metrizamide and Pain

Thoracic disc herniation is uncommon. An incidence of 0.25 to 0.75 per cent of protruded disks are in the thoracic region. A peak incidence is noted in the fourth decade with 75 per cent of the protruded disks occurring below T8. Pain is the most common initial symptom, present in 57 per cent of the cases, followed by sensory disturbances and motor involvement. By the time of diagnosis, 90 per cent of the patients have signs of spinal-cord compression. Although myelography has been considered the test of choice, 8 per cent false negative results and a correct preoperative diagnosis of 56 per cent has been reported. Now, with CT scanning with and without metrizamide, more accurate diagnoses can be achieved, even with cases in which myelography is negative. There has been a considerable improvement in the surgical treatment of herniated thoracic disks with over an 80 per cent rate of success for surgical approaches other than the posterior approach (decompressive laminectomy). An early and accurate diagnosis, coupled with improvement in the surgical approach, offers a much better prognosis for patients with thoracic disk herniation.

Topics: Adolescent; Adult; Aged; Child; Diagnosis, Differential; Female; Humans; Intervertebral Disc Displacement; Male; Metrizamide; Middle Aged; Myelography; Pain; Sensation; Thoracic Vertebrae; Tomography, X-Ray Computed

Two non-ionic contrast media, iohexol and metrizamide, were compared in a double-blind clinical trial which included 50 patients who underwent lumbar myelography for disc herniation or spinal stenosis. The frequency of adverse reactions was lower for iohexol which is recommended for extended trials and for examination of other compartments of the subarachnoid space.

Topics: Adolescent; Adult; Aged; Contrast Media; Double-Blind Method; Drug Evaluation; Female; Headache; Humans; Intervertebral Disc Displacement; Iodobenzoates; Iohexol; Leg; Lumbosacral Region; Male; Metrizamide; Middle Aged; Myelography; Nausea; Neurologic Examination; Pain; Spinal Stenosis; Subarachnoid Space; Triiodobenzoic Acids

Topics: Cavernous Sinus; Contrast Media; Humans; Iodamide; Iopamidol; Iothalamate Meglumine; Iothalamic Acid; Metrizamide; Orbit; Pain; Phlebography

Two new contrast media, iohexol (non-ionic monomer) and ioxaglate (monoacidic dimer), were compared with the non-ionic metrizamide during aortofemoral angiography in a single blind randomized trial in 2 groups of patients with 20 in each. The degree of heat and pain produced by iohexol and ioxaglate did not differ significantly from that produced by metrizamide, while subsequent injections of metrizoate caused significantly more heat and pain. The hemodynamic effects recorded in 10 patients in each group showed that iohexol and ioxaglate induced a decrease in vascular resistance, decrease in blood pressure and increase in heart rate not differing significantly from that induced by metrizamide.

Topics: Aged; Aortography; Blood Pressure; Contrast Media; Female; Femoral Artery; Heart Rate; Hemodynamics; Humans; Iodobenzoates; Iohexol; Ioxaglic Acid; Male; Metrizamide; Middle Aged; Pain; Triiodobenzoic Acids; Vascular Resistance

Two new contrast media, Amipaque (metrizamide, Nyegaard & Co A/S, Oslo) and Hexabrix (ioxaglic acid, Laboratoire Guerbet, Paris) were compared in a double blind study in patients with arterial insufficiency in the legs. The incidence of subjective adverse effects (pain and sensation of heat) was low and similar with both contrast agents. Also the effects on heart rate and blood pressure were small and transient and similar with both contrast agents.

Topics: Adult; Aged; Angiography; Arterial Occlusive Diseases; Blood Pressure; Clinical Trials as Topic; Contrast Media; Female; Heart Rate; Humans; Leg; Male; Metrizamide; Middle Aged; Pain

In a group of 51 patients metrizamide was compared in a double-blind fashion to meglumine ioxithalamate, the contrast medium currently in use at our department, with regard to sensations of warmth or pain elicited by the intra-arterial contrast injection. In all arteries of the head and neck metrizamide injections produce less painful reactions than injections of meglumine ioxithalamate. This difference, however, is statistically significant only for the external carotid and for the vertebral arteries, as pain reactions are much less often elicited in other vessels. It is concluded that in neuroradiology the favourable properties of metrizamide with respect to pain responses can best be utilized in 'sensitive' vascular areas (superselective external carotid angiography, spinal angiography, vertebral angiography).

Topics: Angiography; Double-Blind Method; Head; Humans; Iothalamate Meglumine; Metrizamide; Neck; Pain

The degree of pain produced by Amipaque 260 and Isopaque 260 at intraosseous phlebography in patients with varicose ulcerations in the ankle region was compared. Amipaque produced less pain than Isopaque. No complications or side-effects occurred during the observation period of about one year.

Topics: Clinical Trials as Topic; Double-Blind Method; Drug Evaluation; Humans; Leg; Metrizamide; Metrizoic Acid; Pain; Phlebography; Varicose Ulcer

Metrizamide, a non-ionic contrast medium of low osmolality was compared with meglumine ioxithalamate, the ionic angiographic contrast medium currently in use in our department in a double-blind study. Criteria upon which the comparison was based were: 1) the pain reaction of the patient upon intra-arterial contrast injection, 2) bradycardial reactions upon common carotid injection and 3) the quality of the contrast image. Metrizamide induced significantly less painful sensations than meglumine ioxithalamate in those vessels in which injections of contrast medium are frequently painful (external carotid artery, vertebral artery). No significant difference in the degree of bradycardia was caused by the two contrast media. The degree of bradycardia was also found to be poorly reproducible upon successive injections of the same contrast medium in the same patient, thus raising questions as to the suitability of this method for determining the toxicity of the contrast medium. The quality of the angiograms obtained did not differ significantly with the two media. Spasm, when it occurred during selective external carotid injections, was found to be independent of the contrast agent used, being correlated instead with the depth of distal advance of the catheter tip into the external carotid. Of the 51 patients included in the study, two patients suffered transient neurological deficit after angiography with metrizamide, and one patient suffered a permanent hemiplegia after angiography with meglumine ioxithalamate.

Topics: Aorta, Thoracic; Bradycardia; Carotid Arteries; Catheterization; Cerebral Angiography; Clinical Trials as Topic; Humans; Iothalamate Meglumine; Metrizamide; Pain; Vertebral Artery

Metrizamide and meglumine iocarmate (Dimer-X), which at present are the contrast media for myelography best tolerated by central nervous system, were compared in a double-blind test comprising a total of 86 patients, all with symptoms of lumbar or sacral root involvement. Symptoms appearing were recorded using a standard interview formula 24 hoaurs after myelography. EEG, routine laboratory analyses of CSF and neurologic examinations were also made. In some cases CSF paper electrophoresis, CSF pressure recordings and determination of CSF iodine content were obtained.

Topics: Adult; Aerophagy; Aged; Blood Cell Count; Clinical Trials as Topic; Contrast Media; Female; Headache; Humans; Iodobenzoates; Iothalamate Meglumine; Iothalamic Acid; Male; Metrizamide; Middle Aged; Myelography; Pain; Spinal Cord Diseases

Percutaneous retrogasserian glycerol instillation was performed under local anesthesia for treatment of trigeminal neuralgia in 162 patients. A simplified technique that did not involve cisternography was used. Initial pain relief was achieved in 146 patients (90.1%). Recurrent pain was noted in 27 patients (18.5%) and was more frequent (50%) in patients who had undergone surgical treatments prior to glycerol injection than in those who had no previous surgical treatment (12.3%). A second glycerol injection was carried out in nine patients and a third injection in two patients. The follow-up period extended from 6 to 67 months and 77.8% of patients are totally pain-free after one or more glycerol injections. Another 8.6% experienced good pain relief with the addition of small doses of pharmacological agents. Thus, 140 (86.4%) of the original 162 patients experienced satisfactory pain control following glycerol rhizolysis. Initial sensory loss on the face occurred in 117 patients (71.6%) but at last follow-up examination only 46 patients (28%) experienced mild orofacial hypalgesia and 13 patients (8%) noted analgesia. The corneal reflex was absent in three patients (1.8%) and reduced in five (3.1%). No patients noted corneal ulceration or anesthesia dolorosa. Percutaneous retrogasserian glycerol rhizolysis offers a rapid, safe, reliable, and relatively inexpensive surgical approach to treatment of trigeminal neuralgia.

Topics: Adult; Aged; Aged, 80 and over; Female; Fluoroscopy; Follow-Up Studies; Glycerol; Humans; Injections; Male; Metrizamide; Middle Aged; Pain; Palliative Care; Recurrence; Trigeminal Nerve; Trigeminal Neuralgia

This prospective study compares immediate and delayed patient discomfort in 177 patients following shoulder arthrography using intraarticular combinations of metrizamide, meglumine/sodium diatrizoate, meglumine diatrizoate, lidocaine, epinephrine, and air. Patients receiving conventional ionic monomeric positive contrast media had a 60% (90/150) incidence of moderate or severe delayed exacerbation of their baseline symptoms; only 14% (3/21) of patients receiving metrizamide, a nonionic contrast medium, had similar levels of postprocedural discomfort. Morbidity was somewhat diminished with the use of double-contrast (45%, 34/75) rather than single-contrast (75%, 56/75) examinations, and with avoidance of sodium-containing contrast agents or epinephrine. Nonionic or monovalent polymeric contrast media, despite their present high cost, may be the agents of choice if single-contrast arthrography is performed in joints (such as the shoulder, hip, and temporomandibular) associated with a high incidence of post-procedural pain.

Topics: Air; Contrast Media; Diatrizoate; Diatrizoate Meglumine; Drug Combinations; Epinephrine; Humans; Metrizamide; Pain; Prospective Studies; Radiography; Random Allocation; Shoulder Joint; Surveys and Questionnaires

Bilateral temporomandibular joint (TMI) arthrography was performed in 31 healthy subjects to determine the prevalence and degree of postprocedural pain and to establish if morbidity could be decreased by use of a nonionic contrast agent. Ionic contrast material (Hypaque 60%) was injected on one side and nonionic contrast material (Amipaque) on the other side. The pain experienced in the 5 days following arthrography was graded and recorded. Discomfort, when present, was described as mild or moderate and usually lasted for 2 days after the procedure. In no instance was the pain considered severe. There was significantly less pain on the side that was injected with nonionic contrast material. The invasiveness of the examination should not be a deterrent since discomfort from TMJ arthrography is minimal when performed by an experienced arthrographer; use of a nonionic contrast agent can further decrease the pain.

Topics: Adult; Contrast Media; Diatrizoate Meglumine; Female; Humans; Male; Metrizamide; Middle Aged; Pain; Radiography; Temporomandibular Joint

Arthrography was performed during steroid injection in 14 patients (22 joints) with noninflammatory conditions of the cervical facet joints. Two isolated spines were also studied. The capsular recesses were found to be quite large, especially near the intervertebral foramen. Though the appearance of the arthrogram was not clinically useful, it was helpful in positioning the needle for the steroid injection and confirming that the joint in question was abnormal. Distension of the capsule provoked pain in about 50% of cases; rupture of the distended capsule was rare but could account for leakage into the epidural space or foramen. Nine patients had significant relief of pain for three days to thirteen months.

Topics: Adult; Arthrography; Cervical Vertebrae; Diatrizoate Meglumine; Female; Humans; Male; Metrizamide; Middle Aged; Pain; Spinal Diseases

In 41 patients peripheral angiography was performed with the non-ionic contrast medium metrizamide (Amipaque) and the ionic iothalamate meglumine (Conray 60). Amipaque was found to give less subjective adverse effects and less changes in blood pressure.

Topics: Adult; Aged; Angiography; Arteriosclerosis; Blood Pressure; Double-Blind Method; Drug Evaluation; Female; Heart Rate; Humans; Iothalamate Meglumine; Leg; Male; Metrizamide; Middle Aged; Pain; Paresthesia

One hundred patients were questioned after metrizamide myelography about the side effects of the examination. The number and type of side effects were tabulated and correlated with investigated region (e.g., cervical, lumbar) and with use of medication (e.g., analgesics, diuretics). The number of side effects, particularly neuropsychologic, were higher than previously reported. The most common side effects were minor meningeal irritations (headache, nausea, dizziness, and vomiting) and were regarded by the patients as inconsequential. All side effects became apparent during the first 24 hr after myelography and all were transitory. The side effects, being minor, should not limit the use of metrizamide for myelography. However, those caring for patients who have undergone the study should be aware of the possible side effects.

Topics: Adult; Affective Symptoms; Aged; Aphasia; Cognition Disorders; Dizziness; Dysarthria; Female; Hearing; Humans; Male; Metrizamide; Middle Aged; Myelography; Nausea; Pain; Sleep Wake Disorders; Time Factors; Vision, Ocular; Vomiting

Iopamidol, a recently developed non-ionic contrast medium, was used for aorta-femoral angiography in a concentration of 370 mg of iodine/ml. The injection of 35-40 ml was painless in most cases and was never severe. A sensation of heat in the legs accompanied all injections. A fall in systolic and diastolic blood pressure and an increase in heart rate occurred, these effects being greater than with metrizamide. The image quality was satisfactory. Iopamidol is well tolerated and preferable to conventional hyperosmolar contrast media in aorto-femoral angiography.

Topics: Aorta; Blood Pressure; Contrast Media; Femoral Artery; Humans; Iopamidol; Iothalamic Acid; Methods; Metrizamide; Pain; Radiography

The degree of albuminuria induced by renal arteriography with the monoacid dimeric contrast medium ioxaglate was studied in 19 patients. Ioxaglate did not cause significant changes in urinary albumin concentrations (median concentration after angiography = 0.022 g/g creatinine). The results with ioxaglate are compared with those of an identically designed study performed earlier with the contrast media metrizoate and metrizamide, in which both caused significantly increased concentrations of urinary albumin (1.1 g/g creatinine and 0.96 g/g creatinine, respectively). The degree of pain/heat sensation following semiselective renal arteriography with metrizoate and ioxaglate was also compared using a visual analog scale in 34 patients. Ioxaglate caused no pain and a significantly lower heat sensation than metrizoate.

Topics: Adult; Aged; Albuminuria; Angiography; Contrast Media; Hot Temperature; Humans; Iodobenzoates; Ioxaglic Acid; Kidney; Metrizamide; Metrizoic Acid; Middle Aged; Pain; Thermosensing; Triiodobenzoic Acids

Topics: Animals; Ataxia; Dog Diseases; Dogs; Female; Male; Metrizamide; Myelography; Nervous System Diseases; Pain; Paralysis

Metrizamide (Amipaque) is a new, non-dissociating contrast medium enabling completely painless angiographic examination of the arteries of the lower extremities. The contrast and visualisation--even of small vessels--are of the same standard as that of the angiographies effected with Amidotrizoat (Angiografin). Since general anaesthesia has been eliminated, the indication for angiography of the femoral artery can be broadened in the case of risk and emergency patients.

Topics: Angiography; Femoral Artery; Humans; Metrizamide; Pain

The adverse side effects in a series of 439 myelographies with metrizamide were analyzed. The most frequent side effect was headache, which could be differentiated as early onset headache, related to hydrodynamic modifications in the spinal fluid following lumbar puncture, and late onset headache related to a metrizamide effect. The frequency of late onset headache was at least 27%, but all together 46% of the patients had postmyelographic headache. Meningeal irritation was seen in 5%, sometimes in a severe form, mimicking a septic complication. Spinal irritation and epileptic fits were rarely seen. Striking was the occurrence of an acute psycho-organic syndrome, frequently observed after cervical myelography which was performed with a higher than usual dose of iodine. We can not confirm the general opinion that the central nervous system had a good tolerance for metrizamide.

Topics: Anaphylaxis; Emotions; Epilepsy; Headache; Humans; Metrizamide; Myelography; Neck; Pain; Perception; Spinal Cord Diseases

Metrizamide, tested in 41 patients, caused less discomfort than injection of Isopaque Cerebral, when injected into the abdominal artery. In view of the high price of metrizamide, it is indicated for what angiographic studies the Malmö General Hospital employs this contrast medium.

Topics: Adult; Aged; Angiography; Arterial Occlusive Diseases; Female; Humans; Leg; Male; Meglumine; Metrizamide; Metrizoic Acid; Middle Aged; Osmolar Concentration; Pain

Metrizamide (Amipaque) and ioxaglate (Hexabrix), both new low osmolality contrast agents, were evaluated in a comparative study of 50 patients with peripheral arterial diseases undergoing in total 118 angiograms. The degree of discomfort caused by the highly selective injection of these compounds and the normal available water-soluble media was estimated. Metrizamide resulted as the optimal contrast medium and Hexabrix is second best. Intra-arterial lidocaine reduced serious discomfort from 70 to 15% in conventional media. None of the evaluated contrast compounds was changing blood flow in this group of patients. But pharmacoangiography with high dosages of tolazoline could provide additional information on vascular pathophysiology.

Topics: Angiography; Contrast Media; Humans; Lidocaine; Meglumine; Metrizamide; Metrizoic Acid; Osmolar Concentration; Pain; Solubility; Tolazoline; Triiodobenzoic Acids; Water

In two studies 267 consecutive patients with suspected venous thrombosis were examined 125I-fibrinogen uptake test at phebography. In 161 patients meglumine metrizoate (Isopaque Cerebral) and in 106 patients metrizamide (Amipaque) was used as contrast medium. The quality of the examinations was equal in the two groups. During the examinations most of the patients examined with meglumine metrizoate had symptoms from the calf described as a cramp-like pain. Only few of the patients examined with metrizamide had such symptoms. In the two groups 47 patients examined with meglumine metrizoate and 41 examined with metrizamide had normal phlebography as well as initially normal 125I-fibrinogen uptake test. After phlebography, 29 of the patients in the first group had a significant rise in fibrinogen uptake while such a rise was not found in patients from the second group. Rephlebography showed fresh deep vein thrombosis in 7 out of 9 patients examined with meglumine metrizoate indicating that thrombosis could be provoked in as many as about half the patients with this high osmolar contrast medium. We have now used metrizamide in about 400 patients without any side-effects.

Topics: Humans; Iodobenzoates; Leg; Meglumine; Metrizamide; Metrizoic Acid; Pain; Phlebography; Sorbitol; Thrombophlebitis

Metrizamide (Amipaque) has been used as the contrast medium for angiography in neuroradiological investigations. Solutions containing 280 mgI/ml. are well tolerated and produce good contrast. The most important difference from previously used contrast media is the lack of pain when injections are made selectively or super-selectively into the external carotid artery and its branches, or into the spinal arteries.

Topics: Adolescent; Adult; Aged; Basilar Artery; Carotid Artery, External; Cerebral Angiography; Female; Humans; Injections, Intra-Arterial; Male; Metrizamide; Middle Aged; Pain; Vertebral Artery

In 20 patients the non-ionic Amipaque (metrizamide) and the ionic Isopaque Cerebral (meglumine/calcium-metrizoate) were injected into the femoral, brachial internal iliac or external carotid arteries. Strain gauge plethysmography of the lower leg demonstrated less increase in blood flow following injections of Amipaque (25%) than following injections of Isopaque Cerebral (95%). None of the 20 patients complained of pain following injection af Amipaque; 15 experienced pain following Isopaque Cerebral.

Topics: Adult; Aged; Brachial Artery; Calcium; Carotid Arteries; Female; Femoral Artery; Humans; Iliac Artery; Iodobenzoates; Leg; Male; Meglumine; Metrizamide; Metrizoic Acid; Middle Aged; Pain; Plethysmography; Radiography

The adverse effects in a series of 50 lumbar myelographies with Amipaque were compared with those in a corresponding series, examined with Dimer-X. Side effects occurred in 58% of the cases examined with Amipaque and in 68% of the Dimer-X series. No seizures occurred in 58% of the cases examined with Amipaque and in 68% of the Dimer-X series. No seizures occurred in either series but slight fibrillations of fasciculations appeared in 2 Dimer-X patients. Hyperreflexia of the legs was recorded in 22% of the Amipaque and in 36% of the Dimer-X cases. Other adverse reactions to the media were mild to moderate. Some burst activity, but no definite paroxysmal abnormality was noted in EEG recordings in 2 Amipaque cases. The low epileptogenicity of Amipaque has ensured a wider safety margin of lumbar myelography.

Topics: Adult; Aged; Brain; Diazepam; Drug Evaluation; Electroencephalography; Female; Fever; Headache; Humans; Iodobenzoates; Iothalamate Meglumine; Iothalamic Acid; Lumbosacral Region; Male; Metrizamide; Middle Aged; Myelography; Nausea; Pain; Premedication; Seizures