Unilateral Pulmonary Edema after Minimally Invasive Cardiac Surgery: A Case Report.

Unilateral pulmonary edema after minimally invasive cardiac surgery is a rare, but potentially life-threatening condition. However, the exact causes of unilateral pulmonary edema remain unclear. We experienced aggressive unilateral pulmonary edema followed by redo-resection of recurrent left atrial myxoma through a right mini-thoracotomy. Intraoperative veno-venous extracorporeal membrane oxygenation was applied after the termination of cardiopulmonary bypass, and separate mechanical ventilation using a double-lumen endotracheal tube was applied after surgery. The patient was successfully treated and discharged uneventfully.

Multiple Cavernous Hemangiomas of the Posterior Mediastinum, Lung, and Liver: A Case Report.

A 71-year-old male patient visited Yeungnam University Hospital with abnormal chest computed tomography (CT) findings. Chest CT revealed multiple lung nodules and a posterior mediastinal tumor, the diagnosis of which was confirmed surgically. Magnetic resonance imaging (MRI) of the abdomen showed multiple small nodules, which were diagnosed as cavernous hemangioma in the liver based on the pathology results of the mediastinal and lung masses in combination with MRI findings. Cavernous hemangiomas are benign tumors that can occur throughout the body, mainly in the skin and subcutaneous tissue. The liver is the most common internal organ containing hemangiomas, whereas they are very rarely found in the lungs or mediastinum.

Comparison of Predicted Postoperative Lung Function in Pneumonectomy Using Computed Tomography and Lung Perfusion Scans.

BACKGROUND: Predicting postoperative lung function after pneumonectomy is essential. We retrospectively compared postoperative lung function to predicted postoperative lung function based on computed tomography (CT) volumetry and perfusion scintigraphy in patients who underwent pneumonectomy. METHODS: Predicted postoperative lung function was calculated based on perfusion scintigraphy and CT volumetry. The predicted function was compared to the postoperative lung function in terms of forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1), using 4 parameters: FVC, FVC%, FEV1, and FEV1%. RESULTS: The correlations between postoperative function and predicted function based on CT volumetry were r=0.632 (p=0.003) for FVC% and r=0.728 (p<0.001) for FEV1%. The correlations between postoperative function and predicted postoperative function based on perfusion scintigraphy were r=0.654 (p=0.002) for FVC% and r=0.758 (p<0.001) for FEV1%. The preoperative Eastern Cooperative Oncology Group (ECOG) scores were significantly higher in the group in which the gap between postoperative FEV1 and predicted postoperative FEV1 analyzed by CT was smaller than the gap analyzed by perfusion scintigraphy (1.2±0.62 vs. 0.4±0.52, p=0.006). CONCLUSION: This study affirms that CT volumetry can replace perfusion scintigraphy for preoperative evaluation of patients needing pneumonectomy. In particular, it was found to be a better predictor of postoperative lung function for poor-performance patients (i.e., those with high ECOG scores).

COVID-19 vaccine-related axillary lymphadenopathy in breast cancer patients: Case series with a review of literature.

PURPOSE: Lymphadenopathy (LAP) after COVID-19 vaccination in patients with a diagnosis of cancer has been challenging. We analyzed imaging and clinical features from early cases of axillary LAP in six COVID-19 vaccine recipients with a history of breast cancer. METHOD: Among the patients with a history of breast cancer and recent COVID-19 vaccine administration, six patients who showed isolated axillary LAP were gathered. Radiologic features were reviewed from breast ultrasound, chest computed tomography, and breast magnetic resonance imaging. Clinical and pathological information were obtained for analysis. RESULTS: The interval between ultrasound detection of LAP and last COVID-19 vaccine administration ranged from 14 to 28 days (mean 21.67 days). Round shape of the lymph node and irregular cortex were noted in 2 and 0 cases, respectively. Mean maximum cortical thickness, length to width ratio and interval aggravation in maximum cortical thickening were 4.2 mm, 1.34, and 2.81-fold with cut-off value of 3 mm, 1.5, 2.0-fold, respectively. CONCLUSION: We observed axillary LAP ipsilateral to a recent vaccine administration persisting longer than what the Centers for Disease Control and Prevention announced. In our patients, COVID-19 vaccine-related LAP tended to show increased cortical thickness without cortical irregularity. Oncologist as well as radiologist should be familiar with the fact that COVID-19 vaccines, regardless of vaccine type or dosage, can frequently cause ipsilateral axillary LAP, showing some suspicious features more often than others, and can persist longer than anticipated so that both over- and underdiagnosis can be avoided. We report our observations in six patients and provide an exhaustive review of the published literature.

A Randomized Controlled Trial for Doing vs. Omitting Intraoperative Frozen Section Biopsy for Resection Margin Status in Selected Patients Undergoing Breast-Conserving Surgery (OFF-MAP Trial).

PURPOSE: Intraoperative frozen section biopsy is used to reduce the margin positive rate and re-excision rate and has been reported to have high diagnostic accuracy. A majority of breast surgeons in the Republic of Korea routinely perform frozen section biopsy to assess margins intraoperatively, despite its long turnaround time and high resource requirements. This study aims to determine whether omitting frozen section biopsy for intraoperative margin evaluation in selected patients is non-inferior to performing frozen section biopsy in terms of resection margin positivity rate. METHODS: This study is a phase III, randomized controlled, parallel-group, multicenter non-inferiority clinical trial. Patients meeting the inclusion criteria and providing written informed consent will be randomized to the "frozen section biopsy" or "frozen section biopsy omission" group after lumpectomy. Patients with clinical stage T1-T3 disease who are diagnosed with invasive breast cancer by core-needle biopsy and plan to undergo breast-conserving surgery will be included in this study. If a daughter nodule, non-mass enhancement, or microcalcification is identified on preoperative imaging, these features must be within 1 cm of the main mass for inclusion in the trial. The target sample size is 646 patients per arm. The primary endpoint will be the resection margin positive rate, and the secondary endpoints include the reoperation rate, operating time, residual cancer after reoperation, residual cancer after re-excision according to the frozen section biopsy result, resection volume, patient quality of life, and cost-effectiveness. DISCUSSION: This is the first randomized clinical trial utilizing frozen section biopsy for intraoperative margin evaluation and aims to determine the non-inferiority of omitting frozen section biopsy in selected patients compared to performing frozen section biopsy. We expect that this trial will help surgeons perform the procedure more efficiently while ensuring patient safety. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03975179; Clinical Research Information Service Identifier: KCT0004606.

ChREBP regulates fructose-induced glucose production independently of insulin signaling.

Obese, insulin-resistant states are characterized by a paradoxical pathogenic condition in which the liver appears to be selectively insulin resistant. Specifically, insulin fails to suppress glucose production, yet successfully stimulates de novo lipogenesis. The mechanisms underlying this dysregulation remain controversial. Here, we hypothesized that carbohydrate-responsive element-binding protein (ChREBP), a transcriptional activator of glycolytic and lipogenic genes, plays a central role in this paradox. Administration of fructose increased hepatic hexose-phosphate levels, activated ChREBP, and caused glucose intolerance, hyperinsulinemia, hypertriglyceridemia, and hepatic steatosis in mice. Activation of ChREBP was required for the increased expression of glycolytic and lipogenic genes as well as glucose-6-phosphatase (G6pc) that was associated with the effects of fructose administration. We found that fructose-induced G6PC activity is a major determinant of hepatic glucose production and reduces hepatic glucose-6-phosphate levels to complete a homeostatic loop. Moreover, fructose activated ChREBP and induced G6pc in the absence of Foxo1a, indicating that carbohydrate-induced activation of ChREBP and G6PC dominates over the suppressive effects of insulin to enhance glucose production. This ChREBP/G6PC signaling axis is conserved in humans. Together, these findings support a carbohydrate-mediated, ChREBP-driven mechanism that contributes to hepatic insulin resistance.

Effects of histone deacetylase inhibitor on extracellular matrix production in human nasal polyp organ cultures.

BACKGROUND: Nasal polyposis is associated with a chronic inflammatory condition of the sinonasal mucosa and involves myofibroblast differentiation and extracellular matrix (ECM) accumulation. Epigenetic modulation by histone deacetylase (HDAC) inhibitors including trichostatin A (TSA) has been reported to have inhibitory effects on myofibroblast differentiation in lung and renal fibroblasts. The purpose of this study was to investigate the inhibitory effect of TSA on myofibroblast differentiation and ECM production in nasal polyp organ cultures. METHODS: Nasal polyp tissues from 18 patients were acquired during endoscopic sinus surgery. After organ culture, nasal polyps were stimulated with TGF-beta1 and then treated with TSA. Alpha-smooth muscle actin (α-SMA), fibronectin, and collagen type I expression levels were examined by reverse transcription-polymerase chain reaction (PCR), real-time PCR, Western blot, and immunofluorescent staining. HDAC2, HDAC4, and acetylated H4 expression levels were assayed by Western blot. Cytotoxicity was analyzed by the terminal deoxynucleotidyl transferase biotin-dUTP nick end labeling assay. RESULTS: The expression levels of α-SMA, fibronectin, and collagen type 1 were increased in nasal polyp after transforming growth factor (TGF) beta1 treatment. TSA-inhibited TGF-beta1 induced these gene and protein expression levels. Furthermore, TSA suppressed protein expression levels of HDAC2 and HDAC4. However, TSA induced hyperacetylation of histones H4. Treatment with TGF-beta1 with or without TSA did not have cytotoxic effect. CONCLUSION: These findings provide novel insights into the epigenetic regulation in myofibroblast differentiation and ECM production of nasal polyp. TSA could be a candidate of a therapeutic agent for reversing the TGF-beta1-induced ECM synthesis that leads to nasal polyp development.

Nox4 mediates hypoxia-stimulated myofibroblast differentiation in nasal polyp-derived fibroblasts.

BACKGROUND: Chronic hypoxia is associated with remodeling in various organs. Reactive oxygen species (ROS) derived from NADPH oxidases (Nox), and transforming growth factor-ß(1) (TGF-ß(1)) have been implicated in the pathogenesis of hypoxia-induced remodeling. The aims of this study were to determine in hypoxia-stimulated nasal polyp-derived fibroblasts (NPDF) the effect of hypoxia on the differentiation of myofibroblasts, the role of ROS, the major Nox homolog mediating myofibroblast differentiation, and the role of TGF-ß(1). METHODS: Eight primary cultures of NPDF were established from nasal polyps, which were incubated under hypoxic conditions. Reverse transcription polymerase chain reaction for αSMA, Nox1, Nox3, Nox4, Nox5, and fibronectin mRNA was performed. Western blotting for α-SMA and fibronectin was done. ROS production was detected using a fluorometer. NPDF were pretreated with ROS scavengers and transfected with siNox4. The TGF-ß(1) protein level was measured by ELISA. The effect of treatment with TGF-ß(1) type I tyrosine kinase inhibitor SB431542 on myofibroblast differentiation was observed. RESULTS: Hypoxic stimulation of NPDF significantly increased α-SMA and fibronectin mRNA and protein expression. ROS production was increased by hypoxia, and ROS scavengers inhibited myofibroblast differentiation. Nox4 mRNA was the only Nox homolog increased by hypoxia. Transfection with siNox4 inhibited myofibroblast differentiation. TGF-ß(1) was secreted endogenously by hypoxic NPDF. SB431542 significantly inhibited myofibroblast differentiation. CONCLUSIONS: Hypoxia induces myofibroblast differentiation of NPDF through a signaling pathway involving Nox4-dependent ROS generation and TGF-ß(1). Therapies targeting Nox4 may be effective against remodeling of nasal polyps.

αB-Crystallin is a Novel Oncoprotein Associated with Poor Prognosis in Breast Cancer.

PURPOSE: αB-crystallin, a small heat shock protein, is an anti-apoptotic protein associated with aggressive tumor behavior. A recent study revealed that αB-crystallin is overexpressed in a metastatic variant of the GI101A human breast carcinoma cell line. The purpose of this study was to investigate whether αB-crystallin is related to other breast tumor markers and can predict a breast cancer prognosis. METHODS: Eighty-two patients who underwent breast cancer surgery at Hallym Sacred Heart Hospital were enrolled. αB-crystallin expression was determined by immunohistochemical staining. Estrogen receptor, progesterone receptor (PR), human epidermal growth factor receptor, lymphovascular invasion, histological grade, other tumor markers and time to recurrence were compared with αB-crystallin expression. RESULTS: αB-crystallin expression in breast cancer tissues was associated with PR (p=0.030), the number of metastatic lymph nodes (pN) (p=0.020), lymphovascular invasion (p=0.022), histological grade (p=0.004) and triple negative breast cancer (TNBC) (p=0.004). αB-crystallin expression significantly decreased time to recurrence (p=0.039). CONCLUSION: The results revealed a strong relationship between αB-crystallin and poor prognostic factors such as the number of metastatic lymph nodes (especially pN2), TNBC, and rapid time to recurrence. We believe that αB-crystallin could be a novel oncoprotein biomarker of a poor prognosis in breast cancer.

Antiproliferation and redifferentiation in thyroid cancer cell lines by polyphenol phytochemicals.

Thyroid carcinogenesis is accompanied by loss of thyroid-specific functions and refractory to radioiodine and thyroid stimulating hormone (TSH) suppression therapy. Redifferentiating agents have been shown to inhibit tumor growth and improve the response to conventional therapy. Polyphenol phytochemicals (PPs) in fruits and vegetables have been reported to inhibit cancer initiation, promotion, progression and induce redifferentiation in selected types. In this study we examined PPs induce redifferentiation in thyroid cancer cell lines. We investigated the effects of genistein, resveratrol, quercetin, kaempferol, and resorcinol on the F9 embryonal carcinoma cell differentiation model. The thyroid cancer cell lines, TPC-1, FTC-133, NPA, FRO, and ARO, displayed growth inhibition in response to genistein, resveratrol, quercetin. We further demonstrated that genistein decreased the dedifferention marker CD97 in NPA cells and resveratrol decreased CD97 in FTC-133, NPA, FRO cells and quercetin decreased CD97 in all cell lines. We observed increased expression of differentiation marker NIS in FTC-133 cells in response to genistein, and resveratrol but no change in NPA, FRO, ARO cells. Quercetin increased or induced NIS in FTC-133, NPA, FRO cells. These findings suggest that PPs may provide a useful therapeutic intervention in thyroid cancer redifferentiation therapy.

Psychological and neuroendocrinological characteristics associated with depressive symptoms in breast cancer patients at the initial cancer diagnosis.

OBJECTIVE: Breast cancer patients can have biopsychosocial changes induced by distress related to the cancer diagnosis. This study investigated psychological characteristics and hypothalamic-pituitary-adrenal (HPA) axis function associated with depressive symptoms in breast cancer patients at the initial diagnosis. METHOD: Seventy-eight breast cancer patients were enrolled, and 61 patients were included in the final analysis. Patients were evaluated concerning psychological adjustment to cancer diagnosis, self-concept and depressive symptoms and given a dexamethasone suppression test before the main surgical treatment. RESULTS: Self-concept scale scores and fighting spirit factor scores of the Korean version of the Mental Adjustment to Cancer (KMAC) scale showed inverse correlations. Anxious preoccupation (AP) factor scores of the KMAC scale positively correlated with depressive symptom scores. Depressive symptom scores were significantly correlated with postdexamethasone serum cortisol levels. In multiple regression analysis, postdexamethasone serum cortisol and the KMAC-AP factor score had significant partial effects in the final model. CONCLUSION: Hypothalamic-pituitary-adrenal axis dysfunction and anxious coping to cancer diagnosis may be associated with depressive symptoms in breast cancer patients before treatment. Based on this analysis, we recommend psychotherapeutic interventions to increase adaptive mental coping strategy and to ameliorate psychological distress. Screening for HPA axis dysfunction and provision of depression treatment may prevent breast cancer patients from developing depressive symptoms.

Curcumin suppresses the paclitaxel-induced nuclear factor-kappaB in breast cancer cells and potentiates the growth inhibitory effect of paclitaxel in a breast cancer nude mice model.

Most anticancer agents activate nuclear factor kappa B (NF-kappaB), which can mediate cell survival, proliferation, and metastasis. Curcumin has been shown to inhibit the growth of various cancer cells, without toxicity to normal cells. The antitumor effects of curcumin could be due in part to the inactivation of NF-kappaB. We hypothesize that blocking NF-kappaB activity may augment paclitaxel cancer chemotherapy. In this study, we investigated whether the inactivation of NF-kappaB by curcumin would enhance the efficacy of paclitaxel for inhibiting breast cancer growth in vitro and in vivo. We confirmed that curcumin inhibited paclitaxel-induced activation of NF-kappaB and potentiated the growth inhibitory effect of paclitaxel in MDA-MB-231 breast cancer cells. The combination of curcumin with paclitaxel elicited significantly greater inhibition of cell growth and more apoptosis, compared with either agent alone. In an experimental breast cancer murine model using MDA-MB-231 cells, combination therapy with paclitaxel and curcumin significantly reduced tumor size and decreased tumor cell proliferation, increased apoptosis, and decreased the expression of matrix metalloprotease 9 compared with either agent alone. These results clearly suggest that a curcumin-paclitaxel combination could be a novel strategy for the treatment of breast cancer.

Expression of neutrophil gelatinase-associated lipocalin in nasal polyps.

OBJECTIVE: To investigate the expression and localization of neutrophil gelatinase-associated lipocalin (NGAL), an antimicrobial peptide, in the normal nasal mucosa and human nasal polyps. Neutrophil gelatinase-associated lipocalin has been identified as a key element in the innate host defense system. However, scant knowledge exists about the expression of NGAL in the human sinonasal tract. DESIGN: Prospective study. SETTING: Academic medical center. PATIENTS: Normal inferior turbinate mucosa was obtained from 10 patients who were undergoing augmentation rhinoplasty. The nasal polyps were obtained from 10 patients who were undergoing endoscopic sinus surgery for chronic rhinosinusitis with polyps. INTERVENTIONS: We performed semiquantitative reverse transcription-polymerase chain reaction, immunohistochemical staining, and Western blot analysis. MAIN OUTCOME MEASURES: We analyzed the expression of the NGAL messenger RNA (mRNA) and localization of the NGAL protein. RESULTS: The NGAL mRNA and NGAL protein were highly expressed in the nasal polyps. The ratio of NGAL mRNA to glyceraldehyde-3-phosphate dehydrogenase mRNA in the nasal polyps was greater compared with that in the normal turbinate mucosa (P = .002). The NGAL protein was observed in the epithelium, the infiltrating inflammatory cells, and the submucosal gland of the nasal polyps, but it was very rarely detected in the normal nasal mucosa. CONCLUSION: Expression of NGAL is upregulated in nasal polyps, and additional work is needed to reveal the possible role of NGAL in the defense systems of the nasal mucosa and the process of polyp formation.

Increased expression of pigment epithelium-derived factor in allergic rhinitis.

OBJECTIVES: To investigate the expression of messenger RNA (mRNA) of the gene for pigment epithelium-derived factor (PEDF) (OMIM *172860) and PEDF protein and to localize the PEDF protein in the nasal mucosa of patients with allergic rhinitis and of control subjects. DESIGN: Investigation of PEDF mRNA and PEDF protein expression in the nasal mucosa using reverse transcription-polymerase chain reaction, Western blotting, and immunohistochemical staining. PARTICIPANTS: We used inferior turbinate mucosal samples from 10 patients with allergic rhinitis and 10 matched healthy control subjects. INTERVENTIONS: We extracted PEDF mRNA from the inferior turbinate mucosa samples and performed reverse transcription-polymerase chain reaction analysis. We used Western blotting to analyze differences in expression levels of PEDF protein between patients with allergic rhinitis and healthy controls, and the PEDF protein was localized immunohistochemically. RESULTS: The expression levels of PEDF mRNA and PEDF protein in the nasal mucosa were significantly increased in patients with allergic rhinitis compared with those in nonallergic controls. The PEDF protein was expressed in the epithelium and submucosal glands. CONCLUSIONS: We found that PEDF protein is expressed in the human nasal mucosa, and its expression is increased in allergic rhinitis. These results suggest a possible contribution of PEDF to the chronic inflammation of the nasal mucosa in allergic rhinitis.

The changes of MRSA infections in chronic suppurative otitis media.

OBJECTIVES: To investigate the epidemiologic and microbiological characteristics of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) and hospital-acquired methicillin-resistant Staphylococcus aureus (HA-MRSA) infections in the otorrhea of chronic suppurative otitis media (COM) patients. DESIGN: Retrospective study of patients with newly identified MRSA infections from January 1998 through December 2006. A total of 2773 patients with a diagnosis of COM were included in this study. An antibiotic sensitivity test was performed for each isolate. RESULTS: The prevalence of MRSA in COM was 4.9 percent (137 of 2773 patients). The proportion of CA-MRSA rose from 0.7 percent in 1998 to 11.4 percent in 2006. However, the proportion of HA-MRSA did not change significantly, from 0.7 percent in 1999 to 1.3 percent in 2006. All of the CA-MRSA strains identified in our study were susceptible to trimethoprim/sulfamethoxazole (TMP/SMX). Rifampin susceptibility was also noted in 90 percent of the cases. CONCLUSIONS: CA-MRSA infections have risen dramatically in the past decade. CA-MRSA and HA-MRSA in COM differed in both clinical and microbiological aspects.

Up-regulation of protease-activated receptor 2 in allergic rhinitis.

OBJECTIVES: We compared the patterns of PAR-2 messenger RNA (mRNA) and protein expression in the nasal mucosa of subjects with and without allergic rhinitis. METHODS: Biopsy specimens were obtained from 10 patients with allergic rhinitis and 10 normal controls. RNA was extracted from the nasal mucosa, and semiquantitative reverse transcription-polymerase chain reaction was performed for PAR-2. Tissue sections were immunostained for PAR-2 by use of specific antibody. RESULTS: The expression levels of PAR-2 mRNA in allergic rhinitis nasal mucosa were significantly up-regulated as compared with those in normal nasal mucosa. PAR-2 immunoreactivity was observed in the epithelium and submucosal glands in both normal controls and subjects with allergic rhinitis. Stronger immunoreactivity for PAR-2 was observed in allergic rhinitis nasal mucosa as compared with normal nasal mucosa. CONCLUSIONS: These results suggest that PAR-2 may be involved in allergic nasal inflammation.

Endoscopic treatment of nasolacrimal sac obstruction secondary to fibrous dysplasia of paranasal sinuses.

Fibrous dysplasia involving paranasal sinuses mostly has asymptomatic features, but sometimes may cause signs and symptoms which relate to the location and extent of bony abnormalities. The use of endoscopic nasal surgery for debulking ethmoidal fibrous dysplasia, blocking the left nasolacrimal sac and simultaneous intranasal endoscopic dacryocystorhinostomy with silicone intubation is presented. The procedure and advantages of endoscopic approach over the external approach are outlined in this paper.

Up-regulation of peroxisome proliferator-activated receptor gamma in perennial allergic rhinitis.

OBJECTIVES: To investigate the expression of peroxisome proliferator-activated receptor gamma (PPAR-gamma) messenger RNA and protein and to localize the PPAR-gamma protein in the nasal mucosa of patients with allergic rhinitis and control subjects. DESIGN: Prospective study. SETTING: Tertiary academic institution. Patients Twenty patients with perennial allergic rhinitis and 20 matched nonallergic patients. INTERVENTIONS: Inferior turbinate mucosa samples were obtained from 20 patients with perennial allergic rhinitis and 20 matched nonallegic patients. Peroxisome proliferator-activated receptor gamma messenger RNA was extracted from the inferior turbinate mucosae, and then reverse transcription-polymerase chain reaction was performed. Western blot testing was used to analyze differences in PPAR-gamma protein expression levels between patients with allergic rhinitis and normal controls, and the PPAR-gamma protein was localized immunohistochemically. RESULTS: The expression levels of PPAR-gamma messenger RNA and protein in the nasal mucosa was significantly increased in patients with perennial allergic rhinitis compared with controls. Peroxisome proliferator-activated receptor gamma protein was expressed in the epithelium, infiltrating inflammatory cells, and submucosal glands. CONCLUSIONS: Peroxisome proliferator-activated receptor gamma is expressed in the human nasal mucosa and is up-regulated in perennial allergic rhinitis. These results suggest a possible contribution for PPAR-gamma in chronic inflammation of the nasal mucosa in perennial allergic rhinitis.

Efficacy of sucralfate in the postoperative management of uvulopalatopharyngoplasty: a double-blind, randomized, controlled study.

OBJECTIVE: To evaluate the effectiveness of sucralfate in influencing throat pain, otalgia, analgesic requirement, bleeding, mucosal recovery, and incidence of postoperative bleeding in patients undergoing uvulopalatopharyngoplasty. DESIGN: A prospective double-blind randomized study. SETTING: University-affiliated tertiary referral hospital. PARTICIPANTS: Eighty adult patients with obstructive sleep apnea syndrome requiring uvulopalatopharyngoplasty were recruited and randomly allocated into either a sucralfate treatment group or a control group. INTERVENTIONS: All patients underwent uvulopalatopharyngoplasty. Patients enrolled in the sucralfate group (n=40) were instructed to gargle the sucralfate suspension and then to swallow. Patients enrolled in the control group (n=40) were instructed to gargle placebo suspension at the same doses and schedule. MAIN OUTCOME MEASURES: Postoperative throat pain, otalgia, amount of analgesic required, degree of strength (defined as patients' general well-being and return to regular daily activities), percentage of mucosal covering, and postoperative bleeding. RESULTS: Throat pain and otalgia occurred significantly less often in sucralfate group, with less analgesic requirement and with rapid mucosal healing and early return to regular daily activities. There was no significant difference in episodes of postoperative bleeding between the 2 groups (P=.37). CONCLUSIONS: Although sucralfate therapy may not provide complete analgesia after uvulopalatopharyngoplasty, it may reduce the amount of analgesic required, thus preventing dose-related adverse effects from the analgesic agent. It can also significantly reduce the total number of days needed to return to normal daily activities (P=.41).