Bioavailability of Isoflavone Metabolites After Korean Fermented Soybean Paste (Doenjang) Ingestion in Estrogen-Deficient Rats.

Doenjang (DJ), a fermented soybean product used in soups, stews, and sauces, contains high quality proteins, fats, vitamins, minerals, and other functional ingredients, including isoflavones and saponins. This study investigated whether DJ improves the bioavailability of isoflavones compared to boiled soybean (BS) in sham-operated or ovariectomized (OVX) rats. We also examined the effects of ovariectomy on the differences in bioavailability of isoflavones. BS and DJ were administered in sham-operated and OVX rats, and blood samples were collected. Twenty-six isoflavone-derived metabolites were identified. Pharmacokinetic analysis revealed that T1/2 values of the individual isoflavone metabolites were most different in sham and OVX rats, even after the same sample treatment; however, Tmax values were significant different in a few metabolites such as daidzein 4'-glucuronide, daidzein 4'-sulfate, 2-(4-hydroxyphenyl)propionic acid, and benzoic acid. For most of the individual metabolites, Cmax was higher in both sham and OVX rats administered BS than those administered DJ. The AUC was generally lower in OVX rats than in sham rats. The AUC of daidzein and genistein in BS-fed sham rats was approximately 1.7-fold higher than those administered DJ, whereas glycitein was detected only in the DJ group. No significant differences in AUC of daidzein and genistein were observed between BS and DJ administration in OVX rats, although the total isoflavone content of DJ was lower; thus, DJ-mediated isoflavone bioavailability was more effective in OVX rats. Similar tendencies were observed for phase II and gut-mediated metabolites. These results suggested that DJ enhanced isoflavone bioavailability under estrogen deficiency, even when the total isoflavone content was decreased by fermentation.

Retraction: Wheatgrass extract inhibits hypoxia-inducible factor-1-mediated epithelial-mesenchymal transition in A549 cells

The editors of Nutrition Research and Practice (NRP) received a letter from a corresponding author who raised concerns regarding this paper. NRP's special committee on research ethics launched an investigation and identified that some of the paper's data is a duplicate of data in another article published by Parmacogn Mag and that these two articles were simultaneously published. The entire article has been retracted from NRP in accordance with NRP policy and editorial decision. This article has been retracted by agreement between the authors and YoonJu Song/Sang-Jin Chung (Editors-in-Chief).

Wheatgrass extract inhibits hypoxia-inducible factor-1-mediated epithelial-mesenchymal transition in A549 cells

BACKGROUND/OBJECTIVES: Epithelial-mesenchymal transition (EMT) is involved in not only cancer development and metastasis but also non-cancerous conditions. Hypoxia is one of the proposed critical factors contributing to formation of chronic rhinosinusitis or nasal polyposis. Wheatgrass (Triticum aestivum) has antioxidant, anti-aging, and anti-inflammatory effects. In this study, we analyzed whether wheatgrass has an inhibitory effect on the EMT process in airway epithelial cells. MATERIALS/METHODS: A549 human lung adenocarcinoma cells were incubated in hypoxic conditions (CO₂ 5%/O₂ 1%) for 24 h in the presence of different concentrations of wheatgrass extract (50, 75, 100, and 150 µg/mL) and changes in expression of epithelial or mesenchymal markers were evaluated by immunoblotting and immunofluorescence. Accordingly, associated EMT-related transcriptional factors, Snail and Smad, were also evaluated. RESULTS: Hypoxia increased expression of N-cadherin and reduced expression of E-cadherin. Mechanistically, E-cadherin levels were recovered during hypoxia by silencing hypoxia inducible factor (HIF)-1α or administering wheatgrass extract. Wheatgrass inhibited the hypoxia-mediated EMT by reducing the expression of phosphorylated Smad3 (pSmad3) and Snail. It suppressed the hypoxia-mediated EMT processes of airway epithelial cells via HIF-1α and the pSmad3 signaling pathway. CONCLUSION: These results suggest that wheatgrass has potential as a therapeutic or supplementary agent for HIF-1-related diseases.

Unusual Presentation of Second Branchial Cleft Cyst: Case Reports and Literature Review / 대한이비인후과학회지

Second branchial cleft cysts are the most common neck masses found in adults. However, the parapharyngeal presence of branchial cleft cyst is very rare. We report three cases of parapharyngeal branchial cleft cyst in adults. They suffered from frequent oropharyngeal infection or abscess. We performed a transoral resection without any surgical complications. Biopsy revealed a squamous lined epithelial wall with lymphoid aggregation, which is characteristic of branchial cleft cyst. No evidence of recurrence was observed in 2 years.

Differential Diagnosis of Chronic Coughing

Cough, the most common symptom, encountered in the outpatient clinic can be caused by various underlying diseases. It defines as chronic cough that the duration of cough is more than 8 weeks with a normal chest X-ray findings. The cause of cough can be found out for more than 90% through the appropriate diagnostic approach and Upper airway cough syndrome, Asthma and Gastroesophageal reflex disease are the most common causes of disease to non-smokers. Chronic cough can be due to not one reason but various reasons and achieve good results by a systematic approach to diagnosis and a concrete treatment on the basis of the sufficient understanding of the underlying disease.

A Case of Giant Carcinosarcoma of the Parotid Gland / 대한이비인후과학회지

Carcinosarcoma, or true malignant mixed tumor of the salivary gland, is a very rare malignant tumor comprised of both carcinomatous and sarcomatous elements and accounts for only 0.04-0.16% of all salivary gland tumors. Carcinosarcoma usually occurs in the parotid gland. Other locations including submandibular gland, minor salivary gland, uterus, bladder or lung have been reported. We report a rare case of carcinosarcoma of the parotid gland in an 85-year-old female. The tumor was large, about 19x17 cm in size, and was successfully excised.

A Case of Optic Neuropathy Secondary to Sphenoid Sinus Aspergillosis

Orbital complication of an isolated sphenoid sinus lesion is rare. We recently experienced one case of optic neuropathy secondary to sphenoid sinus Aspergillosis. The patient presented with a headache and diplopia. Imaging and histology showed a sphenoid sinus lesion, andthe patientunderwent endoscopic sinus surgery. Because of the disease progression after the surgery,the patient was administered an anti-fungal agent underclinical suspicion ofan invasive fungal sinusitis infection before receiving histologic confirmation of tissue invasion by fungal hyphae. The disease stabilized in three months by using approximately one month of anti-fungal agent. The type of treatment required for sphenoid sinus lesions depends on the extent of the disease upon initial examination as well ason the rapidity of diseaseprogression.

A Case of Jacobson's Nerve Schwannoma Extending into the External Auditory Canal / 대한이비인후과학회지

Schwannomas are slow-growing, benign neurogenic tumors arising from schwann cells. Their localization in the external auditory canal and the middle ear has rarely been reported. The authors experienced a very rare case of Jacobson's nerve schwannoma that extended into the external auditory canal in a 55-year-old woman. The tumor eroded the wall of the cochlear promontory and exposed the membranous labyrinth. The jugular foramen and the wall of the ear canal were preserved without destruction. This report represents the first documented case of a Jacobson's nerve schwannoma, which involved the external auditory canal.

Large Perforation of Hypopharynx Secondary to Anterior Cervical Approach : A Complicated Case

Perforation of the hypopharynx, which can occur after anterior cervical approach, is a very rare type of complication. If diagnosed late, it can lead to very fatal course, such as mediastinitis and hematosepsis. Therefore, a precise and prompt diagnosis is crucial. When conservative treatment alone is not expected to heal the perforated site or is likely to lead to serious complications, surgical treatment becomes necessary. This report demonstrates that surgical intervention performed immediately after an early diagnosis can lead to the successful treatment of a large perforation in the hypopharynx on a 58-year-old male patient.

A Case of Benign Fibrous Histiocytoma of the Nasal Dorsum

Benign fibrous histiocytoma is a mesenchymal tumor that has been described as a benign neoplasm composed of fibroblasts and histiocytes. The occurrence of this lesion of the head and neck has been rarely reported. We experienced a case of benign fibrous histiocytoma on the nasal dorsum in a 53-year-old female. During physical examination, we found 1x1-cm-sized bilateral mass on the nasal dorsum. Excision and Z-plasty were performed, and recurrence was not observed for 12 months after operation. We present this rare case with review of the clinical and pathological features.

Nasal Hemangiopericytoma Causing Oncogenic Osteomalacia

Oncogenic osteomalacia is a rare cause that makes abnormalities of bone metabolism. Our case arose in a 47-year-old woman presenting a nasal mass associated with osteomalacia. We excised the mass carefully. After surgery, it was diagnosed as hemangiopericytoma and her symptoms related with osteomalacia were relieved and biochemical abnormalities were restored to normal range. We report and review a rare case of nasal hemangiopericytoma that caused osteomalacia.

Gunshot Injury to the Anterior Arch of Atlas

Penetrating injuries to the upper cervical spine resulting from gunshots are rare in South Korea due to restrictions of gun use. Moreover, gunshot wounds to the upper cervical spine without neurological deficits occur infrequently because of the anatomic location and surrounding essential structures. We present an uncommon case involving the surgical removal of a bullet located in the anterior arch of first cervical vertebra (C1) via a transoral approach without neurological complications or subsequent mechanical instability.

Granular Cell Tumor on Larynx

Granular cell tumors (GCTs) are uncommon neoplasm. They can originate in any part of the body. The most common sites of origin are in the head and neck, while the larynx is a relatively uncommon location. Patients affected with a laryngeal GCT typically present with persistent hoarseness, stridor, hemoptysis, dysphagia, and otalgia but, the tumor may be asymptomatic. Care must be taken to differentiate this lesion from others due to the presence of pseudo-epitheliomatous hyperplasia which overlies the GCT and may occasionally mimic squamous cell carcinoma. Therefore, a confirmative diagnosis should be made histopathologically and should be supported by immunohistochemical staining. These tumors are treated by complete surgical resection. Examining the complete removal of the tumor through securing a negative free margin is considered to be a consequential procedure. We experienced a 64-yr-old man with a laryngeal granular cell tumor involving the right true vocal cord. He was treated by surgical resection under a fine dissection laryngomicroscope. Here we present this case and a review of literature.

A Case of Endoscopic Management of Dacryocystocele in an Adult / 대한이비인후과학회지

Dacryocystocele presents as a distended lacrimal sac and it is often considered to have a congenital etiology. However, dacryocystocele is an uncommon disease in adults. The clinical feature associated with a dacryocystocele is painless swelling at the site of the lacrimal sac, and this is usually found inferior to the medial canthal ligament. The lacrimal excretion test, endoscopy, CT scans and MRI are used to make the diagnosis of dacryocystocele. The management of a congenital dacryocystocele is conservative treatment that involves the use eye drops, lacrimal sac massage, lacrimal probing and surgery in some cases. However, for a dacryocystocele that develops in an adult, the dilated lacrimal sac does not decrease in size, so a nasal drainage procedure is the treatment of choice. We encountered an adult patient who presented with a dacryocystocele with an intranasal cystic mass, which we treated by endoscopic marsupialization. We report on this case along with a review of the related literature.

Development of Guideline for Rating the Physical Impairment of Otolaryngologic Field

We develop a guideline for rating the physical impairment of otolaryngologic fields. Assessment of hearing disturbance and tinnitus required physical examination, pure tone audiometry, speech audiometry, impedance audiometry, brainstem evoked response audiometry, Bekesy audiometry, otoacoustic emission test, and imaging examination. History taking, physical examination, and radiological examination for the vestibular organ and brain, righting reflex test, electronystagmography, and caloric test are taken for evaluation of balance disorder. Olfactory function tests include University of Pennsylvania Smell Identification test, Connecticut Chemosensory Clinical Research Center test, T and T olfactometry and Korean Version of Sniffin's Sticks test. Medical history and physical examination is mandatory to evaluatezseverity of respiration difficulty. Examinations include flexible fiberoptic nasopharyngoscope, bronchoscopy, simple soft-tissue radiography films of upper airway and high resolution computed tomography. Evaluation of mastication and swallowing are history taking, physical examination, examination for upper jaw, lower jaw, and temporomandibular joint, dental examination and radiological studies. Endoscopy and esophagography are also needed. Voice disorder is evaluated based on physical examination, oral pharynx and larynx endoscopy, larynx stroboscopy, hearing assessment, laryngeal electromyography, sound analysis test, aerodynamic test, electroglottography, and radiologic examination. Articulation disorder is assessed by picture consonant articulation test. These are position articulation test, Lee-Kim Korean articulation picture and speech intelligibility assessment.

Significance of the Expression of Tumor Markers in Adenoid Cystic Carcinoma and Pleomorphic Adenoma of the Salivary Gland / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Salivary gland tumors are characterized by extreme histological diversity. Even within a single tumor, various histological patterns are observed. The same histological patterns are shared among various tumor types, regardless of the biological behavior, making diagnosis difficult. Although a great number of immunohistochemical studies of major salivary gland tumors have been published, their clinical and diagnostic implications are not fully apparent. We have performed basic immunohistochemical stains of pleomorphic adenoma (PA) and adenoid cystic carcinoma (ACC) to determine the diagnostic value of c-kit, Ki-67, glial fibrillary acidic protein (GFAP) and p53. MATERIALS AND METHOD: Paraffin-embedded tissue specimens from 48 cases, who were diagnosed as PA (n=31) and ACC (n=17) from 1993 to 2002, were immunohistochemically stained for c-kit, Ki-67, GFAP and p53. RESULTS: In the immunohistochemical stains of c-kit, Ki-67 and p53, there were no difference between PA and ACC. However, in the immunohistochemical stain of GFAP, there were difference in PA and ACC. GFAP was expressed in 74% of the PA and was not expressed in all cases of ACC. CONCLUSION: These data suggest that GFAP immunoreactivity could be helped in the occasional differential diagnostic dilemma of pleomorphic adenoma versus adenoid cystic carcinoma in salivary gland.

The Significance of Connexin 26 Expression in Squamous Cell Lesions of the Larynx / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Gap junctional intercellular communication (GJIC) is a mechanism for direct cell to cell signalling and is mediated by gap junctions, which consist of transmembrane proteins called connexins (Cxs). The authors investigated the role of connexin 26 as a biomarker that helps diagnose laryngeal squamous cell lesions. SUBJECTS AND METHOD: Paraffin-embedded tissue specimens from 50 patients, who were diagnosed with laryngeal invasive squamous cell carcinoma (n=15), carcinoma in situ (n=10), dysplasia (n=15), and non-neoplastic epithelial hyperplasia (n=10) between 1993 and 2005, were immunohistochemically stained for connexin 26 protein. RESULTS: Intracytoplasmic positive expression of connexin 26 was found in 100% of invasive squamous cell carcinoma and in 20% of carcinoma in situ. However, in dysplasia and hyperplasia, there were no positive expressions. Moreover, the majority of intercellular or membranous staining tended to decline in dysplasia, carcinoma in situ, and squamous cell carcinoma. CONCLUSION: These results suggest that aberrant expression of connexin 26 in laryngeal squamous cell lesions can be associated with tumorigenesis and invasion. Further studies are needed to investigate these expressions of connexin 26 and that it may represent more aggressive pathology of the larynx.

Clinical Study of Deep Neck Infection / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The incidence of deep neck infection has decreased after the introduction of antibiotics and improvement of oral hygiene, but it may still be lethal especially when life-threatening complications occur. The objective of this study is to clarify the presenting signs and symptoms, clinical course, microorganisms, and management of deep neck infections. SUBJECTS AND METHOD: We retrospectively reviewed the records of 134 patients who were diagnosed with deep neck infection and who received treatment at the Chosun University Hospital between 1996 and 2005 for the analysis of age and sex, distribution related to spaces involved, the location of cellulitis and abscess, the side of lesion, the symptoms and signs, the etiologic events, the associated conditions, the result of culture, and the treatments. Peritonsillar abscesses were excluded from this study. RESULTS: The parapharyngeal space and extended space were the most commonly involved space of deep neck infections, followed by submandibular space, retropharyngeal space, and Ludwig's angina. The most common pathogens found were Streptococcus, followed by Klebsiella and Staphylococcus. In diabetic patients, Klebsiella pneumoniae was the most common causative pathogen. Peptostreptococcus was the most common anaerobic pathogen. CONCLUSION: Initial management including trial of proper empirical antibiotics is important. According to the culture and antibiotic sensitivity test in this study, a combined therapy of amoxicillin/clavulanic acid and metronidazole is useful in polymicrobial deep neck infection.

A Case of Maxillary Venous Hemangioma with Invasion to Hard Palate and Nasal Cavity / 대한이비인후과학회지

Hemangiomas are common benign soft tissue tumors in the head and neck, but they occur infrequently in the sinonasal cavity. Capillary, cavernous, mixed, and venous types of hemangiomas have been described. Venous hemangiomas are less commonly seen and are composed of thickened blood vessels that can still be recognized as veins. Chief symptoms are recurrent epistaxis and nasal obstruction; if the tumor becomes large, it may cause adjacent bony erosion. Preoperative diagnosis of maxillary sinus hemangioma is important since these lesions can frequently cause a large amount of hemorrhage during surgery. We report a case of a 80-year-old woman with a huge tumor in the maxillary sinus and oral cavity that was histopathologically diagnosed as venous hemangioma.

The Significance of CD44v3 Expression in Squamous Cell Lesions of the Larynx / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is known that a part of laryngeal premalignant lesions progresses to an invasive carcinoma. Despite many previous reports, conventional histology is not sufficient to predict such tumor progression. Herein, the authors investigated the role of CD44v3 as a biomarker in predicting the progression of laryngeal premalignant lesion to an inavasive cancer. SUBJECTS AND METHOD: Paraffin-embedded tissue specimens from 40 patients were diagnosed accordingly as laryngeal invasive squamous cell carcinoma (n=10), Carcinoma in situ (n=10), dysplasia (n=10), and hyperkeratosis (n=10) between 1993 and 2002. They were immunohistochemically stained for CD44v3 protein. RESULTS: In invasive squamous cell carcinoma, the expression of CD44v3 was diffused and gave a strong positive stain, and in carcinoma in situ, it was diffused and gave 3+-2+ stain. However, in dysplasia and hyperkeratosis, the proportion of CD44v3 expression was decreased by 2+-1+, and 1+-0, respectively. CONCLUSION: These results suggest that the expression of CD44v3 in laryngeal premalignant and malignant lesions can be associated with tumorigenesis and invasion. Those strong positive expressions of CD44v3 may represent more aggressive pathology of the larynx.