Indirect radionuclide cystography: a sensitive technique for the detection of vesico-ureteral reflux

The detection or exclusion of vesico-ureteral reflux (VUR) has classically been by micturating cystourethrography (MCUG). Radionuclide cystography will detect VUR but fails to provide the same detailed anatomical informations as MCUG. This study allowed a comparison of indirect radionuclide cystography (IRC) and MCUG in 65 children. Renal reflux was detected by IRC in 32% of renal units, while VUR was seen in 36% by MCUG. When a comparison was made with MCUG, IRC had a sensitivity of 74.1% and a specificity of 90.5%. The markedly reduced radiation dose, avoidance of a bladder catheter plus the ability to monitor the urinary tract constantly during the entire procedure should ensure that IRC is the examination of choice in follow-up studies for VUR in all toilet-trained children.     

The value of cystography in the prediction of early urinary continence after radical prostatectomy

ObjectiveTo determine the association between vesicourethral anastomosis level (VUAL) and the condition of the bladder neck with early recovery of urinary continence on cystography after radical prostatectomy.Materials and methodsThis was a retrospective analysis of 116 patients who underwent radical prostatectomy at our hospital from 2008 to 2013. On cystography, the VUAL in the pelvic cavity was defined according to the upper margin of the pubic symphysis; above the upper margin was considered a higher VUAL and below it was considered a lower VUAL. The condition of the bladder neck was determined by whether or not there was contrast flow into the proximal urethra. Early recovery of urinary continence was defined as not requiring pads within 3 months. We determined the predictive factors for the early recovery of continence.ResultsAmong all patients, 68.1% achieved an early recovery of urinary continence. The patients with a higher VUAL were younger and had a shorter time to continence than those with a lower VUAL. The early recovery rates were 88.9% and 58.8% with a higher and lower VUAL, respectively (p < 0.001). The patients with a closed bladder neck also had better results of early continence than those with an open bladder neck (82.9% vs. 45.7%, respectively). VUAL level and bladder neck condition were independent predictors of an early recovery of urinary continence [odds ratio 5.821 (95% confidence interval: 1.632–20.75) higher vs. lower VUAL, p = 0.007; and odds ratio 5.828 (95% confidence interval: 2.259–15.036) closed vs. open bladder neck, p < 0.0001] after adjusting for age, risk of recurrence, operative method, prostate volume, and nerve sparing procedure.ConclusionPostoperative cystography can provide information on VUAL and bladder neck condition which can predict recovery of urinary continence after radical prostatectomy. A higher VUAL and bladder neck closure were associated with a higher rate of early recovery of urinary continence.     

Enhanced detection of vesicoureteric reflux with isotopic cystography

We compared the accuracy of isotope cystography (IC) and fluoroscopic cystourethrography (FC) in detecting vesicoureteric reflux (VUR) in children. FC and IC were performed in 124 children, 56 boys and 68 girls, aged 1 month to 9.2 years (mean 2.1 years), admitted consecutively for suspected VUR over a 10-month period. VUR was diagnosed by one or both studies in 51 of 124 (41%) patients. The two methods were concordant for the detection of VUR in 84% of kidney-ureter units and in 93% for the detection or exclusion of severe VUR. IC detected VUR more accurately than FC, both when all grades of VUR were considered together (P=0.00001) and when only severe reflux was considered (P=0.004). VUR was missed by FC in 23 of 51 (45%) subjects. Of those 23, 12 had severe VUR detected on one side at least by IC. VUR was missed by IC in 3 subjects. IC is significantly more accurate than FC in the initial diagnosis of VUR, even of severe grade. IC is the method of choice for the first diagnosis of VUR. Boys with VUR diagnosed by IC also need FC to investigate for posterior urethral valves. Received: 4 August 1999 / Revised: 22 November 1999 / Accepted: 23 November 1999     

Detection of low-grade vesicoureteral reflux in children by color Doppler imaging mode

Vesicoureteral reflux (VUR) is common in children with urinary tract infections (UTI) and may result in renal scarring or reflux nephropathy. To date, the primary diagnostic tool has been voiding cystourethrography (VCUG). A new technique for evaluation of grade 1 and 2 VUR is described using color Doppler imaging-mode cystography (CDIMC): 77 children, aged 7 months to 14 years, were examined for VUR by CDIMC and standard VCUG. According to the established reflux sonography (US) using a real-time mode, all patients selected for this study had a normal urinary tract on conventional gray-scale US. We studied 154 ureters, and a total of 31 were found to be refluxing on CDIMC and 30 on VCUG. A positive sonogram was defined as visualization of Doppler signals from the bladder to the ureter during the course of bladder filling. Taking VCUG as the gold standard, we had ten false-positive findings. The false-positive rate of 18.5% may have been due to the shorter observation time of fluoroscopy. Comparison of the two methods shows CDIMC to be 70% sensitive with a specificity of 92% in the detection of VUR grade 1 and 2. To evaluate the incidence of asymptomatic low-grade VUR in a non-infected population, a second series of 38 children (19 males, 19 females) aged 3 to 15 years (mean 8.8 years) with normal urologic status and urine cultures were studied by color Doppler imaging mode (CDIM) for detection of asymptomatic low-grade VUR. Four children were found to have a unilateral refluxing ureter. The incidence of VUR in children with a normal urinary tract and no prior UTI was 10.5%. In conclusion, CDIMC can be used as a possible alternative to standard VCUG for the screening and follow-up of low-grade VUR. In addition, our study indicates that asymptomatic grade 1 and 2 reflux might be a physiological condition.     

Which cystography in the diagnosis and grading of vesicoureteral reflux?

The gold standard procedure for the evaluation of vesicoureteral reflux (VUR) is the radiographic voiding cystourethrography (VCUG); direct radionuclide voiding cystography (DRVC) is an alternative method for detecting VUR. A new imaging procedure, voiding urosonography (VUS) with contrast medium, has recently been introduced. We have carried out a comparative study of these three techniques in 157 patients (aged 6 weeks–4.7 years). VUS showed the presence of VUR in 91 of 311 renal units; VCUG detected reflux in 64 of 233 renal units, and the DRVC in 23 of 78 renal units. VCUG and VUS were compared in 118 patients, and both procedures showed the same grade of reflux in 56 refluxing units (kappa value 0.92); in six cases the reflux grade was greater at VUS than at VCUG. Seven cases of reflux detected by VUS were not identified on VCUG. VCUG did not show a grade of VUR that was higher than in VUS in any patient. In the identification of 4°–5° grade reflux, the sensitivity of VUS reached 100%. VUS and DRVC were found to be equally effective in the detection of VUR (kappa value 0.85). In conclusion, we found that VUS is a useful method for the diagnosis and grading of patients with VUR.     

低浓度造影剂膀胱造影对诊断膀胱小肿瘤的价值

目的　评价低浓度造影剂膀胱造影对诊断膀胱小肿瘤的价值。方法　 1992～ 2 0 0 1年对 187例膀胱疾病患者 ,在电视的监视下经导管向膀胱内注入 6%～ 8%泛影葡胺约 10 0～ 12 0ml,摄取膀胱前后位及双斜位片 ,必要时摄头低足高位片。结果　 187例中 ,检出膀胱肿瘤 10 6例 ,其中瘤体≤ 1.0cm者 8例 ,漏诊 3例 ,检出率为 73 .0 % ,全部经手术及病理证实。 8例中 ,1例为腺癌 ,5例为移行上皮癌 ,2例为乳头状瘤。X线表现为乳头状或菜花样充盈缺损。乳头状瘤及移行上皮癌病灶可有窄基底的蒂 ,当病人变化其体位时 ,肿瘤可有一定的动度。结论　低浓度造影剂膀胱造影是一种经济实用、无创伤的诊断膀胱小肿瘤比较理想的方法     

Quantitation of vesico-ureteral reflux by radionuclide cystography and urodynamics

A method is described for the quantitation of vesico-ureteral reflux by synchronous combined direct radionuclide cystography and urodynamics. Intravesical pressures and volumes are co-ordinated with volumes of reflux. Peak reflux volumes in 11 children diagnosed as having severe (grades 3–4) reflux on conventional contrast cystography ranged from 1 to 50 ml/kidney. A number of different patterns of reflux were observed. Reflux may occur progressively throughout low pressure filling or incrementally with unstable bladder contractions. Reflux during voiding may be maximal as detrusor pressure falls. The method requires wider application to explore the potential for a functional classification of the reflux problem.     

Is there need for both intravenous urography and voiding cystography in the evaluation of children with recurrent urinary tract infections?

Summary In a prospective study 33 children (aged 6–14 years) consecutively referred for recurrent urinary tract infections (RUTI), underwent intravenous urography (IVU) as well as voiding cystography (VC). Seven children had unilateral and two children had bilateral renal scarring, while ten children had unilateral and six children had bilateral vesico-ureteral reflux (VUR). Following normal IVU VUR was demonstrated in 22% of the ureters, but in all cases of low grade. In abnormal IVU, i.e. renal scarring or dilatation of the ureters, VC showed high grade VUR in 54% of the ureters. Based on these results and the current theories on the significance of patient age and the grade of VUR, we conclude that in case of a normal IVU in children with RUTI and age of at least 6 years, there is no reason to supplement the pre-treatment evaluation with VC.     

Isotopic ratios to detect infringements of patents or proprietary processes of pharmaceuticals: two case studies

Because of the increasing problem of drug counterfeiting and the potential danger related as well as the economic losses involved, the pharmaceutical industry and the regulatory instances are interested in the development of anti-counterfeiting and patent protection methodologies. In this paper, the evaluation of measured isotopic ratios by means of explorative chemometric techniques was performed to distinguish groups in two data sets containing samples of acetyl salicylic acid and ibuprofen, respectively. The samples in the data sets originated from different countries and manufacturers. For both compounds a clear distinction of groups of samples could be obtained. These groups could be explained based on the origin of the samples, both geographically as well as based on the manufacturer. Hypotheses were formulated concerning the synthetic pathways of the molecules and they were linked to the groups obtained with the chemometric tools.     

^99mTc-hIgG在炎症性肠病诊断与随访中的临床应用

评价^99mTc-hIgG象法在炎症性肠病定位、疗效随访和预测复发中的临床价值。方法：对54例临床确诊的炎症性肠病病人在正规治疗前、41例经治疗症状得“控制和16例随访过程中症状复发者分别作^99mTc-hIgG核素显象检查。结果：①54例炎症性肠病病人中,50例出现阳性改变,其中2例假阳性,2例因发现新的放射性异常浓集修正丁诊断,4例假阴性,总灵敏度925％,特异性902％,准确率为88.9％;②41例临床缓解病人中,同位素显象出现相应减轻者38例,总符合率92．6％：④16例症状复发者中核素有异常浓集者15例,与临床的符台率为91．6％。结论：在炎症性肠病的诊断方法中,^99mTc-hIgG是一种非创伤性的辅助性方法,具灵敏度高、特异性好的优点,在疗效随访和预测复发方面有良好的实用价值。