technetium-tc-99m-sulfur-colloid and Kidney-Failure--Chronic

Continuous ambulatory peritoneal dialysis is a widely used and convenient alternative to haemodialysis in patients with renal failure. Occasionally, a scrotal swelling may develop during this procedure because of fluid passing through a patent processus vaginalis. We present a case report to illustrate the diagnostic use of radionuclide scintigraphy in this group of patients.

Topics: Aged; Hernia, Inguinal; Humans; Kidney Failure, Chronic; Male; Peritoneal Cavity; Peritoneal Dialysis, Continuous Ambulatory; Radionuclide Imaging; Radiopharmaceuticals; Scrotum; Technetium Tc 99m Sulfur Colloid

Topics: Female; Humans; Kidney Failure, Chronic; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Pleural Effusion; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid

A variety of factors can adversely impact chronic peritoneal dialysis (CPD) as an effective renal replacement therapy for patients with end-stage renal disease. These factors include peritonitis, poor clearances, loss of ultrafiltration, and a variety of anatomic problems, such as hernias, peritoneal fluid leaks, loculations, and catheter-related problems caused by omental blockage. This study reviews our experience with peritoneal scintigraphy for the evaluation of some of these difficulties.. From 1991 to 1996, 50 peritoneal scintigraphy scans were obtained in 48 CPD patients. Indications for scintigraphy were evaluated, and the patients were placed into four groups: group I, abdominal wall swelling; group II, inguinal or genital swelling; group III, pleural fluid; and group IV, poor drainage and/or poor ultrafiltration. A peritoneal scintigraphy protocol was established and the radiotracer isotope that was used was 2.0 mCi of 99mtechnetium sulfur colloid placed in two liters of 2.5% dextrose peritoneal dialysis solution.. Ten scans were obtained to study abdominal wall swelling, with seven scans demonstrating leaks; six of these episodes improved with low-volume exchanges. Twenty scans were obtained to evaluate inguinal or genital swelling, and 10 of these had scintigraphic evidence for an inguinal hernia leak (9 of these were surgically corrected). One of four scans obtained to evaluate a pleural fluid collection demonstrated a peritoneal-pleural leak that corrected with a temporary discontinuation of CPD. Sixteen scans were obtained to assess poor drainage and/or ultrafiltration. Five of these scans demonstrated peritoneal location, and all of these patients required transfer to hemodialysis. The other 11 scans were normal; four patients underwent omentectomies, allowing three patients to continue with CPD.. Peritoneal scintigraphy is useful in the evaluation and assessment of CPD patients who develop anatomical problems (such as anterior abdominal, pleural-peritoneal, inguinal, and genital leaks) and problems with ultrafiltration and/or drainage.

Topics: Adult; Aged; Aged, 80 and over; Edema; Evaluation Studies as Topic; Female; Genitalia; Hernia, Inguinal; Humans; Kidney Failure, Chronic; Male; Middle Aged; Peritoneal Cavity; Peritoneal Dialysis; Pleura; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid

Malnutrition in dialysis patients is of multifactorial etiology and is associated with greatly increased morbidity and mortality. A low serum albumin level is one of the most powerful predictors of death and may persist despite optimization of the dialysis prescription. We retrospectively reviewed our experience in improving nutrition in nondiabetic patients with unexplained hypoalbuminemia. Using radionuclide solid-phase gastric emptying scans, we identified 6 patients who had occult gastroparesis. These patients (one on hemodialysis and five on peritoneal dialysis) were then treated with prokinetic medications (erythromycin elixir or metoclopramide) selected on the basis of their effectiveness in improving the scanning results after being given intravenously. Gastric emptying half-times improved from a median of 122 minutes (range, 95 to >300 minutes; normal, < or = 90 minutes) to 12 +/- 2 minutes (mean +/- SEM). The serum albumin increased from 3.3 +/- 0.04 g/dL to 3.7 +/- 0.08 g/dL at 3 months, with every patient's value higher than 3.5 g/dL. This improvement was statistically significant (P = 0.008) over the 5-month period of observation, which encompassed the 2 months before and 3 months after treatment. There was a linear improvement (P = 0.008) that showed a quadratic trend (P = 0.078) for a plateau at the final sampling point. The serum blood urea nitrogen, creatinine, and hematocrit levels remained unchanged (P > 0.1). We conclude that gastric emptying scans are valuable in identifying occult gastroparesis in high-risk patients and can guide the selection of prokinetic therapy, which may significantly increase serum albumin levels.

Topics: Erythromycin; Female; Gastric Emptying; Gastroparesis; Humans; Kidney Failure, Chronic; Male; Metoclopramide; Middle Aged; Nutrition Disorders; Peritoneal Dialysis; Radionuclide Imaging; Radiopharmaceuticals; Renal Dialysis; Retrospective Studies; Serum Albumin; Stomach; Technetium Tc 99m Sulfur Colloid

Topics: Aged; Dialysis Solutions; Hernia, Inguinal; Humans; Kidney Failure, Chronic; Male; Peritoneal Dialysis, Continuous Ambulatory; Peritoneum; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid

Topics: Adult; Humans; Kidney Failure, Chronic; Male; Peritoneal Cavity; Radionuclide Imaging; Spermatic Cord Torsion; Technetium Tc 99m Sulfur Colloid

Topics: Adenosine Deaminase; Adolescent; Adult; Biopsy; Carrier Proteins; Child; Child, Preschool; Creatinine; Dipeptidyl Peptidase 4; Evaluation Studies as Topic; Graft Rejection; Humans; Infant; Kidney Failure, Chronic; Kidney Transplantation; Kidney Tubular Necrosis, Acute; Technetium Tc 99m Sulfur Colloid

Topics: Ascites; Humans; Kidney Failure, Chronic; Lymph; Male; Peritoneal Cavity; Peritoneal Dialysis, Continuous Ambulatory; Pseudomonas aeruginosa; Pseudomonas Infections; Technetium Tc 99m Sulfur Colloid; Time Factors

Topics: Female; Humans; Hydrothorax; Kidney Failure, Chronic; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Technetium Tc 99m Sulfur Colloid

Forty-eight adult patients without clinical evidence of inguinal or abdominal wall hernias underwent peritoneal scintigraphy shortly after beginning continuous ambulatory peritoneal dialysis (CAPD). Scintigraphically detectable subclinical structural defects involving the inguinal canal or abdominal wall were present in 14 patients. Within 5 months, four of these defects progressed to clinically significant CAPD-related structural complications. These patients could not be distinguished by clinical or scintigraphic criteria from the 10 patients with nonprogressive structural defects. No scintigraphic structural defects were detected in 34 patients, 30 of whom remained free of CAPD-related structural complications. Five patients developed symptomatic structural complications during follow-up in areas that had been scintigraphically normal at the onset of CAPD. We conclude that some CAPD-related structural complications arise de novo, while others represent progression of subclinical pre-existent structural abnormalities that can be detected by peritoneal scintigraphy. However, most asymptomatic scintigraphic defects do not progress to a symptomatic stage, limiting the usefulness of prospective peritoneal scintigraphy as a guide to recommend prophylactic repair of all asymptomatic structural defects in patients beginning CAPD.

Topics: Adult; Aged; Female; Humans; Kidney Failure, Chronic; Male; Middle Aged; Peritoneal Cavity; Peritoneal Dialysis, Continuous Ambulatory; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

In the Ga-67 scintigram, most pyogenic liver abscesses appear to be areas of high radiotracer concentration; rarely photon-deficient lesions may also occur. We present a 58-year-old man with sepsis and hepatic abscess, demonstrated by a Tc-99m BIDA study and a computerized tomogram of the body, showing homogenous radiogallium uptake throughout the liver in the Ga-67 images. To avoid missing such a "warm" lesion, it is emphasized that abdominal Ga-67 scintigrams for localization of a focal inflammatory lesion should be done along with Tc-99m sulfur colloid or Tc-99m BIDA scintigraphy.

Topics: Gallium Radioisotopes; Humans; Imino Acids; Kidney Failure, Chronic; Liver; Liver Abscess; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Renal allograft accumulation of Tc-99m sulfur colloid (TSC) was studied using visual assessment of scintigraphic displays and a quantitative temporal model in 210 examinations of 56 transplant recipients. The quantitative temporal model related the immediate pool of the radioagent in the transplant to the fixed allograft accumulation of TSC at 20 minutes after administration. Examinations performed less than 3 days after grafting or steroid pulse therapy were excluded. Rejection was established by clinical and biochemical evaluation in all 84 examinations that showed acute or chronic allograft rejection. Rejection was accurately diagnosed by visual scintigraphic assessment in 82% of the established cases; this improved to 99% with relative temporal quantitation analysis. Sensitivity improved from 78% by visual examination to 95% with temporal quantitation and specificity improved from 83% to 100%.

Topics: Graft Rejection; Humans; Kidney Failure, Chronic; Kidney Transplantation; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Adult; Humans; Hydrothorax; Kidney Failure, Chronic; Male; Peritoneal Dialysis; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid