Yoo Suk Kim

Tracheal reconstruction using chondrocytes seeded on a poly(l‐lactic‐co‐glycolic acid)–fibrin/hyaluronan

Reconstruction of trachea is still a clinical dilemma. Tissue engineering is a recent and promising concept to resolve this problem. This study evaluated the feasibility of allogeneic chondrocytes cultured with fibrin/hyaluronic acid (HA) hydrogel and degradable porous poly(L-lactic-co-glycolic acid) (PLGA) scaffold for partial tracheal reconstruction. Chondrocytes from rabbit articular cartilage were expanded and cultured with fibrin/HA hydrogel and injected into a 5 × 10 mm-sized, curved patch-shape PLGA scaffold. After 4 weeks in vitro culture, the scaffold was implanted on a tracheal defect in eight rabbits. Six and 10 weeks postoperatively, the implanted sites were evaluated by bronchoscope and radiologic and histologic analyses. Ciliary beat frequency (CBF) of regenerated epithelium was also evaluated. None of the eight rabbits showed any sign of respiratory distress. Bronchoscopic examination did not reveal stenosis of the reconstructed trachea and the defects were completely recovered with respiratory epithelium. Computed tomography scan showed good luminal contour of trachea. Histologic data showed that the implanted chondrocytes successfully formed neocartilage with minimal granulation tissue. CBF of regenerated epithelium was similar to that of normal epithelium. Partial tracheal defect was successfully reconstructed anatomically and functionally using allogeneic chondrocytes cultured with PLGA-fibrin/HA composite scaffold.

Treatment outcomes of sinonasal adenoid cystic carcinoma: 30 cases from a single institution

OBJECTIVE To establish the clinical features and prognostic factors of sinonasal adenoid cystic carcinoma (ACC). MATERIAL AND METHODS Thirty patients with histopathological diagnosis of sinonasal ACC who were treated at Severance Hospital between 1990 and 2010 were included in this retrospective chart review study. RESULTS The 5-year disease-specific survival and disease-free survival rates were 75.3% and 37.2%, respectively. The maxillary sinus (63.3%) and nasal cavity (23.3%) were the most common sites of primary tumour. Most patients were diagnosed with advanced-stage (III/IV) disease (80.0%) and had undergone surgery and postoperative radiotherapy (70.0%). The most common histopathological subtype was cribriform type (40.9%). Local recurrence rate and distant metastasis rates were 26.7% and 23.3%, respectively. The mean time from primary treatment to recurrence was 44.5 months. Sinonasal ACC patients with stage IV and T4 disease had significantly worse survival than those with low stage and T disease. Patients with local recurrence had worse disease-specific survival than those with distant recurrence. Distant metastasis was associated with disease-free survival but not disease-specific survival. CONCLUSION Despite the frequent occurrence of distant metastasis, early diagnosis and effective local control seemed to be the most important factors influencing the survival of sinonasal ACC.

Clinical Implication of Heart Rate Variability in Obstructive Sleep Apnea Syndrome Patients.

AbstractObstructive sleep apnea syndrome (OSAS) is a common disease with the prevalence of approximately 10% in general population, and this disease entity is considered to be highly related with the development of cerebrovascular and cardiovascular diseases. In the pathogenesis of cardiovascular disease, maintaining the homeostasis of autonomic nervous system (ANS) is critical. To evaluate the homeostasis of ANS, heart rate variability (HRV) is commonly used. The object of this study was to evaluate the homeostasis of ANS using the parameters of HRV and to elucidate the correlation between the parameters and apnea-hypopnea index (AHI). Methods:Retrospective review of 806 patients was performed and 164 patients who were diagnosed as having OSAS by in-room polysomnography and met the criteria of age, sex, and body mass index were enrolled. The calculation of HRV parameters was executed using echocardiographic data from polysomnography. Results:Between the control group (N = 81, AHI < 5) and OSAS patient group (N = 83, AHI > 15), standard deviation of NN (SDNN) intervals, SDNN index, HRV triangular index, very low frequency (VLF), low frequency (LF), 5-minute total power (TP), and low-frequency to high-frequency (LF/HF) ratio showed significant differences. In the correlation analysis between AHI and HRV parameters, only LF/HF ratio was proven to be significant. Conclusions:Elucidating the imbalance of ANS in OSAS patients was feasible by HRV and its parameters.

Reliability and validity testing of automated scoring in obstructive sleep apnea diagnosis with the Embletta X100.

To verify the reliability and validity of automated scoring and compare it to that of manual scoring for diagnosing obstructive sleep apnea using an Embletta X100 level 2 portable device.

Cultured chondrocyte and porcine cartilage-derived substance (PCS) construct as a possible dorsal augmentation material in rhinoplasty: A preliminary animal study.

As there is no single ideal material for dorsal augmentation in rhinoplasty, there has been a continuing need for the development of improved materials. Therefore, we aimed to evaluate the outcome of using a novel tissue-engineered construct composed of autologous chondrocytes cultured with a porcine cartilage-derived substance (PCS) scaffold as an augmentation material in rhinoplasty. A scaffold derived from decellularized and powdered porcine articular cartilage was prepared. The rabbit articular cartilage was used as the source of homologous chondrocytes, which were expanded and cultured with the PCS scaffold for 7 weeks. The chondrocyte-PCS constructs were then surgically implanted on the nasal dorsum of six rabbits. Four and eight weeks after implantation, the gross morphology, radiologic images, and histologic features of the site of implant were analyzed. The rabbits showed no signs of postoperative inflammation and infection. The degree of dorsal augmentation was maintained during the 8-week postoperative observation period. Postoperative histologic examinations showed chondrocyte proliferation without an inflammatory response. However, neo-cartilage formation from the constructs was not confirmed. The biocompatibility and structural features of tissue-engineered chondrocyte-PCS constructs indicate their potential as candidate dorsal augmentation material for use in rhinoplasty.

Association of body mass index and other factors with histamine skin reactivity in adults with allergic nasal symptoms.

Background The skin-prick test is the most commonly used method to diagnose allergy. In addition, histamine skin reactivity is used as a positive control for the skin-prick test. However, there is individual variation in histamine skin reactivity. The factors that influence individual variation in histamine skin reactivity remain unknown. Objectives We aimed to investigate the factors associated with histamine skin reaction. Methods Ninety-seven subjects who underwent a skin-prick test to diagnose allergic rhinitis were enrolled in this study. The skin-prick test was performed with six common allergens. The wheal size of the histamine skin reaction was analyzed; other variables included age, sex, body mass index (BMI), atopy, smoking history, and the testing season. Results The wheal size in the histamine skin test was significantly associated with age and BMI. The association between histamine skin reactivity and BMI was also present in multivariate analysis, adjusted for age, sex, atopy, smoking history, and season. Conclusion Histamine skin reactivity increased with BMI (degree of obesity). This association should be considered for better interpretation of the skin-prick test. Further studies regarding the mechanism for this association are needed.BACKGROUND The skin-prick test is the most commonly used method to diagnose allergy. In addition, histamine skin reactivity is used as a positive control for the skin-prick test. However, there is individual variation in histamine skin reactivity. The factors that influence individual variation in histamine skin reactivity remain unknown. OBJECTIVES We aimed to investigate the factors associated with histamine skin reaction. METHODS Ninety-seven subjects who underwent a skin-prick test to diagnose allergic rhinitis were enrolled in this study. The skin-prick test was performed with six common allergens. The wheal size of the histamine skin reaction was analyzed; other variables included age, sex, body mass index (BMI), atopy, smoking history, and the testing season. RESULTS The wheal size in the histamine skin test was significantly associated with age and BMI. The association between histamine skin reactivity and BMI was also present in multivariate analysis, adjusted for age, sex, atopy, smoking history, and season. CONCLUSION Histamine skin reactivity increased with BMI (degree of obesity). This association should be considered for better interpretation of the skin-prick test. Further studies regarding the mechanism for this association are needed.

Five-Year Subjective Outcomes of Obstructive Sleep Apnea Surgery: A Multiinstitutional Study

Objectives To evaluate the effect of obstructive sleep apnea (OSA) surgery on long-term (5-year) subjective outcomes, including sleep disordered breathing (SDB) symptoms and other complications, in patients with OSA. Methods We enrolled patients who underwent diagnostic polysomnography for OSA between January 2006 and December 2006 in ten hospitals. Patients either were treated for OSA or were not treated for OSA. All patients completed a brief telephone survey regarding their SDB signs and symptoms (e.g., snoring, apnea, nocturnal arousals, and daytime sleepiness), positive airway pressure (PAP) compliance, and any adverse effects of either the surgery or PAP. A positive subjective outcome for either surgery or no treatment was taken to be the alleviation of apnea, defined as a ≥50% increase in score. A positive subjective outcome (compliance) for PAP was defined as a PAP usage of ≥4 hours per night and ≥5 days per week. Results A total of 229 patients were included in this study. Patients were divided into three groups: a surgery group (n=87), a PAP group (n=68), and a control (untreated) group (n=74). The surgery group exhibited significant improvement in all SDB symptoms compared with the control group. The long-term subjective outcomes of the surgery (52.9%) and PAP (54.4%) groups were significantly better than those of the control group (25.0%). The subjective outcome of the surgery group was not significantly different from that of the PAP group. The overall surgical complication rate was 23.0% (20 of 87) in the surgery group, and 55.0% (22 of 40) of all patients with PAP experienced adverse effects. Conclusion The extent of SDB symptoms was consistently improved in patients with OSA at 5 years postsurgery. Information about the potential long-term subjective outcomes should be provided to patients when considering surgery.

Correlation between symptoms and objective findings may improve the symptom-based diagnosis of chronic rhinosinusitis for primary care and epidemiological studies

Background In primary care and epidemiological studies of chronic rhinosinusitis (CRS), symptom-based diagnosis is common, yet limited, because endoscopic and radiological signs are not considered. Objectives To evaluate the correlation between symptoms and objective findings of CRS to improve its symptom-based diagnosis for primary care and epidemiological studies by using data from a large-scale nationwide epidemiological study, the Korean National Health and Nutrition Examination Survey (KNHANES). Design Cross-sectional study. Setting Data from 2008 to 2012 KNHANES. Participants 29 225 Adults aged >19 years. Outcome measures Questionnaires targeted two major (nasal blockage and anterior/posterior nasal drip) and two minor (facial pain/pressure and reduction or loss of smell) symptoms. Nasal polyps or mucopurulent discharge from the middle meatus was defined as positive endoscopic findings for diagnosing CRS. Results Of the four symptoms, reduction or loss of smell was the symptom most significantly related to positive endoscopic findings in multivariable analysis (OR=1.936 (95% CI 1.604 to 2.337)). The combinations of symptoms showed higher ORs than individual symptoms and combinations of reduction or loss of smell with other symptoms were statistically more reliable for positive endoscopic findings than other combinations. Conclusions Our results show that reduction or loss of smell was the symptom most significantly related to positive nasal endoscopic findings. Therefore, symptom-based diagnosis of CRS can be improved by considering reduction or loss of smell as an important symptom for positive endoscopic findings of CRS.

Immediate re-insertion of non-autologous materials in revision augmentation rhinoplasty.

ObjectiveThis paper aims to study whether immediate re-insertion of non-autologous augmentation material in revision augmentation rhinoplasty is a safe surgical strategy creating a successful and functional aesthetic outcome. Study DesignRetrospective review and analysis of medical records. SettingTertiary referral hospital. Subjects and MethodsA retrospective analysis of 11 consecutive patients who had undergone removal of previous augmentation material and immediate re-insertion of non-autologous material in revision augmentation rhinoplasty was performed. Demographics, surgical approaches, augmentation materials, material-related complications, time interval between surgeries, surgical outcome, and follow-up period were included in the analysis to evaluate our surgical strategy. ResultsA successful surgical outcome with respect to both functional and aesthetic aspects was obtained in nine of the 11 enrolled patients. In 1 patient, there was a recurrence of material-related complication, while another patient experienced unsatisfactory graft displacement. The unsuccessful cases had 2 common features in that silicone and endonasal approaches were used in the primary and revision surgeries, respectively. ConclusionRemoval of previous augmentation material and immediate re-insertion of non-autologous material for dorsal augmentation in revision rhinoplasty is feasible with respect to functional and aesthetic aspects of patient outcome.

Surgical outcomes of primary and revision augmentation rhinoplasty using a processed fascia lata.

Background Dorsal augmentation is the most commonly performed procedure in rhinoplasty for Asian patients. Due to the anatomic features of the Asian nose, the use of nonautologous materials to obtain a proper degree of augmentation is inevitable in most cases. Because the use of nonautologous materials possesses a higher risk of complications, surgeons are concerned about selecting suitable materials for the procedure, especially in revision rhinoplasty. Therefore, this study was designed to evaluate the suitability and usefulness of a homologous material, Tutoplast-processed fascia lata (TPFL), in revision augmentation rhinoplasty. Methods Retrospective analysis of 104 rhinoplasty patients (primary, 86; revision, 18) who had undergone dorsal augmentation using TPFL was conducted. The comparison of surgical outcomes between primary and revision surgery was made using objective [dorsal height (DH) and radix height (RH), complication rate] and subjective (patient satisfaction) parameters. Results The degree of augmentation represented by DHand RH was comparable between primary and revision rhinoplasty using TPFL. In comparing the rate of postoperative complications, only minor incidents were noted, in six cases after primary surgery and in one case after revision surgery. Patient satisfaction was measured in both primary and revision augmentation, with a significant difference observed between the two groups (40.57 ∓ 9.25 versus 31.48 ∓ 7.59; p < 0.05). Conclusion TPFL is a feasible implant material that delivers suitable augmentation and patient satisfaction with minimal morbidity in both primary and revision rhinoplasty.