Prediction of Invasiveness by the Expressions of CD105 (Endoglin), D2-40 and Vascular Endothelial Growth Factors A and D in the Endoscopic Biopsy Tissue of Stomach Cancer Patients

PURPOSE: CD105 (endoglin) has been shown to be a more useful marker to identify the proliferating endothelium involved in tumor angiogenesis than are the panendothelial markers. The monoclonal antibody D2-40 is a specific lymphatic endothelial marker. METHODS: We investigated CD105, lymphatic vessel marker (D2-40), vascular endothelial growth factor (VEGD)-A and the VEGF-D expressions as possible prognostic markers in the endoscopic biopsy tissue of stomach cancer patients. The pre-operative endoscopic biopsies and surgical biopsies from 73 patients were immunostained for CD105, D2-40, VEGF-A and VEGF-D. Positively stained microvessels were counted in densely vascular foci (hot spots) at a x200 field in each specimen. RESULTS: The microvessel density (MVD) and lymphatic vessel density (LVD), according to the CD105 and D2-40 expressions of the endoscopic biopsies, showed a statistically significant correlation with the surgical biopsies. The MVD via CD105 a showed statistically significant correlation with the histologic differentiation, T-stage, nodal metastasis and stage in the endoscopic biopsies and surgical biopsies, respectively. The lympathic vessel density (LVD) via D2-40 showed a statistically significant correlation with T-stage, nodal metastasis and stage in the endoscopic biopsies. The expressions of VEGF-A and VEGF-D showed a statistically significant correlation with the MVD and LVD. CONCLUSION: The MVD, as determined by the CD105 expression and the LVD as determined by the D2-40 expression may be useful markers for predicting the invasiveness with using a pre-operative endoscopic biopsy of stomach cancer.

A Case of Recurrent Facial Palsy with Severe Hypertension due to Dysplastic Kidney and Renal Artery Aneurysm / 대한이비인후과학회지

Facial paralysis was first described in a hypertensive patient by Moxon in 1869. Subsequently, there have been reports and facial palsy is mentioned as a rare feature of hypertension. Recently, we experienced a case of recurrent facial paralysis in a severe hypertensive child. A 13-month-old boy was admitted because of right peripheral facial paralysis. Two months ago, transarterial embolization of his left renal aneurysm with coils was performed due to left renal dysplasia and renal artery aneurysm. On admission, his blood pressure was 200/110 mmHg. He was treated conservatively with antihypertensive agents and his facial paralysis completely resolved during the next two months. One year later, he experienced facial paralysis again. He was admitted and treated with antihypertensive agents. And his paralysis resolved in the next two months. After his left nephrectomy, performed three years later, there was no additional episode of facial paralysis during the next seven years. We report this case with a brief review of literatures.

Pathophysiologic Consideration of Benign Paroxysmal Positional Vertigo due to the Horizontal Semicircular Canal Cupulolithiasis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular disorders. There have been some reports suggesting that directional changing positional nystagmus occurs due to canalolithiasis and cupulolithiasis of the horizontal semicircular canal (HC). The canalolithiasis theory of HC-BPPV is presented with a transient geotropic direction changing horizontal nystagmus as the pathophysiologic mechanism of BPPV. The HC-BPPV cupulolithiasis is characterized by a positional nystagmus that does not fatigue, but persists as long as the position is held, and changes direction in different head positions. There is still a controversy relating to differentiating the lesion side and the otolith adherent sites on the cupula differentiation. The purpose of this study was to differentiate the lesion side and the otolith adherent site on the cupula, and propose a treatment through analyses of clinical features, electronystagmographic (ENG) results, treatment maneuvers and its effectiveness. SUBJECTS AND METHOD: Fifteen patients who showed ageotropic direction changing horizontal nystagmus were included in this study. Supine head turning test was performed to induce positional nystagmus. Various findings of the nystagmus were recorded with ENG. Other ENG tests (visual tracking tests and bithermal caloric test) and magnetic resonance imaging were checked to exclude the possibility of any central lesion. Cupulolith repositioning maneuver (CuRM) was applied on the all patients and these patients were instructed to keep the healthy side at the lateral decubitus position while sleeping. RESULTS: All patients showed significant differences between the intensity of each side nystagmus, and all of them showed stronger ageotropic direction changing horizontal nystagmus when the head was rotated to the unaffected side in a supine head turning test. The nystagmus had a short latency, no fatigability, and persistency in character. Typical nystagmus and spinning sensation in the supine head turning test had completely subsided after physical therapy. CONCLUSION: In the cupulolithiasis of horizontal semicircular canal, ageotropic nystagmus was stronger when the pathological ear was at the uppermost position, and this excitatory nystagmus beats to the lesion side. The proposed CuRM and post-treatment lateral decubitus position kept during the night (while sleeping on the day of treatment) were effective in differentiating the otolith adherent site on the cupula and treating the cupulolithiasis of the horizontal semicircular canal.

Ancient Schwannoma in the Tracheoesophageal Groove / 대한이비인후과학회지

The schwannoma is an encapsulated nerve sheath tumor. We experienced a case of ancient schwannoma arising in the tracheoesophageal groove, probably originating from the recurrent laryngeal nerve. It was presented on the right lower lateral neck, anterior to the sternocleidomastoid muscle. The CT scan and esophagography suggested a tumor in the thyroid gland and the esophagus, but the fine needle aspiration cytology suggested a neurogenic tumor. The mass was completely removed with careful preservation of its nerve. The mass was interpreted as an ancient schwannoma by a pathologist. The patient had a favorable postoperative course, except for a temporary vocal fold paralysis.