Sleep apnea due to Kimura's disease of the larynx. Report of a case

Kimura's disease is a benign chronic granulomatous disease which presents as a subcutaneous swelling in the head and neck area. The histopathological feature consists of granuloma-forming lymphoid follicles with eosinophil infiltration. Kimura's disease of the larynx is very rare, and only a few cases have been reported. We report a 14-year-old boy who presented with sleep apnea. Laryngological study revealed a submucosal swelling of the bilateral false vocal cord. Histopathological examination showed lymphoid hyperplasia with marked infiltration of eosinophils, which was diagnosed as Kimura's disease. After laser surgery, he had recurrent swelling of the false cord. The patient was given 30 mg of prednisolone, which was gradually tapered. The laryngeal swelling resolved, and the sleep apnea immediately improved after the treatment. However, a low dose of prednisolone was necessary to maintain the remission. Oral administration of pranlukast successfully supported the tapering of prednisolone.     

New diagnostic approach for ocular tuberculosis by ELISA using the cord factor as antigen

BACKGROUND/AIMS: Diagnosis of ocular tuberculosis is difficult, particularly the retinal vasculitis type, because most cases occur without concurrent active pulmonary tuberculosis. Recently, it has been reported that detection of antibodies against purified cord factor (trehalose-6,6'-dimycolate, TDM), the best studied, most antigenic, and most abundant cell wall component of tubercule bacilli, is very useful for rapid serodiagnosis of pulmonary tuberculosis. In this study, an attempt was made to evaluate whether the detection of anticord factor antibody is also useful for diagnosis of ocular tuberculosis and the necessity of antituberculous therapy for tuberculous retinochoroiditis was discussed. METHODS: Cases consisted of 15 patients with uveitis and retinal vasculitis, nine patients with presumed ocular tuberculosis, three patients with sarcoidosis, and three patients with Beh?et's disease. IgG antibodies against purified cord factor prepared from Mycobacterium tuberculosis H37Rv were detected by enzyme linked immunosorbent assay. RESULTS: All cases of clinically presumed ocular tuberculosis were positive, whereas all of the cases of sarcoidosis or Beh?et's disease were negative for anticord factor antibodies. When the anticord factor antibody titres were compared on the basis of the presence or absence of previous antituberculosis chemotherapy, the mean anticord factor antibody titre of the untreated group showed a tendency to be higher than in the treated group, but not significantly (p=0.07). CONCLUSIONS: The detection of anticord factor antibody may be useful to support the diagnosis of ocular tuberculosis. Additionally, a positive result for anticord factor antibody may indicate that tubercule bacilli are present in some organ(s) of the patient even in the absence of active systemic disease.     

Scopolamine fails to diminish chronic haloperidol-induced purposeless chewing in rats

Chronic haloperidol treatment for 4-12 months gradually induces spontaneous, irregular, purposeless oral chewing movements (CMs), apparently involuntary, in some but not all treated rats. Based on phenomenologic and pharmacologic similarities, this laboratory preparation has been used as an animal model of tardive dyskinesia (TD), which is the human hyperkinetic motor syndrome associated with chronic antipsychotic administration. This putative animal model has received the most severe challenge to its validity by claims that its oral movements can be suppressed by anticholinergic treatments, since resistance to anticholinergic suppression is an accepted pharmacologic feature of TD. In this experiment, we challenged a group of haloperidol-treated rats with CMs using three doses of scopolamine (0.1, 0.3, 1.0 mg/kg) and placebo and rated the change in dyskinetic movements. Each scopolamine dose reduced CMs by a similar magnitude, without any dose effect; the saline dose also reduced CMs to an equivalent degree. Therefore, we concluded that some component of the experiment, not the scopolamine, reduced the CMs. The handling component of the procedure was identified as a likely confound, and we tested this further. Rats with CMs were handled at several levels of "severity"; and the dyskinesias were rated at 1 and 3 h later. CMs were reduced by the experimental handling, in relation to the strength of the handling. Minimal handling produced modest CM reductions with quick recovery; whereas, the "strongest" handling plus the placebo injection produced the greatest CM reduction, evident over 3 h, resembling the CM reductions seen in the scopolamine and placebo experiment. Overall, these results suggest that anticholinergic drugs do not suppress chronic haloperidol-induced rat CMs. However, the movements are sensitive to stressful handling situations, and diminish with stress. In both of these characteristics, rat CMs resemble human TD, further supporting a role for this model in studies of human TD.     

Influence of age on serial change in TL/BMIPP dual isotope SPECT images after direct PTCA in patients with acute myocardial infarction

The purpose of this study was to investigate the influence of age on serial change in 201TlCl (TL) and 123I-BMIPP (BMIPP) dual isotope single photon emission computed tomography (SPECT) images after direct PTCA in patients (pts) with acute myocardial infarction (MI). Dual SPECT with TL and BMIPP at rest, radionuclide ventriculography for left ventricular ejection fraction (LVEF), and two-dimensional echocardiography for wall motion analysis were performed in 26 pts at the subacute and chronic phases after direct PTCA for acute MI. A defect score (DS) for SPECT images was interpreted as normal: 0, mildly decreased: 1, moderately or severely decreased: 2, complete defect: 3. The difference in DS between TL and BMIPP was defined as the mismatch score (MS). DS in BMIPP was greater than that in TL at the subacute phase in all pts. Significant improvement in the wall motion score was recognized in pts who showed TL/BMIPP discrepancy at the subacute phase. Pts were classified by age into two groups; group I: younger than 65 years old (n = 18); group II: 65 years and older (n = 8). Improvement of MS from the subacute to chronic phase was significant in group I (5.2 +/- 1.9 to 3.2 +/- 1.9, p = 0.0001), whereas not significant in group II (6.2 +/- 2.9 to 6.1 +/- 2.9, NS). There was a significant negative correlation between relative MS (ratio of subacute MS to chronic MS) and age (r = -0.78, p < 0.0001). No significant correlation was observed between age and improvement in LVEF. These results indicate that disordered myocardial fatty acid metabolism, reflected by TL/BMIPP discrepancy, persist longer in elderly pts than younger pts after acute MI.     

The Cost-Effectiveness of Lanthanum Carbonate in the Treatment of Hyperphosphatemia in Patients with End-Stage Renal Disease

OBJECTIVE: To assess the cost-effectiveness of lanthanum carbonate (LC) as a second-line therapy for hyperphosphatemia in end-stage renal disease (ESRD) patients not achieving target phosphorus levels. METHODS: A cohort of ESRD patients not adequately maintained on calcium carbonate (CC) and three subgroups of patients with baseline phosphorus levels of 5.6 to 6.5 mg/dl, 6.6 to 7.8 mg/dl, and more than 7.9 mg/dl were modeled. The following policy options were considered: continued CC (Policy 1); LC trial-if successful continue LC, if unsuccessful switch to CC (Policy 2). The survival benefit of using second-line LC to improve phosphorus control has been extrapolated from the relationship between hyperphosphatemia and mortality. Lifetime UK National Health Service drug and monitoring costs, expected survival, and quality-adjusted life-years (QALYs) were examined (discounting at 3.5% per annum). RESULTS: Policy 2 had a cost-effectiveness ratio (cost/QALY) of pound25,033 relative to Policy 1. The results show it is particularly cost-effective to treat patients with phosphorus levels above 6.6 mg/dl. The outcomes did not vary significantly during the one-way sensitivity analysis carried out on important model parameters and assumptions except when the utility value for ESRD was decreased by more than 30%. CONCLUSIONS: Applying a cost-effectiveness threshold of pound30,000 per QALY, the model shows it is cost-effective to follow current treatment guidelines and treat all patients who are not adequately maintained on CC (serum phosphorus above 5.6 mg/dl) with second-line LC. This is particularly the case for patients with serum phosphorus above 6.6 mg/dl. Our estimates are probably conservative as the possible compliance difference in favor of LC and the reduced number of hypercalcemic events with LC relative to CC was not considered.     

Relapse patterns of localized non-Hodgkin's lymphoma of the head and neck after clinical remission: results of a strict follow-up procedure

Background. No effective follow-up strategy for non-Hodgkin's lymphoma (NHL) has been identified to date. The aim of this study was to assess the value of a strict follow-up procedure in patients with NHL after they showed clinical remission. Methods. One hundred and twenty-one patients with localized NHL of the head and neck who had achieved clinical remission after radiation therapy and/or chemotherapy were followed with a strict follow-up strategy (consisting of a schedule of frequent office visits, imaging studies, and blood tests, even if the patient was asymptomatic). Results. Thirty-nine patients relapsed after remission. Twenty-two (56.4%) of the relapses were associated with symptoms. In the 17 patients with asymptomatic relapses (43.6%), an abnormal physical examination result initially indicated relapse in 10 patients. The other tests that initially indicated relapse included scheduled computed tomography scans (3 patients), scheduled gallium scans (2 patients), and serum lactate dehydrogenase levels (2 patients). According to the Ann Arbor stage at relapse, 72.7% of the patients with symptomatic relapses were stage III or IV, while 70.6% of the patients with asymptomatic relapses were stage I or II. Conclusions. These results indicate that a strict follow-up procedure is effective in detecting asymptomatic relapses, which generally involve a smaller tumor load than symptomatic relapses. Received: May 10, 2001 / Accepted: October 26, 2001