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Biomedical subjects

A B Drake-Lee

Publications and source records attributed to A B Drake-Lee.

At least 19 recordsLinked to original sources
PubMed2003

Serum IgA and IgG functional antibodies and their subclasses to Streptococcus pneumoniae capsular antigen found in two aged-matched cohorts of children with and without otitis media with effusion.

The relationship between acute otitis media and otitis media with effusion (OME) is uncertain and the aetiology of OME is multifactorial. Otitis media with effusion may be an inflammatory condition; both bacteria and viral infections could play a part in this inflammation. The four bacteria Streptococcus pneumoniae, Haemophilus influenza, Staphylococcus aureus and Branhamella catarrhalis cause 60% of the infections whereas S. pneumoniae accounts for up to 35%. IgA provides the dominant surface response to polysaccharide and lipopolysaccharide antigens, of which IgA2 is the main subclass. Once the mucosa has been breached, most protection is provided by IgG. IgG2 acts mainly against bacterial capsular antigens. This study looked at two groups of 50 children with and without OME who were aged between 3 and 10 years. The aims were to determine if, firstly, the levels of the serum immunoglobulins were different in the two groups, secondly whether these children made the appropriate antibody response to the capsular antigen to S. pneumoniae (PCP), and finally if there was a delay in the maturity of the IgA response. The total IgG, IgA and all subclass levels were measured using radial immunodiffusion. Levels of functional IgA and IgG were measured using ELISAs (25 patients in each group). The results were analysed with non-parametric tests. The immunoglobulin levels were within the normal levels for both groups. There were very good correlations between the IgG total anti-PCP and the IgG2 anti-PCP (R > 0.9, p = 0.001). There was a good correlation between the levels of both IgG total and IgG2 anti-PCP against IgA total anti-PCP in both groups (R > 0.85, p > 0.01). This confirms a normal antibody response between both groups of patients. The ages of the controls and patients (50 samples) were correlated with increasing titres of circulating functional antibodies (P = 0.001). This is highly suggestive of a normal age-related response. In conclusion, the findings were contradictory to our original hypothesis that there is a subtle difference in surface protection between children with and without OME. We believe that a previous history of recurrent acute otitis media is unrelated to the development of OME after 3 years of age.

Chi-Square Distribution↗
PubMed2001

Th2 dominance in nasal mucosa in patients with Wegener's granulomatosis.

Wegener's granulomatosis initially affects upper respiratory tract organs including the nasal mucosa in more than 90% of patients. The inflammation is typically granulomatous with associated vasculitis. T lymphocytes are usually a prominent component of the leucocyte infiltrate. Previous studies using peripheral blood T cells have implicated IFN-gamma rich Th1-type responses. This study addressed the cytokine milieu in nasal mucosa from 10 patients with active Wegener's granulomatosis using immunohistochemistry. Increased levels of CD3+ T cells and eosinophils were present compared with normal and disease controls. There was increased expression of IL-4, down-regulation of IL-2 and no detectable IFN-gamma. There was increased expression of the chemokine receptor CCR3 by infiltrating cells, consistent with an IL-4 dominant, Th2-biased response. In contrast, renal biopsy tissue from 10 patients with active Wegener's granulomatosis showed expression of IL-2 and IL-4. The Th2-type environment within nasal mucosa, often the initial site of disease activity in Wegener's, is consistent with a local allergic response in these patients.

Adolescent↗
PubMed2001

Clinical and histopathological correlation of nasal polyps: are there any surprises?

Nasal polypectomy is a common operation. There is debate about whether all nasal polyps removed at operation should be sent for histopathological examination. To investigate this, a prospective study was performed to check the correlation of clinical and histopathological examination. Three hundred and forty-four nasal polypectomy specimens during the period from September 1997 to September 1999 were sent for histopathological diagnosis, with the clinical diagnosis documented on the pathology form. The clinical diagnosis was then correlated with the histological diagnosis. Three hundred and twenty-eight specimens were diagnosed as inflammatory polyps and 16 as tumours, of which seven were malignant. There was a good correlation between the clinical and histological findings in 340 cases. There was disagreement between the forms and reports in four cases. When the notes were consulted, three cases had forms that were incorrectly filled in. There was only one unsuspected case of inverted papilloma in a polyp specimen, which looked like a benign inflammatory polyp. This study indicates there is a 99.7% correlation between clinical and histopathological diagnosis.

Humans↗
PubMed1999

Nasal haemophilic pseudotumour.

Haemophilic pseudotumour or haemophilic cyst is a rare complication of haemophilia, occurring in one to two per cent of individuals with a severe factor VIII or IX deficiency. We report a case of a haemophilic pseudotumour in a hitherto unreported site, the bony nasal pyramid, and believe this case is also unique on account of it having occurred in a patient with mild haemophilia. The diagnosis and treatment of this rare condition is also reviewed.

Adult↗
PubMed1999

Assessment of mucociliary transport in patients with chronic mucoid rhinitis.

Chronic rhinitis is the manifestation of a heterogeneous group of disease entities and often proves difficult to manage successfully. We present the investigations of the mucociliary system in 40 patients with mucoid rhinorrhoea as their principal symptom of whom 20 had pan respiratory disease. The saccharin clearance time (SCT) was measured and classified as normal if it was below 20 min. Objective measurement of clearance was made using 99mTechnetium-labelled human serum albumin (99mTc-HSA). We have standardized our method using a micrometer syringe driver to produce a droplet of consistent size (droplet size, 0.01 ml, SD 0.0002 ml) that reduces the dose of radiation. The movement of the droplet was measured over 20 min (RLT). The mean, maximum rate and percentage moved were calculated. Patients were divided into those who had chest disease (20) and those without and a chi 2-test was performed for the mean RLT time between the two groups. There was a strong correlation between mean and maximum rates (r = 0.91). One patient has a normal SCT and normal RLT. Patients with chest disease had a significantly lower mean RLT (P > 0.01). Assuming that RLT is the standard investigation, six patients were normal but had an abnormal SCT, this is a false positive error of 15%. The false negative error was 4/40 (10%). The association between sinus and chest disease with abnormal mucociliary clearance is stressed.

Chronic Disease↗
PubMed1998

Children who withdraw consent for elective surgery.

Parents and legal guardians have authority to consent to medical treatment on behalf of minors. Recently, the concept of emerging competence has been popularized, whereby a child may achieve sufficient understanding and maturity to enable him/her to make a wise choice in his/her own interests. Although there are undoubted merits in involving children in their medical treatment, the ultimate legal authority for consent rests with parents and guardians acting on the advice of doctors and in the child's best interests. We describe two cases in which children withdrew their consent to elective surgery, despite the help and encouragement of their parents and doctors. Surgery was cancelled rather than use force to induce anaesthesia. In practice, it seems that a child must demonstrate a greater maturity and understanding to refuse medical treatment than to agree to it. Some advice is given to clinicians facing similar situations.

Adolescent↗
PubMed1996

Increase in epithelial mast cell numbers in the nasal mucosa of patients with perennial allergic rhinitis.

The aim of the study was to compare the numbers and distribution of mast cells in the nasal mucosa of perennial allergic rhinitis (PAR) patients and controls, as demonstrated by different staining methods for light microscopy. Biopsies of inferior turbinate mucosa were taken from 10 patients with PAR and 10 patients undergoing septoplasty or septorhinoplasty (control group). Sections for light microscopy were stained with azure A. chloroacetate esterase and an ABC immunohistochemical technique using antibody to tryptase. Three times more mast cells were found in the epithelium of PAR patients compared to controls using the immunohistochemical technique (p = 0.0074). This method demonstrated considerably more mast cells than the other stains. The increase in epithelial mast cells is consistent with the migration of mast cells seen in seasonal allergic rhinitis, and this may be important in the phenomenon of nasal priming seen after repeated antigen exposure.

Cell Count↗
PubMed1996

Mucociliary function in patients with nasal polyps.

Patients with nasal polyposis complain of nasal blockage and rhinorrhoea, which may be due to impaired mucociliary clearance. The saccharine clearance time and ciliary beat frequency of samples of ciliated epithelium from patients with nasal polyps was measured. We also studied the effect of fluid from the oedematous stroma of nasal polyps and of histamine and prostaglandin (PG) D2, E2 and F2 alpha on the cilia from normal individuals. Polyp fluid was found to increase ciliary beat frequency. Histamine and PGD2 had no effect, but PGE2 and PGF2 alpha both increased ciliary beat frequency and so may cause the ciliostimulatory effect of polyp fluid. The saccharine clearance time was prolonged in three of nine patients, but ciliary beat frequency was only slightly reduced in one of these. Thus, where mucociliary clearance is reduced, it is likely to be due to abnormalities of mucus rather than impaired ciliary activity.

Cilia↗
PubMed1995

The effect of temperature on nasal ciliary beat frequency.

Using a photometric method of measuring ciliary beat frequency, the effect of temperature on ciliary activity was investigated. A linear increase in ciliary beat frequency between 19 degrees and 32 degrees C was found. Between 32 degrees and 40 degrees a plateau was reached in which temperature did not significantly affect frequency and above 40 degrees C the frequency began to decline. It is concluded that nasal cilia are not critically dependent upon temperature in the range 32 degrees and 40 degrees C, the temperature range in which this tissue normally operates.

Adult↗
PubMed1994

Medical treatment of nasal polyps.

Polyps are a multifactorial disease that affect the nasal lining and sinus mucosa, and in about one-third of the patients are associated with asthma. Polyps may occur in other respiratory diseases such as cystic fibrosis, primary ciliary dyskinesia and immune deficiencies. Allergy does not predispose to polyp formation, although mast cell reactions appear to be important. This explains why corticosteroids are effective in controlling some cases and helping to prevent recurrence in some others. Polyp formation in the sinuses is due to three factors: (1) the balance between the inflammatory response and the local homoeostatic mechanisms; (2) the relatively poor blood supply of the sinuses; and (3) the complex anatomy of the ethmoids and middle meatus which aggravates the existing oedema. Half the cases resolve on inhaled corticosteroids. Surgery should be tailored to the patient's needs, but on principle the simplest, least invasive operation should be tried first. If the patients are still symptomatic or recurrence is a problem, surgery may be followed by corticosteroids. If inhaled corticosteroids do not control the symptoms, then oral therapy may be required.

Adult↗
PubMed1993

Sinus computerized tomography in primary hypogammaglobulinaemia.

Thirteen patients suffering from primary hypogammaglobulinaemia receiving intravenous immunoglobulin replacement therapy underwent computerized tomography of the paranasal sinuses. The CT scans were evaluated and related to clinical data from the patients, who were selected for study on the basis of having symptoms of rhinosinusitis. The scans varied from normal to demonstrating widespread sinus abnormality. There was no relationship between the scan findings and duration of ENT symptoms, range of current symptoms, or the interval between the onset of ENT symptoms and the start of intravenous immunoglobulin replacement therapy. It is nevertheless possible that prompt institution of replacement therapy, after correct diagnosis early in the course of the disease, may prevent the development of sinus disease refractory to such treatment.

Adolescent↗
PubMed1993

Ciliary ultrastructure in nasal brushings.

Normal ciliary ultrastructure is thought to be necessary for effective function. There has been little or no attempt to quantify ultrastructural abnormalities in nasal disease and assess their significance. In this study we measured nasal ciliary function and examined ciliary ultrastructure in nasal brushings from 35 patients with perennial nasal symptoms refractory to treatment. Ultrastructural defects included microtubular abnormalities, compound cilia and ciliary 'blebs'. The incidence of abnormal cilia was 16.7%, compared with 9% in controls, but there was only a poor correlation between ultrastructural defects and ciliary beat frequency. One patient had primary ciliary dyskinesia (PCD) with a typical clinical history and immotile cilia. However, only secondary ultrastructural abnormalities were seen. We have been unable to show that ciliary ultrastructural defects form the basis of impaired function. In patients with suspected PCD, nasal brushings should be taken for functional and ultrastructural studies; ideally, a further sample should be obtained for examination of possible primary ultrastructural abnormalities.

Cilia↗
PubMed1992

Factors affecting ciliary function in vitro: a preliminary study.

Nasal ciliary function forms an important defence mechanism within the upper respiratory tract which has largely been ignored in recent years. The effects of various drugs used extensively in the treatment of diseases of the nose have not been fully established. Furthermore, the physiological control of ciliary activity is unclear. The aim of this study was therefore to investigate the effects of drugs on ciliary beat frequency in vitro using a photometric technique. A dose-dependent response to alpha and beta receptor drugs was found, cocaine hydrochloride achieved ciliostasis even at 40-fold dilution, and potassium ions, except at the limits of tolerance for excitable tissue, did not affect ciliary function. In conclusion, we suggest that alpha and beta receptors may be present on ciliated epithelium and be involved in the control of ciliary function in vivo. Ion fluxes across the ciliary cell membrane may also be important in ciliary activity akin to nervous tissue.

Adrenergic Agonists↗
PubMed1992

Beyond music: auditory temporary threshold shift in rock musicians after a heavy metal concert.

Audiometry was undertaken before and within half an hour following a heavy metal concert to assess evidence of noise damage. Of the four members tested, one member wore an ear defender in his right ear during the period of noise exposure. All unprotected ears showed a temporary threshold shift which was maximum in the lower frequencies. There was some evidence that early noise damage had occurred with a dip at 6 kHz. The role of music as noise and its potential to damage the cochlea are discussed.

Adult↗
PubMed1992

A review of the morphology of human nasal mast cells as studied by light and electron microscopy.

This review discusses the distribution and classification of human nasal mast cells after the use of different fixatives, and some of their staining characteristics, both at the light- and electron-microscopical level. The problems encountered with alcoholic and formaldehyde fixation are discussed as well as the limitations of different stains (including the basic aniline dyes), esterase cytochemistry and immunological techniques. Also, the respective limitations of light and electron microscopy are compared. Cells studied by means of electron microscopy are much more difficult to quantify objectively. It is concluded that classification of mast cells--by means of their morphology, fixation and staining characteristics--into two categories (mucosal vs. connective tissue; T-vs. T/C cells) is simplistic, especially since human nasal mast cells are both heterogeneous and pleomorphic.

Animals↗
PubMed1991

Mast cell numbers in the mucosa of the inferior turbinate in patients with perennial allergic rhinitis: a light microscopic study.

The number of mast cells in the inferior turbinate from patients with perennial allergy due to house dust mite were compared with ten normal controls. Ten random high powered fields were counted in the epithelium and the submucosa in samples which had been divided into two and fixed either in aqueous formalin or Carnoy's fixative. The sections from each block were stained with either Azure A or Chloroacetate esterase technique. No statistical differences were found. The lack of increase in mast cell numbers was attributed to degranulation since numbers have been shown to be increased in perennial allergy when sections are examined ultrastructurally.

Cell Count↗
PubMed1991

Ultrastructure of nasal mast cells in normal subjects and patients with perennial allergic rhinitis.

The ultrastructure of mast cells from the nine normal inferior turbinates were compared with those found in eight patients with perennial allergic rhinitis due to house dust mite allergy. Forty-six mast cells from normal patients were found in forty blocks and eighty cells were found in thirty-three blocks in patients with perennial allergy suggesting an increase of mast cell numbers in perennial allergy. There were no basophils outside the blood vessels and whole mast cells were found only in the submucosa. There was no difference in the morphology of cells of different sizes. Mast cells were more degranulated in the allergic mucosa. Degranulation, irrespective of cell size was found at all depths of the mucosa. A review of the literature covered the in vivo and in vitro descriptions of the ultrastructural morphology of human mast cells in the respiratory tract.

Cell Count↗