The velo-uvulo-pharyngeal lift or "roman blinds" technique for treatment of snoring: a preliminary report.

Snoring is caused by vibrating anatomical structures in the upper aerodigestive tract. It can be treated surgically and non-surgically, although resective procedures are associated with high postoperative morbidity and failure rate. We describe a new non-resective surgical procedure called the velo-uvulo-pharyngeal lift in which the soft palate is lifted, shortened, advanced and stiffened by means of permanent threads anchored to fibro-osseous attachments at the level of the posterior nasal spine and both pterygoid hamuli. Four adult patients (median age 44.5 years; range 42-65) affected by snoring and mild obstructive sleep apnoea-hypopnoea syndrome (apneoa-hypopnoea index, AHI < 20) requiring septal surgery under general anesthesia also underwent velo-uvulo-pharyngeal lift. There were no significant intra- or post-operative complications, and all of the patients reported immediate snoring relief. The main complaints were slight pain and a sensation of local fullness, both of which spontaneously disappeared within two days. The subjective clinical improvement in snoring was confirmed during post-operative follow-up (median 15.5 months; range 6-25), as was the stable reshaping of the soft velo-uvulo-pharyngeal tissues and enlargement of the mesopharyngeal space. There was also a decrease in daytime sleepiness. Our preliminary results suggest that velo-uvulo-pharyngeal lift is a simple, cost-effective and minimally invasive means of widening the mesopharyngeal space in snoring patients with or without mild sleep apnoea-hypopnoea syndrome. The widening of the mesopharyngeal space prevents contact-induced wall vibrations and its inspiratory obstruction causing hypopnoea and apnoea. It can also be combined with other procedures if indicated.

An MRI study of Chlamydia pneumoniae infection in Italian multiple sclerosis patients.

We amplified sequences of the Chlamydia pneumoniae (CP) major-outer membrane protein in the cerebrospinal fluid (CSF) from 23 of 107 (21.5%) relapsing-remitting or secondary progressive multiple sclerosis (MS) patients and two of 77 (2.6%) patients with other neurological diseases (OND) (P = 0.00022). CP+ patients showed magnetic resonance imaging (MRI) evidence of more active disease (P = 0.02) compared to CP- MS patients and tended to have an anticipation of age at disease onset (32.3 +/- 12 versus 28.5 +/- 10 years; P = ns) causing a longer disease duration (7.5 +/- 5 versus 4.4 +/- 4 years; P = 0.016) at the time of clinical evaluation. These findings, although indirectly, suggest that CP infection of the central nervous system (CNS) might affect disease course in a subgroup of MS patients.

Stimulus- and event-related evoked potentials: from neuroscience to clinical neuropharmacology.

Synaptic neural (and neural system) functions are peculiarly sensitive to neuroactive compounds. Pharmacological interference/modulation is readily reflected by modifications in the organization of central nervous system (CNS), electrophysiologic signals occurring spontaneously in response to sensory stimulation (stimulus-related or evoked responses) or elicited in conjunction with sensory, motor or cognitive events (event-related potentials). Evoked responses reflect the basic physiology of sensory processes, while event-related potentials combine the time/space resolution of electrophysiologic signals with the specificity of eliciting neuropsychological conditions. The rationale for investigating drug effects on evoked and event-related potentials is manifold. Both are related to sensory and operant behavior and under suitable experimental conditions allow interpretation of drug-related changes in terms of CNS excitability. Some continuity between observations in man and in vivo or in vitro animal data is often possible. Proper handling of the stimulus physical properties or experimental/situational links may allow the responses to be related to sensory input or to neuropsychological manipulation of selectively activated CNS functions or functional subsystems and therefore to control spontaneous variability. This review summarizes today's knowledge of the application of electrophysiology to human neuropharmacology, with due reference to basic pharmacology and experimental evidence.