In the management of carotid cavernous fistula, detachable balloon has become the treatment of choice.However, technical difficulties are not uncommon, and transarterial balloon embolization fail in 5% to 10% ofcases. Failure occurs because in some patients, the fistula orifice may be too small to allow entry. Using atracker catheter system with Guglielmi detachable coils, we achieved successful transarterial occlusion of acarotid cavernous fistula with a small fistula.
Balloon Occlusion ; Catheters ; Fistula* ; Humans

PURPOSE: To evaluate a scoring system based on ultrasonographic findings as a means of distinguishing between benign and malignant solid breast masses. MATERIALS AND METHODS: Histopathologically confirmed benign (n=102) and malignant (n=73) breast masses which ultrasonographic findings of histopathologic masses were reviewed for shape, border, internal echo, boundary echo, posterior echo, lateral echo, and ratio of transverse to anteroposterior diameter. There were statistically significant (p < 0.001 ; chi-square test) differences in each feature for benign and malignant lesions. The findings suggesting benignancy, equivocality, and malignancy of the masses were scored as 0, 1, and 2 respectively. The scores for all features were summed for each lesion. An ROC curve was obtained. RESULTS: When the score was 6, five benign and seven malignant cases were found. Scores of 0 and 1 indicated benign masses and a score above 11, malignancy. The turning point was a score of 6, so a score above 7 suggests malignancy. CONCLUSION: A ultrasonographic scoring system can be used to characterise breast masses. A score of a mass above 7 suggests probable malignancy and a score below 5 suggests benignancy.
Breast* ; ROC Curve ; Ultrasonography*

The unrestricted population of CD4+Foxp3+ regulatory T (Treg) cells, which have been known to control the expression of autoimmune diseases and protective immunity to inflammatory reactions, has led to greater appreciation of functional plasticity. Detecting and/or isolating Ag-specific CD4+Foxp3+ Tregs at the single cell level are required to study their function and plasticity. In this study, we established and compared both MHC class II tetramer and intracellular CD154 staining, in order to detect CD4+Foxp3+ Treg specific for foreign Ag in acute and chronic infections with lymphocytic choriomeningitis virus (LCMV). Our results revealed that MHC class II tetramer staining showed a lower detection rate of LCMV GP66-77-specific CD4+ T cells because most of MHC class II tetramers were unbound and unstable when combined staining was performed with intracellular cytokines. In contrast, intracellular CD154 staining was revealed to be easier and simple for detecting LCMV GP66-77-specific CD4+ T cells, compared to MHC class II tetramer staining. Subsequently, we employed intracellular CD154 staining to detect LCMV GP66-77-specific CD4+Foxp3+ Tregs using Foxp3GFP knock-in mouse, and found that LCMV GP66-77-specific CD4+Foxp3+ Tregs and polyclonal CD4+Foxp3+ Tregs showed differential expansion in mice infected with LCMV Arms or Cl13 at acute (8 and 13 days pi) and chronic phases (35 days pi). Therefore, our results provide insight into the valuable use of intracellular CD154 staining to detect and characterize foreign Ag-specific CD4+Foxp3+ Treg in various models.
Animals ; Arm ; Autoimmune Diseases ; Cytokines ; Lymphocytic choriomeningitis virus ; Mice ; Plastics ; T-Lymphocytes ; T-Lymphocytes, Regulatory*

PURPOSE: To evaluate CT findings of tuberculous pneumonia mainly presenting as parenchymal consolidation. MATERIALS & METHODS: CT scans of twenty patients with tuberculous pneumonia were retrospectively reviewed. Analyses included the location, extent, and homogeneity of consolidation, presence of volume loss of involved lung and air-bronchogram, associated lesions suggesting previous tuberculous infection and evidence of bronchogenic spread. RESULTS: The location of consolidation revealed relatively even distribution without any specific predilection site. The areas of consolidation were irregular in margin (95%), inhomogeneous in attenuation (75%) including focal areas of low attenuation and multiple cavities within it. Volume loss (70%) of the involved lobe was associated. There were lesions suggesting previous tuberculous infection (95%) in the surrounding area and evidences of bronchogenic spread (100%) such as poorly-defined nodules and Iobular consolidations in the remote site from main consolidation. CONCLUSION: In tuberculous pneumonia, the areas of consolidation are irregular in margin and inhomogeneous in attenuation on CT scan. The evidences of bronchogenic spread and lesions suggesting previous tuberculous infection are almost always associated in the surrounding or remote site from main consolidation.
Humans ; Lung ; Pneumonia* ; Retrospective Studies ; Tomography, X-Ray Computed

Purpose: This study aimed to compare the therapeutic effects of corticosteroid irrigations and normal saline irrigations in the early inflammatory state of the salivary gland. Materials and Methods: Adult male Wistar rats were divided into experimental (n=6) and control (n=3) groups. Inflammation was induced in the experimental subjects on both sides of the submandibular gland with ligation. After 14 days, both sides of the glands were de-ligated and retroductal irrigation using saline (n=3) and a corticosteroid (n=3) was performed on the left sides only. The controls (n=3) were used to normalize the gland state for the effects of diet and aging. Magnetic resonance imaging was performed to confirm inflammation and post-irrigation gland recovery by measuring relative signal intensity (SI). The glands were excised for histological examination. Results: All experimental animals showed inflamed glands with increased SI and subsequent recovery of the gland with decreased SI to varying degrees. The SI of the controls showed no significant changes during the overall period. The mean SI change of the irrigated gland was higher than that of the non-irrigated side, without a significant difference. The corticosteroid-irrigated glands showed a greater change in SI than that of the saline-irrigated glands. Histology revealed that inflammation was not observed in most of the irrigated glands, while mild to moderate quantities inflammatory cells were found in non-irrigated glands. Conclusion Corticosteroid irrigation mitigated the early stages of salivary gland inflammation more effectively than normal saline.

Purpose: This study proposed a generative adversarial network (GAN) model for T2-weighted image (WI) synthesis from proton density (PD)-WI in a temporomandibular joint (TMJ) magnetic resonance imaging (MRI) protocol. Materials and Methods: From January to November 2019, MRI scans for TMJ were reviewed and 308 imaging sets were collected. For training, 277 pairs of PD- and T2-WI sagittal TMJ images were used. Transfer learning of the pix2pix GAN model was utilized to generate T2-WI from PD-WI. Model performance was evaluated with the structural similarity index map (SSIM) and peak signal-to-noise ratio (PSNR) indices for 31 predicted T2-WI (pT2). The disc position was clinically diagnosed as anterior disc displacement with or without reduction, and joint effusion as present or absent. The true T2-WI-based diagnosis was regarded as the gold standard, to which pT2-based diagnoses were compared using Cohen’s ĸ coefficient. Results: The mean SSIM and PSNR values were 0.4781(±0.0522) and 21.30(±1.51) dB, respectively. The pT2 protocol showed almost perfect agreement (ĸ=0.81) with the gold standard for disc position. The number of discordant cases was higher for normal disc position (17%) than for anterior displacement with reduction (2%) or without reduction (10%). The effusion diagnosis also showed almost perfect agreement (ĸ=0.88), with higher concordance for the presence (85%) than for the absence (77%) of effusion. Conclusion The application of pT2 images for a TMJ MRI protocol useful for diagnosis, although the image quality of pT2 was not fully satisfactory. Further research is expected to enhance pT2 quality.

Purpose: This study aimed to investigate the computed tomography and magnetic resonance imaging features of giant cell tumors in the temporomandibular joint region to facilitate accurate diagnoses. Materials and Methods: From October 2007 to June 2020, 6 patients (2 men and 4 women) at Yonsei University Dental Hospital had histopathologically proven giant cell tumors in the temporomandibular joint. Their computed tomography and magnetic resonance imaging findings were reviewed retrospectively, and the cases were classified into 3 types based on the tumor center and growth pattern observed on the radiologic findings. Results: The age of the 6 patients ranged from 25 to 53 years. Trismus was found in 5 of the 6 cases. One case recurred. The mean size of the tumors, defined based on their greatest diameter, was 32 mm (range, 15–41 mm). The characteristic features of all cases were a heterogeneously-enhancing tumorous mass with a lobulated margin on computed tomographic images and internal multiplicity of signal intensity on T2-weighted magnetic resonance images. According to the site of origin, 3 tumors were bone-centered, 2 were soft tissue-centered, and 1 was peri-articular. Conclusion Computed tomography and magnetic resonance imaging yielded a tripartite classification of giant cell tumors of the temporomandibular joint according to their location on imaging. This study could help clinicians in the differential diagnosis of giant cell tumors and assist in proper treatment planning for tumorous diseases of the temporomandibular joint.

Purpose: The aim of this study was to investigate the types and frequency of the various incidental findings (IFs) on magnetic resonance images (MRI) taken from the patients with temporomandibular disorder (TMD) symptoms. Materials and Methods: Temporomandibular joint (TMJ) MRI taken from 1,013 patients with TMD symptoms were evaluated retrospectively. IF was defined as imaging features that were accidentally or unexpectedly found, rather than degenerative bony changes of TMJ complex or disc derangement. They were classified into two groups as TMJ site-specific findings and unexpected findings at other regions. The frequency of the sub groups was analyzed.Result: A total of 26 (2.57%) cases with IFs were classified into 13 cases with TMJ site-specific findings and 13 cases with unexpected findings at other region. TMJ site-specific findings included synovial chondromatosis in 6 cases, synovial cyst in 6 cases and osteochondroma in one case. Unexpected findings included salivary gland tumor in 3 cases, developmental cyst in 3 cases, vascular malformation in 2 cases, mastoiditis in 4 cases and sialadenitis on parotid gland in one case. Conclusion When diagnosing TMD through TMJ MRI, clinicians should carefully read the image, considering the possibility of IFs because TMJ MRI can provide pathologic information in TMJ region and other oral and maxillofacial region.

Forensic gait analysis is the identification of individuals by their gait style and walking characteristics. This study aimed to examine the prevalence of gait patterns in healthy adolescents and adults. Five hundred healthy participants (mean age, 36.9 years) were enrolled and divided into four age groups: 13-20, 21-35, 36-50, and ≥51 years. The gait of the participants was recorded in a gait analysis laboratory. Five specialists experienced in gait analysis selected several gait features. The prevalence of out-toe, in-toe, planovalgus, and turtleneck was 25.0%, 1.6%, 6.8%, and 4.2%, respectively. The prevalence of genu varum (10.4%) was higher than that of genu valgum (5.6%). Genu valgum and hindfoot valgus were more common in younger than in older subjects (P=0.018 and P=0.029, respectively). Genu varum was more prevalent in older subjects (P<0.001). The prevalence of out-toe was higher in males (P<0.001), whereas the in-toe and genu valgum were more common in females than in males (P=0.027 and P=0.038, respectively). We have documented the prevalence of several gait features in healthy adolescents and adults. These gait features can be used to enhance evidentiary competence in forensic gait analysis and thereby help improve the arrest rate of offenders.

Japanese encephalitis (JE) is neuroinflammation characterized by uncontrolled infiltration of peripheral leukocytes into the central nervous system (CNS). We previously demonstrated exacerbation of JE following CD11c(hi) dendritic cell (DC) ablation in CD11c-DTR transgenic mice. Moreover, CD11c(hi) DC ablation led to abnormal differentiation of CD11b⁺Ly-6C(hi) monocytes and enhanced permeability of the blood-brain barrier (BBB), resulting in promoting the progression of JE. Here, we examined changes in lymphoid and myeloid-derived leukocyte subpopulations associated with pro- and anti-inflammation during JE progression. The analyses of this study focused on regulatory CD4⁺Foxp3⁺ regulatory T cells (Tregs), IL-17⁺CD4⁺ Th17 cells, and CD11b⁺Ly-6C(hi) and Ly-6C(lo) monocytes. CD11c(hi) DC ablation resulted in the accumulation of IL-17⁺CD4⁺ Th17 cells in the CNS, thereby leading to lower ratio of Tregs to Th17 cells. This result was corroborated by the higher expression levels of IL-17 and RORγT in CD4⁺ T cells from the brains of CD11c(hi) DC-ablated mice. In addition, CD11c(hi) DC-ablated mice showed higher frequency and total number of inflammatory CD11b⁺Ly-6C(hi) monocytes, whereas CD11b⁺Ly-6C(lo) monocytes were detected with lower frequency and total number in CD11c(hi) DC-ablated mice. Furthermore, CD11c(hi) DC ablation altered the phenotype and function of CD11b⁺Ly-6C(lo) monocytes, resulting in lower levels of activation marker and anti-inflammatory cytokine (IL-10 and TGF-β) expression. Collectively, these results indicate that CD11c(hi) DC ablation caused an imbalance in CD4⁺ Th17/Treg cells and CD11b⁺Ly-6C(hi)/Ly-6C(lo) monocytes in the lymphoid tissue and CNS during JE progression. This imbalanced orchestration of pro- and anti-inflammatory leukocytes following CD11c(hi) DC ablation may contribute to the exacerbation of JE.
Animals ; Asian Continental Ancestry Group* ; Blood-Brain Barrier ; Brain ; Central Nervous System ; Dendritic Cells* ; Encephalitis, Japanese* ; Humans ; Interleukin-17 ; Leukocytes ; Lymphoid Tissue ; Mice ; Mice, Transgenic ; Monocytes* ; Permeability ; Phenotype ; T-Lymphocytes ; T-Lymphocytes, Regulatory ; Th17 Cells*