Acute Lymphoblastic Leukemia Diagnosed in a Patient with Acromegaly / 대한내과학회지

Acromegaly is a rare disorder caused by excessive amounts of growth hormone. The incidence of colorectal, breast, and thyroid carcinomas is increased in acromegaly. However, there have been few reports on hematological malignancies in acromegaly. We describe a patient who developed acute lymphoblastic leukemia during the course of acromegaly. A 35-year-old woman presented in February 2012 with unexplained lactation and amenorrhea for 4 months. Her growth hormone level was 12.6 microg/L, insulin-like growth factor 1 592.26 ng/mL, and prolactin 242 microg/L. A pituitary macroadenoma secreting GH and prolactin causing acromegaly was diagnosed. Considering her fertility, the dopamine agonist cabergoline 0.5 mg was administered in March 2012. In February 2014, she presented with cytopenia (hemoglobin 12.2 g/dL, white cell count 2.69 x 10(9)/L, platelets 39 x 10(9)/L) and hepatosplenomegaly. A bone marrow examination showed acute B cell lymphoblastic leukemia. She underwent chemotherapy and bone marrow transplantation. A follow-up bone marrow biopsy showed remission.

Two Cases of Allergy to Insulin in Gestational Diabetes

Allergic reaction to insulin is uncommon since the introduction of human recombinant insulin preparations and is more rare in pregnant than non-pregnant females due to altered immune reaction during pregnancy. Herein, we report two cases of allergic reaction to insulin in gestational diabetes that were successfully managed. One case was a 33-year-old female using isophane-neutral protamine Hagedorn human insulin and insulin lispro. She experienced dyspnea, cough, urticaria and itching sensation at the sites of insulin injection immediately after insulin administration. We discontinued insulin therapy and started oral hypoglycemic agents with metformin and glibenclamide. The other case was a 32-year-old female using insulin lispro and insulin detemer. She experienced pruritus and burning sensation and multiple nodules at the sites of insulin injection. We changed the insulin from insulin lispro to insulin aspart. Assessments including immunoglobulin E (IgE), IgG, eosinophil, insulin antibody level and skin biopsy were performed. In the two cases, the symptoms were resolved after changing the insulin to oral agents or other insulin preparations. We report two cases of allergic reaction to human insulin in gestational diabetes due to its rarity.

A Case of Tracheobronchial Aspergillosis Resolved Spontaneously in an Immunocompetent Host / 결핵및호흡기질환

A 47-year old man visited our hospital because of purulent sputum for 3 months. Chest X-ray showed destruction of both the upper lungs, and bronchoscopy revealed inflammatory change with whitish plaque on the left main bronchus through upper division of the left upper lobe. Tracheobronchial aspergillosis (TBA) was finally diagnosed as a result of histologic and microbiologic examination. However, he went abroad without medication before the diagnosis was made and visited again 10 months later. Follow-up bronchoscopy showed complete regression of the previously noted endobronchial lesion. We describe this case to consider the role of antifungal treatment in immunocompetent hosts, as well as to discuss a rare condition; TBA resolved spontaneously.

Rapidly Progressive Cardiac Manifestation of Behcet's Disease Involving Conduction System and Aortic Valve

Cardiac conduction system impairment is a rare clinical manifestation of Behcet's disease. We report a patient who showed 1st degree atrioventricular block at first presentation, and showed aggravated finding of 3rd degree atrioventricular block on five months later. His cardiac manifestation finally developed to acute severe aortic regurgitation on six months later from his first cardiac manifestation. We observed this rapid progression during 6 months and successfully improved symptom and disease severity of the patient with treatment targeting Behcet's disease.

A Case of Minimal Change Nephrotic Syndrome Presented as Portal Vein Thrombosis and Acute Renal Failure / 대한신장학회지

Patients with the nephrotic syndrome are at risk of developing thromboembolic complications. Much evidence suggests that a hypercoagulable state exists in the setting of the nephrotic syndrome, but the exact mechanisms are poorly understood. The nephrotic syndrome associated with portal vein thrombosis is relatively uncommon. We experienced a case of minimal change nephrotic syndrome presented as portal vein thrombosis and acute renal failure. On renal biopsy, electron microscopic examination reveals diffuse foot process effacement. Treatment with corticosteroid and anticoagulation resulted in complete remission of proteinuria.

Effects of progesterone/progestin on the apoptosis of the human umbilical vein endothelial cell / 대한산부인과학회잡지

OBJECTIVE: The addition of progesterone/progestin is mandatory in women with intact uterus for postmenopausal hormone replacement therapy. However, debate is continuing on whether there is an impact of progesterone/progestin on the hormone replacement therapy for cardiac protection. The aim of this study was to investigate the effect of progesterone/progestin and combination with estrogen on the apoptosis of vascular endothelial cells, which has been demonstrated to be an initial step in the development of atherosclerosis. MATERIAL AND METHODS: Human Umbilical Vein Endothelial Cells (HUVEC) were cultured. HUVEC apoptosis was induced by Tumor Necrosis Factor-alpha (TNF-alpha) (50 ng/ml). 10-7M of estradiol (E2), progesterone (P4), medroxyprogesterone acetate (MPA) and norethindrone acetate (NETA) were added in to the culture media. The percentage of apoptotic HUVEC were measured by 3-[4,5-Dimethylthiazol-2-yl]-2,5- diphenyltetrazolium bromide (MTT) assay and Fluorescence Activated Cell Sorting (FACS) analysis. RESULTS: MTT assay demonstrated a significant decrease in percent of survival cells after 24 hours of TNF-alpha exposure and a reversal of the effect of TNF-alpha with E2 treatment. P4, MPA and NETA treatment also reversed the effect of TNF-alpha. The protective effect of E2 and P4 were not different. Compared to the E2 treatment, the percent of survival cell were decreased when P4, MPA and NETA were added to E2 treatment, respectively. Similarly, FACS analysis revealed 44.0+/-2.6% apoptosis after 24 hours of TNF-alpha exposure. Treatment with E2 resulted a significant decrease (28.4+/-2.9%, P<0.05) in apoptosis. P4 (33.6%+/-2.6%, P<0.05), MPA (35.7+/-1.3%, P<0.05), NETA (34.0+/-3.3%, P<0.05) treatment also showed a reduction of cell death. The percent of apoptotic cells between E2 and MPA treatment was significantly different. The addition of P4 (36.0+/-2.5%), MPA (36.3+/-1.9%) and NETA (37.0+/-2.0%) to E2 treatment significantly increased the percent of apoptotic cells compared to those of E2 treatment. CONCLUSION: These results suggested that not only estradiol, but also progesterone, MPA and NETA inhibited HUVEC apoptosis. But the effect of estrogen on the inhibition of HUVEC apoptosis was attenuated in combination treatment of estrogen and progesterone/progestin.