Sang Hyun Paik

Interleukin-13 and Its Receptors in Idiopathic Interstitial Pneumonia: Clinical Implications for Lung Function

Idiopathic interstitial pneumonia (IIP) is characterized by varying degrees of interstitial fibrosis. IL-13 and IL-4 are strong inducers of tissue fibrosis, whereas IFN-γ has antifibrotic potential. However, the roles of these substances in IIP remain unknown. IL-13, IL-4, and IFN-γ were measured in the BAL fluid of 16 idiopathic pulmonary fibrosis (IPF) patients, 10 nonspecific interstitial pneumonia (NSIP) patients, and 8 normal controls. The expression of IL-13 and IL-13Rα1/α2 in lung tissues was analyzed using ELISA and immunohistochemistry. IL-13 levels were significantly higher in IPF patients than the others (P<0.05). IL-4 levels were higher in both IPF and NSIP patients than in normal controls (P<0.05), and IFN-γ levels were lower in NSIP patients than in normal controls (P=0.047). IL-13 levels correlated inversely with FVC% (r=-0.47, P=0.043) and DLCO% (r=-0.58, P=0.014) in IPF and NSIP patients. IL-13 was strongly expressed in the smooth muscle, bronchial epithelium, alveolar macrophages and endothelium of IPF patients. IL-13Rα1, rather than IL-13Rα2, was strongly expressed in the smooth muscle, bronchial epithelium, and endothelium of IPF patients. IL-13 and its receptors may contribute to the pathogenesis of fibrosis in IIP and appear to be related to the severity of the disease.

Comparison of high-resolution ultrasonography and computed tomography in the diagnosis of nasal fractures.

Objective. The purpose of this study was to compare the value of high‐resolution ultrasonography (HRUS) and computed tomography (CT) in the diagnosis of nasal fractures. Methods. Facial CT and HRUS examinations performed on 140 consecutive patients (103 male and 37 female; age range, 2–74 years; mean, 26 years) with nasal trauma between October 2004 and April 2007 were retrospectively evaluated. Sonograms were obtained with a hockey stick probe (15–7 MHz linear array transducer). All patients also underwent facial CT and conventional radiography. The nasal fracture detection rates for HRUS, CT, and conventional radiography were compared with the clinical and surgical diagnosis. Nasal fractures were classified into high‐ and low‐grade groups according to severity. They were also compared with the CT findings of all 280 lateral nasal bones and with HRUS findings as the reference standard. Results. The accuracy rates for HRUS, CT, and conventional radiography in detecting nasal fractures were 100%, 92.1%, and 78.6%, respectively. Compared with HRUS, CT revealed only 196 of 233 lateral nasal bone fractures; its accuracy was 80%. In high‐grade fractures, the accuracy of CT was 87%, but it decreased to 68% in low‐grade fractures. Conclusions. Compared with HRUS, CT had lower accuracy, especially in low‐grade nasal fractures. Thus, HRUS is a reliable diagnostic tool for the evaluation of nasal fractures.

High-Resolution Sonography for Nasal Fracture in Children

OBJECTIVE We describe the sonographic findings of nasal fracture in children, and we evaluate the diagnostic value of sonography as compared with conventional radiography and clinical findings to determine whether sonography can be a primary technique for evaluating nasal fracture in children. MATERIALS AND METHODS Conventional radiographs and sonographic scans were obtained in 26 consecutive children with nasal trauma who were seen at our hospital from March 2003 to March 2005. There were five girls and 21 boys, and their ages ranged from 1 year 9 months to 15 years 11 months (mean age, 9.9 years). The following sonographic scans (HDI-5000 unit with a 7-15-MHz linear array transducer) were used to evaluate the nasal bone at different levels: a midline longitudinal image; axial scans of the nasal bones at the upper, middle, and lower levels; images of the nasal septum; and transverse and longitudinal scans of both lateral walls. Ten children also underwent CT. RESULTS Conventional radiographs depicted 14 (54%) of 26 fractures. Sonographic scans were able to show all the fracture lines. One case was diagnosed as an old nasal fracture on the basis of a physical examination, even though a visible fracture line was seen on sonography. The sonographic findings of nasal fracture were disruption of the bone continuity with or without separation of the fractured segment (7/26), displacement of the bone segment as being depressed or overriding (20/26), associated septal deviation (7/26), and separation of the pyriform aperture of the maxilla and nasal bone (2/26). The associated findings were soft-tissue edema and hypoechoic hematoma near the fracture lines in 25 cases. The fractures involved both sides of the nasal bones in 11 of 26 cases, the midline part of the bones in six of 26 cases, and the unilateral paramedian or lateral part of the bones in 12 of 26 cases. Among the 10 CT scans, one CT scan did not depict the fracture, showing only soft-tissue swelling, and one scan showed fractures of the orbital floor and maxilla. CONCLUSION Sonography can be a primary diagnostic technique for evaluating nasal fracture in children. It inflicts no radiation, provides various imaging planes without positional change, and can be used to evaluate the cartilaginous septum. Potential pitfalls are the nasofrontal suture, the junction between the nasal bone and the pyriform aperture of the maxilla, the vascular groove, and the presence of an old fracture. CT can be used in addition to sonography in cases of suspected complex facial bone trauma.

Role of neutrophils in persistent airway obstruction due to refractory asthma.

Background and objective:  One of the clinical manifestations of refractory asthma (RA) in a certain group of patients is persistent airway obstruction (PAO), despite treatment with high doses of inhaled and/or systemic corticosteroids. Airway neutrophilic inflammation is frequently observed in RA; however, the relationship between neutrophilic inflammation and PAO has not been evaluated in this group of patients. The aim of this study was to compare the clinical parameters and patterns of inflammatory cells between patients with or without PAO due to RA, and to identify the factors associated with PAO.

Practical Application of Iterative Decomposition of Water and Fat with Echo Asymmetry and Least-Squares Estimation (IDEAL) Imaging in Minimizing Metallic Artifacts

Iterative decomposition of water and fat with echo asymmetry and the least-squares estimation (IDEAL) is a recently developed method for robust separation of fat and water with very high signal-to-noise-ratio (SNR) efficiency. In contrast to conventional fat-saturation methods, IDEAL is insensitive to magnetic field (B0 and B1) inhomogeneity. The aim of this study was to illustrate the practical application of the IDEAL technique in reducing metallic artifacts in postoperative patients with metallic hardware. The IDEAL technique can help musculoskeletal radiologists make an accurate diagnosis particularly in musculoskeletal imaging by reducing metallic artifacts, enabling the use of contrast enhancement, improving SNR performance, and providing various modes of MR images with one scan parameter.

The Bright Rim Sign on MRI for Anterior Talofibular Ligament Injury With Arthroscopic Correlation

OBJECTIVE The purpose of this article is to determine whether bright rim lesions on MRI are a marker for anterior talofibular ligament injury. MATERIALS AND METHODS The study included 34 patients who had an ankle injury and underwent arthroscopic surgery. All patients underwent 3-T MRI for the diagnosis of anterior talofibular ligament injury. If MRI revealed nonvisualization of the ligament, ligament discontinuity, and unusual ligament thickening (criterion 1) or the bright rim sign (criterion 2), the injury was considered to be a ligament disruption. After MRI, ankle arthroscopy was performed in all patients for a definitive diagnosis. RESULTS Arthroscopy showed anterior talofibular ligament disruption in 33 patients. When the MRI diagnosis was based on criterion 1, anterior talofibular ligament disruption was diagnosed with a sensitivity of 60.6-66.7% and an accuracy of 58.8-67.6%. When the MRI diagnosis was based on both criteria 1 and 2, anterior talofibular ligament disruption was diagnosed with a sensitivity of 90.9-97.0% and an accuracy of 88.2-94.1%. By adding criterion 2 to the diagnosis, the sensitivity for anterior talofibular ligament injury was increased significantly (p < 0.01), and 8-12 additional patients with anterior talofibular ligament injury were diagnosed, most of whom exhibited a partial tear of the anterior talofibular ligament on arthroscopy. The interobserver agreement rate for the presence of anterior talofibular ligament disruption using criterion 1, both criteria, and the bright rim sign was fair to excellent. CONCLUSION A cortical defect with bright dotlike or curvilinear high-signal-intensity lesions on T2-weighted MRI may be an additional morphologic feature to increase the diagnostic performance of detecting anterior talofibular ligament injuries, including those with partial tears.

Primary pulmonary T-cell lymphoma: a case report.

Primary pulmonary T-cell lymphoma is an extremely rare malady, and we diagnosed this in a 52-year-old male who was admitted to our hospital with cough for the previous two weeks. The chest CT demonstrated multiple variable sized mass-like consolidations with low density central necrosis in the peripheral portion of both the upper and lower lobes. Positron emission tomography (PET) showed multiple areas of hypermetabolic fluorodeoxyglucose (FDG) uptake in both lungs with central metabolic defects, which correlated with central necrosis seen on CT. The histological sample showed peripheral T-cell lymphoma of the not otherwise specified form. The follow-up CT scan showed an increased extent of the multifocal consolidative lesions despite that the patient had undergone chemotherapy.

Successful Treatment of Malignant Superior Vena Cava Syndrome Using a Stent-Graft

We report successful outcomes after endovascular placement of a stent graft in a 74- and a 77-year-old men, both of whom had malignant superior vena cava syndrome caused by squamous cell carcinoma. In each patient, successful palliation of the malignant superior vena cava syndrome was achieved by placement of a stent graft. No procedure-related complications were observed. The patients were asymptomatic until their deaths, seven and 14 months after stent graft placement, respectively.

A Quantitative Study of Airway Changes on Micro-CT in a Mouse Asthma Model: Comparison With Histopathological Findings.

Purpose To evaluate airway changes in ovalbumin-induced asthmatic mice in terms of postmortem micro-CT images and pathological findings. Methods Asthma was induced in mice by intraperitoneal injection and nasal instillation of ovalbumin aluminium hydroxide into mice (experimental group, n=6), and another group of mice received intraperitoneal injection and nasal instillation of distilled phosphate-buffered saline (control group, n=6). Bronchial lumen area was measured in the main bronchial lumen of the distal third bronchial branch level (6 parts per each mouse) on axial scans of Micro-CT, using a Lucions smart pen (semi-automated) and a curve pen (manual). Bronchial wall thickness was obtained in 4 sections (2 levels on either side) after the third bronchial branch by measuring the diameter which was perpendicular to the longitudinal axis of the main bronchus on curved Multi-planar reconstruction (MPR) images. Histologic slides were obtained from the lesion that was matched with its CT images, and bronchial wall thicknesses were determined. Results The mean bronchial lumen area was 0.196±0.072 mm2 in the experimental group and 0.243±0.116 mm2 in the control group; the difference was significant. Bronchial wall thickness on micro-CT images (mean, 0.119±0.01 vs. 0.108±0.013 mm) and in pathological specimens (mean, 0.066±0.011 vs. 0.041±0.009 mm) were thicker in the experimental group than in the control group; bronchial wall thickness on micro-CT images correlated well with pathological thickness (for the experimental group, r=0.712; for the control group, r=0.46). The thick bronchial wall in the experimental group demonstrated submucosal hypertrophy along with goblet cell hyperplasia and smooth muscle hyperplasia. Conclusions The results of this study suggest that asthma may induce thickening of bronchial wall and narrowing of the lumen area on micro-CT images and that these results may significantly correlate with pathological findings.

Recurrent Malignant Fibrous Histiocytoma of the Right Atrium with Extracardiac Extension

4Department of Pathology, Soonchunhyang University Hospital Bucheon, Bucheon, Gyunggi, 420-767, Korea. primary cardiac malignant fibrous histiocytoma (MFH) of the right atrium was diagnosed in a 34year-old woman admitted to our hospital with dyspnea. Pathohistological examination confirmed MFH. The tumor recurred rapidly, and a second operation was not performed. A CT chest scan revealed a large mass in the right atrium with extracardiac extension. The patient was treated with chemotherapy using a combined drug regimen. Despite hemodynamic impairment and extracardiac extension, adjuvant chemotherapy promoted partial remission. We report a case of recurrent primary cardiac MFH with extracardiac extension and successful chemotherapeutic management. Primary cardiac tumors are uncommon and most are benign. Malignant tumors account for only 25% of all primary cardiac tumors [1, 2]. Most malignant cardiac tumors are angiosarcomas. Malignant fibrous histiocytomas are rare primary cardiac tumors [3–6]. We report on a case of recurrent primary cardiac MFH with extracardiac extension and successful chemotherapeutic management.