ABSTRACT
Iodine-131 is a radioisotope that is routinely used for the treatment of differentiated thyroid cancer after total or near-total thyroidectomy. However, there is some evidence that iodine-131 can induce liver injury . Here we report a rare case of drug-induced liver injury (DILI) caused by iodine-131 in a patient with regional lymph node metastasis after total thyroidectomy. A 47-year-old woman was admitted with elevated liver enzymes and symptoms of general weakness and nausea. Ten weeks earlier she had undergone a total thyroidectomy for papillary thyroid carcinoma and had subsequently been prescribed levothyroxine to reduce the level of thyroid-stimulating hormone. Eight weeks after surgery she underwent iodine-131 ablative therapy at a dose of 100 millicuries, and subsequently presented with acute hepatitis after 10 days. To rule out all possible causative factors, abdominal ultrasonography, endoscopic ultrasonography (on the biliary tree and gall bladder), and a liver biopsy were performed. DILI caused by iodine-131 was suspected. Oral prednisolone was started at 30 mg/day, to which the patient responded well.
Subject(s)
Female , Humans , Middle Aged , Abdomen/diagnostic imaging , Chemical and Drug Induced Liver Injury/diagnosis , Iodine Radioisotopes/chemistry , Lymph Nodes/pathology , Lymphatic Metastasis , Prednisolone/therapeutic use , Thyroid Neoplasms/drug therapy , Thyroidectomy , Thyroxine/therapeutic use , UltrasonographyABSTRACT
Occupational exposure to trichloroethylene (TCE) can occasionally induce severe cutaneous disorders, including hypersensitivity syndrome and Stevens-Johnson syndrome. The clinical manifestation of TCE hypersensitivity syndrome is quite similar to that of drug-induced hypersensitivity syndrome and includes skin lesions, hepatitis, fever, and lymphadenopathy. Almost all cases of TCE hypersensitivity syndrome developed within 2–8 weeks after the first exposure to TCE in an occupational setting. This typical course and clinical feature of hypersensitivity syndrome together with occupational history of TCE contact may lead to prompt diagnosis and treatment of this potentially fatal disease. This report describes a 32-year-old man who has been intermittently engaged in cleaning work using TCE for about 3 years, and then developed TCE hypersensitivity syndrome. To the best of our knowledge, this is the first case of TCE hypersensitivity syndrome with a long duration of symptom onset due to intermittent exposure to TCE. Thus, physicians should take thorough occupational history when seeing a patient with hypersensitivity syndrome has neither history of drug intake nor regular exposure to TCE.
Subject(s)
Adult , Humans , Diagnosis , Fever , Hepatitis , Hypersensitivity , Lymphatic Diseases , Occupational Exposure , Skin , Stevens-Johnson Syndrome , TrichloroethyleneABSTRACT
Untreated hyperthyroidism and high-dose thyroid hormone are associated with osteoporosis, and increased bone mineral density (BMD) has been demonstrated in postmenopausal females with hypoparathyroidism. Studies on the effect of suppressive levothyroxine (LT4) therapy on BMD and bone metabolism after total thyroidectomy in patients with differentiated thyroid carcinoma have presented conflicting results, and few studies in relation to the status of hypoparathyroidism have been studied. One hundred postmenopausal women and 24 premenopausal women on LT4 suppression therapy were included in this study. BMD of lumbar spine and femur and bone turnover markers were measured at the baseline and during the follow-up period up to 18 months using dual energy X-ray absorptiometry. Biochemical marker of bone resorption was measured by urine deoxypyridinoline and bone formation by serum osteocalcin. The age ranged from 36 to 64 years old. Thyroid stimulating hormone (TSH) was suppressed during the study. The results showed that BMD of femur and lumbar spine were not significantly changed in both pre- and postmenopausal women except femur neck in postmenopausal women without hypoparathyroidism. Patients with hypoparathyroidism had higher BMD gain than those without hypoparathyroidism in total hip (1.25 vs. -1.18%, P=0.015). Biochemical markers of bone turnover, serum osteocalcin, and urine deoxypyridinoline did not show significant change. In conclusion, patients with well differentiated thyroid carcinoma are not at a great risk of bone loss after LT4 suppressive therapy. The state of hypoparathyroidism is associated with increased BMD, particularly in postmenopausal women.
Subject(s)
Female , Humans , Absorptiometry, Photon , Biomarkers , Bone Density , Bone Resorption , Femur , Femur Neck , Follow-Up Studies , Hip , Hyperthyroidism , Hypoparathyroidism , Metabolism , Osteocalcin , Osteogenesis , Osteoporosis , Postmenopause , Spine , Thyroid Gland , Thyroid Neoplasms , Thyroidectomy , Thyrotropin , ThyroxineABSTRACT
Eosinophilic granulomatosis with polyangiitis (EGPA), previously called Churg-Strauss syndrome, is an anti-neutrophil cytoplasmic antibody associated vasculitis, accompanied by asthma, hypereosinophilia, nonfixed pulmonary infiltrates, and sinusitis. Peripheral neuropathy is common in patients with EGPA; however, a few cases of EGPA with central nervous system (CNS) involvement have been reported. A 45-year-old female referred for right side weakness and posterior neck pain was diagnosed as EGPA with subarachnoid hemorrhage and mononeuritis multiplex. She was effectively treated with a high dose glucocorticoid, cyclophosphamide, and intravenous immunoglobulin. EGPA with CNS involvement is uncommon and causes significant morbidity and mortality. Therefore more rapid and accurate diagnostic evaluation may be required. EGPA should be considered in patients with neurological symptoms and hypereosinophilia.
Subject(s)
Female , Humans , Middle Aged , Antibodies, Antineutrophil Cytoplasmic , Asthma , Central Nervous System , Churg-Strauss Syndrome , Cyclophosphamide , Eosinophils , Immunoglobulins , Mononeuropathies , Mortality , Neck Pain , Peripheral Nervous System Diseases , Sinusitis , Subarachnoid Hemorrhage , VasculitisABSTRACT
The emerging pathogen, group C rotavirus (RVC) has been reported to cause acute diarrhea. But there was the limitation on the detection and monitoring for the absence of rapid sensitive diagnosis system. For the molecular biology study and diagnostic system development, we could detect porcine RVC by reverse transcriptase PCR (RT-PCR) analyses from 60 diarrheal disease porcine stool samples. VP6 full length RT-PCR product (CA-2 RVC, 1352 bp) was cloned and compared the nucleotide and deduced amino acid sequences with those of previously reported other porcine, human, and bovine rotavirus group A, B and C strains. Analyses data showed >82% homology on the nucleotide sequences and >90% homology on the deduced amino acid sequences with other RVCs. Recombinant baculovirus was prepared with cloned PCR product corresponding to VP6 coding sequence (CDS) (position 22~1206) into BaculoDirect(TM) C-term linear DNA, and used for the transfection of insect cells. The polyclonal antibody was produced from mice with purified recombinant VP6 and confirmed with western blot. Both of VP6 antigen and antibody, are useful for the development of rapid diagnostic system against RVC.
Subject(s)
Animals , Humans , Mice , Amino Acid Sequence , Antibody Formation , Baculoviridae , Base Sequence , Blotting, Western , Clinical Coding , Clone Cells , Diarrhea , DNA , Insecta , Molecular Biology , Polymerase Chain Reaction , Reverse Transcriptase Polymerase Chain Reaction , Rotavirus , TransfectionABSTRACT
One hundred and seventy-two cases of tuberculosis of the bones and joints were treated at the department of orthopedic surgery, Inchon Christian Hospital during the 3 years and 10 months from March, 1979, to December, 1982. The results obtained were as followings: 1. The incidence was decreased progressively 1.92% in 1980 to 1.18 in 1982. 2. Tuberculous lesions involved spine(50.58%), knee(16.28%), hip(13.37%), ankle(2.33%) and greater trochanter(2.33%) in order. 3. Age and sex distribution were not remarkable. 4. The main associated tuberculous lesions were pulmonary tuberculosis and tuberculous pleurisy (20.65%). Therefore, pulmonary problems should be always carefully investigated in every case of skeletal tuberculosis. 5. Average duration of disease was one year and 3.5 months, average hospital days was one month. 6. Initial miss diagnosis of lesions ultimately proved to be tuberculosis. Rheumatoid arthritis:13 cases, Osteoarthritis : 3 cases, Herniated lumbar disc: 3 cases, Cellulitis :2 cases, Neoplasm :2 cases. Early diagnosis is essential since proper therapy is available and far advanced destruction, long suffering and disability can be avoided. 7. Post operative complication was mainly due to failure of bone graft in tuberculous spondylitis and was draining sinus formation and wound disruption in other skeletal tuberculosis. 8. The result of treatment of skeletal tuberculosis from conservative methods were relatively poor. The corroboratory care of skeletal tuberculosis can be obtained by extensive surgery.
Subject(s)
Cellulitis , Diagnosis , Early Diagnosis , Incidence , Joints , Orthopedics , Osteoarthritis , Sex Distribution , Spondylitis , Transplants , Tuberculosis , Tuberculosis, Pleural , Tuberculosis, Pulmonary , Wounds and InjuriesABSTRACT
In 1868 Charcot described the join in tabes dorsalis, which since then has been designated as Charcot neuroarthropathy. It is characterized by painless swelling and abnormal mobility of the affected joint. Arthropathy of the type described by Charcot has been associated with various other conditions, such as diabetes mellitus, syringomyelia, injury to nerve root, congenital indfference to pain, leprosy, and intra-articular use of steroid, etc. Authors present a case of Charcot joint which involved the left knee joint associated with pathologic fracture of the left tibia and fibula.