[Hypoglossal Nerve Stimulation in the Treatment of Obstructive Sleep Apnea]. / Die Hypoglossus-Stimulation zur Therapie der obstruktiven Schlafapnoe.

Reduced genioglossus muscle tone is considered one of the major causes for obstructive sleep apnea (OSA). Hypoglossal nerve stimulation (HNS) keeps the upper airway patent by increasing the muscle tone of the genioglossus muscle being the major airway opener. According to the German S3-Guideline on Sleep Disordered Breathing this treatment is indicated in patients with OSA failing or rejecting positive airway pressure, showing an AHI between 15 and 65, in particular when anatomy is normal and the BMI below 35. In 2021 it has been made available for regular patient care in Germany. However, breathing synchronized, continuous, and bilateral HNS differ in parts relevantly regarding their patient selection criteria, technical features, surgical technique, therapy setting and programming, and daily use for the patient. There are many publications showing the safety, efficacy, and patient satisfaction of breathing synchronized HNS. Less but promising data are available for continuous and the most recent bilateral HNS.

[Conservative treatment of obstructive sleep apnea using non-PAP therapies]. / Konservative Therapie der obstruktiven Schlafapnoe mit Nicht-PAP-Verfahren.

In Germany about one third of adults aged between 30 and 69 years suffer from obstructive sleep apnea (OSA). Snoring, inspiratory flow limitations, hypopneas, and apneas occur, leading to disturbed sleep, reduced daytime performance, and increased cardiovascular morbidity and mortality. Positive airway pressure therapy (PAP therapy) can be successfully administered in every OSA severity. However, other conservative treatments have to be considered for some patients, particularly in PAP failure or intolerance. The individual treatment concept is based on poly(somno)graphic, morphological, and functional assessment, taking treatment acceptance, adherence, and compliance into account.

Safety of cold ablation (coblation) in the treatment of tonsillar hypertrophy of the tongue base.

The treatment of diseases of the lingual tonsils is still under debate, and surgical interventions are often associated with significant morbidity and complications. The aim of the present study was to evaluate the safety of lingual tonsillectomy using cold ablation (coblation) as a new treatment of lingual tonsil diseases. In this retrospective, bicentric study, we included all patients between 2005 and 2012 who underwent cold ablation (Coblation(®)) of the lingual tonsils. We assessed the frequency of postoperative complications based on the patients' charts. A total of 108 patients (47 ± 13, 6 years) underwent lingual tonsillectomy using coblation. All patients were operated on under general anesthesia as inpatients. Intraoperative complications did not occur. Three patients (2.8%) needed revision surgery due to postoperative hemorrhage, and in one of those cases, three revisions were necessary. There was no postoperative airway compromise and no need for tracheostomy. There was no hypoglossal nerve paralysis, but in the case needing multiple revisions, a weakness of the hypoglossal nerve persisted. In all the cases, oral intake was possible with adequate analgesia. Coblation of the tongue base is a safe procedure with a relatively low rate of postoperative complications. Postoperative hemorrhage is the most relevant complication that occurred in our series of patients. Future studies are needed to evaluate the efficacy of the procedure in the treatment of obstructive sleep apnea.

Effects of continuous positive airway pressure on apnea-hypopnea index in obstructive sleep apnea based on long-term compliance.

PURPOSE: Although continuous positive airway pressure (CPAP) is the gold standard in the treatment of obstructive sleep apnea (OSA), its effectiveness depends on the regular use. In this retrospective study, the effectiveness of CPAP with regard to the reduction of the apnea-hypopnea index was calculated based on individual adherence data extracted from a cohort of patients with OSA METHODS: The electronic database was analyzed for follow-up visits of patients receiving CPAP for OSA. The following information was extracted the charts of 750 patients: apnea-hypopnea index (AHI) at diagnosis, AHI with CPAP, duration of therapy, hours of CPAP use, and subjective hours of sleep. Eighty-two successfully treated and stable CPAP patients (AHI/Epworth Sleepiness Scale (ESS) at baseline 35.6 ± 22.1/10.5 ± 5.1) could be further evaluated. RESULTS: Mean AHI under CPAP was 2.4 ± 2.5 with an ESS of 6.9 ± 4.2. Subjective hours of sleep were 6.5 ± 1.1. The average treatment period was 584.6 ± 566.5 days (3,800 h of sleep). Mean hours of use was 2,712 ± 3,234 (4.69 ± 2.42 per night). This leads to the following calculated measures: hours of sleep without CPAP, 1,088; number of respiratory events with CPAP, 6508.8; number of respiratory events without CPAP, 38,732.8; total number or respiratory events, 45,241.6; average AHI, 11.91. CONCLUSIONS: Even in an ideal group of patients, CPAP cannot eliminate respiratory events due to limited adherence. Adherence needs to be taken into account when comparing the effects of CPAP on the AHI with alternative treatment methods, especially those with 100% adherence (e.g., surgery).

Assessment of peri- and postoperative complications and Karnofsky-performance status in head and neck cancer patients after radiation or chemoradiation that underwent surgery with regional or free-flap reconstruction for salvage, palliation, or to improve function.

BACKGROUND: Surgery after (chemo)radiation (RCTX/RTX) is felt to be plagued with a high incidence of wound healing complications reported to be as high as 70%. The additional use of vascularized flaps may help to decrease this high rate of complications. Therefore, we examined within a retrospective single-institutional study the peri--and postoperative complications in patients who underwent surgery for salvage, palliation or functional rehabilitation after (chemo)radiation with regional and free flaps. As a second study end point the Karnofsky performance status (KPS) was determined preoperatively and 3 months postoperatively to assess the impact of such extensive procedures on the overall performance status of this heavily pretreated patient population. FINDINGS: 21 patients were treated between 2005 and 2010 in a single institution (17 male, 4 female) for salvage (10/21), palliation (4/21), or functional rehabilitation (7/21). Overall 23 flaps were performed of which 8 were free flaps. Major recipient site complications were observed in only 4 pts. (19%) (1 postoperative haemorrhage, 1 partial flap loss, 2 fistulas) and major donor site complications in 1 pt (wound dehiscence). Also 2 minor donor site complications were observed. The overall complication rate was 33%. There was no free flap loss. Assessment of pre- and postoperative KPS revealed improvement in 13 out of 21 patients (62%). A decline of KPS was noted in only one patient. CONCLUSIONS: We conclude that within this (chemo)radiated patient population surgical interventions for salvage, palliation or improve function can be safely performed once vascularised grafts are used.

Cluster protocols in SCIT: enough evidence for practical use?

PURPOSE OF REVIEW: The review provides a comprehensive evaluation of Cluster schedules in subcutaneous-specific immunotherapy (SCIT) in terms of the safety profile and onset of clinical and immunological effects. RECENT FINDINGS: Recent major clinical studies could clearly reveal that Cluster schedules with both (semi-)depot-allergen preparations and chemically modified allergen preparations ('allergoids') are well tolerated therapeutic options in SCIT comparable to the safety profile of conventional build-up schedules. Moreover, preliminary data indicate that these accelerated protocols result in a more rapid achievement of clinical and immunological effects. SUMMARY: Conventional schedules in SCIT have the disadvantage of both a high expenditure of time and the need for a high patient compliance. In accelerated cluster schedules two to three injections are administered sequentially per treatment day (with an interval of 30 min between the injections) in weekly intervals aimed to reach the maintenance dose of SCIT in a short time interval. Recent studies indicate that these accelerated SCIT protocols result in a more rapid achievement of clinical and immunological effects than conventional schedules. Moreover, the safety profile is comparable between conventional and cluster SCIT.

Perioperative and follow-up results after central pancreatic head resection (Berne technique) in a consecutive series of patients with chronic pancreatitis.

BACKGROUND: Many patients require surgery for chronic pancreatitis (CP). By combining the essences of the Beger and the Frey procedures, a hybrid procedure was developed: central pancreatic-head resection (CPHR) (Berne technique). METHODS: A prospective evaluation of 100 consecutive patients who underwent CPHR for CP between January 2002 and December 2006 was performed. Long-term follow-up, including quality-of-life (QOL) assessment, was carried out. RESULTS: The hospital mortality rate was 1%; the surgical morbidity rate was 16%; and the relaparotomy rate was 6%. Mean surgery time was 295 +/- 7 minutes; mean intraoperative blood loss was 763 +/- 75 mL; and the mean postsurgical hospital stay was 11.4 +/- .8 days. After a median follow-up of 41 months, pain was improved in 55% of patients; weight increase occurred in 67% of patients; and insulin-dependent diabetes mellitus developed in 22% of the patients. Comparison of QOL parameters with a German adult control population showed no statistically significant differences. CONCLUSIONS: CPHR is a safe surgical option to resolve CP-associated problems. Long-term follow-up QOL after CPHR shows results comparable with date published data after the Beger and the Frey procedures.