Dieckol isolated from Eisenia bicyclis extract suppresses RANKL-induced osteoclastogenesis in murine RAW 264.7 cells

Objective: To demonstrate the effect of dieckol from Eisenia bicyclis on osteoclastogenesis using RAW 264.7 cells. Methods: Murine macrophage RAW 264.7 cells were subjected to dieckol treatment, followed by treatment with receptor activator of nuclear factor kappa-B ligand (RANKL) to induce osteoclastogenesis. Tartrate-resistant acid phosphatase (TRAP) activity was examined using a TRAP activity kit. Western blotting analysis was conducted to examine the level of osteoclast- related factors, including TRAP and calcitonin receptor (CTR), transcriptional factors, including c-Fos, c-Jun, and nuclear factor of activated T cells cytoplasmic 1 (NFATc1), nuclear factor kappa-B (NF-κB), extracellular signal-regulated kinase (ERK), and c-Jun N-terminal kinase (JNK). Immunofluorescence staining was conducted to examine the expression of c-Fos, c-Jun, and NFATc1. Results: Among the four phlorotannin compounds present in Eisenia bicyclis, dieckol significantly hindered osteoclast differentiation and expression of RANKL-induced TRAP and CTR. In addition, dieckol downregulated the expression levels of c-Fos, c-Jun, NFATc1, ERK, and JNK, and suppressed NF-κB signaling. Conclusions: Dieckol can suppress RANKL-induced osteoclastogenesis. Therefore, it has therapeutic potential in treating osteoclastogenesis- associated diseases.

Dieckol isolated from Eisenia bicyclis extract suppresses RANKL-induced osteoclastogenesis in murine RAW 264.7 cells

Objective: To demonstrate the effect of dieckol from Eisenia bicyclis on osteoclastogenesis using RAW 264.7 cells. Methods: Murine macrophage RAW 264.7 cells were subjected to dieckol treatment, followed by treatment with receptor activator of nuclear factor kappa-B ligand (RANKL) to induce osteoclastogenesis. Tartrate-resistant acid phosphatase (TRAP) activity was examined using a TRAP activity kit. Western blotting analysis was conducted to examine the level of osteoclast- related factors, including TRAP and calcitonin receptor (CTR), transcriptional factors, including c-Fos, c-Jun, and nuclear factor of activated T cells cytoplasmic 1 (NFATc1), nuclear factor kappa-B (NF-κB), extracellular signal-regulated kinase (ERK), and c-Jun N-terminal kinase (JNK). Immunofluorescence staining was conducted to examine the expression of c-Fos, c-Jun, and NFATc1. Results: Among the four phlorotannin compounds present in Eisenia bicyclis, dieckol significantly hindered osteoclast differentiation and expression of RANKL-induced TRAP and CTR. In addition, dieckol downregulated the expression levels of c-Fos, c-Jun, NFATc1, ERK, and JNK, and suppressed NF-κB signaling. Conclusions: Dieckol can suppress RANKL-induced osteoclastogenesis. Therefore, it has therapeutic potential in treating osteoclastogenesis- associated diseases.

Immunoglobulin G4 Unrelated Idiopathic Mesenteric Sclerosis / 대한소화기학회지

Sclerosing mesenteritis is a rare benign disease with a prevalence of 0.16–3.4% and is characterized by chronic nonspecific inflammation and extensive fibrosis in the adipose tissue of the mesentery although the exact pathogenesis is still elusive. A 65-year-old woman was referred with suspicion of an abdominal mass and biliary stones on abdominal ultrasonography and CT. Bile duct stones were confirmed by endoscopic ultrasonography and successfully treated by endoscopic retrograde cholangiography with stone removal. Furthermore, a 4.7 cm conglomerated mass on small intestinal mesentery was suspected as sclerosing mesenteritis based on the features on abdominal MRI. However, because it could not be differentiated from malignancy without histologic examination, laparoscopic excisional biopsy was performed; it showed only inflammatory cells with extensive fibrosis. Therefore, the abdominal mass was confirmed as sclerosing fibrosis and the patient was followed-up without any treatments because no mass-related symptoms accompanied the findings. Six months later, abdominal CT showed no significant change in the mass. Herein, we report a rare case of incidentally found idiopathic sclerosing mesenteritis.

Idiopathic Myointimal Hyperplasia of Mesenteric Veins / 대한소화기학회지

No abstract available.

Colonic Diverticulitis Complicating Colo-ovarian Fistula and Tuboovarian Abscess Formation in on Old Woman

The inflammation of colonic diverticulum, diverticulitis, is occasionally accompanied by several complications, such as bleeding, bowel obstruction, fistula and abscess formation. Both colo-ovarian fistula and tuboovarian abscess formation, as complications of diverticulitis, are rare. Here, we report a case of colonic diverticulitis which ultimately resulted in colo-ovarian fistula and tuboovarian abscess formation. A 76-year-old female was presented with lower abdominal pain, diarrhea and intermittent hematochezia for about 1 month. According to the abdominal computed tomography, tuboovarian abscess was shown to adhere to the inflamed sigmoid diverticulum. Sigmoidoscopy revealed pus flowing from the opening of the diverticulum at the sigmoid colon. Hence, the patient underwent oophorosalpingectomy and low anterior resection. Thereafter, she was treated with bowel rest and broad spectrum antibiotics, and finally recovered. Although rare, colonic diverticulitis may result in colo-ovarian fistula causing tuboovarian abscess formation in postmenopausal patients. Early recognition of the condition and appropriate treatment, including surgery and antibiotics, are necessary in order to achieve full recovery from complicated diverticulitis.

Newly Diagnosed Diabetes Mellitus With Pancreatic Cancer Manifested as Hyperglycemic Hyperosmolar State

Here, we report a case of newly diagnosed diabetes, with concurrent pancreatic cancer manifested as hyperglycemic crisis, and aggravated by urinary tract infection. We summarize the initial clinical manifestations and pertinent laboratory, radiologic, and clinical findings in an elderly patient with hyperglycemic emergency. A review of the documents involving pancreatic tumors and hyperglycemic hyperosmolar state, which is an acute complication of diabetes mellitus, is presented. In the absence of other identifiable conditions, it is reasonable to speculate that some factor (or factors) produced by the tumor had a role in the metabolic decompensation. In addition, this discussion should be more carefully considered in the aged people group.

Two Cases of the Norwegian Scabies-Infested Patients with Chronic Disease in Elderly Care Unit

The scabies mite is an ectoparasite, which is able to infest humans. The incidence of scabies decreased during the past 20 years in Korea. However, the incidence is likely to increase again, and may be delayed or missed diagnosis recently. Its clinical presentation is typical, although in a host with compromised immune system, like the mentally retarded and elderly patients, the clinical presentation may be altered. Because a delay in diagnosis may induce rapid spread of the scabies mite, immediate diagnosis and treatment are necessary. We report two cases of scabies in elderly patients from different nursing homes. These patients were transferred to our center for treatment of pneumonia and chronic renal disease. They revealed pruritus and skin rashes after the treatment of further underlying diseases. We consulted to a dermatologist because of worsening symptoms, despite an application of medication with antihistamine and topical steroid, scabies was diagnosed. The symptom improved with topical 1% gamma-benzene hexachloride, an effective scabies drug. We suggest that geriatrists should suspect scabies who presents with pruritus that is persistent or resistant to conventional treatment, especially patients transferred from nursing homes.

Death of a Patient with Turner Syndrome Caused by Arotic Dissection and Rupture after Hemodialysis / 대한신장학회지

The main cause of death in hemodialysis patients is cardiovascular disease. Aortic dissection with rupture is one of the most life threatening cardiovascular diseases. The risk of developing aortic dissection can be increased by renal failure or hemodialysis and the morbidity also increases in Turner syndrome. Here, we report a case of Turner syndrome patient who died from ruptured aortic dissection after hemodialysis, and review relevant literature. A 59 year-old female presented to the emergency department complaining of severe dyspnea and general weakness. Six months ago, she had undergone an operation at another hospital due to horseshoe kidney and staghorn calculus. After the operation, acute renal failure developed, so she received hemodialysis. The chest x-ray image taken at the time of admission showed mediastinal widening compared to image taken 6 months ago. Aortic dissection was diagnosed by chest computer tomograph. Chromosomal analysis was performed and the study revealed the mosaicism of Turner syndrome (45,X/ 46,XX). The genetic defect, renal failure and especially hemodialysis were thought as important risk factors in the development of aortic dissection in this patient. Although storongly advised to have emergency operation, the patient only wanted conservative management. Two months later, the patient died from aorta rupture.

Complication Associated with Onyx Embolization of Spinal Cord Arteriovenous Malformation / 신경중재치료의학

Onyx may be an option for embolization of spinal cord arteriovenous malformation (AVM). However, due to its unique physical characteristics, the embolized vessel is exposed to tractional tension during withdrawal of the microcatheter. We present an unusual case of radicular artery tear associated with Onyx embolization of spinal cord AVM.

Therapeutic Strategies of Middle Cerebral Artery M1 Trunk Aneurysms / 대한뇌혈관외과학회지

OBJECTIVE: This study was designed to define the clinical characteristics and to establish the therapeutic strategies for treating aneurysms located at the M1 trunk of the middle cerebral artery (MCA). METHODS: During the past 30 years from September 1976 to December 2006, 47 (6.2% of the 755 treated MCA aneurysms) consecutive patients with M1 aneurysms were treated at our institute. We retrospectively reviewed the database and imaging studies of these 47 patients for analysis. Nine patients (19.1%) were male and 38 (80.9%) patients were female. The mean age was 51.7 years (range: 381 years). Thirty-three (70.2%) patients had ruptured lesions: 3 patients were Hunt and Hess Grade I, 16 patients were Grade II, 7 patients-were Grade III, 4 patients were Grade IV and 3 patients were Grade V. Intracerebral hemorrhage was identified in 9 patients on the initial computed tomograph images. Fourteen patients had unruptured lesions. The diameters of the aneurysms were 25 mm in 2 patients. The mean diameter of the aneurysms was 5.1mm (range: 2.029.0mm). Eleven patients (23.4%) had multiple aneurysms. The repair methods for the aneurysms were microsurgery in 42 (89.4%) patients (clipping: 36, wrapping: 6, aneurysm resection and suture: 1) and coiling in 5 patients. The mean posttreatment follow up period was 45.5 months. The clinical outcome was assessed using the Glasgow Outcome Scale. The therapeutic results of lesion repair, the long-term clinical outcome and the causes of an unfavorable outcome were also analyzed. RESULTS: The overall outcome was favorable in 39 (82.9%) patients (excellent: 32, good: 7) and unfavorable in 8 (17.1%) (fair: 6, poor: 1, dead: 1) patients. The major causes of an unfavorable outcome were the initial insults. Seven patients suffered from a delayed ischemic deficit, and 3 of them were left with a permanent deficit. Surgery-related complications occurred in 8 patients (cerebral infarction: 6, intracerebral hemorrhage: 2) and 3 were left with a permanent deficit. The angiographic results of coiling were complete packing in 3 (60%), a neck remnant in 1 (20%) and incomplete packing for 1 (20%). There was no coiling-related complication. CONCLUSION: In our series, M1 aneurysms had characteristics of a female predominance, the patients more often presented with intracerebral hemorrhage, and a high risk of postoperative ischemic complication. Due to the small size, wide neck and location at the branching site, M1 aneurysms can be treated with surgery rather than coiling, but surgeons should be careful for injury of the branching vessels like the lateral lenticulostriate artery and they must be prepared for various inevitable situations that occur during surgery.

Clinical Analysis of Patients with Ruptured Cerebral Aneurysms associated with Polycystic Kidney Disease / 대한뇌혈관외과학회지

OBJECTIVE: This study is to define the clinical characteristics and formulate the management strategies of the patients with ruptured cerebral aneurysms associated with polycystic kidney diseases (PKD). METHODS: During the past 30 years, among of 3,013 patients who were treated with intracranial aneurysms, 7 patients had ruptured cerebral aneurysms associated with PKD. The authors retrospectively reviewed the database and imaging studies of such patients as sources for identification and analysis. RESULTS: All 7 patients presented with subarachnoid hemorrhage (SAH). One patient showed Hunt and Hess grade I, 4 of grade II, and 2 of grade III. Six patients showed Fisher group II and 1 patient of group III. Four aneurysms were located at anterior cerebral artery, 2 at middle cerebral artery, and 1 at internal carotid artery. Five patients had small aneurysms and the remaining 2 had large (diameter > or = 10 mm) aneurysms. All aneurysms were in saccular shape. Two of the 7 patients (28.6%) had multiple aneurysms. One patient suffered delayed ischemic neurological deficit. All patients were treated by microsurgery and showed favorable outcome (good: 7). CONCLUSIONS: The patients harboring PKD had high probability of hypertension. So, intact aneurysms in those patients were exposed to higher rate of being ruptured. Surgery was necessary for ruptured lesions, as well as unruptured lesions which size was increased at follow up imaging study. Multimodality management approach with nephrologist and neuroradiologist are very necessary. The ultimate management outcome was satisfactory.

Serial Changes of MR Images Throughout the Stages of Infection of Spondylodiscitis

OBJECTIVE: Spondylodiscitis has been diagnosed by clinical, radiological and laboratory methods. MR imaging is well known as an excellent diagnostic tool for spondylodiscitis. However, the changes in MR images throughout the treatment process has not been studied. Thus we have analyzed the serial changes of MR images throughout the stages of infection. METHODS: Ten patients were selected for retrospective reviewed who had been treated at our institute for infectious spondylodiscitis between 2000 and 2005. These patients had been followed-up at least six months and had taken more than a couple of series of MR scans. We classified the MR images into four groups according to the stages of treatment for the infection and compared them to the clinical and laboratory findings. RESULTS: MR image signals changed minimally or appeared to be normal in the early stages. The progression of spondylodiscitis was characterized by a low T1 WI signal and a high T2 WI signal in disc and vertebral body. The signal changes of the MR images were then propagated and the endplate was destructed. During the treatment, the destructed endplate became stabilized and the signal intensity of both T1 and T2 WI were fixed to low-or iso-intensity. CONCLUSION: We can determine the serial signal changes based on MR images according to the treatment of spondylodiscitis. We can therefore determine the status of the infection and the stage of treatment, as well as the diagnosis of spondylodiscitis using serial MR images.