Clinical Efficiency of Adenoidectomy Using Microdebrider / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Remnant adenoid tissue after adenoidectomy or immoderate procedure result in various complications such as bleeding, damage to the mucosa of posterior nasopharyngeal wall or orifice of Eustachian tube. The purpose of this paper is to compare conventional adenoidectomy with microdebrider-assisted adenoidectomy based on postoperative outcome and intraoperative effectiveness. MATERIALS AND METHOD: We performed a prospective study comparing thirty cases of adenoidectomy using conventional approach with fifteen cases of transoral microdebrider adenoidectomy using an indirect laryngeal mirror. Skull lateral radiographs and a symptom scale were used to evaluate preoperative and postoperative states. RESULTS: There was no significant difference in the improvement of symptoms and postoperative outcome between the conventional group and the microdebrider adenoidectomy group. However, it was found that more adenoid tissue could be removed in the microdebrider group. Postoperative nasopharyngeal endoscopic views revealed that microdebrider removed adenoid tissue precisely and preserved the posterior nasopharyngeal wall better when compared to the conventional group. CONCLUSION: Compared with the conventional procedure, adenoidectomy using the transoral microdebrider with an indirect laryngeal mirror was similar in achieving symptom improvement and postoperative outcomes, but removed more adenoid tissue with higher precision. From this study, we suggest that using microdebrider with indirect laryngeal mirror is another valuable method of adenoidectomy in the aspect of precision.

A case of Basal Cell Nevus Syndrome with Acute Maxillary Sinusitis / 대한이비인후과학회지

A basal cell nevus syndrome, known as the Gorlin syndrome, is a rare autosomal dominant disorder, occuring especially in the oriental population. It is a complex hamartomatous/neoplastic syndrome with multisystemic manifestations involving the five major features: (1) multiple basal cell nevi, occasionally basal cell carcinoma usually seen at an early age; (2) multiple jaw cysts; (3) skeletal abnormalities of ribs, skull, and spine; (4) ectopic calcification; (5) palmar and plantar pits. Because patients are predisposed to this disorder prior to basal cell carcinoma of the skin, ovarian fibroma, and medulloblastoma, the most important aspects of management is frequent examination and early treatment of small tumors. We report here about a 16-year- child with odontogenic maxillary sinusitis, who has developmental multisystemic disorders which coincided with the basal cell nevus syndrome. The patient underwent a sinus operation and now is under a cautious follow-up.

Localized Wegener's Granulomatosis in Maxillary Sinus / 대한이비인후과학회지

Wegener's granulomatosis was first described by Wegener in 1936 as a vasculitis and necrotizing granuloma of the upper or lower respiratory tract. It is largely classified into a generalized necrotizing granuloma and a focal necrotizing granuloma. As a localized form of the disease, the respiratory tract is known to be involved frequently; however, the paranasal sinus is a less frequent site of involvement than other organs. In Korea, there has been no reports of Wegener's granulomatosis in the last ten years, and reports of localized form is extremely rare. We are reporting here a case of Wegener's granulomatosis in the maxillary sinus with literature review.

Expression of Vascular Endothelial Growth Factor and Platelet-Derived Endothelial Cell Growth Factor in Head and Neck Squamous Cell Carcinoma and It's Relation to Angiogensis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tumor angiogenesis is an essential process required for growth and metastasis in cancer. Vascular endothelial growth Factor (VEGF) and platelet-derived endothelial cell growth factor (PD-ECGF) are known to be angiogenetic factors. The objectives of this study were to measure the expression of VEGF, PD-ECGF and microvessel density (MVD) in head and neck squamous cell carcinoma (HNSCC) and compare them to normal larynx. We also evaluated relationships of VEGF, PD-ECGF and MVD to clinicopathologic findings in HNSCC. MATERIAL AND METHODS: The expression of VEGF, PD-ECGF and MVD were evaluated by immunohistochemical staining of 26 cases of HNSCC and 6 cases of normal larynx. RESULTS: The expressions of VEGF, PD-ECGF and MVD in HNSCC were significantly higher than in the normal control (p<0.05). MVD were significantly correlated with VEGF and PD-ECGF expressions in HNSCC (p<0.05). The VEGF, PD-ECGF expression and MVD correlated with many clinicopathologic findings in HNSCC. CONCLUSION: These results suggest that VEGF and PD-ECGF are involved in angiogenesis and are related to clinicopathologic findings of HNSCC. Furthermore, we propose that expressions of VEGF, PD-ECGF and MVD to be investigated more in the future as prognostic indicators of HNSCC.

Downregulation of Protein Kinase C Isozymes on Cholesteatoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The exact pathogenesis of cholesteatoma remains unknown in spite of several theories that have been formulated. The most characteristic histologic finding of cholesteatoma is the proliferation of the squamous cell lining of the lesion. Protein Kinase C (PKC) is a family of phospholipid-dependent serine/threonin protein kinase that sends extracellular signals across the cell surface in order to regulate epithelial cell groweth and differentiation. This study attempted to provide the evidence for the role of PKC in cholesteatoma. MATERIALS AND METHODS: Twenty-five cholesteatoma specimens were obtained from patients for western blotting, immunohistochemical study, RT-PCR, and densitometry. RESULTS: The results of western blotting revealed that considerably lower levels of PKCalpha, PKCbeta, and PKCepsilon protein were detected in cholesteatoma than in the posterior auricular skin. In the immunohistochemical study, PKCalpha, PKCbeta, and PKCepsilon were detected both in the basal and suprabasal layer of posterior auricular skin, but they were not detectable in cholesteatoma. The results of PCR for PKCalpha, PKCbeta, and PKCepsilon showed that there were no differences between cholesteatoma and posterior auricular skin regarding the mRNA expression. CONCLUSION: Downregulation of PKCalpha, PKCbeta, and PKCepsilon in cholesteatoma suggests that abnormal epithelial growth is a possible mechanism of cholesteatoma. The results suggest the following there is an abnormal signal transduction through the PKC pathway in cholesteatoma: downregulation of PKC takes place in the post-transcription phase, and downregulation of PKC is associated with prolonged chronic inflammation of cholesteatoma.

Expression of Phospholipase C-beta1 and Phospholipase C-gamma1 on Cholesteatoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A histological finding that is the most characteristic of cholesteatoma is the proliferation of the squamous cell. Signal transduction through phospholipase C(PLC) participates in the regulation of epidermal cell growth and differentiation. EGF, PDGF, and TGF-alpha bind to their receptors and thereby induce tyrosine phosphorylation of the phospholipase C-gamma1 (PLC-gamma1). PLC-gamma1 is a substrate for several receptor tyrosine kinases and its catalytic activity is increased by tyrosine phosphorylation. Tyrosine kinase phosphorylation of PLC-gamma1 stimulates PLC activation and cell proliferation. The G-protein has been shown to specifically activate PLC-beta1. However, the signal transduction pathway and the significance of PLC in cholesteatoma is unknown. This study attempted to provide some evidence that PLC plays a role in cholesteatoma by investigating the distribution and quantity of PLC-beta1 and PLC-gamma1 in the posterior auricular skin and cholestsatoma. MATERIALS AND METHODS: Western blotting and immunohistochemical study were performed for 20 cholesteatoma specimens obtained from patients who underwent operation. RESULTS: Western blot analyses revealed that PLC-beta1 protein and PLC-gamma1 protein were detectable in cholesteatoma and that these proteins were in higher levels compared with the control. In the imm-unohistochemical study, PLC-gamma1 was detected in the horny cell layer of posterior auricular skin but not in the suprabasal layer and the horny cell layer of cholesteatoma. PLC-beta1 was detected in the primary basal layer and a minor reaction was also noted in the spinous layer of posterior auricular skin. However, there were detactable reactions in both the basal and the suprabasal layers of cholesteatoma. CONCLUSION: The results of this study suggest that there are signal transduction pathways through PLC, over-expression of PLC, the different signaling mechanism by PLC in the basal and the suprabasal layer of cholesteatoma.

A Case of Relapsing Polychondritis Developed in Both Auricles / 대한이비인후과학회지

Relapsing polychondritis is a rare disease of unknown etiology. The disease is an immune disorder probably caused by autoimmunity. The characteristics are episodic with progressive inflammation of the cartilages of the body, most often of the ears, nose, costochondral junctions, joints, airway and cardiovascular system. Authors have recently experienced a case of relapsing polychondritis in a 28 year old man who had recurrent chondritis of both auricles. He did not have other involvement. The pathologic finding to the diagnosis was presented. We report this case with a review of the literature.

Expression of Protein Kinase C on Allergic Nasal Mucosa

Protein Kinase C (PKC) relays information in the form of a various extracellar signals across the membrane and is known to play an important role in the production of B lymphocytes and T lymphocytes, in the antigen-presentation of Langerhans cell, and in inflammatory reactions. The presentation of allergens to T lymphocytes is likely an important aspect in the pathophysiological mechanism of allergic rhinitis. Although several theories have been formulated in allergic rhinitis, signal transduction of this disease remains unknown. In this study, we focused on the role of the enzyme PKC in the allergic mucosa of the nose. Specifically, we investigated the role and the distribution of PKC isozymes in the mucous membrane of the nose. We obtained nasal mucous membrane specimens from 10 patients with house dust mite allergy and 10 patients with normal nasal mucous membrane. We performed an immunohistochemical study, an RT-PCR, and a densitometric measurement. PKCalpha, PKCbeta, and PKCzeta proteins were detected in the subepithelial layer of the allergic mucosa. However there were no detectable reactions in the nonallergic mucosa. In the RT-PCR for PKCalpha, PKCbeta and PKCzeta, there was no difference between the allergic and nonallergic nasal mucous membrane in terms of m-RNA expression. It is possible that the signal transduction pathway of PKC and over-expression of PKC protein at the post-transcription level contribute to the development of allergic inflammation in allergic nasal mucosa.