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Biomedical subjects

Frederick A Kuhn

Publications and source records attributed to Frederick A Kuhn.

11 recordsLinked to original sources
PubMed2007

Radiographic resolution of chronic rhinosinusitis without polyposis after 6 weeks vs 3 weeks of oral antibiotics.

BACKGROUND: Maximal medical therapy is poorly defined in chronic sinusitis treatment. OBJECTIVE: To objectively evaluate the radiographic response of chronic rhinosinusitis without polyposis after 3 and 6 weeks of oral antibiotics. METHODS: Thirty-five patients with confirmed chronic sinusitis without polyposis (disease apparent on initial computed tomography [CT] with appropriate symptom duration) were prescribed 6 weeks of antibiotics. When possible, culture-directed antibiotics were used; otherwise clindamycin was used empirically. A CT was performed after 3 and 6 weeks of therapy. CTs were then graded by the Lund-Mackay system. Demographic data were reviewed. RESULTS: Of the 35 patients, 16 underwent all 3 CT scans and completed all 6 weeks of antibiotics. Three patients completed only 3 weeks of antibiotics, and 16 did not undergo the interval 3-week CT. Six patients (38%) had statistically significant improvement in their CT scans between weeks 3 and 6. In this subset of patients who improved, 37% of their overall radiographic improvement occurred in the 3- to 6-week treatment interval. No prognostic variables predicted which patients would radiographically improve after 3 weeks of antibiotics. CONCLUSION: Some patients achieve radiographic improvement and disease resolution after the completion of a 3-week course of antibiotics. Therefore, maximal medical therapy for chronic sinusitis may consist of longer than 3 weeks of therapy to ensure maximal benefit.

Administration, Oral↗
PubMed2006

An integrated approach to frontal sinus surgery.

This article the most useful procedures into into a comprehensive integrated approach to frontal sinus surgery. It begins with the least invasive and progresses to the most invasive procedure in a step-by-step fashion, which can be applied as needed. The selection of procedure is governed the patient's disease anatomy,and the surgeons skill. The least invasive procedure that can be used should be attempted first, and then, if more is needed, other procedures can be added, either at the same sitting or in subsequent revisions.

Endoscopy↗
PubMed2006

Preservation of natural frontal sinus outflow in the management of frontal sinus osteomas.

INTRODUCTION: Management of frontal sinus tumors has traditionally been through open approaches with obliteration of the sinus. Recently, increased comfort with endoscopic techniques has made endoscopic resection an alternative to more morbid approaches. However, many skilled endoscopists still champion obliteration of the frontal sinus after the open treatment of large osteomas. METHODS: A retrospective review of the senior author's experience with frontal sinus osteomas was performed. RESULTS: Twelve frontal sinus osteomas were treated surgically without obliteration. All patients with greater than 2 cm vertical extension of their tumor into the frontal sinus required an open approach (n = 4), whereas the remainder (n = 8) were treated endoscopically. Frontal ostia were stented if greater that 40% of the mucosa of the frontal recess was denuded. Eleven of 12 patients had patent, functional frontal sinuses. CONCLUSION: Successful resection of frontal sinus osteomas can be performed with preservation of the natural drainage of the frontal sinus in almost all cases. EBM RATING: C-4.

Adult↗
PubMed2005

Stereotactic computer assisted navigation: state of the art for sinus surgery, not standard of care.

There are circumstances in which image guidance is clearly useful to facilitate a more complete operation. By confirming the identity of known anatomic structures, a knowledgeable surgeon's understanding of the disease process can improve and only the necessary structures removed. CT guidance is a clear aid to understanding altered anatomy when combined with a thorough analysis of the preoperative CT scan and office nasal endoscopy. It is the combination of this preoperative planning with image guidance that allows a skilled surgeon to operate with confidence. This discussion intentionally did not refer to image guidance as the standard of care, because although this technology is clearly useful, valuable, and helpful in confirming anatomy and performing many procedures, it is not always necessary in achieving a complete operation. Therefore, it should not be considered the standard of care.

Decompression, Surgical↗
PubMed2004

3D computed tomographic analysis of frontal recess anatomy in patients without frontal sinusitis.

OBJECTIVE: Describe frontal sinus pneumatization in patients with no history of frontal sinus disease. STUDY DESIGN AND METHODS: All 1-mm axial sinus CT scans performed from 2001 through 2003 were eligible for review on a CBYON Suite workstation (CBYON, Mountain View, CA). Exclusion criteria included frontal sinusitis, sinonasal polyposis, age < 18 years, sinus malignancy, fibroosseous lesions, maxillofacial trauma, congenital anomaly, and sinus surgery. RESULTS: A total of 50 patients met the inclusion criteria. The prevalence of each structure was: agger nasi cell (89%), type 1 frontal cell (37%), type 2 frontal cell (19%), type 3 frontal cell (8%), type 4 frontal cell (0%), supraorbital ethmoid cell (62%), suprabullarcell (15%), frontal bullar cell (9%), interfrontal septal cell (14%), and recessus terminalis (22%). CONCLUSIONS: This study describes frontal pneumatization in patients without a history of conditions that influence frontal pneumatization. The results characterize normal frontal recess/sinus pneumatization patterns.

Adolescent↗
PubMed2004

Role of endoscopy in the management of chronic rhinosinusitis.

Endoscopy has multiple uses in both the medical and surgical management of chronic rhinosinusitis (CRS). This article reviews applications of endoscopy in preoperative evaluation and postoperative management of CRS. Before operation, nasal endoscopy is the standard for tissue sampling, evaluation of the mucosa, identifying structural alterations, and staging of allergic fungal sinusitis. As part of the surgical procedure, endoscopy may be used to minimize the time needed for postoperative debridement. Applications of endoscopy in in-office medical management of CRS include culturing the sinuses for fungus or bacteria, inserting a cannula for the delivery of drug therapy, and various minor manipulations following a surgical procedure. Perhaps the most important role for endoscopy in patients with CRS is in medical management, particularly in cases involving eosinophilic inflammation. Angled telescopes are important for visualizing areas often overlooked in sinuses that may otherwise appear to be normal, ie, the depths of the maxillary, frontal, or sphenoid sinus. Further use and research are likely to elicit more uses for this important technology.

Chronic Disease↗
PubMed2003

Allergic fungal sinusitis: diagnosis and treatment.

Since allergic fungal sinusitis was initially described by Millar in 1981, many have tried to define and explain the disorder. It has been labeled as the sinonasal equivalent of allergic bronchopulmonary aspergillosis; however, allergic fungal sinusitis cannot be categorized so easily. According to the literature at this time, there are five major criteria and six associated characteristics or minor criteria of patients with allergic fungal sinusitis. In reality, patients may not develop all five major criteria or have any of the associated criteria for years. Allergic fungal sinusitis is not only difficult to diagnose, but it is one of the most complicated conditions rhinologists must manage. Endoscopic sinus surgery must be used in conjunction with long-term medical therapy, oral and nasal corticosteroids, immunotherapy, antifungal therapy, and antimicrobial agents to effectively control the problem. Allergic fungal sinusitis is most likely the endpoint in a spectrum of sinonasal disease, driven by the presence of fungus and eosinophils with their inflammatory mediators. The affected nasal mucosa no longer functions properly, and a cycle of chronic edema, stasis, and bacterial superinfection results. Therapy entails disrupting the inflammatory process to allow normal mucosal function to resume.

Humans↗
PubMedDate not supplied

Low-grade fibrosarcoma of the anterior skull base: endoscopic resection and repair.

BACKGROUND: Fibrosarcomas of the paranasal sinuses and skull base are uncommon tumors. Traditionally, "open approach" surgery remains the mainstay for treatment of choice for these tumors. METHODS: A 49-year-old man underwent resection of a right anterior skull base fibrosarcoma using the endoscopic approach. RESULTS: Close follow-up using both endoscopic and imaging methods over a period of four years has revealed a well-healed skull base with no evidence of recurrence. CONCLUSION: Significant resistance exists at present for such a technique to deal with malignant diseases of the head and neck but results from advanced centers continue to prove that this may be a technique worth mastering and improving on.

Bone Transplantation↗
PubMedDate not supplied

A preliminary report on the effects of paclitaxel-impregnated stents on sheep nasal mucosa.

INTRODUCTION: Traditional frontal sinus stents serve only as mechanical devices. It has been proposed that stents also may serve as drug-delivery systems for the topical application of drugs that minimize postoperative scarring. Paclitaxel (Taxol), which has recognized antiscarring effects, may be incorporated via a polymeric formulation into standard rubber stents. The impact of topically applied paclitaxel on the morphology of the nasal mucosa is unknown. METHODS: An adult sheep model was used for this study. A modified rubber T-tube stent (incorporating paclitaxel at varying dosages) was secured to each side of the septum in four animals (eight sides). An unmodified T-tube was placed on each side of one animal, a T-tube with the drug carrier (but no paclitaxel) was placed on each side of the second animal, and T-tubes with varying paclitaxel were placed on each side of the final two animals. After 4 weeks, animals were killed and the nasal mucosa was harvested. The nasal mucosa was sectioned and stained with hematoxylin and eosin. A pathologist then assessed the nasal mucosa for vascular congestion, glandular atrophy, chronic inflammation, mucosal metaplasia, and mucosal ulceration. RESULTS: No consistent histopathological differences were noted in the specimens. All specimens showed varying degrees of vascular congestion, glandular atrophy, chronic inflammation, and mucosal metaplasia; the paclitaxel-impregnated stents were not consistently associated with more severe mucosal injury. Finally, mucosal ulceration was noted to be very rare in all specimens. CONCLUSION: This preliminary report describes the impact of paclitaxel-impregnated stents on sheep nasal mucosa, which tolerated these stents very well. Because paclitaxel minimizes scarring reactions at very low concentrations, paclitaxel-impregnated stents may prove useful in clinical situations in which frontal sinus stenting is deemed necessary. Additional investigations with animal models, as well as clinical trials, may be warranted.

Animals↗