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Biomedical subjects

W Pirsig

Publications and source records attributed to W Pirsig.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Meta-analysis of laser-assisted uvulopalatopharyngoplasty. What is clinically relevant up to now?].

BACKGROUND: Laser-assisted uvulopalatoplasty (LAUP) was not recommended by the American Sleep Disorders Association for the treatment of snoring and obstructive sleep apnea (OSA) because of data lacking in 1994. In the meantime numerous new papers concerning this subject have been published in peer reviewed journals. A new evaluation of the value of LAUP is presented. METHODS: In a world-wide literature search (Medline) from 1980 until March 1999, seventy articles were identified. The papers were analyzed concerning the subtopics "operative techniques", "LAUP and OSA", "LAUP and snoring", "pain", "side-effects", "indications" and "predictive criteria". RESULTS: On the basis of the collected data, it is possible to put definitive values on the subtopics "operative techniques", "LAUP and snoring" and "side-effects". In contrast, objective long-term results concerning "LAUP and OSA" are still missing. Short-term results are promising. CONCLUSION: Nevertheless, LAUP and its related procedures presently should not be recommended for the treatment of any severity of OSA.

Adult↗
PubMed2000

Tonsillectomy as a treatment of obstructive sleep apnea in adults with tonsillar hypertrophy.

OBJECTIVES: High surgical success rates for adenotonsillectomy in children with sleep-related breathing disorders have been described in various studies. The purposes of the present study were to observe how often a substantial tonsillar hypertrophy is associated with obstructive sleep apnea (OSA) in adults and to evaluate the efficiency of a bilateral tonsillectomy. STUDY DESIGN: Data from a prospective study with 11 adults who underwent tonsillectomy as single treatment for sleep-related breathing disorders were evaluated based on the severity level of their preoperative apnea-hypopnea index (AHI). MATERIAL AND METHODS: Within 3 years, 11 patients with a substantial tonsillar hypertrophy underwent attended polysomnography in the sleep laboratory. Tonsillectomy was performed, and postoperative complications and polysomnographic findings were reviewed. Follow-up time was 3 to 6 months. RESULTS: Nine of 11 patients (81.8%) were diagnosed with OSA. Five of these patients exhibited severe OSA, four patients had mild OSA, and two patients were simple snorers with an AHI below 10. The surgical response rates (defined as decrease in the postoperative AHI > or = 50% and a postoperative AHI of less than 20) were 80.0% in severe apneics and 100% in mild apneics. No serious complications occurred. CONCLUSIONS: Substantial tonsillar hypertrophy can rarely cause OSA in adults. In the carefully selected patient a tonsillectomy should be considered an effective and safe surgical option for the treatment of this disorder.

Adult↗
PubMed2000

Uvulopalatopharyngoplasty changes fundamental frequency of the voice--a prospective study.

The aim of the study was to find whether a muscle-sparing uvulopalatopharyngoplasty (UPPP) and tonsillectomy cause a measurable change in the voice. The fundamental frequency and the first two formants of five sustained vowels were measured before and nine (six to 15) months following operation. The operation consisted of tonsillectomy and UPPP with preservation of the musculature of the soft palate. All patients received a pre- and post-operative 12-canal polysomnography (level-I sleep study). No patient showed signs of any post-operative velopharyngeal insufficiency. Acoustic analysis showed a significant raising of the fundamental frequency of up to 10 Hz. There was also a lowering of the second formant in two of the five vowels. This was correlated with the volume of the excised tissue. The minimal changes will probably have no significance for those who place no special reliance on their voice, but the possible post-operative changes should be made clear to singers and those relying on their voice for professional reasons.

Adult↗
PubMed2000

Validation of the POLY-MESAM seven-channel ambulatory recording unit.

STUDY OBJECTIVES: To determine the recording capabilities of the POLY-MESAM (PM) unit (MAP; Martinsried, Germany), an American Sleep Disorders Association level III system, and to compare it with simultaneous 12-channel polysomnography in the sleep laboratory. MEASUREMENTS AND RESULTS: Fifty-three patients (49 men and 4 women) with obstructive sleep-related breathing disorders of varying severity were included. The apnea-hypopnea indexes (AHIs) obtained using the two methods differed significantly from each other, although the correlation was close. The PM unit produced false-negative results in patients with mild to moderate obstructive sleep apnea (OSA). The sensitivity of the PM unit in detecting patients with an AHI > 10 was 92%, while the specificity was 96.3%. CONCLUSIONS: The correlation of AHIs obtained with polysomnography and with the PM unit is close. However, in some cases, the PM may underestimate OSA parameters. The PM unit produces false-negative results in patients with mild to moderate OSA. While inpatient polysomnography remains the "gold standard," the PM unit may provide an inexpensive alternative in some special cases.

Adult↗
PubMed1999

The shift in the indications for the tracheotomy between 1940 and 1955: an historical review.

In the period between 1940 and 1955 the indications for tracheotomy were extended. For centuries tracheotomies were performed to treat obstructive diseases of the upper airway (hypopharynx, larynx, trachea). With the end of the second World War tracheotomy was indicated more and more for the therapy of lower airway disturbances. Medical empiricism is thought to be responsible for the gradual shift in the indications during that period from upper to lower airway disturbances. Knowledge about the underlying principles of respiratory physiology was, however, already present at the end of the 19th century, but the shift in the indications did not occur until relatively recently. For many victims of World War II the discovery of the beneficial effect of a tracheotomy in a variety of traumatic disorders may have come too late.

History, 19th Century↗
PubMed1999

Age-related changes in the epiglottis causing failure of nasal continuous positive airway pressure therapy.

At 65 years of age, a former coal miner, now 72-years-old, developed a progressive loss of concentration with daytime sleepiness and sleep disturbances. Work-up in pneumological and medical sleep centres resulted in diagnosis of chronic obstructive pulmonary disease (COPD), borderline obstructive sleep apnoea syndrome and, later, upper airway resistance syndrome. In addition, there was evidence of reduced efficiency of sleep. Neither the initial administration of theophylline nor the later use at night of hyperbaric respiration led to improvement in the patient's symptoms. Instead, the patient developed loud snoring, as well as the inability to sleep while in a lying position. At age 71 years, otorhinolaryngological examination resulted in findings of age-related changes in the epiglottis, that completely blocked the hypopharynx upon inspiration. Polysomnography, which was possible only in a half-seated position, revealed reduction in deep sleep, with a maximum oxygen saturation of 77 per cent at an apnoea-hypopnoea index (AHI) of 4.8. Partial resection of the epiglottis with laser surgery resulted in complete improvement of diurnal drowsiness and reduced stamina. Sleeping in a supine position again became possible. Polysomnography revealed normalization of sleep architecture, but unchanged, low efficiency of sleep. This case underscores the importance of an interdisciplinary approach to the treatment of sleep-related breathing disorders.

Aged↗
PubMed1999

[What are the side-effects of nocturnal continuous positive pressure ventilation (nCPAP) in patients with sleep apnea for the head-neck region?].

BACKGROUND: Nasal continuous positive airway pressure ventilation therapy is the present gold standard in the treatment of obstructive sleep apnea. Depending on the definitions used, about 60% of the patients tolerate nCPAP therapy. The reason for this limited tolerance is a varying number of side effects. The aim of the present retrospective study was to analyze the incidence and intensity of otorhinolaryngological side effects of nCPAP therapy. METHOD: Questionnaires inquiring about the frequency of using nCPAP and objective and subjective complaints were sent to 92 patients who were treated with nCPAP in our department within the last years. Six of 92 patients also used a heated humidifier. A telephone interview was added to complete the questionnaires as correctly as possible. RESULTS: Eighty questionnaires were sent back completely answered. The mean frequency of using nCPAP (+/- standard deviation) was 6.8 +/- 1.6 hours per night and 6.5 +/- 1.4 nights per week. The mean duration of nCPAP therapy was 28.0 +/- 21.0 months; the mean pressure used was 6.8 +/- 1.2 cm H2O. The following side effects were specified most frequently: disturbance of sleep during the night (71.3%), dry mouth (47.5%), dry nose (46.3%), pressure marks by the mask (41.3%), crusts within the nasal cavity (38.8%), and hearing loss (26.3%). Dryness within the nose and mouth was considered the most irritating side effects. CONCLUSIONS: NCPAP therapy has a number of different side effects in the head and neck. These side effects are seen frequently. Prospective analysis must show whether there are correlations between the intensity and frequency of side effects and the duration of therapy, and whether technical improvements (quality of masks, noise reduction, humidifiers) are able to reduce the frequency of side effects.

Adult↗
PubMed1999

[Validating a 7-channel ambulatory polygraphy unit. 1: Operating instructions for the physician and patient].

PURPOSE: For some time, the ambulatory diagnosis of sleep-related breathing disorders has included the use of seven-channel recording units. One such unit is the POLY-MESAM (MAP, Martinsried, FRG). The first part of the present study prospectively investigated the handling of the system for physicians and patients, its technical reliability, reliability of the software used and the results in comparison to handscoring. METHODS: In all, 104 patients (95 males, 9 females) were studied for different severities of obstructive sleep-related breathing disorders. The first 51 patients were connected to the POLY-MESAM in the evening within the clinic. The patients then slept at home and returned the next day. Another 53 patients received only a short briefing in the clinic and connected themselves at home to the POLY-MESAM System. Each patient's status was monitored by means of a visual analogue scale. Automatic evaluation of the data was compared with the results of manual scoring. RESULTS: From the data recorded only 6% of the results were not usable. Patients acceptances of the system were very high (94.3%). On average each patient required 21 minutes for attaching and detaching the device. Scoring and instructing the patients required an average of 23 min. Regarding the apnea-hypopnea index (AHI), the correlation between automatic (AHI = 11.1) and manual (AHI = 11.3) evaluations was high. Analysis of snoring turned out to be insufficient. CONCLUSIONS: The POLY-MESAM proved to be reliable and user-friendly. Our findings show that the system can be recommended for outpatient screening of sleep-related breathing disorders, with patients able to manage the system without help. Validation by using simultaneous polysomnography is the subject of part two of the study.

Adult↗
PubMed1999

[Validating a 7-channel ambulatory polygraph unit. 2: Simultaneous polysomnography].

PURPOSE: For some time, the ambulatory diagnosis of respiratory disturbances during sleep has included the use of seven-channel recording units. One of these systems is the POLY-MESAM unit (MAP, Germany). METHODS: The aim of the present study was to validate the POLY-MESAM system by simultaneously performing 12-channel polysomnography. Forty-nine patients (45 males and 4 females) with different severities of obstructive sleep-related breathing disorders were included. Obstructive sleep apnea was diagnosed, when an apnea-hypopnea index (AHI) > 15 was found by polysomnography. The sensitivity and specificity for POLY-MESAM were calculated on the basis of the polysomnographic AHI. RESULTS: The sensitivity of POLY-MESAM for detecting patients with an AHI > 15 was 86.4% and the specificity was 100%. CONCLUSIONS: The POLY-MESAM system was easy to use. The sensitivity and specificity for the MESAM4 unit were 92% and 97% respectively, which was similar to POLY-MESAM. Additionally, POLY-MESAM provided the possibility for distinguishing the different kinds of apneas. Thus, POLY-MESAM was considered to be a useful development of the previous MESAM4 unit. In some cases, use of the POLY-MESAM unit resulted in underestimation of the AHI. POLY-MESAM produced false-negative results in patients with mild to moderate OSA. This finding was reflected in the relatively poorer sensitivity of the method (86.4%). Cardiorespiratory sleep studies (as possible with POLY-MESAM) are best limited to patients for whom the diagnosis of OSA is highly probable or as a follow-up tool in selected circumstances.

Computer Systems↗
PubMed1998

[Obstructive sleep apnea and obstructing nasal polyps].

BACKGROUND: Nasal obstruction may be a causative factor in the etiology of obstructive sleep apnea. No studies were found that dealt with the role of nasal polyps in sleep apnea. METHOD: Two male patients, 69 and 44 years old, were examined in our clinic because of nasal polyps occluding the nasal cavity. Their main complaint was nasal breathing obstruction with hyposmia. The clinical history revealed snoring but neither apnea nor daytime sleepiness was reported. Both patients underwent full nocturnal 12-channel polysomnography (PSG) prior to endonasal sinus surgery. PSG and nasal endoscopy were performed 3 months postoperatively. RESULT: The patients showed an increased apnea hypopnea index (AHI) from 21.1 to 76.6 and 7 to 38.8 respectively. Excessive daytime sleepiness (EDS) appeared and relative duration of REM sleep decreased. Nasal CPAP therapy was recommended. CONCLUSION: Although patients felt relieved after surgery since their nasal breathing problem was solved, the results with respect to AHI, EDS, and sleep pattern were unexpected. Perhaps these findings can be explained by surgical alteration of nasal receptors or by a postoperative switch from oral to nasal nocturnal breathing.

Adult↗
PubMed1997

[Pharyngeal pressure measurements in topodiagnosis of obstructive sleep apnea].

In order to improve the outcome of surgical treatment for obstructive sleep apnea syndrome certain reports have claimed to identify the site of obstruction in the upper airway. One of the various methods available for topodiagnosis is manometry using intraesophageal and intrapharyngeal pressure probes. In the present literature the surgical success rate for patients undergoing Uvulopalatoplasty (UPP) as treatment for retropalatal obstructions is approximately 50%. For patients with other sites of obstruction the success rate is below 10%. The aim of this study was to evaluate the different theories explaining the still low outcome of UPPP in patients with only retropalatal collapse. Findings showed that measurements within different sleep stages and at different pharyngeal activities during sleep can lead to different results concerning sites of obstruction. Additionally, any surgery to one part of the pharynx seems to influence the other parts of the pharynx in caudal and cranial directions. A literature theory dominates that the pharynx between the nasopharynx and lower hypopharynx acts like several Starling mechanism in series, in which are influences the other. Whether more complicated pressure measurements emphasizing the role of sleep stages and pharyngeal muscle activities could improve the surgical outcome of UPPP is the subject of present investigations. In any case the technical equipment and time consumption of the measurements required will probably disqualify the method for routine use.

Airway Obstruction↗
PubMed1997

[Different forms of microtia depicted on a Flemish altar piece of the 15th century in Ghent].

An alterpiece created by the master of the Wenemaer Triptych, a painter from the Flemish school in the second half of the 15th century, is displayed in the Museum for Fine Arts of Ghent. The triptych comprises five parts with scenes of the life of Christ. The artist painted all the faces with portrait-like features, including anatomical details of the auricles. My medical attention was attracted to deformed auricles depicted in nine of the 41 persons from all age groups. There are good arguments to support the hypothesis that persons with various types of microtia had been models for the painter.

Congenital Abnormalities↗
PubMed1997

[A case of sarcoidosis of the mastoid].

BACKGROUND: Sarcoidosis is a common granulomatous systemic inflammatory disease mainly affecting the interstitial lung tissue and perihilar lymph nodes. Since its first description by Bernier 1889 its etiology has remained obscure. METHOD: Sarcoidosis of the right middle ear in a 38-year-old woman was diagnosed by biopsy. RESULT: After mastoidectomy and treatment with prednisolone the patient has been free of relapse for two years. CONCLUSION: According to our knowledge this is the second reported case of sarcoidosis of the middle ear. In both cases the interstitial lung tissue has been involved as well. This finding increases the importance of excluding sarcoidosis in differential diagnosis of chronic otitis media.

Adult↗
PubMed1997

Complications of septal surgery.

Complications associated with submucous septal resection or septoplasty may originate in incorrect indication and diagnosis because of wrong or incomplete analysis and interpretation of the anatomical structures of the nose and nasal function tests. Complications can arise from technical failures during the procedures of septal surgery from the incision to the reconstruction of the septum. Early and late complications can be caused by infections in the postoperative period involving only the midfacial region or the whole body. Postoperative and late complications may also arise from damage to the septal soft and hard tissues. Although septal surgery complications may interfere with nasal function, cosmesis, and general health, prospective studies with subjective and objective data are extremely rare.

Female↗