The Measurement of Temporal Bone Including Retrolabyrinthine Portion in Meniere's Disease / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: AThe anatomical aspects of the multiple etiopathogenic factors in Meniere's disease such as narrowed vestibular aqueduct, hypoplasia of the perilabyrinthine portion, hypoplastic vestibular aqueduct, anteromedially displaced sigmoid sinus have been studied by other authors. The purpose of this study is to investigate and measure the temporal bone including the retrolabyrinthine portion, and evaluate hypoplasia of the retrolabyrinthine region, anteromedial displacement of sigmoid sinus in the affected ear of unilateral Meniere's disease. MATERIALS AND METHODS: The four parameters in both sides of temporal bone were measure in 30 patients with unilateral Meniere's disease and in the controls using the axial 3DFT CISS image of temporal MRI. RESULTS: The retrolabyrinthine bone development, which contains the vestibular aqueduct and endolymphatic sac, was significantly poorer in the affected ear with unilateral Meniere's disease. However, the anteromedial displacement of sigmoid sinus were not found in the affected ear with Meniere's disease. CONCLUSION: These results suggest that hypoplasia of the retrolabyrinthine region may have a role in the pathogenesis of Meniere's disease.

Expression of NF-K B and I-K B in Allergic Rhinitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: K B is a transcription factor in immune and inflammatory reactions, and exerts its effect by expressing cytokines and chemokines, enzymes, receptors and adhesion molecules. Many of the inflammatory proteins that are expressed in respiratory airways are also regulated, at least in part, by NF-K B. The purpose of this study is to investigate the NF-K B and its inhibitory protein, I-K B expression in normal nasal mucosa and allergic rhinitis. MATERIALS AND METHODS: We have evaluated 20 allergic rhinitis mucosa and 7 normal inferior turbinate. Immunohistochemical study and RT-PCR were done for NF-K B and I-K B expression. RESULTS: NF-K B and I-K B were localized at the epithelium, and in the subepithelial inflammatory cells, vascular endothelial cells, and glandular endothelial cells in both normal nasal mucosa and allergic rhinitis. Compared to normal nasal mucosa, both activated and inactivated forms of NF-K B were significantly increased in the epithelial cell layer of allergic rhinitis. However, for the I-K R expression, no difference could be observed. RT-PCR revealed a significant difference in the expression level of NF-K B mRNA between nasal mucosa and allergic rhinitis, but I- K B expression showed no difference. CONCLUSIONS: This results show that NF-K B is usually activated in the nasal epithelial cell layer and NF-K B may play a role in the inflammatory reaction of allergic rhinitis. But further study is required for the role of I-K B.

The Clinical Usefulness of Axial OMU CT in ESS for Chronic Sinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: OMU CT scans are taken on a direct coronal plane for chronic sinusitis and thus allows evaluation only from the coronal plane. However, axial OMU CT provides view of the surrounding vital structures, variation of air cells, and the anterior to posterior relations of structures associated with chronic sinusitis. We investigated the clinical usefulness of axial OMU CT in chronic sinusitis. MATERIALS AND METHODS: A prospective study was performed in 100 sinuses of 50 patients with chronic sinusitis who underwent endoscopic sinus surgery from May through July of 1998. RESULTS: We observed that axial OMU CT has the advantage of evaluating the outline of the lateral lamella of lamina cribrosa, anterior and posterior ethmoid canal, optic nerve in sphenoid sinus, internal carotid artery in sphenoid sinus, Onodi cell, and anterior to posterior relations of these structures. CONCLUSION: We found that, in chronic sinusitis, axial OMU CT is effective in evaluating the important vital structures, normal variation, and the relations between the structures and that it can help prevent complication during ESS. We therefore recommend axial OMU CT to be included in the routine radiological evaluation for ESS in chronic sinusitis.

The Evaluation and Measurement of Anterior Ethmoidal Canal in Axial OMU CT / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The anterior ethmoid canal is the important surgical landmark in endoscopic sinus surgery, intranasal ethmoidectomy, and frontal sinus surgery. However it is not enough to evaluate the anterior ethmoid canal by coronal OMU CT, especially relating anterior to posterior relationship of the anterior ethmoid canal. The pulpose of this study is to evaluate the anterior ethmoid canal in 1 mm axial OMU CT and measure the five parameters relating the anterior ethmoid canal. MATERIALS AND METHODS: A prospective study was performed in 100 sinuses of 50 patients with chronic sinusitis who underwent endoscopic sinus surgery from May through July of 1998. RESULTS: The anterior ethmoid canal is well demonstrated by 1 mm axial OMU CT. The average of five parameters are 6.2+/-1.5 mm, 6.4+/-4.3 mm, 18.5+/-3.9 mm, 26.5+/-5.6 mm, 24.6+/-14.6degrees. However, there is no difference between the right and left side statistically. We observed that the anterior ethmoid canal is located just posterior to the frontal recess without anterior ethmoid air cell in front of the antirior ethmoid canal in 23%. CONCLUSION: The anterior ethmoid canal is well remarked by the 1 mm axial OMU CT. The length and directional angle of the anterior ethmoid canal is individually variable and there is no anterior ethmoid air cell in front of the anterior ethmoid canal in 23%. In these cases, the anterior ethmoid canal is more likely to be injured. So axial OMU CT may be useful in the radiologic evaluation for endoscopic sinus surgery in chronic sinusitis.

Amplification of int-2 in Head and Neck Squamous Cell Carcinomas and Adjacent Mucosa / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is important to identify potential biomarkers of tumorigenesis that can be utilized on histologically normal epithelia to determine the level of risk of tumor development. With the goal of possibly identifying a biomarker for the process of development of head and neck cancer, the amplification of int-2 was observed in patients with head and neck squamous cell carcinoma. MATERIALS AND METHODS: Fluorescence in situ hybridization using cosmid int-2 probe was performed on paraffin-embedded specimens from tumor and tumor-adjacent and tumor-distant epithelia of 20 patients. Buccal mucosa of cancer-free subjects who smoked and did not smoke cigarettes were used as control. Dot blot hybridization using digoxigenin-labeled int-2 probe was also performed on the frozen tissue from tumor and tumor-adjacent epithelia of 14 patients. RESULTS: In in situ hybridization, buccal epithelia of cancer-free subjects who smoked and did not smoke cigarettes, and tumor-distant epithelia of the patients with head and neck squamous cell carcinoma showed no int-2 amplification. However, eleven of tumor tissue (55%) and five of tumor-adjacent epithelia (25%) in 20 cases showed int-2 amplification. In dot blot hybridization, five tumor tissue (35.7%) and 2 tumor-adjacent epithelia (14.3%) in 14 cases, of which tumor tissue were all found to have int-2 amplification, showed int-2 amplification. CONCLUSION: The amplification of int-2 in the tumor tissue and the tumor-adjacent epithelia of the same cases supports the concept of field cancerization or clonal extension. Such genotype parameters may provide a genetic basis for the development of early recurrence or second primary tumors after therapeutic treatment of head and neck squamous cell carcinomas.

Clinical Application of Modified Technique of Temporal HRCT for Dehiscence of Tympanic Segment of Facial Nerve / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: High Resolution Computed Tomography(HRCT) of the temporal bone is the most accurate diagnostic tool and is popularly used in the chronic otitis media with cholesteatoma. However, the bony dehiscence of tympanic segment of the facial canal may be difficult to evaluate by the conventional HRCT of the temporal bone. This study was undertaken to develop a modified technique of axial CT scan for evaluation of bony dehiscence of tympanic segment of the facial canal. MATERIALS AND METHODS: A prospective study was performed in 33 patients with chronic otitis media with cholesteatoma. These patients had also underwent canal down mastoidectomy from August of 1996 through July of 1997. A correlation study of the CT and surgical findings at 40 degree and 30 degree axial scans was carried out. RESULTS: The sensitivity and specificity of this method for dehiscence of tympanic segment of the facial canal were 88.9% and 95.6%, respectively and the diagnostic predictability was 93.9%. However, the sensitivity, specificity, and diagnostic predictability of the 30 degree axial scan were 77.8%, 83.3%, and 81.8%, respectively. CONCLUSION: We think that the modified technique of axial CT scan of temporal bone is an effective method for detecting the dehiscence of tympanic segment of facial canal.

Conservation Surgery for Hypopharyngeal Cancer / 대한이비인후과학회지

BACKGROUND: Hypopharyngeal cancer was known to be more aggressive, extensive, and clinically malignant than laryngeal cancer, not generally considered suitable for conservative surgery in the past. Ogura, et al(1960) reported little was gained by sacrificing the entire larynx in many cases of hypopharyngeal cancer. OBJECTIVE: Present study was undertaken to evaluate the complications and results of conservation surgery for hypopharyngeal cancer. MATERIALS AND METHODS: A retrospective review of six patients treated by conservation surgery for early hypopharyngeal cancer was performed. The patients had squamous cell carcinomas at various subsites, including the medial wall of piriform sinus(three patients), posterior hypopharyngeal wall(two patients), and lateral wall of hypopharynx(one patient). Stage of primary tumor showed T1 of 4 patients and T2 of 2 patients. Partial laryngopharyngectomy was performed for three patients with medial wall of piriform sinus, median labiomandibular approach for two patients with posterior wall of hypopharynx and partial pharyngectomy via lateral pharyngotomy for a patient with lateral wall of piriform sinus. Four patients with cervical lymph node metastasis underwent radical neck dissection. Postoperative radiation therapy were done for all patient with 5500 to 6700 cGy. RESULTS: Complications of surgical procedure showed two patients with aspiration and a patient with pharyngocutaneous fistula. Despite of shorterm follow-up period all but one patient showed no evidence of disease. A patient is alive with distant metastasis. CONCLUSION: Conservation surgery seems to be effective surgical method to control the early hypopharyngeal cancer.

Gallstone Dissolution with Methyl Tertiary Butyl Ether: An Experimental Study on Selection of Gallstone by Plain Radiography and Ultrasonography

PURPOSE: The purpose of this study was to determine whether in vitro plain radiography and ultrasonography(US) could predict the outcome of gallstone dissolution with methyl tert-butyl ether(MTBE). METHODS AND MATERIALS: The plain radiography and ultrasonography of 75 gallstones removed at surgery from 75 patients were obtained. The plaih radiographic findings were grouped by their calcification pattern as group l:lucent, group 2:central, group 3:diffuse and group 4: laminated. The ultrasonographic findings were grouped by their echo pattern as group 1 :arc shaped, clearly defined surface echo followed by distinct acoustic shadow, group 2:strong surface echo with gradually attenuating, meniscus shaped inner echo, group 3:strong surface echo with fill-in pattern of internal echo, group 4:strong surface echo with irregular inner echo and group 5:entirely discerning circumsference, homogeneous internal echotexture. After imaging, the gallstones underwent MTBE dissolution for 6 hours. The residual weight of each stone was measured every 2 hours. The correlation between imaging findings and dissolution rate was retrospectively analysed. RESULTS: The radiolucent and central calcification stones were dissolved rapidly as compared with the diffuse and laminated calcification stones(p<.05). There was no statistically significant difference among the groups based on ultrasonographic findings alone. However, after exclusion of the certain calcification groups that were resistent to dissolution-diffuse or laminated calcification stones-all US groups except one that shows wholly circumscribed margin and homogeneous fill-in pattern of internal echo dissolved well to average 20% or less of the original weight(p<.05). CONCLUSION: MTBE dissolution can be tried in stones that meet both ultrasonographic (not a stone with homogeneous fill-in pattern of internal echo) and plain radiographic (radiolucent or cental calcification stone) criteria.

Complications after lumbar myelography with amipaque

Amipaque is a water soluble, non-ionic myelographic contrast media, and owing to its high diagnostic accuracy and safety, its use is gradually increasing. The authors studied the complications after Amipaque lumbermyelography in 61 patients with low back pain during the period from Jan. 1981 to Nov. 1981 in Chung Ang University Hospital. The results were as follows; 1. Total complication rate was 52%(32 of 61) and there was nosexual difference in its occurrence. 2. In total, no difference in complication rate was found between head-up positioned group with a degree of 30degrees (group I) after procedure and head-up positioned group with a degree of 70degrees (group II) but female patients had more complication rate in group I than in group II (75% vs 50%).Headache was more common in group I and nausea was more common in group II. 3. Headache was most common complicaiton (44%) and there was no sexual difference in its occurrence. 4. No significant difference in complication rate was found between patients proved to have HBP and patients to have not. 5. Complications were less common in patients with punctured level of L4-5 than in patients with L2-3 or L3-4 level puncture.