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At least 865 records · Page 48Linked to original sources
PubMed1995

111In-octreotide and 99mTc(V)-dimercaptosuccinic acid studies in the imaging of recurrent medullary thyroid carcinoma.

Detection of recurrence from medullary thyroid carcinoma (MTC) remains a diagnostic problem, especially when increased serum tumour marker levels suggest recurrence and conventional imaging techniques are non-diagnostic. In this study, we performed 111In-octreotide and 99mTc(V)-dimercaptosuccinic acid (DMSA) scans in a series of eleven patients with MTC presenting with elevated serum tumour markers after surgery. 111In-octreotide whole body studies detected tumour in six of the eleven patients studied and detected nine tumoral localizations. 99mTc(V)-DMSA whole body studies detected tumour in five of the eleven patients studied and eight tumoral localizations. 111In-octreotide and 99mTc(V)-DMSA studies detected recurrence in all four patients with basal calcitonin levels above 1000 ng/l. We conclude that 111In-octreotide and 99mTc(V)-DMSA studies have limited sensitivity to detect recurrence in patients with MTC, although their sensitivity may improve with high serum calcitonin levels. These radionuclide imaging techniques should be employed when conventional imaging techniques are negative or inconclusive or, in the case of 111In-octreotide studies, should be employed when we went to investigate the presence of somatostatin receptors that provide the basis for treatment with somatostatin analogues.

Adult↗
PubMed1993

The current role of 2,3-dimercaptosuccinic acid (DMSA) in the management of childhood lead poisoning.

2,3-Dimercaptosuccinic acid (DMSA) is an orally active chelating agent used in the treatment of lead and other heavy metal poisonings. In animals, DMSA chelates lead from soft tissues, including the brain, without clinically evident adverse effects or histopathological changes. In lead-poisoned children and adults, DMSA significantly increases urinary lead excretion, and, at least transiently, reduces the blood lead concentration. The safety profile of DMSA in both children and adults is encouraging, with few clinically apparent or biochemical adverse effects reported. However, clinical experience with DMSA is limited, and is not sufficient to exclude the possibility that other more serious drug-related adverse events including hypersensitivity or idiosyncratic reactions may occur. No data currently exist to determine whether drug-enhanced lead excretion with DMSA (or any other chelating agent) is beneficial in reducing lead-related neurotoxicity. The efficacy of DMSA in reducing neuropsychological morbidity, and additional safety data, are key areas requiring additional study before DMSA can be clearly recommended as the chelating agent of choice for the treatment of lead-poisoned children.

Administration, Oral↗
PubMed1997

Clinical applications of commonly used contemporary antidotes. A US perspective.

Poisonings are a common problem. In 1995, over 2 million exposures were reported to American poison information centres alone. The majority of poisoning exposures can be treated without major therapeutic intervention. If therapy is indicated, it is usually in the form of gastrointestinal decontamination with activated charcoal, to prevent absorption of the toxin and the subsequent toxicity that may occur. In a limited number of cases, more aggressive life-support measures may be necessary to treat the adverse effects of poisons. Occasionally, that intervention may include the use of pharmacological antagonists, more commonly referred to as antidotes. According to the American Association of Poison Control Centers, the most commonly used antidotes are acetylcysteine, naloxone, atropine, deferoxamine (desferrioxamine) and antivenins. Overall, 17 antidotes account for 99% of all antidote use and those agents are reviewed in this article. With the exception of naloxone, most antidotes have pharmacological effects that are independent of their inherent antidotal properties. Therefore, antidotes should be used judiciously because their pharmacological properties may exacerbate pre-existing toxicity and only in rare circumstances are they used prophylactically. Some antidotes, such as digoxin-specific antigen binding fragments (digoxin immune Fab), are very expensive, and both the risk: benefit ratio and the associated cost should be considered before the antidote is administered. The principle aims are to "treat the patient, not the poison' and to do no harm to the patient. Antidotes should be used only when they are indicated and may help a patient.

Acetylcysteine↗
PubMed1987

Neonatal hydronephrosis in the era of sonography.

During a 6-year period (1979-1985), 142 neonates with significant hydronephrosis were seen. Seventy-eight percent of the cases were discovered on fetal screening during obstetric sonography. Maternal/fetal intervention was virtually never indicated and most babies were asymptomatic. The most common conditions found were obstruction of the ureteropelvic junction (41%), obstruction of the distal ureter (usually primary megaureter) (23%), upper-pole hydronephrosis associated with duplex anomalies (13%), and posterior urethral valves (10%). Seventeen neonates with multicystic dysplastic kidney were seen (three per year or one for every eight with hydronephrosis). In comparison, during the 30-year period, 1947-1977, 146 neonates with significant hydronephrosis were seen. Most cases were discovered because the patients had signs and/or symptoms--either an abdominal mass (an enlarged kidney or bladder) or urosepsis. The three most common conditions were obstruction of the ureteropelvic junction (22%), posterior urethral valves (19%), and ectopic ureterocele (14%). During this period, 53 neonates with multicystic dysplastic kidney were discovered (two per year or one for every three with hydronephrosis). The dramatic increase in the number of neonates found to have hydronephrosis is primarily due to the widespread use of obstetric sonography and concomitant fetal screening. The pattern of causes before 1979 represented the incidence of symptomatic lesions. The current pattern more accurately reflects the true incidence of congenital anomalies of the urinary tract.

Humans↗
PubMed1989

CT of severe renal trauma in children: evaluation and course of healing with conservative therapy.

Over a 2-year period, blunt renal injuries were classified on a four-point scale: grade 1, contusions; grade 2, tears limited to the cortex (renal lacerations); grade 3, tears extending to the collecting system (renal fractures); and grade 4, renal vascular pedicle injuries. We report our findings in nine children with grade 2 and grade 3 blunt renal injuries who were evaluated with CT. One patient had a nephrectomy; the other eight were managed nonsurgically. Six patients had follow-up CT scans 5-19 months later to assess healing. Scars were evident in each case, and the extent of deformity paralleled the magnitude of the initial injury. One patient with a grade 2 injury and two patients with grade 3 injuries healed with small focal scars; three patients with grade 3 injuries healed with large polar scars. In five patients, the CT findings were compared with the findings on 99mTc-DTPA renal imaging. The injured kidneys contributed 30-45% (mean, 38%) of total renal function. In six patients with renal trauma who were treated conservatively, the involved kidneys healed and significant kidney function was preserved, although early surgical intervention might have been beneficial for one of these patients. Prospective studies are needed to evaluate further the effectiveness of this conservative approach.

Child↗
PubMed1991

Diagnosis of acute pyelonephritis in children: comparison of sonography and 99mTc-DMSA scintigraphy.

Ninety-one children 1 week to 10 years old with culture-documented febrile urinary tract infection were evaluated with renal sonography and renal cortical scintigraphy by using 99mTc-labeled dimercaptosuccinic acid (DMSA). On the basis of previous experimental studies, DMSA scintigraphy was used as the standard of reference for the diagnosis of acute pyelonephritis. The DMSA scans showed changes consistent with acute pyelonephritis in 63% (57/91) of the patients. Sonograms showed changes consistent with acute pyelonephritis in 24% (22/91) of the whole group and in only 39% (22/57) of the patients with scintigraphically documented acute pyelonephritis. Pertinent sonographic findings were areas of increased cortical echogenicity in 14 patients and decreased echogenicity in eight, including three patients with renal abscesses. Dilatation of the renal collecting system was noted in nine patients and renal enlargement was noted in three. We conclude that renal sonography is a relatively insensitive test for the detection of acute inflammatory changes of renal cortex. Therefore, it should not be used as the primary imaging technique for the diagnosis of acute pyelonephritis. However, sonography is a useful technique in evaluating the nature of the defects seen on the DMSA scan and in detecting obstructive uropathies that may be associated with urinary tract infections.

Acute Disease↗
PubMed1993

Sonographic measurement of relative renal volume in children: comparison with scintigraphic determination of relative renal function.

OBJECTIVE: Observer error in the sonographic estimation of renal volume in children has not been reported. Knowledge of the possible magnitude of error is important in assessing abnormalities of renal growth. This study was undertaken to determine the error of sonographic measurements of relative renal volume by comparing them with measurements of relative renal function from 99mTc-dimercaptosuccinic acid (DMSA) scintigraphy. MATERIALS AND METHODS: The study included 52 children, 2 months to 16 years old, who had DMSA scintigraphy and renal sonography on the same day. The sonographic and scintigraphic studies were interpreted independently. Relative function of the right kidney as shown by DMSA scintigrams in the direct posterior view was compared with relative volume as determined with sonography. Renal volumes were calculated by using the formula for a prolate ellipsoid. The standard deviation of the differences (SDD) between relative renal function and relative renal volume was calculated, and the limits of agreement were derived. RESULTS: Thirty-three children had normal renal morphology on both studies. Twenty-five kidneys in 19 children were abnormal on one or both studies, including 14 definitely scarred kidneys in 12 children. Relative function of the right kidney in patients with normal kidneys was 50.1 +/- 2.5%, including one possible outlying value. Normal relative volume of the right kidney was 49.1 +/- 3.1%. In patients with normal kidneys, the difference between relative function and relative volume of the right kidney was 1.0 +/- 2.8% with 95% limits of agreement of 6.7% and -4.7%. Agreement between relative function and relative volume was worse for children with abnormal kidneys; the mean difference was 2.0%, and the largest observed difference was 10.9%. Correlation between relative renal volume and relative renal function for all patients was high (r = .94), with 95% limits of agreement of 8.6% and -5.8%. CONCLUSION: The agreement between relative renal function and relative renal volume was good. In children with normal kidneys, estimated relative renal volume derived from sonography can be expected to lie within 6.7% of the relative renal function determined scintigraphically.

Adolescent↗
PubMed1995

Sonographic measurement of renal enlargement in children with acute pyelonephritis and time needed for resolution: implications for renal growth assessment.

OBJECTIVE: Failure of a kidney to grow satisfactorily in childhood is evidence of renal disease. Because kidneys may enlarge during an episode of acute pyelonephritis, concomitant renal length measurements cannot be used as baselines for growth assessment. This study was designed to determine the degree of renal enlargement in children with acute pyelonephritis and the time the enlargement takes to resolve after treatment is started to find the optimum time for obtaining baseline measurements. SUBJECTS AND METHODS: In a cohort study, 180 children younger than 5 years old with their first proven acute urinary tract infection, with or without pyelonephritis, had renal scintigraphy and sonography within 15 days of starting treatment. The presence of cortical defects on scintigrams indicated pyelonephritis. The lengths of kidneys with and without scintigraphic defects (i.e., with and without pyelonephritis) were compared, adjusting for age and sex, and the length of kidneys with defects was related to time elapsed between the start of treatment and sonography. RESULTS: Ninety-nine kidneys (28%) in 77 children (43%) had scintigraphic defects. Kidneys with defects were an average of 3.2 mm longer than kidneys without defects. Length and time interval between treatment and sonography in kidneys with defects correlated negatively, with mean length approaching that of kidneys without defects by 10-11 days. CONCLUSION: Kidneys with acute pyelonephritis initially increase in length but return to normal on average by the 11th day of treatment. If poor renal growth is used as an indication of renal disease, sonography should be delayed or repeated at least 2 weeks after the start of treatment to determine the length of the uninflamed kidney.

Acute Disease↗
PubMed2000

Comparison of two heavy metal chelators for treatment of lead toxicosis in cockatiels.

OBJECTIVE: To compare efficacy and safety of meso-2,3-dimercaptosuccinic acid (DMSA) and Ca EDTA for treatment of experimentally induced lead toxicosis in cockatiels (Nymphicus hollandicus). ANIMALS: 137 (69 females, 68 males) healthy cockatiels between 6 months and 8 years old. PROCEDURE: Lead toxicosis was induced by placing lead shot in the gastrointestinal tract. Treatment with Ca EDTA (40 mg/kg of body weight, IM, q 12 h), DMSA (40 or 80 mg/kg, PO, q 12 h), and sodium sulfate salts (SSS; 0.5 mg/kg, PO, q 48 h) was initiated 4 days after induction of lead toxicosis. Blood lead concentrations were determined, using atomic absorption spectrophotometry. Number of birds surviving and blood lead concentrations were compared among groups. RESULTS: In Phase II of the study, administration of DMSA and Ca EDTA significantly decreased blood lead concentrations when used alone or in combination in birds with lead toxicosis. Addition of SSS did not result in further decreases in lead concentrations. Eight of 12 (66.7%) birds without lead toxicosis given 80 mg of DMSA/kg did not survive to the end of the study. Lesions related to treatment with chelating agents were not detected during necropsy. CONCLUSIONS AND CLINICAL RELEVANCE: DMSA and Ca EDTA are effective chelating agents in cockatiels. Because DMSA is administered orally, it may be easier than other chelating agents for bird owners to administer at home. However, the narrow margin of safety of DMSA indicates that this agent should be used with caution.

Animals↗
PubMed2003

Effects of calcium disodium EDTA and meso-2,3-dimercaptosuccinic acid on tissue concentrations of lead for use in treatment of calves with experimentally induced lead toxicosis.

OBJECTIVE: To compare the efficacy of calcium disodium EDTA (CaNa2EDTA) and meso-2,3-dimercaptosuccinic acid (DMSA) in reducing concentrations of lead in selected tissues for use in treatment of calves with experimentally induced lead toxicosis. ANIMALS: 19 sexually intact male Holstein calves that weighed 35 to 60 kg. PROCEDURE: Calves were randomly assigned to 1 of 5 treatment groups: group 1, control calves; group 2, lead only; group 3, lead and EDTA; group 4, lead and DMSA; and group 5, lead, EDTA, and DMSA. Calves in groups 2 to 5 were dosed daily with lead (5 mg/kg, PO) for 10 days. Doses of EDTA (100 mg/kg) and DMSA (25 mg/kg) were administered IV once daily for 4 consecutive days beginning on day 11. Effects of the chelators on lead concentrations in the liver, kidneys, testes, muscles, bones, and brain were compared among the various groups. RESULTS: Compared with the effects of EDTA, DMSA greatly reduced lead concentrations in renal and hepatic tissues. We did not detect significant differences for the effects of EDTA or DMSA on lead concentrations in the testes; there was an adverse interaction of EDTA with DMSA that caused an increase in lead concentrations in the testes. CONCLUSIONS AND CLINICAL RELEVANCE: DMSA is much more effective than EDTA in removing lead from renal and hepatic tissues in calves. Use of DMSA in calves with lead intoxication appears to be a viable treatment option. Combining DMSA and EDTA as a treatment modality in calves did not offer any advantages.

Animals↗
PubMed2000

Galactosylated liposomes as carriers for targeting meso-2,3-dimercaptosuccinic acid to cadmium storage sites in cadmium exposed mice.

In this study an attempt has been made to examine the efficacy of meso-2,3-dimercaptosuccinic acid (DMSA) using galactosylated liposomes as carriers for mobilization of cadmium from the body of mice preexposed to cadmium chloride (0.005 mmoles/kg intraperitoneally daily for 4 days). Cadmium-exposed mice after a rest period of 8 weeks were administered DMSA intravenously, two injections 15 micromoles/kg with an interval of 48 h, as free form of DMSA, or DMSA encapsulated in liposomes composed of phosphatidyl choline, cholesterol and phosphatidyl ethanolamine (7:2:1; PC-lip-DMSA) or in liposomes to which p-aminophenyl galactoside had been anchored (Gal-lip-DMSA). Excretion of cadmium through urine and feces was monitored for 5 days. Thereafter animals were sacrificed, liver, kidneys, spleen and isolated hepatocytes were analysed for cadmium, copper and zinc concentration. Efficacy for cadmium mobilization from the body was found to be in the order Gal-lip-DMSA>PC-lip-DMSA>DMSA. These results show that liposomes can be used as targeted carrier system for chelating agents safely and efficiently as compared to administration of free chelating agent.

Animals↗
PubMed1979

Kidney scintigraphy with 99mTc-DMSA and 131I-hippurate.

43 patients underwent an extended scintigraphic procedure with 99mTc-dimercaptosuccinylic acid in order to investigate its proper use for diagnosing morphological and functional kidney abnormalities. The group was comprised of patients without renal disease, and patients with diffuse parenchymal disease, obstructive uropathy, renal cysts and renal tumors. The study was followed by 131I-hippurate renography. We propose a simplified routine procedure with scintiphotos taken 10-15 min after injection for topographic information and 120 min after injection for renal morphology. This procedure allows excellent case finding of diffuse parenchymal disease of a special value in cases of radiological non-visualization. The technique is indicated, when iodine contrast media cannot be used for radiological examinations. DMSA studies, however, do not allow safe functional evaluation in all categories of patients. Neither can obstructive nephropathy be diagnosed unless the renal pelvis is dilated. Renal perfusion studies are contaminated by the perfusion of liver and spleen. Nevertheless, a tentative differentiation between cysts and tumours is possible, the former being hypoperfused the latter hyperperfused. When supplemented with gamma camera 131I-hippurate renography, the total scintigraphic procedure will also include split function determination and run-off evaluation.

Humans↗
PubMed1989

Renal parenchymal damage on DMSA-scintigraphy in pelviureteric obstruction.

During a 1.5 year period 21 children were investigated with 99-m-technetium dimercaptosuccinic acid (DMSA) before operation for hydronephrosis due to pelviureteric obstruction. The age at investigation was 0.2-11.5 years. Fourty-two kidneys were examined. Hydronephrosis existed on the right side in 8 cases, left side in 9 and bilateral in 4 cases. Seventeen kidneys had no obstruction. The scintigraphy was interpreted as normal in 19 kidneys. Decreased isotope uptake was found in 23 kidneys and localized to the upper pole area in 19 kidneys, middle-lateral part in 7, lower pole area in 15 and the middle-medial part in 12 kidneys. There were no predominance for any part of the kidney to be affected by parenchymal damage. In 8 children investigated before the age of 1 year, 4 of 10 hydronephrotic kidneys revealed normal DMSA scintigram. DMSA scintigraphy delineates functioning renal parenchyma. DMSA scintigraphy delineates functioning renal parenchyma. It can be recommended as a routine method for evaluation of the renal parenchyma before surgery and for follow up studies in all ages of childhood.

Child↗
PubMed1990

Initial effect of enalapril on kidney function in patients with moderate to severe chronic nephropathy.

Angiotensin converting enzyme (ACE) inhibitors has been suggested to halt the progression of chronic renal failure. As the initial step of a controlled trial of this hypothesis, it was investigated whether start of enalapril in patients with severe chronic nephropathy might cause a critical fall in their renal function. Thirty-one patients were studied, 26 on chronic antihypertensive treatment with drugs other than ACE inhibitors and 5 untreated normotensive. 51Cr-EDTA plasma clearance and renal technetium-99m dimercaptosuccinic acid (99mTc-DMSA) scintigraphy were made before and 24 h after start of enalapril, mean dose 9 mg. Blood pressure fell from median 148/88 to 119/78 mmHg (p less than 0.01). Glomerular filtration rate (GFR) fell from median 14 to 12 ml/min/1.73 m2 (p less than 0.01). The median change in GFR was -14% (range -44% to +10%). The split renal function was unchanged and the scintigrams showed no intrarenal activity defects. In conclusion, enalapril caused a fall in GFR, which was clinically acceptable in most of the patients.

Adult↗
PubMed1980

The effect of penicillamine and 2,3-dimercaptosuccinic acid on urinary excretion and tissue distribution of gold.

In order to study interactions in vivo between Au+ and SH-containing agents, groups of mice were given 35 mumol/kg of radiolabelled [195Au] thiomalate (Myocrisin) intramuscularly. The administration of Myocrisin is known to result in protein-bound gold and free thiomalate (mercaptosuccinate). High doses of dimercaptosuccinate (1 mmol/kg daily) increased the urinary excretion of radiolabelled gold [195Au] for several days. Treatment for 7 days with 1 mmol/kg of penicillamine or dimercaptosuccinate reduced the blood and kidney levels of gold to 30--50% of the controls. The oral administration of penicillamine in high doses, 1--10 mmol/kg, increased significantly the urinary excretion of [195Au] the first day after the Myocrisin injection, but on the subsequent days the radio-metal excretion was unaffected by the treatment. A lower dose level of penicillamine (0.3 mmol/kg daily) gave rise to only a small and insignificant increase in the urinary excretion of gold. The present results indicate that penicillamine at low clinical doses is an inefficient chelator of gold, while high doses (presumably comparable to about 1 200 mg daily in humans) may mobilize certain amounts of the metal deposits.

Animals↗