BACKGROUND & OBJECTIVES: There are few reports of affecting factors of the longterm prognosis after acute ischemic stroke. The aim of this prospective study was to determine which variables, of those easily measurable during the first 24 hours after stroke onset, would be predictors of longterm outcome. METHOD: Ninety-eight patients with an acute ischemic stroke were evaluated within 24 hours after symptom onset. The following potential affecting factors of outcome were prospectively collected : demographic datas, socioeconomic factors, risk factors of cerebrovascular accidents, clinical f indings as measured by the National Institute of Health (NIH) scale, laboratory findings and premorbid varibles rated according to modified Rankin score (mRS). We evaluated the outcome, assessed with mRS as good (mRS 3 or less) and poor (mRS 4, 5 or death) and follow up was undertaken at 6, 12, 18 and 24 months after onset. The statistical analysis was performed by means of SPSS/PC+package to determine the longterm prognostic factors. RESULTS: The multiple stepwise regression analysis revealed that the outcome depend on NIH scale(p<0.001), age (p<0.01), previous stroke(p<0.01), loss of consciousness (LOC) at onset (p Follow-Up Studies ; Humans ; Paresis ; Prognosis ; Prospective Studies ; Risk Factors ; Socioeconomic Factors ; Stroke ; Unconsciousness

BACKGROUND: Saccade test, smooth pursuit test, and optokinetic nystagmus test are clinically useful tests to accurately diagnose vertigo. However, there have only been a few studies regarding a correlation between the anatomical site of the lesion and the abnormality of eyeball movement in patients with vertigo. METHODS: The medical records of 97 patients with vertigo between January 2006 and June 2008 were reviewed retrospectively. We classified many kinds of abnormalities regarding the saccade test, smooth pursuit test and optokinetic nystagmus test into several categories and analyzed the localizing lesion of vertigo. RESULTS: According to the saccade test, both total saccade abnormality (S-total) and slow velocity of saccade (S-type 3) were shown to be significantly higher in the central lesion of vertigo. According to the smooth pursuit test, symmetrical unidirectional smooth pursuit abnormality (SP-type 2) was observed to be significantly higher in the peripheral lesion over vertigo. Moreover, according to the optokinetic nystagmus test, total optokinetic nystagmus abnormalities (OKN-total) were shown to be significantly useful findings in the diagnosis of the central lesion of vertigo. The coexisting abnormalities of all three tests (S+SP+OKN abnormalities) were shown to be significantly higher in the central lesion of vertigo. CONCLUSION: These results suggest that all these tests, saccade test, smooth pursuit test, and optokinetic nystagmus test, are very useful to distinguish between the central lesion and the peripheral lesion of vertigo. However, these tests are not beneficial in localizing the central lesion of vertigo.
Diagnosis ; Humans ; Medical Records ; Nystagmus, Optokinetic* ; Pursuit, Smooth* ; Retrospective Studies ; Saccades* ; Vertigo

OBJECTIVES: Clusterin (CLU) is known as apolipoprotein J, and has three isoforms with different biological functions. CLU is associated with various diseases such as Alzheimer disease, atherosclerosis, and some malignancies. Recent studies report an association of CLU with inflammation and immune response in inflammatory airway diseases. However, the effect of CLU on mucin secretion of airway epithelial cells has not yet been understood. Therefore, the effect and brief signaling pathway of CLU on MUC5AC (as a major secreted mucin) expression were investigated in human airway epithelial cells. METHODS: In the tissues of nasal polyp and normal inferior turbinate, the presence of MUC5AC and CLU was investigated using immunohistochemical stain and Western blot analysis. In mucin-producing human NCI-H292 airway epithelial cells and primary cultures of normal nasal epithelial cells, the effect and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) signaling pathway of CLU on MUC5AC expression were investigated using immunohistochemical stain, reverse transcription-polymerase chain reaction, real-time polymerase chain reaction, enzyme immunoassay, and Western blot analysis. RESULTS: In the nasal polyps, MUC5AC and CLU were abundantly present in the epithelium on immunohistochemical stain, and nuclear CLU (nCLU) was strongly detected on Western blot analysis. In human NCI-H292 airway epithelial cells or the primary cultures of normal nasal epithelial cells, recombinant nCLU increased MUC5AC expression, and significantly activated phosphorylation of NF-κB. And BAY 11-7085 (a specific NF-κB inhibitor) and knockdown of NF-κB by NF-κB siRNA (small interfering RNA) significantly attenuated recombinant nCLU-induced MUC5AC expression. CONCLUSION: These results suggest that nCLU induces MUC5AC expression via the activation of NF-κB signaling pathway in human airway epithelial cells.
Alzheimer Disease ; Atherosclerosis ; B-Lymphocytes ; Bays ; Blotting, Western ; Clusterin* ; Epithelial Cells* ; Epithelium ; Humans* ; Immunoenzyme Techniques ; Inflammation ; Mucins ; Nasal Polyps ; NF-kappa B ; Phosphorylation ; Protein Isoforms ; Real-Time Polymerase Chain Reaction ; RNA, Small Interfering ; Turbinates

Hamartoma is a tumor-like malformation in which the tissues are arranged haphazardly with an excess of one or more of its components, although the underlying reasons for the occurrence of hamartoma is not fully understood. Hamartoma commonly originates from the lung, kidney and intestine. However, hamartoma is very rare in the head and neck, especially in the palatine tonsil. Presenting symptoms of hamartoma are typically vague and nonspecific. Complete surgical removal of the hamartoma is the treatment of choice as incomplete treatment leaves the risk of recurrence. Recently, we have experienced a 22 year-old male patient who presented with a mass at the posterior pillar area of the right palatine tonsil of several years. The mass was resected completely and confirmed histologically as a hamartoma. Therefore, we report this case with a brief literature review.
Hamartoma ; Head ; Humans ; Intestines ; Kidney ; Lung ; Male ; Neck ; Palatine Tonsil ; Recurrence

Epinephrine is a common use to control bleeding for wide surgeon's range of vision during surgery. However, it may be occurred with some major complications such as reversible cardiomyopathy, pulmonary edema, and cardiac arrest. Stress-induced cardiomyopathy (SIC) is a reversible cardiomyopathy, which is related with sudden surge of catecholamine such as epinephrine, and increase of physical activity and emotional stress. It has been postulated that SIC is a relatively uncommon syndrome with difficult definition. But recently SIC is an increasingly recognized disease entity and is accepted as a unique form of reversible cardiomyopathy. However, SIC rarely is occurred when standard dose of epinephrine is used during a surgery under general anesthesia. Therefore, we presented two patients with SIC after subcutaneous injection of epinephrine during middle ear surgery.
Anesthesia, General ; Cardiomyopathies* ; Ear, Middle* ; Epinephrine* ; Heart Arrest ; Hemorrhage ; Humans ; Injections, Subcutaneous ; Motor Activity ; Pulmonary Edema ; Stress, Psychological

BACKGROUND AND OBJECTIVES: Tinnitus is a disease with high prevalence and a wide range of etiologies. Tinnitus has a lot of impact on the patients, causing psychological distress such as anxiety and depression. Type D personality is related to the negative emotions including to anxiety and depression. Therefore, the goal of this study was to understand the relationship between tinnitus and anxiety/depression/type D personality. SUBJECTS AND METHOD: Ninety three patients with chronic subjective tinnitus, who visited the Department of Otorhinolaryngology-Head Neck Surgery in Yeungnam University Hospital from May, 2012 to October, 2012. The tinnitus patients were asked to complete a survey: regarding demographic data, otologic history, Beck Depression Inventory (BDI), Hamilton anxiety scale (HAM-A), type D personality scale 14 (DS-14), and tinnitus handicap inventory (THI). RESULTS: The tinnitus patients had significantly higher levels of type D personality (58.1%). In the tinnitus patients, as the score of THI increased, the BDI and HAM-A scores increased. As the DS-14 score increased, the THI scores increased. CONCLUSION: These results suggest that the tinnitus patients have high prevalence of type D personality compared to that shown in the general population. And the handicap of tinnitus is related to anxiety, depression and type D personality.
Anxiety* ; Depression* ; Humans ; Neck ; Prevalence ; Tinnitus* ; Type D Personality*

BACKGROUND: Saccade test, smooth pursuit test, and optokinetic nystagmus test are clinically useful tests to accurately diagnose vertigo. However, there have only been a few studies regarding a correlation between the anatomical site of the lesion and the abnormality of eyeball movement in patients with vertigo.METHODS: The medical records of 97 patients with vertigo between January 2006 and June 2008 were reviewed retrospectively. We classified many kinds of abnormalities regarding the saccade test, smooth pursuit test and optokinetic nystagmus test into several categories and analyzed the localizing lesion of vertigo.RESULTS: According to the saccade test, both total saccade abnormality (S-total) and slow velocity of saccade (S-type 3) were shown to be significantly higher in the central lesion of vertigo. According to the smooth pursuit test, symmetrical unidirectional smooth pursuit abnormality (SP-type 2) was observed to be significantly higher in the peripheral lesion over vertigo. Moreover, according to the optokinetic nystagmus test, total optokinetic nystagmus abnormalities (OKN-total) were shown to be significantly useful findings in the diagnosis of the central lesion of vertigo. The coexisting abnormalities of all three tests (S+SP+OKN abnormalities) were shown to be significantly higher in the central lesion of vertigo.CONCLUSION: These results suggest that all these tests, saccade test, smooth pursuit test, and optokinetic nystagmus test, are very useful to distinguish between the central lesion and the peripheral lesion of vertigo. However, these tests are not beneficial in localizing the central lesion of vertigo.
Diagnosis ; Humans ; Medical Records ; Nystagmus, Optokinetic ; Pursuit, Smooth ; Retrospective Studies ; Saccades ; Vertigo

Objectives: . Obesity, which induces chronic low-grade systemic inflammation in the human body, is a known risk factor for various diseases. Recent studies have shown associations between various otorhinolaryngological diseases and obesity. In particular, inflammatory sinonasal diseases have been found to be strongly associated with obesity-related proinflammatory mediators. Many studies have been conducted to identify therapeutic agents for controlling obesity-related inflammatory airway diseases. Ghrelin, an endogenous peptide from the stomach, has anti-inflammatory and antioxidative effects in a wide range of tissues. However, the effect of ghrelin on the regulation of mucus secretion has not yet been studied in the human nasal mucosa. Therefore, we investigated the effects of ghrelin on lipopolysaccharide (LPS)/leptin-mediated MUC5AC expression and mechanisms involved in human nasal epithelial cells (HNEpCs). Methods: . In HNEpCs, the effect and signaling pathways of ghrelin on LPS/leptin-induced MUC5AC expression were examined using reverse transcription polymerase chain reaction, real-time polymerase chain reaction, enzyme immunoassays, Western blotting, and immunofluorescence staining. Results: . Growth hormone secretagogue receptor 1a (GHSR1a) was expressed in the HNEpCs. Ghrelin downregulated LPS/leptin-induced MUC5AC expression, which was abolished by D-Lys-3-growth hormone-releasing peptide 6 (D-Lys-3-GHRP-6). Ghrelin significantly inhibited LPS/leptin-activated extracellular signal-regulated kinase 1/2 (ERK1/2) and p38 mitogen-activated protein kinases (MAPKs). These ghrelin-mediated changes in MAPK activation were abolished by D-Lys-3-GHRP-6. These results showed that ghrelin inhibits LPS/leptin-induced MUC5AC overexpression by modulating the ERK1/2 and p38 MAPK pathways in HNEpCs. Conclusion . These findings suggest that ghrelin is a potential therapeutic agent for treating obesity-related inflammatory sinonasal diseases.

Background and Objectives: Nicotine is oxidized into tobacco-specific nitrosamines (TSNAs; NAB, NAT, NNN, NNAL, NNK) at high temperature and high pressure. TSNAs are associated with airway diseases characterized by mucus hypersecretion as a major pathophysiologic phenomenon. The aim of study is to investigate the effect of TSNAs on mucin overexpression and its molecular mechanism in human airway epithelial cells.Materials and Method: The cytotoxicity of TSNAs was evaluated using EX-Cytox and inverted microscopy. The mRNA and protein levels of MUC5AC and MUC5B were measured using real-time PCR and ELISA. Results: NAB, NNN, NNAL, and NNK did not affect cell viability. NAT did not affect cell viability up to a concentration of 100 μM in human airway epithelial cells. NAT, NNN, NNAL, and NNK significantly induced MUC5AC expression, but not MUC5B expression. NAB did not affect the expression of MUC5AC and MUC5B. Propranolol (a β-adrenergic receptor antagonist) inhibited NAT, NNN, NNAL, and NNK-induced MUC5AC expression, whereas α-bungarotoxin (an α7-nicotinic acetylcholine receptor antagonist) only inhibited NNN- and NNK-induced MUC5AC expression. Conclusion These results suggested that NAT, NNN, NNAL, and NNK induce MUC5AC expression through β-adrenergic receptor and/or α7-nicotinic acetylcholine receptor in human airway epithelial cells, which may be involved in mucus hypersecretion in inflammatory airway diseases.

Despite several advantages, percutaneous dilatational tracheostomy (PDT) performed by physicians who are unfamiliar with head and neck anatomy can result in malpractice and cause significant complications although laryngeal complications due to prolonged cricothyroidotomy caused by malpractice PDT have not been reported. Here we report a 64-year-old female who complained of dysphonia while receiving a fenestrated tube. The tube was mispositioned tube caused by malpractice PDT; the tube was placed at the cricothyroid membrane for four months without awareness. To correct subglottic stenosis and vocal cord edema, the patient underwent tracheostomy conversion and suspension laryngomicrosurgery. Although her voice slightly improved after the operation, she was unable to decannulate the tube and developed laryngeal web and subglottic stenosis. To reduce complications, PDT must be performed with accurate knowledge of anatomy