Role of tumor necrosis factor and granulocyte-macrophage colony-stimulating factor in the late allergic response in human nasal mucosa.

Cytokines play an integral role in the allergic response of the nasal mucosa. The ideal model for analysis of this interaction has yet to be perfected. We present a model for such evaluation and present results of experiments on the release of several cytokines. Freshly harvested human nasal turbinate mucosa was placed on a Gelfoam (Upjohn Co., Kalamazoo, Mich.) raft in a liquid medium to simulate the in situ environment. The allergic response was initiated by exposing the nasal mucosa to various combinations and amounts of human immunoglobulin E and antihuman immunoglobulin E antibody. The supernatants were collected and analyzed by enzyme-linked immunosorbent assay techniques for various cytokines. Histopathologic evaluation of the mucosa was performed throughout the exposure period, confirming normal cellular and tissue architecture and viability. This model was used to monitor the release of interleukin-3, granulocyte-macrophage colony-stimulating factor, tumor necrosis factor-alpha, and soluble tumor necrosis factor receptors after exposure to immunoglobulin E and immunoglobulin E antibody. Interleukin-3 did not show significant increases during the experiment testing period of 48 hours. Tumor necrosis factor-alpha and soluble tumor necrosis factor receptors demonstrated time-dependent increases in concentration after immunoglobulin E stimulation. Granulocyte-macrophage colony-stimulating factor showed the greatest time-dependent increases. Their impact on the understanding of the allergic response will be discussed.

Laryngeal hamartoma: a rare congenital abnormality.

Hamartoma is a rare congenital abnormality of the larynx that must be considered in the differential diagnosis of benign lesions of the larynx. Presenting symptoms may include changes in voice, eating, and activity levels, and respiratory complaints. We treated a 2 1/2-year-old boy with an 8-month history of upper airway compromise. Radiographic studies showed a rounded, right-sided, supraglottic soft tissue mass. Direct laryngoscopy revealed a well-mucosalized, encapsulated, firm 3 x 2.5-cm mass that originated from the right supraglottic structures. The mass was excised endoscopically. Histologic examination revealed a hamartoma. At 18 months, the patient has had an uneventful postoperative course.

Uvulopalatopharyngoplasty for obstructive sleep apnea in adults: clinical correlation with polysomnographic results.

The success of Uvulopalatopharyngoplasty (UPPP) for Obstructive Sleep Apnea (OSA) can be assessed by a variety of parameters including clinical evaluation and polysomnography (PSG). Patients are often reluctant to undergo post-operative testing and insurance companies are often unwilling to reimburse for expensive overnight sleep studies. Due to the reality of these medical and economical problems, can a clinician be confident of the success of UPPP based solely on clinical evaluation? Sixty patients underwent UPPP for the treatment of OSA from July 1987 through June 1992. Patients treated with tracheostomy or other methods were not included in this study. Fifty-three patients (88%) reported an improvement in their symptoms of snoring, daytime somnolence, morning headache and apnea. Twenty-one patients (35%) had post-operative PSG. Eighteen of 21 patients (85%) reported improvement in their symptoms. Eleven of 21 patients (57%) showed objective improvement in their sleep apnea. The objective findings of PSG do not correlate, in a significant number of patients, with subjective clinical improvement of patients treated with UPPP.