Renal tubular acidosis (RTA) is a metabolic acidosis caused by impaired excretion of hydrogen ions or reabsorption of bicarbonate. Disorders caused by impairment of bicarbonate reabsorption in the proximal tubule are classified as proximal RTA, whereas those resulting from impairment of hydrogen ion secretion at the distal tubule are called distal RTA. The most common causes of distal renal tubular acidosis in adults are autoimmune disorders including Sjogren syndrome, systemic lupus erythematosis, rheumatoid arthritis, and autoimmune thyroiditis. Of the thyroiditis states, Graves' disease-associated RTA is a rare disease. We experienced and managed one case of hypokalemic muscle weakness associated with Graves' disease and distal renal tubular acidosis.
Acidosis ; Acidosis, Renal Tubular ; Adult ; Arthritis, Rheumatoid ; Graves Disease ; Humans ; Hypokalemia ; Muscle Weakness ; Paralysis ; Protons ; Rare Diseases ; Sjogren's Syndrome ; Thyroid Gland ; Thyroiditis ; Thyroiditis, Autoimmune

PURPOSE: In this study, we attempted to ascertain the proton magnetic resonance spectroscopy (1H MRS) peak characteristics of human gastric tissue layers and finally to use the metabolic peaks of MRS to distinguish between normal and abnormal gastric specimens. MATENRIALS AND METHODS: Ex-vivo 1H MRS examinations of thirty-five gastric specimens were performed to distinguish abnormal gastric tissues invaded by carcinoma cells from normal stomach-wall tissues. High-resolution 400-MHz (9.4-T) 1H nuclear magnetic resonance (NMR) spectra of two gastric layers, a proper muscle layer, and a composite mucosa- submucosa layer were compared with those of clinical 64- MHz (1.5-T) MR spectra. Three-dimensional spoiled gradient recalled (SPGR) images were used to determine the size and the position of a voxel for MRS data collection. RESULTS: For normal gastric tissue layers, the metabolite peaks of 400-MHz 1H MRS were primarily found to be as follows: lipids at 0.9 ppm and 1.3 ppm; alanine at 1.58 ppm; N-acetyl neuraminic acid (sialic acid) at 2.03 ppm; and glutathione at 2.25 ppm in common. The broad and feature-less spectral peaks of the 64-MHz MRS were bunched near 0.9, 1.3, and 2.0, and 2.2 ppm in human specimens without respect to layers. In a specimen (Borrmmann type III) with a tubular adenocarcinoma, the resonance peaks were measured at 1.26, 1.36 and 3.22 ppm. All the peak intensities of the spectrum of the normal gastric tissue were reduced, but for gastric tumor tissue layers, the lactate peak split into 1.26 and 1.39 ppm, and the peak intensity of choline at 3.21 ppm was increased. CONCLUSION: We found that decreasing lipids, an increasing lactate peak that split into two peaks, 1.26 ppm and 1.36 ppm, and an increasing choline peak at 3.22 ppm were markers of tumor invasion into the gastric tissue layers. This study implies that MR spectroscopy can be a useful diagnostic tool for gastric cancer.
Adenocarcinoma ; Alanine ; Choline ; Data Collection ; Glutathione ; Humans ; Lactic Acid ; Magnetic Resonance Spectroscopy* ; Protons ; Stomach Neoplasms

PURPOSE: In this study, we attempted to ascertain the proton magnetic resonance spectroscopy (1H MRS) peak characteristics of human gastric tissue layers and finally to use the metabolic peaks of MRS to distinguish between normal and abnormal gastric specimens. MATENRIALS AND METHODS: Ex-vivo 1H MRS examinations of thirty-five gastric specimens were performed to distinguish abnormal gastric tissues invaded by carcinoma cells from normal stomach-wall tissues. High-resolution 400-MHz (9.4-T) 1H nuclear magnetic resonance (NMR) spectra of two gastric layers, a proper muscle layer, and a composite mucosa- submucosa layer were compared with those of clinical 64- MHz (1.5-T) MR spectra. Three-dimensional spoiled gradient recalled (SPGR) images were used to determine the size and the position of a voxel for MRS data collection. RESULTS: For normal gastric tissue layers, the metabolite peaks of 400-MHz 1H MRS were primarily found to be as follows: lipids at 0.9 ppm and 1.3 ppm; alanine at 1.58 ppm; N-acetyl neuraminic acid (sialic acid) at 2.03 ppm; and glutathione at 2.25 ppm in common. The broad and feature-less spectral peaks of the 64-MHz MRS were bunched near 0.9, 1.3, and 2.0, and 2.2 ppm in human specimens without respect to layers. In a specimen (Borrmmann type III) with a tubular adenocarcinoma, the resonance peaks were measured at 1.26, 1.36 and 3.22 ppm. All the peak intensities of the spectrum of the normal gastric tissue were reduced, but for gastric tumor tissue layers, the lactate peak split into 1.26 and 1.39 ppm, and the peak intensity of choline at 3.21 ppm was increased. CONCLUSION: We found that decreasing lipids, an increasing lactate peak that split into two peaks, 1.26 ppm and 1.36 ppm, and an increasing choline peak at 3.22 ppm were markers of tumor invasion into the gastric tissue layers. This study implies that MR spectroscopy can be a useful diagnostic tool for gastric cancer.
Adenocarcinoma ; Alanine ; Choline ; Data Collection ; Glutathione ; Humans ; Lactic Acid ; Magnetic Resonance Spectroscopy* ; Protons ; Stomach Neoplasms