Role of sleep endoscopy in obstructive sleep apnea syndrome

There are limited data about the role of sleep endoscopy in obstructive sleep apnea syndrome [OSAS]. The aim of this study was to evaluate the level, degree and shape of obstruction of the upper airway in patients with OSAS by sleep endoscopy and their relation to OSAS severity. Fifty consecutive patients with OSAS were prospectively enrolled in this cross sectional analytic study. All patients underwent history, a full night-attended polysomnogra-phy and sleep endoscopy. The degree of pharyngeal narrowing [grades I-IV] was evaluated at ret-ropalatal, retroglossal and hypopharyngeal levels. Shape of pharyngeal collapse was classified into circular, lateral or antero-posterior at retropalatal and retroglossal levels. Shape of the epiglottis was also observed. All patients showed multisegmental levels of obstruction. Moderate OSAS had a higher percentage of grade II obstruction but a lower percentage of grade I at hypopharyngeal level compared to mild OSAS [P < 0.05]. Also, in moderate OSAS, tongue base obstruction was 47.4% which was significantly higher comparing to mild OSAS [16.7%] [P < 0.05]. There was no significant difference between different grades of obstruction at all anatomical levels in polysomnograph-ic parameters. Omega shaped epiglottis was associated with the highest apnea hypopnea index, desaturation index, lowest average and minimum O[2] level. Sleep endoscopy is a useful tool for the assessment of level, degree and shape of the upper airway obstruction during sleep in OSAS and this could be helpful in preoperative evaluation. Presence of obstruction at hypopharyngeal level or tongue base obstruction is an indicator of OSAS severity

CT venography versus doppler ultrasonography in suspected pulmonary embolism among acute exacerbation COPD patients

Pulmonary embolism [PE] and deep venous thrombosis [DVT] are different aspects of the same disease [VTE]. Variable diagnostic approaches have been used to diagnose VTE. However the latency, lack of accuracy and the recorded complications necessitate a rapid, safe and accurate procedure for the diagnosis. The primary aim of this study was to determine if CTV offers an accurate alternative to venous ultrasonography as a first line evaluation for DVT in the patients present with AECOPD with suspected PE as a single technique. Thirty-three patients presented with AECOPD were included in this study. All patients were undergoing spiral CT pulmonary angiography for the evaluation of PE. CTV was performed 3 minutes after initiation of the contrast bolus infusion and compared with Doppler ultrasonography of the lower extremities. The presence of PE or deep venous thrombosis [DVT] was recorded for all patients. The addition of CT venography to CT pulmonary angiography increases the detection rate of thromboembolic disease by 30%. This study support the use of CTV after spiral CT pulmonary angiography as an alternative to Doppler ultrasonography of the lower limbs in AECOPD patients presenting with suspected pulmonary embolism

Predictors for pulmonary embolism in patients with acute exacerbation of COPD

Diagnosis of pulmonary embolism [PE] is difficult in patients complaining of acute exacerbation of chronic obstructive pulmonary disease [AECOPD]. To detect the numerical predictors in clinical, gasometric and laboratory findings for PE in patients with AECOPD. Will be used cut-off point of the different factors to reach a definite clue for this diagnostic dilemma. Ninety patients with acute exacerbation of COPD who were admitted to Chest department or Respiratory Intensive Care Unit in Assiut University Hospitals. They were 66 males and 24 females with the mean age [61.9 years]. All of them underwent the following clinical examination chest X-ray CBC, ABG, ECG; echocardiography, Duppler US of the lower limbs to diagnose DVT. Spiral CT, pulmonary angiography was performed to all patients to confirm the diagnosis of PE. Indices of coagulation, fibrinolysis and platelet activity were performed to all patients. PE was present in 25 of 90 patients [27.8%] while DVT was diagnosed in 14 cases [15.6%]. Ten patients [11.1%] have both DVT and PE. Spiral CT pulmonary angiography [SCTPA] was the diagnostic tool and the patients were divided into positive for PE 25 [27.8%] and negative [65 [72.2%]]. The Cut off points were used to give the definite diagnosis of PE among those critical patients with AECOPD as the following: Respiratory rate >35 cycles/min, heart rate > 120 beats. Hematocrite value > 56%, platelet count < 200.000/mm3, mean pulmonary artery pressure >60mmHg, P [A-a] O2 >25mmHg, D-dimer >1000ng/ml, thrombin >15mg/dL, B-Thromboglobulin > 80 IU/mL, P-selectin > 300ng/mL, duration of illness > 12 years, frequency of exacerbation > 5/year, no. of hospital admission > 4/year. This study showed a 27.8% prevelance of PE in patients with COPD hospitalized for severe exacerbation. These clinical and laboratory cut-off points can facilitate the diagnosis by a high sensitivity yield with a highly significant importance [P<0.001 - <0.02]

Plasma endothelin-1 and thrombomodulin: correlation with the extent of pulmonary hypertension in patients whith chronic hypoxic pulmonary disease

This study included 47 pulmonary hypertensive patients secondary to chronic hypoxia due to chronic obstructive pulmonary diseases [COPD] and interstitial pulmonary fibrosis [IPF]. They were sampled in the morning after an overnight fast, before medication and after termination of treatment. Endothelin-1 level was 1.45 +/- 0.32 pg/ml which was increased compared with the normal controls [0.5 +/- 0.02]; the difference was statistically significant. Endothelin-1 was significantly correlated with pulmonary pressure and its degree of severity, especially among chronic obstructive pulmonary disease patients. There was a significant reduction in the level of endothelin-1 after long-term oxygen therapy; whereas, it did not correlate with the level of PaO2 either before or after oxygen therapy. Plasma thrombomodulin level was measured to study its pathophysiological significance in pulmonary hypertension secondary to hypoxia. Patients with pulmonary hypertension had higher concentrations of thrombomodulin [15.25 +/- 1.5] than the age matched normal controls [4.8 +/- 0.5 ng/ml]. There was a significant reduction in thrombomodulin after oxygen therapy. Plasma concentrations of thrombomodulin were significantly correlated with time to peak velocity [TPV] as a strong echo parameter of pulmonary hypertension and its severity in mild PH thrombomodulin level was 10.46 +/- 0.56 ng/ml versus 15.82 +/- 3.08 ng/ml among patients with severe pulmonary hypertension. Moreover, thrombomodulin correlated with PaO2 after oxygen therapy especially with patients of IPF