Ultrasonographic Findings in Rheumatoid Arthritis / 대한내과학회지

Rheumatoid arthritis (RA) can be evaluated with ultrasound using both gray scale and Doppler mode. Gray scale provides cross-sectional images of joints, whereas Doppler shows the vascularity of the proliferated synovium. In RA, ultrasound can detect sub-clinical or early synovitis, assess arthritis more accurately than through clinical examination, and predict recurrence. In particular, a Doppler signal detected inside the joint cavity correlates with disease activity. Imaging remission can reflect the true remission status more accurately than with clinical remission. In this review, we focus on the use of ultrasonographic findings for the diagnosis, assessment, and prediction of RA.

A Case of Rheumatoid Arthritis with Chronic Eosinophilic Pneumonia Associated with Eosinophilic Pleural Effusion

We describe a 48-year-old man with family history of rheumatoid arthritis (RA) affected by chronic eosinophilic pneumonia (CEP) with severe peripheral eosinophilia. CEP might develop as a complication of longstanding active RA. The patient with 5 months history of seropositive RA and chronic respiratory symptoms, alveolar and blood eosinophilia, peripheral pulmonary infiltrates and pleural effusion on chest imaging. The lung may be involved as an extraarticular manifestation of RA. However, CEP is not recognized as a typical lung manifestation of RA, and the two diseases rarely coexist. The effusion was an eosinophil predominant exudates and was characterized by low pH, and glucose level and high lactic dehydrogenase. The patient responded rapidly to combination of steroids and disease modifying anti-rheumatic drugs.

Anal Myolipoma: A New Benign Entity in Patients with an Anal Tumor?

A myolipoma is an extremely rare benign neoplasm, occurring most frequently in adults in the deep soft tissue of the abdomen or retroperitoneum. We experienced a case of an anal myolipoma occurring in a 30-year-old woman, and it was surgically resected. To our knowledge, this is the first reported case of a myolipoma arising from the anus, so such a possibility needs to be considered in the differential diagnosis.

A Case of Dermatomyositis Presenting with Rhabdomyolysis

Rhabdomyolysis is caused by injury to skeletal muscle and it involves leakage of intracellular contents into the plasma. Rhabdomyolysis is an extremely rare manifestation of dermatomyositis. Dermatomyositis is a rare idiopathic inflammatory myopathy that is characterized by chronic inflammation of skeletal muscles and skin, resulting in muscle weakness. A 20 year old Korean male soldier presented with acute muscle pain, weakness and skin rashes over the face, neck and anterior chest. He received military training with carrying a radio set one week previouslyago. The patient was treated for rhabdomyolysis. However, the patient's symptoms did not improve. Muscle biopsy results suggested the diagnosis of rhabdomyolysis. Nevertheless, the features of skin and muscle inflammation raised the possibility of dermatomyositis. High dose steroid treatment was started, and then the symptoms and signs of muscle inflammation were improved. Rhabdomyolysis as the presenting sign of dermatomyositis has not been reported in Korea. Thus, we report on this case with a literature review.

Musculoskeletal ultrasound in rheumatology / 대한내과학회지

As technological advances in ultrasound have led to high-resolution imaging of musculoskeletal structures, ultrasonography has become an integral part of diagnosis and management in rheumatology practice. Ultrasound has several advantages over clinical examination in the diagnosis and localization of rheumatic diseases, such as joint effusion, erosion, synovitis, tendon diseases, and enthesopathy. Moreover, ultrasound improves joint aspiration accuracy and both intra-articular and soft tissue injection technique. The Doppler evaluation provides useful clinical information regarding tissue vascularity and can be used to monitor joint and soft tissue disease activity and progression. This paper presents a review of the evidence in support of the application of musculoskeletal ultrasound in rheumatology.

A Case of Localized Skin Infection Due to Scedosporium apiospermum in a Patient with Rheumatoid Arthritis / 대한류마티스학회지

No abstract available.

A Case of Diffuse Muscular Calcification following Necrotizing Cutaneous Vasculitis in a Patient with Dermatomyositis / 대한류마티스학회지

Dermatomyositis is a systemic connective tissue disease affecting the skeletal muscles and skin. Necrotizing cutaneous vasculitis and subsequent diffuse subcutaneous and muscular calcification in patients with dermatomyositis is uncommon and has not been reported. A 23-year-old female with dermatomyositis developed necrotizing cutaneous vasculitis in the knee, elbow, buttock, toe and fingers associated with large ulcer formation. Her left 5th finger was amputated due to massive soft tissue destruction, and her right 5th finger later auto-amputated. Thereafter, she developed small subcutaneous nodules on both wrists, elbows, upper arms, neck, buttocks and thighs. X-ray, computerized tomography and gracilis muscle biopsy confirmed diffuse subcutaneous, fascia and muscular calcifications.

Locally Administered Ketorolac and Bupivacaine for Control of Postoperative Pain in LAG for Gastric Cancer: Prospective Randomized Double Blind Study

PURPOSE: The method of locally administered ketorolac and bupivacaine with epinephrine in LAG patients was examined for the control of postoperative pain. METHODS: Fifty-one patients who had undergone LAG for gastric cancer from Jan. 2005 and Aug. 2005 were enrolled in this study. All the patients were administered a fentanyl patch (25 microgram/hr) on the upper back 2 hours before the entry into the OR. Upon the completion of LAG, the patients were randomly selected for a local injection of Ketolorac and bupivacaine. Ketolorac (30 mg, 1 cc) plus 0.5% bupivacaine with 1 : 100,000 epinephrine (9 cc) was injected in the peritoneum and subcutaneous tissue of the mini-laparotomy wound in the study group, and normal saline (10 cc) was injected into the control group. The postoperative pain scores were assessed at 6 hr, day 1, day 2 and day 5 using a Verbal Numerical Rating Scale by a Wound Ostomy Continence Nurse. Meperidine (25 mg iv.) was used for additional analgesia. RESULTS: The frequency of additional analgesic requirement was significantly lower in the study group and the pain score was significantly lower at 6 hr postoperatively than in the control group. CONCLUSION: Locally administered ketorolac and bupivacaine with epinephrine is a simple and cost-effective technique for alleviating postoperative pain in LAG patients with gastric cancer.

A Case of Systemic Lupus Erythematosus Patient with Crohn's Disease / 대한류마티스학회지

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease of unknown cause, and is characterized by appearance of various autoantibodies and multiple organ involvement. Some of the systems commonly involved in SLE include the muscle and joints, brain and peripheral nervous system, lungs, heart, kidneys, skin, serous membranes, and component of blood. The clinical manifestations of SLE is protean, overlap with other illnesses, and are often subtle. However there are few documented reports on SLE associated with Crohn's disease in other countries and no reporting case in Korea. We experienced a 30-year-old female patient who was admitted for right leg swelling and diagnosed as SLE with Crohn's disease.

Development and Validation of a Modified form of the Stress Response Inventory for Workers / 신경정신의학

OBJECTIVES: The purpose of this study is to develop and validate a modified form of the Stress Response Inventory (SRI-MF) for workers. METHODS: In study I, the Stress Response Inventory was conducted in 3,420 person, who worked for public institutions and large corporations. They were selected from 10 areas throughout the country. After we performed experimental factor analysis in order to select the items by internal consistency and factor loadings, we developed the short form of SRI (SRI-MF). In Study II, SRI-MF was validated by showing convergent/divergent validity with other stress-measuring instruments in another samples. RESULTS: In study I, factor analysis yielded 5 factors, and two of them were excluded because of their low internal consistency. Consequently, total 22 items in the remaining 3 factors (somatization, depression, anger) were selected for the SRI-MF. Test-retest reliability of the SRI-MF was significantly high, ranging between .67-.71. Cronbach's alpha was also high. In study II, convergent validity was computed by correlating scores of other scales (GARS, SCL-90-R, PSQ) score. The correlations were all at significant levels. Discriminant validity was computed by comparing the total score and scores of 3 subscales in the patient and normal group. There were significant differences in the total and scores of 3 subscales between the two groups. CONCLUSION: The results of identifying factor structure in the SRI indicated 5 signifcnt factors. Among them, 3 factors can be employed for the modified form of SRI with a high internal consistency. Thus, we suggest that the SRI-MF should be a effective and valid scale to evaluate stress response in work places.

Comparison of Cell-Mediated Immune Response after Laparoscopic vs Open Gastrectomy in Gastric Cancer

Purpose: We compared the changes in the perioperative peripheral lymphocyte subsets and the acute inflammatory reactants (CRP and SAA) to compare the immune responses between a Laparoscopy-assisted distal gastrectomy (LADG) and a conventional open distal gastrectomy (CODG). METHODS: 23 patients, who underwent an operation for early gastric cancer, between Nov. 2003 and Feb. 2004, were enrolled in this study. The total WBC, lymphocytes, peripheral lymphocyte subsets and acute inflammatory reactants (CRP and SAA) were evaluated on the preoperative day, and 2, and 24 hrs and on the 4th postoperative day in 20 of the 23 cases. RESULTS: There were no significant differences in the preoperative total WBC, lymphocyte, peripheral lymphocyte subsets, CRP and SAA between the two groups (P 0.05). The postoperative CRP and SAA levels; however, gradually increased compared to the preoperative levels, and were significantly lower in the LADG than the CODG group (CRP: P=0.03 and SAA: P=0.01). Conclusion: No difference was detected in the immune-cell numbers in the gastric cancers between the LADG and CODG groups. The LADG was found to influence the acute inflammatory reaction less than the CODG.

Increasing Risk of Mental Health Problems Among Subway Drivers Experiencing Accidents on the Track / 대한산업의학회지

OBJECTIVES: This study examined the prevalence of Post traumatic stress disorder(PTSD) and the comorbidity with panic disorder in subway drivers who experienced accidents on the track. In addition, this study examined the differences in panic disorder, stress levels, work-related problems, and sleep disturbances between drivers with and without an accident-experience. METHODS: 628 Seoul metropolitan subway drivers were participated in this study. We assessed mental health status of the subjects using the Clinician-administered PTSD scale (CAPS), panic disorder scale based on the DSM-IV criteria, Worker's Stress Response Inventory, and Sleep Questionnaire. RESULTS: The prevalence of PTSD and comorbid panic disorder was significantly higher among those drivers who had experienced accidents than in those who had not. Drivers with an accident experience showed significantly higher somatic, depressive, anger symptoms in the stress measures, and more sleep problems than those drivers without an accident experience. CONCLUSIONS: The experience of an accident on the track threatens both the work efficiency and the mental health of drivers. In order to reduce the negative effect of an extremely stressful event related to accidents, intervention programs for PTSD and panic disorder need to be developed and utilized.

The efficacy and safety of etanercept in patients with active rheumatoid arthritis receiving methotrexate / 대한내과학회지

BACKGROUND: This study was performed to investigate the efficacy and safety of etanercept in active rheumatoid arthritis patients with stable dose of methotrexate in Korean. METHODS: In a 12 week, single arm, open trial, we assigned 76 patients with active rheumatoid arthritis who had an inadequate response to disease-modifying antirheumatic drugs. Patients received twice-weekly subcutaneous injections of etanercept 25 mg while continuing to receive methotrexate at a stable dose of 7.5~25 mg per week. The clinical response was defined as the percent improvement in disease activity according to the criteria of the American College of Rheumatology (ACR) at 12 weeks. RESULTS: Etanercept led to significant improvements in disease activity and was safe and well tolerated. At 12 week, 84.4% of the patients receiving 25 mg of etanercept achieved a 20% ACR response, and 53.1% of those receiving etanercept achieved a 50% ACR response. The most common adverse event was injection-site reaction. Other adverse events were upper respiratory infection, nausea, and facial edema, but there were no serious adverse events associated with etanercept. CONCLUSION: In active rheumatoid arthritis patients, etanercept was safe, well tolerated, and provided rapid clinical improvements.

Interaction between Th1 Cytokine and Th2 Cytokine on the Expression of Chemokine and Adhesion Molecule in Human Mesangial Cells / 대한류마티스학회지

PURPOSE: Predominance of IFN-gamma over Th2 cytokines is evident in proliferative lupus nephritis. Th2 cytokines such as IL-10, or IL-4 have been known to suppress Th1 cytokine driven pro-inflammatory responses. However a combination of cytokines can exert variable effects during the evolution of autoimmune diseases depending on the various factors, such as the stage of diseases or local versus systemic expression. To determine whether Th2 cytokines play a pro- or anti-inflammatory role in the local glomerular inflammation induced by IFN-gamma, we studied the effect of IL-10 and IL-4 on the expression of chemokines and adhesion molecules in human mesangial cells stimulated with IFN-gamma. MEHTODS: Human mesangial cells were obtained from 3 patients undergoing nephrectomy. MCP-1, RANTES, ICAM-1, and CD40 expressions were examined in response to various cytokine stimulation; IFN-gamma, IL-10, IL-4, IFN-gamma+IL-10, IFN-gamma+IL-4, and IFN-gamma+IL-10+IL-4, respectively. Expression of MCP-1 mRNA was analyzed by RT-PCR and the levels of MCP-1 and RANTES in the culture supernatants were measured using an enzyme immunoassay. ICAM-1 and CD40 surface expressions were analyzed by flow cytometry. RESULTS: IFN-gamma increased basal mRNA expression of MCP-1, and IL-10 strongly enhanced the level of MCP-1 mRNA and protein expressions induced by IFN-gamma. IL-4 did not affect significantly on the MCP-1 expression induced by IFN-gamma. Although IFN-gamma increased the concentration of RANTES, IL-10 and IL-4 did not affect IFN-gamma induced RNTES expression. Increased expression of ICAM-1 and CD40 induced by IFN-gamma were not down-regulated by IL-10 or IL-4. CONCLUSION: Taken together, IL-10 appears to augment local inflammatory reaction though the up-regulation of MCP-1 from mesangial cells in the presence of IFN-gamma rather than inhibit inflammatory response in the pathogenesis of proliferative glomerulonephritis.

Palindromic Rheumatism with Periatricular Inflammation / 대한류마티스학회지

No abstract available.

Expression of PSD95 in the Rat Sciatic Nerve

This study was designed to elucidate the existence of PSD95 in the rat sciatic nerve. Immunohistochemical stains of cryosection and teased fiber of sciatic nerves were performed with goat polyclonal antibody against PSD95. Western blot analysis was also accomplished with the same antibody. We got an interesting result that the rat sciatic nerve obviously showed PSD95 immunoreactivity especially in the nodal and paranodal regions, and we also identified a distinct band of PSD95 by western blot. These results suggest PSD95 exists in the sciatic nerve as well as it does in the central nervous system. We suppose PSD95 may have some important roles in ion channel clustering, junctional plasticity and signal transduction in the peripheral nerves as well.

Histochemical Characterization of the Lectin-binding Sites in the Equine Vomeronasal Organ

The binding specificities of various lectins, such as the Dolichos biflorus agglutinin (DBA), soybean agglutinin (SBA), and the Bandeiraea simplicifolia BS-1 (Isolectin B4), Triticum vulgaris (WGA), Arachis hypogaea (PNA), and Ulex europaeus (UEA-I) lectins, were studied in the vomeronasal organ of the horse. The microvilli of the vomeronasal sensory epithelium were positive for DBA, SBA, Isolectin B4, WGA, PNA, and UEA-I. The receptor cells showed intense reactivity for DBA and WGA. Lectins were not detected in the supporting cells or basal cells. The Jacobson's glands were positive for WGA and UEA-I, but lectins were absent from the nerve bundles. From these results, we postulate that several lectin-binding carbohydrates on the microvilli and neurosensory cells are associated with chemoreception in the horse. In addition, the differential lectin-binding patterns in the horse suggest that the carbohydrates present in this particular sense organ are species-specific.

Glutathione S-transferase Gene Polymorphisms and Systemic Lupus Erythematosus / 대한류마티스학회지

OBJECTIVE: To determine whether GSTM1, GSTT1 and GSTP1 polymorphisms are associated with susceptibility or disease manifestations in patients with SLE. METHODS: Two hundred eighty-six SLE patients who fulfilled the American College of Rheumatology (ACR) criteria were compared with 271 cases of age and sex matched controls to examine association between GST genotypes and susceptibility to SLE. The effect of genotype on SLE manifestations was assessed using the comparison of ACR diagnostic criteria. GST gene polymorphisms were determined by a multiplex polymerase chain reaction and antibodies to SS-A and SS-B were determined by double immunodiffusion. RESULTS: No association was found in the comparison of GSTM1 null, GSTT1 null, GSTP1 Ile105--

Association of Polymorphism in Glutathione S-transferase Gene with Susceptibility and Severity of Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: We examined the genetic polymorphisms of glutathione S-transferase M1 (GSTM1), T1 (GSTT1), and P1 (GSTP1) in Korean patients with rheumatoid arthritis (RA) and studied to determine whether GSTs influence susceptibility or outcome in RA. METHODS: RA patients with disease duration above 2 years (n=267) and healthy control (n=400) were enrolled. Genetic polymorphism were determined using polymerase chain reaction-based assays. We assumed stage I (Steinbroker's radiologic stage by the ACR criteria) regarded as mild RA and stage II, III, IV as severe RA. Data were analysed using multiple regression analysis with correction for age, sex, disease duration, and rheumatoid factor positivity. RESULTS: The frequency of GSTM1 null genotype in Korean RA patients was significantly higher than that of control (61.7% vs 53.5%, p=0.04). No significant differences in the frequency of the GSTT1 null genotype and GSTP1 genotypes between RA patients and normal controls were identified. The GSTM1 null genotype significantly influence the disease progression and bony erosive change in severe RA groups (p=0.03) compared with in mild RA groups. CONCLUSION: The GSTM1 null genotype increases the risk of rheumatoid arthritis in Korean patients. More severe erosive damage was associated with GSTM1 null genotype. Our study suggests that GSTM1 null genotype may be an independent marker for development of more erosive disease in RA.

Lack of Association between Methylenetetrahydrofolate Reductase Gene Polymorphism and Carotid Atherosclerosis in Korean Patients with Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: Studies have suggested that the 5, 10-methylenetetrahydrofolate reductase (MTHFR) C677T mutation (alanine -- or =1 mg/day) were studied. The genetic polymorphism was detected by the polymerase chain reaction. We measured intima-media thickness (IMT) and plaques of the common carotid arteries by ultrasonography, and evaluated relations among the known risk factors for atherosclerosis, the genetic polymorphism, RA outcomes (Steinbrocker's radiological stage and functional class defined by the ACR criteria) and markers of inflammation (erythrocyte sedimentation rate and C-reactive protein). RESULTS: Among the 40 subjects, 12 had MTHFR genotype CC, 24 genotype CT, and 4 genotype TT. The frequencies of the MTHFR C and T allele were 0.6 and 0.4, respectively. Between the subjects with the CC genotype and those with the mutant T allele, there was no difference in age, body mass index, blood pressure (BP), lipid, duration of RA, RA outcome indices, rheumatoid factor, acute phase reactants and IMT. Carotid IMT was positively associated with age, systolic BP and antihypertensive drug use. There was no significant association between carotid IMT and the MTHFR C677T mutation. CONCLUSION: It is assumed that there was no significant relationship between the MTHFR C677T polymorphism and carotid atherosclerosis in Korean postmenopausal RA women.