[Treatment of allergic rhinitis]. / Therapiemodalitäten der allergischen Rhinitis. Kommen Sie dem "Etagenwechsel" zuvor.

The allergic rhinitis is the most common allergic condition. The causes of allergic rhinitis are still much debated, but there is now a consensus on the need to initiate treatment as early as possible in order to avoid the spreading of the infection to the bronchi. In addition to allergy prevention, the aim of treatment is medical control of the allergic inflammatory reaction and thus improvement of the clinical symptoms. Depending on the severity of the disease and the predominant symptoms, this can be achieved with mast cell stabilizers, local and systemic H1 antagonists, local steroids and anticholinergic drugs. The WHO also recommends hyposensitization, which may be subcutaneous (SIT) or sublingual (SLIT).

[Allergic rhinitis to be diagnosed and treated correctly. Tips for a runny nose]. / Allergische Rhinitis richtig diagnostizieren und behandeln. Tipps für Triefnasen.

Two types of allergic rhinitis are differentiated: seasonal rhinitis caused in particular by pollen allergens, and the perennial form caused by such year-round allergens as house dust (mites), moulds and animal hair. The diagnosis is based on a comprehensive history (family/occupation/environment), clinical symptoms, a rhinoscopic examination, and testing for allergens, e.g. conjunctival tests, prick test or nasal provocative test. The treatment of choice is elimination of the allergens as completely as possible. An additional causal therapeutic option is specific immune therapy (SIT) which, however, is contraindicated in the presence of intercurrent infections, use of beta blockers and immunodeficiency. Available medications include mast cell stabilizers, antihistaminic agents and corticosteroids, which are applied in stepped fashion, depending upon severity. In addition, adjuvant surgical measures may improve obstructive symptoms.

[Rhinosinusitis. Current diagnostic and therapeutic aspects]. / Sinusitis unbedingt abklären und lege artis behandeln. So verhindern Sie die Chronifizierung.

Over the past years, the incidence of acute and chronic forms of rhinosinusitis has been increasing, and between 10 and 15% of the population of Central Europe are affected annually. Accordingly, the economic significance of rhinosinusitis is considerable. This makes the need for appropriate diagnostic and therapeutic strategies all the more urgent. In addition to case history and a physical examination, a helpful diagnostic strategy also includes rhinoendoscopy and--in particular in preparation for surgery--a CT scan. A plain radiograph does not suffice to confirm chronic sinusitis. The major therapeutic pillar in the treatment of acute rhinosinusitis is medication in conformity with accepted guidelines (proof of efficacy!). In the majority of cases chronic courses can be managed by minimally invasive surgery.

[Complications of rhinosinusitis]. / Vom Orbitaödem bis zum Hirnabszess. Das sind die Folgen einer vernachlässigten Sinusitis!

Rhinogenous complications may manifest in the region of the orbits, bone or soft parts of the wall of the frontal sinus, or endocranially. With regard to orbital complications, a differentiation is made between edema, periostitis, subperiosteal abscess and phlegmon--depending on severity and extent. A possible sequela of frontal sinusitis may be osteomyelitis. If the frontal bone is involved, there is a danger that the infection may spread to the endocranium via medullary spaces and blood vessels. The diagnostic basis for deciding appropriate treatment is CT or MRI. While orbital edema and periostitis usually respond to conservative treatment, subperiosteal abscess, orbital phlegmon and abscess of the brain require immediate operative treatment under antibiotic cover. The treatment of choice for osteomyelitis of the frontal bone is the liberal removal of affected bone, also under antibiotic cover.

[CAS of the paranasal sinuses--technology and clinical experience with the Vector-Vision-Compact-System in 102 patients]. / Computerassistierte Chirurgie der Nasennebenhöhlen--Technologie und klinische Erfahrungen mit dem Vector-Vision-Compact-System an 102 Patienten.

INTRODUCTION: Functional endonasal sinus surgery has gained significant importance in the treatment of chronic inflammatory sinus disease over the past 20 years. Still, the risk of jeopardizing adjacent structures, i. e. the anterior skull base, optic nerve or carotid artery, is increased, especially in revision cases. Several attempts have been made in the past to reduce the risk of iatrogenic injuries due to this kind of surgery and to increase the safety of the procedure, one of them being the introduction and clinical application of image guided and computer assisted surgery (CAS) respectively. A new method of patient registration for the CAS is the non-contact laser registration (z-touch trade mark laser). The main advantage of the laser registration device, is that it is no longer necessary to equip the patient with special markers or with a headset for the registration scan, therefore additional CT scans can be avoided. MATERIAL AND METHODS: In this study we summarize our experience with the Vector Vision compact navigation system. The study population contained 102 patient, treated over a period of 18 months (Sept. 2000 - Dez. 2001). The indications for the CAS were mainly revision operations of recurrent nasal polyps, mucoceles or other chronic rhino-sinus diseases, especially of the frontal sinus. In 35 cases the headset registration was applied, in all other cases we used the z-touch trade mark laser registration. RESULTS: The preoperative planning time was significantly lower for z-touch trade mark laser registration ( 5,2 min) compared to the headset registration ( 20,2 min), the set-up-time in the operation room was nearly the same, 7 min for z-touch trade mark laser registration and 6 min for headset registration. The most important criterion for CAS, of course, is accuracy during surgery; here we also observed an increased accuracy for the z-touch trade mark laser registration. CONCLUSIONS: Our data confirm earlier observations indicating that CAS enhances safety during endoscopic sinus surgery especially in revision cases. In addition it might be a helpful adjunct for the beginner and even advanced surgeon during routine sinus procedures. Nevertheless, CAS should not be misinterpreted as a substitute for thorough and meticulous studying of this delicate area including cadaver studies. Our results further demonstrate that the faster and simple registration method allows us to use the system more frequently, thereby increasing the number of navigated cases. The accuracy we can achieve varies between 0.9 and 2.4 mm, with a mean value of 1,3 in the x- and y-axis and 1,4 in the z-axis. In addition it is also possible to use imaging data sets obtained prior to the intent to operate. This not only reduces the cost for imaging studies, but also minimizes the manpower needed to place the fiducials, organize and perform additional acquisition of images.

Involvement of inferior turbinate mucosa in chronic sinusitis--localization of T-cell subset.

BACKGROUND: In chronic sinusitis (CS), different subsets of leukocytes are involved in development of persistent inflammation of the nasal mucosa. The localization and differentiation of these infiltrating lymphocytes may help us to understand the inflammatory interactions in the epithelium, lamina propria, and seromucous glands of the nasal mucosa in CS. METHODS: We examined frozen sections of inferior turbinates from 14 patients with nonallergic CS and 10 normal nonallergic controls. We used the avidin-biotin-peroxidase (ABC) technique with monoclonal antibodies against CD3 (total T cells), CD4 (T-helper/inducer cells), CD8 (T-suppressor/cytotoxic cells), CD22 (B cells), CD56 (natural killer cells), elastase (neutrophil granulocytes), eosinophil cationic protein (eosinophil granulocytes), and CD68 (macrophages). RESULTS: We found significant increases (P < 0.05) of CD3, CD4, and CD8 T cells and B cells in the nasal mucosa of patients with CS. The number of CD68 cells and eosinophils showed no significant rise. CONCLUSIONS: The different types of leukocytes play a key role in the defense of the respiratory tract. The analysis of the distribution of cells in the epithelium, mucosa, and glands of the inferior turbinate confirmed that nonallergic CS is, in fact, chronic, bacterial rhinosinusitis involving the inferior turbinates, and that the pathomechanism is therefore different from that of nasal polyposis.

New method for removing type 2 copper from Rhus laccase.

A new procedure is described for preparing tree laccase that is missing the type 2 copper. The derivative has only about 5% of the activity of the native enzyme, and some, or all, of the residual activity could be due to traces of holoprotein. The type 1 copper is fully oxidized in the purified type-2-depleted protein, while the type 3 site is reduced to the extent of at least 85%. However, the type 3 coppers can be reoxidized by treatment with excess H2O2. Reconstitution is achieved by incubation with Cu(I), and the remetalated protein exhibits the activity and the spectral properties of the native enzyme. The type 2 copper is removed by dialysis against a redox buffer containing ferri- and ferrocyanide ions as well as EDTA. More than 25% of the total copper is removed from laccase during the procedure, but the type-2-depleted fraction is readily isolated by means of an ion-exchange column. The practical advantages of this procedure are described. Finally, the simplicity of the method raises hopes that the mechanism of depletion can be defined.