Summary of molecular mechanisms of spontaneous remission in gouty inflammation / 中国药理学通报

Acute gout subsides spontaneously within a certain period of time after onset, a process known as spontaneous remission of gouty inflammation. Its pathophysiological mechanism is related to the dynamic interaction of various components in the immune system, i. e. through the phagocytosis of autoimmune cells, the negative regulation of inflammatory mediators such as NLRP3 inflammasome, 1L-1R and Toll-like receptors, the recruitment of neutrophil extracellular traps at the site of crystal deposition and the formation of local chronic granuloma, to alleviate the necrotizing inflammation mediated by monosodium urate crystals. This review summarizes the molecular mechanism of spontaneous remission of gouty inflammation.

Chronic Subdural Hematoma Spontaneous Resolution

Introduction Chronic subdural hematoma (CSH) is a hemorrhagic brain injury that persists for more than 21 days after its initial formation. The incidence is predominantly among the elderly population (> 65 years), and varies from 58 to 74/100,000 inhabitants. Spontaneous resolution is considered variable; in the literature series, it is < 1­20% of cases. Objectives To expose the CSH pathophysiological mechanisms of spontaneous resolution and some treatments that lead to hematoma volume reduction. Methods Literature review between 1971 to 2016, using the PubMed, Medline, Embase, Scielo, LILACS and Cochrane databases using key-words, with inclusion and exclusion criteria. Discussion Spontaneous resolution of the CSH pathophysiology is controversial; however, it can be attributed to four basic mechanisms: 1) outer capsule membrane maturation; 2) decreased fibrinolysis; 3) bidirectional flow of blood vessels; and 4) platelet plug. Some drugs, such as mannitol, corticosteroids, tranexamic acid and atorvastatin, contribute to CSH resolution, since they change the capsule membrane permeability, and inhibit the fibrinolytic and inflammatory systems. Conclusion Spontaneous resolution is unpredictable; in some cases, it has a large temporal evolution (of up to 6 years). It occurs in small or laminar collections, asymptomatic or with transient neurological symptoms, and the pathophysiology is still controversial to this day. Therefore, surgical treatment should remain the first option, even though the conservative management is adopted for some patients. Rigorous outpatient and radiological follow-up are recommended.

Introdução O hematoma subdural crônico (HSDC) é uma lesão cerebral hemorrágica que persiste por mais de 21 dias após o começo de sua formação. A sua incidência é predominantemente na população idosa (> 65 anos), e varia de 58­74 /100.000 habitantes, e sua resolução espontânea é considerada rara e variável nas séries da literatura em < 1­20% dos casos. Objetivos Expor os mecanismos fisiopatológicos que favorecem a resolução espontânea do HSDC e alguns tratamentos que favorecem a redução do volume do hematoma. Métodos Revisão bibliográfica entre 1971 e 2016, utilizando as bases de dados PubMed, Medline, Embase, Scielo, LILACS e Cochrane, por meio de palavras-chave, com critérios de inclusão e exclusão. Discussão A fisiopatologia da resolução espontânea dos HSDCs é controversa, porém pode ser atribuída a quatro mecanismos: 1) maturação da membrana externa da cápsula; 2) diminuição da fibrinólise; 3) fluxo bidireccional de vasos sanguíneos; e 4) tampão plaquetário. Alguns medicamentos, tais como manitol, corticoesteroides, ácido tranexâmico e atorvastatina, também podem favorecer a resolução dos HSDCs, uma vez que alteram a permeabilidade da membrana da cápsula e inibem os sistemas fibrinolítico e inflamatório. Conclusão A resolução espontânea é imprevisível; em alguns casos, tem ampla evolução temporal em até 6 anos. Ocorre em coleções pequenas ou laminares, assintomáticas ou com sintomas neurológicos transitórios, e sua fisiopatologia ainda hoje é controversa. Portanto, o tratamento cirúrgico deve continuar sendo a primeira opção, embora se adote uma conduta conservadora para alguns pacientes. O seguimento ambulatorial e radiológico rigoroso é recomendado.

Clinical analysis of 194 patients with congenital hyperinsulinism / 中华实用儿科临床杂志

Objective To summarize the clinical data of 194 patients with congenital hyperinsulinism(CHI),in order to provide the theoretical basis for the diagnosis,treatment and prognosis of CHI.Methods One hundred and ninety-four patients with CHI hospitalized in Beijing Children's Hospital Affiliated to Capital Medical University from February 2002 to January 2016 were recruited.Clinical data of 194 patients were collected and clinical characteristics and treatment were retrospectively analyzed.Results One hundred and forty-four cases in 194 patients were treated with Diazoxide,among whom,88 cases were responsive to Diazoxide,23 cases were unresponsive to Diazoxide,and 33 cases were uncertain to Diazoxide.Twenty-six cases in 194 cases were treated with Octreotide,among whom,16 cases were responsive to Octreotide,5 cases were unresponsive to Octreotide,and 5 cases were uncertain to Octreotide.Eleven cases in 194 cases had the 18 Fluoride-L-dihydroxyphenylalanine positron emission computerized tomography scan (18-F-L-DOPA-PET scan),among whom,7 cases were identified as focal lesion and 4 cases were identified as diffuse lesion.Twelve cases in 194 cases were treated with pancreatectomy,among whom,4 cases achieved normal blood glucose levels,4 cases still suffered from persistent hypoglycemia,3 cases had type 1 diabetes mellitus,and 1 case dropped out after the surgery.Forty-five cases in 194 cases had spontaneous remission and the remission time varied from 1 month to 8 years.Conclusions (1) Diazoxide is the first line drug of CHI.The older age onset is,the higher possibility of responsive to Diazoxide shows.(2)Octreotide is used as the second line drug.(3)18-F-L-DOPA-PET scan is the first choice to identify the location of CHI and it is useful in distinguishing between focal and diffuse forms.(4) The outcome of CHI patients after pancreatectomy is very different.A proper surgical method should be selected before the surgery.The blood glucose should be detected after surgery for a long time.(5) Some patients have the tendency of spontaneous remission.

Spontaneous Resolution of a Traumatic Intracranial Aneurysm

Traumatic intracranial aneurysms are rare, and normally result from blunt or penetrating head traumas. Carotid angiography is considered the gold standard and reliable exam to detect this aneurysm. There are specific angiography features that mark the contrasts between a traumatic aneurysm and a common saccular aneurysm. Most authors agree that once the diagnosis is made, surgery is the ideal treatment. This article presents a case of a successful expectant treatment based on the clinical findings of the patient and combined with a constant evaluation of her case. The clinical findings depend on the location and direction of growth of the aneurysm. Traumatic aneurysms of the internal carotid artery (ICA) are unusual, and occur predominantly in the intracavernous portion of that vessel.

Aneurismas traumáticos intracranianos são raros, e normalmente resultam de um traumatismo craniano fechado ou penetrante. O exame considerado padrão ouro para detectar esse tipo de aneurisma é a angiografia da circulação carotídea. Existem características específicas das angiografias que diferenciam o aneurisma traumático do aneurisma sacular comum. A maioria dos autores acredita que, quando realizado o diagnóstico, o melhor tratamento é a cirurgia. O artigo apresenta um caso de tratamento conservador que evolui com sucesso, baseado nos achados clínicos da paciente, e combinado com avaliação constante do caso. Os achados clínicos na paciente dependem da localização e da direção de crescimento do aneurisma. Aneurismas traumáticos da artéria carótida interna (ACI) são raros, e ocorrem predominantemente na sua porção intracavernosa.

Four Years Prospective Study of Natural History of Atopic Dermatitis Aged 7~8 Years at an Individual Level: A Community-Based Survey by Dermatologists' Skin Examination in Childhood

BACKGROUND: The age-dependent change in atopic dermatitis (AD) at an individual level has mostly performed in a hospital-setting. OBJECTIVE: We evaluated the age-dependent change of AD symptoms at an individual level in a community-setting. METHODS: For the diagnostic accuracy, all participants of schoolchildren were received skin examination by dermatologists (twice a year for the same group), instead of questionnaire-based surveys. For this study, sequential check-ups of 273 elementary school children, aged 7~8 years, were performed for 4 years up to the age of 10~11 years. RESULTS: Among the 47 AD children, who had been diagnosed as having AD at the first-year check-up, spontaneous remission was detected in nine children during the follow-up periods (remission rate of 19.1%). As a consequence, the one-year AD prevalence was decreased by 5.9% in the elementary schoolchildren over four years. Unexpectedly, late onset (after 8 years of age) AD was observed in 21.7% of AD children. There was no statistically significant relationship between spontaneous remission and host factors including sex and family history of atopic diseases. CONCLUSION: We observed that 19.1% of AD children in the age group of 7~11 years showed spontaneous remission based on skin examination by dermatologists. There might be an increase in the prevalence of late onset AD in Korea.

Spontaneous Remission in a Teenage Girl with Acquired Pure Red Cell Aplasia / 임상소아혈액종양

Acquired pure red cell aplasia (PRCA) can be induced by various factors such as viral infection, thymoma, connective tissue disease, lymphoma, and adverse drug reactions. PRCA has not been reported in an adolescent in Korea for the past several decades. We recently experienced a case of acquired PRCA in an adolescent. A 14-year-old girl presented with pallor, dizziness, and mild fever. She had isolated normocytic normochromic anemia with reticulocytopenia in the peripheral blood and erythroblastopenia in the bone marrow. She was diagnosed with secondary acquired PRCA presumably induced by Mycoplasma pneumoniae infection during her clinical course, and she experienced spontaneous remission 11 weeks after initial diagnosis. Her clinical and hematologic statuses were normal as far as 20 months after her diagnosis.

Spontaneous Remission in a Teenage Girl with Acquired Pure Red Cell Aplasia / 임상소아혈액종양

Acquired pure red cell aplasia (PRCA) can be induced by various factors such as viral infection, thymoma, connective tissue disease, lymphoma, and adverse drug reactions. PRCA has not been reported in an adolescent in Korea for the past several decades. We recently experienced a case of acquired PRCA in an adolescent. A 14-year-old girl presented with pallor, dizziness, and mild fever. She had isolated normocytic normochromic anemia with reticulocytopenia in the peripheral blood and erythroblastopenia in the bone marrow. She was diagnosed with secondary acquired PRCA presumably induced by Mycoplasma pneumoniae infection during her clinical course, and she experienced spontaneous remission 11 weeks after initial diagnosis. Her clinical and hematologic statuses were normal as far as 20 months after her diagnosis.

Association of CD4+CD25+FoxP3+ regulatory T cells with natural course of childhood chronic immune thrombocytopenic purpura / 소아과

PURPOSE: The purpose of this study was to determine the frequency of CD4+CD25+FoxP3+ regulatory T cells (Treg) in the peripheral blood of patients with childhood chronic immune thrombocytopenic purpura (ITP) exhibiting thrombocytopenia and spontaneous remission. The findings of this study indicate the possibility of predicting spontaneous recovery and pathogenesis of childhood chronic ITP. METHODS: Eleven children with chronic ITP (seven thrombocytopenic and four spontaneous remission cases; mean age, 8.8 years; range, 1.7-14.9 years) were enrolled in this study. Five healthy children and eight healthy adults were included as controls. The frequency of Treg was evaluated by flow cytometry in the peripheral blood. RESULTS: In this study, four patients (36%) achieved spontaneous remission within 2.8 years (mean year; range, 1.0-4.4 years). The frequency of Treg was significantly lower in patients with persisting thrombocytopenia (0.13%+/-0.09%, P<0.05), than that in the patients with spontaneous remission (0.30%+/-0.02%), healthy adults controls (0.55%+/-0.44%), and healthy children controls (0.46%+/-0.26%). A significantly positive correlation was found between the frequency of Treg and the platelet count in children. CONCLUSION: These data suggest that a lower frequency of Treg contributes to the breakdown of self-tolerance, and may form the basis for future development of specific immunomodulatory therapies. Furthermore, Treg frequency has prognostic implication toward the natural course and long-term outcomes of childhood chronic ITP.

Resolução espontânea de cisto aracnóideo suprasselar / Spontaneous resolution of a suprasellar arachnoid cyst

Cisto aracnóideo é uma coleção de líquido semelhante ao liquor, de parede formada por membranas aracnoides reforçadas por fibras colágenas. É uma anomalia congênita, benigna e rara, correspondendo a aproximadamente 1% das lesões expansivas intracranianas. Geralmente, os cistos aracnóideos (CAr) localizam-se na fossa média e, em apenas 10% dos casos, na região suprasselar. A involução espontânea dos CAr é um fato raro e pouco descrito na literatura. Relata-se um CAr suprasselar diagnosticado intraútero cuja conduta foi conservadora, observando-se sua involução espontânea à ressonância magnética de controle aos 24 meses de vida.

Arachnoid cyst is a benign fluid collection, formed by arachnoid bands. It is a rare congenital abnormality, representing approximately 1% of all intracranial expanding lesions. Generally, the arachnoid cysts (CAr) are located in the middle cranial fossa and only 10% occur in the suprasellar region. The spontaneous resolution of CAr is indeed a rare and poorly described evolution reported in the literature. We report a gestational diagnosed suprasellar cyst with spontaneous resolution at the 24th month old.

A Case of Spontaneous Resolution of Castleman's Disease in the Neck / 대한이비인후과학회지

Castleman's disease, or angiofollicular lymph node hyperplasia, is a rare disorder that involves the proliferation of lymphoid tissue. The disease entity is classified into three pathologic subtypes, namely, the hyaline vascular, plasma cell, and mixed types; however, clinically, they are classified as unicentric and multicentric types. The former is treated primarily by excision, whereas systemic therapies have been used to treat the latter form, because of its more aggressive pattern. We report a case of a 17-year-old woman who underwent an excisional biopsy of one of the multiple affected cervical lymph nodes. A subsequent histopathologic examination revealed hyaline vascular Castleman's disease. One month later, the disease spontaneously regressed and no recurrence was observed over a 12-month period following the excisional biopsy.

Spontaneous Reversibility of an Iatrogenic Orthodontic Elastic Band-induced Localized Periodontitis Following Surgical Intervention – Case Report

Orthodontic elastic bands are an important iatrogenic etiologic factor in the causation of periodontal attachment apparatus breakdown. Appropriate diagnosis and a well constructed treatment plan tailor-made to suit the requirements of the particular patient is imperative for management of periodontal lesions induced by subgingival retention of rubber band. There are conflicting reports regarding the reattachment and regeneration of lost periodontal supporting tissues in such cases. The present case report highlights the spontaneous reversal and correction of periodontal destruction due to iatrogenic orthodontic elastic band displacement deep into the subgingival tissues.

A Case of Hypothyroidism in Remission during Pregnancy

Hypothyroidism should be treated in pregnancy, because it has been associated with an increased risk of adverse pregnancy complications, as well as detrimental effects upon fetal neurocognitive development. The goal of L-thyroxine (LT4) treatment is to normalize maternal serum TSH values within the trimester-specific pregnancy reference range. 50% to 85% of hypothyroid women being treated with exogenous LT4 need to increase the dose during pregnancy. In this study, we report a case of a 29-year-old woman with hypothyroidism who had been in remission and discontinued LT4 treatment during her pregnancy. Three months after delivery she had a relapse of hypothyroidism and was retreated with LT4. Many factors can influence the gestational requirement for LT4, therefore maternal serum TSH should be monitored and the LT4 dose should be adjusted in pregnant patients with treated hypothyroidism.

Spontaneous Complete Occlusion of Middle Cerebral Artery Aneurysm: Case Report

There are few observation papers regarding the natural history of an aneurysm. We report on a case of a completely occluded middle cerebral artery (MCA) aneurysm. A 47-year-old female patient presented with a headache and was diagnosed with rupture of a right MCA aneurysm. Due to a high risk of direct neck clipping, she received conservative treatment after craniotomy and wrapping of her aneurysm. The patient's condition showed improvement, with complete occlusion of the aneurysm and considerable reduction of the aneurysm in size after approximately three years. This is a rare case of an aneurysm of MCA that showed spontaneous resolution. Finally, on the angiogram, characteristics of an aneurysm to occlude spontaneously will be presumed based on literature reviews.

Long Spontaneous Remission in Neuromyelitis Optica

Neuromyelitis optica (NMO) is an inflammatory demyelinating disease of the central nervous system characterized by optic neuritis and longitudinal extensive transverse myelitis. The clinical course can be either polyphasic (relapsing-remitting) or monophasic. The relapsing-remitting course is observed in more than 80% of NMO cases, and relapse generally occurs within 1 year in 60% of patients, and within 3 years in 90%. We report a rare case of long spontaneous remission in untreated NMO.

A Patient with Genetically Confirmed Myoclonus-Dystonia Responded to Anticholinergic Treatment and Improved Spontaneously

BACKGROUND: The various medical treatments applied to myoclonus-dystonia patients with a mutation of the epsilon-sarcoglycan gene (SGCE) have not been beneficial in most cases. Most patients experience progressive deterioration or static clinical courses, with only rare cases of spontaneous remission. CASE REPORT: A 19-year-old girl presented with a 14-year history of myoclonus and dystonia that severely affected her left arm, neck, and trunk. Genetic studies showed a mutation in SGCE [deletion in exon 6 (c.771_772delAT, Cys258X)]. Both myoclonus and dystonia responded to anticholinergic treatment for 7 years and improved spontaneously. CONCLUSIONS: The possibility of spontaneous improvement should be kept in mind when considering the therapeutic strategy in myoclonus-dystonia patients, especially when contemplating deep-brain stimulation.

A Case of Pheochromocytoma Presented with Cardiogenic Shock and Followed by Spontaneous Remission

Pheochromocytoma is derived from the chromaffin cells and patients with pheochromocytoma present with several signs and symptoms by producing, storing and secreting catecholamine. Spontaneous rupture or necrosis of pheochromocytoma is extremely rare, but it can be lethal because of the dramatic change in the circulation such as an acute abdominal emergency or shock. Spontaneous remission of the clinical symptoms due to necrosis of the pheochromocytoma is rare. We describe such a case that presented with cardiogenic shock due to extensive necrosis of the pheochromocytoma and this was followed by spontaneous remission of the clinical symptoms without removal of the pheochromocytoma.

Spontaneous Remission of Nephrotic Syndrome in IgA Nephropathy / 대한신장학회지

Although a moderate degree of proteinuria is common in patients with IgA nephropathy (IgAN), nephrotic syndrome combined with IgAN is rare. It has been reported that approximately 5% of all patients with IgAN are complicated by minimal change disease and these patients respond well to corticosteroid therapy. However, spontaneous remission is uncommon in heavy proteinuric patients with IgAN. Recently, we experienced two cases of spontaneous remission of nephrotic syndrome combined with IgAN without use of corticosteroid. In these patients, heavy proteinuria disappeared in 1 month after the onset and no recurrence occurred during follow-up. With such limited number of cases, factors associated with spontaneous remission in these patients could not be explored. Further study with a larger number of patients is required and careful attention should be paid to these complicated cases.

Temporary Spontaneous Remission in Primary CNS Lymphoma

Spontaneous remission in untreated primary central nervous system lymphoma is rare. A 66-year-old man was admitted with dizziness and gait disturbance. Initial fluid-attenuated inversion-recovery images revealed hyperintensities in the upper brainstem, left temporal lobe, and right occipital lobe. The patient's symptoms and lesions disappeared spontaneously after 1 month. However, he was readmitted after 4 months with right hemiparesis. Magnetic resonance imaging revealed a homogenous enhanced lesion in the left basal ganglia with a vasogenic pattern. This disease warranted biopsy, which revealed large B-cell lymphoma.

Análise comparativa do índice pcc em sujeitos com transtorno fonológico não submetidos a intervenção fonoaudiológica / Comparative analisys of pcc index in individuals with phonological disorders not submitted to speech therapeutic intervention

O objetivo deste estudo foi verificar a ocorrência de remissão espontânea da fala no transtorno fonológico por meio do índice de gravidade Porcentagem de Consoantes Corretas - Revisado (PCC-R). Fizeram parte do estudo 18 sujeitos com diagnóstico funcional de transtorno fonológico, com idades entre 4:0 e 11:5 anos, sendo 14 do sexo masculino e quatro do sexo feminino; nenhum deles havia realizado intervenção fonoaudiológica prévia, e a média entre a avaliação fonoaudiológica inicial para diagnóstico funcional e a avaliação para início de tratamento foi de 5,2 meses. Foram aplicadas as provas de Fonologia do Teste de Linguagem Infantil ABFW, e calculou-se o PCC-R para ambas as provas. Os dados do diagnóstico e avaliação para início de tratamento foram comparados entre si para verificar a ocorrência de remissão, observando-se que não houve diferenças significativas. A correlação entre idade inicial e desempenho fonológico foi fraca, assim como entre tempo de espera e desempenho nas avaliações. Não foi detectada remissão espontânea nos sujeitos estudados.

Phonological disorder’s spontaneous remission was verified by using a severity index, the Percentage of Correct Consonant – Revised (PCC-R). Eighteen individuals with phonological disorder (14 male and four female) aged between 4;0 and 11;5 years old were studied. None of them have had previous speech therapeutic intervention. The mean interval between the initial phonological assessment for diagnosis and the re-assessment for beginning treatment was 5.2 months. Phonological test (Teste de Linguagem Infantil – ABFW) was applied and the PCC-R index was calculated. Data from the initial assessment and from the re-assessment were compared to verify the occurrence of remission. No significant differences were found. The correlation between the age in the initial assessment and the phonological performance was weak. The same was noted in comparing the waiting time for treatment and the performance in the assessment. There was no spontaneous remission in the studied individuals.

An Unusual Case of Spontaneous Remission of Hodgkin's Disease after a Single Cycle of COPP-ABV Chemotherapy Followed by Infectious Complications

Advanced Hodgkin's disease is usually treated with six or more cycles of combination chemotherapy. Spontaneous regression of the cancer is very rarely reported in patients with Hodgkin's disease. We present an unusual case of a patient with Hodgkin's disease who experienced complete remission with a single cycle of chemotherapy, followed by pneumonia. The case was a 36-year-old man diagnosed with stage IVB mixed cellularity Hodgkin's disease in November 2000. After treatment with one cycle of COPP-ABV (cyclophosphamide, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, and vinblastine) chemotherapy without bleomycin, the patient developed interstitial pneumonia and was cared in the intensive care unit (ICU) for two months. Follow-up chest computerized tomography (CT), performed during the course of ICU care, revealed markedly improved mediastinal lymphomatous lesions. Furthermore, follow-up whole body CT and 18-fluorodeoxyglucose positron emission tomography showed complete disappearance of the lymphomatous lesions. Four years later, the patient is well and without relapse. This report is followed by a short review of the literature on spontaneous regression of Hodgkin's disease. To the best of our knowledge, this is the first case report of spontaneous remission of Hodgkin's disease in Korea.