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Biomedical subjects

V J Lund

Publications and source records attributed to V J Lund.

At least 91 records · Page 5Linked to original sources
PubMed1993

The effect of intranasal azelastine and beclomethasone on the symptoms and signs of nasal allergy in patients with perennial allergic rhinitis.

A double-blind, randomized, parallel-group, placebo-controlled study involving 130 patients was conducted at 9 centres in the U.K. to assess the effect of 6 weeks of treatment with azelastine nasal spray (azelastine) and beclomethasone dipropionate nasal spray (BDP) on the symptoms of perennial rhinitis. Efficacy was assessed by patients recording daily the severity of the symptoms of rhinitis on 10-cm visual analogue scales. Analysis of this diary data showed significant reductions in sneezing, blocked nose, running nose, and itching nose during azelastine treatment. Patients on BDP recorded a consistent reduction in rhinitis symptoms, but these reductions were significant only for sneezing on treatment day 7. When rhinitis symptoms were assessed by clinical investigators on a 4-point scale, the scores obtained following treatment with the 2 study medications showed little change from baseline or "active" treatment scores. There was no evidence of a consistent change in nasal airway resistance, measured using anterior rhinomanometry, following treatment with either BDP or azelastine. Azelastine nasal spray and BDP nasal spray were well tolerated by the patients and the relative incidence of adverse events was similar in the azelastine and placebo/azelastine treatment groups, except that taste perversion occurred more frequently during azelastine treatment than during placebo/azelastine treatment. There was no evidence of an increased incidence of somnolence or fatigue in patients who received azelastine nasal spray. Overall, the results of this study indicate that azelastine administered twice daily as an intranasal spray is a safe and efficacious treatment for the symptoms of rhinitis in patients suffering from mild to moderate perennial rhinitis.

Administration, Intranasal↗
PubMed1993

The role of acoustic rhinometry in studying the nasal cycle.

The nasal cycle has been demonstrated in man using several techniques, including magnetic resonance imaging, anterior rhinoscopy, rhinomanometry, all of which have limitations due to expense, discomfort, limited scope or poor reproducibility. Acoustic rhinometry is a new technique which analyses nasal geometry throughout the nasal cavity, not just at the flow-limiting segment. Six adult volunteers were examined at 15-to 30-min intervals using acoustic rhinometry. The classical alternating cycle was seen in three subjects, a non-classical cycle was seen in two, and no cycle seen in one subject. Changes occurred throughout the nasal cavity and corresponded with fluctuations in subjective scores of obstruction and, in one case, with nasal resistance measurements. Acoustic rhinometry is a rapid, reproducible and non-invasive technique. This pilot study demonstrates that it has potential for studying in detail the physiology of the nasal cycle.

Acoustics↗
PubMed1993

The results of inferior and middle meatal antrostomy under endoscopic control.

Inferior and middle meatal antrostomy have been used for over a century in the treatment of chronic rhinosinusitis. The historical, pathophysiological and clinical aspects of the two approaches are discussed to compare the advantages and disadvantages of each. Whilst surgery in the inferior meatus is relatively safe, it does not address the underlying pathophysiology of the condition in contrast to achieving maxillary ostial function which consequently offers better surgical results.

Endoscopy↗
PubMed1992

Quality of life of patients treated surgically for head and neck cancer.

The quality of survival of 48 patients treated surgically for head and neck cancer was assessed using a problem-orientated self-administered questionnaire. The questionnaire was based on the European Organization for Research into the Treatment of Cancer (EORTC) core questionnaire to which a specific head and neck module was added. The following domains were studied: pain, fatigue, physical symptoms (gastrointestinal and 'other'), functional activity, psychological symptoms, overall physical condition and overall quality of life. For the analysis, five groups of patients were considered: laryngectomy (n = 15), pharyngolaryngoesophagectomy (n = 5), craniofacial procedure (n = 11), 'other operations' (n = 9) and patients with disease recurrence (n = 8). Each group identified different problem areas. Laryngectomees and 'other operation' patients reported relatively few problems, whereas patients with disease recurrence described difficulties in all of the domains examined. Symptoms of fatigue were common. Information collected in this way may facilitate improved rehabilitation and thus better quality of survival.

Adult↗
PubMed1992

The midfacial degloving approach to sinonasal disease.

The midfacial degloving approach was first described by Casson et al. in 1974 but despite a number of papers in the American literature advocating its use, it has not gained popularity in Europe. The advantages and application of the technique are presented in 36 patients, ranging from 7-78 years of age. The approach is ideally suited for extensive benign lesions in the nasal cavity, ethmoid and sphenoid sinuses and enables access to the nasopharynx and infratemporal fossa whilst avoiding an external incision. These lesions have included angiofibroma (13 cases), inverted papilloma (five cases), a variety of cysts (three cases) and six miscellaneous cases of benign pathology. Malignant lesions which have not breached the anterior cranial fossa may also be removed, up to and including bilateral maxillectomy (nine cases) and this can be combined with orbital clearance. The approach may be repeated if necessary and is associated with few significant complications though vestibular stenosis, oro-antral fistula, nasolacrimal damage and upward rotation of the nasal tip may occur. Strategies to avoid these problems can be undertaken and long-term cosmetic results are excellent.

Adolescent↗
PubMed1992

Interaction of capsulate Haemophilus influenzae with human airway mucosa in vitro.

Two pairs of isogenic capsulate and noncapsulate and one pair of capsulate fimbriate and nonfimbriate strains of Haemophilus influenzae type b were studied in an organ culture of human respiratory mucosa. Over 24 h, the numbers of recovered bacteria increased from the original inoculum size of 10(5) to 10(8) CFU/ml. Transmission electron microscopy and scanning electron microscopy showed that noncapsulate organisms caused significant epithelial damage, whereas capsulate strains did not. Association of noncapsulate bacteria with damaged epithelial cells was observed by 14 h of incubation. In contrast, capsulate organisms were associated with a dense, thick, gel-like matrix which was observed above the epithelial surface. These capsulate organisms were not seen to associate with the epithelial surface (by transmission electron microscopy), though they were occasionally seen adhering to cells by scanning electron microscopy. Fimbriate capsulate H. influenzae showed increased adherence to buccal cells compared with nonfimbriate capsulate organisms. There was also association of fimbriate capsulate bacteria with damaged organ culture epithelium in one of four experiments. It is concluded that both capsule and fimbriae affect the interaction of H. influenzae with human airway mucosa in vitro by influencing adherence to and damage of the epithelium.

Bacterial Adhesion↗
PubMed1992

Office evaluation of nasal obstruction.

It is evident from the foregoing that the evaluation of such a common complaint as nasal obstruction can be extremely complex. If a thorough history and examination are undertaken, however, only a small number of these investigations (if any) may be required. In each individual, it is always worth considering possible predisposing factors. Good clinical practice dictates that we attempt to quantify problems and measure our success in treating them. Until recently, rhinology has not been overendowed with such investigative tools, so it behooves us to use those now available when unraveling the cause of deceptively simple nasal obstruction.

Acoustics↗
PubMed1992

An evaluation of the penetration of cefuroxime axetil into human paranasal sinus tissue.

Nineteen patients presenting for sinus surgery were studied to evaluate the percentage penetration from serum to paranasal sinus tissue of a single orally administered dose of cefuroxime axetil. The methods and results are presented. Cefuroxime penetrates well into human sinus mucosa following oral administration and the concentrations obtained exceed minimum inhibitory concentrations of cefuroxime for the most common pathogens in sinusitis.

Administration, Oral↗
PubMed1992

The human nasal mucosa after deprivation of airflow: a study of laryngectomy patients.

The effects on the human nasal mucosa of airflow cessation can be studied conveniently in the laryngectomy patient. We studied 39 laryngectomy patients and 50 healthy adults. Mucociliary clearance was measured using the saccharin test, ciliary beat frequency (CBF) analyzed in inferior meatal brushings and transmission electron microscopical observations made in similar nasal brushings. Mucociliary clearance was no faster in laryngectomees (mean 15.4 +/- 7.8 min); however, CBF was higher in the laryngectomees (means 15.0 and 14.1 Hz; p less than 0.05), especially in the first weeks after surgery (mean 16.8 Hz; p less than 0.01). Mucus-producing cells gradually decreased in proportion over the first postoperative year. The changes in the nasal mucosa after airflow cessation are dynamic and require months to equilibrate. This has implications for the timing of postoperative assessment of patients undergoing airway surgery.

Cilia↗
PubMed1991

CT of the paranasal sinuses and functional endoscopic surgery: a critical analysis of 100 symptomatic patients.

CT scans of 100 patients from the Rhinology Clinic at the Royal National Throat, Nose and Ear Hospital were reviewed in order to test the precepts forming the basis of functional endoscopic sinus surgery, especially as they relate to the radiological investigation. These were: (a) the site of origin of sinus infection, (b) The relevance of certain anatomical variants in the middle meatus to sinus infection and (c) The use of CT as the radiological method of diagnosis in all cases. Obstruction in the middle meatus and ostiomeatal complex was associated with an increased incidence of opacity in the sinuses but the primary site of disease was not established: the concept that sinus disease takes origin in the middle meatus was not proven. Anatomical variants in the middle meatus were not associated with an increase in sinus opacity and there was no evidence that these anomalies have any effect on sinus disease by causing middle meatal stenosis. The radiological assessment of patients with inflammatory naso-sinus disease should start with plain X-ray. CT is unnecessary as a routine examination. It should be reserved for the pre-operative assessment of patients for endoscopic surgery, its main function being to show important anatomical landmarks.

Endoscopy↗
PubMed1991

Functional endoscopic sinus surgery in the management of chronic rhinosinusitis. An objective assessment.

Considerable clinical success has been claimed for functional endoscopic sinus surgery but objective assessment of prospective series is lacking in the literature. Twenty-four patients with chronic rhino-sinusitis underwent assessment of symptoms by visual analogue scoring, nasomucociliary function by ciliary beat frequency, olfaction by qualitative olfactometry and nasal airway resistance by anterior rhinomanometry pre- and post-operatively. This demonstrated a significant improvement in all symptoms examined and in ciliary beat frequency. Quantitative olfaction and anterior rhinomanometry were not improved despite diminished symptoms. These results offer quantitative evidence of clinical improvement following functional endoscopic sinus surgery which supports the pathophysiological concepts on which the technique is based.

Adult↗
PubMed1991

Fronto-ethmoidal mucocoeles: a histopathological analysis.

From a series of 118 fronto-ethmoidal mucocoeles, 40 specimens have been submitted to detailed histological analysis. The frequency of each epithelial and sub-epithelial component is considered and reveals features which support a dynamic theory of bone resorption and formation rather than that of pressure erosion in the pathogenesis of mucocoeles.

Epithelium↗
PubMed1991

Serum cotinine as an objective marker for smoking habit in head and neck malignancy.

Cigarette-smoking is a well-established aetiological factor in squamous cell carcinoma of the larynx. In Great Britain the majority of patients with laryngeal cancer are treated by radiotherapy with salvage surgery if necessary. A troublesome side effect of radiotherapy is mucositis which may exacerbate hoarseness, dysphagia, airway obstruction or pain. Although it is a common belief that continued smoking and alcohol consumption during radiotherapy may increase the frequency and severity of these side effects this has not been demonstrated objectively. This study confirms and illustrates the relationship between such radiotherapy reactions to continued smoke exposure by using an objective biochemical marker of smoking status.

Alcohol Drinking↗
PubMed1991

Malignant melanomas of the nasal cavity after occupational exposure to formaldehyde.

Formaldehyde is a well known nasal carcinogen in rodents, but so far there has been no convincing evidence that workers occupationally exposed to formaldehyde have an increased risk of nasal cancer. In this study three cases of malignant melanoma of the nasal mucosa in persons occupationally exposed to formaldehyde for a long time are presented. The occurrence of such a rare tumour in patients with significant exposure to a known carcinogen warrants further investigation.

Aged↗
PubMed1991

Immunologic aspects of chronic sinusitis.

The role of immunological defence mechanisms in the development of acute recurrent or chronic sinusitis is obviously of considerable importance but the incidence of such immune problems is unknown. To elucidate this situation, a prospective study of 47 patients with chronic rhino-sinusitis were examined for abnormalities of serum immunoglobulins, both major class and subclasses. Deficiencies of minor IgG subclasses may be obscured by only measuring the major IgG class and should be specifically sought in clinically suspicious cases. The clinical and therapeutic implications are considered.

Adolescent↗