Hypoparathyroidism and Subclinical Hypothyroidism with Secondary Hemochromatosis

Hemochromatosis is an inherited genetic disorder of iron metabolism which can also occur as a secondary result of iron-overload. It leads to organ damage such as cardiomyopathy, liver cirrhosis, hypogonadism, and diabetes. This paper discusses a case of secondary hemochromatosis associated with repeated transfusions, presenting as asymptomatic hypoparathyroidism and subclinical hypothyroidism with multiple organ involvement. The 29-year-old female, who had severe aplastic anemia, received multiple transfusions totaling approximately 1,400 units of red blood cells over 15 years. During her routine laboratory examination, hypocalcemia was detected with decreased intact parathyroid hormone and increased thyroid stimulating hormone. Serum ferritin, iron, and total iron binding capacity had increased to 27,583.03 ng/mL, 291 microg/dL, and 389 microg/dL, respectively. She had unusually bronze skin and computed tomography revealed iron deposition in the thyroid, liver, and heart. Multiorgan involvement as seen in this case is rare in hemochromatosis associated with secondary transfusions. To the best of the author's knowledge, this is the first case report in Korea of hypoparathyroidism and subclinical hypothyroidism due to iron deposition in the parathyroid and thyroid gland.

Riedel Thyroiditis in a Patient with Graves Disease

Riedel's thyroiditis is a rare form of infiltrative and inflammatory disease of the thyroid gland and can be associated with systemic fibrotic processes, Hashimoto thyroiditis and Graves disease. Riedel thyroiditis in combination with Graves disease however, is very rare. A 57-year-old woman with a past medical history significant for Graves disease diagnosed 30 years ago presented with an enlarging neck mass and voice changes. Due to suspicion of malignancy, thyroidectomy was performed. Histopathologic examination revealed Riedel thyroiditis. To our knowledge, the association of Riedel thyroiditis with Graves disease has not yet been reported in our country. Here we report a patient with Riedel thyroiditis evolved from antecedent Graves disease.

A case of coronary artery true aneurysm developed after stent implantation / 대한내과학회지

Coronary aneurysm is a rare disorder, defined as a abnormal dilatation that exceeds 1.5 times the diameter of the adjacent segment of artery. Percutaneous transluminal coronary angioplasty is often associated with a coronary aneurysm and mechanical injury of vessel wall during the procedure is suspected as the cause. The reported incidence of coronary aneurysms in Caucasians was 4.9%, but the incidence in Asian population was 0.25%. Morphologically, aneurysms can be divided into true versus pseudo aneurysms. These differentiation by intravascular (interventional) ultrasound is important to predict prognosis of the coronary aneurysm. We experienced a case of coronary artery true aneurysm, that developed after coronary balloon angioplasty and stent implantation. So we report the case.

The low dose paclitaxel as first-line chemotherapy for metastatic or recurrent gastric cancer / 대한내과학회지

BACKGROUND: To assess the effect and toxicity of low-dose paclitaxel in patients with metastatic or recurrent gastric cancer with measurable lesions as first-line chemotherapy. METHODS: Patients with measurable metastatic or recurrent gastric cancer were eligible in this study. Paclitaxel and cisplatin were intravenously infused for 3h, at a dose of each 135 mg/m2 and 60 mg/m2, every 3 weeks and then this regimen was repeated until intolerable toxicity or disease progression. Objective tumor responses, duration of response, time to disease progression, and toxicity profile were evaluated in this study. RESULTS: Total 31 patients were enrolled in this study between May 2001 and January 2004. Sixteen patients had ECOG performance status (PS) 1, eleven had PS 2 and four had PS 3. A total of 122 cycles (median 3, range 1~12) were administered. Eleven (35%, 11/31) objective partial responses (PR) were observed and the remaining 19 patients showed stable (9 patients, 30%) and progressive disease (11 patients, 35%). The response rate was 35% (95% confidence interval, 18~51%). The estimated median survival was 8.1 months, median response duration was 5.3 months and median progression-free survival was 3.3 months. Severe toxicities were uncommon. There were 14 episodes (11.5%) of grade 3-4 neutropenia. Grade 3 nausea and vomiting occurred in 4%. Grade 3 peripheral neuropathy occurred in 3.3%. CONCLUSION: This low dose paclitaxel regimen (135 mg/m2) showed comparable results with previously published high-dose paclitaxel regimen (175~250 mg/m2) used in metastatic or recurrent gastric cancer and the toxicity was minimal.

A Case of Double Right Coronary Artery with Arteriovenous Fisula

Double coronary artery with coronary arteriovenous fistula is a very unusual anomaly and has not been reported in Korea. Coronary arteriovenous fistula consists of communication between one of the coronary arteries and a cardiac chamber or vein. It generally drains into the right ventricle, right atrium, coronary sinus, or pulmonary artery. It is being diagnosed with increasing frequency with combined use of coronary angiography and contrast echocardiography. In the present case, coronary angiography showed double right coronary artery with separated ostia. We confirmed that one of them drained into right ventricular chamber by contrast echocardiography performed after intraaortic contrast injection.

Hemin inhibits lipid peroxidation induced by ascorbate/FeSO4 and 2,2'-azobis-2-amidino-propane hydrochloride (ABAP)

Hemin blocked lipid peroxidations induced by either ascorbate/FeSO4, a metal-catalyzed oxidation system, or 2,2'-azobis-2-amidino-propane hydrochloride (ABAP) which produces peroxy radicals at constant rates. Hemin at very low micromolar concentrations strongly inhibited the ascorbate/FeSO4-induced peroxidation of rat liver phopholipids, soybean phosphatidylcholine and arachidonic acid, and this inhibition was also evident with the use of ABAP, although much higher concentrations of hemin were required than those for the inhibition of ascorbate/FeSO4-induced lipid peroxidation. However, hemoproteins such as hemoglobin, myoglobin and cytochrome C did not show any significant effect on this lipid peroxidation. Hemopexin and albumin abolished the inhibitory action of hemin. During incubation with ascorbate/FeSO4 or ABAP, hemin underwent a change in its absorption spectrum, resulting in a progressive decrease in the peak height of the characteristic absorption band at 385 nm. The above results suggest that hemin may act as an important antioxidant in vivo, protecting lipids from the peroxidative damage.

Prophylactic Endoscopic Variceal Ligation Compared with Endoscopic Variceal Ligation for Bleeding Esophageal Varices / 대한소화기내시경학회지

Endoscopic Variceal Ligation(EVL) was developed as an alternative to endoscopic injection sclerotherapy(EIS) for decreasing of complication rate. This new technique involves placement of small elastic O-rings around the variceal channels in the distal esophagus. To evaluate the efficacy of EVL for treatment of the acute bleeding esophagea1 varices and the efficacy of prophylactic EVL, we compared EVL in 88 patients who had recently bled from esophageal varices(Group 1) and prophylactic EVL in 45 patients with large size(Grade 2 or 3 or 4) and red color sign on endoscopic finding who had not previously had upper gastrointestinal bleeding(Group 2). Also, we compared prophylactic EVL group(Group 2) and control group(Group 3) who did not performed EVL. At the time of treatment 28.4%(25/88) of patients had active bleeding. They were all treated acutely with EVL and repeated treatment for the long-term goal of variceal eradication. Initial hemostatic efficacy of EVL for acute bleeding varices was 92%(23/25). Varices were eradicated or reduced to Grade 1 in 68%(17/2S). Early mortality rate within 2 weeks was 8%(2/25). Among patients who had eradicated or reduced to Grade 1 varices by repeated EVL sessions, over a mean follow-up of 11 months there was no difference between Group 1 and Group 2 in recurrent rate(49.1%(27/63) vs. 46.8% (15/32)), rebleeding rate(10.9'Yo (6/55) vs. 9.3% (3/32)), rebleeding interval(average 75 days vs, 83.6 days). There was significant difference between prophylactic EVL group and con- trol group in bleeding rate(9.3%(3/~32) vs. 43.7%(14/32))~(p<0.05). Three patients(6.6%) died in prophylactic EVL group, two from ligation site bleeding of esophageal varix, one from hepatic failure. In conclsion, EVL is an effective method for treatment of acute bleeding esophageal varices with repeated sessions. Although prophylactic EVL can be used to prevent bleeding by eradication with lower initial morbidity are necessary because of EVL-related complications.

589 Cases of Endoscopic Ultrasound Diagnosis in Upper Gastrointestinal Tract and Pancreaticobiliary System Diseases / 대한소화기내시경학회지

Endoscopic ultrasonography (EUS)-a combination of endoscopy a.nd ultrasonography was one of the most useful tools for diagnosis of digestive system diseases. This technique was known to be very effective in the assessment of depth of invasion in gastric cancer and in pancreatico-biliary diseases. We performed EUS in 589 patients with upper gastrointestinal and pancreatico-biliary tract lesion prior to surgery for past 22 months and examined the diagnostic accuracy of EUS, respectively. The results were compared to surgical histology in esophagus and stomach cancer,to concordance witb endoscopic retrograde cholangiopancreatography(ERCP) results for pancreaticobiliary diseases. 1) In 589 patients diagnosed with EUS, the mean age of the patients was 55.9 years with a male to female ratio of 1.7: 1. 2) Patients were divided into three groups; post-upper gastrointestinal endoscopy, post ERCP and undiagnosed with other diagnostic tools. 3) Among post-upper gastrointestinal endoscopy, 64 cases were operated due to esophageal and gastric cancer and then compared to surgical histology. After compared, EUS accuracy on depth of invasion was 78.1% and sensitivity and specificity on lymph node metastasis in gastric cancer were 76.9% and 74.3%, respectively. 4) In post-ERCP cases, EUS results were compared to ERCP results and then concordance rate was 95.4%. 5) In undiagnosed cases, EUS was performed and results were reported.