R. P. Du Cret

Postoperative diuresis renography and ultrasound in patients undergoing pyeloplasty: Predictors of surgical outcome

The authors reviewed 50 pediatric patients (56 renal units) who underwent pyeloplasty and had serial preoperative and postoperative diuresis renogram and ultrasound studies. Of those patients that clinically improved with surgery, 73% and 91% showed improved renographic patterns in postoperative studies at 3 and 12 months, respectively. Ultrasound demonstrated more gradual improvement in grade and pelvic diameters over longer study intervals. Diuresis renography is an excellent predictor of surgical outcome within 3 months of pyeloplasty and showed change well in advance of that seen on ultrasound. Sonography is better suited to longer term evaluation of grade, pelvic diameter, and renal size.

Resting Tl-201 scintigraphy in the evaluation of coronary artery disease in children with Hurler syndrome.

Severe coronary artery disease may occur early in the course of mucopolysaccharidosis. The authors present radiologic, scintigraphic, and pathologic findings in five patients with Hurler syndrome. Thallium-201 myocardial scintigraphy and selective coronary angiography obtained within 2 days to 6 months were correlated in five patients. Postmortem examination of the coronary arterles was obtained in one patient within hours of angiography. Interobserver agreement on grading of scintigraphic abnormalities was poor. Nonspecific findings on TI-201 studies included septal abnormalities in all five patients. Scintigraphic findings were corroborated by angiography and postmortem results in only 3 of 5 patients. Our findings suggest that resting TI-201 scintigraphy has limited value in the detection of coronary artery disease in patients with Hurler syndrome.

The lymphoscintigraphic evaluation of patients with Klippel-Trenaunay syndrome.

Lymphoscintigraphy performed with Tc-99m-labelled antimony sulfur colloid is useful in the selection of patients for vascular microsurgery. Klippel-Trenaunay syndrome is characterized by multiple hemangiomata, limb hypertrophy, and vascular and lymphatic abnormalities. Lymphoscintigraphy findings in this syndrome are demonstrated

The significance of poor renal transplant concentrating ability as assessed by I-131 Hippuran imaging.

A pattern of very poor renal allograft concentration of 1-131 Hippuran and good bladder activity has been observed by the authors. The kidneys are typically barely visualized and the renogram curve is flat. The significance of this particular finding has not been described in the literature. Accordingly, a retrospective review of all patients exhibiting this scan pattern was performed and the authors attempted to correlate it with clinical, laboratory, and pathological findings at the time of study. Of 11 patients exhibiting this scan pattern, three had very high urine outputs at the time of study. Of the remaining eight patients, five had chronic rejection. In the remaining three patients, the diagnosis was: one each, acute rejection, mixed acute and chronic rejection, and cyclosporine toxicity. The authors conclude that although this pattern is non-specific, if the patient is not in a high output state, it is usually related to chronic rejection.

Hepatic diphosphonate accumulation secondary to malignant venous obstruction

Intense hepatic accumulation of Tc-99m methylene diphosphonate is described in the setting of vascular obstruction secondary to renal cell carcinoma. Correlation with magnetic resonance imaging and magnetic resonance angiography demonstrates vena caval and hepatic venous obstruction in a patient with sudden onset of renal and hepatic failure. The authors describe an unusual case of extraskeletal tracer accumulation secondary to metastatic disease

Nonfunctional photomultiplier tubes can produce subtle total-body scan defects.

Nonfunctional photomultiplier tubes produce subtle total body scan defects. The resultant scan shows bands of reduced activity which are far less obvious than those seen on a standard image.