Azithromycin for chronic eosinophilic rhinosinusitis with nasal polyp: a placebo-controlled trial.

BACKGROUND: Chronic eosinophilic rhinosinusitis with nasal polyps (CRSwNP eosinophilic) is characterised by the formation of benign and bilateral nasal polyps. We aimed to compare the effectiveness of azithromycin as an immunomodulator with the use of a placebo in patients presenting with CRSwNP concomitant with asthma and aspirin intolerance after 3 months of treatment and at a 1-year follow-up. METHODOLOGY: We performed a randomised, double-blind, placebo-controlled trial. Patients received 500 mg azithromycin orally three times/week for 12 weeks. Improvement was evaluated by staging, the Sino-Nasal Outcome Test (SNOT-22), and nasal polyp biopsy. Data collected at pretreatment and 3 months posttreatment were compared. Quality of life was evaluated at the 1-year follow-up. RESULTS: Twenty-seven and 21 patients were treated with azithromycin and a placebo, respectively. The medication was well tolerated overall. Twenty patients (74%) in the azithromycin group and three patients (14%) in the placebo group were not refer- red for surgery at the end of the 3-month treatment. Regarding subjective improvement, there was a median decrease only in the azithromycin group, and the between-group difference was significant. SNOT-22 improvement was maintained in the azithromy- cin group at the 1-year follow-up. CONCLUSIONS: Azithromycin could be considered a therapeutic option for patients presenting with CRSwNP concomitant with asthma and aspirin intolerance.

Cytokines profile in cystic fibrosis patients with nasal polyps.

UNLABELLED: Nasal polyposis often complicates the progress of patients with cystic fibrosis and there has been little study about the importance of cytokines in the polyps of such individuals. OBJECTIVE: To assess RNAm expression for interleukins 4, 5, 6, 8, GM-CSF and IFN-gamma by RT-PCR in eosinophilic and non-eosinophilic polyps of patients with cystic fibrosis. MATERIAL AND METHOD: A total of 124 persons were evaluated, of which thirteen patients with cystic fibrosis and nasosinusal polyps were selected--three were eosinophilic and ten were non-eosinophilic. The control group was composed of eleven individuals with normal otorhinolaryngological exam and the mean age was 18 years (3-57). The middle turbinate mucosa and nasal polyps were biopsied from the control group and the cystic fibrosis group respectively, and these were analyzed with RT-PCR. The middle turbinate mucosa was biopsied in the control group and in the cystic fibrosis group polyps that was analyzed to RT-PCR. The polyps of cystic fibrosis patients were also further anaylsed for subjected to a second biopsy in order to determine the percentage of eosinophils. IL-4, IL-5, IL-6, IL-8, IFN-gamma and GM-CSF transcriptions were analyzed. RESULTS: There was no difference in IL-5, IL-8 and GM-CSF when compared to the eosinophilic, non-eosinophilic and control groups (p>0.05). When compared to the eosinophilic and non-eosinophilic groups, higher IL-4 and IL-6 values (p=0.01 and p=0.01 respectively) were observed. When analyzed separately with the control group, IL-4 (p=0.01) expression was higher in the eosinophilic group, while IFN-gamma (p=0.03) was lower in the non-eosinophilic group. IL-5, IL-8, GM-CSF are non-specific cytokines present in the nasosinusal sinonasal polyps of cystic fibrosis patients. IL-4 and IL-6 are important mediators in the eosinophilic sinonasal polyps, while low IFN-gamma may be related to lower eosinophils in non-eosinophilic polyps.

[Lymphographic investigations of oedema of the extremities following reconstructive vascular surgery in the femoro-popliteal territory (author's transl)]. / Lymphangiographische Untersuchungen zum Extremitätenödem nach rekonstruktiven Gefässeingriffen im Femoropoplitealbereich.

In 37 patients, oedema of the legs was observed following successful femoro-popliteal surgery; lymphangiograms were performed between the third and ninth post-operative days and the intact lymph vessels at the knee and at the groin were counted. In 27 patients there was partial to total disruption of the lymphatic vessels. There was a clear correlation between the degree of swelling of the leg and thigh with the number of not divided lymphatic vessels at the knee and groin. In the presence of more than three intact lymph vessels, swelling amounted to only 1 to 2 cm., whereas if all lymph vessels had been divided, swelling amounted to 7 cm. Extensive soft tissue trauma and repeat surgery resulted in a greater reduction in intact lymph vessels and correspondingly more oedema than was found with more conservative surgery and after initial operations. The pre-operative condition of the arteries, the presence of venous disease and the postoperative blood-flow in the leg had no influence on postoperative oedema. In order to avoid post-operative lymphoedema, it is necessary to preserve the lymphatics during surgery. Marked oedema requires treatment consisting of compression bandages and medicaments.

Tissue pO2 and transcutaneous pO2 as guidelines in experimental and clinical drug evaluation.

Tissue pO2 measurements on skeletal muscle surface both in patients and in animals in a model of occlusive disease revealed local tissue hypoxia that, until now, had not been detected with any other method. This kind of local tissue hypoxia is interpreted as a disturbance of local microflow distribution in the presence of unchanged regional blood flow rate. In response to buflomedil infusion, tissue pO2 histograms improved without any change in regional blood flow or distal blood pressure. In comparison to healthy volunteers, transcutaneous pO2 measurements in patients allowed establishment of of tcpO2 profiles along the lower extremity which were in agreement with angiographic localization of vessel occlusion. In a preliminary study, buflomedil infusion (3 mg/kg) over 30 minutes caused a significant increase in tcpO2 in 5 patients in the absence of any significant change of segmental blood pressure. It is concluded that both tissue pO2 and tcpO2 measurements are able to provide unique information about local changes of the microcirculation in occlusive vessel disease.

Prevalence and impact of chronic otitis media in school age children in Brazil. First epidemiologic study concerning chronic otitis media in Latin America.

OBJECTIVE: The first epidemiological study carried out in Latin America to investigate the prevalence of otological disease and its impact in a representative random sample of the school children population. METHODS: A cross sectional epidemiological survey to investigate the epidemiology of otitis in a representative random sample of 1119 children and adolescents from a total of 486166 elementary and high-school students, aged 6-18 years, regularly registered in one of the 521 public and private schools of the city of Belo Horizonte, in the state of Minas Gerais, southern Brazil. The interviews were conducted individually, in the school, by an otolaryngologist or a pediatrician. The interview included all of the personal data and also detailed questions regarding otological disorders and hearing. The otological examination was carried out with Mini-Heine otoscopes and the audiometric evaluation with the AudioScope 3 with 25dB intensity. The questionnaire and basic procedures for medical examination had been previously tested through a pilot test in two schools. RESULTS: The prevalence of chronic otitis media was 0.94%. Impacted wax was found in 12.3% of the students. The prevalence of abnormalities (excluding wax) in the otoscopy examination was 10.5%. It was found that 8.3% of students had a past history of otitis and 7.7% had a past history of otorrhea. These two special groups presented statistically significant associations with chronic otitis media, hearing loss and otolaryngological surgeries (when compared with the other school children). Parents and school children seemed significantly able to identify a special group of children with past history of otitis during childhood.

[A successful blood vessel reconstruction following inadvertent exeresis of arteries during varicose vein surgery]. / Uber eine erfolgreiche Gefässrekonstruktion nach versehentlicher Arterienexhairese bei Varicenoperation

A case of inadvertent stripping of the arterial system of the left leg during an operation of varicose veins is reported. By use of the unchanged saphenous vein the limb was able to be saved and the patient is without any complaint three years afterwards. Conclusions are made to the lege artis carrying out of Babcock's operation.

[A young patient with multiple arterial occlusions]. / Junge Patientin mit multiplen arteriellen Verschlüssen.

BACKGROUND: Mild hyperhomocysteinemia due to genetic causes and nutrition factors is well known as an independent strong risk factor for premature arterial occlusive disease. CASE REPORT: A 27-year-old female with a history of two episodes of small bowel ileus due to vascular causes presented with subacute pain in the left lower extremity. Angiography revealed a short segmental occlusion in the P III segment of the popliteal artery with small vessel collateralization and proximal occlusion of the superior mesenteric artery und the coeliac trunk. Vascular risk factors in this patient included smoking over a duration of 10 years, use of oral contraceptives (estrogen and gestagen combination) and elevated levels of homocysteine in the fasting state and after methionin loading. The patient was treated conservatively with intravenous application of prostaglandins, additionally she underwent training to improve her walking capability. After 4 weeks of the fasting state as well as after methionin loading were normalized by an oral substitution with folate and B vitamins. So far it was not possible to prove a genetic defect of the enzymes participating in the metabolism of homocysteine. CONCLUSION: This clinical conference of a young female patient with occlusion of several arteries illustrates the differential diagnosis of premature occlusive vascular disease with special regard to mild hyperhomocysteinemia as an independent risk factor.