International Consensus Statement on Obstructive Sleep Apnea.

BACKGROUND: Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS: Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS: The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION: This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.

Atrioesophageal Fistula After Atrial Fibrillation Ablation: A Case Report.

Atrioesophageal fistula is a rare, potentially fatal complication of atrial fibrillation ablation that is often missed by clinicians. We report the case of a patient who presented with infectious symptoms 4 weeks after undergoing atrial fibrillation ablation. Our case emphasizes that prompt diagnosis and surgical intervention are crucial to reduce the high morbidity and mortality rates associated with this highly concerning complication.

La fistule atrio-œsophagienne est une complication rare, mais potentiellement fatale de l'ablation de la fibrillation auriculaire que les cliniciens négligent souvent. Nous rapportons le cas d'un patient qui présentait des symptômes d'infection quatre semaines après avoir subi l'ablation de la fibrillation auriculaire. Notre cas démontre que le diagnostic précoce et l'intervention chirurgicale sont cruciaux pour réduire les taux élevés de morbidité et de mortalité associées à cette complication très préoccupante.

A multi-disciplinary approach to the management of intra-venous and intra-cardiac leiomymatosis: A case report.

We herein report a rare presentation of leiomyoma in a 46-year-old female who presented with complaints of shortness of breath on exertion associated with palpitations for the past one year with a history of irregular menstrual bleeding. Ultrasonography of the abdomen and pelvis revealed an enlarged, distorted uterus with multiple intramural fibroids. A trans-thoracic echocardiography was then performed which showed a large right atrial mass. To investigate further, a contrast enhanced computed tomography was performed covering entire chest and upper abdomen. It showed a large lesion in the right atrium of the heart measuring 6x5cm. The lesion appeared hypo dense and was abutting the tricuspid valve and posterior wall of the Right Atrium. It revealed the Right Atrial lesion extending into the Inferior Vena Cava and lower down into the Common Iliac Confluence, Left Common Iliac and External Iliac Veins. A multi-disciplinary approach was undertaken; the patient underwent a single stage procedure involving a total abdominal hysterectomy with bilateral Salpingo-Oophorectomy followed by excision of the intra-cardiac tumour. Recovery was uneventful and the patient was successfully discharged on the 5th post-operative day. Due to the lack of literature and low incidence of this disease, this case report presents a rare opportunity to define management guidelines for such occurrences in the future.

Unidentified Recurrent Acute Compartment Syndrome of the Right Upper Limb.

Acute compartment syndrome (ACS) is a surgical emergency that requires urgent fasciotomy to prevent irreversible sequelae. Symptoms usually include intense pain, tenderness in the affected area, tingling or burning sensation, and in severe cases, numbness or weakness and limb amputation due to ischemia from compression of the blood vessels, respectively. This case report describes a 19-year-old female who presented with complaints of severe pain and swelling in her right forearm. On examination, no bite marks, blisters, or skin necrosis were noted except for several surgical scars from her previous surgeries for the same condition, i.e., compartment syndrome. Upon thorough examination, including relevant investigation and clinical judgment, she was diagnosed with acute compartment syndrome, for which she underwent fasciotomy. There was no basic underlying pathology found in her case, making it an unidentified case of acute compartment syndrome.