Harry W. Fischer

An Evaluation of Pretesting in the Problem of Serious and Fatal Reactions to Excretory Urography

A nationwide survey of 10 years of teaching hospital experience covering 3.8 million excretory urograms revealed an overall death rate of 19 per million. A total of 75% of the radiologists questioned employed a pretest before excretory urography, either routinely or in selected cases. Of these, 96% used an intravenous route. A comparison of death rates between pretested patients and those who were not pretested revealed no statistically significant differences. Thus there seems to be no valid reason to depend upon intravenous pretesting in the hope of avoiding serious reactions.

Renal renin and hemodynamic responses to selective renal artery catheterization and angiography

Selective renal artery catheterization and renal angiography are commonly performed diagnostic procedures; however, the effects of these procedures on renal blood flow (RBF) and renin release have only been partially described. A biphasic RBF response has been well documented furing selective angiography in dogs. The renal autoregulatory mechanisms governing the responses are uncertain. The renin-angiotensin system and the major parameters of contrast media, hypertonicity and viscosity, have been suggested as important factors. In the canine model, we examined the acute changes in renal venous renin activity along with the renal hemodynamic effects of hypertonicity and viscosity. Our results do not support a primary effect mediated by the renin-angiotensin system. Hypertonicity and the contrast medium per se are significant in active and passive autoregulatory responses at the smooth muscle cellular level.

Contrast media in coronary arteriography: a review.

Much knowledge of coronary artery disease and much of the progress in surgical treatment of coronary artery disease has been directly dependent upon the safety with which coronary arteriography has been performed. This safety depends upon the ease of placing the contrast media in the arteries and on the toxicity of the contrast medium itself. This review deals with contrast media toxicity in coronary arteriography, as distinct from toxicity in angiocardiography and other angiography.24

Hemodynamic reactions to angiographic media. A survey and commentary.

For some time it has been known that alterations in blood pressure, heart rate, cardiac output, and other body functions occur after the introduction of contrast media into the vascular system. The full nature and extent of the hemodynamic changes, however, are often not well appreciated, nor has there been general realization of their significance. It is the purpose of this paper to describe these changes, relate their mechanisms so far as they are known, gauge their importance, and indicate avenues available to the radiologist for minimizing them. The morbidity and mortality which still accompany several types of angiography are not a small concern, and we should endeavor to improve our present practices. Basic to this approach are the assumptions that any deviation from the patients pre-examination hemodynamic status is undesirable and that the propensity of a contrast material to cause deviations from the prior hemodynamic status is a measure of its toxicity. The consequences of the surgical events b...

THE EXCRETION OF IODIPAMIDE: RELATION OF BILE AND URINE OUTPUTS TO DOSE.

Iodipamide, the one intravenous cholangiographic agent in present use, is certainly of great value, although room for improvement in visualization of the bile ducts still exists. Too often the ducts are so faintly visualized as not to permit optimal study or no opaque material is seen at all. Poor or unrecognized liver function can be blamed for some failures, but better cholangiography might be sought in a knowledge of the normal pharmacology of iodipamide and attempts to enhance the biliary excretion of this agent. Precise information on the excretion of iodinated substances into the bile is meager, and there has been relatively little interest in modifying biliary excretion of contrast agents. Measurements of iodipamide in blood, bile, and urine in the dog over a range of intravenous doses is the subject of this paper. Iodipamide was originally introduced as the disodium salt of N, Nadipyl-bis (3-amino-2, 4, 6 triiodobenzoic acid), supplied as a 20 per cent solution. More recently the methylglucamine s...

Effects of contrast media on renal function and subcellular morphology in the dog

The effects of intravenous contrast media (CM) on renal excretory function and subcellular morphology are examined in this animal investigation. A decrease in GFR (12.0 +/- 1.6 vs. control 30.2 +/- 2.5 ml/min) was observed when renal function was evaluated by means of the artero-venous extraction method with Tc99m DTPA and the anticipated inverse relationship to urinary flow (Vml/min) noted. An artifactual increase in GFR (43.5 +/- 10.0 vs. control 39.1 +/- 3.8 ml/min) was observed using the timed urinary clearance of inulin. V(ml/min) increased four-fold (0.6 +/- 0.16 control vs. 2.7 +/- 0.7 ml/min; P less than .05) over the first five minutes after injection of CM. Urine osmolality initially approached isotonicity and then returned toward preinjection values. Osmolal clearance (Cosm) rose 2.5 times (1.4 +/- 0.3 control vs. 3.7 +/- 1.0 ml/min; P less than .05). The fractional excretion of both Na+ (FENa+) and K+ (FEK+) increased. A comparison of urinary osmolality vs. time after injection of CM confirms a nonspecific osmotic effect on tubular (and hence total urine) flow. The hemodynamic effects of CM on the kidney via the i.v. route reflect a predominant and nonspecific osmotically mediated vasodilation. No significant light or electron microscopic changes were observed. These findings suggest that the major renal physiologic actions of hypertonic CM are a nonspecific response to agent osmolality.

Urography with Low-Osmolality Contrast Media: Comparative Urinary Excretion of Iopamidol, Hexabrix, and Diatrizoate

The pharmacokinetics and urinary excretion characteristics of sodium diatrizoate, the new low-osmolality contrast medium iopamidol, a nonionic monomer, and ioxaglate, a monoacidic dimer, were compared. Using rabbits, experimental urography was performed at a dose of 450 mg I/kg. The lowosmolality co

Reduction in Ventricular Fibrillation Using Calcium-Enriched Renografin 76

Renografin 76 has been shown to have significant calcium-binding properties in vivo and in vitro. Two contrast media solutions were compared by selective injection into the right coronary artery of dogs. One set of injections was made with commercially available Renografin 76 (referred to as stock Renografin) and another set of injections was made with Renografin 76 to which had been added 24 mMols/liter of calcium chloride dihydrate. Ventricular fibrillation occurred significantly more often with the stock Renografin 76. The nature of the calcium binding and its effects are discussed.

Lymphography of the normal adult male. Observations and their relation to the diagnosis of metastatic neoplasm.

Recent roentgen study of the lymphatic system began with the investigation of edematous legs. The normal radiographic anatomy of the lymph trunks of the upper and lower extremities has been described by Kinmonth et al. (9), Jacobsson and Johansson (8), and Gergely (6), while abnormalities in their number and structure have been reported by Kinmonth and others (9, 1). Although lymphography of the swollen limb has given valuable information that could be added to and correlated with what was previously known or suspected, we have felt for some time that the most worthwhile use of lymphography would be in the study of lymph node disease. We have directed our efforts to contrast radiography of pelvic and abdominal nodes. This area was selected for study because of the frequency of neoplasms of the uterus, bladder, and prostate and their known propensity to metastasize to these nodes. Also, it is an area where nodes, though not necessarily all nodes, can be visualized by an injection technic without surgical e...

Whole-Gut Irrigation as a Means of Cleaning the Colon

The authors describe a whole-gut irrigation method of cleaning the colon. Normal volunteers drank an irrigant solution at varying rates, and all but one achieved a radiologically clean colon within several hours. This method is proposed for use in the occasional study where a clean colon must be obtained in a relatively short period of time.