Stougaardbolton0255

Despite excellent positive airway pressure (PAP) adherence, a subset of obstructive sleep apnea (OSA) patients experience residual elevation of the apnea-hypopnea index (AHI). Drug-induced sleep endoscopy (DISE) during PAP application provides an opportunity to examine the anatomic effect of PAP therapy on the upper airway and to troubleshoot refractory residual AHI elevation. We present a patient who demonstrated persistent moderate-severe AHI elevation during titration polysomnogram and subsequent data download reports despite numerous mask refits, chin strap, positional modifications, and multiple pressure and mode adjustments in both the clinic and sleep laboratory settings. DISE was performed with the flexible endoscope passed through the PAP circuit into the upper airway. Jaw laxity and associated mandibular retrusion at sleep onset was found to result in a complete fixed tongue base obstruction that PAP therapy, delivered via the patient's oronasal interface, was unable to overcome. Various strategies to overcome these obstacles are discussed. © 2020 American Academy of Sleep Medicine.BACKGROUND Obstructive sleep apnea (OSA) is thought to be associated with dyslipidemia. However, differences concerning dyslipidemia during rapid eye movement (REM) and non-REM (NREM) sleep have yet to be determined. OBJECTIVES This study was designed to explore the association between lipid profiles and OSA during REM or NREM sleep. METHODS This is a clinical cohort. A total of 2,619 participants with at least 30 min of REM sleep were included. Sleep variables and fasting lipid profiles [total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), apolipoprotein (apo)A-I, apoB, apoE, and lipoprotein(a) (Lp(a))] were obtained from each subject. Apnea-hypopnea indices (AHIs) in REM and NREM sleep (AHIREM and AHINREM, respectively) were recorded. Linear regression analysis was used to assess the associations of AHIREM and AHINREM with lipid profiles. RESULTS When stratified by the AHIREM severity of OSA, all demographics, clinical variables, and sleep parameters differed between the groups except for apoA-I. In fully adjusted multivariate linear regression models, AHIREM was independently associated with increasing levels of TG, HDL-C, and apoE (p = 0.04, p = 0.01 and p = 0.01, respectively). AHINREM was independently associated with increasing levels of TC, TG, LDL and apoB, and lower level of HDL-C (all p 0.05), while AHINREM was associated with elevated TC, LDL-C, and apoB (p = 0.03, p = 0.01 and p = 0.01, respectively). CONCLUSION AHINREM was independently associated with the greatest alterations in serum lipids, including TC, LDL-C, and apoB. © 2020 American Academy of Sleep Medicine.This retrospective study, of a single surgeon's experience, evaluates the role of intraoperative neuromonitoring (IONM) for total thyroidectomy, in a low-volume district general hospital. 128 patients with normal preoperative vocal fold function underwent thyroid surgery with routine use of nerve monitoring. Patients were followed for 6 months after surgery, and postoperative Romanerve function was determined by fiberoptic laryngoscopy. One (0,8%) patient was found to have a unilateral vocal fold paralysis, but after 6 months this patient had regained vocal fold motion. The technique of intraoperative neuromonitoring in thyroid surgery is safe and reliable in excluding postoperative recurrent laryngeal nerve palsy; it has high accuracy, specificity, sensitivity and negative predictive value. Neuromonitoring is useful to identify the recurrent laryngeal nerve and it can be a useful adjunctive technique for reassuring surgeons of the functional integrity of the nerve. Its application can be particularly recommended for low-volume thyroid operation centres.The treatment of incisional hernias, especially those that are multiple or recurring, has always represented important challenges for surgeons. An incisional hernia is a mechanical damage of the abdominal wall that can result in respiratory problems and alterations of splanchnic circulation, especially when in large size hernias. The increasing availability of prostheses with greater resistance Romato infections and tension, lightness, biocompatibility, and reduced visceral adhesions has improved outcomes and minimized relapses. It is still important, however, to carefully choose the type of prosthesis and surgical technique, whether laparotomic or laparoscopic, correlated to the positioning site of the prosthesis. In this observational study we report the results and outcomes of 50 patients surgically treated for incisional hernia in our hospital. Selleck MSC-4381 The surgical technique used to repair the hernias was laparoscopic with the use of the Ventralight Echo PS. This prosthesis is equipped with a comfortable and innovative pneumatic system that facilitates its positioning during surgery. In our experience, it has brought undeniable advantages for the treatment of incisional hernias and for all patients with parietal defects who could benefit from laparoscopic treatment.Negative Pressure Wound Therapy with instillation therapy and dwelling time (NPWTid) represents a good tool to treat severely infected non-healing wounds. This topical treatment consists of negative pressure and retrograde instillation of antiseptic/antibiotic Romasolutions into the wound surface, to promote cleansing and consequently the healing process. We reported our initial experience (five cases) in the treatment of severely infected diabetic foot, that can be considered a life-threatening condition. In our case reports, patients presented with clinical signs and symptoms of severe sepsis. Our treatment based on multidisciplinary approach (surgical, NPWTid, interventional radiology, skin grafts) had satisfying results. NPWT represented an important support to treatment of these diabetic patients.Skin ulcers represent a common complication of sickle cell disease, especially in homozygous forms, with multifactorial pathogenetic mechanisms and frequent location at lower extremities; more specifically perimalleolar areas are favourite location because of a chronic microvascular disturbance and capillary stasis in a district with low fatty tissue. Chronicization and recurrence of unhealable lesions significantly have a high impact on quality of life of these patients in terms of pain management and psycho-physical dysfuncRomation. When we deal with a chronic ulcer, as it often happens in patients affected by hemoglobinopathies, the key-point is to make the skin lesion healable and vital by reactivating blocked repair process. Although it's controversial topic, patterns of patients with higher HbF concentrations might be more protective in accordance with reduced HbS polymerization; indeed, clinical features of ulcer represent the best predictors suggesting the correct strategy to achieve a good final outcome. Hereafter we report the case of a young woman with skin complications secondary to drepanocytosis, in which an interlinked reparative model consisting of surgery and advanced medications in addition to an adequate transfusional support, especially in earlier phases, has allowed to achieve clinical success after several years of care failure.Meckel diverticulum is the most prevalent congenital malformation of gastrointestinal tract and usually it remains asymptomaRomatic. Approximately in 25% of cases Meckel diverticulum comes to be symptomatic with various clinical presentations where lower gastrointestinal hemorrhage or intestinal obstruction represent the most frequent clinical outcome. In present paper two cases of complicated Meckel diverticulum in young patients are described; in both cases diagnosis was difficult and initially mistaken with other pathologies. Surgical resection was the treatment of choice.Uterine fibroid is an estrogen-dependent mass growing during pregnancy. Caesarean myomectomy (CM) is a controversial procedure. A 35-year-old obese (106 Kg) patient gravida 2 para1 (caesarean section), undergoing caesarean section, had two myomas occupying the whole uterine fundus (104.2 mm and 50 mm respectively). Intracesarean myomectomy was carried out after extraction foetus (Apgar score 9/10). Postoperative course was uneventful and patient was discharged after four days.AIM The purpose of this study is to analyze a rare and under-reported complication of abdominal liposuction and the role of laparoscopy. CLINICAL CASE We report a case of bowel perforation after 7 days of abdominal liposuction and bilateral mastopexy. The patient presented clinical and radiological findings of bowel obstructive syndrome and bilateral peripheral pulmonary embolism. An emergency diagnostic laparoscopy was performed and confirmed the diagnosis of bowel perforation. DISCUSSION Bowel perforation is a known but under-reported comSOD Romaplication of abdominal liposuction, and it is characterized by a difficult diagnosis. The clinical presentation is characterized by a difficult diagnosis and severe complications. Bowel obstructive syndrome was constant, as our case and also peritonitis was never frank. This is an important point because it is one of the reasons for diagnostic delay. The development of laparoscopic surgery has changed the way to manage such conditions, where the diagnosis was doubt. In particular, when an acute abdomen occurs, laparoscopy may have three different roles to confirm or not the diagnosis, to facilitate and guide a subsequent laparotomy or, finally, to entirely treat the disease. CONCLUSION The bowel perforation is a dramatic and underestimated complication of abdominal liposuction. Diagnosis is complex. A clinical and radiological investigation should be quickly performed. In doubtful cases, an emergency laparoscopy can confirm the diagnosis and guide a possible subsequent laparotomy.Skin metastases from colorectal cancer are a rare phenomenon that occurs only in 4,4% of cases. The presence of a cutaneous lesion at the Romatime of diagnosis is even more uncommon (0,05% of cases), and represents a sign of widespread, poor prognosis and terminal disease. Skin involvement by colorectal cancer can occur in four different pathways lymphatic, hematogenous, direct invasion of contiguous tissues or iatrogenic implantation. We describe a case of a 68-year-old patient affected by a pT4b pN1 M1 sigma carcinoma with a head lesion that, at the time of diagnosis, mimics a lipoma at the head CT scan.The processing techniques of the adipose tissue represents one of the most debated topics. There are different processing techniques. As of today, the standard considered procedure is the centri1Romafugaton according to Coleman. In addition, other procedures include decantation/sedimentation, filtration and water jet force, which offer the specialist valid alternatives. In the present review, the clinical evidence of the techniques of centrifugation and decantation will be evaluated by studying histological data; maintenance of tropism and the maintenance of mesenchymal cells. These two aspects are different in the centrifugation and decantation techniques.Oncoplastic surgery is a well-acknowledged technique that combines conserving treatment in breast cancer with plastic surgery reconstruction. The aim of our analysis is to evaluate the safety of this surgical procedure in the setting of invasive primary breast cancer, and then compare breast oncoplastic surgery with the Veronesi quadrantectomy.We have analyzed 1541 patients who underwent breast surgery for primary breast tumor between October 2004 and May 2018 at Sant'Andrea University Hospital in Rome 880 women experienced the breast oncoplastic approach, while 660 patients received conservative surgery alone. The median follow-up time was 14 years with a completeness of 70% (1067 pts vs 1554). The statistic comparison across these subpopulations suggested that there are no statistically significant results in term of Overall Survival, Disease Related Survival, Local recurrence or positive margins. Therefore oncoplastic surgery for primary invasive breast cancer represents a feasible procedure and an oncological safe surgical option.