Intratracheal therapy with autologous bone marrow-derived mononuclear cells reduces airway inflammation in horses with recurrent airway obstruction.

This research evaluated the effects of bone marrow-derived mononuclear cells (BMMCs) on the inflammatory process in the equine recurrent airway obstruction (RAO). Eight horses in RAO clinical score were divided into cell therapy group (Gcel) treated with a single intratracheal dose of BMMCs, and dexamethasone group (Gdex) treated with 21days of oral dexamethasone. The horses were clinically revaluated on days 7 and 21, together with cytological evaluation of the BALF, and detection of inflammatory markers (interleukins [IL]-10, -4, and -17, and interferon γ and α). There were decreases in respiratory effort and clinical score on days 7 and 21(p<0.05) for both groups. The percentage of neutrophils decreased and macrophages increased on days 7 and 21 (p<0.005) in both groups. IL-10 levels increased in the Gcel group on day 21 compared to days 0 and 7 (p<0.05), but this was not observed in the Gdex group. The quantification of IL-4, IL-17, IFN-γ, and IFN-α did not change between evaluations in both groups. These preliminary results suggest that BMMCs may ameliorate the inflammatory response of RAO.

Injeções intratimpânicas de gentamicina no tratamento da doença de ménière / Intratympanic gentamicin for treatment of ménière's disease

A vertigem é, na maioria dos casos, o sintoma mais incapacitante dos pacientes com doença de Ménière. Várias medidas terapêuticas têm sido propostas: tratamentos clínicos nas fases iniciais e procedimentos cirúrgicos para pacientes de difícil controle clínico. A administração de gentamicina intratimpânica permite realizar uma "labirintectotnia química seletiva". Trata-se de uma opção de tratamento cuja relação custo/benefício é superior aos procedimentos cirúrgicos. Na paciente aqui descrita, pequenas doses (40 mg) de gentamicina são injetadas na orelha média em intervalos semanais, no total de quatro sessões. A função vestibular é monitorada através de provas calóricas, observando-se um decréscimo das respostas vestibulares. A audição é acompanhada por audiometrias seriadas; qualquer queda audiométrica leva a interrupção imediata do tratamento. Sendo a gentamicina mais vestibulotóxica do que cocleotóxica, é comum observar-se uma manutenção dos níveis auditivos, na maioria cios casos, ou até alguma pequena recuperação, como foi vista no caso descrito. A melhora da sintomatologia labiríntica, acompanhada a médio/longo prazo foi muito evidente na paciente apresentada. A injeção intratimpânica de gentamicina tem se mostrado segura, de simples realização (procedimento ambulatorial) e bastante eficaz no tratamento de quadros vertiginosos de pacientes com Ménière.

Vertigo is the most disabling symptom for most patients with Meniere's disease. Many treatments have been proposed: conservative medical means in the initial phases of the disease and surgical procedures for intractable cases. The intratympanic injection of gentamicin can achieve "selective chemical labirinthectomy". This treatment can offers better risk/benefit outcome than others surgical procedures. Herein we report a patient which was treated with low doses (40 mg) of gentamicin injected in the middle ear, once a week during 4 weeks. Vestibular function was assessed with caloric tests; a reduction in caloric function was noted. Hearing was staged by periodic audiometric tests; treatment is immediately cut if any change occurs in hearing levels. As gentamicin is relatively more vestibulotoxic than cocleotoxic the hearing thresholds do not change in most cases or may be even better as observed in the reported patient. Our patient stated a relief in episodes of vertigo in longer follow-up. Intratympanic gentamicin is safe and simple (office procedure) that is very effective in controlling vertiginous episodes in patients with Ménière.