Change of Bone Mineral Density and Biochemical Markers of Bone Turnover in Patients on Suppressive Levothyroxine Therapy for Differentiated Thyroid Carcinoma

Untreated hyperthyroidism and high-dose thyroid hormone are associated with osteoporosis, and increased bone mineral density (BMD) has been demonstrated in postmenopausal females with hypoparathyroidism. Studies on the effect of suppressive levothyroxine (LT4) therapy on BMD and bone metabolism after total thyroidectomy in patients with differentiated thyroid carcinoma have presented conflicting results, and few studies in relation to the status of hypoparathyroidism have been studied. One hundred postmenopausal women and 24 premenopausal women on LT4 suppression therapy were included in this study. BMD of lumbar spine and femur and bone turnover markers were measured at the baseline and during the follow-up period up to 18 months using dual energy X-ray absorptiometry. Biochemical marker of bone resorption was measured by urine deoxypyridinoline and bone formation by serum osteocalcin. The age ranged from 36 to 64 years old. Thyroid stimulating hormone (TSH) was suppressed during the study. The results showed that BMD of femur and lumbar spine were not significantly changed in both pre- and postmenopausal women except femur neck in postmenopausal women without hypoparathyroidism. Patients with hypoparathyroidism had higher BMD gain than those without hypoparathyroidism in total hip (1.25 vs. -1.18%, P=0.015). Biochemical markers of bone turnover, serum osteocalcin, and urine deoxypyridinoline did not show significant change. In conclusion, patients with well differentiated thyroid carcinoma are not at a great risk of bone loss after LT4 suppressive therapy. The state of hypoparathyroidism is associated with increased BMD, particularly in postmenopausal women.

Esophageal Ulcer Induced by Alendronate / 대한소화기내시경학회지

Alendronate sodium (Fosamax(R)) is an aminophosphonate used in treatment of postmenopausal osteoporosis by inhibition of osteoclastic activity. Esophageal ulcers related to alendronate use have been reported at the rate of 2~6%. However, there have been no reports of esophagitis or esophageal ulcer by alendronate in Korea. We present a case of esophageal ulcer caused by alendronate. The patient presented with retrosternal pain and severe odynophagia for a few days. Esophagogastroduodenoscopy revealed multiple deep ulcers at the esophagus. Her symptoms resolved completely after stopping alendronate. A follow-up esophagogastroduodenoscopy 6 weeks later revealed complete healing of the ulcers.

A Case of Mitral Regurgitation due to Isolated Cleft Mitral Valve

A cleft in the anterior mitral valve leaflet is commonly associated with an atrioventricular septal defect, but an isolated cleft mitral valve is a rare condition. We report a case of a 27-year-old woman with severe mitral regurgitation due to an isolated cleft mitral valve. The echocardiography showed an anterior cleft on the mitral valve, but a normal sized and positioned left ventricular papillary muscle without septal defect. Under the diagnosis of mitral regurgitation due to the isolated cleft mitral valve the patient underwent mitral cleft repair. After surgery, the further echocardiography showed no mitral regurgitation.

A Case Report on the Inflation Failure of Distal Portion of Inoue Balloon during Percutaneous Mitral Valvuloplasty in a Patient with Rheumatic Mitral Stenosis

Since Inoue et al introduced a specially designed balloon catheter for percutaneous mitral valvuloplasty (PMV) in 1984, the Inoue balloon catheter has been a popular device for the management of mitral stenosis. During the procedure several fatal complications, such as cardiac tamponade, perforation of a cardiac chamber, atrial septal defect, thromboembolism, mitral regurgitation and death have all been reported in the literature. There have also been several international reports regarding deformities of the Inoue balloon, but few reports in Korea. We recently experienced a case of an inflation failure of the distal portion of the Inoue balloon during a percutaneous mitral valvuloplasty in a 34 year old female patient with a tight mitral stenosis. To the best of our knowledge, a similar deformity of an Inoue balloon has never been reported in Korea.

Effects of AII Receptor Blocker on the Urinary Excretion of IL-6 and TGF-beta in IgA Nephropathy / 대한신장학회잡지

BACKGROUND: Urinary levels of cytokines may function as indices of renal disease activity. METHODS: This study was designed to investigate the urinary excretion of IL-6 and TGF-beta in the patients with IgA nephropathy(IgAN) and the effects of AII receptor blockers(ARB : losartan) on it. RESULTS: The patients with IgAN(n=10) showed higher urinary excretion of IL-6 and TGF-beta than normal controls(n=7). There is a positive correlation between IL-6 and TGF-beta. Urinary excretion of IL- 6 was positively correlated with proteinuria in IgAN (IL-6 : gamma2=0.560; p < 0.05) but not with serum creatinine. After 2 months of ARB therapy in IgAN patients, urinary excretion of IL-6 was decreased(IL-6 : 11.3+/-7.7 vs 5.3+/-3.3 pg/mg Cr, p < 0.05). Positive correlations were noticed in ARB group between urinary cytokines and proteinuria. CONCLUSION: Our data suggest that the patients with IgAN showed higher urinary excretion of IL-6 and TGF-beta. and the IL-6 excretion can be effectively reduced by ARB therapy.

Intraoperative Endoscopic Resection of Small Bowel Polyps through Trocar in Patient with Peutz-Jeghers Syndrome / 대한소화기내시경학회지

The Peutz-Jeghers syndrome is an autosomal dominant disease characterized by mucocutaneous pigmentation and gastrointestinal hamartomatous polyps. This syndrome is clinically important because of the complications caused by polyps and of an increased risk of cancer. We experienced a typical case of Peutz-Jeghers syndrome in a 24-year-old female patient who presented with jejunojejunal intussusception. With the use of combined surgery and intraoperative endoscopy through trocar, 60 polyps were removed, performing only 2 enterotomies. We apply a modified endosocopic technique of intraoperative endoscopic resection of small-bowel polyps using conventional 10 mm metal trocar in conjunction with a corrugated anesthetic tube. This allows fully visualized and optically controlled removal of all small intestnal polyps without air leakage. The usefulness of this technique reduces the complications associated with multiple laparotomies and resections.