technetium-tc-99m-sulfur-colloid and Postoperative-Complications

Despite the fact that the spleen has multiple functions, only one has been widely used for evaluation of the organ by imaging techniques (phagocytosis of 99mTc sulfur colloid). The usual splenic uptake of this radiocolloid can by used to determine the size, location, and integrity of the organ. A major use of splenic radiocolloid imaging has been in the study of congenital defects. Thus, eventration of the diaphragm, accessory spleens, splenogonadal fusion, the asplenia and polysplenia syndromes, and the wandering spleen are amenable to study by means of intravenously administered radiocolloid. Interference with the splenic uptake of radiocolloid can be either focal or generalized (as in functional asplenia). Imaging of the spleen has a major role in evaluating suspected trauma of the organ and in following its clinical course. The return of splenic function after splenectomy (splenosis or accessory spleens) can be documented by radionuclide imaging, and likely by hematologic techniques when the volume of tissue is sufficiently large. The detection of intrasplenic lesions is important in tumor staging and as an alerting sign to an ongoing process.

Topics: Abscess; Adult; Child; Child, Preschool; Cysts; Diaphragmatic Eventration; Humans; Hypersplenism; Phagocytosis; Postoperative Complications; Radiation Dosage; Radionuclide Imaging; Spleen; Splenic Diseases; Splenic Neoplasms; Splenic Rupture; Splenomegaly; 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

Topics: Abdominal Injuries; Erythrocytes; Hemobilia; Humans; Kidney; Liver; Postoperative Complications; Spleen; Splenectomy; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed; Tomography, X-Ray Computed; Ultrasonography; Wounds, Nonpenetrating

Secondary lymphedema is a localized, acquired lymphatic microcirculatory disturbance that affects large numbers of patients after breast cancer therapy. There is a paucity of objective methods to quantitate lymphatic function and to anticipate the response to therapeutic interventions. We applied radionuclide lymphoscintigraphy to evaluate lymphatic transport and axillary lymph node visualization in women following breast cancer therapy to determine the utility of these data in these patients. Lymphoscintigraphy was performed after subcutaneous injection of 0.25 mCi of Tc-filtered sulfur colloid. Subcutaneous accumulation of radiotracer ('dermal backflow') and the visualization of axillary lymph nodes were graded using our own scoring system. The ratio of radioactivity within the affected to normal axillae (ARR) was also quantified. Nineteen patients with lymphedema after breast cancer therapy were evaluated. The disease severity was documented by serial measurements of the limb volume using the truncated cone formula. Responses to therapy were quantified after completion of the therapy. There was a correlation between the ARR and the percentage reduction in edema volume. The lymphoscintigraphic score correlated with the initial arm volume excess and with the durationof lymphedema. It can be concluded that quantitative and semi-quantitative assessment by radionuclide lymphoscintigraphy represents a potentially useful tool for the clinical assessment of upper extremity lymphedema.

Topics: Aged; Breast Neoplasms; Female; Humans; Lymph Nodes; Lymphedema; Lymphoscintigraphy; Mastectomy; Middle Aged; Physical Therapy Modalities; Postoperative Complications; Predictive Value of Tests; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid; Upper Extremity

This paper presents a case of an 80-year-old man with idiopathic thrombocytopenic purpura after splenectomy performed many years ago, which normalized platelet count, presented with severe thrombocytopenia with no response to treatment. A SPECT/CT study was performed using 99mTc-labelled Sn-colloid. The histology confirmed the presence of splenic tissue in those foci. Spleen examination (SPECT/CT) using 99mTc-labelled Sn-colloid is able to detect splenic tissue and in our opinion is a simpler and less time-consuming procedure than using 99mTc DRBC.

Topics: Aged, 80 and over; Humans; Male; Multimodal Imaging; Positron-Emission Tomography; Postoperative Complications; Purpura, Thrombocytopenic; Radiopharmaceuticals; Spleen; Splenectomy; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

Topics: Anaphylaxis; Breast Neoplasms; Coloring Agents; Female; Humans; Mastectomy, Segmental; Middle Aged; Neoplasm Staging; Postoperative Complications; Risk Factors; Rosaniline Dyes; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid

This study was performed to determine whether endoleaks could be detected after endovascular aneurysm repair (EVAR) with use of technetium-99m sulfur colloid and (99m)Tc-labeled red blood cell (RBC) nuclear medicine scans.. There were 13 patients enrolled in this study: nine with endoleaks seen on computed tomographic (CT) angiography and four with no endoleak on CT angiography. All patients underwent regularly scheduled surveillance CT angiography examination after EVAR to evaluate for endoleak. Endoleak detection was then attempted in each patient with two nuclear medicine scans: a (99m)Tc sulfur colloid scan and a (99m)Tc-labeled RBC scan. Flow images (5 seconds per frame) were obtained for 1 minute after intravenous administration of 555 MBq (15 mCi) (99m)Tc sulfur colloid. Sequential dynamic images were then obtained every minute for 30 minutes. Next, a (99m)Tc-labeled RBC study was performed after the intravenous administration of 370-1,073 MBq (10-29 mCi) in vitro labeled (99m)Tc RBCs. Flow images were obtained, followed by sequential dynamic images obtained every minute for 30 minutes. Single photon emission CT images of the abdomen were then acquired. The nuclear medicine scans were evaluated for the presence or absence of endoleak independent of the CT angiography findings.. Of the nine patients with endoleaks on CT angiography, seven (78%) had them detected by nuclear medicine examinations. Two of the nine endoleaks seen on CT angiography (22%) were not seen on either scintigraphic examination. All patients with no endoleak on CT angiography had their nuclear medicine scans correctly interpreted as showing no endoleak present (n = 4; 100%). No complications occurred as a result of the nuclear medicine scans.. Endoleaks can be detected with (99m)Tc sulfur colloid and (99m)Tc-labeled RBC nuclear medicine scans. This initial work suggests that the sensitivities of these scintigraphic scanning methods for endoleak detection are lower than that of CT angiography.

Topics: Aortic Aneurysm, Abdominal; Erythrocytes; Female; Humans; Image Processing, Computer-Assisted; Male; Metabolic Clearance Rate; Postoperative Complications; Radionuclide Imaging; Radiopharmaceuticals; Reoperation; Stents; Surgical Procedures, Operative; Technetium; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

A simple method to detect silent aspiration during sleep has not been established in postsurgical oral cancer patients.. Radioactive paste consisting of (99m)TcO(4) (-) and carboxylmethylcellulose was prepared and placed in a maxillary prosthesis with a cavity in the palatal space. The patient was requested to wear this appliance during sleep, and the following morning the patient was subjected to scintigraphic scanning. Both the anterior and posterior aspects of the thorax were scanned using a Shimazu Medical gamma camera with window settings adjusted to a low energy collimator at 500 kilocounts per image.. Silent aspiration that had not been detected by videofluoroscopic examination was clearly demonstrated by the scintigraphic method, showing aspiration of radioactive paste during sleep in the left thorax of the patient.. The method reported for establishing aspiration is simple and reliable to assess silent aspiration during sleep in patients with oral cancer.

Topics: Aged; Carcinoma, Squamous Cell; Follow-Up Studies; Humans; Male; Mouth Neoplasms; Neoplasm Recurrence, Local; Pneumonia, Aspiration; Postoperative Complications; Postoperative Period; Radionuclide Imaging; Risk Assessment; Sensitivity and Specificity; Sleep; Technetium Tc 99m Sulfur Colloid

Gastro-oesophageal reflux (GOR) is a major cause of morbidity in children who undergo surgical repair for oesophageal atresia with tracheo-oesophageal fistula (OA/TOF). We performed a retrospective analysis to determine the incidence of GOR on radionuclide scintigraphy in symptomatic and asymptomatic OA/TOF patients in the first post-operative year. A total of 124 patients (74 males, 50 females), with a mean age of 3.5 months (range, 20 days to 12 months), were studied. Of these 124 patients, 67 were symptomatic and 57 were asymptomatic. On radionuclide scintigraphy, 73 patients (48 symptomatic and 25 asymptomatic) had reflux. Of the 48 symptomatic patients with scintigraphic studies positive for reflux, 79.2% (38) had proximal reflux and 20.8% (10) had distal reflux, whereas, of the 57 asymptomatic patients, 48% (12) had proximal reflux and 52% (13) had distal reflux. There was a significantly higher incidence of GOR in symptomatic children than in asymptomatic children (P<0.01). In particular, there was a significantly higher incidence of proximal GOR in symptomatic children than in asymptomatic children (P<0.001). In conclusion, the severity and incidence of GOR were significantly higher in symptomatic than asymptomatic OA/TOF patients in their first post-operative year. Scintigraphic evidence of proximal reflux correlates with the presence of symptomatic GOR.

Topics: Dilatation; Esophageal Atresia; Follow-Up Studies; Gastroesophageal Reflux; Humans; Incidence; Infant; Infant, Newborn; Postoperative Complications; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid; Tracheoesophageal Fistula

Topics: Female; Femoral Artery; Humans; Lithiasis; Lymph Nodes; Lymphedema; Middle Aged; Postoperative Complications; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid; Thigh

Patients who have undergone low anterior resection (LAR) of the rectum occasionally complain of symptoms related to impaired neorectal evacuation. Using scintigraphy, we assessed neorectal evacuation in 22 patients who underwent LAR and straight anastomosis, and correlated the results with clinical defecatory function, clinical factors, and anorectal manovolumetric parameters.. After the introduction of an artificial stool containing 99mTc-DTPA into the neorectum, sequential lateral gamma images were obtained. From the time-activity curve of radioactivity in the whole pelvis, the time taken to evacuate half of the introduced artificial stool (T(1/2)) and the percentage of artificial stool evacuated in 1 min (Evac1) were calculated.. The Evac1 was significantly lower in the patients who had undergone LAR than in reference normal volunteers. A long T(1/2) was significantly associated with worse defecatory function. The Evac1 was also significantly lower in patients with a low anastomosis. The rectal sensory threshold was significantly greater in patients with a shorter T(1/2). The maximum tolerable volume of the neorectum was significantly greater in patients with a shorter T(1/2) and a higher Evac1.. Poor neorectal evacuation is associated with impaired defecatory function after LAR. Therefore, it is suggested that optimizing both reservoir function and evacuation of the neorectum would improve defecatory function after LAR.

Topics: Adult; Aged; Aged, 80 and over; Case-Control Studies; Defecation; Female; Gastrointestinal Motility; Humans; Male; Middle Aged; Postoperative Complications; Radionuclide Imaging; Radiopharmaceuticals; Rectal Neoplasms; Rectum; Regression Analysis; Statistics, Nonparametric; Surveys and Questionnaires; Technetium Tc 99m Sulfur Colloid

Topics: Bone Marrow; False Positive Reactions; Humans; Indium Radioisotopes; Infections; Leukocytes; Male; Middle Aged; Muscular Diseases; Postoperative Complications; Radionuclide Imaging; Radiopharmaceuticals; Spinal Fusion; Technetium Tc 99m Sulfur Colloid

Topics: Deglutition Disorders; Esophagus; Humans; Mouth Neoplasms; Oropharynx; Postoperative Complications; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid

Intrathoracic splenosis is a rare diagnosis that is usually made following an invasive procedure. Although radiographic and CT findings are nonspecific, these findings combined with a history of splenic injury should suggest the possibility of this diagnosis. We present a patient with intrathoracic splenosis diagnosed on the basis of a technetium Tc 99m heat-damaged RBC scan following false-negative technetium Tc 99m sulfur colloid scan results.

Topics: Diaphragm; Erythrocytes; False Negative Reactions; HIV Seropositivity; Humans; Male; Middle Aged; Pleura; Postoperative Complications; Radionuclide Imaging; Splenic Rupture; Splenosis; Technetium; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

Chylous effusion is an infrequent complication of cardiothoracic surgery and a less frequent complication of central line placement. The authors describe a novel application of lymphoscintigraphy showing thoracic duct injury in an infant after surgery for hypoplastic left heart syndrome.

Topics: Chylothorax; Female; Humans; Hypoplastic Left Heart Syndrome; Infant, Newborn; Postoperative Complications; Radionuclide Imaging; Reoperation; Technetium Tc 99m Sulfur Colloid; Thoracic Duct

Oral-pharyngo-esophageal scintigraphy (OPES) proved to be able to demonstrate the pharyngeal residue of the radioactive bolus after deglutition and the presence and amount of tracheobronchial aspiration, and to calculate exactly the transit time of the various swallowing phases. The aim of this study was to evaluate the real objective effectiveness of OPES in order to assess the degree of swallowing recovery after horizontal supraglottic laryngectomy (HSL).. Nineteen patients entered the study, and 17 healthy subjects were included as control group (group 1). Nineteen patients in whom HSL had been performed at least 1 year before underwent OPES. They were divided into two groups: 13 patients (group 2) in whom the tracheal cannula had been removed and swallowing, phonatory, and respiratory functions were satisfactory and 6 patients (group 3) in whom the tracheostomy tube was still in situ for aspiration of liquids and scarring of the laryngeal vestibule.. Our results showed that in the patients who underwent HSL, all scintigraphic semiquantitative parameters and particularly aspiration percentage values and Pharyngeal Ritention Index (PRI) at 10 and 60 seconds were able to pinpoint some residual "subclinical" alteration and/or minimal surgical sequelae frequently observed after this kind of functional surgery, even though a substantially satisfactory recovery was achieved clinically (group 2 versus group 1). In addition, aspiration amounts in group 3 were markedly higher than those in group 2 (p < .0002), and mean PRI values at 10 and 60 seconds were significantly different (p < .0001) from normal mean control values (group 1).. Oral-pharyngo-esophageal scintigraphy may be regarded as a noninvasive, well-tolerated technique, with a radiation body burden within satisfactory limits of radioprotection. It appeared to be also sensitive in assessing the swallowing recovery after HSL.

Topics: Adult; Aged; Aged, 80 and over; Case-Control Studies; Deglutition; Esophagus; Female; Humans; Laryngectomy; Male; Middle Aged; Oropharynx; Postoperative Complications; Radionuclide Imaging; Radiopharmaceuticals; Statistics, Nonparametric; Technetium Tc 99m Sulfur Colloid

To analyze the clinical and scintigraphic features in four postoperative patients with lower limb edema.. Four case reports are presented, and causes of increased lymphatic flow are discussed.. Filtered 99mTc-sulfur colloid (0.1 mL; 20 MBq) was administered by subcutaneous injection into the second web space of each foot. Sequential local (inguinal) and whole-body imaging was performed periodically up to 24 hours after the injections. The patients were three women who were 40, 51, and 86 years of age and an 81-year-old man.. Each patient had unilateral lower extremity swelling and had recently undergone an ipsilateral lower limb operation. One female patient had previously undergone proximal femoral vein ligation, and another female patient had venous insufficiency demonstrated by Doppler ultrasonography. The male patient had a history of severe arterial insufficiency, and the remaining female patient had no venous or arterial abnormalities. On lymphoscintigraphy, all patients showed increased lymphatic flow in the edematous lower limb. Only the male patient also demonstrated abnormal dermal backflow pattern.. Increased lymphatic flow most likely is a normal response to lower limb edema in the presence of normal peripheral lymphatic structures. In the four described cases, a recent lower limb surgical procedure may have resulted in disturbance of normal proximal lymphatic channels. The role of sympathetic innervation of the peripheral lymphatic system is a potential factor determining lymphatic response to trauma or surgical intervention. Increased flow on lymphoscintigraphy may not necessarily represent normal flow, especially if other scintigraphic features of abnormal lymphatic function-such as dermal backflow pattern-are present.

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Leg; Lymph; Lymphedema; Male; Middle Aged; Postoperative Complications; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid

Twenty-six maxillary sinuses (of 20 patients) were studied following Caldwell-Luc procedures. Surgery had been performed between 1 to 27 years previously. Follow-up studies included nasal endoscopy, coronal computed tomography and camera-sequence scintigraphy. Findings demonstrated that normalization of disturbed mucosal function was possible after surgery. Indications for revision endoscopic sinus surgery are discussed, as are the limitations of surgery.

Topics: Ciliary Motility Disorders; Endoscopy; Ethmoid Bone; Follow-Up Studies; Humans; Maxillary Sinusitis; Mucociliary Clearance; Postoperative Complications; Radionuclide Imaging; Reference Values; Reoperation; Technetium Tc 99m Sulfur Colloid

The recovery of gastrointestinal motility was compared in dogs undergoing either laparoscopic or open sigmoidectomy. During surgery, bipolar recording electrodes were placed on the proximal and distal antrum, mid- and distal colon, and the rectum. Fasting myoelectric data were recorded postoperatively. Scintigraphic gastric emptying studies employing a solid test meal were performed before and after [postoperative day (POD) 2] operation. Ten radiopaque markers were given just before operation and retained markers were counted daily by abdominal x-ray. Gastric emptying on POD 2 was significantly delayed in the open group at 120 min compared with preoperative studies for the open group and compared with the laparoscopic group on POD 2 (P < 0.05 and P < 0.01, respectively). A significant difference in the number of retained markers was observed between the groups on POD 4 (P < 0.05). There were no significant differences in slow-wave frequency, presence of dysrhythmias in the proximal and distal antrum, or presence of either discrete or continuous electrical response activity in the colon and rectum between groups on any days. We conclude that using a laparoscopic approach results in more rapid recovery of fed-state gastrointestinal motility following colon resection. These data also suggest that myoelectric activity alone is not a sensitive enough parameter to detect these differences in recovery in this animal model.

Topics: Animals; Colectomy; Dogs; Female; Food; Gastrointestinal Motility; Intestinal Obstruction; Laparoscopy; Male; Postoperative Complications; Postoperative Period; Technetium Tc 99m Sulfur Colloid; Time Factors

Topics: Adult; Anastomosis, Surgical; Duodenum; Female; Humans; Pancreas Transplantation; Peritoneal Cavity; Postoperative Complications; Radiography; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Splenoptosis which is a congenital fusion anomaly of dorsal mesogastrium in children is a very rare entity. In the literature cases are usually diagnosed at operation and it is noted that in former years splenectomy had a special place among various methods of treatment. In this report, a 7-year-old case of splenoptosis diagnosed on ultrasonography and isotope scintigraphic methods preoperatively and treated by splenopexy is presented. In cases with splenoptosis the clinical and radiologic diagnostic criteria are given and the importance of splenopexy in treatment is emphasized.

Topics: Child; Female; Humans; Postoperative Complications; Radionuclide Imaging; Spleen; Suture Techniques; Technetium Tc 99m Sulfur Colloid; Visceral Prolapse

The mucociliary clearance of the maxillary sinus mucosa was studied before and 6-18 months after functional sinus surgery using 99mTc-SC in 34 sinuses of 22 patients with chronic inflammation of the ethmoid and maxillary sinus. Before operation the mucociliary transport was very slow and sometimes absent. In the postoperative interval between 6 and 18 months we saw a significant return of the mucosal function. In 56% of the sinuses investigated the postoperative clearance rate was within the normal range. We also recorded a similar trend in allergic patients, although there was not such a clear return to normal of the mucociliary clearance, and the rates were not within the normal range. We found no recovery of the mucociliary function in 11 sinuses of 7 patients with impaired healing. Decisions on subsequent treatment were based on postoperative nasal endoscopy and functional mucosal repair.

Topics: Chronic Disease; Endoscopy; Ethmoid Sinusitis; Follow-Up Studies; Humans; Maxillary Sinusitis; Mucociliary Clearance; Postoperative Complications; Radionuclide Imaging; Recurrence; Regeneration; Technetium Tc 99m Sulfur Colloid

A serious and often fatal complication of heart-lung transplantation is the development of obliterative bronchiolitis (OB). Currently the screening for OB is based on symptoms, pulmonary function tests, and transbronchial biopsies. The chest radiographs are often normal with OB. Obliterative bronchiolitis produces luminal narrowing of both bronchioles and bronchi resulting in areas of peripheral consolidation and occasional bronchiectasis. We report a patient in whom a chest film was normal, an aerosol ventilation lung scan was abnormal while a perfusion study was mildly abnormal. Simultaneously, routine CT was essentially normal while high resolution CT with 1 mm thick sections was clearly abnormal and demonstrated areas of consolidation. These imaging modalities detected clear-cut abnormalities at a time when the patient was symptomatic but prior to the development of demonstrable abnormality on chest radiograph.

Topics: Adult; Bronchiolitis Obliterans; Heart-Lung Transplantation; Humans; Male; Postoperative Complications; Radionuclide Imaging; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

Hepatic infarctions are rarely encountered, and scintigraphic findings are reported even less frequently in this entity. A patient who developed a left hepatic lobe infarct after surgical resection of a celiac axis aneurysm is described and a brief review of hepatic infarction is presented.

Topics: Aged; Aneurysm; Celiac Artery; Humans; Infarction; Liver; Male; Postoperative Complications; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Indium-111-labeled leukocyte images of 92 cemented total-hip arthroplasties were correlated with final diagnoses. Prostheses were divided into four zones: head (including acetabulum), trochanter, shaft, and tip. The presence (or absence) and intensity of activity in each zone was noted, and compared to the corresponding contralateral zone. Though present in all 23 infected arthroplasties, periprosthetic activity was also present in 77% of uninfected arthroplasties, and was greater than the contralateral zone 51% of the time. When analyzed by zone, head zone activity was the best criterion for infection (87% sensitivity, 94% specificity, 92% accuracy). Fifty of the arthroplasties were studied with combined labeled leukocyte/sulfur colloid imaging. Using incongruence of images as the criterion for infection, the sensitivity, specificity, and accuracy of the study were 100%, 97%, and 98%, respectively. While variable periprosthetic activity makes labeled leukocyte imaging alone unreliable for diagnosing hip arthroplasty infection, the addition of sulfur colloid imaging results in a highly accurate diagnostic procedure.

Topics: Adult; Aged; Aged, 80 and over; Female; Hip Prosthesis; Humans; Indium Radioisotopes; Infections; Leukocytes; Male; Middle Aged; Postoperative Complications; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Topics: Erythromycin; Gastric Emptying; Gastrointestinal Motility; Humans; Male; Middle Aged; Postoperative Complications; Radionuclide Imaging; Stomach; Stomach Diseases; Technetium Tc 99m Sulfur Colloid; Vagotomy

To determine the value of scintigraphy to detect posttransplantation complications of the allografted pancreas, we retrospectively reviewed 209 scintigrams obtained with 99mTc-sulfur colloid (99mTc-SC) and 99mTc-glucoheptonate (99mTc-GH). The scintigraphic studies were performed in 37 recipients of simultaneous renal and pancreatic allografts harvested from the same donor. 99mTc-SC was used as an indicator of thrombotic vasculitis; pancreatic perfusion and blood-pool parameters were monitored with 99mTc-GH. In 11 of the 37 recipients, scintigraphic abnormalities suggested posttransplantation infarction. Recurrent episodes of acute rejection of the pancreatic allograft, which always coincided with acute rejection of the renal allograft, were monitored in 24 recipients. Rejection-induced ischemic pancreatitis was suggested in 12 of the 24 recipients and persisted in 10 recipients for several weeks after improvement of renal allograft rejection. Pancreatic atrophy was suggested scintigraphically in 16 of the 24 recipients with recurrent episodes of rejection. Spontaneous pancreatic-duct obstruction and obstructive pancreatitis were associated with a scintigraphic pattern similar to that of rejection-induced ischemic pancreatitis. We concluded that the specific radionuclides used in this series are useful for the surveillance and assessment of posttransplantation pancreatic infarction, acute rejection, pancreatitis, and atrophy.

Topics: Adult; Graft Rejection; Humans; Kidney; Kidney Transplantation; Middle Aged; Organotechnetium Compounds; Pancreas; Pancreas Transplantation; Postoperative Complications; Radionuclide Imaging; Retrospective Studies; Sugar Acids; Technetium; Technetium Tc 99m Sulfur Colloid

The aim of this work is to explore the patients operated on for a femoro popliteal bypass (FPB) with lymphoscintigraphy (LS) of the lower limbs. Data concerning 35 limbs from 33 patients operated on for a FPB have been included in a prospective study. Superficial and deep LS have been performed by injecting 74 MBq 99mTc-Rhenium Sulphide Colloid into the subcutaneous tissue of the first interdigital space and of the lateral malleolus region respectively. Both superficial and deep LS have been performed before and after surgery. A postoperative oedema was found in 17 of the 35 limbs. The value of the lymphatic flow indices and their variation after surgery do not significantly differ between the oedematous and non oedematous groups. Thirteen of the 17 limbs with oedema have presented an interruption of the lymphatic circulation or a diffuse activity outside the lymphatic vessels on the postoperative superficial and/or deep LS. This proportion is only 1/18 in the non oedematous group. The difference between the two groups is highly significant (P less than 0.001). By contrast, the proportion of lymph cyst does not differ significantly between the two groups. In conclusion, this study confirms the close relationship between the oedema following FPB and surgical damage to the lymphatics.

Topics: Colloids; Edema; Female; Femoral Artery; Humans; Leg; Lymphoscintigraphy; Male; Middle Aged; Popliteal Artery; Postoperative Complications; Prospective Studies; Rhenium; Technetium Tc 99m Sulfur Colloid

Overwhelming infection after splenectomy remains a problem despite the introduction of vaccine and antimicrobial prophylaxis. To evaluate prospectively various procedures proposed for salvage of the spleen, we measured reticuloendothelial function for two to five years in 51 patients who had initially presented with abdominal trauma and suspected splenic rupture. The mean percentage of pocked erythrocytes and the clearance of antibody-coated autologous erythrocytes in 8 patients who had splenic repair and in 6 who had partial splenectomy were the same as in 11 controls with intraabdominal injury that did not involve the spleen. The mean percentage of pocked erythrocytes remained significantly elevated in 19 patients who had undergone total splenectomy without autotransplantation of splenic tissue. One of seven patients who underwent splenic autotransplantation had a normal level of pocked erythrocytes 18 months after surgery, and a second patient had only a slight elevation at 24 months. The mean (+/- SEM) half-time clearance of labeled erythrocytes was significantly longer in the group that had total splenectomy without autotransplantation (421.1 +/- 74.5 hours) than in the autotransplantation group (91.6 +/- 20.0) or in the controls (5.4 +/- 2.0). We conclude that reticuloendothelial function was better preserved after partial splenectomy and splenic repair than after splenic autotransplantation, but that autotransplantation was superior to total splenectomy and appeared to be safe. Splenic autotransplantation deserves further study in patients who have had splenic trauma when other surgical maneuvers to save the spleen are not possible.

Topics: Adolescent; Adult; Child; Child, Preschool; Chromium Radioisotopes; Erythrocytes; Humans; Infection Control; Methods; Middle Aged; Mononuclear Phagocyte System; Postoperative Complications; Prospective Studies; Spleen; Splenectomy; Splenic Rupture; Technetium Tc 99m Sulfur Colloid; Transplantation, Autologous

Lymphatic drainage was followed with Tc lymphoscintigraphy. Micrometastases in head and neck cancer cases cannot be detected. The drainage pattern is highly variable and does not allow prognostic conclusions in tumors as demonstrated for the parasternal pathways. The method helps to determine the side and extent of a neck dissection prior to surgery as well as follow-up postoperatively. The development of lymphedema can be detected early in order to start treatment by manual lymph drainage.

Topics: Head and Neck Neoplasms; Humans; Lymphatic Metastasis; Lymphedema; Lymphoscintigraphy; Postoperative Complications; Technetium Tc 99m Sulfur Colloid

Aspiration is analyzed by a new scintigraphic technique and standard videofluoroscopy in 78 patients with head and neck pathology and neurologic disorders. When both methods are compared to clinical aspiration and a positive x-ray film of pneumonia, they appear to complement each other and provide a very accurate evaluation. Scintigraphy is a more sensitive method for detecting aspiration below the vocal cords and also provides for flow dynamics and a method of quantifying the amount of aspirated material. Videofluoroscopy shows more clearly the mechanism of the swallowing disorder and how the bolus enters the tracheobronchial tree. Studies in patients following head and neck surgery demonstrate a high incidence of dysphagia, aspiration, and pneumonia.

Topics: Deglutition; Female; Fluoroscopy; Head and Neck Neoplasms; Humans; Male; Pneumonia, Aspiration; Postoperative Complications; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Television

Imaging of the thoracic duct is usually performed by radiological lymphography. However, this procedure, which uses an oil based dye injected directly into the lymph channels, has some adverse effects. In this paper we note that lymphoscintigraphy, a physiological and non invasive method, may visualize thoracic duct abnormalities, and might be particularly useful when radiological lymphography is contraindicated.

Topics: Chylothorax; Chylous Ascites; Humans; Hypertension, Portal; Lymphedema; Postoperative Complications; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Thoracic Duct

The postoperative diagnostic imaging examinations of 44 children who underwent 59 orthotopic liver transplantations were reviewed. The imaging modalities used for the evaluation of suspected complications include plain roentgenography, ultrasonography (US), computed tomography (CT), nuclear scintigraphy, arteriography, percutaneous and operative cholangiography, and endoscopic retrograde cholangiopancreatography. The main postoperative complications included ischemia, thrombosis (hepatic artery and portal vein), infarction, obstruction or leakage of the biliary anastomosis, hepatic and perihepatic infection, and allograft rejection. US, the most frequently used abdominal imaging modality, was best suited for detection of biliary duct dilatation, fluid collections in or around the transplanted liver, and hepatic arterial, inferior vena caval, and portal vein thrombosis. CT was especially helpful in corroborating findings of infection and in locating abscesses. Technetium 99m sulfur colloid (early- and late-phase imaging) provided a sensitive, although nonspecific, means of assessing allograft vascularization and morphology. Angiography showed vascularity most clearly, and cholangiography was the most useful in the assessment of bile duct patency. A diagnostic imaging algorithm is proposed for evaluation of suspected complications.

Topics: Adolescent; Angiography; Biliary Tract Diseases; Child; Child, Preschool; Cholangiography; Cholangiopancreatography, Endoscopic Retrograde; Female; Graft Rejection; Humans; Infant; Liver; Liver Transplantation; Male; Postoperative Care; Postoperative Complications; Radionuclide Imaging; Retrospective Studies; Surgical Wound Infection; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography

Gastroesophageal reflux (GER) is a common cause of repeated emesis, failure to thrive, repeated pulmonary infection, and asthma in infants and children. During a 14-year period 270 children underwent gastroesophageal fundoplication for symptomatic reflux. The 24-hour esophageal pH monitoring is the most accurate test available to verify the presence of GER and is also helpful in evaluating the results of fundoplication. Transabdominal fundoplication may be performed with a low risk of complications. The most frequent complication requiring reoperation is paraesophageal hiatus hernia (6/270 patients), which should be repaired in almost all instances when symptoms develop. Closure of the crura posterior to the esophagus greatly reduces the incidence of this problem. Esophageal motility disorders occur in more than 35% of patients with symptomatic reflux and militate against performing a tight antireflux operation. Approximately 50% of patients with symptomatic reflux have associated gastric motility disorders. Radionuclide studies with 99mTC sulfur colloid in semisolid feedings have determined the magnitude of gastric retention after a feeding and have been helpful in identifying children who require a pyloroplasty with or without fundoplication. Pyloroplasty is performed simultaneously with fundoplication in approximately 10% of patients with symptomatic reflux when the lower esophageal sphincter pressure is low and the esophageal pH monitor shows reflux. The excellent clinical results achieved by fundoplication with or without pyloroplasty and the low morbidity and mortality rates indicate that these procedures should be used early in the management of infants and children who suffer symptomatic GER.

Topics: Adolescent; Child; Child, Preschool; Esophagus; Female; Follow-Up Studies; Gastric Emptying; Gastric Fundus; Gastroesophageal Reflux; Gastrostomy; Humans; Hydrogen-Ion Concentration; Infant; Infant, Newborn; Intubation, Gastrointestinal; Male; Postoperative Complications; Pressure; Pylorus; Technetium Tc 99m Sulfur Colloid

Fifteen patients with intractable reflux or its complications were sequentially studied after the placement of the Angelchik antireflux prosthesis. In all, 16 devices were inserted. Parameters were measured before and 3, 12, 24, and 36 months after prosthesis placement and included symptom scoring, esophageal manometry with Tuttle test, endoscopy, suction biopsy, barium swallow, and gastroesophageal scintigraphy. In addition, a subset of patients underwent stimulation/inhibition of the lower esophageal sphincter (LES) with pentagastrin, metoclopramide, edrophonium, and atropine. At a mean time of 16 months postsurgery, 10 of 16 (63%) patients were reflux-free and there was significant improvement in endoscopic, biopsy, and symptom scoring. Post-insertion, there were statistically significant increments in LES pressure with intravenous boluses of pentagastrin, metoclopramide, and edrophonium, and a significant decrease with atropine. Two patients who developed prosthesis herniation into the chest required removal because of ongoing reflux and dysphagia. An additional patient had prosthesis disruption and migration, which also required removal. Four patients with previously failed antireflux procedures had five prostheses placed. All continued to reflux postoperatively. No patient who was initially reflux-free subsequently developed reflux, despite a tendency for LES pressure to decline with time. Although this procedure proved effective for up to 36 months in patients who had had no previous antireflux procedure, the displacement rate (3/16 = 19%), reoperation rate (3/16 = 19%), and the progressive decline in LES pressure over time should make one cautious about its routine use in the surgical treatment of reflux esophagitis.

Topics: Endoscopy; Esophagogastric Junction; Esophagus; Evaluation Studies as Topic; Gastroesophageal Reflux; Humans; Manometry; Postoperative Complications; Pressure; Prospective Studies; Prostheses and Implants; Radionuclide Imaging; Reoperation; Technetium Tc 99m Sulfur Colloid

The first task of radiocolloid spleen imaging, after trauma, is to determine if the organ is functioning. If this cannot be demonstrated, splenic avulsion must be considered. The second task is to document splenic injury (not to suggest splenectomy, but to serve as a baseline for following later healing). Failure to heal may be a risk factor for subsequent splenic rupture. The third task of spleen imaging is to determine if accessory splenic fragments are present and functional. The radiocolloid spleen scan facilitates the successful accomplishment of all of these tasks.

Topics: Adolescent; Adult; Aged; Child, Preschool; Female; Humans; Iatrogenic Disease; Male; Middle Aged; Postoperative Complications; Radionuclide Imaging; Rupture; Spleen; Splenectomy; Splenic Rupture; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

Topics: Fibrinogen; Humans; Iodine Radioisotopes; Leg; Middle Aged; Postoperative Complications; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Thrombophlebitis; Time Factors

Topics: Female; Humans; Knee Joint; Knee Prosthesis; Middle Aged; Postoperative Complications; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

A recurrent unilateral pleural effusion developed without obvious cause in two patients with cirrhosis of the liver. By the demonstration of the rapid passage of a radiolabelled colloid from abdomen to thorax, these effusions were proved to be secondary to clinically undetectable peritoneal effusions. A diaphragmatic tear, which had occurred during a previous splenectomy and which was apparent only at autopsy, was the cause of peritoneopleural communication in one patient. Previous surgery could also have been responsible for the pleural effusion in the other patient.

Topics: Child; Diaphragm; Female; Humans; Liver Cirrhosis; Liver Cirrhosis, Biliary; Middle Aged; Pleural Effusion; Postoperative Complications; Radionuclide Imaging; Recurrence; Splenectomy; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

The roentgenographic identification of femoral component loosening after hip surface arthroplasty is often impossible because the metallic femoral component obscures the bone-cement interface. The use of combined technetium sulfur colloid and technetium methylene diphosphonate radionuclide imaging has been especially useful in the diagnosis of loosening. In 40 patients, follow-up combined TcSC and TcmDP scans at an average of three, nine, and 27 months postoperation revealed significant differences in the isotope uptakes in patients who had loose prostheses compared with those without complications. Scans were evaluated by first dividing them into eight anatomical regions and then rating the uptake in each region or 'zone' on a five-point scale. Results were compared using the Student's t-test and differences were noted between normal controls and patients who had femoral component loosening. Combining both TcSC and TcmDP studies increased the statistical significance obtained when comparing patients who had complications to those in the control group.

Topics: Aged; Diphosphonates; Equipment Failure; Female; Femur Head; Hip Joint; Hip Prosthesis; Humans; Male; Middle Aged; Postoperative Complications; Radiography; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

Topics: Adolescent; Child; Child, Preschool; Chylothorax; Hodgkin Disease; Humans; Lymph Node Excision; Lymphedema; Lymphoscintigraphy; Neuroblastoma; Pelvic Neoplasms; Postoperative Complications; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Peritoneovenous shunts have been widely used in the management of patients with ascites when medical therapy has failed. Shunt malfunction is a frequent complication. Direct injection of a small amount of Tc-99m-sulfur colloid into the afferent limb of the shunt allows prompt, accurate determination of shunt patency while avoiding some of the hazards and pitfalls of previously described techniques.

Topics: Humans; Peritoneovenous Shunt; Postoperative Complications; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Vascular Surgical Procedures

In an experimental model we have demonstrated that visualization of the target organ is the only dependable criterion for the scintigraphic evaluation of LeVeen shunt patency or nonpatency. The lungs are best suited as the target, because the presence or absence of pulmonary uptake can be easily seen without interference from radiolabeled peritoneal fluid. Proof of shunt patency should not rely upon direct visualization of shunt tubing, because very high or low flow rates are both associated with poor visualization. Maximum accumulation of activity in the shunt tubing occurs with intermediate flow rates (approximately 60 cc/hr).

Topics: Ascites; Colloids; Evaluation Studies as Topic; Female; Humans; Liver; Lung; Methods; Middle Aged; Peritoneal Cavity; Postoperative Complications; Radionuclide Imaging; Serum Albumin; Sulfur; Technetium; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Sulfur Colloid

This case report illustrates the demonstration of pleural-peritoneal communication in a patient with a malfunctioning LeVeen shunt by a simple, noninvasive radionuclide technique. The patient was a 54-year-old woman who had had a LeVeen shunt placed for the treatment of intractable ascites. Tc-99m-sulfur colloid was injected intraperitoneally, and the scan showed concentration of the tracer in the pleural space, thus confirming pleural-peritoneal communication.

Topics: Ascites; Colloids; Female; Fistula; Humans; Middle Aged; Peritoneum; Pleural Diseases; Pleural Effusion; Postoperative Complications; Radiography; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid