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Biomedical subjects

E Svanborg

Publications and source records attributed to E Svanborg.

35 records · Page 2Linked to original sources
PubMed1993

A preoperative and postoperative study of the accuracy and value of electrodiagnosis in patients with lumbosacral disc herniation.

Twenty patients with a radicular syndrome, who underwent surgery for unilevel lumbosacral disc herniations verified by computed tomography were investigated with neurophysiologic tests (electromyograms, F-responses, dermatome somatosensory evoked potentials) preoperatively and 1 year postoperatively. At least one test revealed a pathologic abnormality preoperatively in 13 patients, but in 5 patients only the nerve root level corresponded to computed tomographic findings. Discordance between neurophysiologic and radiologic findings did not predict a surgical success rate. if all neurophysiologic tests were normal the outcome was significantly worse than if any of the tests showed an abnormality (P < 0.01). Four patients who were improved after surgery still had abnormal neurophysiologic findings. In conclusion, neurophysiology is not useful to diagnose the exact level of a nerve root lesion, but may reveal whether it is present. Electrodiagnosis is recommended if radiology and clinical testing conflict. If positive, it may then serve to justify surgical exploration.

Adult↗
PubMed1993

Development of nocturnal respiratory disturbance in untreated patients with obstructive sleep apnea syndrome.

Patient histories suggest that obstructive sleep apnea syndrome (OSAS) is a progressive condition. To investigate whether this could be shown in data from sleep recordings, 42 patients with OSAS were retrospectively studied. All had undergone a screening recording of respiration movements and oximetry at least 6 months (average, 16 months) prior to a diagnostic polysomnogram including these parameters. No treatment was given in the meantime. In the first recording, mean oxygen desaturation index (ODI, average number of desaturations of > 4 percent per sleeping hour) was 10; periodic, obstructive respiration movements occurred during (average) 36 percent of total estimated sleeping time, and mean nadir SaO2 was 85 percent. In the second recording, mean ODI was 21 (significant change, p = 0.0002), periodic respiration time was 61 percent, and nadir SaO2 was 80 percent (p = 0.0001, respectively). In 26 of 42 patients (62 percent), ODI had increased by > 50 percent. Increases in ODIs and periodic breathing were significantly correlated to increases in body weight. There were, however, exceptional patients with considerable increases in respiratory disturbance despite weight loss. The greatest changes were found in the patients who had the highest apnea indices in the polysomnograms. Early treatment may therefore be justified, since a borderline case may change to severe OSAS in 1 to 2 years' time. Follow-up recordings of untreated patients are important.

Aged↗
PubMed1992

Temperature thresholds in the oropharynx of patients with obstructive sleep apnea syndrome.

The temperature thresholds for warmth and cold were determined on the oropharyngeal mucosa of 15 patients with obstructive sleep apnea syndrome (OSAS) and 15 age-matched nonsnoring control subjects. We found that six of the patients with OSAS were not able to detect either the upper (50 degrees C) or lower (25 degrees C) temperature limits of the test when recording from the tonsillar pillar, whereas all control subjects detected the temperature change within the measuring range. The OSAS patients showed a statistically significant higher threshold for warmth on the anterior tonsillar pillar, 46.8 degrees C (95% confidence interval 45.2-48.4) versus 42.5 degrees C (41.3-43.8) for the control subjects (p = 0.0006). The same was found on the tip of the tongue-40.1 degrees C (38.7-41.6) for OSAS patients and 38.2 degrees C (37.1-39.4) for the control subjects (p = 0.036). Determination of temperature thresholds on the skin is an established method of detecting a neuropathy. We speculate that patients with OSAS suffer from a neuropathy in the pharynx caused by prolonged and progressive trauma to the pharyngeal structures from vibration induced by snoring and/or stretching of the structures during apneas. A neuropathy may interfere with the normal stabilizing function of the pharyngeal muscles and with the local reflex mechanism preventing the upper airway from collapsing during inspiration. It is thus possible that snoring itself, by inducing a neuropathy in the pharynx, may contribute to the sequence of events that transform a snorer into a patient suffering from OSAS.

Adult↗
PubMed1991

Autonomic nervous system function in patients with primary obstructive sleep apnoea syndrome.

Ten patients with obstructive sleep apnoea syndrome cured by uvulopalatopharyngoplasty were compared to nine patients considered as surgical failures, using cardiovascular reflex tests--Valsalva manoeuvre, respiratory sinus arrhythmia, isometric handgrip and head-up tilt. Two patients had signs of moderate vagal dysfunction, but no case of definite autonomic nervous dysfunction was diagnosed. The overall results indicated sympathetic overreactivity, positively correlated to oxygen desaturation indices and remaining after successful treatment. Four patients did not exhibit bradycardia during sleep apnoea. Two of them had decreased respiratory sinus arrhythmia when awake, but two had normal values. This implies a difference in vagal responsiveness between the awake and sleeping states, or that other factors besides vagus function influence the bradycardia response to apnoea. The group mean values were all within normal limits. There was no significant difference between the two groups in any test. Autonomic nervous dysfunction therefore does not seem to contribute to surgical failure, nor to occur with increased incidence among patients with primary obstructive sleep apnoea syndrome.

Adult↗
PubMed1991

The exploding head syndrome: polysomnographic recordings and therapeutic suggestions.

Attention has recently been drawn to a condition termed the exploding head syndrome, which is characterized by unpleasant, even terrifying sensations of flashing lights and/or sounds during reported sleep. Nine patients complaining of sensations of explosions in the head during sleep or drowsiness were investigated with polysomnographic recordings. None of them had any neurological disorder. Five patients reported explosions during the recording sessions. According to the recordings, the attacks always took place when the patients were awake and relaxed. In two cases abrupt electroencephalographic (EEG) and electromyographic changes indicating increasing alertness were recorded at the time of the reported attacks. In the remaining three cases no EEG changes were seen. Thus, there were no indications of an epileptic etiology to the condition. In all patients the symptoms ameliorated spontaneously with time. The severity of the symptoms was reduced by reassurance of the harmlessness of the condition. Clomipramine was prescribed to three patients who all reported immediate relief of symptoms. It is concluded that symptoms of this type are probably not true hypnagogic phenomena but may be an expression of emotional stress in the awake state.

Adult↗
PubMed1991

Long-time follow-up after UPPP for obstructive sleep apnea syndrome. Results of sleep apnea recordings and subjective evaluation 6 months and 2 years after surgery.

Fifty unselected consecutive patients with obstructive sleep apnea syndrome (OSAS) underwent uvulopalatopharyngoplasty (UPPP). The diagnosis was based on the patient's history and recording of respiration movements (Static Charge Sensitive Bed. SCSB) and oximetry, alone or combined with polysomnography. Renewed SCSB oximetry recordings were used to evaluate the success of the treatment. Six months postoperatively 40% of the patients were classified as non-responders, i.e. their oxygen desaturation indices (ODI) were reduced by less than 50% or were still above 20. The mean body mass index (BMI) was significantly higher in the non-responder group. A second recording with complete data was obtained in 45 patients after an average of 21 months. It was found that 9 patients who had been responders in the first postoperative recording had become non-responders. Only 18 of the patients with complete data could be verified as responders after 2 years. The patients who relapsed showed a significant increase in mean BMI between the first and second postoperative recordings compared to the patients who remained responders. There were no significant differences between responders and non-responders concerning age or preoperative severity of OSAS expressed as ODI, nadir SaO2 and percentage of obstructive periodic breathing. Of the non-responders, 47% in the first postoperative recording and 52% in the second reported complete recovery from excessive daytime sleepiness. This subjective improvement was not correlated to the objective results. The conclusions of this study are thus that one postoperative recording is not enough to estimate the outcome of UPPP and that statements of the patient's subjective recovery alone must not be used for this purpose.

Adult↗
PubMed1991

Obstructive sleep apnea syndrome in male hypertensives, refractory to drug therapy. Nocturnal automatic blood pressure measurements--an aid to diagnosis?

Sixteen therapy resistant hypertensive males and 16 responders to antihypertensive drug treatment, matched for age, gender and body mass index, were examined by means of Static Charge Sensitive Bed (SCSB) and oximetry for the presence of obstructive sleep apnea syndrome (OSAS). In borderline cases, polysomnography was performed. The prevalence of OSAS among therapy resistant patients was 56%, as compared to 19% in the control group (p less than 0.05). This higher prevalence of OSAS in a weight-matched group of subjects with severe hypertension supports the notion of a causal connexion between hypertension and OSAS. In 10 OSAS patients and 10 hypertensives with normal respiration during sleep, ambulatory noninvasive monitoring (ABPM) of arterial pressure (AP) and heart rate (HR) was also performed. The OSAS patients had a higher nocturnal variability of HR, systolic blood pressure (both p less than 0.05), and diastolic blood pressure (p less than 0.01) in 8 half-hourly single ABPM measurements. Contrary to the non-OSAS subjects they also had a higher HR variability during sleep than they had in the waking state (p less than 0.05). For subjects less than 60 yrs a range/median value of greater than 0.32 for nocturnal diastolic pressure was found to predict OSAS with a sensitivity of 87.5% and a specificity of 100%. It is concluded that therapy-resistant male hypertensives have a high prevalence of OSAS. As this may be a deleterious combination, screening for OSAS is highly indicated in such patients. A high variability of HR and AP in nocturnal ABPM suggests OSAS.

Aged↗
PubMed1990

A limited diagnostic investigation for obstructive sleep apnea syndrome. Oximetry and static charge sensitive bed.

A simplified sleep apnea investigation consisting of combined oximetry and respiration movement monitoring was compared with conventional polysomnography. These two types of recordings were performed simultaneously during one night in 77 patients with suspected obstructive sleep apnea syndrome (OSAS). A static charge sensitive bed (SCSB) was used in the simplified recording because it provides a comfortable and reliable means of recording respiration movements. Periods of obstructive apneas gave a diamond-shaped periodic respiration movement pattern in the SCSB, usually accompanied by repetitive oxygen desaturations. The average number of desaturations greater than or equal to 4 percent per sleeping hour was termed the oxygen desaturation index (ODI) and compared with the apnea index (AI). In the whole population they were well correlated (p less than 0.0001, R2 = 0.41), but in individual cases there were considerable discrepancies. Patients with periodic respiration movements less than 18 percent of total sleeping time and ODI less than 2 never had AI greater than or equal to 5, whereas patients with periodic respiration greater than 45 percent and ODI greater than 6 always had AI greater than or equal to 5. Fifty-one of the 77 patients fulfilled these criteria. A bradycardia response to apneas was absent in 29 percent of patients with AI greater than or equal to 5. A combination of respiration movement and oximetry recording thus seems to give sufficient information to confirm or negate a diagnosis of OSAS in a majority of patients with clinical symptoms. In borderline patients, further investigations should be performed.

Adolescent↗
PubMed1989

B cell and autoantibody repertoire in a pair of monozygotic twins discordant for myasthenia gravis.

A pair of identical twins, 47 years of age, who have been discordant for myasthenia gravis for 15 years were studied with regard to clinical status, neuromuscular function, and presence and properties of myasthenia specific autoantibodies. The autoantibody repertoire was tested in serum, as produced by peripheral lymphocytes in culture and as revealed by B cell lines. The healthy twin had no clinical signs of myasthenia and no signs of impaired neuromuscular function on electrophysiological tests. The autoantibody repertoire and the avidity of the anti-receptor antibodies were similar in both individuals. Epstein-Barr virus transformation of peripheral lymphocytes revealed a higher incidence of B cells committed to make autoantibodies in the healthy twin than in her myasthenic sister.

Antibody Affinity↗
PubMed1989

Serum prolactin during status epilepticus.

The serum concentration of prolactin is frequently increased after single epileptic seizures and has therefore been used as a method to differentiate between hysterical attacks and epileptic seizures. We determined plasma prolactin concentrations in fifteen patients with status epilepticus. Seven patients had absence status, five complex partial and three generalised tonic-clonic status epilepticus. Prolactin levels were normal in all patients which indicates that, in contrast to single seizures, status epilepticus is not associated with an increase in serum prolactin.

Adult↗
PubMed1985

Anti-idiotypic antibodies, acetylcholine receptor antibodies and disturbed neuromuscular function in healthy relatives to patients with myasthenia gravis.

Fifty-eight first-degree relatives to 40 patients with myasthenia gravis were investigated regarding presence of acetylcholine receptor antibodies, anti-idiotypic antibodies against the receptor antibodies and clinical and electrophysiological signs of disturbed neuromuscular function. No relative had clinical signs of muscle weakness. The prevalence of low concentrations of receptor antibodies was 54%, of anti-idiotypic antibodies 37% and of pathological and borderline single fibre EMG 45%. No sibling, only 2/11 children and 3/14 parents were normal in all three tests. A combination of receptor antibodies and anti-idiotypic antibodies was the most common finding and was especially frequent in children. In female siblings and children there was a positive correlation between the presence of HLA-antigen A1 and/or B8 and that of receptor antibodies and anti-idiotypic antibodies. Male siblings and children showed no such correlation but had a higher frequency of pathological single fibre EMG than females.

Autoantibodies↗
PubMedDate not supplied

Nonconvulsive status epilepticus: high incidence of complex partial status.

Nonconvulsive status epilepticus may be subdivided into generalized (absence) status and complex partial status. The latter is regarded as a rarity, whereas the former constitutes the dominant part of the hitherto reported cases. We report 10 consecutive cases of adult patients with nonconvulsive status epilepticus, all documented by ictal electroencephalographic (EEG) recordings. Five had a complex partial status; the origin of the complex partial status appeared to be frontal in four of these patients. Three had recurrent complex partial seizures with incomplete recovery between seizures, and two had more continuous symptoms. One of the latter exhibited neither motor phenomena nor automatisms. The effect of diazepam or clonazepam was immediate in all 10 cases though transient in eight. A lasting control of the status was not achieved in six patients until i.v. phenytoin was added. The difficulties in the differentiation between complex partial status and absence status despite ictal EEG recordings are discussed, illustrated by a case with seizure discharges of a focal onset which rapidly generalized. The study indicates that complex partial status may be more common and the clinical expressions of absence status more variable than hitherto recognized.

Adult↗
PubMedDate not supplied

Polysomnography in chronic neuromuscular disease.

BACKGROUND: Sleep is a risk factor for respiratory failure in patients with chronic neuromuscular diseases (NMD). OBJECTIVE: To explore the diagnostic value of monitoring sleep parameters in addition to nocturnal respiratory parameters. METHODS: Thirty-one patients with chronic NMD underwent whole-night polysomnograms including EMG from accessory respiratory muscles. RESULTS: Sleep macrostructure was normal on average. The number of respiratory arousals per hour of sleep was above the upper limit observed in a control group (>2.1) in 71% of the patients, but was moderate in most cases. Nadir oxygen saturation <85% was the most common finding indicating respiratory dysfunction and was present in 80% of the patients. Noninvasive blood gas monitoring identified all but 2 patients with respiratory-induced sleep abnormalities. The respiratory arousal rate was correlated with the oxygen desaturation index, but otherwise there were no significant correlations between sleep and nocturnal respiratory parameters. Vital capacity was significantly positively correlated with obstructive apnea index and daytime base excess to nadir oxygen saturation. Inspiratory activity in accessory respiratory muscles was present during REM sleep and/or slow wave sleep in 70% of the patients. CONCLUSION: The severity of nocturnal respiratory dysfunction is not reflected in the extent of sleep impairment in patients with chronic neuromuscular diseases.

Adult↗