Chul Hee Lee

Adenoid Cystic Carcinoma of the Sinonasal Tract: Treatment Results

Objectives: Malignancies arising from the sinonasal tract, which includes the nose, paranasal sinuses, and nasopharynx, are uncommon. Although adenoid cystic carcinoma (ACC) is the second most common cancer occurring in the sinonasal tract, only few studies have been reported. This retrospective review was performed to identify the clinical features and treatment outcomes of sinonasal ACC.

The association of nocturnal hypoxemia with arterial stiffness and endothelial dysfunction in male patients with obstructive sleep apnea syndrome.

Background: Obstructive sleep apnea syndrome (OSAS) is associated with cardiovascular complications, and atherosclerosis is considered to mediate this association. Arterial stiffness and endothelial dysfunction are widely accepted as early markers of atherosclerosis. Objectives: The purpose of this study was to investigate the influence of sleep apnea on arterial stiffness and endothelial dysfunction. Methods: We enrolled 83 OSAS patients including 39 with mild to moderate degree (apnea hypopnea index, AHI ≧5, AHI <30) and 44 with severe degree sleep apnea (AHI ≧30) and 29 normal control subjects (AHI <5). After finishing polysomnography, carotid-femoral pulse wave velocity (cfPWV) and flow-mediated dilation (FMD) were measured using noninvasive devices. Results: In patients with severe degree of OSAS, cfPWV was significantly higher than mild to moderate degree of OSAS or normal control subjects. Also, the severe OSAS group showed lower FMD than the normal control group (all p < 0.01). The cfPWV was significantly correlated with FMD (r = –0.26, p < 0.01). Age (β = 0.33, p < 0.01) and percentage of time below 90% O2 saturation (β = 0.34, p < 0.01) were the significant variables to determine cfPWV (adjusted R2 = 21%, p < 0.01) in multivariate analysis, and the lowest O2 saturation was a significant determinant for FMD (β = 0.25, adjusted R2 = 6%, p < 0.01). Conclusions: Nocturnal hypoxemia may alter arterial elasticity and endothelial function in OSAS patients, and those impairments could increase the risk of cardiovascular complications.

The effects of nasal continuous positive airway pressure on vascular functions and serum cardiovascular risk factors in obstructive sleep apnea syndrome

PurposeWe investigated whether the nasal continuous positive airway pressure (nCPAP) could have impacts on impaired vascular functions and serum cardiovascular risk factors in obstructive sleep apnea syndrome (OSAS).MethodsWe enrolled 25 OSAS patients of moderate to severe degree. After polysomnography, carotid-femoral pulse wave velocity (cfPWV) and flow-mediated dilation (FMD) were measured. Also, serum levels of C-reactive protein (CRP), total cholesterol, triglyceride, high-density lipoprotein (HDL) cholesterol, glucose, and insulin were measured. After nCPAP treatment (mean duration, 138.7u2009±u200942.6xa0days), these tests were performed again.ResultsThe mean apnea hypopnea index prior to nCPAP was 64.9u2009±u200920.0/h, which decreased to 4.1u2009±u20092.0/h with nCPAP (pu2009<u20090.001). After nCPAP, cfPWV (m/s) decreased from 11.2u2009±u20094.5 to 9.3u2009±u20092.1 (pu2009=u20090.031), and FMD (%) was improved from 5.52u2009±u20092.49 to 6.58u2009±u20092.50 (pu2009=u20090.006). Body mass index, serum levels of CRP, total cholesterol, triglyceride, HDL cholesterol, or glucose did not change after nCPAP. Insulin resistance was not improved either.ConclusionsThe cfPWV and FMD were significantly improved after nCPAP treatment, even though there was no significant change in body weight or serum cardiovascular risk factors. The nCPAP treatment could decrease risks of cardiovascular complications in OSAS patients through improving vascular functions.

Endothelial dysfunction and inflammatory reactions of elderly and middle-aged men with obstructive sleep apnea syndrome

IntroductionObstructive sleep apnea syndrome (OSAS) is considered to be associated with cardiovascular complications, and atherosclerosis could mediate this relationship. Cardiovascular risk factors of OSAS still need to be elucidated in elderly patients, since studies about the association between OSAS and cardiovascular diseases have been done mainly in middle-aged adults. To investigate whether endothelial dysfunction, as an early marker of atherosclerosis, and inflammatory responses in OSAS were affected by age, we studied flow-mediated dilatation (FMD) and C-reactive protein (CRP) in elderly and middle-aged patients with OSAS.Materials and methodsThis study enrolled 161 male subjects of 117 middle-aged (35–59xa0years old) and 44 elderly (≥60xa0years old) patients with OSAS. After they finished nocturnal polysomnography (NPSG), FMD was measured on the brachial artery and blood samples were obtained to determine serum CRP levels.Results and discussionFMD was significantly lower in the elderly patients (pu2009=u20090.04), but no difference was observed between two age groups in body mass index (BMI), neck circumference, waist-to-hip ratio, apnea hypopnea index (AHI), serum CRP level, or NPSG findings related with nocturnal hypoxemia such as average O2 saturation, percentage of time below 90% O2 saturation, and oxygen desaturation index (ODI). From the results of stepwise multiple linear regression analysis, the lowest oxygen saturation was a significant determinant of FMD (βu2009=u20090.25, pu2009<u20090.01, adjusted R2u2009=u20096%), and BMI (βu2009=u20090.22, pu2009<u20090.05) and waist-to-hip ratio (βu2009=u20090.21, pu2009<u20090.05) were significant variables to explain CRP (adjusted R2u2009=u200911%, pu2009<u20090.01) in the middle aged patients. In the elderly patients, no variable was significant for predicting FMD, but AHI was significant determinant of CRP (βu2009=u20090.46, pu2009<u20090.01, adjusted R2u2009=u200919%, pu2009<u20090.01). In predicting cardiovascular risks of OSAS, both hypoxia and obesity should be considered in the middle-aged group, whereas nocturnal respiratory disturbances are important in the elderly group.

Prevalence of Subjective Olfactory Dysfunction and Its Risk Factors: Korean National Health and Nutrition Examination Survey

Background Population-based studies for olfactory dysfunction are lacking. The aim of this study is to evaluate the prevalence of subjective olfactory dysfunction and its risk factors in the Korean general population. Methods The data were obtained from the 2009 Korea National Health and Nutrition Examination Survey (KNHANES), which was a cross-sectional survey of non-institutionalized population all around the country (nu200a=u200a10,533). All interviewees underwent medical interviews, physical examinations, endoscopic examination and blood/urine tests. Whether sense of smell has been normal or abnormal during the last 3 months was asked. Complete olfaction data were obtained from 7,306 participants and the participants were divided into normosmic and hyposmic group. Multivariate logistic regression analyses were performed to identify its risk factors. Results The weighted prevalence of subjective olfactory dysfunction was 4.5%. Its increased prevalence was significantly associated with the increasing age for both men and women. In the multivariate analyses, low income (adjusted odds ratio [OR]u200a=u200a1.43, 95% Confidence Interval [CI]u200a=u200a1.01–2.03), habitual exposure to air pollutants (adjusted ORu200a=u200a2.18, CIu200a=u200a1.33–3.55), a history of hepatitis B (adjusted ORu200a=u200a3.10, CIu200a=u200a1.25–7.68), rhinitis (adjusted ORu200a=u200a1.78, CIu200a=u200a1.26–2.51) and chronic sinusitis (adjusted ORu200a=u200a14.55, CIu200a=u200a10.06–21.05) were risk factors of olfactory dysfunction. Conclusion Our population-based study showed that olfactory dysfunction was quite prevalent and several risk factors were associated with impaired sense of smell. Given its prevalence, further researches for its prevention and management are required.

Comparison between Gelfoam packing and no packing after endoscopic sinus surgery in the same patients.

After functional endoscopic sinus surgery (FESS), nasal packing may be necessary and a packing material which has benefits in both cost and efficacy would be required. This study aimed to determine the efficacy of Gelfoam packing on hemostasis and wound healing after FESS. Patients who underwent bilateral FESS due to chronic bilateral rhinosinusitis were enrolled. Randomly, one side was selected for Gelfoam packing and the other side for no packing. Subjective symptoms and objective findings such as synechia, granulation, pus discharge, edema, stenosis, and crust were evaluated. A total of 21 patients (17 men and 4 women; mean age 39.7xa0years ranging from 12 to 75xa0years) were included. There were no statistical significant differences between two groups regarding both subjective symptoms and objective findings during 4xa0months after surgery. Three patients had postoperative bleeding in the no packing side. Gelfoam packing may be recommendable in terms of efficacy and cost-benefit after FESS.

Difference of delayed post-tonsillectomy bleeding between children and adults.

OBJECTIVEnTo analyze the characteristics of post-tonsillectomy bleeding and its management comparing with adults.nnnMETHODSnA retrospective chart review of 1489 patients who underwent tonsillectomy in our institution (June 2003-June 2006).nnnRESULTSnPost-tonsillectomy bleeding rate was 3.1%, 2.5% and 10.8% in younger children (age< or =11 years), older children (12< or =age< or =15 years) and adults (age>15 years), respectively. Although adults showed an unimodal peak time for onset of post-tonsillectomy bleeding, children showed a bimodal peak time. In the younger child group, all of the 28 bleeders had spontaneous hemostasis. However, in the older child group, there was no spontaneous hemostasis. Bleeding was controlled under local anesthesia in 3 patients and 2 patients required general anesthesia for bleeding control. In the adult group, spontaneous cessation of bleeding occurred in 25 patients (60.9%) and hemostasis under local or general anesthesia was performed in 16 (39.1%) patients.nnnCONCLUSIONSnPost-tonsillectomy bleeding occurred more frequently in adults than in children. Spontaneous hemostasis was more prevalent in children than in adults. Post-tonsillectomy bleeding in the younger child group was controlled with close observation alone.

Prevalence and Risk Factors of Chronic Rhinosinusitus, Allergic Rhinitis, and Nasal Septal Deviation: Results of the Korean National Health and Nutrition Survey 2008-2012.

IMPORTANCEnChronic rhinosinusitis (CRS), allergic rhinitis (AR), and nasal septal deviation (NSD) are frequent rhinologic diseases that consume considerable health care resources.nnnOBJECTIVEnTo determine the prevalence and risk factors of CRS, AR, and NSD in Korea.nnnDESIGN, SETTING, AND PARTICIPANTSnThis study analyzed 5-year cross-sectional data from the Korean National Health and Nutrition Examination Survey (KNHANES) 2008-2012. A total of 35u202f511 participants, who underwent an interview regarding nasal symptoms and a nasal examination, were enrolled and subsequently divided into 3 groups: children (aged 7-12 years), adolescents (aged 13-19 years), and adults (aged ≥20 years).nnnMAIN OUTCOMES AND MEASURESnAdult CRS was classified into CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). Diagnosis of AR was based on symptoms and serum levels of specific IgE for 3 allergens, including Dermatophagoides farinae. The precise prevalence of AR was reestimated by multiplying the reciprocal of D farinae frequency based on a conventional skin prick test. Nasal septal deviation was diagnosed via nasal endoscopy after nasal decongestion. This study estimated the association of the 3 diseases with demographic data, including sex, age, obesity, level of education, socioeconomic status, residence, smoking, and alcohol.nnnRESULTSnThe prevalence of CRSwNP and CRSsNP in 28u202f912 adults was 2.6% and 5.8%, respectively. An association was found between CRSwNP and age (odds ratio [OR], 1.03; 95% CI, 1.02-1.04; Pu2009<u2009.001), lower level of education (OR, 1.40; 95% CI, 1.02-1.92; Pu2009=u2009.04), and obesity (OR, 1.46; 95% CI, 1.16-1.84; Pu2009=u2009.001). Symptom-based and allergy test result-based AR had a prevalence of 27.5% (nu2009=u200935u202f511) and 16.1% (nu2009=u20092298), respectively. The reestimated prevalence of AR was 18.5% for all ages. Urban residence increased the risk of AR (OR, 1.21; 95% CI, 1.06-1.38; Pu2009=u2009.005), but age was associated with a decreased risk (OR, 0.99; 95% CI, 0.98-0.99; Pu2009<u2009.001). The prevalence of NSD was 48.0% and increased with age. In addition, NSD was a risk factor for CRSsNP (adjusted OR, 1.16; 95% CI, 1.02-1.32; Pu2009=u2009.03) but not for CRSwNP.nnnCONCLUSIONS AND RELEVANCEnIn KNHANES 2008-2012, older age was associated with increased risk for CRSwNP and NSD but associated with a decreased risk for AR. Obesity was another risk factor for CRSwNP.

Effects of Age on the Clinical Features of Men with Obstructive Sleep Apnea Syndrome

Background: There is little information on the differences in polysomnographic findings in obstructive sleep apnea syndrome (OSAS) between elderly and young or middle-aged adults. Objectives: The aim of this study was to elucidate the clinical characteristics of elderly patients compared to young or middle-aged patients with OSAS. Methods: A total of 757 male patients who were found to have OSAS (apnea-hypopnea index, AHI ≥ 5) were enrolled. After nocturnal polysomnography, patients also completed the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale. Results: The patients were divided into three groups: ages 20–44 (n = 254), ages 45–64 (n = 373), and ages 65–86 (n = 130). Body mass index (BMI) and the proportion of overweight patients (BMI ≥25) were lower in the elderly group (ages 65–84) than in the other age groups (all p < 0.01). However, in the elderly group, there was a significant correlation between AHI and BMI (r = 0.28, p < 0.01), and BMI was a significant determinant of AHI (β = 0.30, p < 0.01). In addition, the elderly group showed a high percentage of apneas among apneas and hypopneas ( p = 0.02) and increased duration of apnea-hypopnea (p < 0.01) compared to the other age groups. Conclusions: Despite the occurrence of OSAS in the elderly with low BMI, the influence of body weight on the severity of OSAS was still significant in elderly patients. Age-related high collapsibility of the upper airways could explain the higher percentage of apneas and longer duration of apnea-hypopnea in the elderly compared to young or middle-aged patients with OSAS.

Expression of Bcl-2 in olfactory neuroblastoma and its association with chemotherapy and survival

Objective This study aimed to identify the prognostic value of tumor markers in olfactory neuroblastoma (ONB). Study Design and Setting Seventeen patients with ONB (23 tumor specimens) were included. Each specimen was studied for bcl-2, p53, MIC-2 by immunohistochemistry and for N-myc by chromogenic in situ hybridization. Results Twelve (70%) of 17 patients and 15 (65%) of 23 specimens showed positive reactivity for bcl-2. Of seven patients who were treated with neoadjuvant chemotherapy, one patient with diffuse bcl-2 expression achieved complete remission. Another patient without bcl-2 expression had no response to chemotherapy. Five patients who showed partial positivity achieved partial remission. Survival and bcl-2 expression tended to correlate, but it was not statistically significant (P = 0.06). All of the ONB specimens were negative for N-myc. Positive immunoreactivity for MIC-2 or p53 was found only in one specimen. Conclusion Bcl-2 expression was commonly found in ONB and the immunoreactivity for bcl-2 might predict response to neoadjuvant chemotherapy. In addition, Bcl-2 expression tended to be associated with worse survival.