Radioisotope Scanning Research Articles

Inception of novel equations for estimation of differential renal function changes after successful pyeloplasty in children

ABSTRACT Introduction Ureteropelvic junction obstruction is the most common cause of pediatric hydronephrosis. Anderson Hynes dismembered pyeloplasty as the standard surgical treatment in such cases. Purpose To evaluate and detect factors that affect renal function changes (improvement) after successful pyeloplasty using Tc-99 m Diethylenetriaminepentaacetic (DTPA) renography in children and to predict renal scan changes after successful pyeloplasty. Methods This retrospective study was conducted on children ≤ 18 years of age who underwent successful pyeloplasty from May 2018 to May 2022. Pelvic-abdominal ultrasonography and radioisotope scan Tc-99 m DTPA were performed in all patients. Results Postoperative group showed a significant increase in renal parenchyma thickness, split renal function, and glomerular filtration rate with a decreased renal pelvis anteroposterior diameter (p < 0.05). There was a significant correlation between each postoperative decrease in the anteroposterior diameter of the renal pelvis and the postoperative increase in parenchyma thickness with the postoperative increase in split renal function. The equation used to detect postoperative split renal function and glomerular filtration rate had a high detection rate. Conclusions Pyeloplasty resulted in significant improvements in hydronephrosis, and renal parenchymal changes in association with renal pelvis diameter can predict Postoperative increase in split renal function and glomerular filtration rate.

Congenital Anomalies of the Kidney and Urinary Tract in Patients with Hirschsprung Disease.

To determine the frequency and types of congenital anomalies of the kidney and urinary tract (CAKUT) in patients with Hirschsprung disease. An observational cross-sectional study. Place and Duration of the Study: Department of Paediatric Surgery, National Institute of Child Health, Karachi, Pakistan, from June to December 2022. All patients with biopsy-proven Hirschsprung disease were included. Ultrasound was done to find out the anatomical and structural anomalies of the kidney and urinary tract. Functional assessment was done by renal function tests and MAG3 radioisotope scan where indicated. Fisher's exact test was applied to find out the association. A p ≤0.05 was taken as significant. Out of a total of 83, 15 (18.0%) patients had CAKUT. The mean age of the study population was 5.5 ± 2.3 years. It included 61 (73.5%) males and 22 (26.5%) females. No significant association was found between the type of Hirschsprung disease and CAKUT (p = 0.7). The gender distribution between CAKUT patients was also insignificant (p = 0.7). Renal hypoplasia was the most common anomaly found in six patients followed by hydronephrosis due to pelvi-ureteric junction obstruction in four children. All of these children were asymptomatic. Five male patients had undescended testis. Nearly a fifth of the children with Hirschsprung disease had CAKUT of whom renal dysplasia was the most common anomaly. There was no gender predilection and patients were asymptomatic regarding the urinary system. A routine ultrasound abdomen is a good screening investigation for identifying CAKUT. Hirschsprung disease, Kidney and urinary tract, Congenital diseases of the urinary tract, Congenital anomalies.

Congenital Anomalies of the Kidney and Urinary Tract in Patients with Hirschsprung Disease.

To determine the frequency and types of congenital anomalies of the kidney and urinary tract (CAKUT) in patients with Hirschsprung disease. An observational cross-sectional study. Place and Duration of the Study: Department of Paediatric Surgery, National Institute of Child Health, Karachi, Pakistan, from June to December 2022. All patients with biopsy-proven Hirschsprung disease were included. Ultrasound was done to find out the anatomical and structural anomalies of the kidney and urinary tract. Functional assessment was done by renal function tests and MAG3 radioisotope scan where indicated. Fisher's exact test was applied to find out the association. A p ≤0.05 was taken as significant. Out of a total of 83, 15 (18.0%) patients had CAKUT. The mean age of the study population was 5.5 ± 2.3 years. It included 61 (73.5%) males and 22 (26.5%) females. No significant association was found between the type of Hirschsprung disease and CAKUT (p = 0.7). The gender distribution between CAKUT patients was also insignificant (p = 0.7). Renal hypoplasia was the most common anomaly found in six patients followed by hydronephrosis due to pelvi-ureteric junction obstruction in four children. All of these children were asymptomatic. Five male patients had undescended testis. Nearly a fifth of the children with Hirschsprung disease had CAKUT of whom renal dysplasia was the most common anomaly. There was no gender predilection and patients were asymptomatic regarding the urinary system. A routine ultrasound abdomen is a good screening investigation for identifying CAKUT. Hirschsprung disease, Kidney and urinary tract, Congenital diseases of the urinary tract, Congenital anomalies.

Effects of sufentanil in combination with dexmedetomidine for patient-controlled intravenous analgesia after renal transplantation

Background/Aim. Nowadays, the most convenient analgesic method is patient-controlled intravenous injection of one or more adjuvant drugs. The aim of our study was to evaluate the effects of sufentanil plus dexmedetomidine for patient-controlled intravenous analgesia (PCIA) after renal transplantation. Methods. Seventy-eight patients receiving living-related renal transplantation under general anesthesia were selected. Radioisotope scanning was performed, and the single glomerular filtration rate of the unilateral kidney was ? 40 mL/min/1.73 m2. The control group (CG) and observation group (OG) (39 patients in each group) were analgesic with sufentanil and sufentanil plus dexmedetomidine, respectively. When the Visual Analogue Scale (VAS) score exceeded 4 points, 0.05 mg/kg oxycodone was intravenously injected for remedial analgesia. Plasma levels of endothelin, urea nitrogen, and creatinine were measured by radioimmunoassay. Heart rate (HR), mean arterial pressure, oxygen saturation, VAS score, and sedation score were recorded before anesthesia and after surgery. Analgesic remediation rate, number of effectively pressing the PCIA pump, and incidence rate of adverse reactions within 48 hrs after surgery were recorded. Results. HR of OG was significantly lower than that of CG 6 and 12 hrs after surgery (p &lt; 0.05). VAS score of OG was lower than that of CG 6, 12, and 24 hrs after surgery (p &lt; 0.05). OG had a lower postoperative remedial rate, number of effectively pressing the PCIA pump, and incidence rates of nausea and vomiting (p &lt; 0.05) compared to CG. Endothelin, urea nitrogen, and creatinine levels significantly decreased after surgery compared with those before anesthesia (p &lt; 0.05). The levels of OG were lower than those of CG at each time point after surgery (p &lt; 0.05). Conclusion. Sufentanil plus dexmedetomidine can be safely and effectively used for PCIA after renal transplantation, with superior outcomes to those of sufentanil alone.

LONG-TERM RESULTS OF PER-OPERATIVE KNEE ARTHROSCOPY IN CONFIRMING SUITABILITY FOR UNICOMPARTMENTAL KNEE ARTHROPASTY

AbstractIntroductionPatient selection is key to the success of medial unicondylar knee arthroplasty (UKA). Progression of arthritis is the most common indication for revision. Various methods of assessing the lateral compartment have been used including stress radiography, radioisotope bone scanning, MRI, and visualisation at the time of surgery. Arthroscopy is another means of assessing the integrity of the lateral compartment.MethodsWe used per-operative arthroscopy as a means to confirm suitability for UKA in a consecutive series of 279 Oxford medial UKA. This study reports the long-term results of a previously published cohort of knees. Our series of UKA with per-operative arthroscopy (Group 1) was compared to all Oxford UKA (Group 2) and all UKA in the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) (Group 3).ResultsThe 14-year cumulative percentage revision (CPR) was 18.5% (95% CI 12.7, 26.4) for group 1, 19.7% (95% CI 18.8, 20.6) for group 2, and 19.2% (95% CI 18.5, 19.8) for group 3. There was no statistically significant difference in the (CPR) for the entire period when group 1 was compared to groups 2 or 3. Progression of arthritis was the indication for revision in similar proportions for the three groups (Group 1: 32.3%, Group 2: 35.7% and Group 3: 33.5%). Following per-operative arthroscopy 21.6% (77/356) of knees underwent a change of surgical plan from UKA to TKA.ConclusionPer-operative arthroscopy may improve medium-term medial unicompartmental knee survivorship but does not improve long-term survivorship nor reduce revision due to progression of arthritis.

Sestamibi-guided thoracoscopic excision of functional mediastinal parathyroid adenoma in a child: A case report and review of literature.

Primary hyperparathyroidism secondary to ectopic parathyroid (in anterior mediastinum) is rare in children. We report the case of a 12-year-old girl with a history of multiple fractures, renal calculi and limb deformities. She was diagnosed with hyperparathyroidism secondary to an intrathymic parathyroid adenoma. Sestamibi scan showed a lesion in the anterior mediastinum. A biochemical evaluation revealed hypercalcaemia, elevated alkaline phosphatase and parathormone levels. The lesion was marked with radioisotope and confirmed intraoperatively using a gamma camera. The child underwent thoracoscopic left thymectomy with the adenoma. Immediate decrease in calcium and parathyroid hormone values were noted intraoperatively and serial monitoring showed a downward trend. On follow-up, the child is doing well. Ectopic parathyroid adenoma is very rare. CT with radioisotope scans is helpful in diagnosis. Thoracoscopic excision of ectopic adenoma is safe in children.

A Study on Clinicopathological Corelation and Management of Solitary Thyroid Nodule

Background: A solitary nodule is a goiter which, on clinical examination appears to be a single nodule in one lobe of the thyroid with no palpable abnormality elsewhere in the gland. The incidence of solitary nodule in general population in South India is 9%. This study aims to assess the presence of malignancy in patients presenting with solitary thyroid nodule and to evaluate and compare results of various investigative modalities used to diagnose a solitary thyroid nodule and the outcome of management modalities in solitary thyroid nodule. Methods: The present study on clinicopathological correlation and management of solitary thyroid nodule has been conducted on cases admitted and managed in the Department of Surgery at KIMS medical college, Hubli. Prospective analysis of 50 cases of solitary nodule thyroid in the specified period was done. These cases were selected by random sampling method and studied in detail clinically and recorded as per the proforma. Routine investigations and specific investigations including FNAC of the nodule, Thyroid profile, IDL, Plain X-ray neck, USG neck were done in all cases. Special investigations like radio-isotope scanning were not performed as the facilities were not available. All the patients were managed by surgery and diagnosis was confirmed by histo- pathological examination. The patients were grouped according to different variables like age, sex, size of the nodule, site of the nodule, functional thyroid status, FNAC reports and histo-pathological examination reports, then analyzed and compared with the previous similar studies conducted elsewhere. Results: Total of 50 cases of solitary nodule of thyroid studied. The mean age of presentation is 38.5 years. Cases in 3rd to 5th decades constitutes 72% of the cases studied. Out of 50 cases studied 46 were females and 4 were males, and the ratio comes to M:F = 1 : 11.5. Out of 50 cases along with swelling in front of the neck, 3 cases had pain, 3 cases had discomfort .....

Laparoscopic treatment of vasorenal hydronephrosis in children using aberrant renal vessel transposition

The purpose of this article is to assess the immediate results of laparoscopic transposition of aberrant renal vessels as an effective alternative to pyeloplasty in the treatment of children with external obstruction of the pyeloureteral junction. Material and methods. The laparoscopic vascular transposition technique was used in 3 children with hydronephrosis caused by aberrant renal vessels. The preoperative diagnostic examination included: ultrasound / Doppler scanning, radioisotope renal scanning and contrast computed urography. Renoscintigraphy showed that all patients had intermittent hydronephrosis (24–36 mm) and an obstructive pattern. In order to select patients in whom vascular transposition is possible, the diuretic loading test was made at the beginning of the surgery. During the surgery, accessory renal vessels were mobilized and moved upward, where they were fixed by "wrapping" with renal pelvis tissue. Results. The median operative time was 59.0±10.2 minutes, and the median hospital stay was 3.6±0.5 days. There were no complications at the early observation period. At the follow-up (6.0–24.0 months), all patients showed a decrease in the degree of hydronephrosis and an improvement in excretory function at the renogram. Conclusion. Preliminary results of the study have demonstrated safety and efficacy of laparoscopic repositioning of aberrant renal vessels for the treatment of hydronephrosis. A careful selection of patients through intraoperative functional tests is an important step to confirm indications for this procedure and to maintain its high success rate. Any concerns about the presence of additional internal stenosis of the pyeloureteral junction, of course, should transform this surgical intervention into the classic pyeloplasty.

Importance of fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) in detection of post-thyroidectomy recurrence in differentiated thyroid cancer with negative radio-isotope iodine scan, yet, elevated serum thyroglobulin level

BackgroundThyroid cancer considered the 6th common cancer in female and represents approximately 1% of all cancers. Thyroid cancer is generally characterized by good prognosis, long term survival and low aggressiveness. Its prognosis is related to tumor dimensions, extra capsular extensions, the age at diagnosis and distant metastases sites. Combination between positron emission tomography and computed tomography allow anatomic, functional & molecular information.AimTo demonstrate Fluorine 18 fluorodeoxyglucose positron emission tomography)/computed tomography role for evaluation of post-thyroidectomy recurrence either local or distant metastatic lesions in differentiated cancer thyroid patients with negative radio-isotope iodine scan, yet showing elevated serum thyroglobulin level.ProcedureA prospective study included twenty patients with previous history of differentiated thyroid cancer. All patients after history taking and revising the medical sheet underwent Serum Thyroglobulin level & I-131 whole body scan examinations and then Fluorine 18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography study. The findings of Positron Emission Tomography/Computed Tomography imaging compared with results of histopathology or follow-up clinical results as a gold standard.ResultsFluorine 18 fluorodeoxyglucose positron emission tomography/computed tomography based analysis showed that nineteen true positives and one was true negative as confirmed by the gold standard (Histopathology and clinical follow-up). Thirteen patients had either local recurrence or lymph node metastases without distant metastatic disease, six patients had different distant metastasis. Fluorine 18 fluorodeoxyglucose positron emission tomography/computed tomography based analysis showed that nineteen true positives and one was true negative as confirmed by the gold standard (histopathology and clinical follow-up). The accuracy and sensitivity of Fluorine 18 fluorodeoxyglucose positron emission tomography/computed tomography (95%) were significantly better than those of the Computed Tomography alone (84.2% and 80%, respectively).ConclusionsFluorine 18 Fluorodeoxyglucose positron emission tomography/computed tomography provided a critical role in assessment and management of patients with suspected differentiated thyroid recurrence, presenting with high serum thyroglobulin level and negative radio-isotope iodine scan. It enhances diagnostic accuracy through giving exact anatomical localization of recurrent and/or metastatic tumor foci.

Stereotactic Radiotherapy for Lesions Detected via 68Ga-Prostate-specific Membrane Antigen and 18F-Fluorodexyglucose Positron Emission Tomography/Computed Tomography in Patients with Nonmetastatic Prostate Cancer with Early Prostate-specific Antigen Progression on Androgen Deprivation Therapy: A Prospective Single-center Study

Dual-tracer positron emission tomography/computed tomography (PET/CT) with a 68Ga-labelled prostate-specific membrane antigen (PSMA) ligand and 18F-fluorodeoxyglucose (FDG) improves detection of metastatic heterogeneity and burden in patients with nonmetastatic prostate cancer (nmPCa). However, there is limited prospective evidence regarding its impact on the efficacy of stereotactic body radiotherapy (SBRT). To evaluate metastasis-free survival (MFS) and toxicity after SBRT to dual-tracer PET/CT-detected metastases in patients with nmPCa and early prostate-specific antigen (PSA) progression on androgen deprivation therapy (ADT; PSA ≤2 ng/ml). Patients were prospectively screened using dual-tracer PET/CT between April 2019 and October 2020. SBRT was recommended for patients with five or fewer nonvisceral metastases (SBRT group). Patients without detectable metastases (N-/M- group) and those who refused SBRT (ADT group) continued to receive ADT. Patients were followed with conventional imaging. SBRT to each PET/CT-detected metastasis. Kaplan-Meier methods were used to determine MFS. Toxicity was evaluated using Common Terminology Criteria for Adverse Event v4.0. Seventy-four consecutive patients were screened. The median PSA and PSA doubling time were 0.59 ng/ml and 4.56 mo, respectively. Overall, 54 patients had metastases and 17 had PSMA-/FDG+ disease. Seven patients were excluded from the MFS analysis, including two with a history of abiraterone treatment and five with more than five metastases. The median follow-up was 21.4 mo. The ADT group had shorter MFS than the SBRT group (11.0 mo vs not reached; hazard ratio [HR] 4.69, 95% confidence interval [CI] 2.92-25.0; p < 0.001) and the N-/M- group (11.0 mo vs not reached; HR 8.78, 95% CI 4.04-40.30; p < 0.001). There was no significant difference in median MFS between the SBRT group and the N-/M- group (p = 0.261). A PSA response >90% was achieved by 86% of patients in the SBRT group. There were no grade ≥3 adverse events after SBRT. The nonrandomized design is the major study limitation. Dual-tracer PET/CT-guided SBRT delivered superior local control rates in comparison to ADT alone and had minimal toxicity. We investigated metastasis-targeted radiotherapy for patients with up to five prostate cancer metastases detected with two different radioisotope scans. Our results show that this approach yields promising metastasis-free survival and low toxicity.

Unilateral hypoplastic kidney in adults: An experience of a tertiary-level urology center.

BACKGROUNDUnilateral small-sized kidney is a radiological term referring to both the congenital and acquired causes of reduced kidney volume. However, the hypoplastic kidney may have peculiar clinical and radiological characterizations.AIMTo evaluate the clinical presentations, complications, and management approaches of the radiologically diagnosed unilateral hypoplastic kidney. METHODSA retrospective review of the records of patients with a radiological diagnosis of unilateral hypoplastic kidney between July 2015 and June 2020 was done at Assiut Urology and Nephrology Hospital, Assiut University, Egypt.RESULTSA total of 33 cases were diagnosed to have unilateral hypoplastic kidney with a mean (range) age of 39.5 ± 11.2 (19-73) years. The main clinical presentation was loin pain (51.5%), stone passer (9.1%), anuria (12.1%), accidental discovery (15.2%), or manifestations of urinary tract infections (12.1%). Computed tomography was the most useful tool for radiological diagnosis. However, radioisotope scanning could be requested for verification of surgical interventions and nephrectomy decisions. Urolithiasis occurred in 23 (69.7%) cases and pyuria was detected in 22 (66.7%) cases where the infection was documented by culture and sensitivity test in 19 cases. While the non-complicated cases were managed by assurance only (12.1%), nephrectomy (15.2%) was performed for persistent complications. However, symptomatic (27.3%) and endoscopic (45.6%) approaches were used for the management of correctable complications. CONCLUSIONUnilateral hypoplastic kidney in adults has various complications that range from urinary tract infections to death from septicemia. Diagnosis is mainly radiological and management is usually conservative or minimally invasive.

68Ga-DOTATATE Radioisotope scan to detect neuroendocrine tumors; A Cross-Sectional Study.

Objevtive(s):Neuroendocrine tumors are a heterogeneous group of neoplasms that arise from the peptide-producing cells of the neuroendocrine system. Different functional imaging methods have been suggested to diagnose NETs. There is still not enough evidence to recommend 68Ga-DOTATATE as a standard diagnostic tool in NETs. Therefore, the aim of this study was to assess the value of 68Ga-DOTATATE scan in detecting NETs.Methods:This was a cross-sectional study. All patients with a pathologically confirmed NET tumor referred to Masih Daneshvari Hospital affiliated to Shahid Beheshti University of Medical Sciences entered the study. Patients underwent a 68Ga-DOTATATE PET/CT. All statistical analysis were performed by SPSS software version 18.Results:Forty patients with a mean age of 48.1±15.80 years entered the study. Twenty-one (52.5%) were male and 19 (47.5%) female. In the studied patients, neuroendocrine tumor was present in 19 cases (47.5%) in pancreas and gastrointestinal tract, 9 (22.5%) in lung, 3 (7.5%) in mediastinum and adrenal gland, 6 cases (5%) in liver and 3 other sites. There was no significant association between mean age and gender with primary location of the tumor. The mean SUVmax was 11.62±20.02 and the the mean tumor size was 38.25±31.35 mm. The mean size of the metastasis was 40.55±24.53 mm. The mean percentage of ki-67 was 12.54±18.40. There was no significant correlation between SUVmax of the lesion and age (r=0.063, P=0.701), tumor size (r=-0.63, P=0.067) or Ki-67 (r=0.011, P=0.960). In 20 cases, metastases were reported, of which 14 were (70%) in the liver, 3 in the lungs (15%), 2 in the gastrointestinal and cervical lymph nodes, and 1 in the bones and pancreas(%5).Conclusion: 68Ga-DOTA-peptide PET/CT could find the primary or metastasis sites of NETs with good quality images. In general, this modality can enhance the management in patients with NETs.

Assessment of sentinel lymph node detection by radioisotope scan and methylene blue alone in operable oral cavity cancer to assess its accuracy for metastasis

Background: Squamous cell carcinoma (SCC) is the most common malignancy affecting the oral cavity. It typically metastasizes into the regional cervical lymph nodes before spreading to distant organs.Methods: A prospective study on sentinel lymph node biopsy (SLNB) in early oral cancers using methylene blue dye and sentinel node localisation using pre-operative lymphoscintigraphy and intraoperative gamma probe in early oral cavity cancer.Results: Present study had a male to female ratio of 1.9:1, with (65.5%) male and (34.5%) female patients. Present study had a side distribution of disease more on left side with 138 patients (62.7%) and ratio of left to right was approximately 1.7:1. In present study most predominating gross morphological pattern of growth was ulcerative (35%) followed by ulcero-infilterative (25%). Buccal mucosa was the most common sub-site of origin of carcinoma in oral cavity, followed by tongue, with 83 (37.7%) and 64 (29.1%) patients. Identification rate of methylene blue dye was 91.7% (100 out of 109 patient). Identification rate of radionuclide tracer was 94.6% (105 out of 111 patient). In methylene blue dye group out of 103 metastatic sentinel lymph nodes, 9 metastatic sentinel lymph nodes were detected on IHC.Conclusions: With the above results it can be concluded the SLNB study is liable in detection of actual positive node and can avoid unnecessary neck dissections in patients with SCC with negative sentinel lymph node, as having very low risk of occult lymphatic metastases in the remaining lymphatic drainage.

Review on the Lymphatic Vessels in the Dental Pulp.

Simple SummaryIt is debatable whether lymphatic vessels exist in the dental pulp. Most researchers confirm their presence; however, the lymphatic system in the dental pulp is much less developed compared to other tissues of the body. Lymphangiogenesis occurs in the dental pulp with inflammatory changes as a response to inflammatory stimuli acting on the tooth. If lymphangiogenesis is defined as the development of lymphatic vessels from already existing ones, such a mechanism is possible only when lymphatic vessels are present in healthy teeth. Research papers have not conclusively proved whether lymphatic vessels can form in the dental pulp. The use of an immunohistochemical examination can very likely prove the presence of a lymphatic system in dental tissues. However, the evaluation of the lymphatic system of the teeth is problematic because it is quite difficult to clearly distinguish lymphatic vessels from small blood vessels.Despite many studies, opinions on the lymphatic system of the teeth are still incompatible. Studies using light and electron microscopy and directly using methods such as a radioisotope (radionuclide) scan and interstitial fluid pressure measurement reported incomplete results. Immunohistochemistry (IHC) plays the main role in investigating presence of the lymphatic system in dental tissues. This method uses labeled antibodies against antigens typical of lymphatic vessels. The use of appropriate staining enables the detection of antigen-antibody reaction products using a light (optical), electron or fluorescence microscope. However, these studies do not show the system of vessels, their histologic structure under physiological conditions and inflammation as well as the lymphangiogenesis process in the dental pulp. Unfortunately, there is a lack of studies associating the presence of lymphatic vessels in the dental pulp with local lymphatic nodes or large vessels outside the tooth. In the scientific and research environment, the evaluation of the lymphatic system of the teeth is problematic because it is quite difficult to clearly distinguish lymphatic vessels from small blood vessels. Despite many indications of the presence of lymphatic vessels in the pulp chamber, this problem remains open and needs further research.

In memoriam: John R. Mallard (1927-2021).

In memoriam: John R. Mallard (1927-2021).

Vesicoureteral reflux as a manifestation of CAKUT-syndrome in children: the problem of late diagnosis

CAKUT-syndrome includes combined congenital abnormalities of the kidneys and urinary tract and is a complex problem in pediatrics, requiring an interdisciplinary approach of doctors of various specialties. One of the most severe manifestations of CAKUT-syndrome is vesicoureteral reflux, which is often the main manifestation of a congenital abnormality of the kidneys and urinary tract. Structural and urodynamic disorders in the organs of the urinary system in vesicoureteral reflux can lead to the formation of reflux nephropathy and chronic kidney disease. Low-symptom clinical manifestations of reflux nephropathy make it difficult to diagnose it early. Vesicoureteral reflux leads to intrarenal reflux, repeated attacks of pyelonephritis and sclerosis of the renal tissue, which in 25-60 % of cases causes end-stage chronic renal failure due to vesicoureteral reflux. Given the absence of specific pathognomonic clinical manifestations of reflux nephropathy, laboratory indicators are of fundamental importance in the diagnosis-levels of albuminuria, leukocyturia, urinary sediment fermenturia, urine osmolarity, daily urinary excretion of β2 – microglobulin and a wide arsenal of methods for diagnosing reflux nephropathy and scarring of the renal parenchyma: ultrasound with dopplerography of the renal blood flow, magnetic resonance imaging and computed tomography, radioisotope scanning. The imperfection of instrumental methods for visualizing the initial stages of kidney fibrosis dictates the need to develop alternative, more sensitive methods for early diagnosis of reflux nephropathy. One of the directions of this search is molecular diagnostics, which allows you to detect possible damage to the renal tissue at the subcellular level long before the clinical manifestations of pathology, personify nephroprotective therapy and prevention of reflux nephropathy. The article presents clinical observations from our own practice of late diagnosis of reflux nephropathy, in which renal pathology was first detected at stages 5 and 3 of chronic kidney disease in two boys aged 10 and 16 years, respectively, who were on inpatient treatment in the Nephrology Department of the Children's Republican clinical hospital.

Effects on organ donation of transition from apnoeic-oxygenation to radioisotope brain scanning to diagnose brain death in children

We studied rates of cadaveric organ donation on transition from apnoeic-oxygenation to radioisotope brain perfusion scanning to diagnose brain death. We studied records of children who were organ donors and/or had Technetium Tc99m Exametazine brain scans over 1989-2018. Donation after Brain Death (DBD) commenced in 1989, Donation after Circulatory Death (DCD) in 2011. Brain scanning was adopted in 2002 and apnoeic-oxygenation abandoned in 2007. In total, 95 of 1930 children (4.9%) donated organs (81 DBD, 14 DCD). During 1989-2001, with brain death diagnosed by clinical tests including apnoeic-oxygenation, 40 of 1059 children (3.8%) donated organs at average 3.1/annum. During 2002-2007 when either apnoeic-oxygenation or scanning was used, 18 of 351 children (5.1%) donated organs at average 3.0/year. During 2008-2018 with scanning in lieu of apnoeic-oxygenation, 23 of 520 children (4.4%) donated organs at average 2.1/annum. The difference in DBD rate between eras was not significant (P=0.52). Of 77 children scanned, 65(84%) were diagnosed brain dead after 1 or 2 scans, and 29 (45%) of these donated organs. Of 12 children with limited brain perfusion (not brain dead), DCD proceeded in 8 (67%). DCD or DBD (death diagnosed by scanning) was performed during 2011-2018 in 35 of 370 children (9.5%) which is significantly more (P<0.0001) than DBD (death diagnosed by apnoeic-oxygenation) in 1989-2001. Transition from apnoeic-oxygenation to scanning to diagnose brain death did not change DBD and may facilitate DCD. Brain death can be diagnosed by radionuclide scanning in lieu of apnoeic-oxygenation.

Metastatic Prostate Adenocarcinoma in Rectal Polyp: A Rare Clinical Presentation

Abstract Introduction/Objective Prostate cancer is known to metastasize to bone, lymph node, lungs, liver, and brain, with the GI tract being an uncommon site of metastasis. More commonly, prostate adenocarcinoma involves GI tract by direct colonic extension. Interestingly, few cases have been reported with metastasis presenting as a GI polyp. Methods We herein report a case of 69-year-old African American male who was diagnosed with metastasis of prostate adenocarcinoma presenting as rectal polyp. The patient originally presented with lower urinary tract symptoms. Further examination revealed PSA level of 220. The patient underwent TRUS-guided prostate biopsy which showed prostate adenocarcinoma with Gleason score of 9 (grade group 5). Follow-up CT and radioisotope scans showed direct extension of prostate lesion into bladder, seminal vesicle and rectum. Metastases were noted to right lesser trochanter, L5 vertebra and retroperitoneal lymph nodes. Colonoscopy was performed 1 month after prostate biopsy due to abnormal CT finding of rectal wall thickening. Endoscopy found a single 0.5 mm sessile polyp which was resected by cold snare polypectomy. Results Microscopically, a nodule of tubular glands arranged back to back containing pleomorphic cells with large nuclei, prominent nucleoli, and vacuolated cytoplasm was seen underlying normal colonic mucosa. The malignant cells expressed prostate specific antigen (PSA) and phosphate specific acid phosphatase (PSAP). It was negative for CK7 and CDX2, rendering a diagnosis of metastatic prostate adenocarcinoma. Patient is currently receiving androgen deprivation treatment and enzalutamide with future plans for external beam radiation. The germline alteration testing was positive for BRCA2 which is associated with increased risk of prostate cancer. Conclusion Albeit rare, it’s important for pathologists to be aware of this entity presenting uncommonly as a rectal polyp, particularly given the history of prostate adenocarcinoma which could be mistaken for colonic adenocarcinoma. In rare cases, tumor seeding following TRUS-guided prostate biopsy has also been implicated.

Combined reconstruction plate fixation and submandibular gland translocation for the management of medication-related osteonecrosis of the mandible

The aim of this study was to summarize the clinical outcomes of patients with stage 3 mandibular medication-related osteonecrosis of the jaw (MRONJ) treated using reconstruction plate fixation and ipsilateral submandibular gland translocation after mandibulectomy. The medical records of patients with stage 3 mandibular MRONJ treated using the above surgical method between September 2014 and July 2019 were reviewed. Of a total of 27 patients included in this study, 23 (85.2%) experienced primary wound healing. The remaining four patients developed wound dehiscence and infection within 1 week after the operation. Three of these patients recovered after the plate was removed, and one patient died of the primary cancer. The follow-up period ranged from 3 months to 5 years, with an average of 12.7 months. The 23 patients with primary wound healing had a symmetrical facial appearance, with normal mouth opening and occlusion. Plate fracture occurred in two patients at 1year and 3 years after the operation. Radioisotope scanning in 10 patients showed that the function of the translocated submandibular gland was normal at 6 months after the operation. In summary, for patients with stage 3 MRONJ involving the mandibular angle and/or body, reconstruction plate fixation and submandibular gland translocation after segmental mandibulectomy is an effective treatment method.

Establishing a diagnostic scale of subacute thyroiditis without radioisotope scanning

BackgroundRadioisotope scanning is important to diagnose subacute thyroiditis (SAT), but it’s not always available. So we aim to establish a diagnostic scale for SAT without radioisotope scanning.MethodsThe suspected SAT patients hospitalized in Yuebei people’s Hospital from January 2012 to December 2016 were selected and divided into study group and control group according to whether they were diagnosed as SAT. The clinical indexes of two groups were collected and the diagnostic scale of SAT was established by using binary logistic regression analysis. The effectiveness of the scale was evaluated by ROC curve.ResultsOf 309 patients, 58.25% of patients were confirmed with SAT and the remaining 41.75% of patients were not diagnosed with SAT. After univariate analysis, variables which were considered statistically different(P < 0. 05) between the two groups were selected as independent variables and the diagnosis of SAT was taken as dependent variable in the binary logistic regression model. The logistic regression model consisted of 4 variables, each was thyroid tenderness, firm on palpation, increased ESR and elevated thyroid hormone level. The P value of Omnibus tests was≤0. 001 and the Nagelkerke R Square was 0. 915. The diagnostic scoring scale was established with these four variables according to their regression coefficient. The area under the ROC curve for this diagnostic scale was 0. 991(95% confidence interval, 0. 982–0.999). The highest Youden index was 0. 912, the corresponding cut-off point was 7. Internally validation shows a sensitivity of 92. 78% and a specificity of 98.45% of our scale.ConclusionsWe established and validated a diagnostic scale for SAT without the need for radioisotope scanning for the first time. It has good application in institutions that do not have radioisotope machines or among pregnant and lactating women.