Transitional cell carcinoma such as renal cell carcinoma is the relatively common urinary tract cancer in patients who are on dialysis. A 66-year-old male patient, who had been on maintenance hemodialysis for 5 years, was suffering from gross hematuria. The subsequent image studies revealed multiple masses at the right renal pelvis, the right distal ureter and the trigonal area at the bladder. We performed cystoscopy to evaluate the multiple bladder papillary masses and their blood clots. The patient then underwent bilateral radical nephroureterectomy and radical cystectomy. Histological examination revealed the papillary urothelial carcinoma. Our case may imply that dialysis patients have an increased susceptibility to urological malignancies. Physicians should always raise the possibility of urological malignancy when encountering a dialysis patient with gross hematuria. Because of the high recurrence rate, a more extensive operation and aggressive follow-up protocols should be done for these patients on dialysis.
Male ; Humans

BACKGROUND: Coughing during emergence from general anesthesia is a common clinical problem and results in a number of undesirable side effects. Remifentanil stimulate micron-opioid peptide receptor known to be related to antitussive effect. The goal of this study was to evaluate the effect of remifentanil on coughing after general anesthesia with desflurane. METHODS: Fifty one ASA physical status I and II patients undergoing elective oral and maxillofacial surgery were randomly assigned to receive either remifentanil with 1 ng/ml effect site concentration or normal saline until extubation. The number and intensity of coughs were monitored during emergence and the recovery time was recorded. RESULTS: The incidence and number of coughing during emergence was significant less frequent in the remifentanil group (P < 0.05). The intensity of coughing was significant milder in the remifentanil group (P < 0.05). There was no significant difference between two groups in the recovery time. CONCLUSIONS: Continuous remifentanil infusion with 1 ng/ml effect site concentration during emergence from general anesthesia with desflurane decrease the incidence of coughing without delaying the recovery time.
Anesthesia, General ; Cough ; Humans ; Incidence ; Isoflurane ; Piperidines ; Receptors, Peptide ; Surgery, Oral

In the anterior portion of the inferior turbinate, immune response originates actively from sustained allergenic stimulation. This response can lead to the development of a hyperplastic mass on the anterior portion of the inferior turbinate. The majority of such cases are benign chronic inflammatory lymphoid hyperplasia, but sometimes lymphoma occurs by malignant lymphocyte proliferation. The authors of this study evaluated seven patients who had a small mass on the inferior turbinate. As the result of excisional biopsy, MALT lymphoma was diagnosed in two patients and lymphoid hyperplasia in five. Immunohistochemistry is important for differential diagnosis. Complete excision was performed for initial diagnosis and treatment. Mucosa-associated lymphoid tissue lymphoma patients need to be evaluated for metastasis.
Biopsy ; Diagnosis, Differential ; Humans ; Hyperplasia ; Immunohistochemistry ; Lymphocytes ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone ; Nasal Cavity ; Neoplasm Metastasis ; Turbinates

Congenital Choanal Atresia is a relatively uncommon anomaly. Among various surgical approaches for treating this ailment that have been proposed to date, transpalatal and transnasal endoscopic approaches are the preferred methods for surgical treatments. Because restenosis is the most important post-surgical concern, some authors used topical application of mitomycin C in the choanal atresia and found it to be effective in the prevention and treatment of scar formation. We have experienced a case of right membranous choanal atresia and left membranous choanal stenosis which were treated with a transnasal endoscopic approach using powered instrumentations and topical application of mitomycin C without an application of prolonged stent. Eight months after the treatment, patent neochoanae remains without evidence of restenosis.
Choanal Atresia* ; Cicatrix ; Constriction, Pathologic* ; Endoscopes ; Mitomycin* ; Stents

BACKGROUND: Arginine vasopressin has been used by prophylactic treatment of vasodilatory shock during coronary artery bypass graft (CABG). Vasopressin may be a cause of spasm in graft artery during CABG. We evaluated the effect of propofol on vasopressin-induced contraction in human gastroepiploic artery (GEA). METHODS: Human GEA were obtained from 35 patients (43-74 yr), undergoing subtotal gastrectomy. Vasopressin-induced a concentration contractions (10(-9) to 10(-6) M) were measured after exposed to without propofol, propofol 10(-5), 10(-4), 10(-3) M. After endothelium denuding vasopressin-induced a concentration contractions were measured with or without propofol 10(-3) M in calcium free solution. In the denuded vascular rings, with or without pretreatment of glibenclamide (10(-5) M), nicorandil (10(-5) M), or diltiazem (10(-5) M) were exposed to with or without propofol 10(-3) M, and vasopressin-induced concentration contractions were measured. RESULTS: Vasopressin-induced concentration contraction on human GEA was independent of functional endothelium. Propofol (10(-4), 10(-3) M) attenuated the vasopressin-induced contraction in the human GEA. Diltiazem attenuated the vasopressin-induced contraction in the human GEA. ATP-sensitive potassium channel does not affect the inhibition effect of propofol on vasopressin-induced contraction CONCLUSIONS: Usual anesthetic dose of propofol does not inhibit vasopressin-induced contraction on human GEA. High dose (>10(-4) M) propofol attenuated vasopresssi-induced contraction on GEA.
Arginine ; Arginine Vasopressin ; Arteries ; Calcium ; Contracts ; Coronary Artery Bypass ; Diltiazem ; Endothelium ; Gastrectomy ; Gastroepiploic Artery ; Glyburide ; Humans ; Nicorandil ; Potassium Channels ; Propofol ; Shock ; Spasm ; Transplants ; Vasopressins

Frontal sinus mucocele is a slow-growing benign lesion, which can expand large enough to compress the orbit and intracranial structures. When mucocele develops symptoms, the surgical procedure should be considered. Complete resection of mucocele is one surgical procedure and marsupialization, which makes ventilator pathway and preserves the inner wall of mucocele, is another way. A recent study announced that marsupialization shows similar or better results compared to external resection. We present a case of frontal sinus mucocele, which developed intracranial complication after successful marsupialization.
Frontal Sinus ; Mucocele ; Orbit ; Postoperative Complications ; Ventilators, Mechanical

BACKGROUND AND OBJECTIVES: Frontal recess anatomy can be very complex, with accessory cells extending to the frontal sinus and possibly contributing to the obstruction of the frontal sinus. However, there is still controversy on the effect of the frontal recess cells. We designed this study to assess the effect of frontal recess cells on frontal sinusitis. SUBJECTS AND METHOD: We retrospectively reviewed chart and collected data of those who visited the outpatient clinic between January and June, 2011. Parnasal sinus CT was taken with Brillance 64-slice computed tomography scanners. The image was reviewed by two or more otolaryngologists to identify the frontal recess cells. The nasofrontal isthmus diameter and the area of nasofrontal isthmus was reconstructed and measured with workstation. Then, we compared the radiological results of frontal recess cells with the frequency of frontal sinusitis. RESULTS: The presence of anterior group of frontal recess cells showed no influence on the frontal recess anatomy. The presence of frontal bullar cell was significantly associated with the development of frontal sinusitis by simple (p=0.001) and multiple (p=0.038) logistic regression models. It was shown that the narrower the area of frontal isthmus the more developed were the frontal sinusitis, showing statistically significance in the simple (p=0.013) and multiple (p=0.017) logistic regression models. CONCLUSION: Our results also showed that similar results compared to previous Asianreport. The narrowness of nasofrontal isthmus could be the cause of frontal sinusitis. The frontal bullar cell could be the cause of frontal sinusitis encroaching on the frontal recess and affect the nasofrontal pathway.
Ambulatory Care Facilities ; Asian Continental Ancestry Group ; Frontal Sinus ; Frontal Sinusitis ; Humans ; Logistic Models ; Retrospective Studies

PURPOSE: To assess the prevalence of KRAS, BRAF, and TP53 mutations in cases of low-grade and high-grade serous carcinomas and to evaluate the clinical outcomes of these morphologically distinct carcinomas. MATERIALS AND METHODS: Patients with primary invasive serous carcinomas were classified according to the universal grading system. Grade 2 serous tumors were excluded. A total of 100 patients were included for clinical evaluation. Thirty-seven patients, including 20 with low-grade and 17 with high-grade carcinomas, were selected for mutational analysis. RESULTS: The low-grade carcinoma group was characterized by young age and premenopausal period compared with the high-grade carcinoma group, but there were no statistically significant differences in stage, metastasis of lymph node and residual disease. There were no statistically significant differences in survival rates, however, the low-grade carcinoma group showed a trend for improved progression-free survival compared with the high-grade carcinoma group of early stage (p = 0.064). Mutations in KRAS and BRAF were found in 6 (30%) and 2 (10%) patients in the low-grade carcinoma group, respectively, however, they were not found in the high-grade carcinoma group. KRAS and BRAF mutations were mutually exclusive, and both mutations were observed in 40% (8/20). The frequency of TP53 mutations in low-grade and high-grade carcinoma groups were found in 20% (4/20) and 70.6% (12/17), respectively (p = 0.009). CONCLUSION: Low-grade serous carcinoma shows mutation pattern different from that with high-grade carcinoma. As there were no significant differences in stage distribution and survival, especially in advanced stage, we suggest that more studies are needed to segregate these patients into distinct disease entities.
Adult ; Cystadenocarcinoma, Serous/*genetics ; DNA Mutational Analysis ; Female ; Humans ; Middle Aged ; Ovarian Neoplasms/*genetics ; Proto-Oncogene Proteins/*genetics ; Proto-Oncogene Proteins B-raf/*genetics ; ras Proteins/*genetics

OBJECTIVES: Budesonide nasal irrigation was introduced recently for postoperative management of patients with chronic rhinosinusitis. The safety and therapeutic effectiveness of this procedure is becoming accepted by many physicians. The objective of this study was to evaluate the efficacy of postoperative steroid irrigation in patients with chronic rhinosinusitis and asthma. METHODS: This prospective study involved 12 chronic rhinosinusitis patients with nasal polyps and asthma who received oral steroid treatment for recurring or worsening disease. The 22-item Sinonasal Outcomes Test (SNOT-22) and Lund-Kennedy endoscopy scores were checked before nasal budesonide irrigation, and 1, 2, 4, and 6 months after irrigation. We also calculated the total amount of oral steroids and inhaled steroids in the 6 months before irrigation and the 6 months after it. RESULTS: The mean SNOT-22 score improved from 30.8±14.4 before irrigation to 14.2±8.7 after 6 months of irrigation (P=0.030). The endoscopy score also improved from 7.4±4.7 before irrigation to 2.2±2.7 after 6 months (P<0.001). The total amount of oral steroid was decreased from 397.8±97.6 mg over the 6 months before irrigation to 72.7±99.7 mg over the 6 months after irrigation (P<0.001). CONCLUSION: Nasal irrigation with budesonide is an effective postoperative treatment for chronic rhinosinusitis with asthma, which recurs frequently, reducing the oral steroid intake.
Asthma* ; Budesonide* ; Endoscopy ; Humans ; Nasal Lavage* ; Nasal Polyps ; Prospective Studies ; Sinusitis ; Steroids

BACKGROUND AND OBJECTIVES: The aim of this study is to determine whether the hyperproliferative and hyperkeratotic characters of cholesteatoma are associated with differentiation of keratinocytes in cholesteatoma by examining the localization of marker proteins, such as involucrin, filaggrin, and cytokeratins. MATERIALS AND METHODS: Immunohistochemical study was carried out in 30 cholesteatoma tissues and 10 retroauricular skins to examine the expression of involucrin, filaggrin, cytokeratin 4, 10 and 16. The staining results were graded as negative, weakly positive (<10%), moderately positive (10-70%), and strongly positive (>70%). RESULTS: Involucrin was strongly expressed in upper spinous, granular, and corneal layer of cholesteatoma. Filaggrin was strongly expressed in granular and corneal layer of cholesteatoma. Cytokeratin 4 was expressed in basal layer of retroauricular skin, but occasionally expressed in suprabasal layer of cholesteatoma. Cytokeratin 10 was homogenously expressed in all suprabasal layer of retroauricular skin, whereas pattern of shift to surface layer was showed in cholesteatoma. Cytokeratin 16 was moderately expressed at suprabasal layer in cholesteatoma. CONCLUSIONS: It can be suggested that early differentiation of suprabasal layer may lead to hyperdifferentiation and hyperkeratosis. Different expression of cytokeratins possibly indicates the altered differentiation of cholesteatoma.
Cholesteatoma ; Intermediate Filament Proteins ; Keratin-16 ; Keratin-4 ; Keratinocytes ; Keratins ; Protein Precursors ; Proteins ; Skin