Preoperative Serum Thyroglobulin as a Useful Predictive Marker to Differentiate Follicular Thyroid Cancer from Benign Nodules in Indeterminate Nodules

Indeterminate cytology results increase the number of repetitive procedure and unnecessary surgery. This study was designed to find useful and simple predictive tools to differentiate malignant thyroid nodules from indeterminate nodules. We retrospectively enrolled 164 patients who had undergone thyroid surgery as a result of indeterminate cytology in the National Cancer Center. We reviewed patients' age at diagnosis, sex, preoperative biochemical markers such as thyroglobulin (Tg), anti-Tg antibody, free T4 and TSH level, and sonographical and pathological findings, which were subjected to statistical analysis. We found several clinical and sonographical predictive factors that showed significant differences. Young age, male, preoperative high Tg level, and hypoechoic nodule on sonography all increased cancer probability significantly in multivariate analysis. With a cut-off value of 187.5 ng/mL Tg, sensitivity and specificity were 54.8% and 90.1%, respectively (AUC 0.748, P 1.7 cm, elevated serum Tg predicts the risk of malignancy; especially Tg > 70 ng/mL (odds ratio 3.245, 95% confidence interval 1.115-9.450, P = 0.038). Preoperative Tg levels had very high specificity in predicting thyroid cancer in case of suspicious follicular neoplasm. Therefore, Tg levels may be a useful marker for differentiating thyroid cancer from benign thyroid nodules in the cytological diagnosis of indeterminate nodules.

Evaluation of Xerostomia Following Intensity Modulated Radiotherapy (IMRT) for Head and Neck Cancer Patients / 대한방사선종양학회지

PURPOSE: This study was done to evaluate xerostomia following intensity modulated radiotherapy for patients with head and neck cancer, and to analyze the correlation between the dosimetric parameters and xerostomia parameters. MATERIALS AND MEHTODS: From February till October 2003, 13 patients with 3 months of follow-up were evaluated for xerostomia after being treated for head and neck cancer with IMRT. Their median age was 57 years (range: 43~77). Xerostomia were assessed with a 4-question xerostomia questionnaire score (XQS) and a test for salivary flow rates (unstimulated and stimulated). The patients were also given a validated LENT SOMA scale (LSC) questionnaire. The evaluations were completed before radiation therapy (pre-RT) and at 1 and, 3 months after radiation therapy (RT). We evaluated xerostomia at pre-RT, 1 and, 3 months after RT. The association between the xerostomia parameters (XQS and LSC) and salivary flow rates (unstimulated and stimulated: USFR and SSFR) was assessed at 1 and 3 months after RT. RESULTS: All 13 patients showed no significant changes in XQS, LSC and Salivary Flow rates. As a result, we couldn`t find out about xerostomia development. Based on the total mean parotid dose, 3,500 cGy, we divided these patients into two groups. The 8 patients ( or =3,500 cGy), there was a significant increase in USFR and, SSFR at 3 months after RT, and for the XQS and, LSC at 1 and 3 months after RT. The correlation between XQS and, LSC, and USFR and, SSFR in all patients (13) was significant at 3 months after RT. The correlation had a tendency to the decrease for USFR and, SSFR in proportion to the increase of XQS and, LSC. CONCLUSION: Based on the results of this study, IMRT seem to be an effective treatment to significantly decrease the xerostomia. XQS and, LSC seem to be a effective tool for predicting the xerostomia. A total parotid gland mean dose of <3,500 cGy should be a planning goal if substantial sparing of the gland function is desired. Furthermore, patients should be enrolled in a study to define a more accurate threshold dose for the parotid gland.

Extrahepatic Metastasis of Hepatocellular Carcinoma to the Nasal Cavity Manifested as Massive Epistaxis: A Case Report / 대한간학회지

Extrahepatic metastasis of hepatocellular carcinoma (HCC) is not infrequently found during the later stage, regarding that the autopsy report described its prevalence to be up to 50%. The most frequent sites are known to be the abdominal lymph nodes, lung and bone. However, metastasis to the nasal cavity and paranasal sinuses has been seldom reported, and to out knowledge, there is no Korean report describing extrahepatic metastasis of HCC to these sites. Recently we experienced a case of extrahepatic metastasis of HCC to the nasal cavity in a 50 year-old man with massive epistaxis refractory to conservative treatment. He was found to have a mass of soft tissue attenuation occupying the right nasal cavity at CT, which was biopsy-proven as metastatic HCC. Epistaxis was successfully treated by transcatheter arterial embolization.

A Case of Paradoxical Vocal Fold Motion with Dyspnea and Stridor / 대한이비인후과학회지

Paradoxical vocal fold motion (PVFM) is a rare disorder, characterized by episodic glottic obstruction in which the vocal folds are adducted on respiration. The disorder may aggravate airway obstruction and result in respiratory failure; therefore, a proper diagnosis by the otolaryngologist is critical to subsequent treatment. A review of literature shows that the effective treatment is psychotherapy, breathing education, biofeedback, anti-reflux medications, and most importantly, botulinum toxin injection to both vocal folds. We report a case with PVFM, effectively treated with above modalities.

The Patterns of Expression of p53, bcl-2 and Bax after Irradiation in Cell Lines of Squamous Cell Carcinoma of Head and Neck / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Squamous cell carcinoma of head and neck (HNSCC) undergoes a generally poor hospital course, and response of radiotherapy remains in questionable status. For this carcinoma, the clinical courses, biological behaviors and responses to radiotherapy are variable among cases and difficult to predict accurately. MATERIALS AND METHODS: As a trial to elucidate the prognostic factors of HNSCC after radiotherapy, several responses following irradiation of HNSCC cell lines and the expressions of apoptosis-related markers, such as p53, bcl-2, and Bax, were evaluated in this study. RESULTS: Among the eight HNSCC cell lines, the AMC-HN 1 was considered to be radioresistant, the PCI-1 was radiosensitive, and the AMC-HN 8 showed intermediate response. In immunohistochemistry of p53, AMC-HN 1 was negative, PCI-1 was strongly positive, and AMC-HN 8 was weakly positive. However, the analysis of mRNA using RT-PCR implied different expressions of p53 in the mRNA level. All 3 cell lines showed the p53 mRNA expressions. After irradiation of 2 Gy (137Cs), changes in the expressions of apoptosis-related protein (p53, bcl-2, Bax) were analyzed with the Western blot assay. The p53 and bcl-2 did not show any difference in the expressions between the irradiation group and the non-irradiation group. However, there was a significant difference in the Bax expression in the radiosensitive cell line (PCI-1) after irradiation. CONCLUSION: Those results might imply some roles of Bax in apoptotic responses following radiotherapy. Therefore, further studies should look into finding other possible factors and markers of HNSCC after radiotherapy and the precise role of Bax.

Glomus Tumor of the Trachea / 대한이비인후과학회지

Tracheal glomus tumors are extremely rare. We present clinicopathologic findings of a resected glomus tumor of the trachea in a 43-year-old man with a review of literature, The tumor was an intraluminal polypoid mass, which arose from the posterior wall of the first to third tracheal rings. Tracheal resection with end to end anastomosis was done. Histologically, the tumor exhibited typical features of glomus tumor with areas of glomangiomyoma.

Clinical Characteristics of Chronic Sinusitis with Asthma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chronic sinusitis has been closely related to bronchial asthma. We investigated clinical characteristics of chronic sinusitis including the extent of disease, radiographic findings, subjective sinusitis symptoms, and postoperative outcome in sinusitis patients with asthma, and compared them with those without asthma. MATERIALS AND METHODS: 24 sinusitis patients with asthma and 103 patients without asthma who underwent endoscopic sinus surgery were evaluated. We compared the following 7 parameters between asthma and non-asthma group : presence of allergy, previous sinus surgery, degree of preoperative polyposis, preoperative disease extent scored with OMU CT findings, severity of sinusitis symptoms, patients' sinusitis symptom changes, and postoperative outcome. Postoperative outcome was evaluated by examining the endoscopic findings in 99 patients (asthma group '. 21, non-asthma group 78) who were followed up for more than 6 months. Patients sinusitis symptom changes were also compared before and after surgery in each group. RESULTS: Patients of both groups showed improvement of sinusitis symptoms after surgery. There were no statistical differences between the two groups on the presence of allergy, previous sinus surgery, preoperative polyposis, preoperative OMU CT scores, and severity of sinusitis symptoms. However, asthma group showed poorer postoperative outcome, which was statistically significant, compared with those without asthma. CONCLUSION: Chronic sinusitis with asthma is characterized by poorer postoperative outcome, but there were no differences in the extent of preoperative diseases, allergy, or previous sinus surgery between the two groups. Adequate preoperative management, close attention during surgery and careful endoscopic postsurgical follow-ups would be necessary for patients with chronic sinusitis with asthma.

The Changes of Taste Sense after the Injury of Unilateral Chorda Tympani Nerve during Middle Ear Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Currently, the changes of taste sensation after unilateral injury of chorda tympani nerve during middle ear surgery remains unclear, particularly in objective methods, like threshold to each taste stimulus. This study aims to evaluate the objective changes of taste threshold according to the degrees of injury of chorda tympani nerve. MATERIALS AND METHODS: In 36 patients who underwent middle ear surgery, the degrees of injury were described as "intact", "stretched" and "sacrificed". The taste threshold to citric acid, NaCl, and sucrose were measured preoperatively, and 1 week, 1 month, 3 months after surgery. Subjective changes of taste sensation were questioned together. The amount of changes in threshold according to the degree of injury were statistically analyzed. RESULTS: There were no significant differences of threshold according to the degrees of injury in each taste. Several patients documented subjective taste changes, such as hypogeusia and parageusia. But there were no relationship between subjective and objective findings. CONCLUSION: These results suggest the probability of some compensatory mechanism after unilateral injury of chorda tympani nerve. There might be some discrepancy between taste threshold and real-world taste sensation.

A Case of Oculoauriculovertebral Spectrum with Ossicular Deformity Managed by Oval Window Fenestration / 대한이비인후과학회지

Oculoauriculovertebral spectrum (OAVS) is a disease which has wide range of phenotypic expression from hemifacial microsomia. Hemifacial microsomia denotes unilateral microtia, mandibular hypoplasia to Goldenhar syndrome, which consists of epibulbar dermoids and vertebral anomalies in addition. Various auricular, external ear and middle ear deformities are combined in this disease spectrum. We experienced a case which was characterized as OAVS. The patient complained about congenital hearing loss and showed unilateral conductive hearing loss. Microtia type I with mild stenosis of ear canal, hemifacial microsomia and abnormality of cervical vertebrae were found. Exploration revealed middle ear anomalies with ossicular deformity and aberrant facial nerve. To correct the conductive hearing loss, oval window fenestration was performed with KTP laser and piston wire prosthesis was inserted. Hearing was improved successfully after the surgery. It should be stressed that hearing should be carefully assessed in the patients with OAVS, regardless of the type of clinical findings. The correction of anomalies of the middle ear would be one of the important points for otolaryngologists in treatment of OAVS.

Acoustic Reflex Facilitation with Various Frequencies and Amplitudes of Pure Tone / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are several methods for lowering the acoustic reflex hreshold, a process known as "facilitaion". The most popular facilitation method is the simultaneous stimulation of a high-frequency tone (facilitator) with a reflex-elicing tone (activator). This study was performed in order to analyze and generalize the facilitation phenomenon, and infer clinical applications from this phenomenon. MATERIALS AND METHODS: Authors measured the acoustic reflex thresholds when the facilitators of various amplitudes and frequencies was simultaneously stimulated in normal population. Also, the effects of facilitation was observed on the growth function curve (a curve showing the acoustic reflex pattern in subthreshold and suprathreshold stimulation). RESULTS: Facilitation was observed more effectively by using facilitators of high frequencies and high amplitudes. In the analysis of growth function curve, we found similar result as above. But there was no correlation between the frequency of activator and the mode of facilitation. CONCLUSION: We analyzed the factors affecting the phneomenon of facilitation and discussed a several proposals explaining the different tendencies of facilitation. Further studies should be made on the clinical implication of this phenomenon to sensorineurally hearing-impaired patients or children.

Voice Changes after Laser Assisted Uvulopalatoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The subject of voice change after uvulopalatopharyngoplasty (UPPP) has been a challenging issue, because even minor changes in voice quality or articulation may be critical to a professional voice user. A number of studies reported on acoustic changes after UPPP; however, there has not been any reports concerning voice changes after laser assisted uvulopalatoplasty (LAUP), which is a less extensive surgery compared to UPPP. This study was performed in order to analyze changes in the voice quality and nasalance after LAUP, and to provide guidance to professonal voice users who want to have snoring surgery. MATERIALS AND METHODS: In 20 patients (11 male, 9 female) who were to undergo the LAUP surgery, we measured the first and second formants of /a/, /i/, /u/ phonations, and the nasalance in rabbit, baby and mama passage. These parameters were measured preoperatively and also one month after the operation. Postoperative changes were statistically analyzed. Any subjective voice changes were asked to be reported at the visit one month after the operation. RESULTS: The second formant of /u/ phonation was significantly reduced in females. The changes in nasalance, and formants of /a/ and /i/ phonations were insignificant. No one complained of the changes in voice quality, timbre, articulation or speech. CONCLUSION: In general, there were no postoperative changes in nasalance nor any subjective feeling about voice quality after LAUP. However, changes in formant characteristics of certain vowels warrant clinicians to be more cautious in recommending LAUP for professional voice users.

Correlation between Nasal Obstruction and Parameters in Acoustic Rhinometry

Several attempts have been made to correlate nasal obstruction and acoustic rhinometric parameters, so far failed to find any significant correlation. We evaluated the correlation between the sense of nasal obstruction and parameters measured with acoustic rhinometry, and searched any secondary variables calculated from primary parameters, to explain the sense of nasal obstruction objectively on 114 patients (72 men and 42 women) with nasal obstruction. The sense of nasal obstruction was measured with visual analogue scale. Nasal volume, minimal cross-sectional area, and equivalent resistance were measured by acoustic rhinometry. As secondary variables, we introduced the concept of decongestion rate which representing the amount of change in the parameters after application of nasal decongestant. Weak correlations were found between the sense of nasal obstruction and total minimal cross-sectional area. Significant correlations were found between the sense of nasal obstruction and decongestion rate of total nasal volume, and particularly in the wider cavity. Stronger correlations than in total population were found in male patients. The decongestion rate may have potential implication in explaining the sense of nasal obstruction.