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Biomedical subjects

E V Dubovsky

Publications and source records attributed to E V Dubovsky.

70 records · Page 4Linked to original sources
PubMed1981

Measurement of effective renal plasma flow in congestive heart failure.

In the management of patients with congestive heart failure (CHF), it is often desirable to have precise knowledge of overall renal function, including the effective renal plasma flow (ERPF). It has long been recognized that ERPF is diminished in CHF. Since glomerular filtration rate is often decreased to a much lesser extent, other noninvasive procedures such as the measurement of creatinine clearances may not be entirely suitable. ERPF determination by the single plasma sampling (SPS) method affords a rapid, simple, noninvasive, and economical technique that is quite accurate and reproducible. A SPS method has been well-tested in patients following renal transplantation plus a wide variety of nephrological disorders. We have been concerned whether the SPS method would be valid in volume expanded patients. In 28 determinations of ERPF in patients with CHF, and in five patients who did not have CHF, we have found the SPS estimation of ERPF to yield results that are not clinically significantly different from those obtained by the detailed compartmental analysis method. The volumes of 131I-orthoiodohippurate (OIH) distribution were found to be somewhat higher in CHF than in controls, but fractional rate constants were proportionately lower so that intercompartmental flow rates and OIH concentrations were not different from controls. Therefore, the SPS estimation of ERPF is valid in patients with CHF and may be useful in monitoring the renal effects of various hemodynamic and pharmacological interventions.

Adult↗
PubMed1981

Comprehensive renal scintillation procedures in spinal cord injury: comparison with excretory urography.

A 131iodine orthoiodohippurate comprehensive renal scintillation procedure was performed and compared to results of excretory urography in 200 spinal cord injury patients. No severe urographic abnormalities were undetected by the comprehensive renal scintillation procedure. Only 1.4 per cent of renal units had greater than minimal pyelocaliectasis or ureterectasis in the presence of a normal radionuclide examination. A relatively large number of abnormalities were detected on the renal scintillation procedure when the excretory urogram was normal. Serial followup will be required to determine the significance of these findings but present data suggest that a comprehensive renal scintillation procedure and a plain film of the kidneys, ureters and bladder may be used for screening upper urinary tract abnormalities in lieu of an excretory urogram. This is particularly advantageous for the spinal cord injury population, since there have been no toxic or allergic reactions reported, no bowel preparation or dehydration is required and there is relatively low radiation exposure.

Humans↗
PubMed1980

A macrofunction for computer processing of comprehensive renal function studies.

Details of a series of computer programs associated with a complex renal function procedure, all linked together into a single "macrofunction" are presented. Input consisted of not only in vivo nuclear medicine information, but also data concerning patient identification, urine volumes, voiding time, urine specific gravity, blood pressure and other pertinent information. Computer output consisted of images, curves and typed information presented in an integrated format ready for inclusion into the patient's record. Clinical evaluation of this comprehensive renal function macrofunction has proved to be useful, econominal, rapid and accurate. It has conveniently sorted a wide variety of disease states and provided clinical information not available from any other non-invasive technique.

Adult↗
PubMed1980

Diagnosis of impaired renal function after kidney transplantation using renal scintigraphy, renal plasma flow and urinary excretion of hippurate.

The use of 131I-orthiodohippurate (OIH) scintigraphy combined with the estimated renal plasma flow (ERPF) and excretion index (EI) has been beneficial in separating impaired renal function due to graft rejection from acute tubular necrosis, ureteral obstruction, urinary extravasation and in some instances renal artery occlusion. The radionuclide data accurately identified acute and chronic rejection, confirmed by the clinical course, increase in BUN and serum creatinine and on occasion renal biopsy. Reversible and irreversible acute tubular necrosis (ATN) were clearly differentiated from acute rejection. When the ERPF and EI were plotted on a graph, multiple sequential radionuclide studies accurately predicted graft survival when chronic rejection existed. The limitation of this technique was the inability to discriminate between renal artery stenosis, ureteral obstruction and inflammatory disease. Scintigraphic studies did not distinguish between renal artery stenosis and chronic rejection. In these circumstances arteriography was the diagnostic procedure of choice. Although ureteral obstruction often can be correctly diagnosed by scintigrams, the ERPF, EI and intravenous pyelogram remained the most accurate diagnostic procedures. Recurrent glomerulonephritis, gram negative septicemia and generalized viral illness (herpes zoster or cytomegalovirus) simulated acute rejection and had to be separated by renal biopsy or the clinical course. The most valuable features of the radionuclide technique included: 1) the noninvasive method, 2) the simplicity, 3) the rapidity and 4) the reproducibility.

Adolescent↗
PubMed1978

Radionuclide kidney function evaluation in the management of urolithiasis.

Renal and ureteral stones may cause asymmetrical renal damage that is not measured accurately by serum creatinine and blood urea nitrogen studies, excretory urography, nephrotomography and arteriography. We evaluated with a renal scintillation camera study 77 patients who had renal or ureteral calculi. The radionuclide procedure provided an accurate measure of total effective renal plasma flow and differential effective renal plasma flow. It had the additional advantages of being a non-invasive procedure, causing no allergic reactions, requiring no patient preparation and producing low radiation exposure.

Adult↗
PubMed1978

Technique of scanning for Meckel's diverticulum.

99mTc-pertechnetate scanning is now recognized as a useful means of detecting Meckel's diverticula. When these contain gastric mucosa and present with ulceration and bleeding, the ectopic gastric mucosa can be identified by its secretion of 99mTc-pertechnetate. However, the secretions of normal gastric and salivary glands can pool in the gut and simulate a Meckel's diverticulum. We believe the diagnostic procedure of choice to include both continuous nasogastric suction and continuous sequential gamma camera images. To support this view, we present cases illustrating 1) that 99mTc-pertechnetate can appear in the bowel within the first few minutes of administering 99mTc-pertechnetate, even in the absence of a Meckel's diverticulum; 2) that rapid sequential camera views are helpful but not definitive in distinguishing such bowel activity from a Meckel's diverticulum; and 3) that continuous nasogastric suction most successfully eliminates this interference.

Adult↗
PubMed1978

Liver-kidney relationship in radioisotopic localization of retroheptic and subhepatic masses.

Combined liver-kidney scintigrams in 46 patients were obtained by administering two radiopharmaceuticals labeled with 99mTc. A mass in the right adrenal or subhepatic area was demonstrated as a void or absence of activity between the organs. Normally, the activity in the liver and right kidney blends together so visual separation of organs is not possible. Two clinical cases, including ultrasonic and angiographic studies for comparison, are presented.

Abdominal Neoplasms↗
PubMed1977

Differentiation of cell-mediated and humoral rejection by orthoiodohippurate kinetics.

The differentiation of two types of renal graft rejection may be made early in incipient stages by means of a comprehensive renal function study. In the acute cell-mediated form, prolongation of orthoiodohippurate renal transit time as reflected in a diminished excretory index (El) is first observed, followed by a diminution in the effective renal plasma flow (ERPF). On reversal of the process, El precedes ERPF in returning to normal. In chronic humoral rejection, the principle feature is simple reduction of ERPF; transit time within the kidney appears normal. No reversal processes have been observed, although the process may be decelerated. At approximately 100 ml/min ERPF, these kidneys may undergo an acceleration of the clinical failure with rapid deterioration in El and in ERPF. At this point, surgical removal of the kidney has been carried out.

Acute Disease↗
PubMed1975

Comprehensive evaluation of renal function in the transplanted kidney.

By means of a comprehensive renal function test based on the analysis of orthoidohippurate kinetics carried out 223 times in 86 renal transplatn patients, we have been able to separate clearly five clinical entities: normally functioning transplanted kidneys, acute tubular necrosis, cell-mediated rejection, humoral (chromin) rejection, and postrenal obstruction. Accurate prediction of the fate of the rejecting kidney can be made while still subclinical as much as a week before manifestations by other techniques are evident. Data on 22 donors studied 44 times are also presented. The comprehensive test consists of measurements of effective renal plasma flow (ERPF), sequential scintigraphy, calculations of excretory index (EI) (percent dose actually found in bladder and voided urine as a fraction of the percent dose expected at a given time after injection at the patient's specific ERPF), and residual urine volume. Formulas and regression equations for the calculation of ERPF, EI, residual urine, etc., are presented.

Female↗