BACKGROUND: Among the various mechanisms of Myocardial reperfusion injuries, neutrophil is thought to be one of them. Endogenous coronary vasodilator adenosine is known to have myocardial protective effect through variable pharmacologic action, influencing the function of several cell types involved in the pathogenesis of myocardial reperfusion injury. This study was designed to determine the beneficial effect of adenosine on the left ventricular function during reperfusion and whether this effect is due to the adenosine on the role of neutrophil. METHODS: 27 open-chest cats were randomly divided into 3 groups. 6 cats received ischemic injury without reperfusion(group 1). 21 cats were subjected to 60 minutes of proximal left anterior descending coronary artery occlusion followed by a 60-minute reperfusion. 11 of 21 cats received intravenous adenosine(0.15mg/Kg/min) infusion starting 5 minutes before reperfusion throughout the entire period(group 3). 10 cats received equal volume of saline instead of adenosine(group 2). RESULTS: 1) During the experimental period, significant decrease of heart rate, blood pressure, RPI, negative dP/dT and increase of LVEDP were noted in group 2 and 3 with no difference between the two groups. The reduction of positve dP/dT was more significant in group 2 at 30 and 60 minute of reperfusion than the preocclusion value(1404+/-111, 1631+/-161 vs 1832+/-169mmHg/sec at baseline, p<0.05). In contrast, positive dP/dT in group 3 at 30 and 60 minute of reperfusion were similar to baseline values(1890+/-92, 2052+/-112 vs 2025+/-227mmHg/sec at baseline, p=NS). These were significantly higher(p<0.05) than untreated group 2. 2) Infarct size was significantly reduced in adenosine-treated group 3, when expressed as a percentage of the area at risk(28.4+/-3.3% vs 44.5+/-3.2% of group 2, p<0.05). The significant increase in myeloperoxidase activity observed after reperfusion was not detected in adenosine treated group 3.(0.18+/-0.05 vs 0.46+/-0.09 unit/100mg wet tissue weight, p<0.05). A significant correlation was present between infarct size (% of left ventricle) and myeloperoxidase activity(r=0.72, p<0.01). 3) Light microscopic examination demonstrated the decreased acute interstitial and intra vascular inflammatory infiltration and capillary plugging together with decreased tendency of incidence of contraction band necrosis in adenosine treated group 3. CONCLUSION: These findings suggest that intravenous administration of adenosine during the early reperfusion period significantly reduces infarct size, improving the early recovery of global ventricular function. The probable cause is the effect of adenosine on neutrophil as one of the various protective mechanisms of adenosine in feline heart model subjected to coronary occlusion and reperfusion, 60 minutes each.
Adenosine* ; Administration, Intravenous ; Animals ; Blood Pressure ; Capillaries ; Cats ; Coronary Occlusion ; Coronary Vessels ; Heart Rate ; Heart* ; Incidence ; Myocardial Reperfusion Injury* ; Myocardial Reperfusion* ; Necrosis ; Neutrophils ; Peroxidase ; Reperfusion ; Reperfusion Injury ; Ventricular Function ; Ventricular Function, Left

Epiphora is usually caused by nasolacrimal duct obstruction. The nasolacrimal duct obstruction is related with facial trauma, other nasal or paranasal sinus diseases, or recurrent dacryocystitis. We describe a case of iatrogenic nasolacrimal duct obstruction that occurred secondary to midfacial autologous fat injection. In our case, mal positioned fat tissue was detected on the dacryocystogram to be present in the lacrimal sac and the nasolacrimal duct. They were safely removed during dacryocystorhinostomy.
Dacryocystitis ; Dacryocystorhinostomy ; Lacrimal Apparatus Diseases ; Nasolacrimal Duct ; Paranasal Sinus Diseases

During temporomandibular joint (TMJ) formation, discomalleolar ligament (DML) and anterior malleolar ligament (AML) are formed within the dorsal end of the 1st branchial arch. But, DML is known as a remnant or the degenerated tissue through the TMJ development. There is few reports said that damage of AML and DML cause the damage of middle ear during surgical procedures. Especially, in case of anterior disk displacement of TMJ, aural symptom can be made via DML due to hyperextension anteriorly. A few studies have been reported about DML and AML in embryological and histological points of view, morphology and clinical aspects of DML and AML are still unclear. Four fetuses and sixteen adult hemi -sectioned heads were dissected to clarify the topographical relationship of AML and DML and to find out the anatomico -clinical relevance related with temporomandibular disorder. In fetal specimens, DML was firmly attached from the disk of the TMJ to the malleus. Also, AML in which distinguished into the superior and inferior lamellae was running anteriorly and continuous with the sphenomandibular ligament (SML) through the future petrotympanic fissure (PTF). DML attached to the malleus was observed in all adult specimens and was expanded broadly to the disk and capsule of the TMJ as shown the V -shaped ligament structures. The average distance between the anterior aspects of the malleolar head to the anterior wall of the tympanic cavity was 1.13 mm(0.75 ~1.59), and the length of the DML from the anterior aspect of the malleolar head to the attached site to the TMJ capsule at the PTF was 5.37 mm (4.53 ~6.07). The average width of the DML at the PTF was 6.06 mm (4.72 ~7.46). Most of the posterior attachments of the DML were the cases in which DML was directly attached to the malleus (68.7%). In all specimens, DML was attached to the disk and capsule of TMJ and attached to the anteromedial border of the PTF concurrently. In this study, two morphological patterns of AML were observed according to the presence of the bony ridge on the Huguiers canal in the PTF. The bony ridge of the Huguiers canal showed DML and AML separately in 56.3%, and the fused pattern of DML and AML was observed in 43.7%. AML was not distinguished with two lamellae in most specimens, superior ligament fibers were attached to the anteromedial border of the PTF and most of the inferior lamella was entering the gap in PTF and continuous with the SML. Average length from the anterior aspect of the malleolar head to the exit point of the AML on the PTF was 8.40 mm(6.62 ~11.42), and the shortest distance between the AML and chorda tympani was 2.01 mm(1.25 ~3.02). Taken all together, DML and AML were not the rudimentary, but the distinguishable structures in adults. Through the various morphological findings, DML and AML were separated ligamentous structures in which might be given rise from the divergent origin. And the anterior hyperextension of the disk of TMJ did not lead the movement of the malleus in the tympanic cavity, whereas, the movement of the malleus followed by the traction of the AML and SML was observed in a few cases. So, this results can be explained the possibility of the clinical symptom on the middle ear in case of the over -traction of the AML and SML.
Adult* ; Branchial Region ; Chorda Tympani Nerve ; Ear, Middle ; Fetus* ; Head ; Humans* ; Ligaments* ; Malleus ; Running ; Temporomandibular Joint ; Temporomandibular Joint Disorders ; Traction

BACKGROUND: This study was conducted to compare the accuracy of computered tomography(CT) and sonography(US) in diagnosing acute appendicitis and to analyze the radiologic factors which influence the result. METHODS: We retrospectively studied the cases of 53 patients who were suspected of having appendicitis and who were examined by CT and US covered a three-year period. The final diagnosis was determined from the surgico-pathologic diagnosis and clinical follow-up for two months, as well as from the discharge diagnosis. RESULTS: Thirty-eight(38) patients had acute appendicitis; 15 patients did not. In the analysis, CT and US, respectively, revealed sensitivities of 89.5% and 73.7%, specificities of 93.3% and 60.0%, positive predictive values of 97.1% and 82.4%, negative predictive values of 77.8% and 47.4%. Among patients diagnosed with acute appendicitis, 10 patients were discordant in the US and the CT examinations; CT findings were correct in 8 and US findings in 2. Among non-appendicitis patients, 5 patients were discordant in the US and the CT examinations; CT was correct in 5 and US in 0. Nighteen(19) patients had complications such as an abscess or a perforation. Among these patients, the degree and the extent of the complication were accurately evaluated by CT in 15 patients and by US in 5 patients. CONCLUSION: CT is more accurate than US in diagnosing and excluding acute appendicitis. The use of CT will substantially decrease unnecessary laparotomies and post-operation complications.
Abscess ; Appendicitis* ; Diagnosis ; Follow-Up Studies ; Humans ; Laparotomy ; Retrospective Studies

The toxic effect of azalea extract, especially on cardiovascular system, in relatively unclear. The purpose of this study is to study the possible underlying mechanism and effect of toxic ingredient of azalea on cardiovascular system. The 71 healthy rabbits were divided into 10 groups: In group as preliminary study; 4 cc of normal saline was administered intravenously (N); 0.7 gm/kg and 1.0 gm/kg of azalea extract was administered respectively in the same route, volume (A1, A2); atropine was administered intravenously (A); after pretreatment with atropine (0.04 mg/kg) to block parasympathetic system, azalea extract was injected like the above groups (AA1, AA2); normal saline, 0.7 gm/kg and 1.0 gm/kg of azalea extract were administered respectively with 0.2 cc (1:1000) epinephrine (E0, E1, E2). We measured the following indices at I minute interval during first 10 minutes and then 10 minute interval during next 30 minutes: RR interval, QTc interval, maximal systolic and diastolic pressure drop with occurring time and presence of significant arrhythmia. The results were as follows: 1. The changes of RR interval, QTc interval were significantly increased in groups by Azalea extract. The blood pressure change was significantly decreased in groups by Azalea extract. There were no significant differences according to dosage of Azalea extract. 2. The changes of RR interval, blood pressure were significant differences between administration of atropine and Azalea extract after pretreatment with atropine, but not in the change of QTc interval. 3. There were no significant differences in the change of RR interval, ATc interval, blood pressure drop according to pretreatment with atropine. 4. The interaction between epinephrine and Azalea extract was not noted by the effect of epinephrine itself. 5. The ST change by 0.7 gm/kg, 1.0 gm/kg of Azalea extract was revealed in 1 case (14.0%), 7 case (100%), respectively. 6. Most of all cases with arrhythmia, ventricular tachycardia, ventricular fibrillation, were noted in the group by epinephrine, except on case by Azalea extract (1.0 gm/kg). It was idioventricular rhythm. In conclusion, azalea extract has negative inotropic and chronotropic effect with arrhythmogenic potential possibly through direct myocardial ischemia or injury but we can't be absolutely exclusive of actions of autonomic nervous system, especially parasympathetic nervous system.
Arrhythmias, Cardiac ; Atropine ; Autonomic Nervous System ; Blood Pressure ; Cardiovascular System* ; Epinephrine ; Myocardial Ischemia ; Parasympathetic Nervous System ; Rabbits ; Tachycardia, Ventricular ; Ventricular Fibrillation

OBJECTIVES: Insertion of a silicone stent during endoscopic dacryocystorhinostomy (DCR) is the most common procedure to prevent rhinostomy closure. It has been claimed that silicone intubation improves the surgical outcomes of endoscopic DCR. However, many reports have documented an equally high success rate for surgery without silicone intubation. Accordingly, we conducted a systematic review and meta-analysis to clarify the outcomes of endoscopic DCR with and without silicone intubation and determine whether silicone intubation is actually beneficial for patients. METHODS: PubMed, Embase, and Cochrane Library databases were searched to identify relevant controlled trials evaluating endoscopic DCR with and without silicone intubation. The search was restricted to English articles published between January 2007 and December 2016. Relevant articles were reviewed to obtain information pertaining to interventions and outcomes. We also performed a meta-analysis of the relevant literature. RESULTS: In total, 1,216 patients included in 12 randomized controlled trials were pooled. A total of 1,239 endoscopic DCR procedures were performed, and silicone stents were used in 533 procedures. The overall success rate for endoscopic DCR was 91.9% (1,139/1,239), while the success rates with and without silicone intubation were 92.9% (495/533) and 91.2% (644/706), respectively. There was no statistically significant heterogeneity among the included studies. A meta-analysis using a fixed-effects models showed no significant difference in the success rate between endoscopic DCR with silicone intubation and that without silicone intubation (OR, 1.38; 95% CI, 0.89 to 2.12; P=0.148; z=1.45). Furthermore, there were no significant differences with regard to surgical complications such as synechia, granulation, and postoperative bleeding. CONCLUSION: The findings of our meta-analysis suggest that the success rate and postoperative complication rate for endoscopic DCR is not influenced by the use of silicone intubation during the procedure.
Dacryocystorhinostomy* ; Endoscopy ; Hemorrhage ; Humans ; Intubation* ; Population Characteristics ; Postoperative Complications ; Silicon* ; Silicones* ; Stents

BACKGROUND AND OBJECTIVES: Mucosal malignant melanoma of the nasal cavity and paranasal sinuses is an uncommon tumor with poorer prognosis compared with its cutaneous counterpart. The purpose of this study is to investigate the clinical features and treatment outcomes of mucosal malignant melanoma of the nasal cavity and paranasal sinuses. SUBJECTS AND METHOD: Eighteen patients who were diagnosed and treated as mucosal malignant melanoma of nasal cavity and paranasal sinuses from 1995 to 2004 were included. Male to female ratio was 10 to 8. Their ages ranged from 43 to 87 years with median of 62 years. The medical records were reviewed retrospectively with respect to presenting symptoms, stage, treatment modalities and outcome. RESULT: The most common symptoms were epistaxis and nasal obstruction. The mean duration of symptom was 4.2 months. Commonly involved sites were middle turbinate, inferior turbinate, maxillary sinus and ethmoid sinus. Eight cases belonged to stage I, nine cases to stage II and only one case to stage III. Among them, seventeen patients underwent surgery with or without radiotherapy and immunotherapy. Of the seventeen patients who underwent surgery, twelve had recurrence and the mean period for recurrence was 8.2 months. During the follow-up periods, five had distant metastases. Five-year survival rate was 27.2% and the survival rates according to age, sex, tumor size and stage were not statistically significant. CONCLUSION: Mucosal malignant melanomas of the nasal cavity and paranasal sinuses developed commonly in the 6th to 8th decades. Epistaxis and nasal obstruction were the most common presenting symptoms. Almost all cases belonged to the stage I or II and the mainstay of the treatment was surgery. However, it was associated with frequent recurrences and a poor prognosis.
Epistaxis ; Ethmoid Sinus ; Female ; Follow-Up Studies ; Humans ; Immunotherapy ; Male ; Maxillary Sinus ; Medical Records ; Melanoma* ; Nasal Cavity* ; Nasal Obstruction ; Neoplasm Metastasis ; Paranasal Sinuses* ; Prognosis ; Radiotherapy ; Recurrence ; Retrospective Studies ; Survival Rate ; Turbinates

BACKGROUND AND OBJECTIVES: Many surgical techniques are used for the treatment of nasopharyngeal angiofibroma (NAF). This study aimed to analyze the clinical features of NAF and treatment results according to the surgical modalities. MATERIALS AND METHODS: Twenty-five patients with NAF treated at Seoul National University Hospital from January 1990 through December 2004, were analyzed retrospectively by treatment modalities. RESULTS: According to the Sesson staging system, there were 9 patients with type I, 14 with type II, and 2 with type III. Of the 24 patients treated with surgery, there were 7 cases with pure endoscopic surgery and 17 cases with external approaches including 3 transpalatal approach, 5 midfacial degloving approach, 7 transantral approach, and 2 Le Fort I approach. Endoscope-assisted surgery was performed in 6 out of 17 cases who were treated with external approaches. Until 1996, external approaches were conducted in 12 out of 13 cases. Since 1997, pure endoscopic surgery was the most common approach, with 7 out of 12 cases, and it was applied especially in cases below stage IIA. Endoscopeassisted surgery was adjunct to all external techniques since 1997, with 5 out of 5 cases, and it was even applied in advanced cases over stage IIB . All 25 cases were treated successfully without any recurrence or mortality with surgery or radiation therapy. CONCLUSION: Treatment outcomes of pure endoscopic surgery are acceptable compared to those of traditional external approaches with reduced invasiveness and morbidity if proper selection is made depending on the tumor extent. Endoscope-assisted surgery can be helpful in all external approaches to improve visualization, even in advanced lesions.
Angiofibroma* ; Endoscopes ; Humans ; Mortality ; Recurrence ; Retrospective Studies ; Seoul

BACKGROUND AND OBJECTIVES: Allergic rhinitis (AR) is commonly sub-classified into seasonal and perennial rhinitis. The recent "Allergic Rhinitis and its impact on Asthma (ARIA) Workshop" proposed to replace these terms by intermittent vs persistent AR. But the validity of this new classification is still largely unknown. SUBJECTS AND METHOD: Three hundred-eleven allergic rhinitis patients were included in this study. Patients were categorized into seasonal allergic rhinitis (SAR) and perennial allergic rhinitis (PAR) groups, according to sensitized allergens. Twenty-eight items questionnaire filled out by patients were designed for this study. Based on the questionnaire, patients were classified into either intermittent or persistent AR. Patients' information and associated factors were analysed between the groups. RESULTS: Within the population with AR, 58% of the subjects had persistent AR. About 41% of the patients were classified as moderate-severe persistent AR. There was no association between the intermittent/persistent and the SAR/PAR classifications. Subjects with persistent AR had more severe symptoms, higher rate of self-awareness and had been previously diagnosed with AR. There were no significant difference in sensitization to allergens. However, grass, tree, house dust mite allergy is more common in persistent AR than in intermittent AR. More patients in "Blockers" and "Mixed" groups had persistent AR. CONCLUSION: A statistical comparison of the two classifications showed that they cannot be used interchangeably, as they do not represent the same stratum of disease. There is also an evidence that the persistent type describes a distinct group with characteristics that differentiates them from intermittent AR. These results support the validity of the new ARIA classification as shown in other studies.
Allergens ; Asthma ; Classification* ; Humans ; Hypersensitivity ; Poaceae ; Prevalence* ; Pyroglyphidae ; Surveys and Questionnaires ; Rhinitis* ; Rhinitis, Allergic, Seasonal ; Seasons

BACKGROUND AND OBJECTIVES: Fibrous dysplasia of the paranasal sinus is rare. It is usually secondary to the extension of disease from adjacent bones and rarely limited to the sinuses. The purpose of this study is to get an improved appreciation of the clinical features and courses of fibrous dysplasia involving paranasal sinuses. SUBJECTS AND METHOD: Medical records of 15 patients diagnosed as fibrous dysplasia involving paranasal sinuses from 1990 to 2004 were reviewed retrospectively. Clinical informations including age of diagnosis, presenting symptoms, radiographic findings, treatment and clinical outcome for each patient were analyzed. The male to female ratio was 7 : 8. Their ages ranged from 7 to 68 with the median of 32. Seven patients were younger than 30 years old at presentation. RESULTS: The most common complaint was headache followed by facial swelling. The mean duration of illness was 11 months. In the findings of CT, eight patients belonged to the sclerotic type, six to the pagetoid type, and one the tocystic type. Eight patients were polyostotic while the others were monostotic. The most commonly involved sinus was the sphenoid sinus followed by ethmoid sinus. Seven patients who had facial swelling, exophthalmos or nasal obstruction underwent surgery, and in four of them, the lesion was in progression or recurred. Lesions in eight patients who were older than 30 years old and had no symptoms except headache did not progress thereafter. CONCLUSION: The progression of fibrous dysplasia stops when the bony growth is completed. Thus, if the patients are diagnosed with fibrous dysplasia over the age of 30 and do not have specific symptoms, there may be no need for surgical treatment.
Adult ; Diagnosis ; Ethmoid Sinus ; Exophthalmos ; Female ; Headache ; Humans ; Male ; Medical Records ; Nasal Obstruction ; Paranasal Sinuses* ; Retrospective Studies ; Sphenoid Sinus