Consider obstructive sleep apnea in patients with oropharyngeal vascular malformations.

INTRODUCTION: Patients with oropharyngeal vascular malformations with complaints of upper airway obstruction were referred to a sleep specialist to investigate the existence of obstructive sleep apnea (OSA). METHODS: Demography, complaints, localization, and extent of the malformation were noted. The Epworth Sleeping Scale (ESS) and a polysomnography were performed to analyze the existence of OSA. RESULTS: Thirteen patients with vascular malformations in the upper oropharyngeal tract were referred, with a mean age of 49 years (range, 20-77 years). The male: female ratio was 7:6. In 2 patients the ESS was missed, and in the other 11 patients the mean ESS was 11.7 (range, 4-23). After polysomnography, 11 of the 13 patients (85%) were diagnosed with OSA, of whom 7 patients had severe OSA. CONCLUSION: Patients with oropharyngeal vascular malformations with complaints of upper airway obstruction have a high risk of OSA, and should be referred to a sleep specialist.

Surgical management of gynecomastia: 20 years' experience.

BACKGROUND: Gynecomastia, breast hypertrophy in men, is a common finding. The diagnosis is clinical, and ancillary tests may be performed; however, there is no unanimity in the literature about their use or utility. The mainstay of management is conservative, with a minority of patients being operated on. The surgical treatment of gynecomastia is not restricted to one discipline and is performed by plastic, general, and pediatric surgeons. The aim of this study was to assess the experience treating gynecomastia in a university hospital and the practices of the different surgical disciplines in the diagnosis and surgical treatment of gynecomastia; this knowledge could be used for the formulation of guidelines and the allocation of health-care resources. SETTING: a university medical center. DESIGN: A retrospective cohort study in which all records of patients operated on for gynecomastia over a 20-year period were retrieved. Data were obtained concerning patient demographics, responsible surgical discipline, the workup and etiology found, the surgical technique used, the occurrence of reoperations and revisions, and the use of pathological examination and its results. RESULTS: A total of 179 patients were treated. There was a difference between the patient groups operated on by the different disciplines regarding the indication, the workup, as well as in the operative techniques used. Plastic surgeons performed more bilateral operations than the other disciplines. Surgeons used more radiology and cytology testing. CONCLUSION: These results most probably represent differences in the population and pathologies treated. This is possibly due to a bias in the referrals by primary care physicians.