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G Rasp

Publications and source records attributed to G Rasp.

At least 37 records · Page 2Linked to original sources
PubMed2001

Allergic rhinitis does not constitute a risk factor for obstructive sleep apnea syndrome.

Obstructive sleep apnea syndrome (OSAS) is a condition characterized by recurrent episodes of obstruction of the upper airway. The aim of this study was to evaluate whether nasal obstruction due to allergic rhinitis constitutes a risk factor for OSAS. Patients (n = 119) presenting typical symptoms of sleep apnea were tested for OSAS using polysomnography. Additionally all patients were tested in vivo and in vitro (including nasal eosinophilic cationic protein) for allergic rhinitis. Examination for allergic rhinitis revealed that 88.3% of all patients had no allergic rhinitis, whereas only 11.7% were diagnosed as allergic. No significant differences in sleeping parameters were observed between allergic and non-allergic patients. Comparison of parameters indicative of relevant OSAS (apnea-hypopnea index [AHI] > 10) revealed that 60% of non-allergic patients had relevant OSAS, compared to only 50% of allergic patients. Investigation of allergic subgroups revealed similar results: no significant differences in sleeping parameters or elevated rates of relevant OSAS parameters were observed, especially in perennial allergic rhinitis due to house dust mites. No elevated rates of allergic rhinitis were observed in the studied cohort of patients suffering from sleep apnea or OSAS. Furthermore, no significant differences in sleeping behavior or polysomnography parameters were found on comparing allergic and non-allergic patients. In summary, our data rule out allergic rhinitis as a major risk factor for OSAS.

Electroencephalography↗
PubMed2000

[Autologous rib cartilage harvesting: operative procedure and postoperative pain reduction].

INTRODUCTION: In reconstructive surgery there is a growing demand for cartilage grafts. For small amounts of autologous tissue, cartilage from the nasal septum or ear concha is a sufficient and reliable tissue, but in cases of extensive defects or higher mechanical load autologous rib cartilage is a commonly used transplant. Nevertheless, a serious donor-site morbidity, especially postoperative pain, has to be taken into consideration. We present a modified technique for harvesting rib cartilage with a consecutive local pain therapy. TECHNIQUE: In contrast to the commonly used incision through all layers of tissue the described technique follows the anatomical structures of skin tension-lines, the fascial and muscle fibers and tissue sliding-planes. Starting with a transversal skin incisions 1.5 cm above the costal arch, longitudinal splitting of the rectus abdominis fascia and muscle, the rib cartilage of the ribs 6 to 8 can be exposed. Grafts in the size of at least 3 to 8 cm can be harvested under preservation of the perichondrium. This technique causes a high degree of stability and good function of the abdominal wall. POSTOPERATIVE PAIN THERAPY: After harvesting rib cartilage most patients complain about extensive postoperative pain. For adequate treatment the local application of a long-lasting anesthetic substance close to the intercostal nerves is helpful. The introduction of a peridural catheter opens the feasibility of continuously applying a local anesthetic for 3 to 4 days directly into the donor-site. This procedure reduces the need for general anesthetics dramatically and prevents further complications. DISCUSSION: This modified technique for harvesting rib cartilage diminishes the donor-site morbidity by reducing the risk of pneumothorax, hernias and functional deficits. Moreover, the local pain therapy assures postoperative wellness and mobility.

Anesthetics, Local↗
PubMed2000

[A new system for the classification of ethmoid polyposis. Effect of combined local and systemic steroid therapy].

BACKGROUND: Nasal polyps are a common disease with in the majority of cases unknown origin. Both the medical and surgical treatment of nasal polyps present a challenge in Otorhinolaryngology. METHODS: We developed a four-stage grading system for nasal polyps based on the endoscopic aspect of more than 300 patients. In a study of 37 patients, treated by systemically (Methylprednisolon 64 mg p.o., decreasing amounts for the first 11 days) and locally (Budesonid 400 micrograms intranasal) applied steroids for 90 days, this staging-system was tested. RESULTS: The mean stage of polyps decreased significantly (p < 0.01) from 2.8 at day 0 to 1.7 at day 7 and further to 1.2 and to 0.7 at day 28 and day 90 respectively. The mean nasal symptom score decreased equally from 1.14 on day 1 to 0.19 and to 0.14 on day 7 and day 28 respectively. To summarize, we observed a significant (p < 0.01) decrease in polyp stages of 75% respectively a significant (p < 0.01) reduction of symptom scores of 93%. CONCLUSIONS: Thus, we present a suitable new grading system for nasal polyps which we applied directly to assess the efficacy of combined local and systemic steroid therapy. It was shown that this treatment can reduce polyps and prevent their recurrence over the observed time.

Administration, Intranasal↗
PubMed2000

Nasal interleukin-5, immunoglobulin E, eosinophilic cationic protein, and soluble intercellular adhesion molecule-1 in chronic sinusitis, allergic rhinitis, and nasal polyposis.

OBJECTIVE: To compare concentrations of interleukin-5 (IL-5), immunoglobulin E (IgE), eosinophilic cationic protein (ECP), and soluble intercellular adhesion molecule-1 (sICAM-1) in nasal secretion and serum of patients with chronic nonallergic sinusitis, allergic rhinitis, and nonallergic nasal polyposis to obtain information about the pathogenesis of these diseases. METHODS: Nasal secretion and serum were analyzed by routine enzyme-linked immunosorbent assay techniques. Nineteen patients with chronic nonallergic sinusitis, 24 patients with seasonal allergic rhinitis, and 18 patients with nonallergic nasal polyposis were included in the study. Eight healthy, nonallergic probands served as control subjects. RESULTS: Significantly elevated concentrations of IL-5 (5-fold, P < .05) and IgE (15-fold, P < .01) were detected in nasal secretion of patients with allergic rhinitis (IL-5, 51.8 +/- 13.2 pg/mL; IgE, 41.9 +/- 20.9 kU/L) or nonallergic nasal polyposis (IL-5, 57.9 +/- 36.9 pg(mL; IgE, 40.5 +/- 20.2 kU/L) compared with controls (IL-5, 10.6 +/- 7.8 pg/mL; IgE, 2.8 +/- 0.5 kU/L) or with patients with chronic nonallergic sinusitis (IL-5, 16.5 +/- 13.2 pg/mL; IgE, 5.4 +/- 3.1 kU/L). There were no significant differences between patients with allergic rhinitis and those with nonallergic nasal polyposis. Concentrations of ECP were significantly elevated (sixfold, P < .01) in patients with allergic rhinitis (297.8 ng/mL +/- 173.1) compared with controls (52.4 +/- 28.0 ng/mL) or patients with chronic nonallergic sinusitis (44.8 +/- 40.1 ng/mL), whereas twofold higher concentrations (not significant) of ECP were observed in patients with nonallergic nasal polyposis (107.1 +/- 26.6 ng/mL). Significantly elevated concentrations of sICAM-1 in nasal secretion (threefold, P < .05) were detected only in patients with chronic nonallergic sinusitis (79.4 +/- 45.6 ng/mL). The elevated sICAM-1 nasal secretion values in this group correlated significantly (P < .05) to the serum values. CONCLUSIONS: Equally elevated concentrations of IL-5 and IgE in patients with allergic rhinitis and nonallergic nasal polyposis implicated similar pathogenic processes in both diseases. Whereas the pathogenesis of allergic rhinitis is IgE-specific, the pathogenesis of nasal polyps is not as clear. IL-5 was suggested to play a pivotal role in tissue eosinophilia, which was confirmed by data in the present study. Elevated concentrations of ECP were suggested to result from tissue eosinophilia--a characteristic of both diseases. Elevated concentrations of sICAM-1 in patients with chronic nonallergic sinusitis pointed to its key role in the recruitment of neutrophils into the inflamed tissue, whereas an important role in eosinophil recruitment was ruled out.

Adult↗
PubMed1999

Norm values for eosinophil cationic protein in nasal secretions: influence of specimen collection.

BACKGROUND: Eosinophil granulocytes play an important role in allergic inflammation of the nasal mucosa. Eosinophil cationic protein (ECP) is a specific eosinophil granule protein released upon activation of these cells. ECP concentration in nasal secretions has been demonstrated to be a good marker for the activity of eosinophilic nasal mucosal inflammation. The clinical use of such a marker requires defined values which are regarded as pathological or within normal range. In analyses of nasal secretion samples, the sampling method has an important influence on the data obtained. OBJECTIVE: We investigated ECP levels in nasal secretions (NS) of healthy volunteers obtained by seven different methods of sample collection to define norm values and to evaluate the clinical use of the different methods. METHODS: A total of 839 healthy individuals were evaluated using blowing the nose (Bl: n = 82), suction (Suc: n = 69), Okuda microsuction technique (MSuc: n = 93), absorbent cotton wool samplers (CWS: n = 156), rubber-foam samplers (RFS: n = 193), nasal lavage (Lav: n = 112) and nasal spray washing (NSW: n = 134). RESULTS: Missing values occurred in more than 60% in Bl, Suc and MSuc, so that no norm range was defined for these methods. Norm range for ECP in NS was 5-46 ng/mL for CWS, 7-41 ng/mL for RFS, 4-51 ng/mL for NSW, and 3-31 ng/mL for Lav. CONCLUSIONS: When comparing seven different methods used in this study to collect nasal secretions and determine ECP levels, the method based upon absorption or nasal washing was the best.

Adolescent↗
PubMed1999

[Short-term immunotherapy--a survey of current studies].

Immunotherapy (IT) plays a central role in the therapy of allergic rhinitis as it was proved to be causal and preventive. IT induces humoral and cellular changes in the immune system, a reduction of symptoms and a prophylactic effect regarding a possible expansion of the allergene spectrum and of involved organ systems. Regular therapeutic schedules include allergen injections starting immediately after the pollen season and ending just before the expected beginning of a season. Additionally, perseasonal and perennial therapy schemes have been used. In all these, a phase of dose-increase is followed by an individually adjusted steady-state preservation-phase. In perseasonal and perennial scheme the injections are given during the pollen season. The preseasonal shortterm-immunotherapy is another schedule. The increase of the injected allergen-dose is made very fast (most commonly during seven weeks), so that the phase of dose-increase is shortened considerably, and a preservation-phase does not take place. This shortterm-immunotherapy has been developed for patients who consult their doctor shortly before the start of the pollen season. The preseasonal shortterm-immunotherapy has been shown to be efficient regarding allergic rhinitis caused by grass-, rye-, birch-, hazel- and alder-pollen. Clinical and experimental data of two placebo-controlled trials and one open study are presented and the role of this new immunotherapy approach is discussed.

Adult↗
PubMed1998

Tree-pollen allergy is efficiently treated by short-term immunotherapy (STI) with seven preseasonal injections of molecular standardized allergens.

The efficacy and tolerance of short-term immunotherapy (STI) by seven preseasonal injections of tree-pollen allergens (ALK7 Frühblühermischung) was investigated in a double-blind, placebo-controlled, multicenter study with 111 rhinoconjunctivitis patients. Nasal and bronchial symptoms simultaneously analyzed, and nasal symptoms as a single end point, but not the overall score of nasal, bronchial, and conjunctival symptoms, showed a significantly lower increase with STI during birch-pollen exposure (both P=0.033, n=105, Mann-Whitney U-test). However, a selective analysis with patients from centers with high recruitment figures (n> or =10 patients, n=29 STI, n=32 placebo) showed a significantly lower increase of nasal, bronchial, and overall symptom score (STI 11.0 vs placebo 18.0, P=0.001, U-test). STI had equidirected effects on conjunctival, nasal, and bronchial symptoms analyzed as multiple end points, although conjunctival symptoms were not significantly different as a single end point. The seasonal increase in drug use was reduced by 62% in the STI group compared with placebo (P=0.032, t-test). Specific IgG4 increased only after STI (P<0.001); IgE was not significantly different. Eosinophil cationic protein remained unchanged with STI, but significantly increased with placebo in the pollen season (P=0.003). STI was well tolerated. In conclusion, STI was shown to be efficacious and safe for the treatment of patients with tree-pollen rhinoconjunctivitis.

Adolescent↗
PubMed1997

Short-term immunotherapy: a prospective, randomized, double-blind, placebo-controlled multicenter study of molecular standardized grass and rye allergens in patients with grass pollen-induced allergic rhinitis.

BACKGROUND: Short-term immunotherapy (STI) can be beneficial for patients who are noncompliant with long-term specific immunotherapy. OBJECTIVE: The efficacy and tolerance of STI with seven preseasonal injections of molecular standardized allergens from grass and rye pollen has been investigated in a double-blind, placebo-controlled multicenter study with 87 patients at 12 German University hospitals. METHODS: Symptoms of the eyes, nose, and bronchi and use of symptomatic drugs were documented daily in diaries by patients with allergic rhinitis to grass and/or rye pollen and without bronchial asthma. Patients were monitored by skin prick test titration and measurement of levels of specific IgE and IgG4. RESULTS: The median nasal score for the 10 weeks with the strongest symptoms during the grass pollen season was significantly lower (p = 0.014) with 35.0 for STI (n = 41) versus 69.0 for placebo (n = 40); the overall symptom score was 54.0 for STI versus 97.5 for placebo (p = 0.020). Only STI-treated patients exposed to less than 40 pollen grains per cubic meter per week showed a significantly lower nasal symptom score of 39.0 versus 75.0 for placebo (p = 0.006); these patients also had fewer nasal symptoms and less use of topical nasal drugs (p < 0.001). The threshold dose in skin prick tests was significantly higher, being 9.06 histamine equivalent for skin prick test (HEP) for STI-treated patients who received the maximum dose (n = 22) versus 4.33 HEP for placebo (p = 0.005). Specific IgE levels were significantly higher, being 55.9 SU/ml for STI versus 39.2 SU/ml for placebo after seven injections (p = 0.006) and level of specific IgG4 was 5.36% for STI versus 1.28% for placebo (p < 0.001). No severe systemic reactions were observed. CONCLUSION: STI with seven preseasonal injections with molecular standardized allergens is effective and well tolerated.

Adolescent↗
PubMed1996

[Cell activation markers in rhinitis and rhinosinusitis. 1: Eosinophilic cationic protein (ECP)].

BACKGROUND: The quantitative analysis of the migration and activation of inflammatory cells is standard in current diagnosis of inflammatory diseases of the nasal mucosa. Histological and cytological examinations are mostly used for this purpose. Development and validation of assays for specific marker proteins of the different cell populations make similar analyses possible from nasal secretion samples. Myeloperoxidase (MPO) or Elastase are important markers for neutrophil granulocytes as is Tryptase for mast cells, Lysozyme for macrophages/monocytes and Eosinophil Cationic Protein (ECP). Eosinophil Neurotoxin/Eosinophil Protein X (EDN/EPX) or Major Basic Protein (MBP) for eosinophil granulocytes. METHODS: We performed a prospective study on healthy volunteers and patients with different inflammatory nasal and paranasal sinus diseases and analysed such cell activation markers in nasal secretions. In the healthy volunteers, 183 nasal secretion samples were obtained. A total of 515 samples were obtained in patients with the diagnosis: chronic sinusitis (n = 49), allergic rhinitis to perennial allergens (n = 94), chronic sinusitis with additional allergic rhinitis to perennial allergens (n = 36), nasal polyps (n = 28), allergic rhinitis to seasonal allergens extraseasonally (n = 131), and allergic rhinitis to seasonal allergens during the pollen season (n = 177). RESULTS: In part I of this paper we describe the results for the Eosinophil Cationic Protein (ECP). In all patients with active inflammatory reactions significantly higher ECP levels than in the controls were found. Moreover, ECP levels differed between the diseases investigated. CONCLUSIONS: ECP nasal secretion level seem to be a valuable marker for the assessment of nasal eosinophilic inflammation and might become an adjunct to current diagnostic measures.

Adult↗
PubMed1996

Overexpression of tenascin in cholesteatoma and external auditory meatal skin compared to retroauricular epidermis.

In the present study the distribution of tenascin in cholesteatoma was immunohistochemically investigated. The results were compared with those in external auditory meatal skin and in retroauricular skin of healthy controls. The staining pattern was additionally correlated to the degree of cell proliferation as detected by the monoclonal antibody MIB-1 (Ki-67 antigen). Retroauricular skin showed a limited distribution of tenascin in the papillary dermis and a sparse reactivity of MIB-1 in only a few epithelial cells. External auditory meatal skin revealed a more pronounced reaction for tenascin and MIB-1. In contrast, cholesteatoma tissue exhibited an abundant and continuous expression of tenascin covering the whole stroma compartment. This coincided with a significant increase of MIB-1-positive cells in the basal and suprabasal epithelial layers. Doublestaining experiments revealed most prominent stromal tenascin-expression in areas with marked signs for epithelial proliferation. This suggests that tenascin is selectively increased in response to epidermal hyperproliferation. This matrix protein thus shows a quantitatively and qualitatively enhanced expression under pathological conditions. Moreover, the abundant reactivity for tenascin in the cholesteatoma provides evidence of a deregulated cell-matrix interaction involved in the hyperproliferative process of cholesteatoma formation.

Case-Control Studies↗
PubMed1994

Isolation and characterization of trypsin-like and chymotrypsin-like proteinases from human cholesteatoma.

The mast-cell-specific proteolytic enzymes tryptase and chymase were identified in and isolated from cholesteatoma in a ratio similar to that found in human skin. We assume that this ratio reflects a similar distribution of tryptase-containing and tryptase/chymase-containing mast cells in both these tissues. It seems conceivable that mechanisms able to trigger excessive and/or continuous mast cell degranulation in the middle ear might be causative for the formation of cholesteatoma either directly or via primed chronic inflammatory reactions. By their ability to amplify degranulation of mast cells, mast cell proteinases, in particular chymase, may contribute to the chain of events leading to the formation of cholesteatoma.

Cell Degranulation↗
PubMed1994

Development of a new, more sensitive immunoassay for human tryptase: use in systemic anaphylaxis.

Tryptase, a neutral protease, is selectively concentrated in the secretory granules of human mast cells, and its release into the circulation serves as a clinical marker of mast cell activation. The current study describes a new, more sensitive ELISA utilizing a newly developed, mouse monoclonal IgG1 antibody for capture called B12 and capable of detecting tryptase in normal plasma and serum. The greater sensitivity of the new immunoassay results in part from a greater portion of tryptase being detected. Mean levels of tryptase in serum from normal subjects from Richmond, Virginia (4.9 ng/ml; n = 56), Munich, Germany (3.8 ng/ml; n = 19), and Amersfoort, The Netherlands (1.9 ng/ml; n = 8) were as indicated. In 62 subjects with ongoing allergic rhinitis, tryptase levels were no different in serum than for 19 normal controls, indicating that local mast cell activation is not necessarily reflected in the circulation. In 61 subjects sensitive to honey bee or yellow jacket venom by history, the 17 destined to have a severe, hypotensive response to a sting challenge had higher levels of tryptase at baseline than mild reactors, nonreactors, and controls, suggesting that baseline levels of tryptase may predict the severity of the clinical response to allergen in sensitive subjects.

Anaphylaxis↗
PubMed1994

Eosinophil inflammation of the nasal mucosa in allergic and non-allergic rhinitis measured by eosinophil cationic protein levels in native nasal fluid and serum.

Eosinophil inflammation is essential in many cases of allergic and non-allergic rhinitis. Activated eosinophils release toxic granule proteins. In this study, we compared the degree of local nasal and systemic eosinophil activation by the determination of eosinophil cationic protein (ECP) in serum and native nasal fluid from 119 patients. We found no significant differences in serum ECP levels of the various patient groups. In all patient groups, except in the vasomotor rhinitis group, nasal fluid ECP levels differed significantly from normal controls. We found a nasal fluid ECP (mean +/- SEM) of 32.6 +/- 8.1 ng/ml for normals, 106 +/- 39.7 for non-rhinitic atopics, 87.6 +/- 20.8 ng/ml for patients with chronic non-allergic sinusitis, 101.3 +/- 40.4 ng/ml for patients with a history of pollinosis, 150.5 +/- 35.1 ng/ml for patients with acute pollinosis, 84.7 +/- 24.7 ng/ml for individuals with perennial allergic rhinitis and 112.9 +/- 25.6 ng/ml for patients with both perennial and seasonal allergy. Patients with nasal polyps had mean nasal ECP levels of 146.9 +/- 57.7 ng/ml in absence of allergy and 147.9 +/- 54.9 ng/ml in the presence of allergy. Nasal ECP was 67.0 +/- 22.4 for patients with hyperreactive rhinitis. We found a significant correlation of 0.95 between nasal eosinophils and nasal ECP. Nasal ECP and a subjective symptom score only correlate significantly for chronic sinusitis. We conclude that monitoring native nasal fluid ECP levels may be useful in the diagnosis and management of nasal inflammation. Elevated ECP in nasal secretion may originate from upregulated eosinophil degranulation and thus is a marker for local inflammation although not specific for any particular nasal disease.

Adult↗
PubMed1993

Interaction of human mast cell tryptase and chymase with low-molecular-mass serine proteinase inhibitors from the human respiratory tract.

Mast cell degranulation results in the release of serine class proteinases with trypsin- and chymotrypsin-like specificity. While looking for natural protein inhibitors of these enzymes, we studied their reactions with the double-headed Kunitz-type inhibitor, bikunin, and the human bronchial secretion inhibitor (BSI), which are the only known low-molecular-mass proteinase inhibitors of the human respiratory tract. Both trypsin and chymotrypsin can be inhibited by these inhibitors. However, human BSI is unable to inhibit human tryptase and is the physiological counterpart of chymase in the upper respiratory tract. Human bikunin is unable to inhibit human chymase and human tryptase. Furthermore, human tryptase is also not inhibited by a fragment that consists only of the trypsin-specific C-terminal inhibitor domain of human bikunin. This finding contradicts reports that claim the occurrence of a tryptase-specific proteinase inhibitor in rat mast cells.

Bronchoalveolar Lavage Fluid↗
PubMed1993

[Acoustic rhinometry: measuring the early and late phase of allergic immediate reaction in allergic rhinitis].

Acoustic rhinometry is a method to analyse nasal airway geometry. Almost every antigen-induced allergic reaction in the nasal cavity leads to morphologic changes known as nasal obstruction. Therefore a study in 8 patients suffering from allergic rhinitis was conducted. Patients were challenged with 1,000 Biological Units (BU) of grass pollen or D. pteronyssinus extract in one nostril. Acoustic rhinometry (AR) was performed before and 10, 20, 30, 45 and 60 minutes and then 2 to 8 hours after allergen exposure. 4 of the patients developed a late phase reaction. Changes were seen in the minimal cross-sectional area (MCA) and even better in a newly induced volume parameter called volume A (V-A). Volume A is calculated by integration of the distance/area graph surrounding the anterior part of the lower turbinate. Thus we can get information on more than one point of a graph in the important region of the anterior nose. Early phase reaction leads to a decrease in both MCA and V-A from 30% to 10% of the baseline value whereas late phase reaction gives only a third of this effect. The contralateral V-A and MCA are only slightly affected in the early phase, but there is an almost symmetric reaction of both sides in the late phase reaction. All changes were more pronounced in V-A compared to MCA. Therefore we propose to add V-A to MCA in describing the results of AR. Acoustic rhinometry is a suitable method for measuring local changes following nasal allergen challenge.

Adult↗