[Contrast media in peripheral angiography: does cost reduction mean loss of quality and safety? A reevaluation based on a randomized double-blind comparative study of ioxaglate versus iopromide]. / Kontrastmittel in der peripheren Angiographie: Bedeutet Kostenreduktion Verlust an Qualität und Sicherheit? Eine Reevaluierung anhand einer randomisierten Doppelblind-Vergleichsstudie von Ioxaglat versus Iopromid.

PURPOSE: To evaluate whether meglumine-sodium-ioxaglate (Hexabrix) and iopromide (Ultravist) are identically appropriate for peripheral angiography. Outcome variables were pain, image quality and adverse events. METHODS: Sixty patients were included in a randomised double-blind study. In all patients an intraarterial digital subtraction angiography (i.a. DSA) of iliac and peripheral arteries was performed. RESULTS: Analysis of the study revealed no significant difference between both contrast media in terms of the main and additional outcome variables. In comparison to iopromide, ioxaglate caused milder pain sensations (VAS 4.70 vs. 7.76, p = 0.25). Mild adverse events were observed more frequently in ioxaglate angiography (11% vs. 0%, p = 0.1). CONCLUSION: Both contrast media seem to be appropriate for peripheral angiography using DSA technique. Ioxaglate causes a cost reduction of about 20-35%. However, an increase of mild adverse reactions up to 11% to 15% has to be accepted.

Superparamagnetic iron oxide--enhanced versus gadolinium-enhanced MR imaging for differential diagnosis of focal liver lesions.

PURPOSE: To assess AMI-25- versus gadolinium-enhanced magnetic resonance (MR) imaging in the differential diagnosis of liver tumors. MATERIALS AND METHODS: Twenty-nine patients with liver tumors underwent unenhanced, AMI-25-enhanced (15 micromol/kg), and gadolinium-enhanced(0.1 mmol/kg) imaging within 2 weeks. RESULTS: A significant (P< .05) difference in percentage signal intensity loss (PSIL) was seen in benign tumors on AMI-25-enhanced proton-density-weighted images (nine focal nodular hyperplasia [FNH], 41%; one adenoma, 32.4%) versus malignant tumors. Gadolinium-enhanced T1-weighted gradient-echo images showed strong enhancement in benign lesions (seven FNH, 147.5%; one adenoma, 91.3%) and moderate enhancement in malignant tumors (eight hepatocellular carcinomas, 116.2%, 11 metastases, 39.7%). Receiver operating characteristic analysis revealed a threshold PSIL of 10% on AMI-25-enhanced images as the most essential criteria to distinguish benign from malignant lesions (sensitivity, 88%; specificity. 89%). Interobserver analysis for two observers revealed specificity of 93% for AMI-25-enhanced imaging versus 81.5% for gadolinium-enhanced MR imaging. CONCLUSION: AMI-25 decreased the SI of benign tumors and helped differentiate benign from malignant tumors.

Iobitridol 300 compared to iopromide 300--a double-blind randomized phase-III study of clinical tolerance in total body CT.

UNLABELLED: PURPOSE, MATERIAL AND METHODS: The clinical safety of iobitriodol 300 mg I/ml and iopromide 300 mg I/ml were compared in a randomized double blind phase-III study conducted on 60 patients undergoing abdominal CT for a variety of indications. Each examination was rated as diagnostic or nondiagnostic and the image quality was noted. Nature, onset, intensity as well as outcome of each adverse reaction were recorded. RESULTS: There was no significant difference in imaging quality and side effects between the contrast media. In this study, both iobitridol and iopromide provided excellent image quality and a low rate of side effects. CONCLUSION: Iobitridol is a safe and effective nonionic contrast agent for contrast-enhanced body CT.

Post-vasectomy erectile dysfunction.

We investigated two groups of men with regard to vasectomy acceptance, and subsequent erectile dysfunction. Group I was a group of 45 men chosen at random from 254 vasectomized patients. Group II was a group of 18 men who, out of 180 patients treated for erectile dysfunction, attributed their dysfunction to previous vasectomy. We analysed the social background, motivation for vasectomy and postoperative changes of sexual life or behaviour of the partners. The partnership constellation, particularly the role of a predominant female partner seems to be an important feature for vasectomy acceptance. Low acceptance might cause erectile dysfunction.

PIP: Of 180 patients treated for erectile dysfunction in 1989-91 in Basel, Switzerland, 25 had previously undergone vasectomy. 18 of these latter individuals volunteered to be interviewed about their social background, motivation for vasectomy, and postoperative changes of sex life or partner behavior. All of these men attributed their sexual dysfunction to previous vasectomy. Somatic erectile dysfunction was, however, clinically excluded, thereby making the dysfunction of these men psychological in origin. For comparison, a group of 45 randomly chosen vasectomized men underwent the same psychosexual evaluation in the attempt to find a possible relationship between vasectomy and subsequent erectile dysfunction. The men were chosen from 254 vasectomized patients over the period 1986-90. The 45 controls comprise group one, while the 18 men who attribute their erectile dysfunction to previous vasectomy comprise group two. The mean age at time of vasectomy in group one was 39.1 years in the range of 23-59 years, while the mean age in group two at the time of vasectomy was 56.4 years in the range of 42-71 years. Vasectomy dated back on average 18.8 years. 98% of all patients interviewed were married or living in a steady partnership. 18% of patients in group one and 11% of patients in group two found the operation to be traumatic, while 13% of patients in group one and 17% of patients in group two reported fears of demascularization; these differences were not significant. It was significant, however, that 22% of patients in group two had the decision to undergo vasectomy imposed upon them by their partner. 4% of patients in group one and 22% of patients in group two reported a reduced libido within the first two postoperative years. Less frequent or weaker erections were reported by 2% of patients in group one and 27% of patients in group two. Decreased frequency of orgasm was reported by none of the patients in group one, but by 28% of the patients in group two. Ejaculation quality and orgasm by masturbation remained unchanged in all cases. Decreased sexual activity in the partner was reported by 7% of patients in group one and 33% of patients in group two. 4% of patients in group one and 28% of group two believed there was a connection between previous vasectomy and their own erectile dysfunction. In all patients with erectile dysfunction this occurred within two years of the vasectomy. 4% of patients in group one and 39% of patients in group two had changed their partners within the follow-up time. Generally, a patient's psychosocial environment is most important for the acceptance of vasectomy. A good acceptance of vasectomy is usually found among men living in traditional partnerships with a predominating male. Men in partnerships where the female predominates and where the female may have demanded that the male undergo vasectomy, however, may have difficulty later accepting and coping with such imposed decisions on reproduction. Patients requesting vasectomy should always be asked systematically about their motivation and the manner in which the decision was reached. A prospective study is underway to determine the characteristics of men who are predisposed to become sexually dysfunctional.

[The value of the liver-specific superparamagnetic contrast medium AMI-25 for the detection and differential diagnosis of primary liver tumors versus metastases]. / Wertigkeit des leberspezifischen superparamagnetischen Kontrastmittels AMI-25 für die Detektion und Differential-diagnose lebereigener Tumoren versus Metastasen.

The value of the superparamagnetic contrast medium AMI-25 and its clinical acceptability was investigated in a phase-III-multicenter study. 18 patients with primary and secondary hepatic tumours were studied using T2- and T1-weighted spin-echo sequences, FATSAT sequences and FLASH-2-D-breathold sequences, both before and after intravenous application of AMI-25 (0.2 mmol GE/ml 15 mmol/kg KG in 100 ml 5% glucose infusion), using a 1.5 Tesla MRT (Magnetom 63 SP, Siemens). In 6 patients the MRT findings could be correlated with in vitro results within 30 minutes following surgical resection. In 8 patients a diagnosis of metastases was made. Amongst patients with primary liver tumours (FNH 6 cases, HCC 3 cases, adenomatosis 1 case) 3 of the 10 patients showed more lesions following the injection of contrast; similarly, in 4 patients of the 8 with secondary tumours contrast increased the number of visible lesions. The absence of contrast enhancement separated primary from secondary lesions. Amongst the patients with secondary liver tumours, in vitro correlation always showed more tumours than had been visualised whereas there was exact in vivo/in vitro correlation amongst patients with primary liver tumours.

[Double-blind randomized study comparing ioversol 300 versus iopromide 300 abdominal computed tomography (CT scanner)]. / Etude randomisée en double aveugle comparant ioversol 300 et iopromide 300 en tomodensitométrie abdominale (CT-scanner).

The authors compared ioversol 300 and iopromide 300 (ioversol 41 patients, iopromide 38 patients) in a randomized double blind study conducted on 79 patients undergoing abdominal computed tomography (CT) for a variety of indications. Each study was rated as diagnostic or non-diagnostic and the image quality was recorded. All side-effects were recorded. There was no significant difference in image quality and side-effects between both contrasts. In this study, both ioversol and iopromide provided excellent image quality and a low rate of side-effects. The authors conclude that ioversol is a safe and effective non ionic contrast agent for contrast enhanced body CT.

[Evaluation of clinical tolerability and diagnostic efficacy of ioversol 350 in UIV. A randomized double-blind study of ioversol 350 versus iohexol 350]. / Evaluation de la tolérance clinique et de l'efficacité diagnostique du ioversol 350 en UIV. Etude randomisée en double aveugle ioversol 350 versus iohexol 350.

The authors evaluated the clinical safety and the efficacy of ioversol compared to the reference contrast medium iohexol, during IVP. The clinical safety has been evaluated by the occurrence of side-effects. The efficacy was appreciated in terms of insufficient, medium, good or excellent. No side-effect was recorded for both contrast media. There was no difference in opacification quality and efficacy between ioversol and iohexol. The authors conclude that ioversol is a safe and effective contrast medium which can be, therefore, particularly recommended for urographic examinations of high risk patients.