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

A study is presented of the motor-emptying function of the stomach evaluated by dynamic gastric scintigraphy in 43 patients with duodenal ulcer before and after vagotomy. In the early postoperative period 35 patients showed an enhanced emptying of the stomach, 8--a delayed. It was established that the most unfavourable results of vagotomy (gastrostasis, unhealed and relapsing ulcers) were observed in patients with preoperative dyskinesia of the duodenum and registered duodenogastric reflux. This should be considered in selecting the method of operative intervention. B-II gastric resection should be preferred in patients with duodenal dyskinesia.

Topics: Gastric Emptying; Humans; Peptic Ulcer; Postoperative Complications; Radionuclide Imaging; Recurrence; Sodium Pertechnetate Tc 99m; Stomach; Time Factors; Vagotomy, Proximal Gastric

Two formulations of [99mTc]sucralfate have been used to image gastric and duodenal ulcers and inflammatory bowel disease. One formulation is a complexation of [99mTc]HSA with sucralfate. The second is prepared by directly labeling sucralfate with [99mTc]pertechnetate in the presence of stannous ion. An in vitro study of the factors affecting the production and stability of these labeled sucralfate preparations was conducted. Both formulations were stable at the acidic pH likely encountered in the stomach. However, at pH greater than 6 the albumin-sucralfate complex began to dissociate while directly labeled sucralfate was stable to a pH of 9. Conversely it was shown that directly labeled sucralfate was more susceptible to loss of 99mTc to other chelating species. Sucralfate complexed with [99mTc]HSA was radiochemically stable up to a specific activity of 26 GBq (700 mCi) per gram while directly labeled sucralfate showed decreased 24-hr stability at specific activities greater than 837 mCi (31 GBq) per gram.

Topics: Chemical Phenomena; Chemistry; Drug Stability; Humans; Hydrogen-Ion Concentration; Organometallic Compounds; Organotechnetium Compounds; Peptic Ulcer; Radionuclide Imaging; Serum Albumin; Sodium Pertechnetate Tc 99m; Stomach; Sucralfate; Technetium

Thirty symptomatic patients with retained gastric antrum proved pathologically and/or by isotopic visualization were studied and treated from 1968 to 1983. The latent periods from the antral exclusion to the occurrence of anastomotic ulcers after a subtotal gastrectomy with Billroth's type II reconstruction varied from a few days to 19 years, with an average of 2.8 years. Fasting serum gastrin levels were normal in 14 of 21 patients and were intermittently high in some patients. The basal to maximal acid-output ratio was greater than 0.6 in 69% of the patients; primary cimetidine treatment was effective in three of five patients. Thirty-five operations on 27 patients were divided into six groups; all of these 27 patients eventually underwent resection of retained gastric antrum. We concluded that resection remains the best treatment for anastomotic ulcer related to retained gastric antrum. Additional truncal vagotomy did not provide additional benefit to these patients. Furthermore, cimetidine can be useful to control the symptoms for preoperative preparation or definitive treatment in high-risk patients.

Topics: Adult; Aged; Cimetidine; Female; Follow-Up Studies; Gastrectomy; Gastric Juice; Humans; Iatrogenic Disease; Male; Middle Aged; Peptic Ulcer; Postoperative Complications; Pyloric Antrum; Radionuclide Imaging; Recurrence; Reoperation; Sodium Pertechnetate Tc 99m

Retained gastric antrum (RGA) is a major factor in recurrent peptic ulcer. We studied 121 patients with proven anastomotic ulcers following subtotal gastrectomy and Billroth II reconstruction with sodium pertechnetate Tc 99m to determine the presence of RGA. Of the patients, 59 required surgery, 22 had RGA, and 16 had a positive scan for RGA. This noninvasive examination has 100% specificity. If RGA is identified before operation, minimal time is wasted in exploration of the abdomen, which is especially important in dealing with emergency cases. When an antral scan is negative for RGA, the surgeon is still advised to search for this condition.

Topics: Diagnosis, Differential; Gastrectomy; Humans; Peptic Ulcer; Pyloric Antrum; Radionuclide Imaging; Recurrence; Sodium Pertechnetate Tc 99m; Technetium; Zollinger-Ellison Syndrome

Topics: Colon; Digestive System; Gastrectomy; Humans; Jejunum; Peptic Ulcer; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium