bluuebunny/crossref_metadata_2025 huggingface dataset:
Possible Role of α-Cell Insulin Resistance in Exaggerated Glucagon Responses to Arginine in Type 2 Diabetes
Authors: Tsuchiyama Naomi , Takamura Toshinari , Ando Hitoshi , Sakurai Masaru , Shimizu Akiko , Kato Ken-ichiro , Kurita Seiichiro , Kaneko Shuichi
Published: September 2007

OBJECTIVE—Inappropriate excessive secretion of glucagon, which contributes to postprandial hyperglycemia, is a novel target for the treatment of diabetes. In this study, we sought to determine the factors associated with exaggerated glucagon secretion in response to an arginine challenge in patients with type 1 and type 2 diabetes.

RESEARCH DESIGN AND METHODS—Changes in circulating C-peptide immunoreactivity (CPR) and immunoreactive glucagon (IRG) after an arginine challenge were investigated in 35 patients with type 1 diabetes, 130 patients with type 2 diabetes, and 35 nondiabetic control subjects.

RESULTS—No significant differences were found in the basal level and the area under the concentration-time curve (AUC) of IRG (AUCIRG) among type 1 and type 2 diabetic patients and nondiabetic subjects. However, there was an inverse correlation between the AUCIRG and the AUC of CPR (AUCCPR) for type 1 (r = −0.388, P = 0.023) and type 2 (r = 0.396, P < 0.0001) diabetic patients, whereas AUCIRG was not correlated with AUCCPR in nondiabetic subjects (r = −0.079, P = 0.655). In type 1 diabetic patients, the AUCCPR decreased and the AUCIRG increased with increasing disease duration. In type 2 diabetic patients, both AUCIRG and AUCCPR increased with increasing BMI, basal CPR level, and homeostasis model assessment of insulin resistance value.

CONCLUSIONS—Our findings suggest that the pathophysiology of the exaggerated glucagon response differs between type 1 and type 2 diabetes. Intraislet insulin deficiency and α-cell insulin resistance may be the primary contributors to this condition in type 1 and type 2 diabetes, respectively.
Relationship Among Alcohol, Body Weight, and Cardiovascular Risk Factors in 27,030 Korean Men
Authors: Sung Ki-Chul , Kim Sun H. , Reaven Gerald M.
Published: September 2007

OBJECTIVE— Recent studies suggest a lower risk for overweight/obesity in moderate alcohol drinkers. However, the validity of this relationship and its impact on the putative benefits of alcohol consumption on cardiovascular disease (CVD) risk has not been well evaluated.

RESEARCH DESIGN AND METHODS— We assessed the impact of BMI on the relationship between alcohol consumption and CVD risk factors (blood pressure, lipid panel, and glucose and insulin concentrations) in 27,030 healthy Korean men with no major comorbidities or medication intake seen in a large urban Korean hospital.

RESULTS— BMI and overweight prevalence increased linearly with alcohol intake (P < 0.001). Alcohol intake was also positively associated with blood pressure and triglyceride, HDL, and fasting glucose concentrations (P < 0.001) and negatively associated with LDL and insulin concentrations (P < 0.001). With nondrinkers as the reference group, the odds ratio for having insulin in the top quartile also declined linearly when adjusted for age, BMI, smoking, and exercise, with the heaviest drinkers (>40 g/day) having an odds ratio of 0.71 (95% CI 0.62–0.82) (P < 0.001). The relationship between alcohol and CVD risk factors was similar in normal-weight and overweight individuals.

CONCLUSIONS— Alcohol intake is associated with increasing BMI and several metabolic abnormalities, including higher fasting glucose. Paradoxically, it is also associated with lower insulin concentrations. The clinical significance of these findings needs further investigation.
Patient Perceptions of Quality of Life With Diabetes-Related Complications and Treatments
Authors: Huang Elbert S. , Brown Sydney E.S. , Ewigman Bernard G. , Foley Edward C. , Meltzer David O.
Published: September 2007

OBJECTIVE—Understanding how individuals weigh the quality of life associated with complications and treatments is important in assessing the economic value of diabetes care and may provide insight into treatment adherence. We quantify patients’ utilities (a measure of preference) for the full array of diabetes-related complications and treatments.

RESEARCH DESIGN AND METHODS—We conducted interviews with a multiethnic sample of 701 adult patients living with diabetes who were attending Chicago area clinics. We elicited utilities (ratings on a 0–1 scale, where 0 represents death and 1 represents perfect health) for hypothetical health states by using time-tradeoff questions. We evaluated 9 complication states (e.g., diabetic retinopathy and blindness) and 10 treatment states (e.g., intensive glucose control vs. conventional glucose control and comprehensive diabetes care [i.e., intensive control of multiple risk factors]).

RESULTS—End-stage complications had lower mean utilities than intermediate complications (e.g., blindness 0.38 [SD 0.35] vs. retinopathy 0.53 [0.36], P < 0.01), and end-stage complications had the lowest ratings among all health states. Intensive treatments had lower mean utilities than conventional treatments (e.g., intensive glucose control 0.67 [0.34] vs. conventional glucose control 0.76 [0.31], P < 0.01), and the lowest rated treatment state was comprehensive diabetes care (0.64 [0.34]). Patients rated comprehensive treatment states similarly to intermediate complication states.

CONCLUSIONS—End-stage complications have the greatest perceived burden on quality of life; however, comprehensive diabetes treatments also have significant negative quality-of-life effects. Acknowledging these effects of diabetes care will be important for future economic evaluations of novel drug combination therapies and innovations in drug delivery.
Endonasal Endoscopic Marsupialization of Paranasal Sinus Mucoceles
Authors: Ikeda K. , Takahashi C. , Oshima T. , Suzuki H. , Satake M. , Hidaka H. , Takasaka T.
Published: September 2007

Paranasal sinus mucoceles are relatively common in Japan, especially after prior Caldwell-Luc surgery. Recently developed endonasal endoscopic approaches were used for the drainage and marsupialization of mucoceles. We present the surgical treatment of 97 patients with mucoceles, including 68 maxillary, 13 ethmoid, nine frontal, seven sphenoid, eight frontoethmoid, and one sphenoethmoid sinuses. Six patients with maxillary mucoceles were operated via a sublabial incision. For fronted mucoceles, four patients were treated by a combined external and endonasal endoscopic approach. The other mucoceles underwent complete marsupialization under endonasal endoscopic control. There were no intraoperative or postoperative complications. No evidence of recurrence was observed in any patients during follow-up periods ranging from 36 to 84 months.
Association of Bronchopneumonia with Sinusitis Due to Bordetella Bronchiseptica in an Experimental Rabbit Model
Authors: Berglöf Anna , Norlander Tomas , Feinstein Ricardo , Otori Nobuyoshi , Stierna Pontus , Sandstedt Karin
Published: September 2007

An animal model for rhinogenic sinusitis was developed in rabbits naturally colonized with Bordetella bronchiseptica. It was found that ostial occlusion predisposes the sinus to invasion with this opportunistic bacterium and subsequent sinusitis as a result of reduced local host defense. In addition to the inflammatory lesions in the sinus, bronchitis and pneumonia were found in 84% of the experimental rabbits, suggesting that ostial dysfunction can also contribute to infectious disease of the lower respiratory tract. In such a model it is possible to study the significance of asymptomatic carriage of potential pathogens after ostial occlusion.
Nasal Nitric Oxide is Not Altered by Topical Anesthesia
Authors: Qian Wei , Graciano Agnaldo , Haight James S. J. , McClean Patricia , Zamel Noe , Chapnik Jerry S.
Published: September 2007

This prospective study was undertaken to determine whether topical nasal anesthetic agents affect nasal nitric oxide (NO) output in healthy adults. Seven volunteers (aged: 29–56 (40.6 ± 10.7) years, six male), were recruited. A topical anesthetic (4% lidocaine or 0.5% tetracaine) was sprayed into the subject's right nostril while the left nostril served as a control. Unilateral nasal NO and nasal volume were measured before administration of the anesthetic and at 15 and 30 minutes after the administration. The mean (±SD) unilateral nasal NO output was 307 ± 45.9 nL/minute from the right nostril (exposure side) before the topical application of lidocaine. At 30 minutes after topical application (n = 6), it was 295.5 ± 41.5 in the right nostril and 297.5 ± 39.8 in the left (control side). In the tetracaine group (n = 7), the mean (±SD) unilateral nasal NO output was 302 ± 53.3 before the administration and 307 ± 39.7 at 30 minutes after the administration in the right nostril. The mean NO output in the left nostril at 30 minutes after the administration was 297.7 ± 40.75. In neither group was there any significant difference in nasal NO output between either the pre- and postlocal anesthetic application on the exposure side (Group1, P = 0.76; group 2, P = 0.41) or the two nostrils after topical anesthesia application (group 1, P = 0.83; group 2, P = 0.62). Topical anesthesia with either lidocaine or tetracaine does not alter nasal NO output. NO measurement should not be affected in circumstances that require topical anesthesia of the nasal cavity.
Loratadine: A Potent, Nonsedating, and Long-Acting H1 Antagonist
Authors: Friedman Harold M.
Published: September 2007

Loratadine, a nonclassical selective, peripheral H1-receptor antagonist has undergone extensive preclinical studies and clinical trials in over 6,000 patients. In the treatment of allergic rhinitis, loratadine has efficacy equivalent to clemastine, terfenadine, astemizole, and mequitazine. Its duration of action is 18–24 hours making once daily dosing practical. Loratadine is virtually devoid of sedating or other CNS effects.
The Role of IgE-Mediated Hypersensitivity in Otitis Media with Effusion: A 1987 Update
Authors: Bernstein Joel M.
Published: September 2007

The role of IgE-mediated hypersensitivity in the development of middle ear disease has not been completely resolved. However, on the basis of our investigations and those of other laboratories, we would suggest that approximately two-thirds of patients with chronic recurrent otitis media (OM) are not allergic. The other third may have allergic rhinitis, and this allergic rhinitis may play a direct role in producing eustachian tube dysfunction in recurrent OM. However, viral infections of the upper respiratory tract may also induce IgE-mediated release of mast cell inflammatory mediators and could cause OM on the basis of viral infection alone. The role of allergic rhinitis on eustachian tube dysfunction is now well documented, and finally, the possible role of food allergy and OM must be seriously considered, particularly in the young OM-prone child with chronic recurrent rhinitis and OM.
Allergic Rhinitis: Some Recent Changes in Treatment
Authors: Small Peter
Published: September 2007

Recent changes in treatment of allergic rhinitis have not demonstrated a treatment that is clearly superior to any of the others. My own personal experience has suggested that intranasal topical steroids are the most effective treatment of allergic nasal disease, but minor limitations associated with this form of therapy make its universal use as a primary treatment of allergic rhinitis somewhat questionable. The newer antihistamines are without significant side effects, but require improved efficacy. This will likely occur in the near future. As for immunotherapy, recent immunological modifications of vaccines have not yet provided the clinician with improved efficacy.
Cetirizine, a Novel Antihistamine
Authors: Spector Sheldon L. , Altman Robert
Published: September 2007

Cetirizine, an oxidative metabolite of hydroxyzine, is a cyclizine class H1-receptor antagonist with diminished CNS activity currently under investigation. It has a novel pharmacokinetic profile with a 9-hour half-life, lower volume of distribution and total body clearance, minimal metabolism and essentially renal excretion. Minimal binding to CNS receptors has been demonstrated in animal models. In contrast to its parent compound and diphenhydramine, cetirizine has an effect comparable to placebo on psychomotor function and multiple sleep latency tests. Inhibition of histamine-induced bronchospasm and mild bronchodilation has also been demonstrated. U.S. and European clinical trials have affirmed its safety and efficacy in histamine-associated disorders.
Nasal Polyps: Epidemiology, Pathology, Immunology, and Treatment
Authors: Settipane Guy A.
Published: September 2007

Nasal polyps frequently are associated with aspirin intolerance, intrinsic asthma. Young's syndrome, cystic fibrosis, and Kartagener's syndrome. Children 16 years or younger with nasal polyps should be evaluated for cystic fibrosis. Nasal polyps are frequently bilateral, multiple, freely movable, and pale-gray and arise from the middle meatus of the nose. Histologically, they classically have pseudostratified ciliated columnar epithelium, thickening of the epithelial basement membrane, high stromal eosinophil count, mucin with neutral pH, few glands, and essentially no nerve endings. Cells consist of a mixture of lymphocytes, plasma cells, and eosinophils. Polyps from patients with Young's syndrome, Kartagener's syndrome, and cystic fibrosis have predominately neutrophils with insignificant eosinophils. Chemical mediators found in nasal polyps are as follows: histamine, serotonin, leukotrienes [(SRS-A or LTC4, LTD4, LTE4), LTB4], ECF-A, norepinephrine, kinins, TAME-esterase, and possibly PGD2. There is more histamine in nasal polyps than in normal nasal mucosa, and norepinephrine is present in greater concentration in the base of nasal polyps than in normal mucosa. The concentrations of IgA and IgE and, in some cases, IgG and IgM are greater in polyp fluid than in serum. IgE-mediated disease is not the cause of nasal polyps, but when present, may contribute to episodes of exacerbation. Despite medical or surgical management, a significant number of nasal polyps are recurrent. For treatment, systemic corticosteroids should be tried before surgical polypectomy. Polypectomy does not increase the risk of developing asthma or making asthma worse. At the present time, the pathogenesis of polyp formation is unknown.
Nasal Patency and Its Assessment
Authors: Cole Philip
Published: September 2007

The propagation of nasal airflow resistance and its indispensable role in the modification of inspiratory air is described. Aerodynamic features and principles of rhinomanometric techniques which are commonly involved in the assessment of nasal patency are outlined. The clinical value of rhinomanometry is discussed in the light of the Toronto experience with several thousand patients.
Olfaction—A Review
Authors: Ballenger John J.
Published: September 2007

Belatedly the study of the physiology of olfaction has received a great deal of interest. This manuscript is a review of this subject and suggested treatment of its disorders.
Sublabial Surgical Approach for Naso-Antro-Sphenoidal Inverted Papilloma: A Seven-Year Follow-up
Authors: Lekas Mary D.
Published: September 2007

Inverted papilloma is usually approached by the lateral rhinotomy method. The sublabial approach provides excellent access to the nasal cavity and sinuses, as well as allowing the surgeon adequate exposure and affording the patient minimal morbidity.
A Comparison of the Efficacy of Fluocortin Butyl Powder and Beclomethasone Dipropionate Aerosol Spray for the Treatment of Perennial Rhinitis
Authors: Meltzer Eli O. , Orgel H. Alice , Berman Bernard A. , Pearlman David S. , Slavin Raymond G. , Lauber-Huber Cindy , Naadimuthu Amirtha
Published: September 2007

Fluocortin butyl (FCB) is a new topically active steroid. In this 12-week, parallel, multicenter study, 157 symptomatic patients, aged 12–69 years, with moderate to severe perennial rhinitis were randomized to receive either FCB powder or beclomethasone dipropionate (BDP) aerosol spray intranasally. Four symptoms and four signs were scored at the start of the study and every 2 weeks for 12 weeks. Use of concomitant medications and dosage of intranasal medication were monitored. The nasal cytology and nasal cultures of randomly selected patients were examined. At one center 40 patients had rhinomanometric evaluation. Significant decrease from baseline in symptoms and signs was evident by 2 weeks and then continued at a slower rate for up to 12 weeks with both FCB and BDP. There was also an increase in nasal airflow as shown by rhinomanometry and a decrease in concomitant medications. There was no significant difference in efficacy between the two medications. Both drugs were tolerated with minimal side effects. With a lower incidence of nasal irritation and a simple delivery system, FCB has a definite place in the treatment of rhinitis.
Chronic Sinusitis and Nonallergic Rhinitis
Authors: Druce Howard M.
Published: September 2007

Syndromes of chronic sinusitis (CS) and nonallergic rhinitis (NAR) are poorly defined. There is a paucity of epidemiologic studies and long-term treatment outcome remains based mainly on anecdotal evidence. Clinical diagnoses must be differentiated from those made solely on radiographic criteria. The role of allergic disease in CS is undetermined. Many factors such as vascular reactivity, cellular infiltration, modifications of nasal secretions, anatomic abnormalities, deficiency of mucociliary clearance, immunodeficiency, and nasal reflexes contribute to symptom pathogenesis. The question whether NAR is a disease or an exaggerated physiologic response is controversial and is addressed in this contribution. Ultimately, enhanced knowledge of the pathophysiology of CS and NAR may lead to novel therapeutic approaches. Patients readily attribute a variety of symptoms such as postnasal drainage, facial fullness or swelling, head pressure, and nasal congestion to the paranasal sinuses. Unfortunately, many practitioners do not adopt a critical attitude to diagnosing sinus pathology and differentiating it from exaggerated physiologic responses to environmental factors. In this paper I will try to highlight some of the difficulties in this area.
The Nasal Gateway for Pituitary Surgery
Authors: Lekas Mary D.
Published: September 2007

There has been an evolution in the transseptal transsphenoidal approach for pituitary surgery. The nasal approach to the pituitary gland can be from the sublabial transseptal transsphenoidal; the transseptal transsphenoidal; the alotomy transseptal transsphenoidal; the external rhinoplasty transsphenoidal; the transnasal by mobilizing the whole nose on a pedicle; the transseptal infranasal; the midline columellar incision; all types of nasofacial incisions; and transethmoidal approach with nasal instrumentation. The transsphenoidal hypophysectomy surgery has become a safe and effective approach for pituitary tumors. We are mainly concerned with the transnasal and not the transethmoidal approach to the sella turcica at this time.
Sleep Apnea and Nasal Patency
Authors: Millman Richard P.
Published: September 2007

Clinical investigations over the last decade have revealed that sleep may not be the benign rejuvenating state it was once considered. Sleep apnea is now frequently recognized, and it is clear that patency of the nasal passages and the nasopharynx is crucial for successful treatment of the syndrome. Furthermore, partial or complete nasal obstruction even in normal subjects can cause sleep disruption, hypopneas, and apneas. This may partially explain some of the daytime drowsiness seen in patients with conditions such as allergic rhinitis.
Nasal Reflexes
Authors: Raphael Gordon D. , Meredith Scott D. , Baraniuk James N. , Kaliner Michael A.
Published: September 2007

Nasal reflexes are neurally mediated reactions which arise either through direct stimulation of the nasal mucosa or through stimulation of pathways elsewhere in the body which indirectly involve the nose. The neural pathways involved in these reactions are complex, and the exact nature of the stimuli which trigger these reflexes has not been completely detailed. This review presents a discussion on the innervation of the nose, updates the current understanding about nasal neuropeptides, and then summarizes information about several different types of nasal reflexes.
Immunopharmacology of Nasal Allergic Reactions
Authors: lliopoulos Othon , Proud David , Togias Alkis G. , Pipkorn Ulf , Kagey-Sobotka Anne , Lichtenstein Lawrence M. , Naclerio Robert M.
Published: September 2007

The technique of nasal provocation followed by lavage was used to study the pharmacology and pathophysiology of upper airway allergic reactions. The levels of histamine, TAME-esterase activity, kinins, and arachidonic acid metabolites were measured in the recovered nasal lavage fluid obtained during the early and, in certain cases, the late phase and rechallenge reactions to antigen. Leukocytes contained in the lavage were counted and differentiated. Topical application of azatadine and systemic administration of theophylline reduced both mediators and symptoms during the early reaction, probably by inhibiting antigen-induced mast cell activation. Pretreatment with aspirin decreased the concentration of cyclooxygenase products during the early reaction without ameliorating symptoms. Administration of systemic steroids ablated the increase of mediators and symptoms and the mucosal accumulation of eosinophils and mononuclear cells, but not of neutrophils during the late phase reaction, without affecting the mediators or symptoms of the early reaction, with the exception of kinins. Topical steroids reduced both the amount of mediators and the severity of symptoms during the early, late, and rechallenge reactions. The accumulation of eosinophils, basophils, neutrophils, and mononuclear cells during the late phase reaction was also significantly reduced. Thus, this nasal challenge model has helped us to gain insights into the pathophysiology of allergic reactions and the pharmacology of their treatment and can be used to examine the efficacy of pharmacologic agents designed for the treatment of such reactions.
The Serious Side of Snoring
Authors: Kaluza Charles L.
Published: September 2007

Obstructive sleep apnea, is, in fact, an extreme case of snoring. Snoring can result in minor, serious, and sometimes fatal conditions. The social aspects of snoring can be psychologically damaging and disruptive to the family life of the patient. The damaging effects of a snoring condition can be prevented. During routine physical examinations, physicians need to be alert for airway obstruction and take thorough histories to document presence or absence of sleep dysfunctions. Surgical or medical management of snoring provides relief to a vast majority of patients.
In Vitro and in Vivo Antigen-Induced Release of High-Molecular Weight Neutrophil Chemotactic Activity from Human Nasal Tissue
Authors: Nagakura T. , Onda T. , likura Y. , Endo T. , Nagakura H. , Masaki T. , Nagai H.
Published: September 2007

High molecular weight neutrophil chemotactic activity has been identified in resected human nasal polyps, inferior turbinates, and nasal secretions following antigen challenge. The estimated molecular weight, by gel filtration chromatography, was approximately 600,000. However, a heterogeneity of molecular weight in some patients was recognized. Our results suggest a possible role for high molecular weight-neutrophil chemotactic activity in the pathogenesis of hypersensitivity in the human nasal cavity.
New H1-Receptor Antagonists: A Review
Authors: Simons F. Estelle R. , Simons Keith J.
Published: September 2007

The new H1-receptor antagonists such as astemizole, cetirizine, loratadine, levocabastine, ketotifen, and azelastine have diverse pharmacokinetics, pharmacodynamics, and potency. Astemizole, for example, is the most long-acting of the new drugs and is not suitable for sporadic use. Cetirizine, the carboxylic acid metabolite of hydroxyzine, unlike other H1-receptor antagonists, is minimally metabolized in the body and is primarily excreted in unchanged form in the urine. Levocabastine is the most potent of the new drugs and can be applied topically to the conjunctivae or to the nasal mucosa for relief of allergic rhinoconjunctivitis. Ketotifen and azelastine have well-described antiallergic effects in addition of their antihistaminic effects. None of the new H1-receptor antagonists is any more effective in relieving nasal congestion than the first-generation H1-receptor antagonists are. Most, but not all, of the new H1-receptor antagonists lack anticholinergic effects and are relatively nonsedating.
Middle Turbinectomy Complicated by Cerebrospinal Fluid Leak Secondary to Ethmoid Encephalocele: Transethmoid Repair
Authors: Sataloff Robert Thayer , Zwillenberg David , Myers Donald L.
Published: September 2007

The value of middle turbinectomy for cephalalgia in carefully selected patients has been established. Although surgical treatment for middle turbinate syndrome is usually easy and safe, it may result in complications especially in the presence of unrecognized malformations of the anterior skull base. In the patient presented, cerebrospinal fluid rhinorrhea that was due to an ethmoid encephalocele occurred 1 month following surgery. An intranasal, transethmoid subfrontal craniotomy was devised to repair this defect under direct vision without subjecting the patient to the added risks of subfrontal craniotomy through external incisions. The case is reported to highlight an uncommon surgical hazard and a new approach to its repair and to address questions regarding the adequacy of the standard preoperative evaluation.
Invasive Nasal Alternariosis
Authors: Bartell Thad E. , Ford Charles N.
Published: September 2007

Alternaria, a naturally occurring plant pathogen, may rarely cause infection in immunocompromised patients. This report describes a case of invasive alternariosis in a 33-year-old patient with acute leukemia.
Five-Year Follow-up of the Effects of Bilateral Intranasal Sphenoethmoidectomy in Patients with Sinusitis and Asthma
Authors: Mings Ronald , Friedman William H. , Linford Patricia A. , Slavin Raymond G.
Published: September 2007

Chronic sinusitis has been recognized to be a contributing factor to asthma in some patients. We report a 5-year follow-up study of 16 patients who had undergone bilateral sphenoethmoidectomy after not responding to aggressive medical management of underlying sinusitis. Sixty-two percent had subjective improvement of their asthma with 88% of the patients reporting a significantly reduced prednisone requirement. All patients had improvement of their nasal and sinus symptoms at 5 years. The improvement in the asthma reported at 2 years had for the most part persisted at 5 years.
Selection with and without Rhinomanometry of Patients for Septoplasty
Authors: Jessen Max , Köpman Ari , Malm Lars
Published: September 2007

One hundred and fifty-two patients were selected for septoplasty on the basis of symptoms and clinical examination, but without the aid of rhinomanometry. The patients were reexamined at a mean of 3.5 years later when rhinomanometry was included. On the second occasion, in 30% of the patients nasal airway resistance (NAR) of the narrower cavity after decongestion was lower than the upper 95% prediction limit of NAR of individuals with no nasal complaints, and in 18% NAR was lower than the mean NAR + 1 SD for the same individuals. At reexamination of the patients who had not yet undergone operations, about a quarter of those with a “normal” NAR no longer had any subjective obstruction. It is concluded that rhinomanometry is of value in selecting patients for septoplasty.
Immunohistochemical Studies of Olfactory Mucosa in Patients with Olfactory Disturbances
Authors: Yamagishi Masuo , Nakano Yuichi
Published: September 2007

In order to examine the functional morphology of the human olfactory mucosa when olfaction is disturbed, immunohistochemical methods have been applied to mucosal biopsies. In the group of patients examined anosmia was due to bilateral choanal atresia, to chronic sinusitis, to the common cold (viral infection), and to head trauma. One subject had anosmia of unknown etiology. Antibodies against neuron-specific enolase, glia-specific S-100 protein, and cytokeratin were used as markers for the functional morphology of olfactory receptor cells, Bowman's glands, nerve bundles, and basal cells. Each specimen of mucosa revealed characteristic immunohistochemical findings.
Cartilage Grafts in Nasal Surgery
Authors: Glasgold Alvin I. , Glasgold Mark J. , Silver Frederick H.
Published: September 2007

Cartilage grafts are being used with increasing frequency in nasal surgery, particularly with the growing popularity of open rhinoplasty. The properties of cartilage that make it a preferred grafting material are discussed as well as the historical data relating to the survival of cartilage autografts and homografts. The preferred source of cartilage grafts has been the patient's septum. This is not always feasible because of prior surgical removal or inadequate strength or size. The purpose of this paper is to describe the types of cartilage grafts commonly available for use in nasal surgery. The advantages and limitations of each are discussed. Four clinical cases are presented, demonstrating the use of septal cartilage autograft, septal homograft, irradiated rib cartilage homograft, and conchal cartilage autograft.
Effects of Aging on Nasal Structure and Function
Authors: Koopmann Charles F.
Published: September 2007

The aging nose undergoes structural and functional changes, which can cause alterations in olfaction, breathing, cosmesis, and nutrition, as well as exhibiting increased incidence of epistaxis and rhinitis. A review of these factors and suggestions for management is presented.
A Comparative Cost-Effectiveness Study of Two Treatment Modalities for Ragweed Hay Fever
Authors: Leickly Frederick E. , Sears-Ewald Dolores , Ownby Dennis R.
Published: September 2007

The cost of treatment for ragweed hay fever can vary considerably. The newer classes of antihistamines are purported to be effective and without major side effects, but they are costly. This study compared the cost-effectiveness of terfenadine and chlorpheniramine/pseudoephedrine. We found that the maximum use of a low dose of chlorpheniramine/pseudoephedrine was effective and without major daytime sedation and should be considered when treatment for ragweed-induced allergic rhinitis is begun.
Substance P Evokes Nasal Secretion in the Rat: Mode of Action
Authors: Petersson Göran
Published: September 2007

The effect of substance P (SP) and methacholine (MC) on nasal fluid secretion was studied in anesthetized rats. Pre-weighed filter papers impregnated with the challenging agent were applied to the nasal mucosa, changed every 5 minutes and reweighed to measure the secretion absorbed. SP evoked a dose-dependent increase in nasal secretion that was not affected by pretreatment with propranolol, hexamethonium, lidocaine, or chlorpheniramine combined with ranitidine but was inhibited by the SP antagonist (d-Pro2, d-Trp7,9)-SP. MC evoked a dose-dependent increase in nasal secretion that was inhibited by atropine but not by (d-Pro2, d-Trp7,9)-SP. The secretory response to SP was greater than that to MC at equimolar doses.
Priming of the Nose and Eustachian Tube during Natural Pollen Exposure
Authors: Skoner David P. , Doyle William J. , Boehm Sharon , Fireman Philip
Published: September 2007

Previous studies have suggested that seasonal allergen exposure in allergic individuals “primed” or increased the response of nasal mucosa to subsequent allergen challenge. The purpose of this study was to document the specificity of nasal “priming” and to determine if this effect extends to the eustachian tube (ET). Eight subjects with ragweed allergic rhinitis were challenged intranasally with increasing doses of ragweed (0.05, 0.125, 0.25, 0.5, 2.5, and 5.0 mg) and histamine (0.01, 0.1, 0.5, 1.0, 5.0, and 10 mg) before, during, and 4–6 weeks and 3–5 months after ragweed season. Nasal conductance and ET function were evaluated by computerized posterior rhinomanometry and sonotubometry, respectively. The dose that decreased nasal conductance below a threshold value of 0.1 L/sec/cm H2O was defined as the nasal obstructing (NO) dose and that which resulted in an inability to open the ET by swallowing was the ET obstructing (ETO) dose. For ragweed and histamine mean NO doses decreased during and up to 6 weeks after ragweed season compared to preseason and 3–5 months postseason doses. The ETO doses showed similar patterns for histamine challenges, but ET hyperresponsiveness to ragweed was limited to the ragweed season. Patients’ responses did not correlate with serum IgE antibody level. These data show that both the nose and ET can be primed by allergen exposure to manifest heightened responses to both specific allergen and a nonspecific substance.
Nasal Patency: Subjective and Objective
Authors: Naito Kensei , Cole Philip , Fraschetti John , Humphrey Donna
Published: September 2007

Nasal airflow resistances (cm H2O/L/sec), accelerations (L/sec2), alteration of transnasal differential pressure, duration (sec) of inspiration and expiration and peak flow index were measured in 31 adult patients referred to our nasal airflow laboratory. Measurements by posterior rhinomanometry using a head-out body plethysmograph were compared with symptomatic severity of nasal stuffiness. Symptomatic severity of nasal stuffiness, which is a subjective perception, did not reveal a significant correlation with nasal resistances and alteration of transnasal differential pressure on quiet breathing. Acceleration of inspiratory airflow through the nose showed a direct relationship with symptomatic severity of nasal stuffiness (p < 0.04) but acceleration of expiration was not related to obstructive symptoms. Peak flow indices on expiration in the patients who did not complain of nasal stuffiness were significantly less than those on inspiration; however, as symptoms of nasal stuffiness increased, the differences between inspiratory and expiratory indices decreased. Duration of the respiration cycle showed no particular relationship with severity of obstructive sensation. We think that acceleration of nasal airflow and peak flow index can be applied to complement the diagnosis of subjective nasal stuffiness.
Nasal Provocation Testing
Authors: Okuda Minoru
Published: September 2007

Nasal provocation testing is employed to evaluate the sensitivity of nasal mucous membrane to allergen, mediators of the type I allergy, autonomotropic drug and so on. From our experimental results, nasal provocation should be performed by application of a fixed size of surface area of the bilateral inferior turbinate visually using a rhinoscope and then nasal response produced should be assessed by rhinoscopy together with counting the number of sneezes or with a rhinomanometer. For this purpose, the paper disc method developed by the author was practically useful due to easiness of application, reliability of test result, and minimum side effect.
Allergic and Nonallergic Rhinitis: Classification and Pathogenesis Part I. Allergic Rhinitis
Authors: Zeiger Robert S.
Published: September 2007

Chronic rhinitis, although not life-threatening, substantially interferes with one's quality of life. Associated symptoms of nasal obstruction, sneezing, rhinorrhea, and anosmia afflict an estimated 40 million Americans. Directed clinical history and physical examination combined with noninvasive and routine procedures permit physicians to diagnose the myriad conditions causing rhinitis. Although the precise etiology of many of these conditions is only partially known, a practical diagnostic classification can be formulated based on clinical and laboratory findings. An understanding of the pathophysiology of allergic rhinitis as well as the other less understood entities provides the clinician with a integral foundation to implement preventative and therapeutic measures. This comprehensive review should provide the reader an opportunity to better understand and appreciate the causes and pathophysiology of chronic rhinitis. Part I of this article concentrates on IgE-mediated reactions, mediators, and drugs involved in allergic rhinitis. Part II focuses on the recent advances gained in understanding the nonallergic (non-IgE) causes of chronic rhinitis.
The Effects of Allergen-Induced Nasal Provocation on Pulmonary Function in Patients with Perennial Allergic Rhinitis
Authors: Small Peter , Biskin Natalie
Published: September 2007

Fifteen patients with perennial allergic rhinitis responded intranasally to ragweed antigen challenge. Concomitant measurements of pulmonary function did not reveal a significant decrement on flow rates over a 30-minute period.
Exercise-Induced Nasal Obstruction in Patients with Allergic Rhinitis
Authors: Ohki Motofumi , Hasegawa Makoto , Sakuma Akira
Published: September 2007

Exercise-induced nasal obstruction was studied in 90 patients with allergic rhinitis and 26 normal subjects. Allergic patients as well as normal subjects showed marked decreases of nasal resistance immediately after exercise. In allergic patients, however, the total nasal resistance returned to the pre-exercise level quickly after exercise and surpassed it. Meanwhile, the total nasal resistance gradually returned to the pre-exercise level in the post-exercise period in normal subjects. The profile of the total nasal resistance changes in the allergic patients was statistically different from that in the normal subjects. As far as unilateral nasal resistance is concerned, marked increases of nasal resistance appeared 10–30 minutes after exercise in 20 of 90 allergic patients. On the contrary, this phenomenon was not found in any normal subject. This unilateral nasal obstruction, which appeared only in allergic patients, is probably due to excessive dilatation of the capacitance vessels in the nasal mucosa and considered to appear as an enhancement of the nasal cycle. In this paper, the role of the nasal cycle is discussed in relation to exercise-induced nasal obstruction.
The Incidence of Concha Bullosa and Its Relationship to Chronic Sinonasal Disease
Authors: Clark Steve T. , Babin Richard W. , Salazar Jorge
Published: September 2007

Review of CT scans from 198 consecutive patients demonstrated that 33% of 82 patients with sinusitis demonstrated a concha bullosa on at least one side. The incidence in 116 controls was 11%. This statistically significant difference suggests concha bullosa is somehow related to sinonasal disease.
The Role of Nasal Cytology in the Diagnosis of Chronic Sinusitis
Authors: Gill Fredrick F. , Neiburger James B.
Published: September 2007

Currently the role of nasal cytology in the diagnosis of chronic sinusitis is not well defined. Therefore, we compared the results of nasal cytology with the results of sinus radiography in 300 patients with allergic rhinitis who had both tests performed as part of their initial allergy evaluation. Radiography was significantly more likely to be positive when there were >5 neutrophils/high-power field or <5 eosinophils/high-power field on nasal cytology. These findings were fairly sensitive but nonspecific as predictors of radiographic pathology.
Nasal Hemangioma of Pregnancy
Authors: Goldofsky Elliot , Zahtz Gerald D.
Published: September 2007

Nasal hemangiomas of pregnancy are rare lesions. We present one such case with symptoms of nasal obstruction and epistaxis, with discussion of differential diagnosis and possible etiologies.
IgE-Positive Mast Cells Play a Central Role in Nasal Allergic Disease
Authors: Bachert Claus , Marquardt Ulrich , Korte Markus
Published: September 2007

Mast cells are regularly found in the nasal mucosa of healthy persons. Their number increases in allergic and infections rhinitis. With the help of immunohistochemical techniques, cell surface-bound IgE antibodies within a nasal specimen in allergic rhinitis can be distinguished from other non-IgE-associated pathomechanisms. Using conventional mast cell staining techniques together with immunohistochemistry, we were able to demonstrate that IgE-associated cells within the allergic nasal mucosa predominantly resemble mast cells. They increase in number and migrate into the respiratory epithelium due to allergen exposure and show a high cell turnover and degranulation rate. Their number does not correlate with serum IgE levels. These findings suggest that mast cells not only represent the major mediator cells in Type I allergic reactions, but also the transport media for IgE antibodies produced in regional lymphoid tissues.
A New Rapid Test for the Detection of IgE Antibodies to Inhalant Allergens
Authors: Loidolt Doris
Published: September 2007

The purpose of this study was to investigate if the new IgE-quick®, a test based on an enzyme-linked immunoabsorbent assay method agrees with the established Phadezym-RAST® and the skin prick test. Both in vitro methods correlated very well (r = 0.96) as well as to the skin prick test (SPT) (RAST/SPT r = 0.93, IgE-quick/SPT r = 0.91). The new IgE-quick can be recommended for detection of antigen-specific antibodies, as it correlates to skin prick tests and RASTs to a large extent.
Endoscopic Sinus Surgery in a Residency Training Program
Authors: Sterman Bruce M. , DeVore Richard A. , Lavertu Pierre , Levine Howard L.
Published: September 2007

Endoscopic sinus surgery is becoming an increasingly popular mode of treatment of chronic sinus disease. To evaluate the safety and efficacy of a structured teaching program and resident performance of endoscopic sinus surgery, 100 consecutive patients were reviewed. These patients represented the initial 50 procedures as primary endoscopic surgeon for two otolaryngology residents. There were no major complications and six minor complications. A cadaver “sinusology lab” and perioperative office use of the nasal endoscope enhance learning, increase user confidence, and prepare the resident for surgery. The use of a beam splitter, camera, and video monitor during surgery allows for immediate feedback and graduated operative experience. The results of this study demonstrate that endoscopic sinus surgery can be taught safely when such a format is followed.
The Rabbit Maxillary Sinus: A Review of the Effects of Innervation on Mucociliary Activity
Authors: Lindberg Sven , Uddman Rolf
Published: September 2007

The stable bone walls of the maxillary sinus of the rabbit permit undisturbed recordings of the mucociliary activity by a photoelectric technique in vivo. The distribution of peptidergic neurotransmittors in the rabbit maxillary sinus was compared with their mucociliary effects on the same preparation. Nerve fibers containing neuropeptide Y were abundant around blood vessels and glands in the lamina propria. A few nerve fibers were seen just beneath the epithelium. Injections with neuropeptide Y decreased mucociliary wave frequency, the maximum decrease was about 15% for the doses 1.0 and 5.0 μg/kg. Vasoactive intestinal polypeptide (VIP) was found in the subepithelial layer and also distributed close to glands and blood vessels in the lamina propria. Administration of VIP alone did not change the mucociliary activity. However, if the rabbits were challenged with threshold doses of the mucociliary stimulant methacholine, the response to the cholinergic agonist was potentiated by VIP. Substance P (SP)-containing nerve fibers were found in the subepithelial layer, with single varicose endings sometimes penetrating into the epithelium. Challenges with SP produced a prompt increase of the mucociliary activity (the maximum increase was about 50% above baseline level), presumably due to increased chloride flux toward the lumen. Similar effects were produced by neurokinin A, which emanates from the same precursor molecule as SP. Another sensory peptide, calcitonin gene-related peptide was without effect on the mucociliary system. Our data indicate that there is a correlation between the occurrence of nerve fibers just beneath the epithelium and mucociliary effects. A localization close to the epithelium seems a logical prerequisite for epithelial effects.
Substance P and Calcitonin Gene-related Peptide in Nasal Secretions after Antigen Challenge in Man
Authors: Petersson G. , Ekman R. , Malm L.
Published: September 2007

Substance P (SP), calcitonin gene-related peptide (CGRP), albumin, and histamine were measured in nasal secretions after timothy pollen challenge. The study was performed in 16 patients with allergic rhinitis. Standardized timothy antigen preparations were applied to filter papers, which were inserted into one of the nasal cavities; the contralateral side received nontreated filter papers. Nasal fluid secretion increased on both sides, more on the stimulated side than on the contralateral side. The concentrations of SP, CGRP, and histamine in the nasal fluid did not change in response to antigen challenge. The concentration of albumin increased on the stimulated but not on the contralateral side.
The Physiologic Importance of the Nasal Mucosal Vascular Bed: A Review
Authors: Bende Mats
Published: September 2007

The vascular bed of the nasal mucosa is especially important for the function of the nose. The symptoms that characterize the common cold and allergic rhinitis result from inflammation in the nasal mucosa and are likely to be associated with disturbances in the vascular bed. It is consequently worthwhile to investigate the function of the blood vessels in the nasal mucosa. With more rational methods for these studies, it is possible to get detailed knowledge of the pathogenesis and pathophysiology of nasal disorders and to develop improved methods of managing the diseases.
Allergic Fungal Sinusitis
Authors: Ence Bradford K. , Gourley David S. , Jorgensen Neil L. , Shagets Frank W. , Parsons David S.
Published: September 2007

Fungal sinusitis can present as one of four distinct clinicopathologic entities: 1) fulminant or acute; and three types of chronic, 2) indolent, 3) mycetoma, and 4) allergic fungal sinusitis (AFS). The first three forms differ both clinically and pathologically from AFS. The first reported cases of AFS were associated with the fungus Aspergillus, but recently other fungal organisms have been implicated. Five different fungal organisms have been found to cause AFS in 14 patients. The prevalence of AFS among patients with chronic sinusitis may be as high as 7%. The diagnosis is made on the histologic findings of inspissated allergic mucin containing 1) numerous eosinophils, 2) scattered noninvasive fungal hyphae, and 3) Charcot-Leyden crystals. In addition, AFS patients have a characteristic clinical and immunologic profile. The clinical presentation, diagnosis, and management of AFS are discussed. Uniformity of the classification of fungal sinusitis is proposed.
The Differentiation of Polyps and Their Mucosal Ultrastructure
Authors: Takasaka Tomonori , Kurihara Atsushi , Suzuki Hideaki , Kikuchi Toshihiko , Hozawa Koji , Wataya Hideya
Published: September 2007

This paper reported both ultrastructural and biochemical studies of nasal polyps from 32 patients: 5 with an aspirin-induced asthma; 14 allergic patients with rhinitis; and 13 nonallergic patients with negative skin tests against the major inhalant allergens. The results of the studies have clearly shown that there are two different types of nasal polyps, neutrophil-dominant polyps and eosinophil-dominant polyps, and both leukocytes play a major role as important effector cells in the formation of nasal polyps. Cytotoxic effector molecules from both leukocytes initiate the connective tissue damage of the capillary basement membrane, bringing about enormous tissue edema, with broad disruptions of the epithelial lamina, causing polyp formation.