PURPOSE: It remains unknown whether local inhibition of Nuclear factor-kappa B (NF-κB) could have therapeutic value in the treatment of allergic rhinitis (AR). This study aimed to evaluate the effect of selective NF-κB inhibition using NF-κB decoy oligodeoxynucleotides (ODNs) for the local treatment of AR in ovalbumin (OVA)-sensitized wild-type mice. METHODS: BALB/c mice were sensitized with OVA and alum, and then challenged intranasally with OVA. NF-κB decoy ODNs were given intranasally to the treatment group, and NF-κB scrambled ODNs were given to the sham treatment group. Allergic symptom scores, eosinophil infiltration, cytokine levels in the nasal mucosa, nasal lavage fluid, and spleen cell culture, serum total and OVA-specific immunoglobulins, as well as intercellular adhesion molecure-1 (ICAM-1) in the nasal mucosa, were analyzed. RESULTS: NF-κB decoy ODNs significantly reduced allergic symptoms and eosinophil infiltration in the nasal mucosa. They also suppressed serum levels of total IgE, OVA-specific IgE, and IgG1. IL-5 and TNF-α levels and the expression of ICAM-1 were decreased in the nasal mucosa of the treatment group compared to the positive control and sham treatment groups. In addition, IL-6 levels were significantly decreased in the nasal lavage fluid of the treatment group. Furthermore, NF-κB decoy ODNs significantly reduced expression of the systemic Th2 cytokines, IL-4 and IL-5 in spleen cell culture. CONCLUSIONS: This study demonstrates for the first time that local NF-κB inhibition using NF-κB decoy ODNs suppressed the allergic response in a murine AR model. This shows the therapeutic potential of local NF-κB inhibition in the control of AR.
Animals ; Anti-Allergic Agents ; Cell Culture Techniques ; Cytokines ; Eosinophils ; Immunoglobulin E ; Immunoglobulin G ; Immunoglobulins ; Intercellular Adhesion Molecule-1 ; Interleukin-4 ; Interleukin-5 ; Interleukin-6 ; Mice ; Nasal Lavage Fluid ; Nasal Mucosa ; NF-kappa B ; Oligodeoxyribonucleotides* ; Ovalbumin ; Ovum ; Placebos ; Rhinitis, Allergic* ; Spleen

Objectives: . This study was conducted to determine whether patients with allergic rhinitis might be more susceptible to human rhinovirus (HRV) infection and whether the effects of infection on the elicited immune responses are different in allergic and non-allergic patients with chronic rhinosinusitis (CRS). Methods: . Uncinate process tissues were obtained from 61 CRS patients (of whom 39 had allergies and 22 did not) and were infected with HRV-16 using an air-liquid interface organ culture system. The expression levels of programmed cell death-ligand (PD-L)1, PD-L2, intracellular adhesion molecule 1, interferon-gamma (IFN-γ), interleukin (IL)-4, IL-5, and IL-10 were evaluated in the infected nasal mucosa. Results: . The HRV infection rates were not significantly different between the allergy (74.4%) and non-allergy (72.7%) groups. In the allergy group, the expression of PD-L1 (P=0.013) and IL-10 (P=0.040) was significantly elevated in the HRV-infected tissues, and there was a strong correlation between PD-L1 and IL-10 (r=0.868, P<0.001). In contrast, infected tissues from the non-allergy group displayed increased levels of IL-4 (P=0.039), IL-5 (P=0.023), and IFN-γ (P=0.031), as well as an increased IL-4/IFN-γ ratio, after HRV infection (P=0.043). Conclusion . This study showed that HRV infection rates were similar in the nasal mucosa of patients with CRS regardless of the presence of allergic rhinitis. HRV infection enhanced the Th2 environment by modulating PD-L1 and PD-L2 expression levels in allergic mucosa and by increasing the IL-4/IFN-γ ratio in non-allergic mucosa.

Objectives: . This study was conducted to determine whether patients with allergic rhinitis might be more susceptible to human rhinovirus (HRV) infection and whether the effects of infection on the elicited immune responses are different in allergic and non-allergic patients with chronic rhinosinusitis (CRS). Methods: . Uncinate process tissues were obtained from 61 CRS patients (of whom 39 had allergies and 22 did not) and were infected with HRV-16 using an air-liquid interface organ culture system. The expression levels of programmed cell death-ligand (PD-L)1, PD-L2, intracellular adhesion molecule 1, interferon-gamma (IFN-γ), interleukin (IL)-4, IL-5, and IL-10 were evaluated in the infected nasal mucosa. Results: . The HRV infection rates were not significantly different between the allergy (74.4%) and non-allergy (72.7%) groups. In the allergy group, the expression of PD-L1 (P=0.013) and IL-10 (P=0.040) was significantly elevated in the HRV-infected tissues, and there was a strong correlation between PD-L1 and IL-10 (r=0.868, P<0.001). In contrast, infected tissues from the non-allergy group displayed increased levels of IL-4 (P=0.039), IL-5 (P=0.023), and IFN-γ (P=0.031), as well as an increased IL-4/IFN-γ ratio, after HRV infection (P=0.043). Conclusion . This study showed that HRV infection rates were similar in the nasal mucosa of patients with CRS regardless of the presence of allergic rhinitis. HRV infection enhanced the Th2 environment by modulating PD-L1 and PD-L2 expression levels in allergic mucosa and by increasing the IL-4/IFN-γ ratio in non-allergic mucosa.

Extracranial carotid artery aneurysm is an uncommon disease that otorhinolaryngologists may encounter only rarely. It usually presents as pulsatile neck mass or as other neurologic symptoms. We report a case of extracranial internal carotid artery aneurysm in an 81-year old female who presented with a fever and nonpulsatile oropharyngeal swelling mimicking a peritonsillar abscess. Incision and drainage of the swelling lesion could have resulted in catastrophic events such as aneurismal rupture or a stroke. We thus recommend radiologic evaluations of peritonsillar abscess before performing any procedure, even if it is clinically highly suspicious.

Mucormycosis is a rare invasive and highly aggressive fungal infection, which shows rapid progression with life threatening complications in immunocompromised patients. Therefore, it is important to quickly recognize fungal infection in immunocompromised patients and start treatment with antifungal agents or perform surgical debridement. Most nasal septal abscesses are caused by post-traumatic hematoma and subsequent bacterial infection. In immunocompromised patients, nasal septal abscess can develop without trauma and may involve atypical pathogens like fungus. Herein we report a case of mucormycosis presenting with abscesses of nasal septum and gingivobuccal mucosa in an immunocompromised patient.
Abscess ; Antifungal Agents ; Bacterial Infections ; Debridement ; Fungi ; Hematoma ; Immunocompromised Host ; Mouth ; Mucormycosis ; Mucous Membrane ; Nasal Septum

Although inverted papilloma (IP) of the nose and paranasal sinus is a benign neoplasm, it is associated with frequent recurrence and malignant transformation. Various surgical techniques have been employed for resection of this tumor. Transnasal endoscopic medial maxillectomy (TEMM) is an effective surgical management of IP originating from the maxillary sinus. It usually removes the inferior turbinate, lateral wall of the nasal cavity, and nasolacrimal duct, and may cause adverse effects such as atrophic rhinitis, empty nose syndrome, impairment of nasal physiological function, and epiphora. Recently, however, a modified TEMM, which preserves the inferior turbinate, lateral wall of the nasal cavity, and nasolacrimal duct has been introduced. We present two cases of IP successfully treated by the modified TEMM.
Endoscopy ; Lacrimal Apparatus Diseases ; Maxillary Sinus* ; Nasal Cavity ; Nasolacrimal Duct ; Nose ; Papilloma, Inverted* ; Recurrence ; Rhinitis, Atrophic ; Turbinates

Mucormycosis is a rare invasive and highly aggressive fungal infection, which shows rapid progression with life threatening complications in immunocompromised patients. Therefore, it is important to quickly recognize fungal infection in immunocompromised patients and start treatment with antifungal agents or perform surgical debridement. Most nasal septal abscesses are caused by post-traumatic hematoma and subsequent bacterial infection. In immunocompromised patients, nasal septal abscess can develop without trauma and may involve atypical pathogens like fungus. Herein we report a case of mucormycosis presenting with abscesses of nasal septum and gingivobuccal mucosa in an immunocompromised patient.

BACKGROUND/AIMS: While surgical resection remains the standard of care in the treatment of upper urinary tract malignancies, nephrectomy is a risk factor for the development of chronic kidney disease (CKD). The aim of this study was to determine whether histologic evaluation of non-neoplastic kidney could enable early identification of unrecognized kidney disease and could be of prognostic value in predicting postoperative renal outcomes. METHODS: We retrospectively analyzed 51 patients with upper urinary tract malignancies who received uninephrectomy or uninephroureterectomy. A thorough pathologic evaluation of non-neoplastic kidney including special stains, immunofluorescence, and electron microscopic studies was performed. The degree of parenchymal changes was graded from 0 to 15. RESULTS: Of 51 patients, only 13 showed normal kidney pathology. Fifteen patients showed glomerular abnormalities, 14 showed diabetic nephropathy, and 11 showed vascular nephropathy. There was one case each of reflux nephropathy and chronic pyelonephritis. The median histologic score was 5 points. Only 25.4% of patients had ≤ 3 points. Score more than 5 was observed in 47.1% of patients. Postoperative estimated glomerular filtration rate (eGFR) at 3 to 36 months were obtained from 90.2% of patients, and of those, 34.8% had de novo CKD. Since no one had CKD in partial nephrectomized patients, we determined risk factors for CKD in radical nephrectomized patients. Cox regression analysis revealed that postoperative AKI, preoperative eGFR, and histologic score of non-neoplastic kidney were the independent predictors for CKD. CONCLUSIONS: We conclude that routine pathologic evaluation of non-neoplastic kidney provides valuable diagnostic and prognostic information.
Coloring Agents ; Diabetic Nephropathies ; Fluorescent Antibody Technique ; Glomerular Filtration Rate ; Humans ; Kidney Diseases ; Kidney Neoplasms ; Kidney* ; Nephrectomy ; Pathology ; Pyelonephritis ; Renal Insufficiency, Chronic ; Retrospective Studies ; Risk Factors ; Standard of Care ; Urinary Tract*

BACKGROUND AND OBJECTIVES: Headache secondary to sinonasal disease can improve after surgery, but few prospective studies have investigated this outcome. We aimed to evaluate the characteristics of headaches, such as clinical features, underlying disease, and postoperative improvement in patients who underwent nasal surgery, and to identify the characteristics that reliably predict rhinogenic headache. MATERIALS AND METHOD: Of 356 patients who underwent nasal surgery between March and December 2009, 41 patients with headaches were enrolled in this prospective study. Clinical features of headache, such as onset, time of day, duration, frequency, nature, side and location, existence of aura, aggravating and relieving factors and accompanying nasal symptoms, underlying diseases, endoscopic findings, and computed tomography scans of the paranasal sinuses were evaluated. Headache intensity was graded based on a 10-point visual analog scale (VAS) pre- and post-operatively. RESULTS: The most common characteristics of rhinogenic headache included a stabbing or squeezing nature, frontal area location, accompanying nasal obstruction or rhinorrhea, and underlying sinusitis or septal deviation. The subjective intensity of the headache, measured using the VAS score, improved in 80% (33/41) of the patients after surgery. CONCLUSION: Nasal surgery should be considered when rhinogenic headache is suspected and there are definite nasal pathologies.
Epilepsy ; Headache* ; Humans ; Nasal Obstruction ; Nasal Surgical Procedures ; Nose Diseases ; Pain, Postoperative ; Paranasal Sinuses ; Pathology ; Prospective Studies* ; Sinusitis ; Visual Analog Scale

BACKGROUND AND OBJECTIVES: The aims of the study were to reintroduce a surgical technique for a "mini" Caldwell-Luc operation and to determine its efficacy. MATERIALS AND METHODS: A prospective study was performed in 23 patients undergoing the "mini" Caldwell-Luc operation. Improvements in clinical symptoms and endoscopic and computed tomographic (CT) findings were evaluated postoperatively over a follow-up period ranging from 6 to 21 months. All patients were surveyed for nasal symptoms (nasal obstruction, rhinorrhea, posterior nasal drip, headache, and anosmia), complications (tooth or gum pain, numbness, persistent facial pain, and facial hypo-paresthesia), and recurrence. Preoperative nasal polyps were classified by the Gaskins method, and preoperative paranasal sinusitis was graded according to the Kennedy CT staging system. RESULTS: Symptom scores were all significantly reduced postoperatively (paired t-test, p<0.05). There were no major complications specific to this technique. Among 29 maxillary sinuses that received the "mini" Caldwell-Luc operation, seven showed recurrence (24%). CONCLUSION: The "mini" Caldwell-Luc operation provides an alternative method of obtaining access to the maxillary antrum and is associated with minimal morbidity.
Facial Pain ; Follow-Up Studies ; Gingiva ; Headache ; Humans ; Hypesthesia ; Maxillary Sinus ; Nasal Polyps ; Prospective Studies ; Recurrence ; Sinusitis