bluuebunny/crossref_metadata_2025 huggingface dataset:
Pioglitazone and Rosiglitazone Have Different Effects on Serum Lipoprotein Particle Concentrations and Sizes in Patients With Type 2 Diabetes and Dyslipidemia
Authors: Deeg Mark A. , Buse John B. , Goldberg Ronald B. , Kendall David M. , Zagar Anthony J. , Jacober Scott J. , Khan Mehmood A. , Perez Alfonzo T. , Tan Meng H. ,   on behalf of the GLAI Study Investigators
Published: September 2007

OBJECTIVE—Associated with insulin resistance in type 2 diabetes are increased serum triglycerides, decreased HDL cholesterol, and a predominance of large VLDL, small LDL, and small HDL particles. The comparative effects of thiazolidinedione insulin sensitizers on serum lipoprotein particle concentrations and sizes in type 2 diabetes are not known. We studied the effects of pioglitazone (PIO) and rosiglitazone (ROSI) treatments on serum lipoprotein particle concentrations and sizes in type 2 diabetic patients with dyslipidemia.

RESEARCH DESIGN AND METHODS—This is a prospective, randomized, double-blind, multicenter, parallel-group study. After a 4-week placebo washout period, patients randomized to PIO (n = 369) were treated with 30 mg q.d. for 12 weeks followed by 45 mg q.d. for another 12 weeks, while patients randomized to ROSI (n = 366) were treated with 4 mg q.d. followed by 4 mg b.i.d. for the same intervals. Lipoprotein subclass particle concentrations and sizes were determined by proton nuclear magnetic resonance spectroscopy at baseline and end point (PIO [n = 333] and ROSI [n = 325] patients).

RESULTS—PIO treatment increased total VLDL particle concentration less than ROSI treatment and decreased VLDL particle size more than ROSI. PIO treatment reduced total LDL particle concentration, whereas ROSI treatment increased it. Both treatments increased LDL particle size, with PIO treatment having a greater effect. Whereas PIO treatment increased total HDL particle concentration and size, ROSI treatment decreased them; both increased HDL cholesterol levels.

CONCLUSIONS—PIO and ROSI treatments have different effects on serum lipoprotein subclass particle concentrations and sizes in patients with type 2 diabetes and dyslipidemia.
Parental History and Risk of Type 2 Diabetes in Overweight Latino Adolescents
Authors: Kelly Louise A. , Lane Christianne J. , Weigensberg Marc J. , Koebnick Corinna , Roberts Christian K. , Davis Jaimie N. , Toledo-Corral Claudia M. , Shaibi Gabriel Q. , Goran Michael I.
Published: September 2007

OBJECTIVE— The purpose of this article was to examine metabolic risk factors for type 2 diabetes in children and adolescents as a function of maternal versus paternal family history of type 2 diabetes and to examine whether differences in these risk factors emerge during adolescent growth.

RESEARCH DESIGN AND METHODS— A total of 247 overweight Latino children (baseline age = 11.1 ± 1.7 years) with a parental history of type 2 diabetes were followed annually for 5 years (2.2 ± 1.2 observations/child) with measures of insulin sensitivity, acute insulin response to glucose, and disposition index. Longitudinal linear mixed-effects modeling was used to evaluate the influence of maternal versus paternal family history of type 2 diabetes on changes in diabetes risk factors over age.

RESULTS— Insulin sensitivity and the disposition index decreased over age (β = −0.052 and β = −0.033, P < 0 0.01). Acute insulin response to glucose and fasting and 2-h glucose increased (β = 0.019, β = 0.002, and β = 0.003, P < 0.01). Declines in insulin sensitivity were significantly greater in participants whose maternal grandmothers had a history of type 2 diabetes (β = −0.03, P = 0.03). Declines in the disposition index (β = −0.02, P = 0.04) and increases in fasting glucose were significantly influenced by a maternal history of type 2 diabetes (β = 0.60, P < 0.05).

CONCLUSIONS— Maternal but not paternal family history for diabetes may have a significant impact on insulin dynamics, becoming more pronounced during growth in overweight Latino adolescents. Further research is clearly warranted.
Diabetic Nephropathy in 27,805 Children, Adolescents, and Adults With Type 1 Diabetes
Authors: Raile Klemens , Galler Angela , Hofer Sabine , Herbst Antje , Dunstheimer Desiree , Busch Petra , Holl Reinhard W.
Published: September 2007

OBJECTIVE—To give an up-to-date profile of nephropathy and the involvement of risk factors in a large, prospective cohort of patients with type 1 diabetes and largely pediatric and adolescent onset of disease.

RESEARCH DESIGN AND METHODS—A total of 27,805 patients from the nationwide, prospective German Diabetes Documentation System survey were included in the present analysis. Inclusion criteria were at least two documented urine analyses with identical classification. Urine analyses, treatment regimens, diabetes complications, and risk factors were recorded prospectively. Baseline characteristics were age at diagnosis 9.94 years (median [interquartile range 5.8–14.3]), age at last visit 16.34 years (12.5–22.2), and follow-up time 2.5 years (0.43–5.3). Cumulative incidence of nephropathy was tested by Kaplan-Meier analysis and association with risk factors by logistic regression.

RESULTS—Nephropathy was classified as normal in 26,605, microalbuminuric in 919, macroalbuminuric in 78, and end-stage renal disease (ESRD) in 203 patients. After calculated diabetes duration of 40 years, 25.4% (95% CI 22.3–28.3) had microalbuminuria and 9.4% (8.3–11.4) had macroalbuminuria or ESRD. Risk factors for microalbuminuria were diabetes duration (odds ratio 1.033, P < 0.0001), A1C (1.13, P < 0.0001), LDL cholesterol (1.003, P < 0.0074), and blood pressure (1.008, P < 0.0074), while childhood diabetes onset (1.011, P < 0.0001) was protective. Male sex was associated with the development of macroalbuminuria.

CONCLUSIONS—Diabetes duration, A1C, dyslipidemia, blood pressure, and male sex were identified as risk factors for nephropathy. Therefore, besides the best possible metabolic control, early diagnosis and prompt treatment of dyslipidemia and hypertension is mandatory in patients with type 1 diabetes.
Preventive Counseling Among Women With Histories of Gestational Diabetes Mellitus
Authors: Kim Catherine , McEwen Laura N. , Kerr Eve A. , Piette John D. , Chames Mark C. , Ferrara Assiamira , Herman William H.
Published: September 2007

OBJECTIVE—The purpose of this study was to examine the association between recall of recommendations for diabetes prevention and both health behaviors and screening among women with histories of gestational diabetes mellitus (GDM).

RESEARCH DESIGN AND METHODS—We surveyed 228 women with histories of GDM within the past 5 years who were enrolled in a university-affiliated managed care plan. In a cross-sectional analysis, we assessed the association between recall of health care provider advice and both postpartum lifestyle behaviors and reported performance of postpartum diabetes screening. Multivariate models were constructed that adjusted for correlates of counseling including postpartum diabetes, dyslipidemia, insulin use during pregnancy, and provider type.

RESULTS—Participants were predominantly non-Hispanic white, college educated and affluent, and overweight or obese. The majority reported that they received counseling on lifestyle modification and postpartum diabetes screening. Postpartum physical activity levels, fruit and vegetable intake, and screening were suboptimal. No significant association existed between recall of advice and physical activity or between recall of advice and diet. Recall of advice along with distribution of laboratory slips for glucose testing was associated with performance of postpartum diabetes screening using self-report (adjusted odds ratio 2.07 [95% CI 1.51–2.84]) or claims data (1.64 [1.16–2.32]).

CONCLUSIONS—Women with histories of GDM who recalled advice regarding postpartum glucose testing and received laboratory slips were significantly more likely to report having had postpartum diabetes screening. Although women's recall of services may not reflect the actual services received, simple counseling may not be sufficient to optimize postpartum behaviors to reduce future risk of diabetes.
Costs of the Metabolic Syndrome in Elderly Individuals
Authors: Curtis Lesley H. , Hammill Bradley G. , Bethel M. Angelyn , Anstrom Kevin J. , Gottdiener John S. , Schulman Kevin A.
Published: September 2007

OBJECTIVE—The cardiovascular consequences of the metabolic syndrome and its component risk factors have been documented in elderly individuals. Little is known about how the metabolic syndrome and its individual components translate into long-term medical costs.

RESEARCH DESIGN AND METHODS—We used log-linear regression models to assess the independent contributions of the metabolic syndrome and its individual components to 10-year medical costs among 3,789 individuals aged ≥65 years in the Cardiovascular Health Study.

RESULTS—As defined by the National Cholesterol Education Program Third Adult Treatment Panel report, the metabolic syndrome was present in 47% of the sample. Total costs to Medicare were 20% higher among participants with the metabolic syndrome ($40,873 vs. $33,010; P < 0.001). Controlling for age, sex, race/ethnicity, and other covariates, we found that abdominal obesity, low HDL cholesterol, and elevated blood pressure were associated with 15% (95% CI 4.3–26.7), 16% (1.7–31.8), and 20% (10.1–31.7) higher costs, respectively. When added to the model, the metabolic syndrome composite variable did not contribute significantly (P = 0.32).

CONCLUSIONS—Abdominal obesity, low HDL cholesterol, and hypertension but not the metabolic syndrome per se are important predictors of long-term costs in the Medicare population.
The Endoscopic Management of Chronic Frontal Sinusitis Associated with Frontal Sinus Posterior Table Erosion
Authors: Hurley Dan B. , Javer Amin R. , Kuhn Frederick A. , Citardi Martin J.
Published: September 2007

Expansile inflammatory diseases of the frontal sinuses may produce erosion of the posterior table of the frontal sinus. In these instances, the bone between sinus mucosa and intracranial dura is absent. Over the past decade, endoscopic frontal sinusotomy has emerged as the preferred technique for the treatment of refractory chronic frontal sinusitis. Endoscopic approaches also have a role in the most advanced instances of frontal sinusitis. A retrospective chart review of patients who were treated for frontal sinusitis with erosion of the frontal sinus posterior table was performed. Eight patients were identified. All patients underwent endoscopic frontal sinusotomy; some patients required multiple endoscopic procedures. Complete frontal recess dissection with identification of the frontal ostium was achieved for all involved frontal sinuses. In all cases, this postoperative result was monitored by CT scans (where indicated) and serial nasal endoscopy, which demonstrated good frontal sinus aeration and normal mucociliary clearance. Antibiotics were administered for culture-documented bacterial exacerbations, and systemic steroids were given for management of allergic fungal sinusitis and sinonasal polyposis associated with asthma. No patient underwent frontal sinus obliteration or cranialization. No suppurative intracranial complications were noted during the postoperative period. Endoscopic frontal sinusotomy can be used safely for the definitive management of frontal sinusitis associated with posterior table erosion. In fact, endoscopic techniques may represent the preferred approach for the treatment of this problem. Such an approach avoids the morbidity of more destructive alternatives (such as obliteration), and serves to create a frontal sinus with normal mucociliary clearance.
Experimental Myospherulosis of the Paranasal Sinuses: A Histologic Rabbit Study
Authors: Culviner William T. , Leonard David W. , Wilhelmsen Catherine L. , Bolger William E.
Published: September 2007

Myospherulosis or lipogranuloma formation is frequently iatrogenic and is caused by a petrolatum, lanolin, or paraffin-based ointment becoming trapped within tissue. Four different ointments, including the newly available Bactroban nasal, were studied in a rabbit paranasal sinus model to evaluate their proclivity to induce myospherulosis. The maxillary sinuses of 16 New Zealand white rabbits were bilaterally inoculated with Bactroban, Bactroban nasal, tetracycline, or bacitracin ointments and compared to saline controls in two rabbits. Sinus specimens were harvested at 2 and 4-week intervals and processed for histologic study. Myospherulosis formation was uniformly induced with the Bactroban nasal, bacitracin, and tetracycline ointments in 8/8, 7/8, and 8/8 sinuses, respectively. In contrast, myospherulosis was not induced in the 5/8 of the sinuses using Bactroban. The data from this investigation indicate that Bactroban nasal (paraffin vehicle) is similar to bacitracin and tetracycline ointments (petrolatum and petrolatum-lanolin vehicles) in that they all can cause myospherulosis. In contrast, Bactroban (a water-soluble, polyethylene glycol base) causes myospherulosis to a much smaller extent. Our results emphasize the differences between the two types of Bactroban preparations and provide objective data that can be evaluated by otolaryngologists who apply these ointments following nasal cavity surgery.
The Bacteriology of Chronic Rhinosinusitis: Results Using a Novel Culture Device
Authors: Liu Edmund S. , Lebowitz Richard A. , Jacobs Joseph B. , Tierno Philip M.
Published: September 2007

The bacteriology of chronic rhinosinusitis is an area of great interest among rhinologists. Numerous studies have reported culture results implicating a variety of aerobic and anaerobic organisms in the etiology of this disease process. Sampling is generally accomplished through the nasal cavity, creating the potential for contamination with resident nasal flora. In some reports, strict anaerobic techniques have not been used, possibly accounting for the failure to recover these fastidious organisms. In an attempt to clarify the microbiology of chronic rhinosinusitis, we used a novel culture and transport system in 50 patients undergoing endoscopic sinus surgery. The Accu-CulShure (MLA Systems, Pleasantville, NY, USA) is a self-contained polyethylene culture swab and transport device, capable of collecting a representative sample from the sinus without contamination, and preserving the quality of the material during transport. Our aerobic and anaerobic culture results, as well as pertinent patient data, are presented. The Accu-CulShure device may permit standardization of culture techniques for future studies, and allow for more accurate determination of the microbiology of chronic rhinosinusitis.
Toxicity of Drugs used for Treatment of Rhinitis: A Reminder to the Otorhinolaryngologist
Authors: Balbani Aracy P. S. , Duarte Jurandir G. , de Mello João F. , D'Antonio Walmir E. P. , Câmara José , Butugan Ossamu
Published: September 2007

We retrospectively studied files on toxicity of drugs used for treatment of rhinitis (nasal antihistamines, oral antihistamines, nasal vasoconstrictors, oral decongestants, nasal corticosteroids, nasal anticholinergic agent, nasal mast cell stabilizer, and respiratory antigen preparations for oral use) that occurred in São Paulo, Brazil, from 1 July 1996 to 30 June 1998. There were 823 cases of toxicity by these agents, with a predominance of oral decongestants (in combination with antihistamines) (53.4%). There was a significant incidence of toxicity within children aged 1 to 4 years (P < 0.05) and a preponderance among males aged 5–9 years and females aged 10–39 years. Accidental intake of medicines accounted for the majority of toxicity cases (57.2%).
The Effect of Head Position on the Distribution of Drops within the Nose
Authors: Kubba Haytham , Spinou Ekaterini , Robertson Alasdair
Published: September 2007

Nose drops are commonly prescribed in the United Kingdom, yet clinicians vary considerably in the instructions they give on how to instill them. This is important because how they are used affects how well they work. In this study, a visual assessment of the intranasal distribution of drops was made using endoscopic examination after the instillation of betamethasone drops containing methylene blue. Drops instilled with the head tipped back were found along the nasal floor and in the nasopharynx, with none visible in the middle meatus or elsewhere on the lateral nasal wall. Drops instilled in Mygind's position or in the praying-to-Mecca position were found predominantly in the middle meatus and on the middle and inferior turbinates. No difference was seen between these two positions in the distribution of drops achieved, and this is likely to lead to similar clinical efficacy. Because Mygind's position is much more comfortable for patients, it should be recommended by all doctors prescribing nose drops.
Nasal Rhinomanometry and Experimental Nasal Challenges
Authors: McLean James A.
Published: September 2007

This brief review covers several features of nasal rhinomanometry and experimental nasal challenges. The experimental studies outlined are the collaborative work of many individuals, have been published previously, and are only summarized here. For a broader discussion and specific details, the references cited are suggested.
Assessment of Deficits in the Perception of Smell and Taste
Authors: Lekas Mary , Engen Trygg
Published: September 2007

Perception is usually taken for granted and its significance appreciated after it has been lost or damaged. This seems especially true of olfaction, which is always active but without necessarily involving conscious experience and decisions. There has recently been an increase in the interest both by professionals and laypersons in the impairment of olfaction caused by disease and deleterious environmental effects. This article describes the development of a protocol for measuring deficits in olfaction and its relationship to etiology and treatment.
Comparison of Nasal Airway Patency Changes after Treatment with Oxymetazoline and Pseudoephedrine
Authors: Connell John T. , Linzmayer M. Ines
Published: September 2007

Oxymetazoline (Afrin) and pseudoephedrine (Sudafed) were compared by rhinomanometric measurements using nasal airflow, a parameter of nasal airway patency, and therefore airway congestion. Oxymetazoline had a more rapid onset and duration of action, greater improvement in airway patency, and longer action than pseudoephedrine, the best of the oral decongestants. The decongestive effect was more reliable for oxymetazoline with 28 of 29 subjects experiencing some degree of decongestion compared to 21 of 30 for pseudoephedrine. Utilizing a combination of oral and topical decongestants may result in the most logical regimen for treatment of nasal congestion. Oxymetazoline is the drug of choice for night time decongestion.
External Rhinoplasty Approach for Malignant Tumors of the Anterior Nasal Septum
Authors: Shikowitz Mark J. , Zahtz Gerald D. , Goldstein Mark N.
Published: September 2007

Malignant tumors arising from the nasal septum are rare. The predominant tumors include squamous cell carcinoma, adenocarcinoma, and malignant melanoma. The majority of these lesions are seen on the anterior portion of the septum.

The recommended treatment for septal malignancies is wide excision usually approached via a lateral rhinotomy. However, this procedure may have increased morbidity and a less than desirable cosmetic result.

We feel that the external rhinoplasty approach for tumors of the anterior nasal septum offers the surgeon excellent visualization, decreased morbidity, and superior cosmetic results. We present a case of squamous cell carcinoma of the anterior nasal septum involving the columella that was successfully managed using this approach.
A Comparison of Loratadine, a New Nonsedating Antihistamine, with Clemastine and Placebo in Patients with Fall Seasonal Allergic Rhinitis
Authors: Kemp James P. , Bahna Sami L. , Chervinsky Paul , Rachelefsky Gary S. , Seltzer James M. , Stouwe Robert A. Vande , Valero Ruben N.
Published: September 2007

Loratadine is a new nonsedating long-acting H1-antagonist which has been shown to be effective at various doses in controlling symptoms of spring seasonal allergic rhinitis. In this multicenter, double-blind, parallel study, 313 adolescent and adult patients with moderate to severe, skin-test positive, fall seasonal rhinitis were randomized to receive either loratadine, 10 mg, in the morning and placebo in the evening, clemastine 1 mg. b.i.d., or placebo b.i.d. for 2 weeks. Patients maintained daily diaries of nasal and ocular symptoms and of adverse effects. They were evaluated before and 7 and 14 days after starting treatment. The mean symptom scores on days 7 and 14 showed greater improvement with both loratadine and clemastine treatments than with placebo. The incidence of somnolence in the loratadine group by comparison with the placebo group was not statistically different, whereas clemastine caused significantly more drowsiness than did placebo. We conclude that loratadine, 10 mg, once a day is as effective as clemastine b.i.d. in decreasing the symptoms of fall seasonal rhinitis and the incidence of somnolence with loratadine is not statistically different from that with placebo.
The Response of the Nasal Airway, Middle Ear, and Eustachian Tube to Experimental Rhinovirus Infection
Authors: Doyle William J. , McBride Timothy P. , Swarts J. Douglas , Hayden Frederick G. , Gwaltney Jack M.
Published: September 2007

This paper describes the longitudinal changes in nasal patency, mucociliary clearance rate, eustachian tube function, and middle ear pressure in a group of 40 volunteers infected with rhinovirus type 39. Thirty-two (80%) of the volunteers were judged to have had a cold based on the modified Jackson criteria. Common symptoms included malaise, nasal congestion, rhinorrhea, and sneezing that began on the day after challenge and peaked in intensity on days 3–5. Nasal patency evaluated by active posterior rhinomanometry and mucociliary clearance rate evaluated by the dyed sacharrin technique were significantly decreased following challenge. For nasal patency the effect was primarily limited to days 2–8 postchallenge, while abnormalities in clearance rate were documented for as long as 18 days postchallenge. A 50% increased incidence of abnormal eustachian tube function and a 30% increased incidence of abnormal middle ear pressures were observed for days 2–7 postchallenge with a gradual return to baseline by day 16. For mucociliary clearance, eustachian tube function, and middle ear pressure, but not nasal patency, these abnormalities were more pronounced in patients with a symptomatic cold. These results show that changes in nasal physiology resulting from a rhinovirus infection can be objectively quantified and that the resulting pathophysiology extends to anatomically contiguous structures such as the eustachian tube and middle ear.
Clinical Investigation of Disorders of Olfaction
Authors: Snow James B.
Published: September 2007

The receptor cells in the olfactory neuroepithelium are regularly replaced and, when injured, regenerate from basal cells and reestablish their central connections. This process of reconstitution occurs throughout the life span after mechanical, chemical, and infectious injury. The history and physical findings in association with the quantification of the olfactory loss allow an etiologic diagnosis in many patients. Olfactory losses can be categorized as transport or sensorineural defects. Therapy for transport olfactory losses is frequently effective in restoring the sense of smell. Reasonable strategies for treatment of patients with sensorineural olfactory losses remain limited.
Nasal Provocation and Eustachian Tube Function
Authors: Fireman Philip
Published: September 2007

Nasal provocation, which has played an important role in defining the pathophysiology of nasal diseases has been applied to studying the pathophysiology of eustachian tube function and middle ear diseases. The development of rhinomanometry has provided an objectivity to the assessment of nasal airway obstruction. In addition, the utilization of computer technology to assist in data management has provided a new dimension to this procedure that has enhanced its potential. Recent advances in our understanding of eustachian tube physiology and its relationship to the nasopharynx, plus the documentation of eustachian tube obstruction after nasal provocation, have enhanced the utility of these procedures. This occurred in conjunction with the development of an additional methodology, sonotubometry, to objectively measure eustachian tube obstruction. The ability to perform computer-assisted rhinomanometry and sonotubometry in series and also in conjunction with pulmonary function testing to quantify almost simultaneously several parameters of upper and lower airway obstruction has expanded the usefulness of these procedures. The lack of standardization of the several challenge procedures currently utilized has limited the development of these procedures as clinical tools. At the present time nasal provocation testing is used primarily for clinical investigation because previous definitive studies have not correlated symptoms with test results. There is a need to reassess the clinical application of these procedures in light of the recently developed technology. These have not been adequately explored and have not yet been utilized to their maximum potential. As the methodologies are more refined it is anticipated that nasal provocation testing will play an increasingly important role in studying the pharmacology and management of the allergic response.
Late Phase Eustachian Tube and Nasal Allergic Responses Associated with Inflammatory Mediator Elaboration
Authors: Skoner David P. , Doyle William J. , Boehm Sharon , Fireman Philip
Published: September 2007

Previous work in our laboratories has documented an IgE-mediated functional obstruction of the nose and eustachian tube (ET) immediately after nasal allergen challenge. The goals of this study were to monitor changes in nasal, ET, and bronchial physiology during the 12 hours following nasal allergen challenge and to correlate these changes with the elaboration of inflammatory mediators (IM). Subjects with ragweed allergic rhinitis were challenged intranasally with 2.5 mg of ragweed/nostril, and responses were assessed by posterior rhinomanometry for the nasal airway, sonotubometry for the eustachian tube, and spirometry for the bronchial airway. Blood was obtained simultaneously for quantitating the elaboration of three functionally and metabolically distinct IM. Late nasal responses (3–12 hours postchallenge) were observed in 7 of 10 subjects, with an average decrease of 67 ± 5% in nasal conductance at an average onset time of 6.6 ± 0.8 hours postchallenge. Dual late nasal responses were observed in five subjects. Late ET responses were observed in 10 ears (50%). Two sequential late ET responses were observed in three subjects. Late bronchial responses were detected in three subjects, one of whom did not have an early response. Plasma elevations of one or more IM were detected in all late nasal responders during the late phase response period. Late nasal and ET responses in association with an allergic nasopharyngeal inflammatory process could provide an important insight into the relationship between nasal allergy and middle ear disease.
Intranasal Encephaloceles
Authors: Stone Gwen E. , Donegan J. Oliver
Published: September 2007

Two cases of intranasal encephaloceles in previously asymptomatic adults are presented, and the development, diagnosis, and treatment of encephaloceles are discussed. It is important to include encephaloceles in the differential diagnosis of nasal masses, as inadvertent biopsy or removal can precipitate cerebrospinal leakage and meningitis.
Release of Histamine, Prostaglandins, and Leukotrienes after Antigen Challenge in Hayfever Subjects
Authors: Chan-Yeung Moira , Kinsella Mario , Chan Henry , Lam Stephen , Tse Kam S. , Salari Hassan
Published: September 2007

Nasal washes before and at intervals after nasal challenge with mixed grass pollen extract were carried out in nine patients with allergic rhinitis and four control subjects. In the nasal wash, histamine was measured using the radioenzymatic method, prostaglandins (PGs) and leukotrienes (LTs) were measured by high pressure liquid chromatography. Control subjects did not react to allergen challenge. Small amounts of histamine (0.47 ± 0.23 ng/ml) and PGD2 were found in the nasal fluid before challenge with no increase in either mediator after challenge. Leukotrienes were not found before or after challenge. Subjects with allergic rhinitis developed sneezing, rhinorrhea, and stuffy nose after challenge. High levels of histamine (5.3 ± 7.0 ng/ml) and PGD2 (2.7 ± 3.2 ng/ml) were found in the first prechallenge wash even though the subjects were asymptomatic. The second prechallenge wash showed reduction of histamine (2.8 ± 5.2 ng/ml) and PGD2 (1.4 ± 1.8 ng/ml). Five to 15 minutes after antigen challenge, there was a rise in histamine and PGD2 in four of nine subjects. No LTs were detectable in the prechallenge wash. Five of nine subjects showed a rise in LTC4 and/or LTE4, immediately after challenge. Our results showed that although nasal challenge with antigen can induce the release of mediators in seven of nine subjects with allergic rhinitis, the profile of mediator release was variable, and there was no correlation between the type or amount of mediator released and the severity of the nasal symptoms. The pathogenetic role of these mediators in pollenallergic rhinitis needs further evaluation.
Airway Neuropeptides
Authors: Casale Thomas B.
Published: September 2007

Nonadrenergic and noncholinergic pathways appear to be important in regulating lung functions. The neurotransmitters intrinsic to the nonadrenergic and noncholinergic nerves are peptides. These neuropeptides probably play a significant role in the pathogenesis of asthma by influencing airway tone, pulmonary vasomotor tone, mucus production, mucosal permeability, and inflammatory cell influx and mediator release. This paper reviews the function of these lung neuropeptides and speculates on the role of these peptides in the pathophysiology of asthma.
A Comparison of Acti*Tip™ Allerg*E™ and Allerg*ENS™ System to Phadebas RAST® and Phadebas IgE PRIST® in Assaying Total IgE and Specific IgE in Human Serum
Authors: Connell John T.
Published: September 2007

Two in vitro systems of measuring total IgE and specific IgE antibodies were compared using serum of patients suspected of having allergic rhinitis due to inhalation of grass pollen. One in vitro system was the Phadebas PRIST and RAST. The accuracy of these tests has been well defined and they were used as the standard. The Acti*Tip Allerg*E and Allerg*ENS system is a new technique utilizing a similar solid-phase immunologic methodology with an enzyme-based detection system. It has some advantages primarily related to the mechanics of performing the test and marked reduction in time for obtaining results. The correlation between the Phadebas and Acti*Tip systems was highly significant for measuring total IgE and specific IgE antibodies for grasses in serum.
Endoscopic Intranasal Dacryocystorhinostomy—A Cadaver Study
Authors: Rice Dale H.
Published: September 2007

Several transnasal, transnasal-transseptal, and external approaches for dacryocystorhinostomy have been described. The first two and especially the first have the disadvantage of limited visualization. The third leaves an external scar, disrupts the horizontal canilicular system, and requires manipulation of the medial canthal tendon. The method described, using nasal endoscopes, affords excellent visualization and precise control, while avoiding an external scar, the canilicular system, and the medial canthal tendon.
Left Pansinusitis and Periorbital and Intracranial Abscesses Due to Actinomyces Species
Authors: Paugh Donald R. , Koopmann Charles F.
Published: September 2007

Paranasal sinusitis may occasionally be complicated by intraorbital or intracranial spread of infection. In this presentation, the authors report the case of a 17-year-old male with left pansinusitis complicated by periorbital and intracranial abscess secondary to an infection associated with Actinomyces spp. and coagulase-negative Staphylococcus spp. This appears to be the first case report of Actinomyces involvement in the orbit or frontal sinus. The potential morbidity and/or mortality associated with locally invasive paranasal sinus abscess is reviewed. The combined medical and surgical management of this problem is presented.
A Comparison of Nasal Cytology with Sinus X-Rays for the Diagnosis of Sinusitis
Authors: Wilson Nevin W. , Jalowayski Alfredo A. , Hamburger Robert N.
Published: September 2007

A prospective comparison of nasal cytology with sinus x-rays in 55 patients (35 children and 20 adults) with suspected sinusitis was performed. A sample of the nasal mucosa from the inferior turbinate was obtained with a Rhinoprobe, fixed, and stained with modified Wright-Giemsa. The radiologist and the cytologist were unaware of each other's findings. The x-ray report was considered positive if there was mucoperiosteal thickening, asymmetry, opacification, or air-fluid levels. The cytology report was positive if there was greater than 1 neutrophil per high power field with bacteria present. There was a 79% correlation between the sinus x-rays and nasal cytology reports. Specificity was 0.79 and sensitivity 0.79. When the cytology report was positive with greater than 6 neutrophils per high power field, the x-ray was positive 90% of the time. Two sinus x-rays were uninterpretable by the radiologists. These data indicate that nasal cytology is a safe, noninvasive and useful adjunct in the diagnosis of sinusitis in both adults and children.
Loratadine and Pseudoephedrine Sulfate: A Double-Blind, Placebo-Controlled Comparison of a Combination Tablet (SCH 434) and Its Individual Components in Seasonal Allergic Rhinitis
Authors: Hébert Jacques , Bédard Pierre-Michel , Del Carpio Jaime , Drouin Michel , Gutkowski Andrzej , Kabbash Lynda G. , Nedilski Morris M. , Prévost Michel , Schulz Jan I. , Turenne Yves , Yang William H.
Published: September 2007

SCH 434 is a combination tablet containing the nonsedating antihistamine, loratadine (5 mg), and the well-established nasal decongestant, pseudoephedrine sulfate (120 mg), for twice daily dosing. The efficacy and safety of SCH 434 was compared with its individual components in a 14-day, placebocontrolled, randomized, double-blind, parallel-group, multi-center study in the symptomatic treatment of seasonal allergic rhinitis; 437 patients were evaluated for safety, 417 of whom were also evaluated for efficacy. Throughout the study, SCH 434 provided a significantly greater degree of overall symptom relief than either component alone or placebo. Loratadine alone was also superior to placebo on day 4 and at end point and superior to pseudoephedrine alone on day 4 in decreasing total symptom score. All treatments were well tolerated and no serious or unusual adverse experiences were reported; adverse experiences associated with SCH 434 were typical of the side effects commonly associated with the use of pseudoephedrine. The combination provides for a safe, effective, and convenient alternative for patients requiring the benefits of both an antihistamine and nasal decongestant, but who cannot tolerate, or wish to avoid, the sedative effects of traditional antihistamines.
Nasal Resistance, Sensation of Obstruction, and Rhinoscopic Findings Compared
Authors: Naito Kensei , Cole Philip , Chaban Roman , Oprysk Donna
Published: September 2007

Nasal resistances were measured by posterior rhinomanometry with a head-out body plethysmograph in 101 adult patients referred to our nasal airflow laboratory and were compared with both the patients’ sensations of nasal stuffiness and with rhinoscopic findings. Symptomatic grading of nasal stuffiness, which is a subjective perception, did not reveal a significant correlation with nasal resistances or with rhinoscopic findings; however, ipsilateral rhinoscopic grading and resistance values were directly related (p < 0.05) and application of Ohm's Law for parallel resistors to rhinoscopic grading also showed a direct relationship with measured total nasal resistance (p < 0.05). Pathologic conditions in the anterior nose and anterior septal deviation accompanied by a congested inferior turbinate were important determinants of obstruction.
Imaging in Chronic Sinusitis: Disparity between Radiographic and Ultrasound Interpretation
Authors: Druce Howard M. , Heiberg Elisabeth , Rutledge Joyce
Published: September 2007

Conventional radiographs of the paranasal sinuses were interpreted by two observers and were compared to A-mode ultrasound scans in 100 consecutive patients with classical symptoms of chronic sinusitis. Of the maxillary sinus radiographs 65% were reported as normal by one radiologist. There was poor agreeement between the observers in interpretation of the radiographs and both observers’ interpretations correlated poorly with ultrasound scans. Compared to radiographs, ultrasound had a sensitivity of 31% and specificity of 63% in detecting abnormalities. We suggest that positive imaging tests in chronic sinusitis may not truly reflect the incidence of a pathologic condition and that comparison of images with other parameters (e.g., response to treatment) is needed to ascertain the role of the images in chronic sinusitis.
Aggressive Sinonasal Polyposis
Authors: Parker Gregg S. , Tami Thomas A. , Wilson Joseph F.
Published: September 2007

Sinonasal polyposis is one of the most common nasal conditions encountered by the otolaryngologist. Trauma, inflammation, allergy, and chemical irritation are all said to play a role in its etiology. While polyps generally behave in a benign noninvasive manner, they can assume a more aggressive course. We recently encountered three cases of histologically benign inflammatory sinonasal polyps which acted in an aggressive manner by eroding bone and invading orbit, pterygomaxillary space, and anterior cranial fossae. After appropriate cranial facial surgical therapy, all three of these patients recovered completely. The mechanism responsible for aggressive clinical behavior in these cases may be related to the formation of multiple, microscopic, intrapolyp mucoceles. Aggressive sinonasal polyposis should be considered when lesions of the paranasal sinus are encountered in clinical practice.
Airway and Dentofacial Development
Authors: Meredith George M.
Published: September 2007

All physicians and dentists who evaluate the upper airway and dentofacial skeleton in the growing child should be aware of the wealth of pediatric dental and, especially, orthodontic literature that has been published over the past century as it pertains to airway and dentofacial development. The child who has a genetic predisposition toward the dolichocephalic (narrow) facial skeleton, a neuromuscular deficit, and structural upper airway compromise is particularly at risk for development of the long-face syndrome. Furthermore, the child who has a genetic tendency toward mandibular prognathism, tonsillar and tongue hypertrophy, and who is a chronic mouth-breather, is at particular risk for developing advanced mandibular prognathism. Unfortunately, there is little physician exposure to these concepts during medical school years and even during residency training programs. It behooves each specialty to be aware of the diagnostic and therapeutic modalities and concerns of interrelated specialties. The beneficiaries of this sharing of knowledge will be tomorrow's leaders.
Evaluation of Nonspecific Nasal Reactivity to Histamine during and after Natural Ragweed Pollen Exposure
Authors: Bédard Pierre Michel , Jobin Marie , Clement Lorraine , Mourad Walid , Hébert Jacques
Published: September 2007

An increased nonspecific nasal reactivity (NSNR) to histamine or to methacholine has been reported in patients with rhinitis, but its contribution to clinical symptoms remains unclear. In the present study, the NSNR to histamine, defined as the concentration of histamine necessary to induce, after a topical challenge, a 75% decrease in nasal airflow (PC75), was significantly more severe in a group of ragweed-allergic subjects during natural exposure to pollen (PC75 = 4.65 mg/ml) than in normal volunteers (PC75 = 12.9 mg/ml, p < 0.0001). However, the basal nasal airflow rates of the two groups were not significantly different (290 and 339 cc). The NSNR correlated with skin sensitivity to ragweed (r = 0.46, p < 0.0021) or with the IgE antibody (Ab) levels (r = 0.42, p < 0.01) but not with the symptom scores. Finally, after the pollen season, the allergic group's nasal sensitivity to histamine improved significantly (PC75 = 4.65 to 9.35 mg/ml, p = 0.03) but remained different from that of the control group (13.19 mg/ml, p = 0.04).
The Roof of the Anterior Ethmoid: A Place of Least Resistance in the Skull Base
Authors: Kainz Josef , Stammberger Heinz
Published: September 2007

Because of its special anatomic features the roof of the anterior ethmoid is a preferred area for frontobasal fractures as well as an area of hazard during ethmoid surgery. As clinical experience proves, the most critical area for lesions to occur is in the vicinity of the anterior ethmoidal artery, especially where it leaves the dome of the ethmoid medially to reach the ethmoidal sulcus in the olfactory fossa. Complete ethmoidal specimens were investigated by means of histologic serial sections in the frontal plane. Forty anterior ethmoidal arteries were anatomically prepared. Special features of their topography including connection with the dura, fixation of the dura to the bone of the skull base, and the variations of the thickness of the surrounding bony wall were studied with regard to their surgical relevance. Of utmost importance is the fact that the bone in the vicinity of the ethmoidal sulcus is up to 10 times thinner than the neighboring roof of the ethmoid sinus. Coronal CT scans demonstrating this most critical point with all its many possible variations are found to be invaluable for the preoperative planning of endoscopic or other ethmoid surgery.
Large Septal Perforation Repair Using Inferior Turbinate Sliding Advancement Flap
Authors: Papay Francis A. , Eliachar Isaac , Risica Robert , Carroll Marion
Published: September 2007

A surgical technique for closure of septal perforations is described, along with an illustrative case report. The technique consists of a posterolaterally based sliding advancement flap of the nasal mucosa covering the inferior turbinate, inferolateral nasal wall, and floor of nose. It has proven effective in closure of several large septal defects as illustrated in the case report.
Rhinologic Manifestations of Acquired Immunodeficiency Syndrome
Authors: Lucente Frank E. , Meiteles Lawrence Z. , Schoenfeld Philip S.
Published: September 2007

Among the more common manifestations of acquired immunodeficiency syndrome (AIDS) are infections and tumors that occur in regions treated by the otorhinolaryngologist. In this article we discuss the various infections and tumors of the nose and paranasal sinuses that have been reported among AIDS patients. Many of these disease entities may be the presenting signs of human immunodeficiency virus seropositivity and AIDS. The rhinologist should be able to recognize and diagnose these diseases so that proper testing and treatment may ensue. We also review the universal precautions and specific guidelines recommended for safeguarding the rhinologist and other health care workers who treat these patients.
Experience in Counting Ciliary Beat Frequency from Vital Cytologic Sampling
Authors: Deitmer T. , Phadhana-anek S.
Published: September 2007

From a viable cytologic brush biopsy of the respiratory epithelium you can get an insight into the functional state of the epithelial cell layer, especially of the ciliated cells. We report on our experience of several hundred sampling procedures from the nasal and bronchial mucosa. The technique of the method is described, including the microphotometric apparatus to determine the ciliary beat frequency. We stress the importance of checking the ciliary beat frequency of the 10 most active cells of one preparation to get representative results. Futhermore it is decisive to watch them over a period of 10 seconds, considering the time shift of the ciliary beat frequency. Putting the cell solution into a counting chamber gives the possibility of differentiating viable and dead ciliated cells as well as squamous cells in the sample. These results proved to yield a good picture of the functional state of the sampled respiratory mucosal site.
Safety and Efficacy of Injectable Pentigetide: Double-Blind, Placebo-Controlled Study in Patients with Allergic Rhinitis
Authors: Prenner Bruce M. , Rangus Kathryn F. , Eldon Michael A.
Published: September 2007

Pentigetide is a synthetic pentapeptide derived from the Fc region of human IgE reported to inhibit IgE-mediated allergic responses. A randomized, double-blind, placebo-controlled trial was conducted to evaluate the safety and efficacy of subcutaneously administered pentigetide in the treatment of allergic rhinitis. After a 3-day baseline period, 55 patients received 5 injections of either 20 mg of pentigetide for injection (n = 31) or placebo solution (n = 24), one injection every 3 to 4 days for 14 days. Physician assessment of frequency and severity of sneezing, rhinorrhea, congestion, nasal itching, and 3 non-nasal symptoms obtained at baseline, after 1 week, and study completion were compared between pentigetide and placebo treatment groups. The physician's assessment of therapeutic response made at study completion showed that 71% of patients receiving pentigetide were improved, whereas 37% of patients receiving placebo had improved, a difference which was statistically (chi square, p = 0.013) as well as clinically significant. Mean symptom scores indicated that the frequency and severity of sneezing, rhinorrhea, and nasal itching decreased after 1 week of pentigetide treatment and remained decreased until study completion, whereas congestion was unchanged or slightly increased. In contrast, the frequency and severity of sneezing, rhinorrhea, and nasal itching increased after placebo treatment, with congestion essentially unchanged. No clinical or statistical differences in safety parameters between pentigetide and placebo treatments were observed. The results of this pilot trial suggested that subcutaneous pentigetide is safe and effective in the treatment of allergic rhinitis and justified expanded safety and efficacy studies in a greater number of patients treated for a longer period of time.
Chronic Sinusitis and Rhinitis
Authors: Druce Howard M. , Rutledge Joyce L.
Published: September 2007

In a 6-month period, 186 new patients with chronic nasal symptoms were evaluated. In addition to history and physical examination, all received sinus radiographs. A subset received epicutaneous skin tests to environmental aeroallergens. Patients were divided into five diagnostic categories to determine if history or physical findings could predict abnormal sinus radiographs. No symptom or group of symptoms proved diagnostic; however, no patient with allergic rhinitis had purulent nasal secretions. Positive skin tests occurred in the absence of typical allergy symptoms. Many patients had received inappropriate prior therapy with either surgery or antibiotics. We conclude that sinus radiographs should be obtained in all patients with chronic nasal symptoms not improved by routine therapy.