Activation and Abnormalities of Cell Cycle Regulating Factor in Head and Neck Squamous Cell Carcinoma Cell Lines: Abnormal Expression of CDKN2 Gene in Laryngeal Squamous Cell Carcinoma / 영남의대학술지

BACKGROUND: Cyclin-dependent kinase (CDK) inhibitors are family of molecules that regulate the cell cycle. The CDKN2, a CDK4 inhibitor, also called p16, has been implicated in human tumorigenesis. The CDKN2 inhibits the cyclin/CDK complexes which regulate the transition from G1 to S phase of cell cycle. There is a previous report that homozygous deletion of CDKN2 region on chromosome 9p21 was detected frequently in astrocytoma, glioma and osteosarcoma, less frequently in lung cancer, leukemia and ovarian cancer, but not detected in colon cancer and neuroblastoma. However, little is known about the relationship between CDKN2 and laryngeal cancer. Therefore this study was initiated to investigate the role of CDKN2 in human laryngeal squamous cell carcinoma development. MATERIALS AND METHODS: We used 5 human laryngeal carcinoma cell lines whether they have deletions or losses of CDKN2 gene expression by DNA-PCR or RT-PCR, respectively. We examined 8 fresh frozen human laryngeal cancer tissues to detect the loss of heterozygosity (LOH) of CDKN2. PCR was performed by using microsatellite markers of short arm of human chromosome 9 (D9S126, D9S144, D9S156, D9S161, D9S162, D9S166, D9S171, D9S200 and D9SIFNA). For informative cases, allelic loss was scored if the signal of one allele was significantly decreased in tumor DNA when compared to the same allele in normal DNA. RESULTS: The CDKN2 DNA deletion was observed in 3 cell lines. The CDKN2 mRNA expression was observed in only one cell line, which was very weak. LOH was detected in 7 cases (87.5%). CONCLUSION: These results suggest that CDKN2 plays a role in the carcinogenesis of human laryngeal squamous cell carcinoma.

Vasoactive Intestinal Peptide Induces MUC2/5AC Synthesis in Human Airway Epithelial Cells / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Vasointestinal peptide (VIP) is an important neurotransmitter involved in the regulation of mucus secretion, but the relationship of VIP and mucin genes is not clear. This study was designed to investigate the effect of VIP on MUC2/5AC genes expression and mucin secretion in human airway epithelial cells. MATERIALS AND METHOD: The mRNA levels of MUC2/5AC genes and mucin secretion were determined by RT-PCR and the immunoblot method in cultured human airway NCI-H292 epithelial cells. RESULTS: VIP (10-6-10-10 M) induced MUC2/5AC gene expression and mucin secretion in a reverse dose-dependant manner. The maximum expression of mRNA and mucin secretion level of MUC2/5AC was 10-10 M of VIP. Actinomycin D inhibited the VIP-mediated MUC2/5AC gene expression and mucin secretion, but cycloheximide did not. Budesonide attenuated the VIP-mediated MUC2/5AC genes expression and mucin secretion. RU-486, a glucocorticoid receptor antagonist, restored the inhibitory effect of budesonide. CONCLUSION: These results suggest that VIP regulates MUC2/5AC gene expression and secret mucin by transcriptional regulation, and that budesonide inhibits the VIP-mediated MUC2/5AC genes expression and mucin secretion through the glucocorticoid receptor.

Treatment Outcomes of Septoplasty with Turbinate Surgery in Septal Deviation with Chronic Hypertrophic Rhinitis / 영남의대학술지

BACKGROUND: Septoplasty with turbinate surgery is common surgical treatment in patients with septal deviation and chronic hypertrophic rhinitis. The aim of this study was to evaluation objective outcomes of septoplasty with turbinate surgery by analysis of subjective symptom score with objective acoustic rhinometric test before and after surgery, prospectively. MATERIALS AND METHODS: We reviewed 45 adult patients which were done septoplasty with bilateral turbinectomy or turbinoplasty and followed up at least 3 months by one rhinologist from November 1999 to April 2000, prospectively. We analyzed subjective symptom score, minimal cross-sectional area (MCA), C-notch cross-sectional area, and total volume of both nasal cavity before and after surgery. Correlation test was studied between symptom improvement and acoustic rhinometric results. RESULTS: Twenty nine cases were male and sixteen cases female. The average age was 26.9 year-old (range: 17 to 57 years). There was significantly improvement of symptom score in postoperative 3 months (p<0.05). There was significantly increased C-notch cross-sectional area and total volume in postoperative 3 months. Symptoms improvement were associated with acoustic rhinometric profiles, but, there was not significantly correlation. CONCLUSION: Septoplasty with turbinate surgery is considered to be effective for nasal obstruction in patients with septal deviation and turbinate hypertrophy. Acoustic rhinometric test is favorable objective test for evaluation of symptom improvement after septal surgery.

A Clinical Study of the Laryngeal Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Laryngeal cancer is the most common malignancy in head and neck region. The aim of this study was to evaluate the clinical features and treatment outcomes of laryngeal cancer. MATERIALS AND METHODS: We reviewed medical records of 169 patients from 1984 to 1997 retrospectively. We investigated age, sex distribution, TNM staging in 169 patients and treatment modalities, survival rate in 141 patients who were treated. RESULTS: In all patients, there were 64 glottic, 57 supraglottic, 46 transglottic and 2 subglottic cancers. Among 141 patients, we performed 92 surgical procedures and 49 radiotherapies. Total and near total laryngectomy were performed in 45 cases and conservation laryngectomy in 47 cases. Five year survival rate (YSR) was 88.4% totally. In early cancer cases, 5 YSR was excellent in both surgery and radiotherapy group. Glottic and supraglottic cancer showed much better prognosis than transglottic cancer. There was no statistical differences in the view of 5 YSR between surgery and radiotherapy group. Treatment failures were mainly found at primary sites. Functional preservation of larynx was successful in 79 cases after 3 year-follow up. CONCLUSIONS: Compared with previous studies, our study presented higher proportion of conservation laryngectomy and functional preservation procedues. Early diagnosis and treatment are important and required to improve patient's outcome.

Paranasal Sinus CT Scans Analysis of the Primary Maxillary Sinus Hypoplasia / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Identification of primary maxillary sinus hypoplasia (PMSH) is important diagnostically and therapeutically. Recently, the clinical significance of associated abnormalities in PMSH has been suggested. The aim of this study is to investigate the incidence of PMSH, their associated abnormalities and relationship of anatomical variations and paranasal sinusitis. MATERIALS AND METHODS: We evaluated radiologic diagnostic criteria of PMSH and analyzed the relationship of the anatomical variations of nasal cavity and paranasal sinuses in paranasal sinus CT scans, retrospectively. We measured the volume estimated ratio (VER) in PMSH cases. RESULTS: The incidence of unilateral and bilateral PMSH were 11 cases (5.9%) and 10 cases (5.3%). respectively. According to the Bolger's classification, there were 13 sites (41.9%) of type I with the mean VER of 0.71, 14 sites (45.2%) of type II with the mean VER 0.50, and 4 sites (12.9%) of type III with the mean VER of 0.27. The most common anatomical anomalies in both of the unilateral and bilateral PMSH were zygomatic (90.3%) and alveolar pneumatization (90.3%); the second most common abnormal finding was high maxillary sinus floor (77.4%). Of the anatomical variations, the frequency of uncinate process abnormalities (41.9%), paradoxical middle turbinate (32.3%) and Haller's cell (19.4%) were statistically significant. CONCLUSION: These results suggest that zygomatic and alveolar pneumatization, and high maxillary sinus floor are additionally important anatomical abnormalities associated with PMSH. Careful preoperative assessment of anatomical variations in the paranasal sinus CT scans may be essential to avoid incidental iatrogenic complications during functional endoscopic sinus surgery (FESS) or Caldwell-Luc operation in patients with PMSH.

Endoscopic Sinus Surgery of Antrochoanal Polyp / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Antrochoanal polyp usually appears as a large, soft, gelatinous mass in the nasopharynx. Most incidents of antrochoanal polyp arise from mucosa around the natural ostium of the maxillary sinus. Surgical methods employed in the treatment of antrochoanal polyp are simple avulsion, Caldwell-Luc's operation, osteoplastic maxillary sinus operation, inferior meatal antrostomy, as well as endoscopic removal. Simple avulsion has been known to accompany a high recurrence rate, whereas the incidence of recurrence has been reported to be lower for endoscopic sinus surgery. In this regard, we compared postoperative results of simple avulsion or Caldwell Luc's operation with endoscopic sinus surgery in treating antrochoanal polyp. MATERIALS AND METHODS: We evaluated 42 patients who were treated for antrochoanal polyp from April 1991 until April 1996 by analyzing their clinical features, radiologic findings, postoperative results, and postoperative complications. RESULTS: Simple avulsion method was used to treat 21 cases (50%), and endoscopic sinus surgery method was used to treat another 21 cases (50.0%, three cases were combined with Caldwell-Luc's operation). Among those who received simple avulsion treatment, 9 showed recurrence, whereas none of those who underwent endoscopic sinus surgery and were treated successfully showed recurrence. CONCLUSION: The results suggest that endoscopic sinus surgery is a successful surgical method for treating antrochoanal polyp.

In Vitro Culture of Human Nasal Epithelial Cells by Monolayer Culture of Dissociated Cells / 영남의대학술지

Different techniques for culturing respiratory epithelial cells have been developed to overcome the limitations of studies on in vivo and on bioptic material. Traditionally, culture systems are divided into organ cultures, explant cultures and dissociated cell cultures. The first two contain both epithelial and non-epithelial cells. However, in monolayer cultures of dissociated cells only epithelial cells are present, the effects observed are caused by a pure epithelial responses. The purpose of this study is to establish primary culture method of human nasal epithelium (HNEC) by monolayer culture of dissociated cells to evaluate the role of the epithelial cells in the allergic and non-allergic nasal inflammatory reactions. HNEC was prepared by primary culture method of monolayer culture of dissociated cells from human inferior nasal turbinate mucosa of septal deviation patients. Primary cultured cells were characterized by indirect immunofluorescence assay and transmission electron microscopy. The immunoreactivities of cytokeratin-pan and cytokeratin No. 8 were observed in cultured HNEC. However, the immnoreactivities of vimentin and von Willebrand factor were not observed in cultured HNEC. The tonofilaments and desmosome were observed in cultured HNEC. The cultured epithelial cells were identified to be pure nasal epithelial cells. The monolayer culture of dissociated cells could successfully be employed for further study to investigate the role of the epithelial cells in allergic or non-allergic nasal inflammatory diseases.

Clinical Study of Inverted Papilloma of the Nose and Paranasal Sinuses / 대한이비인후과학회지

BACKGROUND: Inverted papilloma is a benign sinonasal tumor which is locally aggressive and has a significant malignant potential. Complete en bloc excision via lateral rhinotomy and medial maxillectomy has been the mainstay in the treatment in majority of patients. OBJECTIVES: The aim of this study is to evaluate clinical features and outcomes of surgical treatment according to various surgical approaches(external approach vs transnasal endoscopic approach) in the treatment of inverted papilloma of the nose and paranasal sinuses. MATERIALS AND METHOD: We retrospectively examined 24 cases of inverted papilloma of the nose and paranasal sinuses treated in our department from January 1990 to April 1995. We reviewed clinical features, radiologic findings, operative findings, association with malignancy, and outcomes of various surgical approaches. RESULTS: Fifteen patients underwent surgical excision. Of this patients followed up for at least 18 months, lateral rhinotomy was performed in 10 patients, midfacial deglobing in 1 patient and endoscopic surgery in 3 patients. The most common symptoms were nasal obstruction(93.3%) and nasal discharge(80.0%). Ten cases(66.7%) had history of previous nasal surgery. The lateral nasal wall was most frequent site of tumor involvement and concurrent involvement of the adjacent paranasal sinuses was observed in 11 cases. No recurrence was observed both external approach and transnasal endoscopic surgery. CONCLUSION: The optimal management of inverted papilloma of nose and paranasal sinuses is complete excision of tumor and choice of adequate surgical approach(external approach or transnasal endoscopic approach).

Natural Dehiscence of Lamina Papyracea with Prolapse of Orbital Content: Radiologic Evaluation / 대한이비인후과학회지

BACKGROUND: Orbital complications may be occured by means of surgical injury to lamina papyracea during endoscopic sinus surgery or intranasal ethmoidectomy. The frequency of orbital complications increases when the natural dehiscence of lamina papyracea(NDLP) with or without prolapse of orbital content into ethmoid sinus is present. OBJECTIVES: The aim of this study is to evaluate the incidence and radiologic characteristics of NDLP, and to evaluate association NDLP with anatomical variations of nasal cavity and paranasal sinuses. MATERIALS AND METHOD: The axial and coronal paranasal sinus CT scans of 183 patients with chronic paranasal sinusitis(366 sides) who had undergone endoscopic sinus surgery were retrospectively reviewed and analyzed. The incidence and radiologic features of NDLP, and the association NDLP with anatomical variations of paranasal sinus and nasal cavity were analyzed. RESULTS: The NDLP was found in 18 patients(9.8%, n=183 patients) or 22 sides(6.0%, n=366 sides). The most common site of NDLP was superior portion(45.5%) in coronal image of paranasal sinus CT scans and anterior ethmoid sinus area(68.2%) in axial image. Grade 1 of NDLP(86.4%) was observed most commonly. NDLP was not associated with anatomical variations of paranasal sinus. CONCLUSION: The incidence of NDLP with prolapse of orbital content is far beyond general expectation, and close preoperative evaluation of paranasal sinus CT scans is important to avoid possible orbital complications.

Endoscopic Sinus Surgery of Aspergillus Sinusitis / 대한이비인후과학회지

BACKGROUND: The fungal sinusitis is relatively rare but its incidence is increasing due to increasing use of antibiotics, steroids, and chemotherapheutic agents. It is reported that aspergillosis is the most common fungal infection among the fungi which involve the nasal cavity and paranasal sinuses. The surgical treatment of Aspergillus sinusitis were traditional Caldwell-Luc's operation with or without intranasal ethmoidectomy, or endoscopic sinus surgery. OBJECTIVES: The postoperative results and complications of Caldwell-Luc's operation in Aspergillus sinusitis have been enough to report, but there were a few reports about the endoscopic sinus surgery. So, we reported postoperative outcomes and complications of endoscopic sinus surgery in Aspergillus sinusitis. MATERIALS AND METHODS: Eleven cases of Aspergillus sinusitis of paranasal sinuses from April 1994 through April 1996 were analyzed on their clinical features, radiologic findings, operative findings, postoperative results, and complications. RESULTS: All cases were treated successfully by endoscopic sinus surgery. No recurrence and postoperative complications were observed. CONCLUSION: These results suggest that endoscopic sinus surgery is successful surgical method in Aspergillus sinusitis.

Endoscopic Laser-Assisted Repair in a Case of Acquired Bilateral Choanal Stenosis

The operative methods for the choanal atresia or stenosis are transseptal, transnasal, transpalatal and transmaxillary approaches. Among them, endoscopic transnasal approach provides excellent visualization and little age limitation. The use of CO2 laser in the management of choanal atresia enables the accurate incision and vaporization. We experienced a case of acquired bilateral choanal stenosis which developed after external irradiation for nasopharyngeal carcinoma. She presented with the symptoms of slowly progressive bilateral nasal obstruction and persistent nasal discharge for the past three years prior to visiting hospital. We successfully managed her by endoscopic transnasal repair with CO2 laser and found this technique to safe and simple.

Primary Presentation of Malignant Lymphoma in the Middle Ear Cleft: A Case Report / 대한이비인후과학회지

Most malignant lesions of the middle ear and mastoid cavity are usually originated from the epithelium. The squamous cell carcinoma accounts for 75-90% of all malignant tumors in this localization. However, malignant lymphoma of the middle ear cleft is very rare condition and usually occurs as an extension from the temporal bone, affected along the other organs in generalized lymphoma. Also, primary presentation of malignant lymphoma in the middle ear cleft is very extremely rare and only seven cases could be traced in the available literature2)5)6)11)12)13)14). We present a very rare case of diffuse large cell type non-Hodgkin's malignant lymphoma with primary presentation in the middle ear cleft in 30 year-old male patient. So, the authors first report a case of malignant lymphoma of the middle ear cleft in Korea with review of literature.

A clinical study of paranasal sinus mucocele / 대한이비인후과학회지

No abstract available.

A case of otopalatodigital syndrome / 영남의대학술지

In 1962, a case of “generalized skeletal dysplasia with multiple anomalies” was reported by Taybi as a new clinical syndrome. The most characteristic features of the syndrome seemed to be hearing loss, cleft palate and peculiar digital anomalies, so, the syndrome designated as otopalatodigital syndrome by Dudding, et al. Recently, the authors have experienced a case of OPD syndrome who visited Yeungnam University Hospital with the chief complaint of hypernasality, and underwent pharyngoplasty for correction of VPI. We present here a new case and review the literature on the subject.

Clincal Effect of Ketotifen in Allergic Rhinitis / 영남의대학술지

Ketotifen, a benzocycloheptathiophene, has an orally effective antiallergic as well as antihistaminic properties. In pervious studies, Ketotifen has shown encouraging results on patient with allergic rhinitis, either perennial or seasonal. 39 patients with allergic rhinitis had been treated with Ketotifen 1 mg twice daily for 8 weeks. And we obtained following results. 1) The efficacy rate in sneezing attack was 73.5%, in nasal discharge 71%, in nasal obstruction 58%. 2) Some improvements in at least one of three-major symptoms were noted within 1 week in 30.7%, within 2 weeks in 55.8%, within 3 weeks in 66.7%, within 8 weeks in 87.2%. 3) Physical findings such as colour, swelling of turbinate, character of rhinorrhea were not improved significantly. 4) Side effect was observed only in one patient with abdominal pain and diarrhea, which was subsided after interruption of administration. These results suggested that Ketotifen was effective in treatment of allergic rhinitis.

Evaluation of The Neck Mass / 영남의대학술지

As public awareness of the various warning signs of malignancy increases, so does the concern evoked by the self identified finding of mass in the head and neck area. Not all the palpable masses are always significantly abnormal, but any nontender mass especially to the adult is significant enough to warrant further full investigation and follow up, the object of which should be to determine the possibility of malignancy and urgency of treatment. Approach to the diagnosis of the neck mass is so important in that it affects decision regarding further evaluation would lead to the determination of the most efficacious mode of therapy, eventually to the good prognosis. So, it should be emphasized that approach to the diagnosis of neck mass should be planned, systematic and thorough, this begins with the taking careful history following performance of complete examination of the head and neck especially to the nasopharynx, tongue base, pyriform sinus, palatine tonsil and larynx. Then a number of laboratory and radiologic studies are available, following triple endoscopy under general anesthesia and blind biopsy if needed. The most important rule to keep is that any biopsy procedures should be delayed to the last modality of effort to the diagnosis and if it should be done, under the plan of radical neck dissection.

A Case of Nasopharyngeal Angiofibroma / 영남의대학술지

Nasopharyngeal angiofibroma is a relatively rare, but is a well known tumor that occurs almost in male, most frequently during the adolescent stage. Its character is histologically benign but clinically malignant because of locally invasive character to the adjascent structures, massive bleeding tendency during surgical procedure and high recurrence rate after treatment. Recently many advancements diagnostic method and surgical technique has reached satisfactory result in treating this difficult tumor. The authors present a case of nasopharyngeal angiofibroma in 16 years old male patient, who was received surgical removal of the tumor through the transpalatal approach after full diagnostic evaluation and preoperative hormonal therapy.