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Biomedical subjects

E B Kern

Publications and source records attributed to E B Kern.

At least 37 records · Page 2Linked to original sources
PubMed1989

Office endoscopy--when, why, what, and how.

Comprehensive diagnostic nasal endoscopy is a relatively recent advance in the office practice of rhinology. The examination is performed most commonly with 4.0-mm telescopes (0 and 30 degrees) and 2.7-mm telescopes (30 and 70 degrees). Nasal endoscopy provides the rhinologist with unparalleled visualization with brilliant illumination of the nasal cavity which permits more accurate diagnosis of nasal conditions. It also serves as an excellent teaching tool and source of photodocumentation.

Endoscopes↗
PubMed1988

The effects of sinus bacteria on human ciliated nasal epithelium in vitro.

The mechanisms by which bacteria colonize and damage ciliated epithelium are important in understanding the pathophysiology of rhinitis, sinusitis, and otitis. Bacteria that have the ability to impair mucociliary clearance would be at an advantage in establishing infection of ciliated surfaces. This study investigates the effect of Hemophilus Influenzae, Streptococcus pneumoniae, Branhamella catarrhalis, and Staphylococcus epidermidis on the ciliary activity of normal ciliated nasal epithelium in human beings. Ciliary activity of the nasal epithelium in the presence of each pathogen was assessed for more than 240 minutes with a photometric method of ciliary beat frequency (CBF) measurement. H. influenzae exerted significant effects on ciliary activity, with a 46% decrease in the CBF by 4 hours (with bacteria-containing broth) and a 32% decrease with bacteria-free filtrate. S. epidermidis decreased CBF by 44% with the bacterial broth. A sterile cell-free filtrate had no significant effect. S. pneumoniae and B. catarrhalis had no significant effect on CBF within a 240-minute period. H. influenzae and S. epidermidis disrupted normal synchronous ciliary motion, causing adjacent cilia to beat at different rates.

Bacterial Physiological Phenomena↗
PubMed1988

The universal tip: a systematic approach to aesthetic problems of the lower lateral cartilages.

A systematic approach to the various common aesthetic problems of the lower lateral cartilages is presented. Since this approach and technique may be applied to a wide variety of problems, we have taken the liberty of calling this the universal tip. These concepts have emerged from study of the literature and have evolved over the past thousand rhinoplasties. A classification of lower lateral cartilage problems includes five basic variations: (1) the wide, amphorous, ill-defined tip, (2) insufficient projection of the tip, (3) overprojection of the tip, (4) dependent tip with lack of definition, and (5) asymmetrical tip. It is important to realize that any of these five categories may be found in various combinations with each other. The details and fundamental steps of this universal tip technique are presented along with illustrative case examples in each of the five basic variations. In approximately 4 percent of patients there is a postoperative asymmetry in the position of cartilaginous flaps in the region of the dome of the lower lateral cartilage. These abnormalities plus abnormal ridges or bossa can usually be corrected at the time of secondary surgery under local anesthesia.

Cartilage↗
PubMed1987

Suppurative (bacterial) sinusitis.

Upper respiratory tract (viral) infection is the most common predisposing cause of suppurative sinusitis. Acute disease is manifested by pain, nasal discharge, systemic manifestations, and nasal obstruction. In chronic disease (greater than 3 months' duration) nasal airway obstruction and postnasal discharge may be the only symptoms. Diagnosis is made on the basis of the history and physical examination, supported by roentgenographic findings and, if necessary, cultures. Acute infection is treated with antibiotics, decongestants, and analgesics. If medical management fails, surgery is necessary. Complications of suppurative sinusitis include cellulitis, abscess, meningitis and cavernous sinus thrombosis, osteomyelitis, and oroantral fistula.

Acute Disease↗
PubMed1987

Nasal valve physiology. Implications in nasal surgery.

Knowledge of the structure and function of the nasal valve region is required by all who operate on the nose. This article defines and classifies nasal valve region abnormalities; discusses principles, goals, and details of surgery in this area; and considers strategies to avoid or minimize complications, especially in cosmetic rhinoplasty.

Cartilage↗
PubMed1986

Microbiologic analyses of nasal polyp tissue.

Nasal polyps from 40 patients were cultured within 2 1/2 hours after surgical removal to determine whether microorganisms were present. The first 20 polyps were cultured for aerobic and anaerobic bacteria, viruses, fungi, mycoplasmas, and mycobacteria. Of these 20 polyps, eight were sterile by all tests, one grew Cryptococcus albidus, one grew Sporobolomyces, one had large numbers of Peptostreptococcus micros and Propionibacterium acnes, greater than 10(6) colony-forming units per gram (cfu/gm), and nine had aerobic bacteria including 10 different species at levels less than 10(5) cfu/gm. The second 20 polyps were cultured for aerobic bacteria only; 11 polyps were positive. Overall, 14 of 26 polyps from patients with asthma and two of 14 polyps from patients without asthma were positive for aerobic bacteria at levels greater than 10(3) cfu/gm (p less than 0.05). Multiple aerobic bacterial species tended to occur in polyps from patients with asthma (11 of 26) more frequently than in those from patients without asthma (one of 14) (p less than 0.01). There was a highly significant positive correlation between tissue neutrophilia and bacterial count (r = +0.9; p less than 0.001). The results indicate that patients with asthma have a significantly higher number and a tendency to a greater variety of aerobic bacteria in nasal polyp tissue than patients without asthma and that the number of infiltrating neutrophils is directly related to the number of bacteria.

Adolescent↗
PubMed1985

Normal nasal resistance.

Eighty normal adults without nasal symptoms were studied to determine normal nasal resistance values and the variation of nasal resistance in normal adults. A microprocessor-based system for collection and analysis of transnasal pressure and flow was used to obtain nasal resistance values. Unilateral and total transnasal pressure and flow values were determined before and after decongestion of the nose with 1% phenylephrine spray. The distribution of the 80 resistance values was found to be skewed to the right. Log transformation of the resistance values was the best method to normalize their distribution. The mean and variation of normal nasal resistance are reported at flows of 0.1 and 0.2 L/sec, at pressures of 0.5 and 1 cm H2O, and at radii of 1, 2, and 3 on the pressure-flow curve.

Adult↗
PubMed1984

The effect of Le Fort I maxillary impaction on nasal airway resistance.

To evaluate the effect of maxillary superior movement via Le Fort I osteotomy on nasal airway resistance, eleven Caucasian patients whose surgical orthodontic treatment included Le Fort I impaction (range 2 to 8 mm, mean 5.3 mm) were selected. Nasal airway resistance in these patients was determined a few days before and approximately 8 weeks after the Le Fort I surgical procedure. Nasal airway resistance was determined by means of a uninasal active mask rhinomanometric technique. Contrary to the predicted negative effects of maxillary superior movement on nasal airway function, there was a statistically significant improvement in nasal airway resistance (P less than 0.01) after maxillary superior movement. This rather unexpected finding can be explained by examining the effect of maxillary superior movement on the nasal valve area in the anterior nose. The nasal valve area is a teardrop-shaped area bordered by the nasal septum, the caudal end of the upper lateral nasal cartilage, the floor of the nose, and the soft fibrofatty tissue on the lateral aspect of the nose. The apex of the teardrop-shaped area (the angle between the nasal septum and the upper lateral cartilage) is called the nasal valve. In the Caucasian type of nose, the nasal valve accounts for most of the inspiratory resistance to airflow. Maxillary superior movement increases the alar width. It is proposed that this increase in alar width is transmitted at least partially to the nasal valve angle, causing it to widen slightly, paradoxically reducing nasal airway resistance while reducing skeletal intranasal dimensions.

Adolescent↗
PubMed1984

Induction of nasal late-phase reactions by insufflation of ragweed-pollen extract.

We studied changes in NAC in 17 ragweed-sensitive individuals after intranasal ragweed-challenge testing. All patients experienced immediate symptoms of sneezing, rhinorrhea, and nasal congestion that were associated with marked decreases in NAC (mean = 68%). In 10 trials patients also experienced late (greater than 0 hr) symptoms of nasal congestion with or without rhinorrhea; the mean late NAC decrease in this group was 42%. In contrast, no late symptoms were noted in nine trials, and the mean NAC decreased 5% in this group (p less than 0.003). Attempts to passively transfer immediate or late nasal sensitivity to one individual by spraying the nasal cavity with IgE antibody-containing serum, by packing the nose with cotton pledgets soaked in serum, by injecting serum directly into the inferior turbinate, and by transfusion with IgE-containing serum were not successful. We conclude that symptomatic late-phase reactions occur in the nose after intranasal challenge in about 50% of patients and that these symptomatic reactions can be confirmed objectively by rhinomanometry.

Adult↗
PubMed1984

Sinusitis.

Explore the source record for details and available documents.

Cellulitis↗
PubMed1984

Epithelial damage in nasal polyps.

Bronchial epithelial damage occurs regularly in bronchial asthma, but it is not known whether such damage occurs in the mucosa of nasal polyps. We obtained nasal polyp tissues from thirty patients and we examined these tissues for evidence of epithelial damage. Immediately after resection, polyp tissue was fixed in Karnovsky's fixative, embedded in methacrylate and stained with Giemsa pH 6 X 5. Normal nasal tissue from eight patients undergoing nasal septal reconstruction was similarly processed. As a disease control, we examined tissue from eight patients with nasal polyps associated with cystic fibrosis. Tissues were viewed by microscopy and epithelial damage was expressed as the percent of surface involved. Twenty-eight of the thirty patients with idiopathic nasal polyps (93%) showed complete loss of nasal mucosa in varying degrees (range 3-81% of surface; mean, 29%). All patients showed evidence of some epithelial damage, either complete loss or marked desquamation (range 9-99% of surface; mean 54%). In contrast, six of eight biopsies from patients undergoing septal reconstruction and five of eight nasal polyps from patients with cystic fibrosis showed little or no evidence of epithelial damage. The results indicate that nasal polyps regularly show evidence of epithelial damage similar to that seen in bronchial asthma, and this abnormality may partly explain the rhinorrhea which is prominently associated with nasal polyps.

Adult↗
PubMed1984

Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise. Second-Place Resident Award at 1982 Research Forum.

Posterior mask rhinomanometry was used to measure nasal resistance during exercise and hypercapnia in 10 healthy adult volunteers. Exercise was produced by peddling a stationary bicycle at three loads. Hypercapnia was produced by breathing O2 mixtures containing 5%, 6%, and 8% CO2. The results showed that nasal resistance decreases linearly as expired CO2 levels and exercise levels increase, minute ventilation increases linearly as expired CO2 levels and exercise levels increase, and nasal resistance varies inversely with minute ventilation during both hypercapnia and exercise. The constant relationship between nasal resistance and minute ventilation during hypercapnia and exercise suggests that nasal resistance is regulated by the respiratory center to match the level of respiratory demand.

Adult↗
PubMed1984

Objective evaluation of anterior septal surgical reconstruction.

Fifty patients who underwent nasal septal reconstruction for anterior septal deformities were examined preoperatively and postoperatively with anterior mask rhinomanography. A high degree of correlation was found between the reduction in nasal resistance after operation and the patients' subjective assessment of improvement. Those patients who improved subjectively had a mean decrease in nasal resistance of 1.2 cm H2O/L/sec, whereas those patients who indicated no improvement had a mean increase in nasal resistance of 0.2 cm H2O/L/sec.

Airway Resistance↗
PubMed1983

Lateral rhinotomy. Indications, technique, and review of 226 patients.

Lateral rhinotomy provides excellent exposure of the interior of the nose, the paranasal sinuses, and the nasopharynx with minimal postoperative deformity. A review of 226 lateral rhinotomies performed at the Mayo Clinic, Rochester, Minn, from 1970 through 1979, was made to determine the versatility of this incision and some of its limitations and risks. The suitability of this technique to approach the wide variety of pathologic conditions that occur in the midfacial structures was reaffirmed.

Aged↗
PubMed1983

Deep facial osteology as revealed by coronal sections of the dried skull.

An understanding of the bony framework and relationships of the face is essential to the facial reconstructor. A dried human skull was immersed in a hardening agent to preserve the ethmoidal labyrinth and then cut in the coronal plane to produce six sections. The anterior and posterior surface of each section was photographed and landmarks were labeled. Since the thick anterior bony structures were removed with the first slice, the normal delicate laminae of the deep face, within the deeper sections, were exposed for study.

Facial Bones↗
PubMed1983

Why and how to drain a sinus.

The main reason for draining a sinus is removal of pus in subacute or chronic maxillary sinusitis. A sinus wash is also useful for diagnosis. I recommend the anterior maxillary sinus puncture because it is the easiest technique to perform and master.

Drainage↗
PubMed1983

It is really sinusitis?

To answer the question Is it really sinusitis? one must take a careful history, look into the nose, palpate the infected sinuses, and obtain roentgenograms. A history of pain, mucopurulent discharge, nasal obstruction, and systemic involvement should be present for a diagnosis of acute suppurative sinusitis. Physical findings and the presence of a predisposing factor help in the diagnosis, and roentgenographically demonstrated changes of the involved sinus can substantiate it. Acute suppurative sinusitis necessitates antibiotic therapy, which should be continued for seven days after the primary symptoms are relieved in order to avoid recurrence or development of subacute or chronic suppurative sinusitis. Chronic sinusitis requires surgical intervention to remove the diseased mucosa, and the sinuses must be ventilated (oxygenated) for resolution to occur.

Humans↗