RESUMEN
This article describes the case of a 40-year-old man with transient paralysis of both legs as the major symptom of an acute abdominal aortic aneurysm rupture presumably due to the occlusion of blood flow to the conus medullaris.
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Rotura de la Aorta/complicaciones , Rotura de la Aorta/diagnóstico , Paraplejía/etiología , Enfermedad Aguda , Adulto , Rotura de la Aorta/cirugía , Dolor de Espalda/etiología , Humanos , Vértebras Lumbares/diagnóstico por imagen , Masculino , Radiografía , Resultado del TratamientoRESUMEN
STUDY DESIGN: A prospective study of magnetic resonance imaging findings in outpatients with idiopathic scoliosis. OBJECTIVE: The purpose of this study was to determine the prevalence of neural axis abnormalities in outpatients with scoliosis and to analyze the characteristics of patients who had such abnormalities. SUMMARY OF BACKGROUND DATA: In previous studies, neural axis abnormalities were found in 2.9% to 37% of patients with idiopathic scoliosis. The current guidelines for MRI screening in scoliosis are valuable, and the proposed indications for performing MRI in the literature include early onset, atypical curvature, double thoracic curve (King type-5), rapid progression, male gender, and abnormal neurologic findings. METHODS: A total of 472 outpatients with a primary diagnosis of idiopathic scoliosis were examined for neural axis abnormalities by magnetic resonance imaging. Logistic regression was used to determine significant predictors of neural axis abnormalities on MRI. RESULTS: The incidence of neural axis abnormalities on MRI was 3.8% (18 of 472 patients). Among the 18 patients, 6 had a Chiari I malformation alone, 10 had a Chiari I malformation combined with syringomyelia, and 2 had a syringomyelia without Chiari I malformation. Male gender, patients younger than 11 years old, and abnormal superficial abdominal reflexes were significantly associated with the detection of neural axis abnormalities on MRI. CONCLUSION: We recommend routine use of MRI in male patients, younger than 11 years old, and abnormal superficial abdominal reflexes. Even if a patient has no specific indications for MRI, we recommend its routine use in preoperative planning.
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Atención Ambulatoria/métodos , Imagen por Resonancia Magnética , Escoliosis/diagnóstico , Escoliosis/epidemiología , Malformación de Arnold-Chiari/complicaciones , Malformación de Arnold-Chiari/diagnóstico , Malformación de Arnold-Chiari/epidemiología , Niño , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Estudios Prospectivos , Escoliosis/complicaciones , Siringomielia/complicaciones , Siringomielia/diagnóstico , Siringomielia/epidemiologíaRESUMEN
Cathepsin K was originally identified as an osteoclast-specific lysosomal protease, the inhibitor of which has been considered might have therapeutic potential. We show that inhibition of cathepsin K could potently suppress autoimmune inflammation of the joints as well as osteoclastic bone resorption in autoimmune arthritis. Furthermore, cathepsin K-/- mice were resistant to experimental autoimmune encephalomyelitis. Pharmacological inhibition or targeted disruption of cathepsin K resulted in defective Toll-like receptor 9 signaling in dendritic cells in response to unmethylated CpG DNA, which in turn led to attenuated induction of T helper 17 cells, without affecting the antigen-presenting ability of dendritic cells. These results suggest that cathepsin K plays an important role in the immune system and may serve as a valid therapeutic target in autoimmune diseases.