CT检查中造影剂不良反应的预防、处理及对影像学检查的影响分析

目的：在CT等医学影像检查过程中,常需要应用造影剂。在造影剂的使用常常发生不良反应,掌握不良反应的发生率,减少或减轻患者的不良反应,能够使CT增强扫描顺利进行,提高检查安全性。方法：搜集我院2011年10月至2012年9月间的1500例CT造影增强检查患者,包括冠状动脉CT血管成像（冠脉CTA）、头部CT血管成像（头CTA）、肝脏增强、泌尿系三维成像（CTU）以及双下肢血管成像（双下肢CTA）,进行造影剂的不良反应类型、造影剂药物剂量、注射速度等统计分析,总结造成不良反应发生的因素及处理方法。结果：不良反应的类型包括发热、呕吐、荨麻疹、面色潮红、局部疼痛、流泪、血压下降、喉头水肿、休克等。使用非离子型造影剂出现不良反应者85例,占5．67％。其中轻度反应65例,占4．33％;中度反应16例,占1．06％;重度4例,占0．27％。结论：在CT增强扫描过程中,造影剂的用量及注射速度与不良反应的发生有相关性。cT检查过程总应该认真执行操作流程,密切观察病人情况,积极防治,正确处理,将造影剂不良反应降低到最低程度,使患者更加安全。     

CT检查中造影剂不良反应的预防、处理及对影像学检查 的影响分析

目的：在CT 等医学影像检查过程中,常需要应用造影剂。在造影剂的使用常常发生不良反应,掌握不良反应的发生率,减少 或减轻患者的不良反应,能够使CT 增强扫描顺利进行,提高检查安全性。方法：搜集我院2011 年10 月至2012 年9 月间的1500 例CT 造影增强检查患者,包括冠状动脉CT 血管成像（冠脉CTA）、头部CT 血管成像（头CTA）、肝脏增强、泌尿系三维成像 （CTU）以及双下肢血管成像（双下肢CTA）,进行造影剂的不良反应类型、造影剂药物剂量、注射速度等统计分析,总结造成不良 反应发生的因素及处理方法。结果：不良反应的类型包括发热、呕吐、荨麻疹、面色潮红、局部疼痛、流泪、血压下降、喉头水肿、休 克等。使用非离子型造影剂出现不良反应者85 例,占5.67 %。其中轻度反应65 例,占4. 33%;中度反应16 例,占1.06%;重度4 例,占0. 27 %。结论：在CT 增强扫描过程中,造影剂的用量及注射速度与不良反应的发生有相关性。ＣＴ 检查过程总应该认真 执行操作流程,密切观察病人情况,积极防治,正确处理,将造影剂不良反应降低到最低程度,使患者更加安全。     

Changes in Risk of Immediate Adverse Reactions to Iodinated Contrast Media by Repeated Administrations in Patients with Hepatocellular Carcinoma

Background

To elucidate whether repeated exposures to iodinated contrast media increase the risk of adverse reaction.

Materials and Methods

We retrospectively reviewed 1,861 patients with hepatocellular carcinoma who visited authors’ institution, a tertiary referral center, between 2004 and 2008. We analyzed cumulative probability of adverse reactions and risk factors. We categorized all symptoms into hypersensitivity reactions, physiologic reactions, and other reactions, according to the American College of Radiology guidelines, and evaluated each category as an event. We estimated the association between hazard for adverse reactions and the number of cumulative exposures to contrast media. We also evaluated subsequent contrast media injections and adverse reactions.

Results

There were 23,684 contrast media injections in 1,729 patients. One hundred and thirty-two patients were excluded because they were given no contrast media during the study period. Adverse reactions occurred in 196 (0.83%) patients. The cumulative incidence at 10^th, 20^th, and 30^th examination was 7.9%, 15.2%, and 24.1%, respectively. Presence of renal impairment was found to be one of risk factors for adverse reactions. The estimated hazard of overall adverse reaction gradually decreased until around 10^th exposure and rose with subsequent exposures. The estimated hazard of hypersensitivity showed V-shaped change with cumulative number of exposures. The estimated hazard of physiologic reaction had a tendency toward decreasing and that of other reaction had a tendency toward increasing. Second adverse reaction was more severe than the initial in only one among 130 patients receiving subsequent injections.

Conclusion

Repeated exposures to iodinated contrast media increase the risk of adverse reaction.     

Adverse Reactions to Radiographic Contrast Material

Major adverse reactions to radiographic contrast media will occur more often as contrast material is now also administered during computerized tomographic (CT) scanning. Differentiation of the two major contrast reactions, the vagus reaction and the anaphylactoid reaction, is essential. Bradycardia is the key finding for identifying the vagus reaction. The vagus reaction involving hypotension and bradycardia requires treatment with large doses of atropine given intravenously. The immediate generalized reaction or anaphylactoid reaction should be treated as anaphylaxis with administration of vasopressors, fluids, steroids and antihistamines. Steroids and antihistamines given before the examination may offer protection to those high-risk patients who have had previous anaphylactoid reactions to contrast material.     

The involvement of osmolarity in the safety of contrast media

Background

New non-ionic contrast agents, classified into low osmolar agents and iso-osmolar agents, present different biochemical characteristics that may influence the allergic reactions they cause. The aim of our study was to evaluate how osmolarity may affect safety in the use of contrast agents.

Case presentation

Six patients with a positive history for reaction to contrast agent were included in this study. Only one patient prick and intradermal skin test was positive. However, in 5 cases, patients presented an immediate reaction after administration of contrast agent that was not IgE mediated.

Conclusions

In this study, we focused on iodixanol, an iso-osmolar contrast agent, finding good safety of this product in patients with previous hypersensitivity reactions to contrast agent.

     

Dependence of behavioral responses form during shake-off conditional reflex on laterality of the neocortex

Pattern of discharges and interhemispheric interaction of parietal neurons (somatosensory presentation of the ear) were compared in interstimulus intervals before active shake-off and passive freezing reactions at stimuli after elaboration defensive avoid reflex. Before passive reactions in contrast to active right-side influences on left-side neurons were reinforced with delay to 100 ms, it result in appearence of asymmetry in interhemispheric interaction with right-side dominance. Before passive reactions intensity of delta-frequencies was increased in impulsation of single neurons and in interaction of cells pair. On this evidence the pattern of interhemispheric asymmetry before stimuli can be one of a number of factors, determinant active or passive form of behavioral reactions and also reflective of activation level of neocortex.     

Evaluation of monocyte subsets and markers of activation in leprosy reactions

Understanding host immune pathways associated with tissue damage during reactions are of upmost importance to the development of immune intervention strategies. The participation of monocytes in leprosy reactions was evaluated by determining the frequency of monocyte subsets and the degree of cellular activation through the expression of MHCII and the co-stimulatory molecules CD40, CD80, CD86. Leprosy subjects with or without reactions were included in this cross-sectional study. Peripheral blood mononuclear cell were isolated and stained ex vivo to determine monocyte subsets and the degree of cellular activation by flow cytometry. Intermediate monocytes were increased in leprosy patients with reactions when compared to patients without reactions. Although no difference was detected in the frequency of monocyte subsets between type 1 and 2 reactions, the expression of CD80 was increased in monocytes from patients with type 1 reactions and CD40 was higher in paucibacillary subjects presenting type 1 reactions. Moreover, CD86 and MHC II expression were higher in intermediate monocytes when compared to the other subsets in leprosy reaction types 1 and 2. Intermediate monocyte activation with CD86 and MHCII expression is involved with both type 1 and 2 reactions, whereas CD80 and CD40 expression is related to type 1 reactions.     

口服磷酸钠盐用于结肠癌术后老年患者结肠镜检查前肠道准备的 效果观察

目的:评价口服磷酸钠盐用于结肠癌术后老年患者结肠镜检查前肠道准备的有效性、安全性及耐受性.方法:选取2011年9月1日至2011年12月31日间共116例行结肠镜检查的结肠癌术后老年患者,随机分组纳入试验组例和对照组,试验组口服磷酸钠盐进行肠道准备,对照组口服硫酸镁制剂.结肠镜检查术者单盲评价肠道准备的清洁度;患者在肠镜检查当日及检查结束1周后评价肠道准备的耐受度.并记录不良反应(安全性).结果:试验组肠道准备的总满意率为82.1％(46/56),对照组为90.0％(54/60),两组之间无明显差异(P＞0.05).检查当10.7％的试验组患者和38.3％的对照组患者认为肠道准备过程难以耐受(P=0.001).检查结束1周后7.1％的试验组患者和23.3％的对照组患者认为肠道准备过程难以耐受(P=0.003).两组之间不良反应无显著性差异.结论:磷酸钠盐用于结肠癌术后老年患者的肠道准备,清洁效果和不良反应情况与硫酸镁制剂相似,但患者的耐受性却显著提高.     

Dermal and intravascular Langerhans cells at sites of passively induced allergic contact sensitivity.

In order to further define the role of Langerhans cells in contact allergic reactions, passive transfer studies were done in guinea pigs using 2,4-dinitro-1-chlorobenzene (DNCB)-sensitive donor cells. Langerhans cells were found in the lumen of dermal vessels resembling lymphatics at 2, 3, 15, and 48 hr after DNCB challenge. In contrast to the previously reported findings in actively sensitized guinea pigs, the changes involving Langerhans cells in passively sensitized guinea pigs were mainly noted in the dermis. These consisted of increased numbers of Langerhans cells and of mononuclear cells apposed to Langerhans cells 3 or more hours after challenge with DNCB. The increased Langerhans cell population in the dermis and the presence of Langerhans cells in dermal vessels in specifically challenged sites in adoptive immune reactions furnishes further support for a significant role of Langerhans cells in the interaction between antigen and sensitized cells.     

An improved intravenous contrast medium; preliminary studies with hypaque

A relatively new intravenous opaque medium, Hypaque(R) in 50 per cent solution, was used in 50 consecutive patients. None of them had a serious reaction. Twenty-two had mild reactions which were of no clinical significance. The radiographs obtained seemed to be equal in quality to those obtained with other contrast media.     

Differences between Drug-Induced and Contrast Media-Induced Adverse Reactions Based on Spontaneously Reported Adverse Drug Reactions

Objective

We analyzed differences between spontaneously reported drug-induced (not including contrast media) and contrast media-induced adverse reactions.

Methods

Adverse drug reactions reported by an in-hospital pharmacovigilance center (St. Mary’s teaching hospital, Daejeon, Korea) from 2010–2012 were classified as drug-induced or contrast media-induced. Clinical patterns, frequency, causality, severity, Schumock and Thornton’s preventability, and type A/B reactions were recorded. The trends among causality tools measuring drug and contrast-induced adverse reactions were analyzed.

Results

Of 1,335 reports, 636 drug-induced and contrast media-induced adverse reactions were identified. The prevalence of spontaneously reported adverse drug reaction-related admissions revealed a suspected adverse drug reaction-reporting rate of 20.9/100,000 (inpatient, 0.021%) and 3.9/100,000 (outpatients, 0.004%). The most common adverse drug reaction-associated drug classes included nervous system agents and anti-infectives. Dermatological and gastrointestinal adverse drug reactions were most frequently and similarly reported between drug and contrast media-induced adverse reactions. Compared to contrast media-induced adverse reactions, drug-induced adverse reactions were milder, more likely to be preventable (9.8% vs. 1.1%, p < 0.001), and more likely to be type A reactions (73.5% vs. 18.8%, p < 0.001). Females were over-represented among drug-induced adverse reactions (68.1%, p < 0.001) but not among contrast media-induced adverse reactions (56.6%, p = 0.066). Causality patterns differed between the two adverse reaction classes. The World Health Organization–Uppsala Monitoring Centre causality evaluation and Naranjo algorithm results significantly differed from those of the Korean algorithm version II (p < 0.001).

Conclusions

We found differences in sex, preventability, severity, and type A/B reactions between spontaneously reported drug and contrast media-induced adverse reactions. The World Health Organization–Uppsala Monitoring Centre and Naranjo algorithm causality evaluation afforded similar results.     

冠脉护理在320排螺旋CT冠状动脉造影中提高图像质量的作用

目的：探讨320排螺旋CT心脏冠状动脉护理的作用及其临床意义。方法：2009年11月至2010年3月,于我院行心脏检查1024例行320排螺旋CT冠状动脉造影检查的患者,检查前对每一患者进行心理辅导,减轻紧张情绪;进行心率控制、屏气训练等护理措施准备;在扫描过程中配合影像技师使用高压注射器;检查完成后积极与患者交谈,严密观察患者状态,预防造影剂不良反应的发生。结果：受检患者中987例患者顺利完成检查,图像重建后血管显示效果优;16例血管显示良;有1例患者造影剂未全部进入血管内,导致血管显影不充分。有2例出现轻度过敏反应;无空气栓塞或任何心脑血管意外的发生。受检病例中432例同时进行了冠状动脉造影,98%（425/432）与检查结果完全一致,有2%（8/432）与检查结果有轻度误差。结论：检查前细致的护理对提高心脏冠状动脉血管成像成功率、提高至关重要。     

The decay of potentially lethal oxygen-dependent damage in fully hydrated Bacillus megaterium spores exposed to pulsed electron irradiation.

Using a stopped-flow mixing and pulsed irradiation apparatus, a study has been made of the decay, to a harmless form, of radiation-induced species which would otherwise be lethal to spores on contact with oxygen. Aqueous suspensions of Bacillus megaterium spores were irradiated with 600 krad of electrons given over approximately 1 s; at various times after irradiation oxygen in solution was added. As the interval between irradiation and introduction of oxygen increased, the fraction of spores surviving increased. For spores irradiated in a deoxygenated condition the decay of the potentially lethal species, reflected by this change in survival, proceeded as if two parallel first-order reactions with half-lives of 9 and 120 s operate. In contrast, for spores equilibrated with oxygen and then irradiated, the decay is described by a single first-order expression with an associated half-life similar to that of the faster of the two reactions operating in anoxia.     

Resistance and susceptibility to infection in inbred murine strains. I. Variations in the response to thymic hormones in mice infected with Candida albicans

Nine inbred murine strains were either highly resistant or highly susceptible to intravenous challenge with 4 X 10(4) to 1 X 10(5) cells of Candida albicans. The resistant strains had the capacity to develop delayed footpad reactions on appropriate sensitization and challenge; the susceptible strains did not have this innate capacity. Administration of thymosin fraction 5 beginning on the day of infection greatly increased the resistance of the susceptible strains to infection, but decreased the resistance of the resistant strains. In contrast, thymosin fraction 5 enhanced the delayed footpad responses of resistant-sensitized mice to specific antigen, but did not have a detectable effect on the delayed footpad reactions of the susceptible strains. Reinfection of the two types of strains had different effects, in that, depending on the strain, resistance could be increased, decreased, or not influenced at all.     

Blood pressure and heart rate and withdrawal of antihypertensive drugs.

The immediate effects on heart rate and blood pressure of withdrawing antihypertensive drugs were studied over three-day periods in 26 patients. Four groups of drugs were studied. After withdrawal all patients taking clonidine showed a considerable increase in heart rate and blood pressure with intense ectopic activity. Patients taking postganglionic neurone-blocking drugs showed a similar but less pronounced reaction with increased ventricular ectopic activity. No alarming reactions were seen after withdrawal of methyldopa or beta-blocking drugs. Methyldopa and, especially, beta-blocking drugs are less likely to produce withdrawal reactions than clonidine or the postganglionic neurone-blocking drugs, and patients taking these drugs are therefore less likely to suffer violent reactions if they forget to take their tablets.     

Reconstruction of peptidyltransferase activity on 50S and 70S ribosomal particles by peptide fragments of protein L16

Ribosomal protein L16 was digested with Staphylococcus aureus protease V8 and the resulting peptides were separated by reversed-phase high-performance liquid chromatography. One of the fragments, identified by sequence analysis as the N-terminal peptide of L16, was shown to exhibit partial peptide-bond-formation and transesterification activities of peptidyltransferase upon reconstitution with L16-depleted 50S core particles. However, several proteins enhanced these activities. L15 increased both reactions when added to the reconstitution mixture, suggesting a limited capacity of the L16 peptide to incorporate into 50S core particles. In contrast, the interaction of L11 with the N-terminal peptide stimulated the transesterification reaction but not the peptide-bond-forming activity of ribosomes, indicating a different topological domain for these reactions. Also, EF-P, a soluble protein which reconstructs the peptide-bond formation and transesterification reactions on 70S ribosomes, stimulated both peptidyltransferase activities exhibited by the L16 N-terminal peptide.     

Studies on the cell-cycle dependency of the actions of insulin-like growth factor-I in Balb/c 3T3 cells

The present study was conducted to determine the cell-cycle dependency of various actions of IGF-I in Balb/c 3T3 cells. When autophosphorylation of the IGF-I receptor was determined in [32P]-labelled cells, IGF-I increased radioactivity in a 100 K-Da phosphoprotein, presumably beta-subunit of the IGF-I receptor, both in quiescent and in primed competent cells. Likewise, IGF-I stimulated uptake of [3H]deoxyglucose independent of the cell cycle. In contrast, IGF-I increased calcium entry, radioactivity in [3H]diacylglycerol, and [3H]thymidine incorporation in primed competent cells while these reactions were not induced by IGF-I in quiescent cells. The latter three reactions were attenuated when cells were pretreated with pertussis toxin. These results indicate that some, but not all, of the actions of IGF-I are dependent on the cell cycle in Balb/c 3T3 cells. They also suggest that a pertussis-toxin-sensitive G protein may be involved in the cell-cycle-dependent actions of IGF-I.     

Capsaicin-sensitive primary sensory neurons are potent modulators of murine delayed-type hypersensitivity reactions

Capsaicin, a neurotoxin that depletes primary sensory neurons (polymodal nociceptors) of neuropeptides, was used to explore the role of such neurons on the expression of delayed-type hypersensitivity reactions in mice. BALB/c mice received s.c. injections with capsaicin (100 mg/kg) and tested 1 to 2 wk later exhibited insensitivity to chemically induced irritation (greater than 80% reduction in the eye-wiping response for more than 15 wk) as well as loss (greater than 95% reduction) of the ear swelling response to topical capsaicin. Early (less than or equal to 4 h) ear swelling to topical DNFB and oxazolone was also markedly reduced by capsaicin pretreatment, suggesting neurogenic inflammation as a major component of the early irritant reaction to haptens. In contrast, capsaicin-pretreated mice exhibited enhanced contact sensitivity (CS) reactions to oxazolone (greater than 90%) and DNFB (greater than 50%) and enhanced delayed-type hypersensitivity reactions to SRBC (greater than 20%). Adoptive transfer experiments revealed that CS augmentation was not due to generation of increased numbers and/or activity of effector T cells. Histologic studies as well as experiments measuring migration of 51Cr-labeled, Ag-nonspecific cells showed increased edema and enhanced cell localization in CS elicitation sites in capsaicin-pretreated mice. These results indicate that peptidergic neurons, via neuropeptide release, regulate the expression of T cell-mediated, delayed-in-time, cutaneous inflammatory reactions. The net effect of these neurons on the late (cellular) phase of such responses seems to be suppressive, because their impairment results in augmented reactions.     

Changes in immunological parameters in lung cancer patients undergoing immunotherapy with streptococcal preparation OK-432

Summary We have studied the immunological status of patients treated with streptococcal preparation OK-432. Two KE of OK-432 was injected intramuscularly once every week for more than three years unless the patients died. The natural killer (NK) activity in those patients who underwent curative surgery for lung cancer and had no sign of recurrence was significantly increased (P < 0.01) during the OK-432 treatment. However, the NK activity in the patients who had persistent disease (non-resected cases, incompletely resected cases or recurrent cases) was not significantly increased in comparison with that before the immunotherapy. Also, in the cases with no clinical symptoms of recurrence, both the lymphoblastogenetic reactions to the mitogens and the IL-2 production were significantly enhanced(P < 0.01) during the administration of OK-432. Reactions in the SU-PS (polysaccharide taken from the cell-wall fraction of theStreptococcus pyogenes SU strain and containing 7.2% of protein) skin-test appeared to significantly correlate with the immunological status of the patients under OK-432 therapy, but the PHA and PPD skin reactions showed no definitive enhancement. The survival rate of the patients whose SU-PS skin tests were positive during the OK-432 immunotherapy was significantly higher (P < 0.01) than that of the patients with negative reactions.