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Biomedical subjects

C Carenfelt

Publications and source records attributed to C Carenfelt.

At least 19 recordsLinked to original sources
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↗
PubMed1989

Etiology of acute infectious epiglottitis in adults: septic vs. local infection.

Adult patients with acute epiglottitis hospitalized between 1975 and 1988 were retrospectively analysed. 79 of 138 patients had a valid diagnosis and had delivered at least one blood culture and were considered eligible for further evaluation. Cultures from the upper airways, including epiglottis, were available in 43 of the patients as a consequence of prospective measures. 27% of the patients had bacteremia, which may however be an overestimation. Haemophilus influenzae was the predominating finding, but Streptococcus pneumoniae was isolated from 3 severely ill patients, indicating the existence of pneumococcal epiglottitis at a rate of less than 5%. From the non-bacteremic patients with a localized disease, either H. influenzae or beta-hemolytic streptococci were isolated from the epiglottis in one third of the cases. The distribution of pathogens in upper airways indicates that beta-hemolytic streptococci may have an etiological role in acute infectious epiglottitis. Except for H. influenzae, species with the potential ability of beta-lactamase production have no significance in the disease.

Acute Disease↗
PubMed1988

Origin of the choanal polyp.

To study the origin of the choanal polyp, the maxillary sinus was surgically explored using a preservative technique. An antral cyst or a cystic rudiment, usually attached to the inferolateral aspect of the sinus wall, was disclosed in 15 patients with this condition. As a part of the choanal polyp, the antral cyst exhibited a macroarchitecture and microarchitecture identical to the structure of the common intramural cyst of the maxillary sinus as studied in nine patients. It is concluded that the choanal polyp develops from the expanding intramural cyst protruding through the maxillary ostium and into the nasal cavity.

Adult↗
PubMed1988

Bacteriology of maxillary sinusitis in relation to character of inflammation and prior treatment.

By antral aspiration, 200 sinus secretions were obtained from the same number of adult patients with maxillary sinusitis. The bacteriological findings were related to the character of the secretions as well as to the duration of symptoms, previous antibacterial treatment and possible dental genesis. Pathogens were isolated in 87% of 54 patients with untreated acute sinus empyema, Streptococcus pneumoniae being the most prevalent (57%). In 47 cases of treatment failure Haemophilus influenzae predominated and was found in 60% of the purulent secretions. In all, 11% of the 47 cases showed growth of beta-lactamase-producing H. influenzae, corresponding to 18% of all H. influenzae in this group. Staphylococcus aureus and anaerobic bacteria were infrequent findings except in purulent sinus secretion from patients with a long history. In contrast to patients with sinus empyema, no pathogens were found in the majority of 37 patients with non-purulent sinusitis.

Adolescent↗