RESUMO
Obstructive sleep apnea (OSA) is a common condition that can cause daytime or nocturnal symptoms with long-term impact on the patient's health. Various therapies and surgeries have been introduced over the years, and patient wishes and compliance are essential factors in the success of treatment. Drug-induced sleep endoscopy (DISE) is a procedure that assesses the opening and closing of the upper airway in real time. This article summarizes the indications and contraindications of DISE, with a review of sedation methods and the VOTE classification system, in order to facilitate the use of a common nomenclature based on a protocol applied at the CHUV.
Le syndrome d'apnées obstructives du sommeil (SAOS) est une affection courante pouvant provoquer des symptômes diurnes ou nocturnes ayant un impact à long terme sur la santé du patient. Diverses thérapies et chirurgies ont été introduites au fil des années et les souhaits des patients et l'observance thérapeutique sont des facteurs essentiels dans le succès du traitement. L'endoscopie du sommeil induit par les médicaments (DISE: drug-induced sleep endoscopy) permet d'évaluer l'ouverture et la fermeture des voies respiratoires supérieures en temps réel. Cet article résume les indications et contre-indications de la DISE avec un rappel des méthodes de sédation et le système de classification VOTE, afin de faciliter l'utilisation d'une nomenclature commune basée sur un protocole appliqué au CHUV.
Assuntos
Anestesia , Laringe , Humanos , Endoscopia , Contraindicações , SonoRESUMO
CASE REPORT: We report on the case of a 47-year old woman with granulocyte colony-stimulating factor (G-CSF)-producing relapsed oropharyngeal squamous cell cancer. Palliative immunotherapy with nivolumab was started. Absolute neutrophilic count increased during the course of immunotherapy and correlated with tumour progression. Under chemotherapy with weekly paclitaxel, dramatic tumour regression and decreasing absolute neutrophilic count were noted. G-CSF concentration in serum increased from 4.77 to 9.61 pg/ml during the final phase of tumour progression. Immunohistochemical staining of the initial biopsies showed that some of the tumour cells as well as infiltrating cells stained positively for G-CSF, and some of the tumour cells even stained positively for the G-CSF receptor. CONCLUSION: Leukaemoid reaction in malignant disease with increased neutrophilic granulocytes has been shown to correlate with dismal prognosis in other tumours. The role of G-CSF in progression and prognosis of head and neck squamous cell carcinomas is still unclear but in patients with these tumours there seems also to be a correlation between elevated G-CSF and poor prognosis. Further systematic evaluation of G-CSF secretion in this tumour entity should clarify the role and potential treatment possibilities for these tumours.
Assuntos
Fator Estimulador de Colônias de Granulócitos , Neoplasias de Cabeça e Pescoço , Feminino , Humanos , Contagem de Leucócitos , Pessoa de Meia-Idade , Prognóstico , Carcinoma de Células Escamosas de Cabeça e PescoçoRESUMO
Drug fever is a little known side effect and should be considered as a differential diagnosis in the presence of fever. Its early recognition is important to avoid unnecessary investigations. Among the 70 most prescribed drugs in primary care in Switzerland, 8 have been linked to drug feverâ : amoxicillin, atorvastatin, rosuvastatin, esomeprazole, pantoprazole, rivaroxaban, salbutamol and trazodone. There are no specific criterias to distinguish a drug-induced fever. The diagnosis is confirmed with a positive rechallenge test. If a drug fever is suspected, it is recommended to stop the offending agent.
La fièvre d'origine médicamenteuse fait partie du diagnostic différentiel de toute fièvre et est un effet secondaire peu reconnu. Son évocation précoce est importante et permet d'éviter des examens secondaires inutiles. Parmi les 70 substances les plus vendues en ambulatoire en Suisse de 2008 à 2016, 8 médicaments peuvent provoquer de la fièvreâ : l'amoxicilline, l'atorvastatine, la rosuvastatine, l'esoméprazole, le pantoprazole, le rivaroxaban, le salbutamol et la trazodone. Il n'y a pas de critère défini de la fièvre médicamenteuse et aucun signe clinique ou valeur de laboratoire n'est spécifique à un état fébrile secondaire à un médicament. Seul un test de réexposition positif permet de confirmer définitivement le diagnostic. En cas de suspicion de fièvre médicamenteuse, l'arrêt immédiat de la substance est recommandé.
