Jeong-Whun Kim

Histological and immunological features of non-eosinophilic nasal polyps

Objective The aim of this study was to investigate the his-toimmunological features of non-eosinophilic nasal polyps (NPs). METHODS Thirty patients with chronic rhinosinusitis and NPs were included in this study. NPs were grouped into eosinophilic and non-eosinophilic types according to the amount of eosinophils in the NPs. The amount of serum total IgE and peripheral blood eosinophils were measured. Basement membrane (BM) thickness was measured, along with the expression of chemokine receptor 5 (CCR5) and chemokine receptor 3 (CCR3) in NP lymphocytes. RESULTS Non-eosinophilic NPs comprised 66.7% of the total NPs included in this study. The amount of eosinophils in NPs was related to eosinophilia of the peripheral blood, but not to elevated serum IgE. BM was significantly thinner in non-eosinophilic than in eosinophilic NPs. Lymphocytes expressing CCR5 or CCR3 were less frequently found in non-eosinophilic than in eosinophilic NPs. CONCLUSION Histoimmunological characteristics of non-eo-sinophilic NPs differ from those of eosinophilic NPs; non-eosino-philic NPs may be featured by thinner BM and fewer CCR5- and CCR3-positive lymphocytes.

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 incidence, risk factors and prognostic implications of venous thromboembolism in patients with gastric cancer

Summary.u2002 Background: Data on venous thromboembolism (VTE) in gastric cancer (GC) are very scarce. Objective: To investigate the incidence, risk factors and prognostic implications of VTE in Asian GC patients. Methods: Prospective databases containing clinical information on GC patients (nu2003=u20032,085) were used. Results: The 2‐year cumulative incidences of all VTE events were 0.5%, 3.5% and 24.4% in stages I, II–IV(M0) and IV(M1), respectively. Advanced stage, older age and no major surgery were independent risk factors for developing VTE. When the VTE cases were classified into extremity venous thrombosis (EVT), pulmonary thromboembolism (PTE) or intra‐abdominal venous thrombosis (IVT), IVTs (62%) were more common than EVTs (21%) or PTEs (17%). Although peri‐operative pharmacologic thromboprophylaxis was not routinely administered, the VTE incidence after major surgery was only 0.2%. During chemotherapy, EVT/PTE developed more frequently than IVT (54% vs. 19%); however, during untreated or treatment‐refractory periods, IVT developed more frequently than EVT/PTE (69% vs. 36%). In multivariate models, the development of EVT/PTE was a significant predictor of early death when compared with no occurrence of VTE (Pu2003<u20030.05). However, IVT did not affect survival. Conclusion: This is the largest study that specially focused on VTE in GC and the VTE incidence in Asian GC patients was first demonstrated. Considering the low incidence of post‐operative VTE development, the necessity of peri‐operative pharmacologic thromboprophylaxis should be evaluated separately in Asian patients. The clinical situation of the development of EVT/PTE and IVT differed. Only EVT/PTE had an adverse effect on survival and IVT had no prognostic significance.

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.

Prevalence, risk factors and comorbidities of allergic rhinitis in South Korea: The Fifth Korea National Health and Nutrition Examination Survey.

Background There has been no nationwide epidemiological investigation of allergic rhinitis (AR) that was diagnosed by both questionnaires and laboratory tests in Korea. This study investigated the prevalence, risk factors, and comorbidities of AR in South Korea. Methods The Korean National Health and Nutritional Examination Survey examined a representative sample of the Korean population. A total of 2305 participants underwent immunoradiometric assay for specific IgE antibodies against common indoor allergens. Healthy, atopy only, and AR groups were defined according to the results of allergen test. The weighted prevalence for each group was calculated. Risk factors including food and comorbidities were identified using univariate or multivariate analyses. The patients were also categorized into four subgroups according to the Allergic Rhinitis and Its Impact on Asthma (ARIA) classification and associated comorbidities were analyzed. Results The prevalence of atopy only and AR was 30.0 ± 1.2% and 16.2 ± 1.0%, respectively. The multivariate analysis showed that the prevalence was influenced by sex (p < 0.01) for atopy only and sex (p = 0.09), age (p = 0.02), marital status (p = 0.24), and stress level (p = 0 for AR. Compared with the healthy group, asthma (odds ratio [OR] = 4.77), nasal polyp (NP; OR = 3.44), chronic rhinosinusitis (OR = 13.93), and olfactory dysfunction (OR = 4.88) were more prevalent in the AR group. Based on the ARIA guideline, intermittent mild rhinitis was most common (58.1%). Asthma was correlated to severity and atopic dermatitis and NPs was associated with persistency. Daily intake of less mackerel and more carrots, bread, and bean curd were associated with the increased risk of AR. Conclusion Prevalence, risk factors, and comorbidities of AR were evaluated in the general Korean population, which will contribute to prevention and treatment of AR and its comorbidities in Koreans.

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.

Combination chemotherapy with capecitabine and cisplatin for patients with metastatic hepatocellular carcinoma

BACKGROUNDnWe evaluated the efficacy and toxicity of combination chemotherapy with capecitabine and cisplatin (XP) in patients with metastatic hepatocellular carcinoma (HCC).nnnPATIENTS AND METHODSnFrom September 2003 to July 2007, we enrolled patients with HCC who had more than one measurable extrahepatic metastatic lesion. Patients received oral capecitabine (2000 mg/m(2)/day) with a schedule of 2 weeks on and 1 week off and cisplatin (60 mg/m(2)) on the first day of the 3-week cycle.nnnRESULTSnThe study cohort consisted of 32 patients with a median age of 53 years. Overall response rate was 6.3% and disease control rate was 34.4%. The median time to progression (TTP) was 2.0 months [95% confidence interval (CI) 1.5-2.4] and the median overall survival (OS) time was 12.2 months (95% CI 6.5-17.8). The grade 3/4 hematologic toxic effects included thrombocytopenia (7.6%), neutropenia (4.3%) and anemia (2.1%). The grade 3/4 non-hematologic toxic effects included elevated hepatic aminotransferase (12.9%), jaundice (3.2%), mucositis (3.2%) and nausea (3.2%). There was no treatment-related mortality.nnnCONCLUSIONSnBased on the observed response rate and TTP, XP combination chemotherapy showed modest antitumor efficacy in patients with metastatic HCC as systemic first-line treatment. However, XP combination chemotherapy showed tolerable toxicity and demonstrated favorable OS time.

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.