A comparison of triamcinolone acetonide nasal aerosol spray and fluticasone propionate aqueous solution spray in the treatment of spring allergic rhinitis.

BACKGROUND: Many nasal corticosteroids with different potencies and formulations are available, but they have all been proven safe and effective. The clinical relevance, if any, of these differences is not yet completely established. OBJECTIVE: We sought to compare the efficacy, safety, and patients' acceptance of triamcinolone acetonide aerosol spray and fluticasone propionate aqueous solution in the treatment of spring allergic rhinitis. METHODS: After a drug-free baseline evaluation, patients with rhinitis were randomized to receive either a triamcinolone aerosol spray of 110 microg in each nostril once daily (n = 117) or a fluticasone solution spray of 100 microg in each nostril once daily (n = 116) in a single-blind, parallel-group study. The Rhinitis Index Score (sum of scores of symptoms on a scale from 0 to 3) was evaluated daily, in the morning before drug administration, for 21 days. The efficacy of each treatment was assessed by the mean reduction from baseline in the Rhinitis Index Score and in individual symptom scores. Patients' acceptance of the study drugs was also monitored by a daily questionnaire. RESULTS: Reductions of the Rhinitis Index Score (mean +/- SEM) were 4.20 +/- 0.21 and 4.60 +/- 0.21 for triamcinolone and fluticasone, respectively (p = 0.23). There were no statistically significant differences between the drugs in the reduction of any of the individual symptoms. Patients expressed statistically significant differences between the drugs regarding acceptance; different properties of the aerosol and the solution were appreciated differently. CONCLUSIONS: This study shows that triamcinolone acetonide aerosol and fluticasone propionate solution sprays are both clinically equally effective, safe, and well tolerated for the treatment of spring pollen allergic rhinitis.

Laryngeal carcinoma--modifications in surgical technique based on an understanding of tumor growth characteristics.

A study of more than 700 laryngectomy specimens using the technique of whole organ sectioning has resulted in a better understanding of growth and spread of squamous cell carcinoma. The predictability of tumor spread in specific clinical situations has allowed several modifications in surgical technique in order to assure complete removal of the tumor at the time of laryngectomy. These modifications include removal of the thyroid gland on the involved side, removal of pyriform fossa mucosa from the involved side, removal of postcricoid mucosa in tumors involving the posterior commissure, removal of an ellipse of skin from the anterior neck in tumor involving the anterior commissure, and removal of the mucosa of the vallecula in tumors involving the pre-epiglottic space.

Histopathologic and histoenzymatic observations in carcinomas treated with human leukocyte interferon.

In this study histologic and histochemical examinations were performed on the bioptic material of 30 cases of head and neck tumors and 34 cases of uterocervical carcinomas after treatment with human leukocyte interferon (HLI). Particular attention was paid to the interaction between stromal and neoplastic cells as a possible host response to the treatment with interferon. In addition to tumor biopsies, regional lymph nodes were also examined microscopically. Stromal cells (macrophages, T and B lymphocytes, and granulocytes) were detected by enzyme-histochemical methods. Histologic and histochemical criteria for classification of tumor biopsies into five groups included the frequency, the cellular composition of peritumoral stroma, the grade of macrophage infiltration into the tumor (expressed quantitatively), and cytologic changes, followed by the regression of tumor. The overall appraisal of patients with cervical carcinoma based on histopathologic and chemical criteria showed the positive effect of HLI therapy in 70% of the cases; observations of head and neck carcinoma treated with HLI showed positive effects in 82% of the cases.

Application of human leucocyte interferon in patients with tumours of the head and neck.

Local administration of crude human leucocyte interferon (HLI) produced substantial or total remission in patients with cancers of the head and neck. At the end of HLI therapy 10 of 30 patients were considered completely cured. In 10 patients unepithelialised skin lesions were hardly visible, in 5 the tumours were significantly reduced in size and had clear-cut borders, in 2 the tumours showed a tendency towards regression, and in 3 there was no effect. Application of HLI close to the tumour site appears to prevent dispersal of tumour cells during surgical removal of the tumour. It also inhibits metastatic spread, thereby reducing the likelihood of recurrence.

Effect of interferon in therapy of skin and head and neck tumors.

The clinical experimental model of HLI application in the therapy of skin and mucosal cancers of the head and neck has opened new prospects in HLI utilization. Based on clinical observations and research it may be concluded that HLI, if applied topically in the area of the tumor, may induce its disappearance or regression. If applied presurgically, it blocks the dispersion of neocytes during surgery. Also, HLI inhibits metastatic dissemination of malignant tumors and therefore might reduce the percentage of patients with recurrence, decreasing the chance of survival of any other primary tumor.