A clinical study on gestational trophoblastic disease / 부인종양

OBJECTIVE: To evaluate the clinical characteristics and the outcome of the management for gestational trophoblastic disease (GTD) patients diagnosed at our hospital and to report the current situation of GTD in Korea. METHODS: Between January, 1991, and December, 2000, One hundred and eleven women were diagnosed as GTD and managed in our hospital. Patients were classified according to clinical diagnosis and their medical records were investigated. RESULTS: Cases of benign, malignant nonmetastatic, malignant metastatic low risk and malignant metastatic high risk GTDs were 62, 36, 2 and 11 respectively. The mean age (year), gravidity and parity (number) of GTD patients were 33.3+/-9.9 (range: 19-54), 3.2+/-3.0 (range: 0-16) and 1.7+/-1.8 (range: 0-7) overall. About 75% of GTD patients were women in their 20s and 30s, and 85% occurred in patients with parity of 3 or less. The most common prior gestational event was abortion (37.1%) for molar pregnancy and molar pregnancy (61.2%) for persistent gestational trophoblastic tumor (PGTT). The progression rate of molar pregnancies to PGTT was 38.0%. MTX (16.3%) was mainly used as a single agent, and EMACO (28.6%) or MAC (22.4%) were primarily used for multidrug chemotherapy for the treatment of PGTT. In the treatment of PGTT, overall remission rate was 95.9% (n=47/49). CONCLUSION: The trends for GTD in Korea revealed significant changes, not only a decrease in the incidence of GTD, but also an improvement in the outcome of the management. There is a necessity of further community-based surveys for GTD.

Budesonide Down-regulates IL-1beta-Mediated MUC2/MUC5AC Genes Expression and Mucin Secretion in Human Airway Epithelial Cells / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mucus hypersecretion is a hallmark of many respiratory inflammatory diseases such as asthma, bronchitis and sinusitis. While the current therapeutic pharmacological approaches to reducing mucus hypersecretion are limited, clinical studies have suggested that glucocorticoids reduce mucus secretion in patients with airway disease. However, the effect of glucocorticoids on mucus hypersecretion is not clear. Recently, we observed that IL-1beta induces MUC2 gene expression and mucin secretion in a previous experiment. This study was designed to investigate the effects of budesonide on the IL-1beta-mediated MUC2/5AC genes expression and mucin secretion. MATERIALS AND METHOD: We observed the steady state mRNA level of MUC2/5AC genes using RT-PCR and mucin protein using immunoassay method in cultured human airway NCI-H292 epithelial cells. RESULTS: Budesonide attenuated IL-1beta-mediated MUC2/5AC gene expression as well as mucin secretion. The attenuated effect of budesonide was in a dose-dependent pattern. This attenuated effect of budesonide was blocked by glucocorticoid receptor antagonist, RU-486. CONCLUSION: This result suggests that budesonide suppresses the IL-1beta-mediated MUC2/5AC genes expression and mucin secretion via blockage of glucocorticoid receptor.

Primary Nasopharyngeal Chordoma: A Case Report / 대한이비인후과학회지

Chordomas arise mainly in the sacrococcygeal region, and to a lesser extent, in the spheno-occipital region. When occurring in the latter region, they may protrude into nasopharynx and rarely into the sinonasal tract, mainly sphenoid sinus. Histologically, the vacuolated physaliphorous cell is pathognomonic. This tumor is histologically benign but locally aggressive and often far advanced at the time of presentation. The current treatment is applying surgical excision with/without postoperative radiation. Since its first report in 1987, there have a several reports of primary nasopharyngeal chordoma throughout the world. In Korea, one case of sphenoidal chordoma was reported in 1993, but there had been no report of primary nasopharyngeal chordoma. We report a recent case of primary nasopharyngeal chordoma we have treated by transnasal endoscopic surgical excision and present a review of the literature.

Regulation of IL-1beta-Mediated MUC2 Gene and Mucin in Human Airway Epithelial Cells / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mucin secretion is regulated by the mucin genes (MUC) in the respiratory, gastrointestinal and reproductive system. Inflammation induces mucin hypersecretion in the human body. This study demonstrates the effects of IL-1beta on the regulation of mucin protein expression as well as the MUC2 gene in cultured airway epithelial cells. MATERIALS AND METHOD: Analysis of MUC2 gene was done by RT-PCR and the protein analysis was done by a flow cytometric analysis and an immunoassay method using cultured human airway epithelial cells, and NCI-H292 cells. RESULTS: The expression of MUC2 mRNA and protein induced by IL-1beta increased in a dose-and time-dependent manner. The maximum mRNA level of the MUC2 gene was approximately 3-fold, compared to that of the control cell. The IL-1beta-mediated MUC2 protein started at 6 hours of exposure to IL-1beta (20 ng/ml) and the maximum level was 12 hours. The MUC2 protein data of flow cytometric analysis corresponded to that of immunoassay analysis. The expression of MUC2 gene was suppressed by actinomycin D, but not attenuated by cycloheximide. CONCLUSION: These results suggest that the IL-1beta-mediated MUC2 gene and protein expression were increased in a dose- and time-dependent pattern and regulated by transcriptional step.

IL-1beta Mediated COX-2 Expression in Human Airway Epithelial Cells / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Prostaglandin is one of the important inflammatory mediator in inflammatory diseases. Cyclooxygenase-2 (COX-2) plays a key role in biosynthesis of prostaglandins. In this study, we aimed to investigate COX-2 expression and prostaglandin E2 (PGE2) production by interleukin-1beta (IL-1beta) in cultured human airway epithelial cells. MATERIALS AND METHOD: COX-2 gene expression, and COX-2 protein, PGE2 production by IL-1beta were analyzed by RT-PCR, Western blot, and enzymeimmunoassay (EIA) in cultured human airway NCI-H292 epithelial cells. RESULTS: The COX-2 protein production was increased when the cells were exposed to IL-1beta in a dose dependent manner. The maximum level of COX-2 protein was detected at 20 ng/ml of IL-1beta. After 4 hours, the production of COX-2 protein was detected by IL-1beta(20 ng/ml) and this was held up to 12 hour. The maximum level of COX-2 protein production reached at 8 hour of exposure to IL-1beta and this was held up to 12 hour. The release of PGE2 occurred in the same pattern as the IL-1beta-mediated COX-2 protein production. The COX-2 gene expression was induced by IL-1beta (20 ng/ml). The IL-1beta-mediated COX-2 expression was suppressed by actinomycin D, but was not affected by cycloheximide. CONCLUSION: These results suggest that the IL-1beta-mediated COX-2 expression and the PGE2 production were increased in dose and time dependent manner and regulated in the transcriptional step.

Interleukin-1 beta Induces MUC2 Gene Expression and Mucin Secretion via Activation of PKC-MEK/ERK,and PI3K in Human Airway Epithelial Cells

Interleukin 1 beta (IL-1 beta), a proinflammatory cytokine, is related with inflammatory diseases and it up-regulates MUC2 gene expression and mucin secretion. This study was designed to investigate the signal transduction pathway of the IL-1 beta-mediated MUC2 gene expression and mucin secretion in human airway epithelial cells. In cultured human airway NCI-H292 epithelial cells, the steady state of the mRNA level of MUC2 gene expression and mucin secretion induced by IL-1 were determined by reverse transcriptase-polymerase chain reaction (RT-PCR), enzyme immunoassay, and immunoblot analysis. To observe the signal pathway of the IL-1 beta-mediated MUC2 gene expression and mucin secretion, we used several specific inhibitors. PD98059 (MEK/ERK inhibitor) suppressed IL-1 beta-mediated MUC2 gene expression and mucin secretion, while SB203580 (p38 inhibitor) did not. Ro31-8220 (PKC inhibitor) inhibited IL-1 beta-mediated MUC2 gene expression and mucin secretion. It inhibited ERK phosphorylation, but did not inhibit p38 phosphorylation. LY294002 (PI3K inhibitor) also suppressed MUC2 expression, but did not inhibit any MAPKs phosphorylation. These results suggest that the IL-1 -mediated MUC2 gene expression and mucin secretion in NCI-H292 cells are regulated through activation of the PKC-MEK/ERK pathway, and that PI3K is also involved in the IL-1 beta-mediated MUC2 gene expression and mucin secretion.

Treatment Outcomes and Acoustic Rhinometric Results in Endoscopic Sinus Surgery of Adult Chronic Paranasal Sinusitis / 영남의대학술지

BACKGROUND: Chronic paranasal sinusitis is one of the most common disease in the otorhinolaryngologic field. Endoscopic sinus surgery is treatment of choice in chronic paranasal sinusitis. The aim of this study was to evaluate objective and subjective treatment outcomes of endoscopic sinus surgery in adult chronic paranasal sinusitis with or without polyp. MATERIALS AND METHODS: We reviewed 84 adult patients underwent endoscopic sinus surgery by one surgeon from June 1999 to June 2000, prospectively. We analyzed preoperative and postoperative subjective symptom scores and acoustic rhinometric results. RESULTS: Fifty cases were male and thirty four cases female. The average age was of 33 year-old (range: 17 to 66 years). There was significantly improvement of symptom scores in postoperative 3 months and 6 months compared with preoperative symptom scores. There was significantly increased postoperative total volume of nasal cavity. When we compared high score group with low score group, there was statistically significant improvement of symptom scores between preoperative stage and postoperative 3 months in radiologic grading group. CONCLUSIONS: Endoscopic sinus surgery is considered to be effective for the treatment of chronic paranasal sinusitis. It seems to be helpful to employ subjective symptom score system and objective total volume change of nasal cavity through acoustic rhinometric test to analyze effectiveness of endoscopic sinus surgery. In this study, the most important preoperative factor of sinus surgery outcomes is radiologic grading system.

Treatment Outcomes and Acoustic Rhinometric Results in Endoscopic Sinus Surgery of Adult Chronic Paranasal Sinusitis / 영남의대학술지

BACKGROUND: Chronic paranasal sinusitis is one of the most common disease in the otorhinolaryngologic field. Endoscopic sinus surgery is treatment of choice in chronic paranasal sinusitis. The aim of this study was to evaluate objective and subjective treatment outcomes of endoscopic sinus surgery in adult chronic paranasal sinusitis with or without polyp. MATERIALS AND METHODS: We reviewed 84 adult patients underwent endoscopic sinus surgery by one surgeon from June 1999 to June 2000, prospectively. We analyzed preoperative and postoperative subjective symptom scores and acoustic rhinometric results. RESULTS: Fifty cases were male and thirty four cases female. The average age was of 33 year-old (range: 17 to 66 years). There was significantly improvement of symptom scores in postoperative 3 months and 6 months compared with preoperative symptom scores. There was significantly increased postoperative total volume of nasal cavity. When we compared high score group with low score group, there was statistically significant improvement of symptom scores between preoperative stage and postoperative 3 months in radiologic grading group. CONCLUSIONS: Endoscopic sinus surgery is considered to be effective for the treatment of chronic paranasal sinusitis. It seems to be helpful to employ subjective symptom score system and objective total volume change of nasal cavity through acoustic rhinometric test to analyze effectiveness of endoscopic sinus surgery. In this study, the most important preoperative factor of sinus surgery outcomes is radiologic grading system.

IL-1beta-Mediated Cyclooxygenase-2 Expression through Activation of PKC-MEK / ERK in Human Airway Epithelial Cells / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cyclooxygenase-2 (COX-2) plays an important role in the biosynthesis of prostaglandin, which is an important inflammatory mediator in human airway inflammatory disease. We observed that interleukin-1beta(IL-1beta) induces COX-2 gene expression and protein production in NCI-H292 cells in the previous experiment and designed this study to investigate the signal transduction pathway of the IL-1beta-mediated COX-2 expression in human airway epithelial cells. MATERIALS AND METHOD: In the cultured human airway NCI-H292 epithelial cells, the IL-1beta-mediated COX-2 gene and protein expression were analyzed by reverse transcription-polymerase chain reaction (RT-PCR) and Western blot. To identify the signal transduction pathway of the IL-1beta-mediated COX-2 expression, we used specific inhibitors. RESULTS: PD98059, MEK/ERK inhibitor suppressed IL-1beta-mediated COX-2 gene and protein expression, but SB203580, p38 inhibitor did not suppress it. Ro31-8220, PKC inhibitor attenuated IL-1beta-mediated COX-2 gene and protein expression. Ro31-8220 suppressed ERK phosphorylation, but did not inhibit phosphorylation of p38 and JNK. PKC were involved at upstream of ERK in the IL-1beta-mediated COX-2 expression. PI3K inhibitor, LY294002 and tyrosine kinase inhibitor, genistein did not suppress COX-2 expression. CONCLUSION: IL-1beta-induced COX-2 gene and protein expression is up-regulated through activation of PKC-MEK/ERK cascade in human airway NCI-H292 epithelial cells.

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.

Barotrauma of the Middle Ear in Guinea Pigs after Simulated Diving / 대한이비인후과학회지

To confirm the possibility of middle ear barotrauma in Guinea Pigs even to safe, recomm-endable diving profiles to sports SCUBA divers and to study operating microscopic findings and progress of middle ear barotrauma, 16 Guinea Pigs were exposed to hyperbaric chamber for simulated diving. Simulated diving profiles were 20 meter sea water of maximum depth, 18 meter per minute of ascent, descent rates, 20 minutes of bottom time, 60 minutes of surface interval time and 2 repetitive dives in a day for 2 consecutive days. Then, tympanic membrane, middle ear and round membrane window were examined by operating microscope on 1 day, 7 days after simulated diving respectively. The experimental results showed that 26 of 32 ears(81.2%) disclosed findings of barotrauma in total, 23 ears(71.9%) in tympanic membrane, 25(78.1%) in middle ear, 7 ears(21.9%) in round window membrane respectively. The main operating microscopic findings of barotrauma were hyperemia of tympanic membrane in 23 ears(71.9%), hyperemia in 25 ears(78.1%), bleeding in 22 ears(68.8%) of middle ear, followed by bleeding, perforation of tympanic membrane, edema, effusion in middle ear, bleeding and rupture of round window membrane in order. Hyperemia of tympanic membrane and bleeding of middle ear in day 7 group showed significantly lower rate of barotrauma than those of day 1 group, that suggest spontaneous improvement in mild case of experimental middle ear barotrauma.

The efficacy of stellate ganglion block in the treatment of idiopathic sudden sensorineural hearing loss / 대한이비인후과학회지

No abstract available.

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.