Immunohistological Study of the Effects of Intranasal ZnSO4 Instillation on the Mouse Olfactory Epithelium and Olfactory Bulb / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the time course of functional and anatomical recovery of the olfactory epithelium (OE) and olfactory bulb (OB) following intranasal instillation of 1% ZnSO4 in mice. MATERIALS AND METHOD: Two groups of mice, normal control group (intranasal instillation of normal saline, n=6) and experimental group (intranasal instillation of ZnSO4, n=18), were studied. Tissues of olfactory pathways were obtained at 1, 3 and 5 weeks after bilateral intranasal instillation of 1%, 100 microliter ZnSO4 solution, and processed for immunohistochemistry using antisera, olfactory marker protein (OMP), proliferating cell nuclear antigen (PCNA) and tyrosine hydroxylase (TH) to evaluate the olfactory regeneration. For histological study, OE thickness stained with hematoxylin-eosin was analyzed. RESULTS: At 1 week after ZnSO4 intranasal instillation, the lowest peak of OMP expression in OE appeared. Then the number of OMP-positive cells increased progressively at weeks. However, PCNA expression in OE showed quite the opposite. In the corresponding OB at 1 week, there was decrease of TH-positive cells and at 3 weeks, there was few TH-positive cells. At 5 weeks, there was increase in the number of TH-positive cells again. OE thickness was reduced to 20% of control OE at 1 week, and was significantly recovered to 80% of control OE at 5 weeks. CONCLUSION: Our results demonstrated that intranasal instillation of 1% ZnSO4 to mice produces a brief, reversible but essentially complete destruction of functional connection from the olfactory epithelium to the main olfactory bulb.

Expression of Protease-activated Receptor 2 in Nasal Polyp: Immunohistochemical Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Protease-activated receptor 2 (PAR-2) has been known to play an important role in modulating homeostasis and inflammation in the airways. But only a little is known about the localization of PAR-2 in nasal mucosa and relationship between PAR-2 and nasal mucosal inflammation. In this study, we investigated the localization of PAR-2 in nasal polyp and turbinate mucosa and examined the relationship between the PAR-2 expression and eosinophil infiltration. MATERIALS AND METHOD: Nasal polyp tissues were obtained from 20 nasal polyposis patients and inferior turbinate tissues were taken from 12 nasal septal deviation patients as control. PAR-2 expression was assessed by immunohistochemical staining. We compared PAR-2 immunoreactivity between nasal polyp and turbinate mucosa. Infiltrated eosinophils were counted ands its correlation with the intensity of PAR-2 immunoreactivity in nasal polyp was determined. Also, we evaluated the PAR-2 expression in the presence of allergic rhinitis. RESULTS: PAR-2 immunoreactivity was detected in the nasal mucosal epithelium, endothelial cells, vascular myocytes, submucosal glands, fibroblasts and inflammatory cells. PAR-2 expression was similar between nasal polyp and turbinate mucosa, but inflammatory cells of nasal polyp showed stronger immunoreactivity than those of turbinate. Immunoreactivity in inflammatory cells showed correlation with eosinophil infiltration in nasal polyp. There were no differences in the PAR-2 expression between allergic rhinitis patients and non-allergic rhinitis patients. CONCLUSION: Increased expression of PAR-2 in inflammatory cells of nasal polyp and its correlation with eosinophil infiltration raise the possibility that PAR-2 may play a role in pathophysiology of nasal polyposis.

Effect of Rofecoxib on Pain and Hemorrhage after Tonsillectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nonsteroidal anti-inflammatory durgs (NSAIDs) are now widely accepted analgesics for posttonsillectomy patients, but their ability to inhibit platelet cyclooxygenase (COX) may be associated with a risk of increased bleeding after tonsillectomy. Rofecoxib, the recently introduced selective COX-2 inhibitor, may have advantages for analgesics in tonsillectomy in that they produce minimal effects on platelet aggregation. But the analgesic efficacy of rofecoxib in tonsillectomy has not been made known yet. The aim of our randomized prospective study was to compare the analgesic efficacy of rofecoxib, the selective COX-2 inhibitor, and ibuprofen, the classic NSAID, for the posttonsillectomy pain management. We also evaluated the influence of both drugs on the posttonsillectomy bleeding. SUBJECTS AND METHOD: Thirty-eight adult patients undergoing tonsillectomy were randomly divided into either ibuprofen or rofecoxib group. Patients received either oral ibuprofen (600 mg, three times a day) or oral rofecoxib (25 mg, twice a day). Patients recorded pain levels twice daily for 7 days using a visual analogue scale. Posttonsillectomy hemorrhage was recorded in each groups. RESULTS: Pain scores for the 7 days were not significantly different between two groups, but the rofecoxib group reported less pain. Rofecoxib group felt more satisfactorily about early control of postoperative pain. There was no significant difference in the incidence of postoperative hemorrhage between two groups. CONCLUSION: Rofecoxib is as effective as ibuprofen for postoperative pain control in adult tonsillectomy, which might be beneficial for avoiding the adverse effects of NSAIDs.

The Effect of Topical Steroid Nasal Instillation in Induced Anosmic Mice / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the effect of intranasal Mometasone furoate instillation into the nasal cavity of mice which had peripherally induced anosmia. SUBJECTS AND METHOD: Three groups of mice were studied: normal control group (nasal instillation of normal saline, n=6), Mometasone furoate non-instillation group (no treatment after nasal instillation of zinc sulfate, n=12), and Mometasone furoate instillation group (daily mometasone furoate instillation after nasal instillation of zinc sulfate, n=12). Tissues of olfactory mucosa were obtained on 1, 2, 3, 4 weeks after the instillation of zinc sulfate, and processed for immunohistochemistry using antisera to olfactory marker protein (OMP) for evaluation of olfactory regeneration. RESULTS: No OMP-positive cells were observed in the first week after the instillation of zinc sulfate in both groups. However, OMP-positive cells began appearing in the second week in both groups and gradually increased as time goes by. In the Mometasone furoate instillation group, the increase of OMP-positive cells was significantly greater than that of Mometasone furoate non-instillation group. CONCLUSION: Mometasone furoate instillation enhances regeneration of olfactory receptor cells after injury. Mometasone furoate instillation can be suggested as an effective treatment modality for olfactory dysfunction.

Expression of Vascular Endothelial Growth Factor mRNA in Endotoxin Induced Otitis Media with Effusion of the Rat / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The vascular endothelial growth factor (VEGF), a heparin binding growth factor specific for endothelial cells, is both a potent enhancer of vascular permeability and an angiogenic growth factor. The purpose of this study was to investigate the semi-quantitative expression levels of multiple VEGF mRNA splicing variants in endotoxin-induced otitis media with effusion (OME) of rat. MATERIALS AND METHODS: We instilled endotoxin and saline as a control into the middle ear cavity of the rat, and middle ear mucosa were taken at 0 h, 1 h, 3 h, 6 h, 12 h, 1 d, 3 d, 7 d, and 14 d. The levels of splicing variants of VEGF transcripts were evaluated by semi-quantitative RT-PCR. RESULTS: Expression of VEGF164 mRNA and VEGF120 mRNA was first identified at 1 h after endotoxin instillation and was dramatically increased between 6 h and day 1 and then progressively decreased by day 7. Expression level of VEGF120 mRNA was 1.34+/-0.27 fold higher than that of VEGF164, and the expression level of VEGF164 was 3.89+/-0.97 fold higher than that of VEGF188. CONCLUSION: These results suggest that VEGF may be primarily responsible for the increased vascular permeability in OME and that it seems to play a significant role in the pathogenesis of OME.

A Case of Actinomycosis Involving Urachal Remnant / 대한비뇨기과학회지

We report a case of urachal actinomycosis. The patient presented with complaints of micturition pain and a left lower abdominal mass with pain. Magnetic resonance imaging(MRI) showed the mass extending from the dome of the bladder to just beneath the rectus muscle. Exploration revealed a hard mass in the urachal cord, which was attatched to a part of sigmoid colon and the dome of the urinary bladder and extended to the umbilicus. The mass, urinary bladder dome, sigmoid colon and urachal cord were resected, and histopathological revealed actinomycosis.

Analgesic Effect and Postoperative Cognitive Impairment of Patient Controlled Analgesia in Postoperative Elderly / 대한마취과학회지

BACKGROUND: Since postoperative cognitive impairement is common in elderly patients and normal cognitive function is important for proper use of patient controlled analgesia (PCA), we compared the efficacy, adverse effect and postoperative cognitive impairment among postoperative elderly patients given the PCA morphine, fentanyl and meperidine. METHODS: Forty-five elderly patients were randomly allocated to receive patient-controlled analgesia with either morphine, fentanyl or meperidine following upper abdominal surgery. Patients were evaluated for used doses, adverse effects, visual analogue scale, the satisfaction for analgesia during postoperative 2 days and the Mini Mental Status Examination (MMSE) and the Short Portable Mental Status Questionnaire (SPMSQ) at posoperative 1 day. RESULTS: Patients receiving the PCA fentanyl used more opioid based on a dose expressed as morphine equivalents using the putative potency ratios of 1:10:0.01 (morphine/meperidine/fentanyl). But adverse effects, visual analogue scale, and the satisfaction for analgesia were not statistically different between groups. The decrease in MMSE in the PCA-meperidine group was significantly greater than that seen in the PCA-fentanyl group and the PCA-morphine group. SPMSQ were not statistically different between groups. CONCLUSION: The present result suggest that PCA is effective method in posterative elderly without serious complications. But PCA meperidine may be avoided in the elderly because it can contribute to decrease postoperative cognitive function.

Analgesic Effect and Postoperative Cognitive Impairment of Patient Controlled Analgesia in Postoperative Elderly / 대한마취과학회지

BACKGROUND: Since postoperative cognitive impairement is common in elderly patients and normal cognitive function is important for proper use of patient controlled analgesia (PCA), we compared the efficacy, adverse effect and postoperative cognitive impairment among postoperative elderly patients given the PCA morphine, fentanyl and meperidine. METHODS: Forty-five elderly patients were randomly allocated to receive patient-controlled analgesia with either morphine, fentanyl or meperidine following upper abdominal surgery. Patients were evaluated for used doses, adverse effects, visual analogue scale, the satisfaction for analgesia during postoperative 2 days and the Mini Mental Status Examination (MMSE) and the Short Portable Mental Status Questionnaire (SPMSQ) at posoperative 1 day. RESULTS: Patients receiving the PCA fentanyl used more opioid based on a dose expressed as morphine equivalents using the putative potency ratios of 1:10:0.01 (morphine/meperidine/fentanyl). But adverse effects, visual analogue scale, and the satisfaction for analgesia were not statistically different between groups. The decrease in MMSE in the PCA-meperidine group was significantly greater than that seen in the PCA-fentanyl group and the PCA-morphine group. SPMSQ were not statistically different between groups. CONCLUSION: The present result suggest that PCA is effective method in posterative elderly without serious complications. But PCA meperidine may be avoided in the elderly because it can contribute to decrease postoperative cognitive function.

The Effect of Dexamethasone in Tonsillectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tonsillectomy is a very common surgical procedure in otolaryngology. Steroid is often given to decrease postoperative morbidity from the procedure. This study was designed to determine the intraoperative and postoperative efficacy of the intravenous administration of dexamethasone sodium phosphate, the long-acting steroid, before or after tonsillectomy. MATERIALS AND METHODS: Sixty children aged between 3 to 15 years were divided into three groups. Twenty children received intravenous dexamethasone sodium phosphate (1 mg/kg up to 15 mg) before undergoing sharp dissection tonsillectomy (group I). Another twenty children received it after operation (group II). The third group was control and did not receive the intravenous dexamethasone sodium phosphate (group III). Intraoperatively blood loss, surgical and anesthesia time were checked. After the operation, each child was evaluated for pain, oral intake, vomiting, body temperature, and bleeding. RESULTS: There were no statistically significant differences noted in blood loss, surgical time, anesthesia time, pain score, oral intake, vomiting, and postoperative bleeding among the three groups of patients. CONCLUSION: The results showed that a single dose of the intravenous dexamethasone sodium phosphate did not affect the postoperative morbidity in children undergoing sharp dissection tonsillectomy.

Diagnostic and Therapeutic Reliability of Endoscopic Retrograde Cholangiography in Postcholecystectomy Patients / 대한내과학회지

OBJECTIVES: Accurate assessment of the retained or recurrent bile duct stone is important in postcholecystectomy patients who have signs of cholangitis or other pancreatobiliary disease. This study was performed to evaluate the diagnostic and therapeutic reliability of endoscopic retrograde cholangiography in postcholecystectomy patients. METHODS: From October 1975 through August 1995, we reviewed 311 patients retrospectively who had undergone on cholecystectomy. Our study was based on assessment of their age, sex, symptoms and physical findings, comparison between sonographic and endoscopic retrograde cholangiographic findings, and stone removal rate using endoscopic sphincterotomy, basket, electro-hydraulic lithotripsy. RESULTS: The ratio of male to female was 1:1.67, and the mean age was 56+/-14.3 years. After cholecystectomy, they visited our clinic within 2 years in 25 patients(8.4%), beyond 2 years in 286 patients(91.6%). Most common symptoms and physical findings were epigastric pain or tenderness(63.6%). We detected bile duct stone using endoscopic retrograde cholangiography 219 patients. In case of the bile duct stone, we successfully removed it using endoscopic sphincterotomy, basket, electrohydraulic lithotripsy in 194 patients(88.6%). CONCLUSION: From the above results, we concluded that endoscopic retrograde cholangiography was the most effective diagnostic and therapeutic method in postch- olecystetomy patients who have signs of cholangitis.

A Modification of Transaortic Celiac Plexus Neurolysis; One Needle, Periaortic Block: A case report / 대한마취과학회지

Celiac plexus neurolysis is performed to relieve intractable upper abdominal pain. Since Kappis had performed splanchnic nerve block in 1919, many methods and its modifications of celiac plexus block have been introduced. In 1983, Ischia and in 1990, Lieberman has introduced the transaortic technique of celiac plexus block. We employed a transaortic approach with some modification of the original method in 12 patients, in which a single needle was advanced from a left posterior paramedian approach through the aorta to deposit the drug directly onto the celiac plexus. After needle has punctured anterior wall of aorta, 50% alcohol 20ml was injected and after retracting the needle to the posterior wall of aorta, also 50% alcohol 20ml was injected. 11 patients experienced marked pain relief and no major complication was encountered. The authors think that our method has some theoretical benefits in effectiveness than the original transaortic method.

The effect of the combination therapy with antithyroid drug and thyroxine in Graves' disease / 대한내과학회지

OBJECTIVES: It was recently reported that the administration of T4 during antithyroid drug(ATD) therapy resulted in a significant decrease of antibodies to TSH receptors as well as the rate of recurrence of active Graves' disease following discontinuance of ATD treatment. But, there is still controversy whether combination therapy is efficient. Therefore, the present study was undertaken to evaluate the effect of T4 administration of patient with Graves' disease who were being treated with ATD. METHODS: We studied 56 patients received methimazole(MMI) alone(Group 1) and 48 patients received methimazole plus T4(Group 2), They are diagnosed active Graves' disease at department of internal medicine, Kwang ju Christian Hospital from January, 1994 to December, 1995. All the patients were treated initially with 30mg of methimazole daily for one month after then, in the Group 1(methimazole alone), the dose of methimazole was adjusted as necessary to achieve normal serum concentrations of T3, T4, and TSH. The patients of Group 2(methimazole plus T4) continue to receive the combination of T4 at a dose of 100 microgram daily. Simultaneously, we estimated the serum concentration of T3, T4, TSH and Thyroid-stimulating immunoglobulin(TSI) antibody at every three months. RESULTS: We obtained the following result. In the group 1, mean TSI values were 50.1%(first visit), 30.6%(6months), and 24.7%(1year). And, in the group 2 mean TSI values were 51.8%(first visit), 33.6%(6months), and 22.7% (1year). After 6 months of discontinuing of therapy, the recurrence rate was no significant difference in the two groups (the recurrence rate were 55.4%, 50.0%, respectively P>0.05). CONCLUSION: These results suggest that T4 administration in combination with MMI therapy have no significant effect in a decrease in levels of TSH receptors antibodies and recurrence rate within 6 months discontinuing MMI therapy as compared with MMI treatment alone.

Esophagus, Stomach & Intestine; Evaluation of Endoscopic Ultrasonography in Gastric Carcinoma / 대한소화기내시경학회지

BACKGROUND: Endoscopic Ultrasonography(EUS), a combination of endoscopy and ultrasonography is one of the most useful tools for diagnosis of digestive system diseases. EUS is useful in staging the primary tumor invasion and regional lymph node metastasis because of its ability to image the gut wall and adjacent structures in unique detail. We performed a study preoperatively for assessing the accuracy and limitation of EUS in gastric carcinoma. METHODS: In 75 patients(Male 54, Female 21, Mean age 62.3 years) with a gastric carcinoma confirmed by endoscopic biopsy, we performed EUS preoperatively. The results were compared with the postoperative histopathologic staging. RESULTS: 1) In assessing the depth of tumor invasion, EUS accuracy on depth of invasion was 76.0% and overstaging and understaging were 14.7% and 9.3%, respectively. 2) In assessing the lymph node metastasis, the accuracy rate of EUS was 65.3%. A rate of false-positive diagnosis was 27.3%, and a rate of false-negative diagnosis was 24.5%.3) In assessing the incidence of lymph node metastasis for each T stage, the involve rate was 10.5% in pT1, 36.4% in pT2, 95.7% in pT3, 100% in pT4. CONCLUSIONS: EUS is the most accurate diagnostic methods presently available to determine tumor infiltration depth and lymph node metastasis.

Electrohydraulic Lithotripsy(EHL) of Large Common Bile Duct Stone and Endocoil Insertion with Percutaneous Transhepatic Choledochoscopy / 대한소화기내시경학회지

BACKGROUND/AIMS: Electrohydraulic lithotrypsy(EHL) under cholangioscopic control has been performed for difficult bile duct stones. The percutaneous transhepatic approach is technically easy and useful in diagnosis and treatment of bile duct obstruction and stones. Biliary stenting with self expanding metal stent is gaining increasingly wider acceptance as a palliative treatment of bile duct obstruction. METHODS: Between Sep. 1994 and Sep. 1996, EHL under choledochoscopy by percutaneous transhepatic approach was performed in 30 cases(Male: 13, Female: 17). After PTBD with 7F pig tail catheter, the percutaneous transhepatic passage was dilated over guide wire with dilaters of increasing size up to 16Fr in 3-Sdays. In one week, after fistula had been estabilished, choledochoscopy was performed. RESULTS: (1) Mean age was 61.3 years. Mean stone number was 2.5. And mean stone size was 1.6 X 2.3 cm. (2) Com.plete removal of the stone was achieved in all patients(100%). (3) There were no serious complications. (4) In six cases, Endocoils were implanted with successful decompression of obstructions and simultaneous removal of biliary stones located at both side of stricutre. CONCLUSIONS: Percutaneous transhepatic choledochoscopy is easy and safe and assists in the diagnosis and treatment of biliary stricture and the management of difficult CBD stone.

An Evaluation of Pediatric Surgical Patients in Seoul National University Children`s Hospital / 대한마취과학회지

A retrospeetive analysis was performed on 35,598 pediatric patisnts who had received operations from 1986 to 1993 in eight operating rooms, Seoul National University Childrens Hospital (SNUCH). The average distribution of the patient by department in descending order was pediatric sugery 22%,orthopedic sugery 15%,cardiothoracic sugery 14%,otolaryngology 14%, opthalmology 11%,plastic sugery 11 %,urology 8%,neurosugery 4% and others 0.3%. Opthalmology and urology share one operating room each other, why they have some limitations in performing operations. Total number of operations showed generally increasing tendaney ; 3241 in 1986, 4245 in 1987, 4744 in 1988,4402 in 1989, 4522 in 1990, 4786 in 1991, 4921 in 1992 snd 4737 in 1993. The average age distribution in descending order was 38% in group between 2 and 5 years, 28 in group between 6 and 10 years, 16% in group over 10 years, 15% in group between 1 month and 1 year and 3% in group under 1 month. The ratios of emergency sugeries are 8.7%, 5.9%, 6.4%, 12.2%, 5.9%, 6.9%, 9.35% from 1986 to 1993 in sequence. General inhalation anesthesia has been the main anesthetic, of which the ratios are over 95% generally. Utility ratios of pediatrie operating room for each departments increased generally year by year.