Delayed reactions to urographic contrast media.

Reactions to urographic contrast media occurring after the patient had left the department were studied by giving patients a questionnaire to complete. 841 questionnaires were returned (about 80% of those issued). 70% of patients had no delayed reactions and 7% expressed a positive response to urography i.e., found the procedure interesting and not unpleasant; 13% had arm pain, 5% a rash and 14% had a variety of reactions, many of which were the same as those described in iodism. Women had significantly more rashes (7%) than men (4%) and those media containing the meglumine or iodamide ions caused more rashes than other media. Conray 420 caused more arm pain than Conray 280 or the non-ionic media, which would be expected from the known effects on vascular endothelium. Symptoms of iodism were equally common from the various contrast media.

The old and the new: a study of five contrast media for urography.

Five contrast media, Conray 280 and 420, Urografin 370, Uromiro Sodium 300 and Niopam 370, were compared in a randomised trial involving a total of 482 patients. The best urographic agent was Conray 420 and the worst Conray 280, these control agents defining the ends of the scoring system. Uromiro Sodium 300 was very nearly as good as Conray 420. A non-ionic agent, Niopam 370, scored nearly equal with Urografin 370; both were rather better than Conray 280. There was little difference in minor reactions between the media. No reason was found to prefer non-ionic to ionic agents for general use in urography; indeed for a diagnostic examination the sodium salt of an ionic agent is preferable.

Pneumatosis coli: an uncommon but treatable cause of faecal incontinence.

Pneumatosis intestinalis is defined as the presence of gas within the bowel wall. Small bowel pneumatosis is less commonly reported and more severe than colonic disease in adults. Pneumatosis coli is characterised by multiple collections of encysted gas occurring within the sub-mucosa and subserosa of the colon and rectum. It is an uncommon condition which typically presents in late middle age and has been associated with a number of gastrointestinal (e.g. pyloric stenosis, sigmoid volvulus and ischaemic bowel) and non-gastrointestinal (e.g. chronic obstructive pulmonary disease, depression and multiple sclerosis) diseases. Some cases, however, are idiopathic or primary. Symptoms can include diarrhoea, constipation, mucus per rectum, bleeding, flatus, abdominal pain and, rarely, faecal incontinence. We report on two patients, one of whom presented with faecal incontinence, the other who had troublesome lower gastrointestinal symptoms including faecal incontinence. Both responded well to continuous oxygen therapy.