A Case of Plasma Cell Mucositis Arising From the Larynx

Plasma cell mucositis is a very rare benign disease characterized by dense lymphoplasmacytic infiltration in the submucosa layer. It appears as a reddish ulcer on the mucous membrane or as a cobblestone or nodular mass on the affected mucosa. When it involves the pharynx or larynx, the patient presents with dysphagia, voice change and dyspnea. Clinically, it is important to differentiate with malignant diseases such as extramedullary plasmacytoma, amyloidosis and sarcodosis. Several cases of mucositis in the larynx have been reported in English literature, but none have been reported in Korea. We report a case of plasma cell mucositis in the larynx with a review of literature.

A Case of Plasma Cell Mucositis Arising From the Larynx

Plasma cell mucositis is a very rare benign disease characterized by dense lymphoplasmacytic infiltration in the submucosa layer. It appears as a reddish ulcer on the mucous membrane or as a cobblestone or nodular mass on the affected mucosa. When it involves the pharynx or larynx, the patient presents with dysphagia, voice change and dyspnea. Clinically, it is important to differentiate with malignant diseases such as extramedullary plasmacytoma, amyloidosis and sarcodosis. Several cases of mucositis in the larynx have been reported in English literature, but none have been reported in Korea. We report a case of plasma cell mucositis in the larynx with a review of literature.

Analysis of Steroid Effect in Patients with Olfactory Dysfunction / 대한이비인후과학회지

Background and Objectives@#Olfaction plays an important role on sensing and discriminating smell and taste. The number of patients visiting outpatient department for treatment of olfactory dysfunction is increasing along with the change in patients’ perception about the importance of olfactory function.Subjects and Method Patients with olfactory dysfunction, who visited the hospital from 2010 to 2018, were included in this study. The medical records were reviewed focusing on the Korean Version of Sniffin’ Stick, the CT finding of olfactory cleft or signs of sinusitis, and the effect of oral steroids. Postviral olfactory disorder (PVOD) patients and chronic rhinosinusitis (CRS) patients were treated by oral steroid, starting on prednisolon (Solondo Tab®, YuHan Corp.; 40 mg per day) and tapered for 2 weeks. @*Results@#There were 13 cases where patients’ sense of smell was improved only for a short period of time after taking steroids but worsened thereafter. They showed improvement of olfactory function every time they took steroids. We defined this group as “steroid dependent olfactory dysfunction.” @*Conclusion@#It is necessary to understand the physiology and molecular biologic mechanisms behind the causes of olfactory dysfunction in order to establish the diagnostic criteria and treatment strategy. Steroid dependent olfactory dysfunction also needs more investigation.

A Case of Cochlear Implantation in a Child with Congenital Aural Atresia and Cochlear and Cochlear Nerve Malformation / 대한이비인후과학회지

Congenital aural atresia (CAA) is usually accompanied by an anomalous course of facial nerves, which may run over the round window niche toward the promontory in some cases of CAA. Very rarely, cochlear malformation might coexist at the same ear which has CAA, in which case cochlear implantation can be difficult due to anomalous facial nerve. Herein we present a case of cochlear implantation performed in a child who had CAA along with cochlear hypoplasia and cochlear nerve aplasia. The mastoid segment of facial nerve was displaced anteriorly, running over the round window niche. The surgery was done successfully using the round window approach without facial nerve injury.

Two Cases of Recurrent Nasal Polyps in Siblings-Woakes' Syndrome / 대한이비인후과학회지

Woakes' syndrome is a group of disease which include recurrent nasal polyps resulting in the broadening of the nasal pyramid, the onset of hypoplasia of frontal sinus and bronchiectasis, as well as the production of mucous discharge. Children and young adults are mostly susceptible to Woakes' syndrome due to the plasticity of the bone. Even though the exact etiology is unknown, genetic factor is thought to be influential because it is often diagnosed in siblings. Otolaryngologically, the mainstream method of removing nasal polyp by endoscopic sinus surgery as well as topical or systemic treatment can be helpful. We report two siblings who visited our clinic both complaining of nasal obstruction. The patients presented with recurrent nasal polyps and showed signs of bronchiectasis, which led to the diagnosis of Woakes' syndrome. These rare cases are presented here with a review of related literature.

A Case of Head and Neck Mucosa-Associated Lymphoid Tissue Lymphoma Presenting as Progressive Multiple Cranial Nerve Palsy / 대한이비인후과학회지

Lymphoma is a malignant tumor arising from the lymphoid tissue. Chronic inflammation can make lymphocyte accumulation and proliferation in the mucous membrane. Sustained accumulation of these persistent changes in the lymphoid tissues may be responsible for the development of mucosa-associated lymphoid tissue (MALT) lymphoma. Although multiple cranial nerve palsy have been reported in various lymphoma, it has never been reported in MALT lymphoma. A 39-year-old man reported of facial palsy and subsequent vocal fold palsy. MALT lymphoma was diagnosed as involving the parotid gland, nasopharynx, and the skull base. Vocal palsy and facial palsy were successfully recovered after chemotherapy.

Two Cases of Recurrent Nasal Polyps in Siblings-Woakes' Syndrome / 대한이비인후과학회지

Woakes' syndrome is a group of disease which include recurrent nasal polyps resulting in the broadening of the nasal pyramid, the onset of hypoplasia of frontal sinus and bronchiectasis, as well as the production of mucous discharge. Children and young adults are mostly susceptible to Woakes' syndrome due to the plasticity of the bone. Even though the exact etiology is unknown, genetic factor is thought to be influential because it is often diagnosed in siblings. Otolaryngologically, the mainstream method of removing nasal polyp by endoscopic sinus surgery as well as topical or systemic treatment can be helpful. We report two siblings who visited our clinic both complaining of nasal obstruction. The patients presented with recurrent nasal polyps and showed signs of bronchiectasis, which led to the diagnosis of Woakes' syndrome. These rare cases are presented here with a review of related literature.

Alterations of Aquaporin mRNA and Protein Expression in Hypokalemic Rat Kidney / 대한해부학회지

There has been a general agreement that potassium depletion causes metabolic alkalosis and substantial morphological changes in kidney structure, and is associated with renal functional abnormalities, including a decrease in urinary concentrating ability. The present study was to examine the alterations of expression and distribution of AQP-1, 2, 3 and 4 mRNAs and proteins in the kidneys of normal and K-depleted rats using RT-PCR, Western blot analysis, and immunohistochemistry. Predicted size of AQP-1, 2, 3, and 4 mRNAs was 119, 822, 539, and 642 bp, respectively. AQP-1 mRNA expression was gradually decreased in K-depleted rats, particularly LK 2W. AQP-2, 3 mRNAs were markedly decreased in K-depleted rats. AQP-4 mRNA expression was markedly increased in K-depleted rats, particularly LK 2W. Western blot analysis demonstrated that AQP-1 protein expression was only decreased in LK 3D and others were comparable with normal rat. AQP-2, 3 proteins expression was markedly decreased in K-depleted rats, compared with normal rat. But, AQP-4 protein expression was markedly increased in K-depleted rats, particularly LK 3W. In immunohistochemistry, AQP-1 was detected in the apical membranes of proximal tubules and thin limb of Henle loop. In potassium-depleted kidney, the pattern of cellular labeling and signal intensity of AQP-1 protein is identical to that of normal rat. AQP-2 was detected in apical region and cytoplasm of the principal cells of entire collecting duct. In potassium-depleted kidney, the pattern of cellular labeling of AQP-2 protein is identical to that of normal rat, but signal intensity is markedly decreased. AQP-3 was detected in the bosolateral plasma membrane of principal cells of entire collecting duct. In potassium-depleted kidney, the pattern of cellular labeling of AQP-3 protein is identical to that of normal rat, but signal intensity is markedly decreased. AQP-4 was detected in the bosolateral plasma membrane of principal cells of entire collecting duct. In potassium-depleted kidney, the pattern of cellular labeling of AQP-4 protein is identical to that of normal rat, but signal intensity is markedly increased in outer and inner medullary collecting ducts. In summary, these results demonstrate that chronic hypokalemia shows the different expression pattern of AQP-1, 2, 3, and 4 mRNAs and proteins. These results suggest that a decrease in urinary concentrating ability is a major factor in the decreased AQP-2, 3 expression, and that is partly compensated by increased expression of AQP-4.

Alterations of Aquaporin-1, 2, 3 Protein Expression in Pregnant Rat Kidney / 대한해부학회지

The pregnancy causes the marked change in maternal renal hemodynamic and volume homeostasis. During pregnancy, renal sodium and water retention result in an expansion of extracellular fluid and plamsma volume. Although many studies suggested that water balance or water balance disorder was associated with regulation of Aquaporin (AQP) expression, the studies were only limited to AQP-2 expression during the pregnancy. The present study was to examine altered expression and distribution of AQP-1, 2, and 3 proteins in the kidneys of non-pregnant (NP) and pregnant rats using Westhern blot analysis and immunohistochemistry. Pregnant Sprague-Dawley rats were evaluated on various time sets: days 10.5 (P10.5), 12.5 (P12.5), 17.5 (P17.5), and 19.5 (P19.5). In Westhern blot analysis, expression of AQP-1, 2 was peaked at P17.5 and AQP-3 at 19.5. Immunoreactivity of AQP-1 of NP rat was detected in the apical membranes of proximal tubules and thin limb of Henle loop. In pregnant rats, the pattern of cellular labeling of AQP-1 protein was identical to NP rat, but signal intensity was continuously increased from P10.5 and peaked at P17.5. In NP rat, immunoreactivity of AQP-2 was the most prominent in apical region and moderate in cytoplasm of the principal cells of entire collecting duct. In pregnant rats, the pattern of cellular labeling of AQP-2 protein was identical to NP rat, but signal intensity was moderately expressed in P10.5 and P12.5 and most prominent signal was observed in P19.5. In NP rat, immunoreactivity of AQP-3 was most prominent in the bosolateral plasma membrane of principal cells of entire collecting duct. In pregnant rats, the pattern of cellular labeling of AQP-3 protein was identical to NP rat, but signal intensity was continuously increased from P10.5 to P17.5 and peaked at P19.5. These results suggest that the expansion of extracellular fluid volume and water retention are regulated by AQP-1, 2, and 3 during the pregnancy, especially at late stage.

Expression and Localization of General Transcription Factor IIA Gene in Hypokalemic Rat / 대한해부학회지

Potassium balance in chronic hypokalemia is regulated by ion channels, ion transporters, and various related genes. We isolated general transcription factor IIA (GTF IIA) gene using a DNA chip microassay, a useful method in cloning genes. Northern analysis and in situ hybridization (ISH) were carried out to analyze the expression and localization of GTF IIA mRNA in rat in relation to the amount of potassium in the diet. Isoform-specific 32P-labeled cDNA (Northern analysis) or digoxigenin-labeled cRNA (ISH) probes were used. Northern analysis demonstrated that GTF IIA mRNA was expressed abundantly in testis; modestly in heart, kidney, lung, adrenal gland, liver, and spleen; and weakly in brain, distal colon, duodenum, salivary gland, and stomach. In potassium-restricted animals, GTF IIA expression was decreased in the kidney, adrenal gland, and spleen, but expression was restored to normal levels in L3w. The expression level in the lung was decreased in L3d and L2w, and increased in L1w and L3w. ISH showed that mRNA for the GTF IIA gene was detected in the distal convoluted tubule, S3 segment of the proximal tubule, and cortical collecting duct in the normal group. In potassium-restricted groups, the hybridization signal was detected in the distal convoluted tubule, S3 segment of the proximal tubule, and entire collecting tubule. The signal intensity of the outer and inner medullary collecting ducts was higher in the potassium-restricted group than in the normal group but was decreased in the distal convoluted tubule and S3 segment of the proximal tubule. In the normal group, mRNA of the GTF IIA gene was detected in the zona glomerulosa cells of the adrenal gland, lymphocytes of the marginal zone, germinal center of the spleen, and bronchial epithelium and lymphocytes of the lung. mRNA for the GTF IIA gene was also detected in the cells of the basal portion of the intestinal glands of the distal colon and stomach, and in spermatogonia and spermatocytes of the seminiferous tubule. These results suggest that expression of GTF IIA differs between various tissues and that increased expression of the GTF IIA gene in the outer and inner medullary collecting ducts of the hypokalemic kidney might regulate the ion transporter genes in these segments.

The Characteristics of Colonic Adenoma Detected by 18F-FDG-PET / 대한소화기내시경학회지

BACKGROUND/AIMS: FDG-PET is widely used for the evaluation of cancer patients. FDG-PET is usually employed for a staging of colorectal cancer and for the early detection of postoperative recurrence of cancer. Areas of focal uptake that suggest colonic lesions, including benign adenoma, may be seen on an FDG-PET image. This study evaluated the characteristics of colonic adenoma as detected by FDG-PET. METHODS: 60 subjects (M/F: 30:30, mean age: 55+/-11) who underwent both PET study and colonoscopy were enrolled and their data were retrospectively analyzed. RESULTS: A total of 50 lesions of colonic adenoma (3~35 mm) were found in 17 subjects by colonoscopy. Compared with the colonoscopic findings, FDG- PET had a positive predictive value of 52.9% and a negative predictable value of 81.4%. The positive rate increased with the size of the colonic adenoma (15 mm, 100.0%; > or =10 mm, 82.4%; <5 mm, 0.0%) and with the protruded type of polyp (sessile, 25.0%; subpedunculated, 47.7%; pedunculated, 90.9%). CONCLUSIONS: FDG-PET positive colonic lesions should raise a concern for not only possible malignancy, but also for the large sized or malignant transforming colonic adenoma.

Effects of Renal Transplantation on Echocardiographic Changes: Ejection Fraction and Left Ventricular Mass Index

BACKGROUND AND OBJECTIVES: Cardiovascular disease is a leading cause of death in patients on long-term dialysis and cardiac mortality decreases after renal transplantation. The aim of this study was to investigate the effects of successful renal transplantation on cardiac structure and function assessed by echocardiography. MATERIAL AND METHOD: Eighteen adult chronic renal failure patients who were taken renal transplantation in our hospital were included. They were submitted to two echocardiographic evaluations at preoperative time and postoperative time (mean: 23months). RESULTS: At the time of transplantation, 18 patients had undergone hemodialysis through a fistula (mean: 44months). At postoperative follow up, blood urea nitrogen/creatinine were decreased and mean hemoglobin level was increased. And systolic/diastolic blood pressure were decreased. Left ventricular mass index, left ventricular posterior wall thickness and septal wall thickness were decreased and ejection fraction was increased by echocardiography. Diastolic function did not improve. Hemodialysis duration and preoperative blood urea nitrogen/creatinine level affected ejection fraction change. CONCLUSION: We observed significantly decreased left ventricular mass index, increased ejection fraction after renal transplantation. We found that the patients who had been onlonger hemodialysis and higher preoperative blood urea nitrogen/creatinine level showed marked improvement of ejection fraction buy echocardiography.