Seizure and Profound Hypokalemia: Unusual Presentation of Primary Hyperparathyroidism

A 68-year-old man was admitted because of tonic–clonic convulsion. He had been receiving 200 mg itraconazole for 10 days. He had hypokalaemia (2.2 mEq/l), hypercalcaemia (Cacorr 11.0 mg/dl) and elevated serum parathyroid hormone (PTH, 95 pg/ml). Ultrasound examination of the neck revealed a low echoic tumour. Cessation of itraconazole and fluid supplementation eradicated clinical symptoms and profound hypokalaemia, but serum potassium remained low normal (3.4 mEq/l) and the mild hypercalcaemia and elevated PTH were unchanged. To conclude, a small amount of itraconazole (200 mg) precipitated profound hypokalaemia and seizure in a patient with mild hyperparathyroidism and low normal serum potassium

Surgery for myasthenia gravis

The effect of thymectomy on myasthenia gravis was evaluated in the 48 patients with thymectomy for myasthenia gravis in the First Department of Surgery, Nagasaki University School of Medicine. The surgical approaches were done by midsternotomy in 44, by right thoractomy in 3 and by transcervical route in 1 respectively. As a rule, extended thymectomy was mainly applied. The disease stages in most cases included the types of Osserman II b and/or II a. The effect of thymectomy on myasthenia gravis was compared between the patients with and without thymoma. The effect of thymectomy for patients without thymoma was superior to that for patients with thymoma. There was no close relationship between the suffering time and the effect of thymectomy. Interestingly enough, the surgical outcome for those who had moderate or severe formation of germinal center in the resected thymic glands was not satisfactory and some aggravated following thymectomy

Outcomes of patients who developed subsequent solid cancer after hematopoietic cell transplantation

To characterize the outcomes of patients who developed a particular subsequent solid cancer after hematopoietic cell transplantation (HCT), age at cancer diagnosis, survival, and causes of death were compared with the respective primary cancer in the general population, using data from the national HCT registry and population-based cancer registries in Japan. Among 31 867 patients who underwent a first HCT between 1990 and 2013 and had progression-free survival at 1 year, 713 patients developed subsequent solid cancer. The median age at subsequent solid cancer diagnosis was 55 years, which was significantly younger than the 67 years for primary cancer patients in the general population (P < .001). The overall survival probability was 60% at 3 years after diagnosis of subsequent solid cancer and differed according to cancer type. Development of most solid cancers was associated with an increased risk of subsequent mortality after HCT. Subsequent solid cancers accounted for 76% of causes of death. Overall survival probabilities adjusted for age, sex, and year of diagnosis were lower in the HCT population than in the general population for colon, bone/soft tissue, and central nervous system cancers and did not differ statistically for other cancers. In conclusion, most subsequent solid cancers occurred at younger ages than primary cancers, emphasizing the need for cancer screening at younger ages. Subsequent solid cancers showed similar or worse survival compared with primary cancers. Biological and genetic differences between primary and subsequent solid cancers remain to be determined

Sediment cores and their radiocarbon ages in the Western Ross Sea, Antarctica

We describe paleoenvironmental changes related to ice sheet and ice shelf developments in the western Ross Sea in the late Quaternary, based on the three sediment cores collected along ca 167°E We distinguish four lithologic units in their sequences as follows (1) Unit I of diatomaceous mud, (2) Unit IIA of mud, (3) Unit IIB of alternating clay and thin laminated silt, and (4) Unit III of consolidated sandy silt with pebbly gravel Interpreted sedimentary environments based on the time constraints of fifteen AMS ^C dates and characteristics of sediments and diatom assemblages, are summarized as follows (1) Prior to the ice sheet advance, this area was possibly under a marine environment, (2) the grounded ice sheet is thought to have advanced between 35 and 20 ka BP, (3) shelf ice possibly covered the southern site between 25 and 20 ka BP, (4) an open marine environment with moderate productivity existed from 20 ka BP at the northern site, and (5) an open marine environment with high productivity existed from 9kaBP The length and timing of the ice sheet advance cannot explain radiocarbon dates of all sites Radiocarbon dating of marine sediments in the Antarctic area shows a large reservoir effect and contamination of reworked dead carbon In our estimation of the ages, two thousand years correction is needed in the upper unit at least Age data for lower units are thought to be older than the true sedimentary ages though these need further consideratio

Marine sediment cores from the continental shelf around Anvers Island, Antarctic Peninsula region

Sediment core samples are described from the area adjacent to Anvers Island north of the Antarctic Peninsula. The sequence is divided into three lithologic units, siliceous mud, alternation sandy silt and siliceous mud, and sandy silt with gravel, in descending order. These units suggest sedimentary environmental changes from under the ice sheet, to marine with highly influenced by fluctuation of the ice sheet, and finally to open marine. These major environmental changes are dated to ca. 16 ka BP and ca. 11.5 ka BP, respectively, based on uncorrected radiocarbon ages of organic carbon

Successful treatment of ruptured duodenal varices with dual balloon-occluded embolotherapy

Duodenal varices are ectopic portosystemic shunts that do not tend to result in gastrointestinal bleeding. Balloon-occluded retrograde transvenous obliteration is an established treatment for gastric varices. We report a 60-year-old man with melena due to ruptured duodenal varices originating at an inferior pancreaticoduodenal vein; drainage was into a gonadal vein. His ruptured duodenal varices were successfully treated by dual balloon-occluded embolotherapy