Non invasive assessment of renal failure: comparison between the different available techniques to discriminate different causes of acute renal failure [ARF] from chronic renal failure [CRF] with normal kidney size

Forty-one uremic cases presenting to the emergency of nephrology section and 10 normal control subjects [N] were assessed clinically and biochemically [serum levels of urea, creatinine, uric acid, sodium, potassium, calcium and phosphorus and estimation of FENa] by abdominal ultrasonography, color Doppler of renal arteries and static [DMSA] and dynamic [DTPA] renal scintigraphy. Clinical assessment, follow up and/or renal biopsy showed that uremic cases had ARF due to acute tubular necrosis [ATN] in 16, obstructive uropathy[OBST] in 12 and CRF in 13. ATN showed very high FENa [17.7 +/- 10.5% vs 0.69 +/- 0.19, 13.4 +/- 12.9 and 10.1 +/- 5.6 in ATN, N, OBST and CRF cases, respectively], normal DTPA perfusion with poor DTPA accumulation, flat renogram with very long T1/2 and very high resistivity indices of intrarenal arteries measured by D. OBST showed pelvic caliectasis by US, impaired DMSA uptake, impaired DTPA perfusion with fair DTPA accumulation, rising renogram during the excretory phase with very long T1/2 and very high resistivity indices of intrarenal arteries measured by D. CRF had very high resistivity indices, impaired DTPA perfusion and accumulation with poor excretion, flat renogram with very long T1/2 and very high resistivity indices of intrarenal arteries measured by D. Follow up of ATN and OBST cases showed incomplete normalization of US, D and [DTPA] renal scintigraphy in spite of clinical and chemical recovery. The study concluded that the most reliable noninvasive tool in discriminating cases presenting acutely with uremia is radioisotopic static [DMSA] and dynamic [DTPA] renal scintigraphy. Moreover, clinical, biochemical, ultrasonographic and Doppler studies are neither specific nor sensitive tools in such field. Also, the kidneys did not usually recover completely after ARE

bacteriological study of the oral ecology in irradiated head and neck cancer patients

This study was carried out on eleven normal controls and thirty head and neck cancer patients who received a full tumericidal dose [6000 cGy] of Cobalt 60. For all subjects studied [patients and controls], samples of saliva were collected and cultured under aerobic conditions. Samples were taken from the irradiated patients, before, in the middle, at the end and six months after completion of irradiation, for quantitative and qualitative bacteriologic evaluation. The main change was in the staphylococci where there was marked increase in percentage of cases with positive culture for Staph aureus, marked decrease in Staph-albus and complete absence of Staph- citreus. The Gram-negative bacilli were absent and appeared at the end of irradiation. From this study it was found that the post-operative oral sepsis in previously irradiated patients is not only due to the immunological depression of patients but also due to the changes in the oral bacterial ecology