Histological comparison of nasal polyposis in black African, Chinese and Caucasian patients.

We have compared the histological aspects of nasal mucosa biopsies (n = 130) obtained during bilateral polypectomy and ethmoidectomy performed in black African (n = 50), Chinese (n = 30) and Caucasian patients (n = 50) suffering from bilateral nasal polyposis (NP). The three groups of patients were matched for age and sex. The African and Chinese patients did not receive any medical treatment before endoscopic nasal surgery (ENS). All Caucasian patients were treated with corticosteroid nasal spray (400 mg/day) for 6 months. In the absence of subjective and objective clinical improvement, ENS was performed after antibiotic treatment for 10 days and prednisolone 1 mg/kg/day for 5 days. Clinical staging of the NP was graded from I to III (I = polyps limited to the middle meatus, II = polyps extending beyond the middle meatus, and III = polyps occupying the entire nasal cavity). Stage I NP was present in 22% of the Caucasians and 30% of the Chinese. Stage II was found in 58% of the Caucasians, 56% of the Chinese and 8% of the Africans. Stage III was found in 92% of the Africans, while only 20% of the Caucasians and 14% of the Chinese patients had stage III. The extent of submucosal oedema and number of mast cells were similar for the three groups of patients. A significantly greater number of eosinophils were observed in African polyps. Lymphocytes as well as plasmocytes were rare in African but abundant in polyps from both Chinese and Caucasian. Ulceration of the overlying epithelium of the polyps was observed in 20% of the African and 10% of both Chinese and Caucasians patients. We did not find any significant thickening of the basal membrane. We cannot exclude the possibility that the histological difference observed between African and Chinese polyps is related to the very common use among the Chinese population of topical intranasal treatment according to their traditional medicine practices. Since no major histological difference was found in the nasal mucosa and polyps obtained from the three groups of patients, NP in African, Chinese and Caucasian patients is very probably a similar inflammatory disease in all three ethnic groups.

Modulatory effect of two novel CGRP receptor antagonists on nasal vasodilatatory responses to exogenous CGRP, capsaicin, bradykinin and histamine in anaesthetised pigs.

Calcitonin gene-related peptide (CGRP) is a 37-amino acid peptide and potent vasodilatator agent located in sensory C fibres. Several functional studies suggest that CGRP could be involved in the vasodilatation of different vascular beds during neurogenic inflammation. We have studied, in pentobarbital anaesthetised pigs, the antagonistic effect of local intra-arterial (i.a.) pretreatment with the analogues CGRP 8-37, [D31, P34, F35]CGRP 27-37 and [N31, P34, F35]CGRP 27-37 on the vasodilatation of the nasal vascular bed induced by exogenous CGRP, capsaicin, bradykinin (BK) and histamine. The attenuating effect of CGRP 8-37 analogue on exogenous CGRP-induced vasodilatation, previously described in other in vivo animal models, was confirmed in the pig nasal mucosa. It also interfered with BK-and, to a lesser extent, with capsaicin-and histamine-induced decrease in vascular resistance. CGRP 27-37 analogues reduced the duration of CGRP-, capsaicin- and BK-induced vasodilatation by more than 50%. Peak values of vasodilatation were attenuated by more than 25% overall. Attenuation of histamine-induced decrease in vascular resistance was less pronounced. It is concluded that CGRP 27-37 analogues antagonise the action of exogenous CGRP, capsaicin, BK and histamine by attenuating their vasodilatation effect, both in intensity and duration. These results strongly suggest that BK- and histamine-induced vasodilatation is partly mediated by CGRP. CGRP 8-37 and 27-37 appear to be potential contributors to the study of CGRP and its physiological role in neurogenic inflammation. In addition, they may have putative therapeutic applications in the treatment of rhinitic patients suffering from chronic nasal obstruction.

[Evaluation of various antagonists of CGRP, a neuromediator implicated in the inflammatory mechanisms of nasal mucosa]. / Evaluation de différents antagonistes du CGRP, neuromédiateur impliqué dans les mécanismes inflammatoires de la muqueuse nasale.

INTRODUCTION: This article presents a review of the literature addressing the role of different neuropeptides involved in neurogenic inflammation at the level of the nasal mucosa. DISCUSSION: Calcitonin gene-related peptide (CGRP) is a vasodilator peptide located in sensory C fibres. It plays an important role during neurogenic inflammation by controlling both tonicity and permeability of different vascular beds. Its release can be produced by capsaicin, bradykinin (BK) or histamine. In turn, CGRP appears to play an important role in modulating histamine-induced vascular responses. Different CGRP analogues are used to investigate the mechanisms of neurogenic inflammation. Some of them antagonise exogenous substances such as CGRP, capsaicin or bradykinin, attenuating the vasodilatation induced both in intensity and duration. They can contribute to the study of CGRP and its physiological involvement in neurogenic inflammation. Moreover, they may have therapeutic applications in the treatment of patients with nasal hyperreactivity.

Influence of TASP-V, a novel neuropeptide Y (NPY) Y2 agonist, on nasal and bronchial responses evoked by histamine in anaesthetized pigs and in humans.

1. In nine anaesthetized pigs we have studied the influence of intranasal or intrabronchial pretreatment with TASP-V, a neuropeptide Y (NPY) Y2 agonist formed by the attachment of NPY 21-36 to a template-assembled synthetic peptide (TASP), on the functional responses to subsequent intranasal or intrabronchial histamine challenge. 2. In a parallel study, subjective and objective nasal airway resistance (NAR) increase following intranasal histamine challenge was evaluated in 11 healthy volunteers after TASP-V or placebo pretreatment. 3. In pigs, increase in sphenopalatine blood flow induced by histamine dihydrochloride nasal spray (0.25 mg kg(-1) in 3 ml of saline) was significantly reduced by 65% (P<0.05) following intranasal pretreatment with 10 microg kg(-1) of TASP-V. Bronchoconstriction induced by histamine dihydrochloride nebulization (0.5 mg kg(-1) in 3 ml of saline) was significantly attenuated by 25 and 55% following aerosolized pretreatment with TASP-V analogue at 10 and 20 microg kg(-1), respectively. 4. In healthy volunteers, objective increase in NAR and reduction in nasal minimal cross section area (MCSA) induced by intranasal spray of histamine dihydrochloride (15 microg kg(-1) in 200 microl of saline) were significantly attenuated by 50% following local pretreatment with 1.275 microg kg(-1) of TASP-V when compared with saline. 5. It is concluded that intranasal or intrabronchial pretreatment with TASP-V reduced nasal obstruction and bronchoconstriction evoked by histamine challenge in the pig. In healthy human volunteers, this agent attenuated NAR increase and MCSA reduction induced by intranasal application of histamine.

Isolated nasopharyngeal Hodgkin's disease presenting as nasal obstruction.

Lymphomas are the second most frequent malignancy affecting the head and neck. Within head and neck lymphomas, Hodgkin's disease accounts for only 10-35% of all cases; 70-80% of Hodgkin's disease of the head and neck involves nodal tissue, with extranodal Hodgkin's disease being most often found in the tissues of Waldeyer's ring. Extranodal Hodgkin's disease of the head and neck that does not involve Waldeyer's ring is extremely rare. We report a case of isolated extranodal Hodgkin's disease of the nasopharynx who presented to the rhinology clinic with symptoms of nasal obstruction. This unusual site, the possible reasons for its rarity and the investigations and management are discussed with reference to the literature.

The integrated light endoscope: a technical simplification of nasal endoscopy.

OBJECTIVE: Nasal endoscopes depend on cumbersome light generators and fibre-optic cables. This results in restriction of the operator's movements, impairment of tactile sensation, and visual field limitation during the examination. More importantly, its use is difficult outside a clinic setting. A system which integrates a readily available, portable, and inexpensive light source with a nasal endoscope was tested in our department. METHOD: Twenty patients underwent endoscopic examination of their nasal cavities using this simple endoscopic system followed by the traditional light-cable technique. RESULTS: In one patient, the visual information was insufficient with the new system. In all other cases, no additional information was demonstrated by the use of light cables. CONCLUSIONS: The advantages and disadvantages of the system are discussed, as well as the future possibilities suggested by this development.