Malignant Melanoma of the Sphenoid Sinus

Sinonasal malignant melanoma comprises 0.5% ~ 1.5% of all malignant melanomas. Malignant melanoma in the nasal cavity is relatively more predominant than in the paranasal sinus. The maxillary sinus is the most common sinus cavity affected by malignant melanoma, and the sphenoid sinus is a very rare site regardless of a primary or secondary origin. We encountered a patient with frequent epistaxis who was found to have malignant melanoma at the nasal septum and sphenoid sinus. She was treated successfully with endoscopic sinus surgery, and we report this case, along with the associated literature.

Expression of TARC in Nasal Epithelial Cells by IL-4/IL-13 and TNF-alpha in Allergic Rhinitis

BACKGROUND: Thymus and Activation-Regulated Chemokine (TARC) is a highly specific ligand for CCR4 expressed in Th2 lymphocytes. Local production of TARC may play an important role in the induction and maintenance of allergic inflammation with the infiltration of Th2 lymphocytes. However, the cellular sources of TARC among patients with allergic rhinitis (AR) remain unclear. OBJECTIVE: We investigated that nasal epithelial cells from AR could produce TARC and that they could produce TARC differently by various stimulation of cytokines. METHODS: Inferior turbinate mucosal tissues were collected from six patients with AR sensitized to house dust mite. Nasal epithelial cells were isolated, cultured and stimulated with IL-4, IL-13 or TNF-a alone or in combination. The level of TARC in the supernatant was measured by ELISA and mRNA expression of that in the cells by RT-PCR. RESULTS: The level of TARC from cultured nasal epithelial cells (CNEC) among allergic rhinitis patients was higher than that in the control group. IL-4 or IL-13 or TNF-a alone did not upregulate TARC production from CNEC. However, Th2 cytokines in combination with TNF-a increased the production of TARC in CNEC. CONCLUSION: IL-4, IL-13 and TNF-a could upregulate TARC production from nasal epithelial cells in allergic rhinitis and contribute to the infiltration of Th2 cells to the tissue during allergic inflammation.

Fractures of the Wrist and Hand after Punching Injury / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to describe the patterns and results of treatment of fractures of the hand and wrist after punching injury. MATERIALS AND METHODS: The authors retrospectively reviewed 91cases of fractures of the hand and wrist after punching injury in 67 patients from January 1998 to September 2002. The mean follow-up was 18 months. The mean age was 25.7 years old, ranging from 11 years old to 41 years old. The results were evaluated by modified criteria of Bruce and Maudsley. RESULTS: The most common fractures were metacarpal base fractures (42.9%), and the second most common fractures were distal metacarpal fractures (19.8%). Metacarpal base fractures were usually combined with dislocation of carpometacarpal joint, especially in the fourth and fifth metacarpal bone and single fifth metacarpal bone (29.7%). There were a few complications of limitation of motion (4 cases), pain (1 case), angular deformity of distal metacarpal bone (1 case), malunion of metacarpal shaft (2 cases) and nonunion of metacarpal shaft (1 case). There were excellent results in 84 cases, good in 4 cases and fair in 3 cases. CONCLUSION: The most common fractures after punching injury were metacarpal base fractures, especially the forth and fifth metacarpal bone. Distal metacarpal and metacarpal shaft fractures were mostly single fractures. There were diverse patterns of fracture-dislocation of the hand and wrist after punching. We must be careful to evaluate combined injury when a patient visits after punching injury.

The Effectiveness of Long-Term Immunotherapy with Every 3-Month Injection after 3-Year Immunotherapy in the Treatment of Perennial Allergic Rhinitis Using Quality of Life Questionnaires / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Long-term immunotherapy lasting for 3 to 5 years is known to be one of the effective treatment modalities for the perennial allergic rhinitis. However, it is questionable whether open-ended immunotherapy is beneficial to control the symptoms of perennial allergic rhinitis. This study was designed to confirm the effectiveness of open-ended immunotherapy with every 3-month injection after 3-year immunotherapy by comparing the results of immunotherapy between patients who received less than 3 years and those who received more than 3 years. MATERIALS AND METHOD: One hundred-one perennial allergic rhinitis patients who received immunotherapy more than 1 year and had no history of sinonasal operation were chosen. They were divided into two groups; the duration of immunotherapy was from 1 year to 3 years in one group and more than 3 years in the other group. They were surveyed with global study and the questionnaires regarding practical problems about nasal, eye, and generalized systemic symptoms as well as their medical treatment history. This questionnaire was administered twice in one sitting, with the first on recalling symptoms before immunotherapy treatment, and the second on an evaluation of current symptoms. RESULTS: Improvement in the allergic symptoms was preserved in group B as well as in Group A. With the treatment, the patients in both groups experienced decrease in the frequency of absence from work or school, hospital visits and the use of antibiotics. There were no significant differences in the results between two groups. CONCLUSION: The long-term maintenance of immunotherapy with 3-month injection after 3-year immunotherapy is effective for the prevention of recurrence of perennial allergic rhinitis.

The Effect of Tumor Necrosis Factor-alpa on Type I Procollagen and Collagenase Gene Expression in Hypertrophic Scar and Keloid Fibroblast

Recent studies have demonstrated that tumor necrosis factor-alpa(TNF-alpa) decreased production of type I and III procollagens and increased production of collagenase in cultured human dermal fibroblasts. The purpose of this study was to examine the effect of TNF-alpa on the level of expression of type I procollagen, collagenase mRNA in hypertrophic scar and keloid fibroblasts in culture. The cultured fibroblasts from normal skin, hypertrophic scar and keloid were exposed to 0, 1, 10, and 100 ng/ml of TNF-alpa for 24 hours. Then, type I procollagen mRNA and collagenase mRNA were measured by quantitative RT-PCR and quantified by computerized densitometry(TINA). In normal skin fibroblasts, TNF-alpa significantly decreased the level of type I procollagen mRNA and increased collagenase mRNA. The maximal inhibition for type I procollagen mRNA was noted at 100 ng/ml of TNF-alpa and maximal enhancement for collagenase mRNA was noted at 100ng/ml of TNF-alpa. In hypertrophic scar fibroblasts, TNF-alpa significantly decreased the level of type I procollagen mRNA and increased collagenase mRNA. The maximal inhibition for type I procollagen mRNA was noted at 100 ng/ml of TNF-alpa which was the same as normal skin fibroblasts but there were no significant differences among TNF-alpa treated groups for collagenase mRNA. In keloid fibroblasts, TNF-alpa also significantly decreased the level of type I procollagen mRNA and increased collagenase mRNA. The maximal inhibition for type I procollagen mRNA was noted at 100 ng/ml of TNF-alpa which was the same as normal skin and hypertrophic scar fibroblasts but there were no significant differences among TNF-alpa treated groups for collagenase mRNA. These results strongly suggested that TNF-alpa might have a role in preventing progression of fibroproliferative disease, such as hypertrophic scar or keloid, and that the most effective concentration of TNF-alpa was found in 100 ng/ml.

A Case of Carcinoma Ex Pleomorphic Adenoma in the Maxillary Sinus

Carcinoma ex pleomorphic adenoma is one of the rare malignant tumors arising in the salivary glands. Parotid gland is the most frequently affected site, while the other minor salivary glands have much lower incidence rates. There has been no clinical report of the carcinoma ex pleomorphic adenoma developed in the maxillary sinus. Carcinoma ex pleomorphic adenoma is very malignant and its prognosis is rarest among those of parotid gland tumors. We experienced a 24-year-old male patient who had a bulging mass on his left infraorbital area for 18 months. A carcinoma ex pleomorphic adenoma arising in the left maxillary sinus was diagnosed and medial maxillectomy, postoperative chemotherapy and concurrent radiotherapy were done. So far we have followed up the patient for 15 months and there is no sign or symptom of recurrence or metastasis.

The Effect of Location of Venous Pedicle on the Survival of Island Flaps in White Rats

It has been known that the improved drainage of a flap increases its survival and the increasing number of draining vein improves survival of flaps. But recently, researches have proved that the different orientation of venous outflow on the island flap is more important than the number of outflow tracts. The purpose of this study is to investgate the survival rates of flaps with various numbers or locations of draining veins. An 6 X 7cm flap was raised on the abdomen of 40 white rats (Sprague-Dowley, 350 - 400 gm). Rats were divided into 4 groups and each group consisted of 10 rats. In group 1 (A l$ flaps were based on the inferior epigastric artery and vein on the ipsilateral side. In group 2 (A-V), flaps were based on the inferior epigastric artery on the ipsilateral side and the inferior epigastric vein on the contralateral side. In group 3 (AV-V), flaps were based on the inferior epigastric artery and vein on the ipsilateral side and the inferior epigastric vein on the contralateral side. In group 4 (Av-V), flaps were based on the inferior epigastric artery and lateral thoracoepigastric vein on the ipsilateral side and the inferior epigastric vein on the contralateral side. A definite assessment was made on the seventh day after flap elevation. The necrotic areas of flaps were determined with Computer Image Analysis System and barum-sulfate microangiographys were performed The necrotic area was 38.14% in group 1, 18.73% in group 2, 33.53% in group 3, and 31.94% in group 4 respectively. The microangiographs showed striking digerences in the vascular pattern in the flaps, and numerous collaterals and dilated anastomotic vessels were observed in group 2. These data indicate that the location of draining vein is more important than the number, and proper location of the draining vein allows the recruitment of an adjacent angiosome and can improve the survival rates of island flap.