Hepatic Injury during Treatment with Antithyroid Drugs in Patients with Hyperthyroidism / 대한내분비학회지

BACKGROUND: Propylthiouracil (PIV) and methimazole (MMI) were widely used for the treatment of hyperthyroidism. Hepatic injury caused by these agents is a rare but serious complication. This study is to investigate the clinical features of hepatotoxicity from antithyroid drugs. METHODS: We reviewed 17 cases of hepatic injury during treatment with antithyroid drugs in patients with hyperthyroidism. Included were 6 cases we experienced and 11 cases reported in Korean literature from 1986 to 1999. We analyzed the clinical features of hepatic injury. RESULTS: Of 17 cases of hepatic injury, 12 were PTU cases and 5 MMI cases. The mean age of PTU cases was 40 years with 6/12 patients over 40 years old and 2/5 MMI cases were over 40 years old. The dose of PTU was 300 mg/d or more in 10/12 cases (83%) and the dose of MMI was 30 mg/d in 3/5 cases (60%). The hepatic injury occurred within 3 months in 8/12 PTU cases (67%) and within 2 months in 4/5 MMI cases (80%). The duration of hepatic injury tended to be longer in MMI cases than in PTV cases (median; 80 vs 41 days, p=0.102). In PTU cases, the duration of hepatic injury was correlated with the duration of drug use before hepatic injury (p<0.05). All of 8 biopsied cases who took PTU had predominantly hepatocellular necrosis. Two biopsied cases who took MMI had cholestatic jaundice and nonspecific abnormality, respectively. Biochemical findings of all MMI cases were compatible with cholestatic jaundice. As to the treatment of hyperthyroidism after hepatic injury, 4/12 PTU cases were treated with RAI therapy, 5 with MMI and one with surgery, and treatment was unknown in two. On the other hand 3/5 MMI cases interestingly entered into spontaneous remission after hepatic injury and 2/5 had RAI therapy. Hepatic dysfunction recurred in each one whom treatment by changing to MMI or PTU was tried on. CONCLUSION: Most of hepatic injury during treatment with antithyroid drugs developed within two to three months of drug use. The hepatic injury related to PTU was mainly cytotoxic whereas that related to MMI was cholestatic. Since there is a cross-reaction between PTU and MMI in hepatotoxicity, RAI therapy or operation shoud be considered as an alternative treatment of hyperthyroidism after hepatic injury.

Successful Hemodialysis in Acute Phenobarbital Intoxication / 대한신장학회잡지

Phenobarbital is one of long-acting barbiturate with low lipid solubility and used frequently as an anticonvulsant. However, in severe intoxication, hypotension and respiratory arrest are the major causes of prehospital mortality. Mortality is 3M for blood levels over HO pg/mL and estimated lethal adult dose is 6-10g. No effective antidotes are available. We report a case of phenobarbital intoxication in a 29-year-old female, treated successfully with hemodialysis. She was found corhatose on the day of admission and was alleged to have taken 30g of phenobarbital. On physical examination, the blood pressure was 80/60mmHg, and pulse, 97/min. There was no respiration. Pupil was dilated fully. Corneal and deep tendon reflexes were absent. There was no response to painful stimuli. She was treated conservatively with mechanical ventilation, gut decontamination and forced diuresis. Hemodialysis was tried to remove excess phenobarbital for 13 hours. The blood phenobarbital level at admission was 162.2 pg/ mL, which was decreased to 114.4pg/mL after first session of hemodialysis. On the fifth hospital day, blood level decreased to 41.8 pg/mL and she regained her consciousness. She was discharged on the 10th hospital day without major sequelae.

A Case of Endoscopic Drainage of Pancreatic Abscess with Biliary Stent / 대한내과학회지

Pancreatic abscess is a highly lethal infectious complication of acute pancreatitis despite a wide variety of operative approaches and percutaneous drainage for the treatment. Surgical drainage has its limitation because of high postoperative mortality, recurrence, operative hemorrhage and/or gastrointestinal fistula. Percutaneous drainage has been used only as a temporizing measure prior to operation in critically ill patient or as additional modality for a postoperative recurrent abscess. Endoscopic drainage can be indicated as a primary therapy for the well-localized paraintestinal pancreatic abscess bulging into the duodenal or gastric lumen, as it has been proven successful in patients with pancreatic pseudocyst compressing duodenum or stomach. However, the report is rare. We report a case of pancreatic abscess successfully treated with endoscopic drainage without any complications.

A Case of Acute Respiratory Distress Syndrome with Pulmonary Embolism induced by Injection of Silicone at Vaginal Wall / 결핵

Silicone fluid(polydimethylsiloxane) is widely used in breast augmentation and other cosmetic procedures because of little incidence of complications and low mortality rate. However, local reaction following silicone injections can be occurred sometimes leading to serious complications. Especially, illicit silicone injections have resulted in severe reactions within the pulmonary area, and some have resulted in acute respiratory distress syndrome subsequently. We experienced a case of acute respiratory distress syndrome induced by subcutaneous injections of silicone at vaginal wall. The patients was 39-year-old, previously healthy woman who had complained of dyspnea related to silicone injection at vaginal wall. Chest X-ray and chest CT scan show diffuse air consolidation with ground glass opacities and perfusion lung scan revealed likelihood of pulmonary embolism as showing multiple perfusion defects. We report a case of acute respiratory distress syndrome after silicone injection with review of literature.

Complete Remission in a Patient with Multiple Myeloma after High Dose Melphalan and CD34+ Selected Autologous Transplantation / 대한혈액학회지

Multiple myeloma is characterized by long clinical course and drug resistance. Conventional chemotherapy results in modest survival benefit. High dose therapy with autologous stem cell transplantation results in markedly increased response rate and survival, confirmed by a randomized study. But there are any evidences yet this approach confers cure. To decrease relapse rate, several approaches are ongoing. Among them, purified CD34+ selected transplantation is an attractive approach because of reduced contamination of myeloma cells. Recently we have experienced CD34+ selected autologous transplantation in a multiple myeloma patient. After VAD induction chemotherapy, high dose melphalan (200mg/m2) with CD34+ selected autotransplantation was followed. Immunoadsorption using CeprateSC resulted in 81% purity and 42% yield. Infused CD34+ cell number was 3.1x106/kg. Absolute granulocytopenic and thrombocytopenic period was less than a week. Grade lll or more extramedullary toxicities were not observed. After high dose therapy, complete remission by immunofixation was achieved. We have experienced a case of CD34+ selected transplantation in multiple myeloma and found that it was safe in terms of short term engraftment.