Behandlung der Nasenatmungsbehinderung bei Patienten mit obstruktiver Schlafapnoe

Zusammenfassung

Die Frage, welchen Einfluss die Behandlung einer eventuellen Nasenatmungsbehinderung bei obstruktiver Schlafapnoe (OSA) hat, wird auf Kongressen immer noch intensiv diskutiert. Grund hierfür sind vermutlich die sehr zwiespältigen Ergebnisse in Bezug auf die Verbesserung der Schlafqualität einerseits und den Schweregrad der OSA andererseits. Die Schlafqualität und damit die Erholfunktion des Schlafs verbessern sich hoch signifikant sowohl nach konservativer wie auch nach operativer Therapie einer Nasenatmungsbehinderung. Das hat auch Auswirkungen auf verschiedene Messparameter zur Bestimmung der Lebensqualität. Demgegenüber ist der Effekt einer konservativen oder operativen Verbesserung der Nasenluftpassage auf den Schweregrad einer OSA, gemessen im Apnoe-Hypopnoe-Index, von seltenen Ausnahmen abgesehen sehr gering. Es gibt aber erste Hinweise, dass sich bei einer erfolgreichen Nasenoperation der effektive Druck einer Ventilationstherapie reduzieren lässt.

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Update HNO

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Towards the development of innovative multi-mycotoxin reference materials as promising metrological tool for emerging and regulated mycotoxin analyses

Abstract

The interest in LC-MS/MS multi-mycotoxin methods unveiled an urgent need for multi-mycotoxin reference material. A multi-fusariotoxin, including deoxynivalenol (DON); zearalenone (ZEN); T-2 toxin (T-2); HT-2 toxin (HT-2); enniatin A, A1, B, and B1 (ENNs); and beauvericin (BEA), contaminated wheat flour was obtained by inoculation Fusarium spp. strains. The candidate material has successfully passed the homogeneity test and submitted to an international interlaboratory study achieved by 19 laboratories from 11 countries using their routine analytical method. The dispersion of the results for ZEN and BEA did not allow the derivation of reliable consensus values, while the assignment was only possible for DON, HT-2, T-2, and ENN A. No link was found between the methods used by the participants and the results. Significant changes in dry matter contents (≥±1.4 % of the initial dry matter) and significant changes in ergosterol contents (≥±10 %) did not occur. Using the mycotoxin contents in wheat flour stored at −80 °C as reference values, statistically significant decreases were observed only for T-2 contents at +24 °C, in contrast to the storage at −20 and +4 °C. For the other involved toxins, the candidate material was found to be stable at −20, +4, or +24 °C. Based on the T-2 decreases, a shelf life of 6 years was derived from isochronous study when the material is kept at −20 °C. At room temperature (e.g., +24 °C) or higher, this time validity drastically decreases down to 6 months. The development of this metrological tool is an important step towards food and feed quality control using multi-mycotoxin analyses. In vivo animal experiments using multi-mycotoxin-contaminated feeds dealing with the carryover or mitigation could further benefit from the methodology of this work.

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Contributors

Publication date: December 2016
Source:Anesthesiology Clinics, Volume 34, Issue 4





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The Patient with Multimorbidities: Does 1 + 1 Always Simply Equal 2?

Publication date: December 2016
Source:Anesthesiology Clinics, Volume 34, Issue 4
Author(s): Lee A. Fleisher




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Medically Complex Patients

Publication date: December 2016
Source:Anesthesiology Clinics, Volume 34, Issue 4
Author(s): Robert B. Schonberger, Stanley H. Rosenbaum




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Medically Complex Patients

Publication date: December 2016
Source:Anesthesiology Clinics, Volume 34, Issue 4
Author(s): Robert B. Schonberger, Stanley H. Rosenbaum




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Anesthetic Management of the Adult Patient with Concomitant Cardiac and Pulmonary Disease

Publication date: December 2016
Source:Anesthesiology Clinics, Volume 34, Issue 4
Author(s): Misty A. Radosevich, Daniel R. Brown

Teaser

Several common diseases of the cardiac and pulmonary systems and the interactions of the two in disease and anesthetic management are discussed. Management of these disease processes in isolation is reviewed and how the management of one organ system impacts another is then explored. For example, in a patient with acute lung injury and right heart failure, lung-protective ventilation may directly conflict with strategies to minimize right heart afterload. Such challenging clinical scenarios require appreciation of each disease entity, their appropriate management, and the balance between competing priorities.


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Anesthesia for the Patient with Concomitant Hepatic and Renal Impairment

Publication date: December 2016
Source:Anesthesiology Clinics, Volume 34, Issue 4
Author(s): Tricia E. Brentjens, Ryan Chadha

Teaser

Hepatic and renal disease are common comorbidities in patients presenting for intermediate- and high-risk surgery. With the evolution of perioperative medicine, anesthesiologists are encountering more patients who have significant hepatic and renal disease, both acute and chronic in nature. It is important that anesthesiologists have an in-depth understanding of the physiologic derangements seen with hepatic and renal disease to evaluate and manage these patients appropriately. Perioperative management requires an understanding of the physiologic perturbations associated with each disease process. This article elucidates the goals in the management and treatment of this complex patient population.


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Coexisting Cardiac and Hematologic Disorders

Publication date: December 2016
Source:Anesthesiology Clinics, Volume 34, Issue 4
Author(s): Jordan E. Goldhammer, Benjamin A. Kohl

Teaser

Patients with concomitant cardiac and hematologic disorders presenting for noncardiac surgery are challenging. Anemic patients with cardiac disease should be approached in a methodical fashion. Transfusion triggers and target should be based on underlying symptomatology. The approach to anticoagulation management in patients with artificial heart valves, cardiac devices, or severe heart failure in the operative setting must encompass a complete understanding of the rationale of a patient's therapy as well as calculate the risk of changing this regimen. This article focuses common disorders and discusses strategies to optimize care in patients with coexisting cardiac and hematologic disease.


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Surgical Critical Care for the Patient with Sepsis and Multiple Organ Dysfunction

Publication date: December 2016
Source:Anesthesiology Clinics, Volume 34, Issue 4
Author(s): Gary J. Kaml, Kimberly A. Davis

Teaser

Sepsis and multiple organ dysfunction syndrome (MODS) is common in the surgical intensive care unit. Sepsis involves infection and the patient's immune response. Timely recognition of sepsis and swift application of evidence-based interventions is critical to the success of therapy. This article reviews the nature of the septic process, existing definitions of sepsis, and current evidence-based treatment strategies for sepsis and MODS. An improved understanding of the process of sepsis and its relation to MODS has resulted in clinical definitions and scoring systems that allow for the quantification of disease severity and guidelines for treatment.


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Anesthesia for Patients with Concomitant Cardiac and Renal Dysfunction

Publication date: December 2016
Source:Anesthesiology Clinics, Volume 34, Issue 4
Author(s): Radwan Safa, Nicholas Sadovnikoff

Teaser

Renal disease and cardiovascular disease are commonly encountered in the same patient. The dynamic interactions between renal disease and cardiovascular disease have an impact on perioperative management. Renal failure is an independent risk factor for cardiovascular disease and the link between the two disease states remains to be fully elucidated.


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Anesthesia for Patients with Anemia

Publication date: December 2016
Source:Anesthesiology Clinics, Volume 34, Issue 4
Author(s): Aryeh Shander, Gregg P. Lobel, Mazyar Javidroozi

Teaser

Anemia is a common and often ignored condition in surgical patients. Anemia is usually multifactorial and iron deficiency and inflammation are commonly involved. An exacerbating factor in surgical patients is iatrogenic blood loss. Anemia has been repeatedly shown to be an independent predictor of worse outcomes. Patient blood management (PBM) provides a multimodality framework for prevention and management of anemia and related risk factors. The key strategies in PBM include support of hematopoiesis and improving hemoglobin level, optimizing coagulation and hemostasis, use of interdisciplinary blood conservation modalities, and patient-centered decision making throughout the course of care.


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Anesthesia Patients with Concomitant Cardiac and Hepatic Dysfunction

Publication date: December 2016
Source:Anesthesiology Clinics, Volume 34, Issue 4
Author(s): Julianne Ahdout, Michael Nurok

Teaser

Anesthesia and surgery in patients with hepatic and cardiac dysfunction poses a challenge for anesthesiologists. It is imperative to optimize these patients perioperatively. Cirrhosis is associated with a wide range of cardiovascular abnormalities. Cirrhotic cardiomyopathy is characterized by blunted contractile responsiveness or systolic incompetence, and/or diastolic dysfunction. In liver disease, anesthetic drug distribution, metabolism, and elimination may be altered. Among patients with liver disease, propofol is a reasonable anesthetic choice and cisatracurium is the preferred neuromuscular blocker. Regional anesthesia should be used whenever appropriate if not contraindicated by coagulopathy, because it reduces the need for systemic analgesia.


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Anesthesia for Patients with Concomitant Sepsis and Cardiac Dysfunction

Publication date: December 2016
Source:Anesthesiology Clinics, Volume 34, Issue 4
Author(s): Abed Abubaih, Charles Weissman

Teaser

Anesthesiologists faced with a patient with sepsis and concurrent cardiac dysfunction must be cognizant of the patient's cardiac status and cause of the cardiac problem to appropriately adapt physiologic and metabolic monitoring and anesthetic management. Anesthesia in such patients is challenging because the interaction of sepsis and cardiac dysfunction greatly complicates management. Intraoperative anesthesia management requires careful induction and maintenance of anesthesia; optimizing intravascular volume status; avoiding lung injury during mechanical ventilation; and close monitoring of arterial blood gases, serum lactate concentrations, and hematology renal and electrolyte parameters. Such patients have increased mortality because of their inability to adequately compensate for the cardiovascular changes caused by sepsis.


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Anesthesia for Patients with Concomitant Hepatic and Pulmonary Dysfunction

Publication date: December 2016
Source:Anesthesiology Clinics, Volume 34, Issue 4
Author(s): Geraldine C. Diaz, Michael F. O'Connor, John F. Renz

Teaser

Hepatic function and pulmonary function are interrelated with failure of one organ system affecting the other. With improved therapies, patients with concomitant hepatic and pulmonary failure increasingly enjoy a good quality of life and life expectancy. Therefore, the prevalence of such patients is increasing with more presenting for both emergent and elective surgical procedures. Hypoxemia requires a thorough evaluation in patients with end-stage liver disease. The most common etiologies respond to appropriate therapy. Portopulmonary hypertension and hepatopulmonary syndrome are associated with increased perioperative morbidity and mortality. It is incumbent on the anesthesiologist to understand the physiology of liver failure and its early effect on pulmonary function to ensure a successful outcome.


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Index

Publication date: December 2016
Source:Anesthesiology Clinics, Volume 34, Issue 4





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Phase I–II study of lenalidomide and alemtuzumab in refractory chronic lymphocytic leukemia (CLL): effects on T cells and immune checkpoints

Abstract

This phase I–II study explored safety, immunomodulatory and clinical effects of lenalidomide (weeks 1–16) and alemtuzumab (weeks 5–16) in 23 patients with refractory chronic lymphocytic leukemia. Most patients had Rai stage III/IV disease and were heavily pretreated (median 4 prior therapies), and 61% had del(17p)/del(11q). Eleven of 19 evaluable patients (58%) responded, with a median response duration of 12 months (1–29+); time to progression was short in non-responders. Lenalidomide had a narrow therapeutic dose range, 2.5 mg/day was not efficient, and maximum tolerated dose was 5 mg/day. Grade 3–4 neutropenia and thrombocytopenia occurred in 84 and 55%, 30% had febrile neutropenia, and CMV-reactivation requiring valganciclovir occurred in 30% of patients. The frequency of proliferating (Ki67⁺) CD8⁺ T cells was increased at week 4, with further increase in both the CD4⁺ and CD8⁺ subsets (p < 0.01 and <0.05), which was accompanied by significant upregulation of HLA-DR after addition of alemtuzumab. Antigen-experienced cells increased at week 4 as the frequency of effector memory cells increased in the CD8⁺ subset (p < 0.003), while effector cells decreased in both the CD8⁺ and CD4⁺ subsets (p < 0.0001 and p < 0.01). The Th1/Th2 balance was unchanged at week 4 but shifted toward a Th2 profile after combination therapy. At end of treatment, the frequency of Th17 and regulatory T cells was reduced (p < 0.01), naïve T cells decreased, and effector memory T cells increased (p < 0.05 and p < 0.01). Granzyme B⁺ T cells increased at 30-week follow-up (p < 0.05). PD-1 expression was unaffected. In conclusion, low-dose lenalidomide and alemtuzumab induced major perturbations of T cells, including increased proliferative activity and cytotoxic potential.

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Intersurgical interval increased with use of quadrivalent human papillomavirus vaccine (Gardasil) in a pediatric patient with recurrent respiratory papillomatosis: A case report

Publication date: December 2016
Source:International Journal of Pediatric Otorhinolaryngology, Volume 91
Author(s): Maraya M. Baumanis, Charles A. Elmaraghy
This is a case of a 4 year old female with recalcitrant recurrent respiratory papillomatosis with decreasing intersurgical interval that had improvement in clinical course after administration of the quadrivalent HPV vaccine.



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Decision aid prototype development for parents considering adenotonsillectomy for their children with sleep disordered breathing

To describe the process involved in developing a decision aid prototype for parents considering adenotonsillectomy for their children with sleep disordered breathing.

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Cisto Nasoalveolar Bilateral

Imagens Cisto Nasoalveolar Bilateral

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Estudo Orelha – Anatomia Normal

Imagens Estudo Orelha – Anatomia Normal

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