No abstract

No abstract

To characterize the local response in acute otitis media, courses of interleukin (IL)-1beta, IL-6, IL-8, and tumor necrosis factor (TNF)alpha in middle ear fluid (MEF) of the guinea pig otitis media model induced by nonviable Haemophilus influenzae were investigated with enzyme-linked immunosorbent assay (ELISA) kits. The IL-1beta concentration in H. influenzae-inoculated ears peaked 24 hours after inoculation. The IL-8 concentration was significantly higher in H. influenzae-inoculated ears than in controls 48 and 96 hours after inoculation. The TNF-alpha concentration in H. influenzae-inoculated ears had an initial peak 6 hours after inoculation and had significant late increases 48 and 96 hours after inoculation. The results suggest that IL-1beta and TNF-alpha were produced by middle ear mucosa in the early stage of the experiment by stimulation of bacterial inoculation, which caused subsequent inflammatory cell accumulation, and that IL-8 and TNF-alpha were produced in the late stage by accumulating inflammatory cells.

Streptococcus pneumoniae cell wall and pneumolysin are important contributors to pneumococcal pathogenicity in some animal models. To further explore these factors in middle ear inflammation caused by pneumococci, penicillin-induced inflammatory acceleration was studied by using three closely related pneumococcal strains: a wild-type 3 strain (WT3), its pneumolysin-negative derivative (P-1), and its autolysin-negative derivative (A-1). Both middle ears of chinchillas were inoculated with one of the three pneumococcal strains. During the first 12 h, all three strains grew in vivo at the same rate, and all three strains induced similar inflammatory cell responses in middle ear fluid (MEF). Procaine penicillin G was given at 12 h to one-half of the animals in each group, and all treated chinchillas had sterile MEF at 24 h. Penicillin significantly accelerated MEF inflammatory cell influx into WT3-and P-1-infected ears at 18 and 24 h in comparison with the rate for penicillin-treated A-1-infected ears. Inflammatory cell influx was slightly, but not significantly, greater after treatment of WT3 infection than after treatment of P-1 infection. Interleukin (IL)-1␤ and IL-6, but not IL-8, concentrations in MEF at 24 h reflected the penicillin effect on MEF inflammatory cells; however, differences between treatment groups were not significant. Results suggest that pneumococcal otitis media pathogenesis is triggered principally by the inflammatory effects of intact and lytic cell wall products in the middle ear, with at most a modest additional pneumolysin effect. Investigation strategies that limit the release of these products or neutralize them warrant further investigation.

Streptococcus pneumoniae is the most frequent microbe causing middle ear infection. The pathophysiology of pneumococcal otitis media has been characterized by measurement of local inflammatory mediators such as inflammatory cells, lysozyme, oxidative metabolic products, and inflammatory cytokines. The role of cytokines in bacterial infection has been elucidated with animal models, and interleukin (IL)-1␤, IL-6, and IL-8 and tumor necrosis factor alpha (TNF-␣) are recognized as being important local mediators in acute inflammation. We characterized middle ear inflammatory responses in the chinchilla otitis media model after injecting a very small number of viable pneumococci into the middle ear, similar to the natural course of infection. Middle ear fluid (MEF) concentrations of IL-1␤, IL-6, IL-8, and TNF-␣ were measured by using anti-human cytokine enzyme-linked immunosorbent assay reagents. IL-1␤ showed the earliest peak, at 6 h after inoculation, whereas IL-6, IL-8, and TNF-␣ concentrations were increasing 72 h after pneumococcal inoculation. IL-6, IL-8, and TNF-␣ but not IL-1␤ concentrations correlated significantly with total inflammatory cell numbers in MEF, and all four cytokines correlated significantly with MEF neutrophil concentration. Several intercytokine correlations were significant. Cytokines, therefore, participate in the early middle ear inflammatory response to S. pneumoniae.

We report a successful outcome for a large arteriovenous malformation (AVM) of the tongue treated with CyberKnife® (CK) image-based stereotactic radiosurgery (SRS). A 56-year-old man presenting with a tongue AVM underwent ligation of the lingual artery and partial resection of the nidus. Sixteen years later, his pulsating submandibular mass had enlarged. An image study revealed a remarkable re-expansion of the nidus involving the tongue and the oral floor, with a volume of 130 ml. CK SRS was performed with 2 fractions. The prescribed marginal dose was 22 Gy. Thirty-four months after SRS, angiography demonstrated complete obliteration of the nidus without major adverse effects. We conclude that CK SRS may be suitable for the treatment of AVMs in the head and neck region.

Penicillin treatment timing, using the chinchilla pneumococcal otitis media model, was investigated. Early treatment (when approximately 10 3 pneumococcal CFU/ml was present in middle ear fluid) significantly accelerated inflammatory-cell influx, whereas late treatment (with approximately 10 7 pneumococcal CFU/ml present in middle ear fluid) did not. Therefore, antiinflammatory interventions will be needed early in the course of inflammation.

No abstract