Following randomization, groups were not equal due to some factors which may aect response to treatment, while the proportion of allergic and nonallergic patients was symmetric within and between the groups.The furosemide group consisted of males, females, asthmatics, ASA intolerance and recurrences, and the steroid group of males, females, asthmatics, ASA intolerance and recurrences.The patients completed questionnaires concerning subjective nasal symptoms scores at inclusion: obstruction, hypersecretion, olfaction; and general symptoms: fatigue, temperature, previous surgery. After day treatment, subjective and endoscopy scores were redetermined and patients were operated in endotracheal anesthesia. The most supercial polyp was biopted at the operation.Polyps were xed, embedded in paran, and stained by hemalauneosin and tryptase antibodies.Eosinophils and mastocytes were counted in ten high power elds, which were positioned in the middle portion of the polyp, and edema was measured as the distance from the surface submucous gland.The gland that was closest to the basal membrane within the whole polyp was chosen.Both surgeon and pathologists were not aware of the treatment allocation.Both treatments were signicantly eective in reducing subjective scores for main nasal symptoms: mean presteroid score was. after the treatment, respectively. Olfaction was much better improved in steroid group, although the dierence was not statistically signicant due to small sample size and high variability between the scores.Histomorphometric analysis has revealed signicant reduction in <a href="http://www.targetmol.com/compound/Pamabrom"></a>
eosinophil count in steroid group, with no signicant eect on mastocyte count and oedema.Most of the steroid treated patients had a decrease in eosinophil count from to times, while the rest had a slight increase.For the subgroup of previously unoperated patients, the eect was signicant, while in the operated patients, the decrease of oedema was insignicant. The reduction was seen in unoperated patients, while it was seen in in the operated patients.Histomorphometry revealed signicant correlation between pretreatment values of mast cell count and oedema. Topical steroids, widely used in the treatment of nasal polyposis, have evident antiinammatory eect concerning eosinophils in nasal polyp tissue in vitro and in vivo. However, comparison between the eect of topical steroids in vivo and in vitro suggest that the eects in vitro were much more pronounced, in terms of the eect on blood eosinophils apoptosis and the impact on eosinophil survival in vivo. In our patients, eosinophil inltration signicantly correlated with subjective obstruction scores prior to treatment, but not after the treatment.We have also noted that marked reduction of eosinophil count in of patients after steroid treatment, while had a slight rise.However, subjective improvement and polyp reduction was achieved also in part among those where eosinophil count did not decrease, while some patients with marked reduction of eosinophils had no objective reduction of polyp size at endoscopy.However, we did not count proportion of activated eosinophils, which are the more important parameters of inammation.More than half of furosemide treated patients did not have a decrease in eosinophil count, and some had marked increase.Reduction in eosinophil inltration was not related to subjective and endoscopic improvements.It may be caused by our histomorphometric denition of oedema, which takes into account the part of the oedema closer to the epithelia, whereas systemic steroid may also inuence the relations in deeper stromal part of the polyp.