An Unusual Case of Osteoblastic Metastasis from Gastric Carcinoma

We report an unusual case of osteoblastic metastasis from gastric carcinoma. In this case, bone metastasis was the initial manifestation of the cancer. The laboratory findings revealed mild hypocalcemia and markedly elevated alkaline phosphatase levels. Plain X-ray showed mottled osteoblastic changes in the pelvis. Bone marrow and bone biopsy of the pelvis revealed metastatic adenocarcinoma with increased osteoblastic activity. An extensive search for the primary site revealed advanced gastric carcinoma, which was confirmed by endoscopic biopsy.

An Unusual Case of Osteoblastic Metastasis from Gastric Carcinoma

We report an unusual case of osteoblastic metastasis from gastric carcinoma. In this case, bone metastasis was the initial manifestation of the cancer. The laboratory findings revealed mild hypocalcemia and markedly elevated alkaline phosphatase levels. Plain X-ray showed mottled osteoblastic changes in the pelvis. Bone marrow and bone biopsy of the pelvis revealed metastatic adenocarcinoma with increased osteoblastic activity. An extensive search for the primary site revealed advanced gastric carcinoma, which was confirmed by endoscopic biopsy.

A case of slipped capital femoral epiphysis developed during growth hormone treatment / 대한내과학회지

Slipped capital femoral epiphysis (SCFE) is the most common orthopedic hip disorder occuring in adolescence. In this condition, the femoral head (epiphysis) displaces, or slips on the femoral neck through the region of the growth plate. This condition can occur only before the epiphyseal plate closes. The exact etiology is unknown, although it has been associated with obesity, hanical abnormalities, physeal abnormalities, endocrine disturbances (hypothyroidism, growth hormone deficiency, hypogonadism). Interestingly, SCFE was observed in growth hormone deficiency and in patients treated with growth hormone. We report a case of an adolescent male with glycogen storage disease Ia and growth hormone deficiency who developed SCFE during treatment with recombinant human growth hormone. A 17-year-old male was admitted for pain of left hip which was exacerbated by walking 15 days ago. He was diagnosed glycogen storage disease Ia and growh hormone deficiency 2 years ago and treated growth hormone therapy with recombinant human growth hormone at the dose of 2 unit/day. The diagnosis of SCFE was confirmed radiologically. From the time of admission, he received skin traction on the left hip joint and stopped to inject growth hormone and treated surgically with internal fixation of the epiphysis with use of 3-cannulated screw. The patient is followed at out-patient clinic without postoperative complication.

A Case of Synchronized Pineal and Suprasellar Germinoma / 대한내분비학회지

Pineal germinomas are the most common intracranial germ cell tumor and occur in relatively young age, with 26% between 10 and 12, 65% between 10 and 21 and 95% before age 27. Patients with pineal germinoma present headache, lethargy, nausea, and vomiting which result from raised intracranial pressure and Parinaud's syndrome secondary to midbrain tectal compression, and rarely endocrine dysfunction such as diabetes insipidus (DI), panhypopituitarism, and precocious puberty. We experienced a case of pineal and suprasellar germinoma presenting with central diabetes insipidus and panhypopituitarism.

Treatment with intravenous immunoglobulin in a case of adult onset Still's disease / 천식및알레르기

Adult onset Stills Disease (AOSD) is a systemic inflammatory disease characterized by spiking high fevers, arthritis, and an evanescent rash. Although many patients respond to nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroid, some patients fail to do so or are found to be resistant and require high doses of corticosteroid which induce severe side effects. Recently, treatment with intravenous immunoglobulin (IVIG) has been reported to be effective in patients with AOSD who were refractory to NSAIDs. Here, we report a case of AOSD treated with IVIG with a review of the literature.

A case of acquired angioedema with C1 esterase inhibitor deficiency / 천식및알레르기

Angioedema is a well-demarcated localized edema involving the deeper layers of the skin, including the subcutaneous tissue. Angioedema occurs with Cl esterase inhibitor (Cl INH) deficiency that may be inborn as an autosomal dominant characteristic or may be acquired. Acquired angioedema (AAE) is a rare disorder characterized by adult onset and lack of evidence of inheritance of the disease. Two types of AAE are known today: type I in which there are lowering of functional Cl INH, an underlying disease such as a B-cell disease, and no detectable autoantibodies to Cl INH, type II with anti Cl INH autoantibodies in the circulation without detectable underlying disease and with depressed functional Cl INH levels. We experienced a case of angioedema in a 29-year old man. He had no family history of angioedema and laboratory data showed depressed Cl-INH levels. We diagnosed the case as acquired type of angioedema. Even though we could not measure anti-Cl INH auto-antibodies, we identified the case as type II because there was no evidence of underlying disease.

A Case of Methimazole Induced Agranulocytosis Complicated with Deep Neck Abscess / 대한내분비학회지

The thiourea derivatives, propylthiouracil and methimazole are in widespread use for the treatment of hyperthyroidism. The untoward side effects of these drugs are not infrequent and agranulocytosis is the most serious side effect them. We observed one case of methimazole induced agranulocytosis complicated by deep neck abscess. A 54-year-old woman was admitted because of fever, chilling and sore throat for 1 week. The symptom was developed after receiving methimazole 30mg daily day due to hyperthyroidism during last 3 months. Physical examination revealed hyperemic, enlarged tonsils and tender swelling of the right lower neck The peripheral blood total leukoeyte count was 1,500/mm' (absolute neutrophil count, ANC 9) and a peripheral blood smear revealed few neutrophil. The patient was administered G-CSF 2 mg/kg daily, and on the fifth day of hospitalization, fever subsided and ANC increased to 3,431. On the 11th day, fever developed again and the tenderness and swelling in both lower neck area were aggrevated. Computed tomography of the neck was performed, and revealed a large deep neck abscess. After pus aspiration and antibiotics therapy, the neck abscess was disappeared.