Background/Aims: The present study aimed to investigate whether tocotrienol regulates interleukin 17 (IL-17)-induced osteoclastogenesis in rheumatoid arthritis (RA). Methods: We evaluated the effect of tocotrienol on IL-17-induced receptor activator of nuclear factor kappa B ligand (RANKL) production using RA fibroblast-like synoviocyte (FLS), together with real-time polymerase chain reaction and enzyme-linked immunosorbent assay. Osteoclast differentiation was confirmed after culturing IL-17-treated RA FLS and Th17 cells with tocotrienol and monocytes. We analyzed the suppressive effect of tocotrienol on Th17 cells percentage or Th17-cytokine levels among peripheral blood mononuclear cells using flow cytometry. Results: We found that IL-17 stimulated FLS to produce RANKL and tocotrienol decreased this IL-17-induced RANKL production. Tocotrienol decreased the IL-17-induced activation of mammalian target of rapamycin, extracellular signal-regulated kinase, and inhibitor of kappa B-alpha. When monocytes were incubated with IL-17, RANKL, IL-17-treated FLS or Th17 cells, osteoclasts were differentiated and tocotrienol decreased this osteoclast differentiation. Tocotrienol reduced Th17 cell differentiation and the production of IL-17 and sRANKL; however, tocotrienol did not affect Treg cell differentiation. Conclusions Tocotrienol inhibited IL-17- activated RANKL production in RA FLS and IL-17-activated osteoclast formation. In addition, tocotrienol reduced Th17 differentiation. Therefore, tocotrienol could be a new therapeutic choice to treat bone destructive processes in RA.

Epithelial colon polyps are largely divided into hyperplastic and adenomatous polyps. Adenomatous polyps are premalignant lesions, whereas hyperplastic polyps are regarded as benign lesions. However, this histological classification has been blurred, as cases of malignant changes in hyperplastic polyposis, mixed hyperplastic adenomatous polyps (MHAPs), and serrated adenomas in the colon have been reported. Rare cases of MHAP have been reported, and are mainly found at the proximal colon with a relatively large size. MHAPs seem to be an intermediate stage of the hyperplastic polyp-adenoma sequence or a collision tumor. Here, we report on a case of a single polyp in the rectum diagnosed with a MHAP combined with an invasive adenocarcinoma.
Adenocarcinoma ; Adenoma ; Adenomatous Polyps ; Colon ; Polyps ; Rectum

Gastrointestinal stromal tumor is a common type of gastrointestinal mesenchymal tumor. Depending on the patient's age, compliance and health status, and the level of suspicion of malignancy, tumors < or =3 cm in size are typically monitored annually by endoscopic ultrasonography. The examination interval can be extended if no size change is noted on consecutive examinations. We report here on a 44-year-old female who presented with abdominal discomfort and displayed no size change of her gastrointestinal stromal tumor on three consecutive endoscopies over a 44-month interval. The patient was diagnosed with malignant gastrointestinal stromal tumor on the basis of the evident ulceration seen on esophagogastroduodenoscopy and the inhomogenous echo noted on the endoscopic ultrasonography and the pathologic findings by gastric wedge resection.
Adult ; Compliance ; Endoscopy, Digestive System ; Endosonography ; Female ; Gastrointestinal Stromal Tumors ; Humans ; Ulcer

Capsule endoscopy (CE) is a valuable modality for directly examining the small bowel in a relatively noninvasive and safe manner. CE is being increasingly used for obscure gastrointestinal bleeding, Crohn's disease, drug induced ulcer and small bowel tumor. Although capsule retention is a relatively infrequent complication, small bowel obstruction and strictures have been considered contraindications to CE. But some authors have reported that capsule endoscopy can be safely used to help identify the etiology and site of small bowel obstruction, and the retention of the capsule indicates the presence of a lesion requiring surgery. We report here on a case of small bowel obstruction and capsule retention by a small bowel ulcer, and the small bowel ulcer was not found when performing capsule endoscopy.
Capsule Endoscopy ; Constriction, Pathologic ; Crohn Disease ; Endoscopy ; Hemorrhage ; Retention (Psychology) ; Ulcer

Endovascular treatment of ethmoidal dural arteriovenous fistula (DAVF) has not been widely performed because of the technical difficulty of the procedure and the potential risk of central retinal artery occlusion. We report the case of a patient who underwent Onyx embolization through the ophthalmic artery in bilateral ethmoidal DAVF; to our best knowledge this is the first report.
Central Nervous System Vascular Malformations ; Humans ; Ophthalmic Artery ; Retinal Artery Occlusion

BACKGROUND AND PURPOSE: The enlargement of a hematoma occurs commonly in patients with spontaneous intracerebral hemorrhage (ICH) after hospitalization and can worsen the clinical outcome. We conducted this study to determine whether extravasation of a radiographic contrast agent is a predictor of hematoma enlargement occurring after admission in patients with spontaneous ICH. METHODS: We reviewed the clinical records and computerized tomography (CT) scan findings of 384 patients with spontaneous ICH admitted within 24 hours of ictus from 2002 to 2005. Only 71 patients with primary ICH in the basal ganglia or thalamus were included in the study. The first CT scan was preformed within 24 hours of onset and the second CT scan was preformed within 72 hours of onset. We compared patients with and without hematoma enlargement according to the radiological findings, clinical characteristics and laboratory data. RESULTS: Seventeen patients (23.9%) showed hematoma enlargement after admission. Extravasation of the radiographic contrast agent on a CT scan was seen in 23 patients (32.4%). The presence of contrast extravasation on a CT scan closely correlated with evidence of hematoma enlargement, as seen on a follow-up CT scan (p = 0.000). Other variables did not reach statistical significance for the independent association with hematoma enlargement. CONCLUSIONS: Due to a high risk for hematoma enlargement, patients with spontaneous ICH in the basal ganglia and thalamus, especially those with evidence of contrast extravasation on a CT scan, should be closely observed. Short term followup radiological studies are needed for the verification of hematoma enlargement.
Basal Ganglia ; Cerebral Hemorrhage* ; Follow-Up Studies ; Hematoma* ; Hospitalization ; Humans ; Thalamus ; Tomography, X-Ray Computed

Two cases of intracranial dissecting aneurysms of the A1 segment of the anterior cerebral artery(ACA) associated with subarachnoid hemorrhage(SAH) are described. Two patients presented with a ruptured dissecting aneurysm manifesting as sudden bursting headache. Computerized tomography(CT) revealed subarachnoid hemorrhage. In the first case, cerebral angiography revealed a diffuse dilatation of left A1 segment with pooling of contrast medium and poor collateral flow through the anterior communicating artery(AcomA). The dissecting aneurysm was wrapped with a trousers shaped artificial dura, fixed with an aneurysmal clip and coated with fibrin glue. He was discharged without neurological deficit. In the second case, 3 dimensional computerized tomography(3D CT) was checked because the diagnostic angiography was not available due to poor patient's condition. 3D CT showed fusiform dilatation of right A1 segment, focal severe stenosis of proximal A1 segment of ACA, AcomA within normal shape and no laterality of A1 dominance. Trapping surgery was done successfully and she had no neurological deficit at discharge. In the case of SAH of unknown origin, dissecting aneurysm should be kept in mind and surgical treatment might be beneficial.
Aneurysm ; Aneurysm, Dissecting* ; Angiography ; Anterior Cerebral Artery* ; Cerebral Angiography ; Constriction, Pathologic ; Dilatation ; Fibrin Tissue Adhesive ; Headache ; Humans ; Subarachnoid Hemorrhage*

p27Kip1 has been recognized as a negative regulator of cell cycle. Reduced level of p27 expression is associated with development and aggressiveness of several human tumors. To investigate the role of p27Kip1 on progression of colorectal adenocarcinoma, we studied 40 cases of human colorectal adenocarcinomas for expression of p27Kip1 protein using an immunohistochemical method, and compared these results with known prognostic parameters of colorectal adenocarcinoma. Among 40 cases of colorectal adenocarcinomas, p27Kip1 expression was detected in the nuclei of tumor cells in 14 cases (35%). The expression rate of p27Kip1 protein was significantly lower in the cases with lymph node metastasis (25.8%) than in those without lymph node metastasis (66.6%) (p<0.05). But it did not correlate with other parameters such as tumor size, histologic grade, vascular invasion, and Ki-67 labeling index. The results suggest that reduced expression of p27Kip1 protein plays a role in biologically aggressive behavior of colorectal adenocarcinoma.
Adenocarcinoma* ; Cell Cycle ; Cyclin-Dependent Kinase Inhibitor p27* ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis

A satisfactory range of motion is one of the important goal of total knee arthroplasty. We investigated the factors that may influence the range of motion after total knee arthroplasty in 49 arthroplasties of 36 patients with minimum follow-up of 12 months. For minimizing the effect of other variables we included only osteoarthritic patients who received primary AGC(BIOMET) knees, cemented fixation of all three component by one surgeon. Some factors that may affect final results were verified. These factors include BMI(ratio of weight and height), preoperative range of motion, preoperative X-ray findings such as sever- ity of spur change and varus deformity, early continuous passive motion trial. Statistical analysis was done by Students t test. The statistically significant factors which influenced the range of motion after arthroplasty were the preoperative flexion deformity and range of flexion, varus deformity, and spur change.
Arthroplasty* ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Knee* ; Range of Motion, Articular*

Anomalies of the lumbosacral nerve roots, in which conjoined nerve roots are most common, are occasionally accompanied by herniated nucleus pulposus. Most of these anomalies were incidental findings from operations, and recent advances in diagnostic imaging techniques have increased the number of cases of lumbosacral root anomalies reported. All these anomalies are congenital, unilateral and almost exclusively situated at the L5-S1 segment. Diagnostic techniques, such as myelography, CT and MRI detect conjoined nerve root. Conjoined nerve root may be confused with a dumbbell tumor or extruded free disc fragment on CT scans. Surrounded by high-signal intensity epidural fat, a conjoined nerve root is more clearly depicted on MR images than on CT scans. Although the size of disc herniation was small, the symptom was magnified by a relatively fixed conjoined root. At surgery, it is necessary for a larger surgical exposure by means of hemi-laminectomy because of the fixation of the nerve roots, and difficulty in retraction. Recently, we experienced two cases of conjoined nerve root and presented them with a review of the literature.
Diagnostic Imaging ; Incidental Findings ; Magnetic Resonance Imaging ; Myelography ; Tomography, X-Ray Computed