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

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

BACKGROUND AND OBJECTIVES: Epistaxis can be caused or exacerbated by anticoagulant and antiplatelet medication. The use of these medications has been increasing markedly in Korea over the recent years due to it becoming an aging society. This retrospective study assessed the proportion of patients taking anticoagulant and antiplatelet in epistaxis patients and monitored differences in patients' clinical courses. SUBJECTS AND METHOD: A retrospective chart review was performed for consecutive patients referred to the ENT department with epistaxis from the emergency room over a one-year period. RESULTS: One hundred eighty eight patients presented to the emergency room with epistaxis, representing 0.6% of all emergency attendances. Of these patients, 143 (76%) were referred to the ENT department: of these referred to us, 24% had been taking anticoagulant or antiplatelet medication. There were 5 taking Warfarin, 32 Aspirin, 3 Clopidogrel, and six more than one medication simultaneously. Patients that were taking these medications were older and had higher prevalent rate of hypertension. There was no difference in the bleeding site, the recurrence rate, hospitalization and duration of in-patient stay, and method of treatment between groups. CONCLUSION: Patients with epistaxis in ENT emergency taking anticoagulant and antiplatelet medication have been increasing recently, so an understanding of the action of such medication may enable health care personnels to provide more effective management of these patients.
Aging ; Aspirin ; Delivery of Health Care ; Emergencies ; Epistaxis ; Hemorrhage ; Hospitalization ; Humans ; Hypertension ; Korea ; Recurrence ; Retrospective Studies ; Ticlopidine ; Warfarin

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

BACKGROUND AND OBJECTIVES: Nitric oxide (NO) is present in high concentrations in the upper respiratory tract. The physiological role of this mediator is to contribute to the local host's defense, modulate ciliary motility and serve as an aerocrine mediator in helping to maintain adequate ventilation-perfusion matching in the lung. SUBJECTS AND METHOD: The purpose of the study was to assess the relationship of nasal NO (nNO) and exhaled NO (eNO) in nasal airway disease patients. NO concentration was measured using a chemiluminescence analyzer. nNO was analyzed by aspiration at a sampling flow rate of 700 mL/min with velum closure. eNO was analyzed during expiration against a constant resistance of 10 cm H2O. RESULTS: NO concentration of the normal control group (n=32) was compared with that of the allergic rhinitis group (n=31) and the rhinosinusitis with that of the nasal polyp group (n=30). The mean nNO level in the control group was 241+/-89 ppb and eNO was 20.5+/-6.4 ppb. The mean nNO level was significantly increased in the allergic rhinitis group (332+/-125 ppb) but decreased in the chronic sinusitis group (89+/-55 ppb). The mean eNO level was significantly increased both in the allergic rhinitis group (26.9+/-10.1 ppb) and chronic sinusitis group (29.8+/-12.8 ppb). CONCLUSION: nNO concentration was increased in patients with allergic rhinitis and decreased in patients with chronic sinusitis; however, eNO was increased in both patients. This shows that patients with upper respiratory inflammation may also have lower respiratory inflammation, supporting the concept of 'one airway, one disease'. This study shows that measurement of NO is useful for the study or evaluation of nasal diseases.
Humans ; Inflammation ; Luminescence ; Nasal Polyps ; Nitric Oxide ; Nose Diseases ; Respiratory System ; Rhinitis ; Rhinitis, Allergic, Perennial ; Sinusitis

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

A 23-year old woman was admitted to our hospital with hemoptysis. The chest X-ray showed reticulonodular opacity and multiple cysts throughout the entire lung field. The chest CT scan revealed numerous bilateral cysts with various sizes, some of them with thickened walls. An open lung wedge resection was performed. The resected specimen showed scattered small nodules, 0.3 to 0.6 cm in size. Microscopically, each nodule was composed of atypical glands with an occasional papillary architecture spreading to the alveolar septa, which were morphologically consistent with a papillary adenocarcinoma with a bronchioloalveolar carcinoma growth pattern. Immunochemically, the tumor cells were negative for the S-100 protein. The patient was diagnosed with an adenocarcinoma of the lung. A variety of diseases can produce or mimic multiple, thin-walled cysts in the lung. Lung cancer with multiple cysts is quite rare. Nevertheless, adenocarcinoma should be a diagnostic consideration. We report a case of a multiple cystic adenocarcinoma of the lung.
Adenocarcinoma ; Adenocarcinoma, Bronchiolo-Alveolar ; Adenocarcinoma, Papillary ; Female ; Hemoptysis ; Humans ; Hydrazines ; Lung ; Lung Neoplasms ; S100 Proteins ; Thorax

BACKGROUND: The utilization of botulinum toxin has rapidly expanded into various aesthetic applications. Achieving success with the aesthetic use of neurotoxins depends on several factors, including an understanding of the anatomy, the methods of dilution and the injection technique. Any guidelines representing a consensus for aesthetic treatments using botulinum toxin type A (BTA) have not been published in Korea. OBJECTIVE: We wanted to provide consensus recommendations on the treatment of facial wrinkles and benign masseter hypertrophy using BTA in Korean patients. METHODS: A panel of experienced Korean dermatologists was convened to develop a clinical consensus. The clinical consensus was comprised of the recommendations of the panel and the guidelines on general issues, such as the reconstitution and handling of the BTA, the procedural considerations, the dosing and injection-site standardizations, and the prevention and treatment of unwanted effects. Specific recommendations were provided according to the area of treatment, including glabellar lines, horizontal forehead lines, lateral periorbital wrinkles and benign masseter hypertrophy. RESULTS: The recommended final concentration of BTA was 50 units/ml (5 units/0.1 ml) after reconstitution with physiologic saline. For glabellar lines, the members recommend three injection points (a total of 8 units). For forehead wrinkles, the members recommend nine injections in two rows into the frontalis with 1 unit/point. For crow's feet, the members recommend three injections per side (7 units/side) at the lateral part of the orbicularis oculi. For benign masseter hypertrophy, three injections per side (24~30 units/side) were recommended. CONCLUSION: These consensus recommendations will provide a framework for Korean dermatologists who wish to perform safe and efficacious injection of BTA for facial rejuvenation.
Botulinum Toxins ; Botulinum Toxins, Type A ; Consensus ; Foot ; Forehead ; Handling (Psychology) ; Humans ; Hypertrophy ; Korea ; Neurotoxins ; Rejuvenation