The Photodynamic Therapy using 5-Aminolevulinic Acid(ALA): The Study of the Anti-Tumor Effect on in vitro and in vivo Experiments / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: ALA is a precursor of heme and converted to protoporphyrin IX used as effective photosensitizer. The aim of this study was to find the ideal concentration and incubation time of ALA for PDT on in vitro and in vivo experiments and to assess the anti-tumor effect of PDT using ALA on CT-26 colon cancer cell line. MATERIALS AND METHOD: CT-26 cell was cultured with serum free media including ALA in the dark room to show the intracellular accumulation of PpIX. The fluorescence of PpIX in the cell was detected under confocal laser scanning microscope. Also CT-26 cell was incubated with various concentration of ALA (1.0-0.001 mg/ml) and was irradiated with LED at 0 hr, 3 hr, 6 hr, 9 hr, 12 hr and 24 hr after application of ALA. The cell viability was assessed by MTT assay. in vivo PDT was done with optimal treatment condition and the anti-tumor effect of PDT using ALA was measured by tumor volume change. RESULTS: The fluorescence of PpIX was saturated at 6 hour after the ALA application to CT-26 cell and the optimal incubation time with ALA for PDT was 6 hours. For in vivo Study, 632 nm laser irradiation was done around the tumor 6 hours after ALA injection. The PDT using ALA on transplanted CT-26 tumors shows 40% cure rate and 40% partial remission and significant decrease of tumor volume. CONCLUSION: The peak accumulation of PpIX in the cell and in the tumor was reached 6 hours after the application of ALA. The PDT using ALA for CT-26 cells was very effective and this findings suggest that ALA is one of candidate for photosensitizer in head and neck solid tumors.

A Case of Complicated BPPV(Benign Paroxismal Positional Vertigo)

Canalith repositioning maneuver is effective to treat benign paroxysmal positional vertigo(BPPV). This case showed complicated form of the BPPV such as changes of canalolithiasis to cupulolithiasis, involvement of one canal to two canals and from unilateral to bilateral involvement during the reposition maneuver. This patient was diagnosed as left lateral canalolithiasis at first. After left barbecue maneuver, the type was changed to the right posterior cupulolithiasis. Semont maneuver was performed and then the type of BPPV was changed to combined type with right posterior canalolithiasis and left lateral canalolithiasis. We performed left barbecue maneuver and right Epley maneuver. Then the type of BPPV was changed to left lateral cupulolithiasis. After Brandt-Daroff maneuver and left barbecue maneuver, nystagmus and dizziness disappeared finally.

Tissue Reactions of the 532 nm Flash Lamp Pumped Solid State Laser and Diode Pumped Solid State Laser on the Muscle and Skin of the Guinea Pig / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The efficiency of second harmonic generation at 532 nm is high when a pulsed Nd : YAG laseris used as a pump source of fundamental waves. The pulse durations of 532 nm-irradiation can be varied from 10 ns to 1000 ns by changing the pumping method. The purpose of this study was to compare the macroscopic and micropscopic changes in the muscle and skin after irradiation by 532 nm Flash lamp pumped solid state (FPSS) laser and Diode pumped solid state (DPSS) laser, whose pulse durations are 600 ns and 100 ns, respectively. MATERIALS AND METHOD: Two experiments were conducted on the muscle and skin of guinea pig. First, the guinea pig muscle and skin were irradiated by the 532 nm FPSS and DPSS lasers with various intensities and time duration. Macroscopic examinations were performed on the muscle lesions and immediate histopathologic examinations on the skin were carried out. RESULTS: The volume of vaporization and necrosis of the guinea pig muscle by the FPSS laser was larger than that by the DPSS laser. The vaporization and necrosis reaction of skin by the FPSS was significantly stronger than that by the DPSS laser. CONCLUSION: It appears that the DPSS laser system would be superior over the FPSS laser system in providing more accurate and precise surgery with less intense injury on the surrounding tissue.

Psychogenic Dizziness : The psychiatric diagnosis and vestibular function tests

BACKGROUND AND OBJECTIVES: Psychogenic dizziness has not been studied extensively in Korea while it is seen frequently. We investigated the prevalence of psychiatric diagnosis and the results of vestibular function testings in patients with the diagnosis of psychogenic dizziness at a Korean tertiary university hospital. MATERIALS AND METHODS: The study was conducted on 38 patients with the diagnosis of psychogenic dizziness. They all received vestibular function testings (ENG, rotating chair test and posturography). Patients with central or vestibular organic disease were excluded from this study. RESULTS: Somatoform disorder was the most common psychiatric disorder causing psychogenic vertigo(47.4%) in this study. Anxiety disorder(21.1%) and depression(21.1%) were the next common causes. The vestibular function testings were abnormal in 19 patients(50.0%). The electronystagmography in 11, rotating chair test in 6, and posturography in 14 patients were abnormal. CONCLUSIONS: Somatoform disorder was the most common psychiatric disorder and vestibular function tests were abnormal in 50% of psychogenic dizziness patients. It implies that the patients with psychogenic dizziness have functional abnormalities in vestibular system.

The Ototoxicity of Cisplatin is Mediated by NO: A Study using L-NAME and MK-801 in Guinea pigs / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nitric oxide has been suggested to play an important role in the pathogenesis of cisplatin ototoxicity. L-NAME (NG-Nitroarginine Methyl Ester) is an inhibitor of nitric oxide synthase. MK-801 (Dizocilpine Maleate) is a NMDA receptor antagonist. To evaluate a role of nitric oxide in cisplatin ototoxicity, we investigated whether L-NAME and MK-801 can block the cisplatin ototoxicity in guinea pigs. MATERIALS AND METHOD: In the Group 1, normal saline was injected intraperitoneally as a control group. Group 2, 3, 4, and 5 were injected intraperitoneally as described in the following: Group 2, cisplatin only; Group 3, L-NAME+isplatin; Group 4, MK-801+cisplatin; Group 5, L-NAME+K-801+cisplatin. Using an auditory brainstem response, hearing threshold was tested before cisplatin administration and 5 days after cisplatin injection in each group. The morphological changes of the cochlea were observed by scanning electron microscopy. RESULTS: In the Group 2, a significant hearing loss was observed comparing to Group 1. In contrast , Group 3, 4, and 5 did not demonstrate any significant hearing loss compared to Group 1. In the scanning electron microscopy, the Group 2 showed distorsion and loss of stereocilia of the hair cells. However, the Group 1, 3, 4, and 5 demonstrated well preserved cochlear hair cell morphology. CONCLUSION: Hearing loss induced by ototoxicity of cisplatin was prevented by L-NAME and MK-801. This study suggests that NO may mediate cisplatin ototoxicity.

Clinical Study of Acute Arterial Occlusion of Lower Extremities

PURPOSE: The major source of acute peripheral arterial occlusion has been embolization from the heart. However overall improvement in medical care have increased life spans, resulting in significant increase in the incidence of systemic atherosclerosis and thrombotic occlusion of peripheral vessels. Recently, occlusion from in situ thrombosis has surpassed occlusion from embolization as the major cause of acute arterial occlusion. The introduction of the balloon catheter technique in 1963 dramatically simplified the technical aspect of surgical therapy for acute arterial occlusion and it became the main modality of the therapy. Recently, numerous reports have documented increased identification of intraluminal defects after arterial surgery using angioscopy as compared with those using intraoperative arteriography, and for this reason, the use of intraluminal angioscopy has grown in popularity. METHODS: We analyzed clinical characteristics and treatment results in patients with acute arterial occlusion. The variables studied include location, etiology, time interval from occurrence of occlusion to performance of thromboembolectomy. RESULTS: There were 41 men and 4 women and most prevalent age group was in 7th decades. The causes of acute arterial occlusion were embolism in 21 cases (46.7%), thrombosis in 24 cases (53.3%). The primary source of embolism was heart in 20 cases as a result of ischemic heart disease (n=11, 52.4%) and atrial fibrillation (n=9, 42.9%). Two patients in embolic group died of cardiogenic shock and were in shorter duration group (<24 hours). Iliac arterial occlusion group was associated with highest amputation rate (23.1%). Amputation rates were 12.5% for thromboembolectomy performed within 24 hours of onset of symptoms, and 17.4% when performed after 48 hours. We used angioscopic technique in limited cases of 5 patients to detect residual thrombus, intimal flap and other intraluminal defects. CONCLUSION: To improve outcome, early diagnosis and early treatment are essential. Direct visualization of the arterial lumen with angioscopy during thromboembolectomy procedure would provide a more reliable method of assessing luminal morphologic characteristics than angiography alone.

Diagnosis and Therapeutic Optin of Rnovasular Hypertension

No abstract available.

A Case of Systemic Lupus Erythematosus with Mediastinal Lymphadenopathy / 대한류마티스학회지

Approximately half of the patients with systemic lupus erythematosus(SLE) develop localized or diffuse lymphadenopathy during the evolution of the disease. But hilar and mediastinal lymph node enlargement due to SLE is rare. The histologic findings of lupus lymphadenitis range from nonspecific lymphadenitis with variable degrees of cellular necrosis to the less common but more specific appearance of extensive necrosis. Advanced lesions are characterized by hematoxylin bodies and condensation of DNA on the vessel walls. Hematoxylin bodies are amorphous homogeneous violet or lilac colored structures composed of partially depolymerized DNA, mixed with protein, carbohydrates and globulins which may be seen deposited on vessel walls and within the paracortex of lymph node. They are virtually diagnostic of SLE and would exclude malignant lymphoma. SLE with mediastinal lymphadenopathy is rare so we report this case with a review of literatures, which was diagnosed by hematoxylin bodies on pathologin findings of cervical lymph node.

An Analysis on the Vestibular Function Test Findings of Head Trauma Patients with Dizziness / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The incidence of head trauma is increasing, with vertigo or dysequilibrium being the major disability when returning to normal activities. However, the lack of understanding of and appropriate diagnostic methods for dizziness inhibits effective treatment and rehabilitation. We identified the vestibular status of the head trauma patients complaining of dizziness. MATERIAL AND METHODS: We performed electronystagmography battery, rotational chair test and posturography on 79 patients who previously had had head trauma. The patients were then divided according to the five types of head trauma. RESULT: The results of the vestibular function tests(VFT) of the 79 patients were analyzed to give five distinct types: 23 central types(29.1%), 21 peripheral types(26.6%), 5 mixed types(6.3%), 14 non-localizing types(17.7%), and 16 normal types(20.3%). The most common VFT finding of the intracranial lesion group was the central type(70.6%), whereas that of the temporal bone fracture group was the peripheral type(45%). The combined lesion group did not show any single predominant VFT finding. The normal type(33.3%) was the most common fingding in the inapparent head trauma group. CONCLUSION: Although there is some tendency that the vestibular function status of head trauma patients corresponds to the clinical presentations, it did not coincide with many of the patients in this study. This means that the vestibular function tests should be thoroughly performed in head trauma patients complaining of dizziness, so that the patients may be evaluated more accurately and treated better.

Clinical Study of Deep Vein Thrombosis of Lower Extremity

Medical managements and prevention of deep vein thrombosis(DVT) continue to be a difficult problem and DVT often result in serious complications, in spite of improvements in early diagnosis of DVT. Various attemps to treat effectivly and to prevent DVT have been tried. We reviewed 82 patients who were admitted to Department of Surgery of Chonnam University Hospital for treatment of DVT from January, 1991 to May, 1997. The results were as follows. 1) There was a wide age distribution from teenage to 8th decade, and peak age distribution was 7th decade(28.0%). Sex distribution of DVT, male to female ratio, was 1 : 1.1. 2) Main chief complaint in patients with DVT was swelling of lower extremities(97.5%), and followed by pain(51.2%). The left side of lower extremities was more frequently affected than that of right side, left to right ratio was 2.2 : 1. 3) Occupations of patients with DVT were variable, fourty patients(48.8%) had no specific occupations. 4) Most frequent predisposing factor of DVT was trauma(12.2%) and followed by malignancy (11.0%) and operation(7.3%). 5) Diagnosis of DVT was made with plethysmography in all cases, and venography(25 cases), radioiodine(RI) venography with lung scan(7 cases). 6) Treatment was done with heparin and oral anticoagulant in most patients for 3 to 12 months. Fogarty thrombectomy was done in 4 cases, but adequate removal of thrombi was failed in 2 cases because the catheter couldn't be advnaced into the site of thrombi. Anticoagulant therapy was done for 2

A case of Conjoined Twins: Omphalopagus

Conjoined twins are one of the rarest and most challenging congenital anomalies in pediatric surgery. Successful surgical separation is more unusual, since the majority of conjoined twins are incapable of separating successfully. The timing of separation is variable, but separation is usually delayed until such infants are relatively mature (i.e, 9-12 months of age). Operative survival was 50% in those operated on in the neonatal period, but 90% in those of over 4 months of age. Our case was early separated beacase of one of the twins having heart problems. These twins were omphalopagus and shared only simple liver bridge without vascular and biliary communications. Surgical separation was undertaken successfully on the 11th day of life, so we describe our experience with the review of the relevant literatures.

Transiently Evoked Otoacoustic Emission Screening of Neonate / 대한이비인후과학회지

Many features of transiently evoked otoacoustic emission(TEOE) are ideal for clinical use, including their ability to objectively measure cochlear function. TEOE can be used to accurately and efficiently screen for identification of neonatal hearing impairment. The purposes of this study are to provide the reference value of neonatal screening parameters, to evaluate the incidence and etiolgies of neonatal hearing loss, and to confirm the efficacy of neonatal screening. Data were collected from 1145 neonate subjects, the majority of whom is around 30 days of age. Reference values of TEOE are issued. Nine neonates proved to have sensorineural hearing loss of greater than moderate degree. Five of them had high risk factors of neonatal sensorineural hearing loss(SNHL), whereas other four did not. This study reconfirmed neonatal screening with TEOE is a valuable tool for early detection of the babies with SNHL. The babies with high risk factors have higher risk of SNHL(3.4%) than those without risk factors(0.4%). The baby without risk factors occupied some proportion of the babies with SNHL, which implies the necessity of TEOE screening in all neonates.