Biomedical subjects

C Carenfelt

Publications and source records attributed to C Carenfelt.

54 records · Page 3Linked to original sources

PubMed1976

Aspects of the treatment of maxillary sinusitis.

The elimination of bacteria from sinus secretion during antibiotic treatment and the biological environment in the sinus as regards pO2 and pCO2 of sinus secretions were studied. Elimination of bacteria was achieved only, but not invariably, when the antibiotic concentration in the secretion greatly exceeded the MIC values of the bacteria isolated. Bacteriostatic and bactericidal antibiotics were equally effective. In purulent secretions as opposed to nonpurulent secretions the pO2 was always zero or close to zero, and the pCO2 was always higher than, and sometimes more than twice as high as the pCO2 of venous blood. In view of these observations, antibiotic therapy resulting in a high antibiotic concentration in the secretion is advocated in the treatment of purulent maxillary sinusitis. Furthermore, drainage and aeration of the sinus cavity is to be regarded as an important complement to the antibiotic therapy.

Anti-Bacterial Agents↗

PubMed1975

Subacute thyroiditis. A diagnosis in otolaryngology.

Subacute thyroiditis is often unrecognized and patients may be treated for pharyngitis, laryngitis, otitis media or similar disorders connected with otolaryngology. It is conceivable that these patients may seek treatment in ENT departments. The difficulties encountered in making a correct diagnosis are illustrated here on the basis of 12 consecutive cases. Eight of these patients were initially misdiagnosed resulting in useless therapy. Subacute thyroiditis is a self-limiting illness, and permanent myxoedema is rare. Nevertheless, one case with this sequela is reported.

Adrenal Cortex Hormones↗

PubMed1975

Evaluation of the antibiotic effect of treatment of maxillary sinusitis.

As the effect of antibiotic treatment of maxillary sinusitis has been questioned, the elimination of bacteria from sinus secretions was studied during antibiotic treatment. Penicillin V, azidocillin, tetracycline or doxycycline was administered to 54 patients with maxillary sinusitis. Samples of sinus secretion were aspirated both before treatment and 2-3 days after the onset of treatment. When the antibiotic concentration was below the upper limit of MIC for sensitivity group 1, bacterial growth was present in practically all samples. When the antibiotic concentration equalled or was above this limit, there was no bacterial growth in about half of the samples. A prerequisite for antibiotic effect--elimination of bacteria--is that the antibiotic concentration is well above the MIC of the bacteria at the site of infection. The choice between bactericidal or bacteriostatic antibiotics appeared unimportant. Bacterial survival in the maxillary sinus despite a high antibiotic concentration in the sinus illustrates that MIC values determined in the laboratory do not always mirror the sensitivity of bacteria to antibiotics in vivo.

Anti-Bacterial Agents↗

PubMedDate not supplied

Cervical metastases following radical neck dissection that preserved the spinal accessory nerve.

In contrast to the original neck dissection technique, the spinal accessory nerve is routinely sacrificed in the so-called classical neck dissection. The benefit of this routine has never been documented; on the contrary, facts have accumulated that indicate that the nerve should be preserved. The results in this article serve to emphasize this opinion. Of 80 patients who underwent radical neck dissection that preserved the spinal accessory nerve, the potential for cure was not jeopardized in a single case.

Accessory Nerve↗

PubMedDate not supplied

Pathogenesis of sinus empyema.

The crucial event in the pathogenesis of sinus empyema is the ostial obstruction. On the basis of recent reports, some consequences of the obstruction on the local bacterial-host interrelationship have been outlined. The anaerobic gas environment of the empyema is one quality important to the selection of bacteria but probably also to the efficiency of the antibacterial activity of the granulocytes. Release of proteolytic enzymes from neutrophilic granulocytes in the sealed sinus may jeopardize the bacterial engulfment due to proteolytic degradation of opsonins. A longstanding exposure of the sinus mucosa to uninhibited proteolytic enzymes may explain the irreversible lesion of the mucosa in chronic sinusitis.

Bacteria↗

PubMedDate not supplied

Discrimination of purulent from nonpurulent maxillary sinusitis. Clinical and radiographic diagnosis.

For the rational treatment of sinusitis, it is essential to distinguish sinusitis of bacterial origin from that of other etiologies. In maxillary sinusitis, antral purulence indicates a significant amount of pathogenic bacteria, whereas the presence of bacteria seems to be of less or no relevance in nonpurulent sinusitis. Hence, from a therapeutic point of view one important diagnostic goal is the differentiation of purulent from nonpurulent sinusitis. In this respect clinical examination is fairly reliable. Sinus radiography cannot distinguish purulent from nonpurulent sinusitis and offers few advantages when deciding on antibiotic therapy. Antral aspiration offers the most comprehensive information on which to base a reliable diagnosis.

Biopsy, Needle↗

PubMedDate not supplied

Immunoglobulins in maxillary sinus secretion.

The immunoglobin pattern was studied in maxillary sinus secretion of 17 patients with maxillary sinusitis. By single radial immunodiffusion, measurable amounts of IgM were found in the secretions of 15 patients, and of IgA and IgG in the secretion of all patients. In purulent sinus secretion, IgA levels were significantly lower than in serous secretion. Of the total content of IgA in sinus secretion, 30% (purulent secretion) and 43% (serous secretion) were calculated to be locally produced, on average. For IgG these figures were 15% (purulent secretion) and 18% (serous secretion), whereas IgM could not be estimated by the method used. It was also concluded that the maxillary sinus is a suitable organ for investigation of local immunity in regard to bacterial infections.

Adult↗

PubMedDate not supplied

Purulent and non-purulent maxillary sinus secretions with respect to pO2, pCO2 and pH.

Antral secretions from patients with maxillary sinusitis were aspirated for determination of pO2, pCO2 and pH. In 14 non-purulent secretions the mean pO2 was 12.7 kPa (96 mmHg) and the mean pCO2 5.2 kPa (39 mmHg). The mean pH was slightly alkaline. In 18 purulent secretions, usually with a heavy growth of pneumococci or H. influenzae, the pO2 was zero or close to zero and the mean pCO2 greater than or equal to 10.1 kPa (greater than or equal to 76 mmHg). The mean pH was slightly acid and significantly lower than in the nonpurulent secretions. The gas composition and the pH in purulent secretions do not only influence the metabolic activity and multiplication of bacteria, but may also interfere with the local protective functions of the sinus mucosa and with the bactericidal function of granulocytes.

Adult↗

PubMedDate not supplied

Maxillary sinusitis. Effects of treatment on the local antibacterial defence.

Low levels of immunoglobulins and complement in purulent antral secretion might jeopardize the local antibacterial defence. To evaluate whether or not antibiotic treatment and antral drainage influence the local content of immunoglobulins and complement, samples of secretion were analysed both prior to drainage and 1-2 days after drainage. In those patients requiring repeated drainage for their recovery, the local concentration of IgA and IgG was significantly lower in the secretion obtained prior to drainage than the local concentration found in patients who recovered after the initial drainage. It was also demonstrated that after drainage, the level of IgA, IgG and the complement factors C3 and C4 increased significantly, whereas the proteolytic activity in the secretion usually decreased.

Adult↗

PubMedDate not supplied

The role of local gas composition in pathogenesis of maxillary sinus empyema.

An impaired ostial function may be of importance in the pathogenesis of the maxillary sinus empyema due to changes of the antral gas composition. Oxygen is usually not demonstrable in purulent sinus secretion while carbon dioxide accumulates. In vitro, pneumococci were able to create a similar gas environment, provided that the gas exchange between the medium and the atmospheric air was reduced. It is suggested that heavy antral growth of facultative anaerobes, such as pneumococci, is related to the antral ventilation, which when impeded facilitates bacterial growth.

Bacteriological Techniques↗

PubMedDate not supplied

Bacteriology of maxillary sinusitis in relation to quality of the retained secretion.

The bacteriological findings in 200 patients with acute maxillary sinusitis are reported. It is concluded that the sampling technique--by antral aspiration--is highly significant in the evaluation of the bacteriological background of sinusitis, whereas the anerobic transport of the sample seems to be of less importance. By aspiration the purulent secretion can be properly separated from the non-purulent secretion. Pneumococci, H. influenzae and anaerobic bacteria can be isolated in about 90% of the patients with true sinus empyema, while sterile conditions are rare.

Anaerobiosis↗

PubMedDate not supplied

Occurrence, duration and prognosis of unexpected accessory nerve paresis in radical neck dissection.

Injuries to the spinal accessory nerve in connection with radical neck dissection occur frequently, despite the preservation of the nerve. Although the surgeon was unaware of any serious lesion of the accessory nerve, a trapezius paresis of varying degree was observed in about 60% of the patients during convalescence. The shoulder function improved in most patients, but major paresis with loss of essential rotary and supportive functions of the trapezius muscle persisted in 17% of the patients operated on. No further improvement was seen 18 months after the surgical trauma.

Accessory Nerve Injuries↗

PubMedDate not supplied

Analysis of symptoms and clinical signs in the maxillary sinus empyema.

One hundred and fifty-five patients with complaints indicating acute sinusitis were examined and their symptoms and signs registered. The final diagnosis--maxillary sinus empyema versus not empyema--was established by means of antral aspiration. A computer-based analysis of clinical data demonstrated the significance of the clinical examination. Local symptoms such as pain and purulent rhinorrhea with unilateral predominance were particularly guiding, even in bilateral cases, while nasal obstruction, tenderness during percussion, and affected general condition were not. With an overall reliability of about 85%, appropriate therapy can be suggested based on the clinical findings alone.

Adult↗

PubMedDate not supplied

On the diagnosis and pathogenesis of intramural maxillary cysts.

In order to study the etiology of the intramural maxillary cyst, which is the origin of the choanal polyp, an antrotomy was performed on 27 patients with such cysts. The cyst-fluid was analysed with respect to protein distribution and bacterial growth. The findings indicate an inflammatory process characterized by high concentrations of immunoglobulins and by consumption of complement and antiproteases. The growth of bacteria, primarily an oral flora found in the cyst-fluids studied, and the sites of cyst attachment, may indicate an epithelial residue of the dental list as the origin of the intramural cyst. It is further suggested that bacterial substances will provoke an inflammatory response, giving rise to an expansion of the cyst. In all cases studied, the cyst-fluid was capable of gelling after a couple of minutes at room temperature. This observation seems to be a reliable diagnostic procedure at antral aspiration, distinguishing the cyst-fluid from the serous transudate of the serous sinusitis, which according to our results, does not have this capacity to form a gel.

Adolescent↗

PubMedDate not supplied

CR1-expression and C3b-mediated phagocytosis of granulocytes in purulent maxillary secretion and peripheral blood from patients with sinusitis.

Granulocytes in sinus pus and in peripheral blood in 28 patients with maxillary sinus empyema were compared to blood granulocytes obtained from healthy blood donors. A flow cytofluorometric assay technique was used to establish the C3b-mediated phagocytosis and the CR1-receptor expression. The results indicate that a subpopulation of viable granulocytes in situ was activated with an increased ability to ingest particles. From 11 of 28 patients, an increased CR1-expression was also demonstrated in the blood samples, reflecting a priming of the circulating granulocytes before extravasation.

Adult↗

PubMedDate not supplied

Treatment of sinus empyema in adults. A coordinated Nordic multicenter trial of cefixime vs. cefaclor.

In sinus empyema, H. influenzae is the most prevalent pathogen in some subpopulations and in case of therapeutic failure. Cefixime, the first oral cephalosporin of the 3rd generation, is highly potent in vitro against H. influenzae. To study the efficacy and safety of cefixime in adults with acute sinusitis, a coordinated, double-blind multicenter trial was designed for purulent cases, as confirmed by antral aspiration. A total of 364 patients were enrolled in the study with 125 cases randomized to the reference group, assigned to treatment with cefaclor. Evaluation was based on clinical outcome and on antral reaspiration (86% of the cases). No significant differences between the treatment groups were found, as regards short-term or long-term clinical outcome. However, the clinical examination overestimated the therapeutic results. Only 4% of the patients were considered as failures, but the re-aspiration demonstrated remaining suppuration in 14% of all cases (p less than 0.001). Based on re-aspiration, the failure rate among patients with initial growth of pathogens was lower for cefixime (8%) than for cefaclor (20%) (p less than 0.05). Such a difference was not found among patients with growth of H. influenzae. No serious adverse reactions were recorded, but loose stools and diarrhoea were significantly more frequent in the cefixime treatment group. Five patients (2%) in the cefixime treatment group discontinued their treatment due to adverse events.

Cefaclor↗

PubMedDate not supplied

Driving vigilance simulator test.

Drivers suffering from sleepiness at the wheel run the risk of being involved in car accidents. To evaluate whether objective data of driving performance can be assessed in patients with excessive tendency of falling asleep at the wheel, two test versions of a computerized driving program were created to fit an advanced driving simulator. For the evaluation 15 male drivers with habitual sleep spells whilst driving were selected among patients with the clinical features of the sleep apnoea syndrome. The brake reaction time and the deviations from straight road-line were significantly increased when compared to the performance of 10 matched controls. Irrespective of test version, the driving simulator with the program used was found to be a sensitive method to ascertain driving vigilance impairment in quantitative terms. It would also be a valuable method to evaluate the efficiency of treatment in selected patients.

Accidents, Traffic↗

PubMedDate not supplied

Epstein Barr virus (EBV) carrying cells in blood of Hodgkin's disease (HD) and non-Hodgkin lymphoma (NHL) patients with high antibody titers against EBV capsid antigens (VCA).

Three patients with Hodgkin's disease (HD) and 7 patients with non Hodgkin lymphoma (NHL) who had high antibody titers against Epstein Barr virus (EBV) capsid antigens (VCA) were studied for the occurrence of EBV carrying B cells in the blood. The outgrowth of lymphoblastoid cell lines (LCLs) in their blood lymphocyte culture was tested in the presence of Cyclosporin A, which abrogates the growth inhibitory effect of T cells. Transformation occurred in the cultures of 4/10 patients and 4/10 age matched healthy individuals. The frequency of transformation in wells seeded with identical cells number from these 4 individuals in each group did not differ. Thus the lymphoma patients with high anti VCA titers did not show elevated level of EBV carrying B cells in the blood.

Aged↗