ABSTRACT
Tuberculosis infection of skeletal muscle is rare even in countries in which tuberculosis is a relatively common disease. Because tuberculosis of muscle is almost always secondary to underlying tuberculosis of the bone or adjacent joint, hematogenous tuberculosis of skeletal muscle is extremely rare. Therefore, We report a case of hematogenous tuberculosis of skeletal muscle with the review of literatures. A 79-year-old man presented with a history of left shoulder pain, edema, fever and chill. MRI showed inflammatory changes of infraspinatus and deltoid muscle. The histopathology of skeletal muscle showed granulomas surrounded by epithelioid cells and Langhans' giant cells. Mycobacterium tuberculosis was grown from the specimens of sputum, pleural fluid and muscle tissue. The patient improved on anti-tuberculosis treatment.
Subject(s)
Aged , Humans , Deltoid Muscle , Edema , Epithelioid Cells , Fever , Giant Cells , Granuloma , Joints , Magnetic Resonance Imaging , Muscle, Skeletal , Mycobacterium tuberculosis , Shoulder Pain , Sputum , TuberculosisABSTRACT
Bartter's syndrome is characterized by hypokalemia and secondary hyperaldosteronism without edema or hypertension. Its pathogenesis is obscure and the characteristic renal potassium wastage is difficult to treat. We experienced a case of Bartter's syndrome in 47 year-old diabetic female. She had felt dizziness, muscle weakness and cramping for about two years. During diagnostic evaluation, hypokalemic metabolic alkalosis and hyperreninemic hyperaldosteronism were discovered. The patient denied ingestions of laxatives, diuretics, licorice and she had no nausea, vomiting, diarrhea or edema. She had normal blood pressure. The patient improved with potassium supplements and spironolactone therapy along with oral hypoglycemic agent. So we report this case with the review of literature.
Subject(s)
Adult , Female , Humans , Middle Aged , Alkalosis , Bartter Syndrome , Blood Pressure , Diarrhea , Diuretics , Dizziness , Edema , Glycyrrhiza , Hyperaldosteronism , Hypertension , Hypokalemia , Laxatives , Muscle Cramp , Muscle Weakness , Nausea , Potassium , Spironolactone , VomitingABSTRACT
To evaluate the utility of I-131, T1-201 scintigraphy, and serum thyroglobulin(Tg) in the follow-up of differentiated thyroid cancer, we compared retrospectively the data from 33 patients who underwent total or subtotal thyroidectomy. I-131 scintigraphy was performed after optimal endogenous TSH stimulation (TSH>50microgram/ml). Total 41 cases of I-l3l and T1-201 scintigraphy pairs were examined. Concomitant serum thyroglobulin levels were measured for 41 pairs of scan. Tg-off levels(that measured after discontinuation of the thyroid hormone) higher than 40ng/ml were considered positive, and Tg-on levels(that measured during the thyroid hormone replacement) higher than 5ng/ml were considered positive. The concordance rates between I-131 therapeutic scintigraphy and T1-201 scintigraphy was 48% in the 38 case of total scan pairs(59% in the 17 cases of postoperative preablation group, and 38% in the 21 cases of postoperative postablation group), Of 17 studies before the I-131 ablation therapy (preablation group), 7 showed positive I-131 therapeutic scintigraphy despite of negative T1-201 scintigraphy. Among patients with negative I-131 therapeutic scintigraphy, no patients had abnormal T1-201 uptake. However, of 21 studies which were done after radioiodine therapy(postablation group) 6 had abnormal uptake on T1-201 scintigraphy which were not seen on I-131 therapeutic scintigraphy, and Tg-off levels also elevated in this 4 of 6 cases. As a result, I-131 therapeutic scintigraphy showed highest positive rate at postoperative preablation follow-up study in differentiated thyroid cancer patients. T1-201 scintigraphy may be useful in postablation studies, and the use of the combined modalities(T1-201 and Tg levels) provides a higher diagnostic yield.
Subject(s)
Humans , Follow-Up Studies , Radionuclide Imaging , Retrospective Studies , Thyroglobulin , Thyroid Gland , Thyroid Neoplasms , ThyroidectomyABSTRACT
To evaluate the clinical utility of Tc-99m MIBI scan in the detection of residual thyroid tissue or metastatic lesion in postoperative thyroid cancer patients, we compared Tc-99m MIBI scan with I-131 diagnostic and therapeutic scan in 30 postoperative well-differentiated thyroid cancer patients. Thyroglobulin levels of both on and off thyroid hormone medication and antithyroglobulin antibody were tested [Tg(on), Tg(off)l Positive rates for I-131 diagnostic and Tc-99m MIBI scan were 81% and 68% respectively. Concordance between I-131 diagnostic and Tc-99m MIBI scan was observed in 15 cases; 12 positive and 3 negative respectively Among the 6 cases with negative I-131 diagnostic scan and positive Tc-99m MIBI scan, 4 were positive in the therapeutic I-131 scan. We concluded that Tc-99m MIBI scan maybe a useful complementary modality to the currently established method of I131 scan and serum thyroglobulin level in the detection of recurrent or metastatic thyroid cancer, especially in the case of negative I-131 diagnostic scan.