A Case of Simultaneous Presentation of Closed and Open Type of Congenital Cholesteatoma / 대한이비인후과학회지

Congenital cholesteatoma of the middle ear classically presents as a white retrotympanic middle ear mass. In spite of many theories on congenital cholesteatoma, its pathogenesis is still unclear. There are two distinct pathologic types of congenital cholesteatoma, closed and open type. The closed cystic form can be easily removed, but the open type has a tendency to make strong contact with the middle ear mucosa and to infiltrate into the surrounding structures. We report a rare case which presented both open and closed types of congenital cholesteatoma.

Prediction of Nonsentinel Lymph Node (NSLN) Metastasis in Breast Cancer Patients; The Usefulness of Isotope Counts for Sentinel Lymph Node (SLN) Classification

PURPOSE: The goal of this study was to identify a patient subgroup with a positive SLN where exposure to the morbidity and cost associated of an axillary lymph node dissection (ALND) is not required. To achieve this goal, we subdivided SLNs according to their isotope counts, and then assessed whether the number of positive SLNs and subdivided status were related to the axillary NSLN status. METHODS: During SLN biopsies, the ex vivo isotope counts were measured for each SLN. Each SLN was labeled as S1, S2 or S3, and so on, in descending count order. An SLN biopsy was performed until the isotope counts of the axilla equaled that of the background. If SLNs were positive, a completion ALND (cALND) was performed. The pathological report was also reviewed and analyzed. RESULTS: SLNs were successfully identified in 243 (99.6%) of 244 patients, with metastases in SLNs identified in 28.0% of patients. An SLN was the only positive lymph node in 52.9% (36/68) of patients, with a positive SLN followed by a cALND. NSLNs metastases were found in 32/68 cases (47.1%). The rate of NSLN metastasis was positively correlated with the number of positive SLN (P=0.017). In SLN positive patients, the NSLN metastasis rate was 60.9% (28/46) in patient with a tumor-harboring last-order SLN (SLN with least isotope counts), but only 18.2% (4/22) in patients with a tumor-free SLN (P=0.001). Similar results were found in patients with either two or more metastatic SLNs (P=0.023). CONCLUSION: In patients with a positive SLN, the number of metastatic SLNs and their isotope counts can be useful in the prediction of NSLNs metastasis. Further investigation will be necessary to confirm these results.

Inducible Nitric Oxide Synthase (iNOS) is Increased in Diabetic Rat Glomeruli: Role of Angiotensin II (AII) / 대한신장학회잡지

BACKGROUND: This study was designed to examine whether iNOS pathway is pathologically altered in experimental diabetic nephropathy and whether therapy with ACE inhibitor (imidapril: I) or angiotensin II type 1 receptor (AT1) blocker (L-158, 809: L) ameliorates these changes. METHODS: Male SD rats were injected with diluent (control: C) or streptozotocin. Diabetic (D) rats were then randomized to receive vehicle, I (2 mg/ kg/d) or L (1 mg/kg/d) by gavage. At the end of the 12-week treatment, rats underwent either a 4 hour placebo or an intraperitoneal LPS (2 mg/kg) challenge. Inducible NOS mRNA and protein were measured by RT-PCR and Western blot in isolated glomeruli. RESULTS: Systolic blood pressure and urinary protein excretion increased significantly in D rats compared with C. The basal expression of iNOS mRNA was increased in D rats compared with that of C, whereas there was no significant difference in the level of protein. Upon LPS stimulation, the iNOS mRNA and protein expression was significantly elevated in D rats. In D rats, this up-regulation of LPS-stimulated iNOS expression was equally ameliorated by both I and L in mRNA and protein levels. CONCLUSION: LPS-stimulated glomerular iNOS expression was enhanced in diabetic nephropathy, and the activation of angiotensin II may play a role in this enhancement.

The Significance of Expression of Matrix Metalloproteinases (MMPs) in Intimal Hyperplasia after Ballon Injured Rat Aorta

PURPOSE: Vascular smooth muscle cells (VSMCs) migration and proliferation are important for neointimal formation after arterial injury. Migration of VSMCs requires degradation of basement membrane and extracelluar matrix surrounding the cell, and there is increasing evidence that VSMCs produce extracelluar matrix-degradating proteinases, such as matrix metalloproteinases (MMPs) after arterial injury. To assess the role of MMPs in VSMCs proliferation, migration and intimal thickening, we measured the expression of MMP-2 and MMP-9 in the balloon-injured rat aorta model. METHOD: Twenty-five male Sprague-Dawley rats weighting of 250~300 gm were underwent aortic intimal denudation with 2F balloon catheter. Aorta was harvested at various time intervals of 1, 3, 5, 7, 21 days and then analyzed the MMP expression used by gelatin zymography. Intimal hyperplasia caused by balloon injury was confirmed by microscopic examination. RESULT: MMP-2 (72 kD) was constitutively expressed in the normal aorta and was not increased substantially after injury. But the expression of 62 kd forms, which is activated form of MMP-2, was significantly increased during the period of 5 through 7 days after injury (P<0.05). The expression of MMP-9 (92 kD) was significantly increased at 1st day after injury and diminished thereafter (P<0.05). CONCLUSION: These results suggest that activated MMP-2 (62 kD) and MMP-9 (92 kD) may play an important role in VSMCs migration and formation of intimal hyperplasia after arterial injury. And the activated form of MMP-2 (62 kD) seems to be involved mainly in degradation of basement membrane and matrix.

Effects of Respirator Use Evaluated by Urinary Hippuric Acid Concentration in Toluene-Exposed Workers / 대한산업의학회지

OBJECTIVES: This study was carried out in order to raise workers'recognition of the effects of respirator use by providing concrete and practical data. METHODS: Twenty-six workers who dealt with toluene based ink and diluents at a gravure printing office in Seoul were investigated. The toluene exposure level and urinary hippuric acid level were monitored under respirator non-wearing(RNW) and under respiratory wearing(RW) conditions. RESULTS: The mean concentrations of toluene exposed to each worker through the air of gravure printing office were 147.52+/-57.34 and 134.55+/-52.44 ppm on respirator non-wearing day and respirator wearing day, respectively. There was no significant difference in toluene exposure concentration for the two days. The mean concentration of urinary hippuric acid in RNW and RW groups were 1.51 (0.53) g/L and 0.49 (0.14) g/L, respectively, as measured at the end of the workday. There was a significant difference seen in urinary hippuric acid concentration between the two days. The urinary hippuric acid concentration began to increase at 4 hours after the start of the workday(13:00) in RNW. However, there was no significant increase until the end of the workday in the case of RW. The urinary hippuric acid concentration in RW reduced 89.3% as compared with the concentration seen in RNW. There was a significant correlation between the toluene concentration and the urinary hippuric acid concentration in RNW. The regression equation was Y (urinary hippuric acid concentration, g/L) = 0.007 X x(toluene concentration in the air, ppm) + 0.665. CONCLUSIONS: Our results indicate that the respirator intercepted most toluene that may have been absorbed into the respiratory organs, and suggested that properly wearing a respiratory such as wearing the respirator during the entire workday and performing a proper fit test played an important role in the protection from toluene exposure

Avascular Necrosis of Bone Complicating Treatment of Malignant Lymphoma: Report of 6 cases / 대한암학회지

BACKGROUND: Several reports have documented the association of avascular necrosis (AVN) of bone and the treatment of malignant lymphoma with steroid-containing chemotherapy. It is important to recognize these conditions, as they can be mistaken for those of lymphomatous involvement.Cases: This report describes the experience at the Severance hospital over a 10-year period with 6 patients in whom AVN developed during or following treatment of malignant lymphoma. Four patients of non-Hodgkin's lymphoma and two of Hodgkin's disease were treated with steroid-containing chemotherapy. The predominant symptom is pain on motion or weight bearing. Symptoms leading to diagnosis of AVN developed between 5 and 27 months after starting prednisolone (mean 17.8 months), and the mean cumulative dose of prednisolone to the onset of AVN was 4,447 mg (range, 1,800~9,490 mg). All but one were involved in both hip joint. Diagnosis was based on the radiologic appearance, and in the majority radiographic changes consistent with AVN were present at the time of presentation of symptoms. Four patients received total hip replacement and two had conservative care. CONCLUSION: Patients with malignant lymphoma who developed pain on joint during or after the use of steroid-containing chemothearpy should be carefully investigated with MRI and radionuclear bone scan for early diagnosis and proper management.