Successful long-term management of late-stage precursor-targeted immune-mediated anemia with prednisolone and mycophenolate mofetil in a dog

A 13-year-old neutered male Maltese dog presented to our hospital with lethargy and anorexia. Laboratory abnormalities included severe non-regenerative anemia (hematocrit, 12.9%; reticulocyte count 12.8 K/μL). The cytology of bone marrow revealed erythroid hypercellularity with mild myelofibrosis. Therefore, late-stage precursor-targeted immune-mediated anemia (PIMA) was diagnosed. Multimodal treatment including 2 immunosuppressant drugs (prednisolone and mycophenolate mofetil), antithrombic drug (clopidogrel), and blood transfusion was performed. The dog showed complete remission from PIMA, and the total duration of follow-up was 622 days. This is the first case report of canine PIMA managed successfully with prednisolone and mycophenolate mofetil in Korea.

Expression of Matrix Metalloproteinase-2/-9 in Nasal Polyp and Antrochoanal Polyp / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nasal polyp (NP) and antrochoanal polyp (ACP) are soft tissue masses, featuring chronic inflammation and tissue remodeling. To elucidate the mechanism of tissue remodeling, we investigated the expressions of matrix metalloproteinase-2 (MMP-2) and MMP-9 in ACP and NP and compared them with normal inferior turbinate mucosa. SUBJECTS AND METHOD: Nasal samples, obtained from controls (n=10), from ACP (n=10) and from NP (n=13), were analysed by immunohistochemistry. MMP-2/-9 expression was identified in epithelial, endothelial, gland, inflammatory cells. We assessed MMP-2/-9 immunoreactivity of ACP and NP in comparison with the normal inferior turbinate. The number of immunostained inflammatory cells were determined. RESULTS: In ACP, compared with controls, the MMP-2 expression was increased in vessel endothelium, while the MMP-9 expression was increased in vessel endothelium and inflammatory cells. In NP, compared with controls, increased expression of MMP-9 was observed in gland and inflammatory cells. CONCLUSION: ACP showed increased expression of MMP-2/-9, while NP showed increased expression of MMP-9. It is concluded that MMP-2/-9 in ACP and MMP-9 in NP may play a role in tissue remodeling.

A Case of Multiple Vasculitis and Stroke due to Sphenoid Sinusitis / 대한이비인후과학회지

Sinogenic intracranial complications are rare but serious conditions. Sometimes, the diagnosis is delayed because the initial symptoms of sphenoid sinuses intracranial complications are not remarkable especially when they are of sphenoid sinus origin. Deep location of the sphenoid sinuses places them adjacent to the dura mater, major intracranial vessels, and some cranial nerves. Therefore, delayed diagnosis of the sphenoid sinusitis and its complications can make disastrous results. We experienced a 55 year old female patient who developed fulminant meningitis, vasculitis, and a stroke due to vasculitis as a complication of sphenoid sinusitis. We review the case and related articles.

Effect of Ventilation Tube Insertion on the Quality of Life / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Traditionally, the treatment results after ventilation tube insertion (VTI) in otitis media with effusion (OME) have been reported using the objective measures such as the changes in hearing levels, the recurrence rate of OME and the occurrence rate of tympanic membrane sequelae. This present study was to determine the effect of VTI on the quality of life (QOL) in patients of OME after the surgery. MATERIALS AND METHOD: Sixty-nine children with OME were included. For the measurement of QOL, the study was performed using questionnaires including six items such as physical suffering, hearing loss, speech impairment, emotional distress, activity limitations and care-provider concerns. We questioned the parents of the patiens on these items pre-operatively and at least one month after VTI. Test-retest reliability was determined by reviewing the results of the repeated questionnaires within 7 days in the subgroup of patients with stabilized status. The effect of VTI was determined by the standardized response mean (SRM), which is defined as the mean change score divided by standard deviation. SRM of less than 0.5 was defined as small effectiveness: greater than 0.5 but less than 0.8 as moderate effectiveness; greater than 0.8 as large effectiveness. RESULTS: Individual items of the questionnaire showed excellent test-retest reliability. The median of the preoperative QOL score was 4.1. The median change of the QOL scores after VTI was 2.4, with a SRM of 0.77 (95% confidence interval 0.54-0.99), indicating moderate effectiveness. The QOL scores of the items regarding hearing loss, care-provider concerns and physical suffering showed greater changes after VTI than those of other items. Among the items, those regarding speech impairment showed least change. CONCLUSION: VTI resulted in the improvement of QOL in most patients. Measurement of QOL could be a reliable test to study the effect of VTI in OME patients.

The Relationship between Functional Recovery and Reorganization of Nucleus Ambiguus Following Laryngeal Reinnervation in Rats / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Ideally, treatment for vocal cord paralysis should restore normal physiologic and dynamic movement of the vocal fold. Recently, numerous studies of laryngeal reinnervation have been designed to restore function of the paralyzed larynx. None of these approaches have been consistently successful, probably due to synkinesis and an inadequate number of regenerated axons. In previous study, we confirmed the efficacy of PEMS on the early functional recovery in rats with surgically transected and reanastomosed recurrent laryngeal nerve. In this study, the relationship between functional recovery and reorganization of nucleus ambiguus following laryngeal reinnervation in rats was evaluated by retrograde double tracing technique and electron microscope. MATERIALS AND METHOD: Transections and primary anastomosis were done on left recurrent laryngeal nerves of 86 healthy male Sprague-Dawley rats. Rats were then randomly assigned to 2 groups (the group A: stimulation with PEMS, the group B: non-stimulation with PEMS). Functionally recovered status was confirmed with laryngo-videostroboscopy and laryngeal EMG. And then, functional reorganization of laryngeal motoneuron in the nucleus ambiguus (NA) was evaluated using retrograde double tracing techniques. Morphological changes of the degeneration and regeneration processes following injury was observed by electron microscopy. RESULTS: 20 rats (63%) in group A and 5 rats (17%) in the group B showed recovery of vocal fold motion. The functional reorganization of laryngeal motor neurons in the NA was observed in the rats with functional recovery (n=8), but not in the rats without functional recovery (n=8). In the electron microscopic finding, the nerve fibers of functional recovered rats were relatively well regenerated. But the configuration of the nerve fibers of non-functionally recovered rats was markedly irregular and the total axon population was smaller than that of the recovered rats, except for some cases. CONCLUSION: This study shows that failure of functional recovery of vocal fold movement following laryngeal reinnervation is probably due to not only the misdirected reinnervation, but also the incomplete axonal regeneration.

The Effects of Pulsed Electromagnetic Stimulation on Functional Recovery Following Laryngeal Reinnervation in the Rat / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Ideal treatment for vocal cord paralysis is to restore normal movement of the vocal cord and to bring back the natural voice. Pulsed electromagnetic stimulation (PEMS)has been known to bring early nerve regeneration as well as better functional recovery. The purpose of this investigation is to learn the effect of PEMS on regeneration of the recurrent laryngeal nerve. MATERIALS AND METHOD: Using 36 healthy male Sprague-Dawley rats, we made transections on their left recurrent laryngeal nerves and performed primary anastomosis under the operating microscope. Rats were divided into an experimental group and a control group, each having 18 rats by random sampling. For the experimental group, PEMS was carried out three hours a day and five days a week for twelve weeks. For the control group, PEMS was not given while other conditions were kept the same as in the experimental group. The extent of functional recovery was observed for each group by performing videostroboscopic examination once every week. After twelve weeks, a test for the functional recovery was performed electrophysiologically through laryngeal electromyography during respiration. RESULTS: After the twelve-week experiment, 14 out of 18 rats survived in the group which received PEMS while 8 out of 18 rats stayed alive in the control group. Ten rats (71%)in the PEMS performed group and 3 rats (38%)in the control group showed recovery of vocal cord movement, but it did not reveal any significant difference statistically. However, the time it took for functional recovery was 3.93+/-0.27 weeks and 7.87+/-0.85 weeks for the PEMS performed group and the control group, respectively. And the difference was statistically significant. CONCLUSION: This investigation confirmed the efficacy of PEMS on the early functional recovery in rats with surgically transected and reanastomosed recurrent laryngeal nerve. Further studies to understand the mechanism of action of these effects as well as the local stimulation rather than the total body stimulation seem to be necessary.

Effects of Pseudomonas Aeruginosa Infection and Mechanical Trauma to the Sinus Mucosa on Polyp Formation in the Rabbit Maxillary Sinuses

The aim of this study is to develop an animal model of polyps that is more suitable for further polyp studies by semiquantitatively analyzing the effects of Pseudomonas aeruginosa infection and/or mechanical trauma to the sinus mucosa, based on the epithelial rupture theory, on polyp formation in the rabbit maxillary sinuses. The natural ostia were occluded in 30 Pasturellafree New Zealand white rabbits. All rabbits were divided into three groups according to the following modes of manipulation on the right maxillary sinus: inoculation with P. aeruginosa (group A), brushing of the sinus mucosa (group B), and inoculation with P. aeruginosa accompanied by brushing of the mucosa (group C). The left maxillary sinuses were used as the control. After four weeks, macroscopic polyps and light microscopic polyps and/or polypoid mucosa were semiquantitatively analyzed. The number of macroscopic polyps per sinus was significantly larger in groups A (1.0 polyps) and C (1.3 polyps) than in group B (0.0 polyps). Microscopic examination revealed significantly higher levels of polyps and/or polypoid mucosa in groups A and C than in group B. The results of this study suggest that a rabbit model of polyps using P. aeruginosa is suitable for further polyp studies and that induction of this type of model needs no mechanical trauma to the sinus mucosa.

Significance of Caloric Test in Reversed Position / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Caloric nystagmus has been known since a century ago, and the thermal convection theory proposed by Barany has been widely accepted. Gravity plays an important role in thermal convection. In 1984, caloric nystagmus was reported in weightless space environments and although the response was weak, the nystagmus was found to occur in the same direction as the earth. This implies that factors other than thermal convection might participate in the caloric nystagmus. MATERIALS AND METHODS: Using 50 normal ears as subjects, this study compared the responses of conventional caloric test and reversed caloric test, which places the plane of the lateral semicircular canal upside down. RESULTS: The direction of the nystagmus was reversed, and the maximal slow phase velocity was decreased compared to that of the normal caloric test. CONCLUSION: The reversed direction of the nystagmus observed in this study basically supports the theory by Barany, however, the differences that are noted implicate that other factors with a certain direction maybe involved.

Effects of Mechanical Trauma to the Sinus Mucosa on Polyp Formation in Induction of Maxillary Sinusitis in Rabbits by Streptococcus Pneumoniae / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Pathogenesis, definition, and treatment of sinonasal polyps remain uncertain. To elucidate them, many studies on polyps have been made. However, recently reported studies on polyps using animal models seldom provided comparative data on polyp formation in various conditions. The aim of this study is to develop an animal model of polyps which is more suitable for further polyp studies. We attempted a semiquantitative analysis on the effects of mechnical trauma to the sinus mucosa on formation of polyps and polypoid mucosa in duction of rabbit maxillary sinusitis by Streptococcus pneumoniae and compared the prevalences of polyps under the different conditions. MATERIALS AND METHODS: The natural ostia of both sinuses were occluded in 10 Pasturella-free New Zealand white rabbits. Both sinuses were inoculated with S. pneumoniae, without brushing the mucosa in the left maxillary sinuses (control group) and with brushing in the right sinuses (experimental group). After four weeks, all sinuses were re-opened. Macroscopic polyp and light microscopic polyps and/or polypoid mucosa were semiquantitatively analyzed and each prevalence was compared between the two groups. RESULTS: The number of macroscopic polyps per sinus was significantly larger in the experimental group (1.1 polyps) than that in the control group (0.1 polyps). Microscopic examination revealed significantly more polyps and/or polypoid mucosa in the experimental group than in the control group. CONCLUSIONS: Our results suggest that mechanically traumatizing the sinus mucosa, such as brushing, is more helpful to polyp formation when a rabbit model of polyps is to be induced by S. pneumoniae.

A Case of Bilateral Internal Jugular Phlebectasia / 대한이비인후과학회지

Phlebectasia is an abnormal dilatation of an isolated vein and a rare venous anomaly and is usually asymptomatic. Internal jugular phlebectasia is a localized, nonpulsatile, nontender, compressible, and saccular or fusiform dilatation that enlarges with Valsalva maneuver, sneezing, coughing and straining which increases intrathoracic pressure. Internal jugular phlebectasia predominantly affects young children and its etiology is idiopathic in most cases, but several predisposing factors have been suggested. Although histopathological findings of most cases had no significant abnormality, those of some cases showed elastic dysplasia, focal intimal thickening and muscular defect within the wall of the vein. A swelling in the neck which enlarges with Valsalva maneuver must be differentiated from other diseases. Internal jugular phlebectasia is most likely to be mistaken for laryngocele, superior mediastinal cyst or branchial cleft cyst. Diagnosis should be as non-invasive as possible because no treatment is indicated for this benign self-limiting condition. We present a case of bilateral internal jugular phlebectasia of which diagnosis was made by sonography with doppler technique and neck CT.