PURPOSE: The purpose of this study is to investigate pathologic changes of blood vessels and perivascular tissue in subsynovial connective tissue (SSCT) of idiopathic carpal tunnel syndrome (CTS) by examining elastin distribution and vascular morphology and by observing ultrasturctural changes of extracellular matrix using transmission electron microscope (TEM). MATERIALS AND METHODS: The Verhoeff-van Gieson stain was used to identify histopathology and to localize elastin in the SSCT of the middle finger flexor digitorum superficialis (FDS) within the carpal tunnel in ten CTS patients and ten cadaver specimens as control group. In each specimen, the elastin density within and around vessels was calculated with image analyzing software including Adobe photoshop 6.0 and Scion image analysis. The vessel number per unit area and the mean thickness of vessel walls were also calculated. The ultrastructural changes of SSCT were compared between the specimens of both groups by TEM. RESULTS: The mean elastin density within vessels was 0.10 +/- 0.03 (p=0.001) in the CTS group and 0.18 +/- 0.04 in the control group. The mean elastin density around vessels was 0.15 +/- 0.04 in the CTS group and 0.23 +/- 0.04 in the control group (p=0.002). The mean number of vessels per unit area (0.00155 mm2) was 0.36 +/- 0.12 in the CTS group and 0.15 +/- 0.10 in the control group (p=0.002). The mean thickness of blood vessels was 38.10 +/- 20.60 micrometer in the CTS group and 18.90 +/- 3.68 micrometer in the control group (p=0.023). In general, the severer the vascular hypertrophy and obstruction, the less elastin noted within and around blood vessels. The TEM showed some important ultrastructural changes in SSCT of CTS. Generally, SSCT contained two kinds of cells, fibroblast-like cells and macrophage-like cells. And these cells and elastin were dispersed among collagen fibrils. In SSCT of control group, the collagen fibrils showed round margin and uniform diameter in transverse section, and showed similar thickness in longitudinal section. However, in SSCT of CTS, the collagen fibrils had irregular margin called "spiraled collagen"and variable diameter in transverse section, and uneven thickness in longitudinal section. In addition, the elastolysis and the phagocytosis of the changed collagen fibrils were observed. CONCLUSION: SSCT of CTS showed significant decrease of elastin density within and around vessels along with degenerative histopathological vascular changes. In addition TEM revealed ultrastructural abnormalities like metamorphosis of collagen fibrils, phagocytosis of spiraled collagen fibrils and elastolysis. Therefore, it is suggested that pathology of CTS may involve active cellular processing related to ischemic cellular environmental changes in carpal tunnel as well as well known pathology of nerve.
Blood Vessels* ; Cadaver ; Carpal Tunnel Syndrome* ; Collagen ; Connective Tissue* ; Elastin ; Extracellular Matrix* ; Fingers ; Humans ; Hypertrophy ; Pathology ; Phagocytosis

BACKGROUND/AIMS: We assessed changes in hemodynamic and arterial stiffness parameters following reductions of dialysate calcium concentrations in patients undergoing hemodialysis. METHODS: In this prospective study, 20 patients on maintenance hemodialysis (10 females, 10 males) with dialysate calcium concentrations of 1.75 mmol/L were enrolled. At the start of the study, the dialysate calcium level was lowered to 1.50 mmol/L. Serial changes in biochemical, hemodynamic, and arterial stiffness parameters, including pulse wave velocity (PWV) and augmentation index (AIx), were assessed every 2 months for 6 months. We also examined changes in the calcification-inhibitory protein, serum fetuin-A. RESULTS: During the 6-month study period, serum total calcium and ionized calcium decreased consistently (9.5 +/- 1.0 to 9.0 +/- 0.7, p = 0.002 vs. 1.3 +/- 0.1 to 1.1 +/- 0.1, p = 0.035). Although no apparent changes in blood pressure were observed, heart-femoral PWW (hf-PWV) and AIx showed significant improvement (p = 0.012, 0.043, respectively). Repeated-measures ANOVA indicated a significant effect of lowering dialysate calcium on hf-PWV (F = 4.58, p = 0.004) and AIx (F = 2.55, p = 0.049). Accompanying the change in serum calcium, serum fetuin-A levels significantly increased (95.8 +/- 45.8 pmol/mL at baseline to 124.9 +/- 82.2 pmol/mL at 6 months, p = 0.043). CONCLUSIONS: Lowering dialysate calcium concentration significantly improved arterial stiffness parameters, which may have been associated with upregulation of serum fetuin-A.
Aged ; Analysis of Variance ; Ankle Brachial Index ; Arteries/*drug effects/physiopathology ; Biological Markers/blood ; Blood Pressure/drug effects ; Calcium/*administration & dosage/adverse effects ; Compliance ; Female ; Hemodialysis Solutions/*administration & dosage/adverse effects/chemistry ; Humans ; Male ; Middle Aged ; Prospective Studies ; Pulsatile Flow/*drug effects ; *Renal Dialysis ; Republic of Korea ; Time Factors ; Treatment Outcome ; alpha-2-HS-Glycoprotein/metabolism

Invasive aspergillosis has been reported in patients with profound neutropenia or patients with any form of immunodeficiency. Bone aspergillosis remains a rare. Herein, as we had experienced one case of bone aspergillosis patient treated with voriconazole, we report it with the review of literature.
Aspergillosis* ; Humans ; Neutropenia

Invasive aspergillosis has been reported in patients with profound neutropenia or patients with any form of immunodeficiency. Bone aspergillosis remains a rare. Herein, as we had experienced one case of bone aspergillosis patient treated with voriconazole, we report it with the review of literature.
Aspergillosis* ; Humans ; Neutropenia

BACKGROUND: We have demonstrated recently that citrus red mite(Panonychus citri) is the most important allergen in citrus-cultivating farmers with asthma and/or rhinitis. OBJECTIVE: A cross-sectional survey was performed to evaluate the sensitizat,ion to the citrus red mite and the effect of environmental exposure on the specific sensitization among primary school children living in rural areas of Cheju Island. Material and METHODS: A total of 4,490 children (from ages 7 to 12 years) living in rural are- as were enrolled in this study. Each subject was evaluated by a questionnaire developed by International Study of Allergy and Asthma in Childhood (ISAAC), and a skin prick test with 11 common inhalant allergens including citrus red mite. RESULTS: On skin prick tests, the most common sensitizing allergen was Dermatophagoides pteronyssinus(7-9 years : 22.7%, 10-12 years : 25.5%), followed by D. farinae(20.4%, 21.8%), cockroach(9.6%, 12.8%), and citrus red mite(8.8%, 12.6%). The sensitization rate to citrus
Allergens ; Asthma ; Child* ; Citrus* ; Cross-Sectional Studies ; Environmental Exposure ; Humans ; Hypersensitivity ; Jeju-do* ; Mites* ; Pyroglyphidae ; Rhinitis ; Skin ; Surveys and Questionnaires

Involvement of central nervous system is a well- known compication in uremic patients. However, development of acute extrapyramidal symptoms with bilateral basal ganglia involvement (acute basal ganglia syndrome), especially in non-diabetic hemodialysis patient is very rare. We report a case of acute basal ganglia syndrome in a non-diabetic hemodialysis patient. A 45-year-old man with autosomal dominant polycystic kidney disease (ADPKD) on chronic hemodialysis treatment for the last 4 years was admitted due to generalized myalgia. On admission, the patient was found to have rhabdomyolysis and intractable metabolic acidosis. Nine days after admission, he suddenly developed dysarthria, lateralizing ataxia, and bradykinesia. Brain MRI demonstrated low and high signals in bilateral basal ganglia and cerebellar vermis in T1-weighted and T2-weighted images, respectively. Intensified hemodialysis treatment combined with general supportive therapy resolved the severe metabolic acidosis and the neurologic manifestations gradually improved. Follow up brain CT scan taken 3 months later showed decreased size of initial low attenuation lesions in bilateral basal ganglia and cerebellar vermis. Although no definite pathophysiology is yet established, severe metabolic disorder is believed to play an important role in development of acute basal ganglia syndrome. Correction of metabolic acidosis and hypoglycemia in our patient lead to improvement in neurologic manifestations and organic brain lesions. Our case suggests that severe metabolic acidosis and hypoglycemia in uremic patient may act as risk factors for acute basal ganglia syndrome even in non-diabetic patient.
Acidosis ; Ataxia ; Basal Ganglia* ; Brain ; Central Nervous System ; Dysarthria ; Follow-Up Studies ; Humans ; Hypoglycemia ; Hypokinesia ; Magnetic Resonance Imaging ; Middle Aged ; Myalgia ; Neurologic Manifestations ; Polycystic Kidney, Autosomal Dominant ; Renal Dialysis* ; Rhabdomyolysis ; Risk Factors ; Tomography, X-Ray Computed