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Biomedical subjects

D W Kennedy

Publications and source records attributed to D W Kennedy.

At least 19 recordsLinked to original sources
PubMed2005

Treatment of chronic rhinosinusitis with high-dose oral terbinafine: a double blind, placebo-controlled study.

OBJECTIVES: To evaluate antifungal terbinafine in patients with chronic rhinosinusitis. STUDY DESIGN: Randomized, double-blind, placebo-controlled multicenter pilot study. METHODS: Fifty-three adults with chronic rhinosinusitis received terbinafine 625 mg/day (n = 25) or placebo (n = 28) once daily for 6 weeks. Sinus secretions were collected at screening for mycology. Computed tomography was graded for extent of opacification at baseline and at week 6 using a modification of the Lund-Mackay scoring system. Patients recorded rhinosinusitis symptoms on a visual analogue scale and completed the Rhinosinusitis Disability Index. RESULTS: Positive fungal cultures were found in 41 of 53 patients (17 terbinafine, 24 placebo). (Two subjects from the Terbinafine group and one subject from the control group had no week 6 data). The mean opacification scores pre- and posttreatment for the entire study group improved from 24.2 to 22.5 in placebo (n = 26) and from 26.3 to 24.2 in terbinafine group (n = 23). The least squares means for percent change from baseline (SE) were -6.0 (8.7) for placebo compared with -7.2 (8.1) for terbinafine; 95% confidence interval for treatment difference (-18.9, 21.1); P = .91. Results were similar when only patients with positive fungal cultures were evaluated in the efficacy analysis. Investigator therapeutic evaluations and sinus symptom scores were not significantly different between the two groups at baseline or at treatment completion. CONCLUSION: Treatment with terbinafine failed to improve the symptoms or radiographic appearance of chronic rhinosinusitis even when nasal irrigation samples were positive for fungus on culture. One consideration is that the fungi isolated were not a major pathologic factor in this cohort. It is also possible that, even at high dose, terbinafine may not have maintained therapeutic levels in the nasal secretions.

Administration, Oral↗
PubMed2001

Rigid nasal endoscopy versus sinus puncture and aspiration for microbiologic documentation of acute bacterial maxillary sinusitis.

Sinus puncture and aspiration is an invasive procedure that hinders patient enrollment in studies of acute bacterial maxillary sinusitis (ABMS). Pain and minor bleeding also limit its potential diagnostic utility in clinical practice. Cultures obtained by rigid nasal endoscopy were compared with those from sinus puncture and aspiration in 53 patients with ABMS; 46 patients were assessable. Considering recovery of Haemophilus influenzae, Moraxella catarrhalis, or Streptococcus pneumoniae from puncture and aspiration as the gold standard, endoscopy cultures demonstrated a sensitivity of 85.7% (95% confidence interval, 56.2-97.5), specificity of 90.6% (73.8-97.5), positive predictive value of 80% (51.4-94.7), negative predictive value of 93.5% (77.2-98.9), and accuracy of 89.1% (75.6-95.9). Ten adverse events related to puncture and aspiration occurred in 5 (9.6%) of 52 patients; there were no endoscopy-related adverse events. In our study, the largest to date, endoscopic sampling compared favorably with puncture and aspiration for identifying H. influenzae, M. catarrhalis, and S. pneumoniae in ABMS and produced less morbidity.

Acute Disease↗
PubMed2001

Surgical intervention for sinusitis in adults.

This article briefly reviews the latest developments in the indications for and performance of paranasal sinus surgery. Although the central role of medical therapy in the treatment of inflammatory chronic rhinosinusitis remains essentially unchanged, the past few years have seen a gradual evolution in the indications for, and the expectations of, sinus surgery. Although many controversies still exist in the optimal management of rhinosinusitis, especially regarding the treatment of chronic frontal rhinosinusitis, the long-term beneficial role of functional endoscopic sinus techniques in combination with medical therapy has become firmly established for patients who do not respond well to medical treatment alone.

Adult↗
PubMed2001

Revision endoscopic frontal sinus surgery.

Frontal sinusitis following functional endoscopic sinus surgery may represent persistent, recurrent, or iatrogenic disease. The narrow frontal recess is unforgiving of technical errors, and surgery within its confines requires ample training, skill, and patience. Revision surgery in this area, compromised by scarring and long-standing mucosal disease, demands even more of the endoscopic sinus surgeon. While successful treatment of this condition is a formidable task, strict attention to principles of proper medical and surgical therapy can increase the chances of a favorable outcome.

Chronic Disease↗
PubMed2001

The ATLS course, a survey of 228 ATLS providers.

Advanced Trauma Life Support (ATLS) courses teach a system for the initial assessment and management of trauma patients that aims to optimise initial care and reduce mortality and morbidity, and have been adopted worldwide. This questionnaire survey characterised those who took up this particular educational resource in Scotland during a four year period after its introduction, and analysed how they felt it had affected their clinical competence. Irrespective of their previous level of training and experience, nearly all surgeons and anaesthetists who took this course felt that it had improved their clinical skills and other professional attributes. The significance of these results is discussed in the context of postgraduate surgical and anaesthetic training in Scotland.

Attitude of Health Personnel↗
PubMed2000

Use of an electronic nose to distinguish cerebrospinal fluid from serum.

BACKGROUND: Efforts to mimic the biologic olfactory system have resulted in the development of an electronic nose, whereby volatile gases may be identified by means of organic semiconductors. Such devices have been used in the food and beverage industry for quality-control purposes, but to date have not been used in the field of medicine. OBJECTIVE: To present the application of an electronic nose for clinical decision making by assessing the ability of an electronic nose to distinguish cerebrospinal fluid (CSF) from serum. DESIGN: Randomized, prospective, masked study. SUBJECTS: Nineteen matched sets of CSF and serum from inpatients at a university hospital. RESULTS: The electronic nose was able to distinguish CSF from serum in 18 of 19 patients. The data points for 18 of 19 CSF and 18 of 19 serum samples were within statistically distinct cluster groups, suggesting that the device is able to identify an unknown sample as CSF or serum. CONCLUSIONS: This new technology is able to distinguish CSF from serum with a high degree of accuracy and speed, and with small sample quantity, potentially allowing the physician to identify reliably CSF otorrhea or rhinorrhea. This revolutionary diagnostic approach may have further, widespread application in the field of otorhinolaryngology and in medicine as a whole.

Blood↗
PubMed2000

Objective and subjective outcomes in surgery for chronic sinusitis.

Endoscopic and radiological findings in patients with chronic sinusitis do not always correlate with symptoms. Studies suggest that postoperative endoscopic examination of the sinonasal cavity provides prognostic information regarding the potential for future episodes of sinusitis and the need for revision surgery. It is recommended that findings on nasal endoscopy be included in future outcomes studies on sinusitis.

Chronic Disease↗
PubMed2000

Bone involvement in sinusitis: an apparent pathway for the spread of disease.

OBJECTIVES/HYPOTHESIS: To study the effects of bone involvement in experimentally induced sinusitis and the effect of involved bone on the overlying mucosa. STUDY DESIGN: Animal study. METHODS: Sinusitis was induced unilaterally with Pseudomonas aeruginosa in the maxillary sinus of 19 New Zealand white rabbits. At 6 weeks, the pathogenic organism was confirmed by culture, and a segment of the bone from the medial wall of the sinus implanted in a submucosal pocket in the opposite sinus. The rabbits were killed at predetermined time intervals up to 13 weeks from sinusitis induction, and en bloc sinus sections were decalcified and stained. RESULTS: The implanted bone reabsorbed partially or totally in all specimens. However, the study revealed clear histological evidence of bone involvement adjacent to the infected sinuses and the bony changes extended to the noninfected side in all specimens. The histological findings were identical to those seen in chronic osteomyelitis. CONCLUSIONS: This study demonstrates the ability for pseudomonal sinusitis, at least in the presence of surgical intervention, to involve bone at a distance from the site of primary infection in the absence of intervening mucosal disease. If confirmed with additional organisms and models, these findings have significant implications for the therapeutic management of chronic sinus disease.

Animals↗
PubMed1999

Long-term impact of functional endoscopic sinus surgery on asthma.

Using objective and subjective criteria, we performed a study to assess the long-term impact of functional endoscopic sinus surgery (FESS) in patients with chronic rhinosinusitis and asthma at an average follow-up of 6.5 years. One hundred twenty patients who underwent FESS for chronic rhinosinusitis were followed up for an average of 6.5 years (range 6.0 to 10.6 years). Seventy-two (60%) patients responded to a follow-up questionnaire, and 30 (42%) of them reported a history of asthma. Subjective levels of improvement and assessments of medication need were evaluated and statistically assessed with parametric and nonparametric methods. Of these 30 patients, 27 (90%) reported that their asthma was better than it had been before FESS, 6.5 years ago. Average reported improvement increased from 49% at 1.1 years after surgery to 65% at 6.5 years after surgery. Asthma attacks declined in 20 of 27 (74.1%). Medication use for asthma showed similar improvement, with approximately half reporting less inhaler usage and nearly two thirds reporting less oral steroid use. This study demonstrates that a combination of FESS, careful postoperative care, and appropriate medical therapy for chronic rhinosinusitis has a favorable long-term effect on asthma in patients with symptomatic chronic sinusitis. In this study asthma severity, frequency of attacks, and medication need were all improved.

Asthma↗
PubMed1999

Endoscopic septoplasty: indications, technique, and results.

Endoscopic septoplasty is an attractive alternative to traditional "headlight" approaches to septoplasty. The primary advantage of the technique is the ability to reduce morbidity and postoperative swelling in isolated septal deviations by limiting the dissection to the area of the deviation. This ability to markedly reduce the extent of subperichondrial dissection is particularly valuable in patients who have undergone prior septal cartilage resection. Other advantages include improved visualization, particularly in posterior septal deformities; improved surgical transition between septoplasty and sinus surgery; and its use as an effective teaching tool. We present our experience with endoscopic septoplasty in a series of 111 patients. Surgical indications, technique, and complications are discussed.

Congenital Abnormalities↗
PubMed1999

Dissimilatory reduction of Fe(III) and other electron acceptors by a Thermus isolate.

A thermophilic bacterium that can use O2, NO3-, Fe(III), and S0 as terminal electron acceptors for growth was isolated from groundwater sampled at a 3.2-km depth in a South African gold mine. This organism, designated SA-01, clustered most closely with members of the genus Thermus, as determined by 16S rRNA gene (rDNA) sequence analysis. The 16S rDNA sequence of SA-01 was >98% similar to that of Thermus strain NMX2 A.1, which was previously isolated by other investigators from a thermal spring in New Mexico. Strain NMX2 A.1 was also able to reduce Fe(III) and other electron acceptors. Neither SA-01 nor NMX2 A.1 grew fermentatively, i.e., addition of an external electron acceptor was required for anaerobic growth. Thermus strain SA-01 reduced soluble Fe(III) complexed with citrate or nitrilotriacetic acid (NTA); however, it could reduce only relatively small quantities (0.5 mM) of hydrous ferric oxide except when the humic acid analog 2,6-anthraquinone disulfonate was added as an electron shuttle, in which case 10 mM Fe(III) was reduced. Fe(III)-NTA was reduced quantitatively to Fe(II); reduction of Fe(III)-NTA was coupled to the oxidation of lactate and supported growth through three consecutive transfers. Suspensions of Thermus strain SA-01 cells also reduced Mn(IV), Co(III)-EDTA, Cr(VI), and U(VI). Mn(IV)-oxide was reduced in the presence of either lactate or H2. Both strains were also able to mineralize NTA to CO2 and to couple its oxidation to Fe(III) reduction and growth. The optimum temperature for growth and Fe(III) reduction by Thermus strains SA-01 and NMX2 A.1 is approximately 65 degrees C; their optimum pH is 6.5 to 7.0. This is the first report of a Thermus sp. being able to couple the oxidation of organic compounds to the reduction of Fe, Mn, or S.

Biodegradation, Environmental↗
PubMed1998

Mature monocytic cells enter tissues and engraft.

The goal of this study was to identify the circulating cell that is the immediate precursor of tissue macrophages. ROSA 26 marrow mononuclear cells (containing the beta-geo transgene that encodes beta-galactosidase and neomycin resistance activities) were cultured in the presence of macrophage colony-stimulating factor and flt3 Ligand for 6 days to generate monocytic cells at all stages of maturation. Expanded monocyte cells (EMC), the immature (ER-MP12(+)) and more mature (ER-MP20(+)) subpopulations, were transplanted into irradiated B6/129 F2 mice. beta-gal staining of tissue sections from animals 15 min after transplantation demonstrated that the donor cells landed randomly. By 3 h, donor cells in lung and liver were more frequent in animals transplanted with ER-MP20(+) (more mature) EMC than in animals transplanted with unseparated EMC or fresh marrow mononuclear cells, a pattern that persisted at 3 and 7 days. At 3 days, donor cells were found in spleen, liver, lung, and brain (rarely) as clusters as well as individual cells. By 7 and 14 days, the clusters had increased in size, and the cells expressed the macrophage antigen F4/80, suggesting that further replication and differentiation had occurred. PCR for the neogene was used to quantitate the amount of donor DNA in tissues from transplanted animals and confirmed that ER-MP20(+) EMC preferentially engrafted. These data demonstrate that a mature monocytic cell gives rise to tissue macrophages. Because these cells can be expanded and manipulated in vitro, they may be a suitable target population for gene therapy of lysosomal storage diseases.

Animals↗
PubMed1998

Correlation of intraocular pressure and central corneal thickness in normal myopic eyes and after laser in situ keratomileusis.

PURPOSE: To determine the relationship of intraocular pressure (IOP) and central corneal thickness (CCT) in normal myopic eyes and after laser in situ keratomileusis (LASIK). SETTING: TLC The Windsor Laser Center, Windsor, Ontario, Canada. METHODS: Intraocular pressure measured by Goldmann applanation tonometry and CCT by ultrasonic pachymetry were determined in a group of untreated corneas of 120 patients (203 eyes) and in 50 patients (85 eyes) pre- and post-LASIK. Statistical analyses were performed with the Pearson correlation coefficient and paired Student t test. RESULTS: In the untreated group of 288 eyes, mean CCT was 544.0 microns +/- 37.3 (SD) (range 461 to 664 microns) and mean IOP, 15.6 +/- 2.7 mm Hg (range 10 to 24 mm Hg). The correlation between IOP and CCT in this group was highly significant (r = 0.44; P < .0001). The slope was 0.032 mm Hg/micron of CCT or an approximate decrease of 1 mm Hg, for a reduction in CCT of 31.3 microns. In the post-LASIK group, mean CCT dropped approximately 73.0 microns to 479.5 +/- 41.2 microns (range 408 to 503 microns) and IOP dropped to a mean of 13.6 +/- 3.3 mm Hg (range 7 to 22 mm Hg). A significant correlation was found between IOP and CCT after LASIK (r = 0.33; P < .002). The difference between the mean pre- and post-LASIK measurements of applanation IOP was 2.5 mm Hg, which was significant (P < .0001). The post-LASIK slope was 0.027 mm Hg/micron, or a decrease of 1.0 mm Hg per 37.8 microns reduction in CCT. CONCLUSION: Central corneal thickness is an important variable in the evaluation of applanation IOP and should be included in the assessment of any case of potential glaucoma or ocular hypertension, particularly in eyes with previous photoablative refractive surgery.

Adult↗
PubMed1998

Surgical management of rhinosinusitis.

Rhinosinusitis, an inflammatory disease involving the nasal cavity and paranasal sinuses, affects millions of individuals and its costs run into the billions of dollars. The development of rigid nasal telescopes has revolutionized the diagnosis and treatment of this disease. Recent endoscopic evaluations have identified certain key areas within the nasal cavity that, when inflamed, lead to sinus ostial obstruction and subsequent sinus infection. The telescope's increased visualization capabilities permits the physician to better target and individualize patient care and the techniques that have grown out of this new tool allow for a more physiologic approach to surgical treatment. The pathophysiology of rhinosinusitis and its medical treatments are considered. Indications for surgical management are reviewed, with attention to nontraditional or extended applications of endoscopic techniques. Preoperative evaluation, including nasal endoscopy and radiographic imaging, as well as surgical technique and postoperative care are discussed. Evaluation of outcomes from surgical treatment in appropriately selected patients have demonstrated the success of this technique.

Endoscopy↗
PubMed1998

Long-term results of functional endoscopic sinus surgery.

Although much has been reported on the short-term outcomes of functional endoscopic sinus surgery (FESS), little has been reported with regard to its long-term impact on chronic sinusitis. The senior author (D.W.K.) previously reported detailed subjective and endoscopic follow-up on 120 patients at a mean of 18 months following surgery. This current study represents a long-term follow-up (average, 7.8 years) of 72 patients (60%) from the same cohort. Of patients responding to a question about overall symptoms, 98.4% (n = 66) reported improvement compared with before surgery. There was a trend toward continued subjective improvement in symptom scores with longer follow-up, but the changes did not reach statistical significance. Thirteen patients (18%) required subsequent surgical procedures. Preoperative stage, prior surgery, and other factors that might affect outcome were evaluated. The study demonstrates that excellent subjective results following FESS can be maintained in the long term with appropriate postoperative management. The study also validates the concept that patients in whom the cavity can be normalized following surgery are unlikely to require further surgery.

Anti-Bacterial Agents↗