Cardiac function in obstructive sleep apnea patients following uvulopalatopharyngoplasty.

Obstructive sleep apnea syndrome (OSAS) is associated with severe cardiac arrhythmias and conduction abnormalities. Cor pulmonale and right-sided heart failure may ensue. Uvulopalatopharyngoplasty (UPPP) is one of several treatment modalities suggested for OSAS. Tracheotomy and CPAP treatment in adult OSAS patients and adenotonsillectomy in children with OSAS were shown to lead to improvement in some cardiac parameters. Cardiac function was prospectively evaluated in 19 OSAS patients before and after UPPP. No significant changes after surgery were noted on electrocardiographic studies. Improvement in global and regional function of both ventricles was seen in 91% of the patients. A trend toward significant elevation in left ventricular ejection fraction and a statistically significant increase in right ventricular ejection fraction were observed (45% +/- 9% to 50% +/- 7% [p = 0.007]). Our results support performance of UPPP in selected OSAS patients for relief of potentially life-threatening cardiac pathologies.     

AMG-1和腺苷对大鼠脑突触体谷氨酸释放的影响

观察了腺苷类化合物AMG-1对大鼠脑突触体前膜谷氨酸(glu)释放的影响。AMG-1在0.1～0.3 mmol·L^-1能明显抑制突触前膜Ca²⁺-依赖性glu的释放,并呈现剂量—效应关系。其作用强度与腺苷基本相似。提示AMG-1对脑保护作用可能与它激活腺苷A₁受体,从而抑制兴奋性氨基酸释放有关。     

AMG-1对突触体内游离钙水平及大鼠尾动脉收缩力的影响

观察了AMG-1对高钾所致大鼠脑突触体内游离钙浓度[Ca²⁺]i升高,及去甲肾上腺素引起的离体大鼠尾动脉环收缩力的影响。结果表明,AMG-110和100μmol·L^-1可对抗高钾(30mmol·L^-1)引起的[Ca²⁺]i升高,使分别降低19±11%及57±12%;在无钙Krebs-Hensleleit液中,AMG-1能抑制去甲肾上腺素引起大鼠尾动脉收缩力的作用。     

The clinical behavior of isolated sphenoid sinusitis.

OBJECTIVE: We sought to study the clinical behavior and treatment outcome of isolated sphenoid sinusitis (ISS). STUDY DESIGN AND SETTING: We conducted a retrospective study of patients diagnosed with ISS in a tertiary medical center over 20 years. RESULTS: Of 72 patients with ISS, 79 percent had acute symptoms, 15 percent had chronic symptoms, and 6 percent had incidental radiological findings. Fifteen percent were children. Most patients were diagnosed between January and April (P < 0.01), and increasing incidence was noted over the years (P < 0.001). Headache was the most common presenting symptom (85%). Chronic patients complained also of nasal symptoms (82%). Six patients had a major complication of sinusitis (none of them were children), and two patients died. Immunocompromised patients had more major complications (P 相似文献   

Seasonal variations in rhino-cerebral Mucor infection

OBJECTIVES: Rhino-orbito-cerebral mucormycosis (ROCM) is an uncommon, potentially lethal infection that occurs mostly in immunocompromised hosts. The seasonal occurrence of ROCM was studied in two of Israel's largest medical centers. METHODS: A total of 36 patients were seen during a 25-year period in this retrospective bi-institutional cohort study. Meteorologic data were obtained and analyzed for a possible linkage of infection with precipitation and temperature. RESULTS: Twenty-one of the 36 patients (58%) presented between the months of August and October, and 27 patients (75%) presented between the months of August and December. A peak incidence of ROCM was noted in the month of September (13/36 patients; 36%). No association was noted between meteorologic conditions and the incidence of ROCM infection. CONCLUSIONS: A consistent seasonal peak was observed in ROCM. Heightened awareness is important for early recognition and treatment of this disease.     

Tuberculosis of a periglandular lymphnode presenting as a parotid tumor

The presentation of tuberculosis as isolated cervical adenopathy is not a common entity. The presentation of this disease as a parotid mass has rarely been reported. In most instances, direct parenchymal involvement exists, although involvement of intraglandular lymphnodes has also been reported. In most cases, an initial misdiagnosis of a parotid tumor, usually a pleomorphic adenoma, was made. We report a case of a 57-year-old patient with a left parotid mass of two years' duration. The patient was referred because of the development of firm, nontender, ipsilateral cervical adenopathy, suggesting possible malignancy. The course of the disease, diagnosis, and treatment are reported. The relevant literature is reviewed.     

Quality of life of nasopharyngeal carcinoma patients

BACKGROUND: Quality of life (QOL) issues in patients with head and neck carcinoma are of importance beyond the incidence of these tumors because of the impact of the disease and its treatment on external appearance and function of the upper aerodigestive tract. Nasopharyngeal carcinoma (NPC) patients comprise a unique subgroup in whom, to our knowledge, QOL has not been studied directly. METHODS: Adult patients with NPC treated during the past 15 years at the Chaim Sheba Medical Center with a minimum follow-up of 6 months were included in the current study. Patients were mailed the revised University of Washington quality of life (UW-QOL) questionnaire and data pertaining to their disease were recorded. Patients with recurrent disease or another malignancy or those whose present status could not be ascertained were excluded from the study. QOL scores were analyzed based on treatment, disease stage, and patient age. RESULTS: Twenty-eight patients of 35 disease-free patients (80%) responded to the questionnaire sent to patients meeting the study criteria. The mean score for general health was 3.1 (range, 1-5). Pain was not a significant factor. Other domains without noteworthy problems were speech and shoulder disability. The majority of patients described their appearance as normal or with minor changes, and questions concerning activity, recreation/entertainment, employment, and swallowing all scored > 70 (range, 0-100). Dry mouth, chewing, and ear problems were of major concern with the majority of patients and affected the QOL indices. Nevertheless, the overall mean QOL score of these patients was rated as "good" (4.2 on a scale of 1-6). CONCLUSIONS: In the current study, patients with NPC reported ear problems, difficulties in chewing, and dry mouth but their overall QOL appeared to be good. Ear problems such as secretory otitis media should be recognized at the time of presentation and treated. Conformal radiotherapy techniques sparing the salivary glands and temporal bone most likely will be useful in reducing the morbidity associated with treatment.     

Pulmonary function after pectoralis major myocutaneous flap harvest

OBJECTIVE: The pectoralis major myocutaneous flap is widely used in the reconstruction of surgical defects in the head and neck region. Pulmonary atelectasis has been reported in patients undergoing these procedures, and many of these patients are heavy smokers and drinkers and have associated cardiopulmonary disorders. Flap harvest and donor site closure may lead to impairment of pulmonary function before and after the use of pectoralis major myocutaneous (PMC) in surgical reconstruction in patients with cancer of the head and neck. METHODS: Patients undergoing extirpation of head and neck tumors with PMC reconstruction were prospectively evaluated. Patient age, smoking history (pack-years), anesthesia duration, percentage predicted pre- and postoperative FEV1, percentage-predicted pre- and postoperative FVC (forced vital capacity), and preoperative SaO2 (oxygen saturation) were evaluated. Preoperative FEV1/FVC ratio was calculated. Chest x-rays were reviewed. RESULTS: Only 11 patients, 5 of whom smoked, could be evaluated postoperatively. Preoperative FEV1/FVC was more than 70 and FEV1 more than 75% predicted in all patients. A decrease in FVC was observed in 7 of the 11 patients, which ranged between 2% and 27% without any clinically obvious respiratory manifestations. A baseline SaO2 of more than 96% was noted in all patients. Four of 9 postoperative chest x-rays demonstrated atelectasis. CONCLUSIONS: PMC harvest and donor site closure may lead to the recorded decrease in FVC measurements. These changes did not manifest clinically. Nevertheless, alternative methods of surgical defect closure should be considered in patients with severe preexisting pulmonary disorders.     

Quality of life issues in cancer of the oral cavity

Quality of life issues in head and neck cancer have been portrayed increasingly in the medical literature in recent decades. Reports vary in sample size and study design but the majority are cross-sectional and suffer from inherent bias. Many of the patients' complaints in cancer of the head and neck manifest close linkage to problems related to the oral cavity. Frequent specific problems are trismus, pain, xerostomia, and speech and swallowing disorders. Although quality of life is multifactorial and subjective, some improvement may be achieved by recognizing and addressing problems during the course of treatment. More longitudinal long-term studies are indicated in order to better define quality of life along the time axis.