Una etiología infrecuente de síndrome de resistencia de las vías aéreas superiores / An unusual etiology of upper airway resistance syndrome

Presentamos el caso de un hombre de 38 años que consultó por presentar frecuentes crisis de despertar asfícticas con sensación de ahogo siempre que dormía. Asociaba además somnolencia excesiva diurna y un ronquido intenso antes de cada despertar, pero no durante el resto del sueño. El estudio polisomnográfico evidenció valores normales en el índice de desaturaciones de O2, en la mínima saturación de O2, una desestructuración de la arquitectura del sueño, con mínimos porcentajes de los estadios IIIIV, un índice elevado de arousals y un RDI <5. Los diámetros faríngeos medidos mediante TC resultaron normales, pero el grado de hipersomnia detectado en la escala de Epworth fue muy elevado. El estudio nasofibroscópico objetivó una epiglotis basculante que en inspiración forzada ocluía totalmente la vía aérea. La ausencia de episodios de desaturación con numerosos despertares durante el sueño y somnolencia diurna excesiva condujeron al diagnóstico de síndrome de resistencia de las vías aéreas superiores (SRVAS). El tratamiento con C-PAP condicionó empeoramiento de los síntomas, pero la epiglotectomía parcial con láser CO2 fue resolutiva de los mismos. Se comentan los aspectos fisiopatólogicos del SRVAS, así como su monitorización y alternativas terapéuticas (AU)

We present the case of a thirty-eight years-old man bearing of frequent crisis of asphyxiating wakefulness and breathnessless whenever he was asleep. There also were excessive daytime sleepiness and a strong snore before every wakefulness, but not for the rest of sleep. A polysomnographic study revealed normal values in the oxygen desaturation index, minimum oxygen saturation, an sleep structure alteration with a decrease of III-IV stages, high arousals index and RDI < 5. Pharyngeal diameters measured by mean of TC were normal, but sleepiness degree detected in the Epworth scale was high. Nasal fiberoptic endoscopy study allowed to see a swinging epiglottis that closed totally the upper airway during forced inspiration. The lack of desaturation episodes with numerous wakefulness along the sleep and excessive daytime sleepiness drove to the diagnosis of upper airway resistance syndrome (UARS). Treatment whit C-PAP just provoked an impairment in symptoms, but a CO2-laser partial epiglottectomy improved them. Patophysiological aspects of UARS, as well as its follow-up and therapeutic alternatives are commented (AU)

[Oxidative profile of tonsil infection. Study of antioxidant enzymes in tonsil and blood]. / Perfil oxidativo de la infección amigdalar. Estudio de las enzimas antioxidantes en amígdala y sangre.

In order to investigate the effect of oxidative damage due to free radicals on ENT infectious diseases, levels of superoxide dismutase (SOD), glutathione-peroxidase (GPx) and reductase (GRt) and the total antioxidant status (TAS) were measured by spectrophotometry on tonsillar tissue obtained from tonsillectomy in 538 patients, who were divided in three groups according to their surgical indication: tonsillar hypertrophy (n = 235), recurrent tonsillitis (n = 280) or peritonsillar abscess (n = 23). SOD concentration were also measured on adenoid tissue and middle ear exudate in 75 patients from the first two groups. Erythrocyte and tonsillar SOD levels were significantly greater in the abscess group, and lower in the hypertrophic one. These differences were similar for GPx and TAS. For GRt, its level in abscess were lower than in the other two groups in a statistically significant way. There were strong correlations between erythrocyte and tonsillar SOD, tonsillar SOD and GPx, tonsillar SOD and TAS, and tonsillar GPx and TAS. SOD concentrations from adenoid tissue and middle ear exudate did not affect its blood level. So, we can conclude that tonsillar oxidative damage is determined by the frequency or the severity of local infections, and it can be evaluated by measuring the SOD concentration in the tonsillar tissue or in the peripheral blood. So, it can be considered a good marker of tonsillar damage.

[Clinical and functional analysis of long-term results of uvulopalatopharyngoplasty]. / Análisis clínico y funcional de los resultados de la uvulopalatofaringoplastia a largo plazo.

In order to evaluate the clinical and functional effectiveness of uvulopalatopharyngoplasty (UPPP) in chronic roncopathy, we studied the subjective improvement of operated patients and compared to pulsioximetry findings before and after surgery. A follow-up was made on 72 patients entitled of chronic roncopathy--51 with obstructive sleep apnea syndrome (OSAS) and 21 with simple snoring-, for a mean period of time of 41 months. Preoperatory study included on ENT exploration, fibre optic endoscopy, Müller maneuver, pharyngeal CT, value of daytime sleepiness with Epworth's scale, espirometry and pulsioximetry, and the postoperatory study included of pulsioximetry and a health questionnaire over snoring and daytime sleepiness. Snoring improved or disappeared in 13 of 21 patients (61.8%), and daytime sleepiness did it in 26 of 39 (66.6%). Therapeutic failure in snoring was mainly due to an increase in the body mass index. After UPPP in OSAS, only 21 patients (41.1%) showed all positive response criteria (decrease into ODI > or = 50% or in absolute values < 6, CT 90% < 1%, and SaO2 Min > or = 85%). UPPP failed in long term evaluation in the rest of individuals. Patient selection is mandatory to optimize clinical response of UPPP for snoring, without OSAS success depends on body mass index, respiratory disturbances ratios and the eventual presence of another upper airways collapses below velopharyngeal segment.

Análisis clínico y funcional de los resultados de la uvulopalatofaringoplastia a largo plazo / Clinical and functional analysis in long-term results of uvulopalatopharyngoplasty

Con objeto de valorar la eficacia clínica y funcional de la uvulopalatofaringoplastia (UPPP) en la roncopatía crónica, se estudió el grado de mejoría subjetiva de pacientes intervenidos y se comparó con los hallazgos pulsioximétricos pre y postoperatorios. Se efectuó seguimiento sobre 72 pacientes con roncopatía crónica -51 con síndrome de apnea obstructiva del sueño (SAOS) y 21 con ronquido simple (RS)-, durante un período medio de 41 meses. Se efectuó estudio preoperatorio mediante exploración ORL, nasofibroscopia, maniobra de Müller, escala de Epworth, TC faríngeo, espirometría y pulsioximetría nocturna, y postoperatorio mediante pulsioximetría nocturna y un cuestionario de salud sobre el ronquido y la hipersomnia diurna mediante escala de Epworth. Existió mejoría o curación del ronquido en 13 de los 21 pacientes afectos (61,8 por ciento) y de la hipersomnia en 26 de 39 (66,6 por ciento). El fracaso terapéutico en el ronquido simple se asoció al aumento del índice de masa corporal. En el SAOS, tras la UPPP, sólo se cumplieron en 21 pacientes (41,1 por ciento) todos los criterios de respuesta (reducción del ODI 50 por ciento, reducción del ODI <6, CT 90 por ciento <1 por ciento, y SaO2 Min 85 por ciento). A largo plazo la UPPP fracasó en el resto de individuos. Concluimos señalando que se deben seleccionar los pacientes para UPPP incluso en caso de RS y que el fracaso de la UPPP en el SAOS está en función del índice de masa corporal, los índices elevados de disturbios respiratorios y la existencia de otros segmentos colapsables de las vías altas caudalmente al velo palatino (AU)

In order to evaluate the clinical and functional effectiveness of uvulopalatopharyngoplasty (UPPP) in chronic roncopathy, we studied the subjective improvement of operated patients and compared to pulsioximetry findings before and after surgery. A follow-up was made on 72 patients entitled of chronic roncopathy--51 with obstructive sleep apnea syndrome (OSAS) and 21 with simple snoring-, for a mean period of time of 41 months. Preoperatory study included on ENT exploration, fibre optic endoscopy, Müller maneuver, pharyngeal CT, value of daytime sleepiness with Epworth's scale, espirometry and pulsioximetry, and the postoperatory study included of pulsioximetry and a health questionnaire over snoring and daytime sleepiness. Snoring improved or disappeared in 13 of 21 patients (61.8%), and daytime sleepiness did it in 26 of 39 (66.6%). Therapeutic failure in snoring was mainly due to an increase in the body mass index. After UPPP in OSAS, only 21 patients (41.1%) showed all positive response criteria (decrease into ODI > or = 50% or in absolute values < 6, CT 90% < 1%, and SaO2 Min > or = 85%). UPPP failed in long term evaluation in the rest of individuals. Patient selection is mandatory to optimize clinical response of UPPP for snoring, without OSAS success depends on body mass index, respiratory disturbances ratios and the eventual presence of another upper airways collapses below velopharyngeal segment (AU)

[Infrequent etiology of upper airway resistance syndrome]. / Una etiología infrecuente de síndrome de resistencia de las vías aéreas superiores.

We present the case of a thirty-eight years-old man bearing of frequent crisis of asphyxiating wakefulness and breathnessless whenever he was asleep. There also were excessive daytime sleepiness and a strong snore before every wakefulness, but not for the rest of sleep. A polysomnographic study revealed normal values in the oxygen desaturation index, minimum oxygen saturation, an sleep structure alteration with a decrease of III-IV stages, high arousals index and RDI < 5. Pharyngeal diameters measured by mean of TC were normal, but sleepiness degree detected in the Epworth scale was high. Nasal fiberoptic endoscopy study allowed to see a swinging epiglottis that closed totally the upper airway during forced inspiration. The lack of desaturation episodes with numerous wakefulness along the sleep and excessive daytime sleepiness drove to the diagnosis of upper airway resistance syndrome (UARS). Treatment whit C-PAP just provoked an impairment in symptoms, but a CO2-laser partial epiglottectomy improved them. Patophysiological aspects of UARS, as well as its follow-up and therapeutic alternatives are commented.

[Non-interventional study on blood filterability changes in the clinical onset of sensorineural sudden deafness]. / Estudio no intervencionista de las alteraciones de la filtrabilidad sanguínea en el debut clínico de sorderas súbitas neurosensoriales.

An hemorheological study on whole blood filterability (WBF) was done in eleven patients bearing of sudden deafness, in a continuous way, even before clinical onset. This evaluation is making usually in animal models, but not in humans. Independently of clinical diagnosis of each patient (two cases of diabetes mellitus, one of ulcerative colitis, systemic lupus erythematosus, systemic hypertension, after blood transfusion, sepsis with disseminated intravascular coagulation, upper respiratory ways infection, after surgery, and two healthy individuals), all of them showed a decreased WBF when hearing loss appeared (from 19.97 +/- 1.15 microliters/sec to 16.87 +/- 1.21 microliters/sec). This value normalized at six or seven days from the onset in cases with some kind of hearing recovery (18.83 +/- 1.01 microliters/sec, n = 4), but did not in those with no improvement even at thirty days (17.39 +/- 0.77 microliters/sec, n = 7). There were differences in WBF values of patients with and without hearing recovery in determinations at seven and thirty days from onset. Decrease in WBF accompanies this hearing disorder and confirms the cochlear microcirculation susceptibility to the impairment of blood viscoelastic properties.

[Co-administration of histamine H1 antagonist and oral anticoagulants]. / Empleo simultáneo de antihistamínicos H1 y anticoagulantes orales.

Indications for oral anticoagulation and antihistamine H1 antagonists therapies are increasingly. So, it is easy to find individuals who need both treatments. The unknowledgement about possible interferences of antihistamines over acenocumarin often makes to avoid them at the same time. A review on a population receiving anticoagulation on a Therapeutic Center allowed us to verify disorders secondary to the association of antihistamines into their therapeutic scheme. Loratadine, ebastine and cetirizine show similar records of interaction into acenocumarin pharmacokinetics, probably due to a liver enzymatic induction on the anticoagulant drug, producing a decrease on INR values in which anticoagulation is measured. This could make necessary to increase temporally acenocumarin dose. During coadministration no thromboembolic event nor bleeding were registered.