Infection Status of Estuarine Fish and Oysters with Intestinal Fluke Metacercariae in Muan-gun, Jeollanam-do, Korea

The source of human infection with intestinal flukes was surveyed in estuarine fishes, including the dotted gizzard shad, common sea bass, common blackish goby, redlip mullet, black sea bream, and oyster collected from Muan-gun, Jeollanam-do, Korea during August and September 2007. Collected fishes and oysters were artificially digested in pepsin-HCl solution and examined under a stereomicroscope. In 36 shads (Konosirus punctatus) and 20 basses (Lateolabrax japonicus) examined, Heterophyopsis continua metacercariae were found in 58.3% and 100%, and their average numbers were 12.0 and 6.3 per infected fish, respectively. In 34 gobies (Acanthogobius flavimanus) examined, metacercariae of H. continua were detected in 79.4%, Stictodora lari in 97.1%, and Acanthotrema felis in 92.1%, and their average numbers were 45.8, 189.3, and 235.3 per infected fish, respectively. In 37 redlip mullets (Chelon haematocheilus), Heterophyes nocens metacercariae were found in 56.8%, Pygidiopsis summa in 94.6%, and Stictodora fuscata in 45.9%, and the average metacercarial densities were 17.4, 31.3, and 35.1 per infected fish, respectively. In 30 black sea breams (Acanthopagrus schlegeli) and 45 oysters (Crassostrea gigas) examined, no metacercariae were detected. From the above results, it has been confirmed that the dotted gizzard shad, common sea bass, common blackish goby, and redlip mullet from Muan-gun, Jeollanam-do, Korea are infected with the metacercariae of heterophyid flukes.

Long Term Results of Dacryocystorhinostomy in Adults / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the long-term outcome of primary endoscopic dacryocystorhinostomy (DCR) or conjunctivo-dacryocystorhinostomy (CDCR) in adults with nasolacrimal duct obstruction. SUBJECTS AND METHOD: We retrospectively reviewed 31 eyes of 27 patients who underwent primary DCR or CDCR for anatomical or functional blockage of the lacrimal drainage system (4 males, 27 females, mean age 54.4+/-12.7 years). The mean follow-up period was 45.4+/-10.8 months. The main outcome measure for success was assessed by symptomatic improvement. Pre-operative CT findings and endoscopic findings, sites of obstruction, types of surgery, post-operative complications were evaluated and the outcome was assessed according to the level of obstruction and types of surgery. RESULTS: Two years after the surgery, the success rate was 83.9% including complete resolution of symptoms (64.5%) and partial improvement (19.4%). No improvement was reported in 16.1%. There was no significant difference in success rates of DCR according to the obstruction sites. Patients with functional blockage had worse success rate than those with anatomical obstruction. CONCLUSION: Both endoscopic DCR and CDCR had successful outcome in the long term con-trol of epiphora and functional nasolacrimal duct obstruction showed worse prognosis when compared with anatomical obstruction.

Epidemiological Survey on the Infection of Intestinal Flukes in Residents of Muan-gun, Jeollanam-do, the Republic of Korea

Infection status of intestinal flukes was investigated in residents of Muan-gun, Jeollanam-do, the Republic of Korea. Total 1,257 fecal samples of residents were examined by formalin-ether sedimentation technique and Kato-Katz thick smear method. Helminth eggs were detected from 95 (7.6%) residents, and eggs of heterophyid flukes and Clonorchis sinensis were found from 62 (4.9%) and 40 (3.2%) cases, respectively. The larger heterophyid eggs, somewhat dark-brown in color and 37.7 x 21.5 micrometer in average size, and found in 32 (2.6%) out of 62 egg positive cases of heterophyid flukes. To confirm the adult flukes, we performed worm recovery from 12 cases after praziquantel treatment and purgation with MgSO4. A total of 1,281 adult flukes, assigned to 7 species, were recovered from 9 cooperative cases. Heterophyes nocens (total 981 specimens) was collected from 9 cases, Stictodora fuscata (80) from 7, Gymnophalloides seoi (75) from 5, Pygidiopsis summa (140) from 3, Stellantchasmus falcatus (3) from 2, and Stictodora lari and Acanthotrema felis (each 1 worm) from 1 case each. The intrauterine eggs of S. fuscata collected from the recovered worm were identical with the larger heterophyid eggs detected in the stool examination. By the present study, it was confirmed that A. felis is a new intestinal fluke infecting humans, and residents in Muan-gun, Jeollanam-do are infected with variable species of intestinal trematodes.

Frequently Used Grafts in Korean Rhinoplasty: Nomenclature and Definitions / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: No definite concepts or nomenclature have yet been established in Korean for a number of different grafts used frequently in Korean rhinoplasty. The aims of this study were to define indications and usages of grafts frequently used in Korean rhinoplasty and to suggest appropriate Korean nomenclatures for these grafts. MATERIALS AND METHOD: We prepared diagrams and explanations for the grafts frequently used in rhinoplasty in Korea and suggested Korean nomenclature that were considered the most appropriate. We carried out a survey on the rhinoplasty experts in order to reach a consensus on the nomenclature. We also reviewed recent Korean articles on rhinoplasty to investigate how names of each graft had been translated into Korean nomenclature. RESULTS: We classified grafts according to anatomical locations; the nasal dorsum, the nasal tip, the alar region, and the alar base. Grafts of the nasal dorsum included radix graft, dorsal onlay graft, dorsal sidewall onlay graft, and spreader graft. Grafts of the nasal tip were the columellar strut, shield graft, buttress graft, cap graft, and septal extension graft. The alar batten graft, alar rim graft, composite alar rim graft, lateral crural onlay graft, and lateral crural strut graft belonged to grafts of the alar region. Grafts of the alar base included the columellar plumping graft, premaxillary graft, and alar base graft. The names of all these grafts were translated into Korean. CONCLUSION: We set definitions, indications, and usages of each graft, and suggested the most appropriate Korean nomenclature. We hope that this nomenclature can be widely accepted and used in future papers and books on Korean rhinoplasty.

A Case of Benign Fibrohistiocytoma on Nasal Vestibule

Benign fibrohistiocytoma is a very rare tumor in the head and neck. There has never before been a reported case of this tumor originating from the nasal vestibule. Recently, we experienced a case of benign fibrohistiocytoma on the nasal vestibule in a 12-year-old boy who complained of nasal obstruction and recurrent epistaxis. During physical examination, we found a 1x1 cm-sized mass on his right nasal vestibule. Excision and repair with full thickness skin graft was performed and diagnosis of benign fibrohistiocytoma was made with pathologic and clinical findings. We present this rare case with review of the clinical and pathological features.

Viability of Chondrocytes in the Crushed Septal Cartilage Depending on Degree of Crushing and Their Mechanism of Cell Death / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To analyze the viability of chondrocytes according to different degrees of crushing and to investigate the mechanism of cell death in the crushed cartilage. SUBJECTS AND METHOD: Septal cartilages were obtained from 22 patients and cartilage pieces were allocated to four groups; normal, mildly crushed, moderately crushed and severely crushed. The cartilage specimens were stained with hematoxylin-eosin and examined under light microscope. The viability of the chondrocytes and the mechanism of cell death were assessed using confocal laser scanning microscopy. RESULTS: As crushing intensity increased, chondrocyte viability significantly decreased. The mechanism of cell death was mainly due to necrosis rather than apoptosis. CONCLUSION: The viability of chondrocytes in the crushed cartilage depends on the degree of crushing. The mechanism of cell death after crushing is mainly necrosis. Therefore, for the clinical use of the crushed cartilage, slight overcorrection and standardization of the degree of crushing are recommended.

Analysis of the Development of the Nasal Septum according to Age and Gender Using MRI

OBJECTIVES: This study was designed to evaluate the normal development of the nasal septum in Koreans using sagittal MRI for the valuable clinical information on septal procedures. METHODS: Two hundred eighty patients who had their whole nasal septum visualized in the midline sagittal view were selected among the 3,904 patients with brain MRI from January, 2004 to December, 2006 at Dankook University Hospital. The patients who had a history of nasal septal surgery or nasal trauma were excluded. Following parameters are calculated and analyzed: lengths of bony and cartilage dorsum and septal cartilage-nasal bone overlap, total septal area, septal cartilage area and, the proportion of the cartilage area to septal area and the maximal harvestable cartilage for grafting were calculated using the PAC(TM) program. RESULTS: All the parameters were increased until adolescence. Thereafter, bony dorsal length, cartilage dorsal length, total dorsal length, total septal area and maximal harvestable cartilage for grafting have not changed significantly with age, while SC-NB overlap length, septal cartilage area, and proportion of the cartilage area to the total septal area were significantly decreased with age. The SC-NB overlap length was positively correlated with the septal cartilage area and the proportion of the cartilage area to the total septal area. CONCLUSION: The small septal cartilage area and its proportion to the total septal area were significantly correlated with a short overlap length of the septal cartilage under the nasal bone. Septal procedures should be carefully performed in the elderly due to the risk of incurring saddle nose.

A Case of Huge Pneumatized Uncinate Process Causing Obstruction in Patient with Chronic Rhinosinusitis / 대한이비인후과학회지

Chronic rhinosinusitis is one of the most common diseases in rhinology. The importance of the ostiomeatal complex (OMC) has been known. Anatomic abnormalities and inflammatory changes lead to sinus ostial obstruction and subsequently induce chronic or recurrent sinusitis. Therefore, anatomic variations of the nasal cavity were considered as important factors in causing chronic rhinosinusitis. Whereas pneumatization of the middle and superior turbinate is a common finding, that of uncinate process is extremely rare. It can cause obstruction of the OMC by narrowing the middle meatus and infundibulum. We have recently experienced a huge pneumatized uncinate process causing obstruction in patient with chronic rhinosinusitis. We could successfully perform endoscopic sinus surgery with good results. Therefore, we present this rare case and briefly discuss the possible pathogenesis.

Anatomical and Radiologic Analysis of Keystone Area of Korean Nose / 체질인류학회지

The keystone area of nose is a clinically important structure for maintaining the stability of dorsum of nose. However, anthropometric data for individual structure constituting the keystone area were less studied. Dissections of external nose were performed in 12 cadavers for measuring the length and width of structural components of keystone area. Shape of nasal bones and the overlap area between upper lateral cartilage and nasal bonewere classified. Measurements of the keystone area were also performed in 380 MRI and PACS images. Types of the caudal margin of nasal bone were classified as follows; type A: flat margin, type B: M shape, type C: extended midline, type D: retracted midline. Types of overlapped portion between upper lateral cartilage and nasal bone were categorized as follows; type Ao: flat midline, type Bo: short elongated midline, type Co: long elongated midline. Overlap length of upper lateral cartilage with nasal bone was 4~9 mm (mean 6.5 mm)in the midline, 0~4.5 mm (mean 2.7 mm)in the paramedian area of nasal bone. Overlapped width of upper lateral cartilage with nasal bone was 8~14 mm(mean 9.7 mm). Individual component of the keystone area has various shape and overlapped length. Therefore, cautious preoperative and intraoperative evaluation of each component is necessary for a safe nasal surgery.

An Anatomic Study on the Overlap Patterns of Structural Components in the Keystone Area in Noses of Koreans

OBJECTIVES: The keystone area has critical importance in maintaining the stability of the nasal dorsum. However, overlap patterns between structural components in the keystone area have rarely been studied, especially in the noses of Koreans. METHODS: Dissections were performed on 18 cadaveric noses. The length and width of the structural components in the keystone area were measured. The shape of the caudal margin of the nasal bone and the overlap patterns between the upper lateral cartilage and the nasal bone were classified. RESULTS: The shape of the caudal margin of the nasal bone were classified as follows: type A, curvilinear margin; type B, paramedian retractions or "M" shape; type C, elongated midline; and type D, retracted midline. The overlap area between the upper lateral cartilage and the nasal bone was classified as follows: type Ao, crescent shape; type Bo, short midline extension; and type Co, long midline extension. The cephalocaudal length of the overlap area between the upper lateral cartilage and the nasal bone was 4-10 mm (mean, 7 mm) in the midline, and 0-7 mm (mean, 3.1 mm) in the paramedian area. The overlap width of the upper lateral cartilage with the nasal bone was 8-14 mm (mean, 9.7 mm). CONCLUSION: The overlap pattern of the structural components in the keystone area is variable. Therefore, a thorough understanding and a cautious evaluation of the relationships of these components before and during surgery is important in performing safe and effective nasal procedures.

A Case of Massive Skull Base Erosion by Fungus Ball in the Sphenoid Sinus / 대한이비인후과학회지

Isolated sphenoid fungal sinusitis is rare and difficult to diagnose because the presenting symptoms are often vague and nonspecific. In addition, cases with skull base erosion are extremely rare. In this paper, we describe a rare case of destructive, but non-invasive isolated sphenoid fungus ball with massive skull base erosion causing recalcitrant headache and hypertension.

Change of Nitric Oxide Synthase Expression and Dynamic Ciliary Activity Responding to Nitric Oxide in Sinusitis Mucosa / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are conflicting results about ciliary activity in chronic rhinosinusitis (CRS). Dynamic movements reacting to various stimuli in CRS mucosa have been rarely studied. This study was designed to investigate the dynamic ciliary activity in response to nitric oxide stimulation in sinusitis. We aimed to identify the difference in the expression of nitric oxide synthase (NOS) in normal and CRS mucosa. SUBJECTS AND METHOD: Nasal mucosal samples were obtained from 25 sinusitis and 15 normal subjects. We measured ciliary beat frequency (CBF) in the basal and activated status. Immunohistochemial staining was used to evaluate the expression of NOS in the sinusitis. RESULTS: The CRS mucosa showed marked differences in the CBF changes stimulated by NO compared to the normal mucosa; both the maximal increase and duration of increase of CBF by NO were significantly reduced in CRS mucosa. The results of immunohistochemical stain showed that eNOS expression was evident in the normal nasal mucosa and iNOS expression was markedly increased in CRS mucosa. CONCLUSION: Dynamic ciliary activity responding to NO was markedly attenuated in the CRS mucosa. The L-NAME markedly attenuated the duration of increase and maximal increase of CBF by ATP both in the normal and CRS mucosa. eNOS expression was relatively evident in the normal mucosa, whereas iNOS expression was relatively increased in the CRS mucosa, implicating different actions of NO on CBF.

Ciliary Activity in Basal and Activated Status and Its Correlation with Clinical Findings in Chronic Rhinosinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are conflicting results about ciliary activity in chronic rhinosinusitis (CRS). And dynamic movements reacting to various stimuli in sinusitis mucosa have been studied rarely. This study was designed to investigate the ciliary activity according to the severity of sinusitis and clinical symptoms. We aimed to identify the dynamic ciliary activity in response to purinergic stimulation in sinusitis. SUBJECTS AND METHOD: Nasal mucosal samples were obtained from 44 CRS and 20 normal subjects. We measured ciliary beat frequency (CBF) in the basal and activated status. For evaluating the correlation of CBF with clinical findings, nasal symptoms, endoscopic findings, CT findings, allergy tests, and olfactory tests were reviewed. RESULTS: No significant differences were found in basal CBF between normal and CRS mucosa. However, the CBF stimulated by ATP in normal and CRS mucosa showed marked differences: both the maximal increase and duration of increased CBF by ATP were significantly reduced in CRS mucosa. The olfactory test showed significant correlation with basal CBF, but the presence of allergy or nasal symptoms did not show significant correlation with the basal CBF. The CT score and presence of nasal polyposis showed negative correlation with the basal CBF (p<0.05). CONCLUSION: The basal CBF of normal and CRS mucosa showed no difference. However, dynamic ciliary activity responding to purinergic stimulation was markedly attenuated in sinusitis mucosa. The severity of sinusitis and presence of polyposis negatively affected CBF.

A Case of Dermoid Cyst of the Maxillay Sinus / 대한이비인후과학회지

Dermoid cyst (DC), which is a cystic form of teratoma, is one of developmental anomalies in the soft tissue. DCs originating from the maxillary sinus have been very rarely reported. We have recently experienced a case of dermoid cyst arising from the maxillary sinus. The patient was a 44-year-old female who complained of swelling in the left cheek area. We could successfully operate the patient through sublabial approach with good results. Therefore, we present the case and briefly discuss the possible pathogenesis.

The Difference between Clinical and Pathophysiologic Recovery according to Recovery Periods in Experimental Maxillary Sinusitis of Rabbit / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study was designed to investigate the difference between clinical and pathophysiologic recovery by comparing the recovery periods in the rabbit sinusitis model. MATERIALS AND METHOD: A synthetic sponge was inserted into the right-side nasal cavities of 15 rabbits. After 2 weeks, the maxillary sinusitis was induced and confirmed by computed tomography (CT) scan. The opacification in CT scan was graded, and the mucosa was harvested from the maxillary sinus. Ciliary beat frequency (CBF) was measured for evaluating mucosal function. Light microscopic, scanning and transmission electron microscopic (SEM & TEM) examinations were performed. Histopathologic findings in microscopic examinations were scored in a semiquantitative measure. Each examination was performed at the time of re-opening of maxillary sinus ostium, 4 weeks and 8 weeks after re-opening of maxillary sinus ostium. RESULTS: The sinus opacification in CT scan and ciliary regeneration in SEM showed significant improvement 8 weeks after re-opening of maxillary sinus ostium. But CBF, tissue inflammation score and ciliary wave disorder were not improved significantly 8 weeks after re-opening of maxillary sinus ostium. CONCLUSION: Clinical, functional and histopathologic recoveries from sinusitis require different periods of time. Incomplete functional and histopathologic recoveries can be the cause of relapse or recurrence of sinusitis. Therefore, close follow-up will be necessary after clinical resolution of sinusitis.

A Case of Simultaneous Antrochoanal and Sphenochoanal Polyps / 대한이비인후과학회지

Antrochoanal polyps account for four to six percent of all nasal polyps. Sphenochoanal polyps are extremely rare. Coexistence of antrochoanal and sphenochoanal polyp is not reported in Korean literature. We have recently experienced a case of an antrochoanal and an accompanying sphenochoanal polyp that have been successfully managed by endoscopic sinus surgery. Therefore, we present this rare case and review the clinical, radiological, and pathological features.

Isolated Sphenoid Sinus Lesion: A Clinical Analysis of 56 Cases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Isolated lesions of the sphenoid sinus are a rare disease entity that occurs after a wide use of antibiotics. This lesion may have severe complications such as cranial nerve palsies due to its deep location in the skull. The use of endoscopic surgery for the sphenoid sinus has become popular for its several advantages. We report our experiences of 56 case-isolated sphenoid lesions with a review of articles. SUBJECTS AND METHOD: Fifty-six patients with isolated sphenoid lesions who were treated at Seoul National University Hospital from January 1985 through December 2003 were analyzed. Patients who have lesions confined to the sphenoid sinus on radiologic images (CT or MRI) were included. A retrospective chart review was performed with respect to the patient's symptom, pathology and surgical outcome. RESULTS: Thirty-nine of 56 cases were inflammatory lesions, 8 neoplastic lesions, and 9 fibrous dysplasias. Headache was the most common symptom (66%), followed by nasal symptoms such as nasal obstruction and postnasal drip. Ophthalmologic symptoms were observed in 14 cases. Endoscopic transnasal sphenoidotomy was perforemd in 33 of 39 cases of inflammatory diseases. Symptoms were completely improved in 32 cases after the operation and ophthalmologic symptoms were nearly all improved in all cases. CONCLUSION: The wide use of CT and MRI has increased the detection of isolated lesions of the sphenoid sinus. Complications like cranial nerve palsies were uncommon unlike from the reports that came out in the country. Primary physicians must rule out isolated lesions of the sphenoid to account for intractable headaches.

Effects of Enterotoxins of Staphylococcus Aureus on Ciliary Activity of the Nasal Mucosa / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The pathogenesis of paranasal sinusitis has not been fully understood. The role of staphylococcal enterotoxins in the development of the paranasal sinusitis has recently been identified. The aim of the study is to investigate the in vitro effects of enterotoxin of Staphylococcus aureus on ciliary activity of the nasal mucosa and its in vivo activity on histology of sinus mucosa. MATERIALS AND METHOD: Maxillary sinus mucosa of the rabbit is harvested and prepared. Ciliary beat frequency (CBF) of the mucosa is observed in the culture media containing staphylococcal enterotoxin A (SEA). After direct instillation of SEA into the maxillary sinus, CBF and the histological finding of the maxillary sinus mucosa are examined. RESULTS: After exposure to low dose enterotoxin (0.03 or 0.3 ng/ml of SEA), CBF did not decrease. But, after exposure to high dose enterotoxin (1.5, 3, 30 ng/ml of SEA), CBF decreased significantly as a function of time. Twenty four hours after instillation of high dose (30 ng/ml) SEA, CBF decreased. Seven days after instillation of high dose SEA, sinusitis is observed. After instillation of low dose (0.3 ng/ml) SEA, CBF and epithelial integrity is not affected. But, subepithelial edema and the infiltration of inflammatory cells are observed. CONCLUSION: The induction of sinusitis with high dose SEA may be related to the ciliostatic effect of staphylococcal enterotoxin. But, low dose staphylococcal enterotoxin can induce sinus inflammation without ciliostatic effect.

Change of Nasal Dimension and Resistance with Aging in Korean / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is often observed that the nasal cavity becomes atrophic with old age. However, there is no exact data that prove senile atrophic changes in the nasal cavity. Thus we evaluated the effect of aging on the dimension and the resistance of the nasal cavity. SUBJECTS AND METHOD: One hundred twelve healthy subjects free of nasal diseases were included in this study. Acoustic rhinometry and rhinomanometry were performed before and after nasal decongestion. The subjects were classified into 6 age groups and cross-sectional area (CSA) measured by acoustic rhinometry and the total nasal resistance were analyzed by rhinomanometry among each group. RESULTS: The average value of CSA at the nasal valve area increased slightly with age. However, there was no significant difference before and after nasal decongestion. The average values of CSA at the attachment of the inferior turbinate before and after decongestion were on the increase with age. However, the difference of CSA between pre- and post-decongestion did not change significantly with age. Rhinomanometry showed that nasal resistance markedly decreased from twenties and thirties but did not change significantly after the thirty decade. CONCLUSION: The dimension of nasal cavity increases and the nasal resistance decreases with age. The increased dimension of the nasal cavity in old age might be attributed to the structural change such as bony atrophy rather than mucosal change.

Inhibition of Allergic Response by CpG Motif Immunostimulatory Oligodeoxynucleotide Conjugate in Murine Model of Allergic Rhinitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Recently, the incidence of allergic diseases such as asthma, allergic rhinitis and atopic dermatitis is on the increase with the society getting more and more industrialized. Although many therapeutic options for prevention and treatment of the allergic diseases have been developed, true allergen desensitization remains a challenging goal. The classic immunotherapy using protein-based allergen has limited efficacy, is inconvenient, and has a risk of anaphylaxis. Recent reports revealed that immunostimulatory DNA sequences (ISS-ODN, CpG motif) have been shown to act as a strong Th1 response-inducing adjuvants and that DNA-based vaccination might be an effective therapeutic option for treatment of allergic diseases. In this study, we investigated whether ISS-ODN/Dermatophagoides farinae (Der f) conjugate has anti-allergic effects in the mouse model of allergic rhinitis, which is sensitive to house dust mites. Der f is the most common allergen inducing allergic rhinitis in Korea. MATERIALS AND METHOD: C57BL/6 mice were systemically and locally sensitized with crude extracts of Der f. After the injection of ISS-ODN/Der f conjugate and the mutant-ODN/Der f conjugate, several parameters of allergic response were evaluated. RESULTS: Scratching and sneezing symptoms, and eosinophilic infiltration into nasal mucosa were suppressed by the injection of ISS-ODN/Der f conjugate. IL-5 level in nasal lavage fluid (NLF) was decreased and IFN gamma level was increased. Der f-specific IgE was decreased, however, as it was not statistically significant. CONCLUSION: The results showed that ISS-ODN/Der f conjugate has anti-allergic effects and biased Th1 reaction in the allergic rhinitis model of Der f allergen.