MRI has the advantages of having excellent soft-tissue contrast and providing functional information without any harmful ionizing radiation. Although previous technical limitations restricted the use of chest MRI, recent technological advances and expansion of insurance coverage are increasing the demand for chest MRI. Recognizing the need for guidelines on appropriate use of chest MRI in Korean clinical settings, the Korean Society of Radiology has composed a development committee, working committee, and advisory committee to develop Korean chest MRI justification guidelines. Five key questions were selected and recommendations have been made with the evidence-based clinical imaging guideline adaptation methodology.Recommendations are as follows. Chest MRI can be considered in the following circumstances:for patients with incidentally found anterior mediastinal masses to exclude non-neoplastic conditions, for pneumoconiosis patients with lung masses to differentiate progressive massive fibrosis from lung cancer, and when invasion of the chest wall, vertebrae, diaphragm, or major vessels by malignant pleural mesothelioma or non-small cell lung cancer is suspected. Chest MRI without contrast enhancement or with minimal dose low-risk contrast media can be considered for pregnant women with suspected pulmonary embolism. Lastly, chest MRI is recommended for patients with pancoast tumors planned for radical surgery.

MRI has the advantages of having excellent soft-tissue contrast and providing functional information without any harmful ionizing radiation. Although previous technical limitations restricted the use of chest MRI, recent technological advances and expansion of insurance coverage are increasing the demand for chest MRI. Recognizing the need for guidelines on appropriate use of chest MRI in Korean clinical settings, the Korean Society of Radiology has composed a development committee, working committee, and advisory committee to develop Korean chest MRI justification guidelines. Five key questions were selected and recommendations have been made with the evidence-based clinical imaging guideline adaptation methodology.Recommendations are as follows. Chest MRI can be considered in the following circumstances:for patients with incidentally found anterior mediastinal masses to exclude non-neoplastic conditions, for pneumoconiosis patients with lung masses to differentiate progressive massive fibrosis from lung cancer, and when invasion of the chest wall, vertebrae, diaphragm, or major vessels by malignant pleural mesothelioma or non-small cell lung cancer is suspected. Chest MRI without contrast enhancement or with minimal dose low-risk contrast media can be considered for pregnant women with suspected pulmonary embolism. Lastly, chest MRI is recommended for patients with pancoast tumors planned for radical surgery.

OBJECTIVES: The transoral removal of stones by sialodochoplasty has been popularized in the treatment of submandibular sialolithiasis. However, the effectiveness of sialodochoplasty is controversial, and there are no reports on the long-term outcomes of this procedure. The purpose of this study was to assess the effectiveness and long-term outcomes of sialodochoplasty in patients with submandibular sialolithiasis. METHODS: We conducted a cross-sectional study that included retrospective chart reviews and prospective telephone or interview surveys of 150 patients treated for submandibular sialolithiasis from March 2001 to January 2008. The patients were treated with two different procedures by two different surgeons. One surgeon performed a transoral sialolithectomy without sialodochoplasty in 107 patients (SS group), and the other surgeon performed a transoral sialolithectomy with sialodochoplasty in 43 patients (SP group). RESULTS: The success rate of transoral sialolithectomy was 98.1% in the SS group and 93% in the SP group. The recurrence rates of symptoms or stones were 1.9% and 4.7% in the SS and SP groups, respectively. The incidence of postoperative transient hypoesthesia was 13.1% in the SS group and 34.9% in the SP group. The mean operating times were 29.79 and 47.44 minutes in the SS and SP groups, respectively. The mean percentage of general anesthesia was 42.1% in the SS group and 83.7% in the SP group. CONCLUSION: Sialodochoplasty in addition to transoral sialolithectomy for submandibular sialolithiasis did not affect the rate of symptom or stone recurrence, but did increase the postoperative hypoesthesia incidence and general anesthesia percentage.
Anesthesia, General ; Cross-Sectional Studies ; Humans ; Hypesthesia ; Incidence ; Prospective Studies ; Recurrence ; Retrospective Studies ; Salivary Gland Calculi ; Telephone

OBJECTIVES: Surgical excision via a sublabial approach is considered the standard treatment for nasolabial cysts. Although transnasal marsupialization has been proposed as an alternative method, no prospective study has compared the effectiveness of these techniques. We thus compared the surgical procedure, operating time, postoperative pain, complications, and recurrence rate between the two surgical methods. METHODS: Twenty patients diagnosed with nasolabial cysts were allocated randomly into two groups according to the surgical technique. In the sublabial approach group, the cysts were excised completely using a sublabial approach, while in the transnasal marsupialization group, the cysts were marsupialized transnasally under the guidance of nasal endoscopes. The pure operating time was measured and postoperative pain was evaluated using a visual analog scale. Complications after the procedure were assessed and recurrence was determined according to the clinical symptoms and postoperative radiologic findings. RESULTS: The transnasal marsupialization group had significantly shorter operating times, less postoperative pain, lower complication rates, and shorter duration of side effects than the sublabial approach group. No recurrence occurred in either group after a 1-yr follow-up period. CONCLUSION: Although both methods are effective for treating nasolabial cysts, the transnasal marsupialization of nasolabial cysts has many benefits over the conventional sublabial approach. Therefore, we propose that transnasal marsupialization be the treatment of choice for nasolabial cysts.
Endoscopes ; Follow-Up Studies ; Humans ; Pain, Postoperative ; Prospective Studies ; Recurrence

Advanced glycation endproducts (AGEs)-induced vascular smooth muscle cell (VSMCs) proliferation and formation of reactive oxygen species (ROS) are emerging as one of the important mechanisms of diabetic vasculopathy but little is known about the antioxidative action of HMG CoA reductase inhibitor (statin) on AGEs. We hypothesized that statin might reduce AGEs-induced intracellular ROS of VSMCs and analyzed the possible mechanism of action of statin in AGEs-induced cellular signaling. Aortic smooth muscle cell of Sprague-Dawley rat (RASMC) culture was done using the different levels of AGEs stimulation in the presence or absence of statin. The proliferation of RASMC, ROS formation and cellular signaling was evaluated and neointimal formation after balloon injury in diabetic rats was analyzed. Increasing concentration of AGEs stimulation was associated with increased RASMC proliferation and increased ROS formation and they were decreased with statin in a dose-dependent manner. Increased NF-kappaB p65, phosphorylated ERK, phosphorylated p38 MAPK, cyclooxygenase-2, and c-jun by AGEs stimulation were noted and their expression was inhibited by statin. Neointimal formation after balloon injury was much thicker in diabetic rats than the sham-treated group but less neointimal growth was observed in those treated with statin after balloon injury. Increased ROS formation, subsequent activation of MAPK system and increased VSMC proliferation may be possible mechanisms of diabetic vasculopathy induced by AGEs and statin may play a key role in the treatment of AGEs-induced diabetic atherosclerosis.
Animals ; Aorta/metabolism/pathology ; Cell Proliferation/drug effects ; Cyclooxygenase 2/metabolism ; Diabetes Mellitus, Experimental/drug therapy/metabolism/pathology ; Diabetic Angiopathies/*drug therapy/*metabolism/pathology ; Glycosylation End Products, Advanced/*metabolism ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/*pharmacology/therapeutic use ; Male ; Myocytes, Smooth Muscle/*metabolism/pathology ; Oxidative Stress/*drug effects ; Proto-Oncogene Proteins c-jun/metabolism ; Rats ; Rats, Sprague-Dawley ; Reactive Oxygen Species/metabolism ; Signal Transduction/drug effects ; Simvastatin/*pharmacology/therapeutic use ; Transcription Factor RelA/metabolism ; p38 Mitogen-Activated Protein Kinases/metabolism

BACKGROUND AND OBJECTIVES: Speech audiometry is a useful test for obtaining practical information which could not be gotten from the pure-tone audiometer test. Nowadays, Hahm's Korean disyllabic word lists are the most commonly used word lists for the speech reception threshold test in Korea. The disyllabic word lists should be composed of spondaic words (equally stressed words). The aim of this study is to evaluate the characteristic frequency of Hahm's disyllabic word lists. SUBJECTS AND METHOD: Two of the Hahm's disyllabic word lists were evaluated. The word lists were analyzed using an acoustic analysis program that has the MATLAB function. RESULTS: The percentage of disyllabic words in the Hahm's disyllabic word lists that had the spondaic words pattern were 33%. The characteristic frequencies of these words were equally stressed above 1,000 Hz. Other disyllabic words showed an unequally stressed pattern. The percentage of words that had the first syllable stressed pattern was 31% and the percentage of second syllable stressed pattern was 36%. CONCLUSION: Some words, which are commonly used in the Hahm's disyllabic words lists, had an unequally stressed pattern. A new Korean dissyllabic word list needs to use more balanced words that have the characteristic frequency of each word.
Acoustics ; Audiometry, Speech ; Korea ; Speech Reception Threshold Test

BACKGROUND: Cystic neoplasms of the pancreas are being recognized with increased frequency. In 1993, a report on 123 cases of cystic neoplasms of the pancreas diagnosed over a period of 32 years was published in Korea. Many changes on the concept of cystic neoplasms of the pancreas have been made, including classification and diagnostic criteria. The present study was conducted wherein a new survey on cystic neoplasms of the pancreas in Korea. METHODS: Cystic neoplasms of the pancreas diagnosed over a period of 12 years, from 1993 to 2004 in 25 university hospitals throughout Korea were collected. They were classified according to the World Health Organization classification of cystic neoplasms of the pancreas. RESULTS: A total of 1264 cases of cystic neoplasms of the pancreas were diagnosed. The diagnoses and frequencies are as follows: intraductal papillary mucinous neoplasm, 499 (39.5%); mucinous cystic neoplasm, 318 (25.2%); serous cystic neoplasm, 232 (18.4%); solid pseudopapillary neoplasm, 192 (15.2%); cystic endocrine neoplasm, 11 (0.8%); lymphoepithelial cyst, 8 (0.6%); acinar cell neoplasm, 3 (0.2%); mature teratoma, 1 (0.1%). Increase in the annual number of diagnoses was evident. In intraductal papillary mucinous neoplasm and mucinous cystic neoplasm, a significant increase in mean age was seen in patients with malignant neoplasms. CONCLUSIONS: Cystic neoplasms of the pancreas are diagnosed with increasing frequency in Korea, the most common being intraductal papillary mucinous neoplasm of the pancreas. In intraductal papillary mucinous neoplasm and mucinous cystic neoplasm, the grade of dysplasia increased with mean age, suggesting an adenoma-carcinoma sequence.
Acinar Cells ; Classification ; Diagnosis ; Hospitals, University ; Humans ; Korea* ; Mucins ; Pancreas* ; Teratoma ; World Health Organization

BACKGROUND/AIMS: The extraction of large common bile duct (CBD) stones after an endoscopic sphincterotomy (EST) is successful in 80~90% of cases but it often requires a prolonged time and repeated trials. This study investigated the utility of a combined endoscopic papillary large balloon dilatation (EPLBD) and a mid-incision of an EST (m-EST) method for the removal of large CBD stones. METHODS: Thirty patients with large CBD stones were enrolled in this study. EPLBD was carried out using the one-step inflation of a 15~18 mm diameter balloon after m-EST. RESULTS: The maximum stone diameter was 21.62+/-5.38 mm. Twelve patients had more than 4 stones, 7 patients had 2 stones, and the remainder had a single large stone. Complete ductal clearance was achieved in all patients. After the procedure, the serum amylase and/or lipase levels were elevated in 3 patients (13.3%). However, there was no episode of true pancreatitis. Minor bleeding was encountered in only one patient (3.3%), and was easily controlled by an endoscopic epinephrine injection. The procedure was carried out safely in 6 patients with periampullary diverticulum. No perforation or mortality was encountered. CONCLUSIONS: Combined EPLBD and m-EST is a safe and effective method, and may be a good alternative treatment for removing large CBD stones.
Amylases ; Bile Ducts* ; Bile* ; Choledocholithiasis ; Common Bile Duct ; Dilatation* ; Diverticulum ; Epinephrine ; Hemorrhage ; Humans ; Inflation, Economic ; Lipase ; Mortality ; Pancreatitis ; Sphincterotomy, Endoscopic*

BACKGROUND AND OBJECTIVES: Angiogenesis and alteration of apoptosis are hypothesized to be the mechanisms of the growth of tumor. Vascular endothelial growth factor (VEGF) is considered to be the most primary factor prompting the angiogenesis in tumor tissue, which also holds the central position in the course of formation and metastasis of tumor and regulates expression of survivin. The survivin protein is the member of inhibitor of apoptosis protein (IAP) family which inhibits apoptosis. Recently, several authors reported survivin and VEGF expression was found in various cancer tissue and they are suggest to play on the important role in cancer development. The purpose of this study is to evaluate the expression of VEGF and survivin and to investigate their correlation with the clinical stage, nodal involvement, and histologic grade in the squamous cell carcinoma of larynx. SUBJECTS AND METHOD: Immunohistochemical staining for the paraffin sections by using a polyclonal antibody for VEGF and survivin by the standard avidin-biotin-peroxidase technique was performed in 19 cases with the squamouse cell carcinoma of larynx. The relationships between the expression of VEGF and survivin and clinicopathological characteristics were analyzed. RESULTS: Immunohistochemical analysis showed the expression of VEGF in 15 of 19 cases (78.9%) and survivin in 19 of 19 cases (100%). There was no correlation between the expression of VEGF and survivin and the clinical stage, nodal involvement, and histologic grade in the squamous cell carcinoma of larynx (p>0.05). But VEGF results in an increased expression of survivin (p<0.05). CONCLUSION: Further study will be needed to understand the relationships between the VEGF and survivin and squamous cell carcinoma of larynx.
Apoptosis ; Carcinoma, Squamous Cell* ; Humans ; Inhibitor of Apoptosis Proteins ; Laryngeal Neoplasms ; Larynx* ; Neoplasm Metastasis ; Paraffin ; Vascular Endothelial Growth Factor A

BACKGROUND AND OBJECTIVES: beta-catenin has an essential role in intercellular adhesion and signal transduction. The Adenomatous poliposis coli (APC) protein interacts with beta-catenin in a multi-protein complex to regulate the level of expression of beta-catenin. Mutations in beta-catenin or APC gene can lead to the accumulation of beta-catenin in the cytosol and the nucleus. This study was designed to investigate the expression of APC and beta-catenin in laryngeal cancer. SUBJECTS AND METHOD: Immunohistochemical methods were used to determine the beta-catenin and APC protein expression in 15 laryngeal cancers. Results were correlated with clinicopathological parameters. RESULTS: beta-catenin expression to the plasma membrane was reduced or absent in 11 of 15 cases (73%) of the laryngeal cancers. Cytoplasmic expression of the beta-catenin was seen in 6 out of 15 cases (40%). APC immunoactivity was negative in 5 of 15 (33%) of the laryngeal cancers. One of the six cytoplasmic expressions of the beta-catenin was negative for APC immunoactivity, and one of the five negative for APC immunoactivity was cytoplasmic expression of the beta-catenin. CONCLUSION: There was no correlation between beta-catenin and APC protein in the analysis. This finding suggests that cytoplasmic expression of the beta-catenin resulted not from the APC mutation but from the beta-catenin mutation and abnormal Wnt signal. Only the expression of the beta-catenin in cytoplasm was associated with lymph node metastasis.
beta Catenin* ; Carcinoma, Squamous Cell* ; Cell Membrane ; Cytoplasm ; Cytosol ; Genes, APC ; Laryngeal Neoplasms* ; Lymph Nodes ; Neoplasm Metastasis ; Signal Transduction