Shiann-Yann Lee

Clinical Experiences of Removing Foreign Bodies in the Airway and Esophagus with a Rigid Endoscope: A Series of 3217 Cases from 1970 to 1996

This study examined 11,333 rigid endoscopy procedures performed in the Department of Otolaryngology, National Taiwan University Hospital, during a 27-year period from 1970 to 1996. Among these cases, 3217 were performed to remove foreign bodies from the airway (459 cases, 14.3%) and esophagus (2758 cases, 85.7%). Retrospective analysis of these data revealed that peanuts (217 cases) and animal bones (1184 cases) were the most frequent foreign bodies encountered in the airway and esophagus, respectively. The successful rate of removal of these foreign bodies was 99.9% (3213/3217). The complication rate was only 0.2% (8/3217), and the mortality rate was less than 0.1% (2/3217). On the basis of these results, we conclude that foreign bodies in the airway and esophagus can be removed safely under direct visualization through rigid endoscopy with relatively few complications. A significant finding in this study is the declining trend in the number of cases in recent years. Despite the decline in the number of procedures, endoscopic removal of foreign bodies remains as a vital skill of the aerodigestive tract surgeon.

Two-Dimensional and Three-Dimensional Power Doppler Sonographic Classification of Vascular Patterns in Cervical Lymphadenopathies

Vascular patterns may reflect some pathologic behaviors of tumors and lymph nodes. Power Doppler ultrasonography, with improved sensitivity and better noise contrast, were used to depict vasculature in 289 cases of cervical lymphadenopathy. Four patterns of vasculature, in addition to avascular nodes, were classified. Benign lymphadenopathies represented 89% and 83% of avascular and hilar type nodes, respectively. However, malignant lymphadenopathies dominated in nodes that were of spotted (72%), peripheral (60%), and mixed type (80%). Correlation between nodal sizes and chronologic changes of vascular patterns in malignant lymphadenopathies implied a reasonable classification. Three‐dimensional power angiography, with the advantage of less plane‐sampling bias, was further used to validate our classification.

Expression of SPLUNC1 protein in nasal polyp epithelial cells in air-liquid interface culture treated with IL-13.

Background Short palate, lung, and nasal epithelium clone 1 (SPLUNC1) protein is an airway epithelial cell–derived molecule exerting host defense against pathogen. However, the function and regulation of SPLUNC1 in nasal epithelial cells are still unclear. Chronic rhinosinusitis with nasal polyps (CRSwNPs) is a disorder characterized by eosinophilic Th2 inflammation and frequent microbial colonization. The pathogenesis has been postulated as a disturbed mucosal immune response. This study investigates the SPLUNC1 expression of nasal polyp epithelial cells in air–liquid interface (ALI) culture and after treating with Th2 inflammatory cytokines IL-13. Methods Human nasal polyp epithelial cells isolated from patients with CRSwNPs were put in different cell culture models at days 0 and 21 and were assessed for expression of SPLUNC1 by microarray. Cultured cells in ALI plus retinoic acid (ALI + RA) model were then incubated with 0, 1, 10, and 100 ng/mL human recombinant IL-13 for up to 5 days. The expression of SPLUNC1 was assessed by real-time quantitative polymerase chain reaction (RT-Q-PCR), reverse-transcriptase PCR (RT-PCR) and Western blot analysis. Results ALI + RA culture model harvesting ciliary differentiated nasal epithelial cells constitutively expressed high levels of SPLUNC1. In contrast, SPLUNC1 is reduced under classic submerged single layer culture. SPLUNC1 is also dose-responsively down-regulated after incubation with IL-13. Conclusions A microenvironmental milieu containing IL-13 may be detrimental to the host innate immunity response, at least in part, through the inhibition of SPLUNC1 production.

Potentiation of noise-induced hearing loss by amikacin in guinea pigs

Noise and aminoglycosides initially attack cochlear outer hair cells (OHCs). Distortion product otoacoustic emissions (DPOAEs) are used for the early diagnosis of damage to OHCs. The effects of sub-damaging doses of amikacin, an aminoglycoside antibiotic agent, on noise-induced hearing loss (NIHL) were examined in guinea pigs. Animals were grouped by gender and exposed to broadband noise at 105 dB SPL for 12 h and/or injected i.m. with either amikacin (100 mg/kg/day) or saline for 10 days. Auditory brainstem response (ABR) thresholds, along with DPOAE amplitudes, were measured serially before and after noise exposure. DPOAE amplitudes decreased and ABR thresholds elevated immediately after noise exposure and then gradually recovered. At all frequencies, the emission amplitudes recovered completely to pre-exposure baseline values by 4 days after noise exposure. There was no effect of amikacin on either the ABR threshold or DPOAE amplitudes, in animals treated with amikacin only. However, amikacin significantly prolonged the effect of noise exposure on DPOAE amplitude but not on the noise-induced temporary threshold shift (TTS) of the ABR. In animals treated with a combination of noise and amikacin, significant changes in DPOAE amplitudes were still observed at 4 weeks after cessation of noise exposure. No gender difference in the responses to noise and/or amikacin could be demonstrated. The present findings indicate that even sub-damaging dosages of amikacin might impair recovery from NIHL in guinea pigs.

Epithelial Cells of Nasal Mucosa Express Functional Gap Junctions of Connexin 43

Objective—Recent studies have suggested that inositol triphosphate is transmitted through the gap junction of adjacent epithelial cells and communicates the intracellular calcium wave that controls the beating of cilia. Therefore, gap junction-mediated intercellular communication may modulate the metachronal ciliary beating of respiratory mucosa. Material and Methods—The expression and function of gap junctions were evaluated in nasal mucosa using immunofluorescent staining, Western blotting and Lucifer Yellow dye coupling in both whole nasal mucosa and cultured nasal epithelial cells. Results—Among connexins (Cxs) 26, 32 and 43, only Cx43 was found in the nasal mucosa, in both the epithelial cells and submucosa tissue. Using Western blotting, Cx43 protein was found in protein extracts of both whole mucosa and cultured epithelial cells. The Cx43 protein content increased twofold between the 3rd and 6th days of culture. Lucifer Yellow dye, microinjected into single cultured epithelial cells, had spread to the adjacent cells. Conclusions—Cx43 is present in nasal mucosa. The expression of Cx43 on epithelial cells increases after culture. The dye-coupling study in epithelial cells indicated that the signal may be transmitted to neighboring cells via a gap junction composed of Cx43. Thus, Cx43 may be involved in the regulation of metachronal ciliary beating in ciliated epithelial cells and growth or differentiation in nasal tissue.

Stretch-activated nonselective cation, Cl− and K+ channels in apical membrane of epithelial cells of Reissner's membrane

Ion channels on the apical membrane of epithelial cells (the surface facing the endolymph) of acutely isolated Reissners membrane from guinea-pig cochlea were investigated by using patch-clamp technique in cell-attached and inside-out configurations. Three types of ion channel were identified: namely, a stretch-activated nonselective cation, a chloride and a potassium channel. When the pipette was filled with high-K+ endolymph-like solution, the most significant channel activity was nonselective cation channels (85/110, 77% patches). The current versus voltage relationship was linear with a unitary conductance of 22.1 +/- 0.4 pS and reversal potential (Vr) of 2.3 +/- 0.8 mV (n = 18). The channel exhibited a lower conductance (14.0 +/- 0.6 pS, n = 8) to Ca2+. The open probability was low (NPo approximately 0.1) in cell-attached configuration under +60 mV pipette potential and increased when the membrane was stretched with negative pressure. The channel was blocked by 10 microM extracellular Gd3+. The two other types of channels were a small voltage-sensitive Cl- channel (6.0 +/- 0.3 pS; 91/99, 92% patches) and a K+ channel (approximately 30 pS; 29/191, 15% patches). These channels might play roles in the regulation of cell volume, in balancing the hydrostatic pressure across Reissners membrane and in maintaining the electrochemical composition of endolymph.

Lipopolysaccharide decreases connexin 43 expression on nasal epithelial cells in vitro.

Conclusions Decreased connexin 43 (Cx43) expression as a result of application of lipopolysaccharide (LPS) may limit the diffusion of intercellular signaling molecules that is essential to the coordinated function of neighboring cells. Therefore, it may be related to a ciliary beating defect in nasal epithelial cells and result in accumulation of harmful substances. Objective Gap junction intercellular communication (GJIC) is altered during inflammation in tracheal epithelial cells. Thus, we aimed to investigate whether LPS affects the expression of Cx43, the elementary protein composing the gap junction of nasal epithelial cells, in vitro. Material and methods LPS (Pseudomonas aeruginosa serotype 10) was applied to epithelial cells obtained from nasal polyp for 24 h in vitro. As an inflammatory indicator, IL-8 secretion was measured using a commercially available ELISA kit. Cx43 protein was detected semi-quantitatively using Western blotting. Results The nasal epithelial cells constitutively secreted IL-8 at a concentration of 0.45±0.03 ng/µg protein. In the presence of 10−2 mg/ml LPS, the concentration of IL-8 was significantly increased to 0.55±0.05 ng/µg protein (n=8). Expression of the Cx43:β-actin ratio decreased in a time- and dose-dependent fashion (10−3–10−1 mg/ml LPS).

Basaloid squamous cell carcinoma of the larynx

than 85% of the epithelial malignancies of the larynx are squamous cell carcinoma. Other carcinomas, such as undifferentiated carcinoma, verrucous carcinoma, pleomorphic carcinoma, mucoepidermoid carcinoma, and adenocarcinoma, are occasionally encountered.1 The MEDLINE database was searched from 1966 to 1996, but only some sporadic series in the English language literature reported basaloid squamous cell carcinoma of the head and neck.2-12 In the larynx, most of these tumors were located in supraglottis, with the involvement of tongue base or pyriform sinus. The prognosis for these patients was usually poor; most died of local recurrence or distant metastasis despite aggressive treatment. This case report is of a patient with early glottic basaloid squamous cell carcinoma who was successfully treated with partial vertical laryngectomy.

Increased Communication Among Nasal Epithelial Cells in Air‐Liquid Interface Culture

Objective/Hypothesis: The retinoid acid (RA) sufficient air‐liquid interface (ALI) cell culture model, but not the classical submerged single layer (SSL) cell culture model, can achieve ciliary differentiation of nasal epithelial cells. Because gap junction mediated intercellular communication (GJIC) may contribute to differentiation in numerous cell types, this study compared the extent of GJIC and the expression of Connexin 43 (Cx43) in nasal epithelial cells in both SSL and ALI cultures.

Changes of Hair Cell Stereocilia and Threshold Shift after Acoustic Trauma in Guinea Pigs: Comparison between Inner and Outer Hair Cells

The vulnerability of inner hair cells (IHCs) and outer hair cells (OHCs) to acoustic overstimulation is still controversially discussed. The present study was undertaken to investigate the vulnerability of IHCs and OHCs and the relation between chronological changes of auditory threshold shifts and stereocilia damages on IHCs and OHCs in guinea pigs after moderate acoustic trauma, caused by a single continuous exposure to pink noise (20 Hz to 20 kHz) of around 106 ± 2 dB SPL for 44 h. Stereocilia changes and threshold shifts of auditory brainstem responses (ABR) were assessed at regular intervals after noise exposure for 9 weeks. Scanning electron microscopy demonstrated the morphological changes of steriocilia as early as 1 day after noise exposure. The morphological changes included fused, bent, collapsed, and even missing stereocilia. These damages were more prominent on IHCs than on OHCs. The shift of ABR threshold was not parallel to the chronological change of the stereocilia on IHCs as well as OHCs. The elevation of the ABR threshold (40–60 dB SPL) was greatest on the 1st day after noise exposure, whereas the stereocilia showed the most damage 7 days after noise exposure. Combined with the results from previous studies, we conclude that moderate-level (around 105–110 dB) noise tends to induce more damage to the stereocilia of IHCs than of OHCs. Other damage (e.g., metabolic disturbance) than morphological damage of hair cell stereocilia may contribute partially to the hearing threshold shift induced by moderate acoustic overstimulation.