The Correlations of E-Cadherin Catenin Complex(alpha, beta, gamma, p120cat) Expressions and Clinicopathological Findings in Tongue Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: E-cadherin and catenins (alpha, beta, gamma, p120cat) are important epithelial adhesion molecules in normal epithelial cells. Loss of E-cadherin-catenin adhesion is an important step in the progression of epithelial cancers such as tongue cancer. E-cadherin and catenins expression in carcinoma of human tongue was evaluated in relation to their clinicopathological features and prognostic values. SUBJECTS AND METHOD: Thirty-nine specimens of tongue squamous cell carcinoma were examined in this study. These patients were all treated by primary surgery without prior radiotherapy or chemotherapy. The specimens of formalin-fixed and paraffin-embedded tumor tissues were investigated by immunohistochemical analysis using E-cadherin and catenin (alpha, beta, gamma, p120cat) monoclonal antibodies. RESULTS: The expressions of E-cadherin, alpha-catenin, beta-catenin, gamma-catenin and p120cat in cell membranes were reduced or absent in 71.8%, 74.4%, 76.9%, 59.0% and 82.1% of the tumors examined, respectively. The reduced expressions of alpha-catenin and gamma-catenin in the cell membranes was cor-related with tumore differentiation (p=0.018, p=0.004, respectively). There were significant correlations between E-cadherin and expressions of the four cantenins in the cell membranes of tongue cancer. There were no correlations between beta-catenin and p120cat expression in the cytoplasm, cell nucleus and clinicopathological features. There was significant correlation between E-cadherin expression and Kaplan-Meier survival curves. CONCLUSION: These results suggest that E-cadherin and catenins (alpha, beta, gamma, p120cat) can be used as prognostic markers of human tongue squamous cell carninoma. The result of beta-catenin and p120cat absence in the nucleus suggests that Wnt/Wingless signaling or Kaiso transcription did not occur in the human tongue squamous cell carcinoma.

The Clinical and Component Analyses of Submandibular Sialolithes / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sialolithiasis occurs in the submandibular gland rather than in the parotid or sublingual gland. It was manifested by several biochemical and anatomical factors inducing saliva retension. There have been various clinical reports about sialolith, but only a few analytical reports. MATERIALS AND METHODS: A retrospective review was carried out for the period of July, 1998 to July, 2000 of 25 cases of the submandibular sialolithes, which was diagnosed and removed . We performed clinical and component analysis of sialolithes with a new method that uses the absorption band of an infrared spectrometer analysis. RESULTS: Calcium phosphate (16 cases) showed a strong band at 1000cm-1 and calcium phosphate and albumin (9 cases) showed a strong double band at 1700cm-1 and 1000cm-1. The incidence of submandibular sialolithiasis was predominant in females, accounting for the male to female ratio of 8:17. The age distribution of sialolithes was 15 to 62 years. Sialolithes were removed by the transoral approach under local anesthesia and external approach (submandibular gland resection) under general anesthesia. For most patients, sialolithes were brown in color (12 cases), 2~14mm in size, 2.1~1636.8ng in weight and located on the Wharton's duct orifice (17 cases). CONCLUSION: The most common types of sialolithes were calcium phosphate (16 cases, 64%). The rest of sialolithes (9 cases, 36%) were mixed calcium phosphate and albumin. Compared to all the other methods used in the sialolithes analysis, the infrared analysis furnished the permanent record in the shortest time. It was also ideal for qualitative identification and semiquantitative estimation of small fractions of calcium.

Two cases of fish bone foreign body presenting as tongue and neck mass / 대한이비인후과학회지

Foreign bodies are one of the most frequently observed accidental cases in the otolaryngological fields. Most of food pieces as foreign bodies are removable with a laryngoscope or a esophagoscope, etc. But sometimes surgical removal is needed, as in the two interesting cases we experienced of fish bones. One case was misconceived as tongue cancer at first, and the other case dealt with the migration of a fish bone from hypopharynx to the cervical space We removed them surgically. So we report these cases with a review of literature.

Recovery Time of Auricular Sensation after the Retroauricular Incision / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: When the great auricular nerve and lesser occipital nerve are transected via retroauricular incision in ear surgeries, postsurgical hypoesthesia and numbness of the ear can occur. However, little attention has been paid to these symptoms and the morbidity associated with their sacrifice. Therefore, in this study, we examined the recovery time of auricle sensation. MATERIAL AND METHODS: Thirty patients who had received mastoidectomy with retroauricular incision in Wallace Memorial Baptist Hospital from November 1998 to March 1999 were included in this study. For these patients, two point discriminatian tests were performed by placing the sharp legs of a compass at the lower 1/3 portion of the auricular helix before and after the surgery at 1-week intervals until the postoperative value became equal to the preoperative value. We also measured the minimal painful Ampere with the electrical stimulator in the same area, and in triangular fossa and cavum concha before and after the surgery while carring out the two point discrimination study. RESULTS: With the two point discrimination test, the postoperative value became equal to the preoperative value 17.23+/-1.88 weeks after the surgery. With the electrical stimulation which uses a Hilger stimulator, the time when postoperative value became equal to the preoperative value was found to be 17.7+/-2.03 weeks at the lower 1/3 portion of the helix, 20.l3+/-2.16 weeks at triangular fossa and 20.66+/-1.64 weeks at cavum concha, The result of the two point discrimination test was not statistically different from that of the electrical stimulation test using Hilger facial nerve stimulator at the lower 1/3 portion of the helix (p<0.05). CONCLUSIONS: We thought that Hilger stimulator may be useful in assessing the sensory recovery time, and we could measure the sensory recovery rime at three positions of the auricle innervated by different nerves.

A Comparative Acoustic Study of Voice Rehabilitation After Total Laryngectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Acoustic parameters of maximal phonation time, sound intensity, fundamental frequency, voice range, jitter and shimmer were analyzed in order to evaluate voice quality and differences among esophageal speech (ES), tracheoesophageal shunt speech (TES), pneumatic aid speech (PA), electrolaryngeal speech (EL) according to phonetic rehabilitation methods in 16 cases of laryngectomees. MATERIALS AND METHODS: We acquired acoustic data on alaryngeal voice by different methods, and analysed each of those using specially designed programs (Laryngeal analyser V1.0 base on Matlab V5.0). RESULTS: Maximal phonation time was significantly longer in TES voice and PA speech than in ES voice (p<0.05). Jitter and shimmer were significantly regular and stable in the EL and PA speech than in the ES and TES voice (p<0.05). Voice range was significantly wider in TES voice and PA speech than in EL and ES voice (p<0.05). In two cases capable of bi-modal speech of ES and TES voice, maximal phonation time was longer with wider voice range in TES voice than in ES voice. Jitter and shimmer were regular and stable in ES voice than in TES voice. CONCLUSION: PA speech displays phonetically more natural laryngeal speech than other rehabilitation methods. But this methods is inconvenient and cosmetically unacceptable, because patients have to bite intraoral vibrator in the patient's mouth. So, we recommend TES voice rather than ES voice, without the use of speech-making device such as EL and PA speech.

A Case of Ameloblastoma in the Maxilla / 대한이비인후과학회지

Ameloblastoma occurs most commonly at the jaw and accounts for 1% of all tumors of jaw. There have been much arguments about ameloblastoma in name, development, classification and treatment. According to the histologic classification of tumors announced by WHO, ameloblastoma had been classified as benign and malignant. And now it is classified as unicystic, multicystic and peripheral ameloblastoma. It has both benign and partially invasive, malignant character. It occurs commonly at the mandible and rarely at the maxilla. According to statistics, it occurs at the mandible 80-95% and at the maxilla 5-20%. We have experienced a case of ameloblastoma occurring in the maxilla, and treated with infrastructure maxillectomy. The histopathologic diagnosis was a acanthomatous ameloblastoma. So, we present this case with a review of literature.

The Vocal Tract and Speech Intelligibility of Tracheoesophageal Shunt Patients after Total Laryngectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In this paper, rehabilitation of voice after total laryngectomy has been suggested through the correct estimation and simulation of patients' vocal tract. Material and Methods: The author studied the shape of vocal tract during the phonation of five Korean vowels /u, o, a, e, i/ in tracheoesophageal shunt patients by magnetic resonance images (MRI). The same vocal tract was determined in each vowels from MRI. First, speech data produced by them were analyzed and also checked for speech intelligibility. Then the author tried to synthesize vowels from the vocal tract area of each vowels and from the expanded pharyngeal section of the vocal tract. RESULTS: The obtained results were as follows: 1) The sounds of /a/, /e/, /i/ were similar to natural sounds in actual patients' speech. The sound of /o/ was heard as /sigma/. The sound of /u/ was heard as strained /u/. 2) The synthesized vowels of /a/, /e/ from MRI were heard as natural sounds. The sounds of /u/, /o/, /i/ were heard as other sounds. 3) The synthesized vowel by the expanded pharyngeal section of 3 times in vowel /o/ was more naturally heard than that of 2 times. The synthesized vowel from Formfrek was more naturally heard than that from AreatoFormant. CONCLUSION: In conclusion, some of the synthesized sounds from MRI disagrees with the actual sounds produced by the subjects. This could be best identified by the synthesis from the area data. Future MRI studies should consider this problem for more accurate measurements. Also, pharyngeal areas with varied sizes should be experimented to secure better speech output because the correct shapes of vocal tract ensures correct vowel pronunciation.

Familial Enlarged Vestibular Aqueduct Syndrome (FEVAS) / 대한이비인후과학회지

The enlarged vestibular aqueduct syndrome (EVAS) is a clinical disease causing anatomical abnormality of bony canal in the temporal bone containing endolymphatic duct and sac. It is also associated with progressive sensorineural hearing loss with an isolated enlarged vestibular aqueduct. Familial inheritance of enlarged vestibular aqueduct syndrome (FEVAS) is rare and the correct mode of inheritance is not yet discovered. We studied familial inheritance in EVAS by performing clinical, audiological, radiographic and chromosomal analyses, and found strong indications that FEVAS may be an autosomal recessive trait. Further study would be focused on genetic evaluation of FEVAS.

Correlations between Invasiveness of Tongue Cancer and Its Prognosis / 대한이비인후과학회지

BACKGROUND: Tongue cancer comprises 10% of all head and neck cancer, and in spite of progress of therapeutic and diagnostic procedures in oncology, the prognosis of tongue cancer remains poor because of rich lymphatics of the tongue and high propensity of early subclinical lymph node metastasis. MATERIALS AND METHODS: Eighteen cases of tongue cancer specimens were sectioned serially and reviewed to investigate the correlations between macroscopic surface extension diameter and microscopic depth of invasion. And correlations between surface extension, muscular invasion and cervical lymph node metastasis of tongue cancer were studied. Furthermore, safety margin for glossectomy was also studied. RESULTS: The obtained results were as follows: 1) The macroscopic diameter of surface extension and microscopic depth of invasion of tongue cancer were correlated to each other (especially when the macroscopic diameter of surface extension was below 20 mm).2) Surface extension and muscular invasion were correlated independently with cervical lymph node metastasis. However, the 95% confidence index using the Cornfield method was too broad in order to draw a correlation among these three factors. 3) The safety margin was between 2.3mm and 13.5 mm. CONCLUSION: Macroscopic surface extension of tongue cancer serves as a valuable prognostic factor in predicting the depth of muscular invasion. Therefore, the safety resection depth can be estimated by the surface extension. In 12 cases of muscular invasions, relatively high prevalence of cervical lymph node metastasis were found, when compared to that of non-muscular invasive cancer. Therefore, muscular invasion itself is a very useful prognostic factor. But it is difficult to confirm the correlation between muscular invasion and cervical lymph node metastasis because of too broad CI.

Cancer Invasion to Laryngeal Cartilage after Radiation Therapy in Salvaged Laryngectomy Specimens / 대한이비인후과학회지

BACKGROUND: Many head and neck surgeons preferred the radiotherapy as a first choice in treating early laryngeal carcinoma(T1, T2) to surgical operation because of the relatively high curability(80-90%), organ preservation and better quality of life. If radiotherapy failed, some surgeons perform total laryngectomy as salvage operation, but others prefer to perform partial laryngectomy, which is increasing in tendency. OBJECTIVE: To investigate the pattern of cancer invasion to the laryngeal cartilages using salvage laryngectomized cancer specimens which had recurred after radiotherapy. MATERIALS & METHOD: Preoperative computerized tomograpy images were retrospectively compared to postoperative salvage laryngectomized cancer specimens which had recurred after radiotherapy 13 cases from March, 1985 to February, 1994. RESULTS: 1) In laryngeal cacer recurred after radiotherapy, incidence of cartilage invasion was not in early supragolttic cancer. but all in advanced supraglottic cancer, and 3cases of 5 cases(60.0%) in early glottic cancer, 4cases of 5 cases(80.0%) in advanced glottic cancer. 2) The order of laryngeal cartilage invasion was the first thyroid cartilage(61.5%), the second arytenoid cartilage(30.7%), and the third cricoid cartilage(23.1%). 3) The diagnostic accuracy of preoperative CT scan for laryngeal cartilage invasion was 66.7% in thyroid cartilage, 55.6% in arytenoid cartilage, 55.6% in cricoid cartilage, and 100% in epiglottis. CONCLUSION: Selection of partial laryngectomy as salvage operation should be considered carefully.

Effect of r-interferon-gamma on inerleukin-1 production by keratinocytes / 대한피부과학회지

It now appears that in addition to being a target for immunologic injury, the epidermis actively participate in various immunologic processes and thus may serve as the peripheral limb of the immune system. For example, keratinocytes produce the cytokines including IL-1 and in certain inflammatory diseases characterized by accumulation of T lymphocytes, kerationchtes aberrantly express HLA-DR antigen. In this study, the effect of interferon-gamma on keratinocytes IL-1alpha production were invesigated by radioimmunoassay, using as a model cultured keratinocytes stimulated with 30U/ml of recombinant-Interferon-gamma(IFN), IFN and 1microgram/ml of PMA(IFN-PMA), IFN-gamma and 25microgram/ml of LPS(IFN-LPS), PMA, and LPS. The expression of HLA-DR antigen and the effect of IFN-gammaon the proliferation of kerationcytes were also evaluated. The results were as follows: 1. The proliferation of keratinocytes was significantly inhibited in the IFN, IFN-PMA, and IFN-LPS groups compared with the control. The proliferation of kerationcytes in PMA and LPS groups was not inhibited. 2. The percent of HLA-DR positive kerationcytes was 62.5+/-3.1%, and 65.8+/-2.6% in IFN, IFN-PMA, and IFN-LPS group, respectively. There were no HLA-DR expression in the control, PMA, and LPS groups. 3. The amounts of IL-lalpha were 22.58+/-8.41, 49.32+/-13.01, 57.02+/-14.99, 96.98+/-43.17, 22.30+/-4.26, and 44.60+/-20.51 fmol in supernatant of control, IFN, IFN-PMA, IFN-LPS, PMA, and LPS group, respectively. The differences between IFN and control, IFN-PMA and PMA, and IFN-LPS and LPS were significant (P<0.05). The produciton of IL-1alphawas enhanced by IFN, but not PMA and LPS. The IL-1alpha induced by IFN and PMA was higher than that induced by IFN or PMA alone. The IL-1alpha induced by IFN and LPS was higher tthan that induced by IFN or LPS alone. 4. The amounts of IL-1alpha were 59.82+/-11.57, 70.15+/-25.22, 73.50+/-17.15, 63.67+/-32.38, 48.62+/-4.81, and 50.92+/-15.01 fmol in cell lysate of control, IFN, IFN-PMA, IFN-LPS, PMA, PMA, and LPS groups, respectively. The amount of IL-1alpha in IFN-PMA was significantly increased as compared to PMA(P<0.05). 5. The total amounts of IL-1alpha were 82.40+/-8.98, 119.47+/-21.88, 130.52+/-8.12, 160.66+/-34.51, 70.92+/-1.15, and 95.53+/-27.89 fmol in the control, IFN, IFN-PMA, IFN-LPS, Pma, and LPS groups, respectively, The differences between IFN and control, control, IFN-PMA and PMA and IFN-LPS and LPS were signigicant (P<0.05) the production of IL-1alpha was enhanced by IFN, but not PMA and LPS. The IL-1alpha induced by IFN and PMA was higher than that induced by PMA. The IL-1alpha induced by IFN and LPS was higher than that induced by IFN or LPS alone. In summary, the results indicate that when kerationcytes are activated by IFN-gamma, they are actively participating in the immunologic reaction by the increasing production of IL-1alpha.