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Biomedical subjects

E Hultcrantz

Publications and source records attributed to E Hultcrantz.

At least 19 recordsLinked to original sources
PubMed1999

Tonsillectomy or tonsillotomy?--A randomized study comparing postoperative pain and long-term effects.

BACKGROUND: tonsillectomy (TE) is currently the most common treatment for children with snoring and sleep apnea. Many of these children have not had any severe throat infections. To cure such children from their obstructive problems, without influencing the immunological function of the tonsils, tonsillotomy (TT) with CO2-laser was performed in a randomized study comparing it to regular tonsillectomy, with special attention to postoperative pain and symptom recurrence. METHOD: 41 children 3.5-8 years-old were included--21 'TT's' and 20 'TE's'. They were all operated under the same anesthesia and followed the same postoperative scheme for analgesia. A visual analogue scale for pain measurements with faces was used for the first 24 h. After that, each day until pain-free, the parents registered the child's pain on a three graded scale, what the child was able to eat, and the amount of analgesic drugs used. RESULTS: all the children were cured from their breathing obstruction. The mean time used for the surgery was the same and no postoperative bleeding was seen in either group. 'TT children' were pain-free after 5 days and 'TE children' after 8 days. Eight to ten days after surgery, the TT-children had gained weight and the TE children lost weight significantly. The TE group used twice as much analgesic drugs as the TT group during the first postoperative week. The TT group was healed with normal-looking, but small tonsils after 8-10 days; the TE group often still showed edema and crusts. At the one-year follow-up 2/21 among the 'TT-children' snored, but did not require re-surgery. CONCLUSION: tonsillotomy is much less painful than TE and children recover more quickly. Results with respect to breathing obstruction are almost the same for both methods at 1-year follow-up.

Child↗
PubMed1999

Using the carbon dioxide laser for tonsillotomy in children.

Carbon dioxide laser tonsillotomies were performed on 33 children aged 1-12 years for the relief of obstructive symptoms due to tonsillar hyperplasia. As opposed to conventional tonsillectomy, only the protruding part of each tonsil was removed. A carbon dioxide laser delivering 20 W was used for the excision. Twenty-one children were seen in active short-term follow-up and the records of all the children were checked for possible surgery related events up to 20-33 months after surgery. Laser tonsillotomy was uniformly effective in relieving the obstruction, with good hemostasis. The tonsillar remnants healed completely within 2 weeks. No major adverse events occurred. Post-operative pain appeared slight and easily controlled. There was no gain in operating time compared with conventional tonsillectomy. The laser tonsillotomies were in most cases done in day surgery. No recurrence of obstructive problems was reported up to 20-33 months after surgery. It was concluded that tonsillotomy, using a carbon dixoide laser, is a valid treatment for obstructive symptoms caused by enlarged tonsils, which can be performed with little bleeding and post-operative pain. The improved hemostasis may enable a shift from in-patient to day surgery.

Acetaminophen↗
PubMed1999

[Many persons with snoring problems and apnea are untreated. A review of therapeutic methods].

As sleep apnoea and snoring are very disabling conditions both for patients and their families, and hazardous for drivers and others in traffic, there is good reason to treat snoring problems. Treatment should be individualised, always beginning conservatively--i.e., positional training, weight reduction if necessary, more sleep if sleep deficiency is present, and a review of any muscle-relaxant or mucolytic medication. Sleep registration will demonstrate the extent of any sleep apnoea syndrome, which is of decisive importance for further choice of treatment. Mild apnoics and social snorers may initially be offered an occlusal splint if their dental status allows. Otherwise, in such cases surgery is a form of treatment yielding immediate results, though the patient must be forewarned of the discomfort which can occur in isolated cases. For patients with sleep apnoea syndrome of marked or intermediate severity, continuous positive airway pressure (CPAP) treatment should be available. If the patient can not tolerate CPAP treatment, the occlusal splint alternative can be tried. For patients who can not have CPAP or occlusal splint treatment, tracheostomy is a possibility. This treatment may be lifelong, but if weight reduction is achieved postoperatively, it may be possible to remove the tracheostomy.

Humans↗
PubMed1999

[Medical aspects of diving--a sport for both women and men].

As interest in scuba diving is increasing in both sexes, doctors need to be aware of the risks encountered when diving and about gender-related differences in these risks. Individuals prone to panic attacks, claustrophobia or reckless risk-taking should avoid diving. In tolerating cold, muscle mass is more important than the amount of subcutaneous fat. The risk of decompression disease seems to be slightly greater among women, probably due to their fat distribution. Pregnant women are recommended not to dive, because the risk of birth defects seems to be greater among those who do, and there is a serious risk of fetal decompression disease. All participants in the sport must be responsible for their own diving safety.

Adaptation, Physiological↗
PubMed1999

The effect of uvulopalatopharyngoplasty without tonsillectomy using local anaesthesia: a prospective long-term follow-up.

This paper presents the long-term effect of restricted surgery for snoring and sleep apnoea. Patients with obstructive sleep apnoea (OSAS) (19) or heavy snoring (HS) (36) were studied prospectively for five to seven years after uvulopalatopharyngoplasty without tonsillectomy performed by regular surgical technique using local anaesthesia (LUPP). Five years after surgery, 90 per cent answered a questionnaire. All OSAS patients were offered a polysomnography, and the HS patients were offered a sleep study. Eighty per cent still showed a positive effect on daytime somnolence, and 77 per cent on snoring. Side-effects were reported by 40 per cent; most common was choking (20 per cent) the first year. Eighteen per cent had local problems such as globus sensation. The polysomnography showed that 80 per cent were still 'responders' with an apnoea index (AI) reduction of > 50 per cent. None of the HS patients had developed OSAS. In conclusion, LUPP in selected patients with OSAS or HS has a good long-term effect. Side-effects are common, but diminish with time.

Airway Obstruction↗
PubMed1999

Breathing obstruction in relation to craniofacial and dental arch morphology in 4-year-old children.

The prevalence of breathing obstruction was determined in a cohort of 4-year-old children. Craniofacial morphology was studied in obstructed children and compared with data from a control group of 4-year-old children with ideal occlusion. Dental arch morphology was compared in obstructed and non-obstructed children in the group. Parents of 95.5 per cent of the study base of 644 children answered a questionnaire concerning their child's nocturnal behaviour and related questions. The 48 children who, based on parental report, snored every night or stopped breathing when snoring (the 'snoring group'), showed a higher rate of disturbed sleep, mouth-breathing, and a history of throat infections as compared with the rest of the cohort. These children were examined by both an orthodontist and an otorhinolaryngologist and, when indicated, they were also monitored in a sleep laboratory. Twenty-eight of the children were diagnosed as having a breathing obstruction (4.3 per cent of the cohort) and six children (0.9 per cent) had sleep apnoea (mean apnoea-hypopnoea index of 17.3), using the same definition as that for adults. Cephalometric values among the obstructed children differed from those of a Swedish sample of the same age with ideal occlusion. Thy had a smaller cranial base angle and a lower ratio of posterior/anterior total face height. Small, but not significant differences were seen for NSL-ML and NL-ML. Compared with 48 asymptomatic children from the same cohort, the obstructed children had a narrower maxilla, a deeper palatal height, and a shorter lower dental arch. In addition, the prevalence of lateral crossbite was significantly higher among the obstructed children.

Adolescent↗
PubMed1997

Long-term follow-up of patients with obstructive sleep apnea treated with uvulopalatopharyngoplasty.

OBJECTIVE: To study the long-term outcome after treatment with uvulopalatopharyngoplasty (UPPP). DESIGN: Long-term follow-up (4-8 years) with polysomnography. SETTING: Referral center for patients with sleep-disordered breathing. PATIENTS: Thirty-four consecutive patients of whom 25 (22 men and 3 women; mean age, 49 years) participated in the follow-up. All patients had obstructive sleep apnea syndrome. INTERVENTION: Uvulopalatopharyngoplasty. MAIN OUTCOME MEASURES: Symptoms and apnea-hypopnea index (AHI) before and after UPPP. Response to treatment defined as a 50% or more reduction in AHI and a postoperative AHI of 10 or less. RESULTS: Reduced prevalence of snoring and daytime sleepiness and reduction in AHI (mean [+/-SD], 40 +/- 26 to 21 +/- 21) at follow-up (P < .001). Sixteen patients (64%) were responders after 6 months and 12 (48%) at the long-term follow-up. Responders had a lower preoperative AHI (25 +/- 7) than did nonresponders (48 +/- 29) (P < .05). None of the 7 patients with preoperative AHI of more than 40 were responders (P < .01). No difference was seen in preoperative body mass index, lung function, ventilatory response to carbon dioxide, computed tomography scan of upper airways, or change in body mass index between responders and nonresponders. CONCLUSIONS: Four to 8 years after UPPP, about half of our patients were clinically and objectively improved. Uvulopalatopharyngoplasty should be reserved for patients with mild or moderate obstructive sleep apnea. After UPPP, long-term follow-up is recommended because some initially successfully treated patients will relapse in the long term.

Female↗
PubMed1995

The epidemiology of sleep related breathing disorder in children.

An epidemiological study of sleep obstruction and its orthodontic consequences is under way on a cohort (500) of 4-year-old children. The parents are asked about the child's snoring, sleep apnea, sucking habits, infections and 'genetic clues'. Dental casts have been made from the first 100 children and the group of children who snore are being compared to the non-snorers. A sleep study, a lateral cephalogram and dental casts are done on all snorers in the cohort. Preliminary results show that 6.2% snore every night by age 4 and another 18% when infected. More children use pacifiers among the snorers than in the non-snoring group (60% vs. 35%). Tonsillar angina is 3 times more common in the snorer group and twice as many of their parents have been adenoidectomized (A) and/or tonsillectomized (T). The dental casts show a significant difference in width of the maxilla and length of the mandible. The children are treated for their breathing obstruction with A or A+T. Two years later, the same cohort will be examined again. The prevalence of snoring and sleep apnea among 4-year-olds will be known as will whether and how treatment for breathing obstruction influences facial development.

Child, Preschool↗
PubMed1994

The cochlear blood flow: a comparison between the laser Doppler and the microsphere surface methods.

Since the introduction in the early 1980s, of the laser Doppler (LD) method for measuring cochlear blood flow (CBF) it has been debated whether the measured changes reflect the total or regional blood flow and whether the method per se influences the CBF. In order to answer those questions, the effect of one vasodilating drug, sodium nitroprusside, was investigated after topical application on the round window membrane (RWM) with respect to its influence on CBF. Two different techniques, the microspheres surface method and the LD method, were used. Untreated animals and animals which received saline or nicotine acid on the RWM were used as controls. The effects on CBF and blood pressure (BP) were continuously registered with LD. When a maximal flow had stabilized, 6 x 10(6) microspheres were injected into the left side of the heart. After the microspheres had been distributed within the body, the animals were killed. Both cochleae were microdissected and the microspheres counted turn by turn in the lateral wall. The number of spheres in the two ears was compared and the difference was recorded as the increase caused by the drug. The percentage change in CBF measured using the LD was compared with that obtained by using the microsphere surface method (MSM). No change in CBF measured by the two techniques was registered in the untreated animals, or after saline or nicotinic acid, while sodium nitroprusside induced a substantial increase in CBF. The mean percentage change of CBF measured with the LD method was compared with the calculated mean percentage change of microspheres for all turns in the cochlea, and in the first turn. Student's t-test and the linear correlation coefficient were calculated.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Topical↗
PubMed1994

Excessive daytime sleepiness and fatigue in nonapnoeic snorers: improvement after UPPP.

Even in the absence of sleep apnoea, heavy snoring may be a cause of excessive daytime sleepiness (EDS) and fatigue. The aim of this investigation was to study whether uvulopalatopharyngoplasty (UPPP) is effective in relieving snoring and excessive daytime sleepiness in nonapnoeic snoring patients. UPPP was assessed in 155 nonapnoeic, snoring patients (136 men and 19 women, mean age 45 yrs). Postoperative evaluation was made after 3 months in 105 patients, and after 12 months in 50 patients. Fifty four patients were evaluated after both 3 and 12 months. In 49 patients, a further evaluation was made after 2 yrs. The results were compared with those of 76 conservatively-treated, nonapnoeic, snoring patients, who were reinvestigated 12 months after their initial examination. The proportion of patients with frequent loud snoring had decreased postoperatively from 96 to 18%. A highly significant improvement was reported in EDS and daytime fatigue. The proportion of patients who reported problems staying awake when driving had decreased from 29 to 7%, and the number who felt rested when awakening in the morning had increased from 23 to 78 after the operation. The patients in the UPPP group had somewhat more severe symptoms before treatment than those treated conservatively. One year after treatment the situation had been reversed, with significantly more snoring and excessive daytime sleepiness in the conservatively-treated group. In conclusion, these results indicate that UPPP is effective in relieving snoring and EDS in nonapnoeic snorers.

Adult↗
PubMed1993

The effect of topical application of vasodilating agents on cochlear electrophysiology.

The aim of this investigation was to study whether increased blood flow has beneficial effects on the ear or whether it is damaging to the auditory function, expressed as the auditory gross neural response. Four vasodilating agents were examined after topical application with respect to their influence on cochlear blood flow (CBF), blood pressure, and auditory function in the normal guinea pig. CBF was recorded with laser-Doppler. The drugs used were sodium nitroprusside, hydralazine, nicotinic acid and histamine. Sodium nitroprusside and hydralazine increased CBF and induced concentration dependent loss of auditory function. Neither nicotinic acid nor histamine had any effect on CBF. Nicotinic acid had varying effects: in some cases a negative influence on threshold shifts was seen, and in others a positive one. In most cases histamine caused improvement of the auditory function. The data indicate that topical administration of drugs to the inner ear is effective to influence both CBF and auditory function.

Administration, Topical↗
PubMed1992

Body growth in relation to tonsillar enlargement and tonsillectomy.

Severe airway obstruction caused by tonsillar enlargement can result in disturbances in body growth. The effect of this interference and of tonsillectomy in the child with only moderate symptoms have been less satisfactoril evaluated. In this study, 122 children with symptoms and signs of tonsillar obstruction were investigated concerning the height and weight before and after tonsillectomy. None of the individuals demonstrated cardiopulmonary complications of tonsillar obstruction. Altogether 10% of the children exhibited abnormalities in body weight and/or length prior to surgery. Especially during the first postoperative year, the weight and height gain exceeded the expected in 75% of the patients. The accelerated weight gain increased with tonsil size, but there was no relation to the extent of difficulties in swallowing or sleeping disruptions. The results support the hypothesis that tonsillar hypertrophy frequently is associated with disturbances in body growth and that this is seldom demonstrable prior to tonsillectomy.

Adolescent↗
PubMed1992

Cochlear blood flow in response to dilating agents.

Reduced cochlear blood flow (CBF) has been implicated in various pathologies of the inner ear, including sudden deafness, noise-induced hearing loss and Meniere's disease. Thus the aim of some current therapeutic regimens to treat these conditions is to increase CBF and thereby improve oxygenation of the inner ear tissues. Most of the vasodilating agents in clinical use, however, do not have specific experimental evidence to support their effects on CBF. The hypotension which can follow systemic administration may limit their local effectiveness and general utility, just as it complicates the interpretation of the data in animal experiments. In the current study we investigated the effect of six agents, known for their systemic cardiovascular actions, on CBF: hydralazine, sodium nitroprusside, papaverine, nicotinic acid, verapamil and histamine. The effect of these drugs was studied after topical applications on the round window membrane (RWM) and systemic intravenous administrations. CBF was monitored with a laser Doppler flowmeter (LDF). Topical administration of sodium nitroprusside was the most effective in increasing CBF, followed, in order, by hydralazine and histamine. No change in CBF was observed for papaverine, verapamil or nicotinic acid. Systemic administrations of all the agents caused a marked decrease in blood pressure and variable effects on CBF. We discuss the CBF changes in relation to the different pharmacological mechanisms of action of each drug. The study demonstrates the effectiveness of topical application of vasodilating agents in increasing CBF.

Administration, Topical↗
PubMed1991

Down syndrome and sleep apnea--a therapeutic challenge.

This case report describes 3 patients with Down syndrome and obstructive breathing problems, ages: 5 months, 15 months, and 22 years. The youngest one had normal cardiopulmonary function at birth, but soon developed a pulmonary hypertension. The next had a severe atrioventricular defect and additional pulmonary hypertension and there was little hope for her to survive heart surgery. The oldest one had had apneas since childhood with increasing severity, but was regarded as having normal heart function. All 3 were operated to relieve their breathing obstruction. The 5-month-old boy improved only slightly after an initial UPPP and had to be tracheotomized, which solved his problems. The tracheotomy could be removed when he was one year. The 15-month-old girl was cured of her breathing problems through an A + T and survived her heart surgery one month later. Tonsillectomy and UPPP was performed on the oldest patient. Following surgery, he had an episode of life-threatening bleeding and developed a DIC syndrome, and was critically ill for 18 days. After he recovered, his sleep apnea had improved. Once a myxoedema was diagnosed and treated, he made further progress. These cases stress the significance of early recognition of sleep apnea in children with Down syndrome and the importance of a careful preoperative investigation in collaboration with cardiologists.

Adenoidectomy↗
PubMed1991

The influence of tonsillar obstruction and tonsillectomy on facial growth and dental arch morphology.

Children, who were tonsillectomized because of sleep apnea were examined with respect to facial growth and dental arch morphology. Dental casts and lateral roentgencephalograms were analysed before surgery and two years after tonsillectomy. The findings were compared to data from children without tonsillary obstruction. A higher proportion of malocclusion than normal, especially open bite and crossbite, was noticed before surgery. Two years after surgery, 77% of the open bites were normalised and 50-65% of the buccal and anterior crossbites. The best results were seen in children operated before the age of 6.

Adolescent↗
PubMed1991

Symptoms in heavy snorers with and without obstructive sleep apnea.

Five hundred and eighty persons who were heavy snorers filled in a questionnaire regarding symptoms on a 5-grade scale. Of these, 178 had a complete polysomnography investigation while 402 patients underwent oxymetric screening during the night only. On the basis of these investigations. 217 were classified as suffering from the obstructive sleep apnea syndrome (OSAS) and 363 as snorers without OSAS. The symptom scores differed between the two groups, but the range was wide and some persons with OSAS claimed only minor daytime sleepiness, somnolence, etc., while a high proportion of persons without OSAS frequently suffered from such symptoms. Thus, it was not possible to discriminate between patients with and without OSAS on the basis of their symptoms only. Furthermore, there are many persons who are "only" heavy snorers but who have symptoms that affect their career and social life and who so far have only received scant interest from the medical profession. Excessive daytime sleepiness and somnolence thus do not seem to be secondary to hypoxemia at night but rather to poor quality of sleep, which may be the case in association with heavy snoring even without appreciable deterioration of oxygen saturation.

Adult↗