Metformin is a kind of biguanide hypoglycemic agent that has been widely used in patients with diabetes mellitus. In clinical practice, whether metformin should be stopped before Fundus fluorescein angiography (FFA) remains largely unclear. Some endocrinologists suggest stop metformin before FFA. However, ophthalmologists do not always adopt this opinion in their practice. This situation may lead to disputes between physicians and patients. This article analyzed contrast-induced nephropathy(CIN) and the related contrast agent, as well as the adverse reactions of fluorescein angiography. It pointed out that the discrepancy may be caused by misunderstanding of contrast agents used in FFA. For angiography using iodine contrast agent, metformin must be stopped because of the increased possibility of CIN, while for FFA using fluorescein sodium, no CIN has been reported yet. Therefore, the authors believe FFA is safe for diabetic patients with oral metformin and it is unnecessary to stop metformin before the examination.
Administration, Oral ; Contrast Media ; adverse effects ; Diabetes Mellitus, Type 2 ; diagnostic imaging ; drug therapy ; Diabetic Retinopathy ; diagnostic imaging ; Fluorescein Angiography ; adverse effects ; methods ; Humans ; Hypoglycemic Agents ; therapeutic use ; Kidney Diseases ; chemically induced ; Metformin ; therapeutic use

BACKGROUND/AIMS: With the increasing incidence of cardiovascular disease, angiocardiography using contrast-enhancing media has become an essential diagnostic and therapeutic tool, despite the risk of contrast-medium-induced acute kidney injury (CIAKI). CIAKI may be exacerbated by renin-angiotensin-system (RAS) blockers, which are also used in a variety of cardiovascular disorders. This study evaluated the effects of RAS blockade on CIAKI after coronary angiography. METHODS: Patients who underwent coronary angiography in our hospital between May 2009 and July 2011 were reviewed. Serum creatinine levels before and after coronary angiography were recorded. CIAKI was diagnosed according to an increase in serum creatinine > 0.5 mg/dL or 25% above baseline. RESULTS: A total of 1,472 subjects were included in this study. Patients taking RAS blockers were older, had a higher baseline creatinine level, lower estimated glomerular filtration rate (eGFR), and had received a greater volume of contrast medium. After propensity score matching, no difference was observed between the RAS (+) and RAS (.) groups. Multiple logistic regression identified RAS blockade, age, severe heart failure, contrast volume used, hemoglobin level, and eGFR as predictors of CIAKI. Multiple logistic regression after propensity matching showed that RAS blockade was associated with CIAKI (odds ratio, 1.552; p = 0.026). CONCLUSIONS: This study showed that the incidence of CIAKI was increased in patients treated with RAS blockers.
Acute Kidney Injury/*chemically induced/diagnosis/epidemiology/physiopathology ; Aged ; Angiotensin II Type 1 Receptor Blockers/*adverse effects ; Angiotensin-Converting Enzyme Inhibitors/*adverse effects ; Biological Markers/blood ; Chi-Square Distribution ; Contrast Media/*adverse effects/diagnostic use ; Coronary Angiography/*adverse effects ; Creatinine/blood ; Female ; Glomerular Filtration Rate/drug effects ; Humans ; Incidence ; Kidney/*drug effects/physiopathology ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Propensity Score ; Renin-Angiotensin System/*drug effects ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Assessment ; Risk Factors

Acute kidney injury (AKI) is closely associated with the mortality of hospitalized patients and long-term development of chronic kidney disease, especially in children. The purpose of our study was to assess the evidence of contrast-induced AKI after cardiac catheterization in children with heart disease and evaluate the clinical usefulness of candidate biomarkers in AKI. A total of 26 children undergoing cardiac catheterization due to various heart diseases were selected and urine and blood samples were taken at 0 hr, 6 hr, 24 hr, and 48 hr after cardiac catheterization. Until 48 hr after cardiac catheterization, there was no significant increase in serum creatinine level in all patients. Unlike urine kidney injury molecule-1, IL-18 and neutrophil gelatinase-associated lipocalin, urine liver-type fatty acid-binding protein (L-FABP) level showed biphasic pattern and the significant difference in the levels of urine L-FABP between 24 and 48 hr. We suggest that urine L-FABP can be one of the useful biomarkers to detect subclinical AKI developed by the contrast before cardiac surgery.
Acute Kidney Injury/blood/*chemically induced/*urine ; Biological Markers/urine ; Cardiac Catheterization/*adverse effects ; Child ; Contrast Media/adverse effects/diagnostic use ; Fatty Acid-Binding Proteins/*urine ; Female ; Heart Defects, Congenital/complications/*radiography ; Humans ; Iohexol/adverse effects/*analogs & derivatives/diagnostic use ; Male ; Radiography, Interventional/adverse effects ; Reproducibility of Results ; Sensitivity and Specificity

A 14-month-old boy was transferred because of dilated and hypertrophied left ventricle, neutropenia, and developmental delay. After checking computed tomographic angiography with contrast-dye, the patient showed acute exacerbation and finally died from multi-organ failure despite intensive cares. From genetic analysis, we revealed that the patient had Barth syndrome and found a novel hemizygous frame shift mutation in his TAZ gene, c.227delC (p.Pro76LeufsX7), which was inherited from his mother. Herein, we report a patient with Barth syndrome who had a novel mutation in TAZ gene and experienced unexpected acute exacerbation after contrast dye injection for computed tomographic angiography.
Acidosis/etiology ; Acute Disease ; Adolescent ; Barth Syndrome/diagnosis/*genetics ; Contrast Media/adverse effects/*diagnostic use ; Frameshift Mutation ; Heart Failure/etiology ; Homozygote ; Humans ; Male ; Mutation ; Pedigree ; Sequence Analysis, DNA ; Tomography, X-Ray Computed ; Transcription Factors/*genetics

We aimed to determine the characteristic adverse events (AEs) of iodinated contrast media (IOCM) and to compare the safety profiles of different IOCM. This study used the database of AEs reports submitted by healthcare professionals from 15 Regional Pharmacovigilance Centers between June 24, 2009 and December 31, 2010 in Korea. All reports of IOCM, including iopromide, iohexol, iopamidol, iomeprol, ioversol, iobitridol and iodixanol, were analyzed. Safety profiles were compared between different IOCM at the system organ level using the proportional reporting ratio (PRR) and 95% confidence interval (95% CI). Among a total of 48,261 reports, 6,524 (13.5%) reports were related to the use of IOCM. Iopromide (45.5%), iohexol (16.9%), iopamidol (14.3%) and iomeprol (10.3%) were identified as frequently reported media. 'Platelet, bleeding & clotting disorders' (PRR, 29.6; 95%CI, 1.9-472.6) and 'urinary system disorders' (PRR, 22.3; 95% CI, 17.1-29.1) were more frequently reported for iodixanol than the other IOCM. In conclusion, the frequency of AEs by organ class was significantly different between individual media. These differences among different IOCM should be considered when selecting a medium among various IOCM and when monitoring patients during and after its use to ensure optimum usage and patient safety.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Blood Platelet Disorders/chemically induced ; Child ; Child, Preschool ; Contrast Media/*adverse effects/diagnostic use ; Databases, Factual ; Female ; Humans ; Infant ; Infant, Newborn ; Iodine Radioisotopes/chemistry ; Male ; Middle Aged ; Neoplasms/radionuclide imaging ; Radiopharmaceuticals/*adverse effects/diagnostic use ; Urologic Diseases/chemically induced ; Young Adult

This study describes the first case of biliary peritonitis after radiofrequency ablation diagnosed by magnetic resonance (MR) imaging with gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA), a hepatocyte-specific MR imaging contrast agent. The image acquired 300 minutes after the administration of Gd-EOB-DTPA was useful to make a definite diagnosis and to identify the pathway of bile leakage. It is important to decide on the acquisition timing with consideration of the predicted location of bile duct injury.
Aged, 80 and over ; Bile Duct Diseases/*diagnosis/etiology ; Carcinoma, Hepatocellular/diagnosis/surgery ; Catheter Ablation/*adverse effects ; Contrast Media/diagnostic use ; Diagnosis, Differential ; Follow-Up Studies ; Gadolinium DTPA/*diagnostic use ; Hepatectomy/adverse effects/methods ; Humans ; Liver Neoplasms/diagnosis/*surgery ; Magnetic Resonance Imaging/*methods ; Male ; Peritonitis/*diagnosis/etiology

Gross hematuria secondary to vesical varices is an unusual presentation. We report such a case recurrent gross hematuria in a male patient who had a history of bladder substitution with ileal segments that had been treated by balloon-occluded percutaneous transhepatic obliteration of vesical varices.
Balloon Occlusion/*adverse effects ; Contrast Media/diagnostic use ; Embolization, Therapeutic/*methods ; Hematuria/*etiology ; Humans ; Male ; Middle Aged ; Phlebography ; Recurrence ; Tomography, X-Ray Computed ; Varicose Veins/*complications/*therapy

OBJECTIVETo evaluate the protective effect of amlodipine against contrast agent-induced renal injury in elderly patients with coronary heart disease.

METHODSA total of 189 elderly patients (>60 years) with coronary heart disease undergoing coronary artery angiography were randomly assigned into amlodipine group and control group to receive amlodipine or placebo, respectively, before and after administration of the contrast agent. At 24 h, 48 h and 5 days after contrast agent administration, the parameters of renal function were measured including serum cystatin C, urea nitrogen, creatinine, creatinine clearance rate, urine β2-microglobulin, and urine N-acetyl-β-glucosaminidase.

RESULTSIn both groups, the contrast agents obviously affected the renal functions of the patients (P<0.05). At 24 h after contrast administration, the levels of serum cystatin C, urine β2-microglobulin and urine NAG were significantly lower in amlodipine group than in the control group, but the other functional parameters showed no significant difference. At 48 h after contrast administration, the glomerular and tubular functional parameters were all superior in amlodipine group (P<0.05). At 5 days, the two groups showed significant differences in such glomerular and tubular functional parameters as urea nitrogen, creatinine, creatinine clearance rate, urine β2-microglobulin, and urine NAG (P<0.05), but not in serum cystatin C level. The incidence of contrast agent-induced nephropathy was significantly lower in amlodipine group than in the control group (5/95 vs 10/94, P<0.05).

CONCLUSIONSAmlodipine offers protection against radiographic contrast agent-induced renal injury in elderly patients with coronary heart disease.

Aged ; Amlodipine ; pharmacology ; therapeutic use ; Contrast Media ; adverse effects ; pharmacology ; Coronary Angiography ; Coronary Disease ; diagnostic imaging ; Female ; Humans ; Kidney Diseases ; chemically induced ; drug therapy ; Kidney Function Tests ; Male ; Middle Aged

BACKGROUND/AIMS: This study was designed to determine whether bile aspiration before contrast injection cholangiogram prevent of post-ERCP cholangitis, liver function worsening, cholecystitis and pancreatitis. METHODS: One hundred and two patients in the bile aspiration group before contrast injection from December 1, 2008 to December 30, 2009 and 115 patients in the conventional control group from January 1, 2010 to June 30, 2010 were analyzed. The incidence of post-ERCP cholangitis, liver function worsening, cholecystitis, pancreatitis, and hyperamylasemia only were compared between these two groups. RESULTS: In the 102 patients with the bile aspiration group, post-ERCP cholangitis in 3 patients (2.9%), liver function worsening in 4 patients (3.9%), cholecystitis and pancreatitis in none, and hyperamylasemia only in 6 patients (5.8%) occurred. In the 115 patients with control group, post-ERCP cholangitis in 1 patient (0.4%), liver function worsening in 9 patients (7.8%), cholecystitis in none, pancreatitis in 3 patients (2.6%), hyperamylasemia only in 10 patients (8.6%) developed. The two groups did not significantly differ in terms of the incidence of post-ERCP cholangitis, liver function worsening, pancreatitis, and hyperamylasemia only (p>0.05). CONCLUSIONS: Initially bile juice aspiration just before contrast injection into the bile duct rarely prevented post-ERCP cholangitis, liver function worsening, and pancreatitis in patients with the extrahepatic bile duct obstruction.
Adult ; Aged ; Aged, 80 and over ; *Bile ; Cholangiopancreatography, Endoscopic Retrograde/*adverse effects ; Cholangitis/epidemiology/etiology/prevention & control ; Contrast Media/*diagnostic use ; Female ; Humans ; Hyperamylasemia/epidemiology/etiology/prevention & control ; Incidence ; Liver Diseases/physiopathology ; Liver Function Tests ; Male ; Middle Aged ; Pancreatitis/epidemiology/etiology/prevention & control ; Suction

OBJECTIVE: We wanted to prospectively assess the adverse events and hemodynamic effects associated with an intravenous adenosine infusion in patients with suspected or known coronary artery disease and who were undergoing cardiac MRI. MATERIALS AND METHODS: One hundred and sixty-eight patients (64 +/- 9 years) received adenosine (140 microg/kg/min) during cardiac MRI. Before and during the administration, the heart rate, systemic blood pressure, and oxygen saturation were monitored using a MRI-compatible system. We documented any signs and symptoms of potential adverse events. RESULTS: In total, 47 out of 168 patients (28%) experienced adverse effects, which were mostly mild or moderate. In 13 patients (8%), the adenosine infusion was discontinued due to intolerable dyspnea or chest pain. No high grade atrioventricular block, bronchospasm or other life-threatening adverse events occurred. The hemodynamic measurements showed a significant increase in the heart rate during adenosine infusion (69.3 +/- 11.7 versus 82.4 +/- 13.0 beats/min, respectively; p < 0.001). A significant but clinically irrelevant increase in oxygen saturation occurred during adenosine infusion (96 +/- 1.9% versus 97 +/- 1.3%, respectively; p < 0.001). The blood pressure did not significantly change during adenosine infusion (systolic: 142.8 +/- 24.0 versus 140.9 +/- 25.7 mmHg; diastolic: 80.2 +/- 12.5 mmHg versus 78.9 +/- 15.6, respectively). CONCLUSION: This study confirms the safety of adenosine infusion during cardiac MRI. A considerable proportion of all patients will experience minor adverse effects and some patients will not tolerate adenosine infusion. However, all adverse events can be successfully managed by a radiologist. The increased heart rate during adenosine infusion highlights the need to individually adjust the settings according to the patient, e.g., the number of slices of myocardial perfusion imaging.
Adenosine/administration & dosage/*adverse effects ; Adult ; Aged ; Aged, 80 and over ; Blood Pressure/drug effects ; Contrast Media/diagnostic use ; Coronary Disease/*diagnosis ; Female ; Gadolinium DTPA/diagnostic use ; Heart Rate/drug effects ; Hemodynamics ; Humans ; Infusions, Intravenous ; *Magnetic Resonance Imaging ; Male ; Middle Aged ; Oxygen/blood ; Prospective Studies ; Vasodilator Agents/administration & dosage/*adverse effects