**12. Mytomycin C and DCR**

Mitomycin C is a chemotherapeutic antibiotic isolated from the broth of *streptomyces caespitosus*. Mitomycin C is an alkylating agent that is widely used systemically for the treatment of malignancies, and has also gained popularity as a topical adjunctive in the treatment of ocular surface neoplasia. The ability of this drug to modify the normal wound healing pathway by inhibiting fibroblast and endothelial cell growth and replication has made it an attractive adjunct in glaucoma and pterygium surgery, as well as in DCR surgery14.

The primary cause of failure in DCR surgery is closure of the surgical osteotomy due to fibrosis, scarring, and granulation tissue. The intraoperative application of the antimetabolite mitomycin C to the surgical anastamosis can theoretically inhibit such closure, and has been previously shown to increase the ostium size. Mitomycin C application varies in different published articles according to duration, manner and procedures14.

Liao et al. by a randomized trial of 88 eyes undergoing external DCR, showed a significant increase in the number of symptom-free cases from 70.5% to 95.5% with the use of mitomycin C at 10-months follow-up and You and Fang showed increases in both ostium patency and size with the use of mitomycin C during external DCR at a mean follow-up of 3 years. Based on our study, it appeared that patients with nasolacrimal obstruction who underwent endoscopic DCR did not benefit from adjunctive topical application of mitomycin C. However, we suggest further multi-central trials for comparing results in different hospital settings14.

**5** 

*Talavera de la Reina* 

*Spain* 

**Treatment of Allergic Rhinitis:** 

Jesús Jurado-Palomo1, Irina Diana Bobolea2,

*3Centro de Salud La Solana, Talavera de la Reina* 

**Cromones and Vasoconstrictors** 

María Teresa Belver González2, Álvaro Moreno-Ancillo1, Ana Carmen Gil Adrados3 and José Manuel Morales Puebla4 *1Department of Allergology, Nuestra Señora del Prado General Hospital,* 

**ARIA Document, Nasal Lavage, Antihistamines,** 

*2Department of Allergology, Hospital La Paz Health Research Institute (IdiPAZ), Madrid* 

Throughout history, various classifications of rhinitis have emerged, many of which originated from expert groups. We would have to go back to 1994 to find the "*International Consensus Report on Diagnosis and Management of Rhinitis*" (International Rhinitis Management Working Group, 1994), which was subsequently modified in the 2000 "*Consensus statement on the treatment of allergic rhinitis*. *EAACI Position paper"* (Van Cauwenberge et al, 2000). Of particular interest is the "*Executive Summary of Joint Task Force Practice Parameters on Diagnosis and Management of Rhinitis"* of 1998 (Dykewicz & Fineman, 1998). In 2001, a group of experts, the *"Allergic Rhinitis and its Impact on Asthma (ARIA) Workshop Expert Panel"*, met to develop guidelines on the diagnosis and treatment of rhinitis, which also dealt with other inflammatory processes interrelated/associated with asthma. The acronym "ARIA" comes from "Allergic Rhinitis and its Impact on Asthma". ARIA is a document from a non-governmental organisation of the World Health Organization (WHO), endorsed by numerous scientific societies, such as the International Association of Allergology and Clinical Immunology (IAACI) and the World Allergy Organization (WAO)

It was established as an educational program as the "Guidelines for recommendations for the diagnosis and comprehensive handling of patients with rhinitis", associated with

Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. The chronic inflammation is associated with airway hyperresponsiveness

asthma and other interrelated processes (sinusitis, conjunctivitis and otitis).

**1. Introduction** 

(Bousquet et al, 2001).

**2. The "United airway" concept** 

*4Department of Otorhinolaryngology, University General Hospital, Ciudad Real* 

#### **14. Acknowledgement**

I would like to thank Dr. Neda Baghbanian, resident of otolaryngology- head and neck surgery, for her kind cooperation in writing this chapter.

#### **15. References**

