Eo-Jin Kim

Mucosal expression of ENaC and AQP in experimental otitis media induced by Eustachian tube obstruction

OBJECTIVE We investigated the expression of the epithelial sodium channel (ENaC) and aquaporins (AQPs) in the middle ear mucosa of a rat model of otitis media with effusion caused by surgical obstruction of the Eustachian tube. METHODS Sixty-four rats were randomly assigned to either undergo unilateral Eustachian tube obstruction (groups 1, 2, and 3) or to undergo no procedure (control group). Bony Eustachian tubes were approached through ventral incisions and obstructed with electrocautery. On days 14, 28, and 56, the ears were evaluated, and the rats were sacrificed for otoscopic evaluation and real-time RT-PCR. Immunohistochemistry was done for ENaC-alpha and AQP-1. RESULTS The level of ENaC-alpha expression decreased 0.28- and 0.73-fold at 2 and 4 weeks, respectively, but increased 1.48-fold at 8 weeks (p<0.05). The change in ENaC-beta expression at 2 weeks was insignificant. However, the level of ENaC-beta expression increased 3.17- and 7.85-fold at 4 and 8 weeks, respectively (p<0.05). The level of ENaC-gamma expression increased 1.51-, 4.82- and 14.79-fold at 2, 4 and 8 weeks, respectively (p<0.05). The level of AQP-1 expression decreased 0.10- and 0.04-fold at 4 and 8 weeks, respectively (p<0.05). The change in AQP4 expression at 4 and 8 weeks was insignificant (p>0.05). The pattern of immunoreactivity of ENaC-alpha and AQP-1 was similar with that of gene expression. CONCLUSION The experimental methods provoked reproducible otitis media with effusion. This model is well suited for studies of middle ear homeostasis during disease pathogenesis. Middle ear mucosa homeostasis is altered significantly by ETO, and the subunits of AQP proteins show a characteristic expression pattern over time.

Spontaneous Epidural Hematoma from Skull Base Metastasis of Hepatocellular Carcinoma

We report a case of an acute spontaneous epidural hematoma (EDH) due to skull base metastasis in a 46-year-old male patient with hepatocellular carcinoma (HCC). The patient presented with the acute onset of severe headache followed by unconsciousness, and computed tomography showed a large EDH in the right temporal and parietal lobes with midline shift. Emergency evacuation of the EDH was performed, and the hemorrhage was determined to be secondary to skull base metastasis of HCC.

Simultaneous adrenal pheochromocytoma and sarcoidosis.

A 48-year-old man presented for evaluation of general weakness. Because he had a history of excessive alcohol use, an abdominal computed tomography scan was obtained, which revealed a left adrenal mass. Hormonal evaluation showed elevated levels of urinary catecholamines. Bilateral hilar lymphadenopathy was detected on a chest radiograph. The suspected diagnosis was asymptomatic pheochromocytoma with sarcoidosis. We performed a mediastinoscopic lymph node biopsy, which was followed by endoscopic adrenalectomy. Histologic tissue analysis confirmed an adrenal pheochromocytoma and sarcoid granulomas in the mediastinal lymph nodes. This case highlights the difficulty in determining the appropriate work up of patients presenting with an adrenal incidentaloma and concomitant systemic disease.

Cauda equina syndrome caused by pseudogout involving the lumbar intervertebral disc.

Calcium pyrophosphate dihydrate (CPPD) deposition disease, also known as pseudogout, is a disease that causes inflammatory arthropathy in peripheral joints, however, symptomatic involvement of the intervertebral disc is uncommon. Herein, we describe a 59-yr-old patient who presented with cauda equina syndrome. Magnetic resonance imaging of the patient showed an epidural mass-like lesion at the disc space of L4-L5, which was compressing the thecal sac. Biopsy of the intervertebral disc and epidural mass-like lesion was determined to be CPPD deposits. We reviewed previously reported cases of pseudogout involving the lumbar intervertebral disc and discuss the pathogenesis and treatment of the disease.

Persistent chemical peritonitis resulting from spontaneous rupture of an ovarian mature cystic teratoma

726 PERSISTENT CHEMICAL PERITONITIS RESULTING FROM SPONTANEOUS RUPTURE OF AN OVARIAN MATURE CYSTIC TERATOMA Hyun Sung Yang, MD, Tae Hun Song, MD, Hyun Chul Bang, MD, Jun-Ho Park, MD, Chae Hyeong Lee, MD, Ju-Won Roh, MD, PhD, Eo-Jin Kim, MD, PhD, Yong Seok Lee, MD, PhD, Seung-Su Han, MD Departments of Obstetrics and Gynecology, Pathology, Radiology, Dongguk University College of Medicine; Department of Obstetrics and Gynecology, Chung-Ang University College of Medicine, Seoul, Korea