Impact of Gate 99mTc DTPA GFR, Serum Creatinine and Urea in Diagnosis of Patients with Chronic Kidney Failure.

AIM: The aim of this study was determination of validity of 99mTcDTPA estimation of GFR for early detection of chronic kidney failure. MATERIAL AND METHODS: There were 110 patients (54 males and 56 females) with kidney disease referred for evaluation of renal function at UCC of Kosovo. All patients were included in two groups. In the first group were included 30 patients confirmed with renal failure, whereas in the second group were included 80 patients with other renal disease. In study were included only patients with ready results of creatinine, urea and glucose in the blood serum. For estimation of GFR we have used the Gate GFR DTPA method. The statistical data processing was conducted using statistical methods such as arithmetic average, the student t-test, percentage or rate, sensitivity, specificity and accuracy of the test. RESULTS: The average age of all patients was 36 years old. The average age of female was 37 whereas of male 35. Patients with renal failure was significantly older than patients with other renal disease (p<0.005). Renal failure was found in 30 patients (27.27%). The concentration of urea and creatinine in blood serum of patients with renal failure were significantly higher than in patients with other renal disease (P< 0.00001). GFR in patients with renal failure were significantly lower than in patients with other renal disease, 51.75 ml/min (p<0.00001). Sensitivity of uremia and creatininemia for detection of renal failure were 83.33%, whereas sensitivity of 99mTcDTPA GFR was 100%. Specificity of uraemia and creatininemia were 63% whereas specificity of 99mTcDTPA GFR was 47.5%. Diagnostic accuracy of blood urea and creatinine in detecting of renal failure were 69%, whereas diagnostic accuracy of 99mTcDTPA GFR was 61.8%. CONCLUSION: Gate 99mTc DTPA scintigraphy in collaboration with biochemical tests are very sensitive methods for early detection of patients with chronic renal failure.

Management of the Patient with Aggressive and Resistant Papillary Thyroid Carcinoma.

PURPOSE: Papillary carcinoma is the most frequent type of thyroid cancer and was considered the most benign of all thyroid carcinomas, with a low risk of distant metastases. However, there are some variants of papillary thyroid carcinoma that have affinity to spread in many organs, such as: lymph nodes, lungs and bones. AIM: The aim of this study was presentation of a case with papillary carcinoma of the thyroid gland, very persistent and resistant in treatment with I 131. MATERIAL AND RESULTS: A man 56 years old were diagnosed with papillary carcinoma of thyroid gland. He underwent a surgical removal of the tumor and right lobe of thyroid gland. With histopathology examination, were confirmed follicular variant of papillary carcinoma pT4. Two weeks later he underwent total thyroidectomy and was treated with 100 mCi of J 131. Six months later, the value of thyroglobulin was found elevated above upper measured limits (more than 500 ng/ml). Patient underwent surgical removal of 10 metastatic lymph nodes in the left side of the neck and has been treated with 145 mCi of radioiodine I 131. The examination after 5 months shows elevation of thyroglobulin, more than 20000 ng/ml and focally uptake of J 131 in the left lung. Patient was treated once again with 150 mCi radioiodine J 131. Whole body scintigraphy was registered focal uptake of radioiodine in the middle of the left collarbone. After a month, patient refers the enlargement of the lymph node in the right side of the neck. Currently patient is being treated with kinase inhibitor drug sorafenib and ibandronate. We have identified first positive response in treatment. Enlarged lymph node in the neck was reduced and the patient began feeling better. CONCLUSION: This study suggests that some subtypes of papillary thyroid carcinoma appear to have more aggressive biological course. Subtypes of papillary thyroid carcinoma such as diffuse sclerosing carcinoma, tall cell or columnar cell and insular variants, appears to have more aggressive biological course and need early detection and other kind of treatment.

An experimental comparison of two different technetium source activities which can imitate thyroid scintigraphy in case of thyroid toxic nodule.

PURPOSE: In cases of thyroid toxic autonomous nodule, anterior projection of Tc-99m pertechnetate image shows a hot nodule that occupies most, or the entire thyroid lobe with near-total or total suppression of the contra lateral lobe. In this case is very difficult to distinguish toxic nodule from lobe agenesis. Our interest was to estimate and determinate the rate of radioactivity when the source with high activity can make total suppression of the second source with low activity in same conditions with thyroid scintigraphy procedures. MATERIAL AND METHODOLOGY: Thyroid scintigraphy was performed with Technetium 99 meta stable pertechnetate. A parallel high resolution low energy collimator was used as an energy setting of 140 KeV photo peak for T-99m. Images are acquired at 200 Kilo Counts in the anterior projection with the collimator positioned as close as the patient's extended neck (approximately in distance of 18 cm). The scintigraphy of thyroid gland was performed 15 minutes after intravenous administration of 1.5 mCi Tc-99m pertechnetate. Technetium 99 meta stable radioactive sources with different activity were used for two scintigraphies studies, performed in same thyroid scintigraphy acquisition procedures. In the first study, were compared the standard source with high activity A=11.2 mCi with sources with variable activities B=1.33 mCi; 1.03 mCi; 0.7 mCi; 0.36 mCi; and 0.16mCi) in distance of 1.5cm from each other sources, which is approximately same with distance between two thyroid lobes. In the second study were compared the sources with low activity in proportion 70:1(source A = 1.5 mCi and source B=0.021mCi). As clinical studies we preferred two different patents with different thyroid disorders. There were one patient with thyroid toxic nodule in the right lobe, therefore the second patient was with left thyroid nodule agenesis. RESULTS: During our examination, we accurately determined that two radioactive sources in proportion 70:1 will be displayed as only one source with complete suppression of other source with low radioactivity. Also we found that covering of toxic nodules with lead cover (plaque), can allow visualization of activity in suppressed lobe. CONCLUSION: Our study concluded that total lobe suppression, in cases of patients with thyroid toxic nodule, will happened for sure, if toxic nodule had accumulated seventy times more radioactivity than normal lobe. Also we concluded that covering of the toxic nodule with lead plaque, may permit the presentation of radioactivity in suppressed nodule.

Abnormal insertion of right ureter into the left ureter associated with absence of normal right ureterovesical junction.

AIM: There are lots of factors which cause the dilatation of one or both ureteres. Congenital absence of ureterovesical junction was reported as very rare cause of megaureter. Early detection of congenital absence of normal ureterovesical junction offers utilities for reconstruction and prevents the complications such as megaureter and vesicoureteral reflux. MATERIAL AND METHODS: A male patient 16 months old was referred for renal DTPA scintigraphy confirmed previously with diagnosis as megaureter of left kidney associated with consecutive stasis grades III of the left ureter. Dynamic renal scintigraphy was performed after intravenously injection of 37 MBq Tc DTPA. Scintigraphy was carried out on a Dual Head-Siemens gamma camera using a high resolution collimator. During the dynamic scintigraphy patient was positioned in supine position. RESULTS: Male patient 16 month old with vomiting, diarrhoea, fever, indolence during last two weeks were referred for dynamic renal scintigraphy. Meanwhile patient was also performed other laboratory tests such as: RBC = 4.07 x 1012, SRE= 47, Hb = 111, Bun = 5.2, Creatinine=29 and urine proteins ++. Examinations with Ultrasound, CXR and intravenously urography confirmed diagnosis of left megaureter associated with consecutive stasis Gr.III and Stasis of left kidney gr. I-II. With dynamic scintigraphy was confirmed the absence of right ureterovesical junction followed by joining of right and left ureter at the level of the lower part of the left ureter. CONCLUSION: Renal dynamic scintigraphy demonstrates abnormal insertion of right ureter into the left ureter associated with absence of normal right ureterovesical junction, right megaureter and with vesicoureteral reflux.

Report of one interesting case--unilateral kidney agenesis associated with ipsilateral kidney malrotation, anal atresia and pulmonary artery failure.

AIM: Renal agenesis is a fairly common congenital anomaly with an unknown definite etiology. Unilateral renal agenesis is much more common than bilateral renal agenesis, but it usually does not carry any major health consequence, as long as the other kidney is healthy. In some cases, renal agenesis may by associated with other congenital anomalies. We report a neonatal female patient born with unilateral renal agenesis associated with malrotation of ipsilateral kidney, anal atresia and pulmonary artery failure. MATERIAL AND METHODS: One month old female child was referred to Nuclear Medicine Department for dynamic renal scintigraphy which performed after intravenously injection of 0.5 mCi(99m) TcDTPA. Scintigraphy was carried out on a Dual Head-Siemens gamma camera using a high resolution collimator. During the dynamic scintigraphy patient was positioned in a supine position. Furosemide, as diuretic stimulator was administered intravenously at 18th minute of the study. RESULTS: The female patient, eight months old, with cough, short breath (dispnea), fatigue, nausea, vomiting and diarrhea was referred to DTPA renal scintigraphy. Symptoms were manifested ten days before patient had undergone the renal scintigraphy. During this time the patient was under pediatrics' control. A patient has undergone the biochemistry, ultrasound and radiologic examinations. Samples were isolated from the urine culture Pseudomonas aureginosa. The patient received antibiotics (Amikacin) for seven days, whereas last five days she received salbutamole and bisolvon. During physical examination we noticed a left abdominal stoma without palpation sensibility associated with an imperforate anus. From DTPA renal scintigraphy we found the absence of a right kidney, malrotation of a left kidney associated with seriously problems during the elimination of urine. DISCUSSION: Unilateral renal agenesis usually is without any major health consequences, but in cases where it is associated with other congenital malformations, such as malrotation of existing kidney, anal atresia and cardiopulmonary anomalies can be very serious problem for life. CONCLUSION: Dynamic renal scintigraphy is very highly sensitive and helpful method for detection of renal congenital malformations and function abnormalities.