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Bilioduodenal and biliojejunal anastomoses are effective for the treatment of biliary obstruction. The objective of this study was to compare the effects of these anastomoses on hepatobiliary excretion and enterobiliary reflux. Enterobiliary reflux and biliary excretion were evaluated respectively after oral administration of technetium ((99m)Tc) in combination with sodium phytate and intravenous infusion of (99m)Tc with diisopropyl-iminodiacetic acid. Enterobiliary reflux occurred to an equal degree in the bilioduodenal and biliojejunal groups. Maximum hepatic activity time (T(max)) and radiotracer clearance half-time (T(1/2)) were similar in both groups. However, when compared with that found for the sham-operated group, T(max), and T(1/2) were higher in the biliojejunal group (P = 0.02 and P = 0.01, respectively). Histopathological analysis showed marked reduction in ductal proliferation in both groups. These data undermine the theoretical advantages attributed to biliojejunal anastomosis and further the understanding of the pathophysiology of cholangitis that occurs even with patent anastomosis.

Acute tubular necrosis (ATN) is a major complication of kidney transplantation, so as of urologic and vascular surgeries. In transplantation, although organ perfusion with proper solution are feasible and at least partially effective, new approaches remains needed to avoid lost of graft function due to ischemic insults, and by this way, chlorpromazine may play this hole. Sixteen male rats were evaluated by scintigraphy (dynamic renal scan with Tc-99m-MAG 3 ), before and after surgically promote ischemia of left kidney. Animals were divided in 3 groups: Group A (control) without ischemic insult; Group B (ischemia without chlorpromazine) and Group C (ischemia with chlorpromazine). Group B demonstrated marked decreased of left renal function, compared with itself (right kidney; p<0,001) and compared with groups A and C (both p<0,001). No statistically observations was noted in group A, that makes sure of non-error source of surgical procedure lonely (p<0,05). Nevertheless mild decrease of left renal function was observed in some animals of group C, these appointments were not statistically significant (p<0,05). Further studies may prove, in the future, its usefulness in humans, specially concerning kidney transplantation. Available from URL: http:// www.scielo.br/acb

RDP is a frequently encountered artifact in obese patients undergoing rest/stress Tc-99m sestamibi SPECT, particularly in men with abdominal protuberance and in women with large, dense breasts.

Typical (TPP) and atypical (APP) perfusion patterns (PP) may be seen in ictal SPECT of patients with temporal lobe epilepsy (TLE). APP may pose problem in the lateralization of the epileptogenic zone (EZ). We aimed to investigate predictive variables for the occurrence of TPP and APP. Fifty-one TLE patients were submitted to successful anterior-mesial temporal lobectomy. Univariate (UVA) and multivariate (MVA) analysis were performed upon clinical data, distribution of interictal spikes, and ictal chronology of seizures. From MVA, a final predictive model (FPM) was determined to better predict TPP and APP. Forty patients showed TPP (78.5%) and 11 patients APP (21.5%). Accuracy of ictal SPECT was higher in the unilateral (UIS) than in the bilateral (BIS) interictal spikes group (P = 0.05). FPM showed that patients exhibiting BIS, with shorter proportion of the electrographic seizure occurring after completion of tracer injection, and longer clinical than EEG seizure duration had more APP (P = 0.003). Generalized tonic-clonic seizures did not result in more APP. We concluded that analysis of ictal SPECT in TLE requires the knowledge of TPP and APP, the distribution of interictal spikes on temporal lobes and the ictal chronology of seizures. BIS showed that beyond a more complex epileptogenicity and seizure propagation, they may also lead to APP.

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PURPOSE:Fetal hydronephrosis is a frequent finding due to advances in prenatal ultrasonography. The definition of fetal and neonatal urinary tract obstruction is a very difficult task requiring confirmation of reduced renal function and hydronephrosis. In this study we followed a series of consecutive patients with intrauterine hydronephrosis that persisted during post-natal life. METHODS:116 newborns with antenatal hydronephrosis diagnosed by ultrasound and submitted to a specific post-natal evaluative protocol with a follow-up period of 6 years. RESULTS:In 45 (38.8%) of 116 patients, ureteropelvic junction (UPJ) obstruction was confirmed and surgical correction of the UPJ obstruction was done in 19 patients. From 26 children who were initially submitted to non-surgical treatment, only 6 (23%) needed a surgical approach during follow up. Overall analysis showed that surgery was performed in 25 patients with UPJ obstruction, and the others 20 patients were kept under clinical observation, since normal renal function was confirmed by scintigraphy scans. CONCLUSION:Fetal hydronephrosis due to UPJ obstruction deserves careful postnatal evaluation. UPJ obstruction is the most frequent anomaly and its surgical treatment has very precise indications. The evaluative protocol was useful in identify patients that could be followed-up with a non-surgical approach.Key words: Hydronephrosis. Prenatal Diagnosis. Radionuclide Imaging. RESUMO OBJETIVO:Com a ampla utilização dos exames ultrassonográficos na avaliação pré-natal, é frequente o diagnóstico da hidronefrose fetal. A definição de obstrução do trato urinário no periodo pós-natal necessita da confirmação de redução da função renal além da hidronefrose. Neste estudo, acompanhamos uma série de pacientes consecutivos com hidronefrose intra-útero que persistiu no periodo pós-natal. MÉTODOS:116 recém-nascidos com hidronefrose pré-natal diagnosticada pela ultrassonografia foram submetidos a protocolo específico de avaliação e companhados pelo periodo de 06 anos. inicialmente para observação clínica, apenas 6 (23%) necessitaram cirurgia durante o seguimento ambulatorial. Na análise geral, o procedimento cirúrgico para correção da estenose da JUP foi indicado em 25 pacientes. Nas outras 20 crianças não houve necessidade da realização da cirurgia. RESULTADOS:CONCLUSÃO: a hidronefrose fetal requer cuidadosa avaliação pós-natal. A estenose da junção pielo-ureteral é a anomalia mais frequente como causa da hidronefrose, e sua correção cirúrgica tem indicações precisas. O protocolo aplicado foi útil em diferenciar pacientes que não necessitaram cirurgia para tratamento da estenose da JUP. Descritores:Hidronefrose. Diagnóstico Pré-natal. Cintilografia.

Intrapulmonary vascular dilatations (IPVD), diagnosed by transthoracic contrast-enhanced echocardiography (CEE), can be observed in 13% to 47% of individuals with liver cirrhosis. 1,2 Despite the presence of IPVD, most patients are not characterized as having hepatopulmonary syndrome (HPS), since the diagnosis of this syndrome requires the presence of abnormal arterial oxygenation (partial pressure of arterial oxygen Ͻ 70 mm Hg, or alveolar arterial oxygen gradient Ͼ 20 mm Hg). 3,4 One of the major controversies is whether cirrhotic individuals with IPVD but without changes in arterial oxygenation are affected by HPS in the early phase and whether these alterations would appear during followup. 5 To our knowledge, there are no prospective studies of the evolution of pulmonary parameters in cirrhotic individuals with IPVD but without changes in arterial oxygenation. Would these patients fulfill HPS criteria during follow-up?In our series 6 of 56 cirrhotic patients on a waiting list for orthotopic liver transplantation, the frequency of IPVD was 45% (25 patients). Among these patients, 16 (64%) did not fulfill the criteria for HPS, confirming the high frequency of IPVD in cirrhotic subjects without HPS. These patients were followed prospectively to assess the evolution of pulmonary parameters. Of 16 cirrhotic patients with IPVD without changes in arterial oxygenation, 12 were excluded from the study, 11 due to death (after exploratory laparotomy [1], cancer of the larynx [1], digestive hemorrhage [5], spontaneous bacterial peritonitis [2], orthotopic liver transplantation [1 sepsis and 1 hemorrhage]) and 1 because he was submitted to orthotopic liver transplantation. Mean follow-up of the excluded patients was 13.8 months (2-28 months). The complementary tests were not repeated in any of the excluded patients. Thus, the final series consisted of 4 patients with a mean follow-up of 24 months (21-30 months). All patients were submitted to contrastenhanced echocardiography and measurement of arterial blood gases at the beginning and at the end of follow-up. The results are presented in Table 1. The contrast-enhanced echocardiography remained positive in all patients. No patient presented significant changes in arterial oxygenation that would characterize him as having HPS. The present data suggest stability of the pulmonary parameters during the 2-year follow-up period.The causes of the high mortality rate of our patients did not seem to be related to the presence of HPS, both because of the absence of pulmonary causes and because of the short period of time between the diagnosis of IPVD and death. Schenk et al. 7 demonstrated that not only the presence but also the severity of HPS are related to the survival of cirrhotic patients. It should be emphasized that our patients did not have HPS nor did they present alterations in gas exchanges. In addition, our patients with HPS 6 tend to have mild degrees of the syndrome, in contrast to the data reported by Schenk et al. 7 However, although this is unlikely, we cann...