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Radioisotope Renography* 1 October 1966 S.A. JOURNAL OF RADIOLOGY 27 the kidney could in fact sometimes be due to such obstruc­ 7. Bowman. W. qUOted by Lewis, O. J. (1842): Phil. Trans. B., 132, 57. 132, 57. tion. I approached Dr. P. Maas," Senior Urologist at the 8. Boyle. R. (1668): Of rhe Usefu/Iless of Narura/ Phi/osoph}·. Oxford. 9. Brewer, G. E. (1897): Jber. ges. Med.. 33, 24. Pretoria General Hospital and Pretoria University, and in 10. BrOde!. M. (1901): Bull. Johns Hopk. Hosp.. 12, 10. a verbal communication he confirmed that he had, in fact, 11. Chatain, 1. (1959): Anal. Rec.. 133, 2. 12. Chatterjee. S. K. and Dutta. A. K. (1963): J. Ind. Med. Assoc., 40. come across such cases at operation. no. 4. 13. Chaiudano, C. (1955): Arreriografia Rena/e. Torino: Cane & Durando. 2. In 26 (31·7~o) of the 82 cases there was foetal 14. Czeck. B. and Weiman, Z. (1962): Folia Morph. (Warszawa), 13, 171. 15. Eisendrath. D. N. (1920): Ann. Surg.. 71. 726. lobulation of the kidney (Fig. 8). One should therefore 16. Idem (1930): J. Urol. (BaJtimore). 24, 173. not be too hasty to diagnose pyelonephritis merely on 17. Eisendrath, D. N. and Strauss, D. C. (1910): J. Amer. Med. Assoc.. 55, 1375. [he finding of an irregular renal outline on a plain radio­ 18. Eralp, IIhan (1961): Istanbul Oniv. Tip. Fak. Mec.. 24, 641. 19. Eustachius. B. (1563): De Renum Scruclura. Venice. graph or a nephrogram, as so many clinicians are inclined 20. Fuchs. F. (1931): Z. Urol. Chir.. 33, 1. to do. 21. Galen, C. ill Kuhn, C. G .. ed. (1821-1833): De Allaromicis Admillis­ lrationibus. Leipzig. 3. A type of vessel within the kidney subs:ance to 22. Gerard, G. (1911): J. Anal. Physiol.. 46, 531. 23. Goldby. F. and Harrison. R. J. (1961): Recelll Adval1ces ill AllalOm}', which no reference could be found in the literature, is the 2nd series. London: J. & A. Churchill. 24. Graves, F. T. (1954): Bril. J. Surg.. 42, 132. one which lies neither anteriorly nor posteriorly and which 25. Idem (1956): tbid., 43, 605. I have named intermediate. This type of vessel was found 26. tdem (1956): J. Anal. (Land.). 90, 553. 27. Idem (1957): Proc. Roy. Soc. Med.. 50, 368. in 70% of cases. 28. Hou-Jensen. H. (1930): Z. Anat. Entwickl. Gesch.. 91, 1. 29. Huber, C. (1906): Amer. J. Anal.. 6, 391. 4. When transplantation of kidneys becomes a practical 30. Hyrtl, J. (1882): Topographische Al1alOmie, Vienna. 31. Kelly. H. (1902): Bril. Med. J., I. 256. procedure, as surely it must at some future date, it will be 32. Kuprinjanoff, F. (1924): Dtsch. Z. Chir.. 188, 206. very important to make a thorough contrast-medium study 33. LOfgren, F. (1949): Das Topographische Sysrem der Ma/pighisclrell Pyramiden der f'vtenschenniere. Lund: A. B. Gleerupska Univ.-Bok­ of the kidney of the donor to eliminate the possibility of handeln. 34. Ludwig. C. ill Stricker, S. (1871): Handbuch der Lehre VOIl den severed accessory vessels, since transplantation of such Geweben des Menschen wzd der Thiere. Band J, pp. 489-507. Leipzig: kidneys will inevitably lead to necrosis of the segments of Verlag van Wilhelm Engelman. 35. Maas. P. (1965): Personal communication. the kidney originally supplied by accessory arteries, lead­ 36. MacCullum. D. B. (1926): Amer. J. Anal.. 38, 153. 37. Malpighi. M. (1666): Exercirario Anaromica de Renibus. Bologna. ing to renewed complications. 38. Merklin, R. J. (1956): Anal. Rec., 124, 334. 39. Merklin. R. J. and Michels. '. A. (1958): J. 1nl. Call. Surg.. 29, 41. I wish to thank the University of Pretoria for permiSSIOn to 40. More, R. H. and Duff. G. L. (1951): Amer. J. Path., 27, 95. 41. Palumbo. V. (1952): Arch. ital. Urol., 25, 329. publish these extracts from my M.D. thesis submitted to them. 42. Ruppert, R. R. (1913): Surg. Gynec. Obstel.. 17, 580. 43. Ruysch, F. (1721): Opera Omnia AIlQIOmico. Amsterdam: Medico­ REFERENCES Chirurgica. 44. Schiefferdecker. P. (1882): Arch. anal. Entwickl.-Gesch.. 11, 78. 1. Albarron, P. and Papin, A. (1908): Revue de Gynecologie I'AnalOmie, 45. Schmerber. F. (1895): Recherches Anatomiques sur I'Artere Rena/e. 310. Association Ty~ographique. 2. Anson. B. J .. Richardson. G. A. and Minear. W. L. (1936): J. Urol. 46. Seldowitsch. J. B. (1909): Langenbecks Arch. klin. Chir., 89, 1071. (Baltimore). 36, 211. 47. Smith, G. T. (1963): J. Urol. (Baltimore), 89, 275. 3. Anson. B. J. and Kurth. L. E. (1955): Surg. Gynec. Obstel., 100, 156. 48. Smithuis. T. (1956): Arch. chir. neerl.. 8, 227. 4. Anson. B. J. and Daseler, E. H. (1961): Ibid., 112, 439. 49. Sykes, D. (1963): Brit. J. Surg., I, 222. 5. Bellini. L. (1662): De Scructura Renwn. Florence. 50. Thompson. A. (1889): J. Anal. Physiol., .25, 89. 6. Boijsen. E. (1959): Acta radiol. (Stockh.), suppl. 183. 51. Ungvary. G. and Faller. J. (1962): Morph. Igazs. Orv. Szemle. 2, 252. RADIOISOTOPE RENOGRAPHY* L. GECELTER, M.R, RCH. (RAND), F.R.C.S., F.R.C.S.E., Renal Unit and Department of Urology, Johannesburg Hospital and the University of the Witwatersrand Radioisotope renography as used in its present form was collimator is used. A standard cesium (,30C) source is used introduced by Nordyke et al.] in 1960. l3II-labelled ortho­ to calibrate the probes. iodohippurate (Hippuran) has been the isotope used in Since its inception various methods have been employed this method 0f investigation. It is cleared from the blood to obtain the most satisfactory radio-renographic curves. at a rapid rate and exclusively by the kidneys, 75% being This has required different doses of the isotope, alteration recovered in the urine of normal patients 30 minutes after in the position of patient and/or placement of scintillation intravenous injection.' It produces the highest functional probes, different time constants and range of counting. A peak of all agents tested to date, rapidly reaching this peak standardization method used allows for uniformity of in 4 - 6 minutes. The normal renogram is completed 8 - 12 results and for technicians to be trained fairly quickly. The minutes after injection of the labelled Hippuran. whole procedure then can be performed by them except for the intravenous injections of the radioisotopes. METHODS The method used here has been standardized as follows: The Picker clinical analyser, Model 5802B, is used incor­ Where possible a straight X-ray of the abdomen or intra­ porating dual 1 inch sodium iodide scintillation detectors. venous pyelogram is used to localize the kidneys. When a These are cO!ll1ected to a rate meter and then to dual recti­ retrograde pyelogram or renal arteriogram has been per­ linear recorders and are mounted on mobile adjustable formed, this is used in preference, The centre of the arms. The crystals are recessed 4 cm. and a 36° wide-angle kidney is taken as being 1 cm. lateral to the middle calyx. This is usually found 8 - 12 cm. above the iliac crest and ·Radio-renography has been used at the above centre for the 6 - 9 cm. lateral to the mid-dorsal spines, which are the past 18 months in a wide variety of renal conditions. The purpose of this article is to discuss the clinical applications surface markings used as reference points. and limitations of this test. It should be remembered that a straight X-ray of the 28 S.A. TYDSKRIF VIR RADIOLOGIE J Oktober 1966 abdominal pyelogram and aortogram are taken in the At present, an investigation has been started in pregnant supine position. Jf the radioisotope renogram is performed women. The standard procedure, as described above, ha in the sitting position, a descent of as much as 2 vertebral been modified to minimize the radiation hazard. This in­ spaces may occur.' This is more marked on the right. When cludes a dose of Lugol's iodine 2 - 3 days bdore the test the IVP is used. the difference can be obviated by taking at to block the foetal uptake of the radioactive l3l1 in the least one of the excretory pyelograms in the sitting or Hippuran. A smaller dose of 2-5 - 4 p.c. is given and the standing position. test is done in the sitting position. This is done to ascertain To obviate the problems involved in using the sitting the effect of gravity and uterine compression. position and the placement of the scintillation probes according to the X-ray position in the supine position, an intravenous injection 2 p.c. of ""Hg chlormerodrin ( eohy­ \ drin) is given at least 10 minutes before the commence­ I ment of the test.'o The patient is then placed in the prone I SCINTILLATION position on a mobile table with a soft pillow under the I PROBE abdomen. 1 The scintillation probe is used to localize each kidney I separately in the position in which the test is done. The w available X-rays are used as a guide to the position of the w kidneys. Often the two will coincide, but a preliminary al:: I X-ray is not necessary with the present method. The ''03Hg U I V) I, Neohydrin remains in the kidney where it is selectively ~MS transported hy the tubules, and probing will record the o : 10 \ maximum counting obtainable for that kidney, taking <W ,....J position rotation, thickness of kidney mass, function and '%;1 depth from skin into consideration. \ The site of maximum counting rate is marked for each kidney and a t inch lead shield measuring 4 x 6 inches is placed in the mid-ver:ical position between the two kid­ neys." The scintillation probes are then placed 10 cm.
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