Nitric oxide (NO) signaling has been one of the most rapidly growing areas of study in biology. We know today that NO acts as a signal molecule in the nervous system, a weapon against infection, a regulator of blood pressure, and a gatekeeper of blood flow to different organs. However, much remains to be determined about the physiological and pathophysiological role of NO in the airways. NO appears to be co-localized to cholinergic innervation and involved in vasomotor and secretomotor control of the nasal mucosa. NO is present in exhaled air and appears to originate mainly from paranasal sinus epithelium. Moreover, immunohistochemical and in situ hybridization studies identify all three known isoforms of NO synthase in nasal mucosa. Inhaled endogenous NO in the airways is suggested as playing a role in host defense, and involved in the regulation of pulmonary function as an 'aerocrine.' However, the role of NO in airway inflammation is complicated and clearly has to be determined. The physiological role of NO in the nasal mucosa and its possible pathophysiological role in rhinitis are to be discussed.
Biology ; Blood Pressure ; Epithelium ; In Situ Hybridization ; Inflammation ; Nasal Mucosa* ; Nervous System ; Nitric Oxide Synthase ; Nitric Oxide* ; Protein Isoforms ; Rhinitis*

No abstract available.
Sinusitis*

Systemic corticosteroids currently represent the most effective treatment for chronic rhinosinusitis with nasal polyps (CRSwNP), but their long-term use is constrained due to their detrimental side effects. Until recently, development of novel drugs for CRSwNP has been difficult partly due to the absence of a standard animal model of CRSwNP. Exotoxins of Staphylococcus aureus such as staphylococcal enterotoxin B (SEB), are well-known superantigens which can induce a strong immune response; there have been many studies on the association of staphylococcal enterotoxins and development of CRSwNP over the past two decades. Based on previous studies, we invented a mouse model of CRSwNP using SEB. Herein, we explain the protocol development for the mouse model, as well as identify histological and immunological similarities between this mouse model and humans. Furthermore, we describe a study that analyzed the risk factors for CRSwNP such as smoking, and also elaborate on a series of studies that searched for new potential drugs for CRSwNP, including resveratrol, anti-periostin antibody, topical hypoxia-inducible factors, and topical cyclosporine. Based on preceding studies, we have concluded that this mouse model might be a useful tool to investigate the pathophysiology and development of novel drugs for CRSwNP.
Adrenal Cortex Hormones ; Animals ; Cyclosporine ; Enterotoxins ; Exotoxins ; Humans ; Mice* ; Models, Animal ; Nasal Polyps* ; Risk Factors ; Smoke ; Smoking ; Staphylococcus aureus ; Superantigens

Allergic fungal sinusitis (AFS) is a benign, noninvasive form of fungal sinusitis. Histologically, AFS is characterized by allergic mucin, which consists of eosinophilic mucinous material with occasional laminar deposits of eosinophils. A diagnosis of AFS can be made when there is a demonstration of characteristic allergic mucin and an appearance of fungal hypae scattered within the mucin with no evidence of tissue invasion, or when fungi cultures yield positive results. Until now, no cases of AFS have been reported in Korea, though there have been many cases of mycetomas and a few cases of invasive fungal sinusitis. We present the first two cases of AFS in Korea. The patients demonstrated characteristic allergic mucin, fungal hypae scattered within the mucin, and no evidence of tissue invasion on histopathology. Nasal polyps, involvement of the unilateral sinuses, peripheral eosinophilia, an elevated total IgE, and hyperattenuated masses observed in the CT supported the diagnosis of AFS. The patients recovered and did not display recurrence after surgery and treatment with topical steroids and saline irrigation.
Diagnosis ; Eosinophilia ; Eosinophils ; Fungi ; Humans ; Immunoglobulin E ; Korea ; Mucins ; Mycetoma ; Nasal Polyps ; Recurrence ; Sinusitis* ; Steroids

BACKGROUND AND OBJECTIVES: An understanding of the cross-sectional structures and histological features of experimental animals is necessary for conducting the research of rhinosinusitis in experimental animals. The aim of this study is to determine the most suitable cross-sectional level of rhinosinusitis in a rat model. MATERIALS AND METHODS: The study examined the histological features of the mucosal epithelium, gland, lymphoid tissue, and vomeronasal organs using 4 week-old male rats weighing 60-70 g as test subjects. Whole mounted sinus-nose complexes were divided into four levels of areas which were sectioned according to the coronal plane and each section was stained with hematoxylin-eosin and observed under light microscopy. RESULTS: Level I revealed the nasal turbinate, maxilloturbinale, and nasolacrimal duct. Level II revealed the nasal turbinate, maxilloturbinale, vomeronasal organ, and nasolacrimal duct. Level III revealed the ectoturbinale I, II, endoturbinale II, III, maxillary sinus, Steno's gland, maxillary sinus gland, and nasal associated lymphoid tissue (NALT). Level IV revealed the ectoturbinale II, endoturbinale III, IV, pharyx respiratorius, and NALT. The lining epithelia were squamous, respiratory and olfactory. However, the squamous epithelium was not observed in level III and IV. CONCLUSION: The Level III appears to be the most suitable for the rhinosinusitis animal rat model since we can observe the respiratory epithelium lined sinonasal airspace including the maxillary sinus and NALT.
Animals ; Epithelium ; Humans ; Lymphoid Tissue ; Male ; Maxillary Sinus ; Microscopy ; Models, Animal ; Nasal Cavity* ; Nasolacrimal Duct ; Nose ; Paranasal Sinuses* ; Rats* ; Respiratory Mucosa ; Turbinates ; Vomeronasal Organ

Foreign bodies in the paranasal sinuses are rare, but they may become more common with an increasing number of road traffic accidents. Foreign bodies in the paranasal sinuses cause vague symptoms. They are occasionally encountered either after occurrence of complications or after radiological workup for some other reasons. They may be missed if their presence is not suspected initially. Therefore, the presence of foreign bodies should be suspected even in seemingly trivial lacerations over the paranasal sinuses in cases of maxillofacial trauma. The suspicion of foreign bodies may prevent the development of intracranial and intrasinus complications. Although a wide variety of foreign bodies have been reported in the paranasal sinuses, glass were rare in the frontal sinus. We present a case of frontal mucocele with glass in the frontal sinus which occurred as a result of road traffic accident with a brief review of the literature.
Accidents, Traffic ; Craniocerebral Trauma* ; Foreign Bodies* ; Frontal Sinus ; Glass* ; Head* ; Humans ; Lacerations ; Mucocele* ; Paranasal Sinuses

PURPOSE: The third year students at Gyeong-Sang National University College of Medicine were asked to perform objective structured clinical examination (OSCE) at the end of the 2004 academic year. In this article, we analysed the correlation among the scores of OSCE with those of Final Term Examination in Internal Medicine (FTE), Clerkship Performance in Internal Medicine (CP) and Case Conference Examination (CCE), which assess knowledge, skill and attitude, and problem solving ability in medicine, respectively. We also analyzed difficulty and discrimination indexes of the test questions or evaluation criteria, and assessed their objectivity. METHODS: 1) Relevance: the pearson correlation analysis was performed on the scores of 85 students from 6 OSCE stations, FTE, CP and CCE. 2) Analysis on the evaluation criteria: the difficulty and discrimination indexes of the 59 evaluation criteria were calculated. 3) Objectivity: in order to assess objectivity in the scores, the Student t-test was performed on the scores of students from 4 OSCE stations where there was a change in the examiners after the morning sessions and on the students from 2 OSCE stations that had no change of examiners. RESULTS: 1) Relevance: Correlation coefficients between the scores of OSCE and FTE, CP or CCE were 0.335, 0.326 and 0.421, respectively (p < 0.01). 2) Analysis on the evaluation criteria: difficulty indexes of the 59 criteria ranged from 0.15 to 0.98, and 43% of the criteria belonged to the acceptable range. Discrimination indexes ranged from -0.22 to 0.61, and 69% of the criteria were acceptable. 3) Objectivity: The student t-test showed significant differences between the scores of the morning and afternoon sessions in 2 of the 4 stations, where the examiners were changed in the afternoon (p < 0.01). CONCLUSION: Our results suggest that OSCE performed in 2004 may have relevance to a valid tool in assessing clinical competence of medical students in terms of knowledge, skill, attitude and problem solving ability. However, in order to reuse the test materials in the future, evaluation criteria need to be refined further based on difficulty and discrimination indexes, and measures to improve objectivity of examiners should also be studied.
Clinical Competence ; Discrimination (Psychology) ; Humans ; Internal Medicine ; Problem Solving ; Students, Medical

The close vicinity of the optic nerve to the sphenoid sinus may cause visual loss in the sphenoid fungus ball. We present a case of blindness secondary to sphenoid fungus ball without any evidence of orbital invasion in imaging studies. A 61-year-old man, suffering from uncomplicated diabetes, was referred for right visual loss that developed 1 day ago. He perceived hand motion on the right. CT and MRI revealed a fungus ball in the right sphenoid sinus. However, there was no evidence of orbital invasion. Endoscopic sphenoethmoidectomy was performed to remove the fungus ball. Systemic mega-dose steroid and amphotericin B were started because he lost the light perception 3 days after surgery. Biopsy revealed aspergillus fungus ball and no evidence of mucosal invasion. However, blindness was not reversed. Evidence of orbital invasion in imaging diagnosis is elusive in sphenoid fungus ball; therefore, systemic antifungal treatment should be initiated and early endoscopic sphenoidotomy should be performed in case of rapidly progressing visual loss, especially in diabetic or immunocompromised patients. Mega-dose steroid therapy for optic neuropathy should be selective because it may aggravate underlying systemic diseases to cause early termination of systemic antifungal treatment.
Amphotericin B ; Aspergillus ; Biopsy ; Blindness ; Fungi ; Hand ; Humans ; Immunocompromised Host ; Light ; Middle Aged ; Optic Nerve ; Optic Nerve Diseases ; Orbit ; Sphenoid Sinus ; Stress, Psychological

The expanded endonasal approach (EEA) to the ventral skull base provides endoscopic access from the frontal sinus to the second cervical vertebra. Potential advantages of the EEA include not only improved cosmesis but more importantly, the potential for reduced neurovascular manipulation. EEA is based on the principle of extracapsular dissection with full visualization of important neurovascular structures. There are significant risks of neural and vascular injury associated with EEA, and the reconstruction of dural defects is challenging. Experienced teams including rhinologists and neurosurgeons are needed for successful implementation of EEA. The surgical team must have adequate endoscopic skills to achieve hemostasis and address vascular emergencies. Advantages of having a skilled second surgeon to provide endoscopic visualization include dynamic adjustments of the endoscope to ensure the best view and avoid contact interference of instruments, second surgical opinions in complex anatomical areas, and maintenance of endoscopic views in cases of crisis such as vascular injury. Complications of the EEA such as neurovascular injury, cerebrospinal fluid leaks and infection are the same as those of open approaches. With the advent of the nasoseptal flap, problematic cases involving huge bony defects subsequent to the resection of skull base tumors have been greatly resolved.
Dietary Sucrose ; Emergencies ; Endoscopes ; Frontal Sinus ; Hemostasis ; Reconstructive Surgical Procedures ; Sella Turcica ; Skull Base ; Spine ; Surgical Flaps ; Vascular System Injuries

The korean society of otolaryngology has had and experience on intraining examination since 1992. We also had the fortieth annual board examination for specialist in 1997. But we have no evidence on the validity of these tests yet. The aim of this study is to examine the validity of the intraining examinations as a tool of formative evaluation, to present a personal progress index demonstrating constructive validity, and to examine the validity of the board examination as a tool of summative evaluation. We did statistic analysis on the consecutive personal scores of 1995 and 1996 intraining examinations, and 1997 written and oral board examinations. Analysis of the averages, standard deviations, distribution curves, and Wilcoxon singed rank test on the scores of 1995 and 1996 intraining examinations demonstrated the constructive validity. Chi-square test revealed that those who had low scores in intraining examinations of two consecutive years had low scores in 1997 board examinations and personal progress index demonstrated the predictive validity. Correlation and linear regression analysis demonstrated a strong correlation between 1997 written and oral board examination. Analysis of the averages, standard deviations, distribution curves, and Spearman rank correlation coefficient revealed that 1997 written board examination had higher concurrent validity than the that of oral examination.
Diagnosis, Oral ; Humans ; Linear Models ; Otolaryngology* ; Specialization