Usefulness of high-sensitivity troponin I for the monitoring of subclinical acute cellular rejection after cardiac transplantation.

BACKGROUND: There are conflicting data about the role of cardiac troponin I (cTnI) as determined by means of conventional methods for the prediction of acute rejection after heart transplantation (HT). The purpose of this study was to evaluate whether cTnI as measured by means of the early prototype high-sensitivity assay (hs-cTnI) can predict acute rejection episode after HT compared with grade of rejection in endomyocardial biopsy (EMB). METHODS: This was a single-center cross-sectional study evaluating cTnI levels with the use of both hs-cTnI and current less sensitive conventional cTnI (conv-cTnI) assays measured at the time of EMB after HT. We calculated an index ratio of observed cTnI to expected mean cTnI for each individual patient defined as the mean cTnI measurements at EMB 60 days after HT. RESULTS: A total of 252 biopsies from 47 patients were included in this study. In the multivariable mixed model analysis in relation to the presence of acute rejection 60 days after HT, hs-cTnI level was significantly related to the presence of rejection (P = .010). The hs-cTnI ratio index was significantly higher at the time of rejection (median, 1.37; interquartile range [IQR], 1.23-2.88) compared with those without rejection (median, 0.90; IQR, 0.51-1.16; P < .001). In receiver operating characteristic curve analysis, an hs-cTnI ratio index of ≥1.17 could predict the acute rejection with a sensitivity of 82.4% and a specificity of 77.1%. CONCLUSIONS: An increased hs-cTnI ratio index was significantly related to rejection episodes. Serial monitoring of hs-cTnI and comparing it with the values without rejection might be useful for the detection of acute rejection after HT.

The incidence of epiglottic cysts in a cohort of adults with acute epiglottitis.

OBJECTIVE: To evaluate the effects of a coexisting epiglottic cyst on the clinical course and airway management of acute epiglottitis in adults. A review of the airway risk factors were studied in adults with acute epiglottitis in South Korea from 1997 to 2009. DESIGN: Retrospective chart review. SETTING: Academic tertiary care referral medical center. PARTICIPANTS: The study included 117 adult patients that were diagnosed with acute epiglottitis laryngoscopically over a period of 12 years. Two distinct groups were identified: one with acute epiglottitis associated with an infected epiglottic cyst (n = 29, 25%) and the other with acute epiglotittis without a cyst (n = 88, 75%). MAIN OUTCOME MEASURES: Patient background data, clinical manifestations, laboratory data, airway management, outcomes, and recurrence were recorded. RESULTS: Eight (28%) out of 29 patients with an infected epiglottic cyst required airway intervention compared to the four (5%) out of 88 patients without a cyst. The difference between the two groups was statistically significant (P = 0.001). Five out of six patients with recurrent acute epiglottitis had a coexisting epiglottic cyst. The recurrence of acute epiglottitis in patients with a cyst was significantly more frequent (P = 0.003). Twelve patients (10%) required airway intervention. There was no mortality found in this study. Logistic regression analysis showed that an older age, dyspnoea, a high pulse rate, and the presence of an epiglottic cyst were associated with an increased risk for airway obstruction. CONCLUSIONS: The results of this study showed that a pre-existing epiglottic cyst might be associated with a suppurative infection of the supraglottis. Infected epiglottic cysts increased the risk for airway obstruction and recurrence of acute epiglottitis.

Expression of mRNA of trefoil factor peptides in human nasal mucosa.

Trefoil factor family (TFF) peptides are typical secretory products of gastrointestinal mucus epithelia. Three TFF peptides exist in humans, TFF1 (formerly pS2), TFF2 (formerly hSP) and TFF3 (formerly hP1.B/hITF), acting as link peptides and influencing the rheological properties of mucous gels. The combined actions of TFF peptides and mucins have been shown to provide significant protection to mucosal surfaces. In this respect, TFF peptides may play a key role in the maintenance of the surface integrity of nasal mucosa. The present study aimed to investigate the expression of mRNA of TFF peptides in human inferior turbinate mucosa using reverse transcription polymerase chain reaction and in situ hybridization. TFF1 and TFF3 mRNA were detected in the human turbinate tissues examined. In contrast, TFF2 mRNA was not expressed in any samples. Using in situ hybridization, TFF1 and TFF3 mRNA were predominantly localized in epithelial cells and submucosal glandular epithelium. These data suggest that nasal epithelia and submucosal glands may secrete TFF1 and TFF3, contributing to the stabilization of the mucous lining of human nasal mucosa.

Low expression of p27(Kip1) in advanced mucoepidermoid carcinomas of head and neck.

BACKGROUND: p27(Kip1), a cyclin-dependent kinase inhibitor, negatively regulates the G1 phase progression of the cell cycle by binding to the cyclin E/cyclin-dependent kinase 2 complex. This study was done to investigate the expression of p27(Kip1) in mucoepidermoid carcinomas and its usefulness as an indicator in tumor progression, aggressiveness, and prognosis. METHODS: Thirty-one patients with mucoepidermoid carcinomas who had surgical resection were studied retrospectively. Clinicopathologic features, including histologic types, T stage, nodal status, perineural invasion, overall AJCC stage, and survival data, were obtained from medical records. Immunohistochemical staining with monoclonal antibodies against p27(Kip1) was performed on the formalin-fixed, paraffin-embedded specimens from each patient. The percentage of tumor cells expressing p27(Kip1) (labeling index) was evaluated by counting 1000 cells per slide in at least four different areas and comparing with the patients' clinicopathologic features and survival rates. RESULTS: Significant correlation was found between low p27(Kip1) expression and tumors with high-grade, advanced T stages, positive nodal status, and advanced clinical stages (p =.001 for all) except perineural invasion. Multivariate analysis indicated that p27(Kip1) expression (p =.030) was the most significant, and gender (p =.048) was the next significant predictor of overall survival among the variables. Also patients with low p27(Kip1) expression showed poor prognosis (p =.002). CONCLUSIONS: We suggest that p27(Kip1) is a reliable independent marker of tumor progression, invasiveness, and prognosis in the mucoepidermoid carcinomas.

Clinical analysis of voice change as a parameter of premenstrual syndrome.

We have evaluated the relationship between voice change and premenstrual syndrome (PMS) by comparing acoustic measurements made during the follicular phase and the premenstrual phase. Twenty-eight women were followed for 2 months for this study. Each participant was asked to produce an /a/ sound for 5 seconds at the midfollicular phase of the menstrual cycle and then 2-3 days before menstruation. Each voice sample was stored and analyzed by the Dr. Speech Science program. The voice data collected from all subjects during the two phases were compared. After that, the subjects were divided into a PMS-positive and PMS-negative group according to the criteria cited in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV); the voice data from each group were compared separately between the two phases. There was no significant difference in the acoustic parameters between the two phases in all subjects (N = 28). In the PMS-positive group (N = 16), jitter was significantly increased during the premenstrual phase compared to the follicular phase (p = 0.048). The patient's PMS score was not correlated with the severity of voice change. We conclude that the change of voice parameter was objectively identified in the PMS-positive group, therefore more careful voice habituation is required during the premenstrual phase in that group.

Analysis of proteoglycan gene messages in human nasal mucosa and nasal polyp using dot blot hybridization.

It has been suggested that the formation and growth of nasal polyp require the remodeling of extracellular matrix. Proteoglycans (PGs) are major components of the extracellular matrix that maintain the integrity of structural tissue. The leucine-rich repeat PGs include lumican, decorin and biglycan and have many important biologic activities in various pathologic conditions, including the remodeling of the extracellular matrix. Therefore, these small-PG families may be involved in the formation and growth of nasal polyp. In the present study, surgical specimens of nasal polyps and nasal mucosa were assessed for expression of mRNA coding for lumican, decorin and biglycan using reverse transcriptase-polymerase chain reaction followed by dot blot hybridization. Lumican, decorin and biglycan mRNA were expressed in all tissue samples examined. Semiquantitative dot blot hybridization revealed that the levels of the lumican and biglycan messages are lower in nasal polyp tissues than in nasal mucosa. The decorin messages in nasal polyp were expressed at levels similar to those in nasal mucosa. These results suggest that lumican, decorin and biglycan may be important components of the extracellular matrix in nasal mucosa. Considering the function of these PGs, normal levels of decorin associated with low levels of biglycan and lumican may play a role in the pathogenesis of nasal polyposis.

Olfactory mucosal findings in patients with persistent anosmia after endoscopic sinus surgery.

Sixty-three biopsy specimens were obtained from the olfactory region of 15 patients with persistent anosmia and 6 patients with normosmia after sinus surgery. Immunohistochemical examination of all specimens with microtubule-associated protein 5 (MAP5) antisera demonstrated olfactory epithelium in 11 of 18 specimens from normosmic patients and in 12 of 45 samples from anosmic patients. There was a significant difference in the proportion of specimens containing olfactory epithelium between the two groups of patients. In normosmic patients, most of the biopsy samples contained normal-appearing olfactory tissue. However, 2 main patterns of histologic findings were noted in the olfactory mucosa of anosmic patients. First, the olfactory receptor cells were remarkably decreased in number. Second, the orderly arrangement of cells characteristic of normal olfactory epithelium was lost, demonstrating a degenerative appearance. These data suggest that olfactory epithelium can be degenerated even in chronic sinusitis and thereafter extensively replaced with respiratory epithelium, resulting in increased sampling error. Moreover, an unimproved olfactory deficit after sinus surgery may be due to the abnormalities observed at the olfactory epithelium level.

Expression of human beta-defensin 1 mRNA in human nasal mucosa.

Antimicrobial peptides are cationic proteins that are found in a wide range of organisms. Recent reports suggested that human beta-defensin 1 (hBD-1), a prominent group of antimicrobial peptides, is an important component of the innate immune response, particularly at mucosal surfaces that are vulnerable to colonization by potential pathogens. Therefore, hBD-1 may participate in providing intrinsic nasal mucosal defence against microbial infections. The present study aimed to look for hBD-1 mRNA in human nasal mucosa without obvious signs of inflammation. Total RNA was isolated from human inferior turbinate mucosa and hBD-1 mRNA was detected in these tissues by using reverse transcription and polymerase chain reaction (RT-PCR). By in situ hybridization, hBD-1 mRNA was predominantly localized in superficial epithelial cells and submucosal glandular epithelium of human inferior turbinate mucosa. These data suggest that nasal epithelia and submucosal glands may secrete hBD-1, contributing to the mucosal defences of the nose.

Combined use of pectoralis major myocutaneous and free radial forearm flaps for reconstruction of through-and-through defects from excision of head and neck cancers.

OBJECTIVES: The aim of this study was to examine the outcome and complication in patients who underwent reconstruction with combined use of pectoralis major myocutaneous flap (PMMCF) and free radial forearm flap (FRFF) for the through-and-through defect after surgical resection for head and neck cancer. METHOD: Twelve patients underwent primary reconstruction with the combined use of PMMCF and FRFF for through-and-through defect of facial or cervical skin and oral or pharyngeal mucosa resulting from treatment of head and neck cancer. Free radial forearm flap was used for three patients with oral mucosal defect, two patients with oropharyngeal mucosal defect, and two patients with defect from total laryngopharyngectomy. The osteocutaneous FRFF was used for five patients with defect of oral mucosa and mandible. Pectoralis major myocutaneous flap was used for seven patients with facial skin defect and five patients with cervical skin defect. RESULTS: All PMMCFs and FRFFs were successful. Early complications were minor and occurred in 4 (33%) of 12 patients. No delayed complication was observed. During the follow-up period, 5 patients died of disease between 10 and 52 months. Currently, 6 patients are alive with no evidence of disease and 1 patient developed a distant metastasis to the lung. The follow-up period ranged from 12 to 54 months. CONCLUSION: For patients with through-and-through defect after resection of mucosa of upper aerodigestive tract and skin, the combination of PMMF and FRFF reconstruction achieved optimal long-term results.

Expression of myosin heavy chain mRNA in rat laryngeal muscles.

The composition of myosin heavy chain mRNA was analysed quantitatively in 5 intrinsic laryngeal muscles of rats, using a competitive polymerase chain reaction. Intrinsic laryngeal muscles with the fastest contraction times, e.g. ventricular thyroarytenoid muscle. lateral cricoarytenoid muscle. and vocalis muscle, contained 2 fast isoforms, comprising mainly type 2B myosin heavy chains (52.1, 44.6 and 8.2%, respectively) and type 2X myosin heavy chains (21.9, 37.6 and 80.8%, respectively). Conversely, muscles with slower contraction times, such as posterior cricoarytenoid muscle and cricothyroid muscle, contained more than 85% of 2 fast isoforms; mainly type 2X myosin heavy chains (52.4-72.1%, respectively) and type 2A myosin heavy chains (34.6-25.2%, respectively). The results show a strong correlation between the composition of fast myosin heavy chain isoforms and muscle contraction times. Type 2L myosin heavy chain transcripts specific for laryngeal muscles and extra-ocular muscles were expressed in the order of ventricular thyroarytenoid (9.5%) > lateral cricoarytenoid (4.8%) > vocalis (2.5%) > posterior cricoarytenoid muscle (0.9%), but were not expressed in cricothyroid muscle. Neonatal myosin heavy chain was also expressed in all laryngeal muscles, ranging from 0.04 to 3%, but embryonic myosin heavy chain was expressed in ventricular thyroarytenoid, posterior cricoarytenoid and cricothyroid muscle at very low levels. These results suggest that intrinsic laryngeal muscles have different expression patterns for myosin heavy chain isoforms and may have different regulatory roles related to their functional requirement.

Expression of vascular endothelial growth factor in otitis media.

Increased vascular permeability and endothelial cell growth are important in the pathogenesis of otitis media with effusion (OME) and the vascular endothelial growth factor (VEGF) is known to play an important role in the increased vascular permeability and angiogenesis. To date, at least five isoforms of the VEGF family have been identified as VEGF transcripts, encoding polypeptides of 206, 189, 165, 145 and 121, but their physiological roles are unclear. The purpose of this study was to investigate the expression of VEGF, in both endotoxin-induced OME of the rat and human otitis media. We instilled endotoxin and saline as a control into the middle ear cavity of the rat. Middle ear mucosa were taken at 0 h, 1 h, 3 h, 6 h, 12 h, 1 day, 3 days, 7 days and 14 days and the expression of VEGF mRNA and VEGF protein was evaluated using semi-quantitative RT-PCR and immunohistochemistry. Expression of VEGF164 mRNA and VEGF120 mRNA was first identified 1 h after endotoxin instillation and was dramatically increased over the period 6 h-1 day and then progressively decreased by day 7. The level of expression of VEGF120 mRNA was slightly higher than that of VEGF164 mRNA and that of VEGF164 mRNA was much higher than that of VEGF188 mRNA. Immunostaining revealed expression of VEGF during 6 h to day 3 and its expression was localized to ciliated cells and some inflammatory cells. We also performed RT-PCRs of cDNA from middle ear fluids of 8 human OME patients and middle ear mucosa of 4 chronic otitis media patients for the identification of VEGF mRNA expression. VEGF121 mRNA was highly expressed in all samples compared with VEGF165 mRNA. These results suggest that VEGF may be primarily responsible for increased vascular permeability and endothelial cell growth in OME and that VEGF seems to play a significant role in the pathogenesis of OME.

Tissue concentrations of chlordanes in mice after long-term exposures to technical grade chlordane at indoor air levels.

We determined concentrations of chlordanes (5 chlordane compounds and 2 metabolites) in tissues and organs of mice following a prolonged exposure to Chlordane (technical grade chlordane) at levels as low as those in indoor air.After exposure to 4.22-11.36 µ g/m(3) Chlordane (total of 5 compounds) in the air for 1-6 months, 6.44-13.00 ppm chlordanes (total of 7 compounds) were detected in mice (2 tissues and 6 organs). The adipose tissue among the 2 tissues / 6 organs examined contained the highest chlordanes. The ratio of the adipose tissue chlordanes to the liver chlordanes was approximately 5.6 times, followed by the muscle (0.9), lungs (0.4), kidneys (0.4), heart (0.3), spleen (0.2) and brain (0.1). In addition, trans-nonachlor, oxychlordane and heptachlorepoxide in chlordanes were at a high level.The level of Chlordane exposure (dose) and the level of chlordanes accumulation in each tissue or organ of the mice except for the heart were closely correlated (r=0.9388-0.7130), and showed a linear relationship. The tendency of chlordanes accumulation in light of the linear relationship was adipose ≫ liver ≥ muscle.Thus, even with a low level of Chlordane in indoor air, chlordanes may be steadily accumulated in the bodies of human residents with prolonged exposure similarly. The present findings suggest that it is necessary to investigate die risk of organochlorine chemicals contamination in indoor air at prolonged exposure.

Tortuous common carotid artery encountered during neck dissection.

Anomalies of the carotid artery are rare in clinical experience. To our knowledge a tortuous common carotid artery with an abnormal course encountered during neck dissection has never been reported in the available world literature. During dissection of the lower neck in a 60-year-old Korean man, a tortuous right common carotid artery was found to cross over the lower cervical trachea anteriorly and then was positioned in its usual site in the carotid sheath in the mid-neck.

Squamous cell carcinoma of the tonsil--clinical features and treatment results.

Squamous cell carcinoma of the tonsil has a relatively poor prognosis. Aggressive surgery, radiation therapy and combinations of irradiation and surgery have been employed but there exists some controversy about the efficacy of these treatment modalities. The purpose of this paper is to compare the efficacy of treatment between the surgery followed by radiation therapy and the preoperative radiation therapy followed by surgical resection. The medical records of 33 patients treated for squamous cell carcinoma of the tonsil at the Department of Otolaryngology-Head and Neck Surgery, Korea University Hospital between 1989-1993 were reviewed retrospectively. None of the patients were stage I, but stage II, III, and IV were four, five, and 24 patients, respectively. There were 30 males and three females. The most common histopathology was moderately differentiated squamous cell carcinoma (20/33). The 13 patients treated initially with surgery had an overall three-year survival rate of 38.5%, and the rate for the 20 patients treated initially with radiation was 40%. The main pattern of treatment failure was a local recurrence and neck metastases, and pathologic differentiation thought to be an important prognostic factor. Complications are fewer in patients treated initially with surgery (23.1%) than patients initially treated with radiation (50.0%). There is no difference in the efficacy between the two therapeutic groups.

Age-related changes of IgA immunocytes and serum and salivary IgA after tonsillectomy.

For determining treatment options of tonsillar diseases, the authors compared immunohistochemical differences for IgA immunocytes and measured the changes in concentrations of the serum immunoglobulin A and salivary secretory immunoglobulin A before and after tonsillectomy according to age in 126 cases (60 control cases, 66 tonsillectomy cases). The serum IgA and salivary SIgA concentrations of the control group reached to adult's level at the age of 11 to 13. In the tonsillectomies, the serum IgA concentrations below the age of 10 were higher than that of controls and were decreased to the levels of the controls after tonsillectomy in all ages and the salivary SIgA concentrations were decreased to the levels of the controls at the 30th postoperative day, especially at the age of 5 to 7 and 8 to 10. Morphometric features of tonsils in the group below the age of 8 were more active than those in the group above the age of 8 in the controls. In the tonsillectomies, morphometric features of the tonsils were similar to those in the group above the age of 8, but the reticular part of the crypt epithelium remained significantly. Total number of IgA immunocytes was the highest at the age of 5 to 7 with a decline by age, especially at the age of 19 in the controls. In the tonsillectomy group, the number of IgA immunocytes of the extrafollicular area and the reticular part of crypt epithelium decreased below the levels of the control group. In conclusion, tonsils in preschool children are important as a local immunologic defense mechanism, but no significant changes in the immunologic system occurs after tonsillectomy.