Background: This study examined possible risk factors for myringosclerosis formation after ventilation tube insertion (VTI). Methods: A retrospective study was performed in a single tertiary referral center. A total of 582 patients who underwent VTI were enrolled in this study. Patients were divided into two groups based on the presence or absence of myringosclerosis: MS+ and MS−. Characteristics of patients were collected through medical chart review; these included age, gender, nature and duration of effusion, type of ventilation tube (VT), duration and frequency of VTI, incidence of post-VTI infection, incidence of intraoperative bleeding, and presence of postoperative perforation. Incidences of risk factors for myringosclerosis and the severity of myringosclerosis in association with possible risk factors were analyzed. Results: Myringosclerosis developed in 168 of 582 patients (28.9%) after VTI. Patients in the MS+ group had an older mean age than those in the MS− group. The rates of myringosclerosis were higher in patients with older age, serous otitis media, type 2 VT, post-VTI perforation, and frequent VTI. However, there were no differences in occurrence of myringosclerosis based on gender, duration of effusion, duration of VT placement, incidence of post-VTI infection, or incidence of intraoperative bleeding. The severity of myringosclerosis was associated with the duration of effusion and frequency of VTI. Conclusion Older age, serous effusion, type 2 VT, presence of post-VTI perforation, and frequent VTI may be risk factors for myringosclerosis after VTI; the severity of myringosclerosis may vary based on the duration of effusion and frequency of VTI.

Malignant tumors of the external auditory canal (EAC) are very rare. Squamous cell carcinoma, adenoid cystic carcinoma and basal cell carcinoma on the decreasing frequency are the most common pathologic forms of EAC malignancy. Mucoepidermoid carcinoma (MEC) of the EAC is extremely rare. Only three cases of MEC occurring in EAC were reported to date in the English literature. We present a case of MEC occurring in the EAC with the review of related literatures.
Aminocaproic Acids ; Carcinoma, Adenoid Cystic ; Carcinoma, Basal Cell ; Carcinoma, Mucoepidermoid ; Carcinoma, Squamous Cell ; Ear Canal

Fibromatosis is a benign tumor arising from the musculoaponeurotic tissues of the body. The natural history of fibromatosis is slow, progressive growth with invasion of adjacent tissues but this tumor has no malignant or metastatic potential. Complete surgical excision is the mainstay of treatment. However, it is often difficult due to the complex anatomy, close proximity of vital structures in the head and neck region. Preoperative core needle biopsy and MR images can make it possible to diagnose preoperatively and outline the tumor extent, which are very important to treat patients with fibromatosis. In this report, a rare case of fibromatosis occurring in the levator scapulae muscle is presented with a review of literatures.
Biopsy, Large-Core Needle ; Fibroma ; Head ; Humans ; Muscles ; Natural History ; Neck ; Scapula

Pneumocephalus is defined as the presence of air within the cranial cavity. Trauma such as automobile accidents, motorcycle accidents, and missile injuries is the most common cause of pneumocephalus. There have previously been four reported cases of pneumocephalus following stab wounds to the neck in the English literature. We present an unusual case of pneumocephalus following a neck stab wound with a review of the literatures.
Automobiles ; Motorcycles ; Neck ; Pneumocephalus ; Wounds, Stab

Primary duodenal tuberculosis, duodenal Crohn's disease, duodenal lymphoma, duodenal cancer is extremely rare event. Vague upper abdominal pain, weight loss(10 Kg) had been present for several months in a 52-yeer-old woman. Endoscopy revealed an irregular ulcer in the second part of the duodenum. CT of the abdomen revealed pooly defined hypodense and centrally low density masses along the hepatoduodenal ligament, with poor separation from the head of pancreas. Hypotonic duodenogram showed spiculation and smooth indentation of mucosal fold at medical aspect of sup. portion m descending duodenum. ERCP showed medially displaced distal CBD and main pancreaticduct. At first, lymphoma, cancer, Crohn's disease, duodenal tuberculosis were considered in the differential diagnosis. Endoscopic biopsy sepecimen of duodenal lesion showed atypical lymphocytes. We excluded the diagnosis of the duodenal cancer. We started anti-tubercular drugs because in our country tuberculosis is endemic. After 4 weeks anti-tuberculosis therapy, follow up endoscopy and biopsy specimens showed healing stage of duodenal ulcer and chronic granulomatous inflammation with multinucleated giant cell. Thus we concluded that when duodenal lesion which could not confirmed histopathologically it was wise to start antitubercular therapy than to perform exploraparotomic dianostic procedures.
Abdomen ; Abdominal Pain ; Biopsy ; Cholangiopancreatography, Endoscopic Retrograde ; Crohn Disease ; Diagnosis ; Diagnosis, Differential ; Duodenal Neoplasms ; Duodenal Ulcer ; Duodenum ; Endoscopy ; Female ; Follow-Up Studies ; Giant Cells ; Head ; Humans ; Inflammation ; Ligaments ; Lymphocytes ; Lymphoma* ; Pancreas ; Tuberculosis* ; Ulcer

BACKGROUND AND OBJECTIVES: In many chronic infections, bacteria are present as a form of biofilms. Recently, bacterial biofilm has been implicated in persistent or recurrent chronic otolaryngologic infections, because they are highly resistant to treatment with antimicrobial agents and capable of shedding individual bacteria to the surrounding tissues. In this study, we aimed to evaluate biofilm in chronic middle ear infections. SUBJECTS AND METHOD: A total of 85 cases with chronic middle ear infections were included in this study. Histomorphologic studies for middle ear granulations and cholesteatomas were performed using light and electron microscopy. RESULTS: In middle ear granulations, about 33% of the cases showed the evidence of bacterial biofilm. In comparison, about 64% of the cases in cholesteatoma tissues have the evidences of bacterial biofilm. CONCLUSION: Biofilms are associated with chronic middle ear infection and they may play a role in the pathogenesis of refractory or persistent chronic middle ear infections.
Anti-Infective Agents ; Bacteria ; Biofilms ; Cholesteatoma ; Ear, Middle ; Humans ; Light ; Microscopy, Electron ; Otitis ; Otitis Media

BACKGROUND AND OBJECTIVES: The role of Staphylococcus aureus enterotoxin B (SEB) in allergic rhinitis remains controversial. We used a mouse model of airway allergy to determine the effects of nasal instillation of SEB on allergic inflammation. MATERIALS AND METHOD: BALB/c mice were intranasally sensitized with compound of Aspergillus melleus proteinase (AMp) and ovalbumin (ova) in the presence (group 3) or absence of SEB (group 2). Control mice were intranasally sensitized with either phosphate buffered saline (PBS)(group 1) or SEB (group 4) alone. The production of serum antigen-specific antibodies and total IgE, and concentrations of cytokines including interleukin-4 (IL-4), IL-5, interferon-gamma (IFN-gamma) in nasal lavage fluid (NLF) and broncoalveolar lavage fluid (BALF) were compared among the groups. Pathologic studies for eosinophilic infiltrations in the nasal mucosa and peribronchial area were also conducted. RESULTS: Serum ova-specific immunoglobulin E (IgE) & immunoglobulin G1 (IgG1) were significantly increased in group 2 and 3 compared to group 1. The concentrations of IL-4 in BALF were significantly increased in group 2, 3, and 4 compared to group 1. The concentrations of IL-5 in BALF and NLF were significantly increased in Group 2, 3, and 4 compared to group 1. The concentrations of IFN-gamma were significantly increased in group 3 and 4 compared to group 2 although there was no significant difference among the groups in NLF. Group 2 demonstrates increased infiltration of eosinophils in the nasal mucosa and peribronchial area compared to group 3 and 4. CONCLUSION: These results suggest that the nasal exposure to SEB did not aggravate inflammation in allergic mice.
Animals ; Antibodies ; Aspergillus ; Cytokines ; Enterotoxins ; Eosinophils ; Hypersensitivity ; Immunoglobulin E ; Immunoglobulins ; Inflammation ; Interferon-gamma ; Interleukin-4 ; Interleukin-5 ; Mice ; Nasal Lavage Fluid ; Nasal Mucosa ; Ovalbumin ; Rhinitis ; Rhinitis, Allergic, Perennial ; Staphylococcus ; Staphylococcus aureus ; Therapeutic Irrigation

BACKGROUND AND OBJECTIVES: In general, aminoglycosides are known to cause ototoxicity through the glutamate induced nitric oxide production. The N-methyl-D-aspartate (NMDA) related glutamate receptors have a pivotal role in aminoglycoside induced ototoxicity. Memantine is known as a safe NMDA antagonist and is also used in some neurologic insults, such as the Alzheimer disease. In this study, we observed the effect of memantine on gentamicin induced vestibulotoxicity in an animal model. MATERIALS AND METHOD: Vestibulotoxicity was induced with intratympanic administration of gentamicin and memantine was injected intraperitoneally to a study group. Histomorphological studies for vestibule were performed via light and electron microscopy. Immunohistochemical studies were performed for iNOS, nitrotyrosine and apoptosis via TUNEL staining. RESULTS: The numbers of hair cells were decreased significantly in the gentamicin group than in the gentamicin-memantine group. Increased immunoreactivities for iNOS and nitrotyrosine were observed in the gentamicin group than in the memantine-pretreated gentamicin group. TUNEL positive cells were more frequently observed in the gentamicin group than in the memantinepretreated gentamicin group. CONCLUSION: This result shows that memantine has a protection effect on gentamicin-induced vestibulotoxicity in an animal model.
Alzheimer Disease ; Aminoglycosides ; Animals ; Apoptosis ; Gentamicins ; Glutamic Acid ; Guinea ; Guinea Pigs ; Hair ; In Situ Nick-End Labeling ; Light ; Memantine ; Microscopy, Electron ; Models, Animal ; N-Methylaspartate ; Nitric Oxide ; Receptors, Glutamate ; Tyrosine

PURPOSE: The purpose of this study is to clarify the degree of corneal neovascularization and its expression of MMP-2. 9(matrix metalloproteinase) and TIMP-1, 2(tissue inhibitor of metalloproteinases) according to the different concentrations of VEGF(vascular endothelial growth factor). METHODS: After the pellets with different amounts of VEGF(VEGF 125, 250 ng) were inserted into the corneal stroma of rat model, their degree of corneal neovascularization and the expression of MMP-2, 9 and TIMP-1, 2 were compared with those of control group where pellets were filled with phosphate-buffered saline. RESULTS: At the 7th day after the pellet insertion, degree of neovascularization was most highly scored in the group with pellet which contained the largest amount of VEGF, 250 ng, and there was statistically noticeable increase of eovascularization with the increase of VEGF amount(P<0.05). On immunohistochemical staining, as the amount of VEGF increases, not only MMP-2, 9 and flk-1, but also TIMP-1, 2 were expressed more. CONCLUSIONS: In conclusion, when it comes to neovascularization, MMP-2, 9, which induces angiogenesis, as well as its inhibitor TIMP-1, 2 are increased to maintain the homeostasis of the cornea.
Cornea ; Corneal Neovascularization* ; Corneal Stroma ; Homeostasis ; Models, Animal ; Tissue Inhibitor of Metalloproteinase-1* ; Vascular Endothelial Growth Factor A

Liddle's syndrome was described in 1963 by Liddle, et al., as the disease featuring a hypertension and hypokalemia but with negligible secretion of aldosterone. This syndrome, which morphologically belongs to an abnormal intrinsic tubular disorder with normal renal function, is characterized by hypokalemia, metabolic alkalosis, and hypertension due to the abnormal increase in excretion of potassium in distal tubules or collecting duct and the increase in reabsorption of sodium in distal tubules. This syndrome, which is rare disease, is observed with the low level of plasma and urinary aldosterone and suppressed plasma renin level and is known as dominant mode of inheritance with a family background. The authors paid attention to a 79-year-old man who showed a high blood pressure of 210/130mmHg as well as musle weakness, especially lower extremities due to metabolic alkalosis featuring a hypokalemia level of 2.0mEq/L when he was admitted to our hospital, Because his serum potassium were not improved with the medication of intravenous potassium supply, and his blood pressure continued to be high without the improvement of muscle weakness, we prescribed 300mg of spironolactone for two weeks. His symptom, however, was not cured. Then, instead of spironolactone, we prescribed 150mg of triamterene and a low salt diet which finally improved his symptoms. Because there has been no reported case in the Korean medical literature, we report a case of successfully treated Liddle's syndrome due to triamterene administration.
Aged ; Aldosterone ; Alkalosis ; Blood Pressure ; Diet ; Humans ; Hypertension ; Hypokalemia ; Lower Extremity ; Muscle Weakness* ; Plasma ; Potassium ; Rare Diseases ; Renin ; Sodium ; Spironolactone ; Triamterene ; Wills