Iohexol and ioxithalamate for intravenous urography. A comparative parallel study

Omnipaque (iohexol) 350 mg I/ml has been compared with Telebrix (ioxithalamate) 380 mg I/ml in 48 patients undergoing intravenous urography. The contrast medium dose corresponded to 400 mg I/kg body weight. No cardiovascular reactions (BP and pulse rate) were observed. Subjective reactions occurred somewhat more frequently after Telebrix than after Omnipaque. Sensation of warmth was significantly less with Omnipaque (p less than or equal to 0.05). The overall radiological quality was equally good for the two contrast media.     

Omnipaque and Urografin in left ventriculography and coronary arteriography. A randomised, double blind study

In order to compare tolerability and radiographic properties of Omnipaque (iohexol) 350 mg I/ml and Urografin (sodium meglumine diatrizoate) 76% (370 mg I/ml) in left ventriculography and coronary arteriography, a randomised, double-blind parallel study was conducted. ECG, heart rate, blood pressure, cardiac output, oxygen saturation, CK-MB, adverse reactions and opacification were recorded. Twenty-five patients received Omnipaque and 24 Urografin and all patients were included in the final material. Omnipaque was found to have less influence on haemodynamics than Urografin. Few adverse reactions were encountered in the entire study, but fewer after injections of Omnipaque than after Urografin. Equally good opacification was demonstrated for both media. Omnipaque was found well suited for cardioangiography and superior to standard ionic media.     

Iohexol and ioxaglate in peripheral angiography

A double-blind, cross-over trial of the non-ionic, low-osmolar contrast medium iohexol (Omnipaque) and the ionic, low-osmolar medium ioxaglate (Hexabrix) at concentrations of 300 mg I/ml was carried out in 107 consecutive patients with arterial insufficiency of the lower limbs. The purpose of the study was to observe possible 'carry-over' effects from any of the contrast media, and to evaluate patient discomfort such as pain, adverse reactions, or effect on peripheral blood pressure. No carry-over effect was seen. Ioxaglate caused less injection pain and heat sensations than iohexol, and showed less effect on the systemic blood pressure.     

Comparison of low-osmolar contrast media in paediatric cardiac angiography

Sixty-two children investigated by cardiac angiography for a wide spectrum of congenital heart disease were randomly assigned to one of two groups, one for iohexol, 350 mg I/ml (Omnipaque, Nycomed UK Ltd) and one for iopamidol, 370 mg I/ml (Niopam, E. Merck Ltd). Changes in systolic pressure, end-diastolic pressure when the injection was made into a ventricle, heart rate and rhythm and plasma osmolality were assessed at 1 min and 3 min after the injection of contrast medium. The angiograms were subjectively assessed for angiographic quality. No significant differences were detected between the two groups.     

Iohexol in coronary angiography. A double blind investigation

Iohexol 350 mg I/ml (Omnipaque) was compared with the routine contrast medium meglumine, Na-Ca-metrizoate 370 mg I/ml (Isopaque Coronar) in coronary angiography in 30 patients. A randomized, double blind, crossover design was employed. Angiographic image quality, ECG, heart rate, aortic blood pressure and adverse reactions were recorded. Excellent image quality was obtained with both media. Except for one single event of hypotension, only few and minor changes in the parameters measured were recorded. No distinct difference between the two media was found. Iohexol seems to be suitable for selective coronary angiography.     

Clinical testing of omnipaque and amipaque in external carotid and vertebral angiography: randomized double-blind crossover study

Omnipaque, 300 mg l/ml, was compared with Amipaque, 300 mg l/ml, for cerebral angiography. Twelve patients were included in a randomized, double-blind, crossover study. Twenty comparisons were made in the external carotid and 21 in the vertebral artery, Both contrast media caused no or minor changes in blood pressure and heart rate. Good to excellent radiographic visualization of the cerebral arteries was obtained with both agents. The frequency of subjective reactions was almost equal, but the intensity of the reactions was less with Amipaque. No severe reactions were observed. Omnipaque is a more practical nonionic contrast medium than Amipaque because it is delivered in ready-to-use solutions.     

Comparative double-blind investigation of meglumine metrizoate, metrizamide, and iohexol in carotid angiography

The new nonionic contrast medium iohexol (Omnipaque) was compared with its predecessor metrizamide (Amipaque) and with the conventional ionic medium meglumine metrizoate (Isopaque Cerebral) in carotid angiography using a double-blind crossover technique. The results indicated that iohexol and metrizamide caused less discomfort than the ionic medium. The circulatory effects of the three media were generally mild, and the diagnostic effectiveness was comparable when the iodine concentration was kept in the range of 280-300 mg I/ml.     

Non-ionic contrast media: a comparison of iodine delivery rates during manual injection angiography

Iodine delivery rates (IDR) of five commonly used non-ionic contrast media were determined at room temperature (24 degrees C) and body temperature (37 degrees C). Contrast media of strength 300 mgI/ml were also evaluated at 50% dilution (150 mgI/ml) with N-saline. Iodine delivery differed significantly (p less than 0.005) between samples at room temperature: Omnipaque 350 (1163 mg/s) less than Niopam 370 (1311 mg/s) less than Omnipaque 300 (1422 mg/s) less than Niopam 300 (1635 mg/s) and Ultravist 300 (1636 mg/s). Niopam 300 and Ultravist 300 delivered 41% more iodine per second than Omnipaque 350 at room temperature. Similar differences were identified at body temperature, while delivery of individual media was on average 23.5% greater than at room temperature. No significant difference between iodine delivery rates of diluted media at room temperature or body temperature was identified. The results demonstrate that iodine delivery and hence vascular opacification are better achieved during hand-injection arteriography by using relatively low viscosity media such as Niopam 300 or Ultravist 300. In digital subtraction arteriography all 300 strength contrast media diluted to 150 strength are equally effective.     

Polysorbate 80 and low-osmolality water-soluble contrast medium enema in diagnosis and treatment of faecal obstruction in malignant phaeochromocytoma. Report of a case

Stercoral obstruction in a young woman with disseminated phaeochromocytoma was diagnosed and treated successfully using an enema of isosmolar iohexol (Omnipaque) and 1% polysorbate 80 (Tween 80) without complication. Surgical intervention was thus avoided. A low osmolality water-soluble contrast medium (iohexol 150 mg I/ml) with a wetting agent (1% Tween 80) was used because a barium suspension would have inspissated, exacerbating the constipation and a hyperosmolar contrast medium might have precipitated a hypertensive crisis and destabilized her critical salt and water balance.     

Myelography with a dimeric (iodixanol) and a monomeric (iohexol) contrast medium: a clinical multicentre comparative study

The purpose of this study was to evaluate and compare the radiographic efficacy and safety of iodixanol (Visipaque; 270 and 320 mg I/ml) and iohexol (Omnipaque; 300 mg I/ml) in myelography. The study was randomized, double-blind and comparative including 398 patients from five European university clinics. The radiographic visualisation was evaluated as poor, good or excellent. Adverse events were recorded by interviewing the patients after the myelography, and each patient was given a questionnaire to be returned after 1 week. In cervical myelography with cervical puncture more films with excellent quality was obtained after iodixanol 320 mgI/ml compared with iohexol 300 mgI/ml (p = 0.009). Also in lumbar myelography iodixanol 320 mgI/ml compared favourably with iohexol 300 mgI/ml (p = 0.006). The most frequent adverse event was headache, which occurred in 5–35 % of patients during the first 24 h and in 19–61 % within the first 7 days, depending on the centre. There was no difference in frequency and severity of the adverse effects between the contrast media. Received 13 March 1997; Revision received 29 December 1997; Accepted 5 January 1997     

Adult myelography with iohexol

An open, multicenter trial of adult myelography was carried out at six centers in 117 patients with iohexol (Omnipaque) 240 mg I/ml and 300 mg I/ml to determine whether there was a difference in visualization or side-effects when a lumbar or cervical approach was used to visualize the areas where disease was suspected. One hundred and thirteen myelograms were analysable. In over 85% of the myelograms with a lumbar approach, visualization of the area injected was excellent or good. Just over half of these were obtained with the intention of visualizing primarily the cervical area, and in 93% of these visualization was good or excellent at that site. In 100% of the cervically injected myelograms, visualization was excellent in the cervical area. Areas more distant from the injections were well visualized in the majority of patients. There was no significant difference overall in visualization with either of the two concentrations of iohexol used. There were 59 side-effects, mostly mild in nature; 40 of them occurred in 50 patients receiving the higher concentration and 19 in 63 patients receiving the lower concentration. The most common side-effect was headache (23 patients). Nystagmus was the only severe side-effect and occurred in only one patient having cervical myelography. The patient made a complete recovery within 36 hours.     

Cervical myelography with iohexol

An open, non comparative study of cervical myelography in 68 adult patients using iohexol (Omnipaque) containing 300 mg I/ml is reported. Satisfactory visualisation was achieved in all cases. Minor adverse effects occurred in 13 patients (19%); they were headache (8), neck or back pain (3), vomiting (3), nausea (1), dizziness (1) and nystagmus (1) and were of minor degree in most and moderate in a few, lasting more than 24 hours in only one patient. EEG performed in 39 patients before and 24 h after the myelogram showed no seizure activity or significant change. Iohexol is a very satisfactory drug for all types of myelography.     

Comparative trial of Omnipaque 350 (iohexol) and Telebrix 350 (sodium-meglumine-ioxithalamate) in left ventriculography and coronary arteriography.

In a double-blind randomized trial, the hemodynamic and electrophysiologic effects of the low-osmolar nonionic contrast medium iohexol (Omnipaque) and the standard high-osmolar ionic monomer sodium-meglumine-ioxithalamate (Telebrix) at left ventricular angiography and selective coronary arteriography were evaluated. Sixty patients were divided into two groups of 30 patients; one group received Omnipaque in a dosage of 350 mgI/ml and the other group received Telebrix in a dosage of 350 mgI/ml. The Omnipaque showed significantly less effects on heart rate and myocardial contractility, and induced less electrophysiological changes than did Telebrix. However, there was a significant increase of 10% in the diameter of the left coronary artery following selective coronary injection with Telebrix, while Omnipaque induced practically no change in vessel diameter. All hemodynamic and electrophysiologic effects proved to be short-lasting. We conclude that ionic and nonionic agents are similarly efficacious in providing adequate images with minimal risk to the patient. However, the nonionic agents exert slightly more alterations in cardiac hemodynamics and in electrocardiographic intervals. The vasodilatory effect on coronary artery diameter by Telebrix may entail a more rapid clearance of contrast medium from the coronary circulation, which might be of some advantage over nonionic contrast media.     

Iohexol compared to metrizamide in cervical and thoracic myelography

Summary A randomized double blind study with iohexol (Omnipaque) and metrizamide (Amipaque) in cervical myelography was performed in 50 patients, 29 with iohexol and 21 with metrizamide. The myelographies were performed either with lumbar or with C₁–C₂ puncture in about equal groups, using 300 mg I/ml and 240 mg I/ml of the contrast media respectively. The image quality was equal with both contrast media, excellent in about 4/5 and good in 1/5 of the examinations. Subjective side effects were twice as frequent with metrizamide as with iohexol. The most frequent side effect was headache, occurring in 34% with iohexol and in 67% with metrizamide. Altogether 24% or the patients had EEG changes after iohexol as compared to 47% after metrizamide. All EEG changes were slight dysrythmia-except in three patients with spike activity after metrizamide. These were the only ones with mental reactions as well. It can be concluded that in this trial iohexol was better suited for cervical myelography than metrizamide.     

Demonstration of splenic and portal veins at routine celiac angiography. A clinical investigation of metrizoate and ioxaglate

The demonstration of splenic and portal veins during routine celiac angiography was prospectively investigated and blindly scored in 25 patients. Two identical angiographic series were performed with randomized intraindividual injections of either metrizoate 280 mg I/ml and ioxaglate 280 mg I/ml or metrizoate 370 mg I/ml and ioxaglate 320 mg I/ml. The splenic and portal veins were significantly better demonstrated when ioxaglate 280 mg I/ml was used, compared with metrizoate 280 mg/ml. No significant difference was found between metrizoate 370 mg I/ml and ioxaglate 320 mg I/ml. Ioxaglate and metrizoate adequately demonstrated the splenic veins but ioxaglate did so at a lower iodine concentration. A slower transcapillary diffusion rate combined with a lower osmolality of ioxaglate compared with metriozate is considered the major explanation for the better demonstration of the veins.     

托烷司琼联合地塞米松预防小儿脑瘫术后曲马多镇痛恶心呕吐的临床观察

目的研究托烷司琼联合地塞米松用于预防小儿脑瘫术后曲马多PCIA镇痛恶心呕吐的临床效果。方法选择60例小儿脑瘫II期手术术后接受曲马多PCIA镇痛的患儿,随机分为三组。镇痛泵中曲马多用量均为15mg/kg。I组病人在手术时静注生理盐水2ml,泵中加入生理盐水至100ml。II组病人手术结束时静注托烷司琼0.1mg/kg,泵中加入托烷司琼0.1mg/kg,并稀释至100ml。III组病人麻醉诱导时静注地塞米松0.2mg/kg,手术结束时静注托烷司琼0.05mg/kg,泵中加入托烷司琼0.1mg/kg,并稀释至100ml。比较各组患儿术后24h恶心呕吐的发生率。结果 II、III组恶心呕吐发生率明显低于I组(P<0.01).II、III组的发生率比较差异无统计学意义(P>0.05)。结论托烷司琼联合地塞米松可有效预防曲马多PCIA镇痛的恶心呕吐,且可提高疗效,减少单一药物的用量。     

Low dose urography. A clinical comparison of three low osmolar (ratio 3) contrast media

Three modern low osmolar contrast media (Iopamiro, Omnipaque and Hexabrix) were injected intravenously in 150 patients. They were all effective for urography in a concentration iso-osmolar to blood and with a dose of 90 mg I/kg body weight in patients with normal renal function. In patients with decreased renal function, this low dose is not sufficient and should be doubled. No significant diagnostic differences between the three media were found. The subjective and objective adverse effects were minimal and transient.     

Technical innovation: wire guided ductography

To introduce an easy and improved technique for performing ductography using inexpensive easily available intravenous cannula. Guide wire: Prolene/Surgipro 3-0 (Polypropylene mono filament non-absorbable surgical suture). A plastic 26 G intravenous cannula. Disposable syringe 2 ml. Non-ionic contrast (low density like Omnipaque 240 mg I/I). The guide wire (Prolene 3-0) is introduced into the orifice of the duct heaving discharge and 26 G intravenous plastic cannula is then passed over the guide wire. The cannula is advanced in the duct over guide wire by spinning around it. When the cannula is in place the guide wire is removed. Any air bubbles present in the hub of the cannula can be displaced by filling the hub from bottom upwards with needle attached to contrast filled syringe. 0.2-0.4 ml non-ionic contrast is gently injected. Injection is stopped if the patient has pain or burning. Magnified cranio-caudal view is obtained with cannula tapped in place and gentle compression is applied with the patient sitting. If duct filling is satisfactory a 90* lateral view is obtained. A successful adaptation of the technique for performing ductography is presented. The materials required for the technique are easily available in most radiology departments and are inexpensive, thus making the procedure comfortable for the patient and radiologist with considerable cost effectiveness.     

The effect of intrathecal iohexol on visual evoked response latency: a comparison including incidence of headache with iopamidol and metrizamide in myeloradiculography

Fifty consecutive unselected patients referred for myeloradiculography and examined by the same radiologist, when facilities for measuring the visual evoked response were available, are considered. The effect on the visual evoked response of the examination and the incidence of headache following the use of iohexol as the contrast medium are compared with those after the use of iopamidol and metrizamide reported in a previous study. A total of 400 cases examined with iopamidol and 200 cases examined with iohexol are reviewed with regard to the incidence of headache. Whereas iopamidol and, to a greater extent metrizamide, were found to cause significant lengthening of the visual evoked response latency 20 hours after the radiological examination, iohexol did not. Furthermore there was no significant difference in the 20 hour reading following the use of iohexol compared with the original control group of patients who underwent lumbar puncture alone. There was a lower incidence and severity of headache following the use of iohexol than with iopamidol and a markedly reduced incidence compared with metrizamide. Iohexol is considered less neurotoxic than iopamidol which had previously superceded metrizamide as the contrast medium used for myeloradiculography in the Royal Surrey County Hospital. Volumes of up to 14 ml of iohexol 300 mg I/ml have been used for lumbar radiculography and for total myelography and up to 10 ml for direct lateral cervical puncture. In 350 cases examined to date with iohexol the only serious sequel was a case of chemical meningitis following the lumbar injection of 10 ml of the 300 mg I/ml solution for a cervical examination. The patient made an uneventful recovery.     

Incidence of ventricular fibrillation during coronary arteriography in the rabbit. A comparative study of isotonic ioxaglate and iohexol

The incidence of major ECG changes, particularly ventricular fibrillation, was evaluated in rabbits during prolonged, selective right coronary injection of sodium/meglumine ioxaglate (Hexabrix 160) and iohexol (Omnipaque 140), two isotonic contrast media. The anesthetized animals (n = 12) per test solution) each received 1.5 ml of contrast material, delivered at a rate of 3 ml/minute. Both contrast media caused major ECG changes, which were reversible within seconds after administration. No fibrillation occurred with ioxaglate, but ventricular fibrillation was seen in seven animals given iohexol. There was a significant difference in the incidence of ventricular fibrillation between the contrast media (P less than .01). Both test solutions induced transient, more or less marked bradycardia, but without significant differences. The intracoronary injections produced similar decreases in blood pressure for both contrast agents. Reactive hypertension was observed only in those animals in which an episode of fibrillation occurred with iohexol. The causes underlying these effects are analyzed for both contrast agents.