Sclerosing Cholangitis: Clinicopathologic Features,Imaging Spectrum,and Systemic Approach to Differential Diagnosis

Sclerosing cholangitis is a spectrum of chronic progressive cholestatic liver disease characterized by inflammation, fibrosis, and stricture of the bile ducts, which can be classified as primary and secondary sclerosing cholangitis. Primary sclerosing cholangitis is a chronic progressive liver disease of unknown cause. On the other hand, secondary sclerosing cholangitis has identifiable causes that include immunoglobulin G4-related sclerosing disease, recurrent pyogenic cholangitis, ischemic cholangitis, acquired immunodeficiency syndrome-related cholangitis, and eosinophilic cholangitis. In this review, we suggest a systemic approach to the differential diagnosis of sclerosing cholangitis based on the clinical and laboratory findings, as well as the typical imaging features on computed tomography and magnetic resonance (MR) imaging with MR cholangiography. Familiarity with various etiologies of sclerosing cholangitis and awareness of their typical clinical and imaging findings are essential for an accurate diagnosis and appropriate management.     

Objective and subjective assessment of masticatory function for patients with temporomandibular disorder in Korea

This study examined the differences in the masticatory function of patients with temporomandibular disorder (TMD) in Korea. The experimental groups were as follows: 23 patients with painful arthralgia classified as pain group according to the research diagnostic criteria for temporomandibular disorder (RDC/TMC) and 28 patients with pain-free disc displacement and reduction classified as clicking group. The subjects were obtained from those who had visited Yonsei University Dental Hospital from 2007 to 2008. Twenty dental students without TMD symptoms were enroled as the normal control group. The Mixing Ability Index (MAI) was used as the objective index, and the Food Intake Ability (FIA) Index, Visual Analogue Scale (VAS) and oral health impact profile (OHIP) were used as the subjective indices. The MAI, FIA and VAS were significantly lower in the pain group than in the normal and clicking groups (P<0·05). The pain group showed a MAI, FIA and VAS of 16%, 81% and 67%, respectively, compared to that of the normal group. However, there were no significant differences in the MAI, FIA and VAS between the clicking and normal groups. The pain and clicking groups showed a 1·7 and 1·4 times higher OHIP value than the normal group (P<0·05). The MAI and subjective indices, such as the FIA (r=0·40) and VAS (r=0·48), showed a moderate correlation (P<0·01). In conclusion, pain is the main factor for the reduced masticatory function in patients with TMD in Korea, and the joint sound, not the masticatory function, affects the declining OHIP.     

Trigeminal neuralgia: Assessment with T2 VISTA and FLAIR VISTA fusion imaging

Objective  

To evaluate the neurovascular compression (NVC) in patients with trigeminal neuralgia (TN) using T2 VISTA and FLAIR VISTA fusion imaging.     

A case of stenotic change from gastric candidiasis managed with temporary stent insertion

Invasive gastric Candida infection in patient with co-morbidity can cause stenotic change if it is developed at anatomically narrowing portion, such as distal antrum, pylorus, or duodenal bulb. However, proper management of benign stenosis by diffuse gastric Candidasis is still under controversy and palliative bypass surgery has several shortcomings because high risk operative group may be included in this case. Palliative placement of self-expandable metallic stent has been settled as a standard management of malignant gastric pyloric obstruction and it is expected to be applied in benign stenotic lesions due to its gradual dilation effect. We described a case of stenosis by diffuse gastric Candidasis at anastomosis of subtotal gastrectomy, which was managed by temporary placement of self-expandable metallic stent.     

Prognostic factors for motor outcome in patients with compressed corticospinal tract by intracerebral hematoma

Little is known about prognostic factors associated with motor outcome when the corticospinal tract (CST) was compressed by hematoma. Using diffusion tensor tractography (DTT), we attempted to investigate prognostic factors for motor outcome in patients whose affected CST was compressed by hematoma. The study included 51 consecutive severe hemiparetic patients with a hematoma involving the corona radiata and basal ganglia. Integrities of the affected CSTs were preserved to the cerebral cortex and were found to be compressed by a hematoma on DTT. Patients were classified into four groups according to the region which the CST was originated from the precentral gyrus (type A), postcentral gyrus (type B), posterior parietal cortex (type C), and premotor cortex (type D). We measured the ratios of DTT parameters between affected/unaffected hemispheres.The motor function of the affected extremities at 6-month after onset was better with the following order: DTT type A, type B, type C, and type D patients. The 6-month motor function for DTT type A patients was higher than that of DTT type D patients (p=0.008). The fractional anisotropy ratio between the affected and unaffected CST was positively correlated with the 6-month motor function of the affected extremities (Pearson's correlation coefficient, p=0.025, r=0.313). We found that motor outcome differed according to the originated area of the affected CST and the degree of injury of the affected CST in patients whose affected CST was compressed by hematoma.