BACKGROUND AND OBJECTIVES: Endoscopic sinus surgery has become an effective tool for the treatment of chronic sinusitis. The success of this procedure can be best determined by a long-term evaluation of the surgery results from patients who are grouped according to the prepoerative severity of the disease. In this study we attempted to evaluate the results of endoscopic sinus surgery according to the severity of the disease and the length of the follow-up period. MATERIALS AND METHODS: Questionnaires were sent out to 313 patients with chronic sinusitis who underwent endoscopic sinus surgery at our department from April 1992 to October 1995. Replies from 118 patients (37.69%) were analyzed. All patients had taken preoperative ostiomeatal unit computed tomography (OMU-CT) and their results were graded according to the Levine and May's grading system. The follow-up periods ranged from 7 to 51 months, with the mean of 27 months. RESULTS: All nasal symptoms including nasal obstruction, rhinorrhea, postnasal drip, anosmia and headache significantly improved. The nasal obstruction symptom improved by 76.8%, rhinorrhea 62.1%, postnasal drip 64.4%, anosmia 50.0% and headache 80.0%. However, no statistical significance could be drawn between the improvement rate and the different lengths of the follow-up periods. CONCLUSION: The results suggest that endoscopic sinus surgery might improve nasal symptoms in patients with chronic sinusitis regardless of the severity of disease and the length of follow-up period.
Follow-Up Studies* ; Headache ; Humans ; Nasal Obstruction ; Olfaction Disorders ; Surveys and Questionnaires ; Sinusitis

No abstract available.
Cholesteatoma* ; Otitis Media* ; Otitis* ; Temporal Bone*

The superficial lymph nodes may be enlarged in consequence of biologic or non-biologic antigenic stimuli, lymphoreticular maligna ntneoplasm, metastatic tumor or infiltrative disorders such as histiocytosis-X, and biopsy of the enlarged superficial lymph node is a time-honored diagnostic, therapeutic and follow-up tool. At present it is performed with ease and wideness. But in Korea there is no comprehensive studies about the diseases involving superficial ly-mph nodes of pediatric ages based on clinical and histopathological aspects. The present study is an sttempt to research for the histopathological aspects. The present study is an attempt to research for the histopathological findings of the superficial lymphadenopathy in correlation with the clinical characteristics. The histopathological findings of enlarged superficial lymph nodes, biopsied in Yonsei Univ-ersity Hospital for a 5year-period from 1976 to 1980, were reviewed. All patients were under 15year-old age, whose chief complaints were palpable lymph node with or without other sympt-oms. The results were as follows; 1. Of the 150 enlarged superficial lymph nodes, the male to female ratio was 1.68:1. Most of the biopsies were performed after the preschool age group and only 8 were of neonate or inf-ancy. 2. Of the 150 enlarged superficial lymph nodes, 79(52.7%) showed reactive hyperplasia, and inflammatory and malignant lymphadenopathies were 37.3% and 10.0% respectively. 3. Nonspecific reactive hyperplasia was the most common cause of the superfical lymphad-enopathy in pediatric ages, being 52.1% of total. Tuberculous lymphadenitis comprised 26.7%, being the 2nd most common cause, and of the 15 malignant lymphadenopathy 11 were primary lymphoreticular and 6 of the latter were histiocytic medullary reticulosis. 4. Ten percent of the patients with tuberculous lymphadenitis were of infancy, but none of those with both primary and metastatic malignant lymphadenopathy was of that age group. 5. The clinical symptoms and signs observed were fever, hepatosplenomegaly, gastrointest-inal symptoms and signs, rash, upper respiratory infection and others, irrespective of the histol-ogical classification. 6. The duration of superficial lymphadenopathy was less than 6 months in most cases of fu-ngal, acute and subacute nonspecific inflammatory and malignant origin, whereas it was more than 6 months in 38.5% of tyberculous lymphadentis and 41.7% of nonspecific reactive. 7. Superficial lymph node enlargement was most frequently found at cervical area which was followed by inguinal and axillary areas. 8. The superficial lymphadenopathy involved a single node in 63.9% of tuberculous origin but it tended to involve multiple ondes of one or more anatomical sites in nonspecific inflamm-ation, fungal infection, nonspecific reactive hyperplasia and malignancy. 9. The enlarged superficial lymph noded tendes to be soft and nontender in tuberculosis and nonspecific reactive hyperplasia, in contrast to the acute and subacute lymphadenitis and mali-gnant lymphadenopathy where they were more commonly hard with variable tenderness.
Biopsy ; Classification ; Exanthema ; Female ; Fever ; Follow-Up Studies ; Histiocytosis, Langerhans-Cell ; Humans ; Hyperplasia ; Infant, Newborn ; Korea ; Lymph Nodes ; Lymphadenitis ; Lymphatic Diseases* ; Male ; Tuberculosis ; Tuberculosis, Lymph Node

Iatrogenic cerebrospinal fluid(CSF) rhinorrhea, rarely occuring, is one of the major complications, and should be managed immediately if it occurs during operation. CSF leakage can be repaired intracranially or extracranially. Extracranial approaches are subdivided into extranasal and intranasal. Recent advance in nasal endoscopy and its advantage of low morbidity allow more surgeons to perform the intranasal approach using endoscope. As graft materials, free or rotational flaps of temporalis muscle fascia, muscle, fat, and mucosa or mucoperiosteum in the nasal septum or turbinates have widely been used. Sometimes composite graft such as osteomucoperiosteal(OMP) free flap was also used. By intranal endoscopic approach using OMP free flap obtained from the middle Turbinate(MT), we successfully repaired CSF leakage from a defect, 5~7mm in size, which had occured in the right ethmoid roof near the lamina cribrosa during endoscopic sinus surgery on a patient with chronic paranasal sinusitis. Repair of CSF rhinorrhea using MT OMP free flap may be an useful technique for immediate intraoperative management of the defect, if it is not so large, because of availability and easy handling of this flap in the same surgical field.
Cerebrospinal Fluid Rhinorrhea* ; Cerebrospinal Fluid* ; Endoscopes ; Endoscopy ; Fascia ; Free Tissue Flaps* ; Humans ; Mucous Membrane ; Nasal Septum ; Sinusitis ; Transplants ; Turbinates*

No abstract available.
Humans ; Sarcoma, Kaposi*

PURPOSE: We have evaluated the diagnostic and predictive value of HLA-DR, ICAM-1 and VCAM-1 expression in patients clinically suspected with acute rejection. METHODS: Immunohistochemical staining for HLA-DR, ICAM-1 and VCAM-1 was performed in 21 patients who had graft dysfunction. According to the Banff 97 working classification of renal allograft pathology, eight cases were classified as acute rejection (one borderline changes, two Type IA, two Type IB, one Type IIA, two Type IIB). The other cause of renal dysfunction included mild acute tubular necrosis (n=4), recurrent focal segmental glomerulosclerosis (n=3), recurrent IgA nephropathy with or without chronic transplant nephropathy (n=3), chronic allograft nephropathy (n=2), allograft glomerulopathy (n=1). Among these, three patients showed mild acute cyclosporin toxicity. RESULTS: Expression of HLA-DR more than 25% of tubular cells was noted in 8 cases out of 12 patients with clinically improved serum creatinine levels. These 8 cases were pathologically diagnosed as borderline in 1 case, acute rejection Type IA in 2, Type IB in 2, Type IIA in 1 case and Type IIB in 2 cases. In one patient showing pathologically 'borderline changes' and high HLA-DR expression (90% of tubular cells), serum creatinine level was remarkably improved from 5.5 mg/dl to 1.5 mg/dl after treating for acute rejection. Nine cases with no or low expression of HLA-DR (weak staining in less than 10% of tubular cells) include 3 biopsies of recurrent FSGS, 3 recurrent IgA nephropathy, 1 allograft glomerulopathy, 3 acute cyclosporin toxicity, and 3 acute tubular necrosis. CONCLUSION: Our data show that increased tubular expression of HLA-DR, ICAM-1 and VCAM-1 is significantly related to acute graft rejection. Immunohistochemical staining for HLA- DR is more useful than ICAM-1 and VCAM-1 in the diagnosis of renal allograft rejection.
Allografts* ; Biopsy ; Classification ; Creatinine ; Cyclosporine ; Diagnosis ; Glomerulonephritis, IGA ; Glomerulosclerosis, Focal Segmental ; Graft Rejection ; HLA-DR Antigens* ; Humans ; Intercellular Adhesion Molecule-1* ; Kidney Transplantation ; Necrosis ; Pathology ; Transplants ; Vascular Cell Adhesion Molecule-1*

The isolation arm test at upper limb for the study of muscle relaxants sensitivity of human muscle is described. In the healthy adults, succinylcholine 100ug/kg or vecuronium 5~6ug/kg combined with 20ml saline is given intravenously at various sites of injection while the circulation to the arm is occluded with upper arm pneumatic tournique. After injection of muscle relaxants, neuromuscular transmission is then studied by TOF stimulation to ulnar nerve with EMG monitor(ABM, Dates) and changes of twitch response in evoked muscle action potential amplitude from hypothenar muscle are recorded. In the results, twitch height is depressed weakly and slowly but incompletely after muscle relaxant is injected intravenously at cubital fossa, and declines further depression following recovery after the release of upper arm tourniquet occiuded systemic circulation(two stage response). There are not any changes of twitch response while muscle relaxants are given intravenously between upper arm and forearm pneumatic tourniquet. But twitch height is depressed rapidely and completely after muscle relaxants are given intravenously at doris hand under the upper arm or forearm pneumatic tourniquet. Conclusively, twitch response under the isolation arm test is influenced from the site of injection, and in order to obtain the correct assessment of neuromuscular blockade, muscle relaxants will be given intravenously at dorsi hand with forearm pneumatic tourniquet.
Action Potentials ; Adult ; Arm* ; Depression ; Forearm ; Hand ; Humans ; Neuromuscular Blockade ; Succinylcholine ; Tourniquets ; Ulnar Nerve ; Upper Extremity ; Vecuronium Bromide

The cystic teratoma is the most common germ cell tumors in reproductive age women. The malignant change of cystic teratoma is rare, about 1~2%, and mostly change to squ-amous cell carcinoma. We experienced 4 cases of squamous cell carcinoma arising in cystic teratoma and re- port our cases with a brief review of the literature.
Carcinoma, Squamous Cell* ; Female ; Humans ; Neoplasms, Germ Cell and Embryonal ; Ovary* ; Teratoma*

Hypocrellin A has gained much attention in recent years due to its light-induced antitumor, antifungal and antiviral activities. Here we report that hypocrellin A exerts immunomodulatory effects on MHC-restricted presentation of antigen. Hypocrellin A inhibited class II-MHC restricted presentation of exogenous antigen, but not class I MHC-restricted presentation of exogenous antigen, in dendritic cells. Hypocrellin A also inhibited the cytosolic pathway of endogenous antigen presentation. However, hypocrellin A did not inhibit the expression of class I and class II MHC molecules on dendritic cells (DCs), the phagocytic activity of DCs, or the H-2K(b)-restricted presentation of a synthetic peptide, SIINFEKL. These results show that hypocrellin A differentially modulates the MHC-restricted antigen presentation pathways.
Antigen Presentation ; Cytosol ; Dendritic Cells ; Perylene ; Quinones

There is an evidence that onset time and potency of the non-depolarizing neuromuscular blocking agents are related. However the relationship between onset time and the recovery has not been investigated yet. In this experiment, the onset times of six neuromuscular blocking agents have been compared with their recovery times. The neuromuscular transmission of mivacurium 0.15 mg/kg, atracurium 0.4 mg/kg, vecuronium 0.08 mg/kg, pipecuronium 0.08 mg/kg, pancuronium 0.1 mg/kg and succinylcholine 1 mg/kg were studied in 58 adult healthy patient (ASA I and II) during O2-N2O-isoflurane anesthesia using train-of-four stimulation with Relaxograph. It has been demonstrated that there is a close relationship between onset time and recovery in depolarizing neuromuscular blocking agent but not in non-depolarizing agents. Consequently, it is proposed that the relationships between the onset time and the recovery may hardly expected in clinical practice following systemic administration of non-depolarizing neuromuscular blocking agents.
Adult ; Anesthesia ; Atracurium ; Humans ; Neuromuscular Blockade* ; Neuromuscular Blocking Agents ; Pancuronium ; Pipecuronium ; Succinylcholine ; Vecuronium Bromide