Clinical Evaluation of a Concentrated Iodine Preparation

Abstract

In response to the increasing interest in more concentrated radiographic media for intravenous pyelography and nephrography, clinical evaluation of 70 per cent Urokon Sodium (sodium acetrizoate)2 has been made. The methods used in the evaluation were (1) intravenous nephrography, and (2) intravenous pyelography. Intravenous Nephrography Thirteen nephrograms were made on adult patients, with the technic of Wall and Rose. Briefly this procedure consists of preparation of the patient as if for intravenous pyelography; exposure of a preliminary film; intravenous injection of 50 c.c. of 70 per cent Urokon Sodium as rapidly as possible (five seconds) through a 15-gauge needle; exposure of the first film at ten seconds and the second film at twenty-five seconds following the end of the injection; completing the excretory urogram series with exposure of films at five, ten, and fifteen minutes. Thus, all three phases of the cycle of events associated with nephrography, as outlined by Vesey et al., are covered. These are the arterial phase, during which the contrast medium fills the aorta, renal, and associated vessels; the capillary phase, during which the medium fills the arterioles and venules and gives the kidney maximum radiopacification; the excretory phase, in which the tubules and collecting system are filled to give “intravenous pyelograms.” No special x-ray or other equipment or extra personnel was required. Due to human error, our first films were taken at five to fifteen seconds following completion of the injection, and our second films at twenty-two to thirty seconds. Reactions: Of the 13 patients, 10 suffered reactions to the solution. Eight of them had mild transient nausea, choking, and flushing, lasting two to ten minutes. In one case these symptoms were followed by generalized urticaria which responded quickly to antihistaminics, but the patient continued to complain of generalized malaise for thirty-six hours. In another patient extravasation of the dye resulted in tissue slough requiring skin graft. Results: Ten good nephrograms (capillary phase) were obtained (Figs. 1 and 2), 2 were poor, and there was 1 failure. In 6 cases both the first and second films showed the nephrogram; in 10 it was present in the second film. Six of the total series were studied for kidney tumor. There was pooling or puddling of dye in 4 of these, 3 of which were proved at surgery to be hypernephromas. The other did not come to surgery. Another showed a non-opaque shadow in the right kidney (Fig. 1) proved at surgery to be a benign intrarenal cyst. Eight arteriograms (arterial phase) were obtained, all but one occurring in the first film. In only 4 of these were the renal vessels visualized with any degree of accuracy. Figure 3 represents an arteriogram visualizing the aorta, both renal vessels, the hepatic, splenic, thoracic, intercostal, colic, and iliac vessels.