Tomoaki Kai

A Case Report: Steroid Induced Hypersensitivity Reaction in a Patient with Bell's Palsy

Glucocorticoids are effective medications and have been used for a multitude of indications. However, adverse effects and intolerance reactions have been reported since 1974.We report a steroid-induced hypersensitivity reaction in a case with Bells palsy. A 40-year-old male consulted our out-patient clinic due to right peripheral facial palsy.As soon as he was injected with the hydrocortisone sodium succinate, he developed erythema all over his body, moderate itchiness and respiratory distress. His condition was improved immediately after the cessation of infusion.The medication for facial palsy was altered from infusion to oral prednisolone. Thereafter, he showed no hypersensitivity reaction. Intradermal reaction was positive for three steroids with succinate-ester and negative for two steroids with phosphate-ester. We speculated that the succinate-ester component of hydrocortisone played a pivotal role in the anaphylactoid reaction in this case.

13 Cases Who Underwent Simultaneous UPPP and Nasal Surgery.

We performed uvulopalatopharyngoplasty (UPPP) and nasal surgery simultaneously for 13 patients with sleep-disordered breathing.Comparing these patients with 21 cases who underwent UPPP and nasal surgery, respectively, for age, body mass index (BMI), nasal cavity resistance, quantity of bleeding, operation duration, post-operative course and hospitalization period, there were no statistically significant differences except hospitalization period. (p<0.05).No major complications such as airway loss, near-fatal hemorrhage, or arrythmia occurred.We performed simultaneous operations under patient selection standards as follows: 1) aged under 45, 2) BMI less than 30kg/m2, 3) no cardiopulmonary diseases, 4) the subject has simple snoring or obstructive sleep apnea with an apnea index of less than 20times/hour, 5) no indications for the type of tongue base.We consider that maintaining these standards and careful respiratory management will lead to good results.

The Correlation between Obstructive Sleep Apnea Syndrome and Obesity.

To investigate the correlation between obstructive sleep apnea syndrome (OSAS) and obesity, 71 OSAS patients whose sites of obstruction were diagnosed based on sleep nasendoscopy findings were studied. The patients were subdivided into three groups by body mass index (BMI) as follows: Group A, 24 patients with BMI less than 25 (kg/m2); Group B, 19patients with BMI between 25 and 28; and Group C, 28 patients with BMI more than 28. Variables examined include the apnea index (AI), 4% O2 desaturation index (DI), nadir SpO2, and cephalometric data (SNA, SNB, PNS-U, MP-H, PAS). AT and cephalometric data were not correlated with BMI, but DI and nadir SpO2 were mutually correlated with BMI. These data suggest that OSAS may be worsened by obesity. Of the 71 patients, 45 were treated with surgery based on sleep nasendoscopy findings, and 33 patients, AI, DI, and nadir SpO2 were evaluated after surgery. There was a 77.4% and 72.7% improvement in the AT and DI respectively, but neither were correlated with BMI. The response rates were slightly better than previous reports. We believe that careful patient selection using sleep nasendoscopy data as well as avoiding surgery for extremely obese patients when possible may contribute to good results of surgical treatments.

The Effect of Therapy on Sleep Apnea and Simple Snoring.

A sleep test was performed 108 times on 85 patients at the Self-Defense Forces Central Hospital for one year between September 1997 and August 1998. 36 patients (42%) had sleep apnea and 46 (57%) had simple snoring. Surgery was performed on 41 patients (55%) and a dental splint was used on 3 (4%). We issued a questionnaire about the effect of the therapy to the 44 patients after surgery and dental splint use. We received questionnaires back from 34 patients (77%). The improvement ratio of snoring was 94% and that of apnea during sleep was 93% after surgery. 88% of the patients raised their health awareness and 82% and significantly decreased their body weight after therapy.

A Clinical Study Evaluating the Effects of EN028 in Patients with Simple Snoring.

The efficacy of EN028 was evaluated in 25 patients (20 males, 5 females) who had been diagnosed with simple snoring by the sleep test. All patients did not wish to undergo surgical treatment and gave their consent to participate in the present clinical study after having been given full and adequate information about the purpose and investigational nature of the study.The efficacy rate was 68%, and two patients dropped out in the middle of the study because of alleged post-drug discomfort. Non-responds for the most part were found to have severe hypoventilation or a low post-drug decrease in nasal airway resistance. If such patients could be avoided in the selection of study subjects, the efficacy rate of EN028 would be higher than in the present study.

Clinical Experience with Midline Laser Glossectomy.

Midline laser glossectomy with UPPP was performed on 9 patients exhibiting sleep apnea syndrome with the site of obstruction at the base of the tongue. The sleep apnea was diagnosed by a sleep study using medications. Based on the apnea index, of 9 patients, 5 showed a marked improvement after treatment; 3 showed a slight improvement; and 1 showed no improvement. There were some complications as follows; bleeding 12 and 17 days postoperatively (n=2), an abnormal sensation in the throat (n=5), and a change in taste for more than 1 year (n=1). There were no major complications, and no persistent difficulties with speech or swallowing. Furthermore, no one required tracheostomy. These results demonstrate that midline laser glossectomy with UPPP is a useful treatment for the base of the tongue type obstructive sleep apnea.