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Biomedical subjects

E B Kern

Publications and source records attributed to E B Kern.

106 records · Page 6Linked to original sources
PubMedDate not supplied

Laryngeal regulation of airway resistance. II. Pulmonary receptor reflexes.

The response of laryngeal airway resistance to pulmonary receptor stimulation was studied in 20 mongrel dogs anesthetized with alpha-chloralose (80 mg/kg). Stimulation of pulmonary stretch receptors by lung inflation inhibited the phasic variation of laryngeal resistance during respiration and produced a sustained reduction of laryngeal resistance, which was related to lung inflation pressure. Stimulation of pulmonary J-receptors with capsaicin produced apnea and a large increase in laryngea resistance. Capsaicin produced this reflex when injected into the pulmonary circulation but not when injected into the systemic circulation. Irritant receptor stimulation with histamine hydrochloride produced tachypnea and a reduction in inspiratory laryngeal resistance. Pulmonary receptor reflexes were abolished by dividing the vagus nerves distal to the origin of the recurrent laryngeal nerves. Laryngeal reflexes may be important in the regulation of respiration and the production of physiologic and pathologic alterations in pumonary function.

Airway Resistance↗
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The nasal valve: a rhinomanometric evaluation of maximum nasal inspiratory flow and pressure curves.

The nasal valve is defined as the region of the nasal airway bounded by the caudal end of the upper lateral cartilages and the nasal septum. During inspiration this region of the nasal airway may collapse and produce a marked increase in nasal airway resistance. To define the function of this region, measurements of the nasal airway resistance in 38 subjects were performed. Using anterior mask rhinomanometry, right and left total nasal resistance, right and left upstream nasal resistance, right and left downstream nasal resistance, and right and left transmural collapsing pressure of the nasal valve were measured. Subjects who complained of nasal obstruction and had anatomical evidence of anterior nasal deformity showed a reduced level of transmural closing pressure compared with subjects complaining of no airway obstruction or those with anatomical evidence of posterior nasal deformity. This suggests that premature collapse of the nasal valve due to inadequate cartilaginous support is an important factor in producing nasal airway obstruction in individuals with anterior nasal septal abnormality. In those individuals with nasal airway obstruction and anatomical evidence of posterior nasal deformity, downstream nasal resistance was elevated compared with the asymptomatic group and the group with anatomical evidence of anterior nasal septal deformity. This paper demonstrates that premature collapse of the nasal valve is responsible for the symptom of nasal obstruction in many patients with anterior nasal septal deformity.

Air Pressure↗
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Sleep and breathing disturbance secondary to nasal obstruction.

The purpose of this study was to determine the effect of acute nasal obstruction on sleep and breathing in eight normal persons. The subjects were randomized into two groups. One night the subject was studied with the nose open and a second night with the nose obstructed. The electroencephalogram, electrocardiogram, inspiratory effort, nasal and oral airflow, and oxygen saturation were monitored. Sleep proved to be both subjectively and objectively disturbed. The subjects with the nose obstructed awoke more often, had a greater number of changes in sleep stage, had a prolongation of rapid-eye-movement (REM) latency, and spent a greater amount of time in stage I non-REM sleep (light sleep). Acute nasal obstruction caused a statistically significant increase in the number of partial and total obstructive respiratory events (obstructive hypopnea and obstructive apnea). Sleep apnea developed in one subject during this study merely on the basis of acute nasal obstruction.

Adult↗
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Carcinoma of the nasal septum: experience with 85 cases.

A review of 85 Mayo Clinic patients with carcinoma of the nasal septum revealed squamous cell carcinoma (58 patients) to be the predominant cell type, with adenocarcinoma (12 patients) and malignant melanoma (7 patients) being next in frequency. Twenty-five (29%) of the 85 patients had metastatic disease. Twenty percent (17) of the patients had another malignancy at some time during their lives. The study suggests that tobacco smoking may have a role in the etiology of squamous cell carcinomas of the nasal septum. In most patients, wide excision was the initial choice of treatment.

Carcinoma↗
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Prosthetic closure of nasal septal perforations.

One hundred seventy-one patients had closure of symptomatic nasal septal perforations by insertion of a Silastic nasal septal prosthesis between June 1972 and August 1981. Follow-up revealed that successful closure of the defect was accomplished in 73% of cases, with reduction in crusting and epistaxis and improvement in nasal respiration in many cases. Prefabricated prostheses have been effective in treating smaller perforations. The treatment of four patients with unusually large septal perforations by custom-carved prostheses sized using computerized axial tomographic scanning is described.

Adolescent↗
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Isolated sphenoid sinus lesions.

Pathologic conditions involving the sphenoid sinus alone are rare. A retrospective chart review was performed of 182 cases of isolated sphenoid sinus lesions seen at the Mayo Clinic between 1935 and 1998. There were 53 cases of sinusitis, 44 mucoceles, and 15 fungus-related cases (61.5%), and the rest of the cases were divided among numerous other pathologic entities. Symptoms, differential diagnosis, and various therapeutic modalities are discussed. We believe that these data will be useful to clinicians considering multiple pathologic possibilities when faced with a lesion involving the sphenoid sinus alone.

Adolescent↗
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The versatile autogenous rib graft in septorhinoplasty.

In the graft depleted revision rhinoplasty patient and the patient with major tissue needs, alternatives to septal and conchal cartilage grafts are needed. The costal cartilage graft and rib bone/costal cartilage combination graft are excellent alternatives. In this study 14 patients received 40 grafts from 20 autogenous ribs harvested during septorhinoplasty. Materials were harvested for use as septal replacement grafts, cantilevered grafts, dorsal onlay grafts, columellar struts, and tip grafts. Patient followup was 6 to 31 months, and no evidence of graft resorption or warpage was evident during that period. Complications of harvest were minimal, and harvest techniques are detailed.

Bone Transplantation↗
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Sluder's sphenopalatine ganglion neuralgia--treatment with 88% phenol.

Patients who experience chronic recurring head and face pain present a diagnostic and therapeutic challenge. Treatment options for Sluder's neuralgia, an uncommon cause for recurring head and face pain, are controversial. We reviewed the outcomes of patients who underwent intranasal phenolization of the sphenopalatine ganglion for the treatment of Sluder's neuralgia. Eight patients were treated with intranasal cauterization of the sphenopalatine ganglion between 1990 and 1995. Patients were treated an average of 13 times. Overall, patients experienced a 90% decrease in head and face pain for an average of 9.5 months duration. Interestingly, the patients described recurrent pain as less severe, less frequent, and of shorter duration. Intranasal phenolization of the sphenopalatine ganglion appears to be a safe and effective, although temporary, treatment for patients with Sluder's neuralgia. This article will review the symptomatology, differential diagnosis, and phenolization technique for treatment of Sluder's neuralgia.

Facial Neuralgia↗
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CSF rhinorrhea: 95 consecutive surgical cases with long term follow-up at the Mayo Clinic.

A persistent cerebrospinal fluid (CSF) leak is potentially lethal, and surgical treatment is often required. CSF leak repair is an infrequently performed procedure, and only limited information is available on the long term success of the surgical techniques that are used. This retrospective chart review includes 95 patients who underwent various types of repair surgery for CSF rhinorrhea at the Mayo Clinic. The purpose of this study was to extract factors such as the choice of sealing material, etiology, location of defect(s), surgical approach, and previous procedures, and to analyze their association with the long term success and failure of surgical repair. The mean time interval in this study between unsuccessful surgery and recurrence was 50.8 months, and the mean follow-up 109 months. Among the various approaches, defects repaired endonasally had the lowest recurrence rate. Local nasal mucosa advancement flaps failed more frequently (83.3% failure) than other types of graft material (p = 0.023). These failures took place in a delayed fashion (mean interval until failure: 80 months). Local osteo-mucoperiosteal or chondro-mucoperichondrial flaps (22.2% recurrence rate) and free graft material (15.6% recurrence rate) had the best outcome. The use of fibrin glue to fixate free grafts did not improve the result in this series. Transcranial procedures were associated with a higher complication rate than extracranial procedures (12.9% versus 3.2%). Overall, successful repair was achieved in 91.6% of the patients. We discourage the use of mucosa advancement flaps and advocate free grafts or pedicled osteomucoperiosteal or chondro-mucoperichondrial flaps as sealing material of choice in the majority of cases. The occurrence of delayed failure has to be considered when evaluating reports of CSF rhinorrhea after surgical repair.

Adolescent↗
PubMedDate not supplied

Response of nasal airway resistance to hypercapnia and hypoxia in the dog.

Nasal airway resistance was calculated in 9 anesthetized mongrel dogs by measuring the pressure difference across the nasal airway while a continuous flow of humidified air was passed through the upper airway. Hypercapnia produced a significant decrease in nasal airway resistance (P less than 0.05, Wilcoxon signed-rank test), which was proportional to the Paco2 over the range of 40 to 70 torr. Hypoxia produced a decrease in nasal airway resistance only when there was severe depression of Pao2. Direct stimulation of peripheral chemoreceptors by intravenously administered NaCN (100 microgram/kg) resulted in a significant decrease in nasal airway resistance (P = 0.06, Wilcoxon signed-rank test). Interruption of the cervical sympathetic trunk bilaterally abolished or reversed the response of the nasal airway resistance to hypercapnia and to NaCN. The study indicates that the nasal airway can modify airway resistance in response to respiratory stimuli and that this reflex is mediated by the sympathetic nervous system.

Airway Resistance↗
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alpha-Adrenoceptor-mediated secretion from the anterior nasal glands of the dog.

The secretion of fluid from the anterior nasal glands in pentobarbital-anesthetized dogs was measured by absorption on filter papers that were weighed before and after insertion into the nose. The secretion was stimulated by the local effects of drugs present on the dried filter paper. Methacholine evoked a dose-related secretion that could be reduced by atropine. Phenylephrine caused a scanty but measurable secretion in a dose that is used in topical nasal decongestants. When this alpha-adrenoceptor-stimulating drug was tested in combination with different doses of methacholine, a large increase in secretion was obtained over that with methacholine used alone. The increased secretion evoked by the combination was abolished by the alpha-adrenoceptor blocking drug phentolamine.

Animals↗
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Atrophic rhinitis: a review of 242 cases.

Atrophic rhinitis is a debilitating nasal mucosal disease of unknown etiology. It is characterized by progressive nasal mucosal atrophy, nasal crusting, fetor, and enlargement of the nasal space with paradoxical nasal congestion. Primary atrophic rhinitis has decreased markedly in incidence in the last century. This probably relates to the increased use of antibiotics for chronic nasal infection. Secondary atrophic rhinitis resulting from trauma, surgery granulomatous diseases, infection, and radiation exposure accounts for the majority of cases encountered by the rhinologist today. Excessive turbinate surgery has been both acquitted and accused in the literature as an etiology for secondary atrophic rhinitis. We saw 242 patients with the diagnosis of atrophic rhinitis between 1982 and 1999. The diagnosis was confirmed by physical examination, biopsy, and imaging studies. Patients were diagnosed with primary atrophic rhinitis if their condition developed in a previously healthy nose and secondary atrophic rhinitis if their condition developed after sinonasal surgery, trauma, or chronic granulomatous disease. Prevention and treatment of the disease is discussed.

Adolescent↗
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Use of photoplethysmography to determine the survival length of skin flaps.

Photoplethysmography was used to evaluate 14 skin flaps in the pig. Eight skin flaps were 4x12 cm and were based dorsally. Six skin flaps were 4x18 cm and were based ventrally. All flaps were designed to undergo necrosis of the distal end. After elevation of the flap, blood flow to the skin flaps was estimated immediately by means of intravenously administered fluorescein. Photoplethysmography was used to determine blood flow to the skin flaps at 3, 24, 72, and 144 hours after elevation. Surviving length of the skin flaps was measured at nine days. Fluorescein accurately predicted the surviving length of the skin flaps. Photoplethysmography did not show a decrease in blood flow at the level of fluorescein penetration 3 or 48 hours after elevation. However, 72 and 144 hours after elevation, an abrupt decrease in blood flow was noted by photoplethysmography at the level of eventual skin necrosis.

Animals↗