Biomedical subjects
Publications and source records attributed to E B Kern.
Nasal secretory activity was measured in seven dogs in response to topical stimulation by histamine and methacholine. The methacholine response was blocked by atropine but not by chlorpheniramine. The histamine response was blocked by chlorpheniramine but not by atropine. These results suggest that there are two independent mechanisms of nasal secretion in the dog.
We determined the effect of preseasonal intranasal short ragweed (SRW) immunotherapy in a double-blind, nonpaired, 20-wk study involving 33 SRW-sensitive patients. Patients were selected on the basis of an elevated IGE serum antibody level, a positive intradermal skin test, and a positive intranasal challenge to SRW antigen. SRW-treated patients sprayed SRW solutions intranasally six times a day for 12 wk preseasonally. Placebo-treated patients used nebulized solutions containing buffer or histamine that were interchanged randomly throughout this period. The SRW-treated group reported more preseasonal symptoms than the placebo-treated group (p less than 0.003); however, during the SRW pollination season, the SRW-treated group reported significantly less sneezing, nasal congestion, rhinorrhea, red/itchy eyes, itchy nose/throat, and cough/wheeze. Supplemental antihistamine usage was similar in both groups. The treatment did not affect serum IgE antibody levels to crude SRW, AgE Ra3, or Ra5 in either group at any time during the study. No significant production of IgG antibody to SRW was seen in either group. One SRW-treated patient developed acute sinusitis after 2 wk of treatment; otherwise no side effects other than symptoms of hay fever were noted. Although intranasal SRW immunotherapy may offer an effective and less costly alternative to parenteral immunotherapy, reduction in hay fever symptoms during the pollination season was achieved at the expense of provoking these symptoms during the preceding weeks.
Approximately 600 resistance values were obtained for 50 subjects. Of the 50 subjects, 14 did not have evidence of a normal nasal cycle. These 14 subjects were selected for the study of the noncycle nose. The other 36 subjects with normal nasal cycles served as controls. By use of a mask flowmeter technique of rhinomanometry, three separate categories of noncyclicity were determined. Type 1 noncycle nose had no evidence of a nasal cycle and no fluctuation of either the right or the left side. Type 2 noncycle nose had no fluctuation of nasal resistance on one side and moderate fluctuation of nasal resistance on the opposite side. Type 3 noncycle nose had fluctuation of nasal resistance on both sides but the dominance did not reverse or change from one side to the other. This is the first study to characterize the noncycle nose and to subdivide it into three separate types using rhinomanometry.
The domestic pig exhibits characteristic fluctuations in nasal mucous membrane congestion and decongestion which meet the stipulated criterion for the existence of a nasal cycle. This phenomenon was documented in 6 of the 11 pigs studied. Also, unilateral sympathectomy acutely affects ipsilateral nasal resistance, but this elevated nasal resistance gradually decreases to preoperative values over several weeks. Finally, a new technique using active anterior rhinomanometry has been developed which can be applied to the study of nasal resistance changes in laboratory animals.
Current methods of rhinomanometry used by various workers from around the world were presented. The data for this communication is based on the work from the International Committee on Rhinomanometric Standards who presented their information at the 8th Congress of the European Rhinologic Society, October 21, 1980, in Bologna, Italy. These workers have an accumulation of approximately 42 years of experience with more than 10,000 rhinomanometric examinations. The results of this summary provide a consensus of methods, procedures, data collection and presentation which should be considered so that rhinomanometric uniformity may be achieved. It is well recognized that standardization of rhinomanometry still requires further inquiry and evaluation. This is not the final communication on the subject but merely a progress report and current consensus from a few workers in the field.
Explore the source record for details and available documents.
Although nasal injury is common-place in childhood, nasal septal trauma often is neglected and frequently goes undiagnosed until complications ensue. Only a complete intranasal examination in all cases of nasal trauma will detect intranasal fractures, dislocations, lacerations, hematomas, and abscess formation. Untreated, these septal and associated injuries can lead to considerable functional (nasal respiratory) and cosmetic (external) abnormalities. We report a case to illustrate the destructive sequelae of a "minor" nasal injury. Treatment may require formal surgical exploration with hematoma evacuation, reconstruction of the septal skeletal structures, and repair of lacerations of the intranasal mucosa. We review the management of cartilage resorption secondary to hematoma or abscess formation. A technique for replacing the caudal end of the septum is discussed and illustrated.
Nasal glioma is a developmental abnormality of neurogenic origin with o malignant potential. An intranasal mass requires careful rhinologic and occassionally ophthalmologic, neurologic, and roentgenologic examinations. With a bony defect, pneumoencephalography, angiography, or computerized tomography may be helpful. In such cases, a neurosurgeon should be available at the time of biopsy. Biopsy is necessary for establishing a histopathologic diagnosis. Aspiration of the tumor with a needle or incisional biopsy may yield inconclusive findings and may be associated with CSF rhinorrhea and meningitis, especially if there is an intracranial connection. With adequate initial removal, excisional biopsy usually offers complete cure. A frontal craniotomy approach is preferred for those patients who have nasal glioma with an intracranial connection, CSF rhinorrhea, or recurrent episodes of meningitis. With no evidence of an intracranial connection, a conservative extracranial approach is recommended.
A systematic method for the perioperative management of routine cases of pituitary microadenoma treated by transsphenoidal microsurgery is presented. These methods have evolved over a 7-year period and have been utilized in the management of more than 750 patients with pituitary tumors and related problems treated by trans-sphenoidal surgery. The goals in this joint neurosurgical, endocrinological, and otorhinolaryngological team effort are to eliminate errors in patient management, to assure the safety of the patient in the perioperative period, and to make the therapy as efficient and as cost-effective as possible.
Fresh allografts (homografts) of cartilage and bone, crushed and uncrushed, were transplanted in 53 rabbits. Each material was implanted into the auricle and concomitantly into the subdermis of the face. Postoperative assessment was every 1 to 3 days; sacrifice was at 6 weeks, 6 months, and 1 year for microscopic evaluation. Uncrushed cartilage allografts remained viable, and no significant resorption occurred. Crushed cartilage was significantly resorbed by 6 weeks but changed little after that. Resorption of uncrushed bone was moderate and appeared to be ongoing. Total resorption by 1 year occurred in the absence of contact with perichondrium or periosteum. Crushed bone, like crushed cartilage, was largely resorbed. These data document the fact that uncrushed cartilage is superior to crushed cartilage, crushed bone, or uncrushed bone for fresh allograft transplantation in the rabbit and that uncrushed cartilage is probably superior to all other fresh allografts for use in the clinical setting.
The completeness of the Emergency Room evaluation of the injured nose was determined by reviewing 250 cases of acute nasal injury. A recorded examination of intranasal structures was found for only 42 (21 percent) of 200 patients with blunt nasal trauma. In another group of 50 patients with roentgenographically documented nasal fractures, only 21 (42 percent) had a recorded intranasal examination. Failure to examine the internal nose thoroughly will leave undiagnosed such serious pathologic conditions as septal hematomas, mucosal tears, and fractures and dislocations of the bony and cartilaginous septum, which may cause permanent functional disturbances (nasal airway obstruction) and cosmetic deformities.
Explore the source record for details and available documents.
A six-year-old child with obstruction of the upper airway and a pectus excavatum defect ("funnel chest") is presented. Correction of the funnel-chest deformity was observed four years after the performance of a tonsillectomy and adenoidectomy to relieve the obstruction of the upper airway. The relationship between chronic upper-airway obstruction and a pectus excavatum deformity is discussed, and the reversibility of such a deformity is documented.
Explore the source record for details and available documents.
Seventy-three patients had medical-grade Silastic buttons inserted transnasally (between June 1972 and June 1976) into a perforation of the nasal septum. This nonsurgical technique was done as an office procedure on 67 of the patients with the use of topically applied 5% cocaine solution. The Silastic button has remained in place in 72.6% of the entire study group; follow-up times for this group range from six months to four years. This mechanical covering of the perforation substantially reduced crusting and epistaxis, and it improved nasal respiration in many cases.
This study evaluated autografts of bone and cartilage, uncrushed and crushed, in the perichondrial space of the ear and subcutaneously in the paraspinal region in rabbits six weeks and six months after transplantation. The results support the belief that in a clinical setting it is important to preserve perichondrium because it facilitates growth of new cartilage. This study suggests that when autogenous tissue is to be used for subcutaneous augmentation, it is best to use crushed or uncrushed cartilage or uncrushed bone because they remain viable. In the perichondrial space, crushed and uncrushed cartilage grafts not only remain viable but also induce growth of new cartilage and bone. Autogenous crushed bone does not survive in the perichondrial space of the rabbit ear.
Nasal airway resistance was evaluated in 1,000 patients who were seen at the Mayo Clinic between 1971 and 1977 for rhinologic complaints. Nasal obstruction was reported as the major symptom in 863 patients. Nasal airway resistance correlated well with the side and the severity of the obstructive symptoms. Symptoms of nasal obstruction typically occurred with a total nasal resistance greater than 3 cm H2O/L/s. Rhinoscopic evidence of nasal deformity could not be used to predict an increase in nasal resistance since many patients with rhinoscopically abnormal noses had "normal" nasal resistances. We conclude that the calculation of nasal airway resistance is a useful technique in the clinical evaluation of nasal obstruction. Nasal airway resistance data provide objective values that can substantiate and quantitate the symptoms of nasal obstruction.
Four types of synthetic materials were implanted in 54 rabbits: Supramid, Proplast, Plasti-Pore, and Silastic. Each material was implanted into the auricle and concomitantly into the subdermis of the face. Postoperative assessment was every one to three days, while killing was done at six weeks, six months, and one year postoperatively for microscopic evaluation. Supramid mesh contains black pigment, which became incorporated within the histiocytes and giant cells around the implanted mesh by six weeks; at one year, the soft tissues were pigmented microscopically. Proplast was not extruded despite an intense and persistent histiocytic and giant-cell reaction; its black color constituted a major drawback for implantation beneath thin skin. The Plasti-Pore used in these studies was rigid and somewhat difficult to sculpture, and it induced a persistent but minor cellular reaction. Silastic was easily displaced.