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Biomedical subjects

F A Kuhn

Publications and source records attributed to F A Kuhn.

At least 37 records · Page 2Linked to original sources
PubMed1996

Fungal sinusitis: an update.

OBJECTIVE: To review the classification of fungal sinusitis as well as discuss current approaches to diagnosis and management. DATA SOURCES: A MEDLINE literature search was performed using the index terms sinus infection, fungal, diagnosis, radiology, microbiology, and treatment. The search was restricted to the English language and human subjects. With one exception the references were restricted to the last 10 years. Clinical data from studies performed at our institution were also included. RESULTS: Fungal sinusitis can be divided into four primary categories: (1) acute/fulminant (invasive), (2) chronic/indolent (invasive), (3) fungus ball, and (4) allergic fungal sinusitis. Each subtype has unique immunologic, pathologic, and clinical features. Allergic fungal sinusitis is the most recently described and most common form. The treatment and prognosis of fungal sinusitis varies significantly among the four different categories. CONCLUSION: Recent advances in endoscopy and computed tomography have enhanced the understanding of fungal sinusitis; however, they remain diseases surrounded by controversy. New insights into the etiology and pathogenesis of these diseases along with advances in diagnosis and treatment will lead to improved medical therapy.

Humans↗
PubMed1996

Antifungal activity against allergic fungal sinusitis organisms.

A review of more than 50 allergic fungal sinusitis (AFS) patients indicates that most patients experience postoperative recurrences once weaned from oral steroids, leaving a glaring need for improved treatment. Topical antifungal therapy has not been described for AFS, but it could potentially lower fungal antigen loads via postoperative irrigations. No information exists to direct the choice of antifungal agent. The purpose of this study was to identify the appropriate drug to use for postoperative irrigations in AFS patients. Twenty-two fungal cultures grown from 15 AFS patients were studied for in vitro susceptibility to five common antifungal drugs: ketoconazole, amphotericin B, itraconazole, nystatin, and fluconazole. Results demonstrated that ketoconazole and amphotericin B were the most effective. Clinical trials are indicated to evaluate the efficacy of these drugs as a supplement to current AFS treatment.

Administration, Topical↗
PubMed1996

Using the KTP/532 laser to control epistaxis in patients with hereditary hemorrhagic telangiectasia.

Osler-Weber-Rendu disease remains a challenging clinical management problem. We have found the potassium-titanyl-phosphate laser (KTP/532) for photocoagulation of intranasal telangiectases to be useful in controlling epistaxis refractory to traditional surgical therapy. We present the case of a patient who had Osler-Weber-Rendu disease previously treated with partial septectomy, turbinectomy, and intranasal dermoplasty. A technique using the KTP laser for photocoagulation of intranasal telangiectases is described. This technique has resulted in reducing the frequency of epistaxis, decreasing the need for transfusions, diminishing hospital admissions, and improving quality of life for this patient. The KTP laser plays an important role in the management of recurrent epistaxis in patients with Osler-Weber-Rendu disease.

Epistaxis↗
PubMed1995

Radiation exposure in paranasal sinus imaging.

Plain films of the paranasal sinus were the imaging technique most frequently used before the advent of computed tomography. With improved resolution, computed tomography imaging has become the standard for evaluating patients with disease of the paranasal sinuses. With the widespread availability of computed tomography scanning, patients are likely to undergo multiple examinations during the treatment of their disease. Concern has been raised over the radiation exposure to the patient, in particular, with regard to radiation-induced cataracts. The purpose of this study is to measure the radiation dose associated with a variety of techniques for imaging the paranasal sinuses. A cadaveric specimen with thermoluminescent dosimeters placed over the orbits was used to measure radiation exposure during plain-film imaging, limited computed tomography, standard axial and coronal computed tomography, thin-cut axial computed tomography, and thin-cut coronal computed tomography. The measured dose in all these techniques is less than 4% of the acute dose associated with cataract formation.

Cataract↗
PubMed1994

Transmucosal cricopharyngeal myotomy with the potassium-titanyl-phosphate laser in the treatment of cricopharyngeal dysmotility.

Cricopharyngeal dysfunction is a relatively uncommon disorder that is widely misunderstood. Cricopharyngeal dysmotility is thought to represent abnormal function of the upper esophageal or cricopharyngeal sphincter. The cause of this dysfunction is related to uncoordinated pharyngeal swallowing, achalasia, or a combination of these factors. Unfortunately, standard diagnostic tests have not consistently demonstrated a failure of the cricopharyngeal sphincter to malfunction; therefore, cricopharyngeal myotomy has been suggested as a diagnostic and therapeutic tool in the treatment of dysmotility. Our report focuses on the current trends in the diagnosis and treatment of cricopharyngeal dysfunction. We also present a case report of a transmucosal cricopharyngeal myotomy performed with the potassium-titanyl-phosphate (KTP) laser. The KTP laser was found to be relatively safe and effective and did not demonstrate significant morbidity. Our conclusion was that a transmucosal cricopharyngeal myotomy with the KTP laser may represent a viable alternative for patients with cricopharyngeal dysmotility.

Deglutition Disorders↗
PubMed1994

Diagnosis of allergic fungal sinusitis.

Allergic fungal sinusitis is a noninvasive disease first recognized approximately one decade ago. It accounts for approximately 6% to 8% of all chronic sinusitis requiring surgical intervention and has become a subject of increasing interest to otolaryngologists and related specialists. Although certain signs and symptoms, as well as radiographic, intraoperative, and pathologic findings, may cause the physician to suspect allergic fungal sinusitis, no standards have been defined for establishing the diagnosis. It is extremely important to recognize allergic fungal sinusitis and differentiate it from chronic bacterial sinusitis and other forms of fungal sinusitis because the treatments and prognoses for these disorders vary significantly. To delineate a set of diagnostic criteria, we prospectively evaluated our most recent 15 patients with allergic fungal sinusitis. An allergy evaluation confirmed atopy through a strong history of inhalant mold allergies, an elevated total immunoglobulin E level, or a positive result of a skin test or radioallergosorbent test to fungal antigens in 100% of patients. All 15 patients had nasal polyposis, and 8 of 15 had asthma. There was a unilateral predominance in 13 of 15 cases. A characteristic computerized tomography finding of serpiginous areas of high attenuation in affected sinuses was seen in all patients, and 12 of 15 patients had some degree of radiographic bone erosion. Pathologic examination uniformly revealed eosinophilic mucus without fungal invasion into soft tissue; Charcot-Leyden crystals and peripheral eosinophilia were each observed in 6 of 15 patients. Every patient had fungus identified on fungal smear, although only 11 of 15 fungal cultures were positive.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Lacrimal drainage system injury in functional endoscopic sinus surgery. Incidence, analysis, and prevention.

Injury to the lacrimal drainage system with resultant epiphora is a complication of functional endoscopic sinus surgery. A study of 24 patients was conducted to determine the incidence and significance of lacrimal drainage system injuries during functional endoscopic sinus surgery. Intraoperative testing demonstrated seven occult injuries (15%) in 46 endoscopic procedures. Postoperative testing demonstrated diversion of lacrimal drainage into the middle meatus in two patients and spontaneous healing of the injured lacrimal drainage system with restoration of normal drainage in three of the patients available for follow-up testing. In no patient did epiphora develop. It is concluded that the nasolacrimal drainage system is in close proximity to the dissection cavity during functional endoscopic sinus surgery and, hence, is at risk for inadvertent injury. Occult damage to the nasolacrimal drainage system would appear to be a common event during functional endoscopic sinus surgery; however, the complication of postoperative epiphora is rare.

Child↗
PubMed1992

Zenker's diverticulotomy using the KTP/532 laser.

Multiple forms of surgical treatment exist for Zenker's diverticulum. Appropriate treatment needs to be tailored based on the needs of the patient and the resources and skills of the surgeon. We have reviewed the available surgical options and presented a series of 10 patients treated with a new technique, the KTP/532 laser diverticulotomy. The diverticulotomy is particularly well-suited to the debilitated patient who cannot tolerate a prolonged operation or a prolonged postoperative recovery. The results of the technique are comparable with those of other forms of diverticulotomy, and it is concluded that the KTP/532 laser is a simple, safe, and effective form of surgical treatment with exciting potential for future use.

Adult↗
PubMed1977

Hypopharyngeal diverticulum.

The diagnosis and surgical management of 26 patients with hypopharyngeal diverticulum treated in the Department of Otolaryngology of the Washington University Medical School from 1961 to 1973 is discussed. The surgical technique for external excision of the diverticulum is described in detail. Results and complications are presented. The surgical excision of hypopharyngeal diverticulum is a standard, safe, and proven method of management which can be expected to result in satisfactory long-term results with minimal morbidity.

Adult↗
PubMedDate not supplied

Stereotactic computer-assisted navigational sinus surgery: accuracy of an electromagnetic tracking system with the tissue debrider and when utilizing different headsets for the same patient.

The InstaTrak system by Visualization Technologies, Inc. (Woburn, MA) has recently introduced attachments that can be utilized to localize the tip of the XPS Straightshot debrider (Xomed Industries, Jacksonville, FL) during image-guided surgery. The accuracy of these newer attachments has not been objectively tested in a clinical setting. Our primary objective was to compare the actual instrument (XPS debrider tip) location with its computer screen location in the coronal, sagittal, and axial views. This was considered to be the "accuracy" of the instrument being tested. We secondarily compared its accuracy with the accuracy of the 0 degree and 45 degrees curved localizing aspirators in a prospective study. The manufacturer also recommends that the same headset used during scanning be utilized during surgery. A second objective therefore was to determine if a headset other than the one used during CT scanning could be used intraoperatively with an acceptable level of accuracy. Accuracy of the instruments between the patients' own headset (used during CT scanning) and a generic or research headset (not used during scanning) was compared intraoperatively. The third and final objective was to determine if the same headset could be used repeatedly with an acceptable level of accuracy. Generic "research" headsets were therefore utilized for a total of five surgeries per headset and visual accuracy between the multiply utilized research headsets and the patients' own headsets was recorded and compared. Anatomic localization accuracy was 1.06 mm for the XPS debrider, 0.89 mm for the 0 degree aspirator, and 1.05 mm for the 45 aspirator when the patients own headset was utilized. When the research (generic) headset was utilized the respective values were 0.69 mm for the debrider, 0.77 mm for the 0 degree aspirator, and 0.99 mm for the 45 degrees aspirator. With multiple utilization of a single headset, there was no significant loss in accuracy. In conclusion, the accuracy of the newly marketed attachment for the debrider was found to be comparable to the standard aspirators. Accuracy remained acceptable when a headset other than the one used during CT scanning was used intraoperatively. No loss in accuracy was noted when a headset was utilized more than once.

Debridement↗
PubMedDate not supplied

The frontal sinus rescue procedure: early experience and three-year follow-up.

The frontal sinus rescue (FSR), first described in 1997, has now been performed on 24 patients (32 sides) over a period of three years. It is a functional endoscopic surgical approach to correct an iatrogenically scarred and obstructed frontal recess, which cannot be successfully opened via a normal endoscopic frontal sinusotomy approach. It is utilized primarily for patients whose only remaining option is either a Draf-type drill-out (modified intranasal Lothrop) procedure or frontal sinus obliteration. The FSR is a technically challenging procedure, but faster, less difficult, and less destructive for the patient than a "drill-out" or frontal sinus obliteration. Once learned, it can save the patient from undergoing the more radical drill-out or obliterative procedure. The early experience and three-year follow-up with this new endoscopic procedure is presented in our first 24 patients (32 sides).

Adult↗
PubMedDate not supplied

The endoscopic management of chronic frontal sinusitis associated with frontal sinus posterior table erosion.

Expansile inflammatory diseases of the frontal sinuses may produce erosion of the posterior table of the frontal sinus. In these instances, the bone between sinus mucosa and intracranial dura is absent. Over the past decade, endoscopic frontal sinusotomy has emerged as the preferred technique for the treatment of refractory chronic frontal sinusitis. Endoscopic approaches also have a role in the most advanced instances of frontal sinusitis. A retrospective chart review of patients who were treated for frontal sinusitis with erosion of the frontal sinus posterior table was performed. Eight patients were identified. All patients underwent endoscopic frontal sinusotomy; some patients required multiple endoscopic procedures. Complete frontal recess dissection with identification of the frontal ostium was achieved for all involved frontal sinuses. In all cases, this postoperative result was monitored by CT scans (where indicated) and serial nasal endoscopy, which demonstrated good frontal sinus aeration and normal mucociliary clearance. Antibiotics were administered for culture-documented bacterial exacerbations, and systemic steroids were given for management of allergic fungal sinusitis and sinonasal polyposis associated with asthma. No patient underwent frontal sinus obliteration or cranialization. No suppurative intracranial complications were noted during the postoperative period. Endoscopic frontal sinusotomy can be used safely for the definitive management of frontal sinusitis associated with posterior table erosion. In fact, endoscopic techniques may represent the preferred approach for the treatment of this problem. Such an approach avoids the morbidity of more destructive alternatives (such as obliteration), and serves to create a frontal sinus with normal mucociliary clearance.

Adult↗
PubMedDate not supplied

Allergic fungal sinusitis: a four-year follow-up.

Allergic fungal sinusitis (AFS), first described over 18 years ago and subsequently identified using established criteria, remains a challenge to treat. Our protocol has included complete functional endoscopic sinus surgery to remove the fungal load and restore physiologic mucous clearance. The patient is treated with prednisone for several months and followed monthly with total serum IgE levels and an established endoscopic mucosal staging system. A group of 11 patients first treated in 1994 and presented at the 1995 American Rhinology Society Spring meeting are being presented again to provide an update on their progress over the past four years. A great deal of experience has been gained from their treatment and has continued to modify our postoperative medical management. An overview of AFS, our evolving and current treatment protocol, and possible future trends are discussed in this paper.

Anti-Inflammatory Agents↗
PubMedDate not supplied

Combined endoscopic intranasal and external frontal sinusotomy.

We review our experience treating patients with medically refractory frontal sinusitis that could not be relieved with endoscopic intranasal surgery alone. Fourteen combined external and intranasal endoscopic frontal sinusotomies were performed on a consecutive sample of 11 patients presenting over a 38-month period of study. Postoperative results were classified as cured, improved, unchanged, or worse, based on patient symptoms and physical findings. At a mean postoperative follow-up of 19 months (range 4-36), 100% of these patients had benefited from this technique (7 cured, 4 improved, 0 unchanged, 0 worse). There were no major complications and natural sinus physiology was preserved. We conclude that a combined external and endoscopic intranasal frontal sinusotomy is an effective alternative to frontal sinus obliteration.

Adult↗
PubMedDate not supplied

Capsaicin's effect on rat nasal mucosa substance P release: experimental basis for vasomotor rhinitis treatment.

Substance P (SP) is one of several neuropeptides found in nasal mucosa. It exists primarily in sensory afferent neurons, which are best demonstrated by immunohistochemical staining. These substance P-like immunoreactive (SPLI) nerve fibers are unmyelinated C fibers, which connect to the trigeminal ganglion and the spinal trigeminal nucleus. They are found around vessels and seromucinous glands in the submucosa. When the nasal mucosa receives a noxious stimulus, SP is released and acts orthodromically as a comediator of nasal pain, while antidromically it induces vasodilatation, plasma extravasation, mucosal edema, and rhinorrhea. Its antidromic effects have been implicated in vasomotor rhinitis and can be blocked by topical intranasal capsaicin application. Wolf and others have demonstrated in human subjects that vasomotor rhinitis can be blocked up to 1 year by a series of intranasal capsaicin applications. It has not yet been demonstrated that nasal mucous SP levels following noxious nasal stimulus change after intranasal capsaicin pretreatment. Consequently a project was designed to determine whether intranasal capsaicin pretreatment would affect nasal substance P release measured in nasal secretion. Nasal secretion SP levels were measured before and after noxious nasal stimulus in controls and in capsaicin pretreated rats. The difference in measured nasal secretion SP levels were significant (p < 0.05).

Administration, Intranasal↗