Ascitic fluid filtration and intravenous infusion versus total-volume paracentesis with infusion of plasma expander in cirrhosis with tense or intractable ascites.

BACKGROUND: Patients with cirrhotic ascites have low serum albumin levels, and paracentesis of ascitic fluid could compromise them further. AIM: We compared the therapeutic efficacy of ascitic fluid filtration and concentrate infusion (AFI) versus total-volume paracentesis (TVP) with colloid infusion in control of tense or intractable cirrhotic ascites. METHODS: Ten patients underwent AFI; their ascitic fluid was filtered repeatedly through hollow-fiber hemodialyzer, and the concentrate reinfused intravenously. In ten patients TVP was done with simultaneous intravenous colloid infusion. Follow-up was done weekly and the study terminated if the patient needed diuretics or developed complications. RESULTS: Pre-study parameters were similar in the two groups. In the AFI and TVP groups, the duration of procedure was median 12 hours and 5.5 hours; fluid removed by paracentesis was 10.2 L and 8.0 L, respectively; and fluid infused intravenously was 0.5 L [with mean (SD) protein content 5.7 (1.3) g/dl] and 1.1 L, respectively. Glomerular filtration rates were lower than normal in the two groups but did not change significantly with the procedure; body weight remained significantly lower up to week 3 and week 2, respectively. The study was terminated at median week 3 (range 1-8) and week 2 (1-4), respectively. Fever was an accompaniment of AFI and one patient developed peritonitis. CONCLUSION: Patients undergoing AFI remained diuretic-free longer; the procedure is cost-effective but needs to be further evaluated to minimize the side-effects.

Bone imaging in sports medicine.

Increased participation in sports by the general public leads to increase in sports induced injuries including stress fractures, shin splints, arthritis and host of musculotendenous maladies. We have studied twenty patients referred from sports clinic for bone scanning to evaluate clinically difficult problems. It showed stress fracture in twelve patients, bilateral shin splint in five patients and normal bone scan in three patients. Present study highlights the utility of bone imaging for the diagnosis of various sports injuries in sports medicine.

Detection of medullary carcinoma of thyroid, with liver metastasis, using 99mTc DMSA(V) scintigraphy.

A sixty year old female referred for thyroid and liver scintigraphy had a clinical history of progressive swelling in the neck with hepatomegaly. A large cold area was detected in the right thyroid lobe using 99mTc pertechnetate and in the right lobe of liver using 99mTc phytate. Subsequent whole body scan with 99mTC DMSA(V) showed avid tracer uptake in right lobe of thyroid and liver. Aspiration cytology of thyroid and liver showed medullary carcinoma of thyroid with its metastasis in liver. Histopathology following thyroidectomy confirmed the diagnosis. Thus 99mTc pentavalent DMSA contributes specificity to diagnose medullary carcinoma of thyroid and metastatic lesions.

Scintigraphic detection of bile leak and follow-up in a post-cholecystectomy patient with recognition of tail sign.

Early detection of site and extent of biliary tract disruption can significantly reduce mortality and morbidity in a postoperative biliary leak. We report a case in whom extent and location of post surgical biliary leak was detected with the help of 99mTc BULIDA cholescintigraphy and showed a good correlation with "T" tube cholangiography. Cholescintigraphy was also useful in assessing the follow up of this patient. We conclude that 99mTc BULIDA cholescintigraphy is a non-invasive, safe, simple and sensitive procedure in the detection of the site, extent of the leak and in follow up of the postoperative biliary leak.

Pulmonary metastases on bone scan in a patient with osteogenic sarcoma.

This paper describes a young man who was treated with amputation for osteogenic sarcoma of the lower end of the right tibia. Pre-operative whole body bone scan with 99 mTc did not reveal abnormal tracer concentration in the lungs. A similar follow-up bone scan six months post-operatively demonstrated an area of abnormal tracer concentration in the lower lobe of each lung.

Radionuclide assessment of peritoneovenous shunt patency.

Denver shunt patency can be easily assessed by sequential scintigraphy with a Gamma camera after an intraperitoneal injection of 99mTc sulphur colloid. If the shunt is patent, the tracer will be seen throughout the shunt upto it's opening into the right atrium. The following case report illustrates the application and usefulness of this procedure.

Cholescintigraphic detection of biliary leaks.

We report four cases in whom post-traumatic or post-surgical biliary leak was detected using dynamic 99mtechnetium-iminodiacetic acid (IDA) cholescintigraphy. This technique is a non-invasive, safe, simple and sensitive method of documenting the presence, location and extent of biliary leaks. Further, it can be repeated and hence, is useful in evaluating the response to treatment. Surgery is indicated when a moderate extravasation of labeled bile suggests that the leak is the chief pathway of bile drainage, with relatively little bile entering the intestine.

Scintigraphic right-to-left liver lobe ratio and liver-to-spleen ratio in cirrhosis and non cirrhotic liver diseases.

Various criteria are used together for the scintigraphic diagnosis of cirrhosis as no single criterion may be reliable. However, low right-to-left hepatic lobe uptake ratio has been reported to be sensitive and specific for alcoholic cirrhosis. A low liver-to-spleen uptake ratio has also been reported in various hepatocellular disorders. We tested these ratios in patients with cirrhosis and non cirrhotic causes of portal hypertension. The right-to-left lobe uptake ratio was significantly lower (1.59 +/- 1.23 vs 2.36 +/- 0.63 in normals; p = 0.037) in only Child's C alcoholic cirrhosis, but the sensitivity of this ratio was low (40%) even in this subgroup of cirrhosis (mean +/- SD 1.72 +/- 1.08) as against 1 of 10 patients with non cirrhotic portal hypertension (3.57 +/- 1.33; p = 0.0005). We conclude that the right-to-left hepatic lobe uptake ratio is not a discriminatory scintigraphic sign in liver disease. A low liver-to-spleen uptake ratio can distinguish cirrhosis from non cirrhotic causes of portal hypertension.