The differential expression of EPHB4 and ephrin B2 in cutaneous squamous cell carcinoma according to the grade of tumor differentiation: a clinicopathological study.

BACKGROUND: EPHB4 and its ligand, ephrin B2, which are receptor tyrosine kinases of the erythropoietin-producing hepatocellular (EPH) family, are known to be linked to several human cancers. The aim of this study was to investigate their expression patterns in cutaneous squamous cell carcinoma (CSCC) in association with tumor differentiation and other variable clinical characteristics. MATERIALS AND METHODS: Immunohistochemical staining for EPHB4 and ephrin B2 was performed in 32 cases of CSCC with different histologic grades. The clinical characteristics and histologic grades of CSCC were evaluated in association with EPHB4 and ephrin B2 expression patterns. RESULTS: EPHB4 and ephrin B2 expression levels were significantly inversely proportional to the grade of differentiation of CSCC (P < 0.001 and P < 0.001, respectively). CONCLUSION: These results indicated that EPHB4 and ephrin B2 can be useful markers for poorly differentiated CSCC.

Measurement of horizontal ocular deviation on magnetic resonance imaging in various disease with acute vertigo.

In our previous study, we found that horizontal ocular deviation (OD) was significantly increased in patients with unilateral vestibular neuritis (VN). This study is aimed to compare the measurements of horizontal OD in various diseases which can present as acute vertigo in the emergency department. We retrospectively reviewed patients who visited the emergency department and underwent brain MRI due to acute vertigo. We compared them to healthy controls who underwent brain MRI for a regular health examination. Among the study participants, 149 patients who were diagnosed with benign paroxysmal positional vertigo (BPPV), unilateral Ménière's disease (MD), vestibular migraine (VM), unilateral vestibular neuritis (VN), or posterior inferior cerebellar artery (PICA) infarction were enrolled. Absolute angles of horizontal OD were larger in the definite MD (19.1 ± 12.7°), possible and probable MD (15.5 ± 11.7°), and VN (22.2 ± 11.7°) groups compared to the control group (4.3 ± 3.7°). Most VN patients (83.3%) had horizontal OD toward the direction of the lesion. About half of the MD patients (46.2%) and half of the patients with PICA infarction (50.0%) had horizontal OD toward the opposite direction of the lesion. Regarding PICA infarction, horizontal OD was observed only in patients who immediately underwent an MRI after developing the PICA territory vestibulocerebellar infarction. Although the exact mechanism of horizontal OD is unclear, this study suggests that horizontal OD reflects a static vestibular imbalance, and that the eyeball is deviated to the weaker of the two vestibular nuclei during neural resting activity. Therefore, horizontal OD could be helpful in assessing for a prior vestibular imbalance.

Post-factum autopsy to confirm cardiac structures visible on computed tomography images of Korean mummies: the radiological basis of paleo-cardiology.

Accurate interpretation of radiological data is important for reliable paleopathological study of mummies. This is especially true for the mummified heart, an anatomically complicated organ that is distorted and displaced due to long-term dehydration and the action of gravity. In the present study, we compared post-factum autopsy results for mummified hearts of differing preservation statuses with corresponding radiological (computed tomography [CT]-image) findings in order to obtain information necessary for accurate radiological diagnosis. We found that the valvular apparatus (especially the aortic valve and chordae tendinae) was easily distinguishable on the CT images of mummies in which more cardiac structures were preserved. We also identified several situations that are known to incur misdiagnosis of cardiac CT images: the presence of pseudo-cavities in the cardiac wall, confusion of the valvular apparatus with cardiac-wall debris, and invisibility of cardiac structures on CT images due to collapse or adhesion. While acknowledging the merits of top-priority CT scanning in non-invasive research, post-factum autopsy also has value as a complementary and confirmatory analysis for enhanced accuracy of diagnoses in paleo-radiological studies.

Knowledge-based iterative model reconstruction in coronary computed tomography angiography: comparison with hybrid iterative reconstruction and filtered back projection.

Background Knowledge-based iterative model reconstruction (IMR) is known to allow radiation dose reduction while preserving image quality. Purpose To investigate the effect of IMR on coronary computed tomography angiography (CCTA) by comparing it with filtered back projection (FBP) and hybrid iterative reconstruction (HIR). Material and Methods Forty-five patients (group A) who underwent CCTA with prospective electrocardiogram (ECG) triggering at 80 kVp were included. All images were reconstructed using three algorithms: FBP, HIR, and IMR. The control group comprised 45 patients (group B) who underwent CCTA at 100 kVp; their images were reconstructed with HIR alone. Objective and subjective image quality was assessed by two radiologists. Results In group A, the signal-to-noise and contrast-to-noise ratios were significantly higher for images reconstructed with IMR than with HIR or FBP ( P < 0.001). IMR was also superior to HIR and FBP in subjective image quality analyses, including image noise, vessel sharpness, beam-hardening artifact, and overall quality ( P < 0.001). Moreover, the images reconstructed using IMR in group A had superior image quality with less radiation exposure than those reconstructed using HIR in group B on both objective and subjective analyses ( P < 0.001). The mean attenuation values were also significantly higher in group A than in group B ( P < 0.001). Conclusion Compared with HIR and FBP, IMR provided higher quality images with less radiation exposure in CCTA, using low kilovoltage and prospective ECG triggering.

Prediction of Vestibular Imbalance in Acute Peripheral Vestibulopathy by Measuring Horizontal Ocular Deviation on Magnetic Resonance Imaging.

OBJECTIVES: The aim of the study is to evaluate whether horizontal ocular deviation (OD) from MR imaging in the emergency room (ER) reflects vestibular imbalance, by comparing the horizontal OD in patients with acute vestibulopathy to controls. STUDY DESIGN: Retrospective review. PATIENTS AND METHODS: A total of 69 patients with acute unilateral peripheral vestibulopathy and 30 healthy subjects were included. Horizontal OD was quantified by using the axial T2-weighted fast-spin echo (FSE) images of the brain at 1.5 T. In the study group, the results of VFTs (videonystagmography [VNG], caloric test, rotary chair test, and cervical vestibular evoked myogenic potentials [cVEMP]) were also reviewed. The averaged angle of right and left horizontal ODs was compared between patients with acute unilateral vestibulopathy and healthy controls. Also, the correlation between horizontal OD and results of VFTs was analyzed in the study group. RESULTS: The averaged angle of horizontal OD in study group (23.7°â€Š±â€Š11.6°) was significantly greater than that of control group (4.27°â€Š±â€Š3.7°) (p < 0.05). Horizontal OD significantly correlated with slow phase velocity of spontaneous nystagmus (SN), the value of caloric paresis (CP) on caloric testing, rotary chair gain, asymmetry ratio of rotary chair test and interaural difference (IAD) of cVEMP, regardless of time intervals between magnetic resonance imaging (MRI) and VFTs. CONCLUSIONS: Horizontal OD significantly correlated with parameters of VFT which reflect the vestibular imbalance. Therefore, horizontal OD can be used as an indicator of unilateral peripheral vestibular weakness.

Spontaneous Resolution of Chronic Subdural Hematoma : Close Observation as a Treatment Strategy.

OBJECTIVE: Chronic subdural hematoma (cSDH) is common condition in neurosurgical field. It is difficult to select the treatment modality between the surgical method and the conservative method when patients have no or mild symptoms. The purpose of this study is to provide a suggestion that the patients could be cured with conservative treatment modality. METHODS: We enrolled 16 patients who had received conservative treatment for cSDH without special medications which could affect hematoma resolution such as mannitol, steroids, tranexamic acid and angiotensin converting enzyme inhibitors. The patients were classified according to the Markwalder's Grading Scale. RESULTS: Among these 16 patients, 13 (81.3%) patients showed spontaneously resolved cSDH and 3 (18.7%) patients received surgery due to symptom aggravation and growing hematoma. They were categorized into two groups based on whether they were cured with conservative treatment or not. The first group was the spontaneous resolution group. The second group was the progression-surgery group. The mean hematoma volume in the spontaneous resolution group was 43.1 mL. The mean degree of midline shift in the spontaneous resolution group was 5.3 mm. The mean hematoma volume in the progression-surgery group was 62.0 mL. The mean degree of midline shift in the second group was 6 mm. CONCLUSION: We suggest that the treatment modality should be determined according to the patient's symptoms and clinical condition and close observation could be performed in patients who do not have any symptoms or in patients who have mild to moderate headache without neurological deterioration.

Joseon funerary texts tested using ancient DNA analysis of a Korean mummy.

In Korea, ancient DNA (aDNA) analysis has been applied to investigations into the genetic affiliations of mummies found in Joseon Dynasty tombs (1392-1910 CE), becoming now indispensable tool for researches studying human remains from archaeological sites. In the course of our recent examinations on a Korean mummy of Joseon Dynasty, we discovered many teeth contained in a pouch. And in fact, the historical literature on the topic of Joseon funerals contain general accounts of pouches in which an individual's lost teeth were collected over the course of a lifetime and, after death, placed in the coffin with the body. To test the veracity of the historical texts, the present study undertook aDNA analyses and compared the results between specifically questioned (Q) samples (teeth) and known (K) samples (brain and bone) from the mummy to ensure that they came from the same individual. Although the Q-K comparison of autosomal short tandem repeat results did not show full concordance due to allelic drop-outs in some loci, our statistical calculation indicated that the teeth in the pouch are highly likely those of the mummy. Additionally, Q-K comparison of mitochondrial DNA sequence results showed 100% matches between samples. There results, in short, could not gainsay the conjecture that the teeth samples originated from the person buried in the tomb; and if so, he must have kept his teeth for a long time after their loss. As the application of aDNA analysis to Korean mummy studies develops, there will be other opportunities to test historical documents, particularly those referring to funerary rites.

Expression of insulin-like growth factor-1 receptor in conventional cutaneous squamous cell carcinoma with different histological grades of differentiation.

BACKGROUND: Insulin-like growth factor-1 receptor (IGF-1R) is a key regulator of cell transformation and controls the expression of genes that governs cell cycling and cell survival. The aim of this pilot study was to gain insight into the expression pattern of IGF-1R in conventional cutaneous squamous cell carcinoma (CSCC) using immunohistochemical analysis. MATERIALS AND METHODS: Five cases of normal human paraffin-embedded skin sections, 4 cases of actinic keratosis, and 28 cases of paraffin-embedded sections of different histological subtypes of CSCC were selected for immunohistochemical analysis. RESULTS: In normal skin, IGF-1R expression was detected in the epidermal basal cell layer. In actinic keratosis, IGF-1R was expressed in the lower part of the epidermis. IGF-1R was detected in the cell surface membrane of well-differentiated CSCC. In moderately differentiated CSCC, IGF-1R was expressed predominantly in the cytoplasm. Interestingly, IGF-1R was expressed in the nuclei of tumor cells of poorly differentiated CSCC. CONCLUSIONS: The strong and differential expression of IGF-1R in different histological degrees of CSCC indicates a possible role for IGF-insulin receptor in the carcinogenesis and differentiation of this disease and identifies IGF-1R as an interesting target for prevention and treatment of CSCC that deserves further investigation.

3-Dimensional reconstruction of the venous system in patients suffering from pulsatile tinnitus.

CONCLUSIONS: An abrupt change in the venous caliber, producing turbulent flow, may be a cause of pulsatile tinnitus (PT). The largest area/smallest area (L/S) ratio >4.75 may be a criterion indicating abrupt caliber change and causing PT. OBJECTIVES: Contrast-enhanced CT is recommended as an initial work-up modality in PT. But, in the majority of cases, no definite pathology can be found, even after extensive work-up. In these cases, the unilateral dominant venous system may be the cause of PT. The aim of this study was to compare, through 3D-reformatted images of the intracranial venous system, the volume, cross-sectional area, and caliber changes in patients with PT and normal controls. METHODS: This was a cross-sectional study set in a tertiary referral center. Eleven patients (11 unilateral PT ears) and 12 normal control ears were enrolled. All the subjects were confirmed with normal CT angiography findings. The intracranial venous structure was three-dimensionally reconstructed. Three areas with the largest and the smallest dimension were selected for further analysis: the transverse sinus (T), isthmus (I), and the jugular bulb (B). The total volume, cross-sectional area, and cross-sectional area ratios of the three areas were compared in the PT group and the normal control group. RESULTS: The L/S ratio was significantly increased in the PT group (5.01), compared with the control group (3.42). When the threshold value of the L/S ratio was assessed by the ROC method, 4.75 seemed to be the significant dissecting point. The sensitivity of this method was 0.64 and the specificity was 0.83.

Aquagenic urticaria: a report of two cases.

Aquagenic urticaria is a rare form of physical urticaria, in which contact with water evokes wheals. A 19-year-old man and a 4-year-old boy complained of recurrent episodes of urticaria. Urticaria appeared while taking a bath or a shower, in the rain, or in a swimming pool. Well-defined pin head to small pea-sized wheals surrounded by variable sized erythema were provoked by contact with water on the face, neck, and trunk, regardless of its temperature or source. Results from a physical examination and a baseline laboratory evaluation were within normal limits. Treatment of the 19-year-old man with 180 mg fexofenadine daily was successful to prevent the wheals and erythema. Treatment with 5 ml ketotifen syrup bid per day resulted in improvement of symptoms in the 4-year-old boy.

Diffuse pneumocephalus : a rare complication of spinal surgery.

The common etiologies of pneumocephalus, presence of air in the intracranial cavity, are trauma and cranial surgery. Pneumocephalus after spinal surgery is an unusual postoperative complication. We report the case of a male 59-year-old man who developed a pneumacephalus after posterior lumbar surgery for spinal stenosis. Intraoperatively, a cerebrospinal fluid leak following a dural tear was noted and immediately repaired. The next day, the patient complained of headache and dizziness. Head and lumbar computed tomography scans revealed significant air in the frontal region, several cisterns, intraventricle, and extra-dural area in the spine canal. Symptoms were spontaneously resolved within 2 weeks with conservative management.

Diffusion tensor imaging and fiber tractography of patients with cervical spinal cord injury.

To verify the usefulness of diffusion tensor imaging (DTI) and fiber tractography (FT) compared with routine magnetic resonance imaging (MRI) in patients with cervical spinal cord injury, and to clarify the relationship between motor and sensory impairments and DTI and FT parameters, we performed routine MRI and DTI on 10 patients with chronic cervical spinal cord injury and on 10 controls. Quantitative parameters of DTI, such as fractional anisotropy (FA) and apparent diffusion coefficient (ADC), were calculated for each cervical cord level. FT parameters of imaginary crossing fiber numbers were also determined at the C3 level, from C3-C6, and from C3-C7, as well as each connection rate. All patients' clinical motor and sensory functions were examined using the International Standards for the Neurological Classification of Spinal Cord Injury (ISCSCI). FA values in the controls and patients were 0.76 ± 0.08 (mean ± standard deviation) and 0.58 ± 0.11, respectively, and ADC values in the controls and patients were 1.29 ± 0.75 × 10(-3) mm(2)/sec and 1.26 ± 0.66 × 10(-3) mm(2)/sec, respectively. In patients with cervical cord injury, abnormal cervical levels detected on routine MRI were not correlated with clinical findings and DTI parameters, but FA of DTI was correlated with motor function, as were imaginary crossing fiber numbers and connection rates of FT. Quantitative DTI and FT analyses were useful in the evaluation of patients with cervical spinal cord injury. The injured cervical spinal cord can be evaluated in more detail and more precisely using DTI and FT, for which findings are correlated with clinical findings such as neurological impairments.

Cystic embryonal sarcoma of the kidney: report of a case with US and CT findings.

Here we report a case in a 41-year-old woman histologically proven cystic embryonal sarcoma of the kidney, with emphasis on the imaging findings and pathological features. A large lobulated solid mass in the cystically dilated pelvocalyceal region was accompanied with hydroureter as depicted on both ultrasound and contrast-enhanced CT images.

Magnetic resonance imaging performed on a hydrated mummy of medieval Korea.

Previous investigations have shown that magnetic resonance imaging (MRI) can be employed as an efficient non-invasive diagnostic tool in studies on Egyptian mummies. MRI, moreover, because it produces especially clear images of well-hydrated tissue, could be a particularly effective diagnostic option for mummies that still retain humidity within tissues or organs. Therefore, in the present study, we tested MRI on a 17th century mummy, one of the most perfectly preserved 'hydrated mummies' ever found in Korea, in order to determine the quality of images that could be obtained. We found that the diagnostic value of an MRI scan of the hydrated mummy was not inferior to that of a computed tomography scan. The T1- and T2-weighted magnetic resonance (MR) signals showed unique patterns not easily obtained by computed tomography, the resultant MR images revealing the organ specificities clearly. Overall, the quality of the MR images from the hydrated mummy was superb and the scientific value of MRI in the study of hydrated mummies should not be underestimated.

Three-dimensional reconstruction of medieval child mummy in Yangju, Korea, using multi-detector computed tomography.

Recently reported studies on the medieval mummies in Korea have been regarded as an invaluable source for studying the physical characteristics of medieval Koreans. However, since the reported medieval mummies were re-buried by their descendants without any scientific investigations, the development of a brief, non-invasive investigation technique was desperately needed among the researchers in Korea. In this regard, we tried to apply high-quality multi-detector computed tomography (MDCT) with three-dimensional (3D) reconstructions and multi-planar reformat (MPR) to investigate Korean mummies. In our study, after 1.25 or 2.5mm thin slice axial images were taken, 3D reconstruction and MPR were performed to get more accurate information about internal organs. In this trial, we successfully showed high-quality images for the brain, muscles, bones, heart and liver. During various trials for getting selected organs, we could make the 3D reconstructed images of them. Since we could show that the current MDCT technique could be useful for obtaining high-quality 3D reconstructed images of the internal organs of Korean mummies, this technique will be used in forthcoming similar cases, which could not be investigated using invasive techniques.