succimer and Postoperative-Complications

This article describes the role of nuclear medicine in the evaluation of the genitourinary tract. The technical aspects of radionuclide imaging (radiopharmaceuticals, radiation dosimetry, instrumentation, and method) are briefly presented, and each of the indications for renal scintigraphy--including the evaluation of differential renal function, hypertension, obstruction, renal transplants, masses, trauma, congenital anomalies, vesicoureteral reflux, and infection--are discussed. The relative advantages and disadvantages of radionuclide imaging with respect to alternative radiographic examinations (such as intravenous urography, ultrasonography, CT, angiography, and magnetic resonance imaging) are emphasized wherever applicable.

Topics: Graft Rejection; Humans; Hypertension, Renovascular; Iodohippuric Acid; Kidney; Kidney Function Tests; Kidney Neoplasms; Kidney Transplantation; Kidney Tubular Necrosis, Acute; Male; Organotechnetium Compounds; Pentetic Acid; Postoperative Complications; Pyelonephritis; Radioisotope Renography; Spermatic Cord Torsion; Succimer; Sugar Acids; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Ureteral Obstruction; Urinary Tract; Vesico-Ureteral Reflux

To demonstrate the safety and efficacy of percutaneous nephrolithotomy (PCNL) for management of large renal stones between single-functioning kidney and double-kidney patients.. Thirty single-functioning kidneys and 30 double-kidney patients with a mean age of 38.5 (±15.6) years in the single group and 42.1 (±14.3) years in the double group (range 11-72 years) underwent PCNL for renal stones larger than 2 cm. The effect of PCNL on global and regional cortical activity was measured using quantitative single-photon emission CT measurement of technetium-99m ((99m)Tc) dimercaptosuccinic acid (DMSA) scan uptake by the kidneys before and 6 months after PCNL. Variables assessed were stone bulk, size, location, the number of punctures, and anatomic factors. Average hemoglobin and serum creatinine changes, mean operative time, transfusion rate, hospital stay, and different complications were also assessed.. Mean stone size, mean hospital stay, success rate, and complications were statistically similar in both groups. Mean serum creatinine changes (preoperative and postoperative) were not statistically significant between the two groups (P=0.12). Mean hemoglobin drop (preoperative and postoperative) in both groups was significant, and there was a valuable difference between them (P=0.01). There was a significant difference in the uptake by the treated kidneys before vs after PCNL between both groups statistically (P=0.019), so that the DMSA renal uptake was obviously higher 6 months after PCNL in the double-kidney group compared with its uptake in the single-functioning kidney group.. (99m)Tc-DMSA renal scan confirms that renal function was preserved or even often improved after percutaneous stone removal, and the procedure had no detrimental effects on renal function in both groups. There was no statistically significant difference between these groups in terms of morbidity and stone clearance.

Topics: Adolescent; Adult; Aged; Child; Creatinine; Hemoglobins; Humans; Kidney; Kidney Calculi; Length of Stay; Middle Aged; Nephrostomy, Percutaneous; Postoperative Complications; Succimer; Time Factors; Treatment Outcome; Young Adult

Peritoneal exposure to mercury has been rarely reported and long-term consequences of this type of exposure have not been documented. We report the clinical course of a patient who has survived almost eight years with a massive intraperitoneal load of mercury. She has suffered formication, pruritus, fatigue, irritiability, insomnia, alopecia, dizziness, a gait disturbance, loss of balance and multiple falls, abdominal pain, choking, and headaches. Two courses of chelation with dimercaptosuccinic acid using the standard protocol were undertaken, resulting in increased daily excretion, but without demonstrable objective or subjective benefit or lasting effect. She had multiple medical problems before the mercury intoxication, which complicates the attribution of all her problems to mercury intoxication. It is of particular interest that the patient survived and did not suffer any marked cognitive deterioration. She died in 2002 shortly after being diagnosed with lung cancer and declaring that she would fight it. Phasing out of mercury-weighted tubes is recommended.

Topics: Chelating Agents; Creatine; Crohn Disease; Electroencephalography; Fatal Outcome; Female; Humans; Intestinal Obstruction; Intubation, Gastrointestinal; Irritable Mood; Mercury; Mercury Poisoning; Middle Aged; Neurotoxicity Syndromes; Peritoneum; Postoperative Complications; Radiography; Succimer

Reflux nephropathy, renal scarring after urine infection, typically occurs in infancy. Although vesicoureteric reflux occurs commonly in kidney allografts, grafts have not previously been regarded as likely to be affected by reflux nephropathy, perhaps because older kidneys are considered to have matured out of the risk. Evidence that adult pigs remain at risk of reflux nephropathy challenges that assumption. We therefore reviewed the pathological findings in allograft nephrectomy specimens to look for evidence of reflux nephropathy, and sought evidence of focal transplant renal scarring in paediatric recipients who had a urine infection and vesicoureteric reflux. Consecutive allograft nephrectomy specimens (146) that had been removed between 1990 and 1999 were examined for evidence of reflux nephropathy, and relevant case notes were reviewed. Also, children with a renal transplant who had a urine infection were investigated for focal scarring by dimercaptosuccinic acid (DMSA) scanning and for reflux with a cystogram. Four transplanted kidneys from adult donors that were removed from adult recipients had developed changes consistent with reflux nephropathy. Of these, 3 also had definite evidence and 1 probable evidence of a glomerulopathy associated with hyperfiltration due to reduced renal mass. All 4 patients had had recurrent urine infection and the 2 assessed had had vesicoureteric reflux. Two children with renal transplants that also had urine infections and vesicoureteric reflux to their graft were shown to have sustained focal damage on DMSA scan, confirmed as reflux nephropathy scarring on biopsy in 1 case. The grafts were aged 14.4 years and over 16 years at the time of scarring. Reflux nephropathy can occur in previously healthy adult human kidneys after transplantation. Previous studies of the effect of vesicoureteric reflux on renal allografts were not designed to assess the possibility of mild or focal scarring.

Topics: Adolescent; Adult; Chelating Agents; Child, Preschool; Cicatrix; Female; Humans; Kidney; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Radionuclide Imaging; Succimer; Transplantation, Homologous; Vesico-Ureteral Reflux

A 43-year-old female patient with hypertension was diagnosed as having one-kidney renovascular hypertension with dysfunction of the contralateral kidney, and percutaneous transluminal renal angioplasty was carried out. Marked polyuria was observed during the 2- to 72-hour postoperative period. During the 12- to 18-hour period of polyuria, the urine volume was 8.9 liters/6 h, which was 62% of the glomerular filtration, and was accompanied by high fractional excretion of sodium and of potassium and a high urine beta 2-microglobulin level. The mechanism of polyuria in this case is discussed.

Topics: Adult; Angioplasty, Balloon; Blood Pressure; Female; Humans; Hypertension, Renovascular; Organotechnetium Compounds; Polyuria; Postoperative Complications; Radiography; Radioisotope Renography; Renal Artery; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid

We report a case of renal polar infarction in a 13-year old boy following surgical excision of contralateral congenital lobar emphysema. Patient history was unremarkable and yielded no data suggestive of any other underlying pathology or systemic disease. The diagnosis was made on the CT, arteriography and DMSA scan findings. The etiology could not be determined. The patient was treated conservatively with prophylactic antibiotic therapy and followed closely. There were no complications; the patient was asymptomatic one month after the episode. The control IVP showed residual segmental atrophy and ultrasound evaluation disclosed cortical atrophy. The most common cause of this condition, the diagnostic algorithm, treatments and their indications are discussed. Renal graft infarction, which may be associated with acute rejection or venous and/or arterial thrombosis, warrants special attention. The treatment and clinical course are significantly different, although the diagnosis is made using the same methods.

Topics: Adolescent; Algorithms; Angiography; Anti-Bacterial Agents; Diagnosis, Computer-Assisted; Follow-Up Studies; Humans; Infarction; Kidney; Lung; Male; Organotechnetium Compounds; Postoperative Complications; Pulmonary Emphysema; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Time Factors; Tomography, X-Ray Computed

Post-transplant hypertension can be a diagnostic dilemma. In a select population of pediatric patients, in whom other diagnostic methods failed to reveal an abnormality, renal cortical SPECT imaging, using either Tc-99m GH or Tc-99m DMSA, revealed information that was not apparent on conventional planar renal scintigraphy. Abnormalities detected by this methodology included unsuspected renal infarct and areas of segmental perfusion deficit. The authors conclude that this methodology is a valuable tool in the evaluation of post renal transplantation hypertension in pediatric patients.

Topics: Adolescent; Adult; Child; Female; Humans; Hypertension, Renal; Kidney Cortex; Kidney Transplantation; Male; Organotechnetium Compounds; Postoperative Complications; Succimer; Sugar Acids; Technetium Tc 99m Dimercaptosuccinic Acid; Tomography, Emission-Computed, Single-Photon

During a 4-year period 40 children (13 boys and 27 girls) with renal duplex system were examined with DMSA scintigraphy. The age at the investigation varied from 18 days to 9 years, mean 2.5 years. Duplicated system existed in 52 kidneys, bilaterally in 12 cases, right-sided in 10 and left-sided in 18 cases. The renal DMSA scintigraphy of the 52 duplicated kidneys revealed insignificant parenchymal damage in 19 kidneys. Moderate parenchymal damage existed in 10 kidneys. In the remaining 23 kidneys, severely deteriorated function of the upper moiety was found in 15 cases and of the lower pole in 9 cases, as both moieties were affected in one kidney. The function of the severely deteriorated moiety varied between 0% and 14%, mean 5.7% of the total renal function. All the 23 cases with severely deteriorated function were operated upon, 22 with heminephrectomy and one with nephrectomy. The assessment of parenchymal function of the separate parts of the kidney with duplex system by DMSA scintigraphy is of great value in the decision of management and surgical procedure.

Topics: Child; Child, Preschool; Female; Humans; Image Processing, Computer-Assisted; Infant; Infant, Newborn; Kidney; Kidney Function Tests; Male; Postoperative Complications; Radioisotope Renography; Succimer; Vesico-Ureteral Reflux

The renal function of sixty one adult patients was monitored by 99mTc-DMSA renal scan after cystectomy for a malignant tumour followed by ileal conduit urinary diversion. The postoperative follow-up period was 10 years. The stenosis rate of the uretero-ileal anastomosis was 12.8% and the incidence of pyelonephritis was 8% The mean value for overall renal function and for the function of each kidney did not deteriorate significantly (p = 0.1 and p = 0.7, respectively) over time. However, 26% of kidneys evaluated at 1 year and at 5 years showed a markedly decreased uptake on the renogram. In 70% of cases, this decreased uptake was related to the development of stenosis of the uretero-ileal anastomosis or pyelonephritis. Renal function remained stable at 5 years in group A, corresponding to patients with good initial renal function (n = 22, p = 0.07), and in group B, corresponding to patients with poor initial renal function (n = 7, p = 0.9). Similarly, the function of solitary kidneys did not deteriorate over the 5-year postoperative follow-up period (n = 7, p = 0.5). The functional value of the kidneys was therefore not globally altered after ileal conduit urinary diversion. The existence of a mechanical or infectious complication should be systematically investigated in the presence of a deterioration in renal function. DMSA isotope renal scan is a complete, qualitative and quantitative, follow-up examination after this type of urinary diversion.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Ileum; Incidence; Kidney Function Tests; Male; Middle Aged; Organotechnetium Compounds; Postoperative Complications; Pyelonephritis; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Ureteral Obstruction; Urinary Diversion

A 35-yr-old patient developed severe acute tubular necrosis requiring hemodialysis. A [99mTc]dimercaptosuccinic acid scan of the kidneys showed no renal uptake at 4 or 24 hr, but the patient subsequently recovered normal renal function as judged by a normal serum creatinine. Based on this case report and a review of the literature, one cannot assume irreversible loss of function in patients with acute renal failure, based on the absence of radiopharmaceutical uptake by the kidneys.

Topics: Acute Kidney Injury; Adult; Blood Urea Nitrogen; Creatinine; Female; Hemorrhage; Humans; Hysterectomy; Kidney; Kidney Tubular Necrosis, Acute; Postoperative Complications; Pregnancy; Puerperal Disorders; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stomach; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid

To study the accuracy of renal function quantification with 99Tcm-DMSA we compared DMSA renal uptake and creatinine clearance in 16 cases of children with single kidney. The age of the patients ranged from two months to fourteen years. Creatinine clearance was normalized to 1.73 m2. DMSA uptake was measured 7 h after intravenous injection. Background subtraction was used and soft tissue attenuation was taken into account. The uptake was normalized in percentage of the injected activity. A significant correlation was found between creatinine clearance and DMSA uptake (rt = 0.866, p less than 0.01). Normal creatinine clearance range in children (80 to 120 ml min-1/1.73 m2) allowed determination of normal uptake range (36 to 60%). This study indicates that in case of asymmetrical renal impairment renal uptake will reflect split renal creatinine clearance. Since the former is much easier to measure, DMSA should play an important role in the evaluation of differential renal function.

Topics: Adolescent; Child; Child, Preschool; Creatinine; Female; Humans; Infant; Kidney; Kidney Function Tests; Male; Nephrectomy; Postoperative Complications; Radionuclide Imaging; Succimer; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid