Clifton T. Furukawa

Blinded comparison of maxillary sinus radiography and ultrasound for diagnosis of sinusitis

The correlation of Waters view radiographs and A-mode ultrasound for diagnosing sinusitis was evaluated in 75 subjects with allergic rhinitis who presented with signs and symptoms suggesting sinus disease. All patients had Waters view radiographs, which were read by a radiologist (E. G.) who was not provided with historical information. Ultrasound tracings were obtained by registered nurses who were trained to perform this procedure. Tracings were interpreted by two representatives of American Electromedics Corporation, the manufacturer of the Echosine ultrasound machine used in this study. Most common symptoms among the patients were cough and rhinorrhea. The complaint of headache correlated negatively (p = 0.001) with an abnormal radiograph, whereas physical findings of copious and purulent rhinorrhea correlated positively (p = 0.05 and 0.001, respectively). Middle ear abnormalities on examination and tympanometry were more common in those with abnormal radiographs, p less than 0.05 and p less than 0.01, respectively. If the radiograph is considered to be a gold standard, sensitivity of ultrasound varied from 44% to 58% and specificity from 55% to 61%, dependent on which criteria are applied to the radiograph to consider it normal. A-mode ultrasound is not sufficiently comparable to radiography to be used as its substitute for diagnosing sinus disease.

Methacholine bronchial challenge in children

Methacholine sensitivity was evaluated in 166 young subjects who had normal resting spirometric values but who presented problems suggesting lower airways hyperreactivity. Fifty-eight patients (35%) did not have significant sensitivity. The diagnosis of asthma was excluded in this subgroup. Forty-one patients (25%) had mild methacholine sensitivity, 49 (30%) had moderate sensitivity, and 18 (11%) had extreme methacholine sensitivity. Many patients who reacted had chief complaints of cough, bronchitis, or other low respiratory-tract symptoms and did not complain of wheezing. Methacholine challenge helped to clarify appropriate therapy in these individuals. One-year follow-up of these patients showed most patients to be continuing the therapeutic regimen that had been prescribed initially. Methacholine bronchoprovocation was a useful adjunct to management of this large outpatient population of children and young adults and deserves attention as a procedure relevant to patients care, not solely as an investigational test.

The Aarskog syndrome

The observations on a third family with a recently described pattern of malformation, the Aarskog syndrome, serve to further delineate this entity. Affected males are consistently short in stature and have ocular hypertelorism, a widows, peak, thickened and down-turned superior ear helices, a bulbous and broad-appearing nose, a hypoplastic maxilla, varying degrees of pectus excavatum, a mildly protruding umbilicus, and an unusual scrotal skin configuration. Inconsistent features are small broad hands and feet, hypoplasia of the fifth finger with but a single ventral crease, mild webbing between fingers, cryptorchidism, and inguinal hernias. Our findings of partial expression in two obligatory carrier females and one of their daughters suggest X-linked semidominant inheritance, although autosomal dominant with partial expression in the heterozygous female is not excluded.

Induction of eustachian tube dysfunction with histamine nasal provocation

Abstract This study assessed changes in nasal airway resistance and nasal airway power as well as eustachian tube function after histamine nasal provocation in 12 atopic subjects and 10 nonatopic subjects. Results demonstrated that subjects could not be placed in the atopic or nonatopic group on the basis of prechallenge nasal resistance and power measurements. Atopic subjects demonstrated a statistically significant difference in nasal airway power after histamine provocation ( p p

Defective monocyte and polymorphonuclear leukocyte chemotaxis in atopic disease.

Monocyte (MN) and polymorphonuclear (PMN) leukocyte chemotaxis was studied in 17 atopic children with hyperimmunoglobulinemia E (IgE), 9 age- and diagnosis-matched children with normal IgE levels, 10 pediatric controls, and 45 adult controls. Twenty-one of the 26 atopic patients had eczema, while 5 had only respiratory allergies. All patients were free of infection and receiving no systemic corticosteroids. Depressed PMN chemotaxis was found in only one patient. Defects of MN chemotaxis were detected in 8 of 17 atopic children with IgE and 2 of 9 with normal IgE values. Seven of 21 patients with atopic eczema and 3 of 5 with respiratory allergies had depressed MN chemoatxis. No evidence was found for a cell-directed chemotactic inhibitor in the plasma of patients with abnormal MN chemotaxis. These data demonstrate that: (1) MN chemotaxis is frequently depressed in uninfected atopic patients; (2) this abnormality occurs in patients with respiratory allergies as well as in those with eczema and is more prevalent in atopics with IgE; and (3) PMN chemotactic defects are uncommon in allergic patients. Whether abnormal MN chemotaxis is a primary or a secondary event in atopy requires further investigation.

Therapeutic range cromolyn dose-response inhibition and complete obliteration of SO2-induced bronchoconstriction in atopic adolescents

Eight atopic adolescent subjects with exercise-induced bronchospasm were studied to determine whether cromolyn sodium could inhibit or block sulfur dioxide (SO2)-induced bronchoconstriction. Cromolyn or placebo were administered by turboinhaler 20 minutes before 10 minutes of SO2 exposure at 1.0 ppm during continuous moderate exercise on a treadmill. The exercise level that was chosen did not in itself produce bronchoconstriction. The cromolyn doses were 0 (placebo), 20, 40, and 60 mg. Pulmonary functions (FEV1, and total respiratory resistance) were measured before and after drug administration and after exposure. SO2 exposure after placebo produced significant bronchoconstriction. Pretreatment with 20 mg of cromolyn did not change the SO2 response, 40 mg significantly inhibited the response, and 60 mg completely abolished the pulmonary function changes. These results demonstrate for the first time a dose-response inhibition of SO2-induced bronchoconstriction in atopic subjects within a clinically acceptable dosage range and complete obliteration of SO2 sensitivity in this group with 60 mg of cromolyn pretreatment.

The effects of albuterol on sulfur dioxide-induced bronchoconstriction in allergic adolescents

Ten allergic subjects with exercise-induced bronchospasm were studied to determine whether albuterol could prevent sulfur dioxide (SO2)-induced bronchoconstriction. Albuterol or placebo (180 micrograms) were administered by metered-dose inhaler 20 minutes before a 10-minute exposure to SO2 or clean air during moderate exercise on a treadmill at an exercise level that by itself did not produce exercise-induced bronchospasm. Pulmonary functions (FEV1 and total respiratory resistance [RT]) were measured before the drug, after the drug, and after exposure to SO2 or clean air. Albuterol treatment produced significant bronchodilation and also prevented SO2-induced bronchoconstriction. Following SO2 inhalation after placebo, FEV1 decreased 15% (p less than 0.02) and RT increased 50% (p less than 0.03). Following SO2 inhalation after albuterol treatment, neither FEV1 or RT changed significantly. We conclude that albuterol, a beta 2-agonist, inhibits SO2-induced bronchoconstriction. This result suggests that the adrenergic nervous system or mast cell degranulation are involved in SO2-induced bronchoconstriction.

Double-blind evaluation of nebulized cromolyn, terbutaline, and the combination for childhood asthma

To evaluate whether the potency of a long-acting selective beta 2-agonist negates the need for cromolyn, 27 children, aged 6 to 12 years, with mild to moderate asthma requiring long-term medication, were assessed for the therapeutic effects of cromolyn and/or terbutaline by jet nebulizer. Patients received either cromolyn, 20 mg, terbutaline, 0.1 mg/kg up to 4 mg, or the combination, three times daily. The study design was double-blind, crossover with each patient receiving the three treatment regimens in randomized order for a period of 8 weeks each. Daily diary mean scores generally demonstrated best symptom control with cromolyn or the combination than with terbutaline alone. Cough was significantly less with cromolyn than with terbutaline (p less than 0.05). Morning peak flow measures were higher with combination therapy than with terbutaline (p less than 0.05). Evening peak flow measures were higher with the combination and cromolyn alone than with terbutaline alone (p less than 0.01). Methacholine challenge demonstrated less bronchial hyperreactivity with the combination or cromolyn alone than with terbutaline alone (p less than 0.02). The effectiveness of the nebulizer regimen for children with chronic asthma is better when cromolyn is used alone or in combination with terbutaline than when the beta-agonist is used alone.

Coma in an infant due to hypertonic sodium phosphate medication

The use of phosphate preparations as therapy for hypercalcemia is reviewed by Goldsmith and Ingbar. * In their series of patients a significant number achieved values in the normal range, and, in addition, hypocalcemia was never induced. Calcium concentrations in serum showed rapid response to the administration of phosphate, with effects chemically apparent within 24 hours regardless of route of administrat ion?

A comparison of the effectiveness of free-running and treadmill exercise for assessing exercise-induced bronchospasm in clinical practice

Exercise-induced bronchospasm (EIB) is an important problem for many patients with asthma as well as for many allergic rhinitis patients who do not have clinical asthma.’ Both the free-running system and treadmill exercise test are frequently used to make the diagnosis of EIB. Free running is generally recognized to be the most asthmogenic form of exercise. It has been claimed, however, that vigorous treadmill exercise capable of raising the pulse to 170 bpm for 6 min is almost as asthmogenic as free running and is therefore quite useful for eliciting EIB. Furthermore, it has been stated that a greater work load will not increase the incidence of EIB over that achieved with treadmill exercise if the pulse reaches 170 bpm and is maintained at that rate.’ We have utilized both the free running and treadmill tests in 2 large populations of allergic children and adolescents and have attempted to answer 2 questions: (1) Is the similarity between treadmill exercise and free running sufficient to allow either to be used in clinical practice to delineate patients who may be in need of treatment for EIB? (2) Is there any increase in EIB incidence if one raises the pulse to 180 bpm from 170 bpm during the treadmill test?