Systemic corticosteroids currently represent the most effective treatment for chronic rhinosinusitis with nasal polyps (CRSwNP), but their long-term use is constrained due to their detrimental side effects. Until recently, development of novel drugs for CRSwNP has been difficult partly due to the absence of a standard animal model of CRSwNP. Exotoxins of Staphylococcus aureus such as staphylococcal enterotoxin B (SEB), are well-known superantigens which can induce a strong immune response; there have been many studies on the association of staphylococcal enterotoxins and development of CRSwNP over the past two decades. Based on previous studies, we invented a mouse model of CRSwNP using SEB. Herein, we explain the protocol development for the mouse model, as well as identify histological and immunological similarities between this mouse model and humans. Furthermore, we describe a study that analyzed the risk factors for CRSwNP such as smoking, and also elaborate on a series of studies that searched for new potential drugs for CRSwNP, including resveratrol, anti-periostin antibody, topical hypoxia-inducible factors, and topical cyclosporine. Based on preceding studies, we have concluded that this mouse model might be a useful tool to investigate the pathophysiology and development of novel drugs for CRSwNP.
Adrenal Cortex Hormones ; Animals ; Cyclosporine ; Enterotoxins ; Exotoxins ; Humans ; Mice* ; Models, Animal ; Nasal Polyps* ; Risk Factors ; Smoke ; Smoking ; Staphylococcus aureus ; Superantigens

BACKGROUND: In order to improve the quality of life of dying patients so that they may die with dignity, they need to receive not only the physical, psychological, social, and spiritual care, but also systematic and continuous care. However, their is no adequate medical service at present. We studied terminal cancer patients'behavior patterns of health care utilization, the problems of caring for the patient, and medical services that bereaved families suggested for terminal cancer patients and their families. METHODS: From 271 patients'families who participated in our hospice program from March 1991 to February 1996, 108 bereaved families whom we able to had been contact were interviewed by three student nurses with a structured questionnaire. RESULTS: The terminal cancer patients received their medical care through admission to hospital(45.4%), outpatient clinic(22.2%), emergency room(16.7%), and oriental medicine(12.0%). But during their terminal phase of the illness, 32.4% of patients never received medical care including oriental medicine, and 28.7% received alternative medicine care such as intake of mushroom and elm tree. 26 bereaved families(24.1%) pointed out the indifference of the medical team as a problem receiving proper hospital care, and 22 bereaved families(20.4%) emphasized emotional strain of their helplessness with the patient's suffering as a problem of caring for the patient at home. Over 90% of bereaved families from their experience suggested needs of continuous care, hospice care, home care, and 24hr telephone service. CONCLUSIONS: There were inappropriate behavior patterns of health care utilization which resulted in large proportion of terminal cancer patients received alternative medicine never receiving proper medical care. Therefore, there is a need to develop the continuous and comprehensive care for terminal cancer patients and their family, such as hospice.)
Agaricales ; Complementary Therapies ; Delivery of Health Care* ; Emergencies ; Home Care Services ; Hospice Care ; Hospices ; Humans ; Medicine, East Asian Traditional ; Outpatients ; Quality of Life ; Telephone ; Ulmus ; Surveys and Questionnaires

Bipotent progenitors for T and natural killer (NK) lymphocytes are thought to exist among early precursor thymocytes or liver lymphocytes. The identification of such a progenitor population or mature NK cells in such organs remains undefined. Here we report the identification of a novel receptor of NK cells, p58 (HLA class I-specific inhibitory receptors), in fetal thymocytes and fetal liver lymphocytes. Our finding suggests the NK cells mature in the developmental stage during feta1 ontogeny. Flow cytometric analysis revealed p58 positive cells in thymocytes or in fetal liver lymphocytes and reverse transcription PCR also showed amplification of p58 RNA. The result of single stranded conformational polymorphism (SSCP) showed it discriminates one or two base pair differences of the p58 gene. Although the question still remains as to whether the expression of p58 is due to the NK cells or natural T cells, it is clear the p58 is expressed in fetal thymocytes or liver lymphocytes. And SSCP analysis using appropriate sets of primers used in this study, is helpful to study the diversity of p58.
Base Pairing ; Killer Cells, Natural ; Liver* ; Lymphocytes* ; Polymerase Chain Reaction ; Polymorphism, Single-Stranded Conformational ; Reverse Transcription ; RNA ; T-Lymphocytes ; Thymocytes*

Fetal thymus may be the organ for NK cell maturation, but the in vivo evidences are few, Here, by analyzing NK cell receptor, we present that NK cells develop in fetal thymus and fetal liver and that NK cell receptor appears earlier than the expression CD16 or CD56. Moreover, the finding that the repertoire of NK cell receptor is different between fetal thymus and fetal liver lymphocytes suggests that the environmental factors may influence the NK cell receptor repertoire during NK cell maturation.
Killer Cells, Natural* ; Liver* ; Lymphocytes* ; Thymocytes* ; Thymus Gland

BACKGROUND: Generally, for patients with cancer, chronic disease, burn injury or pediatric patients to whom oral medication is difficult or whose vessels are fragile, it is difficult to inject analgesics parenterally. To know the effect of subcutaneous infusion which would be directly used by patients themselves or their care givers, we compared subcutaneous patient-controlled analgesia (SQ PCA) with intravenous patient-controlled analgesia (IV PCA) morphine for acute postoperative pain. METHODS: We undertook a study to prospective, randomized, controlled patients (n = 30) undergoing elective total hysterectomy to compare SQ PCA with IV PCA morphine for postoperative pain control. We prepared a 5 mg/ml solution of morphine for the SQ PCA group (n = 15) and a 1 mg/ml solution of morphine for the IV PCA group (n = 15). The regimen of morphine was a basal rate 20 microgram/kg/h, 1 mg bolus, 10 min lockout interval, 1 hour limit of 8 mg. We evaluated the VAS score at rest and at coughing after postoperative 6, 12, 18, 24, 30, 36, 42 and 48 hours, 6 hourly doses of morphine, total requirement of infused morphine for 48 hours and delivery to demand ratio. Side effects and satisfactory score were checked too. RESULTS: The Visual analogue scale (VAS) pain score at rest and with coughing, the 6 hourly doses of morphine, the total requirement of infused morphine for 48 hours, the delivery to demand ratio, side effects and the satisfactory score were not significantly different in the two groups (P<0.05). CONCLUSION: Thus SQ PCA morphine represents a clinically acceptable alternative to IV PCA in the treatment of postoperative pain control.
Analgesia, Patient-Controlled* ; Analgesics ; Burns ; Caregivers ; Chronic Disease ; Cough ; Humans ; Hysterectomy ; Infusions, Subcutaneous ; Morphine* ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Prospective Studies

Chronic eosinophilic pneumonia is a very rare disorder of unknown etiology characterized by striking systemic and pulmonary manifestations such as fever, weight loss, dyspnea, blood eosinophilia, and fluffy peripheral opacities on chest radiograph. A number of these patients developed asthma before or with the onset of illness. The roentgenographic lesion rapidly resoluted with corticosteroid and recurrence was occasionally occured in the same location. Histopathologic features of chronic eosinophilic pneumonia include dense aggregates of eosinophils, histiocytes, and multinucleated giant cells within alveolar spaces, interstitium, and bronchioles associated with scattered lymphocytes and plasma cells. We report a case of chronic eosinophilic pneumonia diagnosed by clinical, radiographic, and histologic findings with review of the literature.
Asthma ; Bronchioles ; Dyspnea ; Eosinophilia ; Eosinophils* ; Fever ; Giant Cells ; Histiocytes ; Humans ; Lymphocytes ; Plasma Cells ; Pneumonia ; Pulmonary Eosinophilia* ; Radiography, Thoracic ; Recurrence ; Strikes, Employee ; Weight Loss

BACKGROUND: The aim of this study was to compare dexmedetomidine (DEX), which is a selective, short-acting, central alpha2-adrenergic agonist, with fentanyl in terms of the hemodynamic stability, achieving hypnosis and sedation, and the postoperative pain control at the PACU (postanesthetic care unit). METHODS: In this double-blind study, 50 consecutive total laparoscopic hysterectomy patients scheduled for elective surgery were randomly assigned to receive either dexmedetomidine 1 microg/kg over 10 min followed by a 0.5 microg/kg/hr infusion (the DK group) or fentanyl 0.8-1.2 microg/kg over 1 min followed by a 0.2-0.6 microg/kg/hr infusion (the FK group) from the time of ending the operation after total hysterectomy to the time in the PACU. We evaluated the pain VAS scores, the modified OAA/S scores, the BIS, the vital signs, the respiratory variables (SpO2, RR and EtCO2) and the perioperative side effects to compare the efficacy of dexmedetomidine and fentanyl. RESULTS: Compared with the fentanyl-ketorolac (FK) group, the modified OAA/S scores were significantly lower in the dexmedetomine-ketorolac (DK) group at 0, 5 and 10 min after arrival at the PACU (P < 0.05), whereas the pain VAS and BIS were not significantly different between the two groups. The blood pressure and heart rate in the DK group was significantly lower than that of the FK group at the PACU (P < 0.05). CONCLUSIONS: The DK group, at the doses used in this study, has a significant advantage over the FK group in terms of the postoperative hemodynamic stability at the PACU. There was no significant difference between the two groups for the postoperative pain control.
Blood Pressure ; Dexmedetomidine ; Double-Blind Method ; Fentanyl ; Heart Rate ; Hemodynamics ; Humans ; Hypnosis ; Hysterectomy ; Imidazoles ; Nitro Compounds ; Pain, Postoperative ; Vital Signs

BACKGROUND: The aim of this study was to compare dexmedetomidine (DEX), which is a selective, short-acting, central alpha2-adrenergic agonist, with fentanyl in terms of the hemodynamic stability, achieving hypnosis and sedation, and the postoperative pain control at the PACU (postanesthetic care unit). METHODS: In this double-blind study, 50 consecutive total laparoscopic hysterectomy patients scheduled for elective surgery were randomly assigned to receive either dexmedetomidine 1 microg/kg over 10 min followed by a 0.5 microg/kg/hr infusion (the DK group) or fentanyl 0.8-1.2 microg/kg over 1 min followed by a 0.2-0.6 microg/kg/hr infusion (the FK group) from the time of ending the operation after total hysterectomy to the time in the PACU. We evaluated the pain VAS scores, the modified OAA/S scores, the BIS, the vital signs, the respiratory variables (SpO2, RR and EtCO2) and the perioperative side effects to compare the efficacy of dexmedetomidine and fentanyl. RESULTS: Compared with the fentanyl-ketorolac (FK) group, the modified OAA/S scores were significantly lower in the dexmedetomine-ketorolac (DK) group at 0, 5 and 10 min after arrival at the PACU (P < 0.05), whereas the pain VAS and BIS were not significantly different between the two groups. The blood pressure and heart rate in the DK group was significantly lower than that of the FK group at the PACU (P < 0.05). CONCLUSIONS: The DK group, at the doses used in this study, has a significant advantage over the FK group in terms of the postoperative hemodynamic stability at the PACU. There was no significant difference between the two groups for the postoperative pain control.
Blood Pressure ; Dexmedetomidine ; Double-Blind Method ; Fentanyl ; Heart Rate ; Hemodynamics ; Humans ; Hypnosis ; Hysterectomy ; Imidazoles ; Nitro Compounds ; Pain, Postoperative ; Vital Signs

Precise reduction and rigid fixation is essential in preventing facial asymmetry in zygoma fracture patients. Numerous methods are used for treating zygoma fractures categorized largely as open reduction and simple external reduction. The conventional three point open reduction method has drawbacks such as long operating time, visible scar, cheek drooping and soft tissue violence. Simple external reduction has drawbacks such as inadequate mechanical fixation, long lasting external fixation, long term deviation of malar eminence and poor visualization. To avoid drawbacks of the conventional method, we combined one point plate fixation method and one point external fixation with double K wire technique. Total 25 patients were treated with this technique. Follow up time was 3 months to 3 year. All cases showed very good cosmetic symmetry without any complications. Advantages of this technique include, simple procedure, smaller incisional scar, early removal of pin, early return to mastication, prevention of malar eminence deviation, and less soft tissue violence. This internal and external fixation technique is a simple and effective method in treatment of uncomminuted zygoma fracture.
Cheek ; Cicatrix ; Facial Asymmetry ; Follow-Up Studies ; Humans ; Mastication ; Violence ; Zygoma*

STUDY DESIGN: A retrospective study. PURPOSE: To assess the radiographic progression of degenerative lumbar scoliosis after short segment decompression and fusion without deformity correction. OVERVIEW OF LITERATURE: The aims of surgery in degenerative lumbar scoliosis are the relief of low back and leg pain along with a correction of the deformity. Short segment decompression and fusion can be performed to decrease the level of low back and leg pain provided the patient is not indicated for a deformity correction due to medical problems. In such circumstance, the patients and surgeon should be concerned with whether the scoliotic angle increases postoperatively. METHODS: Forty-seven patients who had undergone short segment decompression and fusion were evaluated. The average follow-up period was more than 3 years. The preoperative scoliotic angle and number of fusion segments was 13.6+/-3.9degrees and 2.3+/-0.5, respectively. The preoperative, postoperative and last follow-up scoliotic angles were compared and the time of progression of scoliotic angle was determined. RESULTS: The postoperative and last follow-up scoliotic angle was 10.4+/-2.3degrees and 12.1+/-3.6degrees, respectively. In eight patients, conversion to long segment fusion was required due to the rapid progression of the scoliotic angle that accelerated from 6 to 9 months after the primary surgery. The postoperative scoliosis aggravated rapidly when the preoperative scoliotic angle was larger and the fusion was extended to the apical vertebra. CONCLUSIONS: The scoliotic angle after short segment decompression and fusion was not deteriorated seriously in degenerative lumbar scoliosis. A larger scoliotic angle and fusion to the apical vertebra are significant risk factors for the acceleration of degenerative lumbar scoliosis.
Acceleration ; Congenital Abnormalities ; Decompression ; Follow-Up Studies ; Humans ; Leg ; Retrospective Studies ; Risk Factors ; Scoliosis ; Spine