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New MR Contrast Agents. The Devil you know vs the Devil you don't know.

This blog deals with my assessment of superparamagnetic iron oxide particulate agents as MR contrast agents. It is highly compacted- but can be extrapolated to the entire field of MR contrast, and perhaps everything else in life. I had not seen this article before (a review on SPIO MR agents), because it is written in an obscure journal that a radiologist would not have ready access. In part I say this because one has to pay attention to the audience and how likely they are to see an article > hence should they have known.. Take this exactly as it reads and extend it to everything else we are dealing with. That being said, I like it, it is brief and describes the degree of thought that has g

Chelation with DTPA

Variations of this blog have been previously written, but it is worth repeating, as it is central to management of GDD. The following is the protocol that we generally use. I will also provide rationale for this protocol and suggest reasonable modifications, and when to use them. This protocol we have published in our article on DTPA chelation published in Investigative Radiology, but often perform in a simplified fashion. We administer Ca-DTPA on day 1, and Zn-DTPA on day 2. An iv is started with 20 - 22 gauge iv cath and hang a 1 L bag of normal saline. The 5 ml ampule of DTPA we inject as two 2.5 ml injections, each as a 1 min bolus pushes into the iv line We space the split dose appro

Amount of Retained Gadolinium ???

A well informed sufferer sent me this email some months bacK: Years ago while trying to determine how much gadolinium someone might have in their body if they only retained 1% of the Gd in each dose of contrast they received, I found the following from Dr. Jerrold Abraham (SUNY). Dr. Abraham estimated that everyone might retain between 1-2% of the gadolinium injected in each dose of contrast they received. http://www.upstate.edu/pathenvi/studies/cases/case10.php “However, it is noteworthy that even in persons with normal renal function, a small amount of the Gd from GBCA is apparently released into the body and stored in the bones, most likely incorporated into hydroxyapatite. In a single

Where Does Subcutaneous Injection of a GBCA Go?

This would be true of all subcutaneous injections and some drugs are deliberately injected subcutaneously, including some of the chelating agents. Reasons for deliberate subcutaneous injection include primarily that there is slow access to the vascular system and therefore prolonged effect of the agent injected. So this would also be true of a subcutaneous injection of a GBCA. In some ways this may emulate the conditions that are created with por renal function, GBCA injection, and development of NSF. The combined factors of a GBCA injection (almost always linear with NSF) and prolonged retention in the body secondary to renal failure, represent the fertile grounds for developing NSF. So my

GDD and the Microbiome

Over recent years the intestinal microbiome has become an important and fascinating subject of research in medicine and health. As I am an abdominal radiologist, I also love the concept of emphasizing the importance of the microbiome in health. Scientific knowledge and learning is still early with the microbiome. Some aspects though are important: 1. the total cell mass of the microbiome is enormous: the number of bacteria that form important functions in our body appear to outnumber our host cells. 2. the microbiome serves as an important front line protection and is part of our immune system: like mercenaries. 3. there are extensive communications between the microbiome and many (perhaps a

 
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