Clinical Analysis of Angioedema of the Head and Neck / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Angioedema is a localized, nonpitting edema resulting from extravasation of fluid into the interstitial space. It usually develops suddenly and fades during the course of 24 to 48 hours. However, angioedema of the upper respiratory tract can result in serious acute respiratory distress, airway obstruction, and death. The purpose of this study was to analyze clinical characteristics of angioedema in the head and neck. SUBJECTS AND METHOD: A review of 144 patients with angioedema of the head and neck over 3-year period was conducted. RESULTS: The presumptive causes were 115 allergic reactions to food, drug, or environmental exposure, 3 losses of C1 esterase inhibitor, 1 angiotensin-converting enzyme inhibitor use, and 25 idiopathic conditions. The main locations of the edema were 100 face/lips, 4 oral cavity/oropharynx, 5 larynx/hypopharynx, and 35 multiple sites of the head and neck. Most of patients were treated with steroids and H1 and H2 blockers. All of 7 patients with low oxygen saturation and 14 out of 18 patients with hypotension on arrival were improved within 24 hours. There were 4 patients with airway distress treated with urgent airway intervention, three of them were completely recovered within 110-240 hours but one of them died of the disease. Patients with the cause of idiopathic and loss of C1 esterase inhibitor were found to stay longer in the hospital over 48 hours (p<0.05). CONCLUSION: Angioedema of the head and neck usually responds well to the treatment. However, there might be cases with life-threatening airway obstruction.

Immunohistochemical Study on bcl-2, c-myc, EGFR as Predictable Factor for Radiosensitivity in Early Glottic Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The radiotherapy or surgery is the main treatment modality for early glottic cancer. The advantage of radiotherapy is the preservation of good voice quality after treatment but the main problem is increased complications in the salvage surgery when local control fails. So, it is important to predict the success of radiotherapy. The purpose of this study is to find predictable factors of the radiosensitivity in the early glottic cancer. MATERIALS AND METHOD: Immunohistochemical staining was performed on the paraffin sections of the biopsy specimens of 57 patients with early glottic cancer who had undertaken radiotherapy treatments in Chonnam National University Hospital from January 1988 to October 1998. Primary antibodies were the anti-bcl-2 monoclonal antibody, the anti-c-myc monoclonal antibody, and the anti-EGFR monoclonal antibodies. The relation between the local control outcome after radiotherapy and the result of immunostaining was analyzed by the chi-square and the Fisher's exact test. RESULTS: Positive expression of bcl-2 was 21.1% in the local controlled group and 12.3% in the uncontrolled group. There was no statistical significance between two groups. The expression rate of c-myc was statistically higher in the controlled group (36.8%) than in the uncontrolled group (7.0%) (p=0.025). Expression of EGFR was 57.9% in the controlled group and 22.5% in the uncontolled group. However, there was no statistical significance between two groups. CONCLUSION: The relation between the positive c-myc expression and the radiosensitivity suggests that c-myc might be a predictable factor of the radiosensitivity in early glottic cancer.

Expression of Matrix Metalloproteinase-2,-9 and Extracapsular Spread of Cervical Node Metastasis in the Head and Neck Squamous Cell Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cervical lymph node metastasis is the most important prognostic factor in head and neck squamous cell carcinoma (HNSCC). Further, it is important to predict extracapsular spread (ECS) before treatment, because ECS makes prognosis worse. It has been well established that matrix metalloproteinases (MMPs) expression correlates with cervical lymph node metastasis, but studies on its involvement in extracapsular spread are not enough. The aim of this study was to investigate the correlationship between extracapsular spread of cervical lymph node metastasis and expression of matrix metalloproteinases in the primary sites of head and neck cancer and metastatic cervical lymph nodes. SUBJECTS AND METHOD: An immunohistochemical study was carried out using monoclonal antibodies to MMP-2, MMP-9 on tissue obtained from 46 patients with head and neck cancer who underwent a surgery of primary tumor removal and neck dissection. We evaluated correlations between the expressions of MMP-2, MMP-9 in the primary tumor and ECS of metastatic lymph nodes, and that between expressions of MMP-2, MMP-9 in the metastatic lymph nodes and ECS. RESULTS: The result showed that while there is no significant correlation between expressions of MMP-2, MMP-9 in primary tumor and ECS of cervical lymph nodes, expressions of the MMPs in the positive lymph nodes and ECS of the lymph nodes have significant relationships. CONCLUSION: Expression of MMP-2,-9 may play a pivotal role in extracapsular spread beyond lymphatic metastasis and in the progression of HNSCC.

Prognostic Significance and Treatment Outcomes of Combination of Radiotherapy and Chemotherapy in Nasopharyngeal Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: T he diagnosis of a nasopharyngeal carcinoma is frequently made at an advanced stage. The anatomic complexicity of the nasopharynx makes a surgical approach difficult, so the radiation therapy is traditionally used as a primary option. Because of the high incidence of a locoregional failure following the radiotherapy and the distant metastasis, the combined treatment modality with the chemotherapy has been applied. The author attempted to investigate the clinical characteristics and the treatment outcomes of nasopharyngeal cancer patients treated with the combination of the radiotherapy and the chemotherapy. SUBJECTS AND METHOD: We retrospectively analyzed 82 patients who were diagnosed with the nasopharyngeal carcinoma in Chonnam National University Hospital. RESULTS: The cumulative survival rates for a 5-year period were 42%. The pathologic type, the clinical stage, the cranial nerve invasion, and the response to the radiotherapy were related to the survival rate of the Kaplan-Meier test (p<0.05). In the Cox proportional hazard model, only the response to radiotherapy was related to the survival rate (p=0.05), as the clinical stage wasn't (p=.06). In the multivariate analysis between the responses to radiation and the clinical factor, the histological type (p=0.018) and the response to the chemotherapy (p=0.021) was statistically significant. CONCLUSION: The response to radiation is the most important in the patient's survival. The clinical stage is a probable prognostic factor. Factors affecting the response to radiation are the histological type and the response to chemotherapy.