A case of jejunal neurofibroma in von Recklinghausen's disease with active hemorrhage, detected and located with gastrointestinal bleeding scintigraphy: A case report with literature review.

A 69 year old patient was admitted to hospital with massive gastrointestinal hemorrhage. The clinical presentation of the patient, except for bleeding, was dominated by the presence of neurofibromatosis type 1 - Von Recklinghausen disease. The patient was referred to multislice computed tomography (CT) angiography, magnetic resonance imaging (MRI), esophagogastroduodenoscopy and colonoscopy, which were performed without successful detection of the bleeding site. The MRI examination showed the existence of a tumor located in the small pelvis. After that, gastrointestinal bleeding scintigraphy (GIBS) with technetium-99m (99mTc) pyrophosphate in vivo labeled erythrocytes was done. Gastrointestinal bleeding scintigraphy showed active intraluminal bleeding from the projection of jejunum, which flowed through the small intestine to the descending colon and the sigmoidal and rectal segment of the colon. Surgical resection of the abdomen revealed the existence of tumors in the jejunum with active bleeding and resection and anastomosis was done. Histopathological verification showed intestinal neurofibroma. In this case GIBS showed usefulness in proving the existence of active bleeding in the small intestine and its localization, and it was of a great help in planning the surgical treatment of a patient.

An innovative method for precise lymph node detection before surgical treatment in breast cancer.

OBJECTIVE: To describe a new method of 3D interactive modeling which integrates images obtained by separate SPET and multi slice computed tomography (MSCT) modalities using an original software in order to better localize SNL in BC patients. SUBJECTS AND METHODS: We used technetium-99m-colloid rhenium sulphate for identifying SNL in seven patients with BC. Markers were made of lead pearls wrapped with cotton wool soaked in 99mTc-pertechnetate and placed on the skin of the patients forming of a triangle. Using an original software, two separate 3D models were made after SPET and MSCT imaging and then merged into a hybrid 3D model which enabled precise visualization and localization of the SNL. RESULTS: In all cases the position of the SNL established by our method was successfully verified using a gamma probe. Duration of SNL identification and extirpation were significantly reduced in less than 10 minutes per patient. The reproducibility of this method was confirmed by precise identification and biopsy of the SNL. CONCLUSION: We found this integrated SPET/MSCT 3D model to be much faster and easier to use as compared with the "classic" method, which was based on a radioactivity detection probe. In addition, our method was reproducible, accurate and of low cost. In other words, the method described in this paper could be very useful for health facilities with modest budget, because it obviates the need for buying expensive integrated SPET/MSCT hybrid imaging systems while detecting SNLs more accurately and in shorter time.

THYRPAN-TM Prototype: New System for Online Telemonitoring of Patients with Thyroid Carcinoma During the Treatment with a High Dose of Radioiodine.

BACKGROUND: Our team devised a real-time telemonitoring system (THYRPAN-TM) for measurement of the radiation exposure rate during the hospitalization of patients treated with high doses of radioiodine in the special premises with restricted access ("restricted area" [RA]). SUBJECTS AND METHODS: The THYRPAN-TM prototype was tested for stability, efficacy, and linearity in a 32-day measurement of a 110 MBq (131)I source. Furthermore, it was tested on 15 patients with differentiated thyroid carcinoma who stayed in the RA for 3 days, following their radioiodine treatment. RESULTS: Minor deviation from the theoretical values was detected when the (131)I source was measured by the THYRPAN-TM, but only at the beginning of the measurement (7.20%). CONCLUSIONS: THYRPAN-TM is a stable, user-friendly detection system for the measurement of the exposure rate following radioiodine administration. It enables the telemonitoring of patients, as well as real-time and online measurement of the whole-body burden of (131)I.

Three reasons for on-line remote telemonitoring of patients treated with high doses of radionuclide therapy. Our experience.

OBJECTIVE: Following radionuclide therapy, patients usually must remain hospitalised in special "restricted access area" 2-5 days, until radiation in their body drops below a certain level. During this period medical personnel can be faced with some challenges. Based on our previous experience, we used telemedicine approach as solution for it. We have developed comprehensive telemedicine system, which consists of three own developed hardware & software modules which are accessible remotely. SUBJECTS AND METHODS: Challenge #1 Some of patients can experiencing serious complications related to radionuclide therapy or related to co-morbidities, if they have any of it. In some of those cases audio-visual contact with patients and follow-up their vital functions can be of high importance in case of patient needs urgent intervention. Solution #1 System for on-line remote monitoring of patients' vital functions registered with bed side monitor and video surveillance of area which use patients during hospitalisation. This system is established by IP cameras and bedside patient monitor, equipped with appropriate network card and software. Using remote connection (LAN or internet), a physician can watch at personal computer or mobile phone the waves and vital signs patterns from the bedside monitor, as well as live video from surveillance cameras. It provides prompt intervention in case of emergency. Challenge #2 Having in mind the overall costs of radionuclide therapy and patients hospital stay on the one hand, and limited capacity of the hospital premises for radionuclide therapy, on the other, it is of high importance to estimate as early as possible the time period after which the radiation in a patient's body will drop below the limit imposed by the law. Solution #2 On-line remote radiation monitoring system, which measures the radiation exposure rate by means of a pancake probe, which is connected to a PTZ (Pan-tilt-zoom) device and DVR (Digital video recorder). Those devices enable precise positioning of the detector on target region of the patient's body. The positioning of the detector can be visually controlled by a micro camera, placed at the center of detector's plane. Furthermore, there are three LASER pointers placed around the detector in order to mark the area where it is directed. In addition, two ultrasound sensors placed on the edge of the detector holder in order to estimate the exact distance between the probe and the patient's body. All those devices are controlled by the DVR. The data collected by the detector are acquired and processed by a PC, using customized hardware/software system developed by Italian ThereminoR group. Using remote connection, a physician can watch on-line radiation exposure rate in any time and can use commands of PTZ and DVR device for proper positioning of probe during measurement and control it by micro camera, LASER pointers and US sensors. Physician demands from the patients to take the same position for 5 minutes on each hour, during first 10 hours. Those data we use as reference points for further processing by our software. Based on two exponential matematical model, our software estimates the whole process of elimination of radioactivity from the patient's body, using reference points collected during the first day after radionuclide therapy. Based on that, physician can predict (on first day after therapy!) when patient will be able to leave the restricted access area". Challenge #3 Despite strict instructions given to them by physician and nurse before administration of radionuclide therapy, some patients sometimes try to leave "restricted access area". Solution #3 We have developed a system which continuously monitors the corridor which a patient must use in case of an attempt to leave the "restricted access area". Our system consists of a survey meter equipped with pancake probe directed towards the corridor. The survey meter is connected to a trigger circuit which gives signal in the case when the measeured count rate exceeds previously adjusted value. Trigger circuit is connected to the programmable siren, blinking light, alarm device unit with SIM card and IP surveillance camera. On the siren we previously recorded the voice alarm. In the case when the system is triggered, the patient will hear warning message and see blinking light. When the alarm device is triggered it will call responsible physician and nurse on mobile phone and IP camera simultaneously records this event. System also sending via email appropriate data about each event, when it happens. CONCLUSION: From our experience gained over the past 4 years, our telemonitoring system dedicated for patients receiving radionuclide therapy ensures a high level of safety for the patient and medical staff.

Short term treatment with lithium carbonate as adjunct to radioiodine treatment for long-lasting Graves' hyperthyroidism.

OBJECTIVE: Lithium carbonate is primarily used for the treatment of patients with bipolar affective disorders. Initial treatment of Graves' hyperthyroidism (GHT) with antithyroid drugs (ATD) has limitations at over 50% of treated patients because of significant side effects and relatively high relapses of the disease after drugs withdrawal. Till now, the influence of LiCO3on RIT outcome was mainly studied in patients with recent onset of GHT, and results were contradicted. Meta-analysis of case-control studies showed higher rated hypothyroidism in patients with mood disorders treated with LiCO3(121/869) than in controls (10/578). Although in a small number of patients (n=28) with long-lasting GHT, preliminary results of ours showed that ¹³¹I treatment with LiCO3for 7 days significantly improved the efficacy of RIT versus the non-LiCO3treated patients (P<0.001). Lithium treated patients were cured faster (12 of 13 patients were cured after one month) than those treated only with ¹³¹I (8 patients were cured after one and 11/15 patients after 12 months). Fewer patients treated with ¹³¹I and LiCO3had persistent hyperthyroidism than those treated with ¹³¹I alone. There were no toxic effects of LiCO3during 7 days treatment. CONCLUSION: These observations indicate of that short-term treatment with LiCO3in GHT patients as adjunct to ¹³¹I-NaI improves the efficacy of RIT, prevents transient exacerbation of hyperthyroidism, early induction of hypothyroidism and does not worsen ophthalmopathy.

Online remote monitoring of patients with differentiated thyroid carcinomas and neuroendocrine tumors treated with high doses of radionuclides.

BACKGROUND: Telemedicine could be very useful for patients in remote areas experiencing adverse drug reactions or being in need of sophisticated diagnostic or therapeutic procedures. The aim of this article is to show the experience of our Department of Nuclear Medicine (DNM) in telemonitoring patients with differentiated thyroid carcinomas and neuroendocrine tumors. SUBJECTS AND METHODS: The DNM at the Clinical Center Kragujevac, Serbia, uses continuous remote monitoring of patients' vital functions, including heart rate, electrocardiogram, respiration rate, blood pressure, and oxygen saturation, as well as video surveillance of the physical isolation area for patients with neuroendocrine tumors (NETs) and some patients with differentiated thyroid carcinomas (DTCs), during administration of radionuclide therapy and for the days following treatment. RESULTS: The DNM used a telemonitoring system for 156 patients with either DTC or NET who received radionuclide therapy during the last 3 years. There were 32 interventions on patients in the physical isolation area based on changes of the patients' vital functions detected by the telemonitoring system. Twenty-five patients (78%) experienced symptoms, whereas the other seven patients (22%) were symptomless. A responsible physician intervened with treatment of tachycardia (18 cases), hypertension (10 cases), hypotension (2 cases), ventricular extrasystoles (1 case), and ST-segment depression (1 case). After administration of the treatment the health status of the patients was normalized. CONCLUSION: From our experience gained over the past 3 years, this model of organization and supervision with a telemonitoring system of patients receiving radionuclide therapy ensures a high level of safety for the patient, with significant reduction of staff costs.

Effect of furosemide on radioiodine-131 retention in mice thyroid gland.

Retention of iodine in the thyroid gland is the result of renal excretion and transport of iodine to thyroid cells. Both processes are affected by furosemide. The aim of our study was to test whether furosemide influenced radioiodine-131 ((131)I) retention in the thyroid gland of living mice. Our methods were as follows: After 15 days of low-iodine diet, 19 Swiss mice received an intra-peritoneal injection of 0.37+/-0.03 MBq of (131)I. Thereafter, 11 mice were treated with intraperitoneal injections of furosemide (0.3 mg/kg, every 8 h, for 72 h), Group A and 8 mice served as controls, Group B. Seventy-two hours after (131)I administration, the mice were anaesthetized, their thyroids were carefully extirpated, and their radioactivity was measured by a gamma counter. Our results showed that the mean value of (131)I retention after 72 h was 63.09% in Group A and 82.25% in Group B. The difference between these two groups was significant (T=3.0919, P=0.0033). In conclusion, furosemide after the administration of (131)I, decreases retention of (131)I in the thyroid gland in mice. The well known increase of iodine renal excretion by furosemide and consequently decrease of iodine blood pool may be the reason for this decreased (131)I retention by the thyroid gland.

Botulinum toxin type A in combination with standard urotherapy for children with dysfunctional voiding.

PURPOSE: We investigated the role of botulinum toxin type A and urotherapy in the treatment of children with dysfunctional voiding. MATERIALS AND METHODS: Nine female children with dysfunctional voiding refractory to standard urotherapy and alpha1-adrenergic blocking agents were included in the prospective clinical study. Botulinum toxin type A in a dose of 500 units was injected transperineally into the external urinary sphincter. Bladder rehabilitation was introduced 2 weeks after botulinum toxin type A treatment. Uroflow studies with ultrasound residual urine volumes were obtained before and 6 months after treatment. All children were tested before and 6 months after treatment using the empirically designed International Reflux Study in Children modified questionnaire. RESULTS: After treatment the mean +/- SD voided volume increased from 180 +/- 73 to 228 +/- 94 ml (p <0.05) while post-void residual urine volume decreased from 52 +/- 40 to 19 +/- 18 ml (p <0.05). Significant differences in other uroflowmetry parameters were not found. However, significant symptom score improvement was detected 6 months after treatment, being decreased by 7 vs 20 (p <0.01). No systemic side effects occurred following botulinum toxin type A injection. CONCLUSIONS: Our study demonstrates that the voiding mechanism in children with dysfunctional voiding refractory to standard therapy can be significantly improved and maintained at least 6 months after combined botulinum toxin type A injection and bladder rehabilitation.

Hepatic radionuclide angiography and Doppler ultrasonography in the detection and assessment of vascular disturbances in the portal system.

BACKGROUND/AIMS: The aim of the study was evaluation of the morphology of the blood vessels, blood flow velocity and direction with Doppler ultrasound (D-US) and correlation with the relative liver parenchymal perfusion assessed by hepatic radionuclide angiography (HRA). METHODOLOGY: Real-time, D-US and HRA were performed in 108 patients. RESULTS: In patients with portal venous aneurysm, hepatopetal blood flow was increased, while portal perfusion did not differ from controls. In portal hypertensive patients, D-US detected dilatation of the portal system veins, with decreased blood flow. In comparison to the portal perfusion in controls and portal venous aneurysm, values were significantly (p < 0.01) lower in chronic active hepatitis and liver cirrhosis and differed between themselves (p < 0.01). In the groups of cirrhotic patients with esophageal varices, sclerosed esophageal varices, recanalized umbilical vein, partial portal thrombosis and cavernous portal vein with hepatofugal, hyperkinetic or slow blood flow, and very low velocities beside the thrombi, portal perfusion was lower (p < 0.01) than in controls, portal venous aneurysm, chronic active hepatitis and liver cirrhosis without collaterals. In complete thrombosis, minimal collateral flow was found with D-US, while HRA proved no portal supply. CONCLUSIONS: D-US and HRA are complementary for the estimation of various liver vascular disorders.

The effect of short-term treatment with lithium carbonate on the outcome of radioiodine therapy in patients with long-lasting Graves' hyperthyroidism.

OBJECTIVE: The outcome of radioiodine therapy (RIT) in Graves' hyperthyroidism (GH) mainly depends on radioiodine (131I) uptake and the effective half-life of 131I in the gland. Studies have shown that lithium carbonate (LiCO3) enhances the 131I half-life and increases the applied thyroid radiation dose without affecting the thyroid 131I uptake. We investigated the effect of short-term treatment with LiCO3 on the outcome of RIT in patients with long-lasting GH, its influence on the thyroid hormones levels 7 days after RIT, and possible side effects. METHODS: Study prospectively included 30 patients treated with LiCO3 and 131I (RI-Li group) and 30 patients only with 131I (RI group). Treatment with LiCO3 (900 mg/day) started 1 day before RIT and continued 6 days after. Anti-thyroid drugs withdrawal was 7 days before RIT. Patients were followed up for 12 months. We defined a success of RIT as euthyroidism or hypothyroidism, and a failure as persistent hyperthyroidism. RESULTS: In RI-Li group, a serum level of Li was 0.571 ± 0.156 mmol/l before RIT. Serum levels of TT4 and FT4 increased while TSH decreased only in RI group 7 days after RIT. No toxic effects were noticed during LiCO3 treatment. After 12 months, a success of RIT was 73.3% in RI and 90.0% in RI-Li group (P < 0.01). Hypothyroidism was achieved faster in RI-Li (1st month) than in RI group (3rd month). Euthyroidism slowly decreased in RI-Li group, and not all patients became hypothyroid for 12 months. In contrast, euthyroidism rapidly declined in RI group, and all cured patients became hypothyroid after 6 months. CONCLUSION: The short-term treatment with LiCO3 as an adjunct to 131I improves efficacy of RIT in patients with long-lasting GH. A success of RIT achieves faster in lithium-treated than in RI group. Treatment with LiCO3 for 7 days prevents transient worsening of hyperthyroidism after RIT. Short-term use of LiCO3 shows no toxic side effects.

Are Interferential Electrical Stimulation and Diaphragmatic Breathing Exercises Beneficial in Children With Bladder and Bowel Dysfunction?

OBJECTIVE: To evaluate the effects of interferential current (IC) stimulation and diaphragmatic breathing exercises (DBEs) in children with bladder and bowel dysfunction. PATIENTS AND METHODS: Seventy-nine children with dysfunctional voiding and chronic constipation who were failures of primary care interventions were included in the prospective clinical study. All the children were checked for their medical history regarding lower urinary tract symptoms and bowel habits. Physical examination, including abdominal and anorectal digital examination, was performed. Children kept a bladder and bowel diary, and underwent urinalyses and urine culture, ultrasound examination of bladder and kidneys, and uroflowmetry with pelvic floor electromyography. Eligible children were divided into 3 groups (A, B, and C). All groups were assigned education and behavioral modifications. Additionally, group A underwent DBEs and IC stimulation, whereas group B received only DBEs. The treatment was conducted for 2 weeks in the clinic in all 3 groups,. The behavioral modifications and DBEs were continued at home for 1 month. Clinical manifestations, uroflowmetry parameters, and postvoided residual urine were analyzed before and after 6 weeks of therapy. RESULTS: After the treatment, significant improvement in defecation frequency and fecal incontinence was noticed only in group A (P < .001 and P < .05, respectively). These children demonstrated significant improvement in lower urinary tract symptoms and postvoided residual urine (P < .001 and P < .05, respectively). Bell-shaped uroflowmetry curve was observed in 73.3% of group A patients (P < .001). CONCLUSION: IC stimulation and DBEs are beneficial in chronically constipated dysfunctional voiders. Further trials are needed to define the long-term effects of this program.

Immunoscintigraphy of colorectal carcinomas with radiolabeled monoclonal antibody fragments.

BACKGROUND/AIMS: The aim was evaluation of the accuracy and clinical impact of the immunoscintigraphy for the detection of metastases and recurrences of colorectal carcinomas using two different radiolabeled antibody fragments. METHODOLOGY: The study was performed in 5 patients with IMACIS 1 containing the cocktail of 111MBq 131I MoAb 19-9 F(ab')2 and MoAb anti-CEA F(ab')2 and 8 patients with INDIMACIS 19-9 containing 150MBq of 111In-labeled MoAb 19-9 F(ab')2. RESULTS: With IMACIS 1, in all the patients, both tumor marker values were elevated. The number of TN was 3/5 and TP 2/5. From 2 TP, one had recurrence of the diseases with peritoneal carcinosis and one with liver metastases. In one patient, the results influenced the therapeutical management. With INDIMACIS 19-9, there were 2/8 TN, with borderline value of CEA and CA 19-9. TP were 6/8 (all with elevated tumor marker values, five of them many times; 3 with recurrences, 1 with recurrence and liver metastases and two with only liver metastases. In three patients, immunoscintigraphy influenced patient management. CONCLUSIONS: With both radiopharmaceuticals, immunoscintigraphy significantly influenced the patient management or it was complementary. It would be performed in the detection of recurrence, assessment of viability and follow-up of the therapy.

Thyroid blood flow and uptake of technetium-99m pertechnetate in Graves' disease.

The aim of this study was to assess the relation of early thyroid blood flow (EBF) and technetium-99m pertechnetate ((99m)TcO(-)(4)) uptake, as an early diagnostic index in patients with Graves' disease (GD) by dynamic thyroid scintigraphy (40 frames, 3 sec/frame). Thirty patients with GD with mean age 50.0 +/- 9.0 y, range: 35.0-69.0 y, were studied. The results obtained were compared with those of 30 euthyroid individuals (EI) of mean age 46.9 +/- 12.5 y, range: 22.0-68.0 y. The parameters of (99m)TcO(-)(4) EBF and early uptake studied, derived from the background subtracted time activity curves, were as follows: a) The duration of the EBF in sec; b) The perfusion index (PI) - the ratio of counts at the beginning and at the end of the EBF; c) The uptake index 1 (UI1)- the counts ratio between the counts at the end of the EBF and at the 2nd min d) The uptake index 2 (UI2) - the counts ratio between the 1st min and the 2nd min of the uptake curve and e) Delayed (99m)TcO(-)(4) thyroid uptake (TcTU) at 20 min was also calculated as a percentage of net counts activity accumulated in the thyroid gland at 20 min. Results were as follows: a) The mean values of the duration of the EBF were shorter in GD patients (9.90 +/- 2.94 sec) than in EI (15.70 +/- 4.01 sec; P<0.0001); b) PI did not differ significantly (P>0.05); c) The mean UI1 and UI2 values of thyroid uptake of 99m TcO4- were significantly lower in GD (UI1=0.621, UI2=0.772) as compared to EI (UI1=1.106, UI2=0.947; P<0.0001 for both) and d) TcTU values were significantly higher in GD (13.6%) than in the group of EI (1.29%; P<0.0001). A good correlation was found in patients with GD between early (UI1 and UI2) and delayed TcTU (r = -0.562; P=0.010 and r = -0.459; P=0.042 respectively). Also, in patients with GD the EBF correlated poorly with UI1, UI2 and TcTU (P>0.05 for all these parameters). In conclusion, the results of this study indicate that the duration of EBF did not relate significantly to the height of TcTU values in patients with GD. On the contrary, the early uptake, indices UI1 and especially UI2 were shown to be faster in the majority of GD patients and correlated well with the TcTU. These parameters may be used as diagnostic indices for GD. Further investigation is required to support the above findings.

Increased accuracy of single photon emission computed tomography (SPECT) myocardial perfusion scintigraphy using iterative reconstruction of images.

BACKGROUND/AIM: Filtered back projection (FBP) is a common way of processing myocardial perfusion imaging (MPI)studies. There are artifacts in FBP which can cause false-positive results. Iterative reconstruction (IR) is developed to reduce false positive findings in MPI studies. The aim of this study was to evaluate the difference in the number of false-positive findings in MPI studies, between FBP and IR processing. METHODS: We examined 107 patients with angina pectoris with MPI and coronary angiography (CAG), 77 man and 30 woman, aged 32-82. MPI studies were processed with FBP and with IR. Positive finding at MPI was visualization of the perfusion defect. Positive finding at CAG was stenosis of coronary artery. Perfusion defect at MPI without coronary artery stenosis at CAG was considered like false positive. The results were statistically analyzed with bivariate correlation, and with one sample t-test. RESULTS: There were 20.6% normal, and 79.4% pathologic findings at FBP, 30.8% normal and 69.2% pathologic with IR and 37.4% normal and 62.6% pathologic at CAG. FBP produced 19 false positive findings, at IR 11 false positive findings. The correlation between FBP and CAG was 0.658 (P < 0.01) and between IR and CAG 0.784 (P < 0.01). The number of false positive findings at MPI with IR was significantly lower than at FBP (p < 0.01). CONCLUSION: Our study shows that IR processing MPI scintigraphy has less number of false positive findings, therefore it is our choice for processing MPI studies.

Evaluation of neuroendocrine tumors with 99mTc-EDDA/HYNIC TOC.

BACKGROUND: This paper is the short review of our preliminary results obtained with 99mTc-EDDA/HYNIC-TOC. MATERIAL AND METHODS: The total of 495 patients with different neuroendocrine tumors were investigated during last few years. RESULTS: There have been 334 true positive (TP), 73 true negative (TN), 6 false positive (FP) and 82 false negative findings (FN). Diagnosis was made according to SPECT findings in 122 patients (25%). The mean T/NT ratio for TP cases was significantly higher (p < 0.01) on SPECT (3.12 ± 1.13) than on whole body scan (2.2 ± 0.75). According to our results, overall sensitivity of the method is 80%, specificity 92%, positive predictive value 98%, negative predictive value 47% and accuracy 82%. Fifteen TP patients underwent therapy with 90Y-DOTATATE. CONCLUSION: Scintigraphy of neuroendocrine tumors with 99mTc-Tektrotyd is a useful method for diagnosis, staging and follow up of the patients suspected to have neuroendocrine tumors. SPECT had important role in diagnosis. It is also helpful in the appropriate choice of the therapy, including the peptide receptor radionuclide therapy. In the absence of 68Ga-labeled peptides and PET/CT, the special emphasize should be given to application of SPECT/CT as well as to the radioguided surgery.

Diuresis renal scintigraphy "F-0" in diagnosing of upper urinary tract obstruction in children: the clinical significance.

BACKGROUND: The aim of this study was to assess the clinical relevance of diuresis renal scintigraphy after simultaneously administered radiopharmaceutical and diuretic (DRS "F-0") in diagnosing obstruction of upper urinary tract in children with previously documented hydronephrosis and ureterohydronephrosis, analyzing the value of qualitative and quantitative scintigraphy parameters. MATERIAL AND METHODS: This retrospective study enrolled 82 children (30 girls and 52 boys aged between 2 months and 16 years; mean 5.8 +/- 4.5 years) with previously documented hydronephrosis or ureterohydronephrosis (42 left-sided, 28 right-sided and 12 bilateral). DRS "F-0" was started after intravenous administration of diethylene-triamine- pentaacetic acid (DTPA) mixed with furosemide. Results of DRS "F-0" were analyzed qualitatively (visual analysis of scintigrams and renography curves) and quantitatively (time to reach maximum of the kidney curve-T max, washout of the tracer-WO, the furosemide clearance half-time (F/2) and individual kidney function - IKF) and compared with the final diagnoses obtained in 37 children (42 nephroureteric units - NU) after surgery, in 41 children (48 NU) during the medical follow-up lasting at least 6 months, and in 4 children (4 NU) using invasive diagnostic procedures. Diagnostic criteria for obstructed NU (kidney with corresponding ureter) considered presence of pathological at least two of five scintigraphy variables characterized as a sign of obstruction. RESULTS: Forty true positive and 37 true negative results were detected using diagnostic criteria for obstructed and normal NU by means of DRS "F-0". DRS "F-0" failed to detect obstruction in 5 children with a total of 6 obstructed NU, while the results were marked as false positive in 9 children (11 NU). Qualitative scintigraphy analysis was found to be the most sensitive (91%) and accurate predictor (85%) in differentiating obstruction from non-obstructive renal unit. High sensitivity in predicting obstruction was also found for both washout of the radiopharmaceutical (87%) and for furosemide clearance half time (85%). Overall sensitivity of DRS "F-0" using proposed diagnostic criteria in differentiating obstruction was 87%, specificity 77% and accuracy 82%. However, DRS "F-0" has been shown to be more sensitive (90%) in children with UPJ and UVJ obstruction concerning children in whom obstruction was caused by other urinary tract diseases. CONCLUSION: This study showed DRS "F-0" as a sensitive and reliable method in diagnosing children with obstructions of the upper urinary tract. The great advantage of the protocol DRS "F-0" over other diuresis renography protocol modalities is due to the shorter time of the acquisition by half, and the avoidance of additional diuretic application. However, conventional quantitation of diuresis renogram did not improve the sensitivity and specificity with respect to the qualitative analysis of scintigrams and renography curves.

Extracorporeal shock wave lithotripsy for cystine urolithiasis in children: outcome and complications.

The Siemens Lithostar Litotriptor was used to treat 6 children with cystine nephrolithiasis, previously treated by open surgery. Five children had renal calculi (3 multiple caliceal, 2 pelvis) and one had ureteral calculus. Stone size ranged from 0.2-2.5 cm in diameter, and stone burden was from 0.24 to 10.81 cm3 per kidney. From one to 4 ESWL sessions per unit were applied, with a total of 1,800 to 12,000 shock waves. The stone free rate at 3 months was 50%. A complete elimination was obtained with cystine stones in renal pelvis and ureter, however, up to 4 ESWL treatments failed in caliceal stones. Rather location of cystine calculi than previous surgery was associated with ESWL success rate. Two patients with positive urine cultures were successfully treated with appropriate antibiotics before ESWL was attempted. Perirenal hematoma was major complication demonstrated by radionuclide scintigraphy in one patient, and resolved spontaneously by 3 months. In the combined treatment of cystine urolithiasis in children ESWL, as auxillary procedure, was safe and effective in pelvis stone but failed in caliceal stones. Medical dissolution for retained fragments was found effective.

Alteration of 99mTc-DMSA biodistribution in glomerulonephritis.

BACKGROUND: The aim of this study was to assess the relation between (99m)Tc-DMSA biodistribution and its reliability as a marker of renal function in patients with glomerular kidney diseases. MATERIAL AND METHODS: Sixty-seven patients involved in this study were classified into two groups according to (99m)Tc-DTPA clearance and serum creatinine values: the 1st group consisted of 42 patients without renal failure while the 2nd group included 25 patients with renal failure. (99m)Tc-DMSA biodistribution was determined by measuring kidney, blood and urine activity at 2 h and 4 h. RESULTS: The results, compared with those of 23 healthy volunteers, indicated the quantitative alteration of (99m)Tc-DMSA distribution in both glomerulonephritis patient groups. In reference to the control mean values of 2 h and 4 h, in patients without renal failure, kidney activity was found decreased to 52% and 57%, while the blood activity increase of 37% and 44% was recorded together with the urine activity increase of 38% and 23%. In patients with renal failure the alterations of renal and blood activity were more remarkable, but the urine loss was found to be unchanged. CONCLUSIONS: It is suggested that these biodistribution changes originate mainly from tubular impairment. However, in glomerulonephritis patients, altered glomerular filtration might considerably affect biodistribution of this radiopharmaceutical and limits its suitability for precise quantitative estimation of renal function.