The enhanced differentiation and activation of osteoclasts (OCs) in the inflammatory arthritis such as rheumatoid arthritis (RA) and gout causes not only local bone erosion, but also systemic osteoporosis, leading to functional disabilities and morbidity. The induction and amplification of NFATc1, a master regulator of OC differentiation, is mainly regulated by receptor activator of NF-κB (RANK) ligand-RANK and calcium signaling which are amplified in the inflammatory milieu, as well as by inflammatory cytokines such as TNFα, IL-1β and IL-6. Moreover, the predominance of CD4+ T cell subsets, which varies depending on the condition of inflammatory diseases, can determine the fate of OC differentiation. Anti-citrullinated peptide antibodies which are critical in the pathogenesis of RA can bind to the citrullinated vimentin on the surface of OC precursors, and in turn promote OC differentiation and function via IL-8. In addition to adaptive immunity, the activation of innate immune system including the nucleotide oligomerization domain leucine rich repeat with a pyrin domain 3 inflammasome and TLRs can regulate OC maturation. The emerging perspectives about the diverse and close interactions between the immune cells and OCs in inflammatory milieu can have a significant impact on the future direction of drug development.
Adaptive Immunity ; Antibodies ; Arthritis ; Arthritis, Rheumatoid ; Calcium Signaling ; Cytokines ; Gout ; Immune System ; Inflammasomes ; Interleukin-6 ; Interleukin-8 ; Leucine ; Osteoclasts ; Osteolysis ; Osteoporosis ; T-Lymphocyte Subsets ; Vimentin

Hepatic subcapsular steatosis is a rare and unique form of fatty change in the liver. It is a specific finding in diabetic patients receiving continuous ambulatory peritoneal dialysis (CAPD) and intraperitoneal insulin treatment. Intraperitoneal administration of insulin and high glucose cause a unique pattern of fatty infiltration in the subcapsular location of the liver. We report a case of hepatic subcapsular steatosis in a diabetic CAPD patient who has not received intraperitoneal insulin. A 63-year-old diabetic woman on CAPD presented with uncontrolled blood glucose. The patient received a total amount of 44 units of NPH via subcutaneous injection. Her initial blood chemistry showed mildly increased serum lipid profiles. Abdominal CT scan images and MRI revealed characteristic findings consistent with hepatic subcapsular steatosis. We report a case of hepatic subcapsular steatosis in a diabetic patient not taking intraperitoneal insulin who recovered through strict blood sugar control without changing dialysis modality.
Blood Glucose ; Diabetes Mellitus ; Dialysis ; Fatty Liver ; Female ; Glucose ; Humans ; Injections, Subcutaneous ; Insulin ; Liver ; Middle Aged ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory

Miller-Fisher syndrome is an acute poly-neuropathy typically characterized by the triad of ophthalmoplegia, ataxia, and areflexia. Other poly-neuropathy diseases include Guillain-Barre syndrome and Bickerstaff brainstem encephalitis. However, not all cases of Miller-Fisher syndrome have the typical three symptoms. These diseases have been differentiated by clinical manifestations and anti-GQ1b IgG antibody testing. In Miller-Fisher syndrome, anti-GQ1b IgG antibody is present in over 95% of patients; however, the frequency is not so high in normal subjects or in those with other poly-neuropathy diseases. Infectious illnesses, such as respiratory diseases and gastrointestinal diseases, usually precede Miller-Fisher syndrome. In general, Miller-Fisher syndrome is a self-limiting illness; however, a few cases of Miller-Fisher syndrome progressing to respiratory failure have been reported, particularly in children. In this case, we report abnormal angiographic findings. We report a case of atypical Miller-Fisher syndrome with internal carotid artery stenosis treated with prednisolone.
Ataxia ; Brain Stem ; Carotid Artery, Internal ; Carotid Stenosis ; Child ; Encephalitis ; Gastrointestinal Diseases ; Guillain-Barre Syndrome ; Humans ; Immunoglobulin G ; Miller Fisher Syndrome ; Ophthalmoplegia ; Polyneuropathies ; Prednisolone ; Respiratory Insufficiency

BACKGROUND: An association between diabetes and tuberculosis has long ken implied. The severity of diabetes appears to correlate with the degree of tuberculous activity. METHODS: A retrospective chart review of 82 patients with active pulmonary tuberculosis in diabetics(DMTB) and 83 patients with active pulmonary tuberculosis in nondiabetios (Non-DMTB) admitted to the Kyung Hee Medical Center between January 1995 and December 1996 was undertaken. RESULTS: The sex ratio of DMTB was 58 : 24, and that of Non-DMTB was 62 : 21. Male patients predominated in both groups. The highest incidence of DMIB was 6th and 7th decades and that of Non-DMTB was 3rd and 4th decades. In case which the tuberculosis developed after diagnosis of diabetes, the prevalence of pulmonary tuberculosis was the highest in diabetes for 5 -10 years. On chest X-ray findings, the moderate advanced tuberculosis cases were the most common (60.9% in DMTB and 50.6% in Non-DMTB). There was no relation between the degree of tuberculosis activity on chest x-ray(minimal, moderata awl far advanced tuberculosis) and presence of diabetes. The incidence of lower lung field tuberculosis in DMTB was significantly higher than Non-DMTB(p<0.05). The multiple lobe involvement was the predominant chest roentgenograpflc finding in both groups. There was no significant difference of treatment response between DMTB and Non-DMTB. There was no relationship between initial HbA1c and the stverity of pulmonary tuberculosis on chest X-ray. During treatmenu of pulmonary tuberculosis in excellently and well controlled diabetes, the cure rate of pulmonary tuberculosis was sigrificantly higher than the pcorly controlled diabetes and the rate of treatment failure was significantly lower than poorly controlled diabetes. (p<0.05). CONCLUISON: Poor control of blood glucose is related with increased rate of treatment failure in pulmonary tuberculosis with diabetes mellitus. Further investigation will be needed to study the mechanisms of treatment failure in poorly controlled diabetics with pulmonaiy tuberculosis.
Blood Glucose ; Diabetes Mellitus ; Diagnosis ; Humans ; Incidence ; Lung ; Male ; Prevalence ; Retrospective Studies ; Sex Ratio ; Thorax ; Treatment Failure ; Tuberculosis ; Tuberculosis, Pulmonary*

PURPOSE: The purpose of this study was to evaluate the efficacy of contrast-enhanced MR angiography for follow-up examinations after metallic stent placement and to examine the effects of change of imaging parameters used for contrast-enhanced MR angiography. MATERIALS AND METHODS: After four metallic stents (Passager, Ninitol, Wallstent, and Memotherm) were placed in an abdominal aorta shaped vascular phantom, efGRE (enhanced fast gradient recalled echo) 3-D MR angiography was performed, using a 1.5T unit. The four metallic stents were graded 1-3 according to the width and length of their high signal intensity. Variations in the degree of high signal intensity were evaluated according to imaging parameters. RESULTS: The width and length of high signal intensity with the Passager stent and Nitinol stent were greater than with the Wallstent and Memotherm. The larger the field of view, the smaller the matrix number, the larger the flip angle, the greater the width and length of high signal intensity in the metallic stent. CONCLUSION: Contrast-enhanced MR angiography may be a useful follow-up procedure after the placement of Passager and Ninitol metallic stents. The signal intensity of stent lumen varies according to imaging parameters, and the selection of optimal parameters is therefore important.
Angiography* ; Aorta, Abdominal ; Follow-Up Studies ; Stents*

Duodenal diverticulitis is a rare complication of the duodenal diverticulum. Its rarity is due to the relatively large diameter of the duodenum, which makes the intraluminal flow of sterile liquid duodenal contents fluent. Additionally, nonspecific signs and symptoms of duodenal diverticulitis make it very difficult to diagnose properly. We describe a patient presenting with abdominal pain, nausea, and leukocytosis, with diverticulitis of the third portion of the duodenum caused by the impaction of a foreign body, who was diagnosed and treated with enteroscopy.
Abdominal Pain ; Diverticulitis ; Diverticulum ; Double-Balloon Enteroscopy ; Duodenum ; Foreign Bodies ; Humans ; Leukocytosis ; Nausea

Congenital pancreatic duct anomalies result from an error in the complex developmental process. Congenital pancreatic duct anomalies may be categorized by their mechanisms into migration anomaly, fusion anomaly, and duplication anomaly. These ductal abnormalities have been implicated to be potential causes for both acute and chronic pancreatitis. We have recently observed a congenital anomaly of the pancreatic ducts in which bifurcated main pancreatic ducts drain through the major papilla in a 10 year-old boy presenting with recurrent acute pancreatitis. Although its causal relationship with acute pancreatitis is unclear, this kind of pancreatic ductal anomaly has not been found in the literature.
Child* ; Humans ; Male ; Pancreatic Ducts* ; Pancreatitis* ; Pancreatitis, Chronic

Polyarteritis nodosa (PAN) is a disease of small and medium sized muscular arteries, typically involving the skin, kidney, peripheral nerves, muscle and gut. Although its etiology has not been known clearly yet, an immune complex is believed to initiate a vasculitis. Infections, such as hepatitis B virus, hepatitis C virus, and streptococcal infection, may be related with the development of PAN. We experienced a case of PAN preceded by Methicillin resistant staphylococcus aureus-associated otitis media in a 50-year-old woman. This is the first case reported in Korea.
Antigen-Antibody Complex ; Arteries ; Female ; Hepacivirus ; Hepatitis B virus ; Humans ; Kidney ; Korea ; Methicillin Resistance ; Middle Aged ; Otitis Media* ; Otitis* ; Peripheral Nerves ; Polyarteritis Nodosa* ; Skin ; Staphylococcus ; Streptococcal Infections ; Vasculitis

PURPOSE: To determine the time of magnetic resonance(MR) signal intensity changes in denervated skeletal muscle and to compare MR imaging with electromyography(EMG) in the evaluation of peripheral nerve injury. MATERIALS AND METHODS: We evaluated MR imagings of denervated muscles after experimental transection of the sciatic nerve in five rabbits using 1.0T MR unit. MR imaging and EMG were performed 3 days and 1, 2 and 3 weeks after denervation. T1-weighted images(T1-WI), T2-WI and Short Tau Inversion Recovery(STIR) images were obtained. The signal intensity (SI) of muscles in the denervated and normal sides were visually and quantitatively compared. After measuring the SI of the normal and abnormal areas, the time of SI change was determined when there was significant difference (P<0.05) of SI between the normal and denervated sides. RESULTS: On STIR images, two of the five rabbits showed significant SI changes at the third day(P<0.05) and all showed significant changes(P<0.05)at the first week. On T2-WI, one rabbit showed significant SI changes at the third day, and all showed significant SI changes at the first week. On T1-WI, significant SI changes were seen in one rabbit at the second week and in one at the third. One week after denervation, all showed denervation potential on EMG. CONCLUSION: This study suggests that MR imaging using STIR images is a useful method in the evaluation of denervated muscle, and that MR signal changes of denervated muscle may precede EMG changes after denervation. To localize and to determine the severity of the peripheral nerve injury, future analysis of the distribution of abnormal MR SI in denervated muscles would be helpful.
Denervation ; Magnetic Resonance Imaging* ; Muscle, Skeletal* ; Muscles ; Peripheral Nerve Injuries ; Rabbits* ; Sciatic Nerve

The annual incidence of hospital admissions for lower gastrointestinal bleeding in the United States and Europe is 0.02%. Massive hemorrhage from a solitary colon polyp is an extremely rare case. We report two consecutive patients with a single polyp, which was the source of bleeding. The first case is a 68-year-old male patient who visited Daejeon Sun Hospital with the chief complaint of considerable hematochezia. An 1.2 cm colon polyp with active bleeding was observed on the colonoscopy. The second case is a 74-year-old female patient with symptoms of hematochezia. A blood-clot attached, 3.0 cm sized Yamada type-IV colon polyp was examined on the colonoscopy. One case was a sessile polyp, and the other one was a thick-stalked pedunculated polyp. Both types of polyps were supplied with more vessels than other polyps, and both patients were taking aspirin. The two patients underwent snare polypectomy and were discharged without further bleeding evidence.
Aged ; Aspirin ; Colon ; Colonic Polyps ; Colonoscopy ; Europe ; Female ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Incidence ; Male ; Polyps ; SNARE Proteins ; Solar System ; United States