Hypothyroidism can cause a variety of signs and symptoms of the neuromuscular system. However, ptosis in a patient with hypothyroidism is very rare. We report here on a case of central hypothyroidism that was due to Sheehan's syndrome and it manifested as bilateral ptosis in a 51-yr-old woman. She complained of exertional dyspnea and weakness. About 25-yr ago, she had a history of severe postpartum vaginal bleeding. The laboratory studies demonstrated hypopituitarism with secondary hypothyroidism. The ptosis was improved by replacement of thyroid hormone. Hypothyroidism should be considered in the differential diagnosis of patients who manifest with ptosis and that prompt replacement of hormone can lead to a complete recovery.
Blepharoptosis/complications/*diagnosis/drug therapy ; Electromyography ; Female ; Glucocorticoids/therapeutic use ; Humans ; Hypopituitarism/complications/*diagnosis/drug therapy ; Hypothyroidism/complications ; Magnetic Resonance Imaging ; Middle Aged ; Muscular Diseases/etiology ; Neuromuscular Junction/physiopathology ; Prednisolone/therapeutic use ; Thyroxine/therapeutic use

Three siblings with congenital dilatation of the intrahepatic bile ducts (Caroli's disease) are presented. Bile duct pathology was associated with congenital hepatic fibrosis and polycystic renal disease in all three patients. On color Doppler imaging (CD imaingl, multiple small color Doppler signals were observed in or near the vascular radicles within the dilated bile ducts, besides other well-known sonographic findings such as bile duct dilatations, biliary calculi. Dopper frequency spectral analysis confirmed all these color Doppler signals as arterial origin in all patients, showing pulsatile wave pattern. Although portal venous radicles are well known in conventional sonograms or computed tomotraphy(CT), continuous wave patterns were not detected in all patients. In addition to previously reported sonographic findings about Caroli's disease, color Doppler signals showing arterial wave pattern in or around the portal venous radicles within dilated duets are another helpful diagnostic criteria and these findings are easily depicted on routine sonograms with color mapping.
Bile Ducts* ; Bile Ducts, Intrahepatic ; Bile* ; Caroli Disease* ; Dilatation ; Fibrosis ; Gallstones ; Humans ; Pathology ; Polycystic Kidney Diseases ; Siblings ; Ultrasonography

BACKGROUND/AIMS: An HbA1c test result > or = 6.5% has recently been recommended as the defining criterion for diabetes by the American Diabetes Association. We compared the detection of diabetes using oral glucose tolerance test (OGTT)-based and HbA1c-based diagnostic criteria. Additionally, we identified the optimal HbA1c threshold for diabetes in Korea. METHODS: This study was a cross-sectional retrospective design using data from 405 subjects without known diabetes who underwent OGTT and HbA1c tests for the diagnosis of diabetes between January, 2005, and June, 2010, at Dongguk University Gyeongju Hospital, Korea. The OGTT is considered to be the gold standard for diagnosing diabetes. Based on a receiver operating characteristics (ROC) curve, optimal sensitivity and specificity were derived for identifying the HbA1c threshold. RESULTS: For diabetes, HbA1c at 6.5% gave a sensitivity of 52.9%, specificity of 95.1%, positive predictive value of 92.9%, and a negative predictive value of 62.7%. A total of 47.1% of subjects with newly diagnosed diabetes had HbA1c levels <6.5%. Results were similar in sex- and age-stratified analyses. To identify diabetes based on OGTT, the HbA1c threshold of 6.1% had an area under the curve (AUC) of 0.849 with 77.8% sensitivity and 71.7% specificity. CONCLUSIONS: In a Korean population, diabetes prevalence was lower using the HbA1c-based diagnostic criteria. An HbA1c threshold of 6.1% optimally identified diabetes by OGTT-based diagnostic criteria in Korea. Further large-scale, population-based studies are needed to evaluate the HbA1c threshold for diagnosing diabetes in Korea.
Diabetes Mellitus ; Diagnostic Tests, Routine ; Glucose Tolerance Test ; Korea ; Prevalence ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity

Primary ovarian ectopic pregnancy has remained a rare event. It is difficult preoperatively to diagnose and differentiate ovarian pregnancy from hemorrhagic ovarian cyst and tubal ectopic pregnancy. However, improved diagnosis of acute hemoperitoneum of ovarian origin may reveal a higher incidence than reported earlier. The diagnostic criteria were described in 1878 by Spiegelberg, which comprise that the pregnancy is in the ovary and does not involve the tube. Ovarian pregnancy occurs within the ovary and on the corpus luteum, usually with rupture of the ovary and a massive hemoperitoneum. We report a relatively intact primary ovarian pregnancy with a brief review of the literatures.
Corpus Luteum ; Diagnosis ; Female ; Hemoperitoneum ; Incidence ; Ovarian Cysts ; Ovary ; Pregnancy ; Pregnancy, Ectopic* ; Rupture

Amyloid deposition in the thyroid is found in about 30-80% of the patients with primary or secondary amyloidosis. In a few patients with amyloidosis, the thyroid is enlarged and so called amyloid goiter occurs. The thyroid function usually remains normal, but occasionally hypothyroidism or thyrotoxicosis occurs in patients with thyroid amyloidosis. We have experienced one case of thyroid amyloidosis due to bronchiectasis and the patient developed painful goiter and transient thyrotoxicosis resembling subacute thyroiditis. Biopsies from the gastric antrum, duodenum, colon, kidney and thyroid were positive for deposition of amyloid. When patients have signs and symptoms of subacute thyroiditis, but they develop an unusual course, then the diagnosis of thyroid amyloidosis should be considered.
Amyloid ; Amyloidosis ; Biopsy ; Bronchiectasis ; Colon ; Duodenum ; Goiter ; Humans ; Hypothyroidism ; Kidney ; Plaque, Amyloid ; Pyloric Antrum ; Thyroid Gland ; Thyroiditis ; Thyroiditis, Subacute ; Thyrotoxicosis

Use of oral hypoglycemic agents during pregnant women with type 2 diabetes is controversial due to safety issues. Recently, randomized controlled trials support short-term safety of glyburide and metformin for the treatment of gestational diabetes mellitus. However, long-term safety data are not available. Moreover, use of oral hypoglycemic agents, except for metformin and glyburide, during pregnancy were limited to a few case reports. We report the case of a pregnant woman with type 2 diabetes unintentionally exposed to metformin and voglibose in addition to lercanidipine and bisoprolol during fetal organogenesis. The patient was continuously exposed to oral agents because we were not aware of her pregnancy until 22 weeks of gestation. After pregnancy was confirmed, we replaced oral hypoglycemic agents with insulin and discontinue betablockers. Delivery occurred without maternal or fetal complications.
Bisoprolol ; Diabetes, Gestational ; Female ; Glyburide ; Humans ; Hypoglycemic Agents ; Insulin ; Metformin* ; Organogenesis ; Pregnancy ; Pregnancy Trimester, Second* ; Pregnancy* ; Pregnant Women*

Hyponatremia is a frequent condition of body fluid and electrolyte imbalance encountered in clinical practice. However, rhabdomyolysis has rarely been reported in association with hyponatremia. We experienced a 56-year-old woman who had developed symptomatic hyponatremia after prolonged nausea and subsequent rhabdomyolysis. Hyponatremia was probably mediated by hypersecretion of antidiuretic hormones.The woman had developed severe hypotonic hyponatremia with an alternation in mental status after suffering from severe nausea and vomiting for x months/years. She recovered with intensive supportive therapy, including hypertonic saline administration. One day after hospitalization, she complained of thigh pains; furthermore her serum creatine phosphokinase level had increased. She was treated with alkaline diuresis. Renal failure or compartment syndrome did not complicate the clinical course. The patient was discharged and returned to her normal daily activities. The possibility of rhabdomyolysis should be considered in patients with acute hyponatremia who have developed muscle pain.
Body Fluids ; Compartment Syndromes ; Creatine Kinase ; Diuresis ; Female ; Hospitalization ; Humans ; Hyponatremia* ; Middle Aged ; Myalgia ; Nausea ; Renal Insufficiency ; Rhabdomyolysis* ; Thigh ; Vomiting

Acute leukemias are among the most common malignant neoplasms of young woman, but paradoxically, their incidence complicating pregnancy is cited to be very low. In most situations, the course of the pregnancy does not seem to be affected by the presence of the leukemia. So early diagnosis and treatment of acute leukemia might be very important., since acute leukemia in a pregnant young woman poses an immediate threat to life and any treatment delay would significantly worsen the patient's prognosis. We report a 37-year-old female who had symptoms and signs of acute leukemia such as vaginal spotting and leukemia cutis and was diagnosed as acute monoblastic leukemia M5(FAB) in January 2002 with 25 weeks' pregnancy. This case represents the use of combination chemotherapy successfully resulted in complete remission in the second trimester without any adverse impact on the fetus in uterus.
Adult ; Drug Therapy, Combination ; Early Diagnosis ; Female ; Fetus ; Humans ; Incidence ; Leukemia ; Leukemia, Monocytic, Acute* ; Metrorrhagia ; Pregnancy Trimester, Second ; Pregnancy* ; Prognosis ; Uterus

The continuing growth of population aged 65 years and above, the socioeconomic burden of long-term care insurance has consistently increased. This study aimed to review the current system and efficiently develop long-term care insurance services according to changes in socioeconomic situations. First, a 21 items questionnaire survey was conducted from August 16 to August 31, 2022, for all members of the Korean Neurological Association. The survey was divided into seven areas, and individualized results were analyzed. Second, cumulative data on long-term care insurance services were collected and analyzed from July 1, 2008 to December 31, 2021, for the National Health Insurance system, and the results were summarized. In the survey, approximately 21% of the neurologists answered a web-based questionnaire survey on current doctors’ referral slips for long-term insurance services. Most (94%) had doctor referral slips for long-term insurance services. However, the authors estimated that doctors’ referral slips did not sufficiently affect the grading of longterm insurance services. The long-term care insurance services data according to several categories were classified and then, we statistically analyzed the socioeconomic burden of long-term insurance. Those cumulative data showed a gradual increase in the recipient number, diversity of geriatric diseases, and socioeconomic burden. We suggested that it is necessary for the government and academic society to continue to cooperate to develop the long-term care insurance systems for elderly.

BACKGROUND/AIM: Recent advances in both diagnosis and treatment have markedly improved the prognosis in patients with hepatocellular carcinoma (HCC). Bone metastasis has become a clinical problem in the treatment of HCC patients. The purpose of this study was to evaluate the palliative effect of radiotherapy for painful bone metastasis from HCC. METHODS: From January 1991 to June 2000, 51 patients (77 sites) with painful bone metastasis from HCC were retrospectively analyzed. Ages ranged from 21 to 80 years (median 55 years). The male:female ratio was 7.5:1. Synchronous or metachronous bone metastasis was seen in 20 (39%) and 31 patients (61%), respectively. The most common symptom of bone metastasis was pain (45 patients, 88%). Twenty-one patients (41%) had a solitary bone metastasis while 30 (59%) had multiple ones. The sites of bone metastasis, in order of frequency, were the vertebra (38), rib (20), and pelvis (19). The total radiation dose ranged from 12.5 to 50 Gy (median 30 Gy). The Wisconsin Brief Pain Questionnaire was used to evaluate pain response. RESULTS: The overall 1 and 2 year survival rates from the time of bone metastasis were 15% and 4%, respectively. The median survival time was 5 months. Intrahepatic stage(p=0.014), and metastasis to other organs(p=0.019) were significant prognostic factor for survival by univariate analysis. There was, however, no independent prognostic factor on multivariate analysis. Pain relief after radiotherapy was achieved for 56 sites (73%). CONCLUSION: The expected life span (median 5 months) in this group of patients suggests a strong necessity for effective treatment for symptomatic palliation. Radiation therapy was effective in pain palliation for bone metastasis from HCC, and this could improve patients' quality of life.
Adult ; Aged ; Aged, 80 and over ; Bone Neoplasms/*radiotherapy/*secondary ; Carcinoma, Hepatocellular/mortality/*radiotherapy/*secondary ; English Abstract ; Female ; Human ; Liver Neoplasms/mortality/*pathology ; Male ; Middle Aged ; Palliative Care ; Retrospective Studies ; Survival Rate