Assessment of renal functions in patients of chronic liver disease.

AIMS AND OBJECTIVES: Renal involvement in patients of chronic liver disease (CLD) is one of the dreaded complications associated with a steep rise in mortality and morbidity. Derangements in various homeostatic mechanisms in CLD leading to direct renal injury or circulatory compromise have been associated with renal impairment. METHOD: Consecutive cirrhotic patients (n = 100) were included in the study. Structural and functional renal failure was identified and patients were classified into various renal syndromes pre renal, intra-renal and hepatorenal syndrome (HRS). RESULTS: At the time of presentation, 37 patients had renal dysfunction. Thirty patients had pre-renal type of renal failure, six patients had intrinsic renal disease and one patient had structural renal disease. Patients with pre-renal type were further classified into volume responsive pre-renal failure and volume non responsive HRS. Five patients had features suggestive of HRS. Patients with decompensation such as portal hypertension (PHTN), jaundice, upper gastro-intestinal bleed and hepatic encephalopathy had significantly higher incidence of renal derangements as compared to their counterparts. Infection in the form of SBP and/or sepsis predisposed patients to develop renal dysfunction. CONCLUSION: Renal impairment in patients with advanced liver disease is not an uncommon phenomenon and is more commonly associated with a more advanced disease. Presence of PHTN and various signs of decompensation increase the chances of renal derangements in these patients. In view of rising incidence of CLD and higher survival (due to better treatment options available), one should be vigilant for the renal derangements in these patients.

Lymphomatous involvement of epididymis: detection and response assessment with (18)F-FDG PET/CT.

Lymphomatous involvement of epididymis, primary or secondary to extensive extranodal disease, is a rare entity. We describe a case of extranodal non-Hodgkin lymphoma where staging F-FDG PET/CT demonstrated unsuspected lymphomatous involvement of epididymis and restaging FDG PET/CT showed complete response after chemotherapy.

Comparison of software programs for the assessment of left ventricular ejection fraction using 99mTc-tetrofosmin-gated SPECT/CT: correlation with equilibrium radionuclide ventriculography in the Indian population.

OBJECTIVE: The goal of this study was to compare Emory Cardiac Toolbox (ECTb), quantitative gated SPECT (QGS), four-dimensional single photon emission computed tomography (4D-MSPECT) and Myometrix cardiac software programs for the assessment of left ventricular ejection fraction (LVEF) using 99mTc-tetrofosmin-gated SPECT/CT [myocardial perfusion SPECT (MPS)] and correlate them with the LVEF values derived from equilibrium radionuclide ventriculography (ERNV) in patients with known/suspected coronary artery disease (CAD). MATERIALS AND METHODS: A total of 109 patients (80 men, 29 women) were recruited into the study. Fifty-five patients had known CAD and 54 were referred with suspicion of CAD. All the patients underwent ERNV and MPS as per the standard protocol. ERNV was processed using the vendor-provided 'EF analysis' and gated MPS was processed using individual software programs. RESULTS: The mean LVEF on ERNV was 47.9 ± 15.5%. The mean LVEF values for ECTb, QGS, 4D-MSPECT and Myometrix were 51.5 ± 19.6, 51.0 ± 18.6, 57.1 ± 19.3 and 49.7 ± 19%, respectively. On correlation analysis, a very strong positive correlation was observed between LVEF values derived by ERNV and those derived by the MPS software programs: ECTb (r=0.842, P<0.0001), QGS (r=0.835, P<0.0001), 4D-MSPECT (r=0.830, P<0.0001) and Myometrix (r=0.875, P<0.0001). Significant correlation was also seen for LVEFs among the four software programs. Normal cutoff values for ejection fraction on ECTb, QGS, 4D-MSPECT and Myometrix were 56, 52, 54 and 51%, respectively, using a 50% or more cutoff value on ERNV. CONCLUSION: A strong correlation was observed among ECTb, QGS, 4D-MSPECT and Myometrix software programs when compared with ERNV and also between them for assessment of LVEF. However, there are subtle differences in the objective values of ejection fraction generated by individual software, which must be taken into account for clinical studies.