A Case of Licorice Induced Hypokalemic Paralysis with Rhabdomyolysis / 대한내분비학회지

Prolonged ingestion of licorice can cause hypermineralocorticoidism, with sodium retention, potassium loss and hypertension. Nevertheless, its initial presentation with a very severe degree of hypokalemic paralysis and rhabdomyolysis are exceedingly rare. We describe a patient who experienced hypokalemic paralysis and rhabdomyolysis after licorice ingestion. The patient's initial blood pressure was 160/80mmHg. The major biochemical abnormalities included; hypokalemia(K+ 1.3mEq/L), metabolic alkalosis, with a pH of 7.64, and urine myoglobin > 3000ng/mL. The plasma rennin activity and aldosterone level were suppressed. The 24 hour urine cortisol concentration was normal. The patients, over a 1 month period, had ingested 500g of licorice boiled in water. After quitting the licorice, the hypokalemia and muscle paralysis gradually improved and blood pressure returned to normal

Limited Effect of CpG ODN in Preventing Type 1 Diabetes in NOD Mice

Type 1 diabetes is considered as Th1 cell mediated autoimmune disease and the suppression of Th1 cells or the activation of Th2 cells has been regarded as a plausible immunologic intervention for the prevention of type 1 diabetogenesis in a rodent model. CpG ODN is an immunostimulatory sequence primarily present in bacterial DNA, viral DNA and BCG. CpG ODN is conventionally classified as a Th1 cell activator, which has been clinically applied to cancer, allergy and infectious disease. Recently, there was a promising report of that CpG ODN administration suppressed the development of type 1 diabetes in NOD mice by inducing Th2 cell mediated cytokine. However, the antidiabetogenic effect of CpG ODN on NOD mice is controversial. Thus, two studies were serially undertaken with various kinds of CpG motif to find a more optimal sequence and administration method. In the first study, CpG ODN was vaccinated four times and pancreatic inflammation and the quantity of serum insulin subsequently evaluated. In the second study, the amounts of IFN gamma and IL-4 in sera were measured as representative cytokines of Th1 and Th2 cells, respectively. As a result, vaccination or continuous injection of CpG ODN failed to show a preventive effect on type 1 diabetogenesis in NOD mice. Structural differences of CpG ODN also had no affect on the result. CpG ODN also consistently showed affect on the pancreatic pathology. The productions of IFN gamma and IL-4 were detected only in the K and D type CpG ODN administration groups. Comparison of the two cytokines leads to the conclusion that CpG ODN generated a Th1-weighted response in both study groups. It was assumed that CpG ODN failed to produce Th2-weighted cytokine milieu, which can overcome the genetically determined phenotype of NOD mice. Given these results, it was concluded that the immunotherapeutic application of CpG ODN on Type 1 diabetes had clear limitations.

Angiotensin II receptor blocker attenuates overexpression of vascular endothelial growth factor in diabetic podocytes

VEGF expressed in glomerular podocytes, is known to increase vascular permeability to macromolecules. Angiotensin II can stimulate the release of VEGF, and the protective effects of angiotensin II antagonist against diabetic glomerular injury suggest that the angiotensin II-induced VEGF is an important pathogenetic mechanism in the development of proteinuria during diabetic nephropathy although this mechanism is not fully understood. In this study, the changes of VEGF expression was examined in the experimental diabetic nephropathy to determine whether these changes were modified by renoprotective intervention by blockers of angiotensin II receptors. The streptozotocin- induced diabetic rats were treated with L-158,809, a blocker of angiotensin II receptors, for 12 weeks. Age-matched rats with L-158,809 served as controls. RT-PCR and immunohistochemistry were used to assess and quantify gene and protein expression of VEGF. A progressive increase in urinary protein excretion was observed in diabetic rats. Glomerular VEGF expression was significantly higher in diabetic rats than in the control groups, with a significant reduction in glomerular VEGF expression and proteinuria in L-158,809- treated diabetic rats. VEGF mRNA was also significantly higher in diabetic kidneys than in the control groups, with a significant reduction in VEGF mRNA in L-158,809-treated diabetic kidneys. These results demonstrates that VEGF expression is significantly increased in diabetic podocytes, and angiotensin II receptor antagonist attenuated these changes in VEGF expression and prevented the development of proteinuria in vivo. Attenuation of increased VEGF expression in podocytes could contribute to the renoprotective effects of angiotensin II receptor antagonists in diabetic nephropathy.

A case of parathyroid carcinoma with meningioma / 대한내과학회지

Parathyroid carcinoma is a very rare disease which comprising 0.1~5% of hyperparathyroidism, and it usually presents with marked hypercalcemia. Clinically, it shows hypercalcemia due to the effect of excessive secretion of parathyroid hormone, bone disease, renal involvement and palpable neck mass. It is known that hyperparathyroidism is induced mostly by parathyroid adenoma but it can be seen in parathyroid hyperplasia, hyperparathyroid carcinoma, rarely associated with familial or multiple endocrine neoplasia. Parathyroid carcinoma can be diagnosed with distant metastasis or local invasion. Treatment is complete resection of primary cancerous lesion and local tissue. Since recurrence or distant metastases are frequent, radiological studies should be done when hypercalcemia is recurred. Sometimes, other tumors can causes hypercalcemia. There are several reports of parathyroid cancer associated with multiple endocrine neoplasia, but has never been reported of parathyroid carcinoma associated with meningioma. We experienced a parathyroid carcinoma with meningioma in 68 year old woman and report the case with the review of literatures.

A case of parathyroid carcinoma with meningioma / 대한내과학회지

Parathyroid carcinoma is a very rare disease which comprising 0.1~5% of hyperparathyroidism, and it usually presents with marked hypercalcemia. Clinically, it shows hypercalcemia due to the effect of excessive secretion of parathyroid hormone, bone disease, renal involvement and palpable neck mass. It is known that hyperparathyroidism is induced mostly by parathyroid adenoma but it can be seen in parathyroid hyperplasia, hyperparathyroid carcinoma, rarely associated with familial or multiple endocrine neoplasia. Parathyroid carcinoma can be diagnosed with distant metastasis or local invasion. Treatment is complete resection of primary cancerous lesion and local tissue. Since recurrence or distant metastases are frequent, radiological studies should be done when hypercalcemia is recurred. Sometimes, other tumors can causes hypercalcemia. There are several reports of parathyroid cancer associated with multiple endocrine neoplasia, but has never been reported of parathyroid carcinoma associated with meningioma. We experienced a parathyroid carcinoma with meningioma in 68 year old woman and report the case with the review of literatures.

A case of Prader-Willi syndrome with bilateral cryptorchidism and diabets mellitus / 대한내과학회지

Prader-Willi syndrome (PWS) is a complex, multisystem disorder comprising congenital hypotonia, feeding difficulties, hypogonadism and hypogenitalism, short stature, small hands and feet, mental and psychomotor retardation, distinctive facial appearance, onset of obesity in early childhood and a tendency to develop glucose intolerance in adolescence. Yet the syndrome remains difficult to diagnose due to the subtle nature of many of the manifestations. We report an 19-year old man with PWS, confirmed by fluorescence in situ hybridization (FISH) with DNA probes specific for the PWS region on chromosome 15.

Two Cases of Acute Respiratory Distress Syndrome with Pulmonary Hemorrhage Induced by Injection of Silicone at Perineum / 결핵

Silicone fluid is a biomaterial widely used in modern cosmetic procedures because there are few side effects, considerable chemical stability and predictable physical properties. However, many local and systemic adverse reactions have reported. In particular some serious pulmonary complications have been reported such as pulmonary thromboembolism, acute respiratory distress syndrome with some cases leading to mortality. Most of the serious complicated cases were induced by an illegal silicone fluid injection. We experienced two cases of acute respiratory distress syndrome with pulmonary hemorrhage induced by an illegal silicone fluid injection. The patients were 41 & 51 year old women, who complained of dyspnea. The chest X-ray and HRCT scan findings showed a bilateral ground glass attenuation on the bilateral dependent portion of the upper and middle lung zone. The patients clinical symptoms and the radiologic and other laboratory findings were compatible with acute respiratory distress syndrome induced by the silicon fluid injection. Here we report two cases of acute respiratory distress syndrome with pulmonary hemorrhage induced by an illegal silicone injection with a review of the relevant literature.

A Case of 46 XX Male Syndrome / 대한내분비학회지

The 46, XX male syndrome is rare disease that is characterized by a phenotypic male who has a 46, XX female karyotype. Since the first report by de la Chapelle and associates in 1964, several cases have been reported, but it is still a rare entity. Recently we examined a 20-year-old XX male who had the symptoms of gynecomastia, an infantile appearance of the external genitalia, scanty pubic hair, no Adams apple, and no axillary hair. We presently describe a patient with the 46, XX male syndrome who showed a 46, XX karyotype on chromosomal study and review the literatures.

A Case of Tertiary Hyperparathyroidism Combined with Thyroid Papillary Carcinoma / 대한이식학회지

Secondary hyperparathyroidism is the condition which leads to excessive production of the parathyroid hormone secreted to compensate for longstanding hypocalcemia in chronic renal failure. After restoration of normal renal function, some patients continue to have autonomous parathyroid hyperfunction. In 1963 St. Goar termed it tertiary hyperparathyroidism. Hyperparathyroidism in the chronic renal failure is mostly well managed medically, but sometimes may require surgical intervention in refractory hyperparathyroidism. Recently, we have experienced a female patient diagnosed as tertiary hyperparathyroidism with persistent hypercalcemia after renal transplantation and report the results of subtotal parathyroidectomy and thyroid right lobectomy due to hyperparathyroidism and thyroid papillary carcinoma found coincidentally.