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 28,634 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Objective: To investigate the pre-and postoperative pattern of upper airway obstruction in obstructive sleep apnea (OSA) patients treated by uvulopalatopharyngoplasty (UPPP).Background: The response rate to UPPP in unselected OSA patients is generally about 50%.Methods: Intraluminal pressure measurements during sleep were employed to analyze the pattern of upper airway obstruction before and after surgery.Results: Ten patients with mild to moderate OSA (respiratory disturbance index 19.7 (16.9-27.5) events/hr underwent a full night polysomnography before and 114 (6 1-138) days after UPPP. UPPP resulted in a significant improvement in subjective snoring and daytime sleepiness, but did not significantly alter the severity of sleep-disordered breathing. Preoperatively, the major site of obstruction was located at the oropharynx in nine patients, seven of them had additional minor obstruction sites outside the oropharynx. Complete relief of upper airway obstruction was only observed in those two patients with collapse confined to the oropharynx.Conclusions: In unselected OSA patients, UPPP improved subjective snoring and daytime sleepiness but did not result in a significant improvement in RDI or sleep architecture. Our results emphasize the need for a pre-operative investigation of the upper airway during sleep to select patients with collapse confined to the oropharynx.
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PMID:Pattern of upper airway obstruction during sleep before and after uvulopalatopharyngoplasty in patients with obstructive sleep apnea. 1143 47

Microbiological, biological, and chemical toxins have been employed in warfare and in terrorist attacks. In this era, it is imperative that health care providers are familiar with illnesses caused by these agents. Botulinum toxin produces a descending flaccid paralysis. Staphylococcal enterotoxin B produces a syndrome of fever, nausea, and diarrhea and may produce a pulmonary syndrome if aerosolized. Clostridium perfringens epsilon-toxin could possibly be aerosolized to produce acute pulmonary edema. Ricin intoxication can manifest as gastrointestinal hemorrhage after ingestion, severe muscle necrosis after intramuscular injection, and acute pulmonary disease after inhalation. Nerve agents inhibit acetylcholinesterase and thus produce symptoms of increased cholinergic activity. Ammonia, chlorine, vinyl chloride, phosgene, sulfur dioxide, and nitrogen dioxide, tear gas, and zinc chloride primarily injure the upper respiratory tract and the lungs. Sulfur mustard (and nitrogen mustard) are vesicant and alkylating agents. Cyanide poisoning ranges from sudden-onset headache and drowsiness to severe hypoxemia, cardiovascular collapse, and death. Health care providers should be familiar with the medical consequences of toxin exposure, and understand the pathophysiology and management of resulting illness.
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PMID:Microbiological, biological, and chemical weapons of warfare and terrorism. 1207 87

Risperidone is an atypical antipsychotic used in the treatment of several psychiatric disorders in both children and adults. We present two patients with hydrocephalus and learning difficulties who were admitted to the neurosurgical unit with a suspected cerebrospinal fluid shunt malfunction and raised intracranial pressure. They had both been commenced on risperidone for the treatment of aggressive outbursts. Twelve days after commencing risperidone, the first patient developed symptoms of headache, nausea, vomiting, drowsiness, lethargy and two episodes of collapse. The second patient presented with similar symptoms 4 days after his risperidone dose was increased. An unnecessary shunt exploration was averted in both cases when it was noted that the side-effect profile of risperidone mimicked exactly those of shunt malfunction. Discontinuation of the drug resulted in complete resolution of all symptoms within 72 h. Many patients with shunted hydrocephalus have associated developmental disorders that may warrant treatment with risperidone. Clinicians should be aware of the potential symptom overlap between shunt malfunction and risperidone side-effects in these patients.
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PMID:Side-effects of risperidone therapy mimicking cerebrospinal fluid shunt malfunction: implications for clinical monitoring and management. 1209 77

Obstructive sleep apnoea is a disease of increasing importance because of its neurocognitive and cardiovascular sequelae. Abnormalities in the anatomy of the pharynx, the physiology of the upper airway muscle dilator, and the stability of ventilatory control are important causes of repetitive pharyngeal collapse during sleep. Obstructive sleep apnoea can be diagnosed on the basis of characteristic history (snoring, daytime sleepiness) and physical examination (increased neck circumference), but overnight polysomnography is needed to confirm presence of the disorder. Repetitive pharyngeal collapse causes recurrent arousals from sleep, leading to sleepiness and increased risk of motor vehicle and occupational accidents. The surges in hypoxaemia, hypercapnia, and catecholamine associated with this disorder have now been implicated in development of hypertension, but the association between obstructive sleep apnoea and myocardial infarction, stroke, and congestive heart failure is not proven. Continuous positive airway pressure, the treatment of choice for obstructive sleep apnoea, reduces sleepiness and improves hypertension.
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PMID:Obstructive sleep apnoea. 1250 19

Pertussis, also known as whooping cough, is a highly contagious disease, which is most dangerous to infants less than one year old. About half of the babies reported nationally to the Centers for Disease Control and Prevention (CDC) as having the disease are hospitalized. As many as 16/100 babies reported with pertussis get pneumonia, and about 2/100 have convulsions. For those babies reported to have pertussis, about 1/500 has brain problems, some of which can become permanent, and about 1/250 will die because of complications from the disease. Serious illness is less likely in older children and adults. Pertussis vaccine is generally administered in combination with diphtheria and tetanus vaccines, known as DTP vaccine. A primary series of DTP keeps 70-90/100 children from getting pertussis, usually through the elementary school years at least. About half of the children who receive DTP vaccine will not experience any discomfort at all. Some will have minor problems such as soreness, swelling and redness where the shot was given; fever; fussiness; drowsiness; and loss of appetite lasting 1-2 days. Once per 100 to 1000 shots, moderate problems can occur: crying non-stop for 3 hours or more, fever of 105 degrees (F) or higher. For 1 shot in 1750, a child may experience a seizure (convulsions, fits, spasms, twitching, jerking, or staring spells) usually caused by fever, or collapse or fainting (becoming blue, pale, limp, and non-responsive). Very rarely, DTP causes long seizures, decreased consciousness, or coma that usually does not last. Permanent brain damage can very infrequently follow such acute brain problems. There are no tests that can tell in advance if a child will be adversely affected by the DTP vaccine. Definitely the benefits from the DTP vaccine far outweigh the risks for almost all children.
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PMID:Facts about pertussis and DTP vaccine. 1234 38

Moderate to severe obstructive sleep apnoea is usually associated with multiple levels of pharyngeal airway collapse, including tongue base obstruction. A new technique has recently been introduced that improves the nocturnal retro-lingual airway. This study was a prospective, non-randomized single-institution evaluation of a recently introduced surgical technique. Nineteen consecutive patients with previously untreated moderate to severe obstructive sleep apnoea underwent tongue suspension using the Respose system and concomitant palatopharyngoplasty (multilevel pharyngeal surgery). The patient demographics and treatment outcomes were prospectively collected and retrospectively analysed. There were 16 men and three women, with a mean (+/-SD) age of 44.9 years (+/- 14.2) and a mean pre-operative apnoea-hypopnoea index (AHI) of 42.8 +/- 24.8. Twelve of the 19 patients (63.2 per cent) have had post-operative polysomnography; eight of these 12 (67 per cent) met the standard criteria for surgical response. Among these eight patients, the AHI improved from 32.4 to 14.4 (p<0.01); the individual scores fell by a mean of 51.7 per cent. The apnoea index improved from 7.4 to 0.9 (p<0.01), with the individual scores falling by a mean of 81.4 per cent. There was anatomic and radiographic evidence of multilevel upper airway enlargement. Notably, the body mass index remained essentially unchanged (31.5 +/- 7.2 to 31.2 +/- 7.6, p>0.5). Subjectively, the mean Epworth sleepiness scale score fell from 11.0 +/- 5.4 to 5.4 +/- 3.8 (p<0.005). Four patients suffered transient velopharyngeal insufficiency, and two patients complained of limited anterior excursion of the tongue. There were no serious, long-term complications. The tongue suspension procedure represents a minimally invasive technique for improving the nocturnal retro-lingual airway in patients with obstructive sleep apnoea. It is easily performed by otolaryngologists, distinguishing it from other established techniques designed to address tongue base obstruction.
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PMID:Minimally invasive tongue base surgery for obstructive sleep apnoea. 1243 8

The obstructive sleep apnoea syndrome (OSAS) is a diagnosis related to snoring and caused by a collapse in the upper airway. OSAS patients suffer from desaturated oxygen levels during sleep as well as daytime sleepiness. In this paper, we propose a system able to identify and detect respiratory disorders online based on monitoring the airflow amplitude from a sleeping OSAS patient. By the use of chi(2)-analysis and a Haar wavelet transform on signals performed offline, reference templates indicating the specific apnoea pattern for four different patients are constructed and used for similarity matching against online signals. Detection is performed in the early stages of an upcoming airway dysfunction, thus providing an opportunity to alert the patient at sleep. The system-testing results indicate robust performance and flexibility for the patient. Our proposed solution can in turn operate as an alternative to today's OSAS treatment of choice, the continuous positive airway pressure (CPAP).
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PMID:Early online detection of upper airway obstructions in obstructive sleep apnoea syndrome (OSAS) patients. 1249 32

Respiratory disorders are common and important complications in acromegaly. Patients suffering from acromegaly display a 1.6-3.3 fold increase in mortality rate, which is due to respiratory disorders in 25% of cases. In these patients, mortality for lung disease is 2-3 fold higher than in the general population. Every portion of the respiratory system may be involved. Deformities of facial bones, edema and hypertrophy of the mucosae and pharyngeal and laryngeal cartilages, enlargement of the tongue and inspiratory collapse of the hypopharinx, all may contribute to respiratory alterations. Nasal polyps, "hormonal rhinitis", changes of the voice and snoring are common occurrences. Though rarely, a laryngocele may ensue. Pneumomegaly is frequently observed and, as suggested by functional studies, might be due to an increased number rather than volume of the alveoli. An obstructive respiratory syndrome caused by mucosal thickening of the upper airways and bronchi is observed in 25% of female and 70% of male patients. The sleep apnea syndrome (SAS) affects 60-70% of acromegalic patients. SAS may be of obstructive, central or mixed type. Obstructive SAS is the prevailing form in acromegaly. It is due to intermittent obstruction of upper airways with preserved activity of the respiratory center, as testified by the remarkable thoracic and abdominal respiratory efforts. The pathogenesis of the central type of SAS is more complex. Narrowing of the upper airways may induce reflex inhibition of the respiratory center. Moreover, increased GH levels and, possibly, defects in the somatostatinergic pathways, may increase the ventilatory response of the respiratory center to carbon dioxide, thereby leading to respiratory arrest. In the mixed type of SAS, the phenomena underlying the other two forms coexist. Oxygen desaturation concomitant with the apneic episodes accounts for the frequent nocturnal wakening and diurnal drowsiness. Among the clinical correlates of SAS, arterial hypertension is of particular interest due to the close correlation existing between the two disorders. Sleep deprivation related to SAS seems per se to favor the appearance of hypertension. Moreover, short lasting hypoxemia may induce prolonged elevations of blood pressure, mediated by decreased endothelial generation of nitric oxide. Thus, since cardiovascular events are the main cause of mortality in patients with acromegaly, it is reasonable to hypothesize that SAS is involved in the reduced life span of these patients.
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PMID:Prevalence and pathogenesis of sleep apnea and lung disease in acromegaly. 1250 76

Sleep nasendoscopy (SN) is claimed to identify the site of obstruction in habitual snoring and is used to select patients for palatal surgery. The validity of SN is, however, unproven. This is the first prospective blind assessment of the role of SN in the management of habitual snorers. Fifty-five consecutive patients listed for laser-assisted uvulopalatoplasty (LAUP) for simple snoring on clinical criteria underwent SN immediately before surgery. Snoring severity and Epworth Sleepiness Scales were completed before the operation and at least 3 months after the operation. The postoperative scores on the snoring severity scale had significantly improved after LAUP, for each SN grade: grade 1 (palatal obstruction; p = .04) and grade 2 (multisegmental obstruction; grade 2A, p = .003, and grade 2B, p = .01). The Epworth Sleepiness Scale showed significant improvement in the whole group (p = .02). We conclude that SN grading of sites of pharyngeal collapse is an insufficient basis to exclude patients from LAUP. Sleep nasendoscopy is thus not of value in the management of habitual snoring, as the measure is a poor predictor of favorable outcome after palatal surgery.
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PMID:Predictive value of sleep nasendoscopy in the management of habitual snorers. 1517 74

Multiple myeloma (MM) is a plasma cell malignancy characterized by infiltration of bone marrow, bone destruction, infiltration of soft tissues with plasma cells, and suppression of normal hematopoiesis. The production of monoclonal immunoglobulins with or without light chains is a major feature of the disease. Full spectrum of plasma cell dyscrasias include monoclonal gammapathy of undetermined significance, smouldering myeloma, indolent multiple myeloma, and fully developed, symptomatic multiple myeloma. The usual presenting features of MM include bone pain, weakness, fatigue, fever and infection. Neurologic symptoms are less common but one must not forget that MM may present with a neurologic disease. Careful neurologic history and examination are mandatory in patients with MM. Neurologic symptoms may be a direct manifestation of MM or may be due to the immune effect of monoclonal proteins directed against different neural structures. Finally, metabolic consequences (uremia, hypercalcemia, hyperviscosity) of MM may produce a broad spectrum of different neurologic symptoms including headache, blurring of vision, drowsiness, precoma, coma, vertigo, ataxia, hemiparesis and epileptiform seizures. The most common location of bone changes in MM is the thoracic spine, where it causes osteolytic changes with consequent compressive fractures. The most disastrous sequel is paraplegia. Multiple vertebral involvement with the evidence of osteolytic changes in other bones is usual, but solitary vertebral myeloma may occur. Myeloma usually involves the bone of the vertebral body and then spreads into the extradural space. However, patients with solitary extradural myeloma have been reported. Skull myeloma is frequently asymptomatic. It may grow externally or, rarely, there is intracranial expansion. Involvement of the cranial nerves is not rare, with II, V, VI, VII and VIII cranial nerves being most often affected. Isolated intracerebral plasmacytomas are extremely rare. Diagnostic approach includes plain X-rays of the skeleton, which was found to be the method of choice for demonstration of osteolytic changes, whereas magnetic resonance with gadolinium enhancement most reliably displays the degree of vertebral involvement and demonstrates any associated soft tissue mass. Current treatment of osteolytic changes in multiple myeloma include chemotherapy, radiotherapy in combination with dexamethasone, monthly infusions of bisphosphonates, surgical decompression, and kyphoplasty. Therapeutic approach is dictated by the presenting symptoms. In case of pain as the predominant symptom, treatment with chemotherapy and radiotherapy may be appropriate. Compressive symptoms are relieved with dexamethasone followed by radiotherapy and chemotherapy. Surgical decompression is used in patients with vertebral collapse and vertebral instability. Kyphoplasty is a new method used in the treatment of osteolytic changes of vertebral bodies. A viscous cement is injected into the cavity by a balloon-like inflatable bone tampon. It has been successfully employed to improve the quality of life, to reduce pain, and to increase overall functioning in patients with vertebral compression fractures by restoring most of the original height of the vertebral body. Bisphosphonates reduce pain associated with osteolytic changes in multiple myeloma, but also significantly reduce skeletal events (pathologic fracture, spinal cord compression, surgery or irradiation of bone) via unknown mechanism. It seems that bisphosphonates, by inhibiting bone resorption, alter the microenvironment in which the MM cells grow.
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PMID:[Neurologic sequelae of bone changes in multiple myeloma and its therapy]. 1263 Mar 41


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