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1.
Evaluation the Effects of Alpha-tocopherol in Comparison with N-acetylcystein for Prevention of Contrast Induced Nephropathy (CIN) in CKD Patients.
Samadi, K, Naghibi, M, Shabestari, M, Sharifipour, F, Khajeh Dalooee, M, Raeesi, V, Moosavi Nik, S, Samadi, M
Iranian journal of kidney diseases. 2020;(1):26-30
Abstract
INTRODUCTION Contrast induced nephropathy (CIN), a well-known complication of using radio contrast media, dramatically increases the likelihood of patient morbidity and mortality following coronary angiography. As there is no specific treatment for CIN, prevention could be the best strategy to address this issue. Since now, the only approved preventing strategy was hydration with normal saline while antioxidant agents as a new yet unapproved remedy for this purpose could be applied .The present study was conducted to examine the effect of alpha tocopherol in CIN prevention. METHODS This prospective controlled trial was carried out on 201 patients with chronic kidney disease (eGFR < 60 cc/min) underwent coronary angiography. We assigned three groups of CKD patients: 72 patients who received prophylaxis administration with isotonic saline (Group A), 66 patients with isotonic saline plus N-acetylcysteine (1200mg twice a day) for 2 days (Group B) and 63 patients who received isotonic saline plus daily alpha tocopherol (600 IU once daily from one day before till 2 days after angiography) for 4 days (Group C). The contrast media in all three groups was nonionic iso-osmolal agent, Visipaque. RESULTS Even though CIN didn't developed in any of the three aforementioned groups but there was statistically significant reduction in eGFR from baseline in all three groups (P < .001). Moreover, We found no statistically significant difference in GFR reduction between three studied groups. CONCLUSION Administration of alpha tocopherol has no additive beneficial effect over isotonic saline in CIN prevention in CKD patients.
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2.
[Application of Low Concentration Contrast Agent Combined Double Low Dose in CT Pulmonary Angiography for Pulmonary Embolism].
Li, L, Zhao, F, Pu, YM, Zhang, K, Pu, J, Li, YM, Peng, WL, Zhang, JG, Xia, CC, Li, ZL
Sichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science edition. 2018;(2):239-242
Abstract
OBJECTIVE To investigate the feasibility of low concentration contrast agent combined double low dose in CT pulmonary angiography. METHODS 60 patients with clinically suspected pulmonary embolism examed by CT pulmonary angiography (CTPA) were divided into two groups (experimental group: n=30,80 kV, 15 mL,320 mg I/mL;control group: n=30,120 kV,50 mL,370 mg I/mL). The average CT value of main right and left pulmonary arteries,lobar arteries was calculated. Imaging post processing techniques included curved plannar reconstruction (CPR),volume rendering (VR) and maximal intensity projection (MIP). The artifact of the remaining contract in the superior vena cava and overall quality of the image were observed and analyzed by two senior doctors who were double blinded. RESULTS All patients in two groups completed CTPA successfully. The image qualities of two groupssatisfy clinical diagnostic requirements and no difference of the image qualities was observed between two groups (P>0.05). The evaluation of venous pollution in experimental group was better than that of control group (P<0.01).No difference of CT values were observed between two groups [experimental group (423.2±89.4) HU,control group (465.7±85.6) HU](P>0.05). The SNR and CNR in experimental group were lower than those in control group (P<0.01 both).The CT dose index volume (CTDIvol),dose-length product (DLP) and size-specific dose estimates (SSDE) in experimental group were significantly lower than those incontrol group (P<0.01 all). CONCLUSION The low concentration contrast agent combined double low dose in CT pulmonary angiography satisfies clinical diagnostic requirements. It has good clinical value for it could reduce venous pollution,iodine contrast agent and radiation exposure.
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3.
Measurement of shear wave velocity using acoustic radiation force impulse imaging is not hampered by previous use of ultrasound contrast agents.
Cui, XW, Pirri, C, Ignee, A, De Molo, C, Hirche, TO, Schreiber-Dietrich, DG, Dietrich, CF
Zeitschrift fur Gastroenterologie. 2014;(7):649-53
Abstract
PURPOSE To assess the inter-observer reproducibility of acoustic radiation force impulse imaging (ARFI) between 2 skilled physicians and to evaluate if ultrasound contrast agents (UCA) affect the measurement of shear wave velocity (SWV) using ARFI. PATIENTS AND METHODS 53 patients (29 males, 24 females, 59 ± 15 [22-84] years) who underwent contrast enhanced ultrasound (CEUS) examination were included. ARFI was performed on liver segment V by physicians A and B before CEUS, and by physician A within 4-6 minutes and 7-10 minutes after contrast injection. In a subgroup of 31 patients (15 males, 16 females, 57 ± 18 [22-84] years), ARFI was also performed on focal liver lesions (FLL) by physician A before CEUS, and within 4-6 minutes and 7-10 minutes after contrast injection. RESULTS The SWV values obtained by physician A and B before CEUS yielded an intra-class correlation coefficient value of 0.913 (95% CI, 0.849-0.950). No significant differences were shown between the SWV values of liver segment V in all 53 patients and of FLL in the subgroup of 31 patients obtained before CEUS and that of within 4-6 minutes and 7-10 minutes after contrast injection (all P > 0.05). CONCLUSION ARFI showed excellent inter-observer reproducibility between 2 skilled physicians. UCA did not affect the measurement of SWV in both liver parenchyma and FLL, at least when performed 4 minutes after the contrast injection. ARFI may become an additional tool in the differential diagnosis of FLL.
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4.
Early response to anti-tumoral treatment in hepatocellular carcinoma--can quantitative contrast-enhanced ultrasound predict outcome?
Knieling, F, Waldner, MJ, Goertz, RS, Zopf, S, Wildner, D, Neurath, MF, Bernatik, T, Strobel, D
Ultraschall in der Medizin (Stuttgart, Germany : 1980). 2013;(1):38-46
Abstract
PURPOSE In order to detect an early response to anti-angiogenic therapy, this study aims at analyzing specific effects of a sorafenib-based regime on intra-tumoral D-CEUS flow parameters of patients with HCC. MATERIALS AND METHODS Videos of the arterial phase were captured before initiation of a therapy with sorafenib and 1 and 3 months after (n = 9). Patients receiving a non-anti-angiogenic therapy (TACE, n = 10) served as a comparison group. Cross-sectional imaging was performed at the same time points and patients were followed up for 1 year. RESULTS In the responder group (RE), the absolute (percentage) TTP was 11.28 s ± 2.03 s (1.00) before treatment, 13.60 s ± 1.52 s (1.53 ± 0.08) after one month (p = 0.0405), and 16.17 s ± 2.35 s (1.46 ± 0.07) after three months of treatment (p = 0.0071). The TTP increased significantly in the RE group as early as 1 month after initiation of sorafenib compared to the non-responder group. There were no significant differences in the non-responder group or between the NR and the TACE group at any time point. D-CEUS values from all sorafenib-treated patients showed good accordance with RECICL (response evaluation criteria in cancer of the liver) criteria (R2 = 0.7154, p = 0.0001). CONCLUSIONS Quantitative CEUS reveals variations of dynamic parameters of blood flow during anti-tumoral therapy in liver cancer patients. Further investigations and clinical trails have to confirm that the TTP is a promising parameter in the prediction of early response to sorafenib-based therapy.
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5.
Diagnostic evaluation of patients with nonimmediate cutaneous hypersensitivity reactions to iodinated contrast media.
Torres, MJ, Gomez, F, Doña, I, Rosado, A, Mayorga, C, Garcia, I, Blanca-Lopez, N, Canto, G, Blanca, M
Allergy. 2012;(7):929-35
Abstract
BACKGROUND Nonimmediate hypersensitivity reactions to iodinated contrast media (CM) are common. Allergological evaluation is necessary to confirm the diagnosis and to find a tolerated alternative. The aim of this study was to establish the role of skin testing and the drug provocation test (DPT) in the diagnosis of nonimmediate reactions to CM. METHODS Skin intradermal testing and patch testing with delayed readings were carried out with different CM (iobitridol, iomeprol, iodixanol, iohexol, ioversol, iopramide and ioxaglate). Single-blind placebo-controlled DPT was carried out in those cases with a negative skin test. In seven cases, a skin biopsy was obtained from positive skin tests and positive DPT. RESULTS Of the 161 subjects evaluated, 34 (21.1%) were skin-test positive, 21 (50%) to Iomeprol, 7 (16.7%) to Iodixanol, 5 (11.9%) to Iobitridol, 4 (9.5%) to Ioxaglate, 3 (7.1%) to Iohexol and 1 (2.4%) to Iopramide. DPT was positive in 44 cases (34.6%) that were skin-test negative, 38 (76%) to Iodixanol, 8 (16%) to Iomeprol and 4 (8%) to Iohexol. Of 78 cases (48.4%) with confirmed hypersensitivity, 34 (43.6%) were identified by skin testing and 44 (56.4%) by DPT. Skin biopsies showed a perivascular mononuclear cell infiltrate, mainly in the dermis, with higher levels of CD4 than CD8 T lymphocytes, with expression of activation markers and skin homing receptors. CONCLUSION Patients with nonimmediate reactions to CM were identified by skin testing in 43.6% and by DPT in 56.4%. The method to confirm the diagnosis differed depending on the CM involved.
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6.
Sodium bicarbonate for the prevention of contrast-induced nephropathy: the efficacy of high concentration solution.
Tamai, N, Ito, S, Nakasuka, K, Morimoto, K, Miyata, K, Inomata, M, Yoshida, T, Suzuki, S, Murakami, Y, Sato, K
The Journal of invasive cardiology. 2012;(9):439-42
Abstract
BACKGROUND The appropriate dose of sodium bicarbonate to prevent contrast-induced nephropathy (CIN) has not been established. METHODS AND RESULTS To determine the efficacy of high-concentration sodium bicarbonate, 123 consecutive patients with renal dysfunction undergoing coronary angiography with/without intervention were administrated either high-concentration (group H: 833 mEq/L, n = 87) or low-concentration (group L: 160 mEq/L, n = 36) sodium bicarbonate at the rate of 3 mL/kg/h for 1 hour before the contrast exposure, and followed by 1 mL/kg/h for 7 hours. A total of 77 patients (group H, n = 54; group L, n = 23) without prophylactic continuous hemodiafiltration were analyzed in this study. Urine pH (n = 10 for each group and n = 5 for control) was increased by concentration and time-dependent manner in each group. Urine pH at 3 hours after administration of sodium bicarbonate was significantly higher in group H than group L and control (8.50 ± 0.94 vs 6.95 ± 1.17 vs 5.70 ± 0.97, respectively; P<.001). Incidence of CIN (0% vs 17.3%; P=.005) was lower in group H than group L. Percent change in creatinine within 48 hours was significantly lower in group H than group L (-2.65 ± 9.83% vs 9.14 ± 14.0%; P=.001). Percent change in estimated glomerular filtration rate within 48 hours was significantly higher in group H than group L (3.97 ± 11.8 vs -7.43 ± 13.3; P<.001). CONCLUSION Administration of a higher concentration of sodium bicarbonate was more effective for urine alkalization and prevention of CIN.
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7.
N-acetylcysteine for the prevention of contrast-induced nephropathy in the emergency department.
Hsu, TF, Huang, MK, Yu, SH, Yen, DH, Kao, WF, Chen, YC, Huang, MS
Internal medicine (Tokyo, Japan). 2012;(19):2709-14
Abstract
OBJECTIVE To evaluate the use of N-acetylcysteine (NAC), a potent antioxidant, to prevent contrast-induced nephropathy (CIN). METHODS We prospectively studied 209 patients (106 in the NAC group and 103 in the control group) who received contrast-enhanced computed tomography (CECT) in the emergency department (ED). The NAC group received intravenous NAC (600 mg) before CECT imaging to prevent CIN. Both the NAC and control groups were treated using a standardized hydration strategy, where clinically feasible. RESULTS The patients' mean age was 79.6±9.8 years. The prevalence of hypertension, diabetes, and chronic kidney disease (CKD) were 63.2%, 27.3%, and 21.5%, respectively. The baseline clinical characteristics were similar between the two groups except for their body weight (p=0.011), amount of contrast material administered (p=0.049) and prevalence of CKD (p=0.002). The incidence of CIN was 7.5% in the NAC group and 14.6% in the control group. The adjusted odds ratio was 0.305 (95% confidence interval: 0.097 to 0.960, p=0.042). All-cause mortality was 7.5% in the NAC group and 12.6% in the control group, which was not significantly different. Temporary hemodialysis was required in 0% of subjects in the NAC group and 1.0% in the control group, which was not a statistically significant difference. CONCLUSION A single dose of NAC before CECT imaging can prevent CIN in an ED setting. However, it does not improve the mortality rate or the need for dialysis.
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8.
Effect of intravascular iodinated contrast media on natural course of end-stage renal disease progression in hemodialysis patients: a prospective study.
Janousek, R, Krajina, A, Peregrin, JH, Dusilova-Sulkova, S, Renc, O, Hajek, J, Dvorak, K, Fixa, P, Cermakova, E
Cardiovascular and interventional radiology. 2010;(1):61-6
Abstract
We evaluated the impact of intravascular iodinated contrast medium on residual diuresis in hemodialyzed patients. Two groups of clinically stable hemodialyzed patients with residual diuresis minimally 500 ml of urine per day were studied. The patients from the first group were given iso-osmolal contrast agent iodixanol (Visipaque, GE Healthcare, United Kingdom) in concentration of iodine 320 mg/ml with osmolality 290 mOsm/kg of water during the endovascular procedure. The second control group was followed without contrast medium administered. Residual diuresis and residual renal excretory capacity expressed as 24-h calculated creatinine clearance were evaluated in the both groups after 6 months. The evaluated group included 42 patients who were given 99.3 ml of iodixanol in average (range, 60-180 ml). The control group included 45 patients. There was no statistically significant difference found between both groups in daily volume of urine (P = 0.855) and calculated clearance of creatinine (P = 0.573). We can conclude that residual diuresis is not significantly influenced by intravascular administration of iso-osmolal iodinated contrast agent (iodixanol) in range of volume from 60 to 180 ml in comparison to natural course of urinary output and residual renal function during end-stage renal disease. This result can help the nephrologist to decide which imaging method/contrast medium to use in dialyzed patients in current practice.
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9.
[Efficacy of high dose atorvastatin on preventing contrast induced nephropathy in patients underwent coronary angiography].
Zhou, X, Jin, YZ, Wang, Q, Min, R, Zhang, XY
Zhonghua xin xue guan bing za zhi. 2009;(5):394-6
Abstract
OBJECTIVE To compare the efficacy of high and low dose atorvastatin on preventing contrast induced nephropathy (CIN) in patients underwent diagnostic and therapeutic coronary intervention. METHODS All patients received atorvastatin 10 mg/d on the basis of hydrated therapy (n = 100) and high dose group received additional atorvastatin 80 mg at 12 to 24 hours before procedure (n = 50). Scr, Ccr, blood beta(2)-M, urine NAG/Cr, and urine osmolality before and after the procedure were compared between the groups. RESULTS Baseline demographic characteristics and nephropathy risk factors were similar between groups. Ccr was significantly reduced while blood beta(2)-M and uric NAG/Cr were significantly increased in low dose group (all P < 0.05). Blood beta(2)-M in the high dose group was significantly lower than that in the low dose group at day 1 [(2.35 +/- 0.52) mg/L vs. (2.67 +/- 0.64) mg/L, P = 0.008], day 3 [(2.49 +/- 0.55) mg/L vs. (2.80 +/- 0.64) mg/L, P = 0.011] and day 5 [(2.29 +/- 0.53) mg/L vs. (2.56 +/- 0.66) mg/L, P = 0.026] post-procedure respectively;urine NAG/Cr in the high dose group was also significantly lower than that in the low dose group at day 1 [(1.19 +/- 0.30) U/mmol vs. (1.46 +/- 0.34) U/mmol, P < 0.001], day 3 [(1.30 +/- 0.30) U/mmol vs. (1.59 +/- 0.33) U/mmol, P < 0.001], and day 5 [(1.10 +/- 0.30) U/mmol vs. (1.34 +/- 0.35) U/mmol, P = 0.001] post-procedure respectively;Ccr in the high dose group was significantly higher than that in the low dose group at day 1 [(73.69 +/- 20.99) ml/min vs. (65.19 +/- 18.72) ml/min, P = 0.035], day 3 [(64.04 +/- 15.82) ml/min vs. (56.79 +/- 14.50) ml/min, P = 0.019]post-procedure respectively. CONCLUSION High dose atorvastatin use before angiography is superior than low dose atorvastatin on attenuating contrast induced renal dysfunction.
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10.
Radiocontrast media-associated exanthema: identification of cross-reactivity and tolerability by allergologic testing.
Seitz, CS, Pfeuffer, P, Raith, P, Bröcker, EB, Trautmann, A
European journal of radiology. 2009;(1):167-71
Abstract
BACKGROUND All iodinated radiocontrast media (RCM) may cause hypersensitivity reactions, either immediate-type within 5-10 min of RCM injection or delayed-type, which become apparent more than 1h after RCM exposure. Delayed-type hypersensitivity to RCM may pose a problem for future radiologic investigations because due to possible immunological cross-reactivity all iodinated RCM are usually avoided. OBJECTIVE The aim of this study was not only to identify the causal RCM for the exanthema but also to demonstrate that patients may receive alternative iodinated RCM despite a history of RCM-induced allergic exanthema. METHODS We evaluated 32 patients with a history of exanthema after RCM application using standardized patch, prick and intradermal skin testing. In case of positive skin tests intravenous challenges with skin-test-negative RCM were performed to identify non-ionic monomer RCM which are tolerated. RESULTS In 6 out of 32 patients skin tests strongly suggested a delayed-type non-IgE-mediated allergic hypersensitivity to the RCM iomeprol (3x), iopromide (2x), and iopamidol. In 4 patients alternative non-ionic monomer RCM (2x iosarcol, iopromide, and iomeprol) were identified by controlled challenge tests. CONCLUSIONS The evaluation of patients with RCM-associated exanthema should always include appropriate skin tests ensuring that patients with a delayed-type allergic RCM-induced exanthema are not missed. Moreover, allergologic testing may identify alternative RCM of the group of non-ionic monomers, which are tolerated in future radiologic investigations.