Olanzapine-Induced Diabetic Ketoacidosis and Neuroleptic Malignant Syndrome with Rhabdomyolysis: A Case Report

Atypical antipsychotics have replaced conventional antipsychotics in the treatment of schizophrenia because they have less of a propensity to cause undesirable neurologic adverse events including extrapyramidal symptoms, tardive dyskinesia, and neuroleptic malignant syndrome (NMS). However, atypical antipsychotics have been known to result in various metabolic complications such as impaired glucose tolerance, diabetes and even diabetic ketoacidosis (DKA). In addition, a number of NMS cases have been reported in patients treated with atypical antipsychotics, although the absolute incidence of neurologic side effects is currently significantly low. Here, we report a patient who simultaneously developed DKA, acute renal failure and NMS with rhabdomyolysis after olanzapine treatment. Olanzapine-induced metabolic complications and NMS were dramatically improved with cessation of the olanzapine treatment and initiation of supportive management including fluid therapy, hemodialysis, and intensive glycemic control using insulin. At short-term follow-up, insulin secretion was markedly recovered as evidenced by a restoration of serum C-peptide level, and the patient no longer required any hypoglycemic medications. Despite the dramatic increase in the use of atypical antipsychotics treatment, individualized treatments along with careful monitoring may be prudent for high risk or vulnerable patients in order to avoid the development of metabolic side effects.

The Response of Carotid Intima-Media Thickness to Medical Treatment Is Correlated with That of Intracranial Atherosclerosis

BACKGROUND AND PURPOSE: Intracranial atherosclerotic stenosis (ICAS) is considered as a major cause of stroke. The carotid intima-media thickness (CIMT), which accurately reflects the burden of generalized atherosclerosis, is also associated with stroke. The aim of this study was to determine the association between the CIMT and ICAS responses to medical treatment. METHODS: This study constituted part of the "Trial of cilostazol in symptomatic intracranial arterial stenosis"-2 that evaluated the ICAS response after randomized antiplatelet treatment. Magnetic resonance angiography and CIMT measurement were performed at baseline and after 7 months of treatment. CIMT was measured using semiautomated software, and was presented as maximum (CIMT-max) and average (CIMT-ave) values. The change in CIMT was compared relative to the ICAS response (i.e., progression, no-change, and regression). Ordinal logistic regression and analysis of covariance (ANCOVA) were used to analyze the association between the responses. RESULTS: Among the 101 enrolled patients, 85 underwent follow-up CIMT measurement. CIMT increased most in the ICAS progression group (CIMT-max: 0.09+/-0.23, CIMT-ave: 0.04+/-0.12), and to a lesser degree in the no-change group (CIMT-max: 0.02+/-0.16, CIMT-ave: 0.02+/-0.11), but decreased in patients with ICAS regression (CIMT-max: -0.04+/-0.11, CIMT-ave: -0.03+/-0.07; CIMT-max: p=0.010, CIMT-ave: p=0.015). Ordinal logistic regression analysis demonstrated that the change in CIMT-max was independently associated with the ICAS response (p=0.032). However, the ANCOVA revealed that the reverse was not true, in that the ICAS response was not independently associated with the change in CIMT after adjusting for confounding factors. CONCLUSIONS: The ICAS response may be associated with the CIMT response to medical treatment.

Short-term Oncologic Outcome of Curative Resection for Obstructive Colorectal Cancer Followed by Stent Insertion: Comparative Study with Non-abstructive Colorectal Cancer

PURPOSE: Recently, a self-expandable metallic stent has allowed an elective single-stage resection avoiding the risk of emergency operation and stoma formation in patients with obstructive colorectal cancer (CRC). But, forceful expansion of stent may increase the possibility of tumor cell exfoliation and dissemination through bowel lumen, lymphatic and blood vessels. Aim of study is to evaluate the short-term outcome of curative resection for obstructive colorectal cancer followed by stent in terms of oncologic safety. METHODS: Twenty-seven patients who underwent curative resection for obstructive CRC followed by stent insertion were included in 'stent group' and control group included 87 patients who underwent surgery for non-obstructive CRC. The clinicopathologic characteristics and prognosis were compared between two groups. RESULTS: There was no significant difference in clinicopathologic characteristics between two groups. No difference was found in postoperative complications between two groups. Overall survival rate of two groups showed no statistically significant differences (P=0.1254). Stage-matched survival rates (stage II & III) were also showed no differences between two groups. CONCLUSION: Stent insertion itself does not compromise the survival of patients with obstructive CRC. Oncologic safety of stent insertion for obstructive CRC is acceptable. A further large-scaled prospective study and long-term follow-up is necessary to evaluate the oncologic safety of stent insertion in obstructive CRC.

The gamma-Synuclein Expression in Breast Cancer and its Correlation with the Expression of the HER-2/neu Gene / 한국유방암학회지

PURPOSE: Synuclein has been identified as an important neuroprotein for developing pathologic deposits in Alzheimer's and Parkinson's disease patients. gamma-synuclein is also known as a breast cancer-specific gene 1 thats's not found in normal breast tissues but it has been reported to be overexpressed in breast cancer, ovarian cancer and other tumors. To evaluate the availability of gamma-synuclein expression as a prognostic factor for infiltrative breast cancer, we analyzed its correlation with the clinical parameters and the HER-2/neu gene expression. METHODS: Two hundred fiffty samples of breast cancer tissues embedded in paraffin and that were obtained from the infiltrative breast cancer patients who were operated in our institution from January 1995 to December 2000 were analyzed with employing the tissue microarray technique. The expression of gamma-synuclein was studied with immunohistochemistry and with using gamma-synulcein antibodies. One hundred thirty one cases that showed favorable staining were selected and studied retrospectively. RESULTS: Fiffty five% (71/131) of the patients showed gamma-synuclein overexpression. The histopathological findings that significantly correlated with gamma-synuclein overexpression were the number of metastatic lymph nodes (p<0.01) and the cancer stage (p<0.01). Using the same tissue mircoarray, the HER-2/neu gene expression and gamma-synuclein expression also showed statistically significant correlation (p=0.04). CONCLUSION: gamma-synuclein overexpression showed significant correaltion with lymph node metastasis and cancer stage. It also showed significant relevance with the HER-2/neu gene expression, and that is already known to be a prognostic factor for breast cancer. Therefore gamma-synuclein may be a useful prognostic factor for infiltrative breast cancer and further studies on the its correlation with survival, local recurrence, and distant metastasis should be conducted

Loss of Heterozygosity of Chromosome 17p13 and p53 Expression in Invasive Ductal Carcinomas / 한국유방암학회지

PURPOSE: The p53 gene is located on chromosome 17p13 and may play important roles in cell cycle regulation, apoptosis and the regulation of the expression of other genes as well as tumor suppression. In addition, the p53 gene is believed to play an important role in the progression of various human malignant tumors through mutation and overexpression. There have been few studies on loss of heterozygosity (LOH) study on 17p13 in invasive ductal carcinoma. This study evaluated a 17p13 LOH and protein expression in invasive ductal carcinomas and correlated these results with the clinicopathological factors. METHODS: LOH analysis was carried out using a polymerase chain reaction with four polymorphic microsatellite markers (D17S796, TP53, D17S5, D17S513) in 50 surgically resected tumors and their non-tumorous counterparts. The p53 protein expression level was examined using immunohistochemistry. RESULTS: A LOH and protein expression was detected in 66% and 54% of the tumors, respectively. The LOH rates ranged from 26.3% (D17S513) to 33.3% (TP53). There was no detected LOH or protein expression in the non-tumor parts. The LOH results correlate well with the tumor size and stage. The protein expression results correlate well with the tumor histological grade. There was no correlation between the LOH and protein loss. CONCLUSION: 17p13 LOH and p53 gene abnormalities may be associated with tumorigenesis and tumor invasion. In addition, the combined use of both methods may help in early detection as well as for determining the prognosis of an invasive ductal carcinoma. 17p13 LOH and p53 protein expression may contribute to tumor progression through reciprocal complementation in some portions of the invasive ductal carcinoma.

Functional Parathyroid Cyst: A case report / 대한내분비외과학회지

Parathyroid cysts are uncommon lesions of the neck and superior mediastinum, rarely large enough to be of clinical significance. They frequently present as a clinical diagnostic problem. They may mimic solitary thyroid nodule. They can be classified as either functioning or non-functioning depending on whether or not they are associated with hypercalcemia. Non-functioning or “true” cysts are those associated with normocalcemia (85%), whereas functioning or “pseudocysts” are those associated with hypercalcemia (15%). The presence of a high content of intact parathyroid hormone (intact PTH) in the cystic fluid on fine-needle aspiration (FNA), in conjunction with an elevated serum calcium and intact PTH is diagnostic of a functional parathyroid cyst. A functional parathyroid cyst usually requires surgical removal. We report herein one case of functional parathyroid cyst.