Thyroid Associated Ophthalomopathy in a Patient with Hashimoto's Thyroiditis

A 53-year-old man consulted an ophthalmologist with a chief complaint of diplopia and bilateral eyelid swelling. He was diagnosed with hypothyroidism 2 years prior at a local clinic and had been taking levothyroxine 150 mcg daily. CT scan of the orbits showed enlargement of bilateral extraocular muscles. Laboratory findings revealed hyperthyroidism due to high dose levothyroxine. Active ophthalmopathy with Hashimoto's hypothyroidism was diagnosed and the patient was treated with steroid pulse therapy. We reported a rare case of severe ophthalmopathy with Hashimoto's thyroiditis that needed steroid pulse therapy.

Thyroid Associated Ophthalomopathy in a Patient with Hashimoto's Thyroiditis

A 53-year-old man consulted an ophthalmologist with a chief complaint of diplopia and bilateral eyelid swelling. He was diagnosed with hypothyroidism 2 years prior at a local clinic and had been taking levothyroxine 150 mcg daily. CT scan of the orbits showed enlargement of bilateral extraocular muscles. Laboratory findings revealed hyperthyroidism due to high dose levothyroxine. Active ophthalmopathy with Hashimoto's hypothyroidism was diagnosed and the patient was treated with steroid pulse therapy. We reported a rare case of severe ophthalmopathy with Hashimoto's thyroiditis that needed steroid pulse therapy.

Diagnostic Value of Adenosine Deaminase(ADA) and its Isoenzyme in Pleural Effusion / 결핵

BACKGROUND: Etiologic diagnosis of pleural effusion is usually made by clinical characteristics, pleural fluid analysis and pleural biopsy. But, despite careful diagnostic study, the cause of pleural effusion cannot be found in about 20 percent of patients, especially in loculated pleural effusions. Tuberculous pleurisy is one of the most common cause of pleural effusion in Korea. But, pleural fluid culture for Mycobacterium tuberculosis are positive in only 20 to 30 percent of patients and typical pleural biopsy finding in less than 50 percent of patients with this disease. In recent studies, adenosine deaminse(ADA) and its isoenzymes were proposed to be a useful diagnostic tool for differential diagnosis of pleural effusion We investigated the pattern of ADA and its isoenzyme activities in various cause of pleural effusions to evaluate the diagnostic value of measuring ADA and its isoenzymes. METHOD: We measured total ADA and its isoenzyme activities in pleural fluid and serum from 54 patients with pleural effusion(25 tuberculous pleural effusion, 10 parapneumonic effusion, 14 malignant pleural effusion, 5 transudative pleural effusion), including 5 loculated tuberculous pleural effusions and 6 loculated parapneumonic effusions. Total ADA activity was measured by the spectrophotometric method and ADA2 isoenzyme activity was measured with same method using EHNA, potent inhibitor of ADA1 isoenzyme activity. RESULT: Total ADA activity of tuberculous pleural effusion was higher than malignant pleural effusion(p<0.01), but no significant difference was found between tuberculous pleural effusion and parapneumonic effusion (tuberculous pleural effusion:148.9+/-9.91U/L, parapneumonic effusion:129.0+/-119.41U/L, malignant pleural effusion 48.7+/-9.71U/L). Percentage of ADA2 activity to total ADA activity(ADA2%) of pleural effusion of tuberculous pleurisy was higher than parapneumonic effusion(p<0.05), but no significant difference was found between tuberculous pleural effusion and malignant pleural effusion(tuberculous pleural effusion: 57.2+/-10.7%, parapneumonic effusion: 35.9+/-17.8%, malignant pleural effusion: 60.7+/-4.1%). In loculated pleural effusion, ADA2% of tuberculous pleural effusion was higher than parapneumoriic effusion(tuberculous pleural effusion: 53.3+/-3.9%, parapneumonic effusion: 27.8+/-7.9%). CONCLUSION: Measurement of ADA isoenzyme activity is useful for differentiating tuberculous pleural effusion from parapneumonic effusion, especially in loculated pleural effusion.

The effects of nebulized salbutamol on serum potassium concentration in bronchial asthmatics / 천식및알레르기

BACKGROUND AND OBJECTIVE: The knowledge about the effects of the nebulized B2-agonist on serum potassium is limited. We aimed to assess the possible hypokalemia following nebulization of salbutamol. METHOD: Seven patients(mean age 60 +- 7.1years) with acute exacerbated asthma were treated with salbutamol nebulization(5mg nebulization at 1 hour interval, 3 times) without concomitant use of steroid or other bronchodilator such as theophylline. RESULTS: There was a significant increase in FEV1, from 46.41+-25.91% at baseline to 62.86+-22.38% at 3 hours after treatment. Serum potassium concentration was significantly decreased, from 3.93+-0.58mEq/L at baseline to 3.41+-0.62mEq/L and 3.46+-0.53mEq/L at 1 hour and 3 hours after third nebulization, repectively. There was a significant prolongation of the QTc interval in EKG from 454.36+-27.07msec at baseline to 479.41+-35.64msec and 505.09+-58. 69msec at 1 hour and 3 hours after third nebulization, respectively. Serum salbutamol concentration was 4.18+-3.39ng/ml at baseline, and increased to 7.69+-6.94ng/ml and 9.84+10.34ng/ ml at 1 hour and 3 hours after treatment, respectively. Magnitude of the hypokalemia and the degree of prolongation of the electrocardiographic QTc interval were significantly correlated with the level of serum salbutamol concenturation. CONCLUSION: The results suggest that cardiac complication could develop due to hypokalemia during repeated salbutamol nebulization. Caution should be done in monitoring of serum potassium concentration when using nebulized salbutamol repeatedly for the treatment of acute exacerbated bronchial asthma.

A Case of Mixed Infection with Malaria and Babesia / 감염

Despite efforts to control the spread of malaria, the disease persists in certain parts of the world. Moreover, there has been a resurgence of the disease recently. Another protozoan disease, babesiosis is a disease of animals; Humans are infected only incidentally, and when they are infected, they develop a nonspecific febrile illness. Babesia organism enters red blood cells and resembles malaria parasites, thus posing a problem in the differential diagnosis. We encountered an imported case of mixed infection of malaria and babesia. The patient was a 20-year old Korean male who had been in Saong-dume near Gabon for 3 months. We treated him with chloroquine with the diagnosis of Plasmodium malariae infection, but fever recurred after 2 weeks of the treatment. The second peripheral blood smear findings revealed specific ring forms of Babesia spp, so we changed to quinine and clindamycin. The treatment was successful and the patient was well after 4 months of follow-up period.

The Application of Impulse Oscillometry(IOS) in the Detection of Smoking Induced Early Airway Obstruction / 결핵

BACKGROUND: Impulse Oscillometry is a noninvasive and effort-independent test used to characterize the mechanical impedance of the respiratory system. The clinical potential of the 105 is rapid and demands only passive cooperation which makes it especially appealing for children, for epidemiologic surveys and for conditions in which quiet breathig instead of forced expiratory maneuvers are preferred. However, several studies have shown conflicting results that the role of 108 about detection of smoking induced small airway diseases or early airway obstruction METHODS: Study was to evaluate the clinical ability of the 108 to detect about smoking induced early airway obstruction in persons with normal spirometry test. Respiratory asymptomatic study groups were formed that one is non-smoking group, another is smoking group. RESULTS: The parameters of spirometry were not significantly differences between non-smoking group and smoking group. Among the parameters of 108, total resistance(non-smoking group: smoking group= 2.22 +/-1.20 : 2.58 +/-1.71), peripheral resistance( 1.25 +/-0.62 : 1.47 +/-0.10), bronchial compliance(0.44 +/-0.12: 0.47 +/-0.16) were not statistically significant different (p<0.05), but central resistance and lung compliance were not statistically significant different (unit ; resistance= hPa/l/s, compliance= 1/hPa). Resistance(Rrs) was not statistically significant different with changes of frequences(5, 10, 15, 20, 25, 30, 35Hz), but Reactance(Xrs) was statistically significant differenct with low frequences that X5(non-smoking group : smoking group= -0.62 +/-0.28 : - 0.76 +/-0.48, p<0.001) and X10(-0.06 +/-0.19 : -0.15 +/-0.33, p<0.013) (unit; hPa/l/s, hPa=cmH2O) CONCLUSION: Impulse oscillometer(IOS) is clinically available method to detect about smoking induced early airway obstruction. And clinically potential parameters of IOS were considers that total resistance, peripheral resistance, bronchial resistance, and reactance of low frequency at 5Hz, 10Hz.

A Case of Arrhythmogenic Right Ventricular Dysplasia

Arrhythmogenic right ventricular dysplasia is a rare heart muscle disorder of unknown cause that primarily involves the right ventricle. It is characterized pathologically by fibrofatty replacement of the right ventricular myocardium. Clinical manifestations include structural and functional abnormalities of the right ventricle, electrocardiographic depolarization/repolarization changes, and presentation with sudden death or ventricular arrhythmias of right ventricular origin. It is one of the important causes of the ventricular arrhythmia or sudden death among apparently healthy young people. We report a case of arrhythmogenic right ventricular dysplasia with the review of the literature.