5-Lipoxygenase Promotor Polymorphism in Nasal Polyp Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nasal polyps are the most common mass lesions in the nasal cavity and occur on both infectious and noninfectious basis, and genetic etiology is suspected in the development of nasal polyps. 5-Lipoxygenase is the first enzyme committed in the metabolic pathway leading to the intracellular synthesis of leukotrienes. Some studies have shown that leukotrienes were significantly higher in nasal polyps from aspirin-sensitive asthmatics than in nasal polyps from aspirin-tolerant asthmatics and normal nasal mucosa. The purpose of the present study is to evaluate whether genetic polymorphism of the core promoter region of the 5-lipoxygenase gene contributes to the development of nasal polyps. SUBJECTS AND METHOD: This study was conducted in 97 nasal polyp patients associated with chronic sinusitis and 92 healthy controls. Genetic polymorphisms of 5-lipoxygenase gene promoter were genotyped by PCR and direct sequencing. RESULTS: There were no significant differences between the 5-lipoxygenase gene promoter polymorphisms in nasal polyp patients with chronic sinusitis and those in healthy controls (p=0.76). In the nasal polyp patients associated with chronic sinusitis, the frequencies of 6-bp deletion were lower than those of healthy controls (OR, 0.88 95% CI, 0.48-1.60), but there was no statistical significance (p=0.67). The frequencies of 6-bp addition were higher than those of healthy controls (OR, 1.96; 95% CI, 0.33-10.6), but no significant difference was found (p=0.68). CONCLUSION: We concluded that 5-lipoxygenase gene promoter polymorphism did not show genetic predisposition with regard to nasal polyps in the Korean population.

A Case of Osteoma between the Malleus and Incus / 대한이비인후과학회지

We present a case of osteoma that was diagnosed incidentally in the middle ear. Osteomas are benign tumors and may occur as a solitary lesion in the squama, mastoid, middle ear and petrous pyramid. Even though osteomas in the middle ear are extremely rare, those lesions may be one of the causes of the conductive hearing loss by impinging upon the ossicular chain. There are only 22 cases of osteoma reported in the medical literature to date. In most patients, the diagnosis is confirmed by CT scan or at the time of surgery. CT scanning of these disorders is very useful, especially in examining the extent of the lesion and detailed bone destruction.

Extraskeletal Ewing's Sarcoma of the Hard Palate

Extraskeletal Ewing's sarcoma (EES) is a rare soft tissue tumor morphologically indistinguishable from the more common Ewing's sarcoma of bone. We report a case of EES arising in the hard palate of 34-yr-old male patient. Microscopically, the monotonous small round cells without neuronal differentiation showed membranous positive immunoreactivity for MIC2/CD99 and vimentin. Ultrastructurally, the tumor cells showed a few intracytoplasmic organelles without evidence of neurosecretory granules or neurofilaments. The EWS-FLI1 chimeric gene was identified using the nested reverse transcriptase-polymerase chain reaction.

The Effect of Selective Cyclooxygenase-2 Inhibitor on the Expression of Hypoxia-Inducible Factor-1alpha in Nasal Polyps / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used drugs in the world. NSAIDs are known to be potent inhibitors of the cyclooxygenase (COX) enzymes, a family of enzymes that catalyze the conversion of arachidonic acid to prostagladins. Expression of the gene encoding COX-2 might be regulated by hypoxia. Hypoxiainducible factors (HIFs) are activated by hypoxia. HIFs function in the hypoxic environment to orchestrate adaptational adjustments of vascular homeostasis through the activation of several dozens of target genes. The purpose of this study was to investigate whether a selective COX-2 inhibitor inhibits HIF-1alpha in human nasal polyps. SUBJECTS AND METHOD: Seven patients with nasal polyps with chronic sinusitis were selected. After the first biopsy, all patients were treated with selective cyclooxygenase inhibitor (Celebrax(R), 100mg, twice daily) for 7 days. At the end of the treatment period, a second set of biopsies was taken. HIF-1alpha messenger RNA (mRNA) production was measured by reverse transcriptase polymerase chain reaction and the protein expression of HIF-1alpha was determined by immunohistochemical staining. RESULTS: The expression of HIF-1alpha mRNA and protein were detected in nasal polyps. There was no significant difference in the mean level of HIF-1alpha mRNA between selective COX-2 inhibitoruntreated and treated nasal polyps (p>0.05). Immunohistochemistry shows diffuse and increased expression of HIF-1alpha in the nuclei of pseudostratified columnar epithelial cells. Endothelial cells and inflammatory cells including lymphocytes and histiocytes were expressed with HIF-1alpha in the stroma. Subcellular localization of HIF-1alpha were found mostly in the nucleus, but were occasionally observed in the cytoplasm of histiocytes. The expression of HIF-1alpha protein was not significantly different between selective COX-2 inhibitor-treated and selective COX-2 inhibitor-untreated nasal polyps (p>0.05). CONCLUSION: Selective COX-2 inhibitor did not inhibit HIF-1alpha expression in nasal polyps. Further studies are needed to find out the effect of selective COX-2 inhibitor on nasal polyps.

A Case of Bilateral Sudden Hearing Loss Caused by Right Anterior Inferior Cerebellar Artery Plus Syndrome and Left Anterior Inferior Cerebellar Artery Infarction / 대한이비인후과학회지

Acute ischemic stroke in the distribution of anterior inferior cerebellar artery (AICA) is known to be associated with vertigo, nystagmus, facial weakness and gait ataxia. A few reports have carefully examined the deafness associated with the AICA infarction. A 55 year old man was presented with right sudden hearing loss, tinnitus and vertigo. The magnetic resonance image of the brain with 4-vessel angiogram showed stenosis in the lower third of the basilar artery due to partial thrombosis and no remarkable lesion in AICA. Although heparin treatment was done, the patient's hearing was not improved. After 3 months of heparin treatment, the patient was presented again with left sudden hearing loss, tinnitus and facial palsy. The magnetic resonance image and angiogram showed increased size of thrombosis and non-visualization of left vertebral artery and basilar artery. Diffusion scan showed focal infarction involving the left AICA territory. Recently, we experienced a case of bilateral sudden hearing loss caused by the right AICA plus syndrome and the left AICA infarction. So authors report this case with a review of literature.

The Clinical and Pathological Study of the Adenoid Vegetation Above the Age of 20 / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The adenoid increases progressively in size during early childhood, reaching a maximum at the age between 3 and 7. It begins to atrophy and involute after puberty and almost disappears before the age of 20. However, a few authors stated that persistence of the adenoid in adult life is not uncommon and the nasopharyngeal lymphoid tissue can undergo prominent or even marked hyperplasia in adults. We investigated clinical and pathological features of the patients who underwent adenoidectomy at ages beyond 20. SUBJECTS AND METHOD: A retrospective study was performed on 18 patients who underwent adenoidectomy due to adenoid vegetation from October 1997 to December 2002 at Pusan Paik Hospital and they compared the results with children of ages 3 to 10 years. To evaluate hypertrophy, adenoidal-nasopharyngeal ratios (A/N ratio) obtained using simple linear measurements from lateral skull radiographs were described. To investigate pathologic features, all excised adenoids were fixed in neutral 10 % formalin and serial sections of 5 microM thick were prepared and stained by Haematoxylin and Eosin. RESULTS: The A/N ratios of the studied patients were from 7.5 to 9.0. The main symptom of the patients was snoring. Others were nasal obstruction, postnasal drip and frequent upper respiratory infection. The prominent pathologic findings in the patients were increased squamous metaplasia of the surface epithelium and parenchymal fibrosis. CONCLUSION: Snoring and nasal obstruction were often caused by adenoid enlargements in adults. Because the examination of the nasopharynx was inadequate, many cases of enlarged adenoid in adults were misdiagnosed. Pathologic features of enlarged adenoid in adults were slightly different from those in children.

Expression of Hypoxia-Inducible Factor-1alpha and Correlation between Hypoxia-Inducible Factor-1alpha and Vascular Endothelial Growth Factor in Nasal Polyps / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The function of hypoxia-inducible factors (HIFs) in the hypoxic environment is to orchestrate adaptational adjustments of vascular homeostasis through the activation of several dozens of target genes including vascular en-dothelial growth factors (VEGF). It has been suggested that VEGF is involved in the pathogenesis of nasal polyp. The purpose of this study is to determine and correlate concentrations of HIF-1alpha and VEGF in nasal polyps. MATERIALS AND METHOD: Twenty-five nasal polyps were collected at the time of endoscopic sinus surgery. The production of HIF-1alpha and VEGF messenger RNA (mRNA) was measured by reverse transcriptase polymerase chain reaction (RT-PCR) and HIF-1alpha and VEGF proteins were determined by immunohistochemical staining. RESULTS: The expressions of HIF-1, VEGF mRNA and proteins were detected in nasal polyps. RT-PCR demonstrated that the level of mRNA expression of HIF-1alpha and VEGF were 1.12+/-0.33 and 1.11+/-0.42, respectively. A positive correlation was observed between HIF-1alpha and VEGF mRNA (correlation coefficient [r]=0.49, p<0.05). The immunohistochemical studies revealed that HIF-1alpha was predominantly expressed in surface epithelial cells, submucosal glandular cells, endothelial cells and inflammatory cells in the stroma and VEGF was more strongly and diffusely expressed in subglandular epithelial cells, vascular endothelial cells, and inflammatory cells than in surface epithelial cells. The expressions of HIF-1alpha and VEGF proteins were 3.24+/-1.80 and 3.52+/-1.89, respectively. A positive correlation was observed between HIF-1alpha and VEGF proteins (r=0.76, p<0.05). CONCLUSION: We suggest that HIF-1alpha has a role in inducing VEGF in nasal polyps, and hypoxia is an important factor in the growth of nasal polyps.

A case of Peutz-Jeghers syndrome associated with jejuno-ideal intussusception

No abstract available.