Tips for finding magnetic resonance imaging-detected suspicious breast lesions using second-look ultrasonography: a pictorial essay

Second-look ultrasonography (US) is a targeted breast US examination that evaluates suspicious lesions detected on magnetic resonance imaging (MRI). It is a useful tool for determining the probability of malignancy and facilitating US-guided biopsy. Lesions detected on MRI and US should be correlated accurately, which is challenging in some cases. This article documents second-look US and MRI findings that are correlated with the pathology, and suggests helpful approaches for correlating between the two modalities.

Fibrosing Mediastinits Causing Obstruction of Left Lower Lobar Bronchus: A Pediatric Case Report

Fibrosing mediastinitis is a rare benign disorder characterized by the proliferation of dense fibrous tissue within the mediastinum. It typically manifests as localized or infiltrative soft-tissue masses in the middle mediastinum or hilar area, which cause compression and encasement of adjacent mediastinal structures, such as the vessels or airway. Here, we report a rare case of fibrosing mediastinitis in a 13-year-old girl that presented as a middle mediastinal mass lesion on CT scan with obliterating left lower lobar bronchus. The patient’s symptoms and follow-up chest CT showed significant improvement following systemic corticosteroid treatment. As fibrosing mediastinitis can improve with systemic steroid therapy, radiologists must be aware of its radiologic findings when discriminating between infiltrating soft tissue lesions in the mediastinum.

Unilateral Pulmonary Vein Atresia Initially Presenting as Interstitial Lung Disease in an Elderly Female: Serial Chest Radiograph Changes and Its Literature Review

Unilateral pulmonary vein atresia (PVA) is a rare congenital cardiovascular anomaly occurring after the common pulmonary vein fails to incorporate into the left atrium. It is most commonly diagnosed in childhood, and diagnosis after reaching adulthood is extremely rare. Dyspnea on exertion and hemoptysis are common clinical features in adult PVA patients, whereas lung parenchymal abnormalities are indirect signs of PVA, which can manifest as interstitial lung disease. Herein, we present the case of a 62-year-old female diagnosed with unilateral PVA presenting as unilateral interstitial lung disease and report the changes in her chest radiographs over 12 years.

Effect of fermented milk product on composite resin surface / 대한구강보건학회지

Objectives@#The present study was carried out to identify the effects of commercially available fermented milk on the surfaces of composite resins. @*Methods@#The experiment included 6 groups: Fermented milk (Group 3), fermented milk supplemented with 3% calcium (Group 4), specimens coated with fluoride and then treated with fermented milk (Group 5), specimens coated with fluoride and then treated with fermented milk supplemented with calcium (Group 6), mineral water (Group 1), and carbonated beverage (Group 2). The prepared specimens were immersed in the experimental solution to analyze the effects of the test fluid on the surfaces of the composite resin specimens. The degree of microhardness on each specimen surface was subsequently measured. The results were obtained using scanning electron microscopy. @*Results@#The pH values of the experimental solutions in an increasing order were: Group 2 (2.34 ±0.08), Group 3 and Group 5 (3.45±0.03), Group 4 and Group 6 (4.04±0.06), and Group 1 (7.72 ±0.17). Significant differences in the Vickers hardness number (△VHN) were found between the groups when measured before and after immersion in the experimental solution in the following order: -11.48±1.45 (Group 2), -9.54±1.15 (Group 3), -9.21±1.21 (Group 4), -8.14±0.84 (Group 6), -8.10±0.92 (Group 5), and -1.71±0.57 (Group 1) (P<0.05). Scanning electron microscopy findings of the composite resin surfaces in Groups 5 and 6 revealed smooth surfaces similar to those in Group 1 ( negative control). In contrast, Groups 3 and 4 showed rough surfaces with severe cracks between the crystals, similar to those of Group 2 (positive control). @*Conclusions@#The intake of fermented milk may attenuate the surface microhardness of composite resins. To slow down the reduction in microhardness following fermented milk consumption, coating the composite resin surfaces with fluoride and adding calcium supplement to the fermented milk could be considered.

Effect of fermented milk product on composite resin surface / 대한구강보건학회지

Objectives@#The present study was carried out to identify the effects of commercially available fermented milk on the surfaces of composite resins. @*Methods@#The experiment included 6 groups: Fermented milk (Group 3), fermented milk supplemented with 3% calcium (Group 4), specimens coated with fluoride and then treated with fermented milk (Group 5), specimens coated with fluoride and then treated with fermented milk supplemented with calcium (Group 6), mineral water (Group 1), and carbonated beverage (Group 2). The prepared specimens were immersed in the experimental solution to analyze the effects of the test fluid on the surfaces of the composite resin specimens. The degree of microhardness on each specimen surface was subsequently measured. The results were obtained using scanning electron microscopy. @*Results@#The pH values of the experimental solutions in an increasing order were: Group 2 (2.34 ±0.08), Group 3 and Group 5 (3.45±0.03), Group 4 and Group 6 (4.04±0.06), and Group 1 (7.72 ±0.17). Significant differences in the Vickers hardness number (△VHN) were found between the groups when measured before and after immersion in the experimental solution in the following order: -11.48±1.45 (Group 2), -9.54±1.15 (Group 3), -9.21±1.21 (Group 4), -8.14±0.84 (Group 6), -8.10±0.92 (Group 5), and -1.71±0.57 (Group 1) (P<0.05). Scanning electron microscopy findings of the composite resin surfaces in Groups 5 and 6 revealed smooth surfaces similar to those in Group 1 ( negative control). In contrast, Groups 3 and 4 showed rough surfaces with severe cracks between the crystals, similar to those of Group 2 (positive control). @*Conclusions@#The intake of fermented milk may attenuate the surface microhardness of composite resins. To slow down the reduction in microhardness following fermented milk consumption, coating the composite resin surfaces with fluoride and adding calcium supplement to the fermented milk could be considered.

Overlooked and Challenging Encounters–Inflammatory Pseudotumors in the Abdomen and Pelvis: A Pictorial Essay

Inflammatory pseudotumors (IPTs) are uncommon, mass-forming lesions, predominantly involving the lung and orbit. Although the incidence of IPTs is rare in the abdomen and pelvis, they can be encountered as enhancing, soft-tissue lesions, mimicking malignancy or fibrosclerosing disease. Generally, they exhibit a wide range of nonspecific imaging features in various organs. Preoperative imaging diagnosis of IPTs in appropriate clinical settings may help determine proper patient management. In this article, we review radiologic findings of IPTs in the abdominopelvic cavity, including the liver, spleen, kidney, gastrointestinal tract, mesentery, pelvis, and retroperitoneum.

Clinical and Radiological Findings of Coronavirus Disease 2019 Pneumonia: 51 Adult Patients from a Single Center in Daegu, South Korea

Purpose@#The purpose of this study was to describe the clinical features and chest computed tomography (CT) findings of coronavirus disease 2019 (COVID-19) pneumonia. @*Materials and Methods@#An Institutional Review Board-approved retrospective review was performed for 51 laboratory-confirmed COVID-19 pneumonia patients. Patients were divided into two groups depending on their clinical status: mild and severe. Clinical characteristics and chest CT findings were compared between the two groups. @*Results@#Among the 51 patients (22 men, 29 women; mean age, 56.5 ± 16 years; range, 22–88 years), 37 (72.5%) were in the mild group and 14 (27.5%) were in the severe group. The patients in the severe group (68.7 ± 12.5 years) were older than the patients in the mild group (51.8 ± 14.9 years, p < 0.001). Premorbid conditions and decreased lymphocyte counts were more often observed in the severe group than in the mild group (71% vs. 41%, p = 0.049 and 86% vs. 32%, p = 0.001, respectively). On chest CT, most patients exhibited a mixed ground-glass opacification (GGO) with consolidation (76%) or a GGO (22%) pattern. The majority of lesions were predominantly bilateral in the lower lung with a posterior, peripheral distribution. The patients in the severe group had higher severity scores than those in the mild group. @*Conclusion@#Patients with laboratory-confirmed COVID-19 pneumonia have typical chest CT findings that provide important information regarding expected disease severity.

Establishment of a Nationwide Korean Imaging Cohort of Coronavirus Disease 2019

Background@#The Korean Society of Thoracic Radiology (KSTR) recently constructed a nation-wide coronavirus disease 2019 (COVID-19) database and imaging repository, referred to the Korean imaging cohort of COVID-19 (KICC-19) based on the collaborative efforts of its members. The purpose of this study was to provide a summary of the clinico-epidemiological data and imaging data of the KICC-19. @*Methods@#The KSTR members at 17 COVID-19 referral centers retrospectively collected imaging data and clinical information of consecutive patients with reverse transcription polymerase chain reaction-proven COVID-19 in respiratory specimens from February 2020 through May 2020 who underwent diagnostic chest computed tomography (CT) or radiograph in each participating hospital. @*Results@#The cohort consisted of 239 men and 283 women (mean age, 52.3 years; age range, 11–97 years). Of the 522 subjects, 201 (38.5%) had an underlying disease. The most common symptoms were fever (n = 292) and cough (n = 245). The 151 patients (28.9%) had lymphocytopenia, 86 had (16.5%) thrombocytopenia, and 227 patients (43.5%) had an elevated CRP at admission. The 121 (23.4%) needed nasal oxygen therapy or mechanical ventilation (n = 38; 7.3%), and 49 patients (9.4%) were admitted to an intensive care unit.Although most patients had cured, 21 patients (4.0%) died. The 465 (89.1%) subjects underwent a low to standard-dose chest CT scan at least once during hospitalization, resulting in a total of 658 CT scans. The 497 subjects (95.2%) underwent chest radiography at least once during hospitalization, which resulted in a total of 1,475 chest radiographs. @*Conclusion@#The KICC-19 was successfully established and comprised of 658 CT scans and 1,475 chest radiographs of 522 hospitalized Korean COVID-19 patients. The KICC-19 will provide a more comprehensive understanding of the clinical, epidemiological, and radiologic characteristics of patients with COVID-19.

Objective Verification of Acute Tinnitus and Validation of Efficacy of Systemic Steroids in Rats

Background@#This study was performed to identify acute tinnitus and evaluate the efficacy of steroids for noise-induced acute tinnitus by measuring the gap-prepulse inhibition of the acoustic startle (GPIAS) value in an animal model. @*Methods@#Nineteen rats (the noise group [n = 7] and the noise + dexamethasone [DEX] group [n = 12]) were exposed to narrow-band noise centered at 16 kHz from a sound generator for 4 hours. The noise + DEX group received intraperitoneal steroid administration daily for 5 days (1.5 mg/kg/day) after completing noise exposure. Auditory brainstem response and GPIAS value were measured just prior to, and 1 day after noise exposure and on days 1 and 10 days after completing steroid administration. The changes in cochlear structure were evaluated by histological analysis. @*Results@#The threshold shift was checked 1 and 10 days after intraperitoneal steroid injection, and no differences in threshold shift were observed between the two groups in each frequency except for 32 kHz 1 day after steroid injection. The mean GPIAS value in the noise + DEX group (36.4% ± 14.1%) was significantly higher than that in the noise group (16.4% ± 18.8%) 10 days after intraperitoneal steroid administration (P = 0.017). There were no pathological changes associated with noise trauma in the two groups as determined on hematoxylin and eosin and immunohistochemical staining. @*Conclusion@#An acute tinnitus model with minimal structural changes by noise exposure was set up, and used to verify tinnitus objectively by measuring the GPIAS value. Steroid therapy for control of tinnitus was validated in this animal model.

Objective Verification of Acute Tinnitus and Validation of Efficacy of Systemic Steroids in Rats

Background@#This study was performed to identify acute tinnitus and evaluate the efficacy of steroids for noise-induced acute tinnitus by measuring the gap-prepulse inhibition of the acoustic startle (GPIAS) value in an animal model. @*Methods@#Nineteen rats (the noise group [n = 7] and the noise + dexamethasone [DEX] group [n = 12]) were exposed to narrow-band noise centered at 16 kHz from a sound generator for 4 hours. The noise + DEX group received intraperitoneal steroid administration daily for 5 days (1.5 mg/kg/day) after completing noise exposure. Auditory brainstem response and GPIAS value were measured just prior to, and 1 day after noise exposure and on days 1 and 10 days after completing steroid administration. The changes in cochlear structure were evaluated by histological analysis. @*Results@#The threshold shift was checked 1 and 10 days after intraperitoneal steroid injection, and no differences in threshold shift were observed between the two groups in each frequency except for 32 kHz 1 day after steroid injection. The mean GPIAS value in the noise + DEX group (36.4% ± 14.1%) was significantly higher than that in the noise group (16.4% ± 18.8%) 10 days after intraperitoneal steroid administration (P = 0.017). There were no pathological changes associated with noise trauma in the two groups as determined on hematoxylin and eosin and immunohistochemical staining. @*Conclusion@#An acute tinnitus model with minimal structural changes by noise exposure was set up, and used to verify tinnitus objectively by measuring the GPIAS value. Steroid therapy for control of tinnitus was validated in this animal model.

Osteoradionecrosis of the Anterior Thoracic Wall after Radiation Therapy for Breast Cancer

Although osteoradionecrosis of the thoracic wall is rare, severe complications following radiation therapy for breast cancer can occur. The authors report the case of a 65-year-old woman who developed osteoradionecrosis in the left thoracic wall 17 years after undergoing radiation therapy for breast cancer. Chest CT revealed fractures in the left third and fourth ribs as well as in the sternal body, with severe sclerotic and lytic changes and cortical irregularity. Ultrasonography of the left chest wall revealed diffuse edematous changes in the overlying skin layer. Radiologists should be familiar with the imaging findings of osteoradionecrosis to differentiate osteoradionecrosis from bony metastasis.

Ultrasonographic features of traumatic neuromas in breast cancer patients after mastectomy

PURPOSE: The purpose of this study was to evaluate the ultrasonographic (US) features of traumatic neuromas in breast cancer patients after mastectomy. METHODS: This study was performed with approval from our Institutional Review Board, and the requirement for informed consent was waived. Six traumatic neuromas in five patients were included in this study. The US findings of traumatic neuromas were evaluated retrospectively by two radiologists according to the Breast Imaging-Reporting and Data System (BI-RADS) lexicon. The final assessment was also recorded. RESULTS: On US, all six lesions presented as a mass within the pectoralis muscle layer (mean size, 4.8 mm; range, 3.9 to 5.5 mm). Of the six masses, four had an oval shape with a circumscribed margin, and two had an irregular shape and an indistinct margin. They were all hypoechoic. Two lesions showed a non-parallel orientation. On color Doppler examinations, two lesions showed internal vascularity. Strain elastography was performed for four neuromas, resulting in scores of 1 (n=1), 4 (n=2), and 5 (n=1). The final assessment categories were BI-RADS 3 (n=2), 4A (n=2), and 4B (n=2). CONCLUSION: On US, an oval shape, circumscribed margin, parallel orientation, and hypoechogenicity were the most frequent features of traumatic neuromas in breast cancer patients after mastectomy. Neuromas may show increased vascularity on color Doppler imaging and present as a hard mass on elastography.

Establishment of a Multipotent Neural Stem Cell Line from the Adult Mouse Cerebrum / 대한척추외과학회지

STUDY DESIGN: Establishment of a multipotent neural stem cell line from the adult mouse cerebrum. OBJECTIVES: To establish a daughter cell line, B2A1, from B2 cells through the limiting dilution method, and to determine if the cells have the characteristics of neural stem cell (NSCs) using immunocytochemistry and RT-PCR methods. SUMMARY AND LITERATURE REVIEW: In the development of NSCs, differentiated organ or tissue-derived multipotent stem cells have attracted considerable interest because of the lack of ethical issues. Previously, a glial precursor cell line (B2 cells) was generated from the primary cultures of oligodendrocytes/ astrocytes in an adult BALB/c mouse brain. These cells exhibited the cell-type specific markers for immature neuroectodermal cells, astrocytes, and oligodendrocytes in serum-contained media. MATERIALS AND METHODS: The primary cultures of oligodendrocytes/astrocytes were established from the whole brains of 12 to 16-week-old BALB/c mice from either gender. After 6 months with 25 serial passages, the culture consisted of a morphologically homogeneous cell population, which was designated as B2 cells. A subclone, B2A1, was isolated from B2 cells through two consecutive limiting dilutions. RESULTS: More than 90% of B2A1 cells showed immunopositivity for nestin, a specific marker for NSC. The cells also showed immunopositivity for the neuronal, astrocytic and oligodendroglial markers. These cells expressed the genotypic mRNA messages for both neural progenitor cells and differentiated neuronoglial cells. These positive immunocytochemical reactions and mRNA messages for neuronoglial cells varied according to the extrinsic growth factors used. However, the treatment of extrinsic growth factors did not produce any significant differences in the nestin-immunopositive cells. CONCLUSIONS: B2A1 cells have the immunocytochemical and cytogenetic properties of NSCs, and the capacity to differentiate into neuronoglial cells.

A Novel Missense Mutation of Doublecortin: Mutation Analysis of Korean Patients with Subcortical Band Heterotopia

The neuronal migration disorders, X-linked lissencephaly syndrome (XLIS) and subcortical band heterotopia (SBH), also called "double cortex", have been linked to missense, nonsense, aberrant splicing, deletion, and insertion mutations in doublecortin (DCX) in families and sporadic cases. Most DCX mutations identified to date are located in two evolutionarily conserved domains. We performed mutation analysis of DCX in two Korean patients with SBH. The SBH patients had mild to moderate developmental delays, drug-resistant generalized seizures, and diffuse thick SBH upon brain MRI. Sequence analysis of the DCX coding region in Patient 1 revealed a c.386 C>T change in exon 3. The sequence variation results in a serine to leucine amino acid change at position 129 (S129L), which has not been found in other family members of Patient 1 or in a large panel of 120 control X-chromosomes. We report here a novel c.386 C>T mutation of DCX that is responsible for SBH.

The Expressions of iNOS and the Effects of iNOS Inhibitor in the Rats of Cisplatin Induced Nephrotoxicity / 대한비뇨기과학회지

PURPOSE: This study was designed to investigate the role of NO in cisplatin induced nephrotoxicity of rats, especially in association with expressions of inducible nitric oxide synthase(iNOS) and the effects of iNOS inhibitor. MATERIALS AND METHODS: Male, Sprague-Dawley rats weighing 170-190gm were used. Nephrotoxicity was induced by single intraperitoneal administration of cisplatin(10mg/kg). Aminoguanidine sulfate (300mg/kg), a relatively specific iNOS inhibitor, was administrated 30 minutes prior to cisplatin administration. Individual kidneys were obtained from control, cisplatin single treated and cisplatin combined with aminoguanidine treated rats at 6, 12, 24, 48, 72hours and 7days after cisplatin administration. Serum BUN/creatinine(mg/dl), the unit weight of rat kidney (kidney wet weight/body weight) were estimated. HE stain was performed for histologic evaluation of nephrotoxicity. The expressions of iNOS were assessed by Western blotting and RT-PCR. RESULTS: Serum BUN/creatinine levels in aminoguanidine treated groups were suppressed its increment significantly at 12, 24 and 48 hours compared with cisplatin single treated groups (p<0.05). The unit weight of kidneys in aminoguanidine treated groups were decreased significantly at 24 and 48hours compared with cisplatin single treated groups (p<0.05). Western blotting represents intense iNOS protein bands (117KDa) at 24,48 and 72hours in cisplatin single treated groups. RT-PCR assay for iNOS mRNA (429bp) were weakly expressed in control groups and intense expressions were identified cisplatin single treated and cisplatin combined with aminoguanidine treated groups at 6, 12, 24 and 72hours. CONCLUSIONS: From these results, it is suggested that cisplatin induced nephrotoxicity may be partly mediated by NO. Aminoguanidine may delay or suppress the cisplatin induced nephrotoxicity of rat kidney.

Clinical Significance of Basic Fibroblast Growth Factor Expression in Bladder Cancer / 대한비뇨기과학회지

Basic fibroblast growth factor (bFGF) is a potent mitogen and angiogenic protein that may function as an autocrine growth regulator in a variety of malignancies. However, the prognostic value of bFGF expression in bladder cancer has not been adequately studied. We examined tumor tissues of 22 superficial and 25 invasive bladder cancers to define the prognostic value of bFGF expression. We performed immunohistochemical staining of bFGF in formalin-fixed and paraffin-embedded bladder tissue sections using rabbit polyclonal antibody. Microvessels were identified by immunohistochemistry using antibodies to endothelial marker, factor VIII-related antigen. The staining of bFGF were significantly correlated with grade and T stage (p<0.05). The elevated expression of bFGF in patients with invasive bladder cancer was significant correlated with recurrence and 2 year survival (p<0.05). However, no significantly correlation was observed between level of bFGF and vascular counts in frozen sections derived from bladder cancers. These results suggest that the bFGF expression has an important prognostic value in patients with bladder cancer. Immunohistochemical study for bFGF may become a valuable method to predict long-term survival and necessity for adjuvant therapy in patients with bladder cancer.

Ureteral Duplication: Review of 20 Cases / 대한비뇨기과학회지

Duplicated collecting system is one of more common malformations of the urinary tract. Incomplete duplication rarely causes clinical problem but complete duplication often accompany complication of varying degree. We herein analyze retrospectively 20 patients with duplication who admitted to Dept. of Urology, Seoul National University Hospital during recent 3 years. There are 5 patients under age of 15. Six were male, 14 female. Nine patients had complete, 10 incomplete duplication. In 1 patient complete and incomplete duplication were presented. Three patients had bilateral, 17 unilateral duplication. Common chief complaints flank pain, urinary incontinence with voiding, fever and hematuria. Five patients had urinary tract infection documented by urine culture. I.V.P. was performed in all cases. Four refluxes were found in 7 V.C.U., Four ectopic ureteral orifices were recognized in 3 patients by cystopanendoscopy but not identified in 2 patients. Associated abnormalities were 6 extravesical ectopic ureter, 4 hydronephrosis, 4 ureteral stone, 2 ureterocele, 2 vesicoureteral reflux and pyelonephritis in 3 patients. Various surgical interventions were necessary in 17 patients, resulted in relief of chief complains. But 4 out of 17 patients experienced persistent urinary tract infection.

Ureteral Duplication: Review of 20 Cases / 대한비뇨기과학회지

Duplicated collecting system is one of more common malformations of the urinary tract. Incomplete duplication rarely causes clinical problem but complete duplication often accompany complication of varying degree. We herein analyze retrospectively 20 patients with duplication who admitted to Dept. of Urology, Seoul National University Hospital during recent 3 years. There are 5 patients under age of 15. Six were male, 14 female. Nine patients had complete, 10 incomplete duplication. In 1 patient complete and incomplete duplication were presented. Three patients had bilateral, 17 unilateral duplication. Common chief complaints flank pain, urinary incontinence with voiding, fever and hematuria. Five patients had urinary tract infection documented by urine culture. I.V.P. was performed in all cases. Four refluxes were found in 7 V.C.U., Four ectopic ureteral orifices were recognized in 3 patients by cystopanendoscopy but not identified in 2 patients. Associated abnormalities were 6 extravesical ectopic ureter, 4 hydronephrosis, 4 ureteral stone, 2 ureterocele, 2 vesicoureteral reflux and pyelonephritis in 3 patients. Various surgical interventions were necessary in 17 patients, resulted in relief of chief complains. But 4 out of 17 patients experienced persistent urinary tract infection.

Ultrasonography in Urology / 대한비뇨기과학회지

Diagnostic ultrasonography was performed on 34 cases with, various urological disorders, mainly of the kidney, and its diagnostic accuracy and simplicity were evaluated.

Ultrasonography in Urology / 대한비뇨기과학회지

Diagnostic ultrasonography was performed on 34 cases with, various urological disorders, mainly of the kidney, and its diagnostic accuracy and simplicity were evaluated.