Predictability of 99mTc-Galactosyl Human Serum Albumin Scintigraphy for Posthepatectomy Liver Failure.

OBJECTIVE: Posthepatectomy liver failure (PHLF) is one of the most serious complications after hepatectomy. The objective of the present study is to assess the potential diagnostic ability of 99mTc-galactosyl human serum albumin (GSA) scintigraphy to predict PHLF as defined by the International Study Group of Liver Surgery (ISGLS). MATERIALS AND METHODS: Data from 100 patients who underwent 99mTc-GSA scintigraphy and subsequent hepatectomy were retrospectively analyzed. The blood clearance ratio (HH15), hepatic uptake ratio (LHL15), and maximal removal rate (Rmax) of 99mTc-GSA (GSA-Rmax) were calculated as scintigraphic parameters for the total liver. In addition to the ratio of preoperatively estimated remnant liver (ERL) counts to total liver counts (rERL-GSA), the ratio of actual remnant liver (ARL) counts to total liver counts (rARL-GSA), determined by applying a more accurate resection line with reference to both pre- and postoperative CT, was obtained from SPECT images. Functional remnant liver parameters of ERL-LHL15 (LHL15 of the estimated remnant liver), ERL-Rmax (maximal removal rate of estimated remnant liver counts), ARL-LHL15 (LHL15 of the actual remnant liver), and ARL-Rmax (maximal removal rate of actual remnant liver counts) were calculated using these values. ROC analysis was performed to evaluate the ability of these parameters to predict PHLF. Multivariate analysis was performed to identify independent predictors of PHLF. RESULTS: PHLF occurred in 33 patients. Each of the ARL parameters had a significantly higher diagnostic performance compared with the corresponding ERL parameter (AUC values: for rARL-GSA vs rERL-GSA, 0.77 vs 0.62 [p = 0.0004]; for ARL-LHL15 vs ERL-LHL15, 0.79 vs 0.64 [p = 0.0005]; and for ARL-Rmax vs ERL-Rmax, 0.78 vs 0.66 [p = 0.0003]). According to multivariate analysis, each of three ARL parameters was identified as an independent predictor of PHLF (p < 0.0001 for all). CONCLUSION: Technetium-99m-labeled GSA scintigraphy is useful for predicting PHLF, particularly for applying an accurate resection line on GSA-SPECT images.

Lupus-related protein-losing enteropathy associated with pseudo-pseudo Meigs' syndrome and successfully treated with hydroxychloroquine.

We herein report the first case of lupus-related protein-losing enteropathy associated with pseudo-pseudo Meigs' syndrome. Lupus-related protein-losing enteropathy and pseudo-pseudo Meigs' syndrome are extremely rare complications in patients with systemic lupus erythematosus, Both have a similar clinical course characterized by producing marked ascites, and respond to steroids in typical cases. However, in our case, steroid monotherapy was inadequate and the addition of hydroxychloroquine was effective for their treatment. Furthermore, no reports have previously confirmed elevated CA 125 levels with lupus-related protein-losing enteropathy or increased 99mTc-HSA activity with pseudo-pseudo Meigs' syndrome. In addition, we are the first to report an evaluation of the histopathology of lupus-related protein-losing enteropathy. Previously reported cases have been described as being caused by either pseudo-Meigs's syndrome or lupus-related protein-losing enteropathy as the cause of the rare pathology that causes marked pleural effusion and ascites in patients with systemic lupus erythematosus, but it has not been evaluated whether the other is co-occurring. Our case highlights that there is a potential case of overlapping lupus-related protein-losing enteropathy and pseudo-Pseudo-Meigs's syndrome. Furthermore, it is possible that patients with marked ascites with elevated CA 125 levels were mistakenly diagnosed with Meigs's syndrome or pseudo-Meigs's syndrome associated with malignant or benign ovarian tumors and underwent surgery. Clinicians should not forget SLE with pseudo-Pseudo-Meigs's syndrome as one of the differential diagnoses for marked ascites with elevated CA 125 levels.

Protein-losing gastroenteropathy with severe hypoalbuminemia associated with Sjögren's syndrome: A case report and review of the literature.

A 30-year-old man with severe hypoalbuminemia (serum albumin: 0.9 g/dL) was admitted with severe bilateral leg edema and unilateral pleural effusion. Serum anti-SS-A and SS-B antibody levels were abnormally elevated, and his symptoms fulfilled the diagnostic criteria for Sjögren's syndrome. Technetium-99m albumin scintigraphy revealed protein leakage from a large area of the small intestine. Immunohistochemistry revealed perivascular deposition of C1q, C3d, and immunoglobulin G in the duodenal mucosa. The patient was diagnosed with protein-losing gastroenteropathy associated with Sjögren's syndrome. Within 2 months of treatment with oral prednisolone and mycophenolate mofetil, the clinical symptoms of hypoalbuminemia and Sjögren's syndrome disappeared completely.

The diagnostic value of 99m-Tc GSA scintigraphy for liver function and remnant liver volume in hepatic surgery: a retrospective observational cohort study in 27 patients.

BACKGROUND: The aim was to analyze hepatic hypertrophy after portal vein embolization (PVE) and Associating Liver Partition with Portal vein ligation for Staged hepatectomy (ALPPS) to determine whether clinical circumstances associated with major hepatic resections correlated with remnant growth. METHODS: Data was abstracted from a retrospectively maintained database on 27 patients undergoing hepatic resection followed by PVE and the ALPPS procedure between October 1, 2007 and December 31, 2016. The increasing rate of liver volume and remnant liver LU15 was defined as the percentage-point difference between the liver volume and remnant liver LU15 before and after the intervention or surgery. And correlation between kinetic growth rate (KGR) of liver and future remnant liver volume or remnant liver LU15 was analyzed. RESULTS: The degree of hypertrophy (DH) of volume and LU15 was significantly greater after ALPPS (volume: 40.3% and LU15: 65.0%) than after PVE (volume: 22.7% and LU15: 48.8%) (P < 0.05). KGR of volume and LU15 was significantly greater after ALPPS (volume: 19.0 cm3/day and 2.00%/day) (LU15: 0.61 /day and 1.82%/day) than after PVE (volume: 3.89 cm3/day and 0.42%/day) (LU15: 0.19 /day and 0.63%/day) (P < 0.001). An inverse correlation between KGR and initial remnant liver volume was observed. And a positive correlation between KGR and LU15 was observed. CONCLUSION: Future remnant liver volume and KGR was greater after the ALPPS procedure than after PVE. Liver hypertrophy is related to the expected remnant liver volume and total liver function. This study suggested that total liver function and initial remnant liver volume might be a new indication of hepatectomy after PVE and ALPPS in the case of insufficient remnant liver volume.

Protein-losing Gastroenteropathy Related to Mixed Connective Tissue Disease: A Case Report of a Successful Outcome and Literature Review.

We herein report the case of a 44-year-old woman who developed protein-losing gastroenteropathy (PLGE) with hypoalbuminemia as the first manifestation of mixed connective tissue disease (MCTD). Albumin leakage from the stomach and intestinal tract was demonstrated by 99mTc-labeled human serum albumin scintigraphy. The patient's response to prednisolone therapy was insufficient; therefore, additional cyclosporin A (CsA) treatment was administered, and clinical remission was achieved. We concluded that although PLGE is a rare complication of MCTD, it may manifest as an initial clinical episode of MCTD. Furthermore, CsA can be a useful treatment option for refractory PLGE related to MCTD.

A gentleman with an unusual cause of hypoalbuminemia.

Protein-losing enteropathy (PLE) is a rare syndrome of gastrointestinal protein loss that may complicate a variety of diseases. The primary causes can be divided into erosive gastrointestinal disorders, nonerosive gastrointestinal disorders, and disorders involving increased central venous pressure or mesenteric lymphatic obstruction. Herein, we report on a 65-year-old man with PLE caused by invasive gastrointestinal stromal tumor (GIST). To our best knowledge, this is the first reported association between GIST and PLE. A brief review of the literature on the incidence, pathogenesis and management of GIST is also presented.

Protein-losing enteropathy associated with Henoch-Schönlein purpura.

The gastrointestinal manifestations of Henoch-Schönlein purpura include abdominal pain, gastrointestinal bleeding, intussusception, and perforation. Protein-losing enteropathy is rarely associated with Henoch-Schönlein purpura. Two pediatric patients with Henoch-Schönlein purpura who developed protein-losing enteropathy are reported. Tc-99m human serum albumin scintigraphy is useful in the detection of protein-losing enteropathy.