A case of myxedema coma treated with a large oral dose of levothyroxine / 대한내과학회지

Myxedema coma is the most extreme form of hypothyroidism and manifests as central nervous system dysfunction, defective thermoregulation, and cardiopulmonary decompensation. The curative treatment is based on the administration of thyroid hormones, but the dose and route of administration remain controversial. Here, we report a case of myxedema coma that was treated successfully with a large oral dose of levothyroxine

Pancreatic ascites and pleural effusion without pancreatic duct disruption treated with stenting / 대한내과학회지

Pancreatic ascites and pleural effusion is a rare complication of inflammatory disease of pancreas. Disruption of the pancreatic duct secondary to inflammatory pancreatic disease results in an internal pancreatic fistula into the peritoneal or pleural cavities. Thus, pancreatic secretion through the internal pancreatic fistula accumulate within the peritoneal or pleural cavities. The diagnosis is strongly suspected by paracentesis and thoracentesis, which demonstrate a markedly elevated amylase and an albumin level in pancreatic ascites and pleural effusion, and is confirmed by observation of pancreatic duct contrast leakage at endoscopic retrograde pancreatography. We report a patient with pancreatic ascites and pleural effusion who had no demonstrable pancreatic duct disruption on endoscopic retrograde pancreatography, but successfully treated by pancreatic duct stent endoscopically.

Efficacy of Chronic Oral Etoposide and Tamoxifen in the Far-Advanced Hepatocellular Carcinoma / 대한간학회지

BACKGROUND/AIMS: This study evaluated the use and efficacy of chronic oral etoposide plus tamoxifen as a palliative treatment in 30 patients with far-advanced HCC in whom surgical resection, percutaneous ethanol injection or transarterial chemoembolization(TACE) was not possible. METHODS: To be eligible for the study, patients had to have objectively measurable or evaluable tumors, adequate hematologic profiles and hepatorenal functions, had to be between 20 and 75 years of age, and had to have an ECOG performance status of less than or equal to 2. The treatment included etoposide, 50 mg/m2/day, taken orally for 21 days, and tamoxifen, 40 mg/day, taken orally for 21 days. Each cycle was repeated every 5 weeks. RESULTS: Two patients(7%) achieved a partial response(PR) and 16 patients(53%) achieved a stable disease(SD) with a median time-to-progression of 5 months(range: 2-24). Median of patients survival with the response of PR or SD and those patients with the response of progressive disease(PD) was 10 months and 7 months, respectively(p=0.0004). Of the 20 patients with initial elevated serum alpha-fetoprotein(> or =500 ng/ml), 9 patients(45%) experienced a significant(> or =50%) decrease in their values after chemotherapy and all 9 patients achieved objective tumor response of more than or equal to SD. Among the 30 patients in the study, 10 patients(33%) achieved performance status improvements of grade according to the ECOG criteria and 6 patients(20%) experienced improvements of subjective symptoms, such as abdominal pain, abdominal fullness and anorexia. CONCLUSION: Based on our results, the use of chronic oral etoposide plus tamoxifen as a palliative treatment for the far-advanced hepatocellular carcinoma are beneficial. A randomized two-arm study may be warranted to validate the results of this study.

Two Cases of Inflammatory Pseudotumor in Respiratory System / 결핵

Inflammatory pseudotumor is a infrequent, benign tumor that affects at all ages and involves the lung, gastrointestinal tract, and salivary gland. They are the most common, isolated, primary lesion of the lung in children, and usually present as circumscribed, peripheral, parenchymal tumors or endobronchial tumors, which may be usually static or increase slowly in size without causing symptoms. Surgical excision is the treatment of choice because of the location and benign nature of this lesion. The prognosis after resection is excellent. Other therapeutic modalities include radiation and steroid therapy. We experienced two cases of inflammatory pseudotumor of the lung parenchyme and endobronchus. We report these cases with a review of literatures.