Symmetric Bilateral Congenital Middle Ear Cholesteatoma: A Case Report

Congenital middle ear cholesteatoma (CMEC) accounts for 2%-5% of all cases of middle ear cholesteatoma. CMEC is rare and diagnostically challenging; therefore, only a few cases are reported in the literature, and the pathophysiology of this condition remains largely unclear. Currently, epidermoid formation, amniotic fluid contamination, lack of the tympanic ring, and squamous metaplasia are among the mechanisms implicated in the pathogenesis of CMEC; however, no single theory satisfactorily explains the pathophysiology of this disorder. We report a case of CMEC in a young male patient, who showed a symmetric, binaural whitish mass posterior to the anterosuperior quadrant of the tympanic membrane. A few reports have described bilateral CMEC; however, no study has reported symmetrical CMEC as observed in this case. Bilateral tympanoplasty concomitant with cholesteatoma removal was performed, and histopathological evaluation of the resected specimen showed closed-type cholesteatoma. In this report, we describe a rare case of symmetric CMEC, which supports the epidermoid formation theory associated with CMEC, together with a literature review.

Yomogin, Isolated from Artemisia iwayomogi, Inhibits Neuroinflammation Stimulated by Lipopolysaccharide via Regulating MAPK Pathway

Neuroinflammation causes various neurological disorders, including depression and neurodegenerative diseases. Therefore, regulation of neuroinflammation is a promising therapeutic strategy for inflammation-related neurological disorders. This study aimed to investigate whether yomogin, isolated from Artemisia iwayomogi, has anti-neuroinflammatory effects. First, we evaluated the effects of yomogin by assessing pro-inflammatory mediators and cytokines in lipopolysaccharide (LPS)-stimulated BV2 microglial cells. The results showed that yomogin inhibited the increase in neuroinflammatory factors, including nitric oxide, inducible nitric oxide synthase, cyclooxygenase-2, interleukin-6, and tumor necrosis factor-α, and suppressed phosphorylation of c-Jun N-terminal kinase, extracellular signal-regulated kinase and p38, which participate in the mitogen-activated protein kinase (MAPK) pathway. To confirm these effects in vivo, we measured the activation of astrocyte and microglia in LPS-injected mouse brains. Results showed that yomogin treatment decreased astrocyte and microglia activations. Collectively, these results suggest that yomogin suppresses neuroinflammation by regulating the MAPK pathway and it could be a potential candidate for inflammation-mediated neurological diseases.

International classification of abdominal wall planes (ICAP) to describe mesh insertion for ventral hernia repair

BACKGROUND

Nomenclature for mesh insertion during ventral hernia repair is inconsistent and confusing. Several terms, including 'inlay', 'sublay' and 'underlay', can refer to the same anatomical planes in the indexed literature. This frustrates comparisons of surgical practice and may invalidate meta-analyses comparing surgical outcomes. The aim of this study was to establish an international classification of abdominal wall planes.

METHODS

A Delphi study was conducted involving 20 internationally recognized abdominal wall surgeons. Different terms describing anterior abdominal wall planes were identified via literature review and expert consensus. The initial list comprised 59 possible terms. Panellists completed a questionnaire that suggested a list of options for individual abdominal wall planes. Consensus on a term was predefined as occurring if selected by at least 80 per cent of panellists. Terms scoring less than 20 per cent were removed.

RESULTS

Voting started August 2018 and was completed by January 2019. In round 1, 43 terms (73 per cent) were selected by less than 20 per cent of panellists and 37 new terms were suggested, leaving 53 terms for round 2. Four planes reached consensus in round 2, with the terms 'onlay', 'inlay', 'preperitoneal' and 'intraperitoneal'. Thirty-five terms (66 per cent) were selected by less than 20 per cent of panellists and were removed. After round 3, consensus was achieved for 'anterectus', 'interoblique', 'retro-oblique' and 'retromuscular'. Default consensus was achieved for the 'retrorectus' and 'transversalis fascial' planes.

CONCLUSION

Consensus concerning abdominal wall planes was agreed by 20 internationally recognized surgeons. Adoption should improve communication and comparison among surgeons and research studies.

First Report of Leaf Blight Caused by Pantoea agglomerans on Rice in Korea

In September 2009, leaf blights were observed on rice (Oryza sativa L., variety Dongjin 1 and Hopyeong) in paddy fields located in Gwangyang and Naju, Jeonnam Province, Korea. Lesions appeared first as water-soaked stripes or light brown-to-slightly reddish spots on the upper blades of the leaves, ultimately causing leaf blight and stalk rot. Ten strains of bacteria were isolated from the blighted leaf samples and four isolates (EML-ORY1, -ORY2, -ORY3, and -ORY4) suspected to be Pantoea spp. were selected on the basis of colony types and sampling sites. The isolates readily grew at 27 to 32°C but growth was significantly lower at 35°C. Using the API 20E system, EML-ORY1, 2, and 3 showed the same reaction patterns and gave 15 positive reactions whereas EML-ORY4 gave 11 positive reactions, but results were negative for arginine dihydrolase, citrate utilization, sorbitol fermentation, and rhamnose fermentation. All strains were considerably different from Pantoea agglomerans ATCC27155, which produced nine positive reactions. The strains were identified based on the 16S rRNA gene sequence analyses. A neighbor-joining tree was generated for the four isolates using PHYLIP with the following known bacterial strains: P. agglomerans DSM3493; P. vagans LMG24199; P. eucalypti LMG24197; P. ananatis ATCC19321; and Kluyvera georgiana ATCC51603. The four isolates from rice formed a monophyletic cluster and were most closely related to P. agglomerans DSM3493 (GenBank AJ2334231) with an average 16S rRNA sequence similarity of 99.0%. GenBank Accession numbers for the four isolates are: EML-ORY1, HM854282; -ORY2, HM854283; -ORY3, HM854284; and -ORY4, HM854285. On the basis of molecular phylogenetic analyses and API 20E test, we determined that the causal pathogen might be a subspecies of P. agglomerans. Pathogenicity tests were performed on 2-week-old rice seedlings (variety Hopyeong) in duplicate with bacterial suspensions containing 1.5 × 10⁹ CFU/ml with 0.001% Tween 20. Of the isolates, EML-ORY3 demonstrated the strongest pathogenicity to rice seedlings when evaluated by five scoring systems on the basis of symptom development and severity levels. Disease symptoms appeared 3 days after artificial inoculation. Symptoms on the inoculated leaves were similar to those of natural infection and included water-soaked stems with a light brown color, blighted leaves, and stalk rot, with no symptoms found on water-treated controls. P. agglomerans, formerly called Enterobacter agglomerans (or Erwinia herbicola), is a group of gram-negative bacteria that belong to the family Enterobacteriaceae (3). Pantoea spp. are known to cause different diseases on a broad range of host plants including gypsophila, cotton, pineapple, maize, barley, onion, melons, and eucalyptus and also have been implicated as opportunistic pathogens in humans (1,2). P. agglomerans has been widely found in nature on leaves, fruits, and the seeds of many crops and is a known endophyte (1,2). To our knowledge, this is the first report of rice leaf blight caused by a putative subspecies of P. agglomerans in Korea. The importance of this pathogen to rice production in Korea is unknown. References: (1) Y. Feng et al. J. Appl. Microbiol. 100:938, 2006. (2) S. Manulis and I. Barash. Mol. Plant Pathol. 4:307, 2003. (3) M. P. Starr. The genus Erwinia. Page 1260 in: The Prokaryotes: A Handbook on Habitats, Isolation and Identification of Bacteria. Springer-Verlag, NewYork, 1981.

First Report of Powdery Mildew on Trident Maple Caused by Sawadaea nankinensis in Korea

Trident maple (Acer buergerianum Miq.) is widely grown in Korea as an ornamental tree as well as for the art of bonsai. During 2008 and 2009, a powdery mildew was observed on trident maple plants at the campus of Chonnam National University, Gwangju, Korea. Further surveys revealed the disease to be widespread on this species in other areas including Jeonbuk and Chungnam provinces in Korea. White, superficial mycelia were observed on young shoots and leaves early in spring. Both macroconidia and microconidia were produced beginning in May and conidial production continued through the summer into September and October. Production of chasmothecia was observed starting in September and continued into October. Macroconidia were produced in chains that were sinuate in outline. Individual macroconidia were barrel shaped and 23.4 to 30.0 (26.6) × 15.6 to 21.1 (18.1) μm. Foot cells of macroconidial conidiophores were 26.7 to 110.7 (48) × 7.1 to 11.2 (8.8) μm with one to five following cells. Microconidia were broadly ellipsoidal to subglobose and 8.9 to 12.5 (10.5) × 4.3 to 5.8 (5.1) μm. Chasmothecia typically were formed on adaxial leaf surfaces and 193.2 to 238.1 (216.8) μm in diameter. Appendages bore uncinate to circinate apices and were 176.8 to 267.7 (211.5) × 4.3 to 8.0 (6.2) μm. From extracted genomic DNA, internal transcribed spacer (ITS) region inclusive of 5.8S rDNA was amplified with ITS1F (5'-CTTGGTCATTTAGAGGAAGT-3') and LR5F (5'-GCTATCCTGAGGGAAAC-3') primers. The causal fungus was determined to be Sawadaea nankinensis (F.L. Tai) S. Takam. & U. Braun (2) on the basis of morphological data and ITS rDNA sequences. A BLAST search of GenBank with an ITS sequence from this fungus determined that the five sequences exhibiting the highest max score values (1,811 to 2,004) were from S. nankinensis; these sequences produced max ident values from 94% to 99%. In contrast, max score and max ident values from sequences of other Sawadaea spp. were lower, including scores of 1,063 and 98% similarity for S. polyfida var. japonica, 915 and 97% for S. tulasnei, and 913 and 97% for S. bicornis. Pathogenicity tests were conducted on field-grown plants in two replicates. These plants were inoculated with a paintbrush to apply conidia (~5 × 10⁶/ml) collected from powdery-mildew-infected leaves. Inoculated plants developed powdery mildew symptoms within 5 days of inoculation and resembled those observed on naturally infected plants. S. nankinensis (synonym Uncinula nankinensis) was first reported on A. buergerianum from China in 1930 (2). Recently, S. nankinensis (F.L. Tai) S. Takam & U. Braun was reported to occur on A. buergerianum in Japan (3). Until now, three Sawadaea spp. (S. bicornis (Wallr.) Homma, S. negundinis Homma, and S. tulasnei (Fuckel) Homma) have been reported to cause powdery mildew on A. ginnala, but only S. bicornis (= U. circinata Cooke & Peck) has been reported to cause powdery mildew on A. ginnala in Korea (1). However, no Sawadaea sp. previously was reported to cause powdery mildew on A. buergerianum. To our knowledge, this is the first report of powdery mildew on trident maple (A. buergerianum) caused by S. nankinensis in Korea. References: (1) H. D. Shin. Erysiphaceae of Korea. National Institute of Agricultural Science and Technology, 2000. (2) F. L. Tai. Page 1517 in: Sylloge Fungorum Sinicorum. Science Press, Academia Sinica, Peking, 1979. (3) S. Takamatsu et al. Mycoscience 49:161, 2008.

Recombinant human epidermal growth factor treatment of radiation-induced severe oral mucositis in patients with head and neck malignancies

Mucositis of the oral cavity and pharynx is a major dose-limiting factor in the application of radiotherapy (RT) to patients with head and neck cancer. Therefore, we evaluated the wound healing effect of human recombinant epidermal growth factor (rhEGF) in head and neck cancer and lymphoma patients with irradiation (with or without combined chemotherapy-induced oral mucositis). Patients at Asan Medical Center who had undergone definitive RT of the head and neck region with or without combined chemotherapy and who had developed severe oral mucositis (higher than the Radiation Therapy Oncology Group grade 3) were treated with topical rhEGF twice daily for 7 days. The evaluation of response with regard to oral mucositis was performed 1 week later. Of the 11 treated patients, three had nasopharyngeal carcinoma, three had carcinoma of the oropharynx, two had carcinoma of the oral cavity, one had carcinoma of the hypopharynx and two had lymphoma of the head and neck. Six patients received RT only, and five patients received concurrent chemoradiotherapy. All patients showed improvements in their oral mucositis after topical treatment with rhEGF in that the Radiation Therapy Oncology Group grade was significantly decreased (P = 0.0000). This finding suggests that rhEGF is effective and safe for the treatment of radiation-induced mucositis. Further studies are needed to determine the optimal dosage and fractionation schedule.

Controlled growth of vertically aligned ZnO nanowires with different crystal orientation of the ZnO seed layer

A novel synthesis and growth method achieving vertically aligned zinc oxide (ZnO) nanowires on a silicon dioxide (SiO(2)) coated silicon (Si) substrate is demonstrated. The growth direction of the ZnO nanowires is determined by the crystal structure of the ZnO seed layer, which is formed by the oxidation of a DC-sputtered Zn film. The [002] crystal direction of the seed layer is dominant under optimized thickness of the Zn film and thermal treatment. Vertically aligned ZnO nanowires on SiO(2) coated Si substrate are realized from the appropriately thick oxidized Zn seed layer by a vapor-solid growth mechanism by catalyst-free thermal chemical vapor deposition (CVD). These experimental results raise the possibility of using the nanowires as functional blocks for high-density integration systems and/or photonic applications.

Percutaneous direct puncture glue embolization of high-flow craniofacial arteriovenous lesions: a new circular ring compression device with a beveled edge

SUMMARY

The purpose of this study was to evaluate the efficacy of a newly designed circular ring compression device that allows safe and effective glue injection during preoperative embolization of high-flow superficial craniofacial arteriovenous malformations (AVMs). The device was used in 4 cases of craniofacial AVM with multiple feeding arteries and draining veins. It provided a safe glue injection route as well as effective compression of radiating multiple venous drainage routes.

Solitary fibrous tumour of the face: a rare case report

Solitary fibrous tumour is a rare mesenchymal neoplasm that most commonly involves the pleura. The diagnosis of solitary fibrous tumour is primarily histological. It consists of histological and positive immunohistochemical findings of CD-34 and vimentin. Recently, solitary fibrous tumour has been reported to occur in extrapleural soft tissues, such as the orbit, nasal cavity, abdominal cavity, parotid gland, scalp and neck. In an extensive review of the literature, we found no reports of solitary fibrous tumour arising in the facial soft tissue, other than in the parotid gland. This rare location of an uncommon lesion can lead to a confusing diagnosis. We report a case of solitary fibrous tumour originating in the temporal region of the face, and call for awareness of this tumour among plastic surgeons.

Sensate sole-to-sole reconstruction using the combined medial plantar and medialis pedis free flap

The coverage of soft-tissue defects of the sole needs special consideration because of the forces of weight bearing on the reconstruction. A variety of free tissue transfers have been advocated for soft-tissue replacement of the weight-bearing portions. However, there is no doubt that the ideal tissue for resurfacing the sole is the plantar tissue itself. The authors present a case of reconstructing the sole with the combined medial plantar and medialis pedis free flap that involves approximately 70% of the weight-bearing portion. This contralateral, combined fasciocutaneous free flap based on the posterior tibial-medial plantar vascular system is a good alternative in covering extensive sole injuries.

The effect of prostaglandin E1 versus ischemia-reperfusion injury of musculocutaneous flaps

The purpose of this study was twofold. To evaluate whether prostaglandin El can increase the survival of the flap, and to determine its function against ischemia-reperfusion injury in musculocutaneous flaps. Thirty-five Sprague-Dawley rats weighing 250 to 350 g were analyzed. The transverse rectus abdominis musculocutaneous flap was used in all rats. The rats were divided into three groups: group 1 (N = 15), the control group with 4-hour ischemic injury and intraflap injection of normal saline followed by reperfusion; group 2 (N = 15), prostaglandin E1 intraflap injection of 1 microg immediately after ischemic injury and reperfusion 4 hours later; and group 3 (N = 5), the sham-operated group. Analysis consisted of flap skin survival area measurements, immunohistochemical study using anti-intercellular adhesion molecule (anti-ICAM-1) monoclonal antibody, and histological evaluation including endothelium-sticking leukocytes at 24 hours and 5 days after reperfusion. The group treated with prostaglandin E1 showed immunohistochemical findings with decreased expression of ICAM-1 on the surface of the endothelium, and histology showed significant (p < 0.01) reduction of leukocyte adhesion at 24 hours and 5 days after reperfusion. These two factors were considered to play a role against ischemia-reperfusion injury, and led to improved survival of the flap. These results suggest that prostaglandin E1 may increase flap survival and may have a protective mechanism against ischemia-reperfusion injury by decreasing leukocyte-endothelial cell adhesion through decreased expression of ICAM-1.

A vascularized osteocutaneous fibular free flap for reconstruction of a complex injury of the foot

The foot plays a vital role in standing and gait. Its function results from harmonious interaction of bones, joints, and soft tissue. An imbalance or a defect in these structures can result in problems. The cuneiform bone of the foot consists of three bones: medial, intermediate, and lateral. Its structure plays an important role in maintaining the skeletal arch and it supports the body's weight. A defect or dislocation can disrupt the distribution of the weight-bearing complex of the foot and can lead to difficult gait.

A quantitative evaluation of pigmented skin lesions using the L*a*b* color coordinates

The evaluation of pigmentary skin lesions by clinical doctors has been based on subjective and qualitative judgements. Observations have mostly relied on visual inspection, making the effects of treatment difficult to evaluate with any precision. For this reason there is a real need for an objective method to evaluate prognosis after treatment. Recent scientific measurements such as reflectance spectrophotometry and reflectance colorimetry have provided accurate quantitative color information about skin lesions, but these techniques are costly and difficult to apply in the clinical field. The purpose of this study was to develop a simple and cost-effective way of evaluating treatment results. We have developed a software program using the L*a*b* color coordinate system to quantify the effect of treatment and have successfully demonstrated its clinical usefulness. Our method compares the relative color difference between normal skin and skin lesions before and after treatment, instead of measuring the absolute color of skin lesions. The accuracy of our quantitative color analysis was confirmed by the simulated images of hemangioma and ota nevus. Clinical efficacy was also confirmed through a blind test involving 3 clinicians who were asked to grade the treatment effects of 13 cases of hemangioma and 7 cases of ota nevus. These subjective clinical grades correlated well with the treatment results obtained using the proposed color analysis system (Correlation coefficient = 0.84).

Orbital floor and infraorbital rim reconstruction after total maxillectomy using a vascularized calvarial bone flap

A number of techniques have been introduced to support the orbital floor after maxillectomy without orbital exenteration. These methods include skin graft or muscular sling, but they have resulted in severe complications, such as enophthalmos, global ptosis, diplopia, and facial deformity. Currently, advanced microvascular reconstruction using bone and soft tissue is performed by many surgeons. This usually results in the filling of the postmaxillectomy defect, but the lack of support for the orbital rim and floor by the bone flap may still cause the complications mentioned above. Vascularized calvarial bone flap was chosen in this study for reconstruction of the orbital floor and infraorbital rim to function as a buttress, to reconstruct recipient sites of poor vascular bed after radiation therapy, and to withstand further postoperative radiation. By providing a solid floor and rim, these complications can be prevented with satisfactory function and aesthetically acceptable results. From September of 1995 to July of 1998, we performed vascularized bone flap for the reconstruction of the orbital floor and infraorbital rim in four cases after total maxillectomy involving the orbital floor. With a follow-up period from 19 to 35 months (mean, 27 months), we obtained significant improvement of functional and aesthetically acceptable results without global ptosis, enophthalmos, diplopia, or severe facial contour deformity.

Clinical features and outcome of Acanthamoeba keratitis

We retrospectively reviewed 11 patients with culture-proven Acanthamoeba keratitis who presented at the National Taiwan University Hospital between 1989 and 1996. We assessed predisposing factors, initial diagnosis, clinical presentation, treatment, and outcome. A history of contact lens-wear, poor contact lens hygiene, intractable eye pain, and ring infiltrates in the cornea were the most prominent characteristics and clinical manifestations. Acanthamoeba keratitis was often misdiagnosed, with herpetic keratitis (7/11) being the most common initial diagnosis from referring hospitals. These patients were usually treated on the basis of the inaccurate diagnosis for more than 1 month (range 1-8 mo) before referral. All patients ultimately received penetrating keratoplasty because of poor response to delayed medical treatment. We suggest that inadequate contact lens hygiene may be important in Acanthamoeba keratitis. This condition is often misdiagnosed and, as early diagnosis is a major factor for successful medical treatment in such patients, awareness in clinical practice is critical.

Effects of pulsatile reperfusion on globally ischemic myocardium

To evaluate the effects of pulsatile reperfusion on the post ischemic myocardium, two categories of sheep were put on cardiopulmonary bypass (CPB). In Category I, the hearts of 23 sheep were arrested by global ischemia for 30 min, reperfused with pulsatile flow in 10 animals (P group), and non pulsatile flow in 13 animals (NP group), and then defibrillated. The incidence of ventricular fibrillation was much higher in the NP group than the P group, 77% versus 40% (p < 0.05). The lipoperoxide products and creatinine kinase from coronary sinus blood were elevated, but there were no significant differences between the two groups during 2 hour reperfusion. In the P group, less ultrastructural damage was observed, and Na+ and H2O accumulations in the subendomyocardium were significantly less than in the NP group, at 7.11 +/- 0.60 versus 9.98 +/- 1.10 mg/g dry weight (p < 0.05) and 82.58 +/- 0.47% versus 84.3 +/- 0.38% (p < 0.05), respectively. In Category II, the ischemic time of 17 sheep (eight in the P group, nine in the NP group) was prolonged to 45 min, and animals were supported by CPB after defibrillation. Myocardial energy phosphates were measured with high-performance liquid chromatography, and triphenyltetrazolium chloride was used to delineate the infarct size. After 2 hour of reperfusion, there were no significant differences in myocardial AMP and ADP between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of pulsatile reperfusion on myocardial high energy phosphates following global ischemia

To evaluate the effects of pulsatile reperfusion (PR) on the postischemic myocardial phosphometabolites, 17 sheep were put on cardiopulmonary bypass (CPB) and randomly divided into a pulsatile group (P group) and nonpulsatile group (NP group). The heart was arrested by global ischemia for 45 minutes, then defibrillated and reperfused for 2 hours while the circulation was supported by CPB. Myocardial needle biopsies were obtained, and ATP, ADP, and AMP were measured with high performance liquid chromatography. There were no significant differences between the two groups in myocardial ADP and AMP. However, after 120 minutes of reperfusion, the myocardial ATP was restored in the P group, but continued to decrease further in the NP group. Experimental results imply that PR might reduce reperfusion injury and promote recovery of the ischemic myocardium.