Inflammation is known to participate in the mediation of a growing number of acute and chronic neurological disorders. Even so, the involvement of inflammation in the pathogenesis of epilepsy and seizure-induced brain damage has only recently been appreciated. Inflammatory processes, including activation of microglia and astrocytes and production of proinflammatory cytokines and related molecules, have been described in human epilepsy patients as well as in experimental models of epilepsy. For many decades, a functional role for brain inflammation has been implied by the effective use of anti-inflammatory treatments, such as steroids, in treating intractable pediatric epilepsy of diverse causes. Conversely, common pediatric infectious or autoimmune diseases are often accompanied by seizures during the course of illness. In addition, genetic susceptibility to inflammation correlated with an increased risk of epilepsy. Mounting evidence thus supports the hypothesis that inflammation may contribute to epileptogenesis and cause neuronal injury in epilepsy. We provide an overview of the current knowledge that implicates brain inflammation as a common predisposing factor in epilepsy, particularly childhood epilepsy.
Animals ; Blood-Brain Barrier ; Chronic Disease ; Encephalitis/genetics/immunology/metabolism/*pathology ; Epilepsy/immunology/metabolism/*pathology/therapy ; Gene Expression Regulation ; Humans ; Nervous System Diseases/immunology/pathology

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions. Although viral reactivation is associated with DRESS syndrome, its role in TEN remains unclear. An 80-year-old woman visited our hospital because of fever and skin eruption. DRESS syndrome was diagnosed and was thought to caused by the use of the drug allopurinol. She was treated by discontinuation of the drug and administration of systemic steroids. She recovered from DRESS syndrome and was discharged from the hospital with tapering doses of steroids prescribed. One week after discharge, she visited our hospital again as the skin rash recurred and oral pain as well as oral and ocular mucosal lesions developed. In addition to the skin rash, blisters and Nikolsky's sign that were different from the skin lesions present in the previous DRESS syndrome were observed. Unlike those in DRESS syndrome, the viral serological test results were positive for anti-cytomegalovirus (CMV) IgM and CMV polymerase chain reaction. Therefore, it was thought that TEN was due to reactivation of CMV and she was treated this with ganciclovir and intravenous immunoglobulin. Here, we report a case of TEN caused by viral reactivation after DRESS syndrome developed after use of allopurinol which recovered after steroid treatment.
Aged, 80 and over ; Allopurinol ; Blister ; Cytomegalovirus Infections ; Cytomegalovirus ; Drug Hypersensitivity Syndrome ; Eosinophilia ; Exanthema ; Female ; Fever ; Ganciclovir ; Humans ; Immunoglobulin M ; Immunoglobulins ; Polymerase Chain Reaction ; Serologic Tests ; Skin ; Steroids ; Stevens-Johnson Syndrome

In 2017, the American Joint Committee on Cancer announced the 8th edition of its cancer staging system. For breast cancer, the most significant change in the staging system is the incorporation of biomarkers into the anatomic staging to create prognostic stages. Different prognostic stages are assigned to tumors with the same anatomic stages according to the tumor grade, hormone receptor (estrogen receptor; progesterone receptor) status, and HER2 status. A Clinical Prognostic Stage is assigned to all patients regardless of the type of therapy used; in contrast, a Pathologic Prognosis Stage is assigned to patients in whom surgery is the initial treatment. In a few situations, low Oncotype DX recurrence scores can change the prognostic stage. The radiologists need to understand the importance of the biologic factors that can influence cancer staging.
Biological Factors ; Biomarkers ; Breast Neoplasms* ; Breast* ; Humans ; Joints ; Neoplasm Staging ; Progesterone ; Prognosis ; Recurrence

Purpose: Asthma phenotypes are often defined by relative cell counts of airway granulocytes. Induced sputum test results enable clinicians to determine the inflammatory phenotype of asthma based on the eosinophil and neutrophil counts. This study aimed to investigate clinical characteristics of patients with asthma according to the inflammatory phenotype of their condition. Methods: Data from 107 patients with asthma reported at a single tertiary allergy center in Korea during October 2016 to January 2019 were obtained. Patients were categorized into 4 asthma phenotypes based on the cell counts on the induced sputum test: eosinophilic, neutrophilic, mixed, and paucigranulocytic types. Blood eosinophil count, total IgE level, eosinophil cationic protein, spirometric measurements, fractional exhaled nitric oxide, atopy based on the skin prick test, PC20 (provocative concentration of methacholine causing a 20% fall in forced expiratory volume in 1 second) in methacholine provocation test, type of asthma controller used, frequency of exacerbation, and use of systemic corticosteroids were examined. Results: The frequency of phenotype is as follows: eosinophilic (21.4%), neutrophilic (34.8%), mixed (13.4%), and paucigranulocytic types (30.4%). During the observation period, the proportion of patients who experienced an exacerbation and received systemic glucocorticosteroids were significantly lower in patients with the paucigranulocytic type of asthma than in those with the mixed type of asthma (6.3% vs. 40.0%; P = 0.007 and 5.9% vs. 40.0%; P = 0.004, respectively). Conclusion Paucigranulocytic asthma may be associated with lower incidence rates of asthma exacerbation and systemic corticosteroid use than the other phenotypes, classified according to induced sputum test results.

PURPOSE: Churg-Strauss syndrome (CSS) is a rare disease characterized by pulmonary and systemic small vessel necrotizing vasculitis and peripheral blood eosinophilia occurring in asthmatics. Cases of CSS with hepatic involvement have been rarely reported. Here, we reported a case of CSS involving liver, in which liver biopsy revealed eosinophilic vasculitis. METHODS: A 75-year-old man complained of dyspnea and hemoptysis. He had severe blood eosinophilia (white blood cell 28,320/microL, eosinophils 79%). Computed tomography of chest and abdomen showed infiltrations in lungs and multifocal infiltrations in both hepatic lobes. Methacholine PC20 was 2.89 mg/mL, which was in asthmatic range. RESULTS: Ultrasonography-guided liver biopsy was performed, showing eosinophilic vasculitis and portal granulomas. CSS can be diagnosed based on evidence of asthma, blood eosinophilia, pulmonary infiltration and vasculitis on biopsy. CONCLUSION: Taken together, in a suspected case of CSS presenting as hepatic involvement, liver biopsy may be useful to demonstrate the presence of vasculitis.
Abdomen ; Asthma ; Biopsy ; Blood Cells ; Churg-Strauss Syndrome ; Dyspnea ; Eosinophilia ; Eosinophils ; Glycosaminoglycans ; Granuloma ; Hemoptysis ; Liver ; Lung ; Methacholine Chloride ; Pulmonary Eosinophilia ; Rare Diseases ; Thorax ; Vasculitis

A three-dimensional (3D) segmentation and model reconstruction is a specialized tool to reveal spatial interrelationship between multiple internal organs by generating images without overlapping structures. This technique can also be applicable to mummy studies, but related reports have so far been very rare. In this study, we applied 3D segmentation and model reconstruction to computed tomography images of a Korean mummy with congenital diaphragmatic hernia. As originally revealed by the autopsy in 2013, the current 3D reconstruction reveals that the mummy’s heart is shifted to the left due to the liver pushing up to thoracic cavity thorough diaphragmatic hernial defect. We can generate 3D images by calling up the data exclusively from mummy’s target organs, thus minimizing the confusion of diagnosis that could be caused by overlapping organs.

Purpose: The treatment of male breast cancer (MBC) has been extrapolated from female breast cancer (FBC) because of its rarity despite their different clinicopathologic characteristics. We aimed to investigate the distribution of intrinsic subtypes based on immunohistochemistry, their clinical impact, and treatment pattern in clinical practice through a multicenter study in Korea. Materials and Methods: We retrospectively analyzed clinical data of 248 MBC patients from 18 institutions across the country from January 1995 to July 2016. Results: The median age of MBC patients was 63 years (range, 25 to 102 years). Among 148 intrinsic subtype classified patients, 61 (41.2%), 44 (29.7%), 29 (19.5%), and 14 (9.5%) were luminal A, luminal B, human epidermal growth factor receptor 2, and triple-negative breast cancer, respectively. Luminal A subtype showed trends for superior survival compared to other subtypes. Most hormone receptor-positive patients (166 patients, 82.6%) received adjuvant endocrine treatment. Five-year completion of adjuvant endocrine treatment was associated with superior disease-free survival (DFS) in patients classified with an intrinsic subtype (hazard ratio [HR], 0.15; 95% confidence interval [CI], 0.04 to 0.49; p=0.002) and in all patients (HR, 0.16; 95% CI, 0.05 to 0.54; p=0.003). Conclusion Distribution of subtypes of MBC was similar to FBC and luminal type A was most common. Overall survival tended to be improved for luminal A subtype, although there was no statistical significance. Completion of adjuvant endocrine treatment was associated with prolonged DFS in intrinsic subtype classified patients. MBC patients tended to receive less treatment. MBC patients should receive standard treatment according to guidelines as FBC patients.