Long-term quality-of-life outcomes following treatment for adult obstructive sleep apnoea: comparison of upper airway surgery, continuous positive airway pressure and mandibular advancement splints.

OBJECTIVE: Long-term quality-of-life (QOL) outcomes, complications and clinical effectiveness in patients undergoing treatment with upper airway surgery (UAS), continuous positive airway pressure (CPAP) and mandibular advancement splints (MAS) for adult obstructive sleep apnoea (OSA). DESIGN: Retrospective cohort study. SETTING: Multidisciplinary OSA clinic in University teaching hospital. PARTICIPANTS: Consecutive, simultaneously treated patients with OSA undergoing UAS (n = 83), CPAP (n = 83) and MAS (n = 79). MAIN OUTCOME MEASURES: Glasgow Benefit Inventory (GBI), Snoring Severity Scale (SSS), Epworth Sleepiness Score (ESS) and side-effects in all three groups were recorded at a mean of 34.5 months following start of treatment and compared via anova with Bonferroni's adjustment for pairwise comparisons. RESULTS: Upper airway surgery demonstrated a statistically significant QOL benefit over MAS. All three groups showed a significant improvement in SSS with CPAP significantly better than MAS, but equivalent to UAS. Uncomplicated UAS provided a greater QOL outcome than compliant MAS, non-compliant CPAP (P < 0.05) and comparable to compliant CPAP. Patients undergoing UAS with recorded complications still reported equivalent QOL outcomes to compliant CPAP and MAS, suggesting these surgical complications are relatively minor compared to the QOL benefit of OSA treatment. CONCLUSION: Upper airway surgery showed a significant improvement in QOL outcomes compared to non-compliant CPAP or MAS and equivalent benefit to compliant CPAP. This study strongly supports the role for contemporary UAS in OSA when CPAP is not or no longer an option.

Why do some patients with > 80% stenosis of the internal carotid artery not undergo surgery? A retrospective review.

BACKGROUND: Carotid endarterectomy is known to benefit both symptomatic and asymptomatic patients with high-grade internal carotid artery stenosis. Duplex scanning is the 'gold standard' for non-invasive preoperative investigation of carotid artery stenosis. The aim of the present study was to analyse the indications for duplex scanning and to identify other factors that influenced the management of patients with high-grade stenosis who did not undergo carotid endarterectomy. METHODS: A total of 271 patients was observed to have > 80% stenosis of the internal carotid artery on duplex scanning during the period of review. Of these patients, 85 did not undergo carotid endarterectomy. The vascular laboratory database and hospital records of these patients were retrospectively reviewed. RESULTS: The indications for requesting a carotid duplex scan in the 85 patients were transient ischaemic attack (22%), stroke (25%), symptomatic bruit (7%), asymptomatic bruit (12%), and stroke and symptomatic bruit combined (7%). Falls and preoperative carotid assessment prior to coronary surgery were the commonest indications in the remaining patients. The main risk factors were cardiac (68%), hypertension (60%), respiratory (21%), diabetes (25%), peripheral vascular disease (19%), neoplasm (16%) and renal disease (16%). Twenty-five per cent of the patients were over 80 years of age. CONCLUSION: In the present study risk factors associated with increased perioperative morbidity and mortality were the commonest explanation for patients with high-grade stenosis of the internal carotid artery not undergoing surgery. These patients would generally not meet the inclusion criteria for the major carotid endarterectomy trials.

Micro-ribonucleic acids in head and neck cancer: an introduction.

BACKGROUND AND METHODS: Head and neck cancer is the sixth most common cancer worldwide. Advances in management have not greatly altered overall survival. Over the last decade, there have been significant scientific advances in our knowledge of cell cycle regulation and the complex oncogenic processes. MicroRNAs are small, non-coding RNAs which are integral to the regulation of gene expression and which play a part in carcinogenesis. The literature on the role of microRNA in head and neck cancer is reviewed. OBJECTIVE: To introduce the role and significance of microRNAs in head and neck cancer. RESULTS: The possibilities of incorporating microRNAs into clinical practice are discussed, including their potential role in diagnosis, prognosis, prediction of metastatic spread, therapy and tumour surveillance. CONCLUSION: Discoveries in expression profiling of microRNA in head and neck oncology promise advancements in the diagnosis, prognosis and therapy of these cancers.

Primitive neuroectodermal tumour of the tongue.

Peripheral primitive neuroectodermal tumours, which belong to the Ewing sarcoma tumour family, are extremely rare. These tumours are highly aggressive and are known to have a poor prognosis. Immunostaining with at least two neural markers and evidence of an abnormal t(11;22)(q24;q12) translocation are hallmark features in this diagnosis. We present the first reported case of peripheral primitive neuroectodermal tumour to occur in the tongue.