Pseudomembranous Aspergillus Tracheobronchitis: Case Report of a Rare Manifestation of Airway Invasive Aspergillosis

Aspergillus tracheobronchitis, an uncommon form of invasive pulmonary aspergillosis, is characterized by the development of a pseudomembrane, ulcers, or an obstruction that is predominantly confined to the tracheobronchial tree. Pseudomembranous Aspergillus tracheobronchitis is the most severe form of Aspergillus tracheobronchitis, and only a few cases have been reported in Korea. We report the characteristic chest CT findings in a patient diagnosed with pseudomembranous Aspergillus tracheobronchitis after bronchoscopy and successfully treated by proper antifungal treatment.

Guidelines for Cardiovascular Magnetic Resonance Imaging from the Korean Society of Cardiovascular Imaging (KOSCI) - Part 3: Perfusion, Delayed Enhancement, and T1- and T2 Mapping

This document is the third part of the guidelines for the interpretation and post-processing of cardiac magnetic resonance (CMR) studies. These consensus recommendations have been developed by a Consensus Committee of the Korean Society of Cardiovascular Imaging (KOSCI) to standardize the requirements for image interpretation and post-processing of CMR. This third part of the recommendations describes tissue characterization modules, including perfusion, late gadolinium enhancement, and T1- and T2 mapping. Additionally, this document provides guidance for visual and quantitative assessment, consisting of “What-to-See,” “How-To,” and common pitfalls for the analysis of each module. The Consensus Committee hopes that this document will contribute to the standardization of image interpretation and post-processing of CMR studies.

Guidelines for Cardiovascular Magnetic Resonance Imaging from the Korean Society of Cardiovascular Imaging (KOSCI) - Part 2: Interpretation of Cine, Flow, and Angiography Data

Cardiovascular magnetic resonance imaging (CMR) is expected to be increasingly used in Korea due to technology advances and the expanded national insurance coverage of these tests. For improved patient care, it is crucial not only that CMR images are properly acquired but that they are accurately interpreted by well-trained personnel. In response to the increased demand for CMR, the Korean Society of Cardiovascular Imaging (KOSCI) has issued interpretation guidelines in conjunction with the Korean Society of Radiology (KSR). KOSCI has also created a formal Committee on CMR Guidelines to write updated practices. The members of this Committee review previously published interpretation guidelines and discuss the patterns of CMR use in Korea.

CT Features of Vasculitides Based on the 2012 International Chapel Hill Consensus Conference Revised Classification

Vasculitis, characterized by inflammation of vessel walls, is comprised of heterogeneous clinicopathological entities, and thus poses a diagnostic challenge. The most widely used approach for classifying vasculitides is based on the International Chapel Hill Consensus Conference (CHCC) nomenclature system. Based on the recently revised CHCC 2012, we propose computed tomography (CT) features of vasculitides and a differential diagnosis based on location and morphological characteristics. Finally, vasculitis mimics should be differentiated, because erroneous application of immunosuppressive drugs on vasculitis mimics may be ineffective, even deteriorating. This article presents the utility of CT in the diagnosis and differential diagnosis of vasculitides.

Congenital Absence of Superior Vena Cava with no Manifestation of Superior Vena Cava Syndrome

Total absence of superior vena cava (SVC) is a very rare anomaly, and the patient usually suffers from SVC syndrome or conduction disturbances. We report an asymptomatic 27 year-old male, with complete absence of SVC. Transthoracic echocardiography and computed tomography demonstrated the absence of SVC and other congenital cardiac anomalies, but the presence of prominent collateral vessels that allow a sufficient venous return.

Mycobacterium Szulgai Pulmonary Infection: Case Report of an Uncommon Pathogen in Korea

Mycobacterium szulgai (M. szulgai) is an unusual pathogen in a human non-tuberculous mycobacterial infection. Pulmonary infection due to M. szulgai may be clinically and radiologically confused with active pulmonary tuberculosis. In contrast to other non-tuberculous mycobacteria, M. szulgai infection is well controlled by combination antimycobacterial therapy. Most of the previously reported cases of M. szulgai pulmonary infection showed cavitary upper lobe infiltrates. We herein describe a case of pulmonary M. szulgai infection that shows clinical and radiological presentations similar to active pulmonary tuberculosis.

Preoperative N Staging of Gastric Cancer by Stomach Protocol Computed Tomography

PURPOSE: Clinical stage of gastric cancer is currently assessed by computed tomography. Accurate clinical staging is important for the tailoring of therapy. This study evaluated the accuracy of clinical N staging using stomach protocol computed tomography. MATERIALS AND METHODS: Between March 2004 and November 2012, 171 patients with gastric cancer underwent preoperative stomach protocol computed tomography (Jeju National University Hospital; Jeju, Korea). Their demographic and clinical characteristics were reviewed retrospectively. Two radiologists evaluated cN staging using axial and coronal computed tomography images, and cN stage was matched with pathologic results. The diagnostic accuracy of stomach protocol computed tomography for clinical N staging and clinical characteristics associated with diagnostic accuracy were evaluated. RESULTS: The overall accuracy of stomach protocol computed tomography for cN staging was 63.2%. Computed tomography images of slice thickness 3.0 mm had a sensitivity of 60.0%; a specificity of 89.6%; an accuracy of 78.4%; and a positive predictive value of 78.0% in detecting lymph node metastases. Underestimation of cN stage was associated with larger tumor size (P<0.001), undifferentiated type (P=0.003), diffuse type (P=0.020), more advanced pathologic stage (P<0.001), and larger numbers of harvested and metastatic lymph nodes (P<0.001 each). Tumor differentiation was an independent factor affecting underestimation by computed tomography (P=0.045). CONCLUSIONS: Computed tomography with a size criterion of 8 mm is highly specific but relatively insensitive in detecting nodal metastases. Physicians should keep in mind that computed tomography may not be an appropriate tool to detect nodal metastases for choosing appropriate treatment.

Diagnostic Value of Clinical T Staging Assessed by Endoscopy and Stomach Protocol Computed Tomography in Gastric Cancer: The Experience of a Low-Volume Institute

PURPOSE: Clinical staging of gastric cancer appears to be important more and more for tailored therapy. This study aimed to verify the accuracy of clinical T staging in a low-volume institute. MATERIALS AND METHODS: We retrospectively reviewed prospectively collected data of gastric cancer patients who underwent resection. A total of 268 patients of gastric cancer were enrolled from March 2004 to June 2012. These demographics, tumor characteristics, and clinical stages were analyzed for identification of diagnostic value of clinical T staging. RESULTS: The predictive values for pT1 of endoscopy and computed tomography were 90.0% and 89.4%, respectively. In detail, the predictive values of endoscopy for pT1a, pT1b, and pT2 or more were 87%, 58.5%, and 90.6%, respectively. The predictive values of computed tomography for pT1a, pT1b, and pT2 or more were 68.8%, 73.9%, and 84.4%, respectively. The factors leading to underestimation of pT2 or more lesions by gastroscopy were the middle third location, the size greater than 2 cm, and younger age. Those for overestimation of pT1 lesion by computed tomography were male, age more than 70 years, elevated type, and size greater than 3 cm. CONCLUSIONS: Diagnostic accuracy of early gastric cancer was 90%, which is comparable to those of high volume center. In patients with early gastric cancer, limited gastrectomy or minimal invasive surgery can be safely introduced at a low volume center also. However, the surgeon of low-volume institute should consider the accuracy of clinical staging before extending the indication of limited treatment.

Diagnostic Value of Clinical T Staging Assessed by Endoscopy and Stomach Protocol Computed Tomography in Gastric Cancer: The Experience of a Low-Volume Institute

PURPOSE: Clinical staging of gastric cancer appears to be important more and more for tailored therapy. This study aimed to verify the accuracy of clinical T staging in a low-volume institute. MATERIALS AND METHODS: We retrospectively reviewed prospectively collected data of gastric cancer patients who underwent resection. A total of 268 patients of gastric cancer were enrolled from March 2004 to June 2012. These demographics, tumor characteristics, and clinical stages were analyzed for identification of diagnostic value of clinical T staging. RESULTS: The predictive values for pT1 of endoscopy and computed tomography were 90.0% and 89.4%, respectively. In detail, the predictive values of endoscopy for pT1a, pT1b, and pT2 or more were 87%, 58.5%, and 90.6%, respectively. The predictive values of computed tomography for pT1a, pT1b, and pT2 or more were 68.8%, 73.9%, and 84.4%, respectively. The factors leading to underestimation of pT2 or more lesions by gastroscopy were the middle third location, the size greater than 2 cm, and younger age. Those for overestimation of pT1 lesion by computed tomography were male, age more than 70 years, elevated type, and size greater than 3 cm. CONCLUSIONS: Diagnostic accuracy of early gastric cancer was 90%, which is comparable to those of high volume center. In patients with early gastric cancer, limited gastrectomy or minimal invasive surgery can be safely introduced at a low volume center also. However, the surgeon of low-volume institute should consider the accuracy of clinical staging before extending the indication of limited treatment.

B cells activated in the presence of Th1 cytokines inhibit osteoclastogenesis

Host immune response has been considered as an important disease-modifying factor of periodontitis, however, which immune cell(s) or factor(s) are involved in the destruction of periodontium remains unclear. Previously, we reported that osteoclastogenesis is enhanced by activated B cells but suppressed by activated CD8(+)T cells. We present new data that B cells activated in the presence of Th1 cytokines inhibit osteoclastogenesis. Purified murine B cells were activated with anti-IgD mAb, IL-4, and anti-CD40 mAb, in the absence (B(Th2)) or presence of Th1 cytokines, either IL-2 (B(IL-2)) or IFN-gamma (B(IFN-gamma)). Each activated B cell population was co-cultured with RAW264.7 cells in the presence of soluble receptor activator of NF-kappaB ligand (sRANKL), and the effect on osteoclastic differentiation was evaluated. While B(Th2)increased osteoclastogenesis, B(IL-2)and B(IFN-gamma)suppressed it profoundly. To verify the mediating molecule(s), we analyzed cytokine profiles of the activated B cells. Compared to B(Th2), B(IL-2)expressed increased amount of IFN-gamma and B(IFN-gamma)expressed decreased amounts of IL-4, IL-5, and IL-10. IFN-gamma was a key negative regulator of osteoclastic differentiation, and mediated the inhibition by B(IL-2). These results suggest that Th1 cytokines may have new important roles in resistance to periodontitis, acting directly on osteoclasts or indirectly through B cells.

Morphological Study of GFAP Immunoreactive Cells on Fetuses and Neonate Mesencephalon of Korean Native Goat / 대한해부학회지

GFAP (Glial Fibrillary Acidic Protein) was one of the intermediate filament group and used as an astrocyte marker. The numerous studies about GFAP immunoreactive cell's distribution were investigated for fetus, neonate and aged brains. There are several reports about that GFAP immunoreactive cells were appeared at early fetus and after birth. In cases of mammalian fetus radial glia cells migrated toward pial surface at early stage and revealed GFAP immunoreactivity by the immunostain. But in cases of rodents, they migrated at late gestation or after birth. This study, the GFAP immunoreactive cells' localizations and distribution in the fetuses (the 30 th, 45 th, 60 th, 90 th, 105 th, 120 th of gestation) and neonate mesencephalon of korean native goat were investigated by immunohistoche-mistry (ABC method). The results obtained in this study were summarized as followings; 1. Multipolar astrocytes at 60 days of gestation were found in midbrain, in 90 days of gestation were found in cerebral aqueduct. 2. Radial glial cell presented 60 days of gestation and process of GFAP immunoreaction was to stretch out from ventricular to pia mater and nonpolar immunoreactive cell was transformed to bipolar, monopolar and multipolar immunoreactive cell. 3. The number of GFAP immunoreactive cells of field were gradually decreased from 90 days of gestation till 105 days of gestation. But in 120 days of gestation and newborn were slightly increased. 4. Immunoreactivity of GFAP immunoreactive cells were gradually decreased from 95 days of gestation till 120 days of gestatioin. These results were suggested that radial glial cell of midbrain developed very earlier than that of cerebral aqueduct. However, cerebral aqueduct developed lately than that of midbrain, but faster developing than other.