Computerized rhinomanometry: a study of total nasal resistance normal values.

Computerized rhinomanometry with the practical software programmes is used widely as a research tool to evaluate objectively nasal air flow and resistance parameters, while the increase of its clinical application may be facilitated by further standardization of the method. The aim of the study was to determine the total nasal resistance normal values in healthy adult population using a method of computerized rhinomanometry. A randomized sample of 108 white healthy adults (216 nasal cavities), both sexs with a mean age of 32 (20-45) years comprised the test group. Nasal patency was measured by active anterior rhinomanometry in non-decongested mucosa ("at rest") during 10 repetitive measurements at inspiratory and expiratory reference pressure of 150 Pa. Nasal resistance was measured and calculated according to the recommendations of the Committee on objective assessment of the nasal airway, International Rhinologic Society. The mean total nasal resistance in the sample was found to be 0.179 Pa/cm3/s with the confidant interval from 0,167 to 0,191 Pa/cm3/s at the probability level of 95%. Total nasal resistance was very significantly influenced by sex (t = -4.614), height (F=11.625) and weight (F=11.529) of the examinees. This paper provides additional information on total nasal resistance normal values in healthy adult population important for computirezed rhinomanometry normative parameters standardization.

Correction by factor VIII of decreased neutrophil alkaline phosphatase activity in classic haemophilia and von Willebrand's disease.

Neutrophil alkaline phosphatase (NAP) score was estimated in ten patients with hereditary disorders in which antihaemophilic factor (factor VIII) is functionally deficient. NAP scores were estimated immediately before cryoprecipitate was administered, and following correction of patients' clinical condition and factor VIII activity in their plasma. While lower than normal NAP scores were observed before the treatment has been started, normal NAP score estimates were obtained following the successful correction of decreased procoagulant factor VIII (FVIIIC) activity in plasma of patients with classic haemophilia and von Willebrand's disease (vWd).

[Pharmacomodulation of hypersensitivity rhinitis]. / Mogucnosti farmakomodulacije hipersenzitivnog rinitisa.

INTRODUCTION: Hypersensitive rhinitis is characterized by accumulation of mast cells and eosinophils (believed to be primary effector cells) in the nasal epithelium. Treatment of hypersensitive rhinitis is directed towards reducing either tissue accumulation of these activated cells or the end-organ effects of the released mediators. The aim of this study was to examine effects of local corticosteroid treatment on the number of eosinophils in nasal secretion of patients with isolated hypersensitive rhinitis. MATERIAL AND METHODS: A total of 55 subjects were included in a prospective controlled trial. Thirty-seven patients with hypersensitive rhinitis were included in the experimental group, and 18 patients with hypersensitive rhinitis in the control group. A local corticosteroid, beclomethasone dipropionate, aqueous nasal spray, was administrated every 12 hours (400 micrograms per day) to the experimental group during 6 weeks. Patients of both groups were regularly controlled during the study period by ENT and cytological examination of nasal secretions. RESULTS AND DISCUSSION: Very significant differences in regard to the number of eosinophils were found in the nasal secretion of experimental patients with hypersensitive rhinitis, whereas they were insignificant in patients from the control group. Strong antieosinophilic effect of beclomethasone was evident. Eosinophil apoptosis at the inflammatory site appeared to be delayed when interleukin-5 was generated by neighbouring cells, or this delay is due to autocrine production of this cytokine. CONCLUSION: Local corticosteroid treatment of hypersensitive form of chronic rhinitis significantly reduces the number of eosinophils and thus probably modulates the pathogenesis of this inflammatory process.

Occult metastases from supraglottic laryngeal carcinoma.

One hundred and sixty-one patients with a supraglottic laryngeal carcinoma and clinically negative neck were studied. All patients had primary surgery and occult cervical node metastases were found in 18% (29/161). Local dissemination of tumour in the epilarynx did not influence the incidence of occult metastases, while the incidence of occult metastases increased with the degree of local spread in the supraglottis excluding the epilarynx. Ipsilateral occult metastases were more common (76%, 22/29), but both bilateral and contralateral spread was also seen (14%, 4/29 and 10%, 3/29, respectively).

Intradermal tests with vasomotor agents in perennial non-allergic rhinitis.

Nasal reactivity in non-allergic rhinitis patients is well known, but the skin reactivity of these patients is less examined. The aim of this prospective study was to examine the skin reactivity to four vasomotor agents in healthy subjects and perennial non-allergic rhinitis patients and to determine whether rhinitis patients differ from healthy subjects or not. Seventy four perennial non-allergic rhinitis patients and fourty two healthy subjects were undergone to intradermal testing with papaverine (5 mg/ml), metacholine (0.02, 0.2 and 2.0 mg/ml), histamine (0.01, 0.1 and 10.0 micrograms/ml) and compound 48/80 (0.01, 0.1, 1.0 and 10.0 micrograms/ml). It was found that the frequency of pathological skin reactivity to papaverine in perennial non-allergic rhinitis patients (34%) was significantly greater (p = 0.007) then in healthy subjects (9.5%). There was no significant difference for metacholine, histamine, compound 48/80 and saline between these two groups. The frequency of the total pathological skin reactivity to vasomotor agents, singly and in combinations, in perennial non-allergic rhinitis patients (80%) was significantly greater (p = 1.8.10(-6)) then in healthy subjects (33%). These findings suggest that the pathological skin reactivity to vasomotor agents is a feature of perennial non-allergic rhinitis patients as well as healthy subjects and indicate that a difference in the skin reactivity between these groups is noticed.

[Intradermal tests using vasomotor agents in allergic rhinitis]. / Intradermisni testovi vazomotornim agensima u alergijskom rinitisu.

INTRODUCTION: Allergic rhinitis is characterised by nasal hyperactivity to specific and non-specific agents. For research purposes, non-specific nasal hyperactivity can be estimated by histamine and metacholine nasal challenge tests. At present, nasal challenge tests are not used for routine diagnosis of rhinitis. Wayoff and colleagues proposed the examination of the skin reactivity to papaverine, acetylcholine, histamine and compound 48/80 in rhinitis patients. Our previous study of skin reactivity to vasomotor agents, using modified skin tests of Wayoff and colleagues showed their clinical validation and usefulness for subclassification of patients with non-allergic rhinitis. To the present, there are only a few studies of skin reactivity to vasomotor agents in patients with allergic rhinitis. The aim of this study was to examine the skin reactivity to vasomotor agents of allergic rhinitis patients and determine whether the patients with allergic rhinitis differ from healthy subjects. METHODS: A prospective, controlled, in vivo study was carried out in 86 subjects: 44 patients with allergic rhinitis and 42 healthy subjects. Skin reactivity was examined by intradermal tests with different concentrations of papaverine, metacholine, histamine and compound 48/48. The non-specific skin reactivity to saline was also measured. Skin reactivity to intradermal test with different concentrations of papaverine, metacholine, histamine and compound 48/48 was measured, as well as specific skin reactivity to control saline solution. Pathological skin reactivity to vasomotor agents was defined as follows: hyporeactivity to papaverine (5 mg/mL), when wheal-and-flare skin reaction diameter was less than 15 mm; hyper-reactivity to metacholine (0.02, 0.2 and 2.0 mg/mL), when two of three wheal-and-flare skin reaction diameters were greater than 15, 25 and 31 mm, respectively; hyper-reactivity to histamine (0.01, 0.1, 1.0 and 10.0 mg/mL), when three of four wheal-and-flare skin reaction diameters were greater than 7, 13, 25 and 40 mm, respectively; and hyper-reactivity to compound 48/80 (0.01, 0.1, 1.0 and 10.0 mg/mL), when three of four wheal-and-flare skin reaction diameters were greater than 9, 16, 26 and 38 mm, respectively. RESULTS: The study included 86 subjects: 44 patients with allergic rhinitis and 42 healthy subjects. The control group of healthy subjects consisted of 22 females, aged from 18 to 35 yrs (mean 28 yrs), and 20 males, aged from 18 to 40 yrs (mean 28 yrs). The difference between the number [p(= 0.758) > 0.05] and age [p(= 0.990) > 0.05] of females and males was not significant. In the allergic rhinitis patients group, there were 23 females, aged from 18 to 54 yrs (mean 33 yrs) and 21 males, aged from 18 to 50 yrs (mean 36 yrs). The difference between the number [p(= 0.763) > 0.05] and age [p(= 0.558) > 0.05] of females and males was not significant. Frequencies of pathological skin reactivity to single vasomotor agents and saline in the control group of healthy subjects and in the allergic rhinitis patients group are shown in Table 1. In the control group, frequencies of normal skin reactivity to papaverine [p(= 1.8 x 10(-7)) < 0.01], metacholine [p(= 4.3 x 10(-6)) < 0.01], histamine [p(= 4.3 x 10(-6)) < 0.01], compound 48/80 [p(= 1.8 x 10(-7) < 0.01] and saline [p(= 6.9 x 10(-4)) < 0.01] were significantly greater than frequencies of pathological skin reactivity. In the patients group, frequencies of normal skin reactivity to papaverine [p(= 6.0 x 10(-8)) < 0.01] and saline [p(= 2.6 x 10(-3) < 0.01] were significantly greater, and to metacholine [p(= 0.016) < 0.05] were significantly greater than frequencies of pathological skin reactivity. In this group, the difference between frequencies of pathological skin reactivity to histamine [p(= 0.366) > 0.05] and compound 48/80 [p(= 0.070) > 0.05] were not significant. There was no significant intergroup difference for pathological skin reactivity to papaverine, metacholine and saline (Table 1). In the patients group frequencies of pathological skin reactivity to histamine and compound 48/80 were significantly higher than in the control group of healthy subjects. Frequencies of pathological skin reactivity to single vasomotor agents and in combinations in the control group of healthy subjects and in the allergic rhinitis patients group are shown in Table 2. The difference of pathological skin reactivity to single vasomotor agents and in combinations between the control group (14/42) and the allergic rhinitis patients group (27/44) was significant [p(= 0.017) < 0.05]. CONCLUSION: In routine evaluation of the rhinitis patients, skin tests with vasomotor agents have some advantages: these tests do not require special equipment, they are not time-consuming, they are easy to perform and simple for the interpretation of results. (ABSTRACT TRUNCATED)

[Body weight reduction and lipids level normalization in obese non insulin dependent diabetics by liberal dietetic regiment]. / Dejstvo dijete na tezinu tela i lipidni status kod gojaznih insulinonezavisnih dijabetica.

Bearing in mind that diabetes mellitus is frequently associated with secondary hyperlipoproteinemias, the objective of our study was to examine the possibilities for correction of lipid metabolism disorders in obese diabetics by introducing 1500 cal (6200 kJ) dietetic regimen. The study included a group of 20 obese male subjects (BMI>30) suffering from type 2 diabetes mellitus, aged from 28 up to 62 years. During 6 months follow-up, the participants subjects to antidiabetic diet regimen reduced their body weight and significantly lowered BMI (p<0.01). For the evaluation of lipids status serum concentration of cholesterol, triglycerides, LDL, VLDL, HDL atthe beginning of the study and after 6 months follow-up period were determined. The results obtained showed the significant decrease of cholesterol (p<0.01), tryglicerides (p<0.01), LDL (p<0.01) levels and the increase of HDL (p<0.01) level in the sera of the diabetics studies.

[Vasomotor skin tests in non-eosinophilic and eosinophilic long-term (perennial) nonallergic rhinitis]. / Vazomotorni kozni testovi u neeosinofilnom i eozinofilnom dugotrajnom ("perenijalnom") nealergijskom rinitisu.

INTRODUCTION: It has generally been assumed that "perennial" non-allergic rhinitis is a heterogeneous syndrome consisting of at least two groups: non-eosinopilic and eosinophilic. Opposite to non-eosinophilic group, eosinophilic group is characterized by nasal secretion eosinophilia, frequent evolution to nasal polyposis or complete ASA triad (nasal polyposis, intrinsic asthma and intolerance of non-steroidal anti-inflammatory drugs) and by a good response to treatment with anti-histamines and corticosteroids. These characteristics obviously separate eosinophilic from non-eosinophilic rhinitis and point out the importance of nasal secretion eosinophilia for the evolution and therapy of rhinitis. However, the distinction between eosinophilic and non-eosinophilic rhinitis can only be made by nasal cytology. Skin tests with vasomotor agents were carried out to characterize vasomotor skin reactivity in "perennial" non-allergic rhinitis and determine whether the patients with non-eosinophilic rhinitis differ from patients with eosinophilic rhinitis. METHODS: On the basis of the examination of nasal smears of eosinophils, 74 patients with "perennial" non-allergic rhinitis were divided into non-eosinophilic (n = 63) and eosinophilic group (n = 11). Nasal eosinophilic was considered significant when 20% and more of the cells in nasal smear were eosinophils. Skin reactivity to intracutaneous test with different concentrations of papaverine, metacholine, histamine and compound 48/48 was measured, as well as specific skin reactivity to control saline solution. Pathological skin reactivity to vasomotor agents was defined as hyporeactivity to papaverine (5 mg/mL), when wheal-and-flare skin reaction diameter was less than 15 mm; hyper-reactivity to metacholine (0.02, 0.2 and 2.0 mg/mL), when two of three wheal-and-flare skin reaction diameters were greater than 15, 25 and 31 mm, respectively; hyper-reactivity to histamine (0.01, 0.1, 1.0 and 10.0 micrograms/mL), when three of four wheal-and-flare skin reaction diameters were greater than 7, 13, 25 and 40 mm, respectively; and hyper-reactivity to compound 48/80 (0.01, 0.1, 1.0 and 10.0 micrograms/mL, when three of four wheal-and-flare skin reaction diameters were greater than 9, 16, 26 and 38 mm, respectively. RESULTS: Seventy four patients with "perennial" non-allergic rhinitis were included in the study. There were 51 females, age range from 18 to 57 yrs. (mean 37 yrs.) and 23 males, age range from 18 to 73 yrs. (mean 44 yrs.). The difference between the number of females and males was significant (p = 1.1 x 10(-3)), while no significant difference regarding the age between females and males was found (p = 0.122). Significant percentage of eosinophils was found in 15% of "perennial" non-allergic rhinitis patients, and they were classified into eosinophilic group (n = 11). In this group, the percentage of eosinophils varied from 20% to 80%, mean 35%. In non-eosinophilic group (n = 63), it ranged from 0% to 10%, mean 1%. No significant difference concerning sex and age between the two groups of the rhinitis patients was observed (Table 1). There was no significant intergroup difference for pathological skin reactivity to papaverine, metacholine, histamine, compound 48/80 and saline (Table 2). Total pathological skin reactivity to vasomotor agents, single and in combination, was found in 78% of non-eosinophilic and in 91% of eosiniophilic rhinitis patients (Table 3). In both, non-eosinophilic and eosinophilic groups, frequencies of total pathological skin reactivity to vasomotor agents was significantly greater than frequencies of total normal skin reactivity (p = 1.1 x 10(-5) and p = 0.007 respectively). However, the difference of total pathological skin reactivity to vasomotor agents between the two groups was not significant (p = 0.552). (ABSTRACT TRUNCATED)

[Antinuclear antibodies detection in both HEp-2 cells and tissue section of the rat liver using indirect imunofluorescence]. / Okkrivanje antinukleusnih antitela indirektnom imunofluorescentom metodom na humanim epitelijalnim celijama-dva i tkivnim iseccima jetre pacova.

Having in mind the importance of indirect immunofluorescence in antinuclear antibodies detection, the study was aimed to compare characteristics of fluorescent visualization and specificity of HEp-2 cells with tissue cryosections of the rat liver. The study included 76 serum samples obtained from patients with systemic connective tissue diseases. Out of that number, fluorescence findings on HEp-2 cells and rat liver tissue were positive in 74 and 54 patients, respectively. At the same time, only foyr basic types of fluorescence were manifest in tissue samples, while HEp-2 cells revealed 3 mixed types, and within the patchy type, several subgroups were evidenced. Out of the 20 serum samples which enabled positive results only with HEp-2 cells, they all belonged to the group of patchy fluorescence. In addition to the better fluorescence visualization, owing to its more complexs antigenic structure. HEp-2 cells revealed significantly higher specificity when compared to the rat liver tissue thus enabling definitive identification of sertain specific autoantibodies, or they were used as screening methods for its further detection.

Combined ligation and sclerotherapy versus ligation alone for eradication of bleeding esophageal varices: a randomized and prospective trial.

BACKGROUND AND STUDY AIMS: A number of trials have been reported in which a combination of ligation and sclerotherapy was compared with ligation alone, or with sclerotherapy alone. The present trial was carried out to assess whether the combined therapy might achieve more rapid eradication of bleeding esophageal varices. PATIENTS AND METHODS: One hundred and three patients with either active bleeding or stigma of recent bleeding from esophageal varices were randomly assigned to receive ligation plus sclerotherapy, or ligation alone. Ligation was performed with the technique introduced by Stiegmann. Sclerotherapy was carried out using low-volume (1 ml) 1% aethoxysclerol, which was injected into varices proximal to each ligature. Further treatment sessions were held seven days later, and then at two-week intervals, until eradication of the varices was achieved. Endoscopic follow-up examinations were carried out at three-month intervals, or immediately if there was any recurrent bleeding. The mean follow-up period was 14 months. RESULTS: There were no significant differences between the groups of patients compared with regard to the number of sessions required to eradicate the varices (2.4 +/- 0.7 in the combined group, and 2.3 +/- 0.7 in the ligation group; p>0.05). No significant differences were found between the groups with regard to recurrent bleeding (Fp = 2.882; p > 0.05). Three cases of recurrent bleeding (6%) from treatment-induced ulcers and two cases of recurrent bleeding (4%) from duodenal ulcers were observed with the combined therapy and ligation, respectively. No significant differences in the mortality were found between the groups (Fp = 1.145; p>0.05). Two percent of patients in the ligation group died due to bacterial peritonitis. CONCLUSION: Since ligation combined with low-volume sclerotherapy did not reduce the time required for variceal eradication, it can be concluded that the combined therapy is not superior to ligation alone. This mode of endoscopic therapy for the treatment of bleeding esophageal varices is therefore not recommended.

Prevalence of rheumatoid arthritis in Belgrade, Yugoslavia.

OBJECTIVE: To determine the prevalence of chronic arthritis with special reference to rheumatoid arthritis. METHOD: A cross-sectional study was performed during the years 1990 and 1991 in a randomly selected sample of the urban population of Belgrade. RESULTS: Out of 2184 participants, > or = 20 yr old, surveyed by questionnaire, 756 (34.6%) reported peripheral joint complaints. Of those with complaints, 621 (82.1%) agreed to undergo detailed examination. Arthritis was diagnosed in four men (one had rheumatoid arthritis and three had spondylarthropathy with peripheral arthritis) and 11 women (three had rheumatoid arthritis, one had B27-positive polyarthritis and seven had undifferentiated chronic arthritis). The prevalence of chronic arthritis in the adult population was 0.69% (0.35% for men and 1.05% for women). The prevalence for rheumatoid arthritis was 0.18% (0.09% for men and 0.29% for women). Re-examination of 15 individuals with chronic arthritis 3 yr later showed changes in diagnosis only in those patients who at baseline examination had undifferentiated chronic arthritis. CONCLUSION: According to the results obtained, the urban population of Belgrade is among populations with a low prevalence of rheumatoid arthritis.

[Classification of chronic inflammation of the upper respiratory tract based on allergy status]. / Klasifikacija hronicnih inflamacija gornjih disajnih puteva na bazi alergijskog statusa.

Almost one third to one half of all patients in otorhinolaryngologic practice experience some kind of inflammation of the upper respiratory tract out of which allergic mechanisms, either as primary factors or secondary ones, appear in 30-40% of adults and 60-80% of children and adolescents. The objective of this study was to analyse inflammatory conditions of the upper airways on the basis of allergic state of the patient and to establish the classification that will respect the actual immunological alteration level (subclinical allergy, clinical allergy) and spreading (localized allergy, generalized allergy). Inclusion criteria for all sixty nine patients were the diagnosis of chronic upper airway inflammation and their exposition just to ubiquitous allergens. Diagnostic procedure included anamnesis, physical examination and allergic in vivo testing of the skin and nasal mucosa to inhalant allergens. The certain categories of results were established for the skin prick-test (positive, negative, indefinite), specific nasal provocation test (positive, negative, hyperreactive) and nasal symptoms (present, absent). By using a strictly determined combination of results, we were able to define the six groups in our classification: nasal clinical allergy (30% of patients), non-nasal clinical allergy (19% of patients), localized nasal allergy (11% of patients), latent allergy (3% of patient), nonspecific nasal hyperreactivity (12% of patient) and non-allergic inflammation (25% of patients). Our classification takes into consideration the modern knowledge in the field of allergology and may bring an additional quality in respect to selection of therapy options, long-term follow-up of allergy status evolution in the individual person as well as intragroup and intergroup analysis of parameters important to evaluate the effects of antiallergic prevention or therapy.

Circulating haemopoietic progenitor cells in primary and secondary myelofibrosis: relation to collagen and reticulin fibrosis.

The relationship between the extent of bone marrow reticulin and collagen fibrosis and the concentration of granulocytic (CFU-GM), erythroid (BFU-E) and megakaryocyte (CFU-Mk) progenitor cells in the peripheral blood of patients with primary agnogenic myeloid metaplasia (AMM) and secondary myelofibrosis (sMF) has not been definitively correlated. We studied 23 patients with established diagnosis of AMM and 12 patients with sMF for the extent of reticulin and collagen bone marrow fibrosis and for the spontaneous colony (sCFU-GM, sBFU-E and sCFU-Mk) formation. The control group consisted of 11 healthy volunteers. Trephine biopsy of the posterior iliac crest was performed in all individuals studied to determine the type and degree of reticulin and collagen fibrosis. Gomori's silver impregnation technique was used. sCFU-GM, sBFU-E and sCFU-Mk colony formation was related positively to spleen size, the white blood cell counts and the degree of collagen fibrosis in AMM (p < 0.01). Stimulated CFU-GM were also significantly correlated with the degree of bone marrow reticulin and collagen fibrosis. There was no correlation between the extent of peripheral blood progenitor concentration and the degree of bone marrow reticulin or collagen fibrosis in sMF and in control individuals. In conclusion, the extent of bone marrow fibrosis is significantly correlated with the peripheral blood progenitor colony formation in AMM but not in sMF.