sodium-pertechnetate-tc-99m and Duodenal-Ulcer

This exclusively surgical series on pediatric non-variceal gastrointestinal bleed (NVGIB) defines three levels of bleed site and describes etiology, bleed severity, diagnostic algorithm, and surgical management for each bleed site. Management challenges are detailed.. Patients aged ≤ 18 years treated surgically for NVGIB were analysed.. Bleed site (n = 87) was classified as: upper gastrointestinal bleed (UGIB; n = 11); small bowel bleed (SBB: n = 52); and lower GIB (n = 24). Four etiology-based groups were identified: lesions with ectopic gastric mucosa (EGM; n = 33), tumours (n = 23), ulcers (n = 21), and vascular pathology (n = 8). Bleed severity spectrum was: acute severe bleed (n = 12); subacute overt bleed (n = 59); and occult GIB (n = 16). Preoperative diagnosis was obtained in all UGIB and LGIB lesions. Eighty-two percent of surgical SB lesions were diagnosed preoperatively on Tc. The commonest site-specific bleed etiologies were duodenal ulcers for UGIB, EGM lesions for SBB, and tumours for LGIB. SBB presented diagnostic challenge. Diagnostic algorithm was tailored to bleed site, age-specific etiology, bleed severity, and associated abdominal/systemic symptoms. Management challenges were acute severe bleed, occult GIB, SBB, obscure GIB, and rare etiologies. IOE has a useful role in SBB management.

Topics: Adolescent; Algorithms; Aneurysm, False; Capsule Endoscopy; Child; Child, Preschool; Choristoma; Crohn Disease; Duodenal Ulcer; Female; Gastric Mucosa; Gastrointestinal Hemorrhage; Gastrointestinal Neoplasms; Hepatic Artery; Humans; Infant; Male; Meckel Diverticulum; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Tomography, X-Ray Computed; Vascular Malformations

The paper is concerned with the results of clinical application of a new method of investigation of microcirculation in the gastric and duodenal wall. The method is based on the administration of a radiopharmaceutical in the submucous layer of the stomach and duodenum through the bioptic channel of a gastroscope with further recording of its rate of discharge on a gamma-chamber. A total of 48 patients with different gastroduodenal diseases were investigated. Good reproducibility of the method and good correlation of its results with clinical findings were confirmed.

Topics: Duodenal Ulcer; Duodenum; Gastritis, Atrophic; Humans; Iodine Radioisotopes; Methods; Microcirculation; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stomach; Stomach Ulcer

The technique of 99Tcm-labelled red cell scintigraphy as a means of detecting rebleeding was investigated in 33 patients with bleeding peptic ulcers. Scintigrams were performed twice during the 24 h period succeeding diagnostic endoscopy. There was scintigraphic evidence of rebleeding in 23 patients but this was clinically manifest in 14 patients only. Thirteen of the 14 patients with clinical rebleeding had positive scintigrams while only in one patient with clinical rebleeding was the scintigram negative (P less than 0.05). These results show that rebleeding is common and often clinically inapparent during the first 24 h following gastroscopy but that in the absence of scintigraphic rebleeding serious clinical rebleeding is unlikely to occur.

Topics: Adult; Aged; Duodenal Ulcer; Erythrocytes; Female; Humans; Male; Middle Aged; Peptic Ulcer Hemorrhage; Radionuclide Imaging; Recurrence; Sodium Pertechnetate Tc 99m; Stomach Ulcer

Topics: Adult; Duodenal Ulcer; Gastric Acid; Gastric Acidity Determination; Gastric Mucosa; Humans; Middle Aged; Radioisotope Dilution Technique; Sodium Pertechnetate Tc 99m

Topics: Duodenal Ulcer; Erythrocytes; False Negative Reactions; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Following intravenous injection, technetium-99m (99Tcm) is selectively taken up by the stomach, and this uptake, which is stimulated by pentagastrin, may be quantified using a gamma camera. Using this property of 99Tcm as a means of assessing gastric function, we found that the mean rate of 99Tcm uptake was significantly greater in 24 duodenal ulcer patients than in 10 healthy controls (P less than 0.01). Scanning values did not correlate with BAO of MAO which were measured on a separate day. Both vagotomy (n = 10) and cimetidine infusion (n = 5) significantly reduced the rate of uptake of 99Tcm (P less than 0.01). Thus, although 99Tcm reflects a function of the stomach which is similar to acid secretion, scanning did not give a good estimate of acid secretion in this group of subjects.

Topics: Adult; Cimetidine; Duodenal Ulcer; Female; Gastric Juice; Humans; Male; Radionuclide Imaging; Secretory Rate; Sodium Pertechnetate Tc 99m; Stomach; Technetium; Vagotomy

The most common complications of a Meckel's diverticulum is bleeding. With the introduction of abdominal scintigraphy we have a non-invasive examination method at our disposal which enables this condition to be diagnosed with accuracy preoperatively. A relevant case is described.

Topics: Child; Duodenal Ulcer; Gastrointestinal Hemorrhage; Humans; Male; Meckel Diverticulum; Peptic Ulcer Hemorrhage; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium