[EXPERIMENTATION OF A NEW CONTRAST MEDIA FOR INTRAVENOUS CHOLANGIO-CHOLECYSTOGRAPHY (BILIVISTAN SCHERING)].
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The introduction of modern methods of diagnostic imaging as sonography, CT and endoscopic retrograde cholangiopancreaticography has changed the value of intravenous cholegraphy. Since the introduction of the contrast medium Ioglycamide into clinical practice two years ago we evaluated the cholangiocholecystographies of 50 patients. The investigation was indicated, if no elucidation was achieved with sonography. Side effects were not registered with Ioglycamide. Indications and value of the method are discussed.
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.
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).
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Administration of four different contrast media exerted slight but significant and prolonged effects on the hormonal thyroid status, in 53 euthyroid subjects (four subgroups), without any clinical expression of dysthyroidism. Changes in serum T3, rT3 and T4 demonstrated different trends for each iodinated compound, probably depending on the regulatory thyroid mechanisms, and CM pharmacokinetics. Plasma profiles of free fractions (FT3, FT4) slightly reflected consensual changes with circulating iodothyronines, at various time periods of study, demonstrating high correlation indexes with total fractions. The five hormones profiles correlation study suggest that different mechanisms could be responsible for some features encountered of "low T3 syndrome". These effects may be not only equivalent to giving various sources of iodide, but suggest more complex mechanisms. It is apparent that man has a remarkable and possibly unique system of homeostatic thyroid hormone regulation.
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The effect of 6 commonly used contrast media on the results of 3 different methods for determination of thyroid hormone concentration in the serum is examined in vivo. T4 determination by column chromatography proved to be very liable to distortion for contrast media. With some contrast media the Res-O-Mat-ETR test proved unreliable. T4 determination by means of protein binding analysis is not affected by contrast media in the direction of false raised values.
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.
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 excretion of the biliary contrast medium meglumine ioglycamate into the bile is limited by a hepatic transport maximum system. A minimum plasma concentration, approximately 800-1,000 microgram/ml is required to maintain maximum excretion of contrast medium. Serial measurements of the plasma levels of ioglycamate were made on 21 patients during routine intravenous cholangiography, using different infusion rates. An infusion regimen using 10 mg/kg/min for 15 min, then 60 mg/min is described, which rapidly elevates the plasma concentration to the optimum level and maintains it at, or slightly above this level.
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The distribution and biliary excretion of two hepatotropic contrast media, Ioglycamate and Iotroxinate, has been studied in the anaesthetized pig in infusion experiments. The new substance Iotroxinate exceeds the Ioglycamate in two of the investigated parameters: it was excreted faster and reached a higher biliary concentration. The biliary transport maximum, however, was unchanged. On the basis of these experiments the new contrast medium Iotroxinate was tested in men.
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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.
Pulmonary inactivation of prostaglandin E2 (PGE2) was investigated in isolated perfused rat lungs during infusion of ionic and nonionic radiographic contrast media (RCM). When 100 nmol of [14C]-PGE2 was infused slowly into the pulmonary circulation, the ionic ioglycamate decreased the metabolism of PGE2, but other ionic (diatrizoate and ioxaglate) and nonionic RCM (iopamidol and metrizamide) had no significant effect. When a smaller amount of [14C]-PGE2 (10 nmol) was injected as a bolus the metabolism of PGE2 was decreased also by diatrizoate and ioxaglate, but not by iopamidol. After a similar bolus injection of 10 nmol of [14C]-PGE2, the efflux of radioactivity from the lungs was increased by diatrizoate, ioglycamate and ioxaglate but remained unchanged by iopamidol and metrizamide. The RCM infusion did not change the perfusion pressure. The present study indicates that ionic RCM decrease the inactivation of PGE2 in rat lungs and thus possibly increase the circulating level of this prostaglandin.