Seasonal Variation in Flares of Inflammatory Bowel Disease in a Korean Population

BACKGROUND/AIMS: Conflicting data have been reported about the seasonal variation in flare-up of inflammatory bowel disease (IBD). The aim of this study was to assess the occurrence of seasonal variations in flare-up of IBD in the Korean population. METHODS: Patients with IBD, who underwent more than 1 year of follow-up and showed more than 1 episode of flare-up, were included. Flares of disease were refined as follows; receipt of a new prescription and increasing dose of corticosteroids, 5-ASA or immunosuppressant; hospitalized or operated due to development and worsening of symptoms; elevation of inflammatory marker due to worsening of Crohn's Disease Activity Index (CDAI) or Mayo score. In addition, for patients with more than two episodes of flare-up, they were investigated in a monthly and seasonal pattern. RESULTS: Of 573 patients with IBD, 46 patients with Crohn's disease and 61 patients with ulcerative colitis were enrolled. There was no association between month of the year and flare of Crohn's disease (P=0.06) or ulcerative colitis (P=0.58). Further, no association between season of the year and flare of Crohn's disease (P=0.06) or ulcerative colitis (P=0.68). However, in Crohn's disease who experience 2 or more flare-ups, symptoms occurred more frequently during winter, especially December (P=0.029). CONCLUSIONS: In the Korean population, there was no association of seasonal and monthly variation in flares of Crohn's disease and ulcerative colitis. However, in Crohn's disease, individuals with 2 flar-up or more, symptoms occurred more frequently during December.

Enhanced A-FABP expression in visceral fat: potential contributor to the progression of NASH

BACKGROUND/AIMS: Adipose tissue is an active endocrine organ that secretes various metabolically important substances including adipokines, which represent a link between insulin resistance and nonalcoholic steatohepatitis (NASH). The factors responsible for the progression from simple steatosis to steatohepatitis remain elusive, but adipokine imbalance may play a pivotal role. We evaluated the expressions of adipokines such as visfatin, adipocyte-fatty-acid-binding protein (A-FABP), and retinol-binding protein-4 (RBP-4) in serum and tissue. The aim was to discover whether these adipokines are potential predictors of NASH. METHODS: Polymerase chain reaction, quantification of mRNA, and Western blots encoding A-FABP, RBP-4, and visfatin were used to study tissue samples from the liver, and visceral and subcutaneous adipose tissue. The tissue samples were from biopsy specimens obtained from patients with proven NASH who were undergoing laparoscopic cholecystectomy due to gallbladder polyps. RESULTS: Patients were classified into two groups: NASH, n=10 and non-NASH, n=20 according to their nonalcoholic fatty liver disease Activity Score. Although serum A-FABP levels did not differ between the two groups, the expressions of A-FABP mRNA and protein in the visceral adipose tissue were significantly higher in NASH group than in non-NASH group (104.34 vs. 97.05, P<0.05, and 190.01 vs. 95.15, P<0.01, respectively). Furthermore, the A-FABP protein expression ratio between visceral adipose tissue and liver was higher in NASH group than in non-NASH group (4.38 vs. 1.64, P<0.05). CONCLUSIONS: NASH patients had higher levels of A-FABP expression in their visceral fat compared to non-NASH patients. This differential A-FABP expression may predispose patients to the progressive form of NASH.

Usefulness of Polyp Detection Rate as a Quality Indicator in Colonoscopy

BACKGROUND/AIMS: The adenoma detection rate (ADR) has been proposed as a quality indicator of colonoscopy; however, ADR cannot be measured easily with commonly used endoscopy reporting systems because substantial time and effort is required to acquire data from histologic assessments. The purpose of this study was to determine if polyp detection rate (PDR) could be used as a valid proxy for ADR. METHODS: A total of 1,156 consecutive, asymptomatic, individuals of average risk between 50 and 75 years-of-age who underwent screening colonoscopies at four tertiary medical centers by 27 gastroenterologists were included in this study. Each individual endoscopist performed at least 10 colonoscopies during the study period. The ADR and PDR were calculated as the proportion of an endoscopist's cases with an adenoma or polyp divided by the total number of colonoscopies. Pearson's correlation coefficient and the intraclass correlation coefficient were used to determine the level of agreement between ADR and PDR. RESULTS: The mean PDR and ADR for endoscopists was 47.4% (range, 21.7-75.0) and 36.5% (range, 13.0-66.7), respectively. There was a strong correlation between PDR and ADR (Pearson's correlation coefficient 0.94, P<0.001) and there was also good agreement between performance quintiles defined by ADR and PDR (intraclass correlation coefficient 0.94, P<0.001). CONCLUSIONS: PDR is a valid proxy for ADR and may be useful for quality assurance at centers where ADR cannot be easily measured.

Bucillamine-induced Nephropathy / 대한류마티스학회지

OBJECTIVE: Bucillamine is a disease-modifying antirheumatic drug that's widely used in Korea and Japan, and it is reported to be a cause of proteinuria. However, the clinical course of the nephropathy associated with the use of bucillamine in rheumatoid arthritis patients has not been described in detail in Korea. METHODS: We examined clinical records of 835 patients who were treated with bucillamine for rheumatoid arthritis at least 2 months at Ajou University Hospital from 2003 to 2008, and we found 23 patients (2.75%) with proteinuria. Each patient was followed up until the proteinuria had resolved. RESULTS: At the time the proteinuria developed, the mean age of patients was 53.8+/-11.0 years. Only one patient had marked hypoalbuminemia (<3.0 g/dL). The mean value of the random urine protein-creatinine ratio was 3.44+/-2.99. The proteinuria appeared 4~18 months after the initiation of the treatment with bucillamine. Among the patients, renal biopsy was carried out in 18 patients, and pathological findings were 17 cases of membranous glomerulopathy and 1 case of focal segmental glomerulosclerosis. On the follow-up of the 18 patients, the proteinuria in all the patients had resolved completely without deterioration of renal function. But the time to resolution of the proteinuria was positively correlated with the length of bucillamine treatment after the onset of proteinuria (p<0.001, r=0.744). CONCLUSION: Prevalence of proteinuria in patients receiving bucillamine was 2.75%, and bucillamine-induced nephropathy showed a good prognosis in Korea. The most important thing for resolving the bucillamine-induced proteinuria is to discontinue the bucillamine.

A Case of Henoch-Schonlein Purpura Associated with Idiopathic Thrombocytopenic Purpura / 대한류마티스학회지

Henoch-Schonlein purpura (HSP) is rarely associated with other autoimmune diseases. We experienced a case of HSP that was associated with idiopathic thrombocytopenic purpura (ITP). A 65-year old male patient complained of fever, purpura, generalized edema and arthralgia. He was diagnosed with HSP and his condition was improved with high-dose corticosteroid treatment. In 12 weeks, the symptoms of HSP were improving, however a thrombocytopenia developed. There was no reasonable cause for thrombocytopenia on the evaluation. He was diagnosed with ITP after bone marrow biopsy. Due to the refractory thrombocytopenia, which didn't respond to other medical treatments, we then performed splenectomy and the patient showed a good response. We report here on the first case of HSP and ITP, and we include a review of the related literature.

Occupational asthma caused by inhalation of bovine serum albumin powder

Bovine serum albumin (BSA), which is present in bovine plasma, is one of the major allergens affecting patients with food allergies induced by milk and meat. It is also commonly used in research laboratories. Although some reports have documented food allergies associated with BSA, BSA-induced occupational asthma has not been reported. We report a case of occupational asthma and rhinitis in a laboratory worker caused by the inhalation of BSA powder, in which an IgE-mediated response was suggested as the pathogenic mechanism.

Occupational asthma caused by inhalation of bovine serum albumin powder

Bovine serum albumin (BSA), which is present in bovine plasma, is one of the major allergens affecting patients with food allergies induced by milk and meat. It is also commonly used in research laboratories. Although some reports have documented food allergies associated with BSA, BSA-induced occupational asthma has not been reported. We report a case of occupational asthma and rhinitis in a laboratory worker caused by the inhalation of BSA powder, in which an IgE-mediated response was suggested as the pathogenic mechanism.

Dermatomyositis with Diffuse Large B Cell Lymphoma / 대한류마티스학회지

Dermatomyositis (DM) is a rare and idiopathic inflammatory myopathy with characteristic cutaneous manifestations. There is a well-recognized association between DM and cancers. In Korea, several DM cases have been reported to be associated with stomach cancer, breast cancer, acute lymphoblastic leukemia, lung cancer, and tonsil cancer. However, an association between DM and lymphoma in Korea has not been reported up to now. We report a case of DM who developed diffuse large B-cell lymphoma 1 year and 8 months later.