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Background: Subjects with aspirin-intolerant asthma (AIA) respond with bronchoconstriction and extrapulmonary adverse reactions to conventional nonsteroidal anti-inflammatory drugs (NSAIDs) that inhibit the cyclooxygenase (COX) step in the biosynthesis of prostaglandins. Recently, 2 isotypes of COX have been identified, and COX-2-selective NSAIDs have been developed for treatment of inflammatory disorders., Objective: We investigated whether 33 subjects with a typical history of AIA tolerated the new COX-2-selective NSAID celecoxib., Methods: All subjects displayed current aspirin sensitivity in oral or inhalation challenge tests. The subjects first underwent a double-blind, randomized, cross-over, increasing-dose challenge with placebo or celecoxib (10, 30, or 100 mg in suspension) on 2 occasions 7 days apart. Thereafter, all subjects were exposed to 400 mg of celecoxib administered during an open challenge session as two 200-mg doses 2 hours apart. Lung function, clinical symptoms, and urinary excretion of leukotriene E(4) (LTE(4)) were monitored, with the latter being a sensitive biochemical marker of aspirin intolerance., Results: There were no changes in lung function or extrapulmonary symptoms during the double-blind sessions or in urinary excretion of LTE(4). Also, the highest recommended daily dose of celecoxib was well tolerated, with no symptoms, lung function changes, or alterations in urinary LTE(4) levels., Conclusions: A group of subjects with clinically well-documented AIA tolerated acute challenge with the selective COX-2 inhibitor celecoxib. The findings indicate that the intolerance reaction in AIA is due to inhibition of COX-1. Large long-term studies of COX-2 inhibitors in AIA should be undertaken.

Ragweed pollen is the most frequent cause of allergic rhinitis in the late summer-fall in North America. The objectives of this multicenter, randomized, single-blind study are to assess the efficacy and safety of triamcinolone acetonide aqueous (TAA AQ) and beclomethasone dipropionate aqueous (BDP) in the treatment of adult patients with seasonal ragweed-induced allergic rhinitis. Patient's self-assessment of comfort with medication and health-related quality of life were also assessed. A total of 152 patients were randomized to treatment with TAA AQ 200 micrograms once daily in the morning (n = 75) or BDP twice-daily 336 micrograms/day (n = 77). Both treatments were shown to be effective in alleviating the symptoms of allergic rhinitis, with no significant differences between the two treatments in mean reduction from baseline of nasal stuffiness, discharge, nasal index (sum of discharge, stuffiness, and sneezing), itching, and total eye symptoms. There were no significant differences between treatments in quality of life scores. However, TAA AQ was described by patients as having a better taste and smell than aqueous BDP (p < or = 0.05). Both treatments were well tolerated and associated with a similar incidence of adverse events. These results show that both once-daily TAA AQ 220 micrograms and twice-daily BDP 336 micrograms are well tolerated and effective in the treatment of seasonal allergic rhinitis. In addition, both treatments are equally as effective at improving patient health-related quality of life. However, patients preferred the odor and taste of TAA AQ over BDP. It is likely that once-daily dosing and patient preference for the sensory attributes of TAA AQ may enhance treatment compliance.

Allergic rhinoconjunctivitis and asthma are becoming more common in industrialized societies, particularly in the second and third decades of life, when those affected are at a vital stage of their education and career. It is therefore of paramount importance that the treatment options available be effective, improve quality of life, and above all, they must be without any significant unwanted effects. National and international guidelines for the treatment of both allergic rhinitis and asthma have been released recently that put forward recommendations based on an extensive evidence-based review of the literature for the care of these diseases that would meet these goals of disease management.

Purpose: Isolated accounts of neoplastic pouch transformation suggest the need to perform routine ileoanal pouch surveillance with biopsy. These reports imply a model of dysplasia to cancer transformation of the pouch mucosa. More recent reports studying "high risk" ulcerative colitis patients concluded that the development of pouch dysplasia is indeed a rare event. This study was designed to evaluate our institutional incidence of dysplasia in ileoanal pouch during long-term follow-up., Methods: A prospective database of all patients undergoing ileoanal pouch construction (n = 767) was queried for all patients undergoing pouch biopsy between 1983 and 2001. All patients with ulcerative colitis who underwent pouch biopsy were included. This excluded patients with Crohn's disease, indeterminate colitis, and familial adenomatous polyposis. Pathology reports were reviewed for histologic evidence of inflammation, atypia, metaplasia, dysplasia, or cancer. Patient age at biopsy, pouch age at time of biopsy, and pathology were analyzed., Results: The ileoanal pouches of 160 patients were surveyed with biopsies a total of 222 times. The average length of follow-up from pouch construction to time of surveillance and biopsy was 8.4 +/- 4.6 years. There were 83 patients (52 percent) whose pouches were older than 10 years (mean, 12.7 +/- 2) at time of surveillance. With over 1,800 pouch-years of surveillance, only 1 patient had focal, low-grade dysplasia in the pouch. This patient demonstrated no evidence of dysplasia on further surveillance., Conclusion: Even with long-term follow-up of ileoanal pouch patients, there is little evidence to support routine biopsy of the ileal mucosa in ulcerative colitis patients.

Purpose: This is the first report of linear pressure profiles and symmetric findings in preoperative and postoperative (after gracilis muscle retraining) patients. Length of the anal canal and symmetry have been well documented in the literature as significant parameters in the maintenance of anal incontinence. Significant improvement of these parameters should play a critical role in the functional outcome of the stimulated gracilis., Methods: Six patients underwent preoperative and postoperative anorectal manometry using an eight-channel radial catheter. Pressures were collected at 8 Hz using an automated continuous pullout technique (1 mm/sec). Preoperative and posttraining resting and squeeze pressures, pressure volumes, anal canal length, and linear and cross-sectional images were compared., Results: Resting pressures significantly improved from 13.7 mmHg to 26.8 mmHg (P < 0.02). The squeeze pressure significantly improved from 28.67 mmHg to 62.9 mmHg (P < 0.02). The pressure volume increased from 10,429 mmHg to 26,162 mmHg. Anal canal length increased from an abnormal length of 2.95 cm to normal length of 3.55 cm (P < 0.04). The percentage of sphincter asymmetry decreased from 28.6 percent to 23.5 percent (P < 0.01). The most striking observation was the impact the gracilis muscle had on correcting the geographic cross sections as it wrapped more than 360 degrees from the proximal to distal anal canal. Patients were significantly improved, with four of the six patients completely continent to solid stool. Two of the six patients had minor episodes of seepage. Preoperatively, all patients were grossly incontinent to solid stool., Conclusions: Significant improvement in resting pressure, pressure volume, anal canal length, and cross-sectional symmetry has led to a significant improvement in anal incontinence after dynamic myoplasty.

Improvement in patient daily functioning and well-being resulting from disease-related symptom relief is increasingly viewed as a clinically relevant therapeutic outcome. The objective of this study was to evaluate the health-related quality of life (HRQL) effects, safety and efficacy of cetirizine in the treatment of seasonal allergic rhinitis, and impact on self-reported work/school-related productivity and activity impairment (WPAI). This was a double-blind, placebo-controlled, parallel-group study. Adult patients (n = 865) were randomized to daily treatment for 2 weeks with cetirizine or placebo. Patient disease-specific HRQL and WPAI were assessed at baseline and weeks 1 and 2 of treatment using the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and Allergy-Specific Work Productivity and Activity Impairment (WPAI-AS) Instrument, respectively. Treatment with cetirizine resulted in greater (p < 0.001) improvement in overall RQLQ and individual domain scores (activities, sleep, non-nose/eye symptoms, practical problems, nasal symptoms, eye symptoms, emotional), as compared with placebo. Cetirizine therapy produced a 28.9% mean reduction in total symptom severity complex (TSSC) score versus 12.7% with placebo at study end. Work/school productivity and activity impairment were significantly (p < 0.001) decreased from baseline for cetirizine-treated patients compared with placebo. The incidence of treatment-related side effects was similar between groups. Cetirizine provides safe and effective symptomatic relief in adults with SAR while significantly improving HRQL and providing a positive impact on work/school-related productivity and activity impairment. These results provide a more comprehensive assessment of cetirizine, indicating that its benefits extend beyond conventional measures of clinical outcome.

The majority of patients with seasonal allergic rhinitis (SAR) suffer from nasal congestion. Desloratadine, a nonsedating H1-receptor antagonist, has given decongestant relief to patients with mild-to-moderate nasal congestion associated with SAR. The following study was undertaken to show that a once-daily formulation of desloratadine/pseudoephedrine would provide greater decongestant relief to patients experiencing moderate-to-severe nasal congestion compared with component monotherapy. A total of 1018 patients were assigned randomly to receive desloratadine/pseudoephedrine (5 mg/240 mg), desloratdine (5 mg), or pseudoephedrine (240 mg) daily for 15 days. Over the 15-day study period, patients receiving desloratadine/pseudoephedrine combination tablets had a significant reduction in mean A.M./P.M. reflective nasal congestion scores compared with patients receiving desloratadine or pseudoephedrine (p < 0.01); this reduction reached significance by day 2. Desloratadine/pseudoephedrine combination tablets also produced a greater reduction in A.M. instantaneous nasal congestion scores compared with component monotherapy (p < 0.01), indicating not only superior efficacy but also a full 24-hour effect. Desloratadine monotherapy reduced all mean nasal congestion scores to a similar degree as compared with pseudoephedrine monotherapy (p = NS). No unusual or unexpected adverse events were reported in any group. It was concluded that desloratadine/pseudoephedrine offers additional benefit to patients with moderate-to-severe SAR-associated nasal congestion compared with pseudoephedrine therapy alone.

Material and Methods: Dental examinations were carried out on 354 boys aged 5-6 years, and 862 boys aged 12-14 years, attending 40 schools in Riyadh. The prevalence of dental erosion was assessed using diagnostic criteria similar to those employed in the 1993 UK National Survey of Child Dental Health., Results: Pronounced dental erosion (into dentine or dentine and pulp) was observed in 34% of 5-6 year olds and 26% of 12-14 year olds. Information on food and drink consumed and dietary habits was obtained by means of a questionnaire. Parents reported that 65% of 5-6 year old boys took a drink to bed. Water was the commonest drink consumed (37%) followed by carbonated soft drinks (21%). One third of parents reported that their son had something to eat in bed or during the night and 60% of this was sweet food or confectionery. Seventy per cent of 12-14 year old boys reported consuming drinks at night; these were mainly water (30%), carbonated soft drinks (27%) and tea or coffee, with sugar (18%). Forty-six per cent of the 12-14 year olds reported that they ate in bed at least once a week and 54% of this was sweet food or confectionery. When the dental examination and questionnaire results were correlated, a statistically significant relationship was found between the number of primary maxillary incisors with pronounced erosion of their palatal surfaces and the consumption of carbonated soft drinks at night (P=0.015). A significant relationship was also found between the number of permanent maxillary incisors with pronounced erosion on their palatal surfaces and the frequency of drinks at night (P=0.020), as well as the duration of drinks retained in the mouth (P=0.038)., Conclusion: It is concluded that dental erosion is more common in the primary and permanent dentitions of Saudi Arabian boys compared with results for similar age groups from the United Kingdom.

Purpose: Pudendal nerve terminal motor latency testing is useful as a diagnostic tool in fecal incontinence. It has also been used as a predictive factor in sphincteroplasty repairs. The technique is seldom taught and mastered in colorectal training programs. The purpose of this study was to assess a learning curve for teaching this procedure., Methods: The student was a formally trained colorectal surgeon with no pudendal nerve terminal motor latency experience; the instructor has performed more than 3,000 pudendal nerve terminal motor latency studies. Fifty consecutive patients had manometry and pudendal nerve terminal motor latency testing. Both the student and instructor performed pudendal nerve terminal motor latency in a sequential fashion. Variables collected included pudendal nerve terminal motor latency, completion of test, time to complete test, and accuracy of the test. Variables were analyzed with paired t-test and chi-squared analysis., Results: The study group included 41 female and 9 male patients. The average age of the patients was 53 years. Bowel complaints included constipation in 16 and incontinence in 34 patients. Data were analyzed in their entirety and at ten-patient intervals. The student tended to record longer latencies (P < 0.001). This led to false-positive rates of 23 and 21 percent, respectively, for left and right pudendal nerve terminal motor latency. On average, the time to complete the procedure was three times longer for the student than for the instructor (P < 0.001). At ten-patient intervals, the pudendal nerve terminal motor latency difference between the two groups disappeared at the 41-to-50-patient mark., Conclusion: Given the proper learning environment, pudendal nerve terminal motor latency testing can be mastered in a relatively short period. On the basis of this study, our estimation is 40 patients are required for a student to master this technique. The novice examiner can expect false-positive results early in the learning curve, and these should be validated accordingly.