Red cell distribution width is a potential predictor of early relapse in polymyalgia rheumatica.

Red blood cell distribution width (RDW) has been studied as a prognostic biomarker for different chronic inflammatory diseases. In this paper we aim to evaluate its potential role in the prediction of early relapse in patients affected by polymyalgia rheumatica (PMR). We revised retrospectively clinical records of patients who received a diagnosis of PMR, according to 2012 ACR/EULAR classification criteria, for whom baseline clinical and laboratory data were available. The baseline RDW variation coefficient was correlated to the risk of relapse, in the first 6 months of the disease. We identified 44 patients [females 15 (34.0%)/males 29 (66.0%); median age 80 (72-83)], 9 of whom had an early relapse. These patients showed a larger median RDW than patients who did not relapse [13.7 (13.5-14.9)% vs 13.5 (12.7-14.2)%; p=0.04). The two groups were comparable for all the other clinical and laboratory parameters considered. Interestingly, patients in the higher half of the RDW distribution showed a shorter relapse-free survival (p<0.03). In a stepwise logistic regression, RDW (p=0.01) predicted the risk of relapse at 6 months, while age, gender, CRP, ESR, Hb, MCV and prednisone dose did not fit the model. Our results show that RDW is an independent biomarker of early relapse, making this parameter a potentially promising predictive marker in PMR.

Outcome of drug-induced sleep endoscopy-directed surgery for persistent obstructive sleep apnea after adenotonsillar surgery.

PURPOSE: Drug-induced sleep endoscopy (DISE) is suitable for evaluating persistent obstructive sleep apnea syndrome (OSAS) after adenotonsillar surgery as a means to guide surgical intervention, yet few studies demonstrate its usefulness in resolving the syndrome. We describe our experience of DISE-directed surgery in children with persistent OSAS by analysing objective and subjective outcomes of this treatment. METHODS: Prospective study of 20 otherwise healthy 2-12 year-old children with OSAS persisting after adenotonsillar surgery. All patients underwent DISE-directed surgery and were followed up clinically and with a polysomnogram at 12 ±â€¯3 months. RESULTS: All 20 children had an apnea-hypopnea index (AHI) score ≥1 (mean: 6.1 ±â€¯4.9) and 75% had AHI>3 before surgery. We performed a total of 14 total tonsillectomies (70%), 7 with associated pharyngoplasties; 5 radiofrequency turbinate reductions (25%); 7 radiofrequency lingual tonsil reductions (35%); and 10 revision adenoidectomies (50%). No surgery-related complications were observed. AHI scores at follow-up were significantly lower than AHI scores before surgery (1.895 ±â€¯1.11 vs 6.143 ±â€¯4.88; p < 0.05) and, in 85% (n = 17) of patients, AHI was below 3. There was a significant reduction in the number of children with AHI>3 in follow-up at 12 ±â€¯3 months (15%; n = 3) compared to before surgery (75%; n = 15) (p < 0.005). CONCLUSION: DISE-directed surgery for otherwise healthy children with persistent OSAS is a useful and safe technique to decide a therapeutic strategy and to obtain good objective and subjective results regarding resolution of the syndrome.

Obstructive sleep apnea syndrome and growth failure.

Obstructive sleep apnea syndrome is a common problem among children and is recognized as a cause of significant medical morbidity. Since the 1980s, it has been suggested that obstructive sleep apnea syndrome is a risk factor for growth failure in children. In many cases, it has been shown that growth failure is reversible once the obstructive sleep apnea syndrome is resolved. The objectives of this study were to analyze and compare growth failure prevalence in a Mediterranean population of children with obstructive sleep apnea syndrome and healthy children matched in age and sex, and to assess the effectiveness of tonsillectomy and adenoidectomy in resolving growth retardation. We compared 172 children with obstructive sleep apnea syndrome (apnea-hypopnea index ≥ 3) who had undergone tonsillectomy and adenoidectomy with 172 healthy controls in terms of key anthropometric parameters. Most of the criteria used for growth failure were higher to a statistically significant degree in the study group vs the control group: height-for-age ≤ 3rd percentile (7.56% vs 2.91%; p = 0.044), weight-for-age ≤ 5th percentile (9.30% vs 2.33%; p = 0.005), weight-for-age ≤ 3rd percentile (8.14% vs 2.33%; p = 0.013) and height and/or weight for-age ≤ 5th percentile (13.95% vs 5.81%; p = 0.009). The height-for-age ≤ 5th percentile was almost at the limit of statistical significance (8.72% for the study group vs 4.65% for the control group; p = 0.097). At one-year post-surgery follow-up, 10 of 15 children with height-for-age ≤ 5th percentile had achieved catch-up growth (66.6%), and 14 of 24 children with height- and/or weight-for-age ≤ 5th percentile had normalized growth (58.33%). For children with failure to thrive or who have growth failure, physicians should consider the possibility of obstructive sleep apnea. A significant number of children with obstructive sleep apnea concurrent with growth failure could benefit from tonsillectomy and adenoidectomy to recover and normalize their growth rate.

[Gastroesophageal reflux and obstructive sleep apnea syndrome]. / Reflujo gastroesofágico proximal y sindrome de la apnea obstructiva del sueño. Datos preliminares de un estudio prospectivo.

INTRODUCTION: Patients with mild or moderate Sleep Apnea Syndrome (SAS) need wider therapeutic scope options according to their disease severity. AIM: To consider including proton pump inhibitors (PPI) to the therapeutical alternatives of these patients. MATERIAL AND METHODS: A prospective study was designed, among patients with SAS. Nocturnal polysomnography and double channel pHmetry were performed simultaneously. RESULTS: From the 18 patients included in this preliminary phase, in three (16.7%) nocturnal proximal ph monitoring was positive. These 3 patients were treated with PPI during at least 3 months with a very satisfactory outcome in two of them. CONCLUSIONS: Treatment with PPI may be a useful therapeutical alternative in patients with mild to moderate SAS.

[Antibiotic treatment in surgery for cholesteatoma]. / Tratamiento antibiótico en la cirugía del colesteatoma.

Cholesteatoma surgery is considered as a dirty one and consequently tributary of preoperative and postoperative antibiotic treatment. Thirty-seven patients diagnosed of cholesteatoma and surgically treated in 1994 are retrospectively analyzed in this article. All of them, whether or not presented with active preoperative otorrhea, received a protocolized antibiotic treatment with topical gentamicin and dexamethasone and oral clindamycin during seven postoperative days. The presence or absence of preoperative or postoperative infection, usually as suppuration is analyzed. Otopyorrhea occurred in 22 patients (62%) before surgery and only in 9 cases (25%) after surgery. Preoperative discharging ears showed greater disposition to continuing the suppuration. The surgical technique followed and the reconstructive middle ear procedure--with autologous bone or other synthetic materials (PORP, TORP)--have not proved, statistically, any predictably value regarding the appearance of any active postoperative infection. As a result of the study done, oral ciprofloxacin has been protocolized only in those adults showing a refractory suppuration to the antibiotic treatment employed. In patients with preoperative otorrhea, topical ciprofloxacin has been protocolized before surgery with the main aim to decrease the postoperative infections incidence of these cases.

[Adverse effects of continuous positive airway pressure therapy and its relation to the nose]. / Efectos adversos derivados del tratamiento con nCPAP y su relación con la nariz.

The main problem in the treatment of obstructive sleep apnea syndrome (OSAS) with nasal continuous airway pressure (nCPAP) is the lack of compliance. One of the most important reasons for no compliance is the adverse effects of this treatment. We analyse, prospectively, 182 patients treated with nCPAP in order to show the relationship between previous nasal problems and adverse effects of nCPAP. Sixty percent of the population developed one o more side effects. Of this group, 69% showed nasal septum deviation at first examination in front of 31% that did not showed this problem (p = 0.001). In the group of patients with nasal side effects we observed an increase of compliance in 80% of patients treated medically and in 89% of those treated by a septoplasty. We demonstrate that the adverse effects of nCPAP are related to previous nasal problems and, also, that treatment of those problems can achieve an increase in compliance to nCPAP therapy.

[Complications of total laryngectomy in relation to the previous radiotherapy]. / Complicaciones de la laringectomía total en función del uso previo de radioterapia.

Different factors, particularly prior radiotherapy, are associated with the occurrence of postoperative complications after total laryngectomy. We compared the postoperative complications of 50 patients who underwent total laryngectomy without prior radiotherapy and those of 50 patients who underwent total laryngectomy for tumor recurrence or persistence after radiotherapy. Twenty-four percent of the patients without previous irradiation suffered cervical complications compared with 26% of the patients with previous irradiation. The most frequent cervical complication was pharyngo-cutaneous fistula, which occurred in 12% of the non-irradiated patients and in 18% of the irradiated patients. There were no significant differences in the frequency of complications or in the occurrence of fistulas in relation to prior radiotherapy. In the group of irradiated patients, the proportion of major fistulas was greater. The occurrence of cervical complications, particularly pharyngo-cutaneous fistulas, significantly prolonged the hospital stay.

Prognostic factors in laryngotracheal injury following intubation and/or tracheotomy in ICU patients.

The aim of this study was to determine the incidence of laryngotracheal injuries following intubation and/or tracheotomy in intensive care unit (ICU) patients and to analyze their prognostic factors. This prospective study includes the clinical data and endoscopic exploration of 654 ICU patients who underwent oro-tracheal intubation between September 1992 and February 1999. The prognostic factors for upper airway injuries were analyzed using a multivariate statistical study. Endoscopic exploration of the upper airway 6 to 12 months after extubation revealed laryngotracheal injuries in 30 of the 280 patients examined (11%). The most important factors influencing the development of laryngotracheal lesions were the duration of the oro-tracheal intubation and the length of time in the ICU. Patients at high risk of developing injuries were those with pathological background, a non-neurological or non-surgical (medical) admission or upper-airway injuries at an early stage. The length of oro-tracheal intubation is the most important factor in the development of laryngotracheal injuries. Consequently, it is essential to establish a time limit to perform tracheotomy in ICU patients. Such timing should be adapted to each patient and pathology.

Reflujo gastroesofágico proximal y síndrome de la apnea obstructiva del sueño. Datos preliminares de un estudio prospectivo / Gastroesophageal reflux and obstructive sleep apnea syndrome

Introducción: Los pacientes con síndrome de apnea del sueño (SAOS) leve o moderado precisan una ampliación de la oferta terapéutica acorde con la intensidad de su enfermedad. Objetivo: Valorar la posibilidad de incluir los inhibidores de la bomba de protones (IBP) al arsenal terapéutico de estos pacientes. Material y métodos: Se diseña un estudio prospectivo entre pacientes con cuadro clínico de SAOS registrando de forma simultánea polisomnografía (PSG) nocturna y pHmetría de 24 horas de dos canales. Resultados: En esta primera fase del estudio se han recogido un total de 18casos, de los que en tres (16,7%) la pHmetría proximal durante la noche resultó positiva. Estos tres pacientes fueron tratados con IBP durante un mínimo de 3 meses siendo el resultado satisfactorio en dos. Conclusión: El tratamiento con IBP puede ser una alternativa terapéutica útil en algunos pacientes con SAOS de intensidad leve o moderada (AU)

Introduction: Patients with mild or moderate Sleep Apnea Syndrome (SAS) need wider therapeutic scope options according to their disease severity. Aim: To consider including proton pump inhibitors (PPI) to the therapeutical alternatives of these patients. Material and methods: A prospective study was designed, among patients with SAS. Nocturnal polysomnography and double channel pHmetry were performed simultaneously. Results: From the 18 patients included in this preliminary phase, in three (16.7%) nocturnal proximal ph monitoring was positive. These 3 patients were treated with PPI during at least 3 months with a very satisfactory outcome in two of them. Conclusions: Treatment with PPI may be a useful therapeutical alternative in patients with mild to moderate SAS (AU)

Efectos adversos derivados del tratamiento con nCPAP y su relación con la nariz / Adverse effects of continuous positive airway pressure therapy and its relation with the nose

El principal inconveniente del tratamiento del síndrome de la apnea obstructiva del sueño (SAOS) con presión positiva nasal continua (nCPAP) es el incumplimiento, muchas veces debido a los efectos adversos del mismo. Mediante un análisis prospectivo de los pacientes tratados con nCPAP, se pretende demostrar la relación de las alteraciones nasales preexistentes con los efectos adversos de la utilización de nCPAP. Se han recogido 182 casos tratados con nCPAP y el 60 por ciento explicaron uno o más efectos adversos. De éstos, el 69 por ciento tenían dismorfia septal y 31 por ciento no (p=0,001). En los casos con efectos adversos de cariz nasal se observó un 80 por ciento de aumento de la tolerancia al nCPAP en los tratados médicamente y un 89 por ciento en los sometidos a septoplastia. Este trabajo pone en evidencia que los efectos adversos del tratamiento con nCPAP se relacionan de forma significativa con las alteraciones nasales preexistentes y que el tratamiento de éstas colabora a incrementar la tolerancia a nCPAP (AU)

The main problem in the treatment of obstructive sleep apnea syndrome (OSAS) with nasal continuous airway pressure (nCPAP) is the lack of compliance. One of the most important reasons for no compliance is the adverse effects of this treatment. We analyse, prospectively, 182 patients treated with nCPAP in order to show the relationship between previous nasal problems and adverse effects of nCPAP. Sixty percent of the population developed one o more side effects. Of this group, 69% showed nasal septum deviation at first examination in front of 31% that did not showed this problem (p = 0.001). In the group of patients with nasal side effects we observed an increase of compliance in 80% of patients treated medically and in 89% of those treated by a septoplasty. We demonstrate that the adverse effects of nCPAP are related to previous nasal problems and, also, that treatment of those problems can achieve an increase in compliance to nCPAP therapy (AU)