Acute renal failure is the most common complication of rhabdomyolysis. However, hyperosmolar hyperglycemic state (HHS) induced-rhabdomyolysis rarely causes acute renal failure (ARF) because HHS induces osmotic diuresis and prevents tubular necrosis. Here we report a case of acute renal failure caused by HHS-induced rhabdomyolysis in a patient with poorly controlled diabetes mellitus. A 59-year-old male was admitted with comatose mentality. He had been diagnosed with diabetes mellitus 6 months ago but had not been treated. Physical examination showed severe dehydration of oral mucosa. His laboratory findings demonstrated severe HHS, rhabdomyolysis and acute renal failure (plasam glucose 1,543 mg/dL, osmolarity 329 mOsm/L, creatine phophokinase 15,395 IU/L, lactate dehydrogenase 1,046 IU/L, creatinine 2.4 mg/dL). With adequate hydration and insulin therapy, HHS improved but rhabdomyolysis and ARF were more aggravated. With early hemodialysis treatment, he finally improved without sequale.
Acute Kidney Injury* ; Coma ; Creatine ; Creatinine ; Dehydration ; Diabetes Mellitus ; Diuresis ; Glucose ; Humans ; Insulin ; L-Lactate Dehydrogenase ; Male ; Middle Aged ; Mouth Mucosa ; Necrosis ; Osmolar Concentration ; Physical Examination ; Renal Dialysis ; Rhabdomyolysis

Hypokalemia is a common metabolic cause of rhabdomyolysis. Although treatment with thiazide causes hypokalemia frequently, hypokalemic rhabdomyolysis after administration with thiazide is very rare. Here we report two cases of hypokalemic rhabdomyolysis due to thiazide treatment. A 50-year-old woman who had been treated with thiazide for hypertension was admitted due to quadriplegia. The patient had a potassium level of 1.5 mEq/L, a creatinine phosphokinase (CPK) level of 21,346 IU/L, and a lactic dehydrogenase level (LDH) of 2,389 IU/L. An 80-year-old man who had been treated with thiazide for hypertension was admitted due to generalized weakness. His potassium level was 1.9 mEq/L, CPK was 29,000 IU/L, and LDH was 2,393 IU/L. There were no any other causes of rhabdomyolysis except hypokalemia due to thiazide treatment for both patients. With adequate hydration and potassium replacement, hypokalemic rhabdomyolysis recovered completely without sequele.
Aged, 80 and over ; Creatinine ; Female ; Humans ; Hypertension ; Hypokalemia ; Middle Aged ; Oxidoreductases ; Potassium ; Quadriplegia ; Rhabdomyolysis* ; Thiazides

No abstract available.
Adult ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Biomarkers, Tumor/*analysis ; Biopsy ; Carcinoma, Ductal, Breast/*chemistry/*secondary/therapy ; Chemotherapy, Adjuvant ; Disease Progression ; Female ; Humans ; Immunohistochemistry ; Lymph Node Excision ; Lymphatic Metastasis ; Magnetic Resonance Imaging ; Mastectomy ; Neoadjuvant Therapy ; Neoplasm Staging ; Receptors, Estrogen/*analysis ; Skin Neoplasms/*chemistry/*secondary ; Time Factors ; Treatment Outcome ; Triple Negative Breast Neoplasms/*chemistry/*pathology/therapy

No abstract available.
Drug Therapy ; Lymphoma* ; Wernicke Encephalopathy*

Large bowel metastasis from a primary lung cancer is rare and is hard to be asymptomatic. We report a case of intussusception without any symptoms caused by cecal metastasis of primary small cell lung cancer. A 70-year-old woman was admitted to hospital with cough and sputum of 3 weeks' duration. She was diagnosed with small cell lung cancer based on percutaneous needle biopsy of a lung mass identified by chest CT. In abdominal CT, multiple metastatic lesions were detected in the left adrenal gland and cecum with intussusception. After further colonoscopy and biopsy evaluations, the pathology results showed metastatic cancer originating from small cell cancer of the lung.
Adrenal Glands ; Biopsy ; Biopsy, Needle ; Cecum ; Colonoscopy ; Cough ; Female ; Humans ; Intussusception ; Lung ; Lung Neoplasms ; Neoplasm Metastasis ; Small Cell Lung Carcinoma ; Sputum ; Thorax

PURPOSE: We undertook this study to find out the recognitions of terminal cancer patients and doctors about advance directives (ADs), of how they would do in non-response medical conditions and whether ADs could be one of medical options for their dying with dignity. METHODS: One hundred thirty four cancer patients in the Hospice Unit, St. Vincent's Hospital, and 97 medical doctors in the Department of Internal Medicine, Catholic Medical Center, were asked about ADs, including Do-Not-Resuscitate (DNR), medical power of attorney, living will and medical options. RESULTS: One hundred thirty patients (97%) and 38 doctors (39.2%) were unfamiliar with ADs, however, 128 patients (95.5%), 95 doctors (97.9%) agreed with it. Seventy nine patients (59.0%) and 96 doctors (99.0%) wanted DNR rather then intensive treatments if they were in non-response medical conditions. Eighty four patients (62.7%) and 75 doctors (77.3%) were agreeable to medical power of attorney. One hundred Thirty four patients (100.0%) and 94 doctors (96.9%) did not want medical options to be in terminal conditions, and hoped to die in peace. CONCLUSION: Most of patients did not know about ADs and how to make it. However, they showed positive attitudes about it. If we advertise it properly, it is highly likely that a large number of cancer patients would make their living wills easily by ADs. Nevertheless, many legal and ethical problems have to be solved. Doctors should engage their patients in an ongoing communication about the end-of-life. Therefore, let the patients have opportunities to plan their own deaths.
Advance Directives ; Hospice Care ; Hospices ; Humans ; Internal Medicine ; Linear Energy Transfer ; Living Wills

Angiomyolipoma is a rare, benign, mesenchymal hamartomatous neoplasm consisting of a mixture of adipose tissue, smooth muscle cells, and anomalous blood vessels. The kidney is a common origin site, but extrarenal angiomyolipoma has been reported. Simultaneous involvement of the kidney and regional lymph nodes is uncommon, and may be confused with a metastatic malignant lymph node. Lymph node involvement in angiomyolipoma represents a multifocal invasion of the tumor, rather than metastatic disease. Tumor markers usually associate with malignancy but they have sometimes been detected in benign conditions. We report a case of bilateral renal angiomyolipoma with tuberous sclerosis simultaneously involving regional lymph nodes confused with metastatic malignant lymph node enlargement due to associated elevation of serum tumor markers.
Adipose Tissue ; Angiomyolipoma ; Blood Vessels ; Kidney ; Lymph Nodes ; Myocytes, Smooth Muscle ; Tuberous Sclerosis ; Biomarkers, Tumor

BACKGROUND/AIMS: This study was conducted to identify risk factors that predict vulnerability to cancer therapy on the basis of the clinical, geriatric, and quality of life assessment before starting treatment in elderly patients. METHODS: Seventy-five patients aged 65 years and over with newly diagnosed stage IV solid cancer receiving chemotherapy were analyzed. Clinical and laboratory data were collected. The geriatric assessment was performed using the Korean versions of the Modified Barthel Index, Instrumental Activities of Daily Living, Mini-Mental State Examination, and Geriatric Depression Scale. The European Organisation for Research and Treatment of Cancer Quality-of-Life Core Questionnaire (EORTC-QLQ-C30) was also performed. RESULTS: Forty-one patients stopped cancer treatment during or after the end of first-line therapy and were classified as the treatment interruption group. By univariate analysis, treatment interruption was associated with metastases to ≥ 2 distant sites, lower albumin level, lower EORTC-QLQ-C30 physical and role functioning scores, and higher EORTC-QLQ-C30 fatigue and appetite loss symptom scores. By multivariate analysis, treatment interruption was significantly associated with low score for the EORTC-QLQ-C30 physical functioning scale (odds ratio [OR], 1.020; 95% confidence interval [CI], 1.002 to 1.039; p = 0.030), and ≥ 2 sites of distant metastases (OR, 2.965; 95% CI, 1.012 to 8.681; p = 0.047). CONCLUSIONS: The EORTC-QLQ-C30 physical functioning score and metastases to ≥ 2 organs, which indicate a poor physical functional status and metastatic high tumor burden, were significantly associated with interruption of first-line treatment in elderly patients with cancer.
Activities of Daily Living ; Aged* ; Appetite ; Depression ; Drug Therapy ; Fatigue ; Geriatric Assessment ; Humans ; Multivariate Analysis ; Neoplasm Metastasis ; Quality of Life ; Risk Factors ; Tumor Burden

No abstract available.
Humans

Background/Aims: We compared the efficacy of the granisetron transdermal system (GTS) with that of ondansetron for controlling chemotherapy-induced nausea and vomiting (CINV) in patients treated with highly emetogenic chemotherapy (HEC). Methods: We randomized a total of 389 patients to groups treated by GTS and ondansetron before HEC. The primary endpoint was the percentage of patients achieving complete response (CR; no retching/vomiting/rescue medication) of CINV from the time of chemotherapy initiation to 24 hours after the last administration of chemotherapy (prespecified non-inferiority margin of 15%). Quality of life (QoL) was also assessed using the Functional Living Index-Emesis (FLIE). Results: The per protocol analysis included 152 (47.80%) and 166 patients (52.20%) in the GTS and ondansetron groups, respectively. In the full analysis set, the most common diagnosis, regimen, and period of chemotherapy were lung cancer (149 patients, 40.27%), cisplatin-based regimen (297 patients, 80.27%), and 1 day chemotherapy (221 patients, 59.73%). The CR rates were 86.84% and 90.36% in the GTS and ondansetron groups, respectively; the treatment difference was −3.52% (95% confidence interval, −10.52 to 3.48) and met the primary endpoint, indicating that GTS was not inferior to ondansetron. Patient satisfaction, assessed on the FLIE, showed significantly higher scores in the GTS group compared to the ondansetron group (mean ± standard deviation, 1,547.38 ± 306.00 and 1,494.07 ± 312.05 mm, respectively; p = 0.0449). Conclusions GTS provided effective, safe, and well-tolerated control of CINV and improved the QoL in HEC.