Ioglycamide acid (Bilivistan) low-dose drip-infusion cholangiography.

Fifty-five anicteric patients with acute upper abdominal pain were examined with low-dose drip-infusion cholangiography using ioglycamide acid (17 ml Bilivistan, 280 mg I/ml) given over two hours. Good visualization of the biliary system was achieved and no adverse effects were recorded. There was good agreement between the cholangiographic diagnostic and the peroperative findings. No false negative findings were disclosed.

Ioglycamide (Biligram) studies in man--relation between plasma concentration and billary excretion.

Plasma ioglycamide concentration was linearly related to the rate of intravenous infusion over a dose range of from 1 to 4 mg per kg per min. The relation between plasma and biliary concentration of ioglycamide was studied in 15 anicteric patients with a T-tube in situ. Peak biliary concentrations and excretory rates of ioglycamide were seen when the plasma concentration was greater than 1500 micrograms per ml. The mean biliary transport maximum (Tm) for ioglycamide in man was 31.6 mg/min (range 22.0-40.4). The results suggest that near optimal concentrations of iodine in the bile duct can be obtained during intravenous cholangiography if ioglycamide is infused for one hour at a rate of about 4 mg per kg per min.

Ioglycamide (Biligram) studies in man. Radiological opacification of the bile duct. A comparison of a number of different methods.

Intravenous cholangiography was carried out in 80 anicteric patients using ioglycamide (Biligram). Twenty patients were given a 30 ml ampoule of 35% ioglycamide as a slow hand injection over ten minutes; the remainder were given ioglycamide by one hour slow drip infusion at a rate of 2, 3, or 4 mg per kg body weight per minute. The radiological opacification of the bile duct was then assessed independently by two radiologists. There was a statistically significant difference between the bile duct opacification found in patients given either 3 or 4 mg/kg/min of ioglycamide for one hour compared with those given ioglycamide either by ten minute injection or by 2 mg/kg/min drip infusion.

Levels of ioglycamate (Biligram) in the bile of the rhesus monkey following intravenous infusion at different dose-rates.

The maximun rate of excretion of ioglycamate in the bile of the rhesus monkey was achieved when the rate of adminstration was at least twice the rate of excretion. A maximum concentration of ioglycamate in the bile was also established, and this is more important to the visualization of the bileducts than the quanity of ioglycamate excreted. The maximum concentration was obtained at the same rate of infusion as that which produced the maximum rate of excretion. The peak concentration was sustained longer with an infusion lasting two hours than with one lasting 36 minutes, althought the same quanity of ioglycamate had been administered. It is concluded that an infusion at a rate equal to twice the maximum excretory rate and continued for two hours or longer is a rational approach to intravenuous cholangiography particularly in those patients where there has been some diffculty in bile-duct visulization.

The concentration maximum concept in intravenous cholangiography.

The excretion of ioglycamate in the bile of the rhesus monkey was measured at 5% and at 100% bile diversion following an intravenous bolus injection of ioglycamate. At 100% diversion the bile volume was reduced and the concentration of ioglycamate was increased, but the quantity excreted was unchanged. A similar study using iodipamide reported previously gave the same result. When the ioglycamate was given by intravenous infusion, the effect of 100% bile diversion was quite different. The concentration of ioglycamate in the bile was unchanged by the bile diversion but the excretion was reduced. These results indicate that the transport maximum for the excretion of ioglycamate in bile is not a constant and is reduced by interruption of the enterohepatic circulation of bile salts. The maximum concentration of ioglycamate in bile was constant and was independent of the reduction in bile salt output produced by 100% bile diversion. Following a single bolus injection however, the reduction in bile flow produced by 100% bile diversion increased the biliary concentration of ioglycamate. These results suggest that the excretion of ioglycamate is limited by a maximum concentration rather than a transport maximum. The maximum rate of transport (Tm) is dependent on two factors--the maximum concentration of ioglycamate in the bile and the rate of bile flow. The maximum concentration is achieved by an infusion technique and not by a single bolus injection and this supports the view that an infusion technique should be used for intravenous cholangiography.

Intravenous cholangiography in childhood.

Intravenous cholangiography (IVC) was performed on 102 children aged between one and 13 years. Eighty of the patients who were non-icteric were divided into four groups and received contrast medium containing either 53, 75, 106 or 150 mg iodine/kg body weight by intravenous injection over ten minutes. Complete demonstration of the common bile duct (CBD) was achieved in 85% of patients and in a similar proportion of all age groups. There was some delay in opacification of the CBD in young children but this was not of practical significance. The two higher dosage regimen gave significantly better results than the two lower dosages (p less than 0.001) and this improvement was evident in the young and older age groups. Nausea and vomiting occurred as side effects in 6%. In eight patients in whom there was inadequate demonstration by the standard IVC, an infusion technique over 3--8 hours was carried out. This improved the demonstration in three children with diagnostic results in two.

Prolonged drip-infusion cholangiography.

Previous experimenttal work in animals has shown that the hpatic excretion of iodipamide and ioglycamide is subject to a transport maximum (TM). Doses in excess of this TM are largely excreted in the urine. In the present study the TM for man was estimated in three subjects with indwelling T-tubes: figures of 19-23 mg/minute for ioglycamide were obtained. It was thought that prolonged administration of contrast at levels slightly above the TM might have advantages in patients with impaired liver function. In obstruction the gradual excretion of contrast could improve the chances of filling the ducts completely, while in hepato-cellular disease the gall bladder might have time to concentrate the contrast. Ioglycamide was therefore given by slow overnight infusion, equivalent to 35 mg/minute, to patients in whom standard cholangiography had been unsuccessful. The overall success rate was 75 per cent with similar improvement in obstructive and hepatocellular disease.

Adverse reactions to intravenous cholangiography with Biligram.

During the seven year period 1976-82 3937 intravenous cholangiographies were performed with thirty-three adverse reactions to the contrast medium Biligram considered to require treatment. One patient died. The frequency of adverse reactions to intravenous cholangiography with Biligram is no reason for abandoning the method.

The effect of taurocholate on canine bile flow, biliary excretion and concentration of ioglycamide.

The bile acid taurocholate increases the biliary excretion of organic anions, such as sulfobromophthalein (BSP), bilirubin and iopanoic acid. In the present study has been investigated the effect of taurocholate on 1. Canine biliary excretion and concentration of the i.v. contrast medium ioglycamide and 2. Canine bile flow. The experimental model consisted of cholecystectomized, anaesthetized dogs with a fistula, through which the common bile duct could be catheterized and drained. One hour after cannulation, i.v. infusion of ioglycamide at a rate of 4 mumol/min./kg. was started. Two hours after the infusion start a control group received i.v. infusion of saline, while in another a 1.5% sodium taurocholate infusion was started with stepwise increases with 30 min. intervals from 0.4 to 0.8, 1.6 and 3.2 mumol/min./kg. Compared with control, all rates of taurocholate infusion increased bile flow and decreased biliary ioglycamide concentration. Although the bile flow with increasing taurocholate infusion rates was enhanced, the biliary ioglycamide excretion did not increase. The results indicate that ioglycamide and taurocholate are excreted into bile by separate excretion mechanisms. As taurocholate increases the biliary excretion of some other organic anions, it supports the hypothesis that organic anions are excreted into bile by more than two excretion mechanisms, taurocholate affecting only some of them.

[Intravenous cholangio-cystography during childhood (author's transl)]. / Die intravenöse Cholangiozystographie im Kindesalter.

Twenty-five intravenous cholangio-cystograms were carried out in children aged 2 to 15 years (10 by injection, 15 by infusion). Total bilirubin, GOT, GPT, GLDH and alkaline phosphatase were determined before and after injection of the contrast medium. The contrast media used were "Biligram for infusion" (17%) and "biligram for injection" (35%). Contrast dose per kilo body weight depends on the age of the patient: a) For infusion: infants 1.6 ml/kg/KG, small children 1.2 ml/kgKG, older children 0.8 ml/kg/KG. b) for injection: infants 0.8 ml/kg/KG, small children 0.6 ml/kg/KG, older children 0.4 ml/kg/KG. Both methods, in the above doses, provided good demonstration of the biliary tree and gall bladder. Films were taken at 30 minutes, 60 minutes and 90 minutes after the end of the injection, and 40 minutes after a fatty meal. No allergic reactions were observed, nor any effect on the liver enzymes.