Laryngopharyngeal reflux

Laryngopharyngeal reflux (LPR) or reflux laryngitis refers to the backflow of stomach contents into the larynx and hypopharynx. LPR is increasingly cited as the cause of laryngeal signs and symptoms such as globus sensation, hoarseness, chronic cough, chronic throat clearing, and throat pain. The diagnosis of LPR is often based on the presenting symptoms and associated laryngeal signs. An empiric trial of double-dose proton pump inhibitors (PPIs) has been recommended as a first line therapy in patients with suspected LPR. However, recent systemic review has shown no benefit of PPIs over placebo in the treatment of LPR. Clearly, more well designed, prospective large scale trials are warranted in the future.     

A case of sigmoid colon cancer with temporary dysarthria associated with irinotecan

A40 -year-old woman visited our hospital with adenocaricinoma of the sigmoid colon with multiple liver metastases and ovarian metastasis. Because of a stenosis of the primary tumor, she underwent a colostomy before chemotherapy. 5-fluorouracil and irinotecan and leucovorin(FOLFIRI)was selected as first-line chemotherapy. At the start of chemotherapy, just after the end of irinotecan and leucovorin administration, the patient developed dysarthria. There were no neurological abnormalities or hematological abnormalities. The treatment was temporarily discontinued, and the dysarthria completely disappeared within 90 minutes. 5-fluorouracil was administered after the disappearance of dysarthria. Within 60 minutes of the administration of irinotecan and leucovorin at the second chemotherapy treatment, the patient developed dysarthria again. The patient had no neurological or hematological abnormalities. Magnetic resonance imaging(MRI)showed no abnormalities. The treatment was stopped and dysarthria disappeared within 60 minutes as it did the first time. At each time, no treatment for dysarthria was performed. This patient refused to continue irinotecan because of dysarthria. Therefore, chemotherapy without irinotecan was continued for the third time onward. In the previous literature, 8 cases of dysarthria caused by irinotecan were reported as a rare toxicity. In all cases, dysarthria was temporary and reversible. Because the mechanism of dysarthria is unclear, specific treatment and precaution for dysarthria is not recommended. Since dysarthria is reversible, however, irinotecan might be continued until progression.     

The signaling mechanism of glucocorticoid-induced T-cell apoptosis

Glucocorticoid-induced T-cell apoptosis is supposed to require the change of gene expression. Enhanced expression of proapoptotic gene or inhibited expression of antiapoptotic gene seems to be necessary, although the real target gene remain to be elucidated. Recently, it was reported that extracellular signal-regulated protein kinase (ERK) inhibits glucocorticoid-induced T-cell apoptosis. This finding might provide new tools for overcoming glucocorticoid-resistance.