Urinary Concentration Defect and Renal Glycosuria in Cyclosporine-treated Rats

Background@#Urinary concentration impairment is a major feature of cyclosporine nephrotoxicity. @*Methods@#We explored two possible mechanisms that may underlie cyclosporineinduced polyuria; water, and/or osmotic diuresis. Cyclosporine was subcutaneously injected to normal salt-fed Sprague-Dawley rats at a daily dose of 25mg/kg for 2 weeks (Experiment I) and 7.5mg/kg for 6 weeks (Experiment II). @*Results@#In Experiment I, cyclosporine treatment caused an increase in urine volume (2.7±0.5 vs. 10.3±1.13mL/d/100 g BW, p<0.001) and a decrease in urine osmolality (2,831±554 vs. 1,379±478mOsm/kg H2O, p<0.05). Aquaporin-2 (AQP2) protein expression decreased in cyclosporine-treated rat kidneys (cortex, 78±8%, p<0.05; medulla, 80±1%, p<0.05). Experiment II also showed that urine volume was increased by cyclosporine treatment (4.97±0.66 vs. 9.65±1.76mL/d/100 g BW, p<0.05). Whereas urine osmolality was not affected, urinary excretion of osmoles was increased (7.5±0.4 vs. 14.9±1.4mosmoles/d/100 g BW, p<0.005). Notably, urinary excretion of glucose increased in cyclosporine-treated rats (7±1 vs. 10,932±2,462 mg/d/100 g BW, p<0.005) without a significant elevation in plasma glucose. In both Experiment I and II, GLUT2 protein expression in the renal cortex was decreased by cyclosporine treatment (Experiment I, 55±6%, p<0.005; Experiment II, 88 ±3%, p<0.05). @*Conclusion@#Both water diuresis and osmotic diuresis are induced by cyclosporine nephrotoxicity. AQP2 and GLUT2 downregulation may underlie water and osmotic diuresis, respectively.

Urinary Concentration Defect and Renal Glycosuria in Cyclosporine-treated Rats

Background@#Urinary concentration impairment is a major feature of cyclosporine nephrotoxicity. @*Methods@#We explored two possible mechanisms that may underlie cyclosporineinduced polyuria; water, and/or osmotic diuresis. Cyclosporine was subcutaneously injected to normal salt-fed Sprague-Dawley rats at a daily dose of 25mg/kg for 2 weeks (Experiment I) and 7.5mg/kg for 6 weeks (Experiment II). @*Results@#In Experiment I, cyclosporine treatment caused an increase in urine volume (2.7±0.5 vs. 10.3±1.13mL/d/100 g BW, p<0.001) and a decrease in urine osmolality (2,831±554 vs. 1,379±478mOsm/kg H2O, p<0.05). Aquaporin-2 (AQP2) protein expression decreased in cyclosporine-treated rat kidneys (cortex, 78±8%, p<0.05; medulla, 80±1%, p<0.05). Experiment II also showed that urine volume was increased by cyclosporine treatment (4.97±0.66 vs. 9.65±1.76mL/d/100 g BW, p<0.05). Whereas urine osmolality was not affected, urinary excretion of osmoles was increased (7.5±0.4 vs. 14.9±1.4mosmoles/d/100 g BW, p<0.005). Notably, urinary excretion of glucose increased in cyclosporine-treated rats (7±1 vs. 10,932±2,462 mg/d/100 g BW, p<0.005) without a significant elevation in plasma glucose. In both Experiment I and II, GLUT2 protein expression in the renal cortex was decreased by cyclosporine treatment (Experiment I, 55±6%, p<0.005; Experiment II, 88 ±3%, p<0.05). @*Conclusion@#Both water diuresis and osmotic diuresis are induced by cyclosporine nephrotoxicity. AQP2 and GLUT2 downregulation may underlie water and osmotic diuresis, respectively.

Sick Sinus Syndrome Following Severe Hyponatremia Associated with Desmopressin Therapy / 대한내과학회지

Desmopressin diacetate arginine vasopressin (DDAVP) is a synthetic analogue of the arginine vasopressin that is widely used in the treatment of diabetes insipidus, nocturnal enuresis, and polyuria. Although it is generally well-tolerated, DDAVP can cause hyponatremia, especially in elderly patients. There are many reports of DDAVP-induced hyponatremia, but there has been only one case report in which sinus node dysfunction was caused by severe hyponatremia. Here we report a case of sick sinus syndrome that occurred during an episode of severe hyponatremia induced by chronic use of desmopressin in a 91-year-old man who had nocturnal enuresis.

A Case of Jacobson's Nerve Schwannoma Extending into the External Auditory Canal / 대한이비인후과학회지

Schwannomas are slow-growing, benign neurogenic tumors arising from schwann cells. Their localization in the external auditory canal and the middle ear has rarely been reported. The authors experienced a very rare case of Jacobson's nerve schwannoma that extended into the external auditory canal in a 55-year-old woman. The tumor eroded the wall of the cochlear promontory and exposed the membranous labyrinth. The jugular foramen and the wall of the ear canal were preserved without destruction. This report represents the first documented case of a Jacobson's nerve schwannoma, which involved the external auditory canal.

A Case of Benign Fibrous Histiocytoma of the Nasal Dorsum

Benign fibrous histiocytoma is a mesenchymal tumor that has been described as a benign neoplasm composed of fibroblasts and histiocytes. The occurrence of this lesion of the head and neck has been rarely reported. We experienced a case of benign fibrous histiocytoma on the nasal dorsum in a 53-year-old female. During physical examination, we found 1x1-cm-sized bilateral mass on the nasal dorsum. Excision and Z-plasty were performed, and recurrence was not observed for 12 months after operation. We present this rare case with review of the clinical and pathological features.

Genetic Characteristics and Phylogenetic Analysis of Influenza Type B Viruses Isolated from Nasopharyngeal Suction Samples of Korean Patients

To investigate the genetic characteristics of human influenza type B viruses circulating in Chungbuk province, Korea, we tested 510 clinical samples of nasopharyngeal suction from pediatric patients diagnosed with respiratory illness between June 2007 and June 2008. Twelve out of thirty-six isolates were identified as type B influenza virus by RT-PCR and sequencing analysis. Interestingly, genetic characterization of type B viruses isolated in this study revealed that all type B influenza viruses were the Yamagata lineages, a vaccine strains of southern hemisphere during 2007~2008, rather than the Victoria lineage of northern hemisphere during 2007~2008. Furthermore, there were a total of twelve unique mutations (HA: H40Y, D/G230S, V252M and K272R and NA: P3H, P/T/S42Q, N59S) occurred in our type B isolates. These results suggest that relative high prevalence of type B viruses in Korea during 2007~2008 season might be due to the wrong vaccine strains selection. Taken together, the results of this study demonstrate continuous evolutions of human type B viruses by antigenic drift and also highlight the need to closely monitoring of influenza viruses to aid the early detection of potentially pandemic strains as well as underscore the need for new therapeutics.

Significance of the Expression of Tumor Markers in Adenoid Cystic Carcinoma and Pleomorphic Adenoma of the Salivary Gland / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Salivary gland tumors are characterized by extreme histological diversity. Even within a single tumor, various histological patterns are observed. The same histological patterns are shared among various tumor types, regardless of the biological behavior, making diagnosis difficult. Although a great number of immunohistochemical studies of major salivary gland tumors have been published, their clinical and diagnostic implications are not fully apparent. We have performed basic immunohistochemical stains of pleomorphic adenoma (PA) and adenoid cystic carcinoma (ACC) to determine the diagnostic value of c-kit, Ki-67, glial fibrillary acidic protein (GFAP) and p53. MATERIALS AND METHOD: Paraffin-embedded tissue specimens from 48 cases, who were diagnosed as PA (n=31) and ACC (n=17) from 1993 to 2002, were immunohistochemically stained for c-kit, Ki-67, GFAP and p53. RESULTS: In the immunohistochemical stains of c-kit, Ki-67 and p53, there were no difference between PA and ACC. However, in the immunohistochemical stain of GFAP, there were difference in PA and ACC. GFAP was expressed in 74% of the PA and was not expressed in all cases of ACC. CONCLUSION: These data suggest that GFAP immunoreactivity could be helped in the occasional differential diagnostic dilemma of pleomorphic adenoma versus adenoid cystic carcinoma in salivary gland.

The Significance of Connexin 26 Expression in Squamous Cell Lesions of the Larynx / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Gap junctional intercellular communication (GJIC) is a mechanism for direct cell to cell signalling and is mediated by gap junctions, which consist of transmembrane proteins called connexins (Cxs). The authors investigated the role of connexin 26 as a biomarker that helps diagnose laryngeal squamous cell lesions. SUBJECTS AND METHOD: Paraffin-embedded tissue specimens from 50 patients, who were diagnosed with laryngeal invasive squamous cell carcinoma (n=15), carcinoma in situ (n=10), dysplasia (n=15), and non-neoplastic epithelial hyperplasia (n=10) between 1993 and 2005, were immunohistochemically stained for connexin 26 protein. RESULTS: Intracytoplasmic positive expression of connexin 26 was found in 100% of invasive squamous cell carcinoma and in 20% of carcinoma in situ. However, in dysplasia and hyperplasia, there were no positive expressions. Moreover, the majority of intercellular or membranous staining tended to decline in dysplasia, carcinoma in situ, and squamous cell carcinoma. CONCLUSION: These results suggest that aberrant expression of connexin 26 in laryngeal squamous cell lesions can be associated with tumorigenesis and invasion. Further studies are needed to investigate these expressions of connexin 26 and that it may represent more aggressive pathology of the larynx.

A Case of Maxillary Venous Hemangioma with Invasion to Hard Palate and Nasal Cavity / 대한이비인후과학회지

Hemangiomas are common benign soft tissue tumors in the head and neck, but they occur infrequently in the sinonasal cavity. Capillary, cavernous, mixed, and venous types of hemangiomas have been described. Venous hemangiomas are less commonly seen and are composed of thickened blood vessels that can still be recognized as veins. Chief symptoms are recurrent epistaxis and nasal obstruction; if the tumor becomes large, it may cause adjacent bony erosion. Preoperative diagnosis of maxillary sinus hemangioma is important since these lesions can frequently cause a large amount of hemorrhage during surgery. We report a case of a 80-year-old woman with a huge tumor in the maxillary sinus and oral cavity that was histopathologically diagnosed as venous hemangioma.

Clinical Study of Deep Neck Infection / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The incidence of deep neck infection has decreased after the introduction of antibiotics and improvement of oral hygiene, but it may still be lethal especially when life-threatening complications occur. The objective of this study is to clarify the presenting signs and symptoms, clinical course, microorganisms, and management of deep neck infections. SUBJECTS AND METHOD: We retrospectively reviewed the records of 134 patients who were diagnosed with deep neck infection and who received treatment at the Chosun University Hospital between 1996 and 2005 for the analysis of age and sex, distribution related to spaces involved, the location of cellulitis and abscess, the side of lesion, the symptoms and signs, the etiologic events, the associated conditions, the result of culture, and the treatments. Peritonsillar abscesses were excluded from this study. RESULTS: The parapharyngeal space and extended space were the most commonly involved space of deep neck infections, followed by submandibular space, retropharyngeal space, and Ludwig's angina. The most common pathogens found were Streptococcus, followed by Klebsiella and Staphylococcus. In diabetic patients, Klebsiella pneumoniae was the most common causative pathogen. Peptostreptococcus was the most common anaerobic pathogen. CONCLUSION: Initial management including trial of proper empirical antibiotics is important. According to the culture and antibiotic sensitivity test in this study, a combined therapy of amoxicillin/clavulanic acid and metronidazole is useful in polymicrobial deep neck infection.

The Significance of CD44v3 Expression in Squamous Cell Lesions of the Larynx / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is known that a part of laryngeal premalignant lesions progresses to an invasive carcinoma. Despite many previous reports, conventional histology is not sufficient to predict such tumor progression. Herein, the authors investigated the role of CD44v3 as a biomarker in predicting the progression of laryngeal premalignant lesion to an inavasive cancer. SUBJECTS AND METHOD: Paraffin-embedded tissue specimens from 40 patients were diagnosed accordingly as laryngeal invasive squamous cell carcinoma (n=10), Carcinoma in situ (n=10), dysplasia (n=10), and hyperkeratosis (n=10) between 1993 and 2002. They were immunohistochemically stained for CD44v3 protein. RESULTS: In invasive squamous cell carcinoma, the expression of CD44v3 was diffused and gave a strong positive stain, and in carcinoma in situ, it was diffused and gave 3+-2+ stain. However, in dysplasia and hyperkeratosis, the proportion of CD44v3 expression was decreased by 2+-1+, and 1+-0, respectively. CONCLUSION: These results suggest that the expression of CD44v3 in laryngeal premalignant and malignant lesions can be associated with tumorigenesis and invasion. Those strong positive expressions of CD44v3 may represent more aggressive pathology of the larynx.

A Case of Inflammatory Myofibroblastic Tumor of the Maxillary Sinus / 대한이비인후과학회지

Inflammatory myofibroblastic tumor (inflammatory pseudotumor) is a term used to describe the space occupying the neoplastic lesion rather than the inflammatory lesion. Its occurrence in the maxillary sinus is rare. The etiology and pathophysiology of the maxillary inflammatory myofibroblastic tumor is unknown. The diagnosis must be based on histological evidence to exclude other disease. We report a case of a 72-year-old patient with maxillary and nasal cavity inflammatory myofibroblastic tumor that simulated an invasive neoplasm in its clinical presentation, Radiologic findings showed near total coagulation necrosis histopathologically.

Clinical Study of Rhinocerebral Mucormycosis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Rhinocerebral mucormycosis is recognized as a potentially aggressive and commonly fatal fungal infection. The classic presentation involves nasal mucosa and the invasion of the paranasal sinuses and orbit. Treatment includes aggressive debridement, systemic antifungal therapy, and control of underlying comorbid factors. This study aimed to investigate the clinical feature of rhinocerebral mucormycosis and to determine relationships among the underlying disease, extent of mucormycosis, initial time of surgical intervention and prognosis. SUBJECTS AND METHOD: Five cases of mucormycosis were retrospectively reviewed. Prognosis was analyzed according to predisposing factors including the underlying disease, extent of disease and intial time of surgical intervention. Resuits: A 5-year overall survival rate of the patients with mucormycosis was 60%. There was significant survival gain in the group for which the underlying disease was well controlled and extent of disease was limited, No significant difference in survival was observed according to duration between symptom onset and surgical intervention. CONCLUSION: Survival is usually determined at the very early period of treatment. The most important prognostic factor is optimal control of the underlying disease and extent of disease.

A Case of Giant Malignant Clear Cell Hidradenoma / 대한이비인후과학회지

Originating in the eccrine gland and occurring mostly in those above 50 years-old, malignant clear cell hidradenoma is a very rare type of tumor, compared to the common benign hidradenoma. To the author's knowledge, there have been only 4 cases reported worldwide of the malignant transformation, especially in nodular hidradenomas. Clinical manifestation of malignant clear cell hidradenoma includes an appearance of a single tumor generally in either extremities or head, which prevails for a long period and then suddenly enlarges from external stimuli, such as trauma, electrical cauterization or incomplete excision. With its aggressive behavior, it frequently recurs after surgical excision and has high tendency for regional and distant metastasis. We report on our experience on a 75 year-old woman with a 15*7*8 cm malignant clear cell hidradenoma, a malignant tranformation in the long standing nodular hidradenoma, in the right postauricular region and the parotid gland region.

Leiomyosarcoma of the Larynx / 대한이비인후과학회지

Leiomyosarcoma is a malignant tumor that originates in the smooth muscle tissues and represents 5-10% of all soft-tissue sarcomas. It is most often found in the uterus, retroperitoneum, wall of the gastrointestinal tract, and subcutaneous tissue. Leiomyosarcomas of the larynx are extremely rare. Recently, we experienced a case of leiomyosarcoma of the larynx in a 82- year-old man who was considered initially to have as a benign tumor. Therefore we report a case of leiomyosarcoma of the larynx with a review of literature.

The Study of the Pathogenesis of Middle Ear Cholesteatoma with Immunohistochemical Staining of Matrix Metalloproteinases, Extracellular Matrix Proteins and T Lymphocyte Distribution / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The exact pathogenesis of middle ear cholesteatoma is still unknown to some extent. Recently, however, advances of immunology have opened a new chapter in investigating the etiology and pathogenesis of cholesteatoma through immunohistochemical techniques. Matrix metalloproteinases (MMPs) are a group of enzymes thought to be responsible for both normal connective tissue matrix remodelling and the accelerated breakdown associated with tumor development. The aim of this study was to investigate the immunohistochemical expression of MMP-2, MMP-3, and MMP-9 in correlation with the expression of basement membrane antigen (laminin), fibronectin and T lymphocyte in middle ear cholesteatoma to compare them with those in external auditory canal skin as a control group. Material and Methods: The biopsy specimens of cholesteatomatous tissue and external auditory canal skin were obtained during undergoing the middle ear surgery. Immunohistochemical staining was carried out using monoclonal mouse antibodies against MMP-2, MMP-3, MMP-9, laminin, fibronectin and pan T lymphocyte (UCHL1) were used. RESULTS: The results are as follows: In cholesteatomatous tissue, a number of T lymphocytes were expressed and a large number of MMPs were expressed in the basal cell layer and in the stroma of cholesteatoma. Both MMP-2 and MMP-3 showed positive signals in the basal and parabasal cell layer. A strong expression of MMP-9 was shown in granuloma area. Expression of MMP-3 had a significant correlation with a distribution of T lymphocyte (r=-0.522, p<0.05). Expression of MMP-2 had a significant correlation with a distribution of laminin (r=0.662, p <0.05). CONCLUSION: These results indicate that spatial distribution of matrix metalloproteinases in the extracellular matrix show a specific relation to extracellular matrix molecules such as laminin, fibronectin and T-lymphocyte in middle ear cholesteatoma especially inflammatory and immune state.

Detection of Epstein-Barr Virus DNA in Oropharynx by Polymerase Chain Reaction / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The Epstein-Barr virus (EBV) is a human herpes virus which causes infectious mononucleosis and is associated with such human cancers as Burkitt's Lymphoma, Hodgkin's disease, non-Hodgkin's disease, and nasopharyngeal carcinoma. However, the role of EBV as a causative factor in other head & neck tumors is not fully elucidated. This study analyzed the detection rate of Epstein-Barr virus (EBV) in the throat washing samples from pateints with head and neck tumors and non-malignant diseases, as well as from normal subjects. MATERIALS & METHODS: The throat washing samples were collected from 49 patients of head & neck tumors, 52 patients of non-malignant diseases (pharyngitis and tonsillitis) and 24 normal subjects. The EBV DNA was detected by using the EBV (BNRF1)-specific primers & Polymerase Chain Reaction (PCR). RESULT: The EBV DNA was detected in 25 (51%) of the 49 throat washing samples from patients with tumors, as well as 3 (60%) of 5 samples from patients with nasopharyngeal carcinoma, and 22 (50%) of 44 samples from patients with head and neck tumors. The throat wasing samples from 52 patients with non-malignant diseases and 24 samples from healthy subjects were also examined. EBV was detected in 17 (32.7%) of 52 patients with non-malignant diseases and 3 (12.5%) of 24 samples from healthy subjects. CONCLUSION: These data indicate that the EBV may be related to non-malignant diseases and head and neck tumor.

Chronic injury to the distal ulnar growth plate / 대한정형외과학회잡지

No abstract available.