Now that ankylosing spondylitis is known to be relatively common, it is important that mild cases should be diagnosed earlier to avoid inappropriate investigation and unhelpful non-specific therapy and to improve social rehabilitation. However, difficulties in the diagnosis of ankylosing spondylitis are often encountered. To establish the clinical values of SPECT in ankylosing spondylitis, a study of radiologic evaluation, quantitative bone scan and SPECT have been carried out in 34 patients who were firmly suspected as having ankylosing spondylitis by other tests. This study showed that SPECT could improve the applicability of the imaging modality in the diagnosis and the assessment of disease activity and the capacity of early diagnosis in patients with ankylosing spondylitis. We believe that improved three dimensional localization in and around the sacroiliac joints by SPECT might overcome several diagnostic difficulties. Especially when radiographic abnormalities are not present in the early period, the diagnostic values of SPECT may be more potential.
Diagnosis ; Early Diagnosis ; Evaluation Studies as Topic ; Humans ; Rehabilitation ; Sacroiliac Joint ; Spondylitis, Ankylosing* ; Tomography, Emission-Computed, Single-Photon*

BACKGROUND: Chronic irritant contact dermatitis, the common occupational dermatitis of the skin, could be caused by repetitive exposure of the skin to irritants. Adaptation of the skin to repeated influence of exogenous irritants is called the hardening. The defining characteristic of hardening phenomenon has been progressively decreasing inflammatory response with prolonged exposure to an irritant. OBJECTIVE: The purpose of this study was to evaluate the induction of hardening phenomenon by the repeated application of various concentrated sodium lauryl sulfate (SLS) solutions. METHODS: Once a day a 0.1%, 0.5%, 2% solution of SLS and distilled water were applied to the volar forearm skin in 15 healthy volunteers for 10 minutes over 3 weeks. After 3 weeks interval of rest, patch tests with 1% solution of SLS were conducted on previously irritated sites for 24 hours. We measured transepidermal water loss (TEWL) and erythema index (E-index) before irritation, during 3 weeks of repeated application. 4 days after the patches test, we measured TEWL and E-index once a day. RESULTS: During 3 weeks of irritation with repeated application of 0.1%, 0.5%, 2% SLS solution, increase of TEWL was accelerated according to concentrations of SLS. In the study of 24-h patch test with 1% SLS solution on previously irritated sites after 3 weeks interval of rest, TEWL on distilled water application site was significantly higher than other sites irritated with SLS solution on D44 and D45. The TEWL values on the site irritated with higher concentration of SLS solution were lower than those with lower concentration of SLS solution. In contrast, there were no significant differences in E-index value during 3 weeks of irritation and after 24-h patch test with 1% SLS solution. CONCLUSION: Hardening could be induced by repeated irritation with SLS solution for 3 weeks. We suggest that hardening could be induced more efficiently with the higher concentration of SLS solution than the lower concentration.
Dermatitis, Contact ; Dermatitis, Occupational ; Erythema ; Forearm ; Irritants ; Organ Preservation Solutions ; Patch Tests ; Skin ; Sodium ; Sodium Dodecyl Sulfate ; Sucrose ; Water

No abstract available.

Oral allergy syndrome (OAS), an immediate swelling and itching sensation of the mouth and throat after ingestion of a food allergen, is the most common food allergy-related manifestation. It can be present either in isolation or in association to systemic symptoms, and may even result in anaphylaxis. We report a case of a 5-year-old child who suffered from an oral allergy syndrome after eating perilla seeds. We obtained a positive open oral challenge with crude perilla seeds.
Anaphylaxis ; Child ; Child, Preschool ; Eating ; Humans ; Hypersensitivity* ; Mouth ; Perilla* ; Pharynx ; Pruritus ; Sensation

Mycobacterium (M.) fortuitum is a rapidly growing mycobacterium of Runyon's group IV. It is frequently found in water, soil and dust. Although being rarely pathogenic, M. fortuitum can cause soft tissue and skeletal infections through direct inoculation occurring in surgery or penetrating trauma. We report a case of cutaneous infection due to M. fortuitum which occurred in a 56-year-old female who had worked at a public bath. She had received a small injury to her right thigh, and thereafter an erythematous, indurated, tender plaque and small peripheral papules had developed at the injury site. The culture from the skin biopsy specimen on Ogawa medium yielded colonies after 7 days. The microorganism was subsequently identified as M. fortuitum by PCR-restriction fragment length polymorphism analysis. The skin lesions were improved by antibiotic therapy with minocycline and ciprofloxacin.
Baths ; Biopsy ; Ciprofloxacin ; Dust ; Female ; Humans ; Middle Aged ; Minocycline ; Mycobacterium fortuitum* ; Mycobacterium* ; Skin ; Soil ; Thigh

PURPOSE: Receptor activator of nuclear factor-kappa B ligand (RANKL), osteoprotegerin (OPG) have been shown to be important regulators of osteoclastogenesis during bone remodeling, and their expressions were examined during fracture healing in a mouse model of tibial fracture. However, studies linking RANKL and OPG in patients with head injury and fracture are lacking. We evaluated the changes in serum levels of RANKL and OPG in patients with head injury and fracture (head injury group) and in patients with fracture (fracture group) and compared these with levels found in healthy control subjects. MATERIALS AND METHODS: 18 male patients of head injury and fracture and 20 male patients of fracture alone were enrolled. 20 healthy men were recruited to serve as controls. Within the first few hours of admission to hospital, at 4, 8 and 12 weeks after injury 20 ml of blood were obtained from 18 patients with head injury and fracture and 20 patients with fracture only. RESULTS: RANKL levels were significantly lower in the head injury group than in the fracture group at 8 and 12 weeks after injury. OPG levels were significantly higher in the head injury group than in the fracture group at 4, 8 and 12 weeks after injury. RANKL/OPG ratios were significantly lower in the head injury group than in the controls immediately after and 4, 8 and 12 weeks after injury, and were significantly lower in the head injury group than in the fracture group at 8 and 12 weeks after injury. CONCLUSION: We have shown changes in the profiles of RANKL, OPG and RANKL to OPG ratio. The altered RANKL, OPG and RANKL/OPG ratio in the head injury group lasted longer than in those of the fracture group.
Animals ; Bone Remodeling ; Craniocerebral Trauma ; Fracture Healing ; Head ; Humans ; Male ; Mice ; Osteoprotegerin ; RANK Ligand ; Receptor Activator of Nuclear Factor-kappa B ; Tibial Fractures

The terms "gastrointestinal stromal tumor" (GIST) have been applied to mesenchymal tumos that represent neither typical leiomyoma nor schwannoma. The majority of GISTs are Located in the stomach and small intestine, and only 4% of GISTs are found in duodenum. The most important characteristic is their indolent, slow-growing nature, rendering the most common definitions of malignancy invalid and inapplicable. Clinical and pathological criteria to differentiate benign from malignant GISTs are not well established. Tumor size and mitoic activity are commonly considered as important features, allowing for the prediction of biological behaviour and outcome. The case of a 87-year-old male patient who was presented with melena and acute anemia is herein reported. Esophagogastroduodenoscopy and computed tomography of the abdomen revealed two submucosal tumors in the stomach and duodenum. Histological and immunohistochemical studies on the surgical resection specimen revealed a gastrointestinal stromal tumor of an uncommiteed type, with no evidence of increased mitotic activity. The patient was treated with local excision of the tumors and is now in a favorable state.
Abdomen ; Aged, 80 and over ; Anemia ; Duodenum ; Endoscopy, Digestive System ; Gastrointestinal Stromal Tumors* ; Hemorrhage* ; Humans ; Intestine, Small ; Leiomyoma ; Male ; Melena ; Neurilemmoma ; Stomach

Ossification of ligamentum flavum is a very rare disease and one of the new disease entities in myelopathy. We report three cases of ossification of ligamentum flavum in thoracic spine causing thoracic myelopathy. Main symptoms of this disease are numbness of both legs and feet, gait disturbance and spastic motor weakness. Simple spine X-ray, metrizamide myelogram, CT and MRI are most useful diagnostic tools. Sufficient decompressive laminectomy and facetectomy are treatment of choice.
Foot ; Gait ; Hypesthesia ; Laminectomy ; Leg ; Ligamentum Flavum* ; Magnetic Resonance Imaging ; Metrizamide ; Muscle Spasticity ; Rare Diseases ; Spinal Cord Diseases* ; Spine

Pulmonary histiocytosis X is a granulomatous disorder of the lung of unknown cause. Patients with this disease often complain of cough, dyspnea on exertion and , occaionally, chest pain from pneumothorax or bone involvement. However, DI is uncommon in these patients. We report a case of primary pulmonary histiocytosis X with central diabetes insipidus. A 23-year-old man presented with dyspnea suffered from dry cough, exertional dyspnea, polydipsia and polyuria for 4 months. He was a heavy smoker. He was found to have reticulonodular interstitial opacities on chest X-ray film. High-resolution computed tomography revealed thin-walled cysts of various sizes in both lungs. Open lung biopsy was done. On light microscopic examination revealed proliferation and infiltration of Langerhans cells. Immunohistochemically, Langerhans cells showed strong cytoplasmic staining with S-100 protein and electronmicroscopic examination showed Birbeck granules in Langerhans cells. Water deprivation test showed central-type diabetes insipidus and brain MRI showed no abnormal lesion on suprasellar region. Smoking cessation was recommended. He was treated with oral desmopressin.
Biopsy ; Brain ; Chest Pain ; Cough ; Cytoplasm ; Deamino Arginine Vasopressin ; Diabetes Insipidus ; Diabetes Insipidus, Neurogenic* ; Dyspnea ; Histiocytosis, Langerhans-Cell* ; Humans ; Langerhans Cells ; Lung ; Magnetic Resonance Imaging ; Pneumothorax ; Polydipsia ; Polyuria ; S100 Proteins ; Smoking Cessation ; Thorax ; Water Deprivation ; X-Ray Film ; Young Adult

BACKGROUND/AIMS: The extraction of large common bile duct (CBD) stones after an endoscopic sphincterotomy (EST) is successful in 80~90% of cases but it often requires a prolonged time and repeated trials. This study investigated the utility of a combined endoscopic papillary large balloon dilatation (EPLBD) and a mid-incision of an EST (m-EST) method for the removal of large CBD stones. METHODS: Thirty patients with large CBD stones were enrolled in this study. EPLBD was carried out using the one-step inflation of a 15~18 mm diameter balloon after m-EST. RESULTS: The maximum stone diameter was 21.62+/-5.38 mm. Twelve patients had more than 4 stones, 7 patients had 2 stones, and the remainder had a single large stone. Complete ductal clearance was achieved in all patients. After the procedure, the serum amylase and/or lipase levels were elevated in 3 patients (13.3%). However, there was no episode of true pancreatitis. Minor bleeding was encountered in only one patient (3.3%), and was easily controlled by an endoscopic epinephrine injection. The procedure was carried out safely in 6 patients with periampullary diverticulum. No perforation or mortality was encountered. CONCLUSIONS: Combined EPLBD and m-EST is a safe and effective method, and may be a good alternative treatment for removing large CBD stones.
Amylases ; Bile Ducts* ; Bile* ; Choledocholithiasis ; Common Bile Duct ; Dilatation* ; Diverticulum ; Epinephrine ; Hemorrhage ; Humans ; Inflation, Economic ; Lipase ; Mortality ; Pancreatitis ; Sphincterotomy, Endoscopic*