Risk of microbial contamination of iodinated contrast media on multiple use of large-volume bottles.

Large-volume bottles of iodinated contrast material (CM) offer advantages over single-dose vials in respect of handling, radiation protection of personnel, cost and waste. Because non-ionic CM are considered to be susceptible to microbial contamination, the probability of such contamination was investigated under practical conditions with reference to the duration of use. Under conditions identical to those in practice, contamination was found in only about 1% of bottles examined after a single piercing. Under worst-case conditions, a maximum of 9 microorganisms/bottle was found. No pathogen multiplication was observed within 24 h in microbial challenge tests; rather, the nosocomial pathogens examined died quickly in iopromide, the only exception being Pseudomonas aeruginosa. There was not a single case of bacterial multiplication on clinical use of 500-ml infusion bottles in patients undergoing routine computed tomography, using either injection by hand or an automatic infusion device. In conclusion, the microbial count rate did not differ from that of small-volume parenterals used up immediately after piercing. To ensure an adequate safety margin for the avoidance of septicemia or pyrogenic reactions, the CM should be used within 1 examination day.

Iopromide dosage and urographic image quality: is there an optimal dose?

The influence of increasing doses of contrast medium (CM; 0.75, 1.0, 1.5, and 2.0 ml iopromide/kg body weight; 300 mg I/ml) was examined in a randomized, double-blind study. An increase of the dosage resulted in a statistically significant improvement of the quality of the radiographic visualization. This was most pronounced with an increase from 0.75 to 1.0 ml/kg body weight and least pronounced with the increase from 1.5 to 2.0 ml/kg body weight. This improvement was not only visible in the overall quality, but in each part of the urinary tract, the calyces, the pelves, the ureters, and most especially at the parenchyma. Due to economic considerations at the present, a dose of 1.0 ml/kg (300 mg I/ml) is viewed as adequate. Doses below this level should be avoided due to the poorer image quality that results. From a purely medical point of view, the injection of 1.5 ml of nonionic CM/kg body weight is considered optimal.

Urography with monomeric and dimeric nonionic contrast media: comparative, randomized, double-blind study of iotrolan 280 and iopromide 300.

In a double-blind comparative study between the nonionic, dimeric iotrolan and the nonionic, monomeric iopromide the urographic image quality in the dose 300 mg I/kg body weight is better after iopromide up to 20 minutes after the injection. This result appears to be in contradiction to the results of the animal experimental studies. Possible reasons are discussed.

Pharmacokinetics of iohexol, iopamidol, iopromide, and iosimide compared with meglumine diatrizoate.

Four nonionic contrast media (iohexol, iopamidol, iopromide, and iosimide) are compared in this clinical study in their pharmacokinetic behavior with an ionic reference preparation (meglumine diatrizoate). At a dose of 1 ml of contrast medium per kilogram of body weight with approximately the same iodine content, virtually no differences could be established in the pharmacokinetic behavior. The osmotic diuresis of the ionic substance, compared with that of the nonionic preparations--implies an increased osmotic diuresis, thus, a lower maximal iodine concentration in the urine. The elderly patients included in this study have a reduced glomerular filtration rate, which in turn implies a prolonged half-life in the blood and a retarded renal elimination.

[Atresia of the aortic isthmus from the radiological point of view]. / Die Aortenisthmusatresie aus radiologischer Sicht.

The most important angiographic features of atresia of the aortic isthmus are illustrated by three patients. The first patient to have reached an advanced age despite atresia of the aortic isthmus is reported and the diagnosis was confirmed at autopsy. The haemodynamic effects, the age at operation and the incidence of other associated cardiovascular malformations are discussed with reference to the literature.

[Indirect breast lymphography (author's transl)]. / Indirekte Mammalymphographie.

Intradermal areolar contrast injection of a new water-soluble contrast medium, Iotasul, results in regular demonstration of the latero-cranial breast lymphatics and of the subareolar lymphatic plexus. It has been possible, for the first time, to show lymph nodes with this water-soluble contrast medium, although the results are not entirely satisfactory. There have been no side effects.

[Sodium salts or methylglucamine salts in contrast media for infusion pyelography? (author's transl)]. / Natrium- oder Methylglukaminsalze der Kontrastmittel für die Infusionsurographie?

Tolerance of two contrast media was compared by a double blind study. High doses of iodine (45 g) were used for both contrast substances. Sodium Ioglicinate was giving best radiological contrast but produced more side-effects, especially nausea, as compared to Methylglucamine-Ioglicinate. On the contrary Methylglucamine-Ioglicinate did not give best density but did produce less side-effects. Thus the investigator has to consider very carefully, which of the compounds has to be preferred.

[Sodium or methyl glucamine salts as contrast media for urography (author's transl)]. / Natrium- oder Methylglukaminsalze der Kontrastmittel für die Urographie?

A double blind trial was carried out comparing 15 g sodium amidotrizoate and 15.3 methyl glucamine amidotrizoate for urography. The sodium preparation resulted in significantly better visualisation of the urinary tract, both in normal patients and in those with renal insufficiency. For routine urography in the given dose there was no difference as regards demonstration of the parenchyma and filling of the urinary tract. Similarly, there was no difference in tolerance after the intravenous administration of the two substances. The sodium salt should be avoided in patients with cardiac failure, whereas these are better tolerated than methyl glucamine salts by asthmatics. Judging by our results, the sodium salts are to be preferred for routine urography in a dose of 50 ml., particularly for patients with mild to moderate renal insufficiency.

[Angiographic appearances of rare renal tumours; oncocytomas and benign hypernephromas (author's transl)]. / Angiographisches Erscheinungsbild seltener Nierentumoren. Onkozytom und benignes Hypernephrom.

Oncocytomas, called oxyphil proximal tubular adenomas in the Anglo-Saxon literature, and benign hypernephromas are non-malignant, usually symptomless, rare tumours belonging to the renal adenomas. Oncocytomas have angiographic appearances sufficiently uniform to permit a tentative diagnosis. Histologically benign hypernephromas do not possess characteristic angiographic appearances and, in the presence of tumour in the renal vein or necrotic avascular areas, must be regarded as potentially malignant.

Double blind comparison of meglumine iotroxate (Biliscopin), meglumine iodoxamate (Endobil), and meglumine ioglycamate (Biligram).

Two new intravenous cholegraphic agents, iotroxate and iodoxamate, hold a lower general toxicity, lower protein binding, and claim a higher rate of biliary excretion. Both compounds proved to be equally effective in opacifying the gallbladder and the bile ducts in a double-blind clinical study comprising 400 cases. Iotroxate gave significantly earlier good or adequate visualization as a result of its higher excretion rate by the liver (P less than 0.05). Side effects were observed in fewer patients in the iotroxate group (11.6%) compared with the iodoxamate group (16.4%, P greater than 0.05). In a second double-blind study, an iotroxage group of 97 patients who received two thirds of the overall content of iodine (3.6 g) was compared with a group of 98 patients, who received ioglycamate (5.3 g). Visualization was equal in the two groups, while side effects were significantly reduced to 10.3% in the iotroxate group against 20.4% (P less than 0.05). The higher biliary clearance of iotroxate permits a reduction of the amount of iodine.