Biomedical subjects

Sven Lindberg

Publications and source records attributed to Sven Lindberg.

9 recordsLinked to original sources

PubMed2003

Outcome of treatment with valacyclovir and prednisone in patients with Bell's palsy.

Idiopathic facial paralysis, or Bell's palsy, shows a nonepidemic pattern that might indicate reactivation of a latent microorganism such as herpes simplex type I as a causative agent. Thirty percent of patients with Bell's palsy given no treatment will not recover completely, and 5% will have severe sequelae. The aim of this study was to find out whether treatment with an antiviral drug in combination with corticosteroids is more effective than no medical treatment at all in patients with Bell's palsy. Fifty-six consecutive adult patients attending the otorhinolaryngology department of the University Hospital of Lund from 1997 to 1999 were treated with 1 g of valacyclovir hydrochloride 3 times per day for 7 days and 50 mg of prednisone daily for 5 days, with the dose being reduced by 10 mg daily for the next 5 days. Fifty-six adult patients with Bell's palsy attending the same department between 1995 and 1996 who were given no medical treatment were studied retrospectively and used as the control group. Forty-nine patients (87.5%) in the treatment group recovered completely, as compared with 38 patients (68%) in the control group (p < .05). One patient (1.8%) in the treatment group displayed severe sequelae, defined as a House-Brackmann score of IV or worse, as compared with 10 of 56 patients (18%) in the control group (p < .01). Among patients over 60 years old, 10 of 10 in the treatment group had complete recovery, as compared with 5 of 12 patients in the control group (p < .01). The present study showed a significantly better outcome in patients with Bell's palsy treated with valacyclovir and prednisone as compared with patients given no medical treatment. This difference in outcome was especially pronounced among elderly patients.

Acyclovir↗

PubMed2002

One-year low-dose erythromycin treatment of persistent chronic sinusitis after sinus surgery: clinical outcome and effects on mucociliary parameters and nasal nitric oxide.

OBJECTIVE: In 17 patients with chronic sinusitis persistent after sinus surgery, long-term, low-dose erythromycin therapy was tested. The aim of the investigation was to study the clinical outcome and effects on nasal nitric oxide (NO), ciliary beat frequency (CBF), and mucociliary transport (saccharine transit time). STUDY DESIGN AND SETTING: We conducted a prospective open study at a tertiary teaching hospital. Symptoms were assessed using visual analog scales. NO was measured using a chemiluminescence analyzer, and mucociliary transport was measured with the saccharine crystal technique. CBF was measured in nasal brush samples using a phase contrast microscope. All patients were treated with erythromycin succinate 250 mg 2x daily or clarithromycin 250 mg 1x daily and were assessed after 3 months. In cases where there was no response, treatment was abandoned. The remaining patients (responders) were reassessed after 12 months of treatment. RESULTS: Of 17 patients, 12 responded to treatment. The 12-month follow-up showed an improvement in saccharine transit time (P < 0.05) but no significant change in CBF. There was a trend toward an increase in NO (P = 0.12). Endoscopic nasal examination scoring improved significantly (P < 0.01). In the visual analog scale scoring, the most pronounced improvements were seen in nasal congestion, sticky secretion, and runny nose at 3 and 12 months (P < 0.01). Improvements were also seen in headache (P < 0.05). CONCLUSION: The present study suggests that long-term, low-dose treatment with erythromycin is effective in persistent chronic sinusitis that does not respond to sinus surgery or systemic steroid/antibiotic treatment. SIGNIFICANCE: Long-term, low-dose erythromycin therapy seems to be a promising alternative when more conventional therapy fails. However, placebo-controlled studies are needed to validate the potential of this treatment.

Adolescent↗

PubMed2002

A decrease in maxillary sinus pressure, as seen in upper airway allergy or infection, results in an increase in upper airway nitric oxide levels.

The paranasal sinuses are connected to the nasal cavity via small osties. Ostial occlusion, caused by mucosal swelling, will result in a slowly increasing negative pressure inside the sinus cavity. In parallel, the oxygen content in the sinus will decrease, resulting in the development of relative hypoxia. Hypoxia is a powerful inducer of nitric oxide (NO) synthase, and inducible NO synthase has been shown to be present in considerable amounts in the upper airways, including the sinuses. The present study was designed to investigate whether a reduction in sinus pressure would affect upper airway NO production. Thirteen healthy volunteers were investigated. A pressure chamber was used to lower the ambient pressure to -4.9 kPa. NO was sampled from one nostril or via a drainage tube inserted into the maxillary sinus before, during and after the hypobaric exposure. When the pressure was decreased, NO levels increased from 256 +/- 15 to 316 +/- 19 ppb (n = 13, p < 0.001). The NO levels remained elevated (282 +/- 21 ppb; p < 0.05) when measurements were repeated 20 min after leaving the chamber. The nasal airway resistance (V2tot) also increased as a result of the chamber session (from 16 +/- 2 degrees before to 21 +/- 3 degrees after; p < 0.05). An increase in NO levels was also found when the experiments were repeated with NO sampled directly from the maxillary sinus (225 +/- 6 before and 265 +/- 9 ppb after; n = 6, p < 0.001). For control purposes the nasal analyses were repeated again, this time under hyperbaric conditions (+ 4.9 kPa). This resulted in a slight decrease in the NO levels (from 273 +/- 22 to 241 +/- 17 ppb; n = 10, p < 0.001), but there was no change in the nasal airway resistance. We conclude that a reduction in sinus pressure, as seen in upper airway allergy or infection, may result in an increase in upper airway NO production.

Adult↗

PubMed2002

Washout of 133-xenon as an objective assessment of paranasal sinus ventilation in endoscopic sinus surgery.

Endoscopic sinus surgery (ESS) is today a common method for the treatment of chronic rhinosinusitis. Assessment of the results has been based mainly upon subjective evaluation, and only a few reports present objective measurements. In the present study, the 133-xenon washout technique was used for preoperative and postoperative evaluation of paranasal sinus ventilation in 12 patients selected for ESS. The postoperative half-times (T1/2) of 133-xenon washout were lower in the sinuses with abnormal preoperative half-times (T1/2), especially in the maxillary sinuses, where the postoperative T1/2 was 44 (22 to 150) minutes (median and quartiles, Q1-Q3) as compared with a preoperative T1/2 of 202 (94 to 278) minutes. The postoperative evaluation included a questionnaire and a follow-up visit with endoscopy and measurements of nasal nitric oxide. The results showed that patients who declared a marked reduction in symptoms exhibited significantly improved sinus ventilation. However, no direct correlation was found between improvement in ventilation and symptom improvement. Nine of the 12 patients showed improvement on endoscopy, and these patients also exhibited improved sinus ventilation. The postoperative nasal nitric oxide levels were within the normal range in 11 of the 12 patients; the other patient showed pathological T1/2 values for all paranasal sinuses. The 133-xenon washout technique is thus a method that can be used for objective evaluation of the ventilation of the paranasal sinuses before and after ESS procedures. However, the technique cannot be used to evaluate sinuses with totally obstructed ostia or postoperative sinuses with very wide neoostia, as rapid washout may lead to no activity remaining at the time of measurement.

Adult↗

PubMed2002

The paranasal sinuses as reservoirs for nitric oxide.

OBJECTIVE: Nitric oxide (NO) is an important mediator and inflammatory marker in human upper airways. Enzymes responsible for NO production have been demonstrated both in the nose and in the paranasal sinuses, but NO levels in the sinuses are reported to be several times higher than those in the nose. It has been postulated that the paranasal sinuses may be the primary sites for NO production in the upper respiratory tract. The present study was designed to compare the NO levels sampled from the nose with those found in the paranasal sinuses. MATERIAL AND METHODS: NO levels in the maxillary sinus and nose were determined using a continuous chemiluminescence measuring technique in seven healthy volunteers. RESULTS: When NO was sampled, via a drainage tube inserted into the maxillary sinus, a transient peak in NO level was recorded. The maximal NO level (5,761 +/- 1,513 ppb; n = 7) was reached within 10 s and was followed by the establishment of a lower steady-state level (304 +/- 51 ppb). When NO was continuously sampled from the nose a steady-state level, similar to that found in the sinus, was immediately established (313 +/- 52 ppb). CONCLUSION: The data presented confirm previous findings of extremely high NO levels in the paranasal sinuses and suggest that these cavities may also function as reservoirs for NO.

Adult↗

PubMedDate not supplied

Absence of nexin links as a possible cause of primary ciliary dyskinesia.

Transmission electron microscopy of nasal cilia was performed in three patients, two of them siblings, with repeated respiratory infections. Number of microtubuli and dynein arms were within normal limits and they had an ordered arrangement except for a disarray of the microtubuli in some areas of the biopsies from two of the patients. In the normal areas radial spokes and sheaths were easily found but nexin links could not be discerned in any of the patients. The orientation of the cilia was partly random. As all patients repeatedly and constantly had very low nasal NO (range 9-15 ppb; normal findings for persons <10 years old are > 50 ppb), the diagnoses were very likely primary ciliary dyskinesia (PCD). Absence of nexin links may be an ultrastructural variant of PCD. Deficiency of these structures might be the cause of the microtubular disarray observed in some areas of the biopsies.

Adult↗

PubMedDate not supplied

Acute exudative inflammation and nasally exhaled nitric oxide are two independent phenomena.

BACKGROUND: Increased levels of nitric oxide (NO) and the exudations of plasma proteins to the airway lumen have both been considered characteristics of airway inflammation. The aim of the present study was to investigate a possible relationship between nasal NO concentrations and acutely induced exudative inflammation of the nasal mucosa. METHODS: Twelve healthy non-allergic subjects participated. Nasal challenges with saline, histamine 40 microg/ml (H1), histamine 400 microg/ml (H2), oxymethazoline, 0.25 mg/ml (OXY), and a combination of oxymethazoline 0.25 mg/ml and histamine 800 microg/ml (OXYH), were performed on separate occasions. Exhaled NO was measured after each challenge, and alpha(2)-macroglobulin (as a marker of plasma exudation) was measured in nasal lavage fluids after the H1 and H2 challenges. RESULTS: The mean baseline NO in all measurements was 164 plus minus 10.3 ppb. Saline and H1 challenge did not change NO and alpha(2)-macroglobulin levels. H2 challenge showed a tendency to reduce NO levels, and the most pronounced decrease was seen after 10 min (-36.3 +/- 16.3%, p = 0.07). This reduction was sustained throughout the registration period. Simultaneously with the decrease in NO, alpha(2)-macroglobulin levels were increased significantly. OXY challenge alone reduced NO significantly throughout the whole registration period. Maximum decrease was seen at 40 min (-21.3 plus minus 3.4%, p = 0.03). The OXYH challenge also reduced NO, with a maximal reduction recorded at 10 min (-29.4 +/- 6.4%, p = 0.03). The reduction of NO was sustained throughout the registration period (p < 0.01). CONCLUSION: Histamine 400 microg/ml induced a prompt plasma exudation response whereas a decrease in nasal NO was registered, suggesting that these two events are not necessarily linked. Furthermore it was shown that the vasoconstrictor oxymethazoline reduced nasal NO, which could be related to reduced mucosal blood flow, whereas the reduction of nasal NO after histamine challenge remains to be elucidated.

Acute-Phase Reaction↗

PubMedDate not supplied

Effects of oxymetazoline on the ventilation of paranasal sinuses in healthy subjects.

BACKGROUND: Impairment of sinus ostial function is considered an important factor in the pathophysiology of sinus disease. The use of the decongestants such as alpha2-agonists is thought to improve sinus ostial function. Previous studies have shown an effect of alpha2-agonists on maxillary sinus ostial function only when administered in nasal bellows, but not as a nasal spray or nasal drops. The effect of decongestants on ventilation of the frontal and posterior ethmoidal and sphenoidal sinuses has not been studied to date. METHODS: In this study, the 133-xenon washout method was used to determine ventilation for all paranasal sinuses before and after administration of oxymetazoline as nasal drops in eight subjects and from nasal bellows in nine healthy subjects. RESULTS: No significant effect of oxymetazoline on sinus ventilation was seen in either group. CONCLUSIONS: The results indicate that alpha2-agonists do not have any effect on sinus ventilation in healthy subjects. However, one cannot exclude that decongestants improve sinus ventilation in patients suffering from sinus disease and this requires further studies.

Adolescent↗

PubMedDate not supplied

Allergic rhinitis and atopy in 18-year-old students.

BACKGROUND: The aim of this study was to investigate the prevalence of allergic rhinitis and atopy in adolescents and whether air pollution in their schools contributed to allergic sensitization. METHODS: Analyses were performed in 1992-1994 on 511 18-year-old students at four schools and on the indoor air and floor dust of their classrooms. The students underwent skin-prick tests (SPTs) and a nasal lavage and answered a computer-based questionnaire containing questions on allergy and nasal symptoms. RESULTS: Atopy, defined as at least one positive SPT response, was found among 37% of the students, with no difference between students of the four schools, regardless of whether the data were adjusted for gender, hereditary disposition to allergy, and smoking habits. The number of students who had positive SPT and reported nasal symptoms when exposed to possible allergens, which were found among 35%, did not differ between the schools. No correlation was found between the prevalence of atopic individuals and the levels of different indoor air pollutants in the schools. CONCLUSION: The prevalence of allergic rhinitis among adolescents is very high and suggests that it is, at least at the time of our study and in comparison with other studies, still increasing. Our results indicate that the indoor air and floor dust at the schools of the students do not contribute to allergic sensitization.

Adolescent↗