The Inhibitory Mechanism of N-(4-Hydroxyphenyl) Retinamide on Prostaglandin E2 Synthesis in Squamous Cell Carcinoma Cell Line / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is well known that Prostaglandin E2 (PGE2) is the most predominant prostaglandin in squamous cell carcinoma and that PGE2 synthesis is suppressed by retinoid. The purpose of this study was to confirm whether (N-4-Hydroxyphenyl) retinamide (N-4-HPR) suppressed PGE2 synthesis, and investigate its inhibitory mechanism on PGE2 synthesis in squamous cell carcinoma. MATERIALS AND METHOD: MDA 886Ln was used as the squamous cell carcinoma cell line. We evaluated the effects of four retinoids (all-trans-RA, 13-cis-RA, retinyl acetate, and N-4-HPR) on PGE2 synthesis: the effect of N-4-HPR concentration on PGE2 synthesis and Cox-2 mRNA, the effect of N-4-HPR on Cox-2 protein, and the effect of N-4-HPR on the cyclooxygenase activity. RESULTS: Among the four retinoids, N-4-HPR was the most potent suppressor of PGE2 synthesis. N-4-HPR suppressed PGE2 synthesis, but N-4-HPR did not suppress Cox-2 mRNA or Cox-2 protein. Cyclooxygenase activity was suppressed by N-4-HPR. CONCLUSION: With these results, we suggest that the inhibitory mechanism of N-4-HPR on the PGE2 synthesis may be suppression of the cyclooxygenase activity, and Cox-2 mRNA and protein were not suppressed by N-4-HPR.

A Case of Primary Laryngeal Aspergillosis / 대한이비인후과학회지

Primary laryngeal aspergillosis is exceptionally rare, and only nineteen cases have been reported in the literature. It is more commonly seen as a part of a wider infection involving the respiratory system in an immunocompromised host. We present here one case of primary laryngeal aspergillosis without any other airway tract extension and without any generalized immune deficit in a 58-year-old man. Direct laryngoscopy and biopsy confirmed the diagnosis of aspergillosis.

Filter Paper Test to Assess Nasal Hyperreactivity / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We can evaluate nasal hyperreactivity with histamine challenge test (HCT) or metacholine test. In 1981, a simple and reproducible technique using filter paper to collect nasal secretion was introduced. We revised this technique to assess nasal hyperreactivity. The basic concept of the test is that filter paper in the nose acts as a mechanical stimulus to the nasal mucosa, and causes nasal secretion, which is absorbed in the filter paper. The aim of this study was to present filter paper test (FPT) as an objective assessment of nasal hyperreactivity in allergic patients. We compared the sensitivity and the specificity of FPT with HCT, and also evaluated the validity of FPT in assessing the changes of nasal hyperreactivity. SUBJECTS AND METHOD: For FPT, a folded strip of filter paper in 50X6 mm was placed between the septum and the inferior turbinate, and the wetted strip was weighed after 10 minutes. For HCT, a paper disk, saturated with histamine solution (1 mg/ml) was placed on the anterior end of the inferior turbinate, and the number of sneezing was counted per minute. Twenty nine patients with allergic rhinitis and hyperreactive nasal symptoms and 20 normal subjects were included in the study. Fourteen out of the 29 hyperreactive and allergic rhinitis patients were subjected to the evaluation of changes in the amount of nasal secretion. RESULTS: For FPT, sensitivity was 65.5% and specificity was 95%, whereas for HCT, the sensitivity was 69% and specificity was 95%. After systemic steroid treatment, the amount of nasal secretion was decreased significantly. CONCLUSION: FPT showed almost the same sensitivity and the specificity compared to HCT, and appeared to be a valid test to assess the nasal hyperreactivity. These findings imply that FPT is technically easy and reliable, and a valid test to assess nasal hyperreactivity in allergic patients.

A Case of Osteomyelitis of the Maxilla with Associated Aspergillosis / 대한이비인후과학회지

Osteomyelitis of the maxilla is a relatively rare disease. Although the advent of antibiotics has decreased its incidence and morbidity significantly, osteomyelitis still remains a potentially dangerous condition because of the possible risk of intracerebral complications. Clinically, patients present facial swelling, localized pain and tenderness, low-grade fever, draining sinus tracts, suppuration, dental loss, and sequestrum formation. We experienced a case of osteomyelitis of the maxilla with associated aspergillosis. In this paper, we report this case with a review of literature.

A Rat Model of Rhinosinusitis induced by Platelet Activating Factor (PAF) / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Platelet activating factor (PAF), a biologically active phospholipid, has been known to be a potent inflammatory mediator especially in allergic inflammation. However, the exact role of PAF in the pathogenesis of rhinosinusitis has not been established yet. The aim of this study was to develop a rat model of rhinosinusitis induced by PAF. MATERIALS AND METHODS: Rats (4~6 week-old) were applied intranasally with 50 microliter of 16 microgram/ microliter PAF, while the control rats were applied with 50 microliter of 0.9% normal saline. After 1, 3 or 5 days, the rats were killed. The nasal sinuses were prepared for histological investigation. The histological section of the nasal sinuses were examined in a blind manner for the number of nasal sinus cavity occupied by neutrophil clusters, and for the number of eosinophils, goblet cells, epithelial loss and iNOS positive inflammatory cells per high power field (x400) of sinus mucosa. RESULTS: Infected rats killed at 3days had significantly more sinus area occupied by neutrophil clusters, and significantly more eosinophils, goblet cells, epithelial loss and iNOS positive inflammatory cells within the mucosa. CONCLUSION: Topically applied PAF induces acute rhinosinusitis in rats as measured by neutrophil clusters, eosinophils, goblet cells, epithelial loss and iNOS positive inflammatory cells. This study proves a rat model of acute rhinosinusitis.

An Immunohistochemical Tracing on the Central Neural Pathways of the Spinal Accessory Nerve using Pseudorabies Virus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVE: The transsynaptic transfer of neurotropic viruses is an effective tool for tracing chains of connected neurons because the replication of virus in the recipient neurons after transfer amplifies the "tracer signal". The purpose of study was to identify the location of spinal nucleus of the accessory nerve and the central neural pathways using Bartha strain of Pseudorabies virus (PRV-Ba), as a transsynaptic tracer. MATERIALS AND METHODS: PRV-Ba was injected into the sternocleidomastoid muscle of a rat, and the localization of PRV-Ba in the rat spinal cord and CNS was identified with light microscopic immunohistochemistry using primary antibodies against the PRV-Ba. RESULTS: Sequential tracing of retrogradely labeled cells was done. The shapes of positive immunoreactive cells were mostly ovoid or polygonal, and were shown in the spinal nucleus of the accessory nerve, nucleus ambiguus, paraventricular nucleus, and the primary motor area of cerebral cortex. CONCLUSIONS: These results showed the location of spinal accessory nucleus and the central neural pathways of spinal accessory nerve using PRV-Ba.

An Immunohistochemical Tracing on the Central Neural Pathways An Immunohistochemical Tracing on the Central Neural Pathways / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The transsynaptic transfer of neurotropic viruses is an effective tool for tracing chains of connected neurons, because replication of virus in the recipient neurons after the transfer amplifies the "tracer signal". The aim of this study is to identify the central neural pathways projecting to the facial nerve using the Bartha strain of the Pseudorabies virus (PRV-Ba )as a transsynaptic tracer. MATERIALS AND METHODS: PRV-Ba was injected into the facial nerve in the stylomastoid foramen of a rat, and was localized in the rat brain with light microscopic immunohistochemistry using primary antibodies against the PRV-Ba. Sequential tracing was carried out on the retrogradely labeled neurons were done. RESULTS: The shapes of upper motor neurons of facial nerve were mostly ovoid or polygonal. The positive immunoreactive cells observed in the brainstem nuclei included raphe obscurus nucleus, facial nucleus, parvocellular reticular nucleus, spinal trigeminal nucleus, ventral parabrachial nucleus, central gray, and dorsal raphe nucleus. Other positive cells stained in the diencephalon were found in periventricular hypothalamic nucleus, dorsal hypothalamic area, orbital gyri, and infralimbic cortex in the frontal lobe. CONCLUSIONS: These results show the central neural pathways of facial nerve using PRV-Ba.

Malignant Melanoma of the Lacrimal Sac / 대한이비인후과학회지

Malignant melanoma of the lacrimal sac is extremely rare. There are only 22 cases that have been reported in the world literature. One report in Korea concerned a 56 year old man presenting a 1.5-year history of bloody and purulent ocular discharge from the right eye. Chocolate colored bloody discharge appeared when pressing on the right medial canthus. Cytological examination of bloody discharge suggested malignant melanoma. A dacryocystogram showed obstruction of blood flow in the right nasolacrimal duct. CT scan showed a soft tissue density in the right lacrimal sac without any associated bony destruction. Medial maxillectomy inc1uding dacryocystectomy and postoperative irradiation were done. The patient is currently 5 months after surgery with no evidence of recurrence. Prognosis of malignant melanoma of lacrimal sac is very poor. Thus, early diagnosis and treatment is important.

Nitric Oxide Synthase Inhibitor Inhibits Platelet Activating Factor: Induced Microvascular Leakage in Rat Nasal and Tracheal Mucosa / 대한이비인후과학회지

BACKGROUND AND OBJECTIVE: Platelet-activating factor (PAF), a potent chemical mediator in inflammation and allergic reaction, induces microvascular leakage in several tissues. In rat airways, PAF-induced microvascular leakage is not dependent on cyclooxygenase or lipoxygenase products nor on circulating platelets, and it is probably mediated by receptors on vascular endothelium. Nitric oxide (NO), first identified as endothelium-derived relaxing factor, has been reported recently to be an important mediator of the neurogenic vascular exudative process. The aim of this study was to investigate the role of NO in PAF-induced microvascular leakage in rat nasal and tracheal mucosa. METHODS: PAF (1 ug/kg) was injected intravenously to induce microvascular leakage. The degree of microvascular leakage was measured with the amount of extravasated Evans blue (30 mg/kg) using both spectrophotometry and fluorescence microscopy. Five Sprague-Dawley rats were pretreated with Nw-nitro-L -arginine methyl ester (L-NAME, 10 mg/kg, intravenously, 1 hour before the injection of PAF) to inhibit the NO synthase, while four control rats(n=4) were pretreated with normal saline. RESULT: The average amounts of extravasated Evans blue in the nasal mucosa and trachea of the control rats were 24.789 and 28.238 ug/mg wet tissue, and those of the L-NAME pretreated rats were 6.643 and 6.987 ug/mg wet tissue respectively. Tissue sections of the L-NAME pretreated rats showed a definitely decreased extravasation of Evans blue under fluorescence microscopy. CONCLUSION: Pretreatment with L-NAME clearly inhibited PAF-induced microvascular leakage in the nasal and tracheal mucosa of rat. This finding implies that NO may mediate PAF-induced microvascular leakage in rat airways.

Enhancement of Microvascular Leakage in the Nasal Mucosa after Re-exposure to Capsaicin in a Rat Model Challenged/Rechallenged with Capsaicin

It has been suggested that the role of neurogenic inflammation is to protect the airway from various noxious irritants in inhaled air. Repeated exposure to various irritating stimuli has become very common in daily life. However, the process that occurs in neurogenic inflammation after repeated exposure to irritating stimuli is not yet clearly understood. The aim of this study was to investigate the changes of microvascular leakage in the airways after re-exposure to capsaicin in an experiment using a rat model challenged/rechallenged with capsaicin. Twenty-four Sprague-Dawley rats were divided into four groups : a capsaicin-challenged group (10 microgram/kg of capsaicin, intravenous, n=6) and three capsaicin-rechallenged groups (10 microgram/kg of capsaicin, intravenous, n=6 in each group) corresponding to time intervals of 1, 3, or 6 hours after capsaicin-challenge. The amount of microvascular leakage in the nasal mucosa and trachea of the animal in each group was measured with extravasation of Evans blue dye (30 mg/kg, intravenous) using a spectrophotometer. In the nasal mucosa, a significant enhancement of microvascular leakage with capsaicin-rechallenge was observed at 3 hours after capsaicin-challenge (AVOVAR, * : p<0.01). However, there was no significant changes in the trachea. In conclusion, the protective mechanisms against repeated irritating stimuli in the nasal mucosa and trachea are different. After exposure to a noxious irritant, the airway defense mechanism mediated by an axon reflex in the nose may be up- regulated, while that in the trachea may not be changed.

Retrospective Analysis of Acute Laryngeal Trauma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Acute laryngeal trauma is a very rare injury. Controversy still exists in regards to its proper management. The aim of this study was to present clinical findings and management of acute laryngeal trauma. MATERIALS AND METHODS:We analyzed medical records of 15 patients with acute laryngeal trauma from 1987 to 1997 retrospectively. RESULTS: The most common cause of injury was traffic accident. Hoarseness (93.3 %), odynophagia (86.7 %), subcutaneous emphysema (60.0 %) were the common presenting symptoms and thyroid cartilage was the most common site of fracture. The correlation between dyspnea (p=0.03) and subcutaneous emphysema (p=0.08) and major injury was high. Esophageal examination was performed on 11 patients and revealed no injury. All four patients with vocal cord palsy and minor injury findings improved. Patients with major injury showed bad results of airway and voice, and result of voice was worse that of airway. CONCLUSION: If presenting symptoms are emphysema and dyspnea, major injury should be considered. Routine esophageal examination may be skipped in blunt minor injury. Vocal cord palsy with minor injury finding may not be an operative indication in blunt injury.

Megadose Steroids and Intranasal Optic Nerve Decompression in the Treatment of Traumatic Optic Neuropathy

BACKGROUND AND OBJECTIVES: Traumatic optic neuropathy (TON) is a relatively rare complication associated with closed head injury. However, it represents an extremely poor prognosis, and its management remains controversial. We present the treatment results of 15 patients with immediate and complete TON who were treated with megadose steroids (MDS), and, in cases where MDS produced no response, intranasal optic nerve decompression (OND). PATIENTS AND METHODS: The diagnosis of TON was based on evidence of the following : complete loss of vision, absence of direct pupillary light reflex and intact consensual response. All of the patients underwent high resolution CT scans of the orbit and received a complete neuro-opthalmologic examination. MDS was started immediately after the diagnosis. If no response occurred by 48 hours, an intranasal OND was conducted. RESULTS: Two of the 15 patients exhibited improved vision after treatment with MDS, and six of the remaining 13 patients who were unresponsive to MDS demonstrated improved vision after OND. Overall, eight out of the 15 patients experienced improved vision. CONCLUSION: This study is uncontrolled, but suggests that our protocol of MDS and, in cases where this produced no response, OND may be an effective and valid treatment modality for patients with immediate complete TON, which is generally believed to represent an extremely poor prognosis regardless of treatment.

Localization of Vasoactive Intestinal Polypeptide-Containing Nerve Endings in Guinea Pig Nasal Gland by Transmission Electron Microscopy / 대한이비인후과학회지

Vasoactive intestinal polypeptide(VIP), 28-amino acid peptide extracted from porcine duodenum first, has been known as a potent vasodilator. And, VIP is also one of the important neurotransmitters in autonomic pathways affecting secretion and vascular tone of the airway. The purpose of present study is to localize the VIP-containing nerve endings in the nasal gland of the guinea pig at ultrastructural level. For immunoelectron microscopy, adult guinea pigs(300-400g B.W.) were perfused with Zamboni fixative through the aorta and the nasal septum were removed. 20nm cryosections were made for immunocytochemistry using rabbit anti-VIP and ABC methods. After DAB reaction, sections were processed for pre-embedding method, and 70nm ultrathin sections were cut. Routine uranyl acetate and lead citrate staining were employed, and immunoreactivity was observed under transmission electron microscope. VIP-containing nerve endings were located in cytoplasmic interdigitation between acinar cells, and also found along the basal surface of the acini, excretory ducts, and myoepithelial cells as well. These findings imply that VIP might be involved in secretory activity of the nasal gland of the guinea pig.

A Case of Pseudoaneurysm in Neurofibromatosis Type I / 대한이비인후과학회지

Neurofibromatosis type I(NF-1) is a genetic disorder that usually identified clinically by cafeau-lait spots, and cutaneous neurofibromas. Vascular abnormalities are also associated with von Rechlinghausen neurofibromatosis. Whereas renal and gastrointestinal system lesions are common, involvement of the craniocerebral vessels is relatively rare. More than 85% of the reported lesions are of a purely occlusive or stenotic nature, including progressive arterial occlusive disease. Aneurysms are the second most frequently reported vascular abnormality in NF-1. Recent reported cases of extracranial vertebral artery aneurysms and carotid artery aneurysms have been treated by endovascular detachable balloon technique, and yielded good result. The authors experienced a case of pseudoaneurysm in NF-1 patient who complained of sudden-onset neck swelling. That was identified by doppler sonography, and then angiographic embolization was done.

Three Cases of Bilateral Semicircular Canal Aplasia with Normal Cochlear Development in the Same Family Member / 대한이비인후과학회지

Semicircular canal aplasia is rare congenital inner ear anomaly. During embryogenesis, congenital malformation of vestibular labyrinth usually associates with cochlear anomalies. Two cases of semicircular canal aplasia with normal or near-normal cochlear development was reported in the English literature. We present three patients with computed tomographic findings of bilateral total semicircular canal aplasia with normal cochlear development in the same family member. Two patients had significant conductive hearing loss due to congenital stapedial anomalies and the other was congenital deafmute. Temporal bone CT scan revealed total absence of the semicircular canals bilaterally and both cochleas were normal in three cases.

Clinical Features and Significance of Screening Test in Distant Metastases of Head and Neck Squamous Cell Carcinomas / 대한이비인후과학회지

BACKGROUND: As treatment of head and neck cancer has improved, the trend showed that distant metastases(DMs) have become an increasingly common cause of death. Knowing about the presence of DMs is important for deciding treatment protocol. OBJECTIVES: The purpose of this study was to identify tumor characteristics(site of primary tumor, TNM staging, tumor differentiation) of head and neck squamous cell carcinoma related to higher incidence of DMs and determine the accuracy of blood test(alkaline phosphatase, calcium, LFT) in detection of DMs. MATERIALS AND METHODS: A retrospective review was carried out on 74 patients of 134 patients admitted to department of Otolaryngology, Gyeongsang National University Hospital from January 1987 to June 1994. RESULTS: The review revealed 21 DMs in 18 patients. DMs occurred in 18(24.3%) of 74 patients. Lung(47.6%) and bone(42.9%) were common DM site. As site of primary tumor, pharynx increased the incidence of DMs more than larynx, PNS & nasal cavity and oral caity. The incidence of DMs was increased in patients who had tumors of advanced T stage, N stage, Stage(statistically significant, p<0.05) and poor histologic differentiation(statistically insignificant, p=0.11). CONCLUSION: Abnormal alkaline phosphatase and hypercalcemia showed low sensitivity(56% and 0%) for detection of bone metastases. So blood tests(alkaline phosphatase, calcium) may be not useful for screening test for bone metastases. But the sensitivity of abnormal LFT was insignificant due to only one case of liver metastases in our study.

Dynamic CT Findings of Bilateral Castleman Disease in the Neck: A Case Report

We present a case of hyaline vascular type Castleman disease involving the bilateral cervical lymph nodes. To our knowledge, no previous case of this localized form of the disease has been reported. Dynamic CT demonstrated a hypervascular pattern of enhancement, with central less enhanced areas that corresponded histologically to fibrosis. For the diagnosis of this uncommon lymph node disease, these findings might be helpful.

Pleomorphic Adenoma Arising from Heterotopic Salivary Gland Tissue in the Neck: A Case Report

We report a rare case of pleomorphic adenoma arising from heterotopic salivary gland tissue in the upper neck. Although it is difficult to differentiate this condition from lymph node diseases-including metastasis- on the basis of radiologic findings alone, it should be included in the differential diagnosis of a solitary unilateral solid cervical mass, particularly one in the upper neck.

Odontogenic Versus Nonodontogenic Deep Neck Space Infections: CT Manifestations

PURPOSE: The purpose of this study was to evaluate computed tomographic (CT) findings of deep neck space infection(DNSI) with particular attention to the differences in the spaces involved and in complications between odontogenic and nonodontogenic groups. MATERIALS AND METHODS: Forty-four patients(21 odontogenic and 23 nonodontogenic) were included in this study. Among odontogenic DNSls, 15 had the dental infection in the second or third mandibular molar. We compared the CT features between odontogenic and nonodontogenic DNSIs with special emphasis on the differences in the spaces involved and in the rate and type of complications. RESULTS: In all patients, CT clearly differentiated abscess from cellulitis. The most common spaces involved in 21 patients with odontogenic DNSl were the parapharyngeal(n=18), the submandibular(n=18), the anterior visceral(n=13), the masticator(n=9), and the sublingual(n=7) spaces. In contrast, in 23 patients with nonodontogenic DNSI, the anterior visceral space(n=14) was most frequently involved. The parapharyngeal, the submandibular, and the masticator spaces were statistically more frequently involved in odontogenic than in nonodontogenic DNSI(p<.05). Twenty-two patients had one or more complications shown by CT, of which airway compromise was more frequent and severe in odontogenicthan in nonodontogenic DNSI. CONCLUSION: We conclude that the parapharyngeal, the submandibular, and the masticator spaces are more significantly vulnerable in odontogenic DNSl than in nonodontogenic DNSl. The predilection for certain spaces of the neck in odontogenic DNSl seems to originate from the intimate relationship of the mandibular molars to the adjacent deep neck spaces.

Odontogenic Versus Nonodontogenic Deep Neck Space Infections: CT Manifestations

PURPOSE: The purpose of this study was to evaluate computed tomographic (CT) findings of deep neck space infection(DNSI) with particular attention to the differences in the spaces involved and in complications between odontogenic and nonodontogenic groups. MATERIALS AND METHODS: Forty-four patients(21 odontogenic and 23 nonodontogenic) were included in this study. Among odontogenic DNSls, 15 had the dental infection in the second or third mandibular molar. We compared the CT features between odontogenic and nonodontogenic DNSIs with special emphasis on the differences in the spaces involved and in the rate and type of complications. RESULTS: In all patients, CT clearly differentiated abscess from cellulitis. The most common spaces involved in 21 patients with odontogenic DNSl were the parapharyngeal(n=18), the submandibular(n=18), the anterior visceral(n=13), the masticator(n=9), and the sublingual(n=7) spaces. In contrast, in 23 patients with nonodontogenic DNSI, the anterior visceral space(n=14) was most frequently involved. The parapharyngeal, the submandibular, and the masticator spaces were statistically more frequently involved in odontogenic than in nonodontogenic DNSI(p<.05). Twenty-two patients had one or more complications shown by CT, of which airway compromise was more frequent and severe in odontogenicthan in nonodontogenic DNSI. CONCLUSION: We conclude that the parapharyngeal, the submandibular, and the masticator spaces are more significantly vulnerable in odontogenic DNSl than in nonodontogenic DNSl. The predilection for certain spaces of the neck in odontogenic DNSl seems to originate from the intimate relationship of the mandibular molars to the adjacent deep neck spaces.