Management of obstructive sleep apnea in the indigent population: a deviation of standard of care?

Comprehensive management of patients with obstructive sleep apnea (OSA) typically is managed best via a multidisciplinary approach, involving otolaryngologists, sleep psychologists/psychiatrists, pulmonologists, neurologists, oral surgeons, and sleep trained dentists. By utilizing these resources, one could fashion a treatment individualized to the patient, giving rise to the holistic phrase of "personalized medicine." Unfortunately, in situations and environments with limited resources, the treatment options in an otolaryngologist's armamentarium are restricted--typically to continuous positive airway pressure (CPAP) versus sleep surgery. However, a recent patient encounter highlighted here shows how a hospital's reimbursement policy effectively dictated a patient's medical management to sleep surgery. This occurred although the current gold standard for the initial treatment of OSA is CPAP. Changing the course of medical/surgical management by selectively restricting funding is a cause of concern, especially when it promotes patients to choose a treatment option that is not considered the current standard of care.

Association between metformin use and improved survival in patients with laryngeal squamous cell carcinoma.

BACKGROUND: Metformin use has been linked to improved cancer outcomes. The purpose of this study was to determine the impact of metformin on the survival of patients with laryngeal cancer. METHODS: We retrospectively reviewed 205 patients with a diagnosis of laryngeal squamous cell carcinoma (SCC). RESULTS: Patients taking metformin presented with more early-stage tumors (T1 and T2) and less regional metastasis (N0; 81% metformin+ vs 50% metformin-) compared to patients with diabetes not taking metformin. At last follow-up, 76% of patients taking metformin were alive, compared to 41% for diabetics not on metformin and 51% for nondiabetics. Metformin users demonstrated increased disease-free survival (DFS) and overall survival (OS) compared with nonmetformin users and nondiabetics. CONCLUSION: Patients with diabetes taking metformin present with earlier stage disease and have more favorable clinical outcomes when compared to their diabetic counterparts and nondiabetics. Combined with previously published retrospective studies, our results suggest that prospective clinical trials evaluating the role of metformin in head and neck cancer are warranted.

Antineoplastic agents. 570. Isolation and structure elucidation of bacillistatins 1 and 2 from a marine Bacillus silvestris.

Two new cyclodepsipeptides designated bacillistatins 1 (1) and 2 (2) have been isolated from cultures of a sample of Bacillus silvestris that was obtained from a Pacific Ocean (southern Chile) crab. Each 12-unit cyclodepsipeptide strongly inhibited growth of a human cancer cell line panel, with GI(50)'s of 10(-4)-10(-5) microg/mL, and each compound was active against antibiotic-resistant Streptococcus pneumoniae. The structures were elucidated by a combination of X-ray diffraction and mass and 2D NMR spectroscopic analyses, together with chemical degradation.