Clinical Analysis of Endoscopic Transnasal Transsphenoidal Hypophysectomy of Pituitary Tumor / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Various surgical approach has been used for the removal of pituitary tumor. Recently, endoscopic transnasal transsphenoidal approach has been technically upgraded and the morbidity associated with surgical treatment of the pituitary tumor has been decreased. The objectives of our study was to describe surgical techniques and materials used in sellar repair after endoscopic transnasal transsphenoidal approach. SUBJECTS AND METHOD: We retrospectively reviewed the medical records of 18 patients who had received endoscopic transnasal transsphenoidal pituitary surgery between November 2002 and January 2004. We evaluated effectiveness of this technique by analyzing surgical techniques, symptom improvement and complications after surgery. RESULTS: In most of the case, tumor was found to be macroadenoma and 8 of the cases had suprasellar extension. Tumor was totally removed in 13 cases and partially removed in 5 cases. In all cases we used endoscopic unilateral transnasal transsphenoidal approach with anterior sphenoidotomy. CONCLUSION: We may consider that this approach is more safe and effective and a better treatment method for pituitary tumor surgery than the transcranial approach.

Nasal Septal Deviation and Compensated Inferior Turbinate Hypertrophy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Septoplasty with or without turbinate surgery is performed by many otorhinolaryngologists. However, the surgical methods largely rely on clinical judgement alone. The purpose of this study is to investigate the correlation between deviated nasal septum and inferior turbinate with compensatory hypertrophy on paranasal sinus computed tomography (CT) and to suggest a guideline for septal and turbinate surgery. SUBJECTS AND METHOD: Paranasal sinus CT scans of twenty patients with nasal septal deviation and compensatory hypertrophy of inferior turbinate were taken and reviewed. Measurements of thickness of mucosa and medial conchal bone, projection angle of inferior turbinate, distance between medial conchal bone and lateral nasal line, and interval between median line and conchal bone were obtained. Each measurement was compared with that of opposite side of nasal cavity and normal control subjects. RESULTS: The thickness of medial mucosa and conchal bone of inferior turbinate of concave side were more increased than those of the other side (p<0.05). The projection angles of conchal bone from lateral nasal wall in each side were different and the distances between medial conchal bone and lateral nasal line were more increased in concave side (p<0.05). CONCLUSION: Septoplasty and concomitant inferior turbinate surgery that manipulates conchal bone and soft tissue is necessary for the patients with a complaint of nasal obstruction. Reduction of medial mucosa and out-fracture of hypertrophied inferior turbinate are proper for the concomitant inferior turbinate surgery. The data gathered using CT images are important in making a decision regarding turbinate surgery in septoplasty.

The Evaluation of Olfactory Function in Patients with Septal and Turbinate Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Septoplasty with turbinate reductive surgery is a frequently performed operation for the treatment of nasal obstruction. However, the effect of septoplasty on olfactory function has not been systematically evaluated. The purpose of this study is to investigate changes of olfactory function following septoplasty with turbinate reductive surgery and to evaluate correlations between the change of minimal cross sectional area (MCA) of nasal cavity and nasal volume and olfactory function after nasal surgery. SUBJECTS AND METHOD: Olfactory threshold and identification test of 25 patients with nasal septal deviation and compensated hypertrophy of inferior turbinate were taken pre- and postoperatively. Nasal volume and MCA were measured using acoustic rhinometry before and after the nasal surgery. RESULTS: Septoplasty with turbinate reductive surgery increased the volume and MCA of the nasal cavity and scores of the olfactory identification test were increased after the septal surgery (p<0.05). However, some patients have decreased scores in the olfactory function test after surgery. There were no correlation between the changes of olfactory threshold and acoustic rhinometric parameters of nasal cavity. CONCLUSION: Septoplasty with turbinate reductive surgery has some beneficial effect on olfactory function. However, there are no correlation between changes of olfactory function and changes of parameters in acoustic rhinometry. Preoperative olfactory test is advisable and informed consent for postoperative change of olfaction is necessary in assessing patients for nasal surgery.

Clinical Evaluations of Sinonasal Infection in the Patients with Hematopoietic Stem Cell Transplantation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: As a result of increasing the use of hematopoietic stem cell transplantation (HSCT) for hematologic malignancies and certain solid tumors, more patients have become susceptible to infection. Sinonasal infections in patients with HSCT frequently cause problems which are sometimes fatal. The purpose of this study is to determine the clinical features of sinonasal infections in the immunocompromised patients who received HSCT and to suggest a proper evaluation of these patients. MATERIALS AND METHOD: We reviewed retrospectively 1814 patients who had received HSCT in St. Mary's hospital from August 1995 to May 2003 to determine the clinical features of sinonasal infections in these patients and to analyze the correlation between sinonasal infection of pre- and post-HSCT. RESULTS: 403 patients (22.2%) had sinonasal infections. The infection occurred before HSCT in 206 patients (11.3%), whereas it occurred after HSCT in 197 patients (10.8%). Of 197 patients (27.4%) 54 had previously sinonasal infections. CONCLUSION: Sinonasal infection in the patients of pre-HSCT increased incidence of post-HSCT sinonasal infection. Early detection using endoscopic examination and sinus computed tomography scan as well as employing an aggressive combined treatment of medical and surgical modalities are essential for the treatment of sinonasal infections in the HSCT patients.

Anatomic Variations of Sphenoid Sinus and Related Neurovascular Structures: A Study of CT Analysis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Anatomic variations of the sphenoid sinus and the related neurovascular structures are common. Because it is a rule that may complicate surgery in such a place, these variations should be known preoperatively. The aim of this study was to delineate the relationship between the pneumatization of the sphenoid sinus and the related neurovascular structure variations including carotid artery and optic nerve. SUBJECTS AND METHOD: A review of 100 paranasal sinus tomographic scans was made to investigate the anatomic variations of the sphenoid sinus and the related structures. The analyzed items were the pneumatization of the sphenoid bone including anterior clinoid process (ACP) and pterygoid process (PP), the relationship between the pneumatization of the sphenoid sinus and the incidence of bulging of the internal carotid artery (ICA), optic nerve (ON), maxillary nerve and pterygoid nerve. The patterns of intersinus septum and accessory septum were also assessed. RESULTS: The most prevalent type of the pneumatization of the sphenoid sinus was the sellar type (90%). Midline location of the septum was found in 32 patients. Accessory septum was found in 52 patients. The bulging of ICA into the sphenoid sinus was found in 52 patients (retrosellar segment) and 67 patients (presellar segment). ON bulging was found in 52 patients. Patients showing pneumatization of ACP and PP were 20 and 34, respectively. There was a statistically significant relationship between the pneumatization of ACP, PP and the bulging in ICA and ON. Number of patients showing bulging of the maxillary nerve and pterygoid nerve was 36 and 49, respectively. CONCLUSION: Accurate evaluation of the pneumatization of the sphenoid sinus and the variations of the related neurovascular structures is possible with preoperative CT scans of the sinus. Numerous variations of the related neurovascular structures are related with degrees of pneumatization of the sphenoid sinus. For safe sphenoid sinus surgery, a thorough analysis of the preoperative CT scans as well as the precise anatomic knowledge is required.

Effect of Electrical Stimulation on Vestibular Compensation in the Unilateral Labyrinthectomized Rats / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The effect of electrical stimulation (ES) on vestibular compensation was investigated for 28 days after unilateral labyrinthectomy (Lx) in 24 rats. MATERIALS AND METHOD: The rats were divided into 4 groups and were treated as follows: A) Lx only, B) Lx with ES (0.6 mA) for 2 days, C) Lx with ES (0.6 mA) for 7 days, D) Lx with ES (1.2 mA) for 2 days. ES with pulse wave (10 Hz) was applied to temporal portion bilaterally (8 hr/day). Cathodal currents were transmitted to the electrode on the destructive side, anodal to that on the intact side. Postoperatively, spontaneous nystagmus (SN) was recorded with the video camera and yaw and roll head tilt (YHT, RHT) were measured using photo images. Horizontal vestibulo-ocular reflex (VOR) was evaluated at various frequencies (0.05, 0.1, 0.5, 1, 2, 3 Hz with peak angular velocity of 40degrees/sec) with the magnetic search coil system. Locomotor movement was monitored with a video camera. RESULTS: The ES groups showed faster compensation in SN, YHT, and RHT than the Lx group. At 3 days after Lx, the ES groups showed significant improvement in the gain over the whole frequency and asymmetry at low frequency compared to that of the Lx group. But the ES group had no effect on compensation of gain and asymmetry on and after 7 days of post-labyrinthectomy. There was no significant difference in vestibular compensation with respect to duration and intensity of ES. ES had no significant effect on the mean velocity and mean deviation of locomotor movements. CONCLUSION: These results suggest that ES has a favorable effect on the suppression of early static symptoms but has no effect on the compensation of dynamic symptoms after the recovery of resting discharge of the vestibular nuclei neurons.

The Efficacy of Stellate Ganglion Block in Olfactory Disorder Following Upper Respiratory Tract Infection / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: For patients with sudden hearing loss or retina arterial spasm, stellate ganglion block (SGB) has been used as a treatment method to increase the blood flow to the interested area. The aim of this study is to prospectively investigate the efficacy of SGB in patients with olfactory dysfunction following upper respiratory tract infection (URI). MATERIALS AND METHOD: Fifty one patients with anosmia or hyposmia following URI were included. The average duration of olfactory dysfunction was 3.5+/-8.4 years. Thirty eight patients were treated with SGB and compared with the untreated 13 patients. Buthanol threshold test and odor identification test with 16 natural fragrances were used to determine anosmia/hyposmia in these patients and to quantify the improvement of olfactory perception after SGB treatment or follow-up without treatment. RESULTS: Olfactory perception was improved significantly in the treated patients as shown by the buthanol threshold test (p<0.001) and by odor identification test (p<0.001). Subjective olfactory perception was improved in 27 of the 38 treated patients (p<0.001). No complications were observed after SGB and no one reported any worsening in olfactory perception during or after treatment. On the other hand, none of the untreated patients showed any improvement in neither of the tests or the subjective assessment. CONCLUSION: These results suggest that SGB may be a new treatment modality for olfactory dysfunction following URI.

The Expression of Bcl-xL and Bax in Nasal Polyps / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The etiology and the pathophysiology of nasal polyps are still not definitely known and recently, it is suggested that inflammatory responses involving eosinophils may play a major role. The process of the infiltration of eosinophils in tissues is explained by the increase of the movement of eosinophils to the inflammatory area and the delay of apoptosis which results in the longer survival of eosinophils. Recently, there have been studies showing how eosinophils extracted from blood expressed their anti-apoptotic Bcl-xL genes and pro-apoptotic Bax genes when put in a delayed apoptotic condition. The purpose of this study is to investigate Bcl-xL and Bax expressions of eosinophils in nasal polyps and how allergic rhinitis affect their expressions. MATERIALS AND METHOD: Nasal polyps were obtained from patients with chronic paranasal sinusitis (30 cases) and nasal polyps were divided into two groups, one obtained from the patient with allergic rhinitis (15 cases) and the other obtained from the patient without allergic rhinitis (15 cases). The normal control group consisted of 5 cases of normal nasal mucosa in the inferior turbinate. The immunohistochemical stain was used to detect eosinophils and the cells expressing Bcl-xL and Bax. RESULTS: In nasal polyps, a significant statistical correlation between eosinophil numbers and Bcl-xL positive cell numbers was detected. But there was no correlation between them in the normal control. The Bax positive cell numbers had a correlation to eosinophil numbers in both the normal control and nasal polyps. And allergic rhinitis did not affect the expression of Bcl-xL and Bax of eosinophils in nasal polyps. CONCLUSION: The authors propose that in eosinophils of nasal polyps, Bcl-xL plays an important role in delayed apoptosis and allergic rhinitis has no effect on the expression of Bcl-xL and Bax.

Distribution and synaptic organization of nitric oxide synthase immunoreactive neurons in the rat olfactory / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nitric oxide (NO) has been reported to play important roles in the regulation of olfactory information in the mammarian olfactory bulb. Although the distribution of nitric oxide synthase (NOS)-immunoreactive neurons in the olfactory bulb in the rat and other animals have been investigated by light microscopy, ultrastructures of the synaptic organization between NOS-immunoreactive neurons have not been studied yet. This study was conducted in order to identify NOS- immunoreactive neurons in the rat olfactory bulb and to define their synaptic organizations under the electron microscope using the preembedding immunocytochemical method which utilizes anti-NOS antiserum. MATERIALS AND METHODS: The olfactory bulbs of the rats were cut into 50 micromiter thick vertical sections and immunostained using the ABS method. Stained sections were observed under the light microscope. Some of the stained sections, additionally stained with uranyl acetate and dehydrated, were embedded in Epon 812 and prepared into 80 nm thick sections to be observed under the electron microscope. RESULT: NOS-immunoreactive neurons of the rat olfactory bulb made up 25.0% of periglomerular cells and 18.9% of granule cells. NOS-immunoreactive periglomerular cells received synaptic input from unlabeled axon terminals of the olfactory nerve and unlabeled periglomerular cells within the glomeruli. The output targets of NOS immunoreactive periglomerular cells were unlabeled axon terminals of the olfactory nerve and unlabeled periglomerular cells. NOS-immunoreactive granule cells received synaptic input from unlabeled processes of granule cells and axon terminals of mitral cells, and made output synapses onto the unlabeled axon terminals of mitral cells. CONCLUSION: NOS-immunoreactive neurons are periglomerular cells and granule cells, and NO liberated from NOS cells may play important roles in the modulation of olfactory transmission.

Comparison Study of Epithelial Cell Proliferation in Nasal Polyp and Nasal Mucosa / 대한이비인후과학회지

BACKGROUND AND OBJECTIVE: Nasal polyposis is a chronic inflammatory disease with structural modification of the mucosal epithelium and the lamina propria. In one of recent studies related to the lamina propria, the myofibroblast, which is a potent inducer of extracellular matrix (ECM) synthesis, was found to increase the pedicle area of the nasal polyp. In this study, we intended to quantify epithelial cell proliferation of the polyp. We also tried to identify the active area of epithelial proliferation within nasal polyp and to compare it with the active area of ECM synthesis. MATERIALS AND METHODS: During the endoscopic surgery of nasal polyposis patients, anatomically intact polyp, uncinate process, inferior turbinate and middle turbinate were sampled. The normal nasal mucosa of the inferior turbinate and the septum were obtained from patients who underwent septoplasty. The proliferation cell nuclear antigen (PCNA) expression in the samples were quantified by immunohistochemistry. The PCNA index of the two groups were compared. RESULTS: Epithelial proliferation of the nasal polyp was found to be more active than the normal nasal mucosa. The active area of epithelial proliferation within the nasal polyp was the body area. CONCLUSION: The active area of epithelial proliferation was different from the pedicle area, which is the active area of ECM production.

The Role of Allergy in the Severity of Chronic Rhinosinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although allergic rhinitis is one of the most common factors associated with the development of chronic rhinosinusitis, the role of allergy in the severity of chronic rhinosinusitis was not well defined. This study is aimed to determine whether the allergy or factors such as nasal polyp, asthma, aspirin sensitivity can induce more extensive chronic rhinosinusitis, and to determine whether the severity of chronic rhinosinusitis depends on the severity of allergy. MATERIALS AND METHODS: A total of 98 chronic rhinosinusitis patients who underwent endoscopic sinus surgery were evaluated. The severity of chronic rhinosinusitis was assessed by CT scores and symptom scores. An allergic prick test, MAST (Multiple-antigen simultaneous test), the total IgE, and a serum eosinophil count were evaluated for diagnosis and assessment of the severity of allergy. Influences of another factors such as nasal polyp, asthma, and aspirin sensitivity to the severity of chronic rhinosinusitis were evaluated. RESULTS: Although the symptom scores of allergic chronic rhinosinusitis patients were greater than those of non-allergic chronic rhinosinusitis patients, there were no CT score differences between the two groups. Differences in the CT scores and symptom scores in allergic chronic rhinosinusitis patients according to the severity of allergy were statistically insignificant. Nasal polyp, asthma, and aspirin sensitivity did not induce more severe chronic rhinosinusitis. CONCLUSION: Allergy may be associated with the development of chronic rhinosinusitis, but the severity of allergy is not correlated to the severity of chronic rhinosinusitis.

Correlation between Nasal Obstruction Symptoms and Objective Parameters of Peak Nasal Inspiratory Flow Metry and Acoustic Rhinometry

BACKGROUND AND OBJECTIVES: Measurement of the peak nasal inspiratory flow rate (PNIFR) is a useful technique for obtaining a quick measure of nasal obstruction and changes in PNIFR, reflecting changes in symptoms. The aim of the present study was to correlate changes in nasal obstruction symptoms with changes in several parameters of acoustic rhinometry (AR) and peak nasal inspiratory flow metry (PNIFM) before and after decongestion and to examine whether changes in PNIFR correlate with changes in nasal cross-sectional areas and volume. MATERIALS AND METHODS: The subjects of the current study were 30 patients with nasal obstruction symptoms and 20 normal subjects. Subjective nasal patency was assessed by visual analogue scale (VAS). We measured PNIFR and minimal cross-sectional area (MCA), cross-sectional area at distances of 3.3 (CA3.3), 4.0 (CA4.0), and 6.4 (CA6.4) cm from the nostril and volume from the nostril 6.4 cm (V6.4) towards the choanae, in each nasal cavity before and after decongestion. RESULTS: The VAS had no significant correlation with PNIFR, each cross-sectional area and volume in bilateral nasal cavities before decongestion. There was a significant correlation between the changes in VAS and PNIFR and MCA before and after decongestion. There was a significant correlation between changes in PNIFR and MCA and CA3.3 in one side and both sides of nasal cavity before and after decongestion. CONCLUSIONS: These results suggest that PNIFM and AR may have no sensitive diagnostic values in estimating the severity of nasal obstruction symptoms in the nondecongested state of the bilateral nasal cavities, but PNIFM and AR can be recommended especially in provocation studies because PNIFR and MCA reflect changes in subjective symptoms by mucosal changes.

Correlation between Nasal Obstruction Symptoms and Objective Parameters of Peak Nasal Inspiratory Flow Metry and Acoustic Rhinometry

BACKGROUND AND OBJECTIVES: Measurement of the peak nasal inspiratory flow rate (PNIFR) is a useful technique for obtaining a quick measure of nasal obstruction and changes in PNIFR, reflecting changes in symptoms. The aim of the present study was to correlate changes in nasal obstruction symptoms with changes in several parameters of acoustic rhinometry (AR) and peak nasal inspiratory flow metry (PNIFM) before and after decongestion and to examine whether changes in PNIFR correlate with changes in nasal cross-sectional areas and volume. MATERIALS AND METHODS: The subjects of the current study were 30 patients with nasal obstruction symptoms and 20 normal subjects. Subjective nasal patency was assessed by visual analogue scale (VAS). We measured PNIFR and minimal cross-sectional area (MCA), cross-sectional area at distances of 3.3 (CA3.3), 4.0 (CA4.0), and 6.4 (CA6.4) cm from the nostril and volume from the nostril 6.4 cm (V6.4) towards the choanae, in each nasal cavity before and after decongestion. RESULTS: The VAS had no significant correlation with PNIFR, each cross-sectional area and volume in bilateral nasal cavities before decongestion. There was a significant correlation between the changes in VAS and PNIFR and MCA before and after decongestion. There was a significant correlation between changes in PNIFR and MCA and CA3.3 in one side and both sides of nasal cavity before and after decongestion. CONCLUSIONS: These results suggest that PNIFM and AR may have no sensitive diagnostic values in estimating the severity of nasal obstruction symptoms in the nondecongested state of the bilateral nasal cavities, but PNIFM and AR can be recommended especially in provocation studies because PNIFR and MCA reflect changes in subjective symptoms by mucosal changes.

Detection of Human Papillomavirus and Epstein-Barr Virus in Sinonasal Inverted Papillomas and Its Correlation with p53 and Proliferating Cell Nuclear Antigen Expression / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sinonasal inverted papillomas are benign but topographically aggressive neoplasms that have a high recurrence rate and seem to be associated with malignancy. The etiology of inverted papilloma remains unknown, but some hypotheses suggest that nasal polyps proliferation and chronic inflammation are due to allergy or various infectious lesions. This study was to elucidate the biological characteristics and the role of human papillomavirus (HPV) and Ebstein -Barr virus (EBV) and the expression of p53 protein and proliferating cell nuclear antigen (PCNA) in sinonasal inverted papillomas. MATERIALS AND METHODS: We examined 26 specimens from 26 individuals with normal nasal mucosae (n=10) and inverted papillomas (n=16) to determine the occurance of HPV and EBV infection and the expression of p53 protein and PCNA. RESULTS: Of the 16 Inverted papillomas, HPV DNA was detected in eight cases, HPV 18 was detected in two cases (18%), HPV 16 and HPV 33 were both found in every case (6%), HPV 6 and HPV 16 were coinfected in one case (6%), and other types were found in 3 cases. HPV DNA was not detected in the normal nasal mucosae. EBV DNA was detected in 10 cases (62%) out of 16 inverted papillomas ancl in two cases (20%) of 10 normal nasal mocosae. The altered p53 protein expression was observed in four cases (25%), and positive PCNA staining was detected in four cases (25%) out of 16 inverted papillomas. One positive PCNA staining was detected among 10 normal mucosae. The mean PC10 index was 16.0% in the inverted papillomas group and 4.1% in normal nasal mucosae group. CONCLUSION: An inverse correlation may exist between oncogenic HPV infection and p53 alteration in sinonasa1 inverted papillomas.

Expression of Glucocorticoid Receptor in Nasal Polyps and Nasal Mucosa / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Glucocorticoids are currently the most potent medication available for the treatment of nasal polyposis and allergic rhinitis, but exact mechanisms and cellular targets in the nasal mucosa are uncertain. Multifactorial effects of glucocorticoid are initiated by their binding to a specific cytoplasmic glucocorticoid receptor (GR). We performed this study to investigate the localization and distribution ot' human 4R and GR j3 isoform in nasal mucosa and to examine the influence of allergy and eosinophilic infiltration on GR and GR betaisoform expression in nasal polyps. MATERIALS AND METHODS: Nasal polyps (NP), middle turbinate mucosa (MT) and inferior turbinate (IT) mucosa were taken from 40 patients with chronic sinusitis and nasal polyps. We examined to have concomitant allergic rhinitis. Specimens were stained to quantify eosinophils and immunohistochemically stained to quantify GR and GR beta isaform in the unit area of tissues. RESULTS: Immunostaining of GR and GR betaisoform was predominantly localized in epithelial cell and infiltrating inflammatory cell in subepithelial layer, with lesser amounts in the endothelial cells and in the cells surrounding glands. Immunostaining of GR was mostly co-expressed with GR beta isoform. No correlation was found between Gk and GR beta isoform expression in subepithelial layer and the intensity of eosinophilic inflammation and allergy in NP. There was no significant differences in GR and GR beta isoform expression between NP, MT, and IT. CONCLUSION: Epithelial cells may be an important site of action for intranasal steroids, and the increased number of eosinophils infiltrating the mucosa and allergy did not amplify the number of immunostaining of GK and GR beta isoform.

Expression of Inducible Nitric Oxide Synthase and Its Steroid Effect in TDI-Induced Nasal Hyperreactive Guinea Pigs / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nitric oxide (NO) in exhaled air is elevated in allergy. Topical corticosteroid therapy which has been shown to reduce airway inflammation is associated with reduction in exhaled levels of NO in allergy. The aim of this study is to investigate the induction of inducible nitric oxide synthase (iNOS) and the effect of steroid on the expression of iNOS in the nasal mucosa of TDI (toluene diisecyanate)-induced nasal hyperreactive guinea pig. MATERIALS AND METHODS: We developed an allergy model in guinea pigs using the intranasal application of TDI, We evaluated the iNOS expression and in vivo effects of triamcinolone on the expression of iNOS and infiltration of eosinophil in TDI-sensitized guinea pigs by immunohistochemical stain. RESULTS: Nasal symptoms were significantly suppressed and the number of eosinophils in the nasal mucosa were significantly inhibited by the treatment of triamcinolone. Immunoreactivity to iNOS was localized to ciliated cells of epithelium, vascular endothelial cells, secretory cells of nasal glands and some inflammatory cells in the mucosa of the control group. High expression of iNOS in the nasal mucosa of the TDI-sensitized group was demonstrated, and it was suppressed by triamcinolone therapy. CONCLUSION: These results show that increased expression of iNOS may contribute to allergic inflammation and the antiinflammatory effect of steroid in allergy is partly mediated by the reduction of iNOS expression.

The Clinical Study of Endoscopic Dacryocystorhinostomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Endoscopic dacryocystorhinostomy (DCR) has become a common procedure in the otolaryngologic field thanks to the improvement of endoscope. The endoscopic procedure has several advantages, such as better hemostasis, minimal morbidity and no external scar. However, postoperative obstruction of newly created stoma is still a challenging problem. So we used mitomycin C in six cases for analyzing its effect of preventing postoperative obstruction. MATERIALS AND METHODS:We retrospectively reviewed 40 cases of endoscopic DCR performed between Mar., 1997 and Jan., 1998 to analyze preoperative causes of epiphora, postoperative complications, subjective postoperative improvement and overall success rate. RESULTS: The total success rate was 80%. The most common cause of failure was an obstruction of the newly created stoma with granulation tissue. However, we found better success rate (83%) in six cases where mitomycin C were used to prevent obstruction of stoma. CONCLUSION: Endoscopic DCR is considered to be the procedure with more advantages compared to the external approach, and mitomycin C is a valuable choice of antimetabolite to prevent postoperative granuloma formation.

Histopathologic Changes in Nasal Mucosa of Rat with Benzalkonium Chloride / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Benzalkonium Chloride (BZC) is one of the most often used preservatives that has strong germicidal effect. Not only is it used for nasal drops, but also for eye drops and cosmetics. However, there have been many reports that lesions such as dermatitis and conjunctivitis are considered the results of irritation induced by BZC. We evaluated the histological changes after long-term administration of BZC on rat nasal respiratory mucosa. MATERIAL AND METHODS: We divided 40 BZC treated animals into 4 groups. First group received low-concentrated BZC solution which is commonly used for nasal sprays. Second group received high-concentrated BZC solution which is reported to induce dermatitis in human. Third and Fourth group received steroid mixed in the BZC solutions of low and high concentrations, respectively. Control group was administrated with normal saline. After 1, 2, and 4 weeks of topical administration in each group, the symptomatic and histological changes with H&E stain were observed. RESULTS: Sneezing and nose rubbing with forelegs were observed in all subgroups on the 5th day of treatment. The BZC induced lesions, including glandular formation, inflammatory cell infiltration, and edematous changes. The symptomatic and histological changes were pronounced when the duration of BZC administration was increased. Similar results were observed in groups that received steroid mixed in the BZC solution. CONCLUSION: We found that even low concentration of BZC preservative can cause nasal lesions. Thus, there is a strong need to develope a preservative that can be used safely.

Expression of Nitric Oxide Synthase in the Olfactory Bulb of the Rat during Development / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The presence and distribution of NADPH-diaphorase activity in the olfactory bulb during development has been reported. But the precise localization of NO-synthase (NOS) in the olfactory bulb during the developmental stages has not been studied yet. Therefore, we investigated the localization of NOS-immunoreactivity in a developing rat olfactory bulb by immunohistochemistry. MATERIALS AND METHODS: A total of 32 male and female Sprague-Dawley rats. They were of several prenatal and postnatal stages, such as the following: embryonic day 16 (E16), E18, E20, postnatal day 1 (P1), P5, P7, P14 and adult. Indirect immunoperoxidase method using rabbit polyclonal anti-bNOS antibody was performed for detecting the NOS immunoreactivity. RESULTS: In the main olfactory bulb, the first NOS-immunoreactive (IR) neurons were observed in the presumptive granule cell layer (GCL) by E18, and in the glomerular layer (GL) by P1. The density of these neurons was increased as the development stage approached the adult stage. In the GCL, two types of NOS-immunoreactive neurons were observed: intensively stained large, short axon cells and weakly stained small, granule cells. The first, localized in the deeper part of the GCL, was observed in the earlier developmental stages, and the latter which increased in number to the adult period was observed by P1. In the accessory olfactory bulb, NOS-IR neurons were first detected in the GCL by P1, and increased in number to the adult period. The pattern of NOS-IR neurons in the GCL of the accessory olfactory bulb is similar to that in the main olfactory bulb. CONCLUSION: Our results demonstrated that bNOS had a characteristic temporal and spatial patterns of expression in the main and accessory olfactory bulb of the rat during development.

Expression of GABA Transporters in the Rat's Olfactory Bulb during Development

Developmental changes in the expression of two GABA (gamma-aminobutyric acid) transporter proteins, GAT-1 and GAT-3, in the olfactory bulb of embryonic and postnatal rats were examined with immunocytochemistry using antisera against GAT-1 and GAT-3. The expression and localization of GAT-1 and GAT-3 showed distinct temporal patterns during olfactory bulb development. GAT-1 immunoreactivity appeared weakly in most likely growing axons of the presumptive glomerular layer from embryonic day 18 and increased during the first postnatal week. In contrast, GAT-3 immunoreactivity, first detected at E16, was found in radial glial cell fascicles and was replaced by what were likely astroglial cells postnatally. At P7, GAT-1 and GAT-3 immunoreactivities reached the adult pattern i.e., GAT-1 immunoreactivity was observed in the labeled punctate structures in all layers of the olfactory bulb except the nerve fiber layer, while GAT-3 immunoreactivity was observed in the astroglial processes of all layers of the olfactory bulb. Our results suggest that GABA transporters, especially GAT-3, play important roles in regulating the GABA levels of developing olfactory bulbs.