Modified tongue base suspension for multilevel or single level obstructions in sleep apnea: clinical and radiologic results

Objectives

To investigate the radiologic and polysomnographic success in opening the airway using a tongue base suspension procedure alone or in combination with uvulopalatal flap in obstructive sleep apnea syndrome (OSAS) patients.

Methods

This study was conducted in 20 patients with moderate or severe OSAS in a prospective manner. The tongue base suspension technique alone or with a uvulopalatal flap (UPF) technique was applied. Magnetic resonance imaging (MRI) scans of patients obtained during the preoperative period and at the 5th week of the postoperative period were compared. Changes in pain and swallowing difficulties were assessed. Polysomnography (PSG) was applied at the 12th postoperative month, and body mass index (BMI) and Epworth sleepiness scale (ESS) values were determined. The degree of satisfaction relative to the surgery was assessed with 4 questions.

Results

Preoperative apnea-hypopnea index (AHI) level was found to be 24.55 ± 9.87, whereas postoperative AHI level was 12.40 ± 9.87 (P < 0.01). The success rate was determined to be 60%. Preoperative ESS values were 13.90 ± 2.67 and were reduced to 6.55 ± 3.13 postoperatively (P < 0.01), and the preoperative posterior airway space (PAS) level was 10.08 ± 1.23, which was increased to 11.64 ± 1.46 postoperatively (P < 0.01). Visual analog scale (VAS) values for swallowing difficulty were 8.62 at day 1 and decreased to 3.98 at day 7. The VAS values for pain were 9.14 at day 1, but were reduced to 4.18 at day 7.

Conclusions

Patients with OSAS who have hypertrophy of the tongue base may safely receive a tongue base suspension procedure, which is a minimally invasive method. The postoperative hospital stay is short and the success rate is high, as shown with both PSG and MRI.     

Cyclosporin A in severe, therapy-resistant atopic dermatitis: report of an international workshop, April 1993

Summary Data on the use of oral cyclosporin A (CyA; Sandimmun®) therapy for severe adult atopic dermatitis have accumulated since 1987. Details of over 200 adult patients who have received short-term CyA were presented at an international workshop in April 1993. Eighty-six of these patients had participated in three randomized, double-blind, placebo-controlled studies in which CyA was given for 6–8 weeks. The efficacy and safety of short-term CyA treatment in atopic dermatitis is established, provided that appropriate guidelines are observed. Evidence to date suggests that atopic dermatitis patients are no more prone to toxicity than patients with psoriasis, in whom more detailed and longer-term data are available. Early data also suggest that long-term CyA may be effective in atopic dermatitis, but there is concern regarding long-term safety, as experience is still limited. Careful monitoring of all CyA-treated patients is therefore mandatory. CyA should only be used under the direct and regular supervision of a hospital-based dermatologist who is knowledgeable in the use of cyclosporin A, and experienced in the management of severe skin disease and in the use of potentially toxic drugs.     

HAIR FOLLICLE NEVUS

Four cases of hair follicle nevi are described. Hair follicle nevus is an extremely rare hamartoma occurring on the face, which has had no clear histopathologic definition until now. A short review of the clinicopathologic features of this disease is presented.     

Safety and Long‐Term Outcome of Modified Intracardiac Echocardiography‐Assisted “No‐Balloon” Sizing Technique for Transcatheter Closure of Ostium Secundum Atrial Septal Defect

Background: The need for sizing the secundum atrial septal defect (ASD) with the balloon sizing technique is still debated at least in adult patients. We sought to prospectively evaluate the effectiveness of intracardiac echocardiography (ICE)‐aided sizing technique for transcatheter closure of secundum ASD, without using a balloon sizing. Methods: In a prospective 5‐year registry, we enrolled 81 patients (mean age 48 ± 13.7 years, 54 females) who had been referred to three different centers for catheter‐based closure of secundum ASD. Eligible patients underwent ICE study and closure attempt. In a preliminary group of 21 patients, sizing balloon was performed under ICE guidance to assess the value of rim thickness necessary for device anchorage. In the remaining 60 patients, the retrieved value of the rim thickness was measured on ICE and used as key points to measure the defect and select the device. Results: In the preliminary group of patients, the value of thickness at point of initial deflection by the balloon was 1.23 ± 0.1 mm. ASD diameter in the study group was measured at the point of rim with at least 1.2 mm and the mean ASD diameter was 26.2 ± 10.1 mm. Rates of procedural success, predischarge occlusion, and major complications rate were 100%, 93.3%, and 0%, respectively. On mean follow‐up of 5.4 ± 1.8 years, the occlusion rate was 98.7% with no long‐term complications. Conclusions: Our novel ICE‐sizing technique appears to be safe and effective in adult patients, thus eventually minimizing overestimation, costs, and potential complications of balloon sizing. (J Interven Cardiol 2012;25:628–634)     

特发性单侧透明肺的影像诊断

目的分析特发性单侧透明肺的影像诊断。方法本组共29例特发性单侧透明肺。29例均拍胸部正侧位片,其中19例行电视透视,14例行胸部CT扫描,2例做支气管造影,1例行体层摄影,1例行肺动脉、主动脉造影。结果29例患肺透亮度增大,其中左全肺23例,左下叶5例,左全肺并右肺中下叶1例。左肺门及肺血管性纹理细小。21例左侧胸廓轻度塌陷,21例纵隔气管左偏,19例电视透视见纵隔摆动,14例CT扫描见左肺动脉细小,其中主干细小9例,左肺下叶动脉细小5例。12例见右下肺动脉干增粗,5例动脉段延长,7例肺动脉段突出,4例心脏增大,19例支气管扩张。结论影像学检查是特发性单侧透明肺的关键确诊手段。     

次黄嘌呤－内源性单胺氧化酶（MAO）抑制剂样活性的研究

体外实验证明，嘌呤类化合物对Ｂ－型ＭＡＯ活性有不同程度的抑制作用，其抑制强度为：次黄嘌呤＞鸟便嘌呤＞腺嘌呤＞嘌呤＞黄嘌呤＞尿酸。老龄小鼠（１８月龄）的血、脑及肝组织ＭＡＯ活性较年青小鼠（１月龄）显著升高，而上述组织中嘌呤类化合物的含量却随年龄增加而降低。老龄小鼠肝线粒体外膜ＭＡＯ提取物中次黄嘌呤含量明显低于年青小鼠，但两组ＭＡＯ中腺嘌呤含量却无明显差异。离体温孵实验证明［３Ｈ］次黄嘌呤与老龄小鼠脑和肝ＭＡＯ结合量明显高于年青小鼠。体内结合实验结果亦表明［３Ｈ］次黄嘌呤与老龄小鼠肝ＭＡＯ结合量高于年青小鼠外，并证明［３Ｈ］次黄嘌呤的结合部位是在ＭＡＯ酶蛋白上，而非在辅基上。此外，多次灌服次黄嘌呤２００ｍｇ／ｋｇ可明显抑制老龄小鼠脑ＭＡＯ－Ｂ活性，并使单胺类物质（５－ＨＴ、ＤＡ）含量明显增加。     

Effect of auricular acupuncture on oxygen consumption of boxing athletes

Boxing is an official sport at the 2008 Beijing Olympic Games and the fast development of world-class high strength training and sport science has made a significant impact on scientific training. Boxing needs high cardio-respiratory function, speed, muscle strength, and anaerobic and intensive physical demands including weight control covering the grading of athlete's.     

Assesment of the compressive strength of the current restorative materials

ObjectiveThe purpose of this study was to evaluate the compressive strength of the 6 different restorative materials which are frequently used today by using the universal compressive strength test.Materials and methodA total of 60 specimens were prepared as 10 samples in each group for compressive strength test. Group A: G-aenial Posterior Composite Group B: Equia Fil, Group C: Tetric Evo Ceram Bulk Fill, Group D: Glass Fill, Group E: Filtek? Bulk Fill, Group F: SureFil SDR Bulk Fill. The compressive strength test was performed at a speed of 1.00 ± 0.05 mm/min along the long axis of the specimens using a computerized universal test device (Autograph AG-IS; Shimadzu Co, Kyoto, Japan). One Way Anova and Tukey HSD test were used for the statistically analysis.ResultsThe analysis of the obtained data revealed that the highest compressive strength was found in Group F and the lowest compressive strength in Group C and D. The compressive strength of Group F was significantly higher than the other groups (p < 0.01). The compressive strength of Group E was significantly higher than all other groups except Group F (p < 0.01).ConclusionsThe use of bulk fill composites in pediatric dentistry provides convenience by shortening the process steps. Thanks to their mechanical properties, they are used in treatment options instead of conventional composite restorations.     

Long-term clinical outcomes of drug-eluting stents vs. bare-metal stents in Chinese geriatric patients

Background & Objective Little is known about the relative efficacies of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) and bare-metal stents (BMS) in elderly patients. The objective of this study was to evaluate the clinical outcome for geriatric patients who received either DES or BMS. Methods From January 2002 to October 2005, 199 consecutive Chinese geriatric patients (≥ 75 years old) underwent PCI with coronary DES or BMS implantation at our institution. We analyzed the major clinical end points that included all-cause mortality, cardiovascular death, myocardial infarction, target lesion revascularization (TLR), stent thrombosis, and bleeding complications. Results The three-year cumulative rates of all-cause mortality, cardiovascular death, and myocardial infarction were significantly lower in the DES group (6.3%, 3.6%, 5.4%) compared with the BMS group (16.2%, 11.5%, 14.9%; P < 0.05). No significant differences were found in the three-year cumulative rate for target lesion revascularization (6.3% vs. 4.6%, P = 0.61) or stent thrombosis (3.6% vs. 2.3%, P = 0.70). Likewise, there were no statistically significant differences in the cumulative rate for intracranial hemorrhage, or major and minor hemorrhage at three years. Conclusions DES-based PCI was associated with a significant reduction in the three-year cumulative rate of all-cause mortality, cardiovascular death, and myocardial infarction compared with BMS, without increased risk of TLR, stent thrombosis, or bleeding complications at three years in this group of Chinese geriatric patients.