ABSTRACT
BACKGROUND AND OBJECTIVES: ObjectivesZZRecurrent laryngeal nerve (RLN) injury is a potentially debilitating complication of thyroid surgery. In re-operative thyroid surgery, the risk of vocal fold paralysis increases significantly. This study evaluated the efficiency of intraoperative RLN monitoring using an electromyography (EMG) tube in an re-operative thyroid surgery and the prediction of postoperative neural function from the relationship between the intraoperative neuromonitoring response and postoperative vocal fold function. SUBJECTS AND METHOD: Sixty-nine patients undergoing reoperative thyroid surgery were divided into two groups: 37 patients underwent reoperative thyroid surgery with intraoperative neuromonitoring (EMG group) and 32 patients underwent reoperative thyroid surgery without intraoperative neuromonitoring (no EMG group). The prevalence of transient and permanent vocal fold paralysis was evaluated in each group. In addition, the sensitivity, specificity, and negative and positive predictive values of intraoperative neuromonitoring were evaluated. RESULTS: Transient and permanent vocal fold paralysis occurred in 8.1% (3/37) and 2.7% (1/37) of the EMG group and 12.5% (4/32) and 6.3% (2/32) of the no EMG group, respectively. The negative and positive predictive values of intraoperative neuromonitoring using an EMG tube in predicting postoperative vocal fold function were 100% and 57.1%, respectively. CONCLUSION: Although the differences were not significant, intraoperative neuromonitoring using the EMG tube resulted in shorter operating time, and less transient and permanent vocal fold paralysis during reoperative thyroid surgery. Intraoperative neuromonitoring using an EMG tube for reoperative thyroid surgery may be useful for preserving the postoperative vocal fold function.
Subject(s)
Humans , Electromyography , Laryngeal Nerves , Paralysis , Prevalence , Recurrent Laryngeal Nerve , Sensitivity and Specificity , Thyroid Gland , Vocal CordsABSTRACT
Although liposarcomas are second most frequently encountered sarcomas that occur in soft tissue, liposarcomas of the head and neck are very uncommon. Liposarcomas of the retropharyngeal space are rare and do not cause symptoms until they reach a large size to cause mass effect. Depending on the location of the pharyngeal tumor, patients may present with foreign body sensation on throat, swallowing difficulty, respiratory difficulty, a painless neck mass, or obstructive sleep apnea. Recently we have experienced a case of retropharyngeal liposarcoma causing obstructive sleep apnea, so we report our clinical experiences with a brief review of literature.
Subject(s)
Humans , Deglutition , Foreign Bodies , Head , Liposarcoma , Neck , Pharynx , Sarcoma , Sensation , Sleep Apnea Syndromes , Sleep Apnea, ObstructiveABSTRACT
BACKGROUND AND OBJECTIVES: Surfactant protein A (SP-A) which plays a role in the innate host defense of lung is also expressed in Eustachian tube. However the genes underlying the susceptibility to otitis media with effusion (OME) are known insufficiently. The current study attempts to evaluate the difference in the allele distribution of SP-A1 and SP-A2 between normal subjects and subjects with otitis media with effusion. SUBJECTS AND METHOD: PCR-cRFLP-based methodology was used to detect SP-A genotypes in the 38 children with OME, and in the 55 normal newborns for control. RESULTS: The frequencies of specific genotypes such as 6A(2), 1A(2) were increased in OME group, but the frequency of 6A3 was increased in control group. CONCLUSION: It is presumed that SP-A alleles may be inductive (6A(2), 1A(2)) or protective (6A(3)) factors for OME. Specific genoytypes of SP-A may be an important determinant for the predisposition to OME.
Subject(s)
Child , Humans , Infant, Newborn , Alleles , Eustachian Tube , Genotype , Lung , Otitis Media with Effusion , Otitis Media , Otitis , Pulmonary Surfactant-Associated Protein AABSTRACT
BACKGROUND AND OBJECTIVES: Social awareness of the narcotic effects of industrial adhesive vapors have been aroused by some teens who are reported to inhale these vapors to get the narcotic effects. When inhaled, the toxic effects of these chemicals are concentrated to the field of central nervous system, and the excretion system of metabolites like the liver and kidney. The effects of industrial adhesive vapors on the respiratory epithelium are unclear so far. MATERIALS AND METHOD: This was designed to study the morphological changes after exposure of the chemicals on the nasal mucosa in mice. Young healthy mice were exposed to industrial adhesive vapor (mixtures of acetone 5212+/-1268 ppm, c-hexane 3757+/-711 ppm, methyl cyclopentane 1820+/-375 ppm, n-hexane 139+/-30 ppm, toluene 0.9+/-1.4 ppm) for 20 min, once daily for 3 days, 5 days, 7 days, and 14 days. After adhesive vapor exposure, mice respiratory mucosa were excised, fixed in 4% paraformaldehyde for immuno-histochemistry and in 2.5% glutaraldehyde -1.5% paraformaldehyde for transmission electron microscopy and in 2.5% glutaraldehyde for scanning electron microscopy. Fixed tissues were processed for immunohistochemistry and for electron microscopy. RESULTS: Cellular degeneration and necrosis were seen on exposure day 3 and 5 which included erosion or ulceration of epithelium, exfoliation of cell, deciliation, shrinkage of goblet cells etc. The architecture of ciliated columnar cells and goblet cells were regenerated on day 7. Among the ciliated cells, most of the cells were replaced by cuboid ciliated cells. And the secretory pattern of the goblet cells were also changed from the merocrine to apocrine type at same days of exposure. On the other hand, the PCNA immunochemical study revealed that positive cells were increased on day 5. CONCLUSION: These results suggest that the nasal mucosa of mice can be damaged to some extent by daily regular exposure of industrial adhesive vapor. However, it could have a potency of regeneration to cuboidal cells, which are thought to change into more resistant cells in order to adapt to repetitive external stimuli.
Subject(s)
Adolescent , Animals , Humans , Mice , Acetone , Adhesives , Central Nervous System , Cyclopentanes , Epithelium , Glutaral , Goblet Cells , Hand , Immunohistochemistry , Inhalation , Kidney , Liver , Microscopy, Electron , Microscopy, Electron, Scanning , Microscopy, Electron, Transmission , Narcotics , Nasal Mucosa , Necrosis , Proliferating Cell Nuclear Antigen , Regeneration , Respiratory Mucosa , Toluene , UlcerABSTRACT
BACKGROUND AND OBJECTIVES: Recently, accidents have been reported of young adults who inhale industrial bond vapor. Acquiring industrial bond is easy for young adults, and glue sniffing has thus become a serious social problem. However, there have been few reports concerning the changes in the olfactory epithelium after exposure of industrial bond vapor. The aim of this study is to describe the morphological changes of the olfactory mucosa after being exposed to industrial bond vapor, using HE, AB, AB-PAS stains, immunohistochemistry and the electron microscopy. MATERIALS AND METHOD: Healthy ICR mice were exposed to industrial bond vapor (acetone 5212+/-1268 ppm, c-hexane 3757+/-711 ppm, methylcyclopentane 1820+/-375 ppm, n-hexane 139+/-30 ppm and toluene 0.9+/-1.4 ppm). The vapor was given to each animal with duration of 20 min/day for 3 days, 5 days, 7 days or 14 days in a specially designed box for this study. After exposure to industrial bond vapor, mice olfactory mucosae were excised and prepared for HE, AB, AB-PAS stains, immunohistochemistry and electron microscopy. RESULTS: Loss of cells and disarrangements of olfactory epithelium were prominent on the third day of exposure and the epithelium recovered to the normal state after the day 7 in the HE stain. And there were also definite ultrastructural changes in the epithelium : loss of microvilli in supporting cells, exposure of olfactory vesicles to the luminal surface and apoptotic bodies in electron microscopic study. Study with the AB and AB-PAS stains demonstrated an evidence of decreased mucin secretion on the day 3 and the content of mucin was normalized after the day 7. In the PCNA study, cells were unable to proliferate until day 3. The proliferation potential were increased (4 fold) on day 5 and returned to normal on day 14. CONCLUSION: This result indicated that industrial bond vapor can damage the olfactory epithelium of mice which can recover rapidly. Apoptosis and active proliferation could be the factors that are involved in the recovery of the epithelium that is open to regular industrial bond vapor exposure on daily basis.
Subject(s)
Animals , Humans , Mice , Young Adult , Apoptosis , Coloring Agents , Epithelium , Immunohistochemistry , Inhalant Abuse , Mice, Inbred ICR , Microscopy, Electron , Microvilli , Mucins , Olfactory Mucosa , Phenobarbital , Proliferating Cell Nuclear Antigen , Social Problems , TolueneABSTRACT
Optic neuritis (ON) is an acute or subacute inflammatory or demyelination process affecting the optic nerve. ON can be classified ophthalmologically as retrobulbar neuritis, papillitis, neuroretinitis. Retrobulbar neuritis, in which the optic disc appearance is normal, is the most common type of ON in adults. Multiple sclerosis is the most common cause of ON, but in many cases no apparent etiology is found. Paranasal sinusitis as a cause of ON is rare. Management of retrobulbar neuritis which is combined with paranasal sinusitis is controversial. Recently, we experienced a case of retrobulbar neuritis which was combined with paranasal sinusitis without orbital complication. It was treated by endoscopic sinus surgery and endoscopic optic nerve decompression in addition to intravenous antibiotics and corticosteroids. Visual acuity was improved nearly to a normal state after the treatment. The most possible pathophysiologic mechanism of retrobulbar neuritis may be the direct spread of infection of the sphenoid sinus to the optic nerve.
Subject(s)
Adult , Humans , Adrenal Cortex Hormones , Anti-Bacterial Agents , Decompression , Demyelinating Diseases , Multiple Sclerosis , Optic Nerve , Optic Neuritis , Orbit , Papilledema , Retinitis , Sinusitis , Sphenoid Sinus , Visual AcuityABSTRACT
BACKGROUND AND OBJECTIVES: Inverted papillomas (IPs) are rare benign tumors of nasal epithelium with high recurrence rates and malignant transformation potential. Tumor development results from imbalance between cell proliferation and "programmed cell death", also named apoptosis. The purpose of this study was to compare cell proliferation, apoptosis, and apoptosis inhibition in hyperplastic epithelium from IPs and nasal polyps (NPs), and also to understand the mechanism of growth and malignant transformation of IPs. MATERIALS AND METHODS: IP samples were obtained after surgical removal of tumor in 15 patients, and NPs were sampled during endoscopic sinus surgery in 7 patients as a control. IP samples were classified in three groups: group I (n=9) -IP without dysplasia or carcinoma, group II (n=3) -IP with dysplasia, group III (n=3) -IP with carcinoma. Cell proliferation and apoptosis inhibition, respectively, were assessed by immunohistochemical identification of the Ki-67 and the oncoprotein Bcl-2. Apoptosis was evaluated by analyzing the DNA fragmentation using TUNEL method. RESULTS: Ki-67 index was increased in IPs compared to NPs (p=0.001). Of the IPs, Ki-67 index was increased progressively from IP without dysplasia or caccinoma, through IP with dysplasia, to reach the highest level in IP with carcinoma. Apoptotic index was also increased in IPs (p=0.002) with the highest level in IP without dysplasia or carcinoma. Of the IPs, apoptotic index was decreased as the tumor progress. Bcl-2 index was decreased in IPs (p=0.004), but, of the IPs, as the tumor progress, bcl-2 index was more decreased. CONCLUSION: Tumor development of IPs could result from the imbalance between hugely increasing epithelial cell proliferation and slightly increasing apoptosis, and the inhibition of apoptosis via bcl-2 oncoprotein seems to be involved in the growing process of IPs. Although we can not exactly mention due to limited number of cases, these imbalance may be involved in dysplastic or malignant transformation of IPs, but may be independent of the expression of bcl-2.
Subject(s)
Humans , Apoptosis , Cell Proliferation , DNA Fragmentation , Epithelial Cells , Epithelium , In Situ Nick-End Labeling , Nasal Mucosa , Nasal Polyps , Papilloma, Inverted , RecurrenceABSTRACT
Angioleiomyoma is a type of benign smooth muscle tumor. It is common in uterus and the gastrointestinal tract but rare in head and neck. This neoplasm is extremely rare in the larynx as only 10 cases have been reported in the literature in the world so far. Main symptoms are hoarseness and dyspnea. The treatment of choice is complete removal with care taken to avoid profuse bleeding. The authors report one case of angioleiomyoma of the larynx that was excised surgically with CO2 laser under suspension microlaryngoscopy.
Subject(s)
Angiomyoma , Dyspnea , Gastrointestinal Tract , Head , Hemorrhage , Hoarseness , Larynx , Lasers, Gas , Neck , Smooth Muscle Tumor , UterusABSTRACT
BACKGROUND AND OBJECTIVES: Medial orbital wall fractures are seen in association with fractures of the orbital floor or more complex bony disruptions. It is important to diagnose and manage medial orbital wall fractures as early as possible, because of the possibility of functional orbital damage later. In this study, fractures were divided into the following types based on location and severity of injury according to Nolasco and Mathog: type I (confined to the medial orbital wall), type II (medial orbital wall continuous with floor, type III (medial orbital wall with floor-malar fractures), and type IV (medial orbital wall and complex midfacial injuries). MATERIALS AND METHODS: We reviewed 22 cases of medial orbital wall fractures according to the classification of Nolasco and Mathog at Soonchunhyang University Chunan Hospital. RESULTS: 1) Types of fractures observed were type I (9 cases), type II (10 cases), type III (2 cases), and type IV (1 case). 2) The most common age groups were the thirties and the fourties. The male-to-female ratio was 3:1, and more injuries were found at the left orbit. 3) Assault was the most common cause, as observed in 10 of 22 cases (45.5%), and types III and IV injuries only occurred in falls. 4) Diplopia was the most common symptom, as in 15 of 22 cases (68.2%). Ecchymosis and periorbital swelling were more common with type I; diplopia was more common with type II. 5) Type I fractures were generally explored through intranasal approach, whereas the other types were commonly treated with subciliary or Caldwell-Luc approach. SUMMARY: Medial orbital wall fractures were more common in type I and II, the male, and the left side. Commonly, type I fractures caused ecchymosis and periorbital swelling and were treated with conservative treatment. In most cases, type II fractures caused diplopia and were treated with surgery 1 or 2 weeks after trauma.
Subject(s)
Humans , Male , Classification , Diplopia , Ecchymosis , Orbit , Orbital FracturesABSTRACT
No abstract available.