Endoscopic Medial Maxillectomy With Preservation of Inferior Turbinate: Assessing Results by Acoustic Rhinometry.

BACKGROUND: The aim of this study is to demonstrate the effectiveness of the Endoscopic Medial Maxillectomy technique with the preservation of the nasal anatomy and function of the inferior turbinate. METHODS: From January 2005 to December 2016, the authors performed 27 Endoscopic Medial Maxillectomy with preservation of inferior turbinate on 26 patients. The most frequent pathologies diagnosed were inverted papillomas (13/27) and antrochoanal polyps (7/27). There were 21 primary lesions and 6 patients had been previously treated. There were 19 males and 7 females. On 11 patients the authors could perform an acoustic rhinometry at 4 months postoperatively. RESULTS: The authors did not find any recurrences. In all cases the authors note the presence of the C-notch being the narrowest area of the nasal cavity, on both the surgical and nonsurgical nasal fossa. The mean area for the C-notch in the nonsurgical nasal cavities was 0.50 cm (0.18-0.82) and it was 0.57 cm (0.08-1.06) in the surgical nasal cavities. The increase of the C-notch after nasal decongestion was 0.10 cm in nonsurgical cavities and it was 0.03 cm in the surgical cavities. The mean distance for the C-notch was 2.18 cm and 2.36 cm before and after nasal decongestion in the nonsurgical fossae. In the surgical cavities were 2.31 and 2.37  cm respectively. CONCLUSIONS: The authors' rhinometrics data suggest that Endoscopic Medial Maxillectomy with preservation of inferior turbinate is an effective technique that preserves the anatomic structure and the functions of the inferior turbinate after its resection and reposition.

A unilateral septal flap based on the anterior ethmoidal artery (Castelnuovo's flap): CT cadaver study.

OBJECTIVE: We describe our experience for repair septal perforation with a septal flap and we analyse the route of the septal branch of the anterior ethmoidal artery (AEA) in the septum area with a radiological anatomy study in order to perform this flap. STUDY DESIGN: We carry out a prospective analysis with computed tomography scan in the cadaver heads and we perform an endoscopic technique in the patients. METHODS: Ten nasal cavities were analysed in five adult cadaveric heads and two patients diagnosed with anterior septal perforation were surgically treated. Measurements in the cadaveric heads were obtained from a sagittal plane of the nasal septum. The anterior point corresponds to the projection of the anterior insertion of the middle turbinate in the frontal process of the maxilla over the nasal septum. The posterior point was obtained with a vertical line passing through the entrance of the AEA in the nasal septum. RESULTS: The mean distance between the anterior point and the posterior point was 7.35 mm with a standard deviation of 0.95 mm. The lowest value was 5.5 mm and the highest value was 8.7 mm. We observed good epithelialisation and closure of the perforation in all patients. CONCLUSION: The unilateral septal flap pedicle by anterior ethmoidal artery may be used for small and medium perforations with a pedicle smaller than 1 cm posterior to the axilla.

Identification of Candidates for Active Surveillance: Should We Change the Current Paradigm?

Active surveillance (AS) has been claimed to avoid overtreatment of prostate cancer (PCa). It remains unclear which patients may benefit from AS. One way to clarify this is to improve the definition of insignificant PCa. PSA and Gleason score--the basic instruments used to select patients for AS--suffer from systematic errors. The nomograms used to define insignificant PCa are based on patients whose disease was classified before changes were introduced in the 2005 Consensus Conference on Gleason Grading; thus, the experience obtained cannot be directly applied to today's patients. Additionally, despite the standardization of prostate-specific antigen assays promoted by the World Health Organization, differences persist and could lead to misclassification of patients. These factors lead to an incorrect classification of patients into risk groups. Although new variables would increase risk group classification, the necessary first step is to optimize the use of both prostate-specific antigen serum levels and Gleason score.

The influence of prostate volume in prostate health index performance in patients with total PSA lower than 10 µg/L.

Prostate health index (phi), a measure calculated as p2PSA/fPSA × âˆštPSA, has shown valuable results in the detection of prostate cancer (PCa), improving the prediction of the aggressiveness of the tumor. The aim of our study was to test whether prostate volume influences phi performance using univariate and multivariate models. 220 patients with PSA<10 µg/L (102 with negative biopsy and 118 with PCa) were included in the study. Serum concentrations of tPSA, fPSA and p2PSA were measured on Access2 analyzer. The higher accuracy was found for phi, obtaining an AUC of 0.748. Bigger AUCs were obtained for phi, %p2PSA, %fPSA and tPSA in patients with small prostate volume (≤35 cc); meanwhile, the lowest AUCs were found in patients with large prostate volume (>50 cc). Including phi and %p2PSA in a multivariable analysis based on patient age, prostate volume, tPSA, and %fPSA accuracy increased from 0.762 to 0.802 (logistic regression model) or 0.815 (artificial neural network). Accuracy excluding prostate volume in these models was 0.762 and 0.775, respectively. The inclusion of phi and %p2PSA in a multivariate model identifies better men with PCa. Prostate volume remains a key factor in the interpretation of biomarkers used to detect PCa.

Clinical utility of %p2PSA and prostate health index in the detection of prostate cancer.

BACKGROUND: %p2PSA and prostate health index (phi) has shown valuable results in the detection of prostate cancer (PCa), improving the prediction of the aggressiveness of the tumor. The goal of the present study was to evaluate %p2PSA and phi in the detection of PCa, estimating their relationship with the aggressiveness of PCa. METHODS: A total of 354 patients with positive or negative prostatic biopsy were included. Prospectively, 150 were enrolled and 204 were enrolled retrospectively proceeding from our serum bank. RESULTS: The best performance was observed for %p2PSA and phi, obtaining an AUC of 0.723 and 0.732, respectively. The highest specificity at sensitivity around 90% was obtained for phi (27.4%). Using the cut-off of 31.94 for phi, a reduction of 19% biopsies could be obtained, while 17 PCa would have been missed, including only four patients with a Gleason score ≥7. Similarly, using a cut-off of 1.21 for %p2PSA, a reduction of 12.7% biopsies could be obtained, while 16 PCa would have been missed, including only four patients with a Gleason score ≥7. Moreover, among patients with PCa, phi (median: 69.75 vs. 48.04) and %p2PSA (median: 2.60 vs. 1.98) values are significantly higher (p<0.0001) in patients with a biopsy Gleason score ≥7. CONCLUSIONS: Our results confirm previous evaluations, showing similar AUCs and results in sensitivity and specificity to other studies.%p2PSA and phi raise the accuracy in the detection of prostate cancer, reducing the number of unnecessary biopsies and improving the prediction of the aggressiveness of the tumor.

Anatomical and surgical study of the sphenopalatine artery branches.

The sphenopalatine artery gives off two main branches: the posterior lateral nasal branch and the posterior septal branch. From 2007 to 2012 17 patients were treated with cauterization and/or ligature of the sphenopalatine artery with endonasal endoscopic approach. 90 nasal dissections were performed in 45 adult cadaveric heads. We evaluated the number of branches emerging from the sphenopalatine foramen and the presence of an accessory foramen. In the surgery group, we observed a single trunk in 76% of the patients (13/17) and a double trunk in 24% (4/17). We found an accessory foramen in four cases. We obtained a successful result in bleeding control in 88% of the cases. In the cadaver dissection group, 55 nasal cavities had a single arterial trunk (61%), 30 had 2 arterial trunks (33%) and in only 5 nasal fossae we observed 3 arterial trunks (6%). We were able to dissect four accessory foramina. We suggest that in most cases only one or two branches are found in the sphenopalatine foramen.

ProPSA, un nuevo biomarcador para la detección y el manejo del cáncer de próstata / ProPSA, a new biomarker for the detection and management of prostate cancer

La descripción de las nuevas isoformas del PSA libre, como el proPSA, que se asocia a la presencia de cáncer de próstata, ha ampliado las herramientas disponibles para la detección de este tumor. Tras la comercialización de un ensayo para medir [---2] proPSA, una de las fracciones del proPSA, disponemos de datos que avalan el empleo del porcentaje de [---2] proPSA en relación con el PSA libre (%[---2] proPSA) y del prostate health index (phi) que valora conjuntamente [---2] proPSA, PSA libre y PSA total. Los resultados disponibles indican que estos tests permiten reducir el número de biopsias negativas cuando se comparan con el porcentaje del PSA libre. Por otro lado, tanto el %[---2] proPSA como el phi se relacionan con tumores particularmente agresivos, por lo que podrían ser tests útiles para seleccionar qué pacientes podrían beneficiarse de una vigilancia activa y qué pacientes deben ser sometidos a un tratamiento curativo (AU)

The description of new PSA isoforms associated with prostate cancer, such as proPSA, has expanded the available tools for the detection of this tumor. Since the marketing of an assay for the measurement of [---2] proPSA, one of the fractions of proPSA, we have positive data on the use of the percentage of [---2] proPSA in relation to free PSA (%[---2] proPSA) and the prostate health index (phi), which measures [---2] proPSA, total PSA and free PSA together. The available results suggest that the use of these tests would lead to a reduction in the number of negative biopsies compared with the percentage of free PSA. On other hand, both %[---2] proPSA and phi are related to particularly aggressive tumors, so they could be useful to select patients for active surveillance, and to decide which patients must be treated (AU)

Persistencia a largo plazo del síndrome de la apnea-hipopnea obstructiva del sueño infantil tratada con adenoamigdalectomía. Análisis de factores pronósticos / Long-term persistence of obstructive sleep apnoea-hypopnoea syndrome in children treated with adenotonsillectomy. Analysis of prognostic factors

Introducción: La adenoamigdalectomía (AA) para tratar el síndrome de apnea obstructiva del sueño (SAHOS) infantil es efectiva, pero presenta una moderada tasa de persistencia. Objetivo: Analizar la tasa de persistencia en un grupo de pacientes pediátricos tratados con AA y los posibles factores pronósticos. Metodos: Estudio prospectivo con 80 pacientes, entre dos y 13 años de edad, sometidos a AA por SAHOS. Seguidos clínica y polisomnográficamente a un año de la cirugía. Se analizan los factores epidemiológicos y clínicos que pudieran afectar negativamente el resultado de la cirugía. Resultados: La edad media fue de 5,25±2,05 años y el índice de apnea-hipopnea (IAH) medio de 8,13±6,06. Al año, todos los parámetros clínicos mejoraron significativamente y el IAH medio es 2,50. Presentaron persistencia de enfermedad (IAH ≥3), 21 casos (26,3%). Del análisis comparativo de los factores clínicos y epidemiológicos entre el grupo con y sin persistencia, no se obtuvieron diferencias significativas ni en edad y sexo, ni en talla y grado amigdalar de Friedman ni en la severidad de la enfermedad preoperatorios. Únicamente resultó significativo que los pacientes sin persistencia eran más obesos. Conclusión: Las cifras de persistencia del SAHOS después de AA fueron significativas y aconsejaron seguimiento con polisomnografía, especialmente en los grupos de riesgo. En esta serie no se han podido demostrar estos factores de riesgo. Es probable que los resultados estén condicionados por el tipo de población del estudio: edad baja, bajo porcentaje de obesidad y niveles de IAH menos severos(AU)

Introduction: Treatment of obstructive sleep apnoea-hypopnoea syndrome in children with adenotonsillectomy is effective but has a moderate rate of persistent disease. Objectives: To analyse the rate of persistence of sleep apnoea-hypopnoea syndrome in a group of adenotonsillectomy-treated paediatric patients and to assess the possible prognostic factors. Methods: Prospective study of 80 patients aged between 2 and 13 years who had obstructive sleep apnoea-hypopnoea syndrome, treated with adenotonsillectomy. All patients had been followed up clinically and by polysomnography for 1 year after surgery. We analysed the epidemiological and clinical factors that could negatively affect the outcome of surgery. Results: The median age was 5.25±2.05 years and the mean apnoea-hypopnoea index (AHI) was 8.13±6.06. One year after surgery, all clinical parameters improved significantly and the mean AHI was 2.50. Persistent disease (AHI≥3) was present in 21 of the patients (26.3%). The comparative analysis of clinical and epidemiological factors between the group of non-persistence and persistence did not obtain statistically-significant differences in age, sex, tonsillar size, Friedman degree or severity of preoperative disease. The only significant factor was that patients without persistence were more obese. Conclusion: The results of our study about the persistence of obstructive sleep apnoea-hypopnoea syndrome after adenotonsillectomy are significant enough to recommend follow-up with polysomnography, especially in high-risk groups. In the series presented here, we were not able to demonstrate these risk factors. Our results are probably conditioned by the characteristics of the population studied: Low age, low obesity rate and less severe levels of apnoea-hypopnoea index(AU)

[Long-term persistence of obstructive sleep apnoea-hypopnoea syndrome in children treated with adenotonsillectomy. Analysis of prognostic factors]. / Persistencia a largo plazo del síndrome de la apnea-hipopnea obstructiva del sueño infantil tratada con adenoamigdalectomía. Análisis de factores pronósticos.

INTRODUCTION: Treatment of obstructive sleep apnoea-hypopnoea syndrome in children with adenotonsillectomy is effective but has a moderate rate of persistent disease. OBJECTIVES: To analyse the rate of persistence of sleep apnoea-hypopnoea syndrome in a group of adenotonsillectomy-treated paediatric patients and to assess the possible prognostic factors. METHODS: Prospective study of 80 patients aged between 2 and 13 years who had obstructive sleep apnoea-hypopnoea syndrome, treated with adenotonsillectomy. All patients had been followed up clinically and by polysomnography for 1 year after surgery. We analysed the epidemiological and clinical factors that could negatively affect the outcome of surgery. RESULTS: The median age was 5.25 ± 2.05 years and the mean apnoea-hypopnoea index (AHI) was 8.13 ± 6.06. One year after surgery, all clinical parameters improved significantly and the mean AHI was 2.50. Persistent disease (AHI≥3) was present in 21 of the patients (26.3%). The comparative analysis of clinical and epidemiological factors between the group of non-persistence and persistence did not obtain statistically-significant differences in age, sex, tonsillar size, Friedman degree or severity of preoperative disease. The only significant factor was that patients without persistence were more obese. CONCLUSION: The results of our study about the persistence of obstructive sleep apnoea-hypopnoea syndrome after adenotonsillectomy are significant enough to recommend follow-up with polysomnography, especially in high-risk groups. In the series presented here, we were not able to demonstrate these risk factors. Our results are probably conditioned by the characteristics of the population studied: Low age, low obesity rate and less severe levels of apnoea-hypopnoea index.

Alteraciones del desarrollo dentofacial en los trastornos respiratorios del sueño infantil / Dentofacial development abnormalities in paediatric sleep-related breathing disorders

Introducción: El creciente interés por los trastornos respiratorios del sueño ha hecho renacer el antiguo debate de si existe una relación causal entre la obstrucción respiratoria alta y las alteraciones en el desarrollo dentofacial. Objetivo: Averiguar el impacto sobre el desarrollo dentofacial de los trastornos respiratorios del sueño en los niños. Método: Estudio prospectivo donde se comparan los análisis dentofaciales de 30 niños diagnosticados de trastorno respiratorio del sueño mediante polisomnografía y un grupo control de 30 niños sanos. Las edades de ambos grupos se sitúan entre los 3 y los 13 años. Resultados: El estudio estadístico mostró diferencias significativas entre ambos grupos en la proporción de niños con paladar estrecho (83% en el grupo problema y 57% en el control; p=0,024) y mordida cruzada (40 y 13%; p=0,020). En la comparación de medidas de ángulos, la única diferencia estadísticamente significativa fue el ángulo de la base del craneo con el plano mandibular: los niños del grupo problema tenían una media de 37,59±5,56 y los del grupo control de 34,41±4,62 (p=0,023). Conclusión: Los niños con trastornos respiratorios del sueño presentan alteraciones en el desarrollo dental y facial condicionadas por la obstrucción de la vía respiratoria alta. Estas alteraciones, crecimiento vertical de la cara, paladar estrecho y alteraciones en la oclusión dentaria, deberían ser tenidas en cuenta en el momento de realizar la indicación de adenoamigdalectomía (AU)

Introduction: The recent interest in sleep-related breathing disorders has re-opened the old debate as to whether there is a causal relationship between upper respiratory obstruction and abnormalities in dentofacial development. Objective: To establish the impact of dentofacial development on sleep-related breathing disorders in children. Method: This is a prospective study in which the dentofacial studies of 30 children, diagnosed with a sleep-related breathing disorder using polysomnography, were compared with a control group of 30 healthy children. The ages of both groups were between 3 and 13 years. Results: The statistical analysis showed significant differences between the groups in the proportion of children with a narrow palate (83% of the problem group and 57% in the control; P=0.024) and cross bite (40% and 13%; P=0.020). On comparing the angles measured, the only statistically-significant difference was the skull base-mandibular plane angle: The problem children group had a mean of 37.59±5.56 and the control group, a mean of 34.41±4.62 (P=0.023). Conclusion: Children with sleep-related breathing disorders have abnormalities in facial and dental development caused by upper respiratory obstruction. These anomalies, vertical growth of the face, narrow palate and dental occlusion changes should be taken into account when assessing the indication for a adenotonsillectomy (AU)

[Dentofacial development abnormalities in paediatric sleep-related breathing disorders]. / Alteraciones del desarrollo dentofacial en los trastornos respiratorios del sueño infantil.

INTRODUCTION: The recent interest in sleep-related breathing disorders has re-opened the old debate as to whether there is a causal relationship between upper respiratory obstruction and abnormalities in dentofacial development. OBJECTIVE: To establish the impact of dentofacial development on sleep-related breathing disorders in children. METHOD: This is a prospective study in which the dentofacial studies of 30 children, diagnosed with a sleep-related breathing disorder using polysomnography, were compared with a control group of 30 healthy children. The ages of both groups were between 3 and 13 years. RESULTS: The statistical analysis showed significant differences between the groups in the proportion of children with a narrow palate (83% of the problem group and 57% in the control; P=0.024) and cross bite (40% and 13%; P=0.020). On comparing the angles measured, the only statistically-significant difference was the skull base-mandibular plane angle: The problem children group had a mean of 37.59±5.56 and the control group, a mean of 34.41±4.62 (P=0.023). CONCLUSION: Children with sleep-related breathing disorders have abnormalities in facial and dental development caused by upper respiratory obstruction. These anomalies, vertical growth of the face, narrow palate and dental occlusion changes should be taken into account when assessing the indication for a adenotonsillectomy.

Endoscopic medial maxillectomy with preservation of inferior turbinate: how do we do it?

The aim of this study was to describe the endoscopic medial maxillectomy technique with preservation of the inferior turbinate in patients affected by maxillary sinonasal inverted papilloma. We retrospectively reviewed the clinical charts and surgical technique in six patients with paranasal sinus inverted papilloma. There were five males and one female, whose mean age at diagnosis was 60 years ranging between 57 and 65 years. No recurrences were diagnosed, and no nasal crusting was evidenced postoperatively. Nasal breathing was satisfying in all cases. Postoperative epistaxis was not observed, and none of the patients refereed to have epiphora after the surgery. This technique has been successfully performed, showing no recurrence to the present and allowing the preservation of a functional inferior turbinate.

Dispositivos de avance mandibular para el tratamiento de los trastornos respiratorios del sueño del adulto / Mandibular advancement devices for the treatment of adult sleep respiratory disorders

Introducción: Los dispositivos de avance mandibular se muestran cada vez más útiles en el tratamiento de los trastornos respiratorios del sueño en adultos. En 2008 se inició un estudio prospectivo para adaptar 40 dispositivos sin coste, con el objetivo de evaluar su eficacia en nuestros pacientes. Material y método: Se analiza su aplicación en 40 pacientes adultos con un índice de apnea hipoapnea inferior a 40. La totalidad de los casos referían ronquido, el 52,5% apneas observadas y el 47,5% somnolencia diurna. Resultados: Con un seguimiento mínimo de 6 meses, los casos con ronquido descienden a 59%, la mayoría de intensidad significativamente inferior, los casos con apneas observadas al 8,8% y la somnolencia diurna al 14,7%. La mejoria clínica global se consideró en 31 pacientes (91,2%). El índice de apnea hipoapnea medio pasó a 8,4±9,6 y la mejoría polisomnográfica se objetivó en 25 casos (75%). Un resultado positivo global, que requiere la mejoría tanto subjetiva como objetiva, se obtuvo en 23 pacientes (69,7%). Abadonaron su utilización 2 pacientes en los primeros días y otro caso a los 6 meses. Las compliaciones fueron relativamente frecuentes (58,8% de casos), pero leves. Los niveles de cumplimiento fueron satisfactorios: una media de 6,5±1,1 noches a la semana y 7,4±1,09h por noche. Conclusión: Los dispositivos de avance mandibular son una alternativa terapéutica eficaz para tratar los trastornos respiratorios del sueño. Los niveles de cumplimiento pueden ser satisfactorios si se cuenta con la colaboración de un equipo odontológico experto (AU)

Introduction: Mandibular advancement devices are being shown to be increasingly useful in the treatment of adult respiratory sleep disorders. A prospective study was started in April 2008 to apply 40 devices free of charge, with the aim of assessing their usefulness in our patients. Material and methods: The device was applied to 40 patients with an apnoea-hypopnoea index of less than 40. All the cases snored, with 52.5% observed apnoeas and 47.5% diurnal sleepiness. Results: With a minimum follow-up of six months, the cases that snored decreased to 59%, most with a significantly lower intensity; 8.8% of cases had observed apnoeas and 14.7% mentioned diurnal sleepiness. There was an overall clinical improvement in 31 (91.2%) patients. The mean apnoea-hypopnoea index fell to 8.4±9.6 and polysomnographic improvement could be seen in 25 (75%) cases. An overall positive result, showing subjective as well as objective improvement, was obtained in 23 (69.7%) patients. Two patients stopped using the device in the first few days and another patient after six months. Complications were relatively common, but always slight. Compliance levels were satisfactory: a mean of 6.5±1.1 nights per week and 7.4±1.09 days per week. Conclusion: Mandibular advancement devices are an effective therapeutic option for the treatment of respiratory sleep disorders. Compliance levels can be satisfactory if working with an expert odontology team (AU)

[Mandibular advancement devices for the treatment of adult sleep respiratory disorders]. / Dispositivos de avance mandibular para el tratamiento de los trastornos respiratorios del sueño del adulto.

INTRODUCTION: Mandibular advancement devices are being shown to be increasingly useful in the treatment of adult respiratory sleep disorders. A prospective study was started in April 2008 to apply 40 devices free of charge, with the aim of assessing their usefulness in our patients. MATERIAL AND METHODS: The device was applied to 40 patients with an apnoea-hypopnoea index of less than 40. All the cases snored, with 52.5% observed apnoeas and 47.5% diurnal sleepiness. RESULTS: With a minimum follow-up of six months, the cases that snored decreased to 59%, most with a significantly lower intensity; 8.8% of cases had observed apnoeas and 14.7% mentioned diurnal sleepiness. There was an overall clinical improvement in 31 (91.2%) patients. The mean apnoea-hypopnoea index fell to 8.4+/-9.6 and polysomnographic improvement could be seen in 25 (75%) cases. An overall positive result, showing subjective as well as objective improvement, was obtained in 23 (69.7%) patients. Two patients stopped using the device in the first few days and another patient after six months. Complications were relatively common, but always slight. Compliance levels were satisfactory: a mean of 6.5+/-1.1 nights per week and 7.4+/-1.09 days per week. CONCLUSION: Mandibular advancement devices are an effective therapeutic option for the treatment of respiratory sleep disorders. Compliance levels can be satisfactory if working with an expert odontology team.

[Neurocognitive and behavioural abnormalities in paediatric sleep-related breathing disorders]. / Alteraciones neurocognitivas y conductuales en los trastornos respiratorios del sueño infantil.

INTRODUCTION: Behavioural and neurocognitive abnormalities in children may be a consequence of sleep-related breathing disorders. The effectiveness of assessments based on questioning parents is dubious and objective assessment tools are therefore required. AIM: To ascertain the impact of these abnormalities in children with sleep-related breathing disorders and compare the reliability of questioning parents in relation to validated psychological tests. METHOD: A prospective study was performed on 20 children with sleep-related breathing disorders and 20 healthy control children between 3 and 12 years of age. Both groups were subjected to a battery of validated psychological tests. The results of both groups were compared with each other and with the response to clinical questionnaires given to parents in the problem group. RESULTS: More than 75% of the cases in the problem group presented abnormalities with regard to attention, anxiety, memory and spatial structuring. The percentage involvement in all concepts was higher in the problem group. Comparisons of attention (40% of children affected in the control group and 80% in the problem group), memory (50% and 84.2%), and spatial structuring (45% and 75%) were statistically significant. More abnormality was observed in the parameters assessed with psychological tests than the equivalent concept obtained from interviewing the parents. Comparison of abnormal concentration assessed from the questionnaires (40% of children affected) with attention during the psychological test (80%), memory (15% and 84.21%), and delayed language development (10%) compared to spatial structuring (75%) was statistically significant. CONCLUSIONS: A high prevalence of behavioural and neurocognitive abnormalities was observed in children with sleep-related breathing disorders compared to a control group of healthy children. The use of objective assessment such as psychological tests revealed more abnormalities than were expressed by parents in response to clinical interviews.

Alteraciones neurocognitivas y conductuales en los trastornos respiratorios del sueño infantil / Neurocognitive and behavioural abnormalities in paediatric sleep-related breathing disorders

Introducción: Las alteraciones de conducta y neurocognitivas en los niños pueden ser consecuencia del trastorno respiratorio del sueño. Los medios de evaluación basados en el interrogatorio a los padres tienen una eficacia dudosa y por ello se requieren herramientas objetivas de valoración. Objetivo: Averiguar el impacto de estas alteraciones en niños con trastornos respiratorios del sueño y comparar la fiabilidad del interrogatorio a los padres respecto a los tests psicológicos validados. Método: Estudio prospectivo de 20 niños con trastornos respiratorios del sueño y 20 controles sanos entre 3 y 12 años de edad. Se sometió a ambos grupos a una batería de tests psicológicos validados. Se comparan los resultados entre ambos grupos y los resultados de estos tests con la respuesta a los cuestionarios aplicados a los padres en el grupo de casos. Resultados: En el grupo de casos, más del 75% presentaba alteraciones de atención, ansiedad, memoria y estructuración espacial. Los porcentajes de afección en todos los conceptos fueron superiores en el grupo de casos. Resultan estadísticamente significativas las comparaciones de la atención (el 40% de niños afectados en el grupo control y el 80% en el grupo de casos), la memoria (el 50 y el 84,2%) y la estructuración espacial (el 45 y el 75%). Se observa mayor alteración de los parámetros valorados con los tests psicológicos que en los conceptos equivalentes obtenidos del interrogatorio de los padres. Resultaron estadísticamente significativas las comparaciones entre alteración de concentración valorada en el interrogatorio (el 40% de niños afectados) con la atención en el test psicológico (80%), la memoria (el 15 y el 84,21%) y retraso en el lenguaje (10%) comparado con la estructuración espacial (75%). Conclusiones: Se observa una alta prevalencia de alteraciones de conducta y neurocognitivas en los niños con trastornos respiratorios del sueño comparados con un grupo equivalente de niños sanos. Con la utilización de tests psicológicos se observa mayor afección por estas alteraciones respecto a lo expresado por los padres en los interrogatorios clínicos (AU)

Introduction: Behavioural and neurocognitive abnormalities in children may be a consequence of sleep-related breathing disorders. The effectiveness of assessments based on questioning parents is dubious and objective assessment tools are therefore required. Aim: To ascertain the impact of these abnormalities in children with sleep-related breathing disorders and compare the reliability of questioning parents in relation to validated psychological tests. Method: A prospective study was performed on 20 children with sleep-related breathing disorders and 20 healthy control children between 3 and 12 years of age. Both groups were subjected to a battery of validated psychological tests. The results of both groups were compared with each other and with the response to clinical questionnaires given to parents in the problem group. Results: More than 75% of the cases in the problem group presented abnormalities with regard to attention, anxiety, memory and spatial structuring. The percentage involvement in all concepts was higher in the problem group. Comparisons of attention (40% of children affected in the control group and 80% in the problem group), memory (50% and 84.2%), and spatial structuring (45% and 75%) were statistically significant. More abnormality was observed in the parameters assessed with psychological tests than the equivalent concept obtained from interviewing the parents. Comparison of abnormal concentration assessed from the questionnaires (40% of children affected) with attention during the psychological test (80%), memory (15% and 84.21%), and delayed language development (10%) compared to spatial structuring (75%) was statistically significant. Conclusions: A high prevalence of behavioural and neurocognitive abnormalities was observed in children with sleep-related breathing disorders compared to a control group of healthy children. The use of objective assessment such as psychological tests revealed more abnormalities than were expressed by parents in response to clinical interviews (AU)

[Clinical efficacy and polysomnography of adenotonsillectomy in the treatment of sleep-related respiratory disorders in children]. / Efectividad clínica y polisomnográfica de la adenamigdalectomía en el tratamiento de los trastornos respiratorios del sueño en los niños.

INTRODUCTION: If sleep-related breathing disorders in children are not treated quickly, they may be harmful to the child's future development. The best diagnostic test is polysomnography, since clinical assessments alone are not enough. Adenotonsillectomy is the most effective and widespread treatment for such disorders. OBJECTIVE: To assess clinical data on sleep-related breathing disorders, particularly in relation to behaviour and neurocognition, their long-term resolution with surgery and correlation with PSG data. METHOD: Prospective study with 73 children between 3 and 11 years of age, attending a special clinic for sleep-related breathing disorders. A medical history questionnaire was given to the parents, which included questions on the child's sleep patterns, respiratory disorders and behavioural and neurocognitive changes, and a polysomnography was carried out. Cases requiring surgery were monitored after 9 months by means of a further questionnaire and a follow-up polysomnography. RESULTS: Of the 73 children tested, 100 % snore, 87.5 % display objective apnoeas and 89 % suffer from nasal congestion. Drowsiness during the day was reported in only 28 %. Over 50 % of cases report aggressiveness or hyperactivity, while 41 % have concentration difficulties. In 61 of the 73 cases (83.6 %) given a pre-operative polysomnography, the mean apnoea-hypopnoea index was 6.44 (4.44). Postoperative follow-up is available for 44 cases, 29 of them with polysomnography. The resolution of clinical symptoms is highly satisfactory in these cases, but 5 patients (17.2 %) still have an apnoea-hypopnoea index of more than 3. CONCLUSIONS: Adenotonsillectomy is effective in curing the majority of sleep-related respiratory disorder symptoms in children. However, a significant percentage of cases display a persistent polysomnographic change. Long-term postoperative monitoring is recommended in such cases.

Efectividad clínica y polisomnográfica de la adenamigdalectomía en el tratamiento de los trastornos respiratorios del sueño en los niños / Clinical efficacy and polysomnography of adenotonsillectomy in the treatment of sleep-related respiratory disorders in children

Introducción: Si los trastornos respiratorios del sueño en los niños no se tratan precozmente pueden ser nocivos para la ulterior evolución del individuo. La prueba diagnóstica por excelencia es la polisomnografía y las evaluaciones exclusivamente clínicas no son suficientes. La adenamigdalectomía es el tratamiento más extendido y eficaz de estos trastornos. Objetivo: Valorar los datos clínicos de los trastornos respiratorios del sueño, en especial los referentes a conducta y neurocognitivos, y su resolución a largo plazo con la cirugía y su relación con los datos de la polisomnografía. Material y método: Estudio prospectivo de 73 niños, de entre 3 y 11 años de edad, que acuden con una clínica compatible con trastornos respiratorios del sueño. Se realiza un cuestionario clínico a los padres, que incluye preguntas sobre el sueño, sus problemas respiratorios y alteraciones de conducta y neurocognitivas y un estudio polisomnográfico. Los casos sometidos a cirugía son controlados a los 9 meses mediante un nuevo cuestionario y una nueva polisomnografía. Resultados: De los 73 niños analizados, el 100 % son roncadores, el 87,5 % presenta apneas observadas y el 89 %, obstrucción nasal. Únicamente refiere somnolencia diurna el 28 %. Más del 50 % de los casos refieren agresividad o hiperactividad y el 41 %, dificultades en la concentración. En 61 de los 73 casos se ha practicado polisomnografía preoperatoria (83,6 %). La media del índice de apnea-hipopnea preoperatorio ha sido de 6,44 ± 4,44. Se dispone de control postoperatorio en 44 casos, 29 con polisomnografía. La resolución de los síntomas clínicos es muy satisfactoria en estos casos, pero 5 (17,2 %) pacientes siguen con un índice de apnea-hipopnea > 3. Conclusiones: La adenamigdalectomía es eficaz en la resolución de la mayoría de los síntomas de trastornos respiratorios del sueño en niños. Sin embargo, un porcentaje significativo de casos presenta una persistencia de la alteración polisomnográfica. Por ello se recomienda un seguimiento a largo plazo de estos casos después de la cirugía

Introduction: If sleep-related breathing disorders in children are not treated quickly, they may be harmful to the child's future development. The best diagnostic test is polysomnography, since clinical assessments alone are not enough. Adenotonsillectomy is the most effective and widespread treatment for such disorders. Objective: To assess clinical data on sleep-related breathing disorders, particularly in relation to behaviour and neurocognition, their long-term resolution with surgery and correlation with PSG data. Method: Prospective study with 73 children between 3 and 11 years of age, attending a special clinic for sleep-related breathing disorders. A medical history questionnaire was given to the parents, which included questions on the child's sleep patterns, respiratory disorders and behavioural and neurocognitive changes, and a polysomnography was carried out. Cases requiring surgery were monitored after 9 months by means of a further questionnaire and a follow-up polysomnography. Results: Of the 73 children tested, 100 % snore, 87.5 % display objective apnoeas and 89 % suffer from nasal congestion. Drowsiness during the day was reported in only 28 %. Over 50 % of cases report aggressiveness or hyperactivity, while 41 % have concentration difficulties. In 61 of the 73 cases (83.6 %) given a pre-operative polysomnography, the mean apnoea-hypopnoea index was 6.44 (4.44). Postoperative follow-up is available for 44 cases, 29 of them with polysomnography. The resolution of clinical symptoms is highly satisfactory in these cases, but 5 patients (17.2 %) still have an apnoea-hypopnoea index of more than 3. Conclusions: Adenotonsillectomy is effective in curing the majority of sleep-related respiratory disorder symptoms in children. However, a significant percentage of cases display a persistent polysomnographic change. Long-term postoperative monitoring is recommended in such cases

[Diagnosis of proximal gastro-oesophageal reflux in patients with rhonchopathy and sleep apnoea]. / Diagnóstico de reflujo gastroesofágico proximal en pacientes con trastornos respiratorios del sueño.

INTRODUCTION: The close relationship between gastro-oesophageal reflux disease and sleep-related breathing disorders allows the consideration of treatment with proton pump inhibitors as a feasible alternative for patients with snoring or mild to moderate sleep apnoea syndrome. Nevertheless, the presence of gastro-oesophageal reflux in the proximal oesophagus must be identified objectively with a double channel oesophageal pH-metry. OBJECTIVE: To identify clinical data allowing the selection of patients most likely to have proximal oesophageal reflux, and, therefore, candidates for oesophageal pH-metry. MATERIAL AND METHOD: Between January 2004 and September 2006, 121 patients were prospectively included. In these patients, a nocturnal polysomnography and a 24 hour double channel pH-metry were performed on the same day. We compared statistically the clinical data, endoscopic examination of the upper airway and the pH-metry results. RESULTS: A good correlation was observed between the presence of symptoms suggesting pharyngo-laryngeal acid reflux and endoscopic examination of this area (P< .009). However, the comparison between clinical data and pH-metry results was not statistically significant. CONCLUSIONS: Clinical symptoms and endoscopic examination alone are not good tools to determine the presence of gastro-oesophageal reflux in the pharynx, in this group of patients. Its presence must be ascertained by a double channel oesophageal pH-metry.

Diagnóstico de reflujo gastroesofágico proximal en pacientes con trastornos respiratorios del sueño / Diagnosis of proximal gastro-oesophageal reflux in patients with rhonchopathy and sleep apnoea

Introducción: La asociación entre trastornos respiratorios del sueño y la enfermedad por reflujo gastroesofágico permite considerar el tratamiento con inhibidores de la bomba de protones como una alternativa terapéutica en pacientes con roncopatía o síndrome de apnea del sueño leve o moderado. Sin embargo, para ello se debe demostrar la presencia de reflujo gastroesofágico en el esófago proximal mediante una prueba objetiva: la pH-metría esofágica de 24 h de dos canales. Objetivo: Predecir, mediante parámetros clínicos y exploratorios, en qué pacientes con alteraciones respiratorias del sueño hay más posibilidades de reflujo ácido en el esófago proximal y, por lo tanto, sean candidatos a la realización de la pH-metría. Material y método: Se incluyó a 121 pacientes consecutivos que acuden para diagnóstico y tratamiento de alteración respiratoria durante el sueño. Se les practicó polisomnografía nocturna y pH-metría esofágica. Se analizan los datos de la anamnesis y la exploración endoscópica de la vía aérea superior y se comparan estadísticamente con los resultados de la pH-metría. Resultados: Se obtiene una buena correlación estadística entre la clínica faringolaríngea de reflujo y la exploración de la vía aérea superior para signos de reflujo esofágico proximal (p = 0,009). Las comparaciones realizadas entre estos datos clínicos y los obtenidos por pH-metría no mostraron relación positiva estadísticamente significativa. Conclusiones: En esta población de pacientes con trastornos respiratorios del sueño, los datos clínicos y endoscópicos no son útiles para sospechar la presencia de reflujo gastroesofágico esofágico proximal y, por lo tanto, iniciar tratamiento con inhibidores de la bomba de protones. Por ello es necesaria la práctica de una pH-metría esofágica de dos canales

Introduction: The close relationship between gastro-oesophageal reflux disease and sleep-related breathing disorders allows the consideration of treatment with proton pump inhibitors as a feasible alternative for patients with snoring or mild to moderate sleep apnoea syndrome. Nevertheless, the presence of gastro-oesophageal reflux in the proximal oesophagus must be identified objectively with a double channel oesophageal pH-metry. Objective: To identify clinical data allowing the selection of patients most likely to have proximal oesophageal reflux, and, therefore, candidates for oesophageal pH-metry. Material and method: Between January 2004 and September 2006, 121 patients were prospectively included. In these patients, a nocturnal polysomnography and a 24 hour double channel pH-metry were performed on the same day. We compared statistically the clinical data, endoscopic examination of the upper airway and the pH-metry results. Results: A good correlation was observed between the presence of symptoms suggesting pharyngo-laryngeal acid reflux and endoscopic examination of this area (P<.009). However, the comparison between clinical data and pH-metry results was not statistically significant. Conclusions: Clinical symptoms and endoscopic examination alone are not good tools to determine the presence of gastro-oesophageal reflux in the pharynx, in this group of patients. Its presence must be ascertained by a double channel oesophageal pH-metry