A new biosynthesis route for production of 5-aminovalanoic acid, a biobased plastic monomer / 生物工程学报

5-aminovalanoic acid (5AVA) can be used as the precursor of new plastics nylon 5 and nylon 56, and is a promising platform compound for the synthesis of polyimides. At present, the biosynthesis of 5-aminovalanoic acid generally is of low yield, complex synthesis process and high cost, which hampers large-scale industrial production. In order to achieve efficient biosynthesis of 5AVA, we developed a new pathway mediated by 2-keto-6-aminohexanoate. By combinatory expression of L-lysine α-oxidase from Scomber japonicus, α-ketoacid decarcarboxylase from Lactococcus lactis and aldehyde dehydrogenase from Escherichia coli, the synthesis of 5AVA from L-lysine in Escherichia coli was achieved. Under the initial conditions of glucose concentration of 55 g/L and lysine hydrochloride of 40 g/L, the final consumption of 158 g/L glucose and 144 g/L lysine hydrochloride, feeding batch fermentation to produce 57.52 g/L of 5AVA, and the molar yield is 0.62 mol/mol. The new 5AVA biosynthetic pathway does not require ethanol and H2O2, and achieved a higher production efficiency as compared to the previously reported Bio-Chem hybrid pathway mediated by 2-keto-6-aminohexanoate.

The Pterional Approach and Extradural Anterior Clinoidectomy to Clip Paraclinoid Aneurysms

OBJECTIVE: The surgical clipping of paraclinoid segment internal carotid artery aneurysms is considered difficult because of the complex anatomical location and important neighboring structures. Our experiences of pterional craniotomy and extradural anterior clinoidectomy (EAC) to clip paraclinoid aneurysms are reported herein. METHODS: We present two patients with paraclinoid aneurysms who underwent surgical clipping using pterional craniotomy and EAC. The clinical results and operative techniques were reviewed from the patients' medical records. RESULTS: EAC improves the surgical field in the suprasellar and periclinoid regions. Clinically, a good outcome was obtained in both cases. No surgical complications directly resulting from the EAC were observed. CONCLUSION: Favorable surgical results can be obtained with pterional craniotomy and EAC for the clipping of paraclinoid aneurysms. EAC is advocated for the clipping of paraclinoid aneurysms.

A Case of Tubular Adenoma in the External Auditory Canal / 대한이비인후과학회지

Tumors occurring in the external auditory canal (EAC) are rare. In particular, tubular adenoma (TA) is an extremely rare sweat gland neoplasm occurring in the EAC and is generally considered as benign. Up to now, less than one hundred cases of TA have been reported in the English literature. In fact, a comprehensive review of literature shows that TA in the EAC has seldom been reported. Herein, we report a case of a 35-year-old man with TA that occured in the EAC, together with characteristic histopathological findings.

A Case of Tubular Apocrine Adenoma with Syringocystadenoma Papilliferum of External Auditory Canal Removed by Postauricular Approach / 대한이비인후과학회지

Tubular apocrine adenoma (TAA) and syringocystadenoma papilliferum (SCAP) are uncommon cutaneous adnexal neoplasms often found in the head, perianal area, but rarely in external auditory canal (EAC). SCAP in EAC generally presents itself with a mass in the EAC along with conductive hearing loss. We present here a case of a 50-year-old man presenting TAA with SCAP confined to EAC, which was surgically removed. The clinical and histopathological features were described. The patient has been well without relapse or metastasis.

A Case of Spontaneous Temporomandibular Joint Herniation into the External Auditory Canal with Clicking Sound

A bony defect of the external auditory canal (EAC) and herniation of the temporomandibular joint (TMJ) can be caused by tumorous conditions, inflammation, trauma, and otologic procedures. Spontaneous TMJ herniation into the EAC can be caused by a congenital bony defect known as patent Huschke's foramen, which is a very rare condition. In our case, an objective clicking sound was produced when the patient opened his mouth. A protruding mass was found in the anterior wall of the EAC during mouth closing, and herniation of the TMJ was confirmed with computed tomography. Therefore, we thought the clicking sound of our case could have resulted from spontaneous TMJ herniation through the patent foramen of Huschke.

Localization of the Mental and Infraorbital Foramen with related to the Soft-tissue Landmarks

During maxillofacial surgery, the infraorbital and mental nerves are blocked at eac foramen to induce local anesthesia. This study examined the relative locations of the infraorbital foramen (IOF) and mental foramen (MF) based on soft-tissue landmarks. Twenty-eight hemifacial cadavers were dissected to expose the IOF and MF. The distances between the bilateral IOFs, the bilateral MFs, the alae of the nose (alares), and the corners of the mouth (cheilions) were measured directly on cadavers by using a digital vernier caliper. The vertical and horizontal distances of the IOF and MF relative to the alare and cheilion were measured indirectly on digital photographs using Adobe Photoshop (Adobe, CA, USA). The distance between the bilateral IOFs (58.09 +/- 4.04 mm) was longer than the distance between the bilateral MFs (50.32 +/- 1.93 mm). The distances between the bilateral alares and cheilions were 41.22 +/- 3.44 mm and 58.43 +/- 6.62 mm, respectively. The IOF was located 12.92 +/- 3.75 mm superior and 7.88 +/- 2.56 mm lateral to the alare, and the vertical angle (Angle 1) between these structures was 31.67 +/- 13.36degrees superolaterally. The MF was located 21.83 +/- 3.26 mm inferior and 5.56 +/- 3.37 mm medial to the cheilion, and the vertical angle (Angle 2) between these structures was 14.05 +/- 10.12degrees inferomedially. In conclusion, these results provide more detailed information about the locations of the IOF and MF relative to soft-tissue landmarks.

Erythema Annulare Centrifugum Associated with Candida guilliermondii / 대한피부과학회지

Erythema annulare centrifugum (EAC), first described by Darier in 1916, is characterized by annular, circinate, gyrate or serpiginous lesions. Although the pathogenesis of EAC is not fully understood, it is considered to be a hypersensitivity reaction to a wide variety of etiological factors, including autoimmune diseases, internal malignancies, drugs, infections, and pregnancy. To the best our knowledge, no case of EAC associated with Candida guilliermondii infection has ever been published in the Korean medical literature, and there have been a few reported cases associated with Candida albicans in other countries. Herein, we report on a rare and interesting case of EAC in a 62-year-old female patient with Candida guilliermondii infection.

Tubular Apocrine Adenoma with Syringocystadenoma Papilliferum of the External Auditory Canal / 대한이비인후과학회지

Tumors that develop from external auditory canal (EAC) are very rare. Adenoma that originates from apocrine is also a rare entity found in the EAC. Nevus sebaceous, syringocystadenoma papilliferum (SCAP), tubular apocrine adenoma (TAA), and fibroadenoma are known to originate from apocrine. Among them, SCAP is believed to be a benign tumor that is manifested as papule and plague on the scalp and the face. However, TAA is a rare intradermal eccrine tumor and it mostly manifests as an isolated single nodule within the scalp area. Generally, these tumors are considered as two separate entities. Many articles have reported on the prevalence of TAA or SCAP with nevus sebaceous on the body, extremities, and scalp; but only 2 articles were reported on tumors that developed from EAC. In this article, we report on a patient who presented a mass in EAC, with both SCAP and TAA pathohistologic finding without nevus sebaceous.

The Difference of External Auditory Canal pH in 3 Groups of Otitis Externa / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The change of pH in the external auditory canal (EAC) is an important factor in the pathogenesis of otitis externa. However, there is a lack of study focused in this area. Thus, we investigated the differences in the pH in the EAC between several different patient groups of otitis externa and the control group. SUBJECTS AND METHOD: There were 100 patients with otitis externa and 150 normal controls participated in this study. Patients with otitis externa were divided into 3 groups; acute or subacute infective otitis externa, chronic infective otitis externa and chronic allergic otitis externa. The pH of the EAC was measured in otitis externa patients and control subjects on their first visit. RESULTS: The mean EAC pH of the normal control subjects was significantly higher than that of the skin of other parts of the body. The pH difference among the 3 patient groups was statistically significant (the pH of acute or subacute infective otitis externa=6.83+/-0.64; the pH of chronic infective otitis externa=6.16+/-0.67 and the pH of chronic allergic otitis externa=5.78+/-0.59). CONCLUSION: The change in the pH of EAC can be considered as a predisposing factor of otitis externa. We quantified the level of pH at the EAC among three groups of otitis externa patients, and the results showed that the pH difference among the three patient groups was statistically significant. This study warrants a further investigation focusing on the proper choice of eardrops for otitis externa patients according to their pH at the EAC.

Comparison of two peptide radiotracers for prostate carcinoma targeting

OBJECTIVES: Scintigraphy is generally not the first choice treatment for prostate cancer, although successful studies using bombesin analog radiopeptides have been performed. Recently, a novel peptide obtained using a phage display library demonstrated an affinity for prostate tumor cells. The aim of this study was to compare the use of a bombesin analog to that of a phage display library peptide (DUP-1) radiolabeled with technetium-99m for the treatment of prostate carcinoma. The peptides were first conjugated to S-acetyl-MAG3 with a 6-carbon spacer, namely aminohexanoic acid. METHODS: The technetium-99m labeling required a sodium tartrate buffer. Radiochemical evaluation was performed using ITLC and was confirmed by high-performance liquid chromatography. The coefficient partition was determined, and in vitro studies were performed using human prostate tumor cells. Biodistribution was evaluated in healthy animals at various time points and also in mice bearing tumors. RESULTS: The radiochemical purity of both radiotracers was greater than 95 percent. The DUP-1 tracer was more hydrophilic (log P = -2.41) than the bombesin tracer (log P = -0.39). The biodistribution evaluation confirmed this hydrophilicity by revealing the greater kidney uptake of DUP-1. The bombesin concentration in the pancreas was greater than that of DUP-1 due to specific gastrin-releasing peptide receptors. Bombesin internalization occurred for 78.32 percent of the total binding in tumor cells. The DUP-1 tracer showed very low binding to tumor cells during the in vitro evaluation, although tumor uptake for both tracers was similar. The tumors were primarily blocked by DUP1 and the bombesin radiotracer primarily targeted the pancreas. CONCLUSION: Further studies with the radiolabeled DUP-1 peptide are recommended. With further structural changes, this molecule could become an efficient alternative tracer for prostate tumor diagnosis.

A Case of Basal Cell Carcinoma of External Auditory Canal

Malignant tumor originated from external auditory canal (EAC) is very rare with an annual incidence of around 1 per million. Pathologically, squamous cell carcinoma is incidentally most common, and adenoid cystic carcinoma, basal cell carcinoma, and melanoma follow in decreasing order. Due to the rarity of malignant tumor of EAC, there is no widely accepted treatment modality yet. But basal cell carcinoma, known to be less aggressive tumor, can be removed with a minimal safety margin and have better treatment results. Recently we experienced a case of basal cell carcinoma in the EAC, confined in the cartilaginous portion of EAC, presenting with intermittent otorrhea for several years. The patient was treated with a sleeve resection of the EAC with a safety margin reconstructed with a split-thickness skin graft. No tumor recurrence or complication was noted in the first postoperative year.

A Case of Solitary Neurofibroma of the External Auditory Canal / 대한이비인후과학회지

Neurofibroma is a relatively common neurogenic tumor originating from schwann cells or fibroblasts in peripheral nerve sheaths. It is classified as solitary or multiple. Solitary lesions are not usually associated with neurofibromatosis or von Recklinghausen's disease. We report a case of solitary neurofibroma occurred in the right external auditory canal (EAC) in a 30-year-old male who complained of progressive hearing loss and earfullness for 5 years. This diffuse painless mass displaced the auricle laterally and obstructed EAC completely. The lesion was partially excised by retroauricular approach and diagnosed as neurofibroma. This patient does not have any other evidences of neurofibromatosis. A complete excision in this case was not mandatory as malignant change is rare; moreover, it would require extensive resection of periauricular skin, subcutaneous tissue, cartilaginous ear canal and temporalis muscle, followed by reconstruction. We present the clinical characteristics and therapeutic methods of a solitary neurofibroma originating from EAC.

Characteristics of Melanocytic Nevus Arising from the External Auditory Canal / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A nevus is a benign tumor composed of nevus cells that are derived from melanocytes. It may occur anywhere on the skin, but its appearance in the external auditory canal (EAC) is very rare. The aim of this study is to analyze the characteristics of melanocytic nevi of the EAC. SUBJECTS AND METHOD: We retrospectively reviewed the medical records of 10 consecutive patients who underwent surgical excision of EAC nevi between March 2004 and February 2009. RESULTS: The size of these nevi ranged from 4 mm to 12 mm in diameter, with an average of 6.1 mm. Otoscopic examination revealed 7 cases of dome-shaped mass and 3 cases of papillomatous mass. Histological examinations revealed intradermal nevi in all cases, but there was one case of dysplastic nevus and two cases of papillomatous nevi that coexisted with cholesteatoma. These nevi were composed of epidermal hyperplasia and necrobiotic keratin debris within the papillomatous cleft. There has been no recurrence in these patients after 6 to 26 months (average 12.6 months) of follow-up. CONCLUSION: A melanocytic nevus of the EAC may be composed of dysplastic cells or coexist with cholesteatoma; in particular, its gross appearance is papillomatous. Therefore, every nevus should be excised to make a histopathological diagnosis.

A Case of Multiple Osteomas in the External Auditory Canal / 대한이비인후과학회지

Osteoma is a benign neoplasm that can occur and extend beyond the nearest region in the external auditory canal (EAC); however, a multiple growth of the tumor in the ipsilateral ear has never been reported. A 41-year-old male patient having a past history of uncertain chronic otitis media complained of recent otalgia and progressive hearing loss in the same ear. Physical examination showed that two hard masses arising from both anterior and posterior aspect of the right EAC were contacting each other and obstructing most of the lumen. High resolution computed tomography scan revealed not only two growing exophytic bone lesions causing EAC stenosis but also inflammation of the middle ear and sclerotic mastoid cavity. We performed excision and middle ear surgery at the same time. Both specimens were pathologically confirmed as osteomas, so we report this unusual case with a review of literature.

A Case of Spontaneous Temporomandibular Joint Herniation into the External Auditory Canal / 대한이비인후과학회지

Bony defects of the external auditory canal (EAC) may arise from a tumor, infection, inflammation, trauma, complications from ear surgery, or congenital disease. Congenital bony defects of the EAC are known as a patent Huschke's foramen. Here, we describe a 76-year-old male patient who presented an otalgia in his right ear. Physical examination revealed a dome shaped swelling of the anterior EAC wall, which repeated swelling and retraction as the patient's mouth closed and opened. Computed tomography revealed a bony defect of the anterior EAC wall. We believe that the patent Huschke's foramen allowed spontaneous herniation of the temporomandibular joint into the EAC.

The Analysis of Prognostic Factor and Treatment Outcome of Malignancies of the External Auditory Canal / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study was to analyze the survival rate treatment modalities and certain prognostic factors in patients with external auditory canal (EAC) cancer using the University of Pittsburgh TNM Staging System. SUBJECTS AND METHOD: Medical records and radiological findings of 33 patients treated for EAC cancer between January 1995 and January 2009 were reviewed retrospectively. The median follow-up period was 65 months (range, 12-182 months). RESULTS: The most common histological type was squamous cell carcinoma (19 patients; 57.6%), followed by adenoid cystic carcinoma (9 patients; 27.3%), basal cell carcinoma (1 patient), adenocarcinoma (1 patient), rhabdomyosarcoma (1 patient), undifferentiated carcinoma (1 patient) and malignant small round cell tumor (1 patient). Seven of 33 patients died of EAC cancer and the overall survival rate was 70.6%. There was a significant difference in the survival rate with respect to TNM stages (p=.031). The 10 yr-survival rate of patients with stage I disease was 100.0%, whereas those of stages II, III and IV were 50.0, 80.0 and 58.3%, respectively. Five of 7 patients with recurrence had a history of initial positive resection margin. CONCLUSION: Early detection and proper surgical treatment with sufficient resection margin are essential for disease-specific survival and prevention of recurrence in patients with EAC cancer.

Ovarian Endometrioid Adenocarcinoma with a Yolk Sac Tumor Component

Ovarian endometrioid adenocarcinoma (EAC) with a yolk sac tumor (YST) component is extremely rare. Only twelve cases have been reported in the English literature. We report here two additional cases of this rare tumor. The YST component showed classic microscopic features, and immunohistochemically stained positive for alpha-fetoprotein (AFP), but negative for cytokeratin 7 (CK7), epithelial membrane antigen (EMA), estrogen receptor (ER) and progesterone receptor (PR). The EAC appeared to blend into the YST in several areas and immunohistochemically stained positive for CK7, EMA, ER, and PR, but negative for AFP.

Two Cases of Meatoplasty and Otoplasty Simultaneously in Patients with Auricular Deformities and External Auricular Canal Stenosis / 대한이비인후과학회지

As the auricle is a very complex structure covered with thin, sensitive skin, the best reconstruction requires a great deal of skill and the use of diverse approaches. Otolaryngologists should give greater consideration to otoplasty because patients do not want their self-confidence impaired by auricular deformities. When treating external auditory canal (EAC) cholesteatoma caused by EAC stenosis, the blood circulation may be deleteriously affected if the retroauricular incision is made first, and thus the otoplasty must be first carried out. We report two cases of otoplasty performed simultaneously with meatoplasty without the aid of plastic surgeons. The first case involved a 33-year-old woman with cholesteatoma due to congenital auricular atresia and microtia. The second case was a 64-year-old man with traumatic auricular amputation and EAC stenosis due to scar contracture. Simultaneous otoplasty and meatoplasty should be of benefit to patients because it reduces the number of operations and has a high success rate.

Effect of Emergency Auto-Consultation System (EACS) on Length of Stay of Specialty Consultation Patients in the Emergency Department

PURPOSE: The length of stay (LOS) for patients in the emergency department (ED) provides an important measure of both ED overcrowding and patient satisfaction. Specialty consultation is one of the major factors that contributes to longer LOS. The aim of the study was to examine the effectiveness of a computer-based emergency auto-consultation system (EACS) in reducing additional LOS caused by specialty consultation. METHODS: The EACS was developed for use in managing specialty consultation in the ED. Each clinical department provides a daily list of 4 residents and 1 specialist as the doctors on duty. The ED doctors then use the EACS to contact the departments required for a specialty consultation: Clicking the department's name on the computer screen activates the short message service (SMS) calling system, which sends a message with the registration numbers and names of the relevant patients every 10 min to the mobile phones of individuals assigned as doctors on duty, in the order listed. The doctors who receive the SMS are asked to arrive at the ED within 10 minutes. If the the firstlisted doctors on duty do not show up in 10 minutes, an SMS is sent to the next group of doctors on duty on the list. In 50 minutes, therefore, 5 groups of doctors on duty will have received the SMS in the order listed. Each clinical department estimated the response time of doctors on duty 2 months before the adoption of the EACS versus afterward. The LOS of patients admitted to the ED was also compared before and after the adoption of the EACS. A questionnaire was used to survey the health professionals working in the ED about the changes in the intensity of labor and the needs of the EACS. RESULTS: The number of patients participating in the study were 2,035 and 2,216, respectively, before and after the adoption of the EACS. The EACS significantly decreased both the response time of doctors on duty (34.8+/-35.5 min vs. 9.7+/-16.8 min, p=0.000) and the LOS (155.3+/-126.7 min vs. 144.6+/-110.7 min, p=0.003). In the survey, 44.7% of ED health care professionals responded that their intensity of labor were improved, and most of them agreed that the EACS should be required in the ED. CONCLUSION: The computer-based EACS decreased LOS by reducing the response time of doctors on duty, and it also increased satisfaction among the ED health professionals.

Síndrome de Rendu-Osler-Weber: relato de caso e revisão de literatura / Rendu-Osler-Weber Syndrome: case report and literature review

A telangiectasia Hemorrágica Hereditária ou Síndrome de Rendu-Osler-Weber é uma rara displasia fibrovascular que torna a parede vascular vulnerável a traumatismos e rupturas, provocando sangramentos em pele e mucosas. Apresenta herança autossômica dominante. É caracterizada por epistaxes de repetição, telangiectasias mucocutâneas, malformações arteriovenosas viscerais e história familiar positiva. A epistaxe costuma ser a primeira e a principal manifestação. Está associada a malformações arteriovenosas em vários órgãos. São possíveis complicações hematológicas, neurológicas, pulmonares, dermatológicas e de trato gastrointestinal. A terapia é de suporte e de prevenção de complicações. Neste estudo, relata-se um caso de um paciente com a síndrome, atendido no Ambulatório de Otorrinolaringologia da Faculdade de Medicina de Marília, e faz-se uma revisão bibliográfica de sua etiopatogenia, manifestações clínicas e terapêutica clínico-cirúrgica.

Hereditary Hemorrhagic Telangiectasia or Rendu-Osler-Weber Disease is a rare fibrovascular dysplasia that makes vascular walls vulnerable to trauma and rupture, causing skin and mucosa bleeding. It is of dominant autosomal inheritance, characterized by recurrent epistaxis and telangiectasia on the face, hands and oral cavity; visceral arteriovenous malformations and positive family history. Epistaxis is often the first and foremost manifestation. It's associated to arteriovenous malformations in several organs. There are possible hematologic, neurologic, pulmonary, dermatologic and gastrointestinal complications. Treatment is supportive and helps prevent complications. This study is a case report of a patient with this syndrome who came to the ENT Outpatient Ward of the Faculdade de Medicina de Marília; and we have done a bibliographic review of the disease's etiopathogenesis, clinical manifestations and clinical-surgical treatment options.