Gastric Emptying Scintigraphy: Diagnostic Value of Delayed Imaging and the Impact on Reclassification of Diagnosis.

Objectives: To investigate the added diagnostic value of delayed imaging at 3 and 4 h compared to 2 h imaging as well as scanning up to 4 h compared to 3, and by this means, diagnosis reclassification or changes in diagnosis across various time points. Methods: Seventeen patients clinically suspected of gastroparesis, 8 (47.1%) men and 9 (52.9%) women, according to the standard procedural guidelines, underwent gastric emptying scintigraphy after ingesting a standard meal. One-minute static images in anterior and posterior projections were acquired immediately after ingestion and then at 1-, 2-, 3- , and 4 h time points. For image analysis, a manual region-of-interest was drawn, and then, count of stomach in each projection was used to calculate geometric mean for each time point. Decay correction was applied. At 2-, 3- and 4 h time points, percentage of retained activity was compared to standard values; therefore, each patient was labeled as normal or delayed. Results: Pairwise correlation between time points was statistically significant. Value of hour 3 shows an extremely strong correlation with the value of hour 4 (r=0.951, p<0.001). In hour 2, of 17 participants, 11 (64.7%) were diagnosed as normal and 6 (35.3%) as delayed. In hour 3, the diagnosis made as delayed rose to 9 (52.9%), whereas normal was 8 (47.1%). Finally, in hour 4, results were 10 (58.8%) as delayed and 7 (41.2%) as normal. All subjects who were labeled as delayed in hour 3 remained with the same diagnosis and 1 out of 8 subjects categorized as normal in hour 3 changed to delayed. For testing agreement, coefficient of kappa was computed between each pair. Agreement between diagnosis in hour 2 with hours 3 or 4 was not strong (kappa <0.6 for both pairs). However, a strong agreement was found between diagnosis in hours 3 and 4 (kappa: 0.881). Conclusion: Because of excellent correlation between values of hours 3 and 4 and strong agreement between the diagnosis in those time points, extending acquisition from 3 to 4 h adds little to the final dai gnosis and may not be noticeably meaningful, especially in the clinical setting.

Prognostic value of dynamic renal scan with 99mTc-EC in patients with kidney transplantation: a prospective descriptive study.

INTRODUCTION: Renal transplantation is the gold standard treatment for chronic kidney disease. Renal scintigraphy has been performed widely to evaluate postsurgical complications of transplantation, but there are little data regarding 99mTc-EC scintigraphy in kidney transplantation. METHODS AND MATERIALS: This was a prospective descriptive study. All patients who underwent kidney transplantation and passed an uneventful postoperative period entered the study. Demographic characteristics, including age, gender, biochemical parameters before and after the transplantation and 99mTc-EC parameters including time to max, time to ½ max, slope from max to ½ max, upslope time interval and time to 2/3 max as well as episodes of rejection, were recorded. Patients were then followed up for 1 year at 3-, 6-, 9- and 12-month intervals. RESULTS: Forty-one patients who underwent renal transplantation entered the study. Mean ± SD age of patients was 40.65 ± 12.84 years (min 17 and max 74 years). In total, 25% (10) of patients experienced one or two episodes of rejection and were hospitalized. Time of max, time of 1/2 max, time from max to 1/2 max, time of 2/3 max, time from max to 2/3 max and upslope time interval had a significant association with transplant rejection using a Cox regression model. With 1-min increase in time of max, the risk of rejection increased by 27% (hazard ratio = 1.27; CI, 1.03--1.56) and with 1-min increase in time of 1/2 max, the risk of rejection increased by 28% (hazard ratio = 1.28; CI, 1.14-1.45). DISCUSSION: 99mTc-EC renal scintigrahpy was able to predict kidney transplantation rejection in our patients. 99mTc-EC renal scintigrahpy is beneficial to evaluate transplant kidney function to prevent complications and helps close follow-up.

Association between Ala379Val polymorphism of lipoprotein-associated phospholipase A2 and migraine without aura in Iranian population.

BACKGROUND: Migraine is a common neurovascular disorder with multifactorial and polygenic inheritance. The aim of this study was to investigate the association of a migraine without aura and Ala379Val polymorphism of lipoprotein-associated phospholipase A2 (Lp-PLA2) gene in the Iranian population. METHODS: In this study, 103 migraine patients and 100 healthy controls were enrolled. DNA samples were extracted and the Ala379Val polymorphism of Lp-PLA2 gene was investigated. To assess severity of a headache, patients filled out the headache impact test (HIT-6) and migraine severity (MIGSEV) questionnaires. RESULTS: Allele V had significantly lower frequency in the case group than control subjects [P = 0.001, odds ratio (OR) = 0.25, confidence interval (CI): 0.15-0.40]. The frequency of migraine patients that were a carrier of V allele (V/V and A/V) was statistically significant lower than the control group (P = 0.003, OR = 2.39, CI: 1.35-4.23). There was no significant difference of alleles frequency between three grades of MIGSEV (P = 0.316). Furthermore, total HIT-6 score was not significantly different between different genotypes (P = 0.466). CONCLUSION: Our results showed that Ala379Val gene polymorphism of LP-PLA2 is associated with lower risk of migraine but not with severity of headaches in an Iranian population.

Recurrent acute pancreatitis and cholangitis in a patient with autosomal dominant polycystic kidney disease.

Autosomal dominant polycystic kidney disease (ADPKD) is an inherited disorder associated with multiple cyst formation in the different organs. Development of pancreatic cyst in ADPKD is often asymptomatic and is associated with no complication. A 38-year-old man with ADPKD was presented with six episodes of acute pancreatitis and two episodes of cholangitis in a period of 12 months. Various imaging studies revealed multiple renal, hepatic and pancreatic cysts, mild ectasia of pancreatic duct, dilation of biliary system and absence of biliary stone. He was managed with conservative treatment for each attack. ADPKD should be considered as a potential risk factor for recurrent acute and/or chronic pancreatitis and cholangitis.