Rhabdomyolysis and Acute Kidney Injury Associated with Hypothyroidism and Statin Therapy

Rhabdomyolysis is a syndrome involving the breakdown of skeletal muscle that causes myoglobin and other intracellular proteins to leak into the circulatory system, resulting in organ injury including acute kidney injury. We report a case of statin-induced rhabdomyolysis and acute kidney injury that developed in a 63-year-old woman with previously undiagnosed hypothyroidism. Untreated hypothyroidism may have caused her hypercholesterolemia requiring statin treatment, and it is postulated that statin-induced muscle injury was aggravated by hypothyroidism resulting in her full-blown rhabdomyolysis. Although this patient was successfully treated with continuous venovenous hemofiltration and L-thyroxin replacement, rhabdomyolysis with acute kidney injury is a potentially life-threatening disorder. Physicians must pay special attention to the possible presence of subclinical hypothyroidism when administering statins in patients with hypercholesterolemia.

Rhabdomyolysis and Acute Kidney Injury Associated with Hypothyroidism and Statin Therapy

Rhabdomyolysis is a syndrome involving the breakdown of skeletal muscle that causes myoglobin and other intracellular proteins to leak into the circulatory system, resulting in organ injury including acute kidney injury. We report a case of statin-induced rhabdomyolysis and acute kidney injury that developed in a 63-year-old woman with previously undiagnosed hypothyroidism. Untreated hypothyroidism may have caused her hypercholesterolemia requiring statin treatment, and it is postulated that statin-induced muscle injury was aggravated by hypothyroidism resulting in her full-blown rhabdomyolysis. Although this patient was successfully treated with continuous venovenous hemofiltration and L-thyroxin replacement, rhabdomyolysis with acute kidney injury is a potentially life-threatening disorder. Physicians must pay special attention to the possible presence of subclinical hypothyroidism when administering statins in patients with hypercholesterolemia.

Two Cases of Supraclavicular Lymph Node Metastasis in Pancreatic Adenocarcinoma / 대한내과학회지

The supraclavicular lymph node (SCN) is frequently involved in lymphoma and metastatic malignancies of the breast and lung, but is extremely rarely involved in pancreatic cancer. Only 10 such cases have been reported in the medical literature worldwide. We herein report an additional two cases. An 83-year-old male patient had a 7.6 x 5 cm pancreatic tumor from the pancreatic head to tail, and a 71-year-old male patient had a 2.8 x 1.9 cm pancreatic body tumor. PET-CT revealed SCN metastasis, and subsequent excisional biopsy confirmed metastatic adenocarcinoma. With the more popular use of PET-CT in patients with pancreatic cancer, the number of cases of metastasis to the SCN is expected to increase. This suggests that lymphatic spread is the main metastatic route in pancreatic cancer. Further large-scale studies along with increased numbers of case reports are needed to determine whether lymphatic spread is the main metastatic route in pancreatic cancer.

A Case of Gastric Duplication Cyst at Fundus Presenting as a Large Subepithelial Tumor

Gastric duplication cyst is a congenital disease and an uncommon finding in adult patients. Presenting symptoms are often asymptomatic during adulthood. Most cases are discovered incidentally by radiological examination or gastric endoscopy. Preoperative diagnosis of gastric duplication is difficult because definitive diagnosis requires a well-developed coat of smooth muscle with an epithelial lining that represents some portion of the alimentary tract in the lesion. In majority of reported cases, the diagnosis is established by surgical exploration and the treatment is primarily managed by complete excision. We report a case of a gastric duplication cyst in a 40-year-old man.

A Case of Gastric Duplication Cyst at Fundus Presenting as a Large Subepithelial Tumor

Gastric duplication cyst is a congenital disease and an uncommon finding in adult patients. Presenting symptoms are often asymptomatic during adulthood. Most cases are discovered incidentally by radiological examination or gastric endoscopy. Preoperative diagnosis of gastric duplication is difficult because definitive diagnosis requires a well-developed coat of smooth muscle with an epithelial lining that represents some portion of the alimentary tract in the lesion. In majority of reported cases, the diagnosis is established by surgical exploration and the treatment is primarily managed by complete excision. We report a case of a gastric duplication cyst in a 40-year-old man.

Prevalence and Risk Factors of Colorectal Neoplasms according to Coronary Artery Obstructive Disease

BACKGROUND/AIMS: Both colorectal neoplasm (CN) and coronary artery obstructive disease (CAOD) are prevalent and major leading causes of death in Korea. Although CN and CAOD share similar risk factors such as male gender, smoking, hyperlipidemia, diabetes mellitus, and obesity, few studies of both CN and CAOD have been reported. In this study, we evaluated clinical correlations between CN and CAOD. METHODS: Between June 2003 and December 2007, 176 patients (Male: 101, average age: 62.1+/-9.7 yr) who underwent colonoscopy after or before coronary angiography were retrospectively enrolled. The colonoscopic findings (normal, adenoma, or cancer) of patients as well as clinical and laboratory data according to the extent of CAOD (normal, minimal CAOD, or CAOD) were compared. RESULTS: CAOD negative, minimal CAOD, and CAOD patients totaled 36, 40, and 100, respectively. The presence of CN (adenoma and adenocarcinoma) in CAOD negative, minimal CAOD, and CAOD cases was 42%, 48%, and 63%, respectively, which was significantly different (P or =60 yr; P=0.03, odds ratio 2.47) and the presence of CAOD (P=0.02, odds ratio 4.11) were associated with the presence of CN. CONCLUSIONS: The prevalence of CN increased in proportion to the severity of CAOD. Colorectal cancer screening by fecal occult blood tests or colonoscopy should be a priority in patients with CAOD, particularly the elderly.