Microalbuminuria y proteína C reactiva como índices de riesgo cardiovascular en pacientes con síndrome metabólico / Microalbuminuria and C reactive protein as cardiovascular risk indices in patients with metabolic syndrome

Se realizó una investigación cuantitativa de tipo correlacional con el objeto de evaluar la asociación entre microalbuminuria (MA), proteína C reactiva ultrasensible (PCR-us) y riesgo cardiovascular (RCV) de acuerdo a la escala de Framingham en pacientes con síndrome metabólico (SM) que asistieron a la consulta del Servicio de Medicina Interna del Hospital Universitario Dr. Luis Gómez López durante el período junio 2017-junio 2018. La muestra la conformaron 30 pacientes con una edad promedio de 49,53 ± 13,35 años y predominio del sexo femenino. El 53,3% de los pacientes no tenía tratamiento. El 73,3% de los pacientes presentaron RCV muy alto y alto de acuerdo a la escala de Framingham. La mayor parte de los pacientes con RCV muy alto presentaron valores elevados de PCR-us. Se observó una correlación positiva entre los valores de PCR-us y el RCV (R=0,533, p < 0.05). Es importante la identificación temprana del SM como factor de riesgo para el desarrollo de enfermedades cardiovasculares(AU)

A correlation-type quantitative investigation was carried out with the aim to evaluate the association between microalbuminuria (MA), high-sensitive C-reactive protein (hs-CRP) and cardiovascular risk (CVR) determined by the Framingham scale in patients with Metabolic Syndrome (MS) who attended the Internal Medicine Service of the Hospital Universitario Dr. Luis Gómez López during the period June 2017-June 2018. Thirty patients were included with an average age of 49.53 ± 13.35 years and female sex predominance. According to the Framingham scale, 73.3% of patients had very high and high CVR. Most patients with very high CVR had elevated levels of hs-CRP. There was a positive and significant correlation between hs-CRP levels and CVR (R=0.533, p <0.05). An early diagnosis of MS is important as a risk factor for the development of cardiovascular disease(AU)

Combined radionuclide phlebography and V/Q scan in the assessment of iliac vein thrombosis and pulmonary embolism - a case report establishing a cause and effect relationship

Deep vein thrombosis [DVT] is an important life threatening condition that is difficult to diagnose, particularly in the early stages. Looking for DVT in lower limb can be considered ancillary in suspected cases of pulmonary embolism [PE] indirectly highlighting a cause and effect relationship of a single disease [i.e cause being DVT and effect is the assault on the lung vasculature]. Prompt and early identification of one or both of these pathologies calls for urgent intervention in the form of instituting anticoagulation therapy. Synthetic Tc-99m labeled peptides like apcitide, a glycoprotein [GP IIb/IIIa] receptor antagonist is increasingly used as a specific tracer in the detection of acute DVT. But due to its non availability in certain countries, one needs to resort to indirect evidence in the form of Tc-99m MAA to help in the identification of DVT. Radionuclide phlebography [RPh] combined with lung perfusion scintigraphy [LP] is a one stop shop for the rapid and noninvasive diagnostic assessment of PE due to DVT. The aim of this case report is to highlight the underutilization of nuclear techniques in the evaluation of DVT in routine clinical practice. We report a case of a young Indian male who presented with sudden onset dyspnoea. On scintigraphic evaluation by a simultaneous RPh and LP, the cause and effect of DVT could be easily established

[99m]Tc-MDP abdominal scintigraphy in a paediatric case of GI protein loss - a viable and simple alternate to HSA imaging

A nine-month old male child presented with low-grade fever, loose stools and facial puffiness. Clinically patient was otherwise normal except for a firm liver on palpation. The laboratory tests revealed hypoproteinemia [both albumin and globulin] and iron deficiency anemia. Differential diagnosis considered were: 1. Nephrotic syndrome, 2. Cystic fibrosis [in view of recurrent diarrhea and respiratory complaints] 3. Chronic liver disease, in view of firm palpable liver 4. Lastly protein losing enteropathy [PLE]. As biochemically patient revealed no positive results, PLE was suspected. For confirmation 99mTc-Methylene diphosponate [MDP] scintigraphy was found to be useful in the setting of non availability of 99mTc-HSA. MDP scan revealed abnormal minimal extravasation of tracer from bowel loops in right lower abdominal quadrant suggesting a diagnosis of PLE. According to the American Gastroenterological Association [AGA] in patients with iron-deficiency anemia who do have GI symptoms, the prevalence of celiac disease is higher and ranges from 10% to 15% which may be a plausible explanation in our patient. The diagnosis of PLE is most commonly based on the determination of fecal alpha-1 antitrypsin clearance. However the localization of gastrointestinal protein [GI] protein loss is possible by scintgraphic techniques alone, as was done in our case using [99m]Tc-MDP instead of conventionally used [99m]Tc-HSA

Assessment of hepatic reserve function of cirrhosis liver using dynamic SPECT (99m)Tc-galactosyl human serum albumin scintigraphy / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the effectiveness of dynamic SPECT (99m)Tc-galactosyl human serum albumin (GSA) scintigraphy on the assessment of reserve function of cirrhosis liver.</p><p><b>METHODS</b>From January 2010 to December 2011, 55 patients with cirrhosis liver were enrolled in this study. The case numbers of male and female were 43 and 12 respectively and the age was (51 ± 9) years (ranging from 35 to 69 years). After routine biochemistry test, CT scan and (99m)Tc-GSA dynamic SPECT scan were performed in turn using a juxtaposed SPECT/CT system. Then the morphologic volume of liver parenchyma (MLV), functional liver volume (FLV) and the hepatic cell absorption rate constant (GSA-K) were calculated. The correlations between GSA-K and routine biochemistry test, Child-Pugh score, indocyanine green clearance rate (ICG-K) were analyzed. The patients were further divided into 3 groups according to whether there was occlusion or stenosis in the main branch of left portal vein (group 1, n = 5), right portal vein (group 2, n = 13) or not (group 3, n = 37) and the regional hepatic functions index of the 3 groups were compared.</p><p><b>RESULTS</b>The value of FLV of the whole, left and right liver was (594 ± 152) ml, (244 ± 119) ml and (356 ± 171) ml, respectively. There were correlations between GSA-K and total bilirubin, prothrombintime, Child-Pugh score and ICG-K (r = -0.730--0.298, P < 0.05). The FLV and MLV ratios of involved hemiliver to uninvolved hemiliver were 0.09 ± 0.06 and 0.30 ± 0.14 in group 1, 0.57 ± 0.43 and 1.08 ± 0.63 in group 2, 0.71 ± 0.30 and 0.71 ± 0.48 in group 3. The difference in MLV-FLV ratio was signifcant between group 1 and group 3, between group 2 and group 3 (P = 0.000).</p><p><b>CONCLUSIONS</b>The dynamic SPCECT (99m)Tc-GSA scintigraphy can not only assess the whole liver function of cirrhosis liver effectively, but also evaluate the variation of regional liver function accurately.</p>

Right-to-left shunting secondary to microvascular pulmonary arteriovenous malformation demonstrated by lung perfusion scintigraphy

Right-to-left shunting is usually associated with congenital conditions involving the heart, lungs, and the blood vessels that connect both organs. It is demonstrated by echocardiography, transesophageal ultrasound, CT scan, MRI and more definitively by conventional angiography. In this paper, we present a 16-year old female who manifested with progressive dyspnea, persistent cyanosis and decreased arterial oxygen saturation. Clinical assessment and arterial blood gas parameters suggested the presence of significant shunting. However, cardiac evaluation showed no intracardiac defects. High resolution CT scan of the chest with CT angiography of the pulmonary artery also showed no evidence of pulmonary vascular malformation or shunt anomaly. Lung perfusion scintigraphy performed after intravenous administration Tc99m-MAA showed tracer uptake in the brain, spleen and kidneys signifying the presence of a right-to-left shunt in the lungs. Cardiac catheterization later demonstrated the presence of primary pulmonary telangiectasia.

The use of SPECT-CT in determining 90Y microspheres distribution post selective internal radiation therapy

Hepatocellular carcinoma and metastatic colorectal carcinoma are amongst the more common causes of cancer-related mortality worldwide. Selective internal radiation therapy (SIRT) with 90y microspheres is usually indicated in patients with nonresectable status and extensive colorectal liver metastases that are refractory to chemotherapy or target therapy. Several examinations, including CT, MRI or PET, serum chemical analyses, hepatic angiography and liver-lung shunting study with Tc-99m MAA, are done to ensure appropriateness and safety of therapy. Herein, three cases (two with hepatocellular carcinoma and one with metastatic colorectal cancer), which qualified for SIRT and underwent SPECT-CT, are presented. All of them underwent the necessary pre-therapy work-ups. The CT and PET-CT scans identified the hepatic lesions. The blood tests showed nearly normal hepatic and renal functions, except for the third case with elevated bilirubin level. The hepatic angiograms revealed no significant gastrointestinal shunting. The liver-lung shunting studies computed 10% hepatopulmonary shunt. Together with the patient with an elevated bilirubin level, they received a reduced dose of 90Y microspheres by 20%. After SIRT, bremsstrahlung planar imaging and SPECT-CT were performed to localize the distribution of the 90y microspheres, the findings of which correlated well with the results of the pre-therapy scans. The use of SPECT-CT is recommended for better anatomic localization and functional correlation.

Correlation of renal AQP1-4 protein expression with renal parenchyma thickness and glomerular filtration rate in children with congenital hydronephrosis / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the relationship of renal aquaporin -1, -2, -3, and -4 (AQP1-4) expression with renal parenchymal thickness and glomerular filtration rate (GFR) in children with congenital hydronephrotis.</p><p><b>METHODS</b>Renal tissue samples were obtained from 10 kidneys of 10 children (age: 62.3±18.3 months) with hydronephrosis and who underwent Anderson-Hynes pyeloplasty. Renal control samples were obtained from 6 children (age: 62.7±17.1 months) undergoing nephrectomy for nephroblastoma and were confirmed histologically as normal renal tissues. Renal parenchymal thickness of the hydronephrotic kidneys was measured by ultrasound preoperatively and was verified at operation. Renal GFR was assessed using 99mTc-DTPA scintigraphy preoperatively. Western blot was used to examine the expression of AQP1-4 in the renal tissues. The correlations of renal AQP1-4 expression with the renal parenchymal thickness and GFR were assessed by Pearson correlation analysis.</p><p><b>RESULTS</b>The expression of AQP1-4 in the hydronephrotis group was markedly reduced compared to that in the control group (P<0.05). The mean renal parenchymal thickness of the hydronephrotic kidney was 4.59±2.25 mm measured by ultrasound preoperatively. The mean GFR of the obstructed kidney was significantly lower than that of the contralateral kidney in the hydronephrosis group (40±12 mL/min vs 105±20 mL/min; P<0.05). The expression of AQP1, 2, 3 and 4 was positively correlated with preoperative renal GFR and renal parenchymal thickness in the hydronephrosis group (P<0.05). Renal parenchymal thickness was positively correlated with renal GFR (P<0.05).</p><p><b>CONCLUSIONS</b>The expression of renal AQP1-4 is reduced in children with congenital hydronephrosis. The expression levels of AQP1-4 are positively correlated with renal parenchymal thickness and GFR.</p>

Chronic Non-granulomatous Ulcerative Jejunoileitis Assessed by Wireless Capsule Endoscopy / 대한소화기학회지

Chronic non-granulomatous jejunoileitis is a rare disease characterized by malabsorption, abdominal pain, and diarrhea that causes shallow ulcers in the small bowel. The etiology of chronic non-granulomatous jejunolieitis remains unknown. A 69-year-old man complained of abdominal pain and lower extremity edema. A 99m-Tc albumin scan showed increased radioactivity at the left upper quadrant, suggesting protein-losing enteropathy. A small bowel follow-through did not disclose any lesions. Wireless capsule endoscopy revealed several small bowel ulcers and strictures. A jejunoileal segmentectomy with end-to-end anastomosis was performed, and the histologic examination revealed non-granulomatous ulcers with focal villous atrophy. Ruling out all other possible diagnoses, we diagnosed our patient with chronic non-granulomatous ulcerative jejunoileitis. Postoperatively, the patient's abdominal pain and lower extremity edema improved, and the serum albumin normalized. This is the first case of chronic non-granulomatous ulcerative jejunoileitis localized by wireless capsule endoscopy and treated successfully with segment resection.

Application of technetium galactosyl human serum albumin diethylenetriamine pentaacetic acid injection on liver imaging in mouse models with different hepatic injuries / 中国医学科学院学报

<p><b>OBJECTIVE</b>To identify the uptake and biological distribution of technetium galactosyl human serum albumin diethylenetriamine pentaacetic acid injection (99mTc-GSA) in three mouse models with different degrees of hepatic injuries.</p><p><b>METHODS</b>Three mouse models including hepatic fibrosis, hepatic cholestasis, and liver cancer were established. Hepatic fibrosis model was established by intraperitoneal injection of carbon tetrachloride, 0.4 ml 10%, every 48 hours for 48 days. Hepatic cholestasis model was set up by ligature of the common bile duct for 72 hours, and liver cancer model by implantation of H22 tumor cells underneath liver capsule for 10 days. On measurement, each mouse in different models and normal controls was injected with 0.1 ml (0.37 MBq)99mTc-GSA (2 microg) into vena caudalis, and 5 minutes later sacrificed by decapitation. Important organs and tissues including liver, heart, lungs, kidney, spleen, stomach, blood, bones, muscles, and intestines were taken and their different radio countings were measured. The hepatic injuries were evaluated with serum and pathological examinations.</p><p><b>RESULTS</b>99mTc-GSA was concentrated in the liver in all three models and the control mice ( >40% ID x g(-1)). Compared with the control mice (90.05 +/- 10.55)% ID x g(-1), the density of 99mTc-GSA was significantly lower in the models with hepatic injuries (P < 0.001). The liver function test indicated that the injury in hepatic fibrosis model was less serious than those in the other two models. However, the concentration of 99mTc-GSA in hepatic fibrosis model [(72.20 +/- 2.13)% ID x g(-1)] was significantly higher than those in the models with cholestasis [(56.72 +/- 5.92)% ID x g(-1)] and liver cancer [(42.80 +/- 6.05)% ID x g(-1)] (P < 0.001).</p><p><b>CONCLUSIONS</b>99mTc-GSA may well concentrate in liver and its concentration degree is adversely correlated with hepatic injuries. Therefore 99mTc-GSA may be clinically used as liver imaging agent. When combined with three-dimensional scanning technique, it may facilitate constructing a new three-dimensional imaging method to demonstrate the function of designed liver segments.</p>

Reversal of severe hepato-pulmonary syndrome in congenital hepatic fibrosis after living-related liver transplantation.

We report a 5-year-old girl with congenital hepatic fibrosis who presented with clubbing and cyanosis. Partial pressure of oxygen was 40 mmHg with oxy-gen saturation of 70% on room air, which improved to 128 mmHg and 92% on inhalation of 100% oxygen. Macroaggregated albumin scan showed 58% shunting to the brain, suggestive of severe hepatopulmonary syndrome. Echocardiogram and pulmonary angiogram ruled out pulmonary hypertension. Four weeks after living-related liver transplantation, she had normal blood gases and reduction in shunting to 7% on macroaggregated albumin scan.

Comparison of the Results for Sentinel Lymph Node Mapping in the Breast Cancer Patients using 99mTc-Antimony Trisulfide Colloid, 99mTc-Tin Colloid, and 99mTc-Human Serum Albumin / 핵의학분자영상

PURPOSE: In the breast cancer patient, lymphatic mapping and sentinel lymph node biopsy are the most important procedure for axillary lymph node staging. We aimed to compare the three radiocolloids [99mTc-antimony trisulfide colloid (ASC), 99mTc-tin colloid (TC), and 99mTc-human serum albumin (HSA)] for sentinel lymph node mapping. SUBJECTS AND METHODS: Totally, 397 patients with clinically N0 stage were enrolled. 99mTc-ASC was injected in 202 out of 397 patients, 99mTc-TC was injected in 120 patients, and 99mTc-HSA was injected in the remaining 75 patients. The sentinel lymph nodes were localized by lymphoscintigraphy and selected using intraoperative gamma probe. All sentinel lymph nodes were investigated by intraoperative pathologic consultation. The axillary lymph nodes which were harvested by the lymph node dissection were also investigated. RESULTS: The patients of each group showed similar clinical characteristics. There were no significant differences (p>0.05) in the identification rate of sentinel lymph nodes (IR), false negative rate (FNR), and negative predictive value (NPV). The axillary lymphadenectomy revealed axillary lymph node metastases in those three groups (ASC-33.2%, TC-31.7%, HSA-22.7%). The IR, FNR, and NPV were not significantly different among those groups. CONCLUSION: Those three 99mTc-labeled radiocolloids showed equivalent results in sentinel lymph node mapping of breast cancer.

A Case of Protein-losing Enteropathy Associated with Small Bowel Villous Atrophy / 대한소화기학회지

Protein losing enteropathy is described as a diverse group of disorders associated with excessive loss of serum proteins into the gastrointestinal (GI) tract. The etiology of protein losing enteropathy is various. Increased mucosal permeability to protein as a result of cell damage, mucosal erosion, or lymphatic obstruction may develop protein losing enteropathy. Celiac disease is a common cause of protein losing enteropathy associated with small bowel villous atrophy in Europe. We experienced a case of protein losing enteropathy associated with small bowel villous atrophy of unknown origin. A 36-year-old woman was admitted due to chronic watery diarrhea and weight loss. Laboratory findings showed total protein 4.7 g/dL, albumin 2.7 g/dL, cholesterol 100 mg/dL, WBC 6,000/mm(3) (lymphocyte 13.6%) with the absence of proteinuria. On esophagogastroduodenoscopic examination, duodenal ulcer scar was noted on the bulb and colonoscopic finding was nonspecific. On small bowel enteroscopy, jejunal and ileal villi was scantly noticed. Small bowel biopsy showed marked villous atrophy. Her symptoms did not improve after supportive care. Gluten free diet was tried because celiac disease could not be ruled out completely. Diarrhea ceased and body weight regained after gluten free diet.

Extra pulmonary uptake of Tc 99m MAA perfusion lung scan as a result of right to left intra cardiac shunt

Extra pulmonary accumulation of Tc-99m-macroaggregate of albumin [MAA] is rarely seen on perfusion lung scan, and has been reported in less than 4% of a study population of nearly 380 patients1. It occurs when the agent bypasses the lungs due to a right to left [R-L] cardiac or pulmonary shunt, when it is shunted to the portal vein before reaching the right atrium and ventricle of the heart, and when the agent is degraded to a submicron particle size.2 When a pharmaceutical problem is excluded, extra-pulmonary uptake implies unusual hemodynamics with a shunt. A case is reported in which a clinically unsuspected shunt was diagnosed from the lung perfusion scintigraphy

Comparison of pulmonary perfusion imaging with pulmonary angiography in diagnosis of pulmonary involvement in Takayasu's arteritis / 中华心血管病杂志

<p><b>OBJECTIVE</b>To compare the diagnostic value of (99)Tc(m)-MAA pulmonary perfusion imaging with that of pulmonary angiography for pulmonary involvement in Takayasu's arteritis.</p><p><b>METHODS</b>Twenty-one patients (19 women, 2 men), with diagnosed Takayasu's arteritis and underwent both (99)Tc(m)-MAA pulmonary perfusion imaging and pulmonary angiography, were retrospectively analyzed.</p><p><b>RESULTS</b>Out of the 21 patients, pulmonary angiography detected 11 patients with pulmonary artery involvement whereas 13 patients were revealed perfusion defects by pulmonary perfusion imaging. The agreement of diagnosis by pulmonary perfusion imaging with that by pulmonary angiography existed in 19 patients (90.5%, Kappa = 0.81, P < 0.0001). There were 331 pulmonary segments consistently diagnosed by pulmonary perfusion imaging and pulmonary angiography in 378 pulmonary segments (87.5%, Kappa = 0.74, P < 0.0001).</p><p><b>CONCLUSIONS</b>Pulmonary perfusion imaging is highly accorded with pulmonary angiography in detecting the pulmonary involvement in Takayasu's arteritis. Therefore, pulmonary perfusion imaging could be used as a non-invasive screening test for the pulmonary artery involvement in Takayasu's arteritis.</p>

Radionuclide pulmonary perfusion imaging in evaluating pulmonary hypertension in patients with rheumatic heart disease / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the degree of pulmonary hypertension in patients with rheumatic heart disease using radionuclide pulmonary perfusion imaging.</p><p><b>METHODS</b>The pulmonary perfusion in 25 patients with rheumatic heart disease was examined using scintigram with macroaggregates of (99m)Tc-labeled human serum albumin (PPS) before and 7 days after operation. PPS was analyzed for (1) pulmonary perfusion steady time (PT), right upper and lower lung count ratio (RULR). The results were compared with those of catheterization examination during the operation.</p><p><b>RESULTS</b>The pulmonary arterial systolic pressure (PAs) and total pulmonary resistance (TPR) were (60 +/- 21) mm Hg and (421 +/- 106) dyn if PT > or = 20 seconds and RULR > or = 2; The PAs and TPR were (28 +/- 5) mm Hg and (188 +/- 28) dyn if PT < 20 seconds and RULR < 2. The PPS changed in most of the patients during early operation.</p><p><b>CONCLUSION</b>The degree of injury in pulmonary vascular in patients with rheumatic heart disease could be quantitatively analysed by PPS.</p>

A Case of Juvenile Polyposis Presented with Protein Losing Enteropathy / 대한소아소화기영양학회지

Juvenile polyposis is an uncommon condition characterized by the development of multiple juvenile polyps predominantly in the colon but also in the rest of the gastrointestinal tract. Patients with juvenile polyposis commonly present with rectal bleeding, diarrhea, abdominal pain, anemia, prolapse of the polyp. We experienced a juvenile polyposis in a 7 year-old male patient with protein losing enteropathy who was diagnosed by 99MTc-human serum albumin abdominal scintigraphy, colonoscopy, and small bowel series. Proctocolectomy with ileostomy was performed and then protein losing enteropathy was resolved.

Sentinel Node Biopsy as an Indicator for Pelvic Nodes Dissection in Early Stage Cervical Cancer

The purpose of this study was to investigate the feasibility of sentinel node frozen biopsy to minimize the extensive pelvic lymph nodes dissection in early stage cervical cancer patients on the basis that the risk of skip metastasis to the paraaortic area is negligible. Twenty-six patients with early stage cervical cancer were enrolled in this study. Technetium-99m colloid albumin (Tc(99m)) was injected intradermally around the tumor for allowing preoperative lymphoscintigraphy and intraoperative hand-held gama probe detection of seninel nodes. For visual detection, isosulfan blue dye was injected into the peritumoral sites before peritoneal opening. Postoperative morbidity and negative predictive value were the endpoints of this study. The 26 patients, ranging in age from 32 to 71 yr, underwent intraoperative sentinel nodes mapping. All the patients underwent complete pelvic lymph nodes dissection including para-aortic nodes. There was one case with positive non-sentinel nodes despite the negative sentinel node by frozen biopsy (negative predictive value, 95.2%). This new technique of sentinel node mapping is safe and simple to perform. Further clinical trials using the combination of Tc(99m) and isosulfan blue dye are warranted and this technique will make a true advance for less aggressive management of patients with early stage cervical cancer.

A Study for Hypoxemic Mechanisms in Liver Cirrhosis / 대한간학회지

BACKGROUND/AIMS: Hypoxemia is often associated with liver cirrhosis without cardiopulmonary diseases. Pulmonary vascular impairments including intrapulmonary shunt have been considered as a major mechanism of hypoxemia. The aim of this study was to determine the incidence and pathophysiologic basis of hypoxemia in cirrhotic patients without respiratory symptoms. METHODS: In fourty three cirrhotic patients without heart and lung diseases, we performed the arterial blood gas analysis and calculated alveolar arterial oxygen gradient (A-aO2). According to the A-aO2, the patients were divided into hypoxemic and normoxemic groups. In each group, a Tc-99m-macroaggregated albumin (Tc-99m-MAA) scan, a contrast-enhanced echocardiography and a pulmonary function test were performed. RESULTS: Twenty-eight of 43 patients (65%) showed hypoxemia. Hypoxemic patients showed significantly more increased shunt fraction of 3.1 1.4% than normoxemic one of 2.1 1.1% in the Tc-99m-MAA scan (p<0.05). However, only two of hypoxemic patients had shunt fraction above physiologic shunt range. By contrast-enhanced echocardiography, an intrapulmonary shunt was confirmed in one patient. There was no significant correlation between the shunt fraction and the hepatic reserve based on the Child-Pugh classification in hypoxemic patients. In the results of pulmonary function test, only DLco decreased more significantly in hypoxemic group than in normoxemic group (58.4 14.2 % vs 75.3 16.5% of predicted, p<0.05). CONCLUSIONS: Hypoxemia is not infrequently observed in cirrhosis, but incidence of significant intrapulmonary shunt is low. Therefore, other mechanism such as diffusion defect may be suggested to play a role in the development of hypoxemia in cirrhotic patients without respiratory symptoms.

Protein Losing Enteropathy in a Patient with Henoch-Sch nlein Purpura: Successful Treatment with Steroid / 대한신장학회잡지

Although gastrointestinal manifestations are very common in patients with Henoch-Sch nlein purpura, protein losing enteropathy is a rare complication. We here report a case of protein losing enteropathy in a patient with Henoch-Sch nlein purpura. A 52-year old woman presented with lower abdominal pain, purpura and edema on lower extremity. Serum albumin was 1.9g/dL and 24 hour urine protein was 4.7g/ day. Skin and kidney biopsy revealed leukocytoclastic vasculitis and mesangial proliferative glomerulonephritis consistent with Henoch-Sch nlein purpura, respectively. Colonoscopy showed diffuse mucosal erosion at right colon. 99mTc-human serum albumin scintigraphy and fecal alpha-1-antitrypsin clearance confirmed protein losing enteropathy. The protein losing enteropathy improved with steroid treatment.

A Case of Reflex Sympathetic Dystrophy Syndrome developed after Protein Losing Enteropathy / 대한내과학회지

A 16-year old girl was admitted for chronic diarrhea, generalized edema, severe pain of lower extremities, and general weakness. She could not walk because of burning pain of knee and ankle. 99mTc-MDP bone scan demonstrated increased periarticular uptake in both lower extremity with focal increased activity in proximal portion of both tibias.. Abnormal abdominal activity in ascending, transverse, and descending colon is also seen. Bone densitometry showed severe osteoporosis in lower extremity. 99mTc-HSA scan showed abnormal radioactivity in small bowel, and descending colon indicating protein losing enteropathy. Endoscopic biopsy of terminal ileum showed a few dilated lymphatics in the submucosa. After steroid and supplemental therapy, the symptoms and signs of both protein losing enteropathy and RSDS much improved simultaneously. Reflex sympathetic dystrophy syndrome is a complex of symptoms characterized by severe pain, swelling, autonomic vasomotor dysfunction, and impaired mobility of affected extremities. The important causes are trauma, fracture, and inflammation. We assumed that the reflex sympathetic dystrophy syndrome of this girl was due to protein losing enteropathy. And as far as we know there has not been reported case that protein losing enteropathy assumed as a cause of reflex sympathetic dystrophy syndrome.