate in the literature for more than 40 years as to whether flushing of the Fallopian tubes enhances fertility and whether this presumed therapeutic effect is greater with oil-soluble media than with water-soluble media. A meta-analysis of the therapeutic role of oil-soluble contrast media at hysterosalpingography was published in March 1994 (Watson 1994). This Cochrane Review is an expansion and update of that overview. To evaluate the effect of flushing the Fallopian tubes with oil- or water-soluble contrast media on subsequent pregnancy rates in infertility patients. 1. For randomised controlled trials (RCTs): we searched the Cochrane Subfertility Review Group specialised register of controlled trials. 2. For non-randomised controlled studies: Medline and manual search of eight relevant journals. Six RCTs and six non-randomised controlled studies. In two studies tubal flushing was compared with no treatment-controls. Eleven studies, comprising a total of 2635 subjects, compared oil- with water-soluble media. Independently by first 2 authors for: 1. Methodological trial characteristics 2. Characteristics of participants 3. the main studied outcome was pregnancy rate per patient In comparison with no treatment, a significant benefit on pregnancy rates was seen by flushing the tubes with oil-soluble media (OR 1.80, 95% CI 1.29-2.50) but not with water-soluble media (OR 0.87, 95% CI 0.50-1.52). In the direct comparison of oil- and water-soluble media the former lead to significantly higher pregnancy rates (OR 1.92, 95% CI 1.60-2.29). The treatment effect appeared similar in RCTs and non-RCTs. Subgroup analysis suggested the therapeutic benefit was greatest for patients suffering from unexplained infertility and least for those with tubal factor infertility. Flushing of the tubes with oil-soluble media increases subsequent pregnancy rates in infertility patients. The hypothesis that tubal "plugs" are a cause of proximal tubal occlusion and that oil-soluble media may flush them out, is supported by new techniques such as falloposcopy. Clinicians should consider flushing the tubes with OSCM before contemplating more invasive therapies.

Acute esophageal food impaction treated by water-soluble contrast esophagography with maneuvers

This report describes a case of acute esophageal food impaction in the lower esophagus treated by proper physical motions during esophagography using water-soluble contrast medium (WSCM). WSCM was used to avoid the complication from unexpected perforation during the examination. Relief of esophageal obstruction may be accomplished by asking the patient to jump up and down on the ground. Esophagography using WSCM combined with appropriate physical motions may be helpful in treating patients suffering from acute esophageal food impaction.

Enterocele revealed by simultaneous evacuation proctography and peritoneography: does "defecation block" exist?

Pelvic floor weakness may allow prolapse of the bowel into the rectogenital space, forming an enterocele. Enteroceles are believed to obstruct defecation by rectal compression and are therefore considered an abnormal finding on evacuation proctography. With a technique combine evacuation proctography and peritoneography, we prospectively studied constipated patients to reveal the pelvic peritoneal recesses during evacuation and to determine if enterocele actually impairs rectal emptying. Fifty constipated patients were studied prospectively, Using 20 ml of water-soluble contrast medium, we performed peritoneography, then evacuation protography with 120 ml of intrarectal paste. Lateral evacuation and posteroanterior stress views were analyzed by computerized video capture. Anatomic features and functional measurements of rectal emptying were noted. Posteroanterior views were compared with views in 31 subjects undergoing peritoneography for investigation of groin pain. Technical failure in three patients left 47 for analysis. A deep rectogenital pouch was seen in 36 patients (77%). Of these, 12 (58%) contained viscera that formed an enterocele, but the remaining 15 patients (42%) showed no visceral filling. Most pouches were apparent only during straining (31 cases, 86%). Peritoneal descent was greater than in controls (p < .0001), of whom only three had small rectogenital pouches. Patients with enterocele were compared with those who had a rectogenital pouch but no visceral filling and those who had no pouch. Standard anatomic measurements by evacuation proctography were not significantly different, but patients with enterocele evacuated more rapidly (p = .008) and completely (p = .021) than did the other two groups. Combined evacuation proctography and peritoneography is a new technique to diagnose pelvic hernias that occur during evacuation. This technique has shown that a deep rectogenital pouch is common in constipated patients and that just over half such pouches fill with viscera. However, because an enterocele does not impair rectal evacuation, this proctographic finding should be interpreted with caution.

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.

Targeting of Different Ethiodized Oil–Doxorubicin Mixtures to Hypovascular Hepatic Metastases with Intraarterial and Intraportal Injections

The distribution of different ethiodized oil-doxorubicin mixtures within and around hypovascular liver metastases in athymic nude mice was compared following either intraarterial or intraportal injections. Six different mixtures of doxorubicin and ethiodized oil in water-soluble contrast material, shaken for 5, 10, 15, and 30 minutes, respectively, were prepared and the size of the oil droplets in the mixtures evaluated. Intraarterial and intraportal injections of mixtures shaken for 10 and 15 minutes were performed in mice bearing hypovascular hepatic colorectal metastases. In vivo video microscopy was used to evaluate microvascular flow and the biodistribution and the size of the oil droplets within and around the tumors. Oil droplets smaller than 20 microns in diameter were taken up by tumor nodules. There was no significant difference in oil droplet accumulation within the tumor between intraarterial and intraportal injections. Oil droplets larger than 20 microns occluded small and medium portal branches. The optimum combination was 0.1 mL of ethiodized oil in 2 mL of diatrizoate sodium meglumine (Renografin-76) shaken for 15 minutes at 800 rpm, which formed droplets smaller than 20 microns (92%). Avascular regions of hepatic metastases may be embolized with ethiodized oil-anticancer drug mixtures containing oil droplets smaller than 20 microns. Since these droplets penetrate to the tumor interstitium with either intraarterial or intraportal injections, chemoembolization via the arterial route seems preferable for treatment of unresectable hypovascular hepatic metastases since it is easier to perform. The conclusions drawn from this study are limited to the animal model for experimental hypovascular hepatic metastases.

Accidental intrathecal injection of ionic water-soluble contrast medium: report of a case, including treatment

Accidental intrathecal injection of ionic water-soluble contrast medium: report of a case, including treatment

The use of a radiopaque contrast medium in endodontic radiography.

A series of in vitro studies were carried out to investigate the use and application of a radiopaque contrast medium in conventional periapical dental radiography for the diagnosis and evaluation of root canal systems. The water-soluble radiopaque contrast medium was introduced into the root canals of 30 first permanent maxillary and 30 first permanent mandibular molar teeth. The radiographic images of these teeth with and without radiopaque contrast medium in the root canal systems were compared and contrasted. Further comparisons were made with the same teeth rendered transparent. The results indicate that by standardizing the diagnostic criteria the inter-examiner reliability was in good agreement; it was independent of the radiographic technique used. The validity of the radiographs was enhanced by the use of the radiopaque contrast medium. The results confirm that, with the use of a radiopaque contrast medium, images of root canal systems are easier to read and interpret than plain radiographic images of root canal systems. The use of radiopaque contrast medium in endodontic radiography may be a valuable aid in the diagnosis and evaluation of root canal systems. This system would complement rather than replace plain radiography.

Water-soluble contrast material has no therapeutic effect on postoperative small-bowel obstruction: Results of a prospective, randomized clinical trial

Hyperosmotic water-soluble contrast materials have been fo und to be helpful diagnostic tools in postoperative small-bowel obstruction (POSBO); however, their therapeutic value remains controversial. A prospective, randomized clinical study was conducted to examine the use of meglumine ioxitalamate as a supplement to the standard conservative treatment of POSBO. Patients with POSBO (n = 50) suitable for a conservative approach were randomized to receive standard conservative treatment with (n = 25) or without (n = 25) the addition of 100 mL of meglumine ioxitalamate via the nasogastric tube (patients with diffuse carcinomatosis and early POSBO were excluded). Both groups were compared for resolution of obstruction, need for surgical relief of obstruction, and complications. Seven (14%) patients required surgery: 3 in the contrast material group and 4 in the control group (P = not significant [NA]. Resolution of symptoms was achieved in nonsurgical patients within an average of 25.7 hours in the contrast material group and 28.7 hours in the control group (P = NS). There was no mortality in this study. In 2 (4%) patients (1 in each group), strangulated bowel was found during surgery, but only the 1 (2%) patient in the contrast material group required bowel resection. No difference was found in the length of hospital stay or rate of complications. There were no complications that could be attributed to the use of the contrast material itself. Although water-soluble contrast material is a safe and useful diagnostic tool, it offers no advantage as a supplement to the usual conservative treatment of POSBO.

The X-ray contrast medium iodixanol detects increased colonic permeability equally well as 51Cr-labeled ethylenediaminetetraacetic acid in experimental colitis of rats.

Non-ionic, water-soluble radiographic contrast media have been suggested as intestinal permeability probes. We studied the permeability of the isosmolar contrast medium iodixanol and 51Cr-labeled ethylenediaminetetraacetic acid (EDTA) from the non-perforated colon after induction of colonic inflammation. Colonic inflammation and ulcerations were induced by luminal colonic instillation of trinitrobenzenesulfonic acid, dissolved in 40% ethanol. Controls received saline. Fourteen days later iodixanol, 320 mg I/ml, and 51Cr-EDTA were given as an enema. Urine was collected for the subsequent 6 h and subjected to high-performance liquid chromatography and gamma activity counting. Urinary recovery of iodixanol and 51Cr-EDTA increased gradually with severity of the colonic inflammation. The correlation between iodixanol and 51Cr-EDTA recovery was strong (corr.coeff = 0.97). Iodixanol shows as good properties as 51Cr-EDTA when used as intestinal permeability probe in the inflamed and ulcerated rat colon. Use of the radiopaque properties of iodixanol enable intestinal probe exposure registration by film or fluoroscopy.

Untersuchungstechnik der sonographischen Kontrolle des Pharynxverschlusses nach Laryngektomie*

The pharyngocutaneous fistula presents the most common complication after laryngectomy. Despite applying methods of pharyngeal closure, local factors such as irradiation may cause healing disturbances and the development of pharyngeal fistula. Before the nasogastric feeding tube is removed, an additional radiologic control with water-soluble contrast medium is recommended in literature in case of normal clinical healing.The radiologic method was compared with a newly developed sonographic examination technique. Using the so-called "aerophagia maneuver" in sonography, an arising of peripharyngeal air before the "aerophagia maneuver" or a peripharyngeal mass lesion was an uncertain criterion for a pharyngeal fistula. Peripharyngeal air may be seen also due to infection with anaerobic bacteria, and peripharyngeal mass lesion may be caused by seroma or hematoma. In sonography, tissular air is seen typically, in a hyperechoic reflex with distal repetitions.Radiologic examination of the pharynx in 18 laryngectomy patients revealed fistulas in three cases.Our experiences have shown so far that sonographic examination in combination with the so-called "aerophagia maneuver" prove to be reliable or ascertaining pharyngeal closure after laryngectomy.

Self-Expanding Nitinol Stent for Malignant Obstructive Dysphagia–Initial Experience

Between July 1992 and December 1994, a total of 31 patients with inoperable or unresctable malignant obstruction of the esophagus or esophagogastric junction were palliated with self-expanding nitinol stents. They were 33 to 86 years old, 55% being 70 years or older. Twenty patients were male. Twenty patients (65%) had squamous cell carcinoma, 10 (32%) had adenocarcinoma and one (3%) had undifferentiated carcinoma. Twenty-five patients (81%) required prestenting dilatation with balloons, bougies or laser. Stent implantation was successful in 30 patients (97%) but failed in one. Two patients had minor complications and one patient with advanced disease died in the hospital one week after the procedure. All stended patients experienced significant short-term relief of dysphagia. Twenty-two patients (73%) were seen at least once after discharge in a follow-up visit. Twenty (66%) were still swallowing satisfactorily when last seen four to 32 weeks after stenting. We conclude that the new nitinol stent represents an important and valuable addition to the treatment options available for palliation of malignant dysphagia.

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.

Safety and Pharmacokinetics of Iotrolan in Hysterosalpingography

The authors compared the safety and pharmacokinetics of Iotrolan (water-soluble) in hysterosalpingography (HSG) with those of Lipiodol (oil-soluble). Iotrolan and Lipiodol were administered intraperitoneally at doses of 100 mg iodine/kg to female rabbits. Retention in the body was investigated by x-ray imaging, plasma kinetics, and urinary and fecal excretion. Irritability in the abdomen was investigated by histologic examination. Iotrolan was entirely excreted into the urine within 2 days after administration. Conversely, Lipiodol was excreted into the urine, had a half-life of 50 days, and was retained for more than 21 days in the abdomen. Iotrolan induced no inflammatory reaction in the abdomen, whereas Lipiodol induced a marked abdominal inflammatory reaction, including granuloma formation. Iotrolan had no effect on iodine concentration in the thyroid; Lipiodol increased iodine concentration significantly. Iotrolan, which is a water-soluble and nonionic dimeric contrast medium, has potential greater safety for use in HSG than Lipiodol.

Intracolonic pressure measurements during hydrostatic and air contrast barium enema studies in children.

To prospectively evaluate intraluminal pressure changes in the colon of children undergoing conventional hydrostatic (barium and water-soluble contrast material) and air contrast barium enema studies. Dynamic intracolonic pressure was measured in 26 children undergoing hydrostatic barium (23% wt/vol) enema studies, air contrast barium enema studies, or water-soluble contrast material enema examinations. Measurements were obtained with a measuring device capable of recording rapid changes in pressure. Pressure measurements were obtained with the contrast reservoir system open (contrast material was free to run through the tubing into the patient's colon) and closed (tube was clamped). The colonic pressures during the filling phase with liquid contrast material were equal to those elsewhere at the same level with the hydrostatic system. Mean pressure ranged from 30 to 50 mm Hg with peaks of more than 100 mm Hg during Valsalva maneuvers. During air contrast barium enema studies, sharp pressure increases and rapid swings in the intracolonic pressure occurred during and after manual insufflation of air. During conventional hydrostatic barium enema studies, intracolonic pressures remain low. During air insufflation, there were intermittent high, sharp pressure peaks.