Upper airway obstruction by epiglottis and arytenoids hematoma in a patient treated with warfarin sodium.

With the increase in the number of patients undergoing warfarin therapy, reports of complications due to such therapy have become frequent. Although upper airway obstruction secondary to bleeding resulting from warfarin therapy is rare, it is a life-threatening complication because of the risk of airway obstruction. Only one previous case of hematoma of the epiglottis and arytenoids has been reported. We here in report a case of an 83-year-old woman on warfarin therapy who presented with a sore throat. On flexible nasoendoscopy, edema of the epiglottis and bilateral arytenoids with a red and purple hue were observed. The left true vocal cord was erythematous, but the airway was adequately maintained. The PT-INR of the patient was 10. She was managed conservatively and had a good course.

Analysis of the comorbidity of bronchial asthma and allergic rhinitis by questionnaire in 10,009 patients.

BACKGROUND: Bronchial asthma (BA) and allergic rhinitis (AR) are thought to share a common pathogenesis. However, reports concerning the comorbidity of the two diseases in a large-scaled population are rare in Japan. In the present study, we performed an analysis on the two diseases using questionnaires that addressed the diagnosis, symptoms and period of occurrence in more than 10,000 patients with BA or AR. METHODS: Patients with BA (adult: n = 2,781, childhood: n = 3,283) and AR (n = 3,945) were enrolled in the present study during the 3 months from August 1, 2006 to October 31, 2006. RESULTS: Sixty one percent of the patients with adult BA showed symptoms of AR. Among them, 68% of the patients were diagnosed with AR. Among the patients with childhood BA, 68% showed AR symptoms and 60% were diagnosed with AR. On the other hand, 49% of AR patients showed BA symptoms and 35% of them were diagnosed with BA. The symptoms of both BA and AR in the BA and AR patients were frequent in two seasons, March and April, and September and October. In addition, BA and AR symptoms often co-occurred in the patients with BA and AR. CONCLUSIONS: Comorbidity of BA and AR was high in both populations of BA and AR. The symptoms of both BA and AR co-occurred on both a daily and seasonal basis. These results suggested that BA and AR share a common immuno-pathogenesis in the airway and need to be treated as a single airway disease.

I(sK) Channel in Strial Marginal Cells. Voltage-Dependence, Ion-Selectivity, Inhibition by 293B and Sensitivity to Clofilium.

Strial marginal cells (SMC) and vestibular dark cells (VDC) are known to secrete K(+) into endolymph. Slowly-activating, voltage-dependent K(+) channels (KCNQ1/KCNE1; IsK; min K) have been identified in the apical membrane of these cells. Several experimental maneuvers known to increase or decrease transepithelial K(+) secretion have been found in VDC to change the current through these channels in the same ways. In both SMC and VDC the kinetics of activation and deactivation resemble those of the I(sK) channel exogenously expressed in Xenopus oocytes and endogenous to heart myocytes. The present study sought evidence that this current is indeed carried by I(sK) channels and that this current is the basis for transepithelial K(+) secretion. Both on-cell macro-patch recordings of the apical membrane and perforated-patch whole-cell recordings were made on SMC from gerbil in order to measure macroscopic cell currents. The on-cell current was found to 1) be K(+)-selective, 2) have a cation permeability sequence of K(+) ~ Rb(+) > Cs(+) >> Li(+) = Na(+), 3) be activated with a time constant of 1764 ± 413 ms by voltage steps from 0 to +40 mV, 4) be deactivated with a time constant of 324 ± 57 ms by voltage steps from 0 to -40 mV and 5) be reduced 84 ± 5% by bumetanide (10(-5) M), an inhibitor of K(+) secretion. The single-channel conductance of the apical currents in the homologous VDC was estimated by fluctuation analysis to be 1.6 pS. The potent inhibitor of I(sK) channels, chromanol 293B (10(-5) M), reduced the whole-cell current in SMC by 72 ± 10 %. Clofilium (10(-4) M), a putative I(sK) channel inhibitor known to have additional non-specific effects, led to a stimulation of both on-cell (by 598 ± 177%) and whole-cell (by 162 ± 18%) currents in gerbil SMC but to a decrease of whole-cell currents (by 39 ± 12%) in rat SMC. Taken together with other findings reviewed here, these results strongly argue that the slowly-activating, voltage-dependent conductance in the apical membrane of SMC is the I(sK) channel and provide additional evidence for the poor specificity of clofilium.