No abstract available.
Pheochromocytoma

Distant metastases from papillary thyroid carcinoma (PTC) are rare and are associated with a poor prognosis. Here, we describe a patient with metastatic PTC who was treated with a tyrosine kinase inhibitor (TKI, sorafenib) for several months that was acutely exacerbated by discontinuation. A 43-year-old male was diagnosed with PTC in February 2004 and underwent total thyroidectomy followed by two courses of high-dose radioactive iodine (RAI) therapy. Despite two additional courses of high-dose RAI therapy, lung and muscle metastases were developed. Treatment with sorafenib was begun in September 2010. After 11 months treatment of sorafenib, newly developed metastatic lesions were found in mediastinal lymph nodes, liver, and bones. Considered as treatment failure, the administration of sorafenib was discontinued. Two weeks after sorafenib treatment was stopped, the disease progressed abruptly and caused death of the patient by respiratory failure. In our patient, PTC progressed rapidly after the cessation of sorafenib treatment. Patients with several other types of cancer have also experienced such rapid disease progression, termed "flare-ups." Physicians should be aware that flare-ups may occur in advanced PTC patients following the cessation of TKI therapy.
Adult ; Disease Progression* ; Humans ; Iodine ; Liver ; Lung ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Prognosis ; Protein-Tyrosine Kinases ; Respiratory Insufficiency ; Thyroid Neoplasms* ; Thyroidectomy ; Treatment Failure

Undifferentiated carcinoma of the pancreas with osteoclast-like giant cells (UCPOGC) is a rare, highly malignant pancreatic exocrine neoplasm. Here, we report a case of UCPOGC in a 58-year-old man who presented with abdominal pain and weight loss. Abdomen computed tomography (CT) revealed a 5cm sized pancreatic body mass with peripheral enhancement. Endoscopic ultrasound (EUS)-guided biopsy of the mass suggested a solid-pseudopapillary tumor of the pancreas with a marked degenerative change. Distal pancreatectomy and splenectomy were performed. The size of the mass was 5.4 × 4.8 cm and the cut surface showed necrosis and hemorrhage. A definite diagnosis of UCPOGC was made using the histopathology and immunohistochemical findings.
Abdomen ; Abdominal Pain ; Biopsy ; Carcinoma* ; Diagnosis ; Giant Cells* ; Hemorrhage ; Humans ; Middle Aged ; Necrosis ; Osteoclasts ; Pancreas* ; Pancreatectomy ; Splenectomy ; Ultrasonography ; Weight Loss

Recently, serotype K1 Klebsiella pneumoniae has been a major agent of an invasive syndrome characterized by liver abscess and its metastatic infection. Extrahepatic infection and its characteristics in patients with renal abscess caused by K. pneumoniae are poorly understood, and few cases of central nervous system infection have been reported. This is a report of 80-year-old woman with uncontrolled type 2 diabetes mellitus with renal abscess caused by serotype K1 K. pneumoniae, complicated with ventriculitis despite of appropriate use of antibiotics. Physicians need to be aware of possibility of metastatic infection in patients with serotype K1 K. pneumoniae infection, if they develop neurologic symptom and focus of infection is still present.
Abscess* ; Aged, 80 and over ; Anti-Bacterial Agents ; Central Nervous System Infections ; Cerebral Ventriculitis ; Diabetes Mellitus, Type 2 ; Female ; Humans ; Klebsiella pneumoniae* ; Liver Abscess ; Neurologic Manifestations ; Pneumonia

Amyloidosis is a clinical disorder caused by extracellular deposition of proteinaceous insoluble fibrils in various tissues, resulting in organ compromise. Amyloid L (AL) amyloidosis is the most common type of systemic amyloidosis, which occurs in association with multiple myeloma or monoclonal gammopathy of undetermined significance (MGUS). Secondary amyloid A (AA) amyloidosis is a complication of chronic inflammatory conditions, such as rheumatoid arthritis or ankylosing spondylitis. We report a case of a 49-year-old manwith a 11-year history of ankylosing spondylitis, who was recently diagnosed with MGUS presented with cardiac amyloidosis of both the AA and AL types. We report this case along with a review of relevant literature.
Amyloid ; Amyloidosis* ; Arthritis, Rheumatoid ; Humans ; Middle Aged ; Monoclonal Gammopathy of Undetermined Significance* ; Multiple Myeloma ; Spondylitis, Ankylosing*

BACKGROUND AND OBJECTIVES: The sinus venosus (SV) is not a well known source of atrial tachycardia (AT), but it can harbor AT during catheter ablation of atrial fibrillation (AF). SUBJECTS AND METHODS: A total of 1223 patients who underwent catheter ablation for AF were reviewed. Electrophysiological and electrocardiographic characteristics and outcomes after catheter ablation of AT originating from the SV were investigated. RESULTS: Ten patients (0.82%) demonstrated AT from the SV (7 males, 53.9+/-16.0 years, 6 persistent) during ablation of AF. The mean cycle length was 281+/-73 ms. After pulmonary vein isolation and left atrial ablation, AF converted to AT from the SV during right atrial ablation in 2 patients, by rapid atrial pacing after AF termination in 7 patients, and during isoproterenol infusion in 1 patient. Positive P-waves in inferior leads were shown in most patients (90%). The activation sequence of AT was from proximal to distal in the superior vena cava and high to low in the right atrium, which was similar to that of AT from crista terminalis. Fragmented double potentials were recorded during sinus, and a second discrete potential preceded the onset of P wave by 80+/-37 ms during AT. Using 4.4+/-2.7 radiofrequency focal applications, ATs were terminated and became no longer inducible in all. After ablation procedure, two patients showed transient right phrenic nerve palsy. After 19.9+/-14.8 months, all but 1 patient were free of atrial tachyarrhythmia without complications. CONCLUSION: The AT which develops during AF ablation is rarely originated from SV, and its electrophysiologic characteristics may be helpful in guiding effective focal ablation.
Atrial Fibrillation ; Catheter Ablation ; Catheters ; Electrocardiography ; Heart Atria ; Humans ; Isoproterenol ; Male ; Paralysis ; Phrenic Nerve ; Pulmonary Veins ; Tachycardia ; Vena Cava, Superior

Extraintestinal manifestations are not uncommon in Crohn's disease, and a thromboembolic event is a disastrous potential complication. Deep vein thrombosis is the most common manifestation of a thromboembolic event and typically occurs in association with active inflammatory disease. Peripheral neuropathy in Crohn's disease has rarely been reported and is considered an adverse effect of metronidazole therapy. Here, we describe a patient who was initially diagnosed with Crohn's disease complicated with deep vein thrombosis and ulnar neuropathy without metronidazole exposure. The simultaneous occurrence of these complications in the early stage of Crohn's disease has never been reported in the English literature.
Crohn Disease ; Humans ; Metronidazole ; Mononeuropathies ; Peripheral Nervous System Diseases ; Ulnar Neuropathies ; Venous Thrombosis