Long-term treatment of perennial allergic rhinitis with ipratropium bromide nasal spray 0.06%.

The purpose of this study was to assess the safety and efficacy of ipratropium bromide nasal spray 0.06% (aqueous solution), 84 micrograms per nostril three times a day, in reducing nasal hypersecretion in the long-term treatment of patients with perennial allergic rhinitis (PAR). This was an open-label 1-year trial. In the first 6 months all patients were treated with two puffs ipratropium bromide nasal spray 0.06%, 84 micrograms per nostril three times per day, unless they were unable to tolerate the dose. In the last 6 months the dose could be reduced to the lowest amount required to control rhinorrhea. Ninety-six patients entered the trial, and 47 completed it. Sixty-three patients completed more than 6 months of treatment. Patient and physician global evaluation suggested that ipratropium bromide nasal spray 0.06% is effective in controlling rhinorrhea associated with PAR and can contribute to control of congestion, postnasal drip, and sneezing. There was also a trend toward reduction of mucosal edema and improvement in quality of life. The most common drug-related adverse events were nasal dryness, epistaxis/nose bleed, and increased rhinitis. Most adverse events were mild and resulted in drug discontinuation in less than 10% of patients. Ipratropium bromide nasal spray was well tolerated and not associated with serious drug-related adverse events or clinically significant anticholinergic side effects. Use of ipratropium bromide nasal spray alone or with other standard medications should be considered in treating patients with PAR.

Ipratropium bromide (Atrovent nasal spray) reduces the nasal response to methacholine.

We investigated the efficacy of local ipratropium bromide on methacholine-induced nasal secretions in a double-blind, placebo-controlled experiment. Twenty subjects with perennial rhinitis received a total intranasal dose of 21, 42, 84, and 168 micrograms of ipratropium bromide or placebo in each nostril. One hour later, filter paper disks were used to deliver increasing doses of methacholine and to collect secretions from the left septum. Concomitantly, symptoms of rhinorrhea and nasal congestion were scored. Compared with doses of placebo, all doses of ipratropium bromide significantly reduced the methacholine-induced increase in nasal secretion weights and symptoms of rhinorrhea (p less than 0.01). The highest dose was significantly more effective than the lower doses in reducing secretion weights (p = 0.01). We speculate that ipratropium bromide may prove beneficial for the treatment of rhinorrhea in perennial rhinitis. Furthermore, increasing the delivered dose to 168 micrograms may increase efficacy without augmenting side effects.

Autoradiographic studies of oral lichen planus.

3H cytidine autoradiographic labeling patterns have been categorized into those characteristic for neoplastic, preneoplastic, and normal cell types. Specific differences in the patterns of transcription (RNA synthesis) revealed that the histology of a particular lesion generally correlated with (1) the percentage of cells labeled with the isotope, (2) the number of grains per cell, and (3) their intracellular distribution. When these three criteria of labeling were applied to lesions of the oral mucosa, very interesting data were collected on cases of lichen planus. The benign histologic appearance of the oral lichen planus epithelium exhibited a preneoplastic-appearing autoradiogram, an observation which is of particular interest in view of the fact that a small number of patients with this disease develop intraoral squamous cell carcinoma.

Intraoral pemphigus vulgaris.

Twenty-eight cases of intraoral pemphigus vulgaris are presented. All had histologic confirmation, including twenty-six from intraoral biopsies. Detailed descriptions involving many clinical features are reported and discussed. Pertinent histologic findings are also described.

Hyaline bodies: some observations on their ultrastructure.

The ultrastruct of hyaline bodies was examined. Their constant association with elements of squamous epithelium pointed to an epithelial component in their structure. Elements of red blood cells, blood vessels, and endothelium were not evi-ent in these hyaline bodies, thereby negating avascular origin. Due to ultrastrucural limitations, the exact composition of the structures could not be determined.

Verruciform xanthoma. Further light and electron microscopic studies, with the addition of a third case.

The authors report their third case of verruciform xanthoma confirmed by electron microscopy and frozen-section lipid stains. Studies of the blood in this case revealed normal levels of triglycerides, cholesterol, and glucose, just as in the previous two cases reported. An ultrastructural search for etiologic factors with the use of material from all three cases resulted in the hypothesis that this lesion is initiated within the epithelium. The authors propose that epithelial entrapment with degeneration and accumulation of lipid may be the logical sequence of early events leading to the formation of foam cells.