ABSTRACT
Retroperitoneal tumors are rare. They are asymptomatic, and are often found incidentally on abdominal computed tomograms (CTs). The patient reported here visited our hospital complaining of right flank pain. On abdominal CTs, a left-side retroperitoneal mass and a right ureteral stone were found. The hormonal study was normal. After surgical excision, the tumor was confirmed to be a bronchogenic cyst histologically, a very rare cause of retroperitoneal tumor. Our medical center has seen 15 cases with a soft tissue mass in retroperitoneal space over the past 5 years. Benign tumors were incidentally, while malignant tumors were often diagnosed after the patient complained of a palpable mass. In many of these cases, the radiologic impressions and pathologic diagnosis were inconsistent.
Subject(s)
Humans , Bronchogenic Cyst , Diagnosis , Flank Pain , Retroperitoneal Neoplasms , Retroperitoneal Space , Tomography, X-Ray Computed , UreterABSTRACT
BACKGROUND: Remnant lipoproteins are the lipolytic degradation product of the triglyceride-rich lipoproteins produced by the liver (very-low-density lipoprotein cholesterol) and intestine (chylomicrons). Recent studies have demonstrated a correlation between remnant lipoproteins and cardiovascular risk. Our study assessed the relationship between obesity and remnant lipoproteins and evaluated the factors related to remnant lipoprotein in children and adolescents. METHODS: Body mass index (BMI), waist circumference, systolic and diastolic blood pressures, body fat mass, total abdominal fat, visceral and subcutaneous fat areas, total cholesterol, triglyceride (TG), LDL cholesterol (LDL-C), HDL cholesterol (HDL-C) and remnant lipoprotein cholesterol (RLP-C) were measured in 135 children and adolescents (67 boys and 68 girls). Plasma RLP fractions were isolated using an immunoaffinity gel containing specific anti-apoB-100 and anti-apoA-I antibodies. The subjects were divided into three groups: the low ( or = 85 percentile) BMI groups. RESULTS: RLP-C was significantly correlated with age, sex, BMI, waist circumference, systolic and diastolic blood pressures, visceral and subcutaneous fat areas, visceral fat area to subcutaneous fat area ratio (VSR), total cholesterol, TG, HDL-C, apoB, and HOMA-IR. From a multivariate regression analysis, TG (beta = 0.928, P < 0.001) was found to be independently correlated with RLP-C. After excluding TG as an independent variable, a multivariate regression analysis revealed that the HOMA-IR (beta=0.231, P=0.007) and systolic blood pressure (beta=0.169, P=0.046) were independently associated with RLP-C. CONCLUSION: RLP-C was significantly higher in obese children and adolescents. TG, systolic blood pressure, and insulin resistance were related to remnant lipoproteins.
Subject(s)
Adolescent , Child , Humans , Abdominal Fat , Adipose Tissue , Antibodies , Apolipoproteins B , Blood Pressure , Body Mass Index , Cholesterol , Cholesterol, HDL , Cholesterol, LDL , Dyslipidemias , Insulin Resistance , Intestines , Intra-Abdominal Fat , Lipoproteins , Liver , Obesity , Pediatric Obesity , Plasma , Subcutaneous Fat , Triglycerides , Waist CircumferenceABSTRACT
BACKGROUND: Remnant lipoproteins are the lipolytic degradation product of the triglyceride-rich lipoproteins produced by the liver (very-low-density lipoprotein cholesterol) and intestine (chylomicrons). Recent studies have demonstrated a correlation between remnant lipoproteins and cardiovascular risk. Our study assessed the relationship between obesity and remnant lipoproteins and evaluated the factors related to remnant lipoprotein in children and adolescents. METHODS: Body mass index (BMI), waist circumference, systolic and diastolic blood pressures, body fat mass, total abdominal fat, visceral and subcutaneous fat areas, total cholesterol, triglyceride (TG), LDL cholesterol (LDL-C), HDL cholesterol (HDL-C) and remnant lipoprotein cholesterol (RLP-C) were measured in 135 children and adolescents (67 boys and 68 girls). Plasma RLP fractions were isolated using an immunoaffinity gel containing specific anti-apoB-100 and anti-apoA-I antibodies. The subjects were divided into three groups: the low ( or = 85 percentile) BMI groups. RESULTS: RLP-C was significantly correlated with age, sex, BMI, waist circumference, systolic and diastolic blood pressures, visceral and subcutaneous fat areas, visceral fat area to subcutaneous fat area ratio (VSR), total cholesterol, TG, HDL-C, apoB, and HOMA-IR. From a multivariate regression analysis, TG (beta = 0.928, P < 0.001) was found to be independently correlated with RLP-C. After excluding TG as an independent variable, a multivariate regression analysis revealed that the HOMA-IR (beta=0.231, P=0.007) and systolic blood pressure (beta=0.169, P=0.046) were independently associated with RLP-C. CONCLUSION: RLP-C was significantly higher in obese children and adolescents. TG, systolic blood pressure, and insulin resistance were related to remnant lipoproteins.
Subject(s)
Adolescent , Child , Humans , Abdominal Fat , Adipose Tissue , Antibodies , Apolipoproteins B , Blood Pressure , Body Mass Index , Cholesterol , Cholesterol, HDL , Cholesterol, LDL , Dyslipidemias , Insulin Resistance , Intestines , Intra-Abdominal Fat , Lipoproteins , Liver , Obesity , Pediatric Obesity , Plasma , Subcutaneous Fat , Triglycerides , Waist CircumferenceABSTRACT
BACKGROUND: Acute hypokalemic paralysis, a clinical syndrome characterized by acute systemic weakness and low serum potassium, is a rare but treatable cause of acute weakness. The aim of our study is to analyze the cause of hypokalemic paralysis and to define clinical characteristics of hypokalemic paralysis. METHODS: Hypokalemia was defined as a serum potassium concentration less than 3.0 mEq/L in this study. A total 31 patients with hypokalemic paralysis (male 71%, mean age; 35.7 +/- 14.3 years) have been studied retrospectively from June 1994 to March 2004 for the evaluation of clinical characteristics. According to the pathophysiology of hypokalemia, patients were divided into the potassium renal loss group (n=9) and the potassium shift group (n=14). We calculate the UK/UCr (mmol/mmol) ratio, Transtubular K+ concentration gradient (TTKG) and compared the results between two groups. RESULTS: The cause of hypokalemic paralysis was hyperthyroidism (45.2%), medication (19.4%), renal disease (6.5%), hyperaldosteronism (3.2%), poor oral intake (3.2%), vomiting (3.2%), and unknown origin (19.4%). There was a significant difference of UK/UCr ratio (p=0.046) but no significant difference of TTKG (p=0.116) between the potassium loss and shift groups. CONCLUSION: The most common cause of acute hypokalemic paralysis is hyperthyroidism. The UK/UCr ratio is more useful measure than TTKG in differentiation of potassium loss and potassium shift as a cause of hypokalemia.
Subject(s)
Humans , Creatinine , Diagnosis, Differential , Hyperaldosteronism , Hyperthyroidism , Hypokalemia , Paralysis , Potassium , Retrospective Studies , VomitingABSTRACT
A medullary thyroid carcinoma, a neoplasm of parafollicular C cell origin, occurs as a sporadic or hereditary disease. A hereditary medullary thyroid carcinoma is an autosomal dominantly inherited disease, which is composed of multiple endocrine neoplasia 2A and 2B, with a familial medullary thyroid carcinoma. Germline mutations of the RET gene are the underlying cause of the majority of hereditary medullary carcinomas. Here, the case of a 42 years-old man with a familial medullary thyroid carcinoma, confirmed by the detection of a RET proto-oncogene mutation at exon 13 on codon 768 from a GAG(Glu) to a GAT(Asp), is described. The patient underwent a total thyroidectomy and modified radical neck dissection. His sister was found to have the same mutant gene.
Subject(s)
Adult , Humans , Carcinoma, Medullary , Codon , Exons , Genetic Diseases, Inborn , Germ-Line Mutation , Multiple Endocrine Neoplasia , Neck Dissection , Proto-Oncogenes , Siblings , Thyroid Gland , Thyroid Neoplasms , ThyroidectomyABSTRACT
Von Hippel-Lindau (VHL) disease is an autosomal dominant disease, which forms hypervascular tumors in multiple organs, such as hemangioblastomas in the retina and central nervous system, renal cell carcinomas, pheochromocytomas and cysts in various organs. Recent advances in gene testing have made it possible to screen family members for VHL disease. We experienced a 28 year-old male, who was diagnosed with bilateral pheochromocytomas through a family screening test when his elder monozygous twin brother was diagnosed with a pheochromocytoma. He received no treatment until December, 2004, when he visited the Emergency room due to a headache. A hemangioma of the cerebellum was seen in the brain MR study, leading to the diagnosis of type 2A VHL disease. An abdominal CT scan revealed no lesions of the pancreas or kidney. There was no evidence of a hemangioma in the retinal scan. The subsequent gene testing showed a germline mutation in exon 3 codon 167 of the VHL gene. The mother of the patient was revealed to have the same mutation of the VHL gene, but the elder brother of the patient did not.
Subject(s)
Adult , Humans , Male , Brain , Carcinoma, Renal Cell , Central Nervous System , Cerebellum , Codon , Diagnosis , Emergency Service, Hospital , Exons , Germ-Line Mutation , Headache , Hemangioblastoma , Hemangioma , Kidney , Mass Screening , Mothers , Pancreas , Pheochromocytoma , Retina , Retinaldehyde , Siblings , Tomography, X-Ray Computed , von Hippel-Lindau DiseaseABSTRACT
BACKGROUND: BK virus nephropathy (BKVN) has been increasingly recognized as an important cause of renal transplant dysfunction, but no specific antiviral therapy is currently available. Furthermore, a method evaluating the degree of viral infection has not been developed yet. Recently, there have been several case reports in which BKVN was successfully treated with cidofovir injection. In the current study, we report a case with BKVN successfully treated with cidofovir injection. In addition, we assessed the usefulness of quantitative viral load monitoring using a competitive polymerase chain reaction (PCR) in the treatment of BKVN. METHODS: A renal allograft recipient with BKVN was injected with cidofovir. To monitor BK viral load in urine and plasma, we developed a competitive PCR assay and followed the patient prospectively. RESULTS: A 49 year old renal transplant recipient developed a progressive rise in serum creatinine reaching 1.9 mg/dL at 15 months post-transplantation. Subsequently, the patient was diagnosed as BKVAN by allograft biopsy. At this time, BKV DNA was detected in plasma and urine. Despite a reduction of the dose of mycophenolate mofetil, serum creatinine continued to rise, which prompted the initiation of cidofovir trial. The patient was given intravenous cidofovir. After cidofovir treatment, BK virus associated findings disappeared on repeat biopsy, and BK virus in plasma was decreased to the undetectable level. For 7 months after cidofovir treatment, her renal function remained stable. CONCLUSION: Cidofovir therapy may be effective in the treatment for BKVN. Viral load in plasma reflected well the clinical and pathological course of the BK virus infection.
Subject(s)
Humans , Middle Aged , Allografts , Biopsy , BK Virus , Creatinine , DNA , Plasma , Polymerase Chain Reaction , Prospective Studies , Transplantation , Viral LoadABSTRACT
Visible fungal colonization on peritoneal dialysis catheter is a rare complication and it was not reported yet in Korea. We here report a case of Alternaria spp. colonization on peritoneal dialysis catheter without peritonitis. A 58-year-old man on continuous ambulatory peritoneal dialysis for 2 years, noticed 3-4 mm sized two black-brown immobile fungal colonization plaque on peritoneal catheter lumen (15 cm distal from catheter exit site). The dialysate effluent was clear and culture for fungus and bacteria was negative. Peritoneal catheter was removed and culture from the plaque revealed saprophytic fungus, Alternaria species. The catheter removal alone was sufficient for the treatment. He is on hemodialysis thereafter.
Subject(s)
Humans , Middle Aged , Alternaria , Bacteria , Catheters , Colon , Fungi , Korea , Peritoneal Dialysis , Peritoneal Dialysis, Continuous Ambulatory , Peritonitis , Renal DialysisABSTRACT
Idiopathic interstitial pneumonia is a group of lung disease classified by clinical, radiological and pathologic findings. Steroid is described in many reports as an effective treatment for the idiopathic interstitial pneumonitis. For the treatment of steroid non-responders, immuno-suppressive or cytotoxic agents are used as second line drug of choice. We experienced a case of nonspecific interstitial pneumonitis who was treated initially with glucocorticoid and antibiotics without effects, but later did respond to cyclosporin treatment. This 63 year-old patient was admitted due to dyspnea, cough, and sputum production. He was started on glucocorticoid and antibiotics after he was diagnosed as having nonspecific interstitial pneumonitis by open lung biopsy. The initial steroid treatment was not effective, however, after cyclosprin treatment, the patient showed clinical and radiologic improvements.