Treatment guidelines for lead exposure in children. American Academy of Pediatrics Committee on Drugs.
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Chelating Agents↗
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Results for “Succimer”
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Imaging methods in the study of urinary tract infections in children.
UNLABELLED: When studying a child with urinary tract infection it is important to detect and localize any renal (scar) or urologic anomaly. Here we study the information obtained using: renal and vesical ultrasound (US), DMSA scan and radiologic or isotopic cystogram. METHODS: We studied 148 children with more than one urinary infection and/or pyelonephritis; their mean age was 35.9 months (1-148 months); 55% were girls. The three diagnostic examinations--US, DMSA scan and cystogram were made in this order; the DMSA scan or cystogram was never made sooner than one month after the UTI. RESULTS: In 42% of the children the three exams were normal; 4 of these children had another UTI and the urodynamic study revealed vesical disfunction. 11% had renal scars (DMSA scan) with normal US and cystogram; 30% had VUR, 50% of which had an altered US and 57% had renal scars on the DMSA scan. 12% of the children had an altered US with a cystogram showing no VUR; 66% of these had renal scars. 4% had vesical anomalies in the US and cystogram. CONCLUSION: The three exams chosen were able to direct the diagnostic approach of UTI, being sufficient in most of the cases. We would like to emphasize the importance of the DMSA scan in diagnosing unsuspected renal scars.
Acute Disease↗
Tubular reabsorption of technetium-99m-DMSA.
UNLABELLED: Intrarenal handling of 99mTc-DMSA is still controversial, particularly in the existence of tubular reabsorption from the tubular fluid. Experiments were performed with micropuncture technique on the rat kidney in an attempt to elucidate this question. METHODS: The concentration profile of 99mTc-DMSA along the nephron was measured in fluid from Bowman's space of surface glomeruli and from the proximal and distal tubules collected by micropuncture. Superficial loops of proximal tubules were micropunctured and microperfused with 99mTc-DMSA or [99mTc] pertechnetate for 10 or 20 min at physiological flow rates; the recovery of activity was measured in the final urine. RESULTS: Bowman's space urine contained only 14% of the 99mTc activity of arterial plasma, indicating low filtration of 99mTc-DMSA, likely due to high plasma protein binding. Tubular fluid-to-plasma activity ratios of 0.31 in the proximal tubules and 1.31 in the distal tubules suggest that 99mTc-DMSA is neither secreted nor reabsorbed along the nephron. Ninety-eight percent of the 99mTc-DMSA activity was recovered in the final ipsilateral urine, while only 0.5% was found in the urine of the contralateral kidney. CONCLUSION: A low fraction of 99mTc-DMSA enters the tubule by glomerular filtration and is not reabsorbed from the tubular fluid. Thus, only peritubular extraction by the tubular cell is responsible for renal uptake of 99mTc-DMSA.
Absorption↗
[Somatostatin receptor scintigraphy in medullary thyroid carcinomas, GEP and carcinoid tumors].
For this study, 24 patients with medullary thyroid cancer (MTC) and 10 with carcinoid-/GEP-tumours underwent scintigraphy with 123I-Tyr3-octreotide or 111In-DTPA-D-Phe1-octreotide (Octreoscan) or 99mTc-V-DMSA. Calcitonin and CEA were elevated in MTC patients, the other had tumour lesions on CT. Octreoscan-scintigraphy was positive in 68% of all suspicious cases. On the other hand, 123I-Tyr3-octreotide showed only rarely positive results. 99mTc-V-DMSA-scans in MTC patients were positive in 23%. Liver metastases could be seen only with Octreoscan in the non-MTC-group. These results showed better sensitivity of 111In-labelled octreotide.
Adult↗
[Fixation of tubules with radioactive technetium dimercaptosuccinate in parenchymal diseases of the kidney].
In order to evaluate tubular function 99mTc-DMS dynamic kidney scintigraphy and 99mTc-DMS uptake determinations were performed in 55 patients with endemic nephropathy, diabetic nephropathy and glomerulo nephritis. From 64-656th segment of computerized radiorenograms 99mTc-DMS uptake and curve slope were assessed and compared with the corresponding parameters of 20 healthy subjects. Both parameters were decreased in patients of all three groups. Tubular uptake of 99mTc-DMS measured during 60 sec. 4 hours after 99mTc-DMS administration, was decreased in endemic nephropathy and diabetic nephropathy, but without a significant difference in glomerulonephritic patients. The study of the relationship between 4 hour 99mTc-DMS tubular fixation and glomerular filtration rate, estimated by 99mTc-DTPA clearance, showed a positive correlation only in patients with diabetic nephropathy. Patients with renal failure from all three groups had more seriously impaired tubular handling of 99mTc-DMS, that correlated with reduction of the glomerular filtration rate. The present data showed more severe impairment of tubular function in patients with endemic nephropathy and diabetic nephropathy than in glomerulonephritic patients. The method was suitable for estimation of the tubular function.
Balkan Nephropathy↗
Lead poisoning in a radiator repairer.
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Adult↗
[Quantitative analysis of individual renal function using 99mTc-DMSA scintigram--comparison with 131I-OIH renogram].
99mTc-2,3-di-mercapto-succinic acid (DMSA) is able to be used for the quantitative analysis of individual renal function by calculating the uptake ratio. The purpose of this study is to assess the clinical feasibility of DMSA uptake ratio as compared with 131I-ortho-iodo-hippuran (OIH) renogram pattern. Two hundred eleven cases (191 patients, 1 to 87 years old) with renal disorders and 4 normal volunteers (27.8 +/- 2.4 years old) were studied. Just prior to the DMSA study in the same day, OIH renogram was carried out. They were divided into 6 types by OIH renogram patterns. In 24 cases of normal renogram pattern and normal blood data who were defined as the normal group and 4 normal volunteers, DMSA uptake ratio showed negative correlation with increasing age (r = 0.61, p < 0.05). Patients of the severe impaired functioning and the non functioning patterns showed significantly decreased DMSA uptake ratios as compared with the normal pattern. There was also a significant difference in DMSA uptake between impaired functioning patterns. Compensative hemi-hypertrophy kidneys showed significantly higher DMSA uptake ratios than those of atrophic kidneys. The possibility of the quantitative analysis of the functional compensation was presumed. In conclusion, quantitative analysis of individual renal function using DMSA uptake ratio is considered to be useful to evaluate the renal functional reserve.
Adolescent↗
[Effect of dimercaptosuccinic acid per os on distribution and excretion of 210Pb and 203Hg in mice].
Sodium dimercaptosuccinate (Na-DMS) ip 1 g.kg-1, dimercaptosuccinic acid (DMSA) ig 1 g.kg-1, DMSA ig 1 g.kg-1 with NaHCO3 or Na-citrate ig 3 g.kg-1 was given to mice, separately. It enhanced the excretion of 210Pb in urine about 3.4, 3.8, 3.6, and 2.3 times vs control, respectively within 24 h. It enhanced the excretion of 203Hg in urine about 2.4, 2.3, 3.3, and 2.7 times, respectively within 24 h. Fecal excretion was not significantly elevated vs control. Tissue radioactivities showed a remarkable decrease in the levels of 210Pb and 203Hg in most organs, but DMSA increase the 210Pb content in kidney. The therapeutic effect of ig DMSA was similar to that of ip sodium dimercaptosuccinate.
Animals↗
Primary lung cancer SPECT imaging with pentavalent technetium-99m-DMSA.
UNLABELLED: To assess the clinical role of 99mTc(V)-DMSA in primary lung cancers, SPECT imaging was performed on 31 patients with suspected lung cancer. METHODS: Planar and SPECT images were obtained at 3 to 4 hr after intravenous injection of approximately 555 MBq 99mTc(V)-DMSA. Two uptake ratios (the maximum counts/pixel in the lesion to the average counts in normal tissue) were calculated. RESULTS: Various types of primary lung cancers (adenocarcinoma, squamous-cell carcinoma, small-cell carcinoma, large-cell carcinoma and bronchial carcinoid tumor) were imaged by 99mTc(V)-DMSA SPECT. Approximately 90% of the lung carcinomas showed increased uptake and were clearly demonstrated by SPECT images. Four cases incidentally revealed osseous metastatic lesion. Three benign lesions did not show increased uptake. Three cases were false-negative and there were no false-positive cases for the primary lesions. CONCLUSION: Technetium-99m(V)-DMSA SPECT images demonstrated approximately 90% of the primary lung cancers. Uptake ratios were higher in squamous-cell carcinomas than adenocarcinomas. Evaluation of mediastinal tumor extension and nodal metastatic lesion was very difficult by high blood-pool activity in the major cardiovascular structures due to slow blood-pool clearance. However, 99mTc(V)-DMSA SPECT imaging was very useful for detecting primary lung cancers and metastatic lesions to the osseous structures.
Adenocarcinoma↗
Tissue characterization in nuclear oncology: its time has come.
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Deoxyglucose↗
[Influence of extracorporeal shock wave lithotripsy (ESWL) on renal function assessed by 99mTc-DMSA scintigraphy: comparative analysis between ESWL and percutaneous nephroureterolithotripsy (PNL)].
99mTc-DMSA renal scintigraphy was utilized to investigate the influence of ESWL on renal function in comparison with that of PNL. In the beginning, the reproducibility of renal uptake rate by the scintigraphy was examined in eleven healthy volunteers under both non-diuretic and diuretic states. The renal uptake rate was shown to be sufficiently reproducible in the same person in the two different trials. However, the differences and the standard deviations were shown to be a few percentages, which were not statistically significant. Changes in the repeated renal uptake rate seem to indicate not only changes of renal function with the treatment but also some technical errors. Herein, to investigate changes in renal function of the therapeutic side, the uptake ratio rate (rate of uptake rate in the therapeutic side/uptake rate in the contral lateral side) was utilized instead of uptake rate. Renal scintigraphy was carried out in 48 patients with unilateral renal stones before and after ESWL or PNL monotherapy or the combined ESWL and PNL therapies. Within one week of treatment, the uptake ratio rate significantly decreased in patients with PNL or the combined ESWL and PNL, although DMSA uptake rate in the therapeutic side did not significantly changes. Neither renal uptake rate nor uptake ratio rate significantly changed after ESWL treatment. There was no significant difference in changes of uptake ratio rate between Siemens Lithostars Plus and the improved Dornier HM-3 lithotriptors. This study indicated that ESWL monotherapy did not affect the uptake ratio rate, although PNL monotherapy and the combined ESWL and PNL therapies may affect the uptake ratio rate to some extent.
Adult↗
[Comparative sensitivity of intravenous urography, ultrasonography and DMSA scan in the diagnosis of vesicoureteral reflux nephropathy].
We compared the efficiency of the IVP, the ultrasound and the DMSA scan in the detection of pyelonephritic lesions during the evaluation of 165 kidneys in 83 children, aged up to 14 years, with vesicoureteric reflux. Our study showed an efficiency of 60.20% for the IVP, 29.60% for the ultrasound and 96.90% for the DMSA scan. These results clearly show that the best imaging method for detecting renal scars is the DMSA scan, followed by IVP and ultrasound.
Adolescent↗
[Renal infarction following pulmonary surgery in a 13-year-old boy].
We report a case of renal polar infarction in a 13-year old boy following surgical excision of contralateral congenital lobar emphysema. Patient history was unremarkable and yielded no data suggestive of any other underlying pathology or systemic disease. The diagnosis was made on the CT, arteriography and DMSA scan findings. The etiology could not be determined. The patient was treated conservatively with prophylactic antibiotic therapy and followed closely. There were no complications; the patient was asymptomatic one month after the episode. The control IVP showed residual segmental atrophy and ultrasound evaluation disclosed cortical atrophy. The most common cause of this condition, the diagnostic algorithm, treatments and their indications are discussed. Renal graft infarction, which may be associated with acute rejection or venous and/or arterial thrombosis, warrants special attention. The treatment and clinical course are significantly different, although the diagnosis is made using the same methods.
Adolescent↗
[Scintigraphy in the diagnosis of thyroid carcinoma].
Thyroid scans yield functional information useful in the differential diagnosis of thyroid nodules and are usually performed with TcO4-99m for its favourable physical properties, availability, low cost and good correlation with I123. Cold thyroid nodules are very frequent and generally due to benign diseases. To distinguish the minority representing carcinomas, classes of risk must be selected, according to multiple factors, including external radiation exposure, sex, age, iodine intake and thyroid morphology. These patients will undergo fine needle biopsy which can make the final diagnosis. Its accuracy is often preferred as a first line modality in the diagnostic approach to thyroid nodules. Tumour imaging agents are very useful in the staging and follow-up of thyroid carcinomas, but are rarely needed in the primary diagnosis of the disease.
Antibodies, Monoclonal↗
[Evaluation of radionuclide studies in the 8 patients with Takayasu's arteritis].
We evaluated various radionuclide studies performed in the 8 patients with Takayasu's arteritis over the past six years. Radionuclide angiography was performed in 5 patients to investigate the lesions of the branches of the aortic arch, and it demonstrated abnormalities of the affected arteries in 4 patients. Pulmonary perfusion scan demonstrated single or multiple reduced perfusion sites in all the 5 patients examined, while chest radiographies of these patients did not show any abnormalities in the reduced perfusion sites except one case. Renal scintigraphy revealed reduced renal blood flow in 3 patients. In one of those patients, MRI, CT and DSA studies could not detect any stenotic change in the renal artery. Exercise thallium scan revealed myocardial ischemic changes in 2 patients. One of them had angina pectoris, but another patient did not have any complaints. Of the 6 patients who were examined more than one kind of radionuclide studies, five patients showed abnormalities in more than one study. Ambiguous symptoms at the initial stage and rareness of Takayasu's arteritis may delay diagnosis. Radionuclide studies, which can be performed easily and noninvasively to investigate various organs and to depict multiple vascular involvement, seem to be a useful diagnostic tool of this disease.
Adult↗
[Effects of dimercaptosuccinic acid per os on copper excretion in rat].
After dimercaptosuccinic acid (DMSA) was given intragastrically by gavage (ig) 0, 250, or 500 mg.kg-1 following in CuSO4 30 mg.kg-1 daily x 3 d in rats, the Cu contents of serum increased markedly within 1-12 h. When ig DMSA daily x 3 d, the excretion of Cu in urine per 24 h in the treated group was greatly promoted vs the control (P < 0.01), that in the 250 or 500 mg.kg-1 group were enhanced 2.4-3.8 and 5.8-7.8 times, respectively. That the excretion of Cu was increased in bile but not in feces suggested the plausible existence an enterohepatic circulation.
Animals↗
Schwannoma of the extremities: comparison of MRI and pentavalent technetium-99m-dimercaptosuccinic acid and gallium-67-citrate scintigraphy.
The diagnostic value of MRI and scintigraphy was studied in patients with Schwannomas of the upper or lower extremities. MRI (T1- and T2-weighted imaging), pentavalent 99mTc-dimercaptosuccinic acid and 67Ga-citrate scintigraphy were performed in 11 patients with 12 histologically proven benign Schwannomas. All six tumors with a maximum diameter > or = 3 cm showed marked accumulation of pentavalent 99mTc-dimercaptosuccinic acid, whereas they showed no uptake of 67Ga-citrate. MRI detected all of the tumors, and the lesions had a signal intensity equal to or slightly less than that of skeletal muscle on T1-weighted images and hyperintense to that of subcutaneous fat on T2-weighted images. MRI was superior to detect small Schwannomas of the extremities. A positive 99mTc-dimercaptosuccinic acid scan and a negative 67Ga-citrate scan however is useful to distinguish sarcoma with myxoid change from Schwannoma.
Adolescent↗
Imaging in systemic hypertension in paediatrics.
The role of imaging is to establish the cause of systemic hypertension, the main focus being the kidneys. All children require a Doppler ultrasound examination followed by a radioisotope study, usually 99mTc-DMSA. This combination will resolve most clinical situations. There is no role for the intravenous urogram in the majority of children. Arteriography and renal vein renin sampling are reserved for a small proportion of children. Imaging should always start with the least invasive procedure with the lowest radiation burden and high radiation techniques reserved for selected cases. The use of ACE inhibition may allow the diagnosis of renovascular disease in paediatrics noninvasively.
Angiography↗