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Clinical parameters of 72 patients who were operated upon for nasal polyps were evaluated as well as biopsy specimens of the mucosa of the middle and inferior turbinates of 41 of these patients. Biopsies were taken at the time of endoscopic sinus surgery (ESS), after 6 months and after 1 year in 23 patients. During the follow-up period the patients were treated with topical corticosteroids (budesonide). At the time of ESS significantly more CD8+ (suppressor/cytotoxic) cells than CD4+ (helper/inducer) cells were found in the middle and inferior turbinates. At 6 months significantly more CD4+ cells were found than at the time of ESS, whereas at 1 year the number of CD4+ cells had decreased and was lower than at 6 months. These data support the theory that the occurrence of nasal polyps is associated with T-cell-dependent disturbances. Clinical evaluation revealed that most of the patients with chronic airway obstruction had better pulmonary functions postoperatively or required less medication for lung disease. These findings show that ESS combined with topical corticosteroids has a positive effect on upper and lower respiratory tract pathology.

SUMMARY. This study was designed, first, to test a new system for aspiration of human nasal secretions and, secondly, to evaluate protein and immunoglobulin concentrations in these secretions at different levels of secretory activity. The direct aspiration system combines the advantages of minimal irritation of the nasal mucosa with the facility to determine concentrations per gram of secretion. The total protein and immunoglobulin concentrations were inversely related to the amount of secretion obtained. Variations in fluid secretion throughout the day may be responsible for this relationship. The inverse relationship was much more significant in patients with nasal polyps, in which much higher concentrations were found, than in healthy subjects. Ratios of immunoglobulin to total protein were independent of the amount of secretion obtained. Compared to the controls, the ratios of IgM and IgG to protein in the secretions of the patients were significantly increased. The secretory immunoglobulin A to total protein ratios were only slightly higher in the patients' secretions. Additional key phrases: aspiration system; nasal secretions; immunoglobulins; total protein; polyposis nasiThe secretory layer lining the mucosal surfaces in the respiratory tract contains proteins such as lactoferrin and secretory immunoglobulin A (sIgA). These, respectively, inhibit bacterial growth and protect the respiratory mucosa from invasion by micro-organisms. In pathological conditions such as infections or allergic diseases the composition of nasal secretions can vary considerably.' Investigations on nasal secretions have been hampered by the difficulty of obtaining large enough and representative samples.2 Using the nasal lavage method an unknown dilution factor is introduced and, consequently, the immunoglobulin concentrations can only be expressed relative to the total protein conc e n t r a t i o n~.~.~ Nasal secretions have also been collected by absorption onto filter paper5 or by aspiration after stimulation with cellulose sponges.2 In both these methods the mucosa is irritated considerably and the samples obtained may not be representative. We have developed a direct aspiration method which induces minimal stimulation of the nasal mucosa. The samples collected by this method are diluted but the dilution factor can be determined, thus enabling the measurement of absolute concentrations. The system was evaluated by the assay of protein and immunoglobulin concentrations in nasal secretions of healthy individuals and patients with nasal POIYPS. 260

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