Fatores de risco da síndrome da apneia obstrutiva do sono no adulto / Risk factors for obstructive sleep apnea syndrome in adults

Introdução: a síndrome da apneia obstrutiva do sono (SAOS) caracteriza-se por episódios recorrentes de obstrução parcial ou total da via aérea superior, normalmente acompanhada por roncos. É de etiologia multifatorial, e o diagnóstico leva em consideração os fatores de risco e as comorbidades. Objetivo: estudar os fatores de risco da SAOS, devido às comorbidades e às consequências graves que podem estar relacionadas à patologia, visando a atuar em sua prevenção e tratamento. Revisão de literatura: os principais fatores de risco encontrados foram: obesidade, circunferência cervical maior que 40 cm, IMC aumentado, histórico familiar, sexo masculino, meia-idade, Classe III e IV de Mallampati modificada e alterações nas vias aéreas superiores como desvio de septo nasal, palato mole rebaixado e posteriorizado e alterações craniofaciais. Metodologia: realizou-se uma revisão de literatura sobre os fatores de risco da SAOS, utilizando-se as bases de dados Pubmed, Scielo e Medline e os descritores de busca de acordo com os DECs ou Mesh. Conclusão: o estudo dos fatores de risco associados à presença de SAOS demonstra a necessidade da abordagem interdisciplinar dessa patologia junto ao médico otorrinolaringologista, por ser ela multifatorial.

Introduction: obstructive sleep apnea syndrome (OSAS) is characterized by recurrent episodes of partial or total obstruction of the upper airways, usually accompanied by snoring. It has a multifactorial etiology, and the diagnosis takes into account risk factors and comorbidities. Objective: to study the risk factors for OSAS, with regard to morbidities and the serious consequences that may be related to its pathology, aiming at its prevention and treatment. Literature review: according to the literature, the main risk factors are: obesity, cervical circumference greater than 40 cm, increased BMI, family history, male gender, middle age, modified Mallampati Class III o IV, and alterations in the upper airways such as deviated nasal septum and lowered and posterior soft palate and craniofacial changes. Methodology: a review of the literature on the risk factors for OSAS was carried out using the PubMed, Scielo and Medline databases and the search descriptors according to the DECs or Mesh. Conclusion: a study of the risk factors associated with OSAS demonstrates the need for an interdisciplinary approach to this pathology with the otorhinolaryngologist, because of the multifactorial nature of OSAS.

Noncontact endocardial mapping to guide ablation for hemodynamically unstable or nonsustained ventricular tachycardia / 中华心血管病杂志

<p><b>OBJECTIVE</b>To determine the feasibility and assess the validity of noncontact endocardial mapping to guide ablation of hemodynamically unstable or nonsustained ventricular tachycardia (VT).</p><p><b>METHODS</b>Noncontact mapping permitted individual-beat analysis of ventricular arrhythmias. Three-dimensional electroanatomical mapping allowed detailed reconstruction of a chamber geometry and activation sequence. Eighteen hemodynamically unstable or nonsustained VTs were induced (cycle length: 336 ms +/- 58 ms) in 17 patients and mapped by noncontact mapping using an EnSite 3000 system performed for the guidance of catheter ablation.</p><p><b>RESULTS</b>Three patients were mapped during premature ventricular complexes (PVCs) because sustained VT could not be induced. Analysis of the archived noncontact activation maps was performed to identify the exit site and/or the diastolic pathway of the VT reentry circuit. The endocardial exit sites 10 ms +/- 16 ms before QRS were defined in 9 right ventricular outflow tract (RVOT) and 5 ischemic VTs. The diastolic pathway was identified in 5 ischemic VTs. The earliest endocardial diastolic activity preceded the QRS onset by 60.1 ms +/- 42.6 ms. The earliest activation sites were identify in 3 patients with nonsustained VTs or PVCs. Radiofrequency current was applied around the exit site or to create a line of block across the diastolic pathway. Catheter ablation was performed in 17/18 (94%) VTs and 15/17 (88%) VTs was successfully ablated. Two (67%) of the three patients with non-sustained VTs were mapped and successfully ablated during PVCs. Catheter ablation was not performed in 1 patient (peri-Hisian VT) and was unsuccessful in 2 patients.</p><p><b>CONCLUSION</b>Noncontact endocardial mapping is able to be used to guide ablation of untolerated or nonsustained VTs.</p>

The mechanism of low testosterone levels in homozygous sickle-cell disease

Significantly lower testosterone levels are common in male patients with homozygous sickle-cell (SS) disease and have been attributed to either abnormalities of the hypothalamo-pituitary axis or primary testicular failure. The mechanism has now been investigated by observing the response to gonadrotropinthytotropin releasing hormones (GnRH-TRH) in 10 male patients with SS disease and in 10 matched male sibling controls without sickle-cell disease. Mean basal levels of luteninizing hormone (LH) follicular stimulating hormone (FSH) and thyrotropin (TSH) were significantly elevated but prolactin (RL) levels were within the normal range in the SS group. All hormones increased following GnRH-TRH, and proportionate increases over baseline were similar for FSH and TSH in SS and AA subjects, but SS patients showed a lesser percentage increase in LH at 30 minutes, and a higher percentage increase in PRL at 60 minutes. These observations are more consistent with primary testicular failure than with adnormalities of the hypothalmic-pituitaty-testiculat axis.

A randomized controlled trial of Solcoseryl and DuoDerm in chronic sickle-cell ulcers

A randomized controlled trial of Solcoseryl, DuoDerm and conventional conservative therapy with Eusol has been performed in 32 patients with homozygous sickle-cell (SS) disease. After 12 weeks' baseline observation, patients were randomized to one of three therapies and monitored for a further 12 weeks. Of 44 ulcerated legs, 20 received control treatment, 12 Solcoseryl and 12 DuoDerm. DuoDerm was generally unacceptable, and two-thirds of the patients defaulted from this treatment. Solcoseryl increased ulcer healing compared to the controls but the difference was not significant. Solcoseryl was well tolerated and may have a role in the treatment of chronic leg ulcers of sickle-cell disease.

Functional role of carcinoembryonic antigen in the intercelluar adhesion of human colorectal carcinoma cell lines / 대한암학회지

No abstract available.