Marie Paule Derde

Correlations between complaints, inflammatory cells and mediator concentrations in nasal secretions after nasal allergen challenge and during natural allergen exposure

A quantitative determination of the inflammatory mediators was performed and correlated with complaints and the measurement of the inflammatory cells in nasal secretions of 18 seasonal allergic rhinitis patients (group 1) outside the pollen season and 40 symptomatic patients (group 2) with seasonal allergic rhinitis during the pollen season. Ten nonallergic subjects (group 3) were also studied as a normal control group. In group 1, 17 (94%) out of 18 patients had an immediate response of nasal symptoms accompanied by a significant increase of histamine, leukotriene C4 (LTC4), and tryptase 5 min after nasal allergen challenge (NAC). One hour later, a simultaneous increase was seen both in the percentage of the eosinophils and in the eosinophil cationic protein (ECP) concentration. The eosinophil count reached a peak 2 h after NAC with a duration of 8 h, while the highest ECP level was reached only after 24 h with no clear-cut plateau. In group 2, a high percentage of eosinophils was observed. Mostly one observed significantly (p < 0.01) higher concentrations of ECP, LTC4 and histamine but not of tryptase than the baseline values of group 1. The authors concluded that during the pollen season allergic rhinitis reflects mainly a chronic state of allergic inflammation of the nasal mucosa involving various inflammatory components induced by one or more episodes of early-phase type allergic reaction. Infiltration of eosinophils and consequently release of the various late-phase inflammatory mediators into the nasal secretions are certainly believed to be the predominant pathophysiologic condition in the patients.

Fiberoptic examination of the nasal cavity and nasopharynx in children

In this prospective study, a flexible fiberoptic nasolaryngoscope with color video camera was used to examine the nasal cavity and nasopharynx in 180 pediatric patients. The relative size of the adenoid tissue was judged by endoscopy, which lead to a classification into 3 types according to the distance from the vomer to the adenoid tissue. The condition of the nasopharyngeal orifice of the Eustachian tube was also described and differentiated into 3 types relating to the condition of adenoid tissue. Assessment was performed by correlating these measurements with the tympanogram, lateral X-ray and clinical complaints. The authors conclude that: (1) fiberoptic examination allows direct visualization of the size and condition of the adenoid tissue, as well as of the condition of the nasopharyngeal orifice of the Eustachian tube. (2) The size of the adenoid tissue correlates very well with the nasal obstruction complaints as well as with the type of tympanogram. (3) The condition of the nasopharyngeal orifice of the Eustachian tube significantly corresponds with the type of tympanogram. (4) For the indication of adenoidectomy, fiberscopy gives more accurate information than standard X-ray. (5) With a correct choice of premedication and local anesthesia, it is a minor invasive technique which is very well tolerated by children. It is possible in all cases, provided it is performed by a skilled endoscopist and preceded by careful explanation to the child. (6) Finally, thanks to the possibility of direct visualization of the fiberscopic image via a monitor, it allows a better explanation of the indication for adenoidectomy to the childs parents.

Comparison of cell growth in different parts of breast cancers

This study was performed to answer the question: which parts of breast cancers are active in terms of proliferation as measured by the Ki‐67 antibody and in terms of cell division as measured by the mitotic index. Forty‐six breast samples were studied, including 34 breast cancers and 12 benign conditions. The intraductal component of infiltrating breast cancers showed a significantly lower proliferation index than the infiltrating component. The cells at the periphery of infiltrating tumour strands showed a higher proliferation activity than the cells in the core. These findings suggest that infiltration advances through preferential active growth of the cells at the invasion front.

Concentrations of chemical mediators in nasal secretions after nasal allergen challenges in atopic patients

By using a microsuction technique, a quantitative determination of chemical mediators in nasal secretions was performed in 18 hay-fever patients and in a control group of 10 healthy volunteers. The authors then compared these quantitative data for mediators with objective nasal findings counting the number of sneezes, passive anterior rhinomanometry (PAR) and nasal inspiratory peak flow. A sampling protocol was designed with a follow-up of 3 days after nasal allergen challenge (NAC) in order to investigate both early and late allergic reactions. Median baseline concentrations of five major mediators were obtained: histamine, 19 ng/g; leukotriene C4 (LTC4), 5.7 ng/g. tryptase, 0; prostaglandin D2 (PGD2), 477 pg/g; eosinophil cationic protein (ECP), 105 ng/g. Significant increases in histamine (214 ng/g) , LTC4 (20 ng/g) and tryptase (28 μU/g) were found, but a significant decrease occurred in ECP (47 ng/g) and PGD (226 pg/g) immediately after NAC in the patients studied. Most ECP concentrations (94%) increased slowly 1 h after NAC and reached a significantly higher level 24 h later. In evaluating nasal symptoms, sneezes were present in a high percentage of cases (76%) during the early phase but were uncommon during the late phase (29%). Total nasal obstruction occurred in 94% during the early phase. In contrast, unilateral nasal obstruction presented in 82% during the late phase, whereas total nasal obstruction was present only in 41%. The most common type of late phase nasal obstruction shown by PAR was alternating nasal obstruction.

Concentrations of chemical mediators in nasal secretions of patients with hay fever during natural allergen exposure

By using the microsuction technique, quantitative determination of the chemical mediators in nasal secretions was performed in 40 patients with seasonal allergic rhinitis during the pollen season. The aim of this study was to investigate the actual concentrations of these important mediators in nasal secretions during natural allergen exposure so as to better understand the pathophysiology of allergic rhinitis. The median concentrations of four mediators, were histamine: 51.5 ng/g (range: 4-146 ng/g); tryptase: 0 (range: 0-84 microU/g); leukotriene C4 (LTC4): 23 ng/g (range: 11-77 ng/g); and eosinophil cationic protein (ECP): 410 ng/g (range: 6-2380 ng/g). The authors compared these concentrations with those of the same mediator found in a previous study of seasonal allergic rhinitis patients after nasal challenge outside the pollen season. The present study demonstrates that during the season allergic rhinitis reflects a chronic state of allergic inflammation of the nasal mucosa involving various inflammatory mediators induced by one or more episodes of early type allergic reaction.

Monitoring nasal allergic inflammation by measuring the concentration of eosinophil cationic protein and eosinophils in nasal secretions

Quantitative measurement of the eosinophil cationic protein (ECP) concentration and the percentage of eosinophils in nasal secretions has greatly improved our understanding of the inflammatory process after natural allergen exposure. ECP and eosinophils were measured in the nasal secretions of 40 symptomatic patients with seasonal allergic rhinitis during the pollen season. Results showed a significant relationship between a high concentration of ECP (median: 410 ng/g, range: 6–2380 ng/g) and a high percentage of eosinophils (median: 13.5%, range: 1–85%). This quantitative study again demonstrated that infiltration by eosinophils and release of ECP play a key role in allergic rhinitis. It also suggests that the combined measurement of the percentage of eosinophils together with the ECP concentration in nasal secretions seems to be a very useful model in monitoring and assessing the condition of chronic nasal inflammation in patients with allergic rhinitis.

Age-Related CT-scan Study of the Incidence of Sinusitis in Children

Because standard radiographies are not able to give exact information about the diseased state of the sinuses, 196 children with chronic nasal complaints, aged from 3 to 14 years were examined with computed tomographic scan. The aim of the study was to investigate whether an age-related pattern in the occurrence of rhinosinusitis in children could be found. The patient group was subdivided into six age groups (3 to 4, 5 to 6, 7 to 8, 9 to 10, 11 to 12, and 13 to 14 years). Especially younger children, until the age of 7 to 8 years seem to be prone to inflammatory changes of all their sinuses. In older children, mainly the maxillary sinuses stay frequently involved. Septal deviations occur in 16% of the youngest to 72% in the oldest age group. The occurrence of bullous conchae increases with age too, although less prominently.

Ciprofloxacin vs comparative antibiotics in LRTI: A meta-analysis

In view of the excellent antimicrobial activity of ciprofloxacin against most respiratory pathogens and its good penetration into respiratory tissues and fluids, this drug has been extensively used for the treatment of lower respiratory tract infections (LRTI). However, the number of patients in most of the comparative trials was too small to enable a significant difference in efficacy between ciprofloxacin and the comparative drugs to be detected. This study evaluated the efficacy of ciprofloxacin versus other drugs in the treatment of LR n, using an unblinded meta-analysis.