ABSTRACT
Arthroscopic meniscectomy of the knee is generally a safe and effective procedure with a low rate of vascular complications. The authors encountered a case of a pseudoaneurysm of the lateral inferior genicular artery after arthroscopic partial meniscectomy of lateral meniscus. The pseudoaneurysm was treated successfully using transcatheter embolization. No recurrence of the hemarthrosis was observed in the patient after a follow-up of 2 years.
Subject(s)
Humans , Aneurysm, False , Arteries , Follow-Up Studies , Hemarthrosis , Knee , Menisci, Tibial , RecurrenceABSTRACT
BACKGROUND: Systemic sclerosis (scleroderma) is a connective tissue disorder of unknown etiology characterized by fibrosis of the skin and internal organs. It is remarkably heterogeneous in initial presentations and internal organ involvement. Limited and diffuse cutaneous subsets of systemic sclerosis (SSc) are known to be different in clinical and laboratory features. The aim of the present study was to determine the clinical characteristics of systemic sclerosis in Koreans. METHODS: Fifty-six patients with systemic sclerosis at the Rheumatology Clinic of Seoul National University Hospital were studied for age, sex, symptoms, signs, and laboratory results. The differences in clinical and laboratory features between limited and diffuse cutaneous subsets were investigated. RESULTS: The mean age at diagnosis of 56 patients (male:female=1:4.6) was 42.4 years (range 11-72 years). The patients consisted of 30 limited and 26 diffuse cutaneous SSc. Cutaneous involvement was as follows: sclerodactyly (100%), Raynaud's phenomenon (94.6%), digital pitting scar (66.1%), subcutaneous calcinosis (1.8%). In musculoskeletal system, 25 cases (46.3%) developed arthralgia/arthritis, 14 cases (25.9%) myalgia. In gastrointestinal system, esophagus was affected in 11 cases (20.7%). Respiratory involvement consisted of interstitial lung disease (24 cases, 43.7%) and pulmonary hypertension (2 cases, 3.6%). Total skin score and functional vital capacity showed significant negative correlation (p<0.05). Cardiovascular involvement consisted of congestive heart failure (3 cases, 5.5%) and pericardial effusion (1 case, 1.8%). Azotemia was found in one patient (1.8%). Antinuclear antibody was positive in 53 cases (94.6%) and anticentromere antibody 2 cases (3.6%). Anti-Scl 70 antibody was positive in 46.4% of all patients, 40.0% of limited scleroderma and 53.8% of diffuse scleroderma. When comparing clinical features between limited and diffuse cutaneous subsets, musculoskeletal involvement was more common in limited scleroderma. CONCLUSION: Systemic sclerosis in Koreans showed various systemic and organ involvement, musculoskeletal system, lung and esophagus being commonly affected. There was no significant difference between limited and diffuse scleroderma in clinical features except musculoskeletal involvement. Investigation of major internal organs, especially lung and esophagus, is needed, regardless of cutaneous subsets in systemic sclerosis.
Subject(s)
Humans , Antibodies, Antinuclear , Azotemia , Calcinosis , Cicatrix , Connective Tissue , Diagnosis , Esophagus , Fibrosis , Heart Failure , Hypertension, Pulmonary , Lung , Lung Diseases, Interstitial , Musculoskeletal System , Myalgia , Pericardial Effusion , Rheumatology , Scleroderma, Diffuse , Scleroderma, Limited , Scleroderma, Systemic , Seoul , Skin , Vital CapacityABSTRACT
Systemic lupus erythematosus (SLE) has been described very rarely in association with underlying malignancy. We experienced a 68-year-old male with systemic erythematosus lupus associated with squamous cell lung cancer. He had radiation therapy as a primary treatment modality. Ten months after the radiation therapy, he suffered from intermittent fever, myalgia, multiple arthralgia, dry cough, and dyspnea. He had leukocytosis and lymphopenia. Anti-nuclear antibody was positive. He had bilateral pleural effusion, pericardial effusion, and proteinuria (2405 mg/day). He had peripheral neuropathy with lower extremity weakness. There was no evidence of recurrence of lung cancer. He was treated with naproxen (1 gm/day) with symptomatic improvement. We describe a clinical course of paraneoplastic SLE in patient with lung cancer, and review the literatures.
Subject(s)
Aged , Humans , Male , Arthralgia , Cough , Dyspnea , Fever , Leukocytosis , Lower Extremity , Lung Neoplasms , Lung , Lupus Erythematosus, Systemic , Lymphopenia , Myalgia , Naproxen , Paraneoplastic Syndromes , Pericardial Effusion , Peripheral Nervous System Diseases , Pleural Effusion , Proteinuria , RecurrenceABSTRACT
OBJECTIVE: This study was conducted to elucidate the associations of HLA with systemic sclerosis (SSc) in Koreans. METHODS: HLA associations with SSc according to SSc-specific autoantibody status and clinical subsets (diffuse and limited) were investigated. HLA-A, B, and C antigens were typed by the serological method using microlymphocytotoxicity test, and HLA-DR by DNA typing method using PCR-reverse hybridization and PCR-SSCP in 56 Korean patients with SSc and 226 healthy controls. For SSc patients, anti-Scl-70 and anicentromere antibodies were tested by double immunodiffusion and indirect immunofluorescence, respectively. RESULTS: The results of HLA class I antigen typing showed that the frequencies of HLA-A24, B52 and B62 were increased, whereas those of A33, B44 and B58 were decreased in SSc patients compared to healthy controls. The frequency of HLA-DR2 was significantly increased, whereas that of HLA-DR13 was decreased in patients with SSc compared to controls. Among HLA-DR2 alleles, both HLA-DRB1*1501 and *1502 were increased in SSc patients compared to controls. According to clinical status, HLA-DRB1*1501 was increased in limited SSc patients and that of DRB1*1502 was increased both in diffuse and limited SSc patients compared to controls. According to autoantibody status, HLA- DRB1 1502 was significantly increased in anti-Scl-70-positive SSc patients and that of DRB1 1501 was increased in anti-Scl-70-negative SSc patients compared to controls. The association of HLA-DR2 alleles with SSc according to clinical subsets and anti-Scl-70 antibody status revealed that the frequency of HLA- DRB1 *1501 was significantly increased in anti-Scl-70-negative limited SSc patients compared to controls. CONCLUSIONS: These results suggest that different HLA-DR2 alleles are associated with different types of SSc in Koreans. HLA-DRB1 1502 shows strong association with anti-Scl-70-positive SSc, and DRB1 1501 with anti-Scl-70-negative limited SSc. It is concluded that the pathogenesis of SSc in Koreans is in part, based on the same genetic background.
Subject(s)
Humans , Alleles , Antibodies , Asian People , DNA Fingerprinting , Fluorescent Antibody Technique, Indirect , HLA-A Antigens , HLA-A24 Antigen , HLA-DR Antigens , HLA-DR2 Antigen , HLA-DRB1 Chains , Immunodiffusion , Scleroderma, SystemicABSTRACT
OBJECTIVE: To evaluate the effects of piroxicam patch(Trast) in rheumatoid arthritis patients with knee joint pain and swelling and to determine the concentration of plasma and synovial fluid following patch application. METHODS: Twenty-two patients with rheumatoid arthritis participated in a double-blind, placebo-controlled study. The patients were instructed to apply piroxicam or placebo patch at one knee and re-apply it every other day for 2 weeks. They had washout period for 2 weeks and then applied the other patch for 2 weeks at the same joint. The patients recorded knee joint pain using visual analog scale. Knee joint swelling and tenderness were assessed before and after application of piroxicam and placebo patch. Complete blood count, AST, ALT, BUN, creatinine, joint fluid analysis were also done. Piroxicam concentration in plasma and synovial fluid were measured by high performance liquid chromatography(HPLC) after 2 weeks of piroxicam patch application. RESULTS: Knee joint pain improved significantly after the application of piroxicam patch for 2 weeks(visual analog scale, 56. 2+5. 9m vs 48. 2+5. 7mm, p=0. 03 by Wilcoxon signed rank test). There was no significant change in white cell count of synovial fluid, peripheral blood cell count, chemistry, C-reactive protein and erythrocyte sedimentation rate. In terms of adverse effects, mild gastrointesti nal disturbance(8/21 cases, 38%) and local side effects such as pruritus and ery thema(3/21 cases, 14%) were developed, which were insignificant compared with control groups(30%, 15% respectively). Piroxicam concentrations in plasma and synovial fluid after the application of piroxicam patch were 0. 129+0. 04ug/ ml (mean+SE) and 0. 644+0. 202ug/ml respectively. CONCLUSIONS: Piroxicam patch is a safe and effective therapeutic modality for knee joint pain in patients with rheumatoid arthritis. Mild adverse effects such as gastrointestinal disturbance and local side effects were noted. Piroxicam concentration was higher in synovial fluid than in plasma following the application of piroxicam patch.
Subject(s)
Humans , Arthritis, Rheumatoid , Blood Cell Count , Blood Sedimentation , C-Reactive Protein , Cell Count , Chemistry , Creatinine , Joints , Knee , Knee Joint , Piroxicam , Plasma , Pruritus , Synovial Fluid , Visual Analog ScaleABSTRACT
Candida arthritis is a rare joint infection. Its predisposing factors include prosthetic joint, intraarticular injection of corticosteroid and immunosuppression. Clinical diagnosis may be difficult because of the absence of specific signs and symptoms. Hence the presence of Candida species in synovial fluid should never be interpreted as laboratory contamination in patients with a risk factor, and therapy should be initiated promptly. We experienced a case of Candida arithritis secondary to repeated intraarticular corticosteroid injection in chronic tophaceous gout. We report the case with review of relevant literature.
Subject(s)
Humans , Arthritis , Candida , Causality , Diagnosis , Gout , Immunosuppression Therapy , Injections, Intra-Articular , Joints , Risk Factors , Synovial FluidABSTRACT
No abstract available.
Subject(s)
Arthritis, Psoriatic , HLA-B27 Antigen , Korea , Prevalence , Psoriasis , SpondylitisABSTRACT
Systemic lupus erythematosus is a connective tissue disease which can affect every organ system. Neurologic abnormalities are common, occuring in approximately half of all patients at some time during the course of their illness. But symptoms of nervous system as the sole presenting symptoms occur in less than 1% of lupus patients. In patients initially presenting with neurologic symptoms and signs, differential diagnosis is difficult and sometimes it may be misdiagnosed. Therefore extensive laboratory investigations should be carried out in all patients with unusual neurological symptoms, since early diagnosis of lupus can help in providing effective treatment. We report a patient with systemic lupus erythematosus who presented with dysarthria and dysphagia resembling multiple sclerosis.