Bariatric surgery for treatment of sleep apnea syndrome in 15 morbidly obese patients: long-term results.

OBJECTIVE: To evaluate the long-term outcomes of bariatric surgery with respect to respiratory disturbance index (RDI) in sleep apnea syndrome (SAS). DESIGN: Case series with long-term follow-up (1 to 12 years). SETTING: Private clinic in an academic tertiary referral center. PATIENTS: Fifteen morbidly obese patients (10 men, 5 women) who were referred for the treatment of severe SAS. INTERVENTION: For all 15 patients who presented with severe SAS, nasal positive airway pressure breathing was either not available or was not tolerated by the patient; therefore, bariatric surgery was performed as a means of treatment for SAS. MAIN OUTCOME MEASURES: RDIs and minimum oxygen saturation were measured both preoperatively and postoperatively (1 to 12 years after surgery). RESULTS: Weight loss ranged from 60 to 220 pounds (27 to 100 kg). RDI decreased by at least 55% in each patient, and all patients with tracheostomies (8 of 15) had their tracheostomy tubes removed. Average RDI preoperatively was 96.9 and average RDI postoperatively was 11.3. Results were similar for all 15 patients in that minimum oxygen saturation increased during sleep from an average preoperative minimum oxygen saturation of 58.7% to an average postoperative minimum oxygen saturation of 85.2%. CONCLUSIONS: Bariatric surgery as a means of treating SAS in the morbidly obese provides effective long-term reduction in RDI. Bariatric surgery also significantly improves minimum oxygen saturation in morbidly obese patients with SAS. Biliopancreatic bypass is more effective in reducing RDI to normal values than vertical banded gastroplasty.

Microcystic adnexal carcinoma: forty-eight cases, their treatment, and their outcome.

BACKGROUND: Microcystic adnexal carcinoma, or sclerosing sweat duct carcinoma, is an uncommon cutaneous neoplasm associated with extensive local invasion. The standard of care with regard to the best excisional method in treating microcystic adnexal carcinoma has not been established. OBJECTIVES: To perform a retrospective study comparing patients treated by Mohs micrographic surgery with those treated by wide excision and to elucidate the epidemiological features of microcystic adnexal carcinoma. PATIENTS AND METHODS: A retrospective analysis of a case series involving 48 primary and referral patients diagnosed as having microcystic adnexal carcinoma using standardized criteria. All cases were reviewed by the same dermatopathologists. RESULTS: Microcystic adnexal carcinoma predominantly affects the left side of the face of middle-aged women. Microcystic adnexal carcinoma is misdiagnosed 30% of the time. The recurrence rate is 1.98% per patient-year. Mohs micrographic surgery and simple excision show comparable complication rates. Clear margins were obtained in fewer procedures and, therefore, fewer office visits when the lesions were treated with micrographic surgery. The defect surface area after full extirpation following Mohs micrographic surgery was a mean of 4 times that of the clinically apparent size. The wide range of difference between the pre- and the post-Mohs micrographic surgery surface area noted in our data indicates that a margin cannot be safely predicted. CONCLUSIONS: Microcystic adnexal carcinoma is a predominantly left-sided, locally aggressive facial tumor, which results in significant morbidity. Our data do not support the use of standardized predictable margins. Mohs micrographic surgery is a reasonable initial treatment, as it accomplishes cure in fewer office visits and does not rely on predicted margins.