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C Bachert

Publications and source records attributed to C Bachert.

At least 19 recordsLinked to original sources
PubMed2001

[Statistics on allergology and environmental medicine in the ENT specialty in Germany].

Environmental medicine and allergy were found to be important in the daily ENT practice after statistical analysis and an inquiry among all ENT doctors in Germany. 64% of ENT colleagues do practice allergy, 20% environmental medicine. With reference to all registered ENT doctors 24% are titled allergists, 4% specialists in environmental medicine. Focussing on the teaching there is a big difference between both groups. Whereas training facilities for allergists are reasonable, there are only a few chief instructors for environmental medicine in the ENT society. This fact has to be considered on educational plannings in future.

Allergy and Immunology↗
PubMed2001

Decongestant efficacy of desloratadine in patients with seasonal allergic rhinitis.

Recent advances in experimental immunologic approaches to seasonal allergic rhinitis (SAR) have led to a shift in the concepts of its pathogenesis. The conventional view of SAR as a local response to inhaled allergens has largely given way to a new view of this disorder as a systemic condition with local tissue manifestations. This concept, together with an increasing recognition of specific mediators' distinct roles in driving the early- and late-phase allergic responses, has opened multiple lines of therapeutic attack within the allergic cascade. Potent inhibition of inflammatory mediator release at distinct points in this cascade is conferred by desloratadine. In addition to the familiar range of SAR symptoms amenable to antihistamine therapy, desloratadine uniquely attenuates patient ratings of nasal congestion. This novel, nonsedating histamine H1-receptor antagonist is the only once-daily antiallergic product with a consistent decongestant effect that begins within hours of the first morning dose and is sustained for the entire treatment period.

Chemotaxis, Leukocyte↗
PubMed2001

Mizolastine in the treatment of seasonal allergic rhinoconjunctivitis: a European clinical experience with 5408 patients managed in daily practice (PANEOS SAR Study).

BACKGROUND: Mizolastine, a potent H1 antihistamine with additional antiallergic properties, is marketed for the treatment of allergic rhinoconjunctivitis and urticaria. The objective was to investigate the safety and effectiveness of mizolastine under conditions of daily practice in patients with seasonal allergic rhinoconjunctivitis (SAR). METHODS: In an open multicenter study, mizolastine 10 mg daily was administered for 14 days during the pollen season. Nasal and ocular symptoms, time to onset of symptom relief, and effect of the drug on diurnal alertness were evaluated. Safety was evaluated on the basis of self-reported adverse events (AE). RESULTS: A total of 5408 patients (36+/-14 years of age, females=57%) with a history of SAR for 8+/-9 years were treated for a mean of 17.1+/-5.0 days. SAR symptoms improved in 93% and decreased by at least 50% in 86% of patients; 78% reported improvement after the first drug intake and 51% from the first hour. Sixty-nine percent considered mizolastine more effective than other antihistamines taken previously. The incidence of AE was low (3.8%). CONCLUSION: The high responder rate, the rapid onset of action, and the low incidence of AE observed in this large multicenter study confirm the previously reported beneficial efficacy and safety of mizolastine in the management of SAR.

Adolescent↗
PubMed2001

Presence of fluticasone propionate on human nasal mucosal surface and in human nasal tissue over a period of 24 h after intranasal application.

BACKGROUND: Once-daily use of nasally applied glucocorticoids was demonstrated to be effective in the treatment of allergic rhinitis. The aim of the study was to measure concentrations of fluticasone propionate (FP) in nasal secretion and nasal tissue over a period of 1 day after a single application of 100 microg FP. METHODS: Twenty-six patients applied nasal FP spray at different time intervals before surgery. Cotton swabs, used to clean the mucosal surface, and resected nasal tissue were extracted. FP concentrations were determined by RIA. RESULTS: FP was found in nasal secretions in concentrations from 15 to 1 microg/g over a period of 20 h, and in nasal tissue in concentrations from 200 to 13 ng/g up to 24 h after the single application. CONCLUSION: The long-persisting high concentrations of FP provide the pharmacokinetic basis for once-daily treatment.

Administration, Intranasal↗
PubMed2001

Total and specific IgE in nasal polyps is related to local eosinophilic inflammation.

BACKGROUND: Nasal polyps (NPs) are characterized by eosinophilic inflammation and often coexist with asthma. However, the role of atopy and IgE in NP pathogenesis is unclear. OBJECTIVE: We sought to determine whether there is an association between total and specific IgE to a variety of allergens in polyp and nonpolyp tissue and markers of eosinophilic inflammation or skin test results. METHODS: Homogenates were prepared from nasal tissue of 20 patients with NPs and 20 patients without NPs and analyzed for concentrations of IL-5, IL-4, eotaxin, leukotriene (LT) C4/D4/E4, sCD23, and histamine (ELISA). Eosinophil cationic protein (ECP), tryptase, and total and specific IgE for inhalant allergens and Staphylococcus aureus enterotoxins were measured (ImmunoCAP). RESULTS: The concentrations of total IgE, IL-5, eotaxin, ECP, LTC4/D4/E4, and sCD23 were significantly higher in NP tissue compared with nonpolyp tissue. Total IgE was significantly correlated to IL-5, ECP, LTC4/D4/E4, and sCD23 and to the number of eosinophils in NPs. On the basis of the presence of specific IgE antibodies in tissue, 3 NP groups were defined. NP group 1 demonstrated no measurable specific IgE, and NP group 2 selected specific IgE. The third group demonstrated a multiclonal specific IgE, including IgE to S aureus enterotoxins, a high total IgE level, and a high prevalence of asthma. CONCLUSIONS: These studies suggest that there is an association between increased levels of total IgE, specific IgE, and eosinophilic inflammation in NPs, which may be of relevance in the pathophysiology of nasal polyposis. Similarly, the presence of specific IgE to staphylococcal enterotoxins A and B also points to a possible role of bacterial superantigens.

Eosinophils↗
PubMed2001

Lumenal endosomal and Golgi-retrieval determinants involved in pH-sensitive targeting of an early Golgi protein.

Despite the potential importance of retrieval-based targeting, few Golgi cisternae-localized proteins have been demonstrated to be targeted by retrieval, and the putative retrieval signals remain unknown. Golgi phosphoprotein of 130 kDa (GPP130) is a cis-Golgi protein that allows assay of retrieval-based targeting because it redistributes to endosomes upon treatment with agents that disrupt lumenal pH, and it undergoes endosome-to-Golgi retrieval upon drug removal. Analysis of chimeric molecules containing domains from GPP130 and the plasma membrane protein dipeptidylpeptidase IV indicated that GPP130 targeting information is contained entirely within its lumenal domain. Dissection of the lumenal domain indicated that a predicted coiled-coil stem domain adjacent to the transmembrane domain was both required and sufficient for pH-sensitive Golgi localization and endosome-to-Golgi retrieval. Further dissection of this stem domain revealed two noncontiguous stretches that each conferred Golgi localization separated by a stretch that conferred endosomal targeting. Importantly, in the absence of the endosomal determinant the Golgi targeting of constructs containing either or both of the Golgi determinants became insensitive to pH disruption by monensin. Because monensin blocks endosome-to-Golgi transport, the finding that the endosomal determinant confers monensin sensitivity suggests that the endosomal determinant causes GPP130 to traffic to endosomes from which it is normally retrieved. Thus, our observations identify Golgi and endosomal targeting determinants within a lumenal predicted coiled-coil domain that appear to act coordinately to mediate retrieval-based targeting of GPP130.

Animals↗
PubMed2000

Glucocorticosteroids rapidly inhibit allergen-induced expression of E-selectin in vitro in a mucosal model of allergic rhinitis.

BACKGROUND: Transendothelial migration of cells to sites of inflammation is a hallmark of the allergic reaction. The adhesion cascade involves the initial expression of the adhesion molecule E-selectin on endothelial cells. The aim of the study was to determine the efficacy of a 30-min preincubation of the glucocorticosteroids (GCS) fluticasone, prednisolone, and fluocortin butyl on allergen- and interleukin (IL)-1beta-induced E-selectin expression in allergic rhinitis. METHODS: Freshly taken nasal inferior turbinate mucosa of 19 subjects with allergic rhinitis was cut into small cubes and preincubated for 30 min with prednisolone (n = 6), fluticasone (n = 5), and fluocortin butyl (n = 3) in different concentrations, followed by allergen exposure at a concentration of 1000 BU/ml for 1 and 2 h. Additionally, fluticasone-preincubated tissues were exposed to recombinant human rhIL-1beta (n = 5) at a concentration of 2 pg/ml. The expression of E-selectin was assessed by immunohistochemistry (APAAP technique) and computerized image evaluation. RESULTS: In this model, E-selectin expression was significantly upregulated by allergen and rhIL- 1beta within 1 and 2 h. After 30-min preincubation with prednisolone and fluocortin butyl at drug concentrations of 10-8 mol/1, we found a significant (> or = 50%) reduction of the E-selectin expression after 1 and 2 h. Allergen-induced E-selectin expression was nearly abolished at concentrations of 10-5 (prednisolone) and 10-4 mol/l (fluocortin butyl). Fluticasone significantly inhibited E-selectin expression by > or = 50% at concentrations of 10-14 and 10-12 mol/l after 1 and 2 h, and abolished E-selectin induction at concentrations of 10-12 and 10-10 mol/l, respectively. Exposure of mucosal cubes to rhIL-lbeta (n = 5) also induced rapid upregulation of E-selectin expression, an effect which could be only partially suppressed by fluticasone preincubation at concentrations of 10-l0 mol/l. CONCLUSIONS: Allergen-induced E-selectin expression is significantly and rapidly inhibited by GCS preincubation, fluticasone being more potent than prednisolone and fluocortin butyl. We suggest that this rapid effect is mainly indirect, possibly by inhibition of allergen-induced cytokine release.

Adolescent↗
PubMed2000

Value of acoustic rhinometry in environmental medicine.

It is a weak point of environmental medicine that health disturbances, e.g. functional affections of the upper respiratory tract, cannot be objectively judged by physicians resp. researchers. In this study, the validity of acoustic rhinometry, a method giving information on cross-sectional areas of the upper airways by means of ultrasound probing, was tested in 40 volunteers seven times during one year. Furthermore, using a simplified model of the nose the accuracy of this method to measure the minimal cross-sectional area (MCA) in the nose was tested. The measurements were extremely confounded by the mode of connection to the nose (e.g. selected adapter, direction of application) and by the MCA in the nasal cavity. Statistical analyses showed a good reproducibility of measurements repeated within minutes, but suggested an intrapersonal variability over the analyzed examination phases due to apparatus independent factors. However, this variability could not be explained by influencing and confounding factors obtained by questionnaire, medical history, and physical examination. The test model showed little to great errors (1.5 to 568.5%) between the actual and the measured MCA, depending on the diameter. It is concluded that the method of acoustic rhinometry has to be standardized before it's value for environmental medicine can finally be judged. Further studies are necessary that should focus among others on factors influencing the variability of MCA and the effect of MCA on the measurement of the area behind the MCA. So far, the use of acoustic rhinometry for the evaluation of nasal function cannot be recommended.

Acoustics↗
PubMed2000

Value of antral puncture in the intensive care patient with fever of unknown origin.

OBJECTIVE: To evaluate the use of maxillary sinus puncture as a routine diagnostic procedure to exclude or confirm purulent sinusitis in intensive care unit (ICU) patients presenting with fever or a septic state of unknown origin. STUDY DESIGN: Retrospective. METHODS: All patients admitted to the ICU at the University Hospital Ghent who required ENT examination to exclude acute sinusitis as possible cause of their otherwise inexplicable fever or septic state underwent maxillary sinus puncture via the inferior meatus. The results of clinical examination and the relation between the presence of foreign bodies (e.g., nasogastric tubes) and culture results from the middle meatus and sinuses were analyzed. RESULTS: One hundred five punctures were performed in 53 patients. Macroscopic purulent effusions were obtained from 25 and nonpurulent effusions from 19 sinuses. The presence of a nasogastric tube did not influence puncture results but significantly increased colonization of the middle meatus. Staphylococcus aureus and Gram-negative agents were frequently cultured from sinus aspirates. Although purulent secretions often reveal no growth, most patients present with a multibacterial (40%) or monobacterial (28%) infection. Simple anterior rhinoscopy reduces the need for antral puncture. Only 8% of punctures in patients with a normal clinical examination were positive. CONCLUSIONS: Antral puncture proves to be a simple, fast, safe, inexpensive, and effective procedure for immediate diagnosis of acute nosocomial sinusitis in ICU patients and is therefore recommended as first procedure in these patients, even when only minor clinical abnormalities are present.

Adolescent↗
PubMed2000

Guidelines for nasal provocations with aspects on nasal patency, airflow, and airflow resistance. International Committee on Objective Assessment of the Nasal Airways, International Rhinologic Society.

Under the auspices of the International Rhinologic Society (IRS) there is an 'International Committee on Objective Assessment of the Nasal Airways'. In 1984 Rhinology published the Committee's recommendations regarding rhinomanometry (Clement, 1984). During the last Congresses of the European Rhinologic Society (ERS) a subcommittee within that committee has discussed nasal provocations and the value of measuring nasal patency, airflow and airflow resistance to evaluate such provocations. The following is an effort to a consensus of indications and techniques for nasal provocation and to a critical analysis of methods to measure the effects. Only the most known methods will be discussed, i.e. acoustic rhinometry, rhinostereometry, nasal peak airflow and rhinomanometry with its different techniques. For graded responses after provocations the use of such methods is of clinical value only in combination with scores from symptoms such as sneezes and secretion, as allergic rhinitis symptoms consist of obstruction, sneezing, itching and concomitant symptoms of the neighbouring organs. For research all methods can be recommended to be used and their respective value is depending on the specific scientific purposes.

Acoustics↗
PubMed2000

Endoscopic endonasal surgery for paranasal sinus mucoceles.

Paranasal sinus mucoceles are benign, space-occupying, cystic lesions that require a surgical treatment. An endoscopic endonasal marsupialisation is nowadays the surgical approach of choice in most of the cases. The aim of the present study is to validate this option and to determine the clinical characteristics of paranasal sinus mucoceles. A retrospective study based on the clinical experience of several ENT surgeons was performed using a standardised questionnaire. The respondents participate to a report on endoscopic endonasal surgery for non-inflammatory disease in Belgium. One hundred and fourty patients presenting 178 mucoceles were included in this study. Primitive mucoceles were reported in 35% of the patients, posttraumatic mucoceles in 2.1% and postoperative mucoceles in 62.9%. The time interval between first rhinologic procedure and the mucocele diagnosis was respectively 24.4 months after FESS and 108.3 months after an external procedure. Paranasal sinus mucoceles predominantly occur in the fronto-ethmoidal region (64%), followed by the maxillary sinus (18.6%), the sphenoid sinus (8.4%) and the posterior ethmoid sinus (6.7%). Uncommon locations were also reported in 2.3% (Inferior turbinate, middle turbinate, pterygomaxillary space). Endoscopic endonasal marsupialisation (combined with an external procedure for 8 patients) was successful in 97.9% of the patients. Only 3 patients showed recurrence. Endoscopic endonasal marsupialisation of paranasal sinus mucoceles is a reliable therapeutic option with favorable results and is supported by the questioned ENT surgeons in Belgium.

Adolescent↗
PubMed2000

Surgery of inverted papillomas under endoscopic control.

Six centers cooperated in a retrospective study on endoscopic surgical resection of Papillomas of the nose and paranasal sinuses in order to assess both the efficiency and the safety of this kind of surgical approach. From 1991 till march 2000, 87 cases of Papillomas resections under--at least partially--endoscopic control were gathered, among which 85 were Inverted Papillomas (IP), 2 were Exophytic Papilloma (EP) and one was IP coexisting with Collumnar Cell Papilloma (CCP). Malignant transformation was found out in 3 cases of IP. Regarding the 85 patients with IP demographics are as follows: 61 males, 24 females, with a mean age of 58.4 years (STDV: 13.96) in a range from 27 to 92 years. The mean follow-up was of 41.9 months with range of 1-120 months. Fifteen recurrences occurred that were treated by revision surgery either under endoscopic control or by limited external approach. The mean time for recurrences to occur was 8.07 months with range of 1-24 months. The three patients with malignant transformation underwent postoperative radiation therapy. All of the patients are free of recurrence, however for some of them the follow-up is too short to definitely assess their free of disease status. The role of modern diagnostic tools in medical imaging--CAT and MRI--in order to assess clearly the limits of the tumors and to enhance the efficiency and the safety in the choice of a surgical approach is pointed out. The stress is put on the need for radical excision under endoscopic control which can be combined with the Caldwell-Luc transantral approach or with frontal trepanation for the cure of tumors impossible to be reached under endoscopic control only. Irrespective of the tumor extent and of the approaches that was used for excision a close endoscopic follow-up still remain mandatory, by trained surgeons, in the long term management of IP. Biopsies, CAT and/or MRI must be performed in any case with recurrence suspicion.

Adult↗
PubMed2000

Endoscopic endonasal surgery (EES) in skull base repairs and CSF leakage.

This report aims to summarise the current role of Endoscopic Endonasal Surgery (EES) for skull base and cerebrospinal fluid (CSF) leakage repair, to provide some guidelines for the clinical diagnosis and technical procedures of repair, to demonstrate the limits of this approach and to discuss the Belgian experience of the recent years. Endoscopic surgery for chronic sinus disease is being performed with increasing frequency and CSF leak is an significant potential complication of this surgery, although the incidence of osteo-meningeal perforations in endonasal sinus surgery is below 1% overall. CSF leakage bears the risk of meningeal or intracranial infection and complication and therefore should be repaired as soon as recognised. Following proper localisation of the leak, repair is safely performed in most of the cases by endonasal route with the help of free mucoperiostal flaps taken from the inferior or middle turbinates. This also applies for lesions of other aetiologies. The Belgian data support the statement that the endonasal endoscopic approach is a suitable and successful technique to close CSF leaks in the vast majority of our patients.

Adult↗
PubMed2000

Endoscopic sinus surgery for juvenile nasopharyngeal angiofibroma.

Juvenile nasopharyngeal angiofibroma is a rare tumour of the head and neck with very specific characteristics: adolescent males, choana-nasopharynx, pterygomaxillary fossa widening, specific and intense vascularisation. Staging is very important in the decision of the surgical approach. Endoscopic management of juvenile nasopharyngeal angiofibroma is technically possible after preoperative embolisation. Up to now 13 angiofibroma have been treated using the endonasal endoscopic sinus surgery approach in Belgium (Leuven 8; Mont-Godinne 2; Ghent 1; Liege 1; Woluwe 1). In smaller tumors endoscopic resection has been successful in four cases without any recurrence. Five larger tumors, extending in the pterygomaxillary fossa, were also successfully resected. Extension into the infratemporal fossa or the cavernous sinus can be endoscopically removed, but recurrences may occur as they do after classical, external approaches. In conclusion, the endoscopic approach is an acceptable alternative in small to middle sized juvenile nasopharyngeal angiofibroma.

Adolescent↗