Fibrous dysplasia is a benign disorder of bone primarily affecting young people from childhood through the third decade. It usually manifests as an enlargement of bones in and about the orbits or the the cranial vault. Whether localized or diffuse, it rarely involves the cervical spine. We report a case of fibrous dysplasia involving axis combined with atlantoaxial instability which was caused by odontoid process fracture. Transfacetal screw fixation augmented with Halifax interlaminar clamp technique was applied to obtain atlantoaxial stability. Postoperative course was unevenful and postoperative radiologic findings revealed favorable fixation of atlantoaxial joint. The pertinent literature on fibrous dysplasia and atlantoaxial instability is reviewed and discussed.
Atlanto-Axial Joint ; Axis, Cervical Vertebra ; Odontoid Process ; Orbit ; Spine*

Studies over the last 2 decades have identified IL-17 and IL-21 as key cytokines in the modulation of a wide range of immune responses. IL-17 serves as a critical defender against bacterial and fungal pathogens, while maintaining symbiotic relationships with commensal microbiota. However, alterations in its levels can lead to chronic inflammation and autoimmunity. IL-21, on the other hand, bridges the adaptive and innate immune responses, and its imbalance is implicated in autoimmune diseases and cancer, highlighting its important role in both health and disease. Delving into the intricacies of these cytokines not only opens new avenues for understanding the immune system, but also promises innovative advances in the development of therapeutic strategies for numerous diseases. In this review, we will discuss an updated view of the immunobiology and therapeutic potential of IL-17 and IL-21.

OBJECTIVE: To assess the clinical efficacy and safety of meloxicam 7.5mg versus diclofenac 100mg slow release (SR) in the Korean patients with osteoarthritis of the knee. METHODS: Ninety-one patients of four university hospitals in 1999 were randomized to receive once daily oral meloxicam 7.5mg (N=45) or diclofenac 100mg SR (N=46) for 8 weeks. Clinical efficacy was evaluated using 100mm Visual Analogue Scale (VAS) for pain, Lequesne index after 4, 8 weeks of treatment as well as the physician? and patient? global assessment at the end of treatment. Evaluations for clinical safety were performed using the incidence of adverse events, physical examinations, laboratory finding and total ingestion of antacid during the treatment. RESULTS: After 8 weeks of therapy, both groups had significant improvement in 100mm VAS and Lequesne index than baseline although the difference between two groups did not reach statistical significance. The physician? and patient's global assessment were similar in two groups. The incidence of gastrointestinal adverse events was significantly lower in meloxicam group (24.4%) than diclofenac group (50.0%)(p<0.05). CONCLUSION: Meloxicam 7.5mg is comparable to diclofenac 100mg SR in the treatment of Korean patients with osteoarthritis of the knee. Furthermore meloxicam 7.5mg was well tolerated for 8 weeks and has safe advantage of a significantly lower incidence of gastrointestinal adverse events.
Diclofenac* ; Eating ; Hospitals, University ; Humans ; Incidence ; Knee* ; Osteoarthritis* ; Physical Examination

OBJECTIVE: To assess the clinical efficacy and safety of meloxicam 7.5mg versus diclofenac 100mg slow release (SR) in the Korean patients with osteoarthritis of the knee. METHODS: Ninety-one patients of four university hospitals in 1999 were randomized to receive once daily oral meloxicam 7.5mg (N=45) or diclofenac 100mg SR (N=46) for 8 weeks. Clinical efficacy was evaluated using 100mm Visual Analogue Scale (VAS) for pain, Lequesne index after 4, 8 weeks of treatment as well as the physician? and patient? global assessment at the end of treatment. Evaluations for clinical safety were performed using the incidence of adverse events, physical examinations, laboratory finding and total ingestion of antacid during the treatment. RESULTS: After 8 weeks of therapy, both groups had significant improvement in 100mm VAS and Lequesne index than baseline although the difference between two groups did not reach statistical significance. The physician? and patient's global assessment were similar in two groups. The incidence of gastrointestinal adverse events was significantly lower in meloxicam group (24.4%) than diclofenac group (50.0%)(p<0.05). CONCLUSION: Meloxicam 7.5mg is comparable to diclofenac 100mg SR in the treatment of Korean patients with osteoarthritis of the knee. Furthermore meloxicam 7.5mg was well tolerated for 8 weeks and has safe advantage of a significantly lower incidence of gastrointestinal adverse events.
Diclofenac* ; Eating ; Hospitals, University ; Humans ; Incidence ; Knee* ; Osteoarthritis* ; Physical Examination

Antiphospholipid syndrome is a disease that has continuous high titer of antibodies directed against either phospholipids or plasma proteins bound to anionic phospholipids in serum and shows a variety of clinical manifestations including recurrent venous and arterial thrombosis, recurrent fetal losses, livedo reticularis and thrombocytopenia. Because thrombosis may develop in any vessel, clinical manifestations are variable. Renal microangiopathy has been reported in antiphospholipid syndrome associated with systemic lupus erythematosus and rarely reported in primary antiophospholipid syndrome. But there was no case report of antiphospholipid syndrome accompanied by renal microangiopathy in Korea. Recently, we experienced a 25 years old male patient who had primary antiphospholipid syndrome with intrarenal thrombotic microangiopathy and IgA nephropathy. So, we report this case with review of relevant literature.
Adult ; Antibodies ; Antiphospholipid Syndrome* ; Blood Proteins ; Glomerulonephritis, IGA ; Humans ; Korea ; Livedo Reticularis ; Lupus Erythematosus, Systemic ; Male ; Phospholipids ; Thrombocytopenia ; Thrombosis ; Thrombotic Microangiopathies

PURPOSE: It is increasingly being recognized that the lymph node ratio (LNR) is an important prognostic factor for gallbladder carcinoma patients. The present study evaluated predictors of tumor recurrence and survival in a large, mono-institutional cohort of patients who underwent surgical resection for gallbladder carcinoma, focusing specifically on the prognostic value of lymph node (LN) status and of LNR in stage IIIB patients. METHODS: Between 2004 and 2011, 123 patients who underwent R0 radical resection for gallbladder carcinoma at the Chonnam National University Hwasun Hospital were reviewed retrospectively. Patients were staged according to the American Joint Committee on Cancer 7th edition, and prognostic factors affecting disease free survival, such as age, sex, comorbidity, body mass index, presence of preoperative symptoms, perioperative blood transfusion, postoperative complications, LN dissection, tumor size, differentiation, lymph-vascular invasion, perineural invasion, T stage, presence of LN involvement, N stage, numbers of positive LNs, LNR and implementation of adjuvant chemotherapy, were statistically analyzed. RESULTS: LN status was an important prognostic factor in patients undergoing curative resection for gallbladder carcinoma. The total number of LNs examined was implicated with prognosis, especially in N0 patients. LNR was a powerful predictor of disease free survival even after controlling for competing risk factors, in curative resected gallbladder cancer patients, and especially in stage IIIB patients. CONCLUSION: LNR is confirmed as an independent prognostic factor in curative resected gallbladder cancer patients, especially in stage IIIB gallbladder carcinoma.
Blood Transfusion ; Body Mass Index ; Chemotherapy, Adjuvant ; Cohort Studies ; Comorbidity ; Disease-Free Survival ; Gallbladder ; Gallbladder Neoplasms ; Humans ; Joints ; Lymph Nodes ; Postoperative Complications ; Prognosis ; Recurrence ; Retrospective Studies ; Risk Factors

Talus tuberculosis is a rare disease, even in an endemic tuberculosis area. In reviews of the worldwide literature, only 18 cases of talus tuberculosis have been reported. Recently, we experienced a case of a 70-year-old polycythemia vera patient with right metatarsopharyngeal joint pain for 2 months duration who was diagnosed with talus tuberculosis with prostate involvement. Tuberculosis should be considered as one of the causes of monoarticulitis, especially in countries, where the disease is endemic. Additionally, we highly recommend taking a biopsy of the site of suspected infection because an early diagnosis is the key to successful treatment.
Aged ; Arthralgia ; Biopsy ; Early Diagnosis ; Humans ; Osteomyelitis ; Polycythemia ; Polycythemia Vera ; Prostate ; Rare Diseases ; Talus ; Tarsal Bones ; Tuberculosis

PURPOSE: Hyperhomocysteinemia has been identified as an important risk factor for coronary heart disease (CHD), cerebrovascular disease (CVD) and peripheral arterial disease (PAD). Previous reports have identified that elevated total homocysteine levels are associated with the development and progression of PAD, though little is known about its mechanism. Especially hyperhomocysteinemia is known to an independent risk factor for PAD. In this study, we examined the relationship between plasma homocysteine concentration and disease progression and disease severity in a patient with PAD. METHOD: We retrospectively analysed the clinical records of 65 patients, who were diagnosed with arteriosclerosis obliterans, for sex, mean homocysteine concentration, relationship between plasma homocysteine concentration and disease severity and disease progression at Kyung-Hee University Hospital from January 2002 to December 2003. Homocysteine level of 28 healthy adults was measured to identify normal value. Hyperhomocysteinemia was defined as a plasma homocysteine concentration exceeding the 95th percentile of the control group (> or =13.8mumol/L). RESULT: The study group comprised 56 men (86.29%) and 9 (13.8%) women. The mean plasma homocysteine concentration was higher in study group than in controls (11.4mumol/L vs. 10.03.mumol/L, P=0.06). Hyperhomocysteinemia was significantly more common in the disease progression groups (P=0.028). Mean plasma homocysteine concentrations associated with disease severity, according to the Rutherford classification, were 8.33mumol/L, 9.59mumol/L, 12.64 mumol/L and 14.17mumol/L at Grades 0, I, II and III, respectively. The high grade patients were significantly more likely to have high plasma homocysteine concentration (P=0.04). Plasma homocysteine concentration according to associated disease was 10.79mumol/L in patients with PAD alone, 10.88 mumol/L in patients with CVD, 15.02mumol/L in patients with CHD, and 14.99mumol/L in patients with both CVD and CHD. In patients associated with CHD, plasma homocysteine concentration was significantly higher (P=0.035). CONCLUSION: In this study, plasma homocysteine concentration was higher in patients with PAD than in controls. Especially, there was a high rate of hyperhomocysteinemia in patients associated with CHD. Progression of PAD was more likely in patients with elevated plasma homocysteine. The high-grade patients were more likely to have high plasma homocysteine concentration. Therefore, the measurement of plasma homocysteine concentration in patients with PAD is expected to be useful in making prognosis. However, a prospective, randomized study is necessary to prove the effect of homocysteine-lowering therapy in delaying disease progression.
Adult ; Arteriosclerosis Obliterans ; Classification ; Coronary Disease ; Disease Progression ; Female ; Homocysteine* ; Humans ; Hyperhomocysteinemia ; Male ; Peripheral Arterial Disease* ; Plasma* ; Prognosis ; Reference Values ; Retrospective Studies ; Risk Factors

PURPOSE: To determine the number of multiple alternating layers of liver abscess, and changes in this number, as revealed by spiral CT, and to ascertain which factors are related to changes occurring during the three phases of this modality. MATERIALS AND METHODS: Using three-phase spiral CT imaging we studied 26 cases of liver abscess (pyogenic:amebicm=23:3). The number of layers comprising the abscess, as seen on postcontrast CT scans, was determined during the arterial (30sec), portal (70sec), and delayed (220sec) phase, and all cases were assigned to one of two groups according to changes in the number of layers observed during the three phases. With regard to underlying disease, the two groups were compared in terms of the presence of abscess and of diabetes mellitus,CT interval (time from onset of symptoms to CT scanning), microbial agent (pyogenic vs. amebic), and the largest diameter of abscess as revealed by CT. RESULTS: Except in one case, three or four alternating layers [in 13(50%) and 7(27%) cases, respectively] were seen only during the arterial and portal phase. During each of the three phases-and especially the delayed phase, where it was present in 25 of cases (96%)-two alternating layers (2:2:2) was the most common pattern, with a 3:3:3 pattern occurring in one case. All 12 cases (46%) in the unchanging-layer group showed one of these two patterns. All changing-layer group cases (14;54%) demonstrated three or four layers during the arterial and portal phase but only two during the delayed phase. The CT interval was the only significantly different factor between the two groups. During the first week, the number of cases in the unchanging-layer group was much higher than in the changing-layer group (86%,14%), but during the second week this situation reversed (25%, 75%). CONCLUSION: Our study reveals that on three-phase dynamic CT images, a characteristic enhancement feature of liver abscesses is three or four layers during the arterial and portal phases, with reduction to two layers during the delayed phase. This change, as revealed by spiral CT, is rare during the week following the onset of symptoms, but common during the second week.
Abscess ; Liver Abscess ; Liver* ; Tomography, Spiral Computed ; Tomography, X-Ray Computed

A 35-year-old male patient with heart and renal failure and pneumonia was transferred to our department due to recurrent cardiac standstill with syncope. He had been diagnosed as and treated for MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes) syndrome for the past 3 years. Electrocardiography (ECG) showed the Wolff-Parkinson-White pattern, and an echocardiogram showed hypertrophic cardiomyopathy. He developed syncopal attacks intermittently, and ECG monitoring showed intermittent bradycardia. His Holter monitoring showed several episodes of 5-16 seconds of sinus arrest. We conducted an electrophysiological study to evaluate the arrhythmia. During atrial and ventricular extra-stimuli, cardiac standstill developed several times, and the duration of pauses varied from 2.5 to 5.5 seconds. Abrupt asystolic events also developed accompanying syncopal attacks that were not related to the extra-stimuli. We decided to implant a permanent pacemaker. The patient's syncopal episodes disappeared after implantation of a DDD type pacemaker.
Acidosis, Lactic ; Arrhythmias, Cardiac ; Bradycardia ; Cardiomyopathy, Hypertrophic ; Dichlorodiphenyldichloroethane ; Electrocardiography ; Electrocardiography, Ambulatory ; Heart ; Humans ; Male ; MELAS Syndrome ; Muscular Diseases ; Pacemaker, Artificial ; Pneumonia ; Renal Insufficiency ; Sinus Arrest, Cardiac ; Syncope