Comparison of the Wound Healing Effect of Cellulose and Gelatin: An In Vivo Study

BACKGROUND: Many topical hemostatics are widely applied for bleeding control. They can be classified into two categories according to their mechanism of action on the clotting cascade in a biologically active or passive manner. Passive hemostatics include cellulose and gelatin. We performed an experimental study to compare the effect of passive hemostatics in wound healing by applying them to a rectus abdominis muscle defect of white mice. METHODS: Surgicel is a sterile absorbable knitted fabric prepared by the controlled oxidation of regenerated cellulose. Spongostan is an absorbable hemostatic gelatin sponge. In 30 mice, a 1x1 cm defect was created on the rectus abdominis muscle and the materials were applied in three ways: control group, cellulose (Surgicel) group, gelatin (Spongostan) group. For the histologic analysis, biopsies were performed at 3 and 28 days. RESULTS: After 3 days, the cellulose group showed limited granulation formation with acute inflammatory reactions similar to the control group. At the 28th day, moderate amounts of granulation tissue formation was observed with milder inflammatory reactions than the control group. In the gelatin group, after 3 days, gelatin remnants were observed surrounded by severe inflammatory changes. After 28 days, the same quantity of gelatin remnants could be still observed. CONCLUSIONS: This study suggests that cellulose is associated with minimal morbidity in wound healing, while the use of gelatin shows severe adverse tissue reactions with delayed wound healing. Consequently, cellulose is better than gelatin when considering wound healing.

Effectiveness of Vicryl plus(R)(Ethicon, USA) in Nosocomial Bacteria

PURPOSE: Surgical site infections(SSIs) are the third most frequently reported nosocomial infection. Of these SSIs, mostly were confined to the incision associated with underlying disease as diabetes, cigarette smoking, systemic steroid use, obesity, operating room environment, suture and surgical technique. This study has been planned to reduce the SSIs by using Vicryl plus(R)(Ethicon, USA) which contains triclosan, a broad-spectrum antibacterial agent, into the infected wound to evaluate whether or not Vicryl plus(R)(Ethicon, USA) is effective to nosocomial bacteria using a zone of inhibition assay. METHODS: We did a comparison of Vicryl plus(R) suture(with triclosan) size 2-0, 5-0 with Vicryl(R) suture(without triclosan) size 4-0 each as treatment and control group, applied in Mueller-Hinton agar infected by following mircroorganisms: Methicillin-sensitive Staphylococcus aureus (MSSA), Methicillin-resistant Staphylococcus aureus (MRSA), Acinetobacter baumanii, Escherichia coli, Enterobacter faecalis, Pseudomonas aeruginosa, Candida albicans. Cultures were made of the selected mircroorganisms, seeding the study strain in agar plates for 24 and 48-hour period in an oven at 37degrees C followed by zone of inhibition assay. RESULTS: Vicryl plus(R) group has demonstrated to create a zone of inhibition against MRSA, MSSA and A. baumanii, but no effect on E. faecalis, P. aeruginosa, C. albicans. Vicryl plus(TM) suture size 2-0 also had antibactericidal effect while Vicryl plus(R) suture size 5-0 did not. Vicryl(R) group had no zones of inhibition showing colonization at all mircroorganisms. CONCLUSION: Our results seem to warrant the use of Vicryl plus(R) as absorbable buried suture when concerning SSIs as a prophylaxis against surgical nosocomial infection.

Efficacy of Mepitel(R) in Treatment of Second Degree Burn

PURPOSE: The last decade has focused on healing as the major outcome of burn management with little attention paid to other important patient-centered outcomes, such as pain. Traditional standard dressings using silver sulfadiazine cream and vaseline gauze may result in significant pain at dressing change, wound dryness, increase necessity for dressing change, and also traumatizing the skin and wound bed. In this paper we introduce Mepitel(R), a new silicone dressing material showing satisfactory result than previous traditional standard dressings in burn dressing. METHODS: We conducted a prospective, observational study of 15 adult patients with second degree burn. At the arrive, we initially applied Mepitel(R) after bullae aspiration and changed the cover dressing depending on the degree of exudate from burn while still applying Mepitel(R) for 3 days. After dressing change, pain intensity was measured on an 11-point numeric rating scale. RESULTS: Mean time to wound reepithelization was 10.2 days and mean pain scores on a 11-point scale associated with dressing changes was 5.2 while requiring 0.5 intravenous narcotic administrations per dressing change. CONCLUSION: Mepitel(R) is a new grid like silicone coated nylon dressing containing no additional biologic compounds. The advantages of the Mepitel(R) are easy of use, non-adhesion to the wound, very good tolerance, keep moisture of wound and absence of pain during dressing change. This product has been used in our clinics and this paper serves as a report on our experiences with it.

The Analysis of Exercise on the Immune Responses

The immune response to any stimulus is complex, requiring coordinated action by several types of cells in a tightly regulated sequence. Thus, a physical stress such as exercise may act at any number of points in the complex sequence of events collectively termed the immune response. Although exercise causes many propound changes in parameters of immune function, the nature and magnitude of such changes rely on several factors including the immune parameters of interest; type, intensity, and duration of exercise; fitness level or exercise history of the subject; environmental factors such as ambient temperature and humidity. Although regular moderate exercise appears to be important factor for increasing immunity, Athletes are susceptible to illness, in particular upper respiratory track infection, during periods of intense training and after competition. In addition, in elite athletes, frequent illness is associated with overtraining syndrome, a neuroendocrine disorder resulting from excessive training. Through this paper, we want to investigate the effects of exercise on the immunosuppression such as exercise induced lymphopenia, asthma, anaphylaxis, URT (upper respiratory track), and TB (tuberculosis) infection. and also, we want to suggest a direct mechanism, protection and therapy of exercise induced immunosuppression.

Rhinocerebral Mucormycosis with Selective Cranial Nerve Palsy / 대한이비인후과학회지

Rhinocerebral mucormycosis, a rare opportunistic invasive fungal infection, is known to be fatal and aggressive. It is characterized by an aggressive necrotizing infection spreading from the nose to the paranasal sinuses, orbit, and the brain. This disease is most often associated with diabetic ketosis but can be seen with uremic acidisis, leukemia, malnutrition, AIDS, steroid, antimetabolic or antibiotic therapy, severe burn, septicemia, and treatment with immunosuppressive medications. Early clinical recognition of this potentially fatal disease is essential before irreversible changes occur. We report in this study about a 40-year-old man with poorly controlled diabetes mellitus who developed mucormycosis which involved unilateral paranasal sinus, orbit, and selective cranial nerves (especially, hypoglossal nerve). Despite of treatment he died from an abruptly developed acute respiratory distress syndrome that might be caused by mucormycotic hematogenous dissemination 33 days after admission.

Arterial Embolization in Rhinological Field: an Analysis of 19 Cases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The progress of arterial embolization made it possible to control intractable nasal bleeding and to reduce the blood supply of nasopharyngeal angiofibroma. MATERIALS AND METHODS: We reviewed 19 cases of patients who received arterial embolization from Jan. 1993 to Dec. 1999. We analyzed the cases according to the age, sex, hypertension, purpose, result and complications of arterial embolization. RESULTS: Thirteen patients received arterial embolization due to uncontrolled epistaxis by conservative management. Except one patient who had bleeding from the anterior ethmoidal artery, 12 patients stopped bleeding after successful embolization. Three patients received the arterial embolization for continuous bleeding after endoscopic sinus surgery, and other three patients received it for reducing the blood supply of the nasopharyngeal angiofibroma preoperatively. The complications were seizure like movements, fever and facial pain: but these complications were limited to few cases, and were minimal and temporary. CONCLUSION: Arterial embolization is a safe and effective method that should be considered in the treatment of refractory nasal bleeding and for reducing the intraoperative bleeding in angiofibroma.

Effects of Dexamethasone on RANTES Expression of Nasal Fibroblast / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Fibroblasts play an indirectly augmenting effector role in allergic inflammatory response by releasing different proinflammatory cytokines, including RANTES, GM-CSF, IL-8 after stimulation by other inflammatory cytokines such as IFN-gamma, TNF-alpha. The aim of this study was to investigate expression of RANTES in allergic and non-allergic nasal fibroblasts after stimulation with IFN-gamma and TNF-alpha, and to study the effect of dexamethasone on the RANTES expression of nasal fibroblast cell. MATERIALS AND METHODS: Using the 3rd passage of fibroblasts taken from the inferior turbinates of allergic and non-allergic patients, we evaluated the RANTES expression of fibroblasts after the IFN-gamma, TNF-alpha stimulation in the presence or in the absence of dexamethasone by ELISA. RESULTS: The expression of RANTES in allergic nasal fibroblasts stimulated by cytokines was stronger than in non-allergic nasal fibroblasts stimulated by cytokines. And dexamethasone suppressed the RANTES expression in allergic nasal fibroblasts stimulated by IFN-gamma. However, dexamethasone did not affect the RANTES expression in allergic fibroblasts stimulated by TNF-alpha and non-allergic fibroblasts stimulated by IFN-gamma and TNF-alpha. CONCLUSION: This study shows different responses of the RANTES production in nasal fibroblasts to dexamethasone, perhaps reflecting heterogeneity of nasal fibroblasts.

Result of Allergic Skin Test, MAST and Nasal Provocation Test in Children with Atopic Dermatitis / 대한이비인후과학회지

BACKGROUND & OBJECTIVES: Allergic diseases are considered to be systemic diseases. Atopic diseases are the first manifestation among allergic diseases, with the suggested relation to allergic rhinitis and asthma, as reported in several studies. The objective of this study was to evaluate the responses to allergic tests in children who have atopic dermatitis or have allergic rhinitis and atopic dermatitis. Materials & Methods : Eighty subjects without atopic dermatitis (control group) and 80 patients with atopic dermatitis (atopy group) were subjected to study from Nov. 1997 to Nov. 1999. The atopic group included pediatric patients who were diagnosed as having atopic dermatitis, but excluded patients who received medical treatment of steroid or antihistamine before the test for 1 month. In all the control and atopic groups, the nasal cavity volume was first estimated by acoustic rhinometry, followed by the allergic skin test (AST) and MAST. A nasal provocation test was taken with a positive allergen for patients who showed positive response to AST and MAST; for patients who showed negative response to AST and MAST, the test was taken with the House dust mites. RESULTS: In the atopic dermatitis group, the rate of positive responses to AST and MAST were 65% and 72.5%, respectively; in the control group, the rates were 25% and 35%, respectively. The most common positive allergen was the House dust mite in AST and MAST. In the nasal provocation test, the more positive rate was observed in the atopic group. CONCLUSION: The atopic group showed more positive response than the control group to AST, MAST and the nasal provocation test. Also, the nasal mucosa of 37.5% of the atopic dermatitis patients were sensitized to a certain allergen.

Effect of Mahuangbujaseshintang and Soshihotang in animal model of allergic rhinitis / 천식및알레르기

BACKGROUND AND OBJECTIVE: Mahuangbujaseshintang (MBST) and soshihotang (SST) have been used for treatment of chronic disease of respiratory tract. It is necessary to clarify the mechanism of anti-allergic effects and to standardize the extracts. MATERIALS AND METHODS: The effects of MBST and SST were evaluated on histamine release in rat mast cells ex vivo. Several hours after administration of the extracts, mast cells were stimulated by DNP-ascaries and histamine contents were measured. Time course structural change of the cells was examined by dynamic study. In order to evaluate the effect of the extracts on the nasal patency, acoustic rhinometry was performed after administering of leukotriene D4 to both nasal cavities of guinea pig (GP). We examined the effects of the extracts with double-blind study, and also studied change of nasal patency after challenge of antigen by acoustic rhinometry in patients with allergic rhinitis. RESULTS: MBST at 4 hr and SST at 3 hr after oral administration remarkably inhibited histamine release from rat mast cells in a dose-dependent manner. MBST-treated GPs failed to show bi-phasic phenomena which indicated to reduce nasal volume at the time of early and late phases in allergic inflammation. Both groups of patients who took MBST and SST for 1 week or 2 weeks showed significant decreased symptom severity index (SSI) from treatment week 2 (p<0.05). The percent volume change after challenge of the antigen was decreased in 31 patients who took the extracts for 2 weeks. CONCLUSION: We can conclude that the herb medicine of MBST and SST may be effective for allergic rhinitis.

Functional Changes of Interleukin-4 and Interferon-gamma of Peripheral Blood and Nasal Mucosa after Immunotherapy in Patients with Perennial Allergic Rhinitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Immunologic changes of immunotherapy can include reduced allergenstimulated mononuclear cells prolifer-ation and lymphokine production and the generation of allergic-specfic suppressor T cells. The changes and the relationships of the mononuclear cells between the peripheral blood and the nasal mucosa are still unclear during immunotherapy. The purpose of this study was to evaluate the functional changes of the mononuclear cells in peripheral blood and the nasal mucosa following immunotherapy. MATERIALS AND METHODS: We collected the mononuclear cells from the peripheral blood and the nasal mucosa in 25 patients who had received immunotherapy and 10 patients without any treatment. All of the patients were sensitive to house dust mites. And 5 healthy subjects were used as a control. The mononuclear cells were incubated with antigen or phytohemaglutinin (PHA) for 48 hours. And productions of Interleukin-4 and Interferon-gamma were measured in supernatants by ELISA. On the peripheral mononuclear cells stimulated by antigens, the production of Inter-leukin-4 was dominant in the non-treated allergic group and there were no differences of the productions in the group of immunotherapy and healthy control group. Similar findings of Interleukin-4 production were seen on mononuclear cells from the nasal mucosa. And there were no differences of Interferon-gamma production in the nontreated and control group. However the immunotherapy group showed more Interferon-gamma production than those 2 groups in mononuclear cells from both sites. CONCLUSION: These findings suggests that immunotherapy can change the function of mononuclear cells from the peripheral blood as well as the nasal mucosa.

The Transforming Growth Factor-beta1 Expression in Normal Laryngeal Mucosa, Laryngeal Dysplasia and Laryngeal Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Transforming growth factor-beta1 (TGF-beta1) is a multifunctional regulator of cellular differentiation, motility and growth. Loss of sensitivity to the growth inhibitory effects by TGF-beta1 plays important roles in neoplastic progression. So expression of TGF-beta1 has been described in several tumors, but little is known about the role of TGF-beta1 in neoplastic progression of human larynx. The aim of this study was to investigate the role of TGF-beta1 in the neoplastic progression of human larynx. MATERIALS AND METHODS: We evaluated the expression of TGF-beta1 using immunohistochemical study in 6 cases of normal laryngeal mucosa, 6 cases of laryngeal dysplasia, 20 cases of laryngeal carcinoma. RESULTS: The results were as follows: 1) Normal laryngeal mucosa has no expression of TGF-beta1. 2) The expression of TGF-beta was 16.7% in laryngeal dysplasia, 50.0% in laryngeal carcinoma. CONCLUSION: The TGF-beta1 expression rate was correlated to the progression of laryngeal lesions when compared to normal laryngeal mucosa, laryngeal dysplasia and laryngeal carcinoma.

Monothermal Caloric Test: Comparison of Dizziness Sensation and Nystagmus Parameters according to Age Groups / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: here have been some studies on the influence of age on the results of vestibular function tests with conflicting results. In influence of age on the results of caloric test, we investigated the sensation of dizziness during caloric test by drawing a correlation between the direction of rotatory sensation and the direction of nystagmus. MATERIALS AND METHODS: We performed monothermal caloric test on 44 healthy adults and divided them into six age groups ranging from 16 and 67. RESULTS: During the test with eyes-closed, 80.23% of patients reported a sensation of self-rotation. Of those, 55.81% expressed the direction of rotation to be the same as that of the fast component of nystagmus, whereas 24.42% expressed the direction to be the same as that of the slow component of nystagmus. During caloric test with eyes-open in light, 59.30% reported a sensation that their surroundings rotated around them. Of those, 43.02% expressed the direction of rotatory sensation to be the same as that of the fast component of nystagmus, whereas 16.28% expressed the direction to be the same as that of the slow component of nystagmus. During caloric test with eyes-closed, most of the subjects felt themselves rotating, whereas most of the subjects felt the outside world were rotating in tests with eyes-open in the light. CONCLUSION: Nystagmus parameters (latency, duration, SPEV at eyes-open and at eyes-closed, visual suppression) did not result in significant differences among different age groups: therefore, we conclude that age doesn't influence the results of caloric tests.

A Case of Pseudotumor of the Maxillary Sinus / 대한이비인후과학회지

Pseudotumor is a term used to describe a space occupying inflammatory lesion which mimics a true neoplastic process in its clinical presentation and radiologic findings. Its occurrence in the maxillary sinus is rare. The etiology and pathophysiology of the maxillary pseudotumor is unknown. A large and longstanding pseudotumor may induce the erosion or destruction of the maxillary bone wall. Therefore it may be difficult to distinguish such a lesion from a malignant tumor, specific granulomatous disease (e.g. tuberculosis, sarcoidosis, Wegener's granulomatosis) and fungal sinusitis preoperatively. A diagnosis of maxillary pseudotumor must be based on histological evidence to exclude other disease. We report a case of a 49-year-old patient with left maxillary pseudotumor that simulated an aggressive neoplasm in its clinical presentation and radiologic findings.