A Clinical Study on Benign Convulsions with Mild Gastroenteritis / 소아과

PURPOSE: 'Benign convulsions with mild gastroenteritis(BCwMG)' is afebrile seizures associated with gastroenteritis without dehydration or electrolyte imbalance in young children aged almost 6 months to 3 years. Because seizures can occur repeatedly, patients can be misdiagnosed with epilepsy. Therefore, understanding the characteristics of this disease is thought to be important. This study was carried out to investigate the clinical features of the disease. METHODS: From January, 2000 to December, 2003, 17 patients with BCwMG visited the Emergency Department, Inje University Ilsan Paik Hospital. We reviewed the clinical features of seizures, age and sex distribution, laboratory findings and follow-up results. RESULTS: Out of 17 patients with BCwMG, 13 were boys and five girls. Of 17 patients, 14(82.4%) patients were between 1 and 2 years of age. Generalized seizure was observed in all 17 patients. The duration of seizure was between 10 seconds and 10 minutes. Mean seizure frequency was 1.9 times(range, 1-5 times). Two or more seizures occurred in 10 patients(58.8%). All patients had seizures after the onset of gastroenteritis. All episodes occurred within the first five days of gastroenteritis. Rotavirus antigen was positive in stools in eight out of 12 patients(66.7%). Thirteen patients displayed normal psychomotor development at the last follow-up. No patient exhibited a the recurrence of seizures, except for one patient who had a febrile convulsion. CONCLUSION: Our results exhibited that BCwMG is characterized by seizures that are mostly brief and generalized and a cluster of episodes in those aged 1 to 2 years. Seizures occurred within the first three days of gastroenteritis. The proportion of positive rotavirus antigen was more than half.

A Clinical Study on the Etiologies of Acute Seizures in Children Who Visited Emergency Department / 소아과

PURPOSE: Although it is important to know the etiologies of childhood seizures according to age, clinical studies on this topic have been few. The present study was therefore designed to investigate the causes of acute childhood seizures. We hope this study will be helpful in the diagnosis and management of children with seizures. METHODS: This study was retrospectively undertaken to evaluate the age and sex distribution, the clinical seizure types, the seizure causes, and especially the frequencies of age-related seizure causes of 922 cases under 18 years of age, who visited Emergency Departments due to seizures from December, 1999 to January, 2004. RESULTS: The male to female ratio was 1.5 : 1 and the age range was from 1 day to 16 years, 2 months. There were 683 cases(74.1%) with generalized seizures, 61(6.6%) with partial seizures, and 178(19.3%) with unknown clinical seizure types. The causes of seizures were listed as follows : febrile convulsions in 545 cases(59.1%); epilepsies in 229(24.8%); benign convulsions with mild gastroenteritis in 19(1.6%); acute central nervous system infections in 15(1.6%); and metabolic derangements in six(0.7%). Finally, the frequencies of age-related seizure causes were analyzed. Out of 751 cases between 6 months and 5 years of age, 532 cases(70.8%) were febrile convulsions, 122(16.2%) epilepsies, 19(2.5%) benign convulsions with mild gastroenteritis, and 11(1.5%) acute CNS infections. Out of 145 cases among those over 5 years of age, 104 cases(71.7%) were epilepsies, 10(6.9%) febrile convulsions, and three(2.1%) acute CNS infections. CONCLUSION: The above results reveal that the causes of acute childhood seizures in the different age groups are different, and also suggest that febrile convulsion is the most common seizure cause between 6 months and 5 years of age, and epilepsy in more than 5 years of age. We hope that further clinical and epidermiologic studies on this topic will be performed.

CT Finding of Tuberculous Cervical Lymphadenitis and Management / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are controversies in the management of tuberculous cervical lymphadenitis in spite of high prevalence. This study was performed to investigate clinical findings of the patients indicated for surgery and to analyze clinical efficacies of surgery and antituberculous chemotherapy. Materials and METHODS: Fourty patients who had been pathologically confirmed to have cervical tuberculous lymphadenitis were analyzed retrospectively. We classified them into 4 groups according to CT findings and checked their clinical and laborotary findings, as well as efficacies of treatment used. RESULTS: The Type 4 was the most common. All patients were treated with antituberculous medication. In Type 1 and 2, 11 patients among 13 patients were treated with antituberculous medication alone, whereas in Type 3 and 4, 21 patients among 27 patients were treated with the combined method of surgery and antituberculous medication. Most complicated cases were Type 3 and 4, where two cases had recurrence, but most of the cases had local wound problems. All of these complicated cases had recovered to nearly normal state. Two recurrent cases were treated with the combined methods completely. CONCLUSION: For cases that fall into type 1 and 2 tuberculous cervical lymphadenopathys, Antituberculous medication can serve as the first line of treatment. For cases that fall into type 3 and 4 tuberculous cervical lymphadenopathy, the combined method of surgery and antituberculous medication can be the first choice of treatment. For the initial treatment of type 3, 4, applying antituberculous medication for a period of 1-2 months before surgical intervention would be a more effective treatment.

Two Cases of Palatal Island Flap for Reconstruction of Intraoral Defect / 대한이비인후과학회지

After intraoral tumor resection, various reconstructive surgeries have been used to repair the defect. Before the selection of procedure, we should consider the size of defect, the difficulty of operative procedure, operation time and viability of flap, donor site problem in intraoral reconstruction. Palatal island flap within or adjacent to the operative field can frequently provide the necessary tissue, especially, with the lesions of palatine arch, retromolar trigone, tonsillar fossa, and posterior third of the floor of the mouth. We got favorable cosmetic and functional results in two patients who underwent reconstruction with palatal island flaps for intraoral defect. This paper represents the versatility of the palatal island flap for intraoral reconstruction and to introduce our clinical experiences.

Intraluminal Invasion of Upper Aerodigestive Tract by Thyroid Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Thyroid carcinoma infrequently invades the upper aerodigestive tract. However, when invasion occurs, it is the source of significant morbidity and mortality. If the tumor extends into the lumen of the upper aerodigestive tract, more critical problems can happen. There have been much debates about surgical therapy of thyroid carcinoma invading the upper aerodigestive tract whether it should be radical or conservative. This study was designed to investigate the intraluminal extension of the upper aerodigestive tract by thyroid carcinoma and review the spectrum of radical resection. MATERIALS AND METHODS: From 1996 to 2000, six patients with thyroid carcinoma invading the upper aerodigestive tract (intraluminal involvement) were radically resected at Inha University Hospital. Clinical records were reviewed retrospectively. RESULTS: The radical resection consisted of a total thyroidectomy and a neck dissection, combined with radical excisions that included three laryngectomies, two laryngopharyngoesophargectomies, and a case of partial pharyngectomy. The histologic types consisted of 5 papillary carcinoma and 1 anaplastic carcinoma. There was one preoperative mortality. Five patients received radioactive iodine therapy postoperatively. One patient died of nodal recurrence at the 13th postoperative month, and 4 patients are still alive with a follow-up period of 19-52 months. CONCLUSION: Based on our results of these six patients who had intraluminal involvement of the upper aerodigestive tract, we suggest that radical resection might be a worthwhile procedure. But it should be considered that radical resection might cause loss of functions in the head and neck organs, and therefore possibilites of conservative resection should be considered throughly during the preoperative examination.

A Case of Malignant Proliferating Trichilemmal Tumor Occurring in Lower Lip / 대한이비인후과학회지

Proliferating trichilemmal tumor is one of rare benign tumors originating from the outer root of the hair follicle sheath. The tumor is clinically benign, although it can display nuclear atypia, dyskeratotic cells, and mitotic figures. These features can be misleading, and a false diagnosis of a squamous cell carcinoma is possible. An abrupt enlargement of size is suggestive of malignant changes of the tumor. We report a case of a malignant proliferating trichilemmal tumor which occurred not on the scalp but on the lower lip. A 75-year-old man presented a lower lip mass with a smooth surface, measuring 4.5X3 cm, and his right submandibular lymph node was also palpable. The tumor was widely excised with bilateral functional neck dissection, and the defect on the lip was reconstructed using radial forearm free flap including the palmaris longus tendon. No recurrence was observed during the follow-up period.

Treatment of Thoracic Tracheal Stenosis by Sternotomy Approach / 대한이비인후과학회지

BACKGROUND: The treatment for thoracic tracheal stenosis is somewhat different from cervical tracheal stenosis, because it needs approach to the thoracic cavity which contains vital organs such as heart and great vessels. The classic surgical approach to thoracic trachea has been either the posterolateral thoracotomy or through the median sternotomy approach, with the former being preferred to the latter. The purpose of this study is to determine the results of the sternotomy method to approach the thoracic cavity in the management of thoracic tracheal stenosis. MATERIALS AND METHODS: From 1996 to 1998, 4 patients with thoracic tracheal stenosis had surgical treatment through various sternotomy approach. A retrospective study was done about various postoperative values. RESULTS: There has been no operative mortality. Hospital stay ranged from 24 to 55 days (mean 38.5+/-12.9 days). No pulmonary complication occurred postoperatively. There were three cases of postoperative wound infection and mediastinitis. But all of them could be treated with early open drainage, debridement, and greater omentum free flap. And there was no postoperative mortality. CONCLUSIONS: In order to reduce postoperative infection, the strategy of median sternotomy can be used for thoracic tracheal stenosis, because it is simple, easy to perform, provides more physiological ventilation-perfusion condition during the operation and has short operation time, good operation field, low postoperative pulmonary complication rate, and short hospital stay.

A Case of Adenosqumous Carcinoma Ex Pleomorphic Adenoma of Hard Palate / 대한이비인후과학회지

Carcinoma ex pleomorphic adenoma is a carcinoma that shows histologic evidence of arising in or from a preexisting benign mixed tumor. We experienced a case of carcinoma ex pleomorphic adenoma arising in the hard palate with neck metastatasis. The patient was 48-year-old male presenting ovoid elevated palatal mass that has been present for 25 years and rapid growing left neck mass for 3 months. The overlying mucosal surface was ulcerated. The tumor was well marginated but focally tightly adherent to the adjacent tissue. The initial pathologic diagnosis of open biopsy specimen was invasive squamous cell carcinoma. After the total removal, the histologic examination revealed that the tumor was composed of adenosquamous carcinoma and benign pleomorphic adenoma. The adenosquamous carcinoma, where grandular and epithelial differentiation were seen in the same clump of cells, showed extensive stromal hyalinization with necrosis and calcification. The metastatic neck lesion showed only squamous cell carcinoma component without adenocarcinoma. We present a case of an unusual carcinoma ex pleomorphic adenoma with adenosquamous cell carcinoma in the hard palate and neck metastasis.

Acute Respiratory Failure Derived From Subglottic Stenosis in a Patient with Relapsing Polychondritis / 결핵

Relapsing polychondritis (RP) is rare, chronic, relapsing, and multisystemic inflammatory disease targeting the cartilaginous structures. Respiratory track involvement occurs in approximately half of the cases. Subglottic stenosis is a rare manifestation of RP. Here, we report a case of RP with a subglottic stenosis, resulting in acute respiratory failure. A 63-year old man was admitted complaining of multiple joint pain, general weakness, weight loss, throat pain, hoarseness, exertional dyspnea, and hearing difficulties. A laryngoscopy and neck CT revealed a subglottic stenosis. Four days after admission, he complained severe dyspnea resulting in acute respiratory failure. Immediately, a tracheostomy was done for airway preservation. After high dose steroid therapy, the general symptoms were improved. However, the subglottic stenosis was sustained. Thus, a laryngotracheal augumentation and stent insertion was performed. The speech valve was then replaced. The subglottic stenosis was managed with low dose steroid and monthly cyclophosphamide pulse therapy, and the patients has been followed up regularly.

Voice Comparison between Strap Muscle Retraction and Cutting Technique in Thyroidectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A voice analysis was carried out before and after thyroid surgeries without laryngeal nerve injury, between strap muscle retraction and cutting group in thyroid surgery. The study was done by means of questionaires, acoustics and aerodynamic analysis. MATERIALS AND METHODS: A total of fourty-two patients of whom thirty-eight are females and four are males were analyzed; hemithyroidectomy (19 cases) and total thyroidectomy (23 cases). Twenty-seven patients had undergone thyroidectomy via retraction of strap muscle and 15 patients had undergone thyroidectomy via cutting of strap muscle. For evaluation of voice, questionaires for changes of voice, acoustics (fundamental frequency, jitter, shimmer, noise to harmonic ratio, voice intensity, vocal range), and aerodynamic (maximal phonation time, mean flow rate and subglottal pressure) analyses were done. RESULTS: The subjective voice symptoms after thyroidectomy were disturbances of high pitch, loud voice and singing voice, and easy fatigue at phonation. These voice symptoms were related to the extent of surgery. Vocal range was the only diminished parameter in acoustic and aerodynamic analyses after thyroidectomy. There were significant differences in jitter on acoustic and aerodynamic analyses between the strap muscle retraction group and the cutting group. CONCLUSION:Voice alteration after thyroidectomy without laryngeal nerve injury may be associated with the disturbance of the extralaryngeal skeleton- laryngotracheal fixation with impairment of vertical movement or by temporal malfunction of the strap muscles. These voice problems were related to the extent of surgery and cutting of strap muscles.

Reconstruction of Glottis and Hyoppharynx using Radial Forearm - Palmaris Longus Composite Free Flap

Partial laryngectomy and pharyngectomy have been suggested for localized hypopharyngeal cancer to preserve the function of larynx. In case of limited partial laryngectomy, local soft tissue flaps are sufficient to provide adequate bulk for glottic closure. However, in case of extensive partial laryngectomy procedure in which more cartilaginous framework is resected, we feel an increased necessity of considering 'hard tissue' as well as soft tissue restoration to prevent airway collapse and glottic incompetency. We have tried radial forearm free flap including palmaris longus tendon for reconstruction of glottis and hypopharynx following a wide vertical hemilaryngopharyngectomy. We had 2 patients with hypopharyngeal cancers localized in pyriform sinus. The tendon was secured so as to drill holes in the cricoid and thyroid cartilage at the glottic level to help maintain the position of soft tissue lining and sewe as buttress for mobile vocal cord. A good restored phonation and respiration were obtained in two cases of hypopharyngeal cancer patients. But one patient suffered from frequent aspiration due to esophageal inlet stricture after radiation therapy.

LASER Medial Arytenoidectomy in Two Patients of Bilateral Vocal Cord Palsy / 대한이비인후과학회지

Severe airway obstruction occur in bilateral vocal cord paralysis. There exists a variety of treatment methods including external and endoscopic approaches, the endoscopic LASER techniques are more desirable. However, total LASER arytenoidectomy may improve the airway but worsen the voice quality. As an alternative approach, resection medial portion of the arytenoid cartilage may improve the airway with less impairment of voice quality. Our results show that medial arytenoidectomy may be a better treatment method for bilateral vocal cord palsy than the total LASER arytenoidectomy.

Reconstruction of Hypopharynx and Cervical Esophagus Using Reversed Gastric Tube Procedure / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Among various reconstructive methods of hypopharynx and esophagus, stomachs are widely used in total esophagectomized cases. Reversed gastric tube procedure is different from gastric transposition (gastric pull-up) and the procedure was rarely reported. Present study was undertaken to evaluate the complications and results of reversed gastric tube procedure. MAERIALS AND METHODS: A retrospective analysis was carried out on the results of reversed gastric tube procedure for the reconstruction of pharynx and esophagus at Inha University Hospital from June 1996 to January 1998. Reversed gastric tube procedure was performed in six patients ; three patients with hypopharyngeal cancer, two patients with thyroid cancer and one patient with esophageal cancer. RESULTS: The success rate of the transferred gastric tube was 100%. Most common complication was pulmonary complication which was treated conservatively. There was no other serious complications. Oral feeding was well tolerated within two weeks by all except for one patient in whom intestinal obstruction occurred. One thyroid cancer patient who received manubriosternotomy and upper mediastinal dissection died 6 days following the surgey because of great vessel hemorrhage in the mediastinum. CONCLUSION: We concluded that the reversed gastric tube procedure was a safe method of reconstruction for patients with extensive tumors involving the cervical esophagus and requiring total esophagectomy.

Immunohistochemical Study of Neuropeptides in Feline Vagal Afferent Neurons / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nodose ganglion (NG) of the vagus nerve is well known as a sensory ganglion mediated by many neurotransmitters. These neurotransmitters are substance P (SP), calcitonin gene-related peptide (CGRP), cholecystokinin (CCK), neurokinin A (NKA) etc. Controversy exists about other neurotransmitters of NG such as vasoactive intestinal polypeptide (VIP), cholineacetyl transferase (ChAT), and tyrosine hydroxylase (TH). SP is considered to be mainly a sensory neurotransmitter, and ChAT is an enzyme that stimulates acetylcholine synthesis, and is considered to be motor specific. VIP is considered to be a neurotransmitter mainly acting on the parasympathetic system. TH is a rate-limiting enzyme of catecholamine synthesis in the sympathetic system. In this study, we demonstrated the presence of these neurotransmitters in NG. MATERIALS AND METHODS:Seven NG was obtained from five wild cats after ketamine intramuscular anesthesia. Immunohistichemical staining was performed on anti-SP, anti-ChAT, anti-TH, and anti-VIP antibody using Avidin-Biotin-Peroxidae Complex and DAB (diamino benzidine) reaction. RESULTS: 1) Many SP-immunoreactve cells were present in NG, especially in the rostral portion. 2) A few VIP-immunoreactive cells were present, accounting for about 2-5% of all the cells. 3) A few ChAT-immunoreactive cells present. These cells are wide spread in NG, accounting for about 1-3% of all. 4) Many TH-immunoreactive cells present. These cells stained very strongly and were smaller than any other immunoreactive cells. CONCLUSION: We concluded that NG have many neurotransmitters and that their role may be sensory mediation. But we could not exclude the possibility that NG might have other functions other than sensory, so further study should follow.

Vocal Dynamic Studies before and after Laryngeal Microsurgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Perceptual acoustic measures are most often used to judge the outcomes and the objective analysis of phonosurgical results before and after the microlaryngeal surgery. However, they have rarely been reported in this country. The purpose of this study is to analyze aerodynamic and acoustic results before and after microlaryngeal surgery and to analyze the differences of the prognosis of various benign vocal cord lesions. MATERIALS AND METHODS: At Inha University Hospital, from June 1996 to August 1998, 245 microlaryngeal surgeries were done. Malignant lesions were excluded. And 118 (54 females and 64 males) out of 245 patients were followed up after the surgery: the acoustic and the aerodynamic studies before and 8 weeks after microlaryngeal surgery for benign lesions: vocal polyp, vocal nodule, Reinke's edema, intracordal cyst and hyperkeratosis. Seven measurements were performed: fundamental frequency, jitter, shimmer, noise to harmonic ratio as the acoustic analysis, maximal phonation time, mean flow rate and subglottal pressure as the aerodynamic analyses. RESULTS: Postoperative acoustic and aerodynamic data of vocal polyp, vocal nodule, Reinke's edema and intracordal cyst were improved, but those of hyperkeratosis were not improved. CONCLUSION: By comparing the acoustic and aerodynamic data before and after the microlaryngeal surgery, postoperative vocal function was defined more accurately and objectively. Jitter, shimmer, and MFR might be meaningful parameters accessing the quantitative changes in vocal quality before and after the microlaryngeal surgery.

A Study of Laryngeal Innervation by HRP Retrograde Labeling and Immunohistochemical Methods / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Classical concept of the laryngeal neuroanatomy has been questioned by some authors. Double innervation of some intrinsic laryngeal muscles has been suggested but controversy still exists. This study investigates the possibility of double innervation of thyroarytenoid and interarytenoid muscle and also the proportion of motor component in the external and internal branch of the superior laryngeal nerve. MATERIALS AND METHODS: Horse radish peroxidase (HRP) retrograde labeling in dogs, and choline acetyltransferase (ChAT) immunohistochemistry in feline and human laryngeal nerves were used. RESULTS: Evidences suggesting the existence of double innervation in thyroarytenoid and interarytenoid muscle and the existence of sensory component in external branch and motor component in internal branch of the superior laryngeal nerve have been observed. CONCLUSION: This new concept of the laryngeal neuroanatomy may be helpeful for understanding some of the neurologic diseases of the larynx such as spasmodic disphonia or variability of the vocal cord position in vocal cord paralysis. Further neuroanatomic and physiologic study is needed.

Experiences of the Treatment of Laryngeal Cancer in Yongdong Severance Hospital / 대한이비인후과학회지

BACKGROUND AND OBJECTS: Laryngeal cancer is a significant disease in the head and neck malignancy in the aspect of incidence. But, an accurate statistical analysis of long term results is insufficient in Korea. To improve the results of treatment in laryngeal cancer, we evaluate the survival rates according to the primary site, stage and investigating factors. MATERIALS AND METHODS: The study group was made up of 132 patients with squamous cell cancer. They had been treated for laryngeal cancer in our hospital for 11 years from 1985 to 1995. The distribution rates of patients were obtained by the discriptive statistical method according to the sex, age, pathology, primary site and stage. Survival rates were obtained by the Kaplan-Meier method according to the primary site and stage. The AJCC (1992) staging system was used. RESULTS: With respect to the primary site, the survival rate for 5 years was 52.8% in supraglottis and 71.6% in glottis. With respect to the stage, the survival rate was 82.4% in the stage I, 60.3% in the stage II, 53.8% in the stage III and 28.6% in the stage IV. The 5-year survival rate for patients who had taken radiotherapy in T1 glottic cancer was 73.5% for the group involved with anterior commissure and 96.2% for the group not involved. In the advanced laryngeal cancer, treatment failure was influenced by nodal and stomal recurrence. CONCLUSION: For those patients with T 1 laryngeal cancer and who recieved radiotherapy, a significant prognostic factor was whether or not the patients were involved with anterior commissure. Another important prognostic factor for the advanced laryngeal cancer patients was the complete neck management after the operation and prophylactic neck dissection.

Immunohistochemical Localization of Choline Acetyltransferase in External Branch of Superior Laryngeal Nerve in Cat / 대한이비인후과학회지

Existence of the external branch of the superior laryngeal nerve containing afferent fibers is much of concern. In this study, it is the aim to identify the component of fibers by immunohistochemistry using choline acetyltransferase, the specific marker of the cholinergic motor neuron. Both side of external branch of superior laryngeal nerve were excised from 4 adult cats, and also obtained the great auricular nerve and the hypoglossal nerve for sensory control and motor control specimen, respectively. There were no fibers with immune reaction in the great auricular nerve while all of the fibers in the hypoglossal nerve were strongly stained with rabbit anti-choline acetyltransferase antibody. In the external branch of the superior laryngeal nerve, 12.7% of the fibers were not stained with immune reaction product. They are smaller than stained nerve fibers in cross sectioned diameter and peripherally located in the same fascicle. The identification of unstained fiber group in the external branch of the superior laryngeal nerve suggest that it is a mixed nerve and not purely motor, possibly containing the sensory nerve fiber.

Effects of Arytenoid Adduction and Type I Thyroplasty Combined Surgery for Unilateral Vocal Cord Paralysis / 대한이비인후과학회지

Type I thyroplasty, we know, could not overcome the large posterior glottal chink and arytenoid adduction have been proved to be uneffective in the cases of unilateral vocal cord paralysis with vocal cord atrophy or bowing deformity. So we performed type I thyroplasty in conjunction with arytenoid adduction and tried to compare the postoperative results with that of arytenoid adduction. We experienced 8 cases of arytenoid adductions and 6 cases of combined operations in the cases of unilateral vocal cord paralysis. All 14 patients had large posterior glottal chink. In order to compare the postoperative voice results of two groups as objective as possible, we performed preoperative and postoperative videoimage analysis(chink size, interarytenoid distance) and computer-assisted voice analysis(MPT, Jitter, Shimmer, S/N ratio). As a results, the postoperative voice outcome is superior with the combined operation than with the arytenoid adduction only in the cases of unilateral vocal cord paralysis with large glottal chink.

Glutamate-Immunoreactive Neurons in the Nucleus Ambiguus of the Cat: Comparison after Cholera Toxin beta-subunit Injection to the Nodose Ganglion / 대한이비인후과학회지

Though the existence of glutamate-immunoreactive(GL-IR) neurons has been suggested in the nucleus ambiguous(NA) by immunocytochemistry, information regarding the distribution of neurons containing glutamate as a neurotransmitter has been to be elucidated. The author focused on distribution and morphology of GL-IR neurons in the NA, which were compared with cholera toxin beta-subunit(CTB) labeled neurons after its injection to the nodose ganglion(NG) in the cat. The results showed that the majority of neurons in the NA were immunoreactive to excitatory neurotransmitter glutamate, and they seemed to be distributed evenly without any special area of predilection or grouping pattern. The cellular shape was predominantly multipolar. GL-IR neurons showed some similarity in morphology and distribution pattern with CTB labeled cells.