sodium-pertechnetate-tc-99m and Aortic-Diseases

Aortic surgery results in ischemia/reperfusion of the lower body. This may liberate inflammatory mediators that activate neutrophils, and may result in lung microvascular changes with increased permeability and respiratory failure. We studied circulating inflammatory mediators and the pulmonary leak index (PLI) of 67Ga, a measure of transvascular transferrin transport and permeability, in patients scheduled for elective aortic and peripheral vascular surgery, before and after surgery. Aortic surgery patients in Groups 1 (n = 10) and 2 (n = 7) were studied before and at a median of 2.5 and 21.0 h after surgery, respectively. A control Group 3 (n = 6) was studied before and at a median of 2.9 h after peripheral vascular surgery. The PLI (median) increased from a median of 9.1 (range, 6.6 to 14.7) before to a median of 23.4 (range, 18.7 to 86.4) x 10(-3)/min after surgery in Group 1 but not in the other groups (p < 0.001). The postoperative increase in circulating neutrophils and elastase-alpha 1-antitrypsin, a marker of neutrophil activation, was similar among the groups. Plasma levels of activated complement 3a and tumor necrosis factor (TNF-alpha) did not change in any of the groups. In contrast, plasma levels of interleukin-8 (IL-8) increased in Group 1 from < 3 (range, < 3 to 37) before to 324 (range, 36 to 868) pg/ml after surgery, but did not change in the other groups (p < 0.005). The decrease in plasma levels of angiotensin converting enzyme (ACE) was greater in Group 1 than in the other groups (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Aortic Diseases; Capillary Permeability; Citrates; Citric Acid; Erythrocytes; Female; Gallium Radioisotopes; Humans; Inflammation Mediators; Interleukin-8; Lung; Male; Middle Aged; Neutrophil Activation; Peptidyl-Dipeptidase A; Peripheral Vascular Diseases; Postoperative Complications; Radionuclide Imaging; Reperfusion Injury; Respiratory Distress Syndrome; Sodium Pertechnetate Tc 99m

Forty-four patients with symptoms of lower limb arterial insufficiency were examined by radionuclide angiography using 99Tcm in vivo red cell labelling and by contrast aortography. The results of the study indicate that radionuclide angiography may well have a useful role to play in determining the type of contrast study most appropriate for delineating the aortic-iliac segment.

Topics: Adult; Aged; Aorta, Abdominal; Aortic Diseases; Aortography; Arterial Occlusive Diseases; Erythrocytes; Female; Humans; Iliac Artery; Leg; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Diagnosis of gastrointestinal bleeding remains a difficult problem. Radionuclides have been used widely to detect active GI bleeding. A case of actively bleeding aortoduodenal fistula detected on radionuclide imaging is presented.

Topics: Aged; Aorta, Abdominal; Aortic Diseases; Duodenal Diseases; Fistula; Gastrointestinal Hemorrhage; Humans; Intestinal Fistula; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Eighteen patients undergoing elective aortic surgery, either for peripheral vascular insufficiency or abdominal aneurysm, were studied preoperatively by nuclear angiography. By this technique the resting ventricular function of each patient was measured. Nuclear angiography is a safe non-invasive technique which has been shown to have excellent correlation with conventional contrast angiography in the assessment of ejection fraction. Throughout the intraoperative period, measurements of the central venous pressure and pulmonary capillary wedge pressure were taken simultaneously at approximately five-minute intervals. An average of 18 data points was established in each case. The correlation between central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP) was examined. Ten of our patients had preoperative resting ejection fractions less than 55 per cent. In only four of these patients (40 per cent) was correlation between CVP and PCWP judged to be good intraoperatively. Eight of our patients had preoperative ejection fractions greater than 55 per cent. Six of these (75 per cent) showed good correlation between CVP and PCWP intraoperatively. We also assessed our ability to predict by purely clinical means which patients would show poor correlation between CVP and PCWP. Evaluation on purely clinical grounds was as good as the scans at predicting in which patients CVP would not correlate with PCWP and we feel that the routine use of this test would not modify our use of Swan Ganz catheters for intraoperative monitoring in patients undergoing aortic surgery, in the future.

Topics: Aorta, Abdominal; Aortic Diseases; Blood Pressure; Cardiac Output; Hemodynamics; Humans; Myocardial Contraction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

We present what we believe is the first reported case of a spontaneous aortoduodenal fistula, with massive rupture into the duodenum during the performance of a radionuclide study of gastrointestinal bleeding. Our experience suggests that nuclear scintigraphy with labeled red blood cells can help in the diagnosis of this disorder by demonstrating both the presence of an abdominal aortic aneurysm and bleeding in the gut.

Topics: Aged; Aorta, Abdominal; Aortic Diseases; Aortic Rupture; Duodenal Diseases; Erythrocytes; Fistula; Gastrointestinal Hemorrhage; Humans; Intestinal Fistula; Male; Radionuclide Imaging; Rupture, Spontaneous; Sodium Pertechnetate Tc 99m; Technetium