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Sigmoid diverticulitis is in case of complications like perforation, abscess and peritonitis a life-threatening disease. A diagnostic work up with high sensitivity is mandatory. In a prospective study upon 247 patients with the possible diagnosis of acute diverticulitis ultrasound is a screening method with a high specificity (97 %) and leads in combination with the hydrocolonsonography and the colour flow doppler to a high sensitivity (76 %). Without any typical findings in ultrasound, helical CT scan is the best method in the evaluation of the acute diverticulitis (sensitivity and specificity 100 %), because contrast enema is inferior to CT in the evaluation of abscesses (6 %) and perforation (53 %). CT has in case of perforation and of abscesses a sensitivity of 90 % and 100 %, while ultrasound has a sensitivity of 12 % to perforation and of 39 % to abscesses.

In cases of an acute abdomen, bowel obstruction cannot always be excluded. In this case the administration of oral water soluble contrast media (Visotrast) is helpful. On the basis of their experience with 189 patients who underwent gastrointestinal x-ray examination with Visotrast (157 spontaneous mechanical obstruction, 32 postoperative ileus) the authors recommend this diagnostic procedure in difficult situations.

We treated 33 patients with a sudden hearing loss with Natrium - Meglumine-diatrizoat (Urografin) when all other standard therapy had failed. Detailed investigations were carried out, and thorough measures were taken against anaphylactic reactions before and during the intravenous administration of Urografin. In 10 cases (30%) an improvement of hearing of at least 20 dB was observed with restitution of almost normal hearing in some cases. The treatment was most successful in those cases where an excessive hearing loss (more than 40 dB) occurred for the first time. Since the drug is only intended for diagnostic use, further use as a therapeutic agent will require legal endorsement.

The endographic examination by means of pulverized contrast media such as tantalum or visotrast acid has proved to be appropriate in laryngotracheobronchial diseases as a simple and safe, endoscopy-complementing method. It gives diagnostic radiological information in addition to endoscopic, orthograde evaluation by the frontal and sagittal image of the organ in which details of the structure and alterations can be detected. In 170 different examinations of the organ no threatening side-effects could be observed, even not in cases of remarkably obstructive changes. When giving contrast media containing iodine any known iodine allergies should be avoided, despite the water-insolubility of the complex iodine compound.

Throughout the years 1970-1983 571 patients were treated for ileus. Oral gastrografin was performed in 169 patients. This method provides definite differentiation between mechanical and functional obstruction. In patients with adhesions and recurrent incomplete obstruction, further laparotomies may be avoided in this way.

Electrophysiological effects of intracoronarily administered contrast media have been documented in 12 thoracotomized dogs at the cellular level by use of a modified microelectrode technique. Injections (n = 63) of 4 different contrast media uniformly led to a temporary cellular hyperpolarisation of the resting potential and prolongation of the action potential. Additional experiments with intracoronary injections of several electrolyte solutions indicate that the observed effects can be explained by contrast-induced changes in the extracellular electrolyte concentrations, mainly by a local deficiency of potassium ions and an excess of sodium ions. The significance of the findings for mechanisms underlying ECG-changes and ventricular arrhythmia by radiographic contrast media will be discussed.

The contamination of pancreatic juice obtained by endoscopic retrograde catheterism of the papilla by cannulation of the pancreatic duct with contrast medium is possible. When the amount of "VisotrastR 370" is more then 0.05 ml per ml one observes a decrease of the lipase while alpha-amylase is unchanged.--Bilirubin has also an influence on the activity of lipase - but not on the alpha-amylase.

Studies of contrast bolus geometry and dynamics were carried out by means of a chronogram - a digital serial radiographic method. Four situations were considered - contrast volume, speed of injections, subsequent saline injections and rapidly repeated contrast boli. Peak values, maximum duration and half-life of the bolus and maximum contrast enhancement were recorded. The results have shown that a larger volume of contrast with reduced injection speed leads to a lengthening of the peak period. More rapid injection speed up to 8 ml/sec leads to a higher peak and increased contrast enhancement. Further increases of injection speed beyond 8 ml/sec does not further increase contrast enhancement. The subsequent injection of saline has no recognisable effect on bolus geometry or dynamics.

The differential diagnosis of paralytic ileus vs mechanical intestinal obstruction using Gastrografin is a useful method because a correct decision can be made for or against surgery in doubtful cases. Gastrografin is a valuable diagnostic aid in cases with pseudo-obstruction since recurrent obstruction often seems to be a pseudo-obstruction. We doubt if a recurrent obstruction should be treated by any method of intestinopexy.

A double blind trial was carried out comparing 15 g sodium amidotrizoate and 15.3 methyl glucamine amidotrizoate for urography. The sodium preparation resulted in significantly better visualisation of the urinary tract, both in normal patients and in those with renal insufficiency. For routine urography in the given dose there was no difference as regards demonstration of the parenchyma and filling of the urinary tract. Similarly, there was no difference in tolerance after the intravenous administration of the two substances. The sodium salt should be avoided in patients with cardiac failure, whereas these are better tolerated than methyl glucamine salts by asthmatics. Judging by our results, the sodium salts are to be preferred for routine urography in a dose of 50 ml., particularly for patients with mild to moderate renal insufficiency.

Between 30.8.1973 and 30.11.1982 3.200 intravenous urograms were performed with Urografin 76% in patients aged from 0 to 16 years. With regard to the incidence of contrast medium reactions, there was a distinct difference between children who had suffered accidents previously and those who had not: among the former it was 4.24%, in the latter 13.51%. The number of cases appears large enough to rule out randomness. Lalli 's neurodysregulation theory offers the best basis for explaining this highly significant difference: the increased permeability of the blood-brain barrier as a result of microlesions in secondary brain trauma and the increased response of the autonomic nervous system to contrast media which occurs as a result could be a significant factor. However, it does not fully explain the incidents observed. It would be desirable to carry out checks at other clinics and in adults.

The arterial flow rate in the three superficial groups of branches of the middle cerebral artery was determined angiocinematographically in 37 hemispheres of 24 patients. In 10 hemispheres of patients with cerebrovascular diseases the arterial flow rate in the corresponding group of branches was lowered to a statistically significant extent. The importance of the choice of contrast medium is emphasized and that used in our investigations, Angiografin, dealt with in more detail. The diagnostic value of conventional determination of cerebral circulation time from serial angiograms is questioned and compared with the results of angiocinematographic investigation.

Report about a new roentgen contrast medium which contains as salt-forming cations the physiologic alpha-amino acids L-lysine, L-ornithine instead of the body-foreign N-methyl-glucamine base and as anion diatrizoate acids. Favourable results concerning clinical and roentgenological aspects of the lysine salt of diatrizoate acid are derived: general and local tolerance in angiographic and urologic examinations are good, pulse rate remains stable, blood pressure fluctuations are minimal.

The examination of 2 so-called minipigs and 5 patients with respect to the distribution of intravenously applied Diatrizoate into the cerebrospinal fluid yielded the proof of a high blood-cerebrospinal gradient. After the establishment of the relative flow balance about 60 to 120 minutes after the injection, the concentration of the contrast medium in the cerebrospinal fluid reaches 1.0 to 1.5 per cent the blood level. This dose-dependent value is exceeded in case of a disturbed blood-brain barrier. Thus the neurotoxicity of this contrast medium gains special importance.

Experiments in 12 dogs have shown that intra-arterial injection of hyperosmolar contrast into the superior mesenteric artery normally produces a 52% increase in blood flow lasting more than two minutes. Following digitalis-induced mesenteric ischaemia, vaso-dilatation is equally marked, but lasts two and a half times as long. In view of the prolonged vaso-dilator effect of hyperosmolar contrast, arterial spasm could be missed during angiography.

The presence of an entero hepatic circulation of angiographic contrast media has been demonstrated, but quantitatively it is of little importance. About 1/2% of the contrast reaching the gut in the bile is reabsorbed and after being carried through the portal vein to the liver is re-excreted in the bile. Most of the contrastcontaining bile reaching the small bowel is excreted in the faeces; nearly all of the contrast absorbed from the colon is carried through the portal vein to the liver and after reaching the circulation is excreted by the kidneys.

A review of literature is given on histological reactions by bronchograpyhic agents. Description of cytological changes after using Visotrast "B" in biopsy materials of bronches and lungs. Cytological reactions are characteristical. Their intensity is dependent on several factors.

The damaging effect of methylglucamine diatrizoate on the aortic endothelium is tested and compared to the action of a 22% sorbit solution both with the same hypertonicity. In the first group the contrast medium is injected into the aorta once. In a second group three consecutive injections 5 minutes apart are performed. Aortic specimens are investigated by the "Häutchen" method. The degree of endothelial lesion due to contrast medium is direct proportional to the rate of proliferation of endothelial cells as analized by autoradiography. The damage to the aortic endothelium is independent of number of injections (once or three times). The sorbit solution caused no injury to the aortic endothelium. A generalized endothelial damage--as it is seen in shock--could be excluded.

The local quantity of the contrast excretion depends on the filtration rate and the plasma level. Since the latter is influenced by dosage and kind of application from this result immediate practical consequences for the excretion urography, for which at present a large dose and the bolus injection are preferred.

Prof. Morimitsu (Fukuoka, Japan) reported a case of hearing improvement after the intravenous administration of Urografin in 1976. Because we had a similar case, injected 10 ml of Urografin (76%) intravenously in 130 patients with sensorineural deafness and tinnitus, which had not improved with previous treatment consisting of vasodilators and stellate ganglion blocks. 21 patients had a hearing improvement after Urografin-therapy; the tinnitus disappeared in 8 cases, and 2 patients noticed an improvement of their hearing and tinnitus. No adverse reactions to these injections, except for one case with a mild cutaneous allergy, were observed. The data did not reveal any particular clinical or audiological criteria which indicated a favourable prognosis with Urografin-therapy.

From 1978-1984 421 patients were examined by colon enema with gastrografin. The indication in 246 cases was an acute abdomen, in 172 patients the procedure has been performed postoperatively, 3 patients suffered from gastrointestinal bleeding. 81 of 236 pathological findings showed an ileus. 58 of them underwent an operation. The cause of the ileus were tumors of the colon, extraluminal tumors as well as performations and inflammations. In 55 cases the findings of the gastrografin enema were confirmed by the operation, one was proved to be false negative, one uncertain and one false positive. Therefore the diagnostic accuracy of this procedure amounted to 96%.

Three groups of patients (n = 55, 53 and 54) were examined with the x-ray contrast media Gastrografin, Peritrast-Oral GI, and Telebrix Gastro and Telebrix Gastroo assess the diagnostic ranking, side effects and taste of water-soluble oral contrast media. No significant differences were seen in respect of diagnostic ranking and side effects. Side effects were exclusively abdominal symptoms; there was no difference with regard to laxative action. Telebrix Gastroas accepted significantly better in respect of taste than Gastrografin and Peritrast-Oral GI.

In 210 cases of endoscopic retrograde cholangio-pancreaticography (ERCP), Peritrast 400 comp was used as contrast medium. The good tolerence and low rate of complication associated with this preparation despite the higher contrast medium concentration were remarkable. On the whole, only one severe complication was observed, namely, an abscess-forming pancreatitis. This could be controlled by conservative treatment.

In 17 patients with suspected bleeding in the lower intestinal tract 23 scintigraphic studies were performed with Tc-colloid, followed in each case by visceral-artery angiography. Comparison of the two methods with the final clinical diagnosis indicated that angiography was correct in 6 of 23 examinations (26%), scintigraphy in 12 of 23 (52%). All scintigraphically negative results were negative also angiographically. Noninvasive, relatively unstressful scintigraphy should be performed for immediate diagnosis in any case of acute bleeding. Emergency-type angiography is reasonably performed only if scintigraphy is positive.

One hundred and thirty examinations with oral gastrografin were performed in 110 patients with obstructive symptoms, who did not require immediate operation. They consisted of 49 patients with mechanical ileus, eighteen patients with paralytic ileus and 63 patients with incomplete mechanical ileus. All patients with complete mechanical and three patients with paralytic ileus were investigated surgically and treated in this way. Small bowel transit time longer than five hours provides considerable certainty of complete mechanical ileus. The method has been tried for four years; it makes few demands on the patient and has practically no contra-indications, except for deranged electrolyte balance. In children, the amount of contrast medium should be limited and it should be diluted or an isotonic contrast medium should be used. The method provides definite differentiation between mechanical and functional obstruction. In patients with adhesions and recurrent incomplete obstruction, further laparotomies may be avoided in this way.