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American Journal of Surgery Feb 1997
Topics: Contrast Media; Diatrizoate Meglumine; Humans; Intestinal Obstruction; Solubility; Tissue Adhesions
PubMed: 9074385
DOI: 10.1016/S0002-9610(96)00051-7 -
Annals of Surgery Jul 2002
Topics: Barium; Contrast Media; Diatrizoate Meglumine; Humans; Intestinal Obstruction; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 12131079
DOI: 10.1097/00000658-200207000-00003 -
The Cochrane Database of Systematic... Mar 2018Malignant bowel obstruction (MBO) is a common problem in patients with intra-abdominal cancer. Oral water soluble contrast (OWSC) has been shown to be useful in the... (Review)
Review
BACKGROUND
Malignant bowel obstruction (MBO) is a common problem in patients with intra-abdominal cancer. Oral water soluble contrast (OWSC) has been shown to be useful in the management of adhesive small bowel obstruction in identifying patients who will recover with conservative management alone and also in reducing the length of hospital stay. It is not clear whether the benefits of OWSC in adhesive small bowel obstruction are also seen in patients with MBO.
OBJECTIVES
To determine the reliability of OWSC media and follow-up abdominal radiographs in predicting the success of conservative treatment in resolving inoperable MBO with conservative management.To determine the efficacy and safety of OWSC media in reducing the duration of obstruction and reducing hospital stay in people with MBO.
SEARCH METHODS
We identified studies from searching Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and MEDLINE in Process, Embase, CINAHL, Science Citation Index (Web of Science) and Conference Proceedings Citation Index - Science (Web of Science). We also searched registries of clinical trials and the CareSearch Grey Literature database. The date of the search was the 6 June 2017.
SELECTION CRITERIA
Randomised controlled trials (RCTs), or prospective controlled studies, that evaluated the diagnostic potential of OWSC in predicting which malignant bowel obstructions will resolve with conservative treatment.RCTs, or prospective controlled studies, that assessed the therapeutic potential of OWSC in managing MBO at any level compared with placebo, no intervention or usual treatment or supportive care.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by Cochrane. We assessed risk of bias and assessed the evidence using GRADE and created a 'Summary of findings' table.
MAIN RESULTS
We found only one RCT meeting the selection criteria for the second objective (therapeutic potential) of this review. This study recruited nine participants. It compared the use of gastrografin versus placebo in adult patients with MBO with no indication for further intervention (surgery, endoscopy) apart from standardised conservative management.The overall risk of bias for the study was high due to issues with low numbers of participants, selective reporting of outcomes and a high attrition rate for the intervention arm.Primary outcomesThe included trial was a pilot study whose primary outcome was to test the feasibility for a large study. The authors reported specifically on the number of patients screened, the number recruited and reasons for exclusion; this was not the focus of our review.Due to the low number of participants, the authors of the study decided not to report on our primary outcome of assessing the ability of OWSC to predict the likelihood of malignant small bowel obstruction resolving with conservative treatment alone (diagnostic effect). It also did not report on our primary outcome of rate of resolution of MBO in patients receiving OWSC compared with those not receiving it (therapeutic effect).The study reported that no issues regarding safety or tolerability of either gastrografin or placebo were identified. The overall quality of the evidence for the incidence of adverse events with OWSC was very low, downgraded twice for serious limitations to study quality (high risk of selective reporting and attrition bias) and downgraded once for imprecision (sparse data).Secondary outcomesThe study planned to report on this review's secondary outcome measures of length of hospital stay and time from administration of OWSC to resolution of MBO. However the authors of the study decided not to do so due to the low numbers of patients recruited. The study did not report on our secondary outcome measure of survival times from onset of inoperable MBO until death.
AUTHORS' CONCLUSIONS
There is insufficient evidence from RCTs to determine the place of OWSC in predicting which patients with inoperable MBO will respond with conservative treatment alone. There is also insufficient evidence from RCTs to determine the therapeutic effects and safety of OWSC in patients with malignant small bowel obstruction.
Topics: Abdominal Neoplasms; Administration, Oral; Adult; Conservative Treatment; Contrast Media; Diatrizoate Meglumine; Feasibility Studies; Humans; Intestinal Obstruction; Length of Stay; Pilot Projects
PubMed: 29513393
DOI: 10.1002/14651858.CD012014.pub2 -
Journal of Chromatography Apr 1986
Topics: 4-Aminobenzoic Acid; Chromatography, High Pressure Liquid; Diatrizoate; Diatrizoate Meglumine; Humans; Spectrophotometry, Ultraviolet
PubMed: 3486875
DOI: 10.1016/s0378-4347(00)80810-5 -
Radiology Jan 1986Abdominal computed tomography (CT) scans of 55 patients who had ingested Gastrografin (meglumine diatrizoate and diatrizoate sodium) diluted to 2% with tap water and...
Abdominal computed tomography (CT) scans of 55 patients who had ingested Gastrografin (meglumine diatrizoate and diatrizoate sodium) diluted to 2% with tap water and flavored with a commercial fruit juice base were reviewed. Twenty patients (36%) demonstrated intraluminal precipitation of Gastrografin shown by focal areas of markedly increased attenuation within the gastric lumen or trapped within gastric folds. Beam-hardening artifact produced by precipitation was observed, which limited the diagnostic value of some examinations. In vitro CT scans of the same Gastrografin solution titrated with hydrochloric acid or sodium hydroxide showed that by raising the pH of the solution, precipitation was virtually eliminated. Fifty-one CT scans of the abdomen using a buffered Gastrografin solution demonstrated precipitation in only five patients. Properly buffered dilute oral Gastrografin solutions should significantly decrease the prevalence of precipitation during abdominal CT examinations.
Topics: Beverages; Chemical Precipitation; Diatrizoate; Diatrizoate Meglumine; Duodenum; Humans; Hydrogen-Ion Concentration; Radiography, Abdominal; Stomach; Tomography, X-Ray Computed
PubMed: 3940390
DOI: 10.1148/radiology.158.1.3940390 -
The British Journal of Radiology Nov 1992The mechanism of the nephrotoxicity of water-soluble contrast media (WSCM) remains ill defined. We have studied the effect of diatrizoate on the isolated perfused rat...
The mechanism of the nephrotoxicity of water-soluble contrast media (WSCM) remains ill defined. We have studied the effect of diatrizoate on the isolated perfused rat kidney (IPRK). Emphasis was on the effect of low- and high-dose diatrizoate on glomerular filtration rate (GFR), renal perfusate flow (RPF), fractional excretion of albumin (FE Alb) and fractional reabsorption of sodium (FR Na). The addition of diatrizoate to the IPRK led to a dose-dependent biphasic change in RPF and GFR characterized by an initial transient increase followed by a marked and sustained decrease. Diatrizoate induced a diuresis and a parallel increase in urinary sodium excretion (fall of FR Na). Fe Alb was also increased in kidneys exposed to diatrizoate. Electron microscopy of a control kidney showed preservation of cellular architecture, which contrasted with the observed cytoplasmic vacuolation of proximal tubular cells after perfusion with diatrizoate. This study confirms a direct effect of WSCM on the function of the IPRK. In this experimental model, diatrizoate reproduces the effects observed in vivo on GFR and renal perfusion.
Topics: Animals; Diatrizoate Meglumine; Glomerular Filtration Rate; Kidney; Male; Microscopy, Electron; Osmolar Concentration; Perfusion; Rats; Rats, Wistar; Sodium; Urine
PubMed: 1450815
DOI: 10.1259/0007-1285-65-779-1011 -
Acta Radiologica: Diagnosis 1983Model experiments were conducted to simulate the conditions of injection rate and pressure during retrograde pyelography. Pressures at the upper and lower end of a Ch. 5...
Model experiments were conducted to simulate the conditions of injection rate and pressure during retrograde pyelography. Pressures at the upper and lower end of a Ch. 5 and Ch 6. ureteral catheter were determined with 30% and 45% sodium meglumine diatrizoate and water and with different needles allowing leakage of the injected medium from a reservoir at the upper end of the catheter. It is concluded that the pressure at the upper end of the catheter may be kept within physiologic range if (1) the contrast medium is injected slowly, (2) the contrast medium leaks back around the ureteral catheter into the bladder and (3) a contrast medium with a low viscosity is used. It is advisable to use a Ch. 5 ureteral catheter instead of a Ch. 6 for retrograde pyelography.
Topics: Diatrizoate Meglumine; Humans; Kidney Pelvis; Models, Biological; Pressure; Ureter; Urinary Catheterization; Urography
PubMed: 6624518
DOI: 10.1177/028418518302400211 -
Anesthesiology Jan 1979
Topics: Cerebral Ventriculography; Cerebrospinal Fluid Shunts; Diatrizoate; Diatrizoate Meglumine; Humans; Infant; Male; Seizures
PubMed: 310644
DOI: 10.1097/00000542-197901000-00011 -
BJU International Dec 2004To evaluate the location and extent of diffusion that occurs when liquid is injected transurethrally into the prostate gland, by correlating real-time fluoroscopy and...
OBJECTIVES
To evaluate the location and extent of diffusion that occurs when liquid is injected transurethrally into the prostate gland, by correlating real-time fluoroscopy and gross pathology, and to quantify the variables that influence intraprostatic diffusion during chemoablation of the prostate.
MATERIALS AND METHODS
A solution of diatrizoate meglumine (Hypaque, Nycomed, Princeton, NJ) gentamicin and methylene-blue dye (HGM) was injected transurethrally into the prostate in six dogs, using a passive-deflection needle injection system. The intraprostatic diffusion characteristics were evaluated during each injection using real-time C-arm fluoroscopy, and following each injection by gross examination of methylene blue staining within the prostatic tissues. HGM back-flow into the urethra at the time of injection was assessed by measuring gentamicin levels in the collected bladder irrigant after each injection, using a standard dilution formula.
RESULTS
There was variability in the intraprostatic diffusion both fluoroscopically and grossly. The needle occasionally assumed a straighter trajectory than its intended curve. Intraprostatic diffusion was detected in 12 of 36 injections (33%). Using standard manipulations of various devices increased the intraprostatic diffusion in these injections to almost 80%. There was less intraprostatic diffusion when the injection resistance was either extremely high or absent. There was no extraprostatic extravasation of HGM beyond the prostatic capsule.
CONCLUSION
Current methods of transurethral intraprostatic injection are variable for both the diffusion of HGM solution and in needle deployment. The gross diffusion patterns with the HGM solution were consistent with the diffusion patterns documented in our previous research using absolute ethanol. These and other factors may partly explain the variability of the lesions produced with ethanol injection. Therefore, more research is needed to further elucidate the diffusion characteristics of solutions injected intraprostatically using the transurethral approach.
Topics: Animals; Contrast Media; Cystoscopy; Diatrizoate Meglumine; Diffusion; Dogs; Injections; Male; Prostate
PubMed: 15610125
DOI: 10.1111/j.1464-410X.2004.05177.x -
Pediatrics International : Official... Jan 2023
Topics: Humans; Diatrizoate Meglumine; Water; Intestinal Obstruction; Contrast Media
PubMed: 36560900
DOI: 10.1111/ped.15459