We present a patient with type 2 diabetes mellitus and metastatic renal cell carcinoma who developed severe hypoglycemia and metabolic encephalopathy after sunitinib treatment. Sunitinib, a multi-target tyrosine kinase inhibitor, is used to treat metastatic renal cell carcinoma. Sunitinib-induced hypoglycemia has been reported and there are rare case reports of severe hypoglycemia due to sunitinib. Therefore, glycemic control should be monitored closely in diabetic patients treated with sunitinib.
Brain Diseases, Metabolic ; Carcinoma, Renal Cell* ; Coma* ; Diabetes Mellitus, Type 2 ; Humans ; Hypoglycemia ; Protein-Tyrosine Kinases

Secondary involvement of the gallbladder by systemic lymphoma is exceedingly rare and relapsed diffuse large B cell lymphoma of the gallbladder has not been reported. A 78-year-old man was admitted to the hospital due to epigastric pain and jaundice. His past medical history was remarkable for diagnosis with diffuse large B-cell lymphoma of the ileum 5 years ago. He underwent right hemicolectomy and three cycles of adjuvant chemotherapy and had complete remission. Abdominal computed tomography showed choledocholithiasis and focal thickening at fundus of the gallbladder. The patient underwent open cholecystectomy. Pathologic examination revealed diffuse large B-cell lymphoma. We report a case of solitary, relapsed diffuse large B-cell lymphoma of the gallbladder with literature review.
Aged ; B-Lymphocytes* ; Chemotherapy, Adjuvant ; Cholecystectomy ; Choledocholithiasis ; Diagnosis ; Gallbladder* ; Humans ; Ileum ; Jaundice ; Lymphoma ; Lymphoma, B-Cell* ; Lymphoma, Non-Hodgkin ; Recurrence

Many drugs have been known to induce lupus-like syndrome, composing approximately 10% of all SLE cases. Isoniazid-induced lupus erythematosus affects either sex equally and the most common presenting feature is arthralgia or arthritis with anemia. Fever and pleuritis occur in approximately half of the cases, and pericarditis in approximately 30% of cases. We discribe a 28-year-old woman receiving antituberculous medications including isoniazid for one month. She was hospitalized with fever, arthralgia and newly developed pleural effusion The analysis of pleural fluid and serum revealed an elevated level of antinuclear antibody. We suspected of drug induced lupus and stopped isoniazid medication. After discontinuation of isoniazid and short course of prednisolone treatment, her symptoms and pleural effusion disappeared. This case is to our knowledge, the fist report of isoniazid induced SLE in Korea.
Adult ; Anemia ; Antibodies, Antinuclear ; Arthralgia ; Arthritis ; Female ; Fever ; Humans ; Isoniazid* ; Korea ; Lupus Erythematosus, Systemic* ; Pericarditis ; Pleural Effusion ; Pleurisy ; Prednisolone

A 61-year-old woman was admitted to the emergency department with acute chest pain. Echocardiography showed transient cardiomyopathy with akinesia of the basal and midportions of the left ventricle and hyperkinesia of the apex. No evidence of ischemic cardiomyopathy on myocardial SPECT or ergonovine stress echocardiography was observed. The patient's condition at discharge had improved, but she later was diagnosed as having pheochromocytoma. The findings of transient cardiomyopathy revealed inverted Takotsubo cardiomyopathy related to pheochromocytoma. The recognition of such a rare cardiac manifestation should be considered in the diagnosis of pheochromocytoma.
Cardiomyopathies ; Chest Pain ; Echocardiography ; Echocardiography, Stress ; Emergencies ; Ergonovine ; Female ; Heart Ventricles ; Humans ; Hyperkinesis ; Middle Aged ; Pheochromocytoma ; Takotsubo Cardiomyopathy ; Tomography, Emission-Computed, Single-Photon

Atrial Fibrillation (AF) is thought be caused by oxidative stress. Oxidative stress at the cellular level results from many factors, including exposure to alcohol, medications, cold, toxins or radiation. In this study we investigated gene transcriptional profiles on the human myocardial tissues from AF and oxidative stress conditions. Right atrial appendages were obtained from AF patients (n = 26) undergoing the Maze procedure, and from control patients (n = 26) who were in normal sinus rhythm and undergoing coronary artery bypass graft operation. To examine the effects of oxidative stress on AF, we used radioactive complementary DNA (cDNA) microarrays to evaluate changes in the expression of 1,152 known genes. This technology, which monitors thousands of genes simultaneously, gives us a better picture of the interactions between AF and oxidative stress. Total RNAs prepared from the retrieved tissues were used to synthesize(33)P-labeled cDNAs by reverse transcription and hybridized to cDNA microarrays. Gene expression profiles showed that 30 genes were upregulated and 25 were downregulated in AF patients compared with control patients. Moreover, comparison rank analysis revealed that the expression of five genes related to reactive oxygen species (ROS)-including flavin containing monooxygenase 1, monoamine oxidase B, ubiquitin specific protease 8, tyrosinase-related protein 1, and tyrosine 3-monooxygenase-increased by more than 2.0 of the Z-ratio, and two genes related to anti-oxidants including glutathione peroxidase 1, and heme oxygenase 2-decreased to the Z-ratio levels of <= -2.0. Apparently, a balanced regulation of pro- and anti-oxidation can be shifted toward pro-oxidation and can result in serious damage similar to that of human AF. Western blotting analysis confirmed the upregulation of tyrosinase-related protein 1 and tyrosine 3-monooxygenase and the downregulation of heme oxygenase 2. These results suggested that the gene expression pattern of myocardial tissues in AF patients can be associated with oxidative stress, resulting in a significant increase in ROS. Thus, the cDNA microarray technique was useful for investigating transcription profiles in AF. It showed that the intracellular mechanism of oxidative stress plays a pivotal role in the pathologic progression of AF and offers novel insight into potential treatment with antioxidants.
Atrial Appendage/metabolism ; Atrial Fibrillation/*genetics/*metabolism ; Blotting, Western ; DNA, Complementary/genetics ; *Gene Expression Profiling ; Gene Expression Regulation ; Human ; Myocardium/metabolism ; Oligonucleotide Array Sequence Analysis ; Oxidative Stress/*genetics ; Reactive Oxygen Species/metabolism ; Support, Non-U.S. Gov't

Common metastaic sites of hepatocellular carcinoma include lung, peritoneum, adrenal gland and bone, but rarely, skin can be metastatic sites. Although hepatocellular carcinoma is the third commonest malignancy in Korea, cutaneous metastasis from hepatocellular carcinoma was rarely reported. Cutaneous metastasis from malignant neoplasm of the internal organ occur at the variable stage and the growth pattern of cutaneous lesions is nonspecific and various, so the differential diagnosis of skin lesions must be considered to other malignant condition. We report a case of cutaneous metastasis from recurrent hepatocellular carcinoma that was confirmed by skin biopsy with immunohistochemical stain.
Carcinoma, Hepatocellular/*diagnosis/*secondary ; Humans ; Liver Neoplasms/*diagnosis/pathology ; Male ; Middle Aged ; Neoplasm Recurrence, Local/*diagnosis/pathology ; Skin Neoplasms/pathology/*secondary ; Tomography, X-Ray Computed

Percutaneous renal biopsy is essential in the diagnosis of renal parenchymal disease, providing diagnostic and prognostic information to nephrologists. Percutaneous renal biopsy is considered to be a relatively safe procedure, and catastrophic complications are rare. The post-biopsy care of patients typically consists of bed rest and observation for 24 hours. Additionally, recent reports have suggested that most complications after percutaneous renal biopsy are apparent within 24 hours; however, perinephric hematomas have been demonstrated at 24 to 72 hours after percutaneous renal biopsy in over 90% of cases. We report an unusual case of delayed perirenal hematoma that occurred 5 days after percutaneous renal biopsy.
Bed Rest ; Biopsy ; Hematoma ; Hemorrhage ; Humans ; Kidney ; Needles

Hemobilia is a status of bleeding into the biliary tract, which is caused by abnormal communication between the intrahepatic blood vessels and biliary tract, and is a rare cause of upper gastrointestinal hemorrhage. Most cases of the hemobilia originating in the gallbladder are related to gallstones. However, hemobilia is a rare complication of calculous cholecystitis. We report a case of hemobilia as a complication of calculous cholecystitis in a patient given continuous aspirin medication.
Aspirin ; Biliary Tract ; Blood Vessels ; Cholecystitis* ; Gallbladder ; Gallstones ; Gastrointestinal Hemorrhage ; Hemobilia* ; Hemorrhage ; Humans