Ankylosing spondylitis is a disease that shows a young age of onset (less than 40 years old), inflammatory back pain, sacroiliitis and a strong association with HLA-B27. Yet some recently reported cases have presented with a late age of onset (more than 55 years old), atypical clinical presentations and a low response to NSAIDs, and this has also been named late onset spondyloarthropathy (LOSPA). As compared with early onset spondyloarthropathy (EOSPA), the LOSPA patients more frequently suffer with combined peripheral arthritis and inflammatory systemic symptoms and a high ESR and CRP level, but they lack the typical axial symptoms. Yet there have been few reports about late onset ankylosing spondylitis (LOAS). The previous cases of LOSPA and LOAS were managed with NSAIDs, steroids, methotrexate and sulfasalazine, but none were managed with TNF antagonists. LOAS is rare and difficult for management because of the patients' older age and the lack of experiences with this malady, so we report here on the four cases of LOAS that were successfully treated by TNF antagonists.
Age of Onset ; Anti-Inflammatory Agents, Non-Steroidal ; Arthritis ; Back Pain ; HLA-B27 Antigen ; Humans ; Loa ; Methotrexate ; Sacroiliitis ; Spondylarthropathies ; Spondylitis, Ankylosing ; Steroids ; Sulfasalazine

OBJECTIVE: To investigate the effects of asymptomatic back muscle weakness and spinal deformity on low back pain (LBP). METHODS: Sixty healthy subjects without LBP participated in this study. Radiography and an isokinetic/isometric dynamometer were used to respectively measure spinal scoliosis/lordosis and the strength of the trunk flexors/extensors. After 2 years, 48 subjects visited the hospital again and LBP episodes, its severity and the Korean version of the Oswestry Disability Index were assessed. Differences between the group with LBP and the group without LBP were evaluated and the association with LBP incidence and severity was determined. RESULTS: Sex, age, and trunk strength were significantly different in both group. Sex and age were significantly positive associated with LBP incidence. The isometric trunk flexor and extensor strength, maximum isokinetic trunk flexor and extensor strength were significantly and negatively associated with the LBP severity. The maximum isokinetic trunk extensor and maximum isometric trunk extensor strength was significantly negative associated with the LBP incidence. CONCLUSION: LBP incidence is associated with isometric and isokinetic trunk extensor weakness, whereas LBP severity is associated with age, sex, isokinetic trunk extensor and flexor weakness, isometric trunk extensor and flexor weakness.
Back Muscles ; Congenital Abnormalities ; Incidence ; Low Back Pain* ; Muscle Strength Dynamometer ; Muscle Weakness ; Muscles* ; Pilot Projects* ; Radiography ; Risk Factors*

OBJECTIVE: To investigate the effects of asymptomatic back muscle weakness and spinal deformity on low back pain (LBP). METHODS: Sixty healthy subjects without LBP participated in this study. Radiography and an isokinetic/isometric dynamometer were used to respectively measure spinal scoliosis/lordosis and the strength of the trunk flexors/extensors. After 2 years, 48 subjects visited the hospital again and LBP episodes, its severity and the Korean version of the Oswestry Disability Index were assessed. Differences between the group with LBP and the group without LBP were evaluated and the association with LBP incidence and severity was determined. RESULTS: Sex, age, and trunk strength were significantly different in both group. Sex and age were significantly positive associated with LBP incidence. The isometric trunk flexor and extensor strength, maximum isokinetic trunk flexor and extensor strength were significantly and negatively associated with the LBP severity. The maximum isokinetic trunk extensor and maximum isometric trunk extensor strength was significantly negative associated with the LBP incidence. CONCLUSION: LBP incidence is associated with isometric and isokinetic trunk extensor weakness, whereas LBP severity is associated with age, sex, isokinetic trunk extensor and flexor weakness, isometric trunk extensor and flexor weakness.
Back Muscles ; Congenital Abnormalities ; Incidence ; Low Back Pain* ; Muscle Strength Dynamometer ; Muscle Weakness ; Muscles* ; Pilot Projects* ; Radiography ; Risk Factors*

PURPOSE: Eperisone is an oral muscle relaxant used in musculoskeletal disorders causing muscle spasm and pain. For more effective pain control, eperisone is usually prescribed together with nonsteroidal anti-inflammatory drugs (NSAIDs). As such, eperisone may have been overlooked as the cause of anaphylaxis compared with NSAIDs. This study aimed to analyze the adverse drug reaction (ADR) reported in Korea and suggest an appropriate diagnostic approach for eperisone-induced anaphylaxis. METHODS: We reviewed eperisone-related pharmacovigilance data (Korea Institute of Drug Safety-Korea Adverse Event Reporting System [KIDS-KAERS]) reported in Korea from 2010 to 2015. ADRs with causal relationship were selected. Clinical manifestations, severity, outcomes, and re-exposure information were analyzed. For further investigation, 7-year ADR data reported in a single center were also reviewed. Oral provocation test (OPT), skin prick test (SPT) and basophil activation test (BAT) were performed in this center. RESULTS: During the study period, 207 patients had adverse reactions to eperisone. The most common ADRs were cutaneous hypersensitive reactions (30.4%) such as urticaria, itchiness or angioedema. Fifth common reported ADR was anaphylaxis. There were 35 patients with anaphylaxis, comprising 16.9% of the eperisone-related ADRs. In the single center study, there were 11 patients with eperisone-induced anaphylaxis. All the patients underwent OPT and all the provoked patients showed a positive reaction. Four of the 11 patients with anaphylaxis also underwent SPT and BAT, which were all negative. CONCLUSIONS: Incidence of eperisone-induced anaphylaxis calculated from the KIDS-KAERS database was 0.001%. Eperisone can cause hypersensitive reactions, including anaphylaxis, possibly by inducing non-immunoglobulin E-mediated immediate hypersensitivity.
Anaphylaxis ; Angioedema ; Anti-Inflammatory Agents, Non-Steroidal ; Basophils ; Drug-Related Side Effects and Adverse Reactions ; Humans ; Hypersensitivity ; Hypersensitivity, Immediate ; Incidence ; Korea ; Pharmacovigilance ; Skin ; Spasm ; Urticaria

Background/Aims: Accurate diagnosis and the effects of allergen-specific immunotherapy for pollinosis are greatly dependent on the potency and stability of the extract. This study aimed to examine factors, such as temperature and storage buffer composition, that affect the stability of allergen extracts from pollens of allergenic importance in Korea. Methods: We prepared four pollen allergen extracts from ragweed, mugwort, Japanese hop, and sawtooth oak, which are the most important causes of seasonal rhinitis in Korea. Changes of protein and major allergen concentration were measured over 1 year by Bradford assay, two-site enzyme-linked immunosorbent assay, and sodium dodecyl sulfate-polyacrylamide gel electrophoresis after reconstitution of the lyophilized allergen extract in various buffers and stored at room temperature (RT, 18°C to 26°C) or refrigerated (4°C). Results: More than 90% of the original protein concentration in all four extracts examined was detected over 1 year when 50% glycerol was added and refrigerated, whereas 57.9% to 94.5% remained in the extracts at RT. The addition of 50% glycerol to the storage buffer was found to prevent protein degradation at RT. Amb a 1, a major allergen of ragweed, was almost completely degraded in 9 weeks at RT when reconstituted in a buffer without 50% glycerol. However, 55.6% to 92.8% of Amb a 1 content was detected after 1 year of incubation at 4°C in all buffer conditions except 0.3% phenol. Conclusions Addition of 50% glycerol as well as refrigeration was found to be important in increasing the shelf-life of allergen extracts from pollens of allergenic importance.

BACKGROUND AND OBJECTIVES: Cardiac myxoma is histologically benign, but may be lethal because of their strategic position. It may mimic every cardiovascular or systemic disease, and can be missed without a high idex of suspicion. MATERIALS AND METHOD: We reviewed our clinical experience in 25 patients with cardiac myxoma between 1984 and 1999. Special attention was paid to clinical presentation, physical examination, chest X-ray, electrocardiogram, laboratory findings, echocardiographic findings, operative findings and postoperative course. RESULTS: Their age ranged from 23 to 64 (mean 48 years) and there were 6 male (24%) and 19 (76%) female patients. The myxomas were located in the left atrium in 23 (88%), in the right atrium in 2 (12%) cases. The Major presenting symptoms were intracardiac obstruction such as exertional dyspnea in 19 (76%), palpitation in 7 (28%), syncopal episodes in 3 (12%) cases while systemic embolism and constitutional symptoms accounted for 5 (20%) and 10 (40%) cases, respectively. About 70% of patients were present with abnormal, but nonspecific findings in physical examination, chest X-ray, electrocardiogram, and laboratory findings. Echocardiography is the most useful diagnostic screening tool. There was no in-hospital death after operation. But only 1 patient died 5 years after resection from severe pulmonary hypertension and right ventricular failure and 1 patient presented with recurrence at 18 months after primary resection, which was confirmed histologically into chondrosarcoma. CONCLUSION: We conclude that due to nonspecific presentation of cardiac myxoma, a high index of suspicion is needed. If considered as a possible diagnosis, it is easily recognized by echocardiography and usually curative by surgical resection.
Chondrosarcoma ; Diagnosis ; Dyspnea ; Echocardiography ; Electrocardiography ; Embolism ; Female ; Heart Atria ; Humans ; Hypertension, Pulmonary ; Male ; Mass Screening ; Myxoma* ; Physical Examination ; Recurrence ; Syncope ; Thorax

BACKGROUND: The relationship between serum homocysteine levels and non-alcoholic fatty liver disease is poorly understood. This study aims to investigate the sex-specific relationship between serum homocysteine level and non-alcoholic fatty liver disease in the Korean population. METHODS: This cross-sectional study included 150 men and 132 women who participated in medical examination programs in Korea from January 2014 to December 2014. Patients were screened for fatty liver by abdominal ultrasound and patient blood samples were collected to measure homocysteine levels. Patients that consumed more than 20 grams of alcohol per day were excluded from this study. RESULTS: The homocysteine level (11.56 vs. 8.05 nmol/L) and the proportion of non-alcoholic fatty liver disease (60.7% vs. 19.7%) were significantly higher in men than in women. In men, elevated serum homocysteine levels were associated with a greater prevalence of non-alcoholic fatty liver disease (quartile 1, 43.6%; quartile 4, 80.6%; P=0.01); however, in females, there was no significant association between serum homocysteine levels and the prevalence of non-alcoholic fatty liver disease. In the logistic regression model adjusted for age and potential confounding parameters, the odds ratio for men was significantly higher in the uppermost quartile (model 3, quartile 4: odds ratio, 6.78; 95% confidential interval, 1.67 to 27.56); however, serum homocysteine levels in women were not associated with non-alcoholic fatty liver disease in the crude model or in models adjusted for confounders. CONCLUSION: Serum homocysteine levels were associated with the prevalence of non-alcoholic fatty liver disease in men.
Cross-Sectional Studies ; Fatty Liver ; Female ; Homocysteine* ; Humans ; Korea ; Logistic Models ; Male ; Non-alcoholic Fatty Liver Disease* ; Odds Ratio ; Prevalence ; Sex Characteristics* ; Ultrasonography

No abstract available.

Asian-lineage H5 highly pathogenic avian influenza (HPAI) viruses have caused continuous outbreaks in poultry and wild birds. Development of rapid and accurate diagnostic methods is needed for preventing further spread of the virus and reducing the time required for eradication of the virus. We developed a low-density microarray for the rapid detection and identification of avian influenza virus subtypes H5, H7, and H9 and their pathotypes in a previous study. In the present study, we evaluated previously developed diagnostic microarray using avian influenza viruses isolated in Mongolia, including H5 HPAI viruses. All H5 HPAI viruses isolated in Mongolia were shown as H5-specific and highly pathogenic pattern in the microarray. H2, H3 and H12 viruses isolated in Mongolia used in this study did not show any H5, H7 and H9 patterns. These results indicated that this diagnostic microarray has enormous potential for the rapid subtyping and pathotyping of influenza viruses, including viruses isolated in Mongolia.
Animals ; Birds ; Disease Outbreaks ; Influenza in Birds* ; Mongolia* ; Orthomyxoviridae ; Poultry