Usefullness of Sialendoscopy for Recurrent Parotid Swelling / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sialendoscopy is a minimally invasive technique that can be used to explore the salivary duct system and to treat obstructive salivary disease. The aim of this study was to investigate the safety and efficacy of sialendoscopy as a diagnostic and therapeutic tool for recurrent parotid swelling. SUBJECTS AND METHOD: We retrospectively evaluated the endoscopic findings of 41 patients who underwent diagnostic sialendoscopy between August 2003 and January 2008. Interventional sialendoscopy was performed to treat any abnormalities in the ductal system. Stones were fragmented or removed by using a basket or a grasper. Strictures were dilated and mucous plugs were removed endoscopically. RESULTS: Diagnostic sialendoscopy was successfully performed in all cases. Thirty four patients underwent interventional sialendoscopy. Among them, 8 patients (23.5%) had intraductal stones and 7 patients (87.5%) were successfully treated by endoscopic removal. Stenosis of parotid duct was observed in 26 patients (76.5%). Sixteen cases (61.5%) with stenosis were dilated with balloon catheter or endoscopy sheath successfully. Patients were closely observed during the median follow-up of 42 months (1-72 months). Symptomatic relief was achieved in 20 of 26 patients (77%) in parotid stenosis. There were no recurrences of parotid stone. Six patients (23.0%) among 26 patients with parotid ductal stenosis occasionally suffered from recurred parotid swelling. CONCLUSION: The sialendoscopy could be recommended as a useful tool for the diagnosis and treatment of recurrent parotid swelling with a minimally invasive technique.

Insular Carcinoma of the Thyroid with Jugular Vein Invasion / 대한이비인후과학회지

Insular carcinoma of the thyroid is an uncommon thyroglobulin-producing neoplasm, showing intermediate aggressiveness between well-differentiated follicular carcinoma and undifferentiated anaplastic carcinoma. Although microscopic angioinvasion of insular carcinoma is common, gross invasion of the cervical veins and intraluminal propagation are rarely seen. We encountered a case of a 37-year-old man with an insular carcinoma of the thyroid displaying the aggressive local invasion and angioinvasion of the internal jugular vein. After complete resection of the tumor, postoperative radioactive iodine was administered. The patient survives 12 months after surgery, and no locoreginal recurrence and distant metastasis were noted. Aggressive surgical resection and postoperative radioactive iodine therapy may be indicated in the treatment of insular carcinoma of the thyroid with invasion of the internal jugular vein, as we performed in this case, to achieve locoregional disease control and prolonged survival.

Video-assisted Endoscopic Thyroidectomy with Cervical Approach / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Endoscopic approach to the neck is more widely used since it was first reported by M.Gagner in 1996, because of its low invasiveness and better cosmetic result. In this article, we introduce a surgical technique of video-assisted endoscopic thyroidectomy via cervical approach and assess its efficacy for patients with thyroid nodule. SUBJECTS AND METHOD: Eleven patients hospitalized in our department from May to September 2004, underwent video-assisted thyroidectomy with cervical approach. The subjects were 9 women and 2 men with ages ranging from 23 to 62 year old (mean 40.9 years). Inclusion criteria for the subjects were having benign solitary tumor that is less than 30 mm in longitudinal diameter, low risk micropapillary carcinoma that is less than 1 cm, confined to one lobe, within the thyroid gland, and without lymph node swelling on ultrasonography or computed tomography, and follicular neoplasm that is without evidence of any malignancy or with suspicious and indeterminate cytology among patients with no prior neck surgery or previous radiotherapy. Most patients (82%) had thyroid mass less than 2 cm. Nodular hyperplasia was 7 cases and papillary carcinoma was 4 cases. RESULTS: Hemithyroidectomy with or without isthmusectomy was performed in 10 patients. Video-assisted thyroidectomy was converted into conventional thyroidectomy in only one case because of the uncontrolled intraoperative superior thyroid artery bleeding and large thyroid volume. The operation time was 80+/-12 minutes. Temporary recurrent laryngeal nerve palsy occurred in one case. The average postoperative hospital stay was 5.0+/-1.8 days. Operative scars were small and most patients were satisfied with the cosmetic result. CONCLUSION: We conclude that the video-assisted endoscopic thyroidectomy with cervical approach is feasible, practical, and has safe procedures, and has greater cosmetic benefits than the conventional one. We hope that video-assisted thyroidectomy will become another surgical option for small nodular thyroid diseases.

Two Cases of Parotid Lymphadenitis by Toxoplasmosis / 대한이비인후과학회지

Toxoplasma gondii, a coccidian protozoon, infects various animal species and humans. Toxoplasma lymphadenitis is the most common clinical manifestation of toxoplasmosis in an immunocompetent host, but still more rare in Korea than in other countries. We report two cases of toxoplasma lymphadenitis in intraparotid lymph node in an immunocompetent host. Serological results supported a diagnosis of toxoplasmosis correlated with histological findings. In Korea, travels to and from other countries and consumption of meat are increasing, possibly increasing the incidence of toxoplasma lymphadenitis. This report emphasizes the need for clinicians to consider the diagnosis of unexplained lymphadenitis at all sites.

Expression of Caveolin-1 in the Differentiated Vestibular Cell Line (UB/UE-1) after Gentamicin Toxicity

BACKGROUND AND OBJECTIVES: The caveolin is known as a mediator of cell death or survival of injured cell and inhibitor of various signaling pathways. We examined expression of caveolin-1 involved by protein kinase A(PKA) signaling pathway in the differentiated mouse vestibular cell line(UB/UE-1) after gentamicin toxicity. MATERIALS AND METHOD: We observed caveolae in the vestibular hair cell of healthy guinea pig through electron microscope. UB/UE-1 cells were cultured at 95% CO2, 5% O2, 33DegreeC for 2days and at 95% CO2, 5% O2, 39DegreeC for 24 hours for differentiation. Cells were treated with 1 mM of gentamicin, 0.02 mM H89 (PKA inhibitor), and then incubated for 24 hours. Caveolin-1 expression was examined by western blot and PKA activity by PepTag? assay. RESULTS: Caveolae were observed in the vestibular hair cell of healthy guinea pig by electron microscope. Caveolin-1 was expressed spontaneously in differentiated UB/UE-1 cells and increased after gentamicin treatment. PKA is overactivated by gentamicin treatment. The gentamicin induced caveolin-1 expression and PKA overactivation was inhibited by H89. CONCLUSION: Our results indicate that gentamicin induced caveolin-1 expression is mediated by PKA signaling pathway. We conclude that the caveolae/caveolin through a PKA signaling pathway is the important mechanism of gentamicin induced ototoxicity.

Comparison of Vestibule-ocular Reflex of Eccentric Rotation with Centric Rotation in Normal Subjects

BACKGROUND AND OBJECTIVES:Conventional vestibular rotation testing with the head centered on the axis stimulates the semicircular canals evoking compensatory eye movements. By placing subjects off from the axis of rotation, the otolithic organ may also be simultaneously stimulated by additional linear acceleration forces. In the present study, we compared the rotation with subjects placed on axis to those placed in an eccentric position. MATERIALS AND METHOD:In the eccentric rotation, the head of subject was facing outward and placed eccentrically for 33cm on naso-occipital axis. Slow harmonic acceleration test and velocity step test were performed. RESULTS:The sinusoidal eccentric rotation at 0.32, 0.64 Hz produced a significantly higher vestibulo-ocular reflex gain than did on axis rotation. In velocity step test, initial slow component velocity was significantly higher in eccentric rotation than in centric rotation. CONCLUSION:These finding suggest that the gain enhancement due to eccentric rotation is a result of tangentiallinear acceleration, probably sensed by the otolithic organ. This study raises the possibility of using eccentric rotation for the diagnosis of the patients with otolithic dysfunction.