PURPOSE: Current management for patients with differentiated thyroid cancer includes near total thyroidectomy and radioactive iodine therapy followed by administration of supraphysiological doses of levothyroxine (L-T4). Although hyperthyroidism is a well known risk factor for osteoporosis, the effects of L-T4 treatment on bone mineral density (BMD) in patients with thyroid cancer do not appear to be as significant as with endogenous hyperthyroidism. In this study, we evaluated the impact of long-term suppressive therapy with L-T4 on BMD and bone turn over markers in Korean female patients receiving L-T4 suppressive therapy. METHODS: We enrolled 94 female subjects (mean age, 50.84 +/- 11.43 years) receiving L-T4 after total or near total thyroidectomy and radioactive iodine therapy for thyroid cancer (mean follow-up period, 12.17 +/- 4.27 years). The subjects were divided into three groups by thyroid stimulating hormone (TSH) level (group 1 with TSH level < or =0.001 microIU/mL, group 2 with TSH level between 0.001 and 0.17 microIU/mL, group 3 with TSH level >0.17 microIU/mL) and four groups by quartile of free T4 level. L-T4 dosage, BMD (examined by dual-energy x-ray absorptiometry), and bone turnover markers were evaluated according to TSH and free T4 levels. RESULTS: No significant decrease was detected in BMD or bone turnover markers according to TSH level or free T4 level. Also, the prevalence of osteoporosis and osteopenia was not different among groups. CONCLUSION: Long-term L-T4 suppressive therapy after thyroid cancer management did not affect bone density or increase the prevalence of osteoporosis even though TSH levels were supraphysiologically suppressed.
Bone Density* ; Bone Diseases, Metabolic ; Female ; Follow-Up Studies ; Humans ; Hyperthyroidism ; Iodine ; Osteoporosis ; Prevalence ; Risk Factors ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Thyrotropin ; Thyroxine*

We describe a 48-year-old man with family history of rheumatoid arthritis (RA) affected by chronic eosinophilic pneumonia (CEP) with severe peripheral eosinophilia. CEP might develop as a complication of longstanding active RA. The patient with 5 months history of seropositive RA and chronic respiratory symptoms, alveolar and blood eosinophilia, peripheral pulmonary infiltrates and pleural effusion on chest imaging. The lung may be involved as an extraarticular manifestation of RA. However, CEP is not recognized as a typical lung manifestation of RA, and the two diseases rarely coexist. The effusion was an eosinophil predominant exudates and was characterized by low pH, and glucose level and high lactic dehydrogenase. The patient responded rapidly to combination of steroids and disease modifying anti-rheumatic drugs.
Antirheumatic Agents ; Arthritis, Rheumatoid* ; Eosinophilia ; Eosinophils* ; Exudates and Transudates ; Glucose ; Humans ; Hydrogen-Ion Concentration ; Lung ; Middle Aged ; Oxidoreductases ; Pleural Effusion* ; Pulmonary Eosinophilia* ; Steroids ; Thorax

Myocarditis often occurs due to viral infections and postviral immune-mediated responses. Hypersensitivity myocarditis is a rare form of myocarditis. Numerous drugs can induce myocarditis, which is typically reversible after withdrawal of the causative agent. Here, we report a case of hypersensitivity myocarditis that was probably triggered by amoxicillin and that resolved completely with heart failure management as well as discontinuation of the drug. A 68-year-old woman presented with acute chest pain mimicking acute coronary syndromes, but the coronary angiography was normal. A recent history of taking medications, skin rash, and peripheral eosinophilia suggested a diagnosis of hypersensitivity myocarditis, which was confirmed by cardiac magnetic resonance imaging and endomyocardial biopsy.
Aged ; Amoxicillin/*adverse effects ; Anti-Bacterial Agents/*adverse effects ; *Biopsy ; Drug Hypersensitivity/*diagnosis/drug therapy/etiology/pathology ; Electrocardiography ; Female ; Glucocorticoids/therapeutic use ; Humans ; *Magnetic Resonance Imaging ; Myocarditis/chemically induced/*diagnosis/drug therapy/pathology ; Myocardium/*pathology ; Predictive Value of Tests ; Prednisolone/therapeutic use ; Risk Factors ; Treatment Outcome

BACKGROUND/AIMS: Although the majority of patients with Mallory-Weiss syndrome (MWS) have a benign course, MWS patients with recurrent bleeding have an unfavorable outcome and require intensive care. Therefore, this study was carried out to identify the risk factors for recurrent bleeding in MWS patients. METHODS: The medical records of patients with MWS between January 1999 and December 2003, were reviewed retrospectively. Demographics, initial clinical and laboratory parameters, and endoscopic findings of the patients with and without recurrent bleeding were compared and the potential risk factors predicting recurrent bleeding in MWS were evaluated. RESULTS: A total of one hundred and fifty-nine patients (22 women, 137 men, mean age 48.1 years old) were enrolled in the study. Recurrent bleeding was observed in 17 patients (10.7%). Those patients with recurrent bleeding showed higher frequency for the presence of shock at initial manifestation, combined liver cirrhosis and endoscopic findings of active bleeding, lower hemoglobin level and platelet count, higher amount of transfusions and epinephrine-mixed fluid injections, and longer hospital stay than those patients without recurrent bleeding. Significant risk factors predicting the recurrent bleeding in MWS were the presence of shock at initial manifestation (OR 3.71, 95% CI 1.07-14.90) and the evidence of active bleeding on endoscopic examination (OR 9.89, 95% CI 1.88-51.98) on multivariate analysis. CONCLUSIONS: Intensive care with close monitoring is required for the patients with shock on initial manifestation or with evidence of active bleeding on endoscopic examinations since these are independent risk factors predicting the recurrent bleeding in MWS patients.
Female ; Gastrointestinal Hemorrhage/*etiology ; Humans ; Male ; Mallory-Weiss Syndrome/*complications/pathology/therapy ; Middle Aged ; Recurrence

Rhabdomyolysis is caused by injury to skeletal muscle and it involves leakage of intracellular contents into the plasma. Rhabdomyolysis is an extremely rare manifestation of dermatomyositis. Dermatomyositis is a rare idiopathic inflammatory myopathy that is characterized by chronic inflammation of skeletal muscles and skin, resulting in muscle weakness. A 20 year old Korean male soldier presented with acute muscle pain, weakness and skin rashes over the face, neck and anterior chest. He received military training with carrying a radio set one week previouslyago. The patient was treated for rhabdomyolysis. However, the patient's symptoms did not improve. Muscle biopsy results suggested the diagnosis of rhabdomyolysis. Nevertheless, the features of skin and muscle inflammation raised the possibility of dermatomyositis. High dose steroid treatment was started, and then the symptoms and signs of muscle inflammation were improved. Rhabdomyolysis as the presenting sign of dermatomyositis has not been reported in Korea. Thus, we report on this case with a literature review.
Biopsy ; Dermatomyositis ; Exanthema ; Humans ; Inflammation ; Korea ; Lifting ; Male ; Military Personnel ; Muscle Weakness ; Muscle, Skeletal ; Muscles ; Myositis ; Neck ; Plasma ; Rhabdomyolysis ; Skin ; Thorax

Malnutrition in patients with liver disease is common. Consequently, percutaneous endoscopic gastrostomy may be needed for the correction of malnutrition. Percutaneous endoscopic gastrostomy is rarely performed in patients with liver cirrhosis because of the presence of varices and coagulation abnormalities. However, if careful insertion technique along with thorough clinical assessment is undertaken, percutaneous endoscopic gastrostomy may be successfully performed in patients with liver cirrhosis. Here, we report successful application of percutaneous endoscopic gastrostomy in a patient with liver cirrhosis accompanied by both gastric and esophageal varices.
Aged ; *Endoscopy ; *Enteral Nutrition ; Esophageal and Gastric Varices/*complications ; Gastrostomy/*methods ; Humans ; Liver Cirrhosis/complications/*therapy ; Male

Ascaris lumbricoides is the most common intestinal parasite in less-developed countries as well as in areas with poor sanitation. Highly motile mature worms may enter the ampulla of Vater and migrate to the bile or pancreatic ducts causing cholangitis, biliary stones, cholecystitis, pancreatitis and a liver abscess. The incidence of pancreatitis due to biliary ascariasis is relatively common in endemic areas, but only a few cases have been reported in Korea since 1990. A 68-year-old woman was admitted with a sudden onset of epigastric pain. She was diagnosed with acute pancreatits due to ascaris based on computed tomography, the ampulla-impacted state of the worm and an elevated serum amylase level. The patient recovered without complications after the ascaris had been extracted using grasp forceps during endoscopy. The patient also received antihelminthic therapy. We report this case with a review of the relevant literatures.
Aged ; Ampulla of Vater ; Amylases ; Ascariasis ; Ascaris lumbricoides ; Ascaris* ; Bile ; Cholangitis ; Cholecystitis ; Common Bile Duct* ; Developing Countries ; Endoscopy ; Female ; Hand Strength ; Humans ; Incidence ; Korea ; Liver Abscess ; Pancreatic Ducts ; Pancreatitis* ; Parasites ; Sanitation ; Surgical Instruments

Spontaneous pregnancy in Turner's syndrome is very rare because of ovarian dysgenesis and subsequent streak gonads. Recently we experienced 3 cases of pregnancies and deliveries in Turner's syndrome, so we report with a brief review of literature.
Gonads ; Mosaicism ; Pregnancy* ; Turner Syndrome*