泛影葡胺胶浆支管造影的实验研究及临床应用

笔者对４０只家兔分组并分别用泛影葡胺胶浆和７６％复方泛影葡胺做支气管造影，进行Ｘ线和病理的对照研究，并已临床应用２８３例。动物实验和临床应用结果表明，泛影葡胺胶浆对支气管显影效果好，对肺无损害，排出吸收快，肺内无存留。克服了单纯用７６％复方泛影胺做支管造影有流动快，易进入肺泡，不易摄支气管像，刺激性大和易引起肺水肿的缺点。     

数字减影支气管造影的临床应用

目的：利用数字减影技术改善碘支气管造影影像及副作用。材料和方法：应用数字减影支气管造影（ＤＳＢ）技术共检查３５例患者，其中１９例选用７６％泛影葡胺磺胺混悬液，１２例用２０％泛影葡胺、４例用稀释的优维显（Ｕｌｔｒａｖｉｓｔ）做造影剂。结果：３５例ＤＳＢ影像均达优质，但用低浓度泛影葡胺病例的术中术后不良反应明显低于高浓度泛影葡胺。根据ＤＳＢ影像诊断支气管扩张１１例，支气管炎５例，支扩并支气管炎１５例、肺结核１例、支气管狭窄２例、正常１例。结论：ＤＳＢ技术可明显降低碘水的使用浓度，减少副反应，而且图像优良、易于实施。     

恶性滋养叶细胞肿瘤子宫造影诊断价值

目的：研究７６％复方泛影葡胺子宫造影能否用于恶性滋养叶细胞肿瘤的诊断和疗效观察。方法：２４例恶性滋养叶细胞肿瘤病人在化疗前后共进行４２次复方泛影葡胺子宫造影，对造影征象及临床指标进行了对比观察。结果：恶性滋养叶细胞肿瘤其子宫造影片有特征性Ｘ线表现；Ｘ线片系列观察能反映子宫病灶的变化。结论：在恶性滋养叶细胞肿瘤的诊断和疗效观察中，７６％复方泛影葡胺子宫造影是一种安全、易行、实用的方法。     

泛影葡胺－云南白药胶浆选择性支气管灌注对支气管扩张症咯血的治疗及造影作用初探

目的探讨泛影葡胺－云南白药胶浆选择性支气管灌注对支气管扩张症咯血的治疗作用及其造影效果。方法将30例经临床、胸片和纤维支气管镜诊断为支气管扩张症的慢性反复咯血患者,随机分为实验组和对照组各15例,分别作泛影葡胺－云南白药胶浆选择性支气管灌注治疗和造影,或仅作内科保守治疗,分别随访5年。结果实验组15例造影全部成功;其止血效果及5年内复发情况均好于对照组(P<0.05)。结论泛影葡胺－云南白药胶浆对支气管扩张症咯血有明显的止血作用和缓解复发作用,同时也是一种较理想的支气管造影剂,具有进一步研究发展的可行性。     

泛影葡胺—云南白药胶浆选择性支气管灌注对支气管扩张症咯血的治疗及造影作用初探

目的　探讨泛影葡胺－云南白药胶浆选择性支气管灌注对支气管扩张症咯血的治疗作用及其造影效果。方法　将３０例经临床、胸片和纤维支气管镜诊断为支气管扩张症的慢性反复咯血患者,随机分为实验组和对照组各１５例,分别作泛影葡胺一云南白药胶浆选择性支气管灌注治疗和造影,或仅作内科保守治疗,分别随访５年。结果　实验组１５例造影全部成功;其止血效果及５年内复发情况均好于对照组（Ｐ＜０．０５）。结论　泛影葡胺－云南白药胶浆对支气管扩张症咯血有明显的止血作用和缓解复发作用,同时也是一种较理想的支气管造影剂,具有进一步研究发展的可行性。     

应用60%复方泛影萄胺加羧甲基纤维素钠行选择性支气管造影25例分析

本文报告25例应用60%复方泛影葡胺加3%羧甲基纤维素钠(CMC)作选择性支气管造影的造影剂。复方泛影葡胺:CMC=2:1。其浓度和粘稠度适中,充盈满意,优良片达92%。24小时后摄胸片复查,支气管及肺内造影剂全部消失。     

30％泛影葡胺用于乳腺导管造影的价值

30％泛影葡胺或复方泛影葡胺主要是用于血管造影前的碘过敏试验，因为有时用大剂量造影和不需要做过敏试验者．本院每年可剩余数10支1毫升的30％泛影葡胺。我们将其应用于乳腺导管造影，收到了良好的经济效益和技术效益。一、适应症和禁忌症非哺乳期的单侧性乳头溢液或双侧性乳     

中药白芨在支气管造影中的应用

中药白芨在支气管造影中的应用谭光喜陈晓林王晓鹏陈明珍肖治明笔者用中药白芨末加入６０％泛影葡胺内制成造影剂，共做了３５例支气管造影，现介绍如下。材料与方法将白芨末按每瓶２ｇ封装入洗净的青霉素瓶内高温消毒备用，使用时将６０％泛影葡胺３０ｍｌ和白芨末２ｇ倒...     

电子束CT腮腺造影并三维重建在腮腺肿块诊断中的应用

目的：探索电子束ＣＴ腮腺造影泛影葡胺的最佳浓度，电子束ＣＴ平扫、腮腺造影ＣＴ和三维ＣＴ在腮腺肿块诊断中的应用价值。材料和方法：对１６例腮腺肿块分别进行电子束ＣＴ平扫，４５％、６０％和７６％三种不同浓度泛影葡胺腮腺造影ＣＴ扫描，腮腺造影图像应用四种方法进行三维重建，显示结果进行统计学分析和与手术病理对照分析。结果：腮腺造影ＣＴ泛影葡胺浓度以６０％最佳，腮腺造影ＣＴ较电子束ＣＴ平扫对腮腺肿块的显示更为准确。三维ＣＴ对腮腺肿块和其与面神经的关系显示得更为直观，容积显示法可同时显示腮腺肿块和腮腺内导管的改变，较表面显示法更有价值。结论：电子束ＣＴ腮腺造影并三维重建是诊断腮腺肿块非常有价值的检查手段。     

经纤维支气管镜定向导管选择性造影引导肺活检

我院于1988年1月至10月,对难以确诊的15例肺周边病变患者,采用经纤维支气管镜(简称纤支镜)定向导管注入复方泛影葡胺与羧甲基纤维素混悬液,行选择性支气管造影引导肺活检,效果满意,为临床诊断提供了可靠依据,现介绍如下。     

Effects of a rapid injection into the canine superior mesenteric artery of diatrizoate meglumine and diatrizoate sodium (Renografin-76)

In an effort to evaluate the “spillover method” of measuring blood flow during angiography, we explored the effects of rapid injection of diatrizoate meglumine and diatrizoate sodium (Renografin-76) at rates no greater than resting blood flow in the superior mesenteric artery of anesthetized dogs. An increase in mesenteric blood flow and a decrease in mesenteric arterial pressure occurred many seconds after cessation of the injection. The dilation effected by the contrast agent was less marked at elevated blood flow values than at resting flows. The pattern of response to diatrizoate meglumine and diatrizoate sodium resembled that observed with vasodilator drugs. Our findings also suggest that the initial vascular response to a pulsation of the diatrizoate medium is vasodilation. Presented at the 1979 Annual Meeting of the Federation of American Societies of Experimental Biology in Dallas, Texas This work was supported by a grant provided by the John A. Hartford Foundation, Inc.     

Ultrastructural changes in rat aortic endothelium during contrast media infusion

A rat model was employed to investigate contrast media (CM) induced ultrastructural changes in the vascular endothelium. Ionic contrast materials such as Renografin-76 (diatrizoate meglumine diatrizoate sodium), MD-76 (diatrizoate meglumine diatrizoate sodium), and Angiovist (meglumine diatrizoate) were injected into the femoral vein of anesthetized male Wistar rats (240-260 g) and allowed to circulate. Control animals were similarly injected with equiosmolar sucrose and physiologic saline. The thorax was opened 15 minutes, 1 hour, and 4 hours postinjection and cardiac perfusion performed using Karnovsky's fixative; the thoracic aorta was then surgically removed, and processed for transmission electron microscopy. All CM produced shrinkage in cell cytoplasm and nuclear structures thereby causing distortions in cell morphology. In control tissues, however, no such ultrastructural damages were noted. Within 15 minutes of CM infusion, electron dense granules were seen on the luminal surface of endothelial cells, in pinocytotic vesicles, as well as in the gap junctions between cells. These observations indicate that contrast media intake occurs via vesicular transport, and through the cell junction.     

Pulmonary edema following high intravenous doses of ionic contrast media. Effect of the anion composition and concentration

High intravenous doses of diatrizoate are known to induce a profound degree of pulmonary edema which is dose- and injection rate-dependent in the rat. In this study, meglumine salts of diatrizoate, iothalamate, and metrizoate were evaluated for their capacity to induce pulmonary edema following intravenous injections. Differences in anion composition or concentration of diatrizoate meglumine/sodium salts did not cause significantly different degrees of pulmonary edema.     

Pulmonary arteriography: comparison of cough stimulation effects of diatrizoate and ioxaglate

Twenty-five patients were observed in a prospective crossover study to determine whether the new low-osmolality contrast agents would be less prone than conventional agents to produce coughing during pulmonary arteriography. Selective left and right pulmonary arteriography (two views of each side) was performed with alternating administrations of diatrizoate sodium meglumine and ioxaglate sodium meglumine. Twenty-one patients had all four injections while four patients received injections on only one side. Sixteen of 25 patients coughed on at least one injection of diatrizoate, with three of these experiencing explosive coughing. One of 25 patients coughed with ioxaglate, and that was only minimally. This difference is statistically significant (P less than .001, on the basis of McNemar chi 2 test for paired data). When no coughing occurred, the quality of the diatrizoate and ioxaglate radiographs was indistinguishable. We conclude that ioxaglate is useful in pulmonary arteriography because of its lack of cough stimulation.     

Improvement in referral practices elicited by a redesigned request format

Intravascular injection of some radiographic contrast media causes a fall in the concentration of unbound serum calcium (Ca++) and an increase in serum immunoreactive parathyroid hormone (iPTH). The decrease in Ca++ levels was attributed to the presence in the contrast media of calcium chelating agents (disodium edetate and sodium citrate) and to the effects of high ionic strength and hemodilution on calcium ion activity. In the present study, we have tested whether omission of the calcium chelating agents from solutions of diatrizoate will lessen the alterations in systemic calcium metabolism. We compared Renografin-76 (RG-76) (diatrizoate meglumine and diatrizoate sodium), which contains disodium edetate and sodium citrate, with Hypaque-76 (H-76) (diatrizoate meglumine, diatrizoate sodium), which contains no calcium chelating activity. A bolus injection of a mean dose of 62 ml of either contrast medium decreased levels of Ca++ significantly (P less than 0.01) at five minutes. The decrease was significantly greater (P less than 0.025) with RG-76 (0.096 +/- 0.018 mM, mean +/- SE) than it was with H-76 (0.049 +/- 0.018 mM, mean +/- SE). The level of iPTH increased (P less than 0.01) by 68 +/- 13 nanoliter equivalents (nleq) per ml with RG-76 and by 28 +/- 8 nleq per ml with H-76 (P less than 0.01 vs RG-76). In vitro, RG-76 decreased levels of Ca++ in aqueous calcium solutions 3.7-fold more than did H-76, but neither contrast medium had any direct effect on the parathyroid hormone assay system. Omission of divalent cation chelating agents from solutions of diatrizoate reduces their effects on systemic calcium metabolism.     

Effect of water-soluble contrast medium on the lung in rats. Comparison of iotrolan, iopamidol, and diatrizoate

Aspiration is a serious complication of oral contrast media (CM). The authors investigated the effects of iotrolan, iopamidol, and diatrizoate in rats' lungs. To quantify the lung damage induced by CM, pulmonary water and hemoglobin contents were determined. Arterial blood-gas exchange (pH, PCO2, and PO2) also was determined as an indicator of respiratory function. Iotrolan, iopamidol, or sodium/meglumine diatrizoate with a concentration of 300 mg I/mL was administered intrabronchially at a dose of 1 mL/kg. Physiologic saline was administered to the control group. Ten minutes after administration, arterial blood was collected and the lung was removed. Diatrizoate and iopamidol increased pulmonary water and hemoglobin contents and decreased blood PO2. The effect of iotrolan on these parameters was slight and no significant differences were observed between the iotrolan and saline groups. These results suggest that iotrolan is a preferable CM for gastrointestinal examination in the case of suspected aspiration.     

Comparison of iohexol 300 and diatrizoate meglumine 60 for body CT: image quality, adverse reactions, and aborted/repeated examinations.

Six hundred patients were prospectively randomized and given either diatrizoate meglumine 60 or iohexol 300 during dynamic contrast-enhanced body CT in order to compare image quality, contrast reactions, and the number of aborted studies or studies in which images had to be repeated. Three hundred two patients received iohexol 300, and 298 patients received diatrizoate meglumine 60. Thirty-nine percent (119/302) of the patients given iohexol 300 and 63% (188/298) of the patients given diatrizoate meglumine 60 had at least one adverse reaction thought to be related to contrast material during, or within 24 hr of, the body CT scan. When reactions of discomfort (heat or warmth, flushing, bad taste) were excluded, 16% (48/302) of the patients who received iohexol and 33% (99/298) of the patients who were given diatrizoate meglumine 60 had at least one adverse reaction. The differences in both types of reactions between the two agents were significant (p less than .001). Among scans evaluated for study quality, 71% (214/302) of the iohexol 300 group and 62% (184/298) of the diatrizoate meglumine 60 group had optimal enhancement (p = .02). However, when the optimal and adequate categories were combined, 301 of 302 patients given iohexol 300 and 292 of 298 patients given diatrizoate meglumine 60 had diagnostic-quality studies (no statistical difference). Studies were not terminated nor were images repeated in 97% (292/302) of the patients given iohexol 300 and in 94% (280/298) of those given diatrizoate meglumine 60. The CT study was repeated because of movement during the contrast injection or aborted because of contrast-related reactions in 0.7% of the patients given iohexol 300 and in 3.0% of the patients given diatrizoate meglumine 60. This difference was statistically significant (p = .04). Our results suggest that the difference in image quality, number of adverse reactions, and number of aborted/repeated CT scans performed with iohexol 300 or diatrizoate meglumine 60 are not sufficiently different to warrant conversion to nonionic agents for body CT scans.     

Pulmonary angiography with iopamidol: patient comfort, image quality, and hemodynamics

The choice of a contrast agent for pulmonary angiography has important implications for patient comfort, image quality, and perhaps the safety of the procedure, particularly for "high-risk" patients. In a prospective study the nonionic, low-osmolality agent iopamidol eliminated the problem of image degradation due to coughing, and patients showed excellent tolerance for it. However, pressure measurements obtained within 3-5 minutes of injection of iopamidol and diatrizoate sodium meglumine 76% showed no significant difference in the hemodynamic effects of the two contrast agents, either for normotensive or for pulmonary hypertensive patients. Contrary to a common presumption, pulmonary hypertension by itself did not appear to increase the risk of pulmonary angiography. The theoretic presumption of greater hemodynamic stability with low-osmolality contrast agents was not clinically evident in this trial with iopamidol. At present, enhanced patient comfort and improved image quality remain the only confirmed bases for choosing this contrast agent for pulmonary angiography.     

Double-blind study of a new nonionic contrast agent for cardiac angiography

A randomized, double-blind study of a new nonionic contrast agent (ioversol) was performed in 80 patients undergoing routine coronary angiography and left ventriculography. Its hemodynamic and electrocardiographic (ECG) effects were compared with those of a conventional ionic contrast agent (sodium meglumine diatrizoate). There were 40 patients in each group. The radiographic quality and incidence of adverse reactions were comparable for both agents. Following left ventriculography, there was a smaller decrease in systemic and left ventricular systolic blood pressure and a smaller increase in heart rate and pulmonary artery systolic pressure (P less than .05) with ioversol than with meglumine diatrizoate. There was also a slight decrease in cardiac output with ioversol at 1 and 3 minutes after left ventriculography, while meglumine diatrizoate produced a modest increase. In selective coronary angiography, the fall in diastolic blood pressure was also greater (P less than .05). The Q-T interval was more prolonged with meglumine diatrizoate. Ioversol appears to be both safe and efficacious for cardiac angiography, causing fewer and less severe hemodynamic and ECG alterations than meglumine diatrizoate.