Excretory Urography: A Clinical Trial of a New Contrast Medium (Sodium 3-acetylamino-2, 4, 6-triiodobenzoate)

Abstract

A safe medium for excretory urography is the concern of all radiologists and urologists. Although this procedure has proved to be relatively safe, it has been attended by a few fatalities (1). For many years it has been known that reactions of varying degrees of severity may follow the intravenous injection of drugs. Most of these reactions are minor (a sense of warmth, flushing of the skin, nausea or vomiting, and arm pain), but at times they have been of such severity as to cause concern for the safety of the patient. While severe reactions are not common, the possibility of their occurrence must always be borne in mind in an active radiologic service. They represent a hazard which precludes the routine use of intravenous urography, and any precaution or any new preparation that further safeguards the patient during this examination deserves careful consideration. Precautionary Measures Initial Precautions: At the Massachusetts General Hospital, since 1948, certain precautions have been taken when intravenous administration of a contrast medium was to be done. (1) Before ordering an intravenous urogram, the referring physician ascertains and notes in the patient's record (a) whether he is allergic or has a history of hay fever, asthma, eczema, or hives, and (b) whether Diodrast or a similar substance has been previously administered and whether it or any other drug has caused a reaction. If affirmative answers are given to these questions, the possibility of substituting retrograde pyelography is considered. If, however, excretory urography is still considered necessary, the detailed information obtained is discussed with the radiologist and noted on the request for x-ray examination. (2) An intravenous sensitivity test2 is often done on the ward by the referring physician within twenty-four hours of the scheduled examination, and the result recorded on the x-ray requisition. The test consists of the intravenous injection of 1.0 c.c. Diodrast (35 per cent) diluted with 9.0 c.c. saline. The patient is observed carefully for one hour for signs of shock, flushing, urticaria, or other allergic manifestations. Should any be demonstrated, intravenous urography is not done. (3) The blood non-protein nitrogen and the specific gravity of the urine are noted on the requisition. If the non-protein nitrogen is over 40 mg. per cent, or if the specific gravity is less than 1.015, intravenous urography is abandoned, unless the attending physician and the radiologist agree that information to be obtained from the examination warrants the risk. Other Precautions (for the Department of Radiology): 1. It is imperative that there be on hand in the x-ray examining room, ready for immediate use, (a) ampules of epinephrine hydrochloride 1:1000, a sterile hypodermic syringe and needle; (b) a flask of 5 per cent glucose in saline with appropriate apparatus for intravenous infusion.