Avaliação do ritmo de filtração glomerular / Assessment of glomerular filtration rate

A medida do ritmo de filtração glomerular (RFG) é a prova laboratorial mais utilizada na avaliação da função renal. Para tanto, usam-se marcadores indiretos, como as determinações de creatinina e cistatina C no sangue, ou procede-se à determinação do RFG propriamente dito, com indicadores como inulina; contrastes iodados, marcados ou não; e outras substâncias. O exame mais solicitado para avaliação do RFG no laboratório de patologia clínica é a dosagem da creatinina sérica. Em algumas condições, entretanto, o resultado encontrado da creatinina sérica deve ser corrigido (através da utilização de fórmulas que levam em consideração características próprias do indivíduo) para ser devidamente interpretado. De fato, a inulina ainda é vista como marcador ideal de filtração glomerular, mas seu uso não se destina à prática clínica, de modo que ainda hoje persiste a busca por testes adequados para uso rotineiro.

Glomerular filtration rate (GFR) determination is the most frequently used laboratorial test to evaluate renal function. Indirect markers as blood determination of creatinine and cystatin C are used with this purpose, as well as the direct determination of GFR, with indicators like inulin; iodated contrasts, radioactive or not; and others. Serum creatinine is the test that is most commonly performed in order to evaluate GFR in the clinical pathology laboratory. However, in some conditions, aiming at the adequate interpretation of the test, the result of serum creatinine must be corrected (by using formulas that include individual characteristics of the subjects). In fact, inulin is still seen as the ideal marker of glomerular filtration, but its use is not directed to clinical practice; then the search for appropriate tests for routine use continues.

GFRs Measured by Gates' Method According to 5 Background Sites: Comparison with GFR Measured by I-125-Iothalamate Method / 대한핵의학회잡지

PURPOSE: The aim was to assess how the background site affects the Gates' glomerular filtration rate (GFR) measurement using Tc-99m-DTPA in correlation with GFR by I-125-iothalamate method. MATERIAL AND METHODS: The study populations were 63 adults with 39 men and 24 women aged from 20 to 59 yrs (mean = 37.9 yrs). The following five background regions of interest were used in measurement of GFR using Gates' method: 1) lower side of each kidney (subrenal), 2) around each kidney (circumferential), 3) upper side of each kidney (suprarenal), 4) lateral side of each kidney (lateral), 5) between the two kidneys (inter-renal). We also measured GFR using I-125-iothalamate in each subject. The two studies were separated by 1 to 3 weeks. The subjects were divided into two groups by renal depth. Group 1 with renal depth> or=7cm and group 2 with renal depth or=7cm. CONCLUSION: GFRs measured with Gates' method showed higher correlation with the GFR measured by I-125-iothalamate when the regions of interest were placed over the suprarenal and inter-renal backgrounds. And GFRs measured with Gates method showed statistically significant correlation with the GFR measured by I-125-iothalamate in the group with renal depth < 7cm.

Reacciones adversas a medios de contraste de alta osmalaridad. Estudio comparativo--prospectivo / Adverse reactions to high osmolarity contrast media. A comparative-prospective study

The purpose of this study was to verify and compare the different types of reactions to iodinated contrast media available at the Social Security Metropolitan Hospital Complex: Conray 60%, Vascoray and Uromiron. These are ionic, high osmolality compounds. The authors found that, in 400 patients not only the osmolality had an important role in the reactions observed, but that the intrinsic nature of the molecule of the contrast medium used was the determining factor

Comparison of side effects in myelography with Iopamidol and Metrizamide

The study was conducted to compare the side effects in myelography of the two non-ionic water-soluble contrastmedias, Iopamidol(Niopam) and Metrizamide(Amipaque). A total of 111 patients were examined, 64 with Iopamidol and47 with Metizamide. Side effects consisted of headache, nausea, vomiting, dizziness, urinary difficulty, muscularpain, seizure, neurobehavioral distrubance, neurologial sign change, vital sign change and etc. The common sideeffects were headache, nausea, vomiting and dizziness in order of frequency. Most of the side effcts were subsidedwithin 24 hours following meylography. Iopamidol myelography caused fewer and milder side effects than Metrizamidestudy. The side effects were more commonly observed in cervial, thoracic or total myelography than in lumbarmyelography with either lopamidol or Metrizamide. There was no significant correlation between incidence of theside effects and premedication with phenobarbital or valium injection before myelography and CSF sampling duringthe procedure.

Uso e análise de um meio de contraste de baixa osmolalidade em angiografia cerebral / Use and analysis of a low osmolality contrast media in cerebral angiography

Os Autores apresentam sua experiência e resultados obtidos de forma satisfatória no emprego do ioxaglato de sódio e meglumina (Hexabrix) em 43 angiografias cerebrais realizadas sob anestesia local, com excelente opacificaçäo ao exame radiográfico, reaçöes secundárias pouco significativas, auxílio do paciente ao exame, ausência de dor ou desconforto e maior economia

Interacao de agentes curarizantes com contraste radiologico. / Interaction of curare-like agents with radiologic contrast

O acido ioxitalamico, um contraste radiologico que induz raramente a efeitos colaterais, foi estudado na dose de 0,1 mg/kg, isoladamente e em associacao com o brometo de pancuronio (0,04 mg/kg) e com o cloreto de succinilcolina (0,5 mg/kg) quanto a sua acao sobre a funcao mioneural de 30 caes.Os resultados mostraram que esse contraste nao atua isoladamente ou associado aos agentes curarizantes, sobre a juncao mioneural, nem altera o efeito destes. Entretanto, um animal apresentou efeito mio-relaxante prolongado, com associacao do contraste com o brometo de pancuronio. Dois caes, descartados da experiencia, apresentaram reacoes anafilaticas com o contrast

Intraosseous Epidural Venography of the Skull Base by the Injection of a Contrast Medium into the Occipital Condyle

Intraosseous venographic features of the skull base have been studied by the injection of a water-soluble radiopaque medium in the occipital condyle. By this method, the whole intracranial epidural venous structures of the skull base were demonstrated without overlapping of the extracranial vein, except jugular veins and upper cervical vertebral venous plexi. Since 1966, a total of 82 venographies have been performed for the diagnosis of various lesion in the skull base. This series consisted of acoustic neurinoma(3), jugular glomus. Tumor(2), pituitary adenoma(6), sphenoid ridge meningioma(1), metastatic tumor(7), venous malformation(8), pachymeningitis externa(22), parasite infestation(3), trigeminal neuralgia(3), pseudotumor cerebri(16) and others(11). METHOD: Under premedication of Seconal 100 mg and Demerol 50 mg, the patient is placed in the Bowen-Hirtz position. However, until the plain roentgenogram is taken the patient may used a pillow for a comfortable interval. The skin of the mandibulomastoid region is prepared with iodine. A procaine wheal on superficial tissue is made 0.5cm below the lowest attachment of the pinna. Through the wheel an 18-guage spinal puncture needle is introduced in a slightly superior and posterior direction(superior 20 degrees Angle, posterior 10 degrees Angle) until the body surface is touched. The needle is further introduced through the body cortex by steady pressure and rotation. When the needle is firmly fixed the stylet is withdrawn and blood is aspirated from the needle as if in a vein. If free injection with 3-5cc of a saline is established easily by hand, the stylet should be replaced as before. The pillow is then removed and a plain X-ray film, submentovertical view, is taken. After confirmation of an adequate placement of the needle to the occipital condyle on the roentgenogram, an injection of 30cc of 60% angioconray is made as rapidly as possible by hand or a pressure injector. This is the only part of the examination that may cause discomfort to the patient. A film should be taken toward the end of the injection. One film is usually sufficient. Manual jugular compression and/or Vasalva maneuvers, to increase opacification, may be used but its efficacy is not always sufficiently constant. Satisfactory jugular compression can be obtained by use of a sphygmomanometer cuff, adjusted around the neck and inflated up to about 50 mmHg. With this technique the whole venous structure of the skull base, including the middle meningeal and orbital sinuses, can be visualized. This method, because of the close situation of the occipital condyle, has the advantage of demonstrating the whole marginal sinus of the foramen magnum and the upper cervical vertebral venous plexi. To date no complication have been encountered. Its diagnostic significance is gratifying in detecting the extent and localization of space-occupying lesion, inflammatory processes and venous thrombosis or malformation of the skull base.