INTRODUCTION: Congenital pyriform sinus fistula is recognized as a potential cause of recurrent cervical inflammation, recurrent abscess, and acute suppurative thyroiditis. Failure to recognize this diagnosis may result in recurrence following administration of antibiotics and incision and drainage. This study reflects the authors' experience in treating four patients with this diagnosis. MATERIALS AND METHODS: Patients included three children and one adult ranging in age from 7 to 34 years. The steps necessary to confirm the diagnosis and the subsequent surgical treatment are reviewed. RESULTS: All fistula occurred on the left side. In each case the fistula originated in the apex of the pyriform sinus. It subsequently penetrated the inferior constrictor in three cases and the thyroid cartilage in one to end in the thyroid gland or perithyroid tissue. The opening of the pyriform sinus fistula could be identified by either barium swallow or direct endoscopy. Complete fistulectomy resulted in resolution of symptoms in all cases. CONCLUSION: Pyriform sinus fistula is a rare entity. It may be of fourth branchial pouch origin. Identification of the fistula opening in the pyriform sinus may be difficult or impossible during acute inflammation because of edema. The authors advocate the fistula be exposed through incision of the inferior constrictor muscle, which facilitates total removal. Resection of the fistula, adjacent scar tissue, and a portion of the thyroid gland when the fistula is attached, should be regarded as essential steps in curing this entity.

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PubMedDate not supplied

Cyclosporine A-induced hyperactivity in rats: is it mediated by immunosuppression, neurotrophism, or both?

Cyclosporine A (CsA) immunosuppressive treatment has become an adjunctive therapy in neural transplantation of dopamine-secreting cells for treatment of Parkinson's disease (PD). Recently, CsA and its analogues have been shown to promote trophic effects against neurodegenerative disorders, and therefore CsA may have direct beneficial effects on dopaminergic neurons and dopamine-mediated behaviors. The present study examined the interaction between the reported CsA-induced hyperactivity and the possible alterations in nigral tyrosine hydroxylase (TH)-immunoreactive neurons in rats with damaged blood-brain barrier. CsA was administered at a therapeutic dose (10 mg/kg/day, IP, for 9 days) used in neural transplantation protocol for PD animal models. CsA-treated animals displayed significantly higher general spontaneous locomotor activity than control animals at drug injection days 7 and 9. Histological assays at day 9 revealed that there was a significant increase in TH-immunoreactive neurons in the nigra of CsA-treated rats compared to that of the vehicle-treated rats. The nigral TH elevation was accompanied by suppressed calcium-phosphotase calcineurin activity, indicating an inhibition of host immune response. This is the first report of CsA exerting simultaneous immunosuppressive and neurotrophic effects, as well as increasing general spontaneous locomotor behavior. These results support the utility of CsA as a therapeutic agent for PD and other movement disorders.

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