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.

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.

Tympanic Membrane Perforation Due to Metal Spark in a Welder / 대한산업의학회지

Injury to the ear in welders is a recognized but poorly documented entity. The risk for ear injury from molten metal or hot sparks produced during welding procedures is low, but the effects can be significant. Burns, tympanic membrane perforations and chonic otorrhoea are the most common results. One case recently experienced at our institution highlight the risk that exists for middle ear injury. The traumatic thermal injury was caused by a metal spark perforating the tympanic membrane during welding. Neither subject was using ear protection at the time. The use of ear protection is strongly advocated during welding operations that place the ear at risk.

A Case of Frontal Sinus Rhinoliths / 대한이비인후과학회지

Rhinoliths result from calcification of an endogenous or exogenous nidus within the nasal cavity. Patients typically present symptoms of long-standing unilateral nasal obstruction, pain and foul-smelling discharge. Rhinoliths are most often found on the floor of the nose and maxillary antrum. Rhinoliths are most often found on the floor of the nose and maxillary antrum. Rhinoliths present complications involving erosion or perforation of nasal mucosa, septum and palate. Sinusitis is a rare complication of rhinoliths. The authors experienced a case of frontal sinus rhinoliths in 36 years old man who complained of a headache and had a history of a frontal area trauma. At first we suspected it to be fungal sinusitis or mucocele, but finally confirmed it to be frontal sinus rhinolith after carrying out a frontal sinus osteoplastic operation.

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 Neurofibromatosis Type II / 대한이비인후과학회지

Neurofibromatosis affects primarily cell growth of neural tissues and can cause tumors to grow on nerves at any time and any location. it is a heritable disease that is transmitted as an autosomal-dominant trait. Neurofibromatosis type II is characterized by bilateral acoustic neuromas with high incidence of other tumors. Hearing loss is the most common symptom in patients with neurofibromatosis type II. The other symptoms may be tinnitus, facial weakness, and dizziness. Audiometric test and MRI are essential to diagnose neurofibromatosis type II. Most cases of neurofibromatosis type II may need for surgical procedures. We experienced a case of neurofibromatosis type II having cervical spinal cord neuroma, multiple intracranial meningiomas, and bilateral acoustic neuromas. There was positive family history. Her two brothers also had neurofibromatosis type II, confined by MRI. Her acoustic neuroma on left side was removed successfully via translabyrinthine approach and cervical spinal cord neuroma by cervical laminectomy was removed.

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.

Clinical analysis on transseptal transsphenoidal hypophysectomy using columellar flap / 대한이비인후과학회지

No abstract available.