A Case of Removal of Medial Maxillary Intraosseous Hemangioma through an Intranasal Endoscopic Prelacrimal Recess Approach / 대한이비인후과학회지

The intranasal endoscopic prelacrimal recess approach (PLRA) is a novel technique that was recently introduced for the management of maxillary sinus lesions. We utilized this approach for the surgical resection of a medial maxillary bony lesion; gross total resection was achieved without significant complications. The PLRA appears to be an effective and safe technique for the treatment of bony lesions of the maxilla as well as the maxillary sinus, particularly those confined to the medial maxillary wall.

Case Report: Cervicofacial Actinomycosis-Misdiagnosed to Parotid Abscess / 대한이비인후과학회지

Actinomycosis is a disease caused by an anaerobic bacteria called Actinomyces species (predominantly Actinomyces israelii), which is a common and normally nonpathogenic organism found in the nose and throat. The four major clinical presentations of actinomycosis include the cervicofacial, thoracic, abdominal, and pelvic region. Actinomycosis is difficult to diagnose because of variable presentation and fastidious nature of the organism in culture. A high index of suspicion and biopsy are often necessary to make the diagnosis, because the disease can mimic neoplasm or a chronic granulomatous infection. We present, with the appropriate review, a case of actinomycosis in the mandibular angle area which was mistaken for a parotid abscess.

Correlation between Olfactory Dysfunction Measured by T&T Olfactometer and Disease Severity Staged by CT in Chronic Rhinosinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chronic rhinosinusitis is a common etiology in olfactory dysfunction. There have been several studies regarding olfactory dysfunction in chronic rhinosinusitis using olfactory diagnostic tools, other than T & T olfactometer. To establish a relationship between the disease severity and severity of olfactory dysfunction, we evaluated the correlation between disease severity by using sinus CT scan as graded by the Harvard system and olfactory function by using the Butanol threshold test and T & T olfactometer. SUBJECTS AND METHOD: Fifty patients with chronic rhinosinusitis were evaluated. We scored each CT scan on the Harvard system, and the Butanol threshold test and T & T olfactemeter were performed for each patient. Correlation between the CT scores, Butanol test scores and T & T olfactometer scores was assessed. We also assessed for correlation between the 5 odorants used in the T & T olfactometer with the CT scores. RESULTS: The CT scores graded by the Harvard system and the score of Butanol threshold test was correlated significantly (p<0.01). The CT scores and the scores of T & T olfactometer, and those of each odorant used in the T & T olfactometer were correlated significantly (p<0.01). CONCLUSION: Using a T & T olfactometer, we found that disease severity is correlated with the severity of olfactory dysfuction. All odorants of T & T olfactometer were similarly correlated with the disease severity.

Efficacy of a Combination with Pranlukast and Cetirizine in the Treatment of Allergic Rhinitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It has been suggested that the combination of a leukotriene receptor antagonist with an antihistamine may have beneficial effects in the treatment of allergic rhinitis. The aim of this study were to evaluate the effects of combining a leukotriene receptor antagonist, pranlukast, and an antihistamine, cetirizine, to treat nasal symptoms of allergic rhinitis and the quality of life of the patients. SUBJECTS AND METHOD: Thirty-three patients with allergic rhinitis were enrolled in this study. The control group (n=12) received 5 mg cetirizine plus 120 mg pseudoephedrine twice a day while the study group (n=21) received 5 mg cetirizine plus 225 mg pranlukast twice a day. Patients completed a daily symptom-score list for nasal obstruction, rhinorrhea, sneezing, nasal itching during the 7-day treatment period. They also answered the quality of life questionnaire before and after the completion of 7-day treatment. RESULTS: There were significant improvements in the nasal symptoms after the treatment in the control and the study group. However, there was no significant difference between the control and the study group on the improvement of nasal symptom-scores except for the rhinorrhea symptom-score. There were significant improvements in the quality of life domain after the treatment in the control group and the study group. However, there was no significant difference between the control and the study group on the improvement in quality of life domain except for activity limitations. CONCLUSION: A combination of pranlukast and cetirizine is as effective as a combination of pseudoephedrine and cetirizine in treating allergic rhinitis. Therefore, a combination of pranlukast and cetirizine may be another therapeutic alternative for allergic rhinitis patients who are not tolerable of pseudoephedrine.

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.

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.

Expression of Inducible Nitric Oxide Synthase in Rat and Guinea PigRespiratory Epithelium after Capsaicin Treatment / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nitric oxide (NO) production in the respiratory epithelium and the demonstration of inducible nitric oxide synthase in ciliated epithelium of the upper airway have recently been reported. The aim of this study was to investigate the expression of inducible nitric oxide synthase in the nasal epithelium after capsaicin treatment, which stimulates the substance P innervation. MATERIALS AND METHODS: In vivo treatment -Capsaicin (112 nM) was applied to the nasal cavities of the rat and guinea pig, and 30 nl of normal saline was applied for the control groups. After 2 hours, animals were sacrificed with cardiac perfusion of 4% paraformaldehyde and septal mucosa were removed. The 8 nm serial frozen tissue sections were made, and the expression of inducible nitric oxide synthase was determined using nicotinamide adenine diphosphate-diaphorase histochemistry. In vitro treatment- The nasal septum of the rats and the trachea of the guinea pigs were incubated in DMEM culture media with or without 112 nM capsaicin for experimental or control groups. After 0, 30 or 120 minutes of incubation, the tissues were fixed and processed for nicotinamide adenine diphosphate-diaphorase histochemistry. RESULTS: Both in vivo and in vitro studies demonstrated that the strong positive histochemical reactivity were observed in the respiratory epithelium of the rats and guinea pigs after capsaicin treatment compared to control groups. CONCLUSION: These data imply that capsaicin induces the expression of inducible nitric oxide synthase and that the substance P innervation of the nasal mucosa may have a protective role in the airway defense mechanism through nitric oxide production.

Toxicity of Polylactic Acid Polymer in the Treatment of Paranasal Sinusitis

The authors, after inducing acute sinusitis in rabbits, compared cases where we opened the natural ostium and a general dose of administered antibiotics and cases where we opened the natural ostium and locally administered dose of antibiotics using polymer, and found that the application of local antibiotics using polymer is the superior of the two in treating sinusitis. To be able to develop a treatment for sinusitis using antibiotics incorporating polymer, we first need to examine the toxicity of polymer. The purpose of this study was to examine the toxicity of polymer through a general toxicity test as well as a special toxicity test in experiments using animals. As a result of this study, we discovered that poly-L-lactic acid (PLA) polymer works as an intraperitoneal foreign body and causes adhesion of viscera, but nethier acute nor subacute toxicity of PLA polymer was detected, and no negative effect on reproductive function was observed. It was also observed to induce neither immune reaction such as hypersensitivity nor local toxicity to the maxillary sinus mucosa of rabbit. We conclude that the results of this study can provide basic information for developing antibiotics-incorporating PLA polymer for the treatment of sinusitis and for clinical experiments involving such antibiotics.

Introduction to Problem Based Learning / 한국의학교육

Problem-based learning(PBL) is defined as a process of acquiring understanding, knowledge, skills and attitudes in the context of an unfamiliar situation, and applying such learning to that situation. PBL is a way of enabling students thinking more efficiently than they can do in the traditional methods of largely rote learning. Because mordern medical knowledge is growing at an enormous rate, PBL is though as a mean to cope with the rapidly increasing, rapidly changing information base of medicine. The definition, goals, practice, strength, and problems of PBL in medical education are discussed. The curriculum and educational philosophy of McMaster Medical School, where PBL in small group tutorials predominates the programme, are also introduced. Hinderences from implementing PBL in our medical education are discussed.

A clinical study on aspergillus sinusitis / 대한이비인후과학회지

No abstract available.

Computed tomography of deep neck infections

No abstract available.