Impaired Osteophyte formation in Patients with Type II Diabetes Mellitus and Knee Osteoarthritis / 대한류마티스학회지

OBJECTIVE: Insulin has been known as a potent growth factor for connective tissues including cartilage and bone.The pathogenesis of type 2 diabetes mellitus is the insulin resistance due to insulin receptor or postreceptor abnormalities.In the present study,we investigate whether radiographic features of knee osteoarthritis in patients with type 2 DM differ from those in nondiabetogenic controls with knee osteoarthritis. METHODS: Radiographs (knee)from 59 female patients with diabetes and knee osteoarthritis were compared with those from 74 female controls who were similar with respect to age,weight,and duration of OA symptoms.Based on the Kellgren and Lawrence criteria,an overall OA severity grade for the index knee was assigned and was rated for the severity of subchondral sclerosis,osteophytes, geodes and joint space narrowing.Patients with inflammatory arthritis such as RA,severe peripheral neuropathy,or diabetic nephropathy were excluded. RESULTS: Although the 2 groups were similar with respect to the severity of joint space narrowing,geode formation,and subchondral sclerosis,osteophytes formation was less common in patients with type 2 diabetes (P=0.041)than controls.In the patients with symptomatic knee OA at least for 11 years,marked osteophyte formation was noted only in 7 of the 17 with DM (41%),but in 15 of the 27 controls (55%). CONCLUSION: Our results suggest that diminished availability of insulin at the cellular level or diabetic microvascular disease may attenuate the chondro- and osteogenesis required for osteophyte formation in the joint of patients with OA.The clinical significance of osteophyte and the pathologic mechanisms of diminished osteophyte formation in patients of knee osteoarthritis with type 2 diabetes is to be determined.

Symptomatic Sacroiliitis in Female Systemic Lupus Erythematosus / 영남의대학술지

We report a case of 17-year-old female with juvenile onset systemic lupus erythematosus Who developed symptomatic unilateral sacroiliitis. She had neither HLA-DR3 nir B27 antigens. Though sacroiliitis have been reported in mail SLE patient. it has been rarely reported in female patients. The rare coexistence of SLE and sacroiliitis. described in this case. may not be determined soley by genetic factors; sacroiliitis may be just an infrequent manifestation of SLE.

Evaluation of Lung Permeability in Patients with Connective Tissue Disease using 99mTc-DTPA Aerosol Scintigraphy / 대한류마티스학회지

OBJECTIVE: The association between the connective tissue diseases and lung diseases is well established. DLCO and 99mTc-DTPA aerosol scintigraphy are used for evaluation of the alvelolar-capillary permeability. This study evaluated the changes in permeability of alveolar-capillary membrane and the utility of the 99mTc-DTPA aerosol clearance to detect lung involvement in patients with connective tissue diseases. METHODS: The patient group consisted of the patients with any proven connective tissue diseases (27 rheumatoid arthritis, 17 systemic lupus erythematosus, 7 other connective tissue diseases) and the control group consisted of healthy 12 persons. The patients and controls were non-smokers and had no concomitant diseases that could affect the result (diabetes, any lung diseases etc). Chest X-ray, spirometric measurements of lung volumes, flow idices, diffusing capacities and 99mTc-DTPA aerosol scintigraphy were performed in the patient group and control group. 99mTc-DTPA aerosol (1110 MBq) was used with the aero-vent jet nebulizer as a lung delivery system. Patients in sitting position inhaled for 5 minutes at normal tidal oral breathing, Scintigraphic data were recorded using the Picker Prism 2000 gamma cammera, 15 frames of the lung were obtained as the area of interest anteriorly and posteriorly (120 msec at each frame, for 30 minutes). 99mTc-DTPA clearance rate was calculated as the time to half clearance (T1/2). RESULTS: The mean clearance rates of 99mTc-DTPA were 64.0+/-24.1 min (RA 70.7+/-26.2 min, SLE 61.6+/-14.0 min, Others 43.9+/-24.7 min), and 47.0+/-10.3 min in the patient group and the control group respectively. Significant correlation was not found between the pulmonary clearance rate of 99mTc-DTPA and other parameters (disease duration, ESR, CRP, DLCO and FEV1/FVC). CONCLUSION: 99mTc-DTPA clearance in the patient group (RA, SLE, others) was significantly decreased than that in control group (p<0.05). In the patient group with normal chest X-ray, 99mTc-DTPA clearance in the connective tissue disorders was significantly decreased than control group (p<0.05). We suggest that 99mTc-DTPA aerosol scintigraphy may be one of useful technique for early detection of the lung involvement in the connective tissue disorders.

Evaluation of Lung Permeability in Patients with Connective Tissue Disease using 99mTc-DTPA Aerosol Scintigraphy / 대한류마티스학회지

OBJECTIVE: The association between the connective tissue diseases and lung diseases is well established. DLCO and 99mTc-DTPA aerosol scintigraphy are used for evaluation of the alvelolar-capillary permeability. This study evaluated the changes in permeability of alveolar-capillary membrane and the utility of the 99mTc-DTPA aerosol clearance to detect lung involvement in patients with connective tissue diseases. METHODS: The patient group consisted of the patients with any proven connective tissue diseases (27 rheumatoid arthritis, 17 systemic lupus erythematosus, 7 other connective tissue diseases) and the control group consisted of healthy 12 persons. The patients and controls were non-smokers and had no concomitant diseases that could affect the result (diabetes, any lung diseases etc). Chest X-ray, spirometric measurements of lung volumes, flow idices, diffusing capacities and 99mTc-DTPA aerosol scintigraphy were performed in the patient group and control group. 99mTc-DTPA aerosol (1110 MBq) was used with the aero-vent jet nebulizer as a lung delivery system. Patients in sitting position inhaled for 5 minutes at normal tidal oral breathing, Scintigraphic data were recorded using the Picker Prism 2000 gamma cammera, 15 frames of the lung were obtained as the area of interest anteriorly and posteriorly (120 msec at each frame, for 30 minutes). 99mTc-DTPA clearance rate was calculated as the time to half clearance (T1/2). RESULTS: The mean clearance rates of 99mTc-DTPA were 64.0+/-24.1 min (RA 70.7+/-26.2 min, SLE 61.6+/-14.0 min, Others 43.9+/-24.7 min), and 47.0+/-10.3 min in the patient group and the control group respectively. Significant correlation was not found between the pulmonary clearance rate of 99mTc-DTPA and other parameters (disease duration, ESR, CRP, DLCO and FEV1/FVC). CONCLUSION: 99mTc-DTPA clearance in the patient group (RA, SLE, others) was significantly decreased than that in control group (p<0.05). In the patient group with normal chest X-ray, 99mTc-DTPA clearance in the connective tissue disorders was significantly decreased than control group (p<0.05). We suggest that 99mTc-DTPA aerosol scintigraphy may be one of useful technique for early detection of the lung involvement in the connective tissue disorders.

The Clinical Effects of Cefpirome for the Treatment of Acute Lower Respiratory Infection / 영남의대학술지

BACKGROUND: In contrast to a healthy person, patients who have acute lower pespiratory tract infection with underlying pulmonary diseases have various pathogens, a rapidly progressie downhill course, and a poor response to prior antimicrobial therapy. Broad spectrum antivacterial therapy is needed for full evaluation. MATERIALS AND METHODS: To evaluate the efficacy and safety of cefpirome, we administered 1gm cefpirome, twice a day to 30 patients who had signs and symptoms of acute lower repiratory infection regardless of their underlying disease, except to those who had an allergic history to antibiotics or severe systemic diseases. RESULTS: The results were as follows : 1) Among 30 cases, 21 cases(70.0%) showed excellent improvement, and 7 cases(23.3%) showed good improvement in their symptoms and signs of acute lower respiratory infection. 2) In 14 cases with isolated pathogens, we observed bacteriologic eradication in 11 cases(78.6%). 3) Significant side effects were not found CONCLUSION: Above results suggest that cefpirome was effective as a monotherapy in patients with acute lower respriatory infection, especially on those with as underlying chronic obstructive pulmonary disease(COPD).

Two Cases of Systemic Lupus Erythematosus with Cerebrovascular Involvement / 영남의대학술지

Systemic lupus erythematosus(SLE) is an autoimmune disease which may affect many different organs and disclose various clinical manifestations. Recently central nervous system(CNS) involvement has been recognized as an increasingly significant contributor to morbidity and mortality of SLE. The clinical manifestations of CNS-lupus are highly variable and range from mild cognitive dysfunction, movement disorder, headache, psychosis to life-threatening stroke and coma. Among the neuropsychiatric disorders encountered in patients with SLE, cerebrovascular disease has been a relatively rare complication. The diagnosis and management of CNS-lupus is difficult because of the lack of useful diagnostic methods. If, cerebrovascular involvement is suspected, then aggressive treatment such as high dose steroid, immunosuppressive therapy, plasma exchange, may be required to reduce high mortality rate. We experienced 2 cases cerebrovascular disease occurring in SLE patients which presented with various neuropsychiatric manifestations. They were diagnosed as CNS-lupus by neuropsychiatric symptoms, brain MRI, and EEG, and showed good response to high dose steroid pulse therapy.