Background and Objectives: Histamine has been suggested to play an important role during allergic and inflammatory reactions, affecting allergic rhinitis and chronic rhinosinusitis. CXCL8 is a pro-inflammatory chemokine and a critical factor that causes many airway inflammatory diseases including allergic rhinitis and chronic rhinosinusitis.Materials and Method: Histamine cytotoxicity was measured by MTT assay. Real-time polymerase chain reaction was used to identify histamine type 1 receptor in nasal fibroblasts. The fibroblasts were then treated with histamine with or without a histamine type 1 receptor antagonist and the CXCL8 protein was assessed using an enzyme-linked immunosorbent assay (ELISA). The downstream signaling molecules, including phospholipase C and phospho-p50, were evaluated by western blot and immunofluorescent staining. Results: Histamine had no significant cytotoxic effect until the concentration reached 1,000 μM. Histamine type 1 receptor mRNA was expressed in nasal fibroblasts. CXCL8 protein expression level was significantly increased following histamine stimulation. However, the expression level of CXCL8 decreased when phospholipase C was inhibited by U73122. Histamine increased phospho-p50 expression as seen in western blot results. The BAY11-7082, NF-κB inhibitor significantly reduced CXCL8 production in histamine-stimulated nasal fibroblasts. Conclusion Histamine can induce the production of NF-κB controlled-chemokine CXCL8 by nasal fibroblasts, which supports a role for histamine in upper airway inflammatory diseases.

OBJECTIVES: Nasal packing after endoscopic sinus surgery is frequently used to control postoperative bleeding, enhance the wound healing process, and prevent lateralization of the middle turbinate, which causes insufficient ventilation. Many biodegradable materials have been developed to reduce pain and mucosal damage during packing removal. The purpose of this study was to compare the efficacy of Guardcel (Genewel Co.) middle meatal packing with a traditional nonabsorbable middle meatal packing, Merocel (Medtronic Xomed), on wound healing and patient satisfaction. METHODS: In this prospective, single-blind, randomized controlled study, we enrolled 32 consecutive patients (64 nostrils) undergoing bilateral endoscopic sinus surgery at Korea University Guro Hospital from February 2015 to August 2015. Guardcel and Merocel were inserted postoperatively into a randomly assigned side. Objective findings about bleeding, hemostasis, adhesion, and infection were evaluated with nasal endoscopy. Patients’ symptoms including pain and nasal obstruction were evaluated with a visual analog scale. Each evaluation was done at 2–3 days, 1 week, 2 weeks, and 4 weeks after surgery. RESULTS: At 2–3 days after endoscopic sinus surgery, the Guardcel side had a significantly less hemostasis time than the Merocel side (P=0.001). During this period, the pain during packing removal was significantly lower on the Guardcel-inserted side than the Merocel-inserted side (P=0.002). At two weeks after surgery, the adhesion score on the Guardcel side was significantly lower than that of the Merocel side (P=0.011). Other parameters during the study follow-up periods were not statistically significant. There were no severe adverse reactions. CONCLUSION: Guardcel, a newly developed packing material, appeared to shorten the hemostasis time and reduce pain sensation at 2–3 days after surgery; it also prevented adhesion formation 2 weeks after surgery when compared with the control. Guardcel can be an effective and safe candidate to replace conventional packing materials after endoscopic sinus surgery.
Endoscopy ; Follow-Up Studies ; Hemorrhage ; Hemostasis ; Humans ; Korea ; Nasal Obstruction ; Patient Satisfaction ; Prospective Studies* ; Sensation ; Turbinates ; Ventilation ; Visual Analog Scale ; Wound Healing

BACKGROUND AND OBJECTIVES: To review our experience with lacrimal sac tumors in an effort to identify features, to evaluate the results of various methods of management, and to compare our data with previous studies. METHODS: We reviewed the medical records of all patients with lacrimal sac tumors who were managed in our institution between January 1990 and December 2015. The pre-operative clinical data, imaging, operation notes, and follow-up records were reviewed for each patient. RESULTS: The study group consisted of four men and six women with a mean age of 47.6 years. Most patients experienced long-standing epiphora, for a mean period of 20 months. Two of the tumors were benign, and eight of them were malignant. The benign tumors were treated with dacryocystectomy. All but one malignant tumor were treated with medial or total maxillectomy. Adjuvant radiotherapy was administered to four patients with malignant tumors. In the eight patients with malignant tumors, the mean follow-up period was 65 months. CONCLUSIONS: Important characteristics of lacrimal sac tumors include dacryocystitis, epiphora, and in some cases, a palpable medial canthal area mass. Wide en bloc resection via medial or total maxillectomy and/or postoperative radiotherapy are proper treatments for malignant lesions of the lacrimal sac.
Dacryocystitis ; Female ; Follow-Up Studies ; Humans ; Lacrimal Apparatus Diseases ; Male ; Medical Records ; Nasolacrimal Duct* ; Radiotherapy ; Radiotherapy, Adjuvant

Merkel cell carcinoma (MCC) is a rare aggressive skin cancer with the mortality rate of 33%. MCC was first described by Toker in 1972 as a trabecular cell carcinoma and is classified as a neuroendocrine tumor similar to small cell lung carcinoma and melanoma. The pathogenesis of MCC remains largely unknown. However, ultraviolet radiation and immunosuppression are likely to play a significant pathogenic role. The primary skin lesion is usually asymptomatic and it typically presents as a red or purple dome-shaped nodule. The management of MCC is controversial, however, local wide excision followed by radiotherapy is accepted as the primary treatment modality. The regional draining nodal basin is the most common site for recurrence. Therefore, sentinel lymph node biopsy is recommended in all cases, except for the clinically node-negative cases. We herein report two cases of MCC on the left cheek with different clinical manifestations.
Carcinoma, Merkel Cell* ; Cheek* ; Immunosuppression ; Melanoma ; Mortality ; Neuroendocrine Tumors ; Radiotherapy ; Recurrence ; Sentinel Lymph Node Biopsy ; Skin ; Skin Neoplasms ; Small Cell Lung Carcinoma

Branchiogenic carcinoma (BC), which is defined as squamous cell carcinoma arising from a branchial cyst, was first described by Volkmann in 1882. This rare disease is regarded as hypothetical, and remains a controversial disease entity. Among the diagnostic criteria of BC, the key point is the histologic demonstration of a cancer developing from the wall of an epithelial-lined cyst in the lateral site of the neck. In previous literature, many authors argued that this malignancy is actually cystic metastasis from oropharyngeal squamous cell carcinoma. We report a case of a 49-year-old female who was diagnosed as a primary BC patient with a synchronous tonsillar squamous cell carcinoma. Although this case did not meet the traditional diagnostic criteria because of existing tonsil cancer, we could diagnose these diseases as primary malignancies, since the transition zone was clearly seen, and there was no lymph node component in the histopathologic examination.
Branchioma ; Carcinoma, Squamous Cell* ; Epithelial Cells* ; Female ; Humans ; Lymph Nodes ; Middle Aged ; Neck ; Neoplasm Metastasis ; Neoplasms, Multiple Primary ; Palatine Tonsil* ; Rare Diseases ; Tonsillar Neoplasms

Hemangiomas are the most common benign tumors in infancy, occurring most often on cutaneous and mucosal surfaces. Although less than 1% of hemangiomas occur in skeletal muscle, 15% of intramuscular hemangiomas arise in the head and neck musculature. Less than 10 cases of the sternocleidomastoid muscle have been reported in the English literatures. The masseter muscle is most commonly involved in the head and neck. Clinically, these tumors are present as distinct, localized, rubbery swelling. Neck computed tomography scan with enhancement may suggest a vascular mass within the muscle while angiography may detect feeding arteries in large intramuscular hemangiomas. The treatment of the hemangiomas is based on location, accessibility, depth of invasion, age, and cosmetic considerations. The optimal treatment is complete wide resection including the cuff of surrounding muscle. We report a case of hemangioma that occurred in the sternocleidomastoid muscle along with a with literature review.
Angiography ; Arteries ; Head ; Hemangioma ; Hemangioma, Capillary ; Masseter Muscle ; Muscle, Skeletal ; Neck Muscles ; Neck

Hemangiomas are the most common benign tumors in infancy, occurring most often on cutaneous and mucosal surfaces. Although less than 1% of hemangiomas occur in skeletal muscle, 15% of intramuscular hemangiomas arise in the head and neck musculature. Less than 10 cases of the sternocleidomastoid muscle have been reported in the English literatures. The masseter muscle is most commonly involved in the head and neck. Clinically, these tumors are present as distinct, localized, rubbery swelling. Neck computed tomography scan with enhancement may suggest a vascular mass within the muscle while angiography may detect feeding arteries in large intramuscular hemangiomas. The treatment of the hemangiomas is based on location, accessibility, depth of invasion, age, and cosmetic considerations. The optimal treatment is complete wide resection including the cuff of surrounding muscle. We report a case of hemangioma that occurred in the sternocleidomastoid muscle along with a with literature review.

Background: Perioperative adverse cardiac events (PACE), a composite of myocardial infarction, coronary revascularization, congestive heart failure, arrhythmic attack, acute pulmonary embolism, cardiac arrest, and stroke during 30-day postoperative period, is associated with long-term mortality, but with limited clinical evidence. We compared long-term mortality with PACE using data from nationwide multicenter electronic health records. Methods: Data from 7 hospitals, converted to Observational Medical Outcomes Partnership Common Data Model, were used. We extracted records of 277,787 adult patients over 18 years old undergoing non-cardiac surgery for the first time at the hospital and had medical records for more than 180 days before surgery. We performed propensity score matching and then an aggregated meta‑analysis. Results: After 1:4 propensity score matching, 7,970 patients with PACE and 28,807 patients without PACE were matched. The meta‑analysis showed that PACE was associated with higher one-year mortality risk (hazard ratio [HR]: 1.33, 95% CI [1.10, 1.60], P = 0.005) and higher three-year mortality (HR: 1.18, 95% CI [1.01, 1.38], P = 0.038). In subgroup analysis, the risk of one-year mortality by PACE became greater with higher-risk surgical procedures (HR: 1.20, 95% CI [1.04, 1.39], P = 0.020 for low-risk surgery; HR: 1.69, 95% CI [1.45, 1.96], P < 0.001 for intermediate-risk; and HR: 2.38, 95% CI [1.47, 3.86], P = 0.034 for high-risk). Conclusions A nationwide multicenter study showed that PACE was significantly associated with increased one-year mortality. This association was stronger in high-risk surgery, older, male, and chronic kidney disease subgroups. Further studies to improve mortality associated with PACE are needed.