Diabetic muscle infarction (DMI) is an uncommon complication in patients with diabetes and it tends to be underdiagnosed, or misdiagnosed, clinically. Recently, we experienced a case of recurrent diabetic muscle infarction that was unusual in that the patient was younger than other patients. The patient was a 21-year-old woman with a 9-year history of maturity-onset diabetes of the young (MODY) who was referred to our department complaining of pain and edema in her right thigh. Magnetic resonance imaging (MRI) showed an increased T2-weighted signal and edema in the affected muscle. The final diagnosis was DMI. However, when the patient had partially recovered and was receiving supportive care, she had a second attack on the other side of the same leg during her hospitalization, in spite of her blood glucose level being strictly controlled. We report the clinical characteristics and imaging findings of this patient with recurrent DMI.
Blood Glucose ; Diabetes Complications ; Diabetes Mellitus, Type 2 ; Edema ; Female ; Hospitalization ; Humans ; Infarction ; Leg ; Magnetic Resonance Imaging ; Muscles ; Recurrence ; Thigh

Graves' disease is an autoimmune disorder that may present with various clinical manifestations of hyperthyroidism. Patients with Graves' disease have a greater number of thyroid nodules and a higher incidence of thyroid cancer compared with patients with normal thyroid activity. However, cases in which patients are diagnosed with recurrence of Graves' disease shortly after partial thyroidectomy for thyroid cancer are very rare. Here we report a case of hyperthyroid Graves' disease that occurred after partial thyroidectomy for papillary thyroid cancer. In this case, the patient developed hyperthyroidism 9 months after right hemithyroidectomy, and antithyroglobulin autoantibody and thyroid stimulating hormone receptor stimulating autoantibody were positive. Therefore, we diagnosed Graves' disease on the basis of the laboratory test results and thyroid ultrasonography findings. The patient was treated with and maintained on antithyroid drugs. The mechanism of the recurrence of Graves' disease in this patient is still unclear. The mechanism may have been the improper response of the immune system after partial thyroidectomy. To precisely determine the mechanisms in Graves' disease after partial thyroidectomy, further studies based on a greater number of cases are needed.
Antithyroid Agents ; Autoantibodies ; Carcinoma ; Graves Disease ; Humans ; Hyperthyroidism ; Immune System ; Incidence ; Receptors, Thyrotropin ; Recurrence ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroidectomy

BACKGROUND: Epidural pressure is reported to change in accordance with intracranial pressure (ICP). As ICP changes during general anesthesia, it is also possible that epidural pressure may change during general anesthesia. The aim of this study was to obtain trends of epidural pressure change during general anesthesia. METHODS: Eighteen patients scheduled for gastrectomy were allocated for this study after obtaining informed consent. Epidural catheter was inserted at T7-8, T8-9 interspace before induction. Catheter was connected to a pressure transducer after calibration. General anesthesia was induced with thiopental sodium (5 mg/kg), succinylcholine (1 mg/kg), followed by 3% enflurane. Anesthesia was maintained with 50% N2O in oxygen and 1-2% enflurane with vecuronium (0.1 mg/kg). Each patients was mechanically ventilated with tidal volume of 10 ml/kg at a rate of 10 bpm. Epidural pressure was measured before induction, at the time of injection of thiopental sodium, succinylcholine, laryngoscopy, intubation, surgical incision, and 30 minutes after surgical incision. Stastical analysis was done using repeated measures of ANOVA with Helmert option (p<0.05). RESULTS: Epidural pressure significantly changed dynamically during general anesthesia. Epidural pressures increased at intubation and at 30 minutes after surgical incision when compared with those at the time of laryngoscopy and incision, respectively (p<0.05). CONCLUSION: Our study indicates that epidural pressures changes dynamically during induction period of general anesthesia and also showed possibility that epidural pressure monitoring could be used instead of more invasive direct ICP monitoring.
Anesthesia* ; Anesthesia, General ; Calibration ; Catheters ; Enflurane ; Gastrectomy ; Humans ; Informed Consent ; Intracranial Pressure ; Intubation ; Laryngoscopy ; Oxygen ; Succinylcholine ; Thiopental ; Tidal Volume ; Transducers, Pressure ; Vecuronium Bromide

Diabetes mellitus is a complex group of chronic metabolic conditions. The incidence of frailty, sarcopenia, geriatric syndrome, and multiple chronic conditions is high in older patients with diabetes, who often require multiple medications for optimal glucose control and treatment of associated chronic complications. Unfortunately, polypharmacy is associated with a high risk of adverse outcomes, such as hypoglycemia, drug-drug interactions, and an increased socioeconomic burden in older adults with diabetes.Current Concepts: Elderly patients with diabetes are at a high risk for polypharmacy and consequently, a high risk of adverse drug reactions. Polypharmacy is defined as the cumulative use of five or more medications. Comprehensive management and deprescribing are the most important approaches to reduce polypharmacy. Deprescription refers to reduction in or cessation of inappropriate medications.Discussion and Conclusion: Polypharmacy continues to increase the risk of morbidity and mortality among older adults with diabetes. A comprehensive polypharmacy management and deprescription plan is warranted for significant risk reduction in elderly patients with diabetes.

Due to the increased prevalence of papillary thyroid carcinoma (PTC), difficult cases and unexpected events have become more common during long-term follow-up. Herein we reported four cases that exhibited poor progress during long-term follow-up. All the cases were diagnosed with PTC and treated with total thyroidectomy before several years, and the patients had been newly diagnosed with recurrent and metastatic PTC. These four cases included recurred PTC with invasion of large blood vessels, a concomitant second malignancy, malignant transformation, and refractoriness to treatment. Physicians should closely monitor patients to promptly address unforeseen circumstances during PTC follow-up, including PTC recurrence and metastasis. Furthermore, we suggest that the development of a management protocol for refractory or terminal PTC is also warranted.
Blood Vessels ; Carcinoma ; Follow-Up Studies* ; Humans ; Neoplasm Metastasis ; Neoplasms, Second Primary ; Prevalence ; Recurrence ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

Due to the increased prevalence of papillary thyroid carcinoma (PTC), difficult cases and unexpected events have become more common during long-term follow-up. Herein we reported four cases that exhibited poor progress during long-term follow-up. All the cases were diagnosed with PTC and treated with total thyroidectomy before several years, and the patients had been newly diagnosed with recurrent and metastatic PTC. These four cases included recurred PTC with invasion of large blood vessels, a concomitant second malignancy, malignant transformation, and refractoriness to treatment. Physicians should closely monitor patients to promptly address unforeseen circumstances during PTC follow-up, including PTC recurrence and metastasis. Furthermore, we suggest that the development of a management protocol for refractory or terminal PTC is also warranted.
Blood Vessels ; Carcinoma ; Follow-Up Studies* ; Humans ; Neoplasm Metastasis ; Neoplasms, Second Primary ; Prevalence ; Recurrence ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

Two important endocrine emergencies, thyroid crisis and diabetic ketoacidosis (DKA), are uncommon when presented together, but pose serious complications. Without appropriate management, they may result in high mortality. Although several cases of simultaneous presentation of thyroid crisis and DKA have been reported, it is a clinically unusual situation and remains a diagnostic and management challenge in clinical practice. We report rare case with simultaneous presentation of thyroid crisis and DKA without previous warning symptoms. A 23-year-old-woman was brought to the emergency department presenting with acute abdominal pain for one day. She was healthy and there was no personal history of diabetes or thyroid disease. Through careful physical examination and laboratory tests, the patient was diagnosed with thyroid crisis combined with DKA. Concomitance of these two endocrine emergencies led to sudden cardiac arrest, but she was successfully resuscitated. This emphasizes the importance of early recognition and prompt management when the two diseases are presented concomitantly.
Abdominal Pain ; Death, Sudden, Cardiac ; Diabetic Ketoacidosis ; Emergencies ; Heart Arrest ; Humans ; Physical Examination ; Thyroid Crisis ; Thyroid Diseases ; Thyroid Gland

We describe herein an unusual case of subacute thyroiditis presenting as acute psychosis. An 18-year-old male presented at the emergency department due to abnormal behavior, psychomotor agitation, sexual hyperactivity, and a paranoid mental state. Laboratory findings included an erythrocyte sedimentation rate of 36 mm/hr (normal range, 0 to 9), free T4 of 100.0 pmol/L (normal range, 11.5 to 22.7), and thyroid stimulating hormone of 0.018 mU/L (normal range, 0.35 to 5.5). A technetium-99m pertechnetate scan revealed homogeneously reduced activity in the thyroid gland. These results were compatible with subacute thyroiditis, and symptomatic conservative management was initiated. The patient's behavioral abnormalities and painful neck swelling gradually resolved and his thyroid function steadily recovered. Although a primary psychotic disorder should be strongly considered in the differential diagnosis, patients with an abrupt and unusual onset of psychotic symptoms should be screened for thyroid abnormalities. Furthermore, transient thyroiditis should be considered a possible underlying etiology, along with primary hyperthyroidism.
Acute Disease ; Adolescent ; Antipsychotic Agents/therapeutic use ; Humans ; Male ; Psychotic Disorders/diagnosis/drug therapy/*etiology ; Thyroiditis, Subacute/*complications/diagnosis/therapy ; Treatment Outcome

Cerivastatin is novel HMG-CoA reductase inhibitors. Clinical trials showed no significant differences of serum creatine kiase between cerivastatin and placebo, and cerivastatin-induced myopathy was rarely reported. This beneficial effect of cerivastatin is thought to be related to the the dual pathway metabolism by hapatic CYP3A4 and 2C8. We here report three cases of rhabdomyolysis which is associated with cerivastatin therapy. Two patients had diabetes mellitus, and received cerivastatin(0.8 mg/day) for treating hyperlipidemia and the other patient had chronic renal failure due to diabetic nephropathy and has maintained peritoneal dialysis and received cerivastatin(0.4 mg/day). Within one month of cerivastatin treatment, those patients experienced myalgia or muscle weakness. At that time, laboratory findings including muscle enzyme level, and bone scan finding were compatible with rhadomyolysis. Under the impression of cerivastatin- induced rhabodmyolysis, cerivastatin was withdrwan, and conventional treatment for rhabdomyolysis was started. Clinical course was uneventful, and these patients were discharged with good general condition. In conclusion, cerivastatin is regarded as a safe drug as compared with other statins, but it also causes rhabdomyolysis. Careful history taking and regular follow-up of muscle enzyme levels would be necessary to detect cerivastatin-induced rhabdomyolysis.
Creatine ; Diabetes Mellitus ; Diabetic Nephropathies ; Follow-Up Studies ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hyperlipidemias ; Kidney Failure, Chronic ; Metabolism ; Muscle Weakness ; Muscular Diseases ; Myalgia ; Peritoneal Dialysis ; Rhabdomyolysis*

BACKGROUND/AIMS: Argon plasma coagulation (APC) has some merits in the treatment of gastric neoplasms including a shorter operative time and fewer complications compared with endoscopic mucosal resection or endoscopic submucosal dissection. However, there are few reports on the outcomes of gastric neoplasms treated using APC. The aim of this study was to evaluate APC in the treatment of early gastric neoplasms in terms of clinical efficacy, safety, and local recurrence. METHODS: We enrolled 28 patients who received APC therapy at the Kyungpook National University Hospital between May 2007 and April 2013. Clinical outcomes were analyzed. RESULTS: The median follow-up period was 24.8 months (range, 2 to 78). Among the 28 lesions treated using the APC procedure, tumor recurrence was encountered in seven lesions (25.0%). Recurrence was found in 50% (5/10) of single APC cases and 11% (2/18) of rescue APC cases. The mean time to recurrence was 16.1 months (range, 2 to 78). There were no serious APC-related complications such as perforation, bleeding, or infection. CONCLUSIONS: APC therapy can be a useful treatment with a favorable safety profile for patients with early gastric neoplasms. However, further studies are necessary to determine the long-term prognosis of patients undergoing this treatment.
Argon Plasma Coagulation* ; Follow-Up Studies ; Gyeongsangbuk-do ; Hemorrhage ; Humans ; Operative Time ; Prognosis ; Recurrence ; Stomach Neoplasms*