Si Whan Kim

Ki67 antigen as a predictive factor for prognosis of sinonasal mucosal melanoma.

Objectives Sinonasal mucosal melanoma is a rare and aggressive disease. The aim of this study was to analyze the clinical features of patients with sinonasal mucosal melanoma and to determine the role of Ki67 antigen as a predictor of prognosis in sinonasal mucosal melanoma. Methods This was a retrospective case-series study at a single institution, an academic tertiary referral center. From 1995 to 2007, 27 patients with sinonasal mucosal melanoma were reviewed retrospectively, and the expression of Ki67 antigen was assessed by immunohistochemistry. Results The overall 5-yr survival rate was 33.9%. No significant differences were observed in 5-yr survival according to age, sex, stage, or the presence of melanin. The rates of local failure, regional failure, and distant failure were 37.0%, 14.8%, and 11.1%, respectively. Patients with spindle or mixed cell types had better prognoses than those with other cell types. At a cut-off value of 35%, patients with lower Ki67 scores showed better survival than those with higher Ki67 scores. Conclusion The presence of spindle or mixed cell types may indicate a better prognosis than other cell types. Ki67 immunostaining may be a useful predictor of prognosis in patients with mucosal malignant melanoma of the sinonasal tract.

Isolated sphenoid sinus diseases: report of 76 cases

Conclusion. Inflammatory diseases, such as non-specific sinusitis, fungal sinusitis and mucocele, commonly involve the sphenoid sinus. Endoscopic surgery provides an easy and successful access to isolated sphenoid sinus diseases (ISSDs) with rare complications. Objectives. The incidence of ISSDs has decreased since a wide use of antibiotics. ISSDs can cause severe complications due to the deep location in the skull base. Endoscopic surgery for the sphenoid sinus has recently become popular, with several advantages. The aim of this study was to analyse ISSDs in terms of the clinical symptoms, histological diagnosis and treatment outcomes with our 22 years’ experience. Patients and methods. Seventy-six patients with ISSDs, who were treated at Seoul National University Hospital between 1985 and 2007, were analysed. Patients with lesions confined to the sphenoid sinus were included. A retrospective chart review was performed with respect to the symptoms, pathology and treatment outcomes. Results. Fifty-seven of 76 cases were inflammatory lesions, 9 neoplastic lesions and 10 fibrous dysplasia. Headache was the most common symptom (65.8%), followed by nasal obstruction (22.4%) and postnasal drip (21.0%). Ophthalmologic symptoms were observed in 15 cases (19.7%). Endoscopic sphenoidotomy was performed in 51 of the 57 ISSDs. Symptoms completely improved in 92.2% of the patients.

Histamine Induces MUC5AC Expression via a hCLCA1 Pathway

Background: Histamine is an important inflammatory mediator and associated with early phase allergic response. However, the involvement of histamine in mucin gene expression or production has not been elucidated. Objective: The aim of this study is to investigate whether histamine induces MUC5AC production in NCI-H292 cells, and to evaluate which pathway is involved in this mucin production. Methods: MUC5AC production in NCI-H292 cells was analyzed by RT-PCR, immunoassay and immunocytochemical analysis. The effect of histamine on MUC5AC production in these cells at different time courses and concentrations was assessed, and the relationship between hCLCA1 expression and histamine concentration was also evaluated. In addition, cells were pretreated with antihistamine or an hCLCA1 blocker (niflumic acid, NFA) to evaluate the mechanism underlying histamine-induced MUC5AC production. Results: Histamine upregulated MUC5AC gene expression and mucin protein production in a dose-dependent and time-related fashion. Histamine also dose-dependently increased hCLCA1 mRNA expression. Moreover, pretreatment of cells with chlorpheniramine or NFA reduced histamine-induced MUC5AC mRNA expression and protein production in these cells. The histamine-treated cells showed increased cytoplasmic staining for MUC5AC compared to cells treated with media alone, and cells pretreated with chlorpheniramine or NFA before histamine treatment. Conclusion: Our results suggest that histamine-induced MUC5AC production occurs via the upregulation of hCLCA1. It is assumed that antihistamines or hCLCA1 channel blockers can partially suppress histamine-induced MUC5AC production in allergic diseases, e.g. allergic rhinitis.

Primary and secondary fungal infections of the paranasal sinuses: Clinical features and treatment outcomes

Conclusion. In a retrospective study of 239 cases of fungal sinusitis, noninvasive paranasal sinus aspergillosis was most common and successfully treated by endoscopic sinus surgery (ESS) with postoperative sinus irrigation. For the treatment of fungal sinusitis, ESS with or without antifungal agents and control of predisposing factors for secondary cases are recommended. Objective. The aim of this study was to investigate the clinical characteristics of fungal sinusitis and evaluate the treatment outcomes of primary and secondary fungal infections of the paranasal sinuses. Materials and methods. Two hundred thirty-nine cases of fungal infection of the paranasal sinuses seen between January 1997 and December 2006 were retrospectively analyzed by reviewing their medical records. There were 200 cases of primary fungal infection and 39 cases of secondary fungal infection. Results. The symptoms of chronic rhinosinusitis such as nasal obstruction, purulent rhinorrhea, and postnasal drip were commonly present in both primary and secondary infections, and the sphenoid sinus was commonly involved in secondary infection. The radiological findings in fungal sinusitis included haziness, calcification, and bone destruction of the involved sinuses. CT scans in 80% of the primary and 69% of the secondary cases revealed calcific densities in a paranasal soft tissue mass. Twenty-eight of 38 cases which had MR showed decreased signal intensities on T1-weighted images and markedly reduced signal intensities surrounded by bright signal on T2-weighted images. In secondary cases, the most common concomitant disease was diabetes mellitus. All patients received surgery including biopsy, ESS, and Caldwell-Lucs operation. Mucosal hypertrophy with fungus ball, which was the most common finding in both types, was found in 124 cases (62%) with primary and in 26 cases (67%) with secondary cases, and aspergillosis was most common, followed by unidentifiable colony, and mucormycosis. Eleven cases received amphotericin-B postoperatively. Two hundred thirty-eight cases showed no recurrence during the mean follow-up period of 11 months.

Change of nasal function with aging in Korean

Conclusion. The changes of nasal resistance and cross-sectional area (CSA) with aging could suggest that it might be attributed to the change (atrophy) of the non-erectile structural tissues including bone and soft tissues rather than the erectile tissues. Subjects older than 60 years of age had significantly slower ciliary beat frequency (CBF), which could suggest nasal function might begin to decrease at around 60 years of age. Objectives. Nasal physiology can be changed with aging, however, there has been little data that prove senile change of the nasal cavity. This study was conducted to evaluate the effect of aging on nasal resistance and ciliary movement of the nasal cavity. Methods. One hundred and fifty three healthy subjects were included in this study. Acoustic rhinometry and rhinomanometry before and after nasal decongestion, and CBF were measured. Results. The CSA at the attachment of the inferior turbinate was increased with age in both before and after decongestion. However, the difference of CSA between pre- and post-decongestion did not change significantly with age. At the nasal valve area, the CSA showed almost same values between age groups and the difference between pre-and post-decongestion was very small. The nasal resistance was markedly decreased from 2nd to 3rd decade and did not change significantly after 3rd decade. Subjects older than 60 years of age had significantly slower CBFs compared to those younger than 60 years (10.18±0.98 vs. 12.43±1.46) (P<.001).

Functional recovery of rabbit maxillary sinus mucosa in two different experimental injury models.

Objective/Hypothesis: Ciliary wave disorder (CWD) is essential for effective mucociliary transport. The purpose of this study was to investigate morphologic and functional restoration in recovered sinus mucosa after 12 weeks of experimentally induced rhinosinusitis and regenerated sinus mucosa after mechanical injury.

Impact of tonsillectomy on pediatric psychological status

OBJECTIVE Tonsillectomy is one of the most commonly performed procedures in children. However, parents often hesitate to agree to the procedure because of concerns of the possible harmful impact on their childs psychological health. The present study was performed to examine the short-term psychological impact on children who had undergone tonsillectomy. METHODS Forty-three pediatric patients aged 3-11 years who underwent tonsillectomy were enrolled in the study. Postoperative pain was assessed using a 10-point visual analog scale (VAS) on postoperative days 1, 2, 7, and 21. The Korean version of the Child Behavior Checklist (K-CBCL) was given to the parents of the children to evaluate the psychosocial effect of tonsillectomy on the preoperative day and on postoperative day 21. RESULTS There were no significant differences in postoperative pain according to age, tonsil size, degree of adhesion, or operation time. There was no significant relationship between postoperative pain score and K-CBCL score. Sociality, total behavioral problems, externalizing problems, internalizing problems, anxiety/depression, social immaturity, and emotional lability domain scores on the K-CBCL were improved significantly. CONCLUSIONS Improvements in general emotional and social status were observed at 3 weeks after tonsillectomy. Tonsillectomy itself does not have a harmful effect on childrens psychological status.

Effects of corticosteroids on expression of interleukin-18 in the airway mucosa of a mouse model of allergic rhinitis.

Objectives: In this study, we aimed to investigate the release and response of interleukin (IL)-18 to steroid treatment in a mouse model of allergic rhinitis. Methods: BALB/c mice were sensitized systemically by intraperitoneal injection of ovalbumin and locally by ovalbumin inhalation. Dexamethasone sodium phosphate was given by intraperitoneal injection in the steroid treatment group. Symptom scores, eosinophil counts, and IL-18 concentrations in the nasal and lung lavage fluids were analyzed. Results: The symptom scores and eosinophil counts of the negative control and steroid treatment groups were significantly lower than those of the positive control group (p < .01). The mean IL-18 concentrations in the nasal lavage fluid were not significantly different among the three groups (56.68 ± 9.57, 63.39 ± 8.93, and 64.47 ± 6.83 pg/mL, respectively). The IL-18 concentrations in the lung lavage fluid were significantly different between the positive control group and the steroid treatment group (430.75 ± 154.54 and 69.94 ± 14.26 pg/mL, respectively, p = .028). Conclusions: The IL-18 concentration was found to be increased in the lung lavage fluid, but not in the nasal lavage fluid, in a mouse model of allergic rhinitis. Increased IL-18 concentrations returned toward the previous concentrations after steroid treatment. These results suggest that the roles of IL-18 may be different in the pathogenesis of allergic rhinitis and the pathogenesis of asthma.