Kyung Wook Heo

Acute lymphadenitis with cellulitis caused by Staphylococcus lugdunensis.

Although coagulase-negative staphylococci (CNS) have been considered part of the resident flora on the human skin, Staphylococcus lugdunensis is an unusually virulent CNS and can cause many types of infection. We report a rare case of acute lymphadenitis with cellulitis in the right infraauricular region caused by S. lugdunensis. A 62-yr-old woman visited the Department of Otolaryngology of Busan Paik university hospital. She had a palpable mass and swelling in the right infraauricular region and complained of aggressive pain and a febrile sensation in the region for 5 days. On the suspicion of abscess with infection, percutaneous aspiration was performed and smooth, flat, white, opaque colonies grew on a blood agar plate as a pure culture. The biochemical test results showed the organism to be catalase positive, tube coagulase negative, ornithine decarboxylase positive, slide coagulase positive, and latex agglutination tests for coagulase positive. The API Staph Kit was used to identify the isolate to the species level as S. lugdunensis with a 64.6% probability (profile 6716152). We confirmed the species identification of this strain by 16S rDNA sequence analysis. The patients clinical condition improved with appropriate antimicrobial therapy and pus drainage.

Role of acidic mammalian chitinase and chitotriosidase in nasal polyps

OBJECTIVE: Chitin is a recognition element for tissue infiltration by innate cells implicated in allergy and helminth immunity, and this process can be negatively regulated by vertebrate chitinases. Acidic mammalian chitinase (AMCase) and chitotriosidase (ChT) have chitinolytic activity, but little is known about their roles in nasal polyps. STUDY DESIGN: A prospective controlled study. SETTING: A tertiary referral center. SUBJECTS AND METHODS: Nineteen subjects with nasal polyps and 12 subjects with deviated nasal septums were recruited to obtain inferior turbinate mucosa samples. The expression levels of AMCase and ChT were compared in nasal polyp and inferior turbinate tissue samples. The tissue samples were analyzed by reverse transcription-polymerase chain reaction, Western blotting, and immunohistochemical staining. RESULTS: AMCase and ChT were detected in all nasal polyps and inferior turbinate tissues. AMCase and ChT messenger RNA and protein expression were significantly higher in nasal polyps than in inferior turbinate tissues. In nasal polyps, AMCase-positive and ChT-positive cells were detected in the epithelium, inflammatory cells, and submucosal gland. CONCLUSIONS: AMCase and ChT may be important mediators in the pathogenesis of nasal polyps. Nasal polyps appear to have elevated levels of chitinases, and the presence or growth of chitin-containing pathogens might enhance chitinase expression, resulting in nasal polyp formation and growth in susceptible individuals.

Expression of Chitinases in Hypertrophied Adenoids of Children

Objectives/Hypothesis. Chronic rhinosinusitis (CRS), otitis media with effusion (OME), and allergic rhinitis (AR) are common conditions that have been associated with hypertrophied adenoids in children, and adenoidectomy is clinically recommended. The investigators assayed the expression level and site of acidic mammalian chitinase (AMCase) and chitotriosidase (ChT) in hypertrophied adenoids of children to determine the expression levels of 2 chitinases in relation to CRS, OME, and AR. Study Design. A prospective cohort study. Setting. A tertiary care facility. Methods. Hypertrophied adenoids from 41 children were harvested during adenoidectomy. Medical records were reviewed and the subjects were grouped according to the presence of CRS, OME, and AR. Messenger RNA (mRNA) and protein expression of AMCase and ChT in adenoid tissues was assessed by reverse transcription polymerase chain reaction and Western blotting. Immunohistochemical staining revealed the sites of AMCase and ChT expression. Results. mRNA and protein of AMCase and ChT were present in adenoids of all subjects. CRS was a significant variable in AMCase mRNA and protein expression. CRS, OME, and AR were significant variables in ChT mRNA and protein expression. Both AMCase and ChT were expressed in histiocytes and vascular endothelial cells of adenoid tissues. Conclusions. The findings suggest that chitin-containing pathogens or dysregulated immune responses to them in the hypertrophied adenoids of children could be factors contributing to CRS, OME, and AR via AMCase or ChT overexpression.

Expression of galectin-9 by IFN-γ stimulated human nasal polyp fibroblasts through MAPK, PI3K, and JAK/STAT signaling pathways.

Galectin-9 exhibited potent and selective eosinophil chemoattractant activity and attracted eosinophils in vitro and in vivo. Nasal polyposis is a chronic inflammatory disease of the upper airway characterized by the marked presence of inflammatory cells, particularly eosinophils. Thus, galectin-9 may be implicated in the pathogenesis of nasal polyposis. The study was designed to investigate whether interferon-gamma (IFN-γ) can induce the augmentation of galectin-9 expression and induce the expression of galectin-9 in nasal polyps. We examined the correlation between galectin-9 expression and eosinophil infiltration in nasal polyps. In addition, we identified the signaling pathways involved in the elevation of galectin-9 expression in response to IFN-γ. Our data demonstrate that the involvement of mitogen-activated protein kinases (MAPKs), phosphatidylinositol 3 phosphate kinase (PI3K), and Janus kinase/signal transducer and activator of transcription (JAK/STAT) may play important roles in the selective recruitment of eosinophils in nasal polyp tissues through the production of galectin-9. These findings suggest that galectin-9 expression is associated with eosinophil infiltration in polyps of patients with nasal polyposis.

Chitinolytic activity in nasal polyps.

Background Chitin is a recognition element for tissue infiltration by innate cells implicated in allergy and immunity. This process can be negatively regulated by vertebrate chitinases. Both acidic mammalian chitinase (AMCase) and chitotriosidase (ChT) have chitinolytic activity. This study aimed to determine the activities of AMCase and ChT in nasal polyps (NPs), as well as their in situ localization in NP tissue. Methods AMCase and ChT activities in NPs were compared with those in inferior turbinate tissue samples. Tissue samples were measured for AMCase and ChT activities at a range of pHs using the fluorogenic substrate 4-methylumbelliferyl-beta-D-N,N′,N″-triacetyl-chitotriose. Double immunofluorescent staining for the localization of both AMCase and ChT was performed using NP cryosections. Results Both AMCase and ChT displayed markedly increased chitinolytic activity in all NPs, compared with inferior turbinate tissues. Double immunofluorescent staining revealed that CD68 highlighted monocytes in the submucosa of NP and these cells disclosed coexpression of AMCase and ChT. CD31 detected capillary endothelial cells, but did not express any AMCase and ChT. Conclusion The increased chitinolytic activities of AMCase and ChT in NPs may be important in NP pathogenesis, suggesting that inhibition of chitinolytic activity may be a novel therapeutic strategy for the treatment of NPs.

Prospective, Multicenter Study on Tinnitus Changes after Cochlear Implantation

Objective: To investigate the time course of tinnitus changes in patients receiving cochlear implantation (CI) in a prospective, multicenter setting and to determine related factors. Materials and Methods: A total of 79 adult patients who underwent CI were included in this study. We used the same questionnaires sequentially 5 times. The questionnaires included the Visual Analog Scale (VAS) for tinnitus severity, the Tinnitus Handicap Inventory (THI), Becks Depression Index (BDI), and the Brief Encounter Psychosocial Instrument (BEPSI) for stress assessment. Results: Tinnitus was present in 59 (74.7%) of the 79 study subjects. After CI, tinnitus was eliminated in 10 patients (25%) and improved in 16 patients (40%) of the 40 patients who completed the final questionnaires, and most of the tinnitus reduction occurred in the early period of CI use. In an analysis of psychological functioning with CI, BDI was reduced significantly after CI. Multiple linear regression analysis revealed that preoperative auditory steady-state response (ASSR), THI, and final BDI score were significantly associated with the changes in tinnitus after CI. Conclusions: Most of the tinnitus reduction occurred within 1 month after CI use, and the changes were significantly associated with THI, ASSR, and BDI scores 6 months after CI. CI is a valuable therapeutic modality in tinnitus of a deafened ear.

Alternative to Canal Wall-Down Mastoidectomy for Sclerotic Mastoid Cavities: Epitympanoplasty With Mastoid Obliteration

Objectives: Surgical procedures for chronic ear disease can be grossly divided into two tympanoplasty procedures: canal wall–up and canal wall–down (CWD) mastoidectomies. The choice depends on the surgeon’s preference. Epitympanoplasty with mastoid obliteration (EMO) has shown postoperative results similar to those of CWD mastoidectomy with long-term follow-up. In this study, we compared the outcomes of EMO and CWD mastoidectomy in preoperatively sclerotic mastoid cavities with cholesteatoma, chronic otitis media with poor eustachian tube function, or adhesive otitis media. The operations were performed by the same surgeons in order to eliminate any effect of surgeon preference on the surgical outcomes. Methods: We reviewed the medical records of patients who underwent tympanoplasty with EMO (EMO group) or CWD mastoidectomy (CWD group) and followed them for more than 28 months. The postoperative outcomes were analyzed and compared. Results: The EMO and CWD groups comprised 132 and 110 ears, respectively. In both groups, the air-bone gaps were significantly reduced after operation. The relapse rates of the groups were similar. Cavity problems were the most common complication in the CWD group. The overall complication rate in the EMO group was significantly lower than that in the CWD group (p = 0.044). Conclusions: Epitympanoplasty with mastoid obliteration can be considered an alternative procedure to CWD mastoidectomy in patients with preoperatively sclerotic mastoid cavities. It gives similar surgical results and has fewer complications.

Methotrexate induces apoptosis in nasal polyps via caspase cascades and both mitochondria-mediated and p38 mitogen-activated protein kinases/Jun N-terminal kinase pathways.

Background Methotrexate (MTX) is a very effective treatment for chronic inflammatory diseases that induces apoptosis in nasal polyps (NPs). However, the precise apoptotic pathway in NPs remains unclear. The aim of this study was to identify the apoptotic signaling pathways activated by MTX in NPs. Methods NP tissues were organ cultured using an air–liquid interface method. Cultures were maintained in the presence or absence of MTX (10 or 100 μM) for 24 hours. To investigate apoptotic signaling in NPs, we performed reverse transcription–polymerase chain reaction and Western blotting. Results MTX-treated NPs contained significantly increased amounts of the active forms of caspase 8, caspase 9, and caspase 3 and displayed increased cleavage of poly(ADP-ribose) polymerase. Expression of the proapoptotic molecules Bax and Bad at the mRNA and protein levels and of the activated molecules p-Bad and tBid was significantly higher in MTX-treated NPs than in nontreated NPs. In contrast, expression of the antiapoptotic molecule Bcl-2 at the mRNA and protein levels was significantly lower in MTX-treated NPs than in nontreated NPs. Expression of the phosphorylated forms of p38 mitogen-activated protein kinase (MAPK) and c-Jun N-terminal kinase (JNK) was significantly higher in MTX-treated NPs than in nontreated NPs. In contrast, expression of the phosphorylated form of Akt was significantly lower in MTX-treated NPs than in nontreated NPs. Conclusion MTX induces apoptosis in NPs via caspase cascades and both mitochondria-mediated and p38 MAPK/JNK pathways. We suggest that MTX can be used to treat NPs.

Lymphoepithelial carcinoma of the maxillary sinus with orbital invasion.

Lymphoepithelial carcinoma (LEC) of the maxillary sinus is a very rare neoplasm that shares some characteristics with nasopharyngeal carcinoma. Epstein-Barr virus (EBV) has been reported to be associated with LEC located outside of the nasopharynx in Asian populations. A case report of a 64-year-old Asian female with right-sided cheek mass which was diagnosed preoperatively as a maxillary mass by paranasal sinus computed tomography scan is presented. Because maxillary sinus cancer with orbital invasion was considered, she underwent surgical removal of a mass. Final pathology revealed LEC, which is presented in our report. However, in situ hybridization assays returned negative results for Epstein-Barr virus. The patient underwent postoperative chemoradiotherapy, and has remained disease-free during 3-year follow-up. Although a few cases in the maxillary LEC have been reported, this is the first report describing the diagnosis and treatment of LEC occurred in the maxillary sinus. Surgical removal and adjuvant chemoradiotherapy may be useful in the treatment of more advanced maxillary LEC.

Expression of cyclooxygenase-2 and 5-lipoxygenase in nasal polyps associated with interleukin-4 promoter polymorphism -590.

OBJECTIVE: To evaluate expression of cyclooxygenase (COX)-2 and 5-lipoxygenase (5-LO) associated with interleukin (IL)-4 promoter polymorphism -590 in nasal polyp tissues. STUDY DESIGN AND SETTING: A prospective controlled study. A venous blood sample was taken to determine the genotype in 61 nasal polyp subjects. The C-590T variant was determined by the polymerase chain reaction-restriction fragment length polymorphism method. The expression of 5-LO and COX-2 was determined with immunohistochemical staining in 37 nasal polyp tissues associated with genotype. RESULTS: The genotype frequencies at position -590 of the IL-4 gene in the patients with nasal polyp were C/C (8.20%), C/T (40.98%), and T/T (50.82%). There was no significantly increased expression of COX-2 among genotypes. The 5-LO expression was significantly increased in C/C compared with C/T and T/T. CONCLUSION: We suggested that the IL-4 promoter polymorphism -590 C/C is associated with the expression of 5-LO in the patients with nasal polyp.