Changes of circulating thyroxine, triiodothyronine and reverse triiodothyronine after radiographic contrast agents.

Thyroid function was studied for 42 days in 58 patients, 28 of whome had euthyroid goiter, after urography (diatrizoic acid), cholangiography (ioglycamic acid), and cholecystography (Naiopanoate). After urography and cholangiography short-lived increases of the serum thyroxine occurred in a few patients, but the mean thyroxine and triiodothyronine concentration did not change. By contrast, 7 days after oral cholecystography serum thyroxine had risen consistently by 22% with a concomittant rise of the free thyroxine, while triiodothyronine declined by 15%. The thyroxine metabolite 3,3',5'-triiodo-1-thyronine (reverse T3) rose by 50% and serum thyrotropin concentration doubled. After 42 days thryoxine and triiodothyronine had returned to baseline, and none of the 58 patients developed clinical hyperthyroidism. In patients with severe myxoedema kept on a constant replacement dose with 1-thyroxine NA-iopanoate produced similar changes with the exception of the rise of the serum thyroxine. The primary event after Na-iopanoate seems to be a fall of the serum triiodothyronine, which in turn augments thyrotropin and indirectly thyroxine secretion. the marked and sometimes sustained rose of serum thyroxine after cholecystography may lead to the erroneous diagnosis of hyperthyroidism.

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.

[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.

[Intravenous cholegraphy with Chologram (a double blind comparison with Bilivistan) (author's transl)]. / Intravenöse Cholegraphie mit Chologram, Doppelblindstudie gegen Bilivistan

A double blind comparison between Ioglycamid (Bilivistan) and the new I-V cholegraphic medium Iotroxamid (proposed trade name Chologram) is reported. Chologram produces better pictures and it is better tolerated. Pharmaco-kinetic data are published for the first time.

[A contribution to the rate of side-effects of hepatotropic contrast media. A clinical comparative study of iodoxamate (Endomirabil) and ioglycamid (Bilivistan) (author's transl)]. / Beitrag zur Nebenwirkungsrate hepatotroper Kontrastmittel. Klinische Vergleichsuntersuchung von Iodoxamat (Endomirabil) und Ioglycamid (Bilivistan)

The new substance Iodoxamate (Endomirabil) is a hepatotropic contrast medium. In a clinical comparative study, the contrast of the biliary ducts and gall bladder is equivalent compared with Ioglycamid (Bilivistan). Assuming equal conditions of injection and in conformity with animal experimental studies, the rate of side effects of Iodoxamate is distinctly lower than that of the referring substance Iolgycamid (Bilivistan).

IgE-mediated adverse reactivity to a radiographic contrast medium.

In a patient with a previous history of a serious reaction after intravenous injection of the cholangiographic agent ioglycamic acid (Bilivistan), intravenous cholangiography appeared to be necessary. Therefore intradermal tests were performed in the patient and four controls with three radiographic contrast media closely related in chemical structure. In addition a Prausnitz-Kustner test with heated and unheated patient serum was performed. These tests demonstrated the presence in this patient of selective immediate-type reactivity to ioglycamic acid which was probably IgE mediated. Intravenous cholangiography with iodipamide seemed justified and resulted in no adverse reactions. Although this case may be exceptional, the results suggest that intradermal skin tests at proper concentrations may be useful in choosing the administration of radiographic contrast medium to patients with a history of prior adverse reactions.

[Quality of roentgenological visualization and tolerance of various intravenous cholegraphic contrast media (author's transl)]. / Röntgenologische Darstellungsqualität und Verträglichkeit verschiedener intravenöser Cholegraphika.

The recently introduced intravenous cholegraphic contrast media produce a greater diagnostic yield in radiological routine thanks to improved roentgenological contrasting. Whereas the percentage share of roentgenologically clearly assessable cases is about 75 % when using Biligrafin, this percentage is much higher with the more recent contrast media, especially Biliscopin, namely, up to 88 %. These new contrast media are also superior in respect of tolerance, since they produce fewer side effects. While side effects must be expected in about 28 % of the cases when injecting Biligrafin, the side effect quota is about 10 % only with Biliscopin or Endomirabil. If the contrast medium is infused instead of injected, the quota of side effect drops to 2.3 % with Biliscopin or 3.9 % with Endomirabil. Slight and medium side effects have definitely decreased with the more recent contrast media. The slower and more continually the contrast medium is administered, the fewer are the side effects observed; this becomes particularly noticeable in the case of long-term infusions. However, the likelihood of severe incidents caused by the contrast medium, remains unchanged at about 1 % of the examined patients, even with the more recently introduced contrast media.

Sudden death caused by interaction between a macroglobulin and a divalent drug.

Intravenous injection of the divalent X-ray contrast medium ioglycamic acid ("Biligram") induced intravascular precipitation and sudden death of a patient owing to reaction with his monoclonal macroglobulin. Mice reacted similarly in passive transfer experiments. The corresponding monovalent compound, acetrizoic acid, was also bound to the IgM but did not induce precipitation and had no apparent ill-effects on mice in passive transfer experiments.

[A new bile contrast in pediatrics (author's transl)]. / Vergleichende Studie über die Anwendung eines neuen Gallenkontrastmittels im Kindesalter.

Biligram was used for 42 cholegraphies in children aged 2 months to 15 years. A 35% concentration of Biligram was given as intravenous injection in 14 children, a 17% or 3,4% concentration as an intravenous infusion in 16 or 12 patients, respectively. The quality of x-ray films with both Biligram 35% and 17% was equally good whereas Biligram 3,4% gave a weak contrast only. The best time for taking films was 30 and 60 min after injection of Biligram. Allergic reactions or an effect on liver enzymes were not observed.

Double blind comparison of meglumine iotroxate (Biliscopin), meglumine iodoxamate (Endobil), and meglumine ioglycamate (Biligram).

Two new intravenous cholegraphic agents, iotroxate and iodoxamate, hold a lower general toxicity, lower protein binding, and claim a higher rate of biliary excretion. Both compounds proved to be equally effective in opacifying the gallbladder and the bile ducts in a double-blind clinical study comprising 400 cases. Iotroxate gave significantly earlier good or adequate visualization as a result of its higher excretion rate by the liver (P less than 0.05). Side effects were observed in fewer patients in the iotroxate group (11.6%) compared with the iodoxamate group (16.4%, P greater than 0.05). In a second double-blind study, an iotroxage group of 97 patients who received two thirds of the overall content of iodine (3.6 g) was compared with a group of 98 patients, who received ioglycamate (5.3 g). Visualization was equal in the two groups, while side effects were significantly reduced to 10.3% in the iotroxate group against 20.4% (P less than 0.05). The higher biliary clearance of iotroxate permits a reduction of the amount of iodine.

[Injection cholecystography--influence of radiopaque substance and injection time on the excretion of contrast media and incidence of side effects]. / Injektions-Cholegraphie. Der Einfluss von Kontrastsubstanz und Injektionszeit auf Konstrast-mittelausscheidung und Nebenwirkungen

In a total of 532 patients, Bilivistan and Endomirabil are compared in cholecystography regarding side effects and visualization. Endomirabil clearly demonstrates the advantage of better tolerance. It is shown that slow and constant injection leads to a decrease in the rate of adverse reactions and improvement of radiographic demonstration.

[Influence of radiopaque substance and concentration of contrast media as well as time of infusion on excretion of contrast medium and incidence of side effects (author's transl)]. / Infusions-Cholegraphie. Der Einfluss von Kontrastsubstanz und Konstrastmittelkonzentration sowie Infusionszeit auf Kontrastmittelausscheidung und Nebenwirkungen

Two hepatotropic contrast media in 3 different concentrations each are administered to a total of 727 patients for infusion cholecystography. It is the purpose of the study to investigate frequency of adverse reactions and quality of radiographic demonstration. In regard to tolerance, Endomirabil clearly shows advantages over Biligram. The radiologic demonstration of Endomirabil is somewhat better than with Biligram. The frequency of adverse reactions shows to be influenced by the concentration of the contrast medium as well as time of infusion, which particularly applies to Endomirabil, while in regard to the quality of visualization, ni dependence on either concentration of infusion time could be demonstrated.

[The results and tolerability of infusion cholegraphy using ioglycamide-85 (12.75 g meglumine salt in 75 ml) in comparison with the use of a hypotonic adipiodone solution (10 g meglumine salt in 100 ml)]. / Ergebnisse und Verträglichkeit der Infusionscholegraphie mit Ioglycamid-85 (12,75 g Megluminsalz in 75 ml) im Vergleich zur Anwendung einer hypotonen Adipiodon-Lösung (10 g Megluminsalz in 100 ml).

The quality of 96 infusion cholegraphies with isotonic Ioglycamide-85 solution and of 2,080 infusion cholegraphies with hypotonic adipiodone-50 gave equal images in 97% of the cases. Ioglycamide-85 caused side-effects in 15.6%, Adipiodone only in 1.5% of the cases. For improved compatibility of Ioglycamide and of new contrast media as Iotroxamide and Idoxamide the use of hypotonic solutions is recommended for infusion. Their concentration should be osmotically tolerated by the erythrocytes. For the prevention of liver necrosis by contrast media the amount of contrast medium should be limited to 10 g meglumine salt.

Inhalation bronchography using powdered calcium ioglycamic acid.

In 16 baboons, reproducible bronchograms could be achieved by inhalation of 400--800 mg of powdered calcium ioglycamic acid. Anesthesia, tracheal intubation, or premedication were not necessary. In patients and volunteers, the inhalation of the contrast medium dust caused strong cough. Local anesthesia allowed inhalation for about 10 minutes, which resulted in successful demonstration of the pharynx, larynx, and trachea with bifurcation. Lobular and segmental bronchi were demonstrated only after a longer inhalation time. The contrast medium was completely eliminated and did not cause any recognizable adverse reaction. Nonspecific inflammatory reaction of the bronchial mucosa was seen microscopically in baboons.

Adverse reactions at intravenous cholegraphy with ioglycamide. Correlation with the level of circulating sex hormones.

Intravenous cholegraphy with ioglycamide was performed in 861 cases. The patients were divided into hormonally disparate age groups. The phase of the menstrual cycle was recorded. A correlation was demonstrated between the incidence of side effects and the level of circulating sex hormones at the time of examination. The possible mechanisms for these adverse reactions are discussed.

A clinical and radiological trial of meglumine loglycamate, a new intravenous cholangiographic contrast medium.

The efficacy of meglumine ioglycamate was assessed in 100 unselected patients who underwent cholangiography for various reasons. Good to excellent opacification was achieved in 69% of all patients. A total of 17% of all patients showed side-effects, the majority of which were transient and of a minor nature. Blood pressure and liver function were apparently not affected, but SGOT levels increased transiently within 24 hours in 21% of patients. Renal excretion of the contrast medium occurred in 48% of patients, but in only 2 did it interfere with visualisation of the duct.