Acute Onset Methimazole-Induced Arthralgia and Skin Rash / 대한갑상선학회지

Methimazole, a type of thionamide, is used to treat hyperthyroidism. Several adverse effects of thionamides have been reported. The representative minor adverse effects are arthralgia, skin rash, and gastric intolerance. Methimazole is reported to induce 1-6% of arthralgia cases. These patients begin to suffer from arthralgia from 1 month to 2 years after methimazole treatment. Here, we present a patient with acute onset methimazole-induced arthralgia and skin rash. At 2 days after starting methimazole treatment, a 57-year-old female developed arthralgia and a skin rash on her right leg, which subsequently spread to her left leg and right arm, and she stopped taking the medication. The patient was admitted to the rheumatology department of Ulsan University Hospital, where laboratory tests and a skin biopsy were performed to ascertain whether she had a rheumatic disorder. The skin biopsy revealed nonspecific inflammation. At 2 days after stopping methimazole treatment, the arthralgia and skin rashes had improved and methimazole treatment was recommenced. However, the same symptoms developed within 1 day. Therefore, methimazole treatment was again stopped and the symptoms disappeared.

Curcumin Enhances Docetaxel-Induced Apoptosis of 8505C Anaplastic Thyroid Carcinoma Cells

BACKGROUND: Anaplastic thyroid cancer (ATC) is one of the most aggressive malignancies in humans, and its progression is poorly controlled by existing therapeutic methods. Curcumin has been shown to suppress inflammation and angiogenesis. In this study, we evaluated whether curcumin could augment docetaxel-induced apoptosis of ATC cells. We also analyzed changes in nuclear factor kappaB (NF-kappaB) and cyclooxygenase-2 (COX-2) expression levels to delineate possible mechanisms of their combined action. METHODS: ATC cells were cultured and treated with curcumin and docetaxel alone or in combination. The effects on cell viability were determined by MTS assay. Apoptosis was assessed by annexin V staining and confirmed by flow cytometric analysis. Caspase, COX-2, NF-kappaB levels were assayed by Western blotting. RESULTS: Curcumin combined with docetaxel led to lower cell viability than treatment with docetaxel or curcumin alone. Annexin V staining followed by flow cytometric analysis demonstrated that curcumin treatment enhanced the docetaxel-induced apoptosis of ATC cells. Additionally, curcumin inhibited docetaxel-induced p65 activation and COX-2 expression. CONCLUSION: We conclude that curcumin may enhance docetaxel's antitumor activity in ATC cells by interfering with NF-kappaB and COX-2. Our results suggest that curcumin may emerge as an attractive therapeutic candidate to enhance the antitumor activity of taxanes in ATC treatment.

A Case of Insulinoma with Hypoglycemic Encephalopathy / 임상당뇨병

A 47-year-old male with recurrent abnormal behavior for ten years was referred to our clinic. He was diagnosed with insulinoma and cognitive dysfunction. Persistent hypoglycemia leads to a high risk of cognitive dysfunction in diabetic patients. However, cognitive dysfunction associated with insulinoma is rare. In this case study, cognitive dysfunction was confirmed by neurological testing.

Utility of F-18 FDG-PET in Detecting Primary Aldosteronism in Patients with Bilateral Adrenal Incidentalomas

In patients with primary aldosteronism who have bilateral adrenal incidentalomas, it is important to identify which adrenal gland is secreting excess aldosterone. Traditionally, adrenal vein sampling (AVS) has been performed for lateralization despite its invasiveness. Here we report a case of bilateral adrenal incidentaloma in which 18-Fluorodeoxyglucose (FDG)-positron emission tomography (PET) was used to identify the functional adrenal mass. A 53-yr-old man was referred to our clinic due to bilateral adrenal incidentalomas (right: 1 cm, left: 2.5 cm) on computed tomography (CT). Given his history of colon cancer, FDG-PET/CT scanning was used to rule out metastasis. Although there was focal hot uptake lesion in the right adrenal gland, the patient was suspected primary aldosteronism clinically more than metastasis because of the patient's underlying hypertension with hypokalemia. It was consistent with the results of AVS. Based on these findings, we propose that FDG-PET/CT can be used instead of AVS to identify the source of primary aldosteronism between two bilateral adrenal incidentalomas.

A Case of Constrictive Pericarditis Associated With Huge Epicardial Fat Volume

Massive deposits of fat around heart are seen in overweight persons and are associated with coronary artery disease. Investigators have focused on the clinical significance of epicardial fat with respect to metabolic effects such as insulin resistance and inflammation, but the mechanical effects, such as constriction, have been largely ignored. We present an unusual case of a 59-year-old woman with obesity and diabetes mellitus who had been undergoing peritoneal dialysis due to end-stage renal disease, and who developed constrictive pericarditis, possibly secondary to extensive epicardial fatty accumulation.

A Case of Cholethorax following Percutaneous Transhepatic Cholangioscopy / 결핵및호흡기질환

Cholethorax (bilious pleural effusion) is an extravasation of bile into the thoracic cavity via a pleurobiliary fistula (and also a bronchobiliary fistula). It is an extremely rare complication of thoraco-abdominal injuries. It can be caused by congenital anomaly and also by hepatobiliary trauma, severe infection or iatrogenic procedures. The definitive diagnosis is made with aspiration of bilious fluid from the pleural space during thoracentesis, by finding a fistulous tract during endoscopic retrograde cholangiopancreatography (ERCP) or cholagioscopy, or with finding an abnormal pleural accumulation of radioisotope during hepatobiliary nuclear imaging. Its symptoms include coughing, fever, dyspnea and pleuritc chest pain. Herein we report on a case of cholethorax following performance of percutaneous transhepatic cholangioscopy (PTCS) to remove incidentally discovered common bile duct (CBD) stones.

Role of Palliative Gastrojejunostomy for Unresectable Periampullary Carcinoma

PURPOSE: Most patients diagnosed with a periampullary carcinoma are defined as having an unresectable tumor. Therefore, the appropriate relief of the main symptoms such as obstructive jaundice, duodenal obstruction, and pain is of utmost importance to these patients. In these patients, a biliary bypass can improve the quality of life. However, there is some controversy regarding the efficacy of gastrojejunostomy for preventing a duodenal obstruction. This study, evaluated the effect of a palliative gastrojejunostomy and the quality of life in patients with an unresectable periampullary carcinoma. METHODS: Between January 2000 and December 2003, among a total of 46 patients with an unresectable periampullary carcinoma, 24 patients underwent a palliative gastrojejunostomy (Group I) and 22 patients underwent non surgical management (Group II). In these two groups the frequency of nausea and vomiting, serum protein and albumin levels, oral intake, and other metrics were carefully monitored. RESULTS: Of the 46 patients, there were no significant differences in terms of age, gender, TNM stage, and preoperative symptoms. The incidence of nausea and vomiting preoperatively were similar in both groups (43.8% and 40.5%, respectively, P=0.126). However, there were statistically significant differences at the three months after surgery (36.6%, 54.5%, P=0.033). The preoperative protein and albumin were similar in both groups (6.6 g/dl, 6.4 g/dl). On the other hand, protein and albumin levels 3 months after surgery were significantly different (5.9 g/dl, 5.2 g/dl, P=0.010). CONCLUSION: These results suggest a palliative gastrojejunostomy in patients with an unresectable periampullary cancer can reduce the symptoms related to a duodenal obstruction and might contribute to maintaining the patients' quality of life secondary to possible oral intake for a longer period postoperatively.

CO Intoxication in the Car: Case Report / 대한법의학회지

A man and a woman were found dead in their parked car. The car was placed in a deep embankment. The windows were rolled up. Since it was cold winter the engine and heater was running while soil surrounded the rear of the automobile. The cause of death was 87%, 85% carbon-monoxide blood saturation respectively. The source of the CO was a defective exhaust system, The tail pipe outlet was blocked by the soil, and fumes could not escape adequately. Carbon monoxide fumes might entered the vehicle through the rusted floorboards, air conditioning, and through the dash board. It is important to know that unintened carbon monoxide deaths from motor vehicle exhaust can occur outdoors in older vehicles with defective exhaust system. We suggest the public need to be aware of the potential for this life threatening hazard to occur so that there can be proper prevention of fatalities.