Contrast Media in Practice: Questions and Answers

ISBN-13: 9783540647591 / Angielski / Miękka / 1998 / 304 str.

Peter H. Dawson; K. Nimura-Eckert; J. R. Allenberg

Opis

In this small volume experts provide succinct answers to freuqently asked questions about the properties and handling of X-ray contrast media. It is an excellent reference source for all using these agents. Basic information is given on the development, toxicology, pharmacology, pharmacokinetics and clinical testing of contrast agents and in question and answer form on the problems and adverse events which may be associated with them. Most of the book is concerned with the most frequently used iodinated X-ray agents but there are useful sections on the magnetic resonance and ultrasound echo enhancing agents which are assuming greater and increasing importance. This book will be of interest to both radiologists and clinicians.

Spis treści

1 General Fundamentals.- 1.1 A Historical Overview of the Development of Contrast Media for Diagnostic Imaging Procedures in Radiology.- 1.2 Chemistry of Positive X-Ray Contrast Media.- 1.3 Structure - Toxicity Relationships and Molecule Design.- 1.4 Relevant Results of Toxicity Studies of Non-Ionic X-Ray Contrast Media for Estimating the Risk to Man.- 1.5 Physicochemical Properties of Contrast Media: Osmotic Pressure, Viscosity, Solubility, Lipophilicity, Hydrophylicity, Electrical Charge.- 1.6 Pharmacokinetics of Contrast Media.- 1.7 Clinical Documentation of the Tolerance, Safety and Efficacy of X-Ray Contrast Media.- 1.8 Statistical Considerations in the Design and Analysis of Clinical Trials.- 2 Pharmaceutical Quality and Stability of lodinated X-Ray Contrast Media.- 2.1 What are the Steps in the Production of X-Ray Contrast Media?.- 2.2 Which Chemical Degradation Products are Formed?.- 2.3 What Additives do X-Ray Contrast Media Solutions Contain?.- 2.4 What is the Importance of Additives in Contrast Medium Formulations?.- 2.5 How is the Sterility of X-Ray Contrast Media Assured?.- 2.6 How is the Chemical Stability of Contrast Media Checked?.- 2.7 How are X-Ray Contrast Media Checked for Freedom from Pyrogens?.- 2.8 To What are Colour Changes of Contrast Media Attributable?.- 2.9 Does Particulate Contamination Occur in X-Ray Contrast Media, and How Important Is It?.- 2.10 Which Factors Reduce the Stability of X-Ray Contrast Media, and What Are the Implications of Storage Recommendations?.- 2.11 What Precautions Are Necessary in Drawing Up X-Ray Contrast Media into Syringes and in Administering Them Using Infusion Devices and Motorised Pumps?.- 2.12 How Long Do X-Ray Contrast Media Remain Usable After the Original Container Has Been Opened?.- D. Herrmann.- 2.13 May X-Ray Contrast Media be Resterilised, Diluted or Mixed with Other Drugs?.- 2.14 Can the Re-Use of Disposable Catheters for Angiography be Justified?.- 3 Influence of Contrast Media on Organs and Vessels.- 3.1 What are the Mechanisms of Toxicity Associated with Contrast Media?.- 3.2 Do Contrast Media Affect the Viscosity of Blood?.- 3.3 Are there any Differences Between Ionic and Nonionic Contrast Media in Their Effect on Coagulation?.- 3.4 Do Contrast Media Affect Cardiovascular Function?.- 3.5 Do Contrast Media Affect Pulmonary Function?.- 3.6 Do Contrast Media Affect Hepatic Function?.- 3.7 Do Contrast Media Lead to Impaired Kidney Function?.- 3.8 Do Iodinated X-Ray Contrast Media Affect Thyroid Function?.- 3.9 What Is the Relationship Between Iodinated Contrast Media and the Blood-Brain Barrier?.- 3.10 Do Contrast Media Affect the Central Nervous System?.- 3.11 Do Contrast Media Affect Blood Vessel Walls?.- 3.12 Can X-Ray Contrast Media Affect the Results of Laboratory Tests?.- 4 Determination of Risk Factors Regarding the Administration of Contrast Media.- 4.1 In Which Patients is the Administration of X-Ray Contrast Media Associated with an Increased Risk?.- 4.2 How Big is the Risk of an Examination with X-Ray Contrast Media of Patients with Known Hypersensitivity to CM and for Allergic Patients?.- 4.3 Does an Existing Allergy to Iodine Mean an Increased Risk for an X-Ray Contrast Medium Examination?.- 4.4 Why does the Administration of Iodinated Contrast Media to Patients with Manifest or Latent Hyperthyroidism Represent a Risk?.- 4.5 Why does the Administration of Iodinated Contrast Media Represent a Risk to Patients with Non-Toxic Nodular Goitre?.- 4.6 How Do I Recognise Hyperthyroidism or the Presence of Non-Toxic Nodular Goitre?.- 4.7 Does Underlying Cardiovascular Disease Constitute an Increased Risk in Contrast Media Administration?.- 4.8 Why is Pre-Existing Lung Disease a Risk for the Administration of Contrast Media?.- 4.9 Why Does Previous Renal Failure Represent a Risk?.- 4.10 Why Does Previous Diabetes Mellitus Represent a Risk?.- 4.11 Why Does Previous Paraproteinaemia Represent a Risk?.- 4.12 How Can the Risk of Provoking a Hypertensive Crisis in Patients with Phaeochromocytoma be Reduced?.- 4.13 Does the Examination of Dehydrated Patients Represent an Increased Risk?.- 4.14 Are Patients with Autoimmune Disorders at Any Particular Risk on Contrast Media Administration?.- 4.15 Does the Administration of Iodinated Contrast Media to Patients with Sickle Cell Anaemia Result in Further Change in Erythrocytic Shape?.- 4.16 Are Contrast Media-Induced Side Effects Dependent on Age?.- 4.17 Can Contrast Media Procedures Be Carried Out Despite Defined Risks?.- 4.18 What Interactions are Known Between Contrast Media and Other Medications?.- 4.19 What Effects Do Iodinated Contrast Media Have When Administered During Pregnancy or Lactation?.- 5 Prophylactic Measures.- 5.1 What Is the Place of Fasting and Dehydration Before Contrast Media Administration?.- 5.2 Can Hypersensitivity Reactions to Contrast Media be Predicted Through Preliminary Testing?.- 5.3 Is Sedation Indicated Before Administering Contrast Media?.- 5.4 Does General Anaesthesia Prevent the Occurrence of Contrast Media-Induced Side Effects?.- 5.5 Can the Rate of Contrast Media-Induced Side Effects be Lowered by Premedication with Antihistamines?.- 5.6 Can the Adverse Reaction Rate Be Reduced by Administration of Corticosteroids?.- 5.7 How Important is Pharmacoprophylaxis of Hyperthyroidism and How Can it Be Performed?.- 6 Informing the Patient Prior to Contrast Media Administration.- 6.1 What is the Patient’s “Right to Know” Prior to an X-Ray Examination Using Contrast Media?.- 6.2 What Special Information Should a Healthy Volunteer/Patient Receive Who is Participating in a Clinical Study of a New Drug?.- 7 Administration of Contrast Media.- 7.1 Are Contrast Media Heated to Body Temperature Better Tolerated?.- 7.2 Are There Any Guidelines for Maximum Doses in Angiography?.- 7.3 Are There Any Guidelines for Maximum Doses in Myelography?.- 7.4 Are There Any Guidelines for Maximum Doses in Cholegraphy?.- 7.5 Can “Maximum” Doses be Exceeded?.- 7.6 Does the Injection Rate Affect the Tolerance?.- 7.7 What Fluids Can Be Recommended for Flushing Catheters?.- 7.8 Are Contrast Media Dialysable?.- 7.9 What are the Sequelae of Inadverted Paravascular Administration of Iodinated Contrast Media?.- 8 Adverse Reactions and Their Pathophysiology and Management.- 8.1 What Adverse Reactions Can Be Expected After Intravascular Administration of Iodial Containing Contrast Media?.- 8.2 Do Late-Occuring Adverse Reaction to Contrast Media Necessitate Longer Supervision of the Patient?.- 8.3 What Adverse Reactions to Contrast Media are Dose Independent or Dependent?.- 8.4 What Are the Mediators of Anaphylactoid Reactions to Iodinated Contrast Media?.- 8.5 How Often Can Late Reactions be Expected After Administration of Radiographic Contrast Media.- 8.6 Which Are the Clinical Manifestations of Late Reactions to Radiographic Contrast Media?.- 8.7 What Is the Pathophysiology of Late Reactions to Radiographic Contrast Media?.- 8.8 Are Antibodies to Radiographic Contrast Media Known?.- 8.9 Are There Allergies to Contrast Media?.- 8.10 Can Sensitization Due to Frequent Contrast Media Administration be Observed?.- 8.11 Can Epileptogenicity and Arachnoiditis be Observed After Myelography with Nonionic Contrast Media?.- 9 Clinical Use of Iodinated Contrast Media for the Visualization of Vessels, Organs and Organ Systems.- 9.1 Cerebral Angiography.- 9.2 Spinal Angiography and Phlebography.- 9.3 Angiography of the Extremities.- 9.4 Phlebography.- 9.5 Direct Lymphography and Indirect Lymphangiography.- 9.6 Angiocardiography.- 9.7 Angiographic Procedures for the Liver, Spleen, Pancreas and Portal Venous System.- 9.8 Computed Tomography in the Liver, Pancreas and Spleen.- 9.9 Visualization of the Gastrointestinal Tract.- 9.10 Cholecystography and Cholangiography.- 9.11 Intravenous Urography.- 9.12 Urethrography and Micturating Cystrography, Cavernosography, and Seminal Vesiculography and Vasography.- 9.13 Visualization of the Kidneys and the Adrenal Glands.- 9.14 Contrast Media in Gynaecology.- 9.15 Arthrography.- 9.16 Contrast Media for Paediatric Patients.- 9.17 What is the Role of Newer Contrast Media in Interventional Radiology?.- 9.18 Computer Tomography Angiography (CTA).- 9.19 Magnetic Resonance Angiography (MRA).- 9.20 Carbon Dioxide Angiography.- 10 Contrast Media for Magnetic Resonance Imaging and Ultrasound.- 10.1 Contrast Media for Clinical Magnetic Resonance Imaging.- 10.2 Ultrasonographic Contrast Media.

Blurb

In this small volume experts provide succinct answers to frequently asked questions about the properties and handling of X-ray contrast agents. It is an excellent reference source for all using these agents. Basic information is given on the development, toxicology, pharmacology, pharmacokinetics and clinical testing of contrast agents and in question and answer form on the problems and adverse events which may be associated with them. Most of the book is concerned with the most frequently used iodinated X-ray agents but there are useful sections on the magnetic resonance and ultrasound echo enhancing agents which are assuming greater and increasing importance. This book will be of interest to both radiologists and clinicians.