iothalamate-meglumine and Chronic-Disease

Measurement of GFR is important for the management of chronic kidney disease (CKD). Although bolus administration of radiocontrast agents is commonly used to measure GFR, the optimal duration of sampling to assess their plasma clearance is unknown. The purpose of this study was to evaluate whether the duration of plasma sampling influences precision and estimation of GFR.. GFR was measured by sampling plasma 12 times over 5 h in 56 patients with CKD (mean age 64 yr, 98% men, 79% Caucasian, 34% diabetics, estimated GFR 31.8 +/- 14.2 ml/min/1.73 m(2)). In a subset of 12 patients we measured GFR by sampling plasma 17 times over 10 h.. Short sampling intervals considerably overestimated GFR measured using total plasma iothalamate clearance, especially in larger patients. In the higher estimated GFR group (>30 ml/min/1.73 m(2)), the 5-h GFR was 17% higher and 2-h GFR 54% higher compared with the 10-h GFR, which averaged 40.3 ml/min/1.73 m(2). In the lower estimated GFR group (<30 ml/min/1.73 m(2)), the 5-h GFR was 36% higher and 2-h GFR 126% higher compared with the 10-h GFR, which averaged 22.2 ml/min/1.73 m(2). Short sampling duration also reduced the precision of the estimated GFR from 1.67% for 10-h GFR, to 3.48% for 5-h GFR, and to 7.07% for 2-h GFR.. GFR measured over a longer duration with multiple plasma samples spanning the distribution and elimination phases may improve precision and provide a better measure of renal function.

Topics: Aged; Chronic Disease; Contrast Media; Female; Glomerular Filtration Rate; Humans; Injections, Intravenous; Iothalamate Meglumine; Kidney; Kidney Diseases; Male; Middle Aged; Models, Biological; Predictive Value of Tests; Reproducibility of Results

A right subclavian artery pseudoaneurysm caused by blunt trauma is described. CT and digital subtraction angiography helped us to establish a correct diagnosis. Radiologic features of subclavian artery aneurysms and relevant literature are briefly discussed.

Topics: Adult; Aneurysm, False; Angiography, Digital Subtraction; Chronic Disease; Contrast Media; Female; Follow-Up Studies; Humans; Infusions, Intra-Arterial; Iothalamate Meglumine; Subclavian Artery; Thoracic Injuries; Tomography, X-Ray Computed; Wounds, Nonpenetrating

To compare the accuracy of spiral computed tomography (CT) with that of ventilation-perfusion (V-P) scintigraphy in the diagnosis of pulmonary embolism (PE).. Fifty-four patients in whom indeterminate V-P scans or discordant clinical and scintigraphic results were obtained underwent both V-P scanning and contrast material-enhanced spiral CT. The reference standard was pulmonary angiographic results in 26 patients (group I) or clinical outcome in 28 (group II).. Six (25%) of 24 group I patients had proved PE. The prospective sensitivity and specificity for segmental or subsegmental PE were 67% and 100%, respectively, and the positive and negative predictive values were 100% and 90%, respectively. In two group II patients, V-P scans had high probability for acute embolism, but spiral CT scans showed only chronic PE; in one patients, the V-P scan had low probability and the CT scan was positive for acute PE. An alternative CT diagnosis was established in four (31%) of 13 patients in whom a normal or low-probability V-P scan was obtained. Clinical outcome was consistent with spiral CT results in all cases.. Spiral CT has greater accuracy and specificity than V-P scanning in patients with an unresolved diagnosis and may be useful as the primary screening technique for PE.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Angiography; Angiography, Digital Subtraction; Chronic Disease; Contrast Media; Female; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Iohexol; Iothalamate Meglumine; Male; Middle Aged; Predictive Value of Tests; Probability; Prospective Studies; Pulmonary Embolism; Radionuclide Imaging; Radiopharmaceuticals; Reference Standards; Sensitivity and Specificity; Technetium Tc 99m Aggregated Albumin; Tomography, X-Ray Computed; Treatment Outcome; Ventilation-Perfusion Ratio

Chronic obstruction of the biliary tract alters circulatory function. The effects of radiocontrast medium (iothalamate meglumine) on systemic and renal hemodynamics were studied in normal dogs and dogs with chronic common bile duct ligation (CBDL). After intravenous injection of radiocontrast, cardiac output and stroke volume were not altered in normal and CBDL dogs; arterial pressure was stable in normal dogs but decreased significantly in CBDL dogs and was accompanied by reduced systemic vascular resistance. In normal and CBDL dogs the renal hemodynamic responses to radiocontrast medium were characterized by initial vasoconstriction (independent of renal renin release) and later vasodilation. This vasodilatation in CBDL dogs was particularly striking as it occurred despite reduced renal perfusion pressure and the augmented renin-angiotensin system. Inhibition of prostaglandin synthesis with indomethacin in CBDL dogs abolished both the hypotensive and the renal vasodilator responses to radiocontrast medium. We conclude that enhanced prostaglandin activity contributes to the labile hemodynamic function noted in obstructive jaundice.

Topics: Animals; Blood Pressure; Cholestasis; Chronic Disease; Dogs; Female; Hemodynamics; Iothalamate Meglumine; Renal Circulation; Stroke Volume; Vascular Resistance

Seventy-five patients underwent ultrasound (US)-guided percutaneous pancreatography during a 3 1/2-year period. Pancreatography was successful in 67 patients, and there were no significant complications. The technique, which is easy to perform, was primarily employed to assist localization of pancreatic masses at fine-needle aspiration biopsy. It was also used to demonstrate pancreatic duct morphology when endoscopic retrograde pancreatography had failed or proved non-diagnostic. This enabled mapping of the duct system prior to pancreatic surgery. In cases of diagnostic difficulty, assessment of duct appearance with US-guided pancreatography was more accurate in differentiating carcinoma from chronic pancreatitis than was assessment with endoscopic retrograde pancreatography.

Topics: Biopsy, Needle; Cholangiopancreatography, Endoscopic Retrograde; Chronic Disease; Diagnosis, Differential; Humans; Iothalamate Meglumine; Pancreas; Pancreatic Ducts; Pancreatic Neoplasms; Pancreatitis; Premedication; Ultrasonography

Surgery was undertaken on 32 chronic subdural hematomas in a series of 28 patients who had preoperatively undergone delayed contrast-enhanced computed tomography (DCECT). Time-density curves on DCECT and iodine concentrations of subdural specimens revealed that chronic subdural hematomas, regardless of density, were significantly enhanced by the entrance of intravascular contrast medium into the interior of hematomas. The ingress of intravascular contrast medium into the interior of the hematomas was chemically proven and might result from a complex transcapillary shift.

Topics: Adult; Aged; Aged, 80 and over; Chronic Disease; Female; Hematoma, Subdural; Humans; Iodine; Iothalamate Meglumine; Male; Middle Aged; Tomography, X-Ray Computed

One hundred and fourteen upper abdominal computed tomography examinations performed before and after intravenous contrast were reviewed. In 48 patients who had no evidence of biliary or pancreatic disease, the mean gallbladder wall attenuation before contrast was 25 +/- 13 HU and after contrast 42 +/- 18 HU, with a wall thickness of 1.9 +/- 0.43 mm. In 14 patients with chronic pancreatitis these values were 24 +/- 10.5 HU, 44 +/- 25 HU and 2.0 +/- 0.54 mm, respectively. In a further group of 15 patients with chronic biliary disease, the values were 34 +/- 15 HU, 53 +/- 18 HU and 2.3 +/- 0.9 mm. The degree of wall enhancement was statistically significant in each group. There was no statistical difference in the attenuation characteristics or wall enhancement between normal patients and those with chronic pancreatitis. Patients with chronic biliary disease had a thicker gallbladder wall with higher attenuation before contrast but a similar degree of enhancement.

Topics: Biliary Tract Diseases; Cholecystography; Chronic Disease; Female; Humans; Iothalamate Meglumine; Male; Middle Aged; Pancreatitis; Radiographic Image Enhancement; Tomography, X-Ray Computed

Levels of beta-endorphin immunoreactivity in cerebrospinal fluid were measured in 12 chronic pain patients undergoing the surgical implantation of an electrode into the periventricular gray matter. Cerebrospinal fluid fractions were collected following placement of a cannula into the third ventricle, following injection of metrizamide contrast medium into the ventricles, following implantation of the electrode, and following electrical stimulation. A second set of samples was collected on a non-surgical day before and after stimulation. Levels of beta-endorphin immunoreactivity increased significantly from baseline levels to post-electrode implantation in one group of patients, but no significant change was seen following the onset of stimulation. Immunoreactivity increased significantly following metrizamide injection in a second group and was still elevated, in comparison to baseline, following electrode placement, but no increase was seen following the onset of stimulation. Levels of immunoreactive beta-endorphin did not increase in either group after stimulation on a post-surgical day, despite consistent reports of pain relief. Addition of metrizamide or a related contrast medium, iothalamate meglumine (Conray) to the beta-endorphin radioimmunoassay revealed that both compounds interfered with antigen-antibody binding and also quenched the gamma radiation emitted by iodinated peptide ligands. Due to these combined effects, the contrast media alone produced results similar to those of the beta-endorphin standard. Moreover, similar observations were made when contrast media were incorporated into radioimmunoassays for met-enkephalin, dynorphin and cholecystokinin octapeptide. These findings indicate that increased levels of beta-endorphin in cerebrospinal fluid are not directly associated with patient report of pain relief following periventricular gray stimulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: beta-Endorphin; Chronic Disease; Electronarcosis; Endorphins; Humans; Iothalamate Meglumine; Metrizamide; Pain Management; Radioimmunoassay; Thalamus

The effect of hydration on the incidence of complications from myelography with aqueous media was studied. Myelography was performed with methylglucamine iocarmate in dehydrated and vigorously hydrated monkeys. The incidence of seizures and the severity of arachnoiditis were significantly greater in the dehydrated animals. The authors suggest that patients be permitted fluids ad lib. prior to myelography with aqueous media, or in some cases be given fluids intravenously.

Topics: Acute Disease; Animals; Arachnoiditis; Chronic Disease; Haplorhini; Iothalamate Meglumine; Macaca; Myelography; Seizures; Water