The current state of hysterosalpingography.

The authors present an overview of the current status of hysterosalpingography, discussing the advantages and disadvantages of various cannulas, contrast media, and methods of contrast medium introduction. Thirty-two figures illustrate a variety of abnormal findings including among others: intravasation of contrast medium, salpingitis isthmica nodosa, manifestations of pelvic inflammatory disease, the effects of DES exposure, Ascherman's syndrome, adenomyosis, carcinoma, polyps, myomata and developmental uterine abnormalities.

New and old contrast agents: pharmacology, tissue opacification, and excretory urography.

In equivalent doses for intravenous urograms conventional ionic contrast agents give iodine concentrations in the urine of approximately 30 mg iodine/ml, nonionic contrast media provide approximately 50 mg iodine/ml, and the ionic dimer Hexabrix approximately 70 mg iodine/mL. These new low osmolality, contrast media provide significantly higher urinary iodine concentrations than conventional ionic contrast media, provide better diagnostic quality excretory urograms, better patient tolerance, and fewer adverse side-effects and serious reactions. These new low osmolality, contrast media have significant advantages in intravenous urography in both safety and efficacy when compared to conventional higher osmolality contrast media.

High-dose clinical urography with the low-osmolality contrast agent Hexabrix: comparison with a conventional contrast agent.

A double-blind clinical trial was performed in 60 patients to compare Hexabrix (ioxaglate meglumine and ioxaglate sodium) and Renografin-60 (diatrizoate meglumine and diatrizoate sodium). Use of Hexabrix produced higher urinary iodine concentrations, lower urine volumes at 30 minutes, and excretory urograms significantly better in diagnostic quality, as rated by four independent observers. There was no difference in nephrogram quality between contrast agents. Patients receiving Hexabrix had less of an increase in heart rate and demonstrated a slight rise in mean arterial blood pressure, rather than the biphasic rise then fall seen with Renografin-60. There was no significant change for up to 96 hours after urography in results of hematology, clinical chemistry, or urinalysis, except for an increase of 0.005 in urine specific gravity with Renografin-60. Patients reported significantly less body heat, heat in the injection arm, and overall discomfort with Hexabrix. There was a similar amount of nausea and vomiting in the two groups. Hexabrix also caused histaminic-type reactions in three patients.

Medical and economic considerations in using a new contrast medium.

In deciding to use a new intravascular contrast medium, the considerations should be patient safety, Imaging efficacy, and cost. Balancing these factors, use can be estimated. With the new low-osmolality contrast media, particularly the nonionic media, the expected increased patient safety must be balanced against the much higher cost.

Splenic abscess: percutaneous drainage.

Experience with percutaneous drainage in four cases of splenic abscess is presented. Percutaneous drainage and antibiotics were curative in three of four cases. The one case not adequately treated by antibiotics and percutaneous drainage was also complicated by ascites and multilocular collections. Percutaneous drainage in this case did not adversely affect subsequent curative surgery. Percutaneous catheter drainage of splenic abscess under radiologic guidance can be a safe, effective treatment.

Clinical comparison of Hexabrix, iopamidol, and Urografin-60 in whole body computed tomography.

Urografin 60, iopamidol and Hexabrix were studied in patients undergoing body CT scans to examine the pharmacodynamics of these contrast agents. Immediately following rapid injection, the lower osmolality media, Hexabrix and iopamidol, gave greater aortic concentration of iodine in addition to higher concentrations in the liver and spleen. These two agents also provided significantly better renal enhancement than Urografin 60, with Hexabrix giving higher levels than iopamidol. The higher early vascular concentrations of Hexabrix and iopamidol and the relative absence of side effects due to hyperosmolality and decreased toxicity may have advantages in dynamic CT scanning.

Newer contrast agents for urography.

New low-osmolality ratio-3 contrast media have been shown to have less toxicity than currently used contrast media. In intravenous excretory urography, these agents give significantly higher urinary iodine concentrations, produce less diuresis, and are better tolerated by patients because of fewer unpleasant side effects. These newer low-osmolality contrast media have significant advantages in intravenous urography.

Systemic response to excretory urography. Work in progress.

Ninety-seven patients who were undergoing excretory urography for suspected genitourinary tract abnormalities were continuously monitored for systemic blood pressure and pulse rates before (control) and after rapid intravenous injections of contrast material (1.5 ml/kg meglumine iothalamate, 60%) using a Bard pressure monitor. We report the systemic responses observed. Clinically obvious reactions to contrast medium were recorded and compared with the blood pressure and pulse rate responses. The most common response to rapid infusion of contrast medium was a transient hypotension. An increase in systemic pressure had a high association with nausea and vomiting. Significant hypotension (mean blood pressure less than 60 mm Hg) was observed in six patients (6%), but no overt clinical manifestations were present.

Urachal abnormalities in the adult.

A spectrum of rare urachal abnormalities in the adult is described, including urachal cyst, infected urachal cyst and abscess, and urachal carcinoma. The clinical and radiographic features are presented, and diagnosis using ultrasound, computed tomography, and needle aspiration is discussed. Treatment of infected urachal cysts with percutaneous catheter drainage is described.

Milk-of-calcium renal cyst, evaluated by ultrasound and computed tomography.

Milk-of-calcium renal cysts, which when asymptomatic need no treatment, sometimes pose diagnostic problems by conventional radiography. Two such cases are here reported. The first case was further evaluated by ultrasonography only, the second case also by computed tomography and cyst puncture, because of an irregularity in the cyst wall. Both imaging modalities added valuable information.

Reactions to intravenous contrast media. Part I: Severe and fatal cardiovascular reactions in a canine dehydration model.

Investigations into the nature of severe and fatal reactions to contrast media have been severely limited by their unpredictable occurrence in the clinical setting and the absence of suitable laboratory models. The authors report their experience with a canine dehydration model. Intravenous administration of 2 ml/kg of 76% sodium methylglucamine diatrizoate resulted in vomiting, shock, inappropriate slowing of the heart rate, and death. ECG findings indicated suppression of sinoatrial node automaticity, a decrease in the rate of atrioventricular conduction, and depression of myocardial contractility. These results suggest two possible mechanisms: (a) enhanced vagal tone as the result of stimulation of the vasomotor center of the medulla or (b) accentuation of direct contrast-induced myocardial toxicity.

Reactions to intravenous contrast media. Part II: Acute renal response in euvolemic and dehydrated dogs.

Growing concern about acute renal failure as the result of contrast agents prompted an investigation into the renal effects of intravenous contrast materials in euvolemic and dehydrated dogs. Bolus injection of hypertonic agents induced marked reductions in filtration fraction and glomerular filtration rate in both groups of animals; however, these changes were transient, returning to near-base-line values within 30 minutes after injection. The most striking differences between euvolemic and dehydrated animals appeared to be related to prerenal factors such as hypovolemia and contrast-induced hypotension.

Computed tomography of adult polycystic disease.

Twenty-three cases of polycystic disease were reviewed. All were easily detected by computed tomography. All manifested diffuse, bilateral renal cystic disease, and 74% had demonstrable hepatic cystic disease. Computed tomography is more accurate than other conventional modalities in diagnosing renal cysts, and its simplicity of operation and ease of interpretation are unmatched.

The radiographic features of small colon cancers.

The commonly accepted criteria for colon malignancy were investigated in malignant and benign polyps smaller than 3 cm in diameter. It was found that most small tumors, both benign and malignant, were sessile and smooth in outline. It was only when the polyps increased in size that their outlines became lobulated or irregular. A stalk was not seen in polyps smaller than 1 cm in diameter. Retraction at the base of a cancer was likewise not seen in these small lesions. The typical malignant characteristics became apparent only when the polyp had grown to 2 to 3 cm in diameter.

Percutaneous antegrade extrusion of ureteral stones.

A technique to extrude small obstructing ureteral stones with a catheter through a percutaneous nephrostomy tract is described. The technique was successfully used to extrude obstructing ureteral stones in three patients who had ileal loop urinary diversions and who were poor operative risks, and in one patient who had had no previous urinary tract surgery. In these four patients, ureteral stones were dislodged and removed without complication. The technique may have advantages over previously described techniques, particularly in patients with ileal conduits in whom established retrograde cystoscopic techniques are difficult to perform, and in patients who are poor operative risks.

Early medullary cystic disease: a urographic diagnosis?

Excretory urography of a patient with an early stage of medullary cystic disease demonstrated an inhomogeneous, streaky nephrogram confined to the medulla, presumably due to accumulation of contrast material in dilated tubules. This was seen best one to two hours after contrast injection and may represent a specific urographic finding which does not appear to have been described previously in this condition.