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The role of 99mtechnetium dimercapto-succinic acid renal scans in the evaluation of occult ectopic ureters in girls with paradoxical incontinence.

PURPOSE: We describe the use of 99mtechnetium (Tc) dimercapto-succinic acid (DMSA) renal scintigraphy to document poorly functioning and/or ectopic renal units associated with occult ectopic ureters. MATERIALS AND METHODS: During the last 8 years 6 toilet-trained girls were referred for lifelong continuous urinary dribbling. Initial radiological evaluation included renal and bladder sonography in 6, excretory urography in 4, a mercaptoacetyltriglycine-3 renal scan in 1 and cystovaginoscopy in 2. Ultimately a 99mTc-DMSA renal scan was performed in all 6 girls before surgical intervention. RESULTS: Sonography failed to establish the diagnosis of ureteral ectopia in all cases, and revealed a normal solitary kidney in 3, normal kidneys in 1, an apparently uncomplicated unilateral duplication without hydroureteronephrosis in 1 and a contralateral uncomplicated duplication in 1. Excretory urography in 4 cases was inconclusive and showed a solitary kidney in 1, ipsilateral duplication without a normal appearing upper pole collecting system in 1, contralateral uncomplicated duplication in 1 and normal kidneys in 1. A mercaptoacetyltriglycine-3 renal scan in another girl with a solitary kidney on sonography failed to demonstrate a contralateral small ectopic kidney. Cystovaginoscopy performed in 2 patients by other pediatric urologists was nondiagnostic. 99mTc-DMSA renal scintigraphy was diagnostic in all 6 cases, and revealed a small poorly functioning ectopic kidney in 3 and a poorly functioning dysplastic upper pole moiety in 3, which were consistent with a diagnosis of ureteral ectopia. An ectopic ureter was confirmed by cystoscopic and surgical findings in all girls. CONCLUSIONS: 99mTc-DMSA renal scintigraphy reliably detects and localizes hypoplastic ectopic kidneys and poorly functioning upper pole moieties associated with occult ectopic ureters in girls with continuous urinary leakage.

Child↗

[Oxidation of succinic acid in the liver mitochondria in chronic enterocolitis and after resection of the small intestine].

In liver tissue of dogs with experimental chronic enterocolitis rate of phosphorylation and P/O coefficient were decreased, when succinic acid was used as a substrate of oxidation. Within 10-40 days after resection of 1/2 part of small intestine in rats oxidation of succinate was increased with simultaneous decrease in P/O coefficient in liver tissue. In mitochondria of liver tissue on 20th and 30th day after the operation the succinate dehydrogenase activity was increased. In remote period after resection of small intestine (90 days) rates of succinate oxidation and P/3 coefficient approached the normal values, found in liver tissue.

Analysis of Variance↗

Influence of long-term hyper-gravity on the reactivity of succinic acid dehydrogenase and NADPH-diaphorase in the central nervous system of fish: a histochemical study.

In the course of a densitometric evaluation, the histochemically demonstrated reactivity of succinic acid dehydrogenase (SDH) and of NADPH-diaphorase (NADPHD) was determined in different brain nuclei of two teleost fish (cichlid fish Oreochromis mossambicus, swordtail fish Xiphophorus helleri), which had been kept under 3g hyper-gravity for 8 days. SDH was chosen since it is a rate limiting enzyme of the Krebs cycle and therefore it is regarded as a marker for metabolic and neuronal activity. NADPHD reactivity reflects the activity of nitric oxide synthase. Nitric oxide (NO) is a gaseous intercellular messenger that has been suggested to play a major role in several different in vivo models of neuronal plasticity including learning. Within particular vestibulum-connected brain centers, significant effects of hyper-gravity were obtained, e.g., in the magnocellular nucleus, a primary vestibular relay ganglion of the brain stem octavolateralis area, in the superior rectus subdivision of the oculomotoric nucleus and within cerebellar eurydendroid cells, which in teleosts possibly resemble the deep cerebellar nucleus of higher vertebrates. Non-vestibulum related nuclei did not respond to hyper-gravity in a significant way. The effect of hyper-gravity found was much less distinct in adult animals as compared to the circumstances seen in larval fish (Anken et al., Adv. Space Res. 17, 1996), possibly due to a development correlated loss of neuronal plasticity.

Afferent Pathways↗

Control of apple ripening by succinic Acid 2,2-dimethyl hydrazide, 2-chloroethyltrimethylammonium chloride, and ethylene.

Ripening of ;Tydeman's Early' apples (Malus sylvestris L.) assessed by the occurrence of the respiratory climacteric was delayed by succinic acid 2,2-dimethyl hydrazide (B-9) but not by 2-chloroethyltrimethylammonium chloride (CCC), each applied 14 days after bloom. B-9 also inhibited ethylene production by fruits exhibiting the climacteric rise. Inhibition of the climacteric by B-9 was overcome by exogenous ethylene, but the latter treatment failed to completely reverse the B-9 inhibition of endogenous ethylene production.In apple fruitlets harvested within 6 weeks of bloom, ethylene stimulated respiration but did not initiate a climacteric respiratory pattern, did not induce a color change, and did not give rise to any measurable increase in endogenous ethylene production. However, all of these changes did occur in more mature fruit. These data suggest that apples have 2 physiological stages with regard to their reaction to exogenous ethylene.

Journal Article↗

Comparison of lodging safety factor of untreated and succinic Acid 2,2-dimethylhydrazide-treated shoots of mulberry tree.

This study examined the lodging resistance of mulberry tree (Morus bombycis Koidz. cv Kenmochi) shoots treated or not treated with succinic acid 2,2-dimethylhydrazide (SADH). The lodging safety factor, an indicator of lodging resistance, was defined as the ratio of critical lodging load to the leaf fresh weight observed, provided that the distribution of the critical lodging load along the stem was similar to that of the leaf fresh weight observed. The critical lodging load was experimentally estimated by loading weights onto the stems. In the untreated trees, the lodging safety factor was maintained at about 3.2. In the SADH-treated trees, the stem elongation was inhibited to about 80% of that in the untreated trees, and the percentage of shoot dry matter partitioned into the leaves was always larger than that of the untreated trees. This dwarfing of the stem caused by SADH increased the critical lodging load supported by the unit stem dry weight, while this large investment of materials in leaves increased the leaf fresh weight supported by the unit stem dry weight. Since the increments canceled each other, the lodging safety factor of the SADH-treated shoots was similar to that of the untreated ones. These results suggest that the shoot formation of the mulberry tree is controlled to maintain the lodging safety factor at a constant level.

Journal Article↗

Enhancement by succinic acid dimethyl ester of insulin release evoked by D-glucose and glimepiride in the perfused pancreas of normoglycemic and hyperglycemic rats.

The present study deals with the insulinotropic action of the dimethyl ester of succinic acid (SAD), considered as a potential tool for the treatment of non-insulin-dependent diabetes mellitus. In the perfused pancreas prepared from either euglycemic rats or animals first infused for 48 hours with a solution of D-glucose, SAD (10 mM) markedly enhanced insulin output evoked by a high concentration of D-glucose (16.7 mM), whether in the absence or presence of glimepiride (0.5 microM). The succinate ester failed, however, to affect glucagon secretion. Thus, SAD indeed displays favourable attributes for stimulation of insulin release in type 2 diabetes, with emphasis on its insulinotropic efficiency at high concentrations of D-glucose in an animal model of B-cell glucotoxicity.

Animals↗

Suppression by exendin(9-39)amide of glucagon-like peptide-1 insulinotropic action in rats infused with dimethyl ester of succinic acid.

Glucagon-like peptide-1 (GLP-1) acts as a nutrient-dependent insulin-releasing agent, and its insulinotropic action is enhanced by nutrient secretagogues, such as the dimethyl ester of succinic acid (SAD). In the present study, a primed constant infusion of SAD (0.5 micromol followed by 0.25 micromol/min both per g of body wt) was found to increase plasma insulin concentration in fed anesthetized rats, to potentiate the B-cell secretory response to GLP-1 (0.5 pmol/g of body wt), and to unmask the hypoglycemic potential of the gastrointestinal hormone. In the SAD-infused rats, the infusion of exendin(9-39)amide (5.0 pmol/min per g of body wt), 1 min before and 3 min after GLP-1 injection, decreased plasma insulin concentration before GLP-1 injection, suppressed the B-cell secretory response to GLP-1, and both delayed and minimized its hypoglycemic action. It is proposed, therefore, that exendin (9-39)amide could represent a tool in the treatment of alimentary or reactive hypoglycemia.

Animals↗

Potentiation of glucagon-like peptide 1 insulinotropic action by succinic acid dimethyl ester.

The glucagon-like peptide 1 (7-36) amide (GLP-1, 1.0 nM) was administered to isolated rat pancreases perfused either in the absence of exogenous nutrient or presence of 10 mM succinic acid dimethyl ester (SAD). In the absence of any exogenous nutrient, GLP-1 failed to affect either insulin or glucagon release. The administration of SAD caused a biphasic stimulation of insulin output and inhibited glucagon secretion. In the presence of SAD, GLP-1 still failed to affect glucagon release, but markedly enhanced insulin secretion. These findings indicate that GLP-1 is not truly a glucose-dependent, but rather nutrient-dependent insulin secretagogue. They also suggest that non-glucidic nutrients, such as SAD, could be used to optimalize the B-cell secretory response to GLP-1 in non-insulin-dependent diabetes mellitus.

Animals↗

Succinic acid monomethyl ester protects rat pancreatic islet secretory potential against interleukin-1 beta (IL-1 beta) without affecting glutamate decarboxylase expression or nitric oxide production.

Rat pancreatic islets exposed to interleukin-1 beta (IL-1 beta) in the presence of succinic acid monomethyl ester (SAM) have a higher insulin release in response to glucose and higher glucose oxidation rates, as compared to islets exposed to IL-1 beta alone. These beneficial effects of SAM were not accompanied by any decrease in IL-1 beta-induced nitric oxide (NO) production nor inhibition of aconitase activity. Moreover, SAM did not increase biosynthesis of glutamate decarboxylase. SAM apparently improves beta-cell function mostly by increasing the capacity of these cells to endure NO exposure and partial blockage of the Krebs cycle.

Aconitate Hydratase↗

Abnormal dimercapto-succinic acid scans predict an increased risk of breakthrough infection in children with vesicoureteral reflux.

PURPOSE: The management of high grade vesicoureteral reflux remains controversial, with breakthrough infections being an indication for surgical repair. We sought to determine if technetium dimercapto-succinic acid (DMSA) scan could help predict which children are at risk for breakthrough urinary tract infection. MATERIALS AND METHODS: A retrospective review was performed on children presenting with a febrile urinary tract infection and prenatal hydronephrosis who were found to have vesicoureteral reflux and underwent a DMSA scan. Reflux was tabulated according to the highest grade. DMSA results were graded as 0-normal, no parenchymal or size defects, grade 1-focal parenchymal defects or less than a quarter of a renal unit involved, or grade 2-severe defects to include at least half of a renal unit, bilateral defects or unilateral atrophy. RESULTS: A total of 120 consecutive patients were evaluated. An abnormal DMSA scan was documented in 57 (33 females and 24 males), and 35 with grade 1 and 22 with grade 2 defects. Of the patients 53 females and 10 males had a normal scan. Of the 57 children with an abnormal DMSA scan 6% presented with grades 1 and 2 vesicoureteral reflux, 24% with grade 3, 38% with grade 4 and 26% with grade 5. Of the children with grades 3 to 5 reflux 60% had a subsequent breakthrough infection. Of the 63 children with a normal DMSA scan 11% presented with grade 1 reflux, 28% with grade 2, 48% with grade 3, 11% with grade 4 and 2% with grade 5. Of these children 5 had a subsequent breakthrough infection. CONCLUSIONS: An abnormality on DMSA scan in the presence of grade 3 to 5 reflux correlates with a greater chance of having a breakthrough infection (60%). We conclude that children with grade 3 to 5 vesicoureteral reflux and an abnormal DMSA scan are at increased risk for breakthrough urinary tract infection.

Child↗

Resistance of succinic acid dimethyl ester insulinotropic action to exendin (9-39) amide.

Exendin (9-39) amide (Ex [9-39]) was recently proposed for use in the treatment of alimentary or reactive hypoglycaemia. It was indeed found to antagonise the insulinotropic action of GLP-1 in rats infused with the dimethyl ester of succinic acid (SAD). We have now investigated whether, under comparable experimental conditions, Ex (9-39) also opposes the insulin-releasing action of SAD itself. Since this was not the case, Ex (9-39) could be safely used to abolish the incretin effect of GLP-1 without interfering with the control of insulin secretion by circulating nutrients.

Animals↗

99m Technetium dimercapto-succinic acid renal scintigraphy abnormalities in infants with sterile high grade vesicoureteral reflux.

PURPOSE: Although vesicoureteral reflux associated with bacteriuria may cause renal scarring, sterile reflux is thought not to cause renal injury. We determined the incidence and associated characteristics of renal abnormalities using 99mtechnetium(Tc) dimercapto-succinic acid (DMSA) renal scintigraphy in infants with high grade vesicoureteral reflux but no history of urinary tract infection. MATERIALS AND METHODS: We retrospectively reviewed the results of 99mTc-DMSA renal scintigraphy and renal ultrasonography performed during the first 6 months of life in infants with vesicoureteral reflux detected during the postnatal evaluation of prenatal hydronephrosis or sibling reflux screening. Those with a history of urinary tract infection, or evidence of ureteropelvic junction or bladder outlet obstruction were excluded from study. RESULTS: Of the 28 male and 6 female infants who met study criteria vesicoureteral reflux was bilateral in 25 and unilateral in 9. Reflux grade was IV or V, II or III and I in 38, 18 and 3 of the 59 refluxing renal units, respectively. 99mTc-DMSA renal scintigraphy revealed parenchymal abnormalities in 24 refluxing renal units (41%) in 22 patients (65%), of whom 19 (86%) were male and 15 (68%) had bilateral reflux. We noted differential uptake less than 40% with and without cortical defects in 10 and 7 refluxing units, respectively, and cortical defects only in 7. Of the 24 refluxing units with abnormalities 21 were associated with grade IV or V and 3 with grade II or III reflux. Ultrasound showed evidence of renal injury in only 7 of the 17 patients (41%) in whom 99mTc-DMSA scintigraphy was abnormal. CONCLUSIONS: In our study the majority of infants with high grade reflux had decreased differential function and/or cortical defects. Parenchymal defects detected by 99mTc-DMSA renal scintigraphy were often not identified by renal ultrasound. Therefore, 99mTc-DMSA renal scintigraphy is especially useful for initially evaluating infants with high grade, sterile vesicoureteral reflux.

Female↗

No further development of renal scarring after antireflux surgery in children with primary vesicoureteral reflux: review of the results of 99mtechnetium dimercapto-succinic acid renal scan.

PURPOSE: Reports of previous studies using excretory urography indicate that significant numbers of new scars developed in 5 to 31% of cases and scarring progressed in 11 to 16% after antireflux surgery. We evaluated renal scarring after surgery using a more accurate method, that is dimercapto-succinic acid renal scintigraphy. MATERIALS AND METHODS: Between 1985 and 1997 antireflux surgery was performed for primary vesicoureteral reflux in 223 children at our hospital. Of these patients 45 boys and 29 girls with a median age of 74 months at surgery in whom preoperative and postoperative renal scans were available form the basis of our retrospective study. Renal scan was performed 0.3 to 58 months (median 2) preoperatively and 5.3 to 44 months (median 18.7) postoperatively. A total of 24 children (39 renal units) were followed further by additional scanning for as long as 25 to 120 months (median 43.2) postoperatively. Each scan was blindly reviewed for the size, number and zone location of cortical defects based on morphology. Interval changes were grouped into categories as improved, no change, progressed and new scar formation. RESULTS: Postoperatively there was no ureteral obstruction. Pyelonephritis developed in 2 patients (2.7%) and asymptomatic bacteriuria was noted in 35 (47.3%) postoperatively. Of the renal units 110 (86.6%) showed no change, while 15 (11.8%) were improved and 2 (1.6%) had progression. In no case was new renal scar formation observed. CONCLUSIONS: Contrary to most previous reports involving excretory urography, our results indicate no significant progression of renal scarring after antireflux surgery. In most cases postoperative followup renal scans demonstrated no significant morphological change. When there was change, it mostly involved the disappearance or decrease of renal scars.

Child↗

Reliability of 99mtechnetium dimercapto-succinic acid uptake 2 hours after injection in hydronephrosis.

PURPOSE: The accumulation of radioactivity in the dilated collecting system potentially influences the calculation of differential renal function on the radionuclide test. We focused on this reservoir effect in unilateral hydronephrosis and assessed the reliability of calculating differential renal function by dimercapto-succinic acid (DMSA) uptake 2 hours after injection. MATERIALS AND METHODS: Unilateral partial ureteral obstruction was created in 8-week-old rats. Four weeks after surgery the animals were sacrificed 2 and 24 hours after the injection of tracer. The DMSA uptake rates of the renal parenchyma and collecting system were measured separately by autowell gamma counter. Differential function was calculated according to renal parenchymal and whole kidney (parenchyma and collecting system) uptake. RESULTS: There was a higher accumulation of DMSA in the dilated renal pelvis at 2 than at 24 hours. However, DMSA uptake in the collecting system was extremely small in comparison to that in the parenchyma. As a result; differential renal function calculated using parenchymal uptake was similar to that calculated using whole kidney uptake measured 2 and 24 hours after injection. CONCLUSIONS: Our data suggest that the pure reservoir effect of DMSA uptake at early measurement is much smaller than reported in previous experimental animal studies. Further clinical studies are needed to reexamine this reservoir effect in children with unilateral hydronephrosis.

Animals↗