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Biomedical subjects

C Carenfelt

Publications and source records attributed to C Carenfelt.

At least 19 recordsLinked to original sources
PubMed1997

Single dose of betamethasone in combined medical treatment of secretory otitis media.

With the objective of evaluating the efficacy of cefixime and the combination of cefixime and betamethasone in the treatment of secretory otitis media (SOM), we enrolled 142 children 2 to 12 years old in a randomized, double-blind, placebo-controlled study. All children suffered from SOM, verified by otomicroscopy and tympanometry, of at least 3 months' duration. Active treatment was a 10-day course of cefixime with and without a single dose of 6 mg betamethasone. On hundred forty children were available for efficacy evaluation 14 to 23 days after the start of treatment. A statistically significant treatment effect was found in the group treated with cefixime plus betamethasone (n = 59), with a 44.1% cure rate as compared to 19.7% in the cefixime-treated group (n = 61; p < .005) and 5% in the placebo group (n = 20; p < .005). Relapse rates were high and no statistically differences between groups remained at last valid visit. Adverse events possibly or probably associated with active treatment were reported in 11 cases (9.2%). One patient reported a severe adverse event. No serious events occurred. The study did not show any significant long-term effect of cefixime treatment or any long-term treatment benefit with the addition of betamethasone to the antibiotic.

Anti-Bacterial Agents↗
PubMed1996

Incidence, aetiology, and prognosis of acute epiglottitis in children and adults in Sweden.

A retrospective study of the incidence, aetiology and case fatality rate of acute epiglottitis in children and adults was performed. The study covered the whole of Sweden (population 8.4 million) during the years 1987-89, before general vaccination against Haemophilus influenzae (Hi) type b was started. Patients were included if it was documented that they fulfilled all 3 of the following criteria: (a) red and swollen epiglottis visualized by indirect laryngoscopy, (b) inspiratory stridor or difficulties in swallowing, and (c) a temperature > or = 38 degrees C. A total of 306 children and adolescents (0-19 years) and 502 adults (> or = 20 years) were found. The age-specific incidence was highest in children aged 0-4 years, (14.7/100,000 per year). The total incidence was 3.2/100,000 per year. In the age group 0-19 years, blood cultures had been obtained from 195 (64%) and Hi was isolated from 154 (79%). In adults (> or = 20 years), 114 of 298 blood cultures yielded Hi, while pneumococci were isolated from 5 and group A streptococci from 3 patients. A total of 220 children (72%) and 114 adults (23%) needed an artificial airway. Five children and 12 adults died. In conclusion, the incidence of acute epiglottis in Sweden is very high. Compared to a previous country-wide study covering the years 1981-83 that used the same methods for case finding and case definition, the incidence in children had decreased while the incidence in adults had increased.

Adolescent↗
PubMed1995

Long-term effect of uvulopalatopharyngoplasty on driving performance.

OBJECTIVE: It has been questioned whether the effect of uvulopalatopharyngoplasty lasts as years go by. From a previous study it is known that patients with severe rhonchopathy, complaining of sleepiness at the wheel, improve their vigilance and driving performance immediately following uvulopalatopharyngoplasty, but is this effect persisting? DESIGN: In a cohort study, the long-term effect of surgical treatment on driving vigilance was evaluated on 13 middle-aged (median, 52 years) male patients and five matched controls. Three to 4 years postoperatively, they were subjected to a boring 90-minute-long retest in an advanced driving simulator and daytime polysomnography, identical to those performed preoperatively. Factors measured were brake reaction time, lateral position deviation, and off-road incidents. The patients were also asked to assess their driving skills on a self-report and their vigilance on a visual analogue scale. RESULTS: All but one patient reported themselves as being more vigilant and safe drivers following surgery. Objective results showed that the initial improvement in brake reaction time, lateral position deviation, and number of off-road incidents was sustained, but not always in concordance with the apnea index. CONCLUSION: The positive effect of uvulopalatopharyngoplasty on vigilance and driving performance remains after 4 years. This may have a substantial impact on traffic safety.

Accidents, Traffic↗
PubMed1995

Does uvulopalatopharyngoplasty inhibit automobile accidents?

Patients with rhonchopathy, which includes obstructive sleep apnea syndrome (OSAS), who report sleepy spells at the wheel do poorly on simulated monotonous driving tests and have a twofold to threefold increase in traffic accidents. To assess whether drivers with rhonchopathy (heavy snoring, sleep disturbances, and daytime sleepiness) cause fewer automobile accidents after uvulopalatopharyngoplasty (UPPP), the car accident rate for the first 5 years after surgery was compared to the rate of the 5 years immediately before the operation. Data were collected by means of a self-report questionnaire. Fifty-six patients with rhonchopathy were compared to 142 controls without rhonchopathy who had been subjected to nasal surgery. The response rates were 96% and 94%, respectively. The reported habitual sleepiness while driving had disappeared in 87% (P < .001) of drivers who had the problem preoperatively. The accident risk reduction (corrected for mileage) in patients was almost four times greater than the reduction in controls (P < .001) after surgery. The relative rate of patients involved in any single-car accident fell by 77% (P < .05), and the relative rate of single-car accidents fell by 83% (P < .001). It is concluded that drivers with rhonchopathy have an increased risk for car accidents, especially single-car accidents, but that this risk returns to normal after UPPP.

Accidents, Traffic↗
PubMed1993

Adenoid tissue lymphocyte subpopulations--evaluation of a quantitative analysis with flow cytometry.

Secretory otitis media (SOM) is a common childhood disease without a completely clarified etiology. A chronic inflammatory condition in the nasopharynx, presumably caused by an increased bacterial load, is one factor of probable etiological importance. In the present study a flow cytometric method for analysis of adenoid lymphoid cell populations was developed to facilitate quantitative comparisons between children with SOM and children without ear disease. Adenoids removed from 18 children due to adenoid hyperplasia and obstructive symptoms were studied. Results of the flow cytometric analysis correlated well with the findings from immunohistological studies of five of the adenoids. PCA-1 and CD25 were found to be good markers of increased cellular activity after non-specific stimulation in cell culture. It is concluded that the flow cytometric method is suitable for further quantitative analysis of adenoid tissue.

Adenoidectomy↗
PubMed1992

Sleep apnea syndrome symptoms and automobile driving in a general population.

Automobile accidents are reported as being overrepresented in those suffering from the obstructive sleep apnea syndrome (SAS), evident by snoring, sleep disturbances and diurnal hypersomnia. An estimation of the prevalence of these symptoms amongst an adult population, predominantly automobile drivers, was assessed by using a one-stage questionnaire procedure. From a national random sample of 1214 persons a weighted reply rate of 76% was achieved. Snoring, breath cessations, mid-sleep awakenings, and diurnal hypersomnia were reported in 24, 3.8, 27 and 9.1%, respectively. The maximum prevalence of SAS was estimated as 2.8-5.5% among men, aged 30-69 years, depending on definition used. Driving frequency in potential sleep apneics was similar to that of the entire population studied. Diurnal hypersomnia, considered a consequence of SAS, was reported as an overall 2.2%, corresponding to 100,000 automobile drivers in Sweden.

Adult↗
PubMed1992

Preliminary report: validity of symptom analysis and daytime polysomnography in diagnosis of sleep apnea.

The aim of this study was twofold: first, to see if the prevalence of the sleep apnea syndrome (SAS) in a given population could be fairly estimated by our patient questionnaire, mainly based upon the 1979 American Sleep Association definition of SAS; and second, to investigate whether the severity of SAS could be similarly accurately measured by daytime polysomnography (DPSG), as an alternative to the more demanding all-night polysomnography (NPSG). Of 42 patients consecutively examined due to rhonchopathy, 18 had the clinical diagnosis of SAS, which was based on the three symptoms--snoring, sleep disturbances and diurnal hypersomnia--if reported to occur habitually. In 11 patients the diagnosis was established by NPSG [apnea index (AI) greater than 10]. However, in only 10 of the 18 cases NPSG indicated the diagnosis giving a positive predictive value of 56%. When comparing DPSG versus NPSG in 36 patients, the AI ranged from -23 to +65, and the mean AI value was found to be twice as high in the former (mean difference 9.0 +/- 18.4; p less than 0.01). The positive predictive value of DPSG was 63% (10/16). Both the self-report and DPSG were burdened with some 25% false-positive results, and DPSG gave far too variable AI values to be reliable in staging the disease. On the other hand, the negative predictive values were high, 96% (23/24) and 100% (20/20), respectively, indicating their usefulness for screening purposes.

Adult↗
PubMed1991

Simulated long-term driving performance before and after uvulopalatopharyngoplasty.

To investigate whether automobile drivers with the clinical features of sleep apnea syndrome (SAS) perform worse than controls in a simulated long-term test drive, and to see if their driving improves after uvulopalatopharyngoplasty (UPPP), 15 male drivers with SAS, suffering from sleep spells whilst driving, and 10 matched controls without a history of SAS or hypersomnia at the wheel were tested in an advanced driving simulator. Brake reaction time, lateral position deviation and off-road episodes were measured during a 90-min rural drive at twilight conditions. The clinical evaluation was made by a questionnaire scoring symptoms of snoring, sleep disturbances and diurnal sleepiness before and after surgery. Before UPPP the patient group showed impaired performance in all three effect measures compared to controls. UPPP resulted in improved reaction time performance (average mean improvement: 0.5 s, average 90th percentile improvement 0.8 s). Furthermore, 12 of the 15 patients reported a marked improvement regarding sleepiness whilst driving. For these clinically successful cases the number of off-road episodes decreased substantially. We conclude that most patients improve their long-term driving performance as a result of UPPP.

Accidents, Traffic↗
PubMed1991

Laser uvulopalatoplasty in treatment of habitual snoring.

Velopharyngeal sonorous snoring is best treated with uvulopalatopharyngoplasty (UPPP). To reduce surgical risks and minimize the morbidity, a simplified carbon dioxide laser uvulopalatoplasty (LUPP) was performed under local anesthesia. Among a total of 146 patients who had a LUPP performed, there was no significant bleeding or postoperative episodes of asphyxia. The procedure was well tolerated even by those patients with strong vomiting reflexes. The operation time was halved, as was the convalescence. Two patients (1.4%) developed scarring with nasal obstruction, but the impact of factors other than the laser approach itself seemed to be the cause. By scored questionnaires the effect on snoring, family complaints, and daytime somnolence was evaluated in two comparable random groups of patients. Sixty-three patients had LUPP procedures, and 37 had UPPP. The short-term results showed that about 90% of the patients considered themselves essentially improved as regarded snoring and that most patients felt more alert, irrespective of the surgical method used.

Adult↗
PubMed1991

Nasopharyngeal flora in otitis media with effusion. A comparative semiquantitative analysis.

An inflammatory process in the middle ear caused by bacteria or bacterial products emanating from the nasopharynx is one etiological factor considered in the unknown pathogenesis of otitis media with effusion (OME). The nasopharyngeal prevalence of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella (Branhamella) catarrhalis and Streptococcus pyogenes was studied in 191 children with defined OME and in 53 age-matched children without middle ear disease. Duplicate sampling and semiquantitative analysis were performed to assess even minor differences in the distribution of pathogens between the two groups of children. Pathogens were recovered in 91% of OME children. A significantly higher number of pathogen species/patient (1.66 vs. 1.15, p less than 0.01) as well as pathogen colonies/patient was found in OME children compared to control children. Chronic OME in children is associated with an increased pathogen load in the nasopharynx, suggesting a role of these pathogens in the etiology of OME.

Child↗
PubMed1990

Epstein-Barr virus-carrying B cells in the blood during acute infectious mononucleosis give rise to lymphoblastoid lines in vitro by release of transforming virus and by proliferation.

In accordance with earlier studies, we detected higher numbers of Epstein-Barr virus (EBV)-carrying lymphocytes (B-EBV) in the blood of acute infectious mononucleosis (IM) patients and higher amounts of transforming EBV particles in the saliva compared to healthy seropositive individuals. B cells grew in cultures seeded with the low and high density IM lymphocytes. The majority of B cells which grew acquired the infection in vitro (2-step outgrowth), because addition of virus neutralizing antibodies considerably reduced the emergence of lymphoblastoid cell lines (LCLs). Only the minority of the explanted B-EBV cells proliferated. The antiviral drug phosphonoformate (PFA) did not influence the frequency of 2-step LCLs in the IM cultures. This may indicate that a large proportion of EBV carrying B cells have already entered the viral productive cycle in vivo and passed the PFA-sensitive stage at the time of explantation. Earlier experiments with blood of healthy seropositive individuals showed an inhibitory effect of PFA on the generation of LCLs. One healthy individual who entered this study as a control, probably had a reactivated EBV infection as judged by the anti-EA activity in his serum and the high level of virus in his saliva. He had antibodies against EBV nuclear antigens (EBNA), and therefore he did not have a primary infection at the time of the test. Judged by the number of wells with B cell growth, the frequency of virus-carrying B cells in his blood was low. It seems that anti-EBV immunity can control the number of infected B cells in the blood, but does not influence the virus load in the epithelial cells.

Acute Disease↗
PubMed1990

Clinical symptoms of sleep apnea syndrome and automobile accidents.

Patients with clinical features of sleep apnea syndrome (SAS) and self-reported sleep spells at the wheel do poorly in simulated monotonous driving. To evaluate whether drivers with defined symptoms of SAS (heavy snoring, sleep disturbances and daytime sleepiness) compensate in real traffic by careful driving or not, the rate of car accidents over a 5-year period was investigated. A questionnaire was addressed to 140 patients with and 142 controls without symptoms associated to SAS. Seventy-three of the patients had a complete triad of SAS-associated symptoms. Fifty-two percent of these patients reported habitual sleep spells at the wheel, as opposed to less than one percent by the controls. The ratio of drivers being involved in one or more combined-car accident was similar for patients and control drivers, but for single-car accidents the ratio was about 7 times higher for patients with a complete triad of symptoms of SAS compared to controls (p less than 0.001). When corrected for mileage driven, the total number of single-car accidents was almost 12 times higher among patients with sleep spells whilst driving, compared to controls (p less than 0.001). It is concluded that drivers with the clinical features of SAS are at increased risk especially for single-car accidents and that the risk seems to vary with the severity of symptoms.

Accidents, Traffic↗
PubMed1989

Acute infectious epiglottitis in children and adults: annual incidence and mortality.

The incidence and mortality of acute epiglottitis were retrospectively analysed covering a 12-year period, 1975-1987. The diagnosis was made by the laryngoscopic findings in 95% of patients. Based on 902 hospitalized patients, a mean annual incidence of 4.9 cases per 100,000 children and adults was found. Although adult patients predominated (60%), the incidence was far higher in children, 13.8 per 100,000 compared with 3.9 per 100,000 in adults. Two peaks in incidence were identified, one for the youngest children, and the second for young adults (15-29 years). Over the years the incidence varied little in adults, but decreased significantly in children over the last 6 years studied. The data presented indicate acute epiglottitis to be a more frequent disorder than previously believed but with less risk of a fatal outcome. The mortality rate was below 1% in children and adults and the annual incidence of death from acute epiglottitis was estimated at 0.5 cases per million. The primary admission of these patients to ENT units seems to be the single factor having the most powerful impact on mortality.

Acute Disease↗
PubMed1989

Nasopharyngeal culture with quantitative analysis of pathogenes in chronic otitis media with effusion. Effects on pathogen yield of different swabs and transport methods.

The influence of different swabs and transport media on nasopharyngeal culture pathogen recovery has been studied in patients with chronic otitis media with effusion. Transport times of less than two hours have been used. Protecting the cotton wire swab with a polyethylene shealth to prevent contamination by nasal flora did not have any significant influence either on the recovery of potential pathogens or on the contaminating nasal flora. Facilitating a quantitative analysis of the nasopharyngeal culture by transporting the specimen in empty tubes gave a pathogen recovery rate similar to that with transport in Stuart medium, whereas an attempt at transporting in sodium chloride or prereduced PY broth led to significantly lower yields of Branhamella catarrhalis (p less than 0.01) and in PY broth on Haemophilus influenzae as well (p less than 0.01).

Child, Preschool↗
PubMed1989

Test-retest reliability of the nasopharyngeal culture in children.

Aspects of test-retest reliability of the nasopharyngeal culture were evaluated in children with otitis media and in ear, nose and throat (ENT)-healthy children, in all 174 cases. The nasopharyngeal colonization of Streptococcus pneumoniae, Haemophilus influenzae, Branhamella catarrhalis and beta-haemolytic streptococci was determined for a group of children with well-defined otitis media effusion (OME). The valitity of the results was then tested in a new group of children with OME. Despite seasonal differences and different bacteriologists analysing the specimens, high conformity was found between the two groups regarding distribution and recovery rates of the potential pathogens studied. The test-retest reliability of the culture was also analysed by duplicate specimens in children with acute otitis media (AOM), OME and in ENT-healthy children. The reproducibility of the findings of pathogens, whether quantitative aspects were considered or not, was found to be between 70 and 80% for children with AOM and OME.

Bacteria↗