ABSTRACT
Objective: TNF-alpha has a pivotal role in the development of inflammation on mucous lesion in Behcet's disease like Crohn's disease. We examined three single nucleotide polymorphisms (SNPs) of TNF receptor gene of intestinal Behcet's disease and Behcet's disease without gastrointestinal involvement. Methods: DNA of peripheral blood samples was obtained from 43 patients with intestinal Behcet's disease, 59 patients with Behcet's disease without gastrointestinal involvement and 60 healthy controls. After polymerase chain reaction (PCR), we examined SNPs of TNF-alpha gene (-308, -238) and TNF receptor gene (-1493, -196, -1466) by SNaPshot assay. We also analyzed reconstruction of haplotypes of three TNF receptor genes. Results: No significant difference was observed in the distribution of TNF-alpha gene (-308, -238) and TNF receptor gene (-1493, -196, -1466) polymorphisms among the groups. Haplotype reconstruction analysis of three TNF receptor genes showed difference in allele group of (T-T-G)(-1493/-196/-1493) between patients with intestinal Behcet's disease and Behcet's disease without gastrointestinal involvement (p<0.05). However, other allele groups revealed no difference among the groups. Conclusion: The role of TNF-alpha gene (-308, -238) polymorphisms and TNF receptor gene (-1493, -196, -1466) polymorphisms in the pathogenesis of Behcet's disease is not supported by this data. Haplotype reconstruction analysis showed that haplotype of T-T-G (TNFR2, -1493/-196/-1466) in Behcet's disease may have protective effect on gastrointestinal involvement of this disease.
Subject(s)
Humans , Alleles , Crohn Disease , DNA , Haplotypes , Inflammation , Polymerase Chain Reaction , Polymorphism, Single Nucleotide , Receptors, Tumor Necrosis Factor , Tumor Necrosis Factor-alphaABSTRACT
Polyarteritis nodosa (PAN) is a multi systemic disease, occasionally described as limited forms of the disease. Localized form of PAN is usually associated with better prognosis. We describe unusual two cases of patients who has suffered from sudden onset of low extremity pain by localized forms of polyarteritis nodosa. Magnetic resonance imaging of the lower legs showed abnormal signal intensity of the suspected muscle. Acute necrotizing arteritis with myopathy has been revealed by muscle biopsy. The symptom of the patient has been improved soon after corticosteroid administration. Muscle biopsy of symptomatic muscles or MRI-directed biopsies can be useful to diagnose this case as PAN with localized myopathies.
Subject(s)
Humans , Biopsy , Extremities , Leg , Magnetic Resonance Imaging , Muscles , Muscular Diseases , Polyarteritis Nodosa , PrognosisABSTRACT
Garlic(Allium sativum) is recognized as a sensitizing agent responsible for allergic contact dermatitis with food handlers and housewives. Lymphomatoid contact dermatitis, which is a type of allergic contact dermatitis, shows similar histologic features to Mycosis Fungoides. We report a 66-year-old male, who had applied garlic extract to both lower extremities and the trunk for 8 months for relieving his symptoms of arthralgia and generalized pruritis. He had complained of variable sized multiple erythematous pruritic papules on both lower extremities and the trunk and lymphadenopathy of both inguinal and axillary area. Skin biopsy was performed and the histological exam presented microscopically abnormal lymphocyte infiltration in the upper dermis. T-cell marker studies revealed strong CD3 positivity and increased CD4/CD8 ratio. The results of PCR-heteroduplex analysis showed negative for T-cell receptor- gene rearrangement and abscence of T-cell monoclonality. We could diagnose his skin lesion and generalized lymphadenopathy as lymphomatoid contact dermatitis which represented as a T-cell pseudolymphoma histologically. He was treated with local steroid injection and phototherapy and the skin lesion were improved without recurrence.
Subject(s)
Aged , Humans , Male , Arthralgia , Biopsy , Dermatitis, Allergic Contact , Dermatitis, Contact , Dermis , Garlic , Gene Rearrangement , Lower Extremity , Lymphatic Diseases , Lymphocytes , Mycosis Fungoides , Phototherapy , Pruritus , Pseudolymphoma , Recurrence , Skin , T-LymphocytesABSTRACT
Adenomas of the major duodenal papilla are rare but clinically important since they are a premalignant condition. Endoscopic mucosal resection has emerged as the first line therary for ampullary adenoma. However, various complications such as pancreatitis, bleeding or duodenal perforation have been reported after endoscopic mucosal resection. To our knowledge, cholangitis has not been reported as a complication of the procedure in the literature. We report a case of papillary stenosis and cholangitis caused by endoscopic mucosal resection of ampullary adenoma. We performed the endoscopic biliary spincterotomy followed by biliary stenting and cholangitis was successfully controlled.
Subject(s)
Adenoma , Ampulla of Vater , Cholangitis , Constriction, Pathologic , Hemorrhage , Pancreatitis , StentsABSTRACT
Adenomas of the major duodenal papilla are rare but clinically important since they are a premalignant condition. Endoscopic mucosal resection has emerged as the first line therary for ampullary adenoma. However, various complications such as pancreatitis, bleeding or duodenal perforation have been reported after endoscopic mucosal resection. To our knowledge, cholangitis has not been reported as a complication of the procedure in the literature. We report a case of papillary stenosis and cholangitis caused by endoscopic mucosal resection of ampullary adenoma. We performed the endoscopic biliary spincterotomy followed by biliary stenting and cholangitis was successfully controlled.
Subject(s)
Adenoma , Ampulla of Vater , Cholangitis , Constriction, Pathologic , Hemorrhage , Pancreatitis , StentsABSTRACT
Eosinophilic pancreatitis is a rare disorder that may only be diagnosed after pancreatic resection under the suspection of a pancreatic tumor. We experienced a 65-year-old female patient whose initial presentation suggested pancreatic cancer. Radiologic evaluation revealed a pancreatic mass-like lesion which was obstructing the main pancreatic duct. Endoscopic retrograde cholangiopancreatography (ERCP) showed double duct strictures involving the distal common bile duct and the main pancreatic duct. Serum IgE level was elevated. Percutaneous core needle biopsy with an 18-gauge needle was performed targeting the pancreatic lesion. The biopsy specimen revealed fibrotic interlobular septum and intralobular fibrosis with prominent eosinophilic infiltration. The patient was treated with oral prednisolone (40 mg/day). A plastic stent was inserted into the narrowed common bile duct. After three months of oral steroid therapy, symptoms and signs improved rapidly and serum IgE level was decreased. Abdominal computed tomography and ERCP revealed remission of pancreatic mass-like lesion.
Subject(s)
Aged , Female , Humans , Eosinophilia/diagnosis , Pancreatitis/diagnosisABSTRACT
PURPOSE: We describe a 54-year-old woman with systemic lupus erythematosus (SLE) who suddenly presented with chorea and had positive antiphospholipid antibodies. F-18 FDG PET showed abnormally increased glucose metabolism in bilateral putamen and primary motor cotex. Tc-99m ECD SPECT also showed abnormally increased regional cerebral blood flow in bilateral putamen. She was treated with corticosteroid and aspirin after which the symptoms improved. Four months later, follow up F-18 FDG PET showed improvement with resolution of hypermetabolism in bilateral putamen. This case suggests that striatal hypermetabolism is associated with chorea in SLE.
Subject(s)
Female , Humans , Middle Aged , Antibodies, Antiphospholipid , Aspirin , Chorea , Follow-Up Studies , Glucose , Lupus Erythematosus, Systemic , Metabolism , Putamen , Tomography, Emission-Computed, Single-PhotonABSTRACT
BACKGROUND AND OBJECTIVES: Glucocorticoids have demonstrated excellent efficacy in decreasing airway inflammation and controlling bronchial asthma symptoms. However, exacerbations of asthma are frequently observed even during treatment with inhaled glucocorticoids, and most of these episodes occur following viral upper respiratory infections (URI). Recently, it has been suggested that transient resistance to glucocorticoid developed after URI and this resistance to glucocorticoid in asthmatics was related to the increased expression of glucocorticoid receptor beta (GCRbeta). The aim of this study is to evaluate the expression of GCRbeta in asthmatics experiencing exacerbation after an episode of URI. METHODS: Peripheral blood mononuclear cells (PBMCs) were obtained from asthmatics experiencing exacerbation after URI (n=15), stable asthmatics (n=23), and normal controls (n= 12). Exacerbated asthmatics were started on systemic glucocorticoids upto two weeks and PBMCs were obtained again after the treatment. The degree of expression of GCRbeta mRNA and ratio of GCRbeta/GCRalpha mRNA were calculated using the semi-quantitative RT-PCR. RESULTS: Compared with stable asthmatics and normal control, exacerbated asthmatics showed significantly higher expression of GCRbeta mRNA and ratio of GCRbeta/GCRalpha mRNA. However, comparing exacerbated asthmatics before and after treatment, we found no significant difference but trends of reduction in expression of GCRbeta mRNA and ratio of GCRbeta/GCRalpha mRNA after treatment. CONCLUSION: These findings suggest that transient resistance to corticosteroid in asthmatics experiencing exacerbation after an episode of URI may be related to increased expression of GCRbeta.