Prostaglandins, leukotrienes, and other arachidonic acid metabolites in nasal polyps and nasal mucosa

Prostaglandins (PGs) and leukotrienes (LTs) are known to play an important role in allergic inflammatory reactions. The triad of aspirin sensitivity, nasal polyposis, and asthma led us to suspect that PGs, LTs and other arachidonic acid metabolites may be involved in the pathogenesis of nasal polyps. The purpose of this study was to determine arachidonic acid metabolites and to measure concentrations of PGs and LTs in nasal polyps and nasal mucosa. Samples of nasal polyps and nasal mucosa were obtained at the time of polypectomies and nasal procedures. Metabolites of arachidonic acid in tissue were determined by incubation of tissue-homogenates with 14C-arachidonic acid and analyses with thin-layer chromatography and high performance liquid chromatography (HPLC). Levels of PGE2, 6-keto-PGF1 alpha, thromboxane (Tx)B2, 15-hydroxyeicosatetraenoic acid (HETE), LTC4, LTB4 were measured by radioimmunoassay. The predominant arachidonic acid metabolite in both nasal polyps and mucosa with 15-HETE. The HPLC analysis showed that the predominant metabolite in nasal polyp was 15-HETE, especially in polyps from aspirin sensitive patients. Levels of 15-HETE and PGE2 were higher in polyps from patients with a history of allergy than from nonallergic patients. Levels of LTC4 and LTB4 in nasal polyps were determined. The findings of this study will help to explain biochemical basis of the pathogenesis of aspirin-sensitive nasal polyps and to develop better medical treatment for them.     

Prostaglandins, leukotrienes, and other arachidonic acid metabolites in the pathogenesis of otitis media

Among the various inflammatory mediators of otitis media (OM), metabolites of arachidonic acid (AA) such as prostaglandins (PGs) and leukotrienes (LTs) appear to play an important role in the pathogenesis of otitis media. In an effort to investigate the role of AA metabolites on the pathogenesis of otitis media, concentrations of AA metabolites were measured in middle ear effusion (MEE) from human and paralleling animal models of otitis media and the effects of inhibitors of AA metabolism, antibiotics, and tympanostomy tube (TT) on the outcome of animal models of OM were studied. Concentrations of AA metabolites in MEE were higher in the younger age group. Levels of PGE2 and LTB4 in MEE seem to represent the degree of inflammation of OM best. Lipoxygenase products seem to be associated with the mucoid type of MEE. In the study of animal models of OM, combined models and ears with TT showed more inflammation than single models and ears without TT. Study of the therapeutic use of inhibitors of AA metabolism, penicillin, and TT showed that lipoxygenase products may be more important in the pathogenesis of OM than the cyclo-oxygenase products, and that the use of a combination of penicillin and corticosteroid produces the best results. It is clear from these studies that arachidonic acid metabolites are important inflammatory mediators in the pathogenesis of otitis media.     

Treatment of perennial secretory rhinitis

Patients with a history of nonallergic perennial secretory rhinitis of many years' duration were selected for a comparative study investigating the effects of the topical application of ipratropium (an anticholinergic drug) and budesonide (a glucocorticoid). According to the patient's daily registration of nasal symptoms, there was a significant effect of budesonide on nasal secretion and sneezes. Since budesonide proved superior to ipratropium, it is concluded that the secretion in this type of rhinitis might be regulated by mechanisms other than cholinergic.     

Olfactory dysfunction in seasonal and perennial allergic rhinitis

Although the pathogenesis of sudden hearing loss (SHL) is not as yet known, the clinical picture and the frequent association with vascular risk factors make an ischaemic event likely. This study aimed to assess the effect of an extracorporeal procedure (H.E.L.P.) in removing LDL-cholesterol, fibrinogen and lipoprotein (a) from the plasma, on the recovery of hearing SHL. This procedure using the HELP-system was compared with the usual standard treatment with prednisolone, dextranes and pentoxifyllin. We undertook a single centre, prospective, randomized study in which 18 patients were assigned to H.E.L.P.-apheresis and 9 patients were assigned to standard treatment (2:1 randomization). Audiometric and laboratory testing was performed at baseline, 24 h and 6 weeks after start of treatment. Primary endpoint was the improvement of the average pure-tone threshold between 0,125 and 8 kHz after 24 h. Twenty-four hours after H.E.L.P. treatment average pure-tone threshold recovered by 10.4 dB and by 26.4 dB after 6 weeks. The recovery of hearing of the standard treated patients was 5.8 dB and 16.8 dB after 24 h and 6 weeks respectively. LDL-cholesterol, fibrinogen and lipoprotein (a) were significantly reduced in the HELP treated patients compared with standard therapy, resulting in a significant improve in plasma viscosity, erythrocyte aggregation and resistance to oxidative stress of LDL particles. Our results suggest that the clinical outcome of SHL after a single extracorporeal LDL-apheresis is superior or at least equal to the more expensive standard treatment with prednisolone, dextranes and pentoxifyllin. Re-establishment of vascular endothelial function and improved blood rheology may be the underlying cause. These results must be confirmed in larger-scale trials.     

快速免疫治疗常年性变应性鼻炎

目的：探讨快速免疫治疗常年性变应性鼻炎的新方法及疗效。方法：３２例快速免疫组５天半达到维持量,持续治疗一年后评定。３６例常规免疫对照组治疗２年后评定。结果：快速免疫组一年总有效率 ８４． ４％,常规免疫组 ２年总有效率 ８８． ９％,两组疗效无显著性差异（ Ｐ＞０． ０５）。结论：快速免疫疗法减少了注射次数和缩短了疗程,为治疗常年性变应性鼻炎行之有效的方法。     

Nasal pharmacodynamics of brompheniramine in perennial rhinitis

This study evaluated the relationship between brompheniramine maleate and changes in nasal reactivity. Ten subjects with moderate-to-severe perennial rhinitis took brompheniramine for seven days using either a standard formulation or sustained-release preparation. Nasal aerodynamics and response to histamine were assessed at the end of the week. Despite varying doses of brompheniramine maleate (12 to 32 mg/d), there was no significant difference in nasal reactivity to histamine or in changes of nasal airflow, indicating that low doses of brompheniramine are highly effective in blocking histamine, receptors in the nasal mucosa.     

Relation between the anterior ethmoid nerve and perennial rhinitis

The distribution of the autonomic nerves in nasal mucosa was studied by anatomical and histochemical techniques. Cholinergic nerve fibers had been found in the anterior ethmoid nerve. It has been established that the cholinergic nerve fibers in the nasal mucosa mainly came from vidian nerve and anterior ethmoid nerve, the latter distributed in the sensitive region with high density serous glands. The cause of failure of vidian neurectomy in the treatment of perennial rhinitis has been discussed and it is suggested that vidian neurectomy and anterior ethmoid neurectomy should be performed concomitantly in treating perennial rhinitis.     

变应性鼻炎与慢性鼻窦炎的关系

目的:观察常年性变应性鼻炎患者鼻窦炎发生的原因及发生率。方法:回顾性分析57例常年性变应性鼻炎患者的临床资料。结果:18例并发鼻窦炎,发生率为32%;其中17例伴有不同程度不同类型的鼻腔解剖结构异常,包括鼻中隔偏曲、中鼻甲气化、钩突肥大、中鼻甲曲线异常和鼻丘气房过度发育等。39例单纯变应性鼻炎者只有7例伴有鼻腔解剖结构异常。结论:变应性鼻炎并发鼻窦炎的基础可能是鼻腔解剖结构异常,变态反应导致的鼻腔黏膜水肿和鼻腔分泌物性质的改变是鼻窦炎的诱发因素之一。     

Antroconchopexy for surgical treatment of perennial rhinitis.

We report on a rhinomanometric assessment of eleven patients undergoing antroconchopexy for relief of a "stuffy" nose. This little-known procedure involves the lateralization of the inferior turbinate through a large intranasal antrostomy. Our results demonstrate a significant improvement in postoperative inspiratory and expiratory nasal resistance. There was also a significant improvement in patient's scoring for nasal obstruction. Finer points of the surgical technique, and indications for the procedure are discussed.     

鼻内应用Rhinocort治疗常年性变应性鼻炎

目的探讨鼻内应用雷诺考特(Rhinocort)治疗常年性变应性鼻炎的临床效果. 方法 60例常年性变应性鼻炎随机分组,实验组30例应用Rhinocort鼻喷雾剂治疗,对照组30例施以鼻腔微波热凝治疗.于治疗结束后1月和1年分别进行近期和远期疗效评定. 结果两组的近、远期疗效分别为93.3%、96.7%和70.0%、63.3%,χ2检验两组疗效差异均无显著性意义(P＞0.05). 结论 Rhinocort鼻喷雾剂鼻内应用治疗常年性变应性鼻炎使用方便,起效快速,定量准确,全身生物利用度低,安全性和有效性好,是目前治疗常年性变应性鼻炎的好方法.     

Nasal hyper-responsiveness to histamine, methacholine and phentolamine in patients with perennial non-allergic rhinitis and in patients with infectious rhinitis

Recently it has been shown that patients with atopic rhinitis and with an allergy to house dust mites have a stronger nasal response to insufflation of histamine, methacholine and phentolamine than a control group. This hyper-responsiveness could not be demonstrated in patients with perennial non-allergic rhinitis, unless the patients were selected according to the predominant symptoms in the history. Patients with rhinorrhoea ('runners') proved to be hyper-responsive to methacholine compared with normal controls. The existence of two subpopulations was emphasized by hyper-responsiveness to both histamine and methacholine in the runners group compared with the patients with a stuffy nose ('blockers'). Patients with chronic nasal infections (characterized by recurrent episodes of purulent discharge) showed no hyper-responsiveness at all, indicating that either hyper-reactivity does not play an important part in this patient population or methods to detect hyper-reactivity in this group are inadequate. In contrast to our earlier observations in patients with atopic rhinitis, increased responsiveness to phentolamine could not be detected either in the patients with perennial rhinitis or in the patients with infectious rhinitis, indicating that the possible alpha-adrenergic dysfunction found in patients with atopic rhinitis is restricted to this group.     

Intranasal ipratropium: A new treatment for perennial rhinitis

Eighty micrograms of the topically active parasympatholytic ipratropium were applied intranasally 4 times a day to 20 adult patients with perennial rhinitis and severe watery rhinorrhoea in a double-blind placebo controlled cross-over trial. There was a significant reduction in nasal hypersecretion during ipratropium treatment. Fourteen patients preferred the ipratropium period, 3 the placebo period and 3 had no preference. There were no adverse systemic or local effects. Ipratropium was effective also in patients resistant to glucocorticoids, sodium cromoglycate and antihistaminics. As the drug works immediately it can also be used before exposure to known provocating factors. It is concluded that continuous use of this new medication is of value in the management of severe rhinorrhoea in patients with perennial rhinitis, and that the occasional use is helpful in subjects with infrequent attacks of nasal hypersecretion.     

等离子低温消融术在常年性变应性鼻炎治疗中的应用

目的 观察等离子低温消融术治疗常年性变应性鼻炎的疗效.方法 30例常年性变应性鼻炎患者行下鼻甲及鼻丘等离子低温消融术,其中18例加行鼻中隔矫正术,术后随访半年,观察疗效,并用视觉模拟评分表法（VAS）比较手术前后鼻塞症状的改善程度.结果 本组病例显效率73.3%（22/30）,有效率23.3%（7/30）,无效率3.3%（1/30）;手术前后鼻塞症状的VAS值差异有统计学意义（P＜0.001）.结论 等离子低温消融术治疗常年性变应性鼻炎是安全、有效的.     

Treatment of perennial allergic rhinitis with ascorbic acid solution

The object of our study was to assess the therapeutic effects of Ascorbic Acid (AA) solution in patients suffering from perennial allergic rhinitis. Sixty patients were included in a two week randomized study. Synthetic AA Solution was found to decrease symptoms in 74% of patients, parallely there was a decrease of the pH of nasal secretion to normal limits.     

微波结合鼻中隔矫正术治疗常年性变应性鼻炎

目的评价微波结合鼻中隔矫正术治疗常年性变应性鼻炎的疗效.方法应用微波结合鼻中隔矫正术治疗常年性变应性鼻炎67例,对照组 25例仅作鼻中隔矫正术.结果患者术后症状和体征均明显改善,3个月后实验组和对照组显效率分别为98.5%和72.0%,有效率为1.5%和28.0%;1年显效率分别为94% 和68%,有效率为6%和20%;2年显效率分别为91%和52%,有效率为9%和20%.两组差异有显著性(P＜0.05).结论微波结合鼻中隔矫正术治疗常年性变应性鼻炎可获得较好的疗效.     

Intradermal tests with vasomotor agents in perennial non-allergic rhinitis

Nasal reactivity in non-allergic rhinitis patients is well known, but the skin reactivity of these patients is less examined. The aim of this prospective study was to examine the skin reactivity to four vasomotor agents in healthy subjects and perennial non-allergic rhinitis patients and to determine whether rhinitis patients differ from healthy subjects or not. Seventy four perennial non-allergic rhinitis patients and fourty two healthy subjects were undergone to intradermal testing with papaverine (5 mg/ml), metacholine (0.02, 0.2 and 2.0 mg/ml), histamine (0.01, 0.1 and 10.0 micrograms/ml) and compound 48/80 (0.01, 0.1, 1.0 and 10.0 micrograms/ml). It was found that the frequency of pathological skin reactivity to papaverine in perennial non-allergic rhinitis patients (34%) was significantly greater (p = 0.007) then in healthy subjects (9.5%). There was no significant difference for metacholine, histamine, compound 48/80 and saline between these two groups. The frequency of the total pathological skin reactivity to vasomotor agents, singly and in combinations, in perennial non-allergic rhinitis patients (80%) was significantly greater (p = 1.8.10(-6)) then in healthy subjects (33%). These findings suggest that the pathological skin reactivity to vasomotor agents is a feature of perennial non-allergic rhinitis patients as well as healthy subjects and indicate that a difference in the skin reactivity between these groups is noticed.     

儿童青少年常年性变应性鼻炎的流行现状

目的 为观察儿童青少年常年性变应性鼻炎的流行现状,自１９９５年超对江苏省大、中、小学学生进行流行病学调查。方法 调查方法包括问卷调查、鼻腔检查及变应原（屋尘、尘螨）皮肤划痕试验。结果 屋尘、尘螨的致敏率分别为２２．９％和２８．８％,两种变应原同时致敏占１９．１％,至少一种致敏占３２．６％。变应原致敏率随年龄增长而上升（Ｐ〈０．００１）;变应性鼻炎患病率为１．８％,各年龄组间无统计学差异（Ｐ〉０．