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Byline: C. -H. Chang (1), H. -C. Wu (1), J. -J. P. Tsai (2), C. -C. Lin (3), C. -C. Lee (4), A. Kao (4) Keywords: Technetium-99m; Hexamethylpropylene amine oxime; Chronic renal failure Abstract: We used technetium-99m hexamethylpropylene amine oxime (Tc-99m HMPAO) lung scan to detect subclinical lung injury in patients with chronic renal failure (CRF), on regular hemodialysis (HD), who had normal chest X-ray findings (CXR) and pulmonary function test (PFT). The degree of pulmonary vascular endothelium damage was represented as lung/liver uptake ratios (L/L ratios) calculated by Tc-99m HMPAO lung scan. The L/L ratios of the 20 male CRF patients on HD with normal CXR and PFT were compared with those of the 20 male normal controls. The results show that the L/L ratios on Tc-99m HMPAO lung scans were significantly higher in CRF patients on HD (1.06 +- 0.55) than those in normal controls (0.34 +- 0.09). Using a cut-off value of 0.50, 18/20 [90%] CRF patients had abnormally increased L/L ratios. Our findings concluded that the pulmonary vascular endothelium damage represented as significantly increased L/L ratios on Tc-99m HMPAO lung scan in CRF patients on HD with normal CXR and PFT. In addition, Tc-99m HMPAO lung scan has the potential to be a sensitive, objective and noninvasive method to detect subclinical lung injury of CRF patients on HD, which is different from the traditional studies such as CXR or PFT. Author Affiliation: (1) Department of Urology, China Medical College Hospital, Taichung, Taiwan (2) Graduate Institute of Bioinformatics, Taichung Healthcare and Management University, Taichung, Taiwan (3) Department Family Medicine, China Medical College Hospital, Taichung, Taiwan (4) Department of Medical Research, China Medical College Hospital, No. 2, Yuh Der Road, Taichung 404, Taiwan Article History: Accepted Date: 24/02/2003

Byline: V. Bhatnagar (1), D. K. Mitra (1), S. Agarwala (1), R. Kumar (2), C. Patel (2), A. K. Malhotra (2), A. K. Gupta (3) Keywords: Keywords Urinary tract infection; Vesicoureteric reflux; Renal scarring; DMSA scans; Micturating cystourethrography Abstract: The correlation between urinary tract infection (UTI), vesicoureteric reflux (VUR) and renal scarring was studied in 89 patients (177 renal units 1 solitary kidney) during the period 1997--2000. There were 63 males and 26 females ages ranged from neonates to 14years. UTI was diagnosed on the basis of a positive urine culture, VUR was diagnosed and graded by micturating cystourethrogram (MCU), and renal scarring was assessed by technetium 99m Tc-dimercaptosuccinic acid (DMSA) scan. Ultrasonography (US) was done to evaluate renal tract dilatation and other structural abnormalities. A follow up DMSA scan was performed approximately 6months after the initial scan. VUR was present in 106 of the 171 renal units in which it was studied and absent in 65 units. The majority of the VUR was grade V. Renal scars were seen in 90 of 177 renal units at presentation and in 72 of the 163 renal units studied at follow-up. Some information was lacking in 31 patients hence, the correlation between UTI, VUR, and renal scarring was done in 58 patients. The majority of the suspected scars at presentation were not seen at follow-up, but most of the established scars persisted. Only 2 renal units showed scars for the first time on follow-up. On US, approximately 50% of normal kidneys showed either suspicious or established scars on DMSA scan, and patients with bilateral abnormality on US showed renal scars. Renal scars were seen in 15 of 23 children without VUR, 17 of 18 with unilateral VUR, and 16 of 17 with bilateral VUR. Thus, there is a cause-and-effect relationship between UTI and renal scarring that is made worse by VUR. DMSA scans have been shown to be the most reliable method of assessing renal scarring, and an abnormal US scan showing upper-tract dilatation or a structural abnormality may have a predictive value in the detection of renal scarring. Author Affiliation: (1) Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi-110029, India, IN (2) Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi-110029, India, IN (3) Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi-110029, India, IN Article note: Accepted: 18 April 2001

Byline: Y.-C. Shiau (), S.-C. Tsai (), J.-J. Wang (), Y.-J. Ho (), S.-T. Ho (), C.-H. Kao () Abstract: Author Affiliation: () Department of Nuclear Medicine, Far Eastern Memorial Hospital, Institute of Biomedical Engineering, College of Electrical Engineering, National Taiwan University, Taipei, TW () Department of Nuclear Medicine, Show-Chwan Memorial Hospital, Changhua, TW () Department of Medical Research, Chi-Mei Medical Center, Tainan, TW () Department of Radiology, Jen-Ai Hospital, Taichung, TW () School of Medicine, National Defense Medical Center, Taipei, TW () Department of Nuclear Medicine, China Medical College Hospital, Taichung, Taiwan, TW Article History: Accepted Date: 04/10/2001

Byline: S.-S. Sun (1), J.-F. Hsieh (2), S.-C. Tsai (3), Y.-J. Ho (4), C.-H. Kao (5) Keywords: Key words: Isoflurane--Technetium-99m diethylene triamine pentaacetic acid--Lung ventilation--Alveolar epithelial permeability. Abstract: Fifteen patients undergoing surgery and receiving volatile anesthesia with isoflurane were enrolled as the study group. At the same time, 15 patients undergoing surgery with intravenous anesthesia drugs were included as a control group to compare each other. Before surgery, 1 h after surgery, and 1 week after surgery, we investigated these two groups of patients with technetium-99m--labeled diethylene triamine pentaacetic acid radioaerosol inhalation lung scan (DTPA lung scan), a test to evaluate lung ventilation (LV), which was evaluated by the first and equilibrium lung ventilation image and alveolar epithelial permeability (AP) which was evaluated by the half time (T1/2, minutes) of Tc-99m DTPA radioaerosol lung clearance. No significant change and abnormality of LV before surgery, 1 h after surgery, or 1 week after surgery was found in either group of patients. In addition, no significant change in AP before surgery (T1/2 = 64.0 +- 17.3 min), 1 h after surgery (64.5 +- 19.6 min), or 1 week after surgery (63.6 +- 17.6 min) was found among the control group patients (p values &gt 0.05). However, a significant transient increase in AP was found in the study group 1 h after surgery (71.7 +- 17.5 versus 51.2 +- 16.4 min), but it recovered 1 week after surgery (51.2 +- 16.4 versus 70.9 +- 16.0 min) (p values &lt 0.05). We conclude that volatile anesthesia with isoflurane can induce transient increase of AP. Author Affiliation: (1) Department of Nuclear Medicine, China Medical College Hospital Taiwan, TW (2) Department of Nuclear Medicine, Chi-Mei Foundation Hospital Taiwan, TW (3) Department of Nuclear Medicine, Show-Chwan Memorial Hospital Taiwan, TW (4) Department of Radiology, Jen-Ai Hospital Taiwan, TW (5) Department of Nuclear Medicine, Taichung Veterans General Hospital Taiwan, TW Article note: Accepted for publication: 23 February 2000

Short-lived radioactive compounds are frequently used to measure body functions such as the dynamics of heart pumping and blood flow. Compounds containing technetium-99m (99m-Tc) have been developed, as they might be more useful for these imaging studies than isotopes such as thallium-201. To determine whether 99m-Tc-sestamibi, one such compound, is suitable for heart studies, its distribution in heart tissue under different conditions of blood flow was compared with that of thallium-201. The proportion of each compound distributed into heart tissue correlated with the level of blood flow, up to blood flow rates that were three times normal resting levels. The data show that 99m-Tc-labeled compounds provided good contrast between ischemic and non-ischemic heart regions, and this was maintained for at least 90 minutes. The study indicates that 99m-Tc-sestamibi should be at least as sensitive as thallium-201 in the detection of ischemic heart disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

The characterization of the 99Tc from of the radiopharmaceutical [(super99)TcO] apcitide (AcuTect) is reported. Efforts made to determine the mode of binding of technetium to apcitide is presented.

Byline: L. S. Kasat (1), S. S. Borwankar (1), M. Jain (1), A. Naregal (1) Keywords: KeywordsaBile-duct perforation; Bile peritonitis; Biliary ascites Abstract: aA 1.2-year-old male presented with gradual-onset biliary ascites, mild icterus, and failure to thrive due to spontaneous bile-duct perforation (SPBD) confirmed by technetium 99Tc HIDA scan and abdominal paracentesis. Peritoneal tube drainage for 2 weeks helped the perforation to seal spontaneously, as there was no distal obstruction. No surgery was needed. Only less than 100 cases of SPBD have been reported in the English literature. The pathogenesis and treatment options are reviewed and discussed. Author Affiliation: (1) Department of Pediatric Surgery, KEM Hospital, Parel, Mumbai 400 012, India, IN (2) c/o Dr. G. M. Patwardhan, B/9, Swanand CHS, Gokhale Rd., Naupada, Thane (W) 400 602, Mumbai, India, IN Article note: Accepted: 10 May 2000