technetium-tc-99m-sulfur-colloid and Esophageal-and-Gastric-Varices

Gastrointestinal bleeding is a common and occasionally life-threatening problem in infants and children. A careful history and physical examination as well as the application of new endoscopic and radiographic techniques will reveal the source of hemorrhage in most patients. The utility of recently introduced pharmacologic agents and endoscopic techniques in the treatment of peptic disease and variceal hemorrhage in children remains to be determined. A cooperative effort among pediatricians, radiologists, and surgeons should minimize the morbidity and mortality from gastrointestinal tract bleeding in this population.

Topics: Angiography; Antacids; Barium Sulfate; Child; Colonoscopy; Digestive System; Endoscopy; Enema; Esophageal and Gastric Varices; Gastric Lavage; Gastrointestinal Hemorrhage; Hemostatic Techniques; Histamine H2 Antagonists; Humans; Infant; Infant, Newborn; Peptic Ulcer Hemorrhage; Radionuclide Imaging; Sigmoidoscopy; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sulfur Colloid

Angiography has become an integral tool in the management of patients with gastrointestinal bleeding. It is used for localizing the site of bleeding and then for controlling the bleeding when more conservative methods of treatment are unsuccessful.

Topics: Angiography; Blood Vessels; Endoscopy; Erythrocytes; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Hemostatic Techniques; Humans; Intestine, Small; Mesenteric Veins; Peptic Ulcer Hemorrhage; Postoperative Complications; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Varicose Veins; Vasopressins

A prospective study of 101 consecutive patients of portal hypertension was carried out to study the possible relationships between bone marrow activity on 99m technetium labelled sulphocolloid scan and severity of liver disease, etiology of portal hypertension and cirrhosis, as well as presence and extent of collateral circulation, including esophageal varices. The patients were divided into 4 etiological groups: alcoholic cirrhosis (ALD), (38) non-alcoholic cirrhosis (NALD) (35) non-cirrhotic portal fibrosis (NCPF) (14) and extrahepatic portal vein obstruction (EHPVO) (14). Patients of cirrhosis were categorised according to modified Child-Pugh's classification. Esophageal varices were graded endoscopically as (1) no varix (2) small varices (< 5mm) (3) large varices (> 5mm). All patients underwent radionuclide imaging using 99m Technetium labelled sulphocolloid and bone marrow activity was studied. Evaluation of portasystemic collaterals was done ultrasonically. We found that 16.6%, 44.6% and 72.72% patients with Child A, B and C cirrhosis respectively, had increased marrow activity (p < 0.05). There was no significant difference between marrow activity of patients with ALD (52.6%) and NALD (40%). None of the non-cirrhotic patients demonstrated bone marrow uptake of radioisotope. There was no significant difference between bone marrow uptake presence of lienorenal collaterals and presence or size of esophageal varices. We thus conclude the bone marrow activity on radioisotope scanning depends only on the severity of liver disease and does not vary a according to the etiology of cirrhosis, or presence and extent of portasystemic collaterals, including esophageal varices.

Topics: Adult; Bone Marrow; Case-Control Studies; Collateral Circulation; Esophageal and Gastric Varices; Female; Humans; Hypertension, Portal; Liver Cirrhosis; Liver Cirrhosis, Alcoholic; Male; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid

Sclerotherapy in oesophageal variceal bleeding and portal hypertension is a standardized method. Gastro-oesophageal reflux-scintigraphy was performed in 18 from 90 patients. Augmented reflux of gastric acid and signs of insufficiency could not be shown. Our results indicate that a general treatment for avoiding a relapse of variceal bleeding by reflux is not necessary.

Topics: Esophageal and Gastric Varices; Esophageal Stenosis; Esophagogastric Junction; Esophagus; Gastroesophageal Reflux; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis; Radionuclide Imaging; Sclerosing Solutions; Technetium Tc 99m Sulfur Colloid

Partial splenic embolization (PSE) was successfully accomplished in 10 of 11 children, aged 2-9, who had portal hypertension or variceal bleeding. Nine of the 11 children had undergone portoenterostomy (Kasai operation) for biliary atresia, and two had portal vein thrombosis. After embolization these children had a longer period of fever (mean = 23.7 days) and elevated white blood cell (WBC) count (above 10,000, mean = 13.6 days) than adults who have undergone the same procedure. The leukopenia and thrombocytopenia of hypersplenism were corrected by PSE in seven of eight children, and the condition of the eighth child improved. Among ten patients who had experienced episodes of variceal hemorrhage, the frequency of bleeding episodes was reduced from an average of 2.87 per year before PSE to 0.67 per year after PSE. There were no splenic abscesses and no other significant complications of the treatment. Ultrasound (US) evaluation after embolization demonstrated hypoechogenicity of the infarcted areas and tiny, linear echoes scattered throughout the spleen typical of postinfarction intravascular gas. All nine children who underwent follow-up Tc-99m sulfur colloid scanning showed evidence of splenic regeneration, though none has had recurrence of clinical symptoms. Splenic regeneration following PSE may occur more frequently in children than in adults.

Topics: Child; Child, Preschool; Embolization, Therapeutic; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Hypersplenism; Male; Radionuclide Imaging; Spleen; Splenic Artery; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography

99Tcm-DTPA has been evaluated in our clinical and experimental programme for the detection of acute gastrointestinal bleeding. As an adjunct to this programme, a protocol for image subtraction has been developed. The patient remains still while sequential static images I(i) (i = 1, . . ., N) are taken. They are first normalized to equal total counts and then subtracted images are produced according to the following three methods (a) I(i + 1)-I(i) (b) I(i) - I(mask) (c) I(mask) - I(i) where i not equal to mask and I(mask) denotes a user-selected mask image. Method (a) demonstrates fresh bleeding and sequential movement of blood in the bowel. Methods (b) and (c) demonstrate overall migration of blood and accumulated bleeding depending on the choice of the mask image.

Topics: Acute Disease; Colon; Duodenal Ulcer; Erythrocytes; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Pentetic Acid; Peptic Ulcer Hemorrhage; Radionuclide Imaging; Stomach Ulcer; Subtraction Technique; Technetium; Technetium Tc 99m Pentetate; Technetium Tc 99m Sulfur Colloid