An Evaluation of Technetium-99m Tin Colloid--Its Value in the Diagnosis of Renal Transplant Rejection

The value of the Technetium-99m tin colloid (TTC) scan in thediagnosis of renal transplant rejection occurring more than1 month following transplantation was assessed. To our knowledge,use of this agent has not previously been reported. Gamma cameraimaging was performed on 15 occasions in 14 patients in whomplasma creatinine was rising and in three patients in whom renalfunction was stable. Both a qualitative and a quantitative assessmentof images was made. The radioactivity recorded over the graft at 12–16 mmpost injection was expressed as a percentage of that recordedat 0–4 min. In the nine patients in whom graft perfusionwas adequate to allow interpretation of the TTC scan and inwhom rejection was diagnosed by biopsy (six cases) or on clinicalgrounds (three cases), the index ranged from 45 to 153%. Intwo patients the graft was poorly perfused and the accumulationof TTC was predictably low despite the presence of rejection.In the seven patients with either a stable creatinine or withrising creatinine not due to rejection, the index ranged from5 to 43%. Previously reported studies have shown that sulphur colloidsmay be of value in diagnosing graft rejection. This study suggeststhat Tc99m tin colloid may be regarded as a suitable alternativescanning agent and that some simplification of data collectionand analysis can be achieved.     

Temporary loss of renal function: an unusual complication of perinephric hemorrhage after percutaneous renal biopsy

Two cases of temporary loss of function following percutaneous renal biopsy are reported. The mechanism was probably restriction of renal perfusion brought about by the compression of the perirenal hematoma.     

The WBW jugular catheter as long term vascular access for hemodialysis

Single-lumen silastic catheters were placed in the jugular veins of 12 patients to provide vascular access for hemodialysis. In all cases construction of arteriovenous fistulas had been difficult or impossible. The catheters have provided adequate dialysis with a single needle system for periods up to 32 months. Only one case of blood stream infection occurred, in a confused patient who damaged his catheter. There has been no evidence of venous thrombosis or other complications. Jugular vein catheters should be considered as long-term alternatives when A-V fistula construction is not possible.     

T Cells in Nonlymphoid Tissues Give Rise to Lymph-Node-Resident Memory T Cells

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Right atrial ball thrombus as a complication of subclavian catheter insertion for hemodialysis access

In two patients right atrial ball thrombi developed following prolonged subclavian cannulation for hemodialysis. One patient died, the other had the ball thrombus removed by open heart surgery. It appears that repeated friction of the catheter tip may have damaged the endothelium of the right atrial wall. This hitherto unrecognised complication might be prevented by ensuring that subclavian hemodialysis catheters are never allowed to reach as far as the right atrium.     

Outcome of high titer antinuclear antibody positivity in individuals without connective tissue disease: a 10-year follow-up

To ascertain the development of disease in a cohort of connective tissue disease (CTD)-negative patients 10years after testing positive for antinuclear antibody (ANA) in high titer, a telephone survey and serological tests were conducted on a group of CTD-negative patients with high ANA titer identified in a previous study. Thirty-four out of 62 patients (55%) completed only the telephone survey and 27 completed both. The mean length of follow-up was 11.5years. The ages ranged from 27 to 89years with the mean being 58.9years. The sex distribution included 4 (12%) men and 30 (88%) women. Twenty-one out of 27 patients (78%) remained ANA-positive. A total of five patients were diagnosed with CTD with two in the last 5years. Common symptoms described, in order of frequency, were joint pain, Raynaud’s phenomenon, and Sicca symptoms. This study shows that a considerable percentage of CTD-negative individuals with an initial high ANA titer continue to maintain their positivity even after an extended period. It is reassuring, however, that only a small number of these individuals go on to develop CTD. It confirms the fact that the ANA test, despite remaining a useful clinical tool, needs to be used in conjunction with other evidence and clinical judgement when attempting to validate the diagnosis of CTD.