ABSTRACT
BACKGROUND/AIMS: Serum alpha-fetoprotein (AFP) measurement is commonly included in a health check-up program in Korea. However, its benefits remain uncertain. We analyzed whether AFP measurement should be included in a general health check-up program to screen for hepatocellular carcinoma (HCC). METHODS: A total of 36,552 adults aged 18 years or older—who participated in a routine health examination including AFP determination between January 2009 and December 2009 at the Health Promotion Center, Samsung Medical Center, South Korea—were analyzed. High risk of HCC was defined as positivity for hepatitis B surface antigen, anti-hepatitis C virus antibody or having liver cirrhosis. RESULTS: AFP level >10 ng/mL was observed in 27 participants (0.1%) and primary liver cancer was diagnosed in 9 patients (6 HCC and 3 cholangiocarcinoma). Among 1,619 participants with high risk factors of HCC, AFP level >10 ng/mL was observed in 16 participants, of which, 4 diagnoses were made. Sensitivity, specificity, positive predictive value, and negative predictive value of AFP for HCC was 0.66, 0.99, 0.25 and 0.99, respectively, for high risk participants. Among 34,933 participants without risk factors for HCC, 11 patients (<0.1%) showed elevated AFP levels above 10 ng/mL, and no case was diagnosed with primary liver cancer during a median follow-up period of 36 months (range: 0-48 months). CONCLUSIONS: AFP elevation was rare in participants without risk factors for HCC, and was unable to screen for HCC in this population. We discourage routine AFP measurements for asymptomatic adults without risk factors of HCC.
Subject(s)
Adult , Humans , alpha-Fetoproteins , Carcinoma, Hepatocellular , Diagnosis , Follow-Up Studies , Health Promotion , Hepatitis B Surface Antigens , Korea , Liver Cirrhosis , Liver Neoplasms , Mass Screening , Risk Factors , Sensitivity and SpecificityABSTRACT
Diabetic nephropathy is a chronic microvascular complication of type 2 diabetes and the leading cause of end-stage renal disease. We report the case of a 34-year-old male, newly diagnosed with type 2 diabetes mellitus, who had advanced-stage nephropathy with glomerular crescents. A moderately-to-severely decreased glomerular filtration rate with nephrotic syndrome was seen at the time of diagnosis of diabetes. Proliferative diabetic retinopathy was detected, but there was no positive finding in serology tests for glomerulonephritis. Non-necrotizing cellular crescents and nodular glomerulosclerosis were observed in a kidney biopsy, and renal function declined rapidly to the end stage. We review data on diabetic glomerulosclerosis with cellular crescents and the rapid progression of nephropathy.
Subject(s)
Adult , Humans , Male , Biopsy , Diabetes Mellitus, Type 2 , Diabetic Nephropathies , Diabetic Retinopathy , Diagnosis , Disease Progression , Glomerular Filtration Rate , Glomerulonephritis , Kidney , Kidney Failure, Chronic , Nephrotic Syndrome , PathologyABSTRACT
This is a case of a sudden cardio-pulmonary arrest in a 29 year-old female, which occurred immediately after a large bolus infusion of propofol (100 mg) intravenously during dilatation and curettage. The arrest suddenly occurred, and the patient was eventually transferred to our emergency room (ER) on cardiopulmonary resuscitation. At that time, severe hyperkalemia up to 9.1 mEq/L and ventricular fibrillation were noted. Resuscitation in ER worked successfully with conversion of electrocardiograph to sinus rhythm, but this patient expired unfortunately. On view of this acute event immediately after the bolus injection of propofol accompanied without other identified causes, severe hyperkalemia induced by propofol was strongly assumed to be the cause of death. To our understanding with the literature survey, propofol as a cause of hyperkalemia has not been well described yet. Through this case, the relationship as a cause and an effect between propofol and hyperkalemia is suggested.
Subject(s)
Female , Humans , Cardiopulmonary Resuscitation , Cause of Death , Dilatation and Curettage , Electrocardiography , Emergencies , Heart Arrest , Hyperkalemia , Propofol , Resuscitation , Ventricular FibrillationABSTRACT
Hepatitis A virus (HAV) infection is common in developing countries, including Korea. It can be accompanied by extrahepatic complications such as renal failure, arthritis, and vasculitis. Pleural effusion is a very rare complication of HAV infection, which has been reported usually in children, and has benign clinical courses. Here we report a case of pleural effusion with ascites which occurred in an adult hepatitis A patient. A 26-year-old-woman presented generalized myalgia and fever and was diagnosed as acute hepatitis A. Despite of the improvement of laboratory findings, fever and cough persisted. Pleural effusion newly appeared on the serial chest radiologic images. After the fever settled down, the pleural effusion resolved spontaneously at 13th day of admission.
Subject(s)
Adult , Female , Humans , Acute Disease , Hepatitis A/complications , Pleural Effusion/complications , Tomography, X-Ray ComputedABSTRACT
PURPOSE: Hyperphosphatemia and renal osteodystrophy increase the mortality and morbidity in chronic kidney disease. We compared the effects of lanthanum carbonate (LC) and calcium carbonate (CC) on phosphate homeostasis and bone bio-markers in hemodialysis patients. METHODS: The Korean dialysis patients with serum phosphorus more than 5.6 mg/dL were randomized to LC (n=12) or CC (n=11). Serum calcium, phosphorus, intact PTH, bone alkaline phosphatase, and osteocalcin were checked at regular intervals for 6 months. RESULTS: The reduction of serum phosphorus and calcium x phosphorus product at 24-week (wk) from baseline values was similar in LC and CC groups (Phosphorus: baseline, 7.28+/-1.04 mg/dL vs 7.41+/- 1.39 mg/dL, p=NS; at 24-wk, 5.39+/-1.85 mg/dL vs 5.67+/-1.43 mg/dL, p=NS) (Calcium x phosphorus product: baseline, 64.5+/-11.1 mg2/dL2 vs 61.3+/-11.9 mg2/dL2, p=NS; at 24-wk, 47.9+/-14.5 mg2/dL2 vs 51.8+/-14.0 mg2/dL2, p=NS). Despite higher baseline serum calcium levels in LC group, the changes of serum calcium from the baseline at 24-wk were significantly higher in CC group (LC vs CC; 0.23+/-0.38 mg/dL vs 0.94+/-0.87 mg/dL, p<0.05). Bone bio-markers, including iPTH, bone ALP, and osteocalcin, were comparable in 2 groups. However, significant gastrointestinal side effects leading to discontinuing the study were predominantly observed in LC (LC vs CC; n=5/12 vs n=0/11). CONCLUSION: Compared to calcium carbonate, lanthanum carbonate has similar efficacy to reduce serum phosphorus level, but less tendency to increase serum calcium level. However, the high incidence of gastrointestinal side effects in lanthanum carbonate needs further investigation in its correlation to Korean.
Subject(s)
Humans , Alkaline Phosphatase , Calcium , Calcium Carbonate , Carbon , Dialysis , Homeostasis , Hyperphosphatemia , Incidence , Lanthanum , Osteocalcin , Phosphorus , Renal Dialysis , Renal Insufficiency, Chronic , Chronic Kidney Disease-Mineral and Bone DisorderABSTRACT
In hyponatremic patients, the assessment of extracellular fluid volume plays an essential step in diagnosing the etiology of hyponatremia and deciding how to manage it. Although various laboratory tests and diagnostic procedures have been developed for differential diagnosis of hyponatremia, there still are limits to the evaluation of the status of extracellular fluid volume due to the data that overlaps each other, leading to the difficulty in diagnosing between euvolemia and hypovolemia. Also, there is no consensus about how to guide the type and amount of fluid therapy despite many formulas including Adrogue-Madias and Barsoum-Levine formulas have been suggested. Hereby, we are reporting two hyponatremic patients (102 and 105 mEq/L) admitted simultaneously with indistinct volume status on initial clinical and laboratory examinations, but were clarified as euvolemic hyponatremia (syndrome of inappropriate antidiuretic hormone secretion) in one and hypovolemic hyponatremia in the other case after sequential intravenous saline (2 L over 24 hrs) and oral water (20 mL/kg) loading tests. When serum sodium values calculated by the above-mentioned two formulas were compared with actually measured ones during saline loading test in these cases, the Barsoum-Levine formula revealed almost no discrepancy between both the values while the Adrogue-Madias formula underestimated the measured value.
Subject(s)
Humans , Consensus , Diagnosis, Differential , Extracellular Fluid , Fluid Therapy , Hyponatremia , Hypovolemia , Inappropriate ADH Syndrome , Sodium , WaterABSTRACT
Paragonimiasis mainly occurs by ingestion of raw or undercooked freshwater crabs or crayfish. In our country, the prevalence of paragonimiasis was high until late 1960s due to eating habits, but after the 1970s the prevalence of the disease has markedly decreased and now the disease is rarely seen. As the clinical and radiological features as well as the laboratory findings are similar to that of pulmonary tuberculosis, the differential diagnosis of pulmonary paragonimiasis is very difficult. We experienced a case of a patient with pulmonary paragonimiasis who was treated as having pulmonary tuberculosis.
Subject(s)
Humans , Astacoidea , Diagnosis, Differential , Eating , Fresh Water , Paragonimiasis , Prevalence , Tuberculosis , Tuberculosis, PulmonaryABSTRACT
PURPOSE: Febrile seizures affect 2-5% of all children younger than 6 years old. A small proportion of children with febrile seizures later develop epilepsy. Generalized epilepsy with febrile seizures plus(GEFS+) is an important childhood genetic epilepsy syndrome with heterogeneous phenotypes, including febrile seizures(FS) and generalized epilepsies of variable severity. It was reported that the gene locus for GEFS+ exists in the chromosome 19q13.1, and has relationship with a 387 C->G mutation in the voltage- gated sodium channel beta1 subunit(SCN1B) gene. This study is to determine whether there are mutations in children with GEFS+ and FS. METHODS: Eighteen GEFS+ and thirteen FS patients were screened for mutations in the sodium channel beta-subunits SCN1B. The primer pairs used to amplify the exons of SCN1B are given in the supplementary data on the Neurology web site. All exons were amplified by PCR and PCR products were subsequently sequenced. Single-stranded conformation polymorphism(SSCP) was carried out using 8% polyacrylamide gel. RESULTS: Twenty four patients(77%) were younger than 10 years old, three(10%) were between 10 and 14 years old, and four(13%) older than 14 years old. The ratio of female to male was 0.55:1.0. In phenotypes of GEFS+, fourteen patients(88%) had generalized tonic-clonic seizures, one patient(6%) myoclonic seizures and one patient(6%) atonic seizures. In EEG findings of GEFS+, eleven(78%) patients had normal findings, five(28%) patients generalized spike waves and two patients(11%) diffuse slowings. In sequencing and SSCP of PCR products, we could observe added C mutations between 224G and 225C of exon 3 in two unrelated patients with GEFS+. CONCLUSION: We proved the existence of a new mutation of SCN1B in two unrelated patients with GEFS+.