Improvement In Excretion Research Articles

Using Tc-99m Pertechnetate Scintigraphy to Predict the Outcome of Sialoendoscopy in Obstructive Submaxillaritis

The purpose of this study was to investigate whether the findings of Tc-99m pertechnetate salivary gland scintigraphy (SGS) can predict the outcome of sialoendoscopic intervention in patients with obstructive submaxillaritis. Eleven patients with obstructive submaxillaritis were prospectively recruited. All patients underwent sialoendoscopy. Tc-99m pertechnetate SGS was performed both before and after sialoendoscopy. Sialoendoscopy was effective in the glands with tracer uptake (n = 9) demonstrated on SGS before the procedure, evidenced by not only relief of the symptoms but also improvement in excretion in post therapy salivary gland scintigraphy. In contrast, sialoendoscopy was ineffective in the glands without tracer uptake (n = 2) in pretherapy scans. In patients with submaxillaritis, whether a sialoendoscopy should be performed depends on the results of salivary gland scintigraphy.

Relation between radionuclide imaging and pathologic findings of ureteropelvic junction obstruction in neonatal hydronephrosis

An excessive amount of collagen fibers around the muscle cells in the ureteropelvic junction could be responsible for obstruction in patients with hydronephrosis. We aimed to elucidate the ultrastructure of the ureters and correlate this finding with the prognostic outcome and to correlate the histopathological findings with diuretic radionuclide renography findings. Biopsy specimens of 20 children who underwent dismembered pyeloplasty for ureteropelvic junction obstruction were analyzed. The patients were grouped according to their age: infants (<12 months) and others (>12 months). Diuretic radionuclide imaging was performed using (99m)Tc mercaptylacetyltriglycine in the pre- and postoperative periods. Changes in differential renal function and excretion patterns on diuretic renography were evaluated in relation to the findings noted on histopathological examination of the biopsy specimens. Excretion patterns were classified as follows: A, normal; B, responsive to diuretic; C, minimal response to diuretic with some excretion after postural change; and D, very poor/no drainage despite diuretics. Biopsy materials were analyzed for the presence and extent of inflammation, fibrosis and changes in the smooth muscle layer using Masson's trichrome stain and immunohistochemical staining. Histopathological findings were graded from zero to three, depending on severity. In patients aged <12 months, preoperative differential renal function (DRF) was associated with fibrosis (F) and smooth muscle hypertrophy (SMH) [mean (SD) DRF for both F and SMH were Grade 0-1, 47.8% (6.4%); Grade 2-3, 36.2% (11.3%); p<0.05]; and change in DRF was associated with inflammation [Grade 0-1, -0.1% (4.0%); Grade 2-3, 5.8% (3.0%); p<0.05]. Excretion patterns or improvement in excretion were not associated with any of the histopathological features. Change in DRF was significantly associated with inflammation Grade 2-3 (beta coefficient, 5.8; 95% CI 1.4-10.3). Histopathological evaluation of renal parenchymal biopsy specimens obtained during pyeloplasty may be useful to provide an objective method for predicting the recovery of renal function. In addition, this will allow comparison of the types of histopathological alterations with the changes in differential renal function in order to predict the potential final improvement.

URETERODUODENAL FISTULA: A RARE COMPLICATION OF DUODENAL ULCER

A 20-year-old man was admitted to the hospital for anemia. History was significant for duodenal ulcer 8 years before presentation with no regular treatment, 2 episodes of upper gastrointestinal tract bleeding and frequent attacks of right flank soreness for 2 years. Physical examination was unremarkable. Laboratory studies revealed only microcystic anemia. Right hydronephrosis was found incidentally on ultrasound. Excretory urography confirmed severe hydronephrosis and delayed excretion of the right kidney. Retrograde pyelography showed the duodenal mucosa coated with contrast medium (see figure). On exploration inflammation with severe adhesion was noted in the right kidney. The right upper ureter had fibrosis 2 inches long which appeared as a band below the ureteropelvic junction. There was an adhesion between the ureter and secondary portion of the duodenum. At dissection an obvious penetration defect of the secondary portion of the duodenum was found. The bowel defect was repaired and segmental ureterectomy with primary ureteroureterostomy over a 7Fr ureteral stent was performed. Convalescence was uneventful. The ureteral stent was removed 6 weeks postoperatively. Followup excretory urography demonstrated a normal caliber ureter and improvement in excretion of the right kidney.

Urinary xylose excretion in steatorrhoea.

The urinary xylose excretion is low in patients with untreated idiopathic steatorrhoea but subsequent improvement in excretion was noted after treatment in six out of nine patients. This did not coincide with histological improvement. With Crohn's disease low values were found when the jejunum but not the ileum was involved.