Gp Bandopadhayaya

Do Healthy Potential Kidney Donors in India Have an Average Glomerular Filtration Rate of 81.4 ml/min?

Background: Until now, a normal reference range for glomerular filtration rate (GFR) in adult Indian potential kidney donors has not been determined and values from a western population are being used as reference. Aim: To determine the reference range of GFR in healthy adult Indian potential kidney donors. Basic Procedures: GFR was measured in 610 (250 male, 360 female, average age 35.16 years) healthy potential kidney donors using the 99mTc-DTPA (diethylenetriamine pentaacetic acid) two-plasma sample method of Russell. Results: The mean body surface area (BSA)-normalized GFR value of a young healthy Indian adult potential kidney donor was calculated as 81.4 ± 19.4 ml/min/1.73 m2 BSA – for males it was 82.3 ± 21.3 ml/min/1.73 m2 BSA and for females 80.8 ± 18.1 ml/min/1.73 m2 BSA. There was no significant difference between derived mean GFR values in males and females with a p value of 0.37. Conclusions: The normal GFR value for the healthy Indian adult potential kidney donor appears to be much lower than the accepted value for a western population. The mean GFR value of a young healthy Indian adult potential kidney donor is 81.4 ± 19.4 ml/min/1.73 m2 BSA, which is significantly different from the normal value of 109–125 ml/min derived from a western population. These findings might be useful in deciding on a suitable kidney donor in an Indian context.

Multiple ectopic thyroid masses in a hypothyroid child.

A 6-year-old boy presented with neck swelling and global developmental delay since birth.A small swellingwas noted in the posterior part of the tongue in the region of the foramen caecum. Thyroid stimulating hormone was grossly elevated (53 lU/ ml). Pertechnatate radionuclide scintigraphy was performed for evaluation of the neck mass (Fig. 1). This revealed the absence of normal thyroid gland in the thyroid bed, but at three ectopic locations (region of the foramen caecum, suprahyoid and in the region of the cricoid cartilage) along the path of the thyroglossal tract (triple ectopia of thyroid gland). There have been eight reported cases of dual ectopia, but this appears to be the first case of triple ectopia [1]. The thyroid gland develops from the median bud of the thyroglossal duct, which passes from the foramen caecum at the base of tongue to the isthmus of thyroid gland and descends to its normal position in the anterior neck. The ultimobranchial body that arises from a diverticulum of the fourth pharyngeal pouch of each side amalgamates with the corresponding lateral lobe. This pattern of descent explains the occasional presence of thyroid tissue in ectopic locations. Incomplete descent may lead to a thyroid mass at an abnormal position in the neck (e.g. lingual or subhyoid); excessive descent can result in a substernal thyroid. Lingual thyroid is the result of defective migration of the thyroid anlage occurring between the 3rd and 7th weeks of gestation. For the majority of cases the aetiopathology of thyroid ectopia remains unclear. Mutations in thyroid transcription factor 2, which is required for the downward migration of the thyroid gland, has been proposed as a possible mechanism [2]. The majority of patients with thyroid ectopia are asymptomatic, but obstructive symptoms and hypothyroidism have been observed [3]. Hyperthyroidism is an exceptionally rare finding.

Role of skeletal scintigraphy in advanced retinoblastomas.

Purpose: To document the incidence of skeletal metastases exclusively in advanced cases of retinoblastoma and to rationalize the use of preoperative skeletal scintigraphy in such patients. Material and Methods: Preoperative bone scans of 36 consecutive patients with advanced retinoblastoma who underwent skeletal scintigraphy during 1998 to 2003 were analyzed retrospectively. Bone scans were classified as: Grade 1 (high probability scan for skeletal metastases), Grade 2 (equivocal malignant or benign abnormalities), or Grade 3 (normal or certainly benign lesions). Results: Grade 1 scan was found in 3 (8.33%) patients; bone metastases were confirmed by additional investigations. Grade 2 scan was found in 5 (13.88%) patients; bone metastases were excluded in all by additional investigations. Grade 3 scan was found in the remaining 28 (77.77%) patients. Extraorbital extension of disease was demonstrated by fine needle aspiration of lymph nodes in five patients, which included all three patients with Grade 1 scan. In addition to lymph node metastases, two patients had intracranial extension of the disease; demonstrated by contrast‐enhanced magnetic resonance imaging of the head. One patient had liver metastases detected on abdominal ultrasound. None of the patients had skeletal metastases only. Conclusion: Routine preoperative bone scan is not justified in patients with locally advanced retinoblastoma. Bone scan should only be performed in patients with documented extraocular metastatic disease.

Diagnostic significance of semiquantitative and quantitative parameters of Tc99m-Ethylenedicystine renal allograft scintigraphy

Objectives: No objective parameters for renalallograft evaluation have yet been describedfor Tc99m-Ethylenedicystine. This studyevaluates the diagnostic significance ofdifferent quantitative and semi-quantitativeparameters of renal allograft scintigraphyusing Tc99m-Ethylenedicystine.Methods: A total of 72 renal dynamicscintigraphic studies were performed within2-weeks of renal transplantation in 42patients. The graft perfusion, kidney/aortaratio, washout index and retention index werederived from all studies. All these parameterswere evaluated for their ability to distinguishbetween a normal graft, a graft with acuterejection (AR), and a graft with acute tubularnecrosis (ATN). Histopathological verificationof diagnosis was obtained in all cases.Results: Studies were subdivided into 3groups according to histopathological findings:acute rejection (n = 42), normal (n = 18) andacute tubular necrosis (n = 12). Normalallografts were visualized with in2.66 ± 0.59 seconds of visualization ofabdominal aorta. The K/A ratio, wash out indexand retention index was 15.22 ± 6.86,1.67 ± 0.45, and 5.48 ± 0.98 respectively.Allografts with ATN were visualized with in3.36 ± 0.80 seconds of visualization ofabdominal aorta. The K/A ratio, wash out indexand retention index was 12.73 ± 6.74,0.60 ± 0.14, and 9.18 ± 1.48 respectively.In AR, allografts were visualized15.18 ± 9.48 seconds after visualization ofabdominal aorta. The K/A ratio, wash out indexand retention index was 7.07 ± 2.15,0.63 ± 0.11, and 2.26 ± 1.28 respectively.Conclusions: Retention index can separateall the three condition of normal, acuterejection and acute tubular necrosis from eachother. Retention index of <4 suggests acuterejection, a value between 4 and 7 suggestsnormal allograft and avalue of ≥7 is suggestive of acutetubular necrosis. However, perfusion, K/A ratioand washout index can not segregate all thethree groups.