Interleukin-10 and interleukin-5 balance in patients with active asthma, those in remission, and healthy controls.

BACKGROUND: The immunological mechanisms of asthma remission remain unclear although several reports have suggested that balance between T helper (Th) 2 cytokines and regulatory cytokines is related. OBJECTIVE: To study the balance between interleukin (IL) 10 and IL-5 in asthma clinical remission. METHODS: We measured the numbers of IL-5 and IL-10 producing cells in peripheral blood mononuclear cells stimulated with mite antigen obtained from patients with active asthma (group A, n = 18), patients in clinical remission (group R, n = 15) and nonatopic healthy controls (group H, n = 14). RESULTS: The numbers of IL-5 producing cells in groups A and R were significantly higher than in group H. The number of IL-5 producing cells was lower in group R than in group A, although the difference was not statistically significant. The number of IL-10 producing cells was higher in group R than in group A, although again the difference was not statistically significant. There was a significant difference in the number of IL-10 producing cells between groups A and H but not between groups R and H. The ratio of the number of IL-10 to IL-5 producing cells was highest in group H followed by groups R and A, and the differences were statistically significant for each pair of groups. CONCLUSION: Our study suggests that the IL-10/IL-5 balance is related to clinical asthma. The balance differs between patients in clinical remission and healthy controls, suggesting that allergic inflammation may continue even after clinical asthma remission.

[Landiolol hydrochloride is useful for anesthetic management of cesarean section in a patient with Basedow disease].

We report successful anesthetic management of elective cesarean section in a 30-year-old patient with Basedow disease using landiolol hydrochloride, a short-acting beta-1 adrenergic blocker of which greatest advantages are its short duration of action, rapid clearance and high beta-1 selectivity. The patient received landiolol for the prevention of aggravated tachycardia and tachyarrhythmia during cesarean section. She received landiolol continuous infusion at a rate of 5 microg x kg x min(-1) to 8 microg x kg x min(-1) until the uneventful delivery of the infant with good Apgar score, under combined spinal epidural anesthesia (CESA). We could maintain maternal hemodynamics stable leading to good post-cesarean uterus contraction. No severe adverse effects were observed in the infant. In conculusion, landiolol is useful for maintaining the hemodynamics stable in a pregnant woman with Basedow disease and keeping the infant safe from any adverse effect by infusion of landiolol.

[Elderly patient with non specific multiple ulcer of the small intestine associated with nutritional edema and anemia].

An 83-year-old woman had felt malaise. Blood examination showed renal failure, anemia, and hypoproteinemia. On the 7th day, she suddenly had tarry stool. But, gastroscopy and colonfiberscopy disclosed no remarkable abnormality on the mucosal surface of the stomach, the duodenum and the large intestine. On the 10th day, her symptom became aggravated, and emergency laparotomy and endoscopy in the small intestine was scheduled. After the jejunotomy, she underwent endoscopy of the small intestine. The endoscopic examination showed multiple ulcer of the jejunum, and she underwent jejunectomy. Pathologic examination diagnosed her as having non specific multiple ulcer of the small intestine with jejunal lesion.

[A patient with a huge posterior mediastinal tumor and ST-segment depression in electrocardiogram].

A 68-year-old woman had felt a chest and back pain for 3 months. Gradually her symptom became aggravated, and she felt severe dyspnea in supine position and dysphagia combined with superior vena cava syndrome. A huge posterior mediastinal tumor was revealed and her esophagus was severely narrowed on the chest MRI. Therefore, emergency tumor resection was scheduled under general anesthesia. Anesthesia was induced by midazolam (2 mg) with the patient in the right lateral position. After gas exchange and oxygenation were comfirmed by pulse oximetry reading and clinical signs, she was slowly turned to supine position. But, suddenly, ST-segment depression and low amplitude developed in electrocardiogram and systolic blood pressure was depressed to below 60 mmHg. Therefore, she was rapidly retuned to right lateral position, and ST-segment and systolic blood pressure recoverd. On the next time, although she was slowly turned to the right semi-lateral position, there was almost no circulatory failure. A bronchial tube was intubated in her left bronchia under bronchoscope. We should remember that the preparation of percutaneous cardiopulmonary support (PCPS) should be considered as a means of protection against cardiovascular collapse or airway obstruction perioperatively.