ABSTRACT
Diuretic renal scan is preferred noninvasive investigation in evaluating upper urinary tract function and assessing upper tract dilatation or obstruction. There are several protocols for diuretic renal scan which are named according to timing of diuretic administration before, after or at the same time of radiopharmaceutical injection. Timing of diuretic administration is not universally standardized in renography. In the present study we compared F-15, F+20 diuretic renography protocols in patient with upper urinary tract dilatation. From Feb 2004 to Nov 2005, 21 patients were referred with flank pain and pyelocalyceal system dilatation without ureteral dilatation in ultrasonography and after history taking, physical exams and radiological studies such as IVP, retrograde pyelogram, serum creatinin measurement and urine analysis, F-15 and F+20 diuretic renal scans were performed. The pharmaceutical drug in this study was TC-EC [Ethylene dicysteine]. Renal function data, curves and renograms were recorded and patients were undergone conservative or surgical therapy and followed up with physical exams and IVP or diuretic renal scan after 3-6 months and then we compared results with two diuretic renal scan protocols. We used marginal homogeneity test to compare renograms and paired t-student tests to compare renal function in two protocols. Among 21 cases, 15 were male and 6 were female. Mean age was 16.3 +/- 25 years. Left pyelocalyceal system dilatation was reported in 15 cases and right side dilation was seen in 6 cases. Chief complain of patients was flank pain. Ultrasound showed pyelocalyceal dilatation without uretral dilatation. IVP findings included delayed pyelogram and pyelocalyceal dilatation without seeing the ureter. Of all renal diuretic scans, 52.2 percent of patients had obstruction pattern in F-15 and F+20 protocols. Results were equivocal in 23.3% of F+20 scans whereas they had complete obstructive pattern in F-15 scans.14% had normal pattern in F+20 and F-15 scans. 9.5% had nonobstructive pattern in F+20 but equivocal or obstructive pattern in F-15 scans. Obstructions were diagnosed in 52.2% of patient by F+20 scan and in 75.5% by F-15 scan. Renal split function didn't change in F-15 and F+20 diuretic renogram protocols. According to the equivocal results of F+20 diuretic renal scans, F-15 can reduce equivocal results of F+20 diuretic renal scans. Of course we recommend future investigations to approve or disapprove this hypothesis
Subject(s)
Humans , Male , Female , Diuretics , Urinary Tract/diagnostic imaging , Urologic Diseases/diagnostic imagingABSTRACT
In Iran dipyridamole is the main agent used for coronary dilatation before myocardial perfusion SPECT. This study tries to evaluate the side effects after dipyridamole infusion and its relation with hemodynamic changes. We studied 300 patients who referred to myocardial perfusion scan. The exclusion criteria were: 1] AV block degree 2 or more, 2] Asthma 3] Sick sinus syndrome 4] LV EF<25%. Dipyridamole infusion was done with a dose of 0.568 mg/kg of body weight for 4 minutes and blood pressure and pulse rate were measured before infusion of dipyridamole and 2 minutes after termination of infusion. Patients were asked for any side effects and any complaints were recorded. Relationship between these side effects and age and sex of patients as well as hemodynamic changes were studied. 148 female and 152 male patients studied with a mean age of 55.9 years [11.1]. After dipyridamole infusion 79.3% of patients had at least one symptom, with headache [50%] and sweating [3%], the most and the least prevalent symptoms respectively. Mean heart rate increment was 8.8 and 9.2 beat per minute in female and male respectively [P=0.59]. Mean systolic blood pressure decrement was 8.5 [8.6] and 9.6 [7.1] mmHg in male and female respectively [P=0.21]. Diastolic pressure decrement was 4.6 [6.7] and 6.8 [6.3] mmHg in male and female respectively [P=0.003]. Headache and flashing were more frequent in female patients [P=0.004]. Other symptoms like dizziness, dyspnea, chest discomfort and abdominal discomfort were not different between female and male patients [P>0.08]. After dipyridamole infusion, nonspecific side effects are frequent. Headache and flashing is more frequent in female patients. Flashing is related to decrement in diastolic blood pressure