A cephalometric comparison of normal weight and obese subjects with obstructive sleep apnoea

Purpose: To compare the skeletal, oropharyngeal and soft tissue features of two groups of subjects with obstructive sleep apnoea (OSA) using lateral cephalometric radiographs. One group of subjects exhibited a normal body mass index, whilst the other was obese.Methods: Lateral cephalometric radiographs of 48 dentate, white, Caucasian males with confirmed OSA were traced and digitized and comparisons were sought between the skeletal and oropharyngeal morphologies of the two groups. Twenty-eight subjects were obese and 20 individuals exhibited normal body mass indices (BMI). Mann–Whitney U-tests were employed to examine differences between the two groups and a P value of less than 0.05 was considered significant.Results: Subjects with a normal BMI exhibited significantly more retruded maxillae, more upright incisors, smaller mandibles and a shorter distance between the lower incisor and the posterior pharyngeal wall than obese subjects. In the latter group, the length of the lower face was increased. In addition, the lengths and cross-sectional areas of both the soft palate and tongue were significantly larger. The hyoid was further away from both the chin (menton) and the cervical column (C3) in this group. No differences were found in minimum airway dimensions or in the cross-sectional area of the oropharynx between the groups although, as expected, these dimensions were reduced in comparison with control values.Conclusions: Obstructive sleep apnoea subjects of normal weight have more anterior–posterior dentofacial abnormalities than their obese counterparts. However, both groups are clearly distinguishable from control individuals. In the obese subjects, additional soft tissue anomalies are found. It would therefore seem that all OSA subjects exhibit some anatomical basis for their condition, but this is compounded by soft tissue factors in obese individuals. It is therefore doubtful whether loss of weight in obese subjects would significantly influence the severity of the condition.     

Craniometaphyseal dysplasia associated with obstructive sleep apnoea syndrome

Craniometaphyseal dysplasia (CMD) is a genetic craniotubular bone disorder characterized by early progressive hyperostosis and sclerosis of the craniofacial bones, and abnormal modelling of the metaphyses of the tubular bones. We present the case of a patient with a confirmed history of the autosomal dominant form of CMD, associated with symptoms of obstructive sleep apnoea syndrome. Examination and imaging studies revealed several unusual features in addition to the common findings of CMD such as: bimaxillary retrusion with hyperostosis of the mental area, severe notching of the external occipital protuberance, huge occipital horn, decreased angle of the mandible with notching of the body and thickening of the areas of muscle attachment, and macrodontia. The literature and differential diagnoses are reviewed.     

睡眠呼吸暂停综合征与代谢综合征的回顾性研究

目的：研究阻塞性睡眠呼吸暂停综合征（OSAS）与代谢综合征（MS）的相关性。方法：回顾分析323例OSAS患者MS的发病率,并对非肥胖OSAS患者与健康人群MS发病率进行对照研究。结果：323例OSAS患者MS患病率为42.1%,轻、中、重度患者患病率分别为13.5%、37.8%和60.2%。非肥胖OSAS患者中高血压、血脂异常、高血糖的发生率均明显高于健康对照组（P〈0.01）。结论：MS的发生率与OSAS显著相关,且这种关系可能并不依赖于肥胖。     

睡眠呼吸暂停患者肋间外肌氧化应激的研究

目的探索睡眠呼吸暂停（OSAS）患者的肋间外肌是否存在氧化应激及其可能的进一步损害。方法按照特定的标准经过测试确定16例OSAS患者，采用免疫印迹等方法测定其肋间外肌还原型谷胱甘肽（GSH）、蛋白质羰基化以及丙二醛-蛋白质加合物，并与16例非OSAS受试者进行比较。结果OSAS患者的用力呼气容积（FEV）、用力肺活量（FVC）、睡眠最低血氧饱和度（LSaO2）和最大通气量（MVV）明显低于非OSAS对照组（P〈0．001或0．05）；睡眠呼吸暂停低通气指数（AHI）和功能残气量（FRC）则明显高于对照组（P〈0．001或P〈0．05）。OSAS患者肋间外肌的还原型谷胱甘肽明显降低（P〈0．001），蛋白质羰基化水平和丙二醛（MDA）-蛋白加合物明显上升（P〈0．001或P〈0．05）。结论OSAS患者肋间外肌氧化应激水平升高，并伴有蛋白质氧化应激损伤。     

Computed tomographic analysis of renal calculi

An in vitro study sought to determine the feasibility of using computed tomography (CT) to analyze the chemical composition of renal calculi and thus aid in selecting the best treatment method. Sixty-three coded calculi were scanned in a water bath. Region-of-interest measurements provided the mean, standard deviation, and minimum and maximum pixel values for each stone. These parameters were correlated with aspects of the stones' chemical composition. A multivariate analysis showed that the mean and standard deviation of the stones' pixel values were the best CT parameters for differentiating types of renal calculi. By using computerized mapping techniques, uric acid calculi could be perfectly differentiated from struvite and calcium oxalate calculi. The latter two types also were differentiable, but to a lesser extent. CT has a potential role as an adjunct to clinical and laboratory methods for determining the chemical composition of renal calculi in an effort to select optimal treatment.     

Computed tomographic analysis of urinary calculi

Excised urinary calculi were subjected to computed tomographic (CT) scanning in an attempt to determine whether CT attenuation values would allow accurate analysis of stone composition. The mean, maximum, and modal pixel densities of the calculi were recorded and compared; the resulting values reflected considerable heterogeneity in stone density. Although uric acid and cystine calculi could be identified by their discrete ranges on one or more of these criteria, calcium-containing stones of various compositions, including struvite, could not be distinguished reliably. CT analysis of stone density is not likely to be more accurate than standard radiography in characterizing stone composition in vivo.     

Computed tomographic pulmonary changes in patients with chronic rhinosinusitis

Objective:

To investigate whether patients with a diagnosis of chronic rhinosinusitis (CRS) show characteristic pulmonary changes on chest CT compared with a control group without sinusopathy.

Methods:

This retrospective, observational study included patients with and without a diagnosis of CRS who underwent CT examination of the lungs between 2012 and 2014. Two radiologists, who were blinded for the presence of CRS, reviewed the scans for the presence of any abnormalities consensually. The χ² test was used for correlative analysis, with a significance level of 0.05.

Results:

A total of 123 CT series (51.2% from male patients, mean age 41 ± 16 years) were reviewed, including those from 59 (48%) patients with a diagnosis of CRS. Patients with CRS were more likely than the control group to exhibit atelectasis, bronchiolectasis, centrilobular nodules and ground-glass opacities (all p < 0.05), with a significant predilection for middle lobe and lingular involvement observed (p < 0.001). Other abnormalities, such as bronchial wall thickening and air trapping, did not differ between groups.

Conclusion:

Atelectatic changes, ground-glass opacities, bronchiolectasis and centrilobular nodules are the most frequent abnormalities associated with CRS, with peculiar middle lobe and lingular involvement observed on chest CT examinations.

Advances in knowledge:

CRS is a frequent disorder that displays typical pulmonary changes at CT. The recognition of such findings can prevent patients with this condition from undergoing unnecessary investigations that might be based on the presence of the aforementioned radiological features.     

Computed tomographic findings in two patients with vascular hamartomas

The clinical, computed tomographic (CT) and histological findings of two patients with vascular hamartomas are presented. The appearances on CT of the two lesions were markedly different. Although both lesions were histopathologically benign, one showed a more disorganized architecture on histology and clinically behaved in a more aggressive manner. The CT findings in this case reflected the histological picture and could have been interpreted as a malignant process if viewed in isolation. Review of the literature and the cases presented suggest that the CT appearances of vascular hamartomas can be diverse, and to avoid a misdiagnosis the radiological features should be considered in conjunction with the clinical and histopathological findings.     

Computed tomographic scanning in patients with carcinoma of the tongue

Computed tomographic (CT) scanning is useful for staging patients with carcinoma of the tongue. In a study of 13 patients scanned prior to treatment, CT gave additional valuable information about the primary tumour in four patients. Computed tomography detetected non-palpable, abnormal cervical lymph nodes in three patients which directly affected the nature of the subsequent operation.     

Computed tomography of the oropharynx in obstructive sleep apnea

Uvulopalatopharyngoplasty (UPPP) is currently the preferred method for treatment of the obstructive sleep apnea syndrome (OSAS). However, only 50 per cent of the patients operated upon are cured by this surgical procedure, and there is a demand for better and more objective selection criteria. Computed tomography (CT) of the oropharynx was obtained in 32 consecutive adult patients with proven OSAS. An additional 15 patients with the same complaints, but without objective evidence of OSAS, were used as a control group, together with 20 normal subjects. The axial widths of the tongue and the genioglossus and hyoglossus muscles were measured by CT. Both the tongue and genioglossus widths were significantly larger in the OSAS patients than in the two control groups (p less than 0.001). The increased tongue width will cause encroachment of the oropharyngeal airway below the level of the soft palate. Thus, CT can be used to measure the tongue size in order to evaluate its predictive value for the outcome of the UPPP procedure.     

OSAHS软腭受力数理模型探讨腭咽成形术扩大咽腔的要点

目的软腭是OSAHS上气道阻塞的重要部位,探讨软腭受力情况,并总结出腭咽成形术扩大咽腔的手术要点。方法根据伯努利方程推导软腭受力数理模型。结果软腭向咽后壁塌陷的力为F。F与软腭后咽腔截面积平方成反比,与软腭表面积和软腭质量成正比。F随软腭弹性系数增大和软腭向咽后壁位移距离增大而减小。F〈0时,无鼾症和OSA;F=0时,发生鼾症;当F〉0时,发生OSA。结论UPPP手术要点在于扩大软腭后咽腔截面积,缩小软腭表面积和软腭质量,增加软腭弹性系数和软腭向咽后壁位移距离。     

Computed tomographic evaluation of adrenal glands in patients with bronchogenic carcinoma

One hundred thirty-four patients with histo-pathologically proven bronchogenic carcinoma underwent computed tomography (CT) of the thorax and adrenal glands. Prospectively, 23 of the 134 patients had adrenal metastasis, based on CT criteria for enlargement of the gland. Retrospectively, however, some proved to be false positives. In addition, the diagnosis of adrenal metastasis frequently altered the initial staging and the treatment modality. We suggest that valid diagnoses of adrenal metastases on CT scan be made on the basis of altered shape as well as on altered size of the gland.     

Effectiveness of the analysis of craniofacial morphology and pharyngeal airway morphology in the treatment of children with obstructive sleep apnoea syndrome

Objective

In general, no consensus has been reached regarding the diagnostic criteria for obstructive sleep apnoea syndrome (OSAS) in children and the criteria for selecting treatment are inconsistent. Therefore, the craniofacial and pharyngeal airway morphology of OSAS in children who had undergone drug therapy (non-op group) and OSAS in children who had undergone both drug therapy and surgical therapy (adenotonsillectomy) (op group) were compared. The purpose of this study was to examine the effectiveness of craniofacial morphology and pharyngeal airway morphology analysis in the treatment of children with OSAS.

Methods

The craniofacial and pharyngeal airway morphology of the control group, the non-op group and the op group were compared to examine the differences of each group. The comparison used Mann–Whitney''s U test.

Results

A comparison between the non-op and the op groups showed significant differences in the facial axis, mandibular plane angle, ramus plane to the SN (porion and orbit) point, point Pog (pogonion) to the McNamara line, anteroposterior dysplasia indicator (APDI), D-AD1 [the distance between the posterior nasal spine (PNS) point and the nearest adenoid tissue, measured along the PNS–Ba (basion) point plane], D-AD2 (the distance between the PNS point and the nearest adenoid tissue, measured along a line from the PNS point perpendicular to the S (sella turcica)–Ba point plane), upper pharynx and soft palatal length. The op group showed significantly lower values of APDI than the non-op group, indicating that the op group showed a significant occlusion of class II, and that the mandibular bone was positioned posteriorly relative to the maxillary bone.

Conclusions

The op group showed a significant posterior position and backward rotation of the mandibular bone, stenosis of the nasopharyngeal airway and an elongated soft palate compared with the non-op group, and it was speculated that there was a high probability of the necessity of surgical therapy (adenotonsillectomy) when a morphological factor played a major role as a cause of obstructive sleep apnoea. We recommend craniofacial morphology analysis and pharyngeal airway morphology analysis in the diagnosis and treatment planning of OSAS children.     

Computed tomographic analysis of postoperative abdominal compartments. A comparative study of 100 patients with abdominal abscesses

100 patients with 140 abdominal abscesses were included in this study: 113 occurred intraperitoneal, 85% of these postoperatively, 15% spontaneously and in 11.5% the retroperitoneal space was affected concomitantly. In the postoperative group multilocular disease (= more than one typical compartment affected) was much more frequent when compared to spontaneous abscesses. Surgery with peritoneal barrier changes resulted in formation of new and "atypical" abdominal compartments which were the site of 39% of postoperative abscesses in this series. Communications of the lesser sac with the left subphrenic space were most frequently involved, followed by the fused right subphrenic and subhepatic space, when the coronary ligament was disconnected operatively. Knowledge of surgically induced changes of normal abdominal anatomy and its role for abscess formation and propagation may be very essential for correct CT-localization and CT-guided drainage.     

Computed tomographic evaluation of mouth breathers among paediatric patients

Objectives

Mouth breathing causes many serious problems in the paediatric population. It has been maintained that enlarged adenoids are principally responsible for mouth breathing. This study was designed to evaluate whether other mechanical obstacles might predispose the child to mouth breathing.

Methods

67 children with ages ranging from 10 to 15 years were studied and grouped into mouth-breathers and nose-breathers. The children first underwent axial CT scans of the brain for which they were originally referred. In addition, they were subjected to a limited coronal CT examination of the paranasal sinuses. Congenital anatomical variations as well as inflammatory changes were assessed.

Results

87% of mouth-breathing children had hypertrophied adenoids, 77% had maxillary sinusitis, 74% had pneumatized middle concha, 55% had a deviated nasal septum, 55% had hypertrophied inferior conchae, 45% had ethmoidal sinusitis and 23% showed frontal sinusitis. Such changes were significantly less prevalent in nose-breathers. 12.9% of mouth-breathing children did not have adenoids. Of these children, only 3.3% had one or more congenital or inflammatory change whereas the other 9.6% showed a completely normal CT scan signifying the incidence of habitual non-obstructive mouth breathing.

Conclusions

It is clear that adenoids have a dominant role in causing mouth breathing. Yet, we recommend that paediatricians should assess other mechanical obstacles if mouth breathing was not corrected after adenoidectomy. Further research should be performed to test the validity of correction of such factors in improving the quality of life of mouth-breathing children.