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Biomedical subjects

D W Kennedy

Publications and source records attributed to D W Kennedy.

At least 55 records · Page 3Linked to original sources
PubMed1995

Quantification for staging sinusitis. The Staging and Therapy Group.

A method of quantifying the symptoms, radiologic data, and endoscopic findings in extensive sinus disease is proposed. It is intended to enable clinicians to classify patients with extensive sinus disease according to severity of disease and prognostic category. The rubric of extensive sinus disease, for scoring and staging, comprises recurrent acute sinusitis and chronic sinusitis, but not an isolated episode of acute sinusitis. The method assigns simple numeric scores to specific computed tomography findings, elements of surgical history, presence of defining symptoms of sinusitis, and endoscopic appearance. This quantitative system may be rationalized into a staging system.

Adult↗
PubMed1995

Medical management of sinusitis: educational goals and management guidelines. The International Conference on sinus Disease.

The primary goal of sinusitis management is resolution of infection, leading to patency of the ostiomeatal complex. Antibiotics and decongestants are the cornerstones of therapy for acute sinusitis. Diagnosis of acute sinusitis is based on the history and physical findings. Sinusitis is considered to be acute or recurrent acute if infection resolves without residual mucosal damage. Choices for first-line antibiotic therapy include adequate dosages of trimethoprim-sulfamethoxazole, loracarbef, and amoxicillin-clavulanate. Decongestants and mucoevacuants may reduce tissue edema, facilitate drainage, and maintain ostial patency. Topical corticosteroids are useful additional therapy in allergic rhinosinusitis and as an aid in the long-term management of chronic sinusitis. Parenteral corticosteroids have no role in first-line management of acute or recurrent acute sinusitis.

Chronic Disease↗
PubMed1995

Paranasal sinuses:anatomic terminology and nomenclature.

A consensus on the preferred modern usage of potentially confusing or ambiguous terms in sinus anatomy and nomenclature is described. These terms are intended to provide clear communication among otorhinolaryngologists and serve as a basis for discussion among anatomists. Terminology is in English and based on Latin nomenclature. An attempt has been made to reconcile or eliminate duplication, redundancy, and overlap in terminology that have arisen over the past century. A key concept is that the ethmoid complex is divided into anterior and posterior sections by the basal lamella of the middle turbinate.

Ethmoid Sinus↗
PubMed1994

Complications of ethmoidectomy: a survey of fellows of the American Academy of Otolaryngology-Head and Neck Surgery.

A survey regarding complications of sinus surgery was mailed to 6969 otolaryngologists; 3933 responses (56.44%) were obtained, and 3043 of these physicians (77.37%) reported that they performed ethmoidectomy. Completed questionnaires were available for review from 42.21% of all Academy fellows (2942 physicians). Responses were tabulated and summarized question by question. Physicians generally did not rate their residency training in ethmoidectomy highly. The survey confirmed that there has been a marked rise in the frequency of ethmoidectomy and in the amount of training in ethmoidectomy since 1985. Empirical complication rates were calculated for different procedures and time periods. Poisson regression models were then constructed to describe the rate of complications under varying conditions such as the type of surgery performed, time period, experience and training of the surgeon, and type of complication encountered. The models permitted determination of the statistical significance of variables in relation to incidence or complications. The study did not demonstrate a clear and consistent statistical relationship between the incidence of complications, the type of surgery performed, and the quality of training. Moreover, physicians who provided data from record review tended to report higher rates than those who estimated responses. The majority of physicians discussed specific potential complications with their patients before surgery and routinely performed preoperative computed tomography. The study demonstrated that physicians who experienced complications at higher rates were more likely to discuss these complications with patients before surgery.

Ethmoid Sinus↗
PubMed1994

The effect of human olfactory biopsy on olfaction: a preliminary report.

Normal human olfactory function is subject to a wide variety of factors. Although biopsy of human olfactory neuroepithelium has been reported by several researchers, there are no studies which have evaluated the effect of this procedure on olfactory function. In this retrospective study, we sought to determine if tissue removal from the olfactory cleft has an adverse influence on the sense of smell. Nineteen subjects underwent bilateral olfactory testing and subsequent endoscopic olfactory mucosal biopsy. All subjects were retested 6 weeks to 1 year after olfactory neuroepithelial biopsy. No statistical difference was found between olfactory tests performed before or after biopsy. These data suggest that biopsy of human olfactory neuroepithelium has no discernible adverse effect on the ability to smell.

Alzheimer Disease↗
PubMed1994

Neuroimaging in patients with olfactory dysfunction.

This review summarizes neuroimaging findings in patients with olfactory dysfunction. Neuroimaging techniques offer a valuable means for evaluating and distinguishing disorders of olfaction. The new or refined techniques make it possible to pinpoint the anatomic and pathologic changes of many disorders of the sinonasal cavity and brain that cause olfactory deficits. From an anatomic point of view, the causes of olfactory deficits generally can be classified as peripheral or central (intracranial). In the assessment of the peripheral causes, CT and MR imaging reveal anatomic information and structural changes, enable a differential diagnosis, and provide a road map for surgical intervention. In the evaluation of the central causes, MR imaging, positron emission tomography, or single-photon emission computed tomography can provide the links between olfactory dysfunction and structural or functional changes in the brain.

Brain Diseases↗
PubMed1993

Frameless stereotaxic integration of CT imaging data: accuracy and initial applications.

To evaluate the spatial accuracy of a rapid interactive method of transferring computed tomographic (CT) information between its display on a computer screen to its source (test object, operating field), a multidimensional computer combined with a six-jointed position-sensing mechanical arm was tested with a Plexiglas model consisting of 50 rods of varied height and known location, a plastic replica of the skull, and, subsequently, three patients. The median error value between image and real location was 1-2 mm (P > .95), regardless of the registration target sites. The accuracy, however, increased with the selection of widespread registration points, and 95% of all errors were below 3.70 mm (P > .95). The results compare favorably with the four most commonly used stereotaxic framed units. A misregistration error of 0.3-2.2 mm was found during intraoperative correlation between anatomy on the CT display and actual anatomic location in the operative field.

Child↗
PubMed1993

The effects of etidronate disodium on progressive hearing loss from otosclerosis.

A 2-year prospective double-blind study was performed to evaluate the role of etidronate disodium for the treatment of progressive hearing loss in patients with otosclerosis. A pulsed dosage regimen was used during the 2-year period and the patients were followed up with otologic and audiometric examinations. Although statistically significant differences were not achieved between the study and control groups, the study did reveal a trend toward stabilization or improvement in air conduction thresholds in some frequencies (1000 and 4000 Hz) and in bone conduction thresholds at other frequencies (500, 1000, and 2000 Hz). The incidence of adverse side effects was similar in the treatment and control groups. Although no definite conclusions can be drawn from this pilot study, the findings provide encouragement for performing a larger and longer-term study.

Adult↗
PubMed1993

Ruminal distribution of zinc in steers fed a polysaccharide-zinc complex or zinc oxide.

Six Holstein steers (initial BW 335 kg) were used in a replicated 3 x 3 Latin square design to study the distribution of Zn in ruminal contents from a conventional Zn source (ZnO) or Zn sequestered to a polysaccharide (PC-Zn). Treatments consisted of a basal diet (no Zn supplementation) and the basal diet supplemented with Zn from either PC-Zn or ZnO. Steers were provided with 208, 920, or 896 mg of Zn/d from basal, PC-Zn, or ZnO, respectively. On collection day, steers were dosed with 800 mg of Zn from each Zn supplement and whole ruminal contents (WRC) were sampled at 1, 2, 4, 6, and 8 h postdosing. The cell-free (soluble) Zn concentrations in steers fed the PC-Zn or ZnO supplements decreased (P < .05) rapidly after dosing. Mean Zn concentrations of the cell-free fraction were considerably lower than either microbial or particle fractions of WRC. Compared with ZnO, the PC-Zn source resulted in higher (P < .05) cell-free Zn at 1 and 2 h after dosing and higher (P < .05) Zn concentrations (micrograms/gram of DM) in the fluid- and particle-associated microbial and particle fractions. Compared with basal, fluid-associated microbial DM concentration tended to be higher (P < .10) at 6 and 8 h with PC-Zn and ZnO. Results indicate a rapid disappearance of Zn from the soluble fraction and a high concentration of Zn in the DM of the microbial and particle fractions of WRC. Furthermore, PC-Zn resulted in higher levels of Zn in all fractions of WRC, and Zn supplementation tended to increase microbial DM production at later sampling times.

Administration, Oral↗
PubMed1992

The utility of magnetic resonance imaging in the diagnosis of intranasal meningoencephaloceles.

We present three patients in whom the diagnosis of intranasal meningoencephalocele was made by magnetic resonance imaging. The initial clinical evaluation and computed tomographic examinations of these patients failed to distinguish between chronic inflammation and intranasal meningoencephalocele. Although both computed tomography and magnetic resonance imaging are used to distinguish between normal, inflammatory, and neoplastic tissue in the nasal cavity and paranasal sinuses, limitations do exist and these are the focus of our communication. A clear understanding of the efficacy of these radiographic modalities will enhance surgical planning and can preclude severe complications.

Encephalocele↗
PubMed1992

Current concepts in the surgical management of chronic and recurrent acute sinusitis.

It was previously believed that sinusitis lasting longer than 3 months might lead to irreversible disease. Experience with functional endoscopic sinus surgery indicates that this is rarely the case. Functional endoscopic sinus surgery describes an approach whereby target areas of obstruction are cleared of disease, which allows for ventilation of secondarily involved sinuses and return of mucociliary function. Although endoscopic sinus surgery is one of the techniques most frequently used to manage chronic sinus disease, it is not a suitable surgical approach for every otolaryngologist or all patient settings. Success with this endoscopic approach for chronic sinus disease is based primarily on rigorous perioperative medical care and postoperative surgical debridement. The greatest advancement that the nasal endoscope has brought to patient care is the ability to diagnose disease and follow objectively the effects of different treatment modalities. This advantage is recognized by allergists and used at several centers.

Acute Disease↗
PubMed1992

Current concepts in the surgical management of nasal polyposis.

One of the most common and occasionally frustrating health care problems is that of nasal polyposis. Patient symptoms are debilitating and have a tendency to recur despite the treatment modality used. Nasal endoscopy is a significant advancement for the early diagnosis and objective assessment of treatment modalities used for nasal polyposis. Surgery used in conjunction with medical therapies offers a safe, thorough means of relieving patient symptoms. It is possible to monitor these patients closely for recurrence with nasal endoscopy as well as debride early recurrences before they become symptomatic.

Endoscopy↗
PubMed1992

Inverted papilloma: evaluation with MR imaging.

The authors examined the magnetic resonance (MR) appearance of inverted papillomas to determine if this histologically benign lesion could be distinguished from malignancies of the sinonasal cavity. MR images in 10 patients with histologically proved inverted papilloma were retrospectively reviewed. The signal intensity of inverted papillomas on short repetition time (TR) images was iso- to slightly hypertintense to muscle in all 10 patients. Inverted papillomas had intermediate signal intensity on the long TR/echo time (TE) images. The tumors were iso- or slightly hypointense to fat on long TR/short TE images. In the seven patients who received gadopentetate dimeglumine, all inverted papillomas showed solid inhomogeneous enhancement. A review of eight sinonasal malignancies showed no distinctive signal intensity or enhancement characteristics to help differentiate inverted papillomas from various malignant tumors. The authors conclude that there is no signature MR appearance for the benign inverted papilloma. The main utility of MR imaging is in defining the extent of the lesion.

Adipose Tissue↗