Diagnostic Value of SUV in 18F-FDG PET/CT for Papillary Thyroid Cancer

Background and Objectives@#PET/CT is widely used to determine whether metastasis or recurrence will occur following initial treatment of thyroid cancer. However, there are not much research on diagnostic usefulness of preoperative PET/CT imaging for papillary thyroid cancer (PTC). We analyzed the correlation between the preoperative maximum standard uptake value (SUVmax) of PET/CT and prognostic factors of PTC to evaluate the diagnostic usefulness of PET/CT. @*Materials and Methods@#Of the 133 patients who underwent surgery for PTC, 88 patients who had an increased uptake in thyroid mass in preoperative PET/CT were enrolled. They were divided into two groups according to B-RAF gene mutation, extrathyroidal extension (ETE), lymph node metastasis, and recurrence. The average of the SUVmax for each group was analyzed through multiple regression analysis. Correlation analysis were performed on changes in SUVmax according to the size of the thyroid tumor. Statistical analysis was performed to determine whether there were stage differences between the 47 patients who had no increased uptake in PET/CT and the others who had. @*Results@#There were no statistical correlation between recurrence, the presence of central/lateral lymph node metastasis, ETE, stage and the SUVmax in PET/CT (p=0.513, p=0.8, p=0.73, p=0.01, p=0.9). There were statistical correlations between the size of tumor (p=0.001), the presence of the B-RAF mutation (p=0.024) and SUVmax. Statistical correlations between the presence of the hypermetabolic uptake and high stage were found by the chi-square test (p=0.012). @*Conclusion@#The size of tumor, B-RAF are major factors in determining prognosis of PTC. There is a possibility that there is a correlation between preoperative SUVmax and prognosis of PTC.

Differential Diagnosis of a Left Atrial Mass after Surgical Excision of Myxoma: a Remnant or a Thrombus?

Echocardiographic diagnosis of atrial myxoma may not always be straightforward, and the distinction between myxoma and thrombi is not easy, especially when we observe a mass after successful surgery. Our report describes a 72-year-old woman who presented with right upper limb hemiparesis and was subsequently diagnosed as having transient ischemic attack due to a left atrial myxoma. One month after successful surgical resection of the tumor, the patient developed left-sided weakness. Echocardiography revealed a left atrial mass attached to the interatrial septum. Intravenous heparin was administered as a therapeutic trial for postoperative thrombi, which resulted in a decrease in mass size within a week. Anticoagulation with warfarin was continued, and complete resolution was demonstrated on a 4-month follow-up transesophageal echocardiography. This case highlights the fact that thrombus formation at the surgical site should be considered an unusual but potential complication after surgical resection of left atrial myxomas.

Rapid-onset of severe tigecycline-induced coagulopathy in drug reaction with eosinophilia and systemic symptom syndrome

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome-also known as drug-induced hypersensitivity syndrome-is an uncommon disease entity that manifests as fever, skin rash, blood cell abnormalities, lymphadenopathy, and often coagulopathy. Tigecycline is an antibiotic that is selectively used to treat complicated intra-abdominal and soft-tissue infections. Recently, a few cases of tigecycline-induced coagulopathy have been reported. Herein, we report a case of tigecycline-induced coagulopathy in a patient with DRESS syndrome. Both prothrombin time and activated partial thromboplastin time were abruptly exceeded beyond 180 seconds on day 6 of tigecycline treatment and normalized after discontinuation of tigecycline.

Transient global amnesia associated with toxocariasis and secondary hypereosinophilia

Toxocariasis is an important cause of secondary hypereosinophilia in Korea. Here, we describe a rare case of toxocariasis presenting as transient global amnesia due to secondary hypereosinophilia. A 44-year-old male visited the Emergency Department (ED) for transient global amnesia. He ate raw cow liver and omasum 2 weeks before the ED visit. The initial peripheral blood eosinophil count was 15,250/µL and serologic test for serum specific IgG antibodies to Toxocara canis larval antigen was positive. Radiologic studies revealed multiple small embolic infarctions of brainwithout cardioembolic sources or vascular abnormalities. He was treated with systemic corticosteroid, and neither neurologic deficit nor motor deficit was left. In our current case, the patient have a history of frequently eating raw cow liver and omasum, and his total IgE level was extremely high (>5,000 IU/mL). Thus, the patient was diagnosed as having toxocariasis and secondary hypereosinophilia. Toxocariasis should be considered in the differential diagnosis in patients with eosinophilia and atypical neurologic symptoms, such as transient amnesia.

A Case of Infliximab-induced Multifocal Motor Neuropathy in a Patient with Rheumatoid Arthritis and Literature Review

Tumor necrosis factor (TNF) inhibitors are increasingly used in treatment of rheumatoid arthritis (RA), ankylosing spondylitis, psoriatic arthritis, and inflammatory bowel diseases including Crohn's disease and ulcerative colitis. Rarely, anti-TNF therapy is associated with neurological complications, including both central and peripheral nervous system disorders. To the best of our knowledge, only one case of infliximab-associated multifocal motor neuropathy with conduction block in a patient with spondyloarthropathy has been reported to date in Korea. Here, we report on the case of a 58-year-old Korean woman affected by RA who developed multifocal motor neuropathy after infliximab treatment.

Pseudoxanthoma Elasticum-Like Disorder with Multiple Coagulation Factor Deficiency in a Patient with Crohn's Disease / 대한내과학회지

Pseudoxanthoma elasticum (PXE)-like disorder with multiple coagulation factor deficiency is a genetic disease characterized by dystrophic mineralization of the connective tissue in multiple organs such as the skin, arteries, and retina. Patients with this disorder have excessive folding and sagging of the skin with loss of recoil, as well as coagulopathy. Crohn's disease is a chronic inflammatory condition of the gastrointestinal tract, which primary affects the small intestine, often leading to malnutrition. Here, we describe the case of a 25-year-old woman who presented with these diseases. We found that nutrient deficiency due to long-term Crohn's disease aggravated the coagulopathy associated with PXE-like disorder.