Lipid Peroxidation and Antioxidant Defenses According to Severity of PQ Poisoning

PURPOSE: Paraquat (PQ) increases the level of toxic reactive oxygen species in humans. Various endogenous antioxidant mechanisms against PQ exist in humans. The aim of the present study was to assess lipid peroxidation and antioxidative defenses of humans exposed to acute PQ poisoning over time. METHODS: The medical records of patients who presented to the emergency department (ED) within 6 hours after PQ poisoning were reviewed. Patients were classified into three groups based on the severity index of paraquat poisoning (SIPP) using the serum level of PQ and time interval from exposure to ED arrival. The serum level of malondialdehyde (MDA) and the activities of antioxidative enzymes were compared between groups at baseline, 12 hours, 24 hours and 48 hours after presentation. RESULTS: The mean age of enrolled patients was 51.0+/-15.9 years and they ingested 143.3+/-144.4 ml of 24.5% liquid PQ accidently or as an attempted suicide. The baseline MDA level, and the activities of superoxide dismutase (SOD) and glutathione peroxidase (GPx) in the three groups were similar. In the SIPP >50 group, the serum MDA level and the SOD activity significantly increased from baseline, peaking at 24 hours. In the 10< or =SIPP< or =50 group, serum MDA level and SOD activity displayed a smooth and steady increase. In the SIPP <10 group, serum MDA level steadily decreased but SOD activity increased. GPx activity did not show any changes. CONCLUSION: PQ changes serum levels of MDA and SOD activity depending on the severity of PQ intoxication, but serum GPx activity does not significantly change.

Correlation between serum prolactin levels and immunocytochemical findings of pituitary adenomas in patients with acromegaly / 대한내과학회지

BACKGROUND: Acromegaly occurs by excessive secretion of growth hormone and more than 99% of cases are caused by a growth hormone-secreting pituitary adenoma. Pituitary adenomas expressing multiple immunoreactivities are common. We assumed that the pituitary adenomas which is immunochemically detected growth hormone and prolactin are responsible for it and reviewed 28 patients with acromagaly to determine the correlation between serum hormonal level and immunocytochemical finding. METHODS: Twenty-eight patients with acromegaly who underwent surgery of pituitary adenoma in Samsung Medical Center from October 1998 to may 2001 were included. Baseline hormonal evaluations and several endocine tests were performed. Immunocytochemical stain was done. RESULTS: According to the extent of hormonal stain, the adenoma was divided into two groups. The adenoma showing immunoreactivity over 50% to growth hormone was 100%, to prolactin was 71.4% and to FSH was 25.0%. The extent of other hormonal stain was less than 20%. There were no significant differences in age, sex, the ratio of macroadenoma and microadenoma, the basal serum GH level, serum IGF-1 level, and the response to TRH, somatostatin and bromocriptine suppression test between the two groups divided by the the extent of prolactin stain. But the serum prolactin level was 55.0+/-63.4 ng/mL, and 19.9+/-12.2 ng/mL each in two groups which was siginificantly increased in the adenoma showing immunoreactivity over 50% to prolactin. CONCLUSION: Acromegaly patients with higher expression of prolactin on immunocytochemical studies showed higher serum prolactin levels and patients with hyperprolactinemia showed higher serum IGF-1.

Analysis of Ret Proto-oncogene Mutation in Korean Patients with Medullary Thyroid Carcinomas / 대한내분비학회지

BACKGROUND: Medullary thyroid carcinomas (MTC) have been reported as hereditary in about 25 ~30% of cases. The identification of germline mutation in RET proto-oncogene is important in the diagnosis of hereditary MTC, and occurs in three forms: MEN 2A, MEN 2B and familial MTC (FMTC). To evaluate the prevalence of the relationship of RET proto-oncogene mutation and genotype-phenotype was studied in Korean patients with MTC. METHODS: Genomic DNA was obtained from 29 patients, with MTC, who underwent a total thyroidectomy, between 1997 and 2003, at the Samsung Medical Center. There were 7 male and 22 female patients, with an average age of 39, ranging from 20 to 60 years. Exon 10, 11, 13, 14 and 16 of the RET proto-oncogene were amplified, with specific primers, using PCR. A sequencing analysis was performed on the PCR product using an automatic sequencing analyzer. RESULTS: Nine of the 29 patients (31%) were identified as having RET mutations. The average age of these 9 patients was 33 years, ranging from 20 to 51, with a female to male ratio of 2. Five patients had MEN 2A and one had FMTC, with the other 3 thought to have non-hereditary (sporadic) MTC. The 4 patients with MEN 2A had RET mutations on codon 634 of exon 11 (2 patients, C634R; 2 patients, C634Y) and the other patient on codon 618 of exon 10 (C618R). One patient with FMTC had a mutation on codon 634 (C634W). Three patients with sporadic MTC had RET mutations on codon 634 (2 patients, C634Y; 1 patient, C634S). However, no genotype- phenotype relationship could be found, due to the limited number of patients. CONCLUSION: Thirty-one percent (9/29) of the patients with MTC had RET proto-oncogene mutations. Three-quarters (9/12) of the Korean patients with MEN 2A, including another 7 patients reported in 3 papers in Korea, had RET mutations on codon 634 of exon 11 (4 patients, C634R; 4 patients, C634Y; 1 patient, C634W), but a quarter (3/12) had mutations on codon 618 of exon 10 (2 patients, C618R; 1 patient, C618S). Although no relations could be found between the genotypes and phenotypes, extensive prospective studies will be required to verify this.

A Case of Prosthetic Valve Endocarditis Caused by Listeria monocytogenes / 감염

Listerial endocarditis is rare disease with about 60 reported cases in the literatures. Although the clinical and laboratory features of listerial endocarditis are similar to those of subacute bacterial endocarditis caused by other pathogens, the incidence of complications and mortality rates are high. Early diagnosis, adequate treatment, and timely surgery are important for the better outcome. We report a case of a 62 year-old male with prosthetic valve endocarditis caused by Listeria monocytogenes, who was successfully treated with antibiotics and surgery (aortic valve and mitral valve re-replacement).

A Case of Acromegaly with Diabetic Ketoacidosis and Hypertriglyceridemia-Induced Acute Pancreatitis / 대한내분비학회지

Secondary diabetes mellitus caused by increased growth hormone secretion (GH) has well been known. There is a close association between glucose intolerance and GH secretion, and increased GH level itself probably worsens the blood glucose control and lipid profile by increasing glycogenolysis and / or gluconeogenesis and by suppressing lipase activity. We report a case of acromegaly with diabetic ketoacidosis as and hypertriglyceridemia-induced acute pancreatitis. A 38 year old male, previously diagnosed to have acromegaly and diabetes, presented with nausea, vomiting, diffuse abdominal pain and altered mentality. There was no history of drug or alcohol consumption, blood gas analysis showed severe acidosis and urinanalysis for ketone was positive. His serum blood glucose, amylase and lipase levels were 494 mg/dL, 331 U/L, and 1288 U/L, respectively (reference values: 70~110 mg/dL, 13~100 U/L and 13~190 U/L, respectively). The patient was diagnosed as having diabetic ketoacidosis and acute pancreatitis. With the serum concentration of triglyceride being 1488 mg/dL and the absence of any obvious precipitating factors, we considered hypertriglyceridemia to be the cause of acute pancreatitis. He was treated with continuous intravenous insulin infusion, lipid lowering agent, and fluid replacement. After conservative management, general condition gradually improved and his serum amylase, lipase and triglyceride levels were all normalized. GH level was not suppressed under 2 ng/mL during oral glucose loading test, and basal GH and IGF levels were 231 ng/mL and 29.5 ng/mL, respectively. Sella MRI showed a 3.7 cm sized pituitary mass. On the 55th day of admission, transsphenoidal surgery was performed. In immunohistochemical staining, the pathologic tumor specimen was proved to be GH positive pituitary adenoma. This is the first case reported in the English literature of an acromegaly presenting with diabetic ketoacidosis and acute pancreatitis

Clinical and Ultrasonographic Characteristics of Malignant Thyroid Incidentalomas / 대한내분비학회지

BACKGROUND: High-resolution ultrasonography has made the detection of asymptomatic small thyroid possible. Recent increases in the detection of incidentalomas have created a clinical dilemma on how to properly manage such incidental nodules. We investigated the prevalence, clinical and ultrasonographic characteristics, and optimal diagnostic approach toward incidentally detected benign and malignant thyroid nodules of less than 1.5 cm in size. METHODS: A retrospective review was undertaken on the 1,475 patients who had visited Samsung Medical Center, Seoul Korea between January 1999 and December 2000. The review consisted of a physical examination of the thyroid gland, thyroid function test, antithyroid antibodies, thyroid ultrasonography, fine-needle aspiration biopsy, pathology and TNM staging of the incidentally detected thyroid nodules of less than 1.5 cm in size. RESULTS: The prevalence of thyroid incidentalomas was 13.4% and the malignancy rate within them was 28.8%. There were no significant differences in age, sex, thyroid function test and size between the benign and malignant incidentalomas. Ultrasonographic characteristics showed meaningful diagnostic value for the detection of malignancy in incidentalomas. Most malignant incidentalomas were of a low stage. CONCLUSION: Occult thyroid cancers are fairly common finding. There are no clinical difference between benign and malignant thyroid nodules less than 1.5 cm ; however, ultrasonographic fingings can be used to decision of optimal management strategies.

Successful treatment of refractory hemolytic uremic syndrome with intravenous gamma-immunoglobulin therapy / 대한내과학회지

The hemolytic uremic syndrome (HUS) is a clinical syndrome defined by the presence of thrombocytopenia, microangiopathic hemolytic anemia and acute renal failure with or without a clinically apparent etiology. The conventional treatment of choice is plasmapheresis as a first-line therapy. Most patients respond to plasmapheresis whereas some patients are refractory to the therapy. The second-line therapy is not well established although various therapies such as steroid, vincristine, intravenous immunoglobulin have been suggested. The intravenous immunoglobulin therapy in refractory hemolytic-uremic syndrome have rarely been successful in complete remission. We report a case of refractory HUS in a 48 year-old man who developed hemolytic anemia, thrombocytopenia, acute renal failure and ischemic retinopathy. The patient was refractory to plasmapheresis as a first-line therapy. The patient received intravenous immunoglobulin therapy as a second-line therapy after 8 days of plasmapheresis, which subsequently resulted in a complete remission of refractory HUS. The complete remission using immunoglobulin in HUS has not been previously reported in Korea.