Efficacy of microdebrider intracapsular adenotonsillectomy as validated by polysomnography.

OBJECTIVES/HYPOTHESIS: To evaluate the efficacy of microdebrider intracapsular tonsillectomy (MT) as a treatment for pediatric obstructive sleep apnea (OSA) and sleep disordered breathing. STUDY DESIGN: A retrospective study evaluating polysomnogram outcomes for 26 patients who had undergone MT by a sole surgeon (M.G.) for OSA. METHODS: Chart review of patients who underwent polysomnograms pre- and post-adenotonsillectomy. This study represents a single pediatric otolaryngologist's experience at two tertiary care medical centers (Children's Memorial Hospital and Evanston Hospital) in the greater Chicago area. RESULTS: Statistically significant improvement of both the apnea-hypopnea index (AHI) and apnea index with P < .0001. All 26 children in the cohort had improved AHI scores following intracapsular tonsillectomy. Statistical analysis was performed using a P value < .05, which was significant. CONCLUSIONS: MT is an effective means of treating obstructive sleep apnea. Because of its favorable surgical outcomes and minimal morbidity, an increasing number of studies have found MT to be an excellent option for the surgical management of adenotonsillar hypertrophy in pediatric patients with OSA.

Immunoglobulin for concurrent Guillain-Barré and immune thrombocytopenic purpura.

Guillain-Barré syndrome, or acute inflammatory demyelinating polyradiculoneuropathy, and immune thrombocytopenic purpura are both autoimmune disorders thought to result from molecular mimicry in response to an antecedent introduction of foreign antigen. Guillain-Barré syndrome is an ascending motor paralysis that can lead to respiratory compromise. Immune thrombocytopenic purpura is an isolated disorder of platelet destruction leading to mucocutaneous bleeding. Guillain-Barré does not typically occur with other autoimmune disorders, and concurrent Guillain-Barré and immune thrombocytopenic purpura has only rarely been reported. We present a patient with both conditions who experienced prompt resolution of neurologic and hematologic sequelae after intravenous immunoglobulin therapy was initiated within 12 hours of presentation. The case provides further evidence that Guillain-Barré syndrome and immune thrombocytopenic purpura can occur simultaneously, possibly caused by a similar pathogenic mechanism, as well as suggesting that the prompt initiation of intravenous immunoglobulin is an effective monotherapy leading to prompt resolution of both conditions and prevention of further sequelae.

Phase-dependent treatment of delayed sleep phase syndrome with melatonin.

STUDY OBJECTIVE: Delayed sleep phase syndrome (DSPS) is a circadian-rhythm sleep disorder characterized by abnormally late sleep and wake times. Melatonin, taken in the evening, advances sleep and circadian phase in patients with DSPS. However, little is known about the most effective dose or time of administration. In the present study, we tested the effectiveness of melatonin to advance the timing of sleep and circadian phase in individuals with DSPS. DESIGN: Following baseline assessment of sleep and circadian phase, subjects were randomly assigned to 1 of 3 treatment groups. The administration of melatonin (0.3 or 3.0 mg) or placebo was double-blinded. SETTING: All procedures were conducted on an outpatient basis. PARTICIPANTS: Thirteen subjects with DSPS, recruited via flyers, advertisements, and referrals from the Sleep Clinic, completed this study. INTERVENTIONS: Melatonin (0.3 or 3.0 mg) or placebo was administered between 1.5 and 6.5 hours prior to dim light melatonin onset for a 4-week period. MEASUREMENTS AND RESULTS: Both doses of melatonin advanced the circadian phase of endogenous melatonin. The magnitude of phase advance in dim-light melatonin onset correlated strongly with the time of melatonin administration, with earlier times being more effective (r2 = 0.94, P < .0001). Similar, though weaker, relationships were obtained between the timing of melatonin administration and changes in sleep time. CONCLUSIONS: These results indicate that melatonin advances the circadian clock and sleep in patients with DSPS in a phase-dependent manner. This is the first study that reports a relationship between timing of melatonin administration and phase changes in patients with DSPS.