[Nasal resistance and continuous positive airway pressure treatment for sleep apnea/hypopnea syndrome]. / Resistencia nasal y tratamiento con presión positiva continua en la vía aérea en el síndrome de apnea-hipopnea obstructiva del sueño.

OBJECTIVE: To evaluate the relation between nasal resistance and tolerance and compliance with continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea/hypopnea syndrome (SAHS). MATERIAL AND METHOD: One hundred twenty-five patients with a mean apnea/hypopnea index (AHI) of 53 21 were assessed for nasal resistance by active anterior rhinometry before starting CPAP treatment. Airflow (cm3/s) at 150 Pa was measured at each nostril. Tolerance for and compliance with CPAP was assessed at 2 weeks, 6 months and one year after start of treatment. RESULTS: The mean CPAP prescribed was 9 2 cmH2O. Rhinometry findings were considered pathological for 70 patients (56%). We observed no correlation between nasal flow and the CPAP established (r = 0.018). The treatment compliance objective in the first year was 5 1.5 hours/day. The most common nasal side effects during this period were runny nose, itching and sneezing (24%), oronasal dryness (21%) and subjective nasal obstruction (6%). There were no significant differences in tolerance of or compliance with CPAP treatment between patients with normal or abnormal rhinometry. CONCLUSIONS: Nasal resistance assessed by anterior rhinometry is unrelated to optimum CPAP and does not affect either tolerance or compliance among patients with SAHS.

Resistencia nasal y tratamiento con presión positiva continua en la vía aérea en el síndrome de apnea-hipopnea obstructiva del sueño / Nasal resistance and continuous positive airway pressure treatment for sleep apnea/hypopnea syndrome

OBJETIVO: Evaluar la relación de la resistencia nasal (RN) con la tolerancia y el cumplimiento del tratamiento con presión positiva continua en la vía aérea (CPAP) en pacientes con síndrome de apnea-hipopnea obstructiva del sueño (SAHS). MATERIAL Y MÉTODO: Se estudió a 125 pacientes con índice de apneas-hipopneas (IAH) media (desviación típica) de 53 ñ 21, en tratamiento con CPAP. La RN fue medida antes de iniciar el tratamiento mediante rinomanometría anterior activa, considerando los valores de flujo (ml/s) a 150 Pa de presión en cada fosa nasal. Se valoró la tolerancia y el cumplimiento de la CPAP a las 2 semanas, a los 6 meses y al año del tratamiento. RESULTADOS: La media de la presión de CPAP prescrita fue de 9 ñ 2 cmH2O. En 70 pacientes (56 per cent) se consideró que la rinomanometría era patológica. No observamos correlación entre los flujos nasales y la presión de CPAP establecida (r = 0,018). El cumplimiento objetivo del tratamiento en el primer año fue de 5 ñ 1,5 h/día. En este período, los efectos secundarios nasales más frecuentes fueron síntomas funcionales, tales como hidrorrinorrea, picor o estornudos (24 per cent), sequedad oronasal (21 per cent) y obstrucción nasal subjetiva (6 per cent). No hubo diferencias significativas en la tolerancia y el cumplimiento de la CPAP entre los pacientes con rinomanometrías normal y patológica. CONCLUSIONES: En el paciente con SAHS, la RN valorada con rinomanometría anterior no se correlaciona con el nivel de presión óptima de CPAP y no influye en su tolerancia ni en su cumplimiento (AU)

Effect of budesonide and nedocromil sodium on IL-6 and IL-8 release from human nasal mucosa and polyp epithelial cells.

We investigated the effect of budesonide and nedocromil sodium on the secretion of IL-6 and IL-8 by cultured epithelial cells from healthy nasal mucosa and nasal polyps. Human epithelial cell conditioned media was generated with fetal calf serum (FCS) in the presence or absence of budesonide and/or nedocromil sodium. Budesonide inhibited FCS-induced IL-6 and IL-8 release in a dose-dependent manner. The IC25 (25% inhibitory concentration) of budesonide on IL-6 release was higher in nasal polyp than in nasal mucosa epithelial cells (34 nM vs. 200 pM). The IC25 of budesonide on IL-8 release was higher in nasal mucosa than in nasal polyps (145 pM vs. 4 pM). Nedocromil sodium caused a dose-related inhibitory effect on IL-8 release from nasal mucosa (IC25, 207 nM), while it only had a significant effect in nasal polyps at 10(-5) M. Nedocromil sodium had no effect on IL-6 release. The inhibitory effect of budesonide was higher than that of nedocromil sodium on both nasal polyps and nasal mucosa. Budesonide and nedocromil sodium may exert their anti-inflammatory action in the respiratory mucosa by modulating the secretion of IL-6 and IL-8. The different effect of budesonide and nedocromil sodium on IL-6 and IL-8 release may be explained by differences in the mechanisms which regulate the upregulation of these cytokines in inflammatory responses.

Effects of topical anti-inflammatory drugs on eosinophil survival primed by epithelial cells. Additive effect of glucocorticoids and nedocromil sodium.

BACKGROUND: Eosinophil infiltration is a hallmark of the inflammatory response in rhinitis and in nasal polyposis. OBJECTIVE: We studied the effect of steroids and nedocromil sodium on eosinophil survival primed by epithelial cells from healthy (nasal mucosa) and inflamed (nasal polyp) respiratory tissue. METHODS: Blood eosinophils were incubated with increasing concentrations (10(-11)-10(-5) M) of topical steroids (fluticasone propionate, budesonide, triamcinolone acetonide and beclomethasone dipropionate) and/or nedocromil sodium prior to the addition of human epithelial cell conditioned media (HECM), eosinophil viability was measured and IC50 for each drug was calculated. RESULTS: All four steroids and nedocromil sodium caused a dose-related inhibition of HECM-induced eosinophil survival. The IC50 of steroids were lower in eosinophils primed by mucosa HECM than on those primed by polyp HECM (fluticasone, 4 nM vs 114 nM; budesonide, 21 nM vs 280 nM; triamcinolone, 7 nM vs 853 nM; and beclomethasone, 171 nM vs 181 nM). The combined inhibitory effect of 10(-7) M budesonide plus 10(-5) M nedocromil (43.8 +/- 10.8%, P<0.03) was significantly higher than budesonide (28.5 +/- 9.2%) or nedocromil (16.7 +/- 5.4%) alone and close to 10(-5) M budesonide (52.3 +/- 11%). No differences were found in cytokine (IL-8, IL-6, GM-CSF, TNF alpha, IL-1beta and RANTES) concentrations between HECM from mucosa and polyps. CONCLUSION: These results suggest that topical anti-inflammatory drugs may diminish airway eosinophilic infiltration by decreasing eosinophil viability, that nasal polyp epithelial cell secretions may induce steroid resistance in eosinophils, and that nedocromil sodium has additive effects with steroids.

[Solitary naso-sinusal fibrous tumor]. / Tumor fibroso solitario nasosinusal.

Here we present two clinical cases of solitary naso-sinusal fibrous tumour. This tumour has a mesenchymal origin and has an evident pleural location, with well defined immunohistochemical and ultrastructural characteristics. The clinical manifestation is an apparent benign tumour with an inclination to local aggressiveness. The most effective treatment seems to be surgical removal, but given the low number of cases mentioned (there are only eight cases reported in international literature), and the tendency to eventual recurrence, called for cobalt therapy after surgery. The evolution of clinical cases is irregular.

Endoscopic sinus surgery in sinusitis.

In terms of functional treatment of sinonasal pathologies, endoscopic surgery represents a spectacular advance, offering excellent illumination, views of areas previously impossible to monitor, and the ability to view the main reference points in the surgical field. Over a five-year period (1988-1993), the authors have performed 278 paranasal sinus operations, using endoscopic techniques. The results obtained in 250 patients, with a minimum follow-up period of one year, have been analyzed. The criteria of assessment used include: self-assessment by the patient and the surgeon's assessment, made on basis of the endoscopic data. The best results were obtained in cases of antrochoanal polyps, polyposis not associated with asthma or acetylsalicylic acid (ASA) sensitivity, circumscribed chronic sinusitis, and aspergillomas. The worst results, with a high rate of recurrence, have been obtained with ASA sensitivity and chronic suppurative pan-sinusitis. It is essential to reach a consensus on the staging of polyposis so that treatment can be monitored adequately, even though, in itself, the pathology is difficult to classify as it can vary in a single patient for no apparent reason. On the other hand, there is a difference between the subjective and objective assessment of the condition, and this makes it even harder to explain the results obtained.

Comparison of the role of nasal polyp and normal nasal mucosal epithelial cells on in vitro eosinophil survival. Mediation by GM-CSF and inhibition by dexamethasone.

Eosinophilic infiltration of the respiratory mucosa is considered an inflammatory hallmark of allergic rhinitis, bronchial asthma and nasal polyposis. However, the mechanisms involved in this infiltration have not yet been totally elucidated. The objective of this study was to investigate and compare the influence of epithelial cell secretions from both nasal polyps (NP) and normal nasal mucosa (NM) on in vitro eosinophil survival. Epithelial cells were identified by microscopy and immunohistochemistry, cultured to confluence, and human epithelial cell conditioned media (HECM) was generated from cultures. Eosinophils were isolated at high viability and purity (> 90%) from peripheral blood and incubated with HECM. HECM from both NM and NP increased eosinophil survival in a dose-dependent manner, this effect being maximal at a concentration of 25% for NM (73.4% +/- 5.5%, n = 26, P < 0.001) and of 10% for NP (74.5% +/- 8.4%, n = 18, P < 0.001). Incubation of monoclonal antibody to human GM-CSF with HECM, neutralized the induction of eosinophil survival by HECM from both NM and NP. HECM from NP contained higher concentrations of GM-CSF (111 +/- 25.4 pg/ml, n = 17) than HECM from NM (97.1 +/- 15.2 pg/ml, n = 8), without reaching statistical significance. Pre-incubation of dexamethasone with eosinophils also blocked HECM-induced eosinophil survival from both NM (10(-8)-10(-5) M; IC50 = 9.5 nM) and NP (10(-7)-10(-5) M; IC50 = 83 nM). These results suggest that: firstly eosinophil infiltration into the respiratory mucosa during allergic reaction and nasal polyposis may be modulated at least in part by GM-CSF from epithelial cells; and secondly epithelial cells from NP might have a more potent effect on inducing eosinophil infiltration of the respiratory mucosa than epithelial cells from NM. Finally, we may consider this as a reliable in vitro model to compare the role of epithelial cells from inflammatory (NP) and non-inflammatory (NM) tissue in respiratory inflammation.

[Endoscopic naso-sinusal surgery. Experience with 150 cases]. / Cirugía endoscópica nasosinusal. Experiencia en 150 casos.

The AA. expose their experience drawn out from 150 cases of naso-sinusal pathology, treated through endoscopic surgery after the Messerklinger-Stammberger technique. They emphasize either the advantages of the procedure, in comparison with the classic methods, and the postoperative pitfalls. This procedure call for an exact knowledge of the endoscopic anatomy of the ethmoidal area, which can be gained only through corpses training.

[Nasopharyngeal carcinoma. An epidemiological and clinical study]. / Carcinoma de nasofaringe. Estudio epidemiológico y clínico.

Clinical and epidemiological data from 46 cases of nasopharyngeal carcinoma retrieved from our E.N.T. department data base are analysed. These tumors represent about 5% of all head and neck carcinomas seen at our department between 1984 and 1989. Neither geographic origin nor occupation of patients have proved significant to the epidemiological analysis. Patients are most frequently in their sixth decade of life at presentation, with a clear male predominance, but not as marked as in other locations of head and neck tumours. As in other series, a significant relationship between nasopharyngeal tumours and alcohol and tobacco consumption has been discarded. Most patients were in good condition at diagnosis. Sublocation (usually on the lateral and/or posterior walls of the nasopharynx), predominance of undifferentiated carcinomas and isolated neck adenopathy as presenting symptom, are all features found in our series as well as in other reports. In contrast, the time between first symptom and diagnosis has been moderately longer in our patients. Cranial nerve and base of skull involvement have been found in 20% and 37% of cases, respectively. A great proportion of patients present with advanced disease: T3-T4 tumours in 67%; clinically detectable adenopathy in 69.5%; and distant metastasis in 4.3% of cases. Almost 75% of our patients showed stage IV disease at diagnosis.

[Vasomotor rhinitis. Clinical study: an attempt at classification]. / Rinitis por reacción vasomotora. Estudio clínico: un intento de clasificación.

In the AA's opinion the greatest number of rhinitis cases seen in the doctor's office are vasomotor rhinitis. The vasomotor response being determined because of the hyper-reactivity of the subject in face of several agents. After explanations of the fundamentals of their theory a perusal of the more frequent etiologies and differential symptoms are listed. The paper ends with a summary of the medications available, their pharmacologic activity and their respective indications.