Hyoid Bone Suspension as a Part of Multilevel Surgery for Obstructive Sleep Apnea Syndrome

Abstract Introduction Since oropharyngeal surgery alone is often insufficient to treat obstructive sleep apnea (OSA), advances have been developed in hypopharyngeal surgery. Objective To assess hyoid suspension surgery as part of amultilevel OSA surgery, also including palatal surgery. Methods The study included patients with OSA symptoms with apnea hypopnea index (AHI) > 15. They were scheduled for hyoid suspension after a nasoendoscopy during Müller maneuver and drug induced sleep endoscopy (DISE). All patients had body mass index (BMI) < 35 kg/m2. Hyoidothyroidopexy combined with tonsillectomy and palatal suspension was performed in all cases. Results The mean AHI dropped significantly (p < 0.0001) from 68.4 ± 25.3 preoperatively to 25.6 ± 9.52 postoperatively. The mean lowest oxygen (O2) saturation level increased significantly from 66.8 ± 11.3 to 83.2 ± 2.86 (p < 0.0001). In addition, the snoring score significantly decreased (p < 0.0001) from a preoperative mean of 3.4 ± 0.54 to 2 ± 0.7 at 6 months postoperatively. In regard to the Epworth sleepiness scale (ESS), it showed significant improvements (p < 0.0001) as its mean diminished from 13.8 ± 5.4 preoperatively to 5.2 ± 1.6 postoperatively. Conclusion Hyoidothyroidopexy using absorbable suture seems to produce a good outcome in treating OSA. It could be effectively and safely combined with other palatal procedures in the multilevel surgery for OSA.

Changes in leucocytic count and serum immunoglobulins after partial hepatectomy alone and in combination with splenectomy in rats

This work was done to investigate the role of the liver and spleen in the body defense mechanism. Thirty male albino rats were prepared and divided into three groups. The first group was considered as a sham-operated group, the second group was subjected for a partial hepatectomy, and the third group was subjected for partial hepatectomy plus splenectomy. After one week and three weeks postoperatively blood samples were taken from the retroorbital vein and analyzed for total and differential leucocyytic counts and for serum g-globulin level. The results showed that, there is a significant depression in total and differential leucocytic counts and a significant elevation in serum g-globulin level after one week and after three weeks, with significant improvment in lymphocytic count and in gamma globulin level after the third weak. Spleenectomy in the third group worsen the condition and showed a significant depression in leucocytic count without a significant elevation of gamma globulin level that appeared in the second group. These results clarify the role of both liver and spleen in body defense mechanism and in protection against bacterial infection. Also, suggest to reserve the splenic tissue if it is possible and advise for subtotal splenectomy or for splenic tissue transplantation

Role of calcium ions on isolated ischaemic rabbit's heart after reperfusion

The role of Ca++ was evaluated on the heart rate during acute ischaemia and reperfusion of isolated heart of rabbits. Myocardial ischaemia was produced by induction of global ischaemia for 15 minutes followed by reperfusion for 360 minutes using physiological solution of normal, low, and high Ca++ concentrations. Perfusion of non ischaemic myocardium with physiological solution of different Ca++ ion containing high or low Ca++ concentration resulted in a non significant increase or decrease in heart rate respectively. Addition of verapamil [Ca++ channel blocker, CCB] to these physiological solutions resulted in a non significant change in heart rate when compared with the effect of physiological solution containing normal Ca++ concentration. Reperfusion of ischaemic myocardium after induction of global ischaemia by physiological solution containing normal Ca++ concentration resulted in significant tachycardia started immediately and continued for 4 hours. Also, reperfusion with physiological solution containing high Ca++ concentration resulted in significant tachycardia started immediately and continued for 2 hours, while reperfusion with physiological solution containing low Ca++ concentration resulted in a non significant change in heart rate. Addition of verapamil [CCB] to physiological solution containing either normal or low Ca++ concentration resulted in a significant bradycardiac effect, and this effect is delayed by using physiological solution containing high Ca++ concentration. From this work, it is clear that Ca++ may play a role as a cause of tachycardia during reperfusion of ischaemic myocardium. and the bradycardic effect of verapamil is not only due to its hypocalcemic effect. Also this effect of verapamil can be modified by using physio1ogica solutions of different Ca++ concentration, and indicates that Ca++ can share at least in part in the Pathophysiology of tachycardia during reperfusion ischaemic myocardium