Joong Saeng Cho

Changes in histological features of nasal polyps in a Korean population over a 17-year period.

Objective Nasal polyps can be categorized as eosinophilic or non-eosinophilic, depending on inflammatory cell infiltration. There are geographical differences in the prevalence of types of pathologic polyps. The aim of this study was to evaluate the change in the prevalence of histological subtypes of polyps over time in a Korean population. Study Design A retrospective cross-sectional study with histologic analysis. Setting A single academic medical center. Subjects and Methods A total of 230 patients with nasal polyps were enrolled between 1993-1994 (group A) and 2010-2011 (group B). Specimens were fixed in formalin and embedded into paraffin blocks. Slides were stained with hematoxylin-eosin (H&E) and were subsequently reviewed by 2 of the authors. The numbers of eosinophils per high power field (HPF), as well as other cellular, epithelial, and stromal markers, were recorded. Results We compared nasal polyp eosinophil counts according to time period. The average eosinophil count/HPF increased from 6.8 in group A to 19.3 in group B (P = .006). The prevalence of eosinophilic polyps also increased from 24.0% in group A to 50.9% in group B (P < .001). Among other histologic markers, lymphocytes, basement membrane thickening, and gland hyperplasia showed significant differences between groups. Conclusion After comparison of histopathologic findings of nasal polyps from 1993 and 2011 at 1 academic medical center in Korea, the prevalence of eosinophilic nasal polyps, which are known to be rare among Asians, has significantly increased.

Long-term Effects of Specific Allergen Immunotherapy Against House Dust Mites in Polysensitized Patients With Allergic Rhinitis

Purpose Allergen-specific immunotherapy is the only currently available treatment to modify the natural history of allergic rhinitis (AR). If patients are polysensitized, it is difficult to identify the allergen causing the allergic symptoms. We evaluated the effectiveness of immunotherapy against house dust mites (HDMs) in AR patients polysensitized to both HDMs and seasonal allergens. Methods Thirty AR patients polysensitized to both HDMs and seasonal allergens (group A) and 30 patients sensitized to HDMs only (group B) were enrolled in this study. All subjects who received immunotherapy against HDMs for more than 2 years were evaluated by the multiple allergen simultaneous test (MAST) to determine the specific IgE level in luminescence units, total eosinophil counts in peripheral blood, serum total IgE, total nasal symptom scores, and the rhinoconjunctivitis quality of life questionnaire (RQLQ) before and after immunotherapy. Results There were no statistical differences in levels of total and specific IgE, or total eosinophil count between the two groups. The total nasal symptom scores, RQLQ and medication scores significantly decreased after immunotherapy in both groups, however no significant differences were noted between the two groups. Conclusions We determined that the primary causative allergen of AR in Seoul, Korea is perennial allergens, such as HDMs, rather than seasonal allergens. This study provides a reference for the selection of allergens to use in immunotherapy for polysensitized AR patients living in an urban environment.

Short-term effect of multilevel surgery on adipokines and pro-inflammatory cytokines in patients with obstructive sleep apnea.

Abstract Conclusion: This study shows the possibility that multilevel surgery for obstructive sleep apnea (OSA) is helpful to improve the levels of pro-inflammatory cytokines and adipokines, which are related to complications of OSA. Objectives: The effects of multilevel surgery on adipokines and pro-inflammatory cytokines in patients with OSA were assessed. Methods: Fifty-one patients with OSA underwent uvulopalatopharyngoplasty and radiofrequency tongue base reduction. Body mass index (BMI), Epworth sleepiness scale (ESS) and subjective symptoms using visual analog scales were assessed at baseline and 4 weeks after treatment. Adiponectin, leptin, interleukin (IL)-6, and tumor necrosis factor (TNF)-α were measured with a LINCOplex Human Immunoassay at baseline and 4 weeks after surgical treatment. Results: Significant improvements in subjective symptoms and ESS were found at 4 weeks after multilevel surgery. No significant change in BMI was observed. Adiponectin level was significantly increased after surgical treatment. Postoperative leptin, IL-6, and TNF-α levels were significantly decreased. The percent changes of adiponectin, leptin, IL-6, and TNF-α after multilevel surgery were not significantly different among patients with mild, moderate, and severe OSA.

Changes of histamine receptors and CC chemokines in nasal epithelial cells and fibroblasts after respiratory syncytial virus infection.

Background Respiratory syncytial virus (RSV) is reported as the most influential factor that triggers hyperreactivity of the airway and causes asthma in infants and children. However, the mechanisms remain to be elucidated. The study evaluated the changes in the levels of four types of histamine receptor (HR) and CC chemokines, such as eotaxin and regulated on activation, normal T cell expressed and presumably secreted (RANTES), in nasal epithelial cells and fibroblasts after RSV infection. Methods Nasal cavity mucosa attained from 20 patients who had undergone inferior turbinoplasty were cleaned by normal saline mixed with gentamicin. Each sample was divided in half. One-half was used for incubation of epithelial cells, and the other half was used for culturing fibroblasts. The levels of HR 1 (H1R), 2 (H2R), 3 (H3R), 4 (H4R), eotaxin, and RANTES were measured by real-time polymerase chain reaction 0, 12, and 36 hours after infection with RSV. Results H1R was significantly increased at 12 and 36 hours compared with 0 hours in both cell types. The level of H2R was significantly increased in epithelial cells from 0 to 36 and 12 to 36 hours and in fibroblasts from 0 to 12 and 0 to 36 hours. There were significant increases of H3R level in fibroblasts from 0 to 12 and 0 to 36 hours, and of H4R in epithelial cells and fibroblasts from 0 to 12 and 0 to 36 hours. Eotaxin and RANTES were also significantly increased in both epithelial cells and fibroblasts from 0 to 12 and 0 to 36 hours. Conclusion RSV infection increases the levels of all four HRs, especially H1R and H2R, as well as the levels of eotaxin and RANTES in nasal epithelial cells and fibroblasts. These findings suggest that RSV infection might cause respiratory tract hyperreactivity by increasing the content of HRs and CC chemokines.

Comparison of level and degree of upper airway obstruction by Müller's maneuver and drug-induced sleep endoscopy in obstructive sleep apnea patients

OBJECTIVE This study aimed to compare and analyze the level and degree of observed upper airway obstruction in patients with obstructive sleep apnea (OSA) using Müllers maneuver (MM) and drug-induced sleep endoscopy (DISE). We sought to find a method for evaluating the upper airway that could be used to determine surgical sites. METHODS This study included 80 OSA patients who visited Kyung Hee Medical Center and underwent polysomnography (PSG) from March 2013 to March 2014. Obstructive levels observed by MM were classified into retropalatal level, or the lateral wall and retroglossal level. These levels were compared with those determined by DISE through the VOTE classification. RESULTS Based on the results of MM and DISE, lateral wall and retropalatal level obstructions showed relatively high conformity, while retroglossal level obstruction exhibited considerable differences. When evaluated at each level, patients with obstruction on MM also showed partial or complete obstruction on DISE at same level, and patients with no obstruction on DISE also showed no obstruction on MM at same level. CONCLUSION Both examination methods revealed the same obstruction levels in all cases except epiglottic level, but there were some differences in obstructive degree. MM is capable of detecting obstruction levels in the upper airway and can be used to determine surgical sites in cases when DISE cannot be used due to a patients condition or a clinics circumstances.

Local IgE-mediated hypersensitivity to Alternaria in pediatric adenoid tissue §

OBJECTIVE Fungus may contribute to the development and exacerbation of allergic airway diseases. Several studies have demonstrated the presence of humoral immune responses to fungi, including Alternaria and Aspergillus, in patients with nasal polyposis, asthma, or rhinitis. The purpose of this study was to evaluate the role of Alternaria- and Aspergillus-specific IgE antibodies in allergic inflammation of adenoid tissue. METHODS Thirty-nine atopic subjects who were sensitized to more than one common aeroallergen and 39 non-atopic subjects undergoing adenotonsillectomy were recruited. The Phadia ImmunoCAP was used to quantify total IgE, Alternaria- and Aspergillus-specific IgE, eosinophil cationic protein (ECP), and mast cell tryptase in adenoid tissue homogenates. Alternaria- and Aspergillus-specific IgE were detected in the adenoid tissues from some of the subjects (37.2% and 24.4%, respectively) without systemic sensitization to common airborne fungi. RESULTS Both Alternaria- and Aspergillus-specific IgE were more prevalent in adenoid tissues from atopic children (48.7% and 38.5%, respectively) than in tissues from non-atopic children (25.6% and 10.3%, respectively). Subjects with high Alternaria-specific IgE level showed significantly higher serum and adenoid total IgE and adenoid ECP and tryptase than those without specific IgE. Alternaria-specific IgE levels were significantly correlated with serum and adenoid total IgE and with tryptase and ECP levels in adenoid tissue. CONCLUSIONS Adenoid tissues from atopic and non-atopic children displayed local IgE-mediated hypersensitivity to fungi in the absence of systemic fungal hypersensitivity. Locally-produced Alternaria-specific IgE may contribute to mast cell and eosinophil activation, especially in the presence of tissue eosinophilia.

Anatomical anomalies of alar cartilage.

bicularis muscle coincided with the direction of the epicanthal folds. The epicanthus tarsalis, epicanthus supraciliaris, and epicanthus palpebralis, which are thought to be on the same anatomical line,2,3 may be differentiated on the basis of which part of the oblique direction preseptal orbicularis muscle affects most. From this standpoint, a case without the epicanthal fold may be under the influence of the pretarsal orbicularis muscle. An epicanthal fold revision is described, therefore, to change the influence under the preseptal orbicularis muscle to that of the pretarsal orbicularis muscle. DOI: 10.1097/PRS.0b013e31825dc611

Changes of Alpha1-Antitrypsin Levels in Allergen-induced Nasal Inflammation

Objectives Alpha1-antitrypsin (AAT) is the main inhibitor of human neutrophil elastase, and plays a role in counteracting the tissue damage caused by elastase in local inflammatory conditions. The study evaluated the involvement of AAT in nasal allergic inflammation. Methods Forty subjects with mono-sensitization to Dermatophagoides pteronyssinus (Dpt) were enrolled. Twenty allergic rhinitis patients frequently complained of nasal symptoms such as rhinorrhea, stuffiness, sneezing, and showed positive responses to the nasal provocation test (NPT) with Dpt (Group I). The other 20 asymptomatic patients showed sensitization to Dpt but negative NPT (Group II). The levels of AAT, eosinophil cationic protein (ECP), and Dpt-specific IgA antibodies were measured in the nasal lavage fluids (NLFs), collected at baseline, 10 minutes, 30 minutes, 3 hours, and 6 hours after the NPT. Nasal mucosa AAT expression was evaluated with immunohistochemical staining from Group I and Group II. Results At baseline, only the Dpt-specific IgA level was significantly increased in the NLFs of Group I compared with Group II, while ECP and AAT levels were not significantly different between two groups. After Dpt provocation, AAT, ECP, and Dpt-specific IgA levels were significantly increased in the NLFs of Group I during the early and late responses. The protein expression level of AAT was mostly found in the infiltrating inflammatory cells of the nasal mucosa, which was significantly increased in Group I compared to Group II. Conclusion The increment of AAT showed a close relationship with the activation of eosinophils induced by allergen-specific IgA in the NLFs of patients with allergic rhinitis after allergen stimulation. These findings implicate AAT in allergen-induced nasal inflammation.

Clinical Aspects of Alternaria alternata Sensitization in Patients with Allergic Rhinitis

Objectives: Atopic sensitization to the mold Alternaria alternata (AA) has been associated with rhinitis and asthma. Fungal allergen exposure is associated with the development and severity of asthma in sensitized individuals. The contribution of indoor fungal allergen exposure to allergic diseases is still not completely clear. We explore the association of AA sensitization to other allergic diseases and study the influence on rhinoconjunctivitis symptom severity. Methods: 2207 patients who were diagnosed with allergic rhinitis were enrolled in our study. After a skin allergy test, those with sensitivity to AA were placed in group A, and those sensitive to other allergens were placed in Group B. We evaluated the prevalence of other allergic disease and symptom severity using TNSS score. Results: Group A had 73 patients (6.4%), and Group B had 1053 patients. Group A had 8 patients with asthma (10.9%), 9 with atophy (12.3%), 6 with allergic conjunctivitis (8.2%), and 11 with sinusitis (15%) Group B had children under 14 years of age (35 patients), 7 with asthma (20%), 3 with allergic conjunctivitis (8.5%), 5 with sinusitis (14.2%), and 4 with asthma, allergic rhinitis, and atopic dermatitis (11.4%). In group A, TNSS score was higher than Group B, and it was statistically significant. Conclusions: Patients with allergic rhinitis may have other atopic conditions such as asthma or atopic dermatitis. Group B and those over 14 had a higher prevalence of other allergic disease. In group A, allergic rhinitis symptoms were severe. Allergen-specific immunotherapy with standardized A. alternata extract will reduce symptoms of asthma and rhinoconjunctivitis.

Changes of the Histological Features in Nasal Polyps

Objective: Depending on the inflammatory cell infiltration, nasal polyps can be categorized as eosinophilic type or non-eosinophilic type. There is a geographical difference in the prevalence of a certain pathological type of polyp. More than 80% of polyps in Western people are the eosinophilic type, while this type is rarely found among Eastern people. The periodical change in the prevalence of histological types of polyps was evaluated in this study. Method: Two hundred total patients, each confirmed to the polyp biopsy, were enrolled between 1993 and 2010. Specimens were fixed in formalin, then made to a paraffin block and H&E stained slide, which was reviewed by 2 authors. The number of eosinophils per high power field (HPF) and other cellular, epithelial, and stromal markers were reviewed. Results: We compared the nasal polyp eosinophil count by periods, the average eosinophil count/HPF increased from 7.22 (±1.695) in 1993 to 20.44 (±3.635) in 2010 (P = .001). Eosinophilic polyp (showing over 5 eosinophils/HPF) increased significantly from 26% in 1993 to 52% in (P = .000 -> P < .001). Among other histologic markers, lymphocytes, basement membrane thickening, and gland hypertrophy showed significant difference. Conclusion: After comparative studies between histopathologic findings of nasal polyps from 1993 and 2010 respectively, the percentage of eosinophilic nasal polyp, known to be rare among Asians, including Koreans, have increased significantly.