role of tonsillectomy in the treatment of obstructive sleep apnea

Background: Obstructive Sleep Apnea [OS A] is caused by a partial or complete obstruction of the upper airway. OSA is a very inconvenient and relatively common disorder with daytime and nocturnal symptoms. The intervention and management of OSR is dependent on the patients' case severity. The aim of this study was to evaluate the role and the optimal choice of Tonsillectomy for treatment of OSR. Methods: a systematic search in the scientific database [Medline, EMBASE, Google Scholer and Ovid] from 1980 to 2016 was conducted for all relevant retrospective studies including; randomized controlled trials, cohort studies and case-control studies were analyzed and included based on the preset inclusion and exclusion criteria

Results: the search has yielded twelve studies to be included in the present SR [n = 206 patients, 34.4+/- 10.0 years and body mass index: 29.3 +/- 9.6 kg/m2] met criteria. Tonsils sizes were hypertrophied, large, enlarged, extremely enlarged, or grades 2 to 4. Apnea-Hypopnea Index decreased by 65.2% [from 43.73 +/- 21.7 /hour to 13.7 3 +/- 12.7 /hour] [n - 198]. The AHI mean difference [MD] was -30.2 per hour [95% confidence interval [CI] -39.3, -21.1] [P value < 0.00001]

The AHI SMD was -1.37 [-1.65, -1.09] [large effect]. Lowest oxygen saturation improved from 77.7 3 +/- 11.9% to 85.5 3 +/- 8.2% [n = 186]. Lowest oxygen saturation MD was 8.5% [95% CI 5.2, 11.8] [P value < 0.00001]

The Epworth Sleepiness Scale decreased from 11.6 3 +/- 3.7 to 6.1 3 +/- 3.9 [n = 125]. Individual patient outcomes [n = 52] demonstrated an 85.2% success rate [AHI < 20/hour and > 50% reduction] and a 57.4% cure rate. Conclusion: tonsillectomy is an effective and safe surgical intervention for treatment of OSA in adults, particularly among carefully selected patients with large tonsils and mild to moderate OSA severity

Pre-operative chemoradiotherapy using capecitabine and cetuximab followed by definitive surgery in patients with operable rectal cancer

Background: Achieving a high rate of complete pathological response with pre-operative chemoradiotherapy in rectal cancer is an unmet need. We evaluated the efficacy and toxicity of the combination of cetuximab, capecitabine and radiation therapy in the pre-operative setting of localized rectal cancer

Patients and methods: Patients with clinically staged T3, T4 or nodepositive rectal cancer were treated with concurrent capecitabine and radiotherapy with weekly cetuximab starting one week before the start of radiation. This was followed by total mesorectal excision within 6-8 weeks. All patients achieving R0 resection received adjuvant capecitabine for 6 cycles

Results: Fifteen patients were treated and all underwent surgery. Sphincter preservation was achieved in 11 patients [73.3%] and pathological complete response in two. With a median follow up of 48 months [range 8.4-57.5], 12 patients were relapse-free and 14 were alive with 4- year relapse free survival of 80%. Overall survival was 93%. Significant grade 3 and 4 toxicity was mainly cetuximab-induced skin reactions [33%], radiation-induced skin toxicity [13%] and diarrhea [20%]

Conclusions: Adding cetuximab to pre-operative concurrent capecitabine and radiotherapy provides modest efficacy with manageable toxicity