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| 2. |
- Alinasab, Babak, et al.
(författare)
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The Supratarsal Approach for Correction of Anterior Frontal Bone Fractures
- 2018
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Ingår i: The Journal of Craniofacial Surgery. - Philadelphia, PA : Lippincott Williams & Wilkins. - 1049-2275 .- 1536-3732. ; 29:7, s. 1906-1909
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Tidskriftsartikel (refereegranskat)abstract
- Background: To approach isolated anterior frontal bone fracture, coronal incision is the common surgical access of choice. This approach has complications such as aesthetically undesirable scarring and alopecia along the incision line. An alternative approach to these fractures is through a supratarsal incision. The aim of the present study was to correct the frontal bone fracture, through supratarsal approach.Methods: Six consecutive patients with frontal bone fracture were operated through supratarsal incision and evaluated regarding: patient cosmetic satisfaction, forehead contour, scarring, sensibility and motility in forehead and upper eyelids.Results: Seven months (6–12) postoperatively, all the patients had normal mobility in the forehead and the upper eyelids and 17% (n = 1) had hypoesthesia of superior orbital nerve. The forehead contour was excellent in all patients. About 83% (n = 5) of the patients were very satisfied and 17% (n = 1) were satisfied with the surgical result.Conclusion: Correction of anterior frontal bone fracture through a supratarsal approach appears to be safe and offers a sufficient exposure to the frontal bone fracture correction with excellent contouring results and no noticeable scarring.
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| 3. |
- Fridman-Bengtsson, Ola, et al.
(författare)
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Evaluation of different hydrocortisone treatment strategies in transsphenoidal pituitary surgery
- 2019
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Ingår i: Acta Neurochirurgica. - : Springer Nature. - 0001-6268 .- 0942-0940. ; 161:8, s. 1715-1721
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundHydrocortisone treatment in transsphenoidal pituitary surgery has been debated. Although several publications advocate restrictive treatment, centers around the world administer stress doses of hydrocortisone in patients with presumed intact cortisol production. Our aim with this analysis was to compare postoperative hypocortisolism in patients who received three different protocols of hydrocortisone therapy during and after surgery.MethodThis was a retrospective observational study. Based on perioperative hydrocortisone dose given, patients were divided in three groups: high dose (HD), intermediate dose (ID), and low dose (LD). Postoperative evaluation of the pituitary function was performed using S-cortisol at day 4 and short Synacthen test (SST) at 6–8 weeks. Patients with ACTH-producing adenomas or preoperative hydrocortisone treatment were excluded.ResultThere was no difference between the groups regarding failure rate of SST. The rate of failed SST (all groups) was 51/186 (27%), 24/74 (32%) in the HD group and 26/74 (35%) and 11/38 (29%) in the ID and LD groups respectively. There was no significant difference between the ID and LD groups regarding S-cortisol at postoperative day 4 regarding serum cortisol level below 200 nmol/L. There was a significant but weak correlation, rs 0.330 (P < 0.01) between S-cortisol day 4 and SST at 4–6 weeks.ConclusionsPeri and postoperative hydrocortisone treatment did not affect SST response 6–8 weeks postoperatively, whereas the rate of patients with S-cortisol below 200 nmol/L at postoperative day 4 did. LD hydrocortisone therapy seems to favor a better endogenous production in the early postoperative phase.
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| 4. |
- Borgström, A., et al.
(författare)
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Trends and changes in paediatric tonsil surgery in Sweden 1987-2013: A population-based cohort study
- 2017
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 7:1
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Tidskriftsartikel (refereegranskat)abstract
- Objectives The objective of this study was to longitudinally describe the history of tonsil surgery in Swedish children and adolescents regarding incidence, indications for surgery, surgical methods and the age and gender distributions. Setting A retrospective longitudinal population-based cohort study based on register data from the Swedish National Patient Register (NPR) and population data from Statistics Sweden. Participants All Swedish children 1-<18â €..years registered in the NPR with a tonsil surgery procedure 1987-2013. Results 167â €..894 tonsil surgeries were registered in the NPR 1987-2013. An increase in the total incidence rate was observed, from 22/10â €..000 person years in 1987 to 47/10â €..000 in 2013. The most marked increase was noted in children 1-3â €..years of age, increasing from 17 to 73/10â €..000 person years over the period. The proportion children with obstructive/sleep disordered breathing (SDB) indications increased from 42.4% in 1987 to 73.6% in 2013. Partial tonsillectomy, tonsillotomy (TT), increased since 1996 and in 2013 55.1% of all tonsil procedures were TTs. Conclusions There have been considerable changes in clinical practice for tonsil surgery in Swedish children over the past few decades. Overall, a doubling in the total incidence rate was observed. This increase consisted mainly of an increase in surgical procedures due to obstructive/SDB indications, particularly among the youngest age group (1-3â €..years old). TT has gradually replaced tonsillectomy as the predominant method for tonsil surgery.
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| 5. |
- Broström, Anders, et al.
(författare)
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A mixed method evaluation of a group-based educational programme for CPAP use in patients with obstructive sleep apnea
- 2013
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Ingår i: Journal of Evaluation In Clinical Practice. - : Wiley. - 1356-1294 .- 1365-2753. ; 19:1, s. 173-184
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Tidskriftsartikel (refereegranskat)abstract
- Rationale, aims and objectives Continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA) has a low long-term adherence. Educational interventions are few and sparsely described regarding content, pedagogical approach and participants' perceptions. The aim was to describe adherence to CPAP treatment, knowledge about OSA/CPAP, as well as OSA patients' perceptions of participating in a group-based programme using problem-based learning (PBL) for CPAP initiation.Educational programme The PBL programme incorporated elements from theories and models concerning motivation and habits. Tutorial groups consisting of four to eight patients met at six sessions during 6 months.Methods A sequential explanatory mixed method design was used on 25 strategically selected patients. Quantitative data regarding, clinical variables, OSA severity, CPAP use, and knowledge were collected at baseline, after 2 weeks and 6 months. Qualitative data regarding patients' perceptions of participation were collected after 6 months by semi-structured interviews using a phenomenographic approach.Results 72% of the patients were adherent to CPAP treatment after 2 weeks and 6 months. All patients improved their baseline knowledge about OSA and CPAP after 2 weeks and sustained it after 6 months. Anxiety and fear, as well as difficulties and needs were motivational factors for participation. Patients described the difficulties of behavioural change, an awareness that improvements do not occur immediately, a realization of the importance of both technical and emotional support and the need for a healthier lifestyle.Conclusion and practice implications A group-based programme using PBL seems to facilitate adaptive and developmental learning and result in acceptable CPAP adherence levels.
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| 6. |
- Broström, Anders, et al.
(författare)
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Factors associated with undiagnosed obstructive sleep apnoea in hypertensive primary care patients
- 2012
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa Healthcare. - 0281-3432 .- 1502-7724. ; 30:2, s. 107-113
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Tidskriftsartikel (refereegranskat)abstract
- Objective. In hypertensive primary care patients below 65 years of age, (i) to describe the occurrence of undiagnosed obstructive sleep apnoea (OSA), and (ii) to identify the determinants of moderate/severe OSA. Design. Cross-sectional. Setting. Four primary care health centres in Sweden. Patients. 411 consecutive patients (52% women), mean age 57.9 years (SD 5.9 years), with diagnosed and treated hypertension (BP andgt; 140/90). Main outcome measures. Occurrence of OSA as measured by the apnoea hypopnoea index (AHI). Results. Mild (AHI 5-14.9/h) and moderate/severe (AHI andgt; 15/h) OSA were seen among 29% and 30% of the patients, respectively. Comparing those without OSA with those with mild or moderate/severe OSA, no differences were found in blood pressure, pharmacological treatment (anti-hypertensive, anti-depressive, and hypnotics), sleep, insomnia symptoms, daytime sleepiness, or depressive symptoms. Obesity (BMI andgt; 30 kg/m(2)) was seen in 30% and 68% of the patients with mild and moderate/severe OSA, respectively. Male gender, BMI andgt; 30 kg/m(2), snoring, witnessed apnoeas, and sleep duration andgt; 8 hours were determinants of obstructive sleep apnoea. Conclusion. Previously undiagnosed OSA is common among patients with hypertension in primary care. Obesity, snoring, witnessed apnoeas, long sleep duration, and male gender were the best predictors of OSA, even in the absence of daytime sleepiness and depressive symptoms.
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| 7. |
- Broström, Anders, 1963-, et al.
(författare)
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Gender differences in respiratory disturbance, sleep and daytime sleepiness in hypertensive patients with different degrees of obesity
- 2013
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Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press. - 1474-5151 .- 1873-1953. ; 12:2, s. 140-149
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundHypertension (HT) and obesity have both been linked to obstructive sleep apnoea (OSA). Difficulties have been described in identifying patients with OSA in primary care, causing low referral rates to sleep clinics. Increased knowledge about gender-specific characteristics and symptoms may help to identify patients.AimThe aim was to describe gender differences regarding undiagnosed OSA, self-rated sleep, insomnia and daytime sleepiness in middle-aged primary care patients with HT and different degrees of obesity.MethodsA cross-sectional design was used and 394 patients (52.5% women), mean age 57.8 years (SD 6.7 years), with HT (BP >140/90 mmHg) were included. Clinical examinations, respiratory recordings and self-rated scales regarding OSA symptoms, sleep, insomnia and daytime sleepiness were used. Body mass index (BMI) was classified according to the criteria from the National Institutes of Health.ResultsPre-obesity and obesity classes I and II were seen among 53%, 26% and 8% of the men and 37%, 19% and 14% of the women, respectively. Occurrence of mild, moderate and severe OSA increased significantly across the BMI classes for both genders (p<0.01). Ninety percent of the men and 80% of the women in obesity class II had OSA. Insomnia was prevalent in obese patients. Other clinical variables did not differ between BMI classes or genders.ConclusionThe occurrence of overweight/obesity and OSA was high among both genders. A high BMI might be a convenient clinical marker for healthcare personnel to identify hypertensive patients with possible OSA in need of further evaluation and treatment.
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| 8. |
- Broström, Anders, 1963-, et al.
(författare)
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Undiagnosed obstructive sleep apnea in hypertensive outpatients in primary care : Associations with sleep complaints, depressive symptoms and global perceived health
- 2013
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Ingår i: Open Journal of Nursing. - : Scientific Research Publishing, Inc.. - 2162-5336 .- 2162-5344. ; 3:6, s. 445-452
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Tidskriftsartikel (refereegranskat)abstract
- Objective: 1) To describe the prevalence of undiagnosed obstructive sleep apnea (OSA) and depressive symptoms in hypertensive men and women below 65 years of age, and 2) to describe the association of OSA to subjective sleep complaints, depressive symptoms and global perceived health. Design: Cross-sectional design focusing on nursing care outcomes of obstructive sleep apnea. Setting: Four primary care health centres in Sweden. PATIENTS: 411 consecutive patients (52% women), mean age 57.9 years (SD 5.9 years), with diagnosed hypertension (BP > 140/90). Main Outcome Measures: Prevalence of OSA and depressive symptoms, and association of OSA to sleep complaints, depressive symptoms and global perceived health. RESULTS: Mild, moderate and severe OSA was seen among 29%, 16% and 14% of patients, respectively. Depressive symptoms were seen in 16% of the total group, with a higher prevalence among men, compared to women, 21% vs. 12%. No differences were found regarding blood pressure, estimated sleep need, sleep sufficiency index, insomnia symptoms, daytime sleepiness or depressive symptoms with respect to different degrees of OSA. Apnea-hypopnea index was significantly associated to perceived health after adjustment for gender and comorbidities, but when depressive symptoms and non-restorative sleep were added to the model, 33% of the variance in global perceived health was explained. Conclusion: OSA is highly prevalent among patients with hypertension in primary care and does together with sleep complaints and depressive symptoms have a negative impact on global perceived health. Hypertensive patients without subjective sleep complaints or depressive symptoms may still have OSA.
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| 9. |
- Gerhardsson, Hanna, et al.
(författare)
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Pediatric adenoid surgery in Sweden 2004-2013: Incidence, indications and concomitant surgical procedures
- 2016
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Ingår i: International Journal of Pediatric Otorhinolaryngology. - : Elsevier BV. - 0165-5876 .- 1872-8464. ; 87, s. 61-66
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To describe the incidence and indications of adenoid surgery and concomitantly performed ENT surgical procedures in a nationwide cohort covering several years of practice. Methods: A retrospective study based on data from the National patient registry in Sweden. All children born from 1st of January 2004 to December 31st, 2013 who underwent adenoidectomy for the first time in Sweden during 2004-2013 were included in the study. Patient characteristics (age and gender), indications for surgery and performed ENT surgery were evaluated. Results: 40,829 children underwent adenoid surgery during the studied period. Of these, 24,537 (60%) were boys. Mean and median age at surgery in the studied population was 4 years and 3.5 years respectively for both boys and girls. The most frequently performed surgical procedure was adenotonsillar surgery 43% (n = 17,434) followed by solitary adenoid surgery 26% (n = 10,749). The most frequent registered indication was hypertrophy 60% (n = 24,422) followed by hypertrophy and otitis media 21% (n = 8425). The highest age related incidence for all types of adenoid surgery taken together was 2-4 years of age for both genders. Boys had higher incidence rates than girls for all ages and all types of surgery except at eight years of age. Conclusions: The main findings were that adenoidectomy most commonly was performed together with surgery of the tonsils on the indication hypertrophy, that adenoid- and adenoid related ENT surgery were most commonly performed between 2 and 5 years of age and that the incidence in surgical rates was higher for boys than girls. There seem to be large unwarranted variations between countries regarding incidence rates and we believe that there is a need for further studies in order to establish recommendations for best practice regarding adenoid and related ENT surgeries. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
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| 10. |
- Gislason, Thorarinn, et al.
(författare)
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Obstructive sleep apnoea in adults
- 2014. - 65
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Ingår i: Respiratory epidemiology. - : European Respiratory Society. - 9781849840521 ; , s. 88-105
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Bokkapitel (refereegranskat)abstract
- Over the past 30 years OSA has evolved from being a very rare disorder, almost solely characterised by loud snoring and daytime sleepiness, to a common systemic disorder with multiple adverse consequences, which affect a substantial percentage of the middle-aged population. Obesity is the strongest risk factor, but not the only pathogenic mechanism. Other important mechanisms include differences in craniofacial dimensions and even lifestyle factors such as smoking, alcohol consumption and sleeping position. Given the systemic effects, there is developing evidence for the role of OSA as an independent risk factor for: excessive sleepiness with increased risk of traffic accidents, hypertension, cardiovascular disease (including atherosclerosis), myocardial infarction, stroke, impaired glucose metabolism, neurodegeneration, and both cancer mortality and incident cancer. Subjects with untreated OSA have increased mortality and are at higher risk when undergoing surgical procedures. The major clinical challenge today is how simplified diagnostic procedures can confirm or reject the possibility of OSA in various situations.
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