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Adult acute epiglottitis is a rare but life-threatening disease caused by obstruction of the airway. The symptoms and signs of this disease may be nonspecific without apparent airway compromise. We encountered 3 consecutive cases of adult patients with this disease in a single 5-month period in one physician's office. In all cases, physical examination revealed tenderness of the anterior neck over the hyoid bone. These observations assisted us in identifying this rare disease quickly. We suggest that tenderness over the hyoid bone should raise suspicion of adult acute epiglottitis. Adult acute epiglottitis is an inflammatory disease of the epiglottis and adjacent structures resulting from infection. It can be a rapidly fatal condition because of the potential for sudden upper airway obstruction. Early recognition of acute epiglottitis is therefore of the utmost importance in minimizing morbidity and mortality.Unfortunately, misdiagnosis occurs in 23% to 31% of the cases of adult acute epiglottitis.1-3 During a single 5-month period, we encountered 3 cases of the disease in our physician's office. Physical examination revealed tenderness of the middle anterior neck, especially over the hyoid bone, in all patients. This sign enabled us to diagnose this uncommon disease quickly. All the patients steadily improved without the need for interventional airway support. Here we propose that tenderness over the hyoid bone should be considered a major sign in the diagnosis of adult acute epiglottitis. Case ReportsCase 1 A 55-year-old woman presented to the Ehara Clinic in July 2004 complaining of a severe sore throat that had begun the previous day, and with a fever of 37.5°C. She complained of dysphagia and odynophagia. She experienced a loss of vocal power, and talking aggravated her sore throat. At admission, the patient did not seem to be critically ill. Her voice was neither muffled nor hoarse. The vital signs indicating the nature of her condition were as follows: body temperature, 37.0°C (axillary); blood pressure, 90/64 mm Hg; pulse, 64/min; respirations, 24/min; peripheral oxygen saturation, 97%. At this point, these findings were not sufficient to indicate any serious diseases. The pharynx was slightly erythematous. Dyspnea, stridor, and drooling were not found. The bilateral upper cervical lymph nodes were mildly swollen. Careful neck palpation revealed tenderness of the anterior median neck. The lungs were clear. The results of the remainder of the physical examination were within normal limits. A lateral neck radiograph revealed an enlargement of the epiglottis and a narrowing of the vallecula.The patient was referred to the hospital to be seen by an otolaryngologist. Fiberoptic laryngoscopy revealed that the lingual surface of the epiglottis was swollen, but the laryngeal surface and the arytenoids remained unswollen. The patient was given hydrocortisone sodium succinate intravenously (300 mg/day) and instructed to take 60 mg of loxoprofen sodium 3 times a day. Here, it was assumed that the patient was very u...

Peripheral blood T-lymphcyte subsets defined by monoclonal antibodies (OKT-series;OKT3: pan T-cell, OKT4: inducer/helper T-cell, OKT8: suppressor/cytotoxic T-cell) were analysed in patients with gastric cancer.The results were as follows.(1) Percentages of OKT3+, OKT4+ and OKT8+ cells as well as the OKT4/OKT8 ratio showed no significant change according to the clinical stages.(2) In recurrent cases, proportion of OKT4+ cells was decreased and that of OKT8+ cells was increased, and the OKT4/OKT8 ratio was reduced, compared with cancer free patients after operation.(3) The OKT4/OKT8 ratio was not correlated with the percentages of IgGFcR+ T-cell (Tr) and ConA/PHA ratio.(4) In patients with high proportion of Tr and low OKT4/OKT8 ratio, the peripheral blood T-cell response to PHA was deminished.(5) The OKT4/OKT8 ratio was remarkably decreased after palliative operation.

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