Inhibition of Osteoclast Differentiation and Bone Resorption by Poria cocos Wolf Extract / 대한골다공증학회지

OBJECTIVES: Osteoclast differentiation and bone resorption are considered a potential therapeutic target to the treatment of erosive bone diseases, including osteoporosis and rheumatoid arthritis. Poria cocos Wolf (PCW), commonly used herbal medicine, has previously been reported to induce anti-inflammatory effect and anti-cancer effect, and to modulate immunologic responses. However, the effects of PCW on osteoclasts, and its detailed mechanisms are not proven. Therefore, we examined the inhibitory mechanism of PCW on osteoclast differentiation and bone resorption. MATERIALS AND METHODS: To analyze the effects of PCW on osteoclast differentiation, we examined osteoclast differentiation in bone marrow macrophages (BMMs) treated with or without of PCW by TRAP staining. The expression of c-Fos, NFATc1, TRAP and OSCAR mRNA was determined by RT-PCR and the protein levels of c-Fos, NFATc1, p38, ERK, JNK, Akt and IkappaB were assessed by western blot. Also, we evaluated the effect of PCW on bone resorption using hydroxyapatite plate. RESULTS: PCW significantly inhibited RANKL-mediated osteoclast differentiation without any evidence of cytotoxicity. We founded that PCW strongly inhibited RANKL-induced osteoclast formation when added during the early stage of cultures, suggesting that PCW acts on osteoclast precursors to inhibit RANKL/RANK signaling. Among the RANK signaling pathways, PCW inhibited the phosphorylation of p38 and JNK, also inhibited RANKL-induced expression of c-Fos, NFATc1, TRAP and OSCAR. In addition, PCW suppressed the bone resorption of mature osteoclasts. CONCLUSIONS: These findings suggest that PCW may be a potential novel drug for bone disorders by targeting the differentiation of osteoclasts as well as their functions.

A case of huge extrauterine endometrioid-type adenomyoma with cystic change: A case report and literature review / 대한산부인과학회지

Adenomyoma is a benign tumor composed of smooth muscle and benign endometrium. These tumors typically originate within the uterus. An extrauterine adenomyoma is a rare entity. Cystic degeneration of adenomyoma is also very rare case. We report a case of huge extrauterine endometrioid-type adenomyoma with cystic change with brief review of literature.

Laparoscopically assisted vaginal hysterectomy with bilateral salpingo-oophorectomy of adult granulosa cell tumor with endometrial carcinoma: A case report and literature review / 대한산부인과학회지

Granulosa cell tumors of ovary are rare neoplasms, which account for 2~5% of all ovarian malignancies. Ovarian granulosa cell tumors are often associated with endometrial hyperplasia or carcinoma. The endometrial carcinoma is thought to occur under the influence of the estrogen receptor pathway and is typically a low-grade endometrioid adenocarcinoma. We present a case of granulosa cell tumor of the ovary and synchronous endometrial carcinoma that were managed with laparoscopically assisted vaginal hysterectomy and bilateral salpingo-oophorectomy, with brief review of literature.

Effect of Jak2 Inhibitor AG490 on Osteoclast Differentiation / 대한해부학회지

Osteoclasts are cells of hemopoietic origin that play an critical role in bone resorption and responsible for bone diseases, including osteoporosis, periodontal disease, and rheumatoid arthritis. In this study, we examined the effect of AG490, a Jak2-specific inhibitor on osteoclast differentiation. AG490 significantly inhibited receptor activator of NF-kappaB ligand (RANKL)-mediated osteoclast differentiation in a dose-dependent manner. RANKL stimulated the phosphorylation of p38, ERK, and JNK and promoted I-kappaB degradation. However, AG490 suppressed the phosphorylation of p38 induced by RANKL treatment. AG490 suppressed the mRNA expression of TRAP, c-Fos, NFATc1, and OSCAR in bone marrow-derived macrophages (BMMs) treated with RANKL. Also, AG490 significantly inhibited the protein expression of c-Fos and NFATc1 in response to RANKL. These results suggest that AG490 inhibited osteoclast differentiation by suppressing the expression of c-Fos and NFATc1.

Ultrasonographic Findings of Carpal Tunnel Syndrome in Patients with Paraplegia

OBJECTIVE: To assess the diagnostic value of ultrasonography for the median nerve, the state of life style activities and the pain degree of upper extremities in paraplegics with carpal tunnel syndrome (CTS). METHOD: Eighteen wheelchair ambulators with spinal cord injury who had neurological level below T2 were studied. Patients with peripheral or central neuropathies were excluded. Patients were assigned to either the electrodiagnostic CTS (group CTS, 7) or electrodiagnostically negative (group non- CTS, 11), and healthy volunteers (15) were classified as control group. The cross sectional area of the median nerve (MN-CSA) at carpal pisiform level was ultrasonographically measured. The degree of painful restriction to execute ADL by hands (TR-ADL), the pain grade (visual analog scale, VAS) of upper extremities and revised version of Korean spinal cord independence measure (KSCIM-R) for functional level were measured and analyzed. RESULTS: Nine hands (14.3%) of 7 patients out of 34 hands had CTS in electrodiagnostic study. There were significant difference among groups in TR-ADL hours (CTS group; 5.0 vs non-CTS group; 10.2, p0.05), MN-CSA (12.3 mm2 vs 7.9 mm2 vs control group; 8.0 mm2, p<0.05). Using the ROC curve, the cut-off value of MN-CSA produced 8.5 mm2 providing a diagnostic sensitivity of 77.8% and specificity of 59.6%. CONCLUSION: The ultrasonographic measurement of the median nerve may be a useful non-invasive screening test for the diagnosis of CTS in paraplegic patients with wrist pain.

Carcinosarcoma (True Malignant Mixed Tumor) of the Parotid Gland: A Report of a Case with Small Cell Carcinoma as the Carcinoma Component

True malignant mixed tumor (carcinosarcoma) of the salivary gland is an extremely rare tumor. By definition, it is a heterologous neoplasm that's composed of both malignant epithelial and mesenchymal components. We report here on a case of an 83 year old female patient with a parotid gland mass. Histologic examination showed a biphasic pattern of growth with both a poorly differentiated epithelial component and a sarcomatous spindle cell background. The immunohistochemical and ultrastructural findings support the diagnosis of a small cell neuroendocrine epithelial tumor and an undifferentiated malignant mesenchymal features. The histologic and ultrastructural features along with the immunohistochemical findings are presented. We also review the literature and we discuss the different opinions on the exact histogenesis of the true malignant mixed tumor of the salivary gland. To the best of our knowledge, this histological pattern has not been previously reported in the English medical literature.

A case of retroperitoneal leiomyosarcoma presenting as a pelvic mass / 부인종양

The authors report a rare case of retroperitoneal leiomyosarcoma in a 49 year-old woman, with a palpable mass in the left lower abdomen. There is a large neoplasm which was soft and movable, looking a pelvic mass. Abdominal and pelvic CT scan showed a 11.0x9.2x7.5 cm-sized lobulated heterogenous enhancing mass with multifocal necrotic portion near the left ovary. Laparotomy and resection of the mass was performed. Microscopic examination revealed 15 mitoses per 10 high power fields. She was diagnosed as primary leiomyosarcoma originated from the left common iliac vein, stage I (IB). The best treatment of these neoplasms is complete surgical excision, and no therapeutic benefit has been derived from chemotherapy or radiotherapy. Though metastases are occasional, local recurrences can be taken into consideration and, after a careful tumoral re-staging, they can be resected once more. Therefore, careful follow-up is necessary on the basis of neoplastic grading, extension and involvement of the adjacent structures.

Roles of Sphingosine-1 Phosaphate During Pathogenesis of Bone Destruction and Inflammation in Rheumatoid Arthritis Mice Model / 대한해부학회지

Sphingosine 1-phosphate (S1P) is a bioactive lipid molecule that mediates cell proliferation, differentiation, migration, and angiogenesis in vivo. However, the roles of S1P on pathogenesis of arthritis have been not completely understood. This study was designed to determine the effects of S1P modulation on collageninduced arthritis (CIA) model. DBA/1J mice were injected with collagen into the tail for induction of CIA model. S1P was administered into the peritoneal cavity every other days from day 1 to day 42 after collagen injection. To determine the degree of damage in CIA, we examined macroscopic findings of CIA. The inflammation and bone destruction of CIA mice were evaluated by histo-patholigy and radiography (CT and microradiography). The expressions of TNF-alpha, IL-6, and RANKL which have important roles in pathogenesis of rheumatoid arthritis and bone destruction were observed by immuno-histochemical staining. After injection with collagen in the DBA/1J mice, CIA was induced by swelling in the knee and ankle joint. Administration of S1P suppressed damages and incidence of arthritis elicited by collagen. In histologic and radiographic studies, S1P strongly suppressed the infiltration of inflammatory cells, the swelling of synovial membrane, erosion, and the destruction of bone on CIA mice. Injection of S1P resulted in down-regulation of the expression of the pro-inflammatory and bone destruction mediators such as TNF-alpha, IL-6, and RANKL on CIA mice. Furthermore, S1P suppressed the differentiation of bone marrow cells into osteoclasts by RANKL. In conclusion, this study suggest that S1P has protective effects on inflammation and bone destruction during pathogenesis of CIA, which indicates S1P can be a new possible therapeutic strategy for rheumatoid arthritis

A Case of Isoniazid Induced Systemic Lupus Erythematosus / 대한류마티스학회지

Many drugs have been known to induce lupus-like syndrome, composing approximately 10% of all SLE cases. Isoniazid-induced lupus erythematosus affects either sex equally and the most common presenting feature is arthralgia or arthritis with anemia. Fever and pleuritis occur in approximately half of the cases, and pericarditis in approximately 30% of cases. We discribe a 28-year-old woman receiving antituberculous medications including isoniazid for one month. She was hospitalized with fever, arthralgia and newly developed pleural effusion The analysis of pleural fluid and serum revealed an elevated level of antinuclear antibody. We suspected of drug induced lupus and stopped isoniazid medication. After discontinuation of isoniazid and short course of prednisolone treatment, her symptoms and pleural effusion disappeared. This case is to our knowledge, the fist report of isoniazid induced SLE in Korea.

A Case of the Pedunculated Angiomyolipoma Attached to Renal Cortex / 대한신장학회지

A renal angiomyolipoma is uncommon congenital mixed tumor like formations consisting of blood vessel, smooth muscle cells and adipose tissue. We report a case of retroperitoneal hemorrhage from spontaneous rupture of renal angiomyolipoma in a 37 year-old woman that appeared unilateral and pedunculated attached to renal cortex. The patient presented with a clinical feature of flank pain and shock because of massive hemorrhage. Because the patient suffered from flank pain regardless of selective renal embolization, laparoscopic surgery was necessary to remove angiomyolipoma from renal cortex.

The Effect of Vitamin-C Vaginal Tablets (Vagi-C(R)) in Patients with Each Vaginitis in Pregnancy and in Normal Pregnant Women / 대한주산의학회잡지

OBJECTIVE: The purpose of this study is to evaluate the effect of Vitamin-C vaginal tablets on vaginal pH and vaginitis symptoms of pregnant women. METHODS: Ninety pregnant women who visited the antenatal clinic were included in this study after giving their informed consent. The treatment regimen of the vitamin-C vaginal tablets (250 mg, Vagi-C(R), Taurus Pharma GmbH, Germany) was one tablet given once a day for 6 consecutive days. Vaginal pH was measured the day before and the day after the Vit-C vaginal treatment. Ninety women of initial, ten failed to follow-up (participate). After routine screening using microscopic analysis of the vaginal smears, 31 of the 80 participating women fell into one of 3 pathologic groups (15 monilial infection, 10 bacterial vaginosis, 6 trichomonial infection) and leaving 49 pathogen-free pregnant women. 10 of the pathogen-free pregnant women were excluded during the study because they did not complete the treatment period due to vaginal irritation such as itching or burning sensations. The diagnosis of each vaginal infection was made by specific pathologic findings. RESULT: Mean vaginal pH values for the pathology group decreased significantly from 4.9 to 4.2. Pathologic findings of each infection were also improved without specific treatment. Bacterial vaginosis disappeared in 80.0% (8/10) of patients. The specific pathogens of the remained two vaginitis types were not detected in 33.3% (5/15) of monilial infection and 33.3% (2/6) trichomonial infection 1 week after discontinuation of Vitamin-C vaginal tablets. Although it is not significant, mean vaginal pH values decreased from 4.4 to 4.2 in the pathogen-free pregnant women. CONCLUSION: Vitamin-C, when vaginally applied, is effective in lowering vaginal pH and in the treatment of vaginitis in pregnant women.

A Case of bladder stone after intravesical migration of Lippes IUD / 대한산부인과학회지

Migration of an intrauterine device into the bladder, together with secondary stone formation is an extremely rare complication. We have recently encountered the migration of a Lippes loop into the urinary bladder and an associated secondary stone formation. We report our findings together with a review of the literature.

A Study on Correlation of Vascular Endothelial Growth Factor in Preeclampsia / 대한주산의학회잡지

OBJECTIVE: The purpose of this study was to assess the impact of vascular endothelial growth factor (VEGF) in pregnancies with mild and severe preeclampsia. METHODS: From January 1999 to June 2001, we studied the severity for pregnant women with pregnancy induced hypertension between 28 and 40 weeks gestation. In the mild (n=46) and severe preeclamptic women (n=28), the laboratory evaluation included liver function test, platelet counts, and serum creatinine. The systolic/diastolic (S/D) ratio of the fetal umbilical artery flow for placental resistance was measured by ultrasonographic doppler velocimetry. To detect the damage of vascular endothelial cells in all preeclamptic women, serum concentrations of VEGF were measured. RESULTS: Severe preeclampsia had more elevated liver enzymes, thrombocytopenia, high creatinine than mild preeclampsia. HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) was encountered in 8/28 (28.6%) of severe preeclampsia. Fifteen out of twenty-eight cases (53.6%) in severe preeclampsia had elevated S/D ratio from 3.0 to 4.5 including 6 cases with absent end diastolic velocity, whereas 4/46 (8.7%) was elevated SD ratio (>3.0) in mild preeclampsia. Serum concentrations of VEGF were elevated in both mild (7.5+/-4.9 ng/mL, p<0.05) and severe preeclampsia (19.3+/-8.8 ng/mL, p<0.05) compared to normal pregnancy (0.5~2.1 ng/mL). CONCLUSION: The higher serum concentration of VEGF and elevated S/D ratio of umbilical artery were responsible for the changes of the resistance of placental blood flow in severe preeclampsia. Furthermore, elevated S/D ratio of umbilical artery velocity was essential as a surveillance method of fetal health status with IUGR (Intrauterine growth restriction) by vascular declination of placenta.

Involvement of Oxidative Stress in Cisplatin-Induced Apoptosis in HeLa Cells / 대한산부인과학회잡지

OBJECTIVE: To determine whether oxidants are formed as part of the cisplatin-induced apoptotic process, intracellular markers of oxidative stress were examined. METHODS: Apoptotic death of HeLa cells by cisplatin was confirmed by flow cytometry. RESULTS: The pre-treatment with glutathione (GSH) significantly attenuated cisplatin-induced apoptosis through the reduction of reactive oxygen species (ROS) accumulation and diminished caspases-3 and 9 protease activity. Furthermore, z-VAD-fmk, an inhibitor of pan-caspase, effectively inhibited the activation of caspases and prevented apoptosis by cisplatin, although cisplatin-induced ROS generation was not attenuated. CONCLUSION: These data indicate that ROS may play a role as an upstream mediator of caspases. Taken together, our results suggest that oxidative stress mediates cisplatin-induced apoptosis in HeLa cells.