Cirugía del sueño: Definición de una especialidad emergente, propuesta de una clasificación anatomofuncional integral e indicaciones

Resumen Los trastornos respiratorios del sueño (ronquido primario y síndrome de apnea-hipopnea obstructiva del sueño) han sido tratados mediante múltiples modalidades a lo largo de la historia. Sin embargo, la cirugía de la vía aérea superior siempre ha estado presente, dando cabida a la aparición de múltiples técnicas para este fin. El estudio adecuado de los sitios anatómicos de estrechez o colapso de la vía aérea superior y sus contribuyentes (bajo el concepto de topodiagnóstico) y el mejor entendimiento de los mecanismos de acción de los diferentes procedimientos descritos, ha permitido el nacimiento de una nueva disciplina, dedicada al manejo quirúrgico planificado de este grupo de patologías: la cirugía del sueño.

Abstract Sleep-related breathing disorders (primary snoring and obstructive sleep apnea-hypopnea syndrome) have been treated with multiple modalities throughout history. However, upper airway surgery has always been present, giving appearance of multiple techniques for this purpose. The adequate study of the anatomical sites of upper airway narrowness or collapse and its contributors (under the concept of topodiagnosis) and a better understanding of the different procedures, has allowed the birth of a new discipline, dedicated to a planned surgical management for this group of pathologies: sleep surgery.

Diabetic and cardiovascular risk in patients diagnosed with periodontitis.

BACKGROUND: There are well-established associations between periodontitis and diabetes mellitus and cardiovascular disease (CVD). The literature suggests a reciprocal relationship between periodontitis and diabetes. This pilot study aimed to measure in individuals with moderate to severe periodontitis their diabetes and CVD risks. METHODS: Participants with a diagnosis of periodontitis were recruited from the Royal Dental Hospital of Melbourne. Casual blood glucose (CBG), total cholesterol (TC), HbA1c, blood pressure (BP), weight and height were measured for all study participants. RESULTS: Forty-two participants enrolled in our study out of 159 that were approached [mean age 51.3, 26 (61.9%) females]. Twenty-four (57.1%) patients were undiagnosed pre-diabetic and had an HbA1c of ≥5.7; three (7.15%) patients were undiagnosed diabetic with an HbA1c of ≥6.5. Fourteen (33.3%) patients were hypertensive (BP ≥140/90 mmHg) and 17 (40.5%) had hypercholesterolaemia (TC ≥5.5). Twelve (28.6%) patients were smokers and 24 (57.1%) had a blood mass index (BMI) above 25. Twenty-four (57.1%) patients were referred to their general practitioner due to elevated disease markers. CONCLUSIONS: This small study found a large proportion of patients with periodontitis had undiagnosed pre-diabetes or diabetes, hypertension, hypercholesterolaemia and elevated BMI levels.

[Interstitial pneumonia in bone marrow transplantation. Preventive and therapeutic aspects. Our experience and review of the literature]. / Neumonía intersticial en el trasplante de medula ósea. Aspectos profilácticos y terapéuticos. Nuestra experiencia y revisión de la literatura.

From June/82 through November/85 bone marrow transplant recipients in our Institution were given only trimethoprim-sulfamethoxazole as prophylaxis against interstitial pneumonia. In December/85 we began a program of administration of passive immunoprophylaxis with hyperimmune plasma or cytomegalovirus-specific gamma globulin and transfusion of seronegative blood products to all bone marrow transplant recipients whether they were seropositive or seronegative prior to transplant. Nine of 36 patients in the historical control group and 9 of 32 patients in the study group developed an interstitial pneumonia. Interstitial pneumonia, once established, was treated empirically. The 9 patients in the control group received trimethoprim-sulfamethoxazole +/- adenine arabinoside, acyclovir, amphotericin B and anti-bacterial antibiotics; all died. Post-mortem study was performed in 7 (4 CMV, 3 idiopathic). The 9 patients in the study group received high dose cytomegalovirus-specific gamma globulin + acyclovir or ganciclovir in addition to the above measures. Four were cured, one relapsed and responded to treatment again. Five died (1 CMV, 1 candida, 3 idiopathic). We conclude that the prophylactic measures, as applied at our Institution, were inefficient. By contrast, therapy with specific immunoglobulin + acyclovir or ganciclovir can control a high percentage of patients. We compare this experience with reports from other centers.

[Lead poisoning due to drug addiction: a new source of poisoning with clinical interest and important epidemiological consequences]. / Saturnismo por drogadicción: nueva fuente de intoxicación con interés clínico e importantes consecuencias epidemiológicas.

Lead poisoning has accompanied the human being throughout history. Owing to the increasing levels of safety at work, the incidence of occupational poisoning has decreased and new forms of non-occupational poisoning have emerged. We present 3 cases of drug addicts, with lead poisoning, as a result of using adulterated drugs. One of them was an intravenous drug addict who had abdominal pain and anemia. The other 2 inhaled heroin, one being slightly anemic and the other without symptoms and with normal hemoglobin levels. The drug adulterated with lead had not been previously recognized as a source of lead poisoning, being likely to cause serious epidemiological effects.

Hematopoietic growth factors in human serum. erythroid burst-promoting activity in normal subjects and in patients with severe aplastic anemia.

The activity capable of promoting the growth of human erythroid burst-forming cells (BFU-E) in culture was measured in the sera from 39 patients with aplastic anemia (AA) and compared with similar activity in patients with various other hematologic disorders and 31 normal subjects. Burst-promoting activity (BPA) was determined by its ability to support erythroid burst growth from adherent cell-depleted normal human marrow cells. The results were expressed as the percentage of burst growth supported by test serum compared with cultures established in the presence of 20% test serum and 2.5% phytohemagglutinin-stimulated lymphocyte conditioned medium. The mean BPA level in normal serum was 18.5% (1.5 +/- SEM) and was not significantly different from BPA levels in patients with various forms of nonhypoplastic anemia or polycythemia (10.2% +/- 1.2%). In contrast, 15 of the 39 patients with AA had elevated BPA levels, ranging from 40.0% to 106.0%. These elevated levels did not correlate with serum erythropoietin or hematocrit values, white blood cell count, platelet count, time from diagnosis, or the presence or numbers of BFU-E in circulation. The BPA was shown not to be T cell growth factor (interleukin-2), and the effect was not blocked by the addition of cyclosporine to culture, consistent with a direct effect of this activity on BFU-E. When the 39 patients with AA were treated with antithymocyte globulin, 20 obtained a complete or partial remission. BPA levels determined from sera obtained before treatment did not correlate with response or duration of survival but did correlate with granulocyte-macrophage colony-stimulating activity (GM-CSA).(ABSTRACT TRUNCATED AT 250 WORDS)