A systematic method for the perioperative management of routine cases of pituitary microadenoma t... more A systematic method for the perioperative management of routine cases of pituitary microadenoma treated by transsphenoidal microsurgery is presented. These methods have evolved over a 7-year period and have been utilized in the management of more than 750 patients with pituitary tumors and related problems treated by trans-sphenoidal surgery. The goals in this joint neurosurgical, endocrinological, and otorhinolaryngological team effort are to eliminate errors in patient management, to assure the safety of the patient in the perioperative period, and to make the therapy as efficient and as cost-effective as possible.
Changes in nasal obstruction, nasal airway resistance, and postoperative nose appearance were eva... more Changes in nasal obstruction, nasal airway resistance, and postoperative nose appearance were evaluated in 92 rhinoplasty patients. Fifty-six patients had a deviation of their nose from the midline preoperatively. They were improved according to rhinomanometry whether the rhinoplasty was combined with a functional septoplasty or with a submucous resection. Among the other 36 patients who did not have a deviation of the nose from the midline, 23 had a rhinoplasty combined with a functional septoplasty and 13 had no surgery on the septum at all. Rhinomanometrically, only patients operated on with the combined operation were improved; the rest became worse, even in terms of nasal obstruction. Among 58 patients from both groups with preoperative nasal obstruction, there was agreement for 76 percent between the subjective and rhinomanometric changes. The advantages of giving the rhinomanometric results in a polar coordinate system are discussed.
... The filter papers were gently inserted 2 cm into the nasal cavities close to the septum, with... more ... The filter papers were gently inserted 2 cm into the nasal cavities close to the septum, with the two free edges of the V-shaped paper directed toward the bottom of the nose. ... A standardized filter paper technique for assess-ing nasal secretory activity. Clin Allergy 11, 287. ...
The internal and external nasal valves are key to a patient’s breathing function, playing a criti... more The internal and external nasal valves are key to a patient’s breathing function, playing a critical role in rhinoplasty so an esthetically pleasing external nose can result without disturbing nasal breathing. The valve physiology is reviewed and a new classification of internal nasal valve pathology is presented so surgeons can avoid postoperative breathing complications after rhinoplasty.
The alternating congestion and decongestion of the nasal mucosa, termed the "nasal cycle&quo... more The alternating congestion and decongestion of the nasal mucosa, termed the "nasal cycle", was investigated with current mask (posterior) active rhinomanometric techniques. This communication reports variations in nasal resistance in 50 human subjects, each studied for about 7 hours. Approximately 600 resistance values (cm H2O/liter per second) were obtained from each subject. The nasal cycle defined in rhinomanometric terms was that alternating congestion and decongestion of the nasal turbinates which produced a change in pressure and airflow values calculated as resistance (comparing one side with the other) of 20% or greater for two consecutive observations (at least 15 minutes). The data demonstrated that 36 of 50 subjects (12 of 18 males and 24 of 32 females) had at least one nasal cycle during the period of observation.
A series of 1,000 consecutive intranasal ethmoidectomies performed on 565 patients was reviewed. ... more A series of 1,000 consecutive intranasal ethmoidectomies performed on 565 patients was reviewed. There were 28 complications (2.8%) in 26 patients. No patient died, and none became blind. This experience suggests that, in experienced hands, intranasal ethmoidectomy for polypoid disease and chronic ethmoid sinusitis can be a safe operation.
Transseptal, transsphenoidal pituitary surgery is safe and effective in the management of various... more Transseptal, transsphenoidal pituitary surgery is safe and effective in the management of various problems associated with the region of the sella turcica. This series include 285 operations on 272 patients treated from Sept. 1, 1972, to Sept. 1, 1976. The operative mortality was 1.75%. In every patient, the anatomy should be assessed preoperatively by polytomograms of the sella and the sphenoid sinus and by bilateral carotid angiography. The operating microscope and intra-operative x-ray control with the image-intensifier are essentials. Pneumoencephalography is performed whenever the possibility of an empty sella or arachnoidal cyst exists and when angiography does not satisfactorily outline the suprasellar extension of large pituitary tumors. Computerized tomographic scanning is also of value. A new group of pathologic problems, namely microadenomas (tumors less than 1 cm in diameter), has now become amenable to transseptal surgical management. This series includes a group of 50 ...
A 6-year-old child manifested symptoms and signs of alveolar hypoventilation and signs of cor pul... more A 6-year-old child manifested symptoms and signs of alveolar hypoventilation and signs of cor pulmonale caused by obstruction of the upper airway. These symptoms and signs disappeared after tonsillectomy and adenoidectomy. The relationship of upper airway obstruction to hypoventilation and cor pulmonale is discussed in the hope of renewing interest in this problem and alerting physicians to think of this possiblity early in the evaluation of such patients.
A systematic method for the perioperative management of routine cases of pituitary microadenoma t... more A systematic method for the perioperative management of routine cases of pituitary microadenoma treated by transsphenoidal microsurgery is presented. These methods have evolved over a 7-year period and have been utilized in the management of more than 750 patients with pituitary tumors and related problems treated by trans-sphenoidal surgery. The goals in this joint neurosurgical, endocrinological, and otorhinolaryngological team effort are to eliminate errors in patient management, to assure the safety of the patient in the perioperative period, and to make the therapy as efficient and as cost-effective as possible.
Changes in nasal obstruction, nasal airway resistance, and postoperative nose appearance were eva... more Changes in nasal obstruction, nasal airway resistance, and postoperative nose appearance were evaluated in 92 rhinoplasty patients. Fifty-six patients had a deviation of their nose from the midline preoperatively. They were improved according to rhinomanometry whether the rhinoplasty was combined with a functional septoplasty or with a submucous resection. Among the other 36 patients who did not have a deviation of the nose from the midline, 23 had a rhinoplasty combined with a functional septoplasty and 13 had no surgery on the septum at all. Rhinomanometrically, only patients operated on with the combined operation were improved; the rest became worse, even in terms of nasal obstruction. Among 58 patients from both groups with preoperative nasal obstruction, there was agreement for 76 percent between the subjective and rhinomanometric changes. The advantages of giving the rhinomanometric results in a polar coordinate system are discussed.
... The filter papers were gently inserted 2 cm into the nasal cavities close to the septum, with... more ... The filter papers were gently inserted 2 cm into the nasal cavities close to the septum, with the two free edges of the V-shaped paper directed toward the bottom of the nose. ... A standardized filter paper technique for assess-ing nasal secretory activity. Clin Allergy 11, 287. ...
The internal and external nasal valves are key to a patient’s breathing function, playing a criti... more The internal and external nasal valves are key to a patient’s breathing function, playing a critical role in rhinoplasty so an esthetically pleasing external nose can result without disturbing nasal breathing. The valve physiology is reviewed and a new classification of internal nasal valve pathology is presented so surgeons can avoid postoperative breathing complications after rhinoplasty.
The alternating congestion and decongestion of the nasal mucosa, termed the "nasal cycle&quo... more The alternating congestion and decongestion of the nasal mucosa, termed the "nasal cycle", was investigated with current mask (posterior) active rhinomanometric techniques. This communication reports variations in nasal resistance in 50 human subjects, each studied for about 7 hours. Approximately 600 resistance values (cm H2O/liter per second) were obtained from each subject. The nasal cycle defined in rhinomanometric terms was that alternating congestion and decongestion of the nasal turbinates which produced a change in pressure and airflow values calculated as resistance (comparing one side with the other) of 20% or greater for two consecutive observations (at least 15 minutes). The data demonstrated that 36 of 50 subjects (12 of 18 males and 24 of 32 females) had at least one nasal cycle during the period of observation.
A series of 1,000 consecutive intranasal ethmoidectomies performed on 565 patients was reviewed. ... more A series of 1,000 consecutive intranasal ethmoidectomies performed on 565 patients was reviewed. There were 28 complications (2.8%) in 26 patients. No patient died, and none became blind. This experience suggests that, in experienced hands, intranasal ethmoidectomy for polypoid disease and chronic ethmoid sinusitis can be a safe operation.
Transseptal, transsphenoidal pituitary surgery is safe and effective in the management of various... more Transseptal, transsphenoidal pituitary surgery is safe and effective in the management of various problems associated with the region of the sella turcica. This series include 285 operations on 272 patients treated from Sept. 1, 1972, to Sept. 1, 1976. The operative mortality was 1.75%. In every patient, the anatomy should be assessed preoperatively by polytomograms of the sella and the sphenoid sinus and by bilateral carotid angiography. The operating microscope and intra-operative x-ray control with the image-intensifier are essentials. Pneumoencephalography is performed whenever the possibility of an empty sella or arachnoidal cyst exists and when angiography does not satisfactorily outline the suprasellar extension of large pituitary tumors. Computerized tomographic scanning is also of value. A new group of pathologic problems, namely microadenomas (tumors less than 1 cm in diameter), has now become amenable to transseptal surgical management. This series includes a group of 50 ...
A 6-year-old child manifested symptoms and signs of alveolar hypoventilation and signs of cor pul... more A 6-year-old child manifested symptoms and signs of alveolar hypoventilation and signs of cor pulmonale caused by obstruction of the upper airway. These symptoms and signs disappeared after tonsillectomy and adenoidectomy. The relationship of upper airway obstruction to hypoventilation and cor pulmonale is discussed in the hope of renewing interest in this problem and alerting physicians to think of this possiblity early in the evaluation of such patients.
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Papers by Eugene Kern