Cholescintigraphy versus infusion cholecystography in acute cholecystitis

Patients with the clinical diagnosis of acute cholecystitis were studied with intravenous cholecystography and cholescintigraphy. The two examinations alternated in a random order. The final diagnosis was ascertained by surgery in most patients. Either cholecystography or cholescintigraphy could be used in the diagnostics of patients with suspected acute cholecystitis. The methods have about the same accuracy. However, cholescintigraphy is performed more easily and more rapidly than intravenous cholecystography.

Contrast, coagulation, and fibrinolysis

Some adverse clinical effects of intravascular radiologic contrast agents have been attributed to their interference with the normal hemostatic processes. This study compares the effects of the low osmolality agents with those of the conventional agents by in vitro studies of platelet function, fibrin formation, and fibrinolytic activation. In various degrees, all the contrast agents studied inhibit platelet aggregation and fibrin formation but show virtually no direct activation of fibrinolysis. The new low osmolality agents generally show lesser inhibitory effects on the hemostatic mechanisms. Some clinical implications are discussed.

[Changes in thyroid hormone status after injections of iodinated contrast media]

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.

Infusion cholecystography in the early diagnosis of acute gallbladder disease

The value of infusion cholecystography 99mTc HIDA cholescintigraphy and ultrasonography was compared in 51 patients presenting with a clinical diagnosis of acute cholecystitis. Of the 35 patients with proven gallbladder disease, the presence of gallstones was correctly predicted in 31 (88 per cent) by infusion cholecystography, 32 (90 per cent) by 99mTc HIDA cholescintigraphy and 27 (77 per cent) by ultrasonography. There were no false positive investigations. Infusion cholecystography may be of particular interest to surgeons with no ready access to isotope scanning techniques.

Sensitivity of ultrasonography in the demonstration of common bile duct stones and its ranking in comparison with intravenous cholangiography and endoscopic retrograde cholangiopancreatography

A series of 75 patients with surgically verified common bile duct (CBD) stones were re-examined in retrospect, in order to ascertain the sensitivity of ultrasonography (US) in the detection of CBD. The sensitivity of US turned out to be 19%. US detected bile duct dilatation in 58% and all the CBD stones detected or suspected were seen in cases with bile duct dilatation. The sensitivity of intravenous cholangiography (IVC) proved to be 24%. Endoscopic retrograde cholangiopancreatography (ERCP), however, was found to be by far the most sensitive method, since it demonstrated 84% of the CBD stones.

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 computed tomographic cholangiography in acute cholecystitis. A comparison with conventional cholangiography

Forty-nine patients with clinical signs of acute cholecystitis underwent conventional and computed tomographic cholangiography. Among 39 patients with signs of contrast medium in the biliary system at both examinations there was a diagnostic discrepancy in only one patient. Conventional radiography demonstrated cholecystopathy in this patient while contrast medium in the gallbladder and an acute pancreatitis were found at computed tomography. Ten patients with an indeterminate conventional cholangiography had a conclusive computed tomographic examination. Twenty of 30 patients with an abnormal computed tomographic cholangiography underwent cholecystectomy and all had diseased gallbladders. All 17 patients with histopathologically confirmed acute cholecystitis had signs of subserosal edema and/or changes in the omental fatty tissue adjacent to the gallbladder at computed tomography. A layer of tissue of water-density adjacent to the gallbladder and/or changes in omental fatty tissue were also seen in one patient with congestive heart failure and in one with a penetrating duodenal ulcer. None of the 19 patients with a normal computed tomographic cholangiography had a proven acute cholecystitis.

Contrast media reactions: experimental evidence against the allergy theory

In order to clarify whether adverse reactions to radiographic contrast media may be allergic in nature, it is essential to show that contrast media can act as haptens and induce antibody formation in vivo. Experiments in Hooded Lister rats have been carried out using techniques specifically designed to produce favourable conditions for the production of antibodies. No evidence of any antibody formation was found in any of the experiments. These experiments suggest that radiographic contrast media in their native form do not act as haptens, contrary to previously published data, and it therefore seems unlikely that the majority of adverse reactions to radiographic contrast media are allergic in nature.

The effect of ionic and nonionic contrast media on the metabolism of prostaglandin E2 in rat lungs

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.

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.

[The effect of contrast media containing iodine on selected in vitro thyroid test procedures (author's transl)]

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.