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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
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↗
PubMed1990

Multicenter placebo-controlled study of nedocromil sodium 1% nasal solution in ragweed seasonal allergic rhinitis.

An 8-week double-blind study was carried out in 177 ragweed patients with seasonal allergic rhinitis to compare nedocromil sodium 1% nasal solution (Tilarin, QID, Fisons plc) and placebo. Symptoms of rhinitis were significantly reduced by nedocromil sodium during the peak 3-week pollen season (P = .001 for diary summary score) and the active treatment was rated effective by 74% of patients.

Administration, Inhalation↗
PubMed1989

Measurement of multiple microcirculatory parameters in human nasal mucosa using laser-Doppler velocimetry.

LDV has been modified to measure four microcirculatory responses in human nasal mucosa. Resting nasal blood flow was measured in 115 observations in 23 nonatopic subjects and 111 observations in 21 atopic subjects with allergic nasal disease. Other parameters measured concurrently were the number density of moving red blood cells (RBC), mean RBC speed, and flow pulsatility. Challenges with aerosolized buffered saline or water had no significant effect on any parameter. By contrast, nasal application of alpha-adrenergic agonists, oxymetazoline and phenylephrine, produced significant dose-dependent reductions in flow without any significant change in RBC number density. These results suggest a selective alpha-agonist effect on resistance vessels but not on capacitance vessels. Topical cholinergic stimulation with methacholine selectively reduced the RBC number density without affecting other parameters. These modifications of LDV may prove useful in analyzing nasal responses to provocation and determining the sites of action of vasoactive agents on the microcirculation.

Adult↗
PubMed1989

The pathophysiology of rhinitis. II. Assessment of the sources of protein in histamine-induced nasal secretions.

Nasal provocation tests were performed on nine atopic and 15 nonatopic subjects in order to assess the sources of protein in histamine-induced secretions and to examine the bilateral secretory response to unilaterally applied topical histamine (the nasonasal reflex). Nasal lavages were assayed for the following proteins: albumin, total protein, secretory IgA (sIgA), nonsecretory IgA (serum IgA), and total IgA. Histamine stimulation produced a profound ipsilateral protein secretion enriched in the serum proteins albumin and nonsecretory IgA. Histamine also produced a smaller contralateral protein secretion (about 15% as large as the ipsilateral response) which contained disproportionately elevated concentrations of the glandular protein sIgA. Topical pretreatment with chlorpheniramine (an H-1 antihistamine) completely abrogated the ipsilateral nasal secretory response to histamine. Nasal pretreatment with atropine (a muscarinic antagonist) had no significant effect on ipsilateral nasal secretion and did not alter the capacity of histamine to stimulate contralateral secretions (the nasonasal reflex). Histamine therefore stimulates secretion by both a direct action that increases plasma protein extravasation and by an indirect reflex mechanism that stimulates glandular secretion.

Adult↗
PubMed1989

Hypersensitivity reactions to human seminal plasma.

A rare but serious allergic reaction has been described. Human seminal plasma hypersensitivity predominantly occurs in young women possibly as a result of altered immune status involving the reproductive organs. The patients generally have a history of atopy and, in typical cases, immunologic tests corroborate a reaginic humoral mechanism. Fortunately, there is considerable evidence that selected patients can be successfully treated with selective immunotherapy. Alternatively, the application of topical cromolyn holds promise for successful prevention of symptoms.

Adult↗
PubMed1988

Pathophysiology of rhinitis. 1. Assessment of the sources of protein in methacholine-induced nasal secretions.

Nasal provocation tests with normal saline and methacholine (MC) were performed in 25 atopic and 27 nonatopic subjects in an effort to assess the sources of protein in induced airway secretions. Nasal lavages obtained at baseline and after provocation were analyzed for albumin, total protein, secretory IgA (sIgA), and total IgA. Compared with baseline levels or saline provocation, MC provocation increased the secretion of albumin (p less than 0.025), total protein (p less than 0.001), sIgA (p less than 0.025), and total IgA (p less than 0.025), but did not significantly affect the relative proportions of albumin-to-total protein (albumin percent) or sIgA-to-total IgA (sIgA/total IgA ratio). Nasal pretreatment with atropine significantly inhibited MC-induced secretion of all 4 proteins, again without affecting the albumin percent or the sIgA/total IgA ratio. Because MC is known to stimulate atropine-inhibitable secretion of glandular products, these data suggest that sIgA and albumin may accompany glandular secretions. Immunohistochemical analyses of nasal turbinates confirmed that secretory component was found only on serous cells within submucous glands. Thus, it appears that cholinergic stimulation may regulate sIgA secretion and thereby participate in local nasal (and possibly respiratory tract) immunity.

Adolescent↗
PubMed1986

Nasal physiology.

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Autonomic Nervous System↗