Role of DISE in the surgical outcome for patients with obstructive sleep apnea.

PURPOSE: To investigate and compare the surgical outcomes of DISE and non-DISE-guided surgery in cases with obstructive sleep apnea. METHODS: Sixty-three patients with severe OSA and BMI ≤35 kg/m2 were included in the study. Patients were randomly divided into group A where surgical intervention was performed without DISE, and group B where surgery was planned according to the findings of DISE. RESULTS: In group A, the mean AHI, LO2, and Snoring index showed a highly significant improvement (P < 0.0001). Group B had highly significant improvements as regards PSG data (P < 0.0001). High significant differences exist when comparing the operative time of both groups (P < 0.0001). On comparing the success rates in both groups, no statistically significant differences were reported (p = 0.6885). CONCLUSION: Preoperative topo-diagnosis with DISE does not significantly affect the surgical outcomes in OSA. Primary OSA cases could benefit from a no-DISE cost-effective surgical protocol that entails multilevel surgical interventions in a reasonable time.

Suspension-expansion pharyngoplasty: a modified technique for oropharyngeal collapse in obstructive sleep apnea.

BACKGROUND AND PURPOSE: Lateral pharyngeal wall (LPW) collapse plays a fundamental role in the pathogenesis of obstructive sleep apnea (OSA) and might determine the severity of the disease. This study presents the suspension/expansion pharyngoplasty (SEP) for the treatment of selected cases of OSA. The procedure aimed to splint LPW collapse via supporting and lateralization of both superior constrictor muscle (SCM) and palatopharyngeal muscle (PPM) individually and in two different planes. METHODS: Twenty-one adult patients with single-level OSA who showed a lateral pattern of collapse at the oropharyngeal region had the modified procedure (SEP). The basic steps are the individual dissection of the muscular components of the lateral pharyngeal wall: SCM which was sutured anteriorly to the anterior tonsillar pillar and the PPM which was suspended to the pterygomandibular raphe. The supra-tonsillar fat was preserved. RESULTS: At 9-12 months, highly significant improvement was reported as regards the mean Apnea hypopnea index and the mean lowest oxygen saturation (p < 0.000). The Epworth Sleepiness Scale and VAS-snoring showed a significant (p < 0.05) reduction. The oxygen desaturation index showed significant improvement. Non-significant improvements were reported as regards the percentage of total sleep time with oxygen saturation below 90%. According to Sher criteria, successful outcomes were reported in 17 patients. CONCLUSION: SEP could widen the pharyngeal airway and could support the collapsible lateral pharyngeal wall guarding against soft tissue collapse. In selected subjects, SEP had reported subjective and objective favorable outcomes with no significant comorbidities. The procedure could be combined with other procedures in multilevel surgery.

Positional Awake Endoscopy Versus DISE in Assessment of OSA: A Comparative Study.

OBJECTIVE: To compare awake endoscopy with Müller's maneuver (MM) during both sitting and supine positions, with drug-induced sleep endoscopy (DISE) as regard determination of different levels, patterns, and degrees of collapse of the upper airway in adult patients with obstructive sleep apnea (OSA). METHODS: The study included adult patients with OSA symptoms, who had apnea hypopnea index (AHI) > 15. Patients were examined by MM in a sitting position, then during supine position; DISE then followed. Site, pattern, and degree of obstruction were assessed by experienced examiners according to the nose oropharynx hypopharynx and larynx classification. RESULTS: Eighty-one adult subjects were included. The most common pattern of collapse at the retro-palatal level was the concentric pattern, while the predominant pattern at the hypopharyngeal level was the lateral wall collapse. The analysis of the pattern of collapse of the study group revealed that the individual pattern did not change (for the same patient at the same level) in the majority of patients whatever the maneuver or the position. CONCLUSION: This study demonstrates the feasibility of positional awake endoscopy for providing valuable surgical information as regard level, pattern, and degree of severity in OSA. The data of positional awake endoscopy were comparable to those gained from DISE with less morbidity and costs. The idea and results of this work provide a useful foundation for future research in this area. Multicenter studies are encouraged to obtain more reliable conclusions and more clear standards aiming at a better surgical planning. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:2269-2274, 2020.

Voice and Swallowing Outcomes after Hyoid Suspension Surgery in Patients with Obstructive Sleep Apnea.

OBJECTIVE: The role of hyoidthyroidpexia (HTP) surgery in the management of patients with obstructive sleep apnea (OSA) is well described with good reported outcomes. The effect of HTP on other laryngeal functions is not well discussed. This study was designed to evaluate voice and swallowing outcomes after HTP. PATIENTS AND METHODS: This study was applied on a selected group of OSA patients. HTP (as a sole procedure) was performed in 17 patients and 14 patients had simultaneous palatal procedures (e.g., anterior palatoplasty). Pre- and postoperative assessment of voice and swallowing were done. RESULTS: Comparison between pre- and postoperative results of voice and swallowing measures revealed a nonsignificant difference. CONCLUSION: HTP (as a sole technique or as part of a multilevel intervention) could help with airway collapse and might be considered a safe, simple, and effective technique in the management of selected patients experiencing OSA. In addition, it seems to have no hazardous effect on either the voice or swallowing function of patients.

Histologic response after neoadjuvant chemoradiotherapy in locally advanced rectal adenocarcinoma: experience from Sudan.

BACKGROUND: Locally advanced rectal cancer can be down staged by neoadjuvant therapy and the resultant tumor response can be quantified histologically. This study aimed to assess pathological response of neoadjuvant chemoradiation in patients with locally advanced rectal cancers treated in Wad Medani Teaching Hospital (WMTH) and National Cancer Institute (NCI), Wad Medani, Sudan. PATIENTS AND METHODS: A total of 36 consecutive patients with locally advanced rectal cancer that were managed in WMTH and NCI during the period from 2006-2011 were reviewed. Preoperative pelvic radiotherapy was delivered. Total of 46 Gray were delivered concurrently with 5- fluorouracil (5-FU) on the first and last week of radiation. Total mesorectal excision of the rectal tumour either by anterior or abdominoperineal resections was planned at 6-8 weeks from completion of preoperative treatment. The pathological response to therapy was assessed by histopathology examination of the surgical specimen. RESULTS: Initial clinical staging of patients revealed 58.3% of them were stage T3/T4N2M0 and 41.7% were stage T3N0M0. Down-staging to stage T1/T2N0M0 was found in 36.1% and stage T3N0M0 in 30.6%. No response was seen in 8.3% of cases with stage T3/T4N2M0 while complete clinical response (no residual) was seen in 25.0%. Complete histological response was observed in 13.8%. Positive lymph-nodes metastasis was confirmed in 8.3% of cases. CONCLUSION: Neoadjuvant chemoradiation is a reasonable option for cases of rectal cancer and deserves further evaluation.

Surgery as a career choice among medical students at University of Medical Sciences and Technology.

BACKGROUND: Medical students are the source of a country's surgeons. There are concerns regarding a possible decline in the proportion of students choosing surgery as a career in some developing countries. OBJECTIVE: To identify the level of interest in surgical careers and the factors influence a student's interest in pursuing a surgical career in Sudan. METHODS: A cross-sectional descriptive study was conducted in September 2013 at the Faculty of Medicine, University of Medical Sciences and Technology, Khartoum, Sudan. A self administered questionnaire was distributed to 887 male and female students, (from first to fifth academic years) recruited in the study. RESULTS: Response rate was 73% with 647 questionnaires were collected, out of 887 medical students. Of the returned questionnaires, 604 were valid. Most of the students have decided upon a specialty 541 (89.6%) while 63 (10.4%) did not. Two hundred (36.9%) out of the 541 respondents stated that surgery is their choice for specialty. General Surgery was the popular surgical specialty (48%), followed by Cardiothoracic Surgery (16.5%), Neurosurgery (11%) and Orthopedics (10.5%). Compared with students interested in a career in other medical specialties, those interested in surgery were younger (Pre-clerkship students). CONCLUSION: Surgery is the most popular choice of postgraduate training by medical students. Fewer than half of the medical students who choose surgery were willing to consider general surgery as a future career choice. Financial reasons and advice from of others were considered by many students as important factors to select surgery.

Multiple parenchymal leiomyomas of the breast in a Sudanese female.

Leiomyomas are benign smooth muscle neoplasm. They can occur in any organ, but the most common forms occur in the uterus, small bowel and the esophagus. Leiomyomas of breast are rare benign non epithelial tumor. Only 21 cases of solitary parenchymal leiomyoma of the breast have been reported. This is the first case of multiple breast leiomyomas being reported in the literature. Here we report a case of a 38-year-old woman who presented to us with a painless right sided breast swelling. Histopathology revealed a growth pattern of interlacing fascicles of smooth-muscle cells consistent with leiomyoma of breast. To the best of our knowledge, this is the first case of multiple intraparenchymal leiomyomas of the breast reported in the literature.

Evaluation of clinical and pathological response after two cycles of neoadjuvant chemotherapy on Sudanese patients with locally advanced breast cancer.

BACKGROUND: The use of neoadjuvant chemotherapy in treating breast cancer has shown efficacy in downstaging primary tumors, and allows breast conservative surgery to be performed instead of mastectomy. This study aims to evaluate patterns of clinical and pathological response after two cycles of neoadjuvant chemotherapy in patients with locally advanced breast cancer. MATERIALS AND METHODS: This is a prospective study. Ninety-eight patients who presented from April 2009 through May 2011 with locally advanced breast cancer and treated with neoadjuvant chemotherapy were included. RESULTS: The clinical response rate was 83%; 11 patients (11.2%) had a complete clinical remission (cCR); 71 had a partial remission (72.4%); 13 had stable disease (13.3%), and 3 had progressive disease (3.1%). Seven patients had complete pathological response. CONCLUSION: Neoadjuvant chemotherapy can achieve a high objective response rate in patients with locally advanced breast cancer even after two cycles. We recommend further research to find predictors for response.

Cervical Pott's disease presenting as a Retropharyngeal Abscess: Controlled by Aspiration and Anti-tuberculous chemotherapy.

Tuberculosis of the cervical spine is very rare. An unusual case of a 6 year old child presenting with spinal tuberculosis involving cervical and thoracic vertebrae, along with retropharyngeal abscess is reported. The patient presented with progressive neck swelling, neck pain, fever with night sweats and difficulty of swallowing. The lab studies confirmed tuberculosis. The patient was successfully treated with fine-needle aspiration and antituberculous drugs. The patient improved rapidly. His neck stiffness decreased, and he was able to eat comfortably.