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Biomedical subjects

H M Druce

Publications and source records attributed to H M Druce.

At least 19 recordsLinked to original sources
PubMed1998

Brompheniramine, loratadine, and placebo in allergic rhinitis: a placebo-controlled comparative clinical trial.

A double-blind, randomized, placebo-controlled, parallel-group, multicenter study was conducted to compare the effectiveness of an extended-release formulation of a classical antihistamine, brompheniramine, and a second-generation compound, loratadine, in the treatment of allergic rhinitis. Subjects with symptoms of allergic rhinitis received brompheniramine 12 mg twice daily (n = 112), loratadine 10 mg once daily (n = 112), or placebo twice daily (n = 114) for 7 days. Study medications were blinded using a double-dummy technique. Subjects completed an overall evaluation of symptom relief on a daily basis and returned on treatment days 3 and 7, at which times the investigator assessed symptom severity. The investigator and subject each completed a global efficacy evaluation, and subjects were interviewed regarding adverse experiences. The primary efficacy variable was the physicians' global efficacy evaluation on day 3. Symptoms also were analyzed as summed severity scores for all symptoms and for the nasal symptom cluster of rhinorrhea, sneezing, and nasal blockage. At all post-baseline evaluations (days 3, 7, and averaged over the two days), brompheniramine was significantly better than loratadine and placebo for both sets of summed symptom scores and all three global assessments. Loratadine was significantly better than placebo for physician ratings of total symptom severity averaged over the two days and for the physician and subject ratings of the nasal cluster on day 3. Central nervous system-related symptoms were the most frequently reported adverse experiences; somnolence was reported most frequently by patients taking brompheniramine, and its occurrence was less frequent as treatment continued. A nonprescription, extended-release formulation of brompheniramine 12 mg twice daily provided significantly better relief of symptomatic allergic rhinitis than loratadine 10 mg once daily.

Adolescent↗
PubMed1997

Efficacy of brompheniramine maleate for the treatment of rhinovirus colds.

We tested the efficacy of brompheniramine maleate in a large randomized, controlled trial of volunteers with experimental rhinovirus colds. Brompheniramine (12 mg) or placebo was administered at 8:00 A.M. and 8:00 P.M. for < or = 4 days after the onset of symptoms (24, 36, or 48 hours after virus challenge). During the first 3 days of treatment (the first 4 days after virus challenge), nasal secretion weights were lower for infected evaluable subjects receiving brompheniramine (n = 113) than for controls (day 1: 4.3 g vs. 6.8 g; day 2: 4.8 g vs. 7.7 g; and day 3: 3.3 g vs. 5.3 g) (P < or = .03), as were rhinorrhea scores (day 1: 0.6 vs. 0.8; day 2: 0.5 vs. 0.8; and day 3: 0.3 vs. 0.5) (P < .03), sneeze counts (day 1: 1.8 vs. 3.6; day 2: 2.1 vs. 5.1; and day 3: 1.3 vs. 3.3) (P < or = .001), and sneeze severity scores (day 1: 0.3 vs. 0.6; day 2: 0.25 vs. 0.7; and day 3: 0.2 vs. 0.4) (P < .001) (n = 112). Cough counts were lower after day 1 of treatment for the brompheniramine group than for controls (4.7 vs. 7.9) (P = .05) (day 2 after virus challenge), and other symptoms were modestly reduced or were unaffected in the brompheniramine group. Total symptom scores were also lower for the brompheniramine group than for controls on treatment days 1 (4.8 vs. 6.0) (P = .03) and 2 (4.1 vs. 5.6) (days 2 and 3 after virus challenge) (P = .003). Treatment with brompheniramine was associated with the adverse effects of somnolence (n = 3) and confusion (n = 1). Brompheniramine was efficacious treatment for the sneezing, rhinorrhea, and cough associated with rhinovirus colds.

Adolescent↗
PubMed1996

Evidence for acute renal cortical vasoconstriction after uninephrectomy.

The rate of progression of chronic renal failure (CRF) is similar for many diseases, suggesting a common, perhaps intrinsic, renal signal for its progression. The remnant nephron hypothesis of Bricker suggests that CRF may be the result of persistent compensatory renal growth (CRG). Normally, CRG after unilateral nephrectomy (uniNx) ceases within 1 week. Knowledge of the signals that initiate CRG may therefore shed light on the signals responsible for ongoing CRF. The signals responsible for the initiation of compensatory renal growth after uniNx are unknown. Hemodynamic changes in the remaining renal artery have been observed, but there are as yet no data for the main renal compartment which undergoes hypertrophy, the superficial renal cortex. The noninvasive technique of laser-Doppler flowmetry allows the continuous and independent monitoring of blood velocity and blood volume. The product of the two signals is proportional to tissue blood flow per unit volume of the tissue observed. Under controlled conditions in adult male Sprague-Dawley rats, renal cortical blood velocity increased by 22% within 5 min after uniNx and remained elevated at this level for 60 min. Renal cortical blood volume decreased throughout the experiment. Their product, renal cortical blood flow, increased briefly by 14% 5 min after uniNx but decreased over the time of observation in parallel with renal cortical blood volume. The simultaneous increase in blood velocity and decrease in blood volume in the superficial renal cortex acutely after uniNx suggest that vasoconstriction is an early event in compensatory renal growth.

Acute Disease↗
PubMed1995

Comparison of a screening coronal CT versus a contiguous coronal CT for the evaluation of patients with presumptive sinusitis.

BACKGROUND: Computed tomography has greatly improved the accuracy of sinus imaging. While contiguous coronal computed tomography scanning of the sinuses provides detailed imaging as compared with plain sinus radiography, this modality is significantly more expensive and involves exposure of the patient to a higher dose of radiation. It has become increasingly common to obtain screening, or non-contiguous, CT scans of the sinuses when screening for the presence of sinusitis. OBJECTIVE: To calculate the sensitivity and specificity of the screening coronal CT scan of the sinuses in screening for inflammatory disease using the contiguous coronal CT examination of the sinuses as the standard. METHODS: From contiguous coronal computed tomograms of the paranasal sinuses, screening coronal computed tomographic examinations were created for 44 patients. Patients were being screened for the presence of sinusitis in the Comprehensive Sinus Clinic at St. Louis University. The two examinations were reviewed independently and in random order by two neuroradiologists. Using the original examinations as the standard, the sensitivity and specificity of the screening studies were calculated for various situations. RESULTS: Overall, a sensitivity of 93.3% and a specificity of 89.3% for the detection of inflammatory disease of the sinuses by the screening examination was observed. CONCLUSIONS: The screening coronal computed tomogram of the paranasal sinuses may be useful in the evaluation of the patient with possible sinusitis.

Costs and Cost Analysis↗
PubMed1993

Intranasal flunisolide spray as an adjunct to oral antibiotic therapy for sinusitis.

BACKGROUND: The diagnosis of sinusitis is difficult and there are few controlled studies of customary therapies. In particular, the possible role of topical intranasal steroid as an adjunct to antibiotic treatment has not been evaluated. METHODS: The study was a multicenter, double-blind, randomized, parallel trial in which patients aged 14 years or older were recruited from allergy practices. All patients had maxillary sinusitis documented by radiographs. Treatment consisted of amoxicillin/clavulanate potassium 500 mg combined with nasal spray of either 100 micrograms flunisolide or placebo to each nostril three times a day for 3 weeks (phase I) followed by administration of flunisolide or placebo nasal spray alone three times a day for 4 weeks (phase II). RESULTS: Clinical symptoms and signs decreased significantly in both treatment groups during phase I (p < 0.01). There was a trend to greater improvement in the patients treated with flunisolide, but only the decrease in turbinate swelling/obstruction was statistically significant at the end of phase I when compared with placebo (p = 0.041). Patients' global assessment of overall effectiveness of treatment was higher for flunisolide than placebo after phase I (p = 0.007) and after phase II (p = 0.08). Maxillary sinus radiographs showed improvement in both treatment groups during phase I (p < 0.004) with somewhat greater regression of abnormal findings in patients treated with flunisolide after phase II (p = 0.066). However, 80% of radiographs were still abnormal at the end of phase I. All types of inflammatory cells were significantly decreased in nasal cytograms in patients treated with flunisolide in comparison with those treated with placebo. Flare-up of sinusitis during phase II occurred in 26% of with those treated with placebo. Flare-up of sinusitis during phase II occurred in 26% of patients treated with flunisolide and 35% of those treated with placebo and tended to be more severe in the latter, although these differences were not statistically significant. Adverse events, mainly gastrointestinal symptoms and headache, were similar in both groups and more frequent in phase I than in phase II, (42 vs 15 patients); these side effects were probably due to the antibiotic. CONCLUSION: The addition of flunisolide topical nasal spray as an adjunct to antibiotic therapy was most effective in global evaluations, tended to improve symptoms, to decrease inflammatory cells in nasal cytograms, to normalize ultrasound scans, and to aid regression of radiographic abnormalities compared with placebo spray.

Administration, Inhalation↗
PubMed1993

Nasal blood flow.

Although the assessment of allergic reactions was subjective for many years, it is now possible to evaluate nasal blockage objectively by measuring nasal airway resistance. To explore the pathophysiology of nasal blockage, however, it is necessary to analyze the separate components of obstruction, including secretions, cellular infiltrates, and microcirculatory parameters. The preferred techniques for measuring nasal mucosal blood flow are laser-Doppler velocimetry and radioactive xenon washout. Laser-Doppler velocimetry allows the measurement not only of blood flow but also of blood volume, red blood cell speed, and pulsatility of flow. It also permits continuous measurement of microcirculatory parameters over time. This technique has been used to assess the nasal microvascular response to neurohormones, antigenic challenge, and histamine challenge with and without antihistamine pretreatment.

Humans↗
PubMed1992

The use of intranasal anticholinergic agents in the treatment of nonallergic perennial rhinitis.

Nonallergic perennial rhinitis is a heterogenous disorder. Although the underlying cause is unknown, there is evidence of an autonomic imbalance with parasympathetic hyperreactivity in affected persons. We review this evidence and the role of ipratropium bromide, an anticholinergic drug with topical activity, in the management of nonallergic perennial rhinitis. The pharmacologic features, safety, and efficacy of ipratropium bromide are reviewed.

Administration, Intranasal↗
PubMed1992

Diagnosis of sinusitis in adults: history, physical examination, nasal cytology, echo, and rhinoscope.

The symptoms of sinusitis are common and overlap other diseases ranging from common colds to perennial rhinitis. When symptoms are prolonged and interfere with daily living, an appropriate set of investigations are indicated. The workup is designed to detect both the presence and extent of any disease in the paranasal sinus cavities. In chronic sinusitis, a constellation of nonspecific symptoms such as facial pressure, headache, nasal obstruction, and drainage may occur. Physical examination is important to exclude anatomic causes of symptoms. A negative physical examination does not rule out the diagnosis. Adjunctive tests in selected cases include nasal cytologic studies, ultrasound studies, and the use of flexible or rigid nasal endoscopes, in addition to imaging tests such as radiology and computed tomography.

Acute Disease↗
PubMed1992

Allergic rhinitis.

Allergic rhinitis is a common disease with characteristic symptoms affecting the eyes, ears, and face as well as the nose. A detailed history is the foundation of a correct diagnosis. Laboratory tests may be needed to supplement this in atypical presentations. A combination of pharmacotherapy, immunotherapy, and environmental control may be required to control and prevent symptoms.

Adrenal Cortex Hormones↗
PubMed1992

Double-blind study of intranasal ipratropium bromide in nonallergic perennial rhinitis.

We undertook this trial to determine whether ipratropium bromide nasal spray 0.03% (IB) reduced the nasal hypersecretion associated with nonallergic perennial rhinitis (NAPR) without causing excessive dryness or irritation of the nasal mucosa. We compared two drug doses of IB (21 micrograms and 42 micrograms per nostril) to a placebo, administered as two sprays to each nostril twice daily. The study design consisted of a 1-week screening period without treatment, a 1-week single-blind placebo period, a 4-week double-blind treatment comparison period, and a 1-week follow-up period without medication to evaluate nasal rebound. One hundred fifty-two patients were entered and 140 completed the trial. Both doses of IB reduced the severity and duration of rhinorrhea compared with placebo (P = .05 and .03, respectively). Treatment differences were noticeable during the first week of therapy, continued to widen during the second week, and then remained stable throughout the next 2 weeks. There was no evidence of nasal rebound observed during the week after treatment. The drug was well tolerated with side effects limited to infrequent nasal adverse events of nasal dryness, blood-tinged mucus, and epistaxis occurring in 2% to 6% of patients. We conclude that IB is a safe and effective therapy for control of rhinorrhea associated with NAPR.

Administration, Intranasal↗
PubMed1991

Emerging techniques in the diagnosis of sinusitis.

In recent years, the high prevalence of chronic sinusitis has been noted in isolation and in association with bronchial asthma, aspirin sensitivity, and perennial rhinitis. Many sinus-associated symptoms arise from nasal rather than sinus pathology; thus, it is important to detect the presence, extent, and nature of any disease within the sinus cavities. Conventional plain radiographs have limited sensitivity and have been supplanted by more widespread use of computerized tomography. The role of other modalities such as ultrasound and magnetic resonance imaging has not yet been completely determined. Other tests such as cytology and endoscopy can detect the presence of infection without the need for invasive antral puncture. Practitioners should consider the impact of a negative imaging test on their therapeutic plan and order tests on that basis.

Chronic Disease↗
PubMed1990

The effects of an H1-receptor antagonist, terfenadine, on histamine-induced microcirculatory changes and vasopermeability in nasal mucosa.

We used a nonsedating, selective histamine H1-receptor antagonist, terfenadine, to investigate the effects of antihistamines on the microcirculatory changes and vascular permeability induced by topical histamine provocation challenge. We assessed the former by the laser-Doppler measurement of blood flow, volume, and red blood cell speed, and the latter by analysis of albumin/total protein ratios in nasal lavages. Terfenadine reduced the mean symptom score and permeability changes (p less than 0.05) induced by histamine in a dose-related manner. Terfenadine had no effect on blood flow or other microcirculatory parameters. We propose that vascular effects of histamine in the nasal mucosa are not mediated uniquely through the H1 receptor.

Adult↗
PubMed1990

Adjuncts to medical management of sinusitis.

The basic principles of sinusitis therapy are to treat any infection present, facilitate drainage, and promote drainage both during and after treatment to prevent recurrence. Adjunctive measures promoting ciliary function and drainage through the sinus ostia include the following nonpharmacologic measures: steam, astringents, inhalations, saline, and hot, dry air. Pharmacologic measures include decongestants, topical corticosteroids for chronic sinusitis, mucoevacuants, and analgesics. Antihistamines are indicated for acute sinusitis only when a patient with concomitant allergies is symptomatic during the allergy season or after infection has been ruled out as the primary cause of sinusitis. Sinusitis may be associated with asthma, and some patients do not respond optimally to asthma therapy until their sinusitis is diagnosed and treated.

Administration, Topical↗