Lumbar Pyogenic Spondylodiscitis and Bilateral Psoas Abscesses Extending to the Gluteal Muscles and Intrapelvic Area Treated with CT-guided Percutaneous Drainage: A Case Report

Bilateral psoas abscesses extending to the gluteal muscle and intrapelvic area are uncommon. We present our experience with computed tomography (CT)-guided percutaneous catheter drainage for the treatment of multiple aggressive abscesses in a diabetic patient. The abscesses completely resolved after the procedures. Psoas abscess should be considered in the differential diagnosis of older diabetic patients with fever, flank or back pain, and flexion contracture of the hip joint. CT scanning is a useful method in diagnosing abscesses, and CT-guided percutaneous catheter drainage is an effective treatment method in selected patients.

A Case of Congenital Adrenal Hyperplasia due to 11beta-Hydroxylase Deficiency / 대한내분비학회지

Congenital adrenal hyperplasia refers to a group of autosomal recessive disorders that is defective in the synthesis of cortisol. The enzymes most often affected are 21-hydroxylase and 11beta hydroxylase. The low levels of cortisol stimulate the pituitary gland to release ACTH. Chronic elevation of the ACTH level causes bilateral adrenal hyperplasia and a secondary increase in androgen formation. We examined a 19 year-old woman presented with clitoral hypertrophy and vaginal spotting. The subjects basal level of serum cortisol was low, but the serum levels of ACTH, 17a-hydroxyprogesterone, deoxy-corticosterone were elevated. The urinary excretions of 17-ketosteroids and 17-hydroxycorticosteroids were also increased. The karyotyping study and transrectal ultrasonography showed normal findings. The patient underwent clitoris reduction surgery and received hydrocortisone. To the best of our knowledge, this is the first case of 11beta-Hydroxylase deficiency in Korea.

The change of prevalence of diabetes mellitus for 3 years and incidence of diabetes in Koreans over 60 years old / 대한내과학회지

BACKGROUND: As elderly people increasing, prevalence of diabetes will increase but there was paucity of data on the epidemiology of diabetes in Korean elderly population. In this study (Southwest Seoul, SWS study) we investigated the change of prevalence of diabetes mellitus for two points in time (the years 1999 and 2002) and 3-year incidence of diabetes in elderly Korean population of southwest area of Seoul. METHODS: A sampling of 1,652 subjects in 1999 and 1,214 subjects in 2002 who are over 60 years old in southwest area of Seoul were investigated. All subjects underwent a 75 g oral glucose tolerance test (OGTT), biochemical study and anthropometric measurements. Among the 1,652 subjects in 1999, 350 subjects were followed up for 3 years and 294 subjects without diabetes at baseline examination participated in retrospective cohort study. RESULTS: Prevalence of diabetes in 1999 was 20.5% [previous diagnosed people (11.9%), newly diagnosed people (8.6%)] and in 2002 was 22.1% [previous diagnosed people (15.2%), newly diagnosed people (6.9%)]. Prevalence of impaired fasting glucose (IFG) or impaired glucose intolerance (IGT) was 22.8% in 1999 and 27.8% in 2002. In 350 subjects were followed up for 3 years, prevalence of diabetes was 16.0% in 1999 and increased to 23.4% in 2002 (p=0.014). In retrospective cohort study, the annual incidence rate of diabetes was 2.9% (age and sex adjusted rate 2.5%). CONCLUSION: Prevalence of diabetes in elderly Korean population of southwest area of Seoul was 20.5% in 1999 and increased to 22.1% in 2002. Prevalence of IFG or IGT was 22.8% in 1999 and increased to 27.8% in 2002. This report supports that impaired glucose regulations and diabetes mellitus of elderly Korean population will increase in the future as aged Korean population increases.

A Case of Multiple Endocrine Neoplasia 2A with Germ Line Mutation of RET Gene / 대한내분비학회지

Multiple endocrine neoplasia 2A (MEN 2A) is an autosomal dominantly inherited disease, composed of medullary thyroid carcinoma, pheochromocytoma and hyperparathyroidism. The activation of germ-line mutations in the RET proto-oncogene are responsible for MEN 2. The analysis of the RET mutations has replaced the measurement of the calcitonin level in the diagnosis of the MEN carrier state. Specific RET codon mutations correlate with the MEN 2 syndromic variant, the age at onset of the medullary thyroid carcinoma (MTC) and the aggressiveness of the MTC. Herein, our experience of a 47-year-old woman, who had a bilateral pheochromocytoma and MTC, and MEN 2A confirmed by the detection of an RET proto-oncogene mutation at axon 10 on codon 618, is reported. Her sister was found to have the same mutant gene. After a total thyroidectomy and bilateral adrenalectomy, the calcitonin and catecholamine levels were normalized, and the patient discharged without problems. This case is reported, with a review of the literature.

Fra-1 Expression in Malignant and Benign Thyroid Tumor

BACKGROUND: The differential diagnosis of thyroid nodules is very important in deciding the treatment modality and the fine needle aspiration is the best diagnostic method. But, there are some limitations in use because of inadequate test materials and difficulty in interpreting. According to the study of oncogene and tumor suppressor gene about the origin of thyroid tumor, expression of Fra-1, one of AP-1 complex, is increased in thyroid neoplasm, though not present in the normal tissue. So, there is a possibility that it will be used as a method for the differential diagnosis of thyroid nodules. We tried to know whether presence or absence of Fra-1 expression can be used as a diagnostic method in differential diagnosis of thyroid nodules using the immunohistochemical (IHC) staining method. METHOD: In 4 types of thyroid tumor that were confirmed by histologic diagnosis after operation (18 cases of adenomatous goiter, 16 cases of follicular adenoma, 30 cases of papillary cancer, 10 cases of follicular cancer), IHC staining method was performed to evaluate the expression of Fra-1. RESULT: In papillary and follicular thyroid cancers, the expression of Fra-1 was stronger than in benign thyroid tumor, but there was no difference in Fra-1 expression between the two types of carcinoma. Weak expression of Fra-1 was observed in all cases of follicular adenoma, though it was weaker than in carcinoma, and it was also weakly expressed only in some cases (33%) of adenomatous goiter. CONCLUSION: The expression of Fra-1 was stronger in thyroid cancer than in benign thyroid tumor, but it was impossible to differentiate thyroid cancer from benign thyroid tumor by presence or absence of Fra-1 expression using IHC staining method.

Fra - 1 expression in malignant and benign thyroid neoplasm / 대한내과학회지

BACKGROUND: Differential diagnosis of thyroid nodule is important in deciding treatment modality and fine needle aspiration is a good method to do so. But, sometimes, it has limitation in use because of inadequate test material and difficulty in interpreting it. Among the study of oncogene and tumor suppresor gene on the origin of thyroid tumor, expression of Fra-1, one of AP-1 system, is increased in thyroid neoplasm. So there is a possibility that it would be used as a method for differential diagnosis of thyroid nodule. We tried to know whether presence or absence of Fra-1 expression can be used as a diagnostic method in differential diagnosis of thyroid nodule using immuno- histochemical(IHC) staining method. METHODS: In 4 types of thyroid tumor that was confirmed by histologic diagnosis after operation(30 cases of papillary cancer, 10 cases of follicular cancer, 16 cases of follicular adenoma, 18 cases of adenomatous goiter), IHC staining method was performed to evaluate the expression of Fra-1. RESULTS: In papillary and follicular thyroid cancer, the expression of Fra-1 was stronger than benign thyroid tumor, but there was no difference in Fra-1 expression between two types of carcinoma. Weak expression of Fra-1 was observed in all cases of follicular adenoma, and it was also weakly expressed in 6 out 18 cases of adenomatous goiter. CONCLUSION: The expression of Fra-1 was stronger in thyroid cancer than in benign thyroid adenoma, but it was impossible to differentiate thyroid cancer from benign thyroid adenoma by the presence or absence of Fra-1 expression using IHC staining method.

A Case of Afrenocortical Carcinoma Associated with Multiple Paraganglioma / 대한내분비학회지

Simultaneous oceurrence of adrenocortical tumor and pheochromocytoma is extremely rare. Coexistence of adrenal tumor and pheochromocytoma was first reported by Cope in 1952 and some other cases were reported after that. But there was no report about coexistence of adrenocortical carcinoma and paragangliomas. Recently, we experienced a case of adrenocortical carcinoma associated with multiple paragangliomas. A 35-year-old woman was admitted to the hospital because of left upper abdominal pain. A palm-sized fum tender mass was palpated at left upper quadrant. Hormonal studies revealed pheochromocytomas feature. Fmergency operation was performed because of the possibility of intemal hemorrhage of the tumor. Operator found 10 cm sized mass in left adrenal area and also the other 5 small tumors adjacent to IVC. Pathologic report revealed that adrenal mass was adrenocortical carcinoma with hemorrhagic necrosis and tumors adjacent to IVC were paragangliomas. This patient was the first case of adrenocortical carcinoma with multiple paragangliomas in the world. So we report this case with a review of literature.

Massive bleeding from left colonic arteriovenous malformation in a young patient with ventricular septal defect

Arteriovenous malformation of the gut is well known to have been an important bleeding focus in past ages. We report a young Korean male patient, who had been known to have ventricular septal defect, presenting massive lower gastrointestinal bleeding from an arteriovenous malformation involving a long segment of the left colon. Angiographic, gross and histologic findings are presented and the literature is reviewed.