Survival Benefits From Surgery for Stage IVa Head and Neck Squamous Cell Carcinoma: A Multi-Institutional Analysis of 1,033 Cases

Objectives@#. Head and neck squamous cell carcinomas (HNSCs) are frequently diagnosed at the locoregional advanced stage (stage IVa), but controversy remains regarding whether stage IVa HSNCs should be treated with upfront surgery or definitive chemoradiation therapy (CRT). The purpose of this study was to compare overall survival (OS) and disease-free survival (DFS) in patients with stage IVa HNSC treated primarily by surgery with curative intent with/without (neo)adjuvant treatment (surgery group) versus those treated primarily with CRT (CRT group). @*Methods@#. We reviewed data of 1,033 patients with stage IVa HNSC treated with curative intent at 17 cancer centers between 2010 and 2016. @*Results@#. Among 1,033 patients, 765 (74.1%) received upfront surgery and 268 (25.9%) received CRT. The 5-year OS and DFS rates were 64.4% and 62.0% in the surgery group and 49.5% and 45.4% in the CRT group, respectively. In multivariate analyses, OS and DFS were better in the surgery group than in the CRT group (odds ratio [OR] for death, 0.762; 95% confidence interval [CI], 0.592–0.981; OR for recurrence, 0.628; 95% CI, 0.492–0.802). In subgroup analyses, the OS and DFS of patients with oropharyngeal cancer were better in the surgery group (OR for death, 0.548; 95% CI, 0.341–0.879; OR for recurrence, 0.598; 95% CI, 0.377–0.948). In the surgery group, patients with laryngeal cancer showed better OS (OR for death, 0.432; 95% CI, 0.211–0.882), while those with hypopharyngeal cancer DFS was improved (OR for recurrence, 0.506; 95% CI, 0.328–0.780). @*Conclusion@#. A survival benefit from surgery may be achieved even in patients with stage IVa HNSC, particularly those with oropharyngeal and laryngeal cancer. Surgery led to a reduction in the recurrence rate in patients with hypopharyngeal cancer.

Estrogen Replacement Reduces Hearing Threshold Shifts and Cochlear Hair Cell Loss After Acoustic Overexposure in Ovariectomized Rats

Objectives@#. The relationship of estrogen (the primary female sex hormone) with hearing function has been studied in both humans and animals. However, whether estrogen levels affect hearing remains uncertain. Therefore, in this study, we investigated changes in the vulnerability of hearing to acoustic overexposure in ovariectomized female rats. @*Methods@#. Eighteen 8-week-old female Sprague-Dawley rats were separated into four groups as follows: sham ovariectomy (OP), OP only, and OP treated with low (10 µg/kg) or high doses (100 µg/kg) of estrogen. Rats in the estrogen replacement groups were given two intraperitoneal injections. Hearing thresholds were measured before noise exposure, and at 1 day and 2 weeks after exposure. @*Results@#. The hearing thresholds of the sham OP and OP-only groups were not significantly different. However, both estrogen groups showed a lower threshold shift than the OP-only group. Histological immunostaining analyses showed that hair cell loss in the 32 kHz region was more severe in the sham OP group than in the OP-only group. Furthermore, there was little or no hair cell loss in either estrogen replacement group and significantly more hair cell loss in the OP-only group. @*Conclusion@#. These results suggest that estrogen replacement may reduce the vulnerability of hearing to noise exposure in menopausal women.

Survival Benefits From Surgery for Stage IVa Head and Neck Squamous Cell Carcinoma: A Multi-Institutional Analysis of 1,033 Cases

Objectives@#. Head and neck squamous cell carcinomas (HNSCs) are frequently diagnosed at the locoregional advanced stage (stage IVa), but controversy remains regarding whether stage IVa HSNCs should be treated with upfront surgery or definitive chemoradiation therapy (CRT). The purpose of this study was to compare overall survival (OS) and disease-free survival (DFS) in patients with stage IVa HNSC treated primarily by surgery with curative intent with/without (neo)adjuvant treatment (surgery group) versus those treated primarily with CRT (CRT group). @*Methods@#. We reviewed data of 1,033 patients with stage IVa HNSC treated with curative intent at 17 cancer centers between 2010 and 2016. @*Results@#. Among 1,033 patients, 765 (74.1%) received upfront surgery and 268 (25.9%) received CRT. The 5-year OS and DFS rates were 64.4% and 62.0% in the surgery group and 49.5% and 45.4% in the CRT group, respectively. In multivariate analyses, OS and DFS were better in the surgery group than in the CRT group (odds ratio [OR] for death, 0.762; 95% confidence interval [CI], 0.592–0.981; OR for recurrence, 0.628; 95% CI, 0.492–0.802). In subgroup analyses, the OS and DFS of patients with oropharyngeal cancer were better in the surgery group (OR for death, 0.548; 95% CI, 0.341–0.879; OR for recurrence, 0.598; 95% CI, 0.377–0.948). In the surgery group, patients with laryngeal cancer showed better OS (OR for death, 0.432; 95% CI, 0.211–0.882), while those with hypopharyngeal cancer DFS was improved (OR for recurrence, 0.506; 95% CI, 0.328–0.780). @*Conclusion@#. A survival benefit from surgery may be achieved even in patients with stage IVa HNSC, particularly those with oropharyngeal and laryngeal cancer. Surgery led to a reduction in the recurrence rate in patients with hypopharyngeal cancer.

Regulation of Diabetes: a Therapeutic Strategy for Alzheimer's Disease?

Accumulated evidence suggests that sporadic cases of Alzheimer's disease (AD) make up more than 95% of total AD patients, and diabetes has been implicated as a strong risk factor for the development of AD. Diabetes shares pathological features of AD, such as impaired insulin signaling, increased oxidative stress, increased amyloid-beta (Aβ) production, tauopathy and cerebrovascular complication. Due to shared pathologies between the two diseases, anti-diabetic drugs may be a suitable therapeutic option for AD treatment. In this article, we will discuss the well-known pathologies of AD, including Aβ plaques and tau tangles, as well as other mechanisms shared in AD and diabetes including reactive glia and the breakdown of blood brain barrier in order to evaluate the presence of any potential, indirect or direct links of pre-diabetic conditions to AD pathology. In addition, clinical evidence of high incidence of diabetic patients to the development of AD are described together with application of anti-diabetic medications to AD patients.

Guidelines for the Surgical Management of Oral Cancer: Korean Society of Thyroid-Head and Neck Surgery

Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to provide guidance on the implementation of a surgical treatment of oral cancer. MEDLINE databases were searched for articles on subjects related to “surgical management of oral cancer” published in English. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. The quality of evidence was rated with use RoBANS (Risk of Bias Assessment Tool for Nonrandomized Studies) and AMSTAR (A Measurement Tool to Assess the Methodological Quality of Systematic Reviews). Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. Additional directives are provided as expert opinions and Delphi questionnaire when insufficient evidence existed. The Committee developed 68 evidence-based recommendations in 34 categories intended to assist clinicians and patients and counselors, and health policy-makers. Proper surgical treatment selection for oral cancer, which is directed by patient- and subsite-specific factors, remains the greatest predictor of successful treatment outcomes. These guidelines are intended for use in conjunction with the individual patient's treatment goals.

Role and Effectiveness of Postoperative Voice Therapy in Laryngeal Microsurgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Voice therapy is performed following laryngeal microsurgery to help the recovery of the operation site and assist in optimal voice output. The aim of this study was to evaluate the effect of postoperative voice therapy and to obtain objective evidence about the necessity of voice therapy. SUBJECTS AND METHOD: The voice of 109 patients who underwent laryngeal microsurgery for vocal fold lesions and received voice therapy was analyzed. Voice analysis was performed preoperatively, postoperatively, and after the first voice therapy. GRBAS scale was used for auditory perceptual evaluation and acoustic analysis was performed for objective evaluation. RESULTS: Overall, significant improvement was observed postoperatively in both auditory perceptual evaluation and acoustic parameters, and significantly better voice was obtained after the first postoperative voice therapy. The degree of postoperative voice improvement varied on the type of vocal fold lesions, but voice quality was improved in all diseases after first postoperative voice therapy. The number of voice therapy decreased significantly as the voice quality improved after the operation or the first voice therapy. Four or more voice therapy were needed when the cepstral/spectral index of dysphonia (CSID) value was 5.88 or higher. CONCLUSION: Voice therapy following laryngeal microsurgery was effective in better voice output. The CSID value after the first postoperative voice therapy was predictive of finding patients who need long-term voice therapy. These results suggest that the first postoperative voice therapy will be helpful in finding the adequate vocalization method and providing objective evidence for selecting patients who would require continuous voice therapy.

Analysis of Acoustic Parameters to Objectively Reflect the Change of Voice Quality before and after Surgery in Benign Vocal Fold Mucosal Disorders / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to compare between preoperative and postoperative voices by subjective auditory perceptual evaluation and objective acoustic analysis. The study also analyzed the acoustic parameters that best reflected the auditory perceptual characteristics in laryngeal microsurgery. SUBJECTS AND METHOD: The records of 49 patients who had been diagnosed as benign vocal fold mucosal diseases and had undergone laryngeal microsurgery were retrospectively analyzed. Preoperative and postoperative voices were assessed by auditory perceptual evaluation using the GRBAS Scale and acoustic analysis using Multi-Dimensional Voice Program (MDVP) and Analysis of Dysphonia in Speech and Voice (ADSV). Correlation between auditory perceptual characteristics and acoustic parameters was analyzed. RESULTS: Auditory perceptual evaluation showed that the patients' voices were improved after the operation. Several acoustic parameters of MDVP related to short-term and long-term variability showed significant improvement. Also, there were significant differences in several cepstral/spectral parameters of ADSV after operation. In the correlation analysis, the overall grade (G) of the GRBAS Scale showed highest correlation with the cepstral spectral index of dysphonia (CSID) (r=-0.700). The roughness (R) of GRBAS Scale was correlated with the smoothed amplitude perturbation quotient of long-term variability of MDVP (r=0.468), breathiness (B) with cepstral peak prominence (r=-0.703) and strain (S) with CSID (r=0.650) (p<0.01). CONCLUSION: Our results showed that the acoustic parameters were related to the long-term variability of MDVP, and the parameters of cepstrum/spectrum were useful for the objective assessment of voice quality in patients who received laryngeal microsurgery. These parameters were also useful for the quantification of voice quality and abnormality of phonation.

A Case of Ectopic Hamartomatous Thymoma / 대한이비인후과학회지

Ectopic hamartomatous thymoma (EHT) is a rare and distinctive benign tumor that usually occurs in the supraclavicular, suprasternal areas. Histopathologically, it is characterized by a mixture of spindle cells, epithelial cells, and adipose cell elements. The recognition of EHT and differentiation of it from high-grade sarcomas such as synovial sarcoma is important, because EHT follows a benign clinical course and conservative surgical excision is the treatment of choice. We experienced a case of EHT in the supraclavicular area, so we present the case with a review of the related literatures.

Seasonal Specificity of Seasonal Allergens and Validation of the ARIA Classification in Korea

PURPOSE: In Korea, tree pollens are known to be prevalent in spring, grass pollens in summer and weed pollens in autumn. However, few studies have revealed their seasonal specificity for allergic rhinitis symptoms. An ARIA (Allergic Rhinitis and its Impact on Asthma) classification of allergic rhinitis was recently introduced and its clinical validation has not been well proved. The aim of this study was to evaluate the seasonal specificity of seasonal allergens and to validate the ARIA classification with the conventional seasonal and perennial allergic rhinitis (SAR/PAR) classification. METHODS: Two hundred twenty six patients with allergic rhinitis were included in this study. The patients were classified according to the sensitized allergens and the ARIA classifications. A questionnaire survey was performed and the data on the seasonal symptom score, the severity of symptoms and the SNOT (sinonasal outcome test)-20 score was obtained and the data was analyzed and compared between the conventional SAR/PAR classification and the ARIA classification. RESULTS: Seasonal pollens (tree, grass, weed) were not specific to the pollen peak season and the patients' symptoms were severe during spring and autumn regardless of the offending pollens. More than 60% of the patients with SAR showed persistent symptoms and 33% of the patients with perennial allergic rhinitis (PAR) had intermittent symptoms, showing the lack of association between the SAR/PAR/PAR+SAR classification and the ARIA classification. The ARIA classification showed better association not only with the symptomatic score, but also with the SNOT-20 score, which showed better validity than the conventional SAR/PAR classifications. CONCLUSIONS: Seasonal pollens were not specific to their season of prevalence in terms of the severity of symptoms, and the ARIA classification showed better representation of allergic symptoms and quality of life (SNOT-20 score) than did the SAR/PAR classification.

Viability and Regeneration of Chondrocytes after Laser Cartilage Reshaping Using 1,460 nm Diode Laser

OBJECTIVES: Cartilage reshaping by laser irradiation is used to correct septal and auricular cartilage deformities. Chondrocyte viability following laser irradiation and reshaping has been well established. However, the regeneration process of chondrocyte after laser irradiation has not been revealed yet. The aims of this study were to determine the mechanism of cartilaginous thermal injury and the regenerative process of damaged cartilage following laser irradiation. METHODS: Laser irradiation was performed on human septal cartilage and rabbit auricular cartilage using a 1,460-nm diode laser. We observed change in the shape of cartilage and evaluated the extent of cartilage injury using live/dead cell assay via confocal microscopy. Hoechst and propidium iodide (PI) staining was used to evaluate the mechanism of chondrocyte injury after laser irradiation. To evaluate the regeneration of cartilage, laser irradiated cartilages were reimplanted into a subperichondrial pocket and were harvested at 1, 2, and 4 weeks after reimplantation for viability assessment and histologic examination. RESULTS: Laser irradiation using a 1,460-nm diode laser produced a marked shape change in both human septal and rabbit auricular cartilages. Thermal damage on cartilage was correlated with the exposure time and the laser power. Hoechst and PI staining showed that chondrocyte death by laser irradiation was due to mainly necrosis, rather than apoptosis. In lower power treatment group (0.3 W and 0.5 W), all the chondrocytes regenerated within 4 weeks, however, in 1 W treatment group, chondrocytes could not regenerate until 4 weeks. CONCLUSION: Reshaping of cartilage using 1,460 nm diode laser was attained concurrently with the thermal injury to the chondrocytes. The extent of thermal damage on chondrocytes was dependent on the exposure time and the laser power and the damaged chondrocytes irradiated with lower level of laser power could be regenerated after reimplantation into subperichondrial pocket.

Autologous Platelet-Poor Plasma Gel for Injection Laryngoplasty

PURPOSE: To overcome the potential disadvantages of the use of foreign materials and autologous fat or collagen, we introduce here an autologous plasma gel for injection laryngoplasty. The purpose of this study was to present a new injection material, a plasma gel, and to discuss its clinical effectiveness. MATERIALS AND METHODS: From 2 mL of blood, the platelet poor serum layer was collected and heated at 100degrees C for 12 min to form a plasma gel. The plasma gel was then injected into a targeted site; the safety and efficacy thereof were evaluated in 30 rats. We also conducted a phase I/II clinical study of plasma gel injection laryngoplasty in 11 unilateral vocal fold paralysis patients. RESULTS: The plasma gel was semi-solid and an easily injectable material. Of note, plasma gel maintains the same consistency for up to 1 year in a sealed bottle. However, exposure to room air causes the plasma gel to disappear within 1 month. In our animal study, the autologous plasma gel remained in situ for 6 months in animals with minimal inflammation. Clinical study showed that vocal cord palsy was well compensated for with the plasma gel in all patients at two months after injection with no significant complications. Jitter, shimmer, maximum, maximum phonation time (MPT) and mean voice handicap index (VHI) also improved significantly after plasma gel injection. However, because the injected plasma gel was gradually absorbed, 6 patients needed another injection, while the gel remained in place in 2 patients. CONCLUSION: Injection laryngoplasty with autologous plasma gel may be a useful and safe treatment option for temporary vocal cord palsy.

A Case of Hyalinizing Trabecular Tumor of the Thyroid Gland / 대한이비인후과학회지

The hyalinizing trabecular adenoma (HTA) of the thyroid gland is a rare benign tumor, which is characterized by a trabecular growth pattern with hyaline stroma. This tumor is occasionally misdiagnosed as papillary carcinoma and medullary carcinoma. Distinguishing pathologic findings and immunochemical studies are needed to make a definite diagnosis. Recently, we experienced a case of HTA of the thyroid gland. A 54-year-old woman presented with both thyroid nodules (mainly the left thyroid). Fine needle aspiration cytology showed atypical follicular cells. We performed left hemithyroidectomy and finally diagnosed the specimen as HTA. We present this rare case with a brief review of the disease entity.

Clinical Analysis of Risk Factors Related to Recurrent Well Differentiated Thyroid Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Well differentiated thyroid carcinoma is the most common malignancy in thyroid gland. Most patients have an excellent prognosis. However, the recurrence of this disease carries a relatively high risk of tumor-related mortality. Therefore, the objective of this study is to analyze the factors that influence the development of well differentiated recurrent thyroid carcinoma. SUBJECTS AND METHOD: From January 1999 to January 2008, 366 patients who were diagnosed and surgically treated for well differentiated thyroid carcinoma were chosen. Disease free interval was assessed by univariate and multivariate analyses according to each prognostic factor. Prognostic factors consisted of sex, age, extra-capsular spread (ECS), multifocality, lymph node metastasis status, and extent of surgery. RESULTS: ECS and central, lateral LN involvement were significant risk factors for recurrence (p< 0.01). However, size of tumor, age, sex did not reveal any significance (p=0.20, p=0.73, p=0.60). In addition, multifocality, TNM staging showed borderline values (p=0.12, p=0.07). CONCLUSION: Extra-capsular spread and lymph node metastasis revealed high potential for recurrence of well differentiated thyroid carcinoma.

Histopathologic Analysis of Parotid Pleomorphic Adenoma: Resection Margin and Capsular Characterisitcs / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Pleomorphic adenoma is the most common benign neoplasm of the parotid gland. It is well known that margin involvement, pseudopod and satellite nodule are factors contributing to recurrence. In this study, we investigated the pathologic characteristics in the parotidectomy specimen of the pleomorphic adenoma. SUBJECTS AND METHOD: From January 2002 to July 2007, 45 patients who were diagnosed as pleomorphic adenoma of the parotid gland were selected, and their pathologic slides were reviewed by a pathologist. The narrowest resection margin and capsular characteristics such as incomplete capsule, pseudopod and satellite nodule were checked. Also, the relationship between pathologic subtype and the capsular characteristics was analyzed. RESULTS: The narrowest resection margin was related to size and location of the tumor. Smaller tumor had larger resection margin with stastistical significance and tumor located in the superficial lobe had larger resection margin. In pathologic subtypes, capsular characteristics such as incomplete capsule and satellite nodule were more frequent in myxochondroid type. Even in small tumor (<2 cm), capsular characteristics such as satellite nodule and pseudopod were not infrequent. CONCLUSION: Average resection margin was 4 mm but variable. Because the incidence of satellite nodule, pseudopod and incomplete capsule is about 30% in parotid pleomorphic adenoma, the resection of the tumor containing normal parotid tissue is important to reduce the risk of recurrence.

The anticancer effect and mechanism of photodynamic therapy using a new photosensitizer and diode laser on cervical cancer cell / 대한산부인과학회지

OBJECTIVE: During the last several years, such as Photofrin(R), Photogem(R), HpD, and 5-aminolevulenic acid (ALA) has been used as photosensitizers for a wide range of malignant tumors as well as non-malignant disease. A new photosensitizer, 9-Hydroxypheophorbide-a (9-HpbD-a) was derived from Spirulina platensis. The aim of this study was to evaluate the anticancer effect and mechanism of photodynamic therapy in vitro using 9-HpbD-a and 670 nm diode laser on a HT-3 cervical cancer cell line. METHODS: We studied the cytotoxic effect of 9-HpbD-a and 670 nm diode laser in HT-3 cervical cancer cell line. The cultured HT-3 cells were treated with serial concentrations of 9-HpbD-a followed by various irradiation time (0, 5, 15, 30 min) and by various interval times (0, 3, 6, 9, 12 24 hours) until laser irradiation, then 3- (4,5-dimethylthiazol-2-yl) -2,5-diphenyl-tetrazolium bromide (MTT) assay was applied to measure the relative inhibitory effect of PDT. RESULTS: Optimal condition for laser irradiation time was 15 minutes and the cytotoxic effect according to the incubation time after 9-HpbD-a treatment was increased until 6 hours. Under confocal microscopy, to observe intracellular localization of 9-HpbD-a, cells dual-stained with 9-HpbD-a and panel of organelle-specific fluorescence probes (MitoTracker, LysoTracker, ER-Tracker), endoplasmic reticulum (ER) as a major accumulation organelle site in HT-3 cervical cell line for this new photosensitizer. CONCLUSION: The anticancer effect of PDT using 9-HpbD-a is effective in HT-3 cervical cancer cell line. This agent therefore represents a promising photosensitizing prodrug for the treatment of cervical cancer with PDT in clinical setting for the future.

A Clinical Analysis of Peritonsillar Abscess / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Peritonsillar abscess (PTA) is the most common deep neck infection that occurs in adults, but until now there are so many controversies about the treatment modalities. The purpose of this study is to investigate the clinical course according to the treatment modalities for peritonsillar abscess and to evaluate the efficacy of tonsillectomy. SUBJECTS AND METHOD: Two hundred twenty-six patients with peritonsillar abscess admitted from January 1999 to October 2006. Among them, a retrospective review of medical records and additional telephone interview were performed on 151 cases. RESULTS: Among 151 cases, incision and drainage (I&D) was performed in 132 cases: 7 cases were done by aspiration and others were treated by antibiotics only. There was no significant difference in the dutarion of hospitalization between I&D, aspiration and antibiotics only (p>0.05). The incidence of recurrent PTA was only 6.6% (10/151). Tonsillectomy in PTA patients significantly reduced duration, frequency and severity of sore throat in long term follow up (p<0.05). CONCLUSION: The duration of hospitalization in PTA patients did not depend on treatment modalities. We conclude that tonsillectomy is not always necessary due to low incidence of recurrent PTA even though it improves satisfaction of PTA patients.

Incidence of Actinomycosis in the Tonsils and Its Clinical Significance / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The relationship between actinomycosis and chronic tonsillar diseases, such as chronic recurrent tonsillitis or tonsillar hypertrophy, has been reported several times; but there seems to remain some controversy. The aim of this study was to find out the incidence of actinomycosis in the tonsil and its clinical significance. SUBJECTS AND METHOD: A histologic evaluation with tonsil specimen for actinomycosis was done for 300 patients who had undergone tonsillectomy from July 2005 to February 2006. Other clinical features such as age, sex, chief complaints, tonsil size, frequency of recurrent tonsillitis, and laboratory findings were also analyzed. RESULTS: The incidence of actinomycosis in tonsil was significantly high in adult group. There was no significantly statistical difference in the rate of actinomycosis according to sex, chief complaints, tonsil size, frequency of recurrent tonsillitis, number of leukocytes, and hemoglobin. CONCLUSION: Actinomycosis seems to have no causal role in recurrent tonsillitis or tonsillar hypertrophy. However, the possibility of actinomycosis should be considered in unusual tonsillar hypertrophy patients.

Clinical and Radiologic Characteristics of Kikuchi's Disease / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Kikuchi's disease (histiocytic necrotizing lymphadenitis) is a rare self-limiting disorder that typically affects the cervical lymph nodes. It has been occasionally misdiagnosed as tuberculous lymphadenitis or malignant lymphoma. In this study, we analyzed the clinical and radiologic characteristics and tried to find the differential points of Kikuchi's disease. SUBJECTS AND METHOD: Fifty-two patients who underwent, from January 1998 to December 2004, a excisional biopsy or fine needle aspiration of a cervical lymph node and diagnosed histologically with Kikuchi's disease were enrolled in this study. We retrospectively reviewed the medical record and imaging of each patient. The patients were followed up for a period of 14 to 200 seven days. RESULTS: Patients were 36 women and 16 men (2.3:1) with the mean age of 23.7 years old. The affected cervical lymph nodes were most commonly located in the posterior cervical triangle (Level V, 83%). Multiple and unilateral cervical lymph nodes were affected in 23 and 16 patients, respectively. The dimensions of affected lymph nodes were in the range of 1 to 2.5 cm (mean 1.73 cm). Leukopenia was observed in 21 patients (46%) fever in 24 patients (46%). CT finding of Kikuchi's disease appeared to be similar to tuberculous lymphadenitis but it had more homogenous density. One patient was recurred after 104 days since she was diagnosed as Kikuch's disease by biopsy. CONCLUSION: The difinite diagnosis of Kikuch's disease was determined by pathology. But half of the patients show clinical and radiologic features suggestive of Kikuch's disease. Short term use of steroid with high index of suspicion will reduce the unnecessary open biopsy in patient with Kikuchi's disease.

ROS Formation and the Mechanism of Photodynamic Therapy Using 9-Hydroxypheophorbide-a on AMC-HN3 Human Head and Neck Carcinoma Cell Line / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: During PDT, photosensitizer accumulates in the cell and irradiation forms ROS. ROS leads to activation of apoptoticpathway and cell death. Elevated intracellular calcium is known to play important role in apoptotic pathway. There are two type of ROS formation. The type of ROS formation differs in type of photosensitizers. We designed the experiment to define the relationship of ROS and cell death in PDT. MATERIALS AND METHOD: AMC-HN3 cells were cultured. Using a CaspACE assay kit, we measured caspases-3 activity after PDT. We also observed intra-cellular calcium concentrations using confocal microscopy (calcium green-1 stain) after PDT. To determine which type of reaction occursduring ROS formation, MTT assay was performed. RESULTS: Confocal microscopy showed that ROS had formed at the site of photosensitizer formation after PDT. After PDT, intracellular calcium increased. MTT assay showed more viability increase in blocking type II reaction. Caspase assay showed highest level after 4hrs. CONCLUSION: ROS is formed at the site photosentizer formation after PDT. Type II reaction was the main type of ROS formation. Apoptosis was main pathway of cell death in low dose of photosensitizer after PDT.

A Case of Submandibullar Sialolithiasis due to Actinomycosis / 대한이비인후과학회지

Actinomycosis is an uncommon disease caused by actinomyces species, which are gram-positive anaerobic bacteria with filamentous appearance. Actinomyces israelii is the most common pathogen resulting in actinomycotic infection. The infection usually presents 3 distinct localizations: cervicofacial, thoracic, abdomino-pelvic. Cervicofacial actinomycosis accounts for about 50% of the cases. The sulfur granule defines the pathognomic pathologic finding of actinomycosis, but it has been reported in only 40% of cases. We report on a case of submandibular sialolithiasis that occurred due to antinomycosis in a 50-year old male patient.