Enterococcal Otogenic Brain Abscess / 대한이비인후과학회지

Despite advances in imaging and antibiotic treatment, brain abscess is still encountered occasionally and is one of the most significant life-threatening complications of otologic disease. Nowadays, mortality rates of up to 10 percent have been reported. Brain abscesses are developed up to 0.5 percent of cases of acute otitis media and 3 percent of cases of chronic suppurative otitis media. In this case, underlying middle ear pathology showed chronic otitis media with cholesteatoma. Successful management of otogenic brain abscess still includes medical and surgical treatment. Initial surgical treatment of abscess is very controversial today. Some authors prefer the surgical excision of brain abscess prior to the management of temporal bone, yet other authors prefer the surgery of temporal bone prior to the management of brain abscess. Although an enterococcus is a significant cause of human infections outside of the central nervous system but, enterococcal infections involving the central nervous system are uncommon clinical entities. Because of the relatively small number of individuals who develop brain abscess or meningitis due to an enterococcus, an appropriate therapy has not been well defined. We report a case of enterococcal otogenic brain abscess which was treated successfully using antibiotics, immediate radical mastoidectomy and later stereotactic abscess drainage with a review of literatures.

Genetic Alterations of Tumor Suppressor Genes in Laryngeal Squamous Cell Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cancer is a genetic disease in which several genetic events are required to induce normal cells to convert to malignancy. Functional loss of tumor suppressor genes is related to these events, but the molecular mechanism is not well known. This study was designed to identify whether the tumor suppressor genes, Fragile Histidine Triad (FHIT), p16, Retinoblastoma (Rb), and p53 were involved in the carcinogenesis of laryngeal squamous cell carcinoma and to determine whether FHIT alterations play a role in laryngeal squamous cell carcinoma. MATERIALS AND METHOD: The loss of heterozygosity (LOH) was analysed by using microsatellite markers D3S1285 and D3S1481 for FHIT, microsatellite marker D9S171 for p16, investigation of AccII restriction fragment length polymorphism (RFLP) and investigation of variable number of tandem repeat (VNTR) for p53, Xba I RFLP and VNTR for Rb. The FHIT gene was examined by polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP). RESULTS: The results of LOH analysis by using microsatellite markers D3S1285 and D3S1481 for FHIT, microsatellite marker D9S171 for p16, investigation of AccII RFLP and investigation of VNTR for p 53, VNTR for Rb were 8% (1/12), 0% (0/13), 18% (2/11), 14% (1/7), 22% (2/9), 17% (1/6), respectively. As a result of analysis of genomic DNA of FHIT gene by SSCP, two cases showed that the polymorphic change occurs at exon 8 codon 98 (CAT-->CAC), and that it is a silent substitution. CONCLUSION: Based on the experimental result of the change in tumor suppressor genes in laryngeal squamous cell carcinoma, the genetic alterations were most frequently observed in p53 followed by Rb, p16 and FHIT but it is not significant. It is also expected that FHIT has little influence on the process of carcinogenesis of laryngeal squamous cell carcinoma.

An Immunohistochemical Study on the Expression of Matrix Metalloproteinase-2, Tissue Inhibitor of Metalloproteinase-2 and Angiogenesis in Human Laryngeal Squamous Cell Carcinoma / 대한이비인후과학회지

The clinical staging systems for laryngeal cancer is limited as a prognostic indicator because of different biological characteristics of cancer in this region. To determine biological characteristics of laryngeal cancer and whether the matrix metalloproteinase-2(MMP-2), tissue inhibitor of metalloproteinase-2(TIMP-2) and angiogenesis can be used as prognostic indicators, the authors performed immunohistochemical staining of MMP-2, TIMP-2 and factor VIII related antigen in 20 cases of surgically treated squamous cell carcinoma of the larynx. The results are as follows: (1) The positive rates of MMP-2 and TIMP-2 expression in laryngeal squamous cell carcinoma were 55% and 95% respectively.(2) As the clinical stage was advanced, the expression of MMP-2 and TIMP-2 increased significantly(p=0.043, p=0.014).(3) The microvessel count(MVC) did not correlate with the clinical stage and histopathologic grading.(4) As the MVC increased, the expression of MMP-2 and TIMP-2 increased significantly(p=0.0004, p=0.0025). In conclusion, MMP-2 and TIMP-2 can be used as a prognostic indicator of laryngeal squamous cell carcinoma. As MMP-2 increases, so does neovascularization. And as neovascularization increases TIMP-2 does also in order to inhibit it. Since TIMP is an expression of the host response to a tumor and this response is different in each tumor, studies on MMP, TIMP and angiogenesis in other tumors should also be encouraged.

Clinical Analysis for Complications after Endoscopic Sinus Surgery in Korea during Past 7 Years / 대한이비인후과학회지

BACKGROUND: Based on the work of Messerklinger, endoscopic sinus surgery(ESS) has become popular during recent years. Many reports on the technique of, indications for, and results of ESS have been published. Few reports are devoted exclusively to the complications of ESS in Korea. OBJECTIVES: In this paper, the complications of ESS in Korea and the findings and prevention of complications are discussed through early recognition and appropriate management. MATERIALS AND METHODS: A retrospective study about the complications of ESS was done on 42 hospitals from 1988 to 1995 in Korea. The incidence of complications of ESS in Korea(total 31,012 cases) is compared to complications in three other series of patients(total 2,165 cases) who underwent ESS in foreign contries and three series of patients(total 2,454 cases) who underwent conventional endonasal sinus surgery. RESULTS: Major complications occurred in 0.04% and major bleeding was the commonest. Minor complications occurred in 22.54% and were related to recurrent inflammatory symptom and midddle turbinate adhesions. CONCLUSIONS: There are some differences in incidence of each complications according to surgical approach. In major complications, the incidence of intracranial and orbital complication with the conventional endonasal sinus surgery approach was higher than that of endoscopic approach. Another difference is that adhesions do not occur with the conventional approach because middle turbinate is routinely removed. The incidence of recurrent symptoms was highest with ESS in Korea. We discuss complications of the procedures and the related factors to complications.