Systemic bevacizumab as salvage therapy for persistent severe bleeding and anemia in heyde syndrome following aortic valve replacement

Journal of Thrombosis and Thrombolysis - Heyde syndrome is characterized by the co-occurrence of aortic stenosis and bleeding gastrointestinal angiodysplasias, often with acquired von Willebrand...     

The utility of home sleep apnea tests in patients with low versus high pre-test probability for moderate to severe OSA

Purpose

Home sleep apnea tests (HSATs) are an alternative to attended polysomnograms (PSGs) when the pre-test probability for moderate to severe OSA is high. However, insurers often mandate use anytime OSA is suspected regardless of the pre-test probability. Our objective was to determine the ability of HSATs to rule in OSA when the pre-test probability of an apnea hypopnea index (AHI) in the moderate to severe range is low.

Methods

Patients who underwent HSATs were characterized as low or high pre-test probability based on the presence of two symptoms of the STOP instrument plus either BMI >?35 or male gender. The odds of HSAT diagnostic for OSA dependent on pre-test probability was calculated. Stepwise selection determined predictors of non-diagnostic HSAT. As PSG is performed after HSATs that do not confirm OSA, false negative results were assessed.

Results

Among 196 individuals, pre-test probability was low in 74 (38%) and high in 122 (62%). A lower percentage of individuals with a low versus high pre-test probability for moderate to severe OSA had HSAT results that confirmed OSA (61 versus 84%, p?=?0.0002) resulting in an odds ratio (OR) of 0.29 for confirmatory HSAT in the low pre-test probability group (95% CI [0.146, 0.563]). Multivariate logistic regression demonstrated that age ≤?50 (OR 3.10 [1.24–7.73]), female gender (OR 3.58[1.50–8.66]), non-enlarged neck circumference (OR 11.50 [2.50–52.93]), and the absence of loud snoring (OR 3.47 [1.30–9.25]) best predicted non-diagnostic HSAT. OSA was diagnosed by PSG in 54% of individuals with negative HSAT which was similar in both pre-test probability groups.

Conclusion

HSATs should be reserved for individuals with high pre-test probability for moderate to severe disease as opposed to any individual with suspected OSA.

     

MUSICAL HALLUCINATIONS ASSOCIATED WITH RECURRENCE OF A RIGHT OCCIPITAL MENINGIOMA

SUMMARY The case of an 84-year-old woman who experienced musical and visual hallucinations after recurrence of a right occipital meningioma is reported.