Reversible obstructive sleep apnea and right heart failure due to massive tonsillar hypertrophy

Obstructive sleep apnea is a relatively common but under diagnosed clinical entity in children. Adenotonsillar hypertrophy is the most common cause for upper airway obstruction in pediatric patients. If the obstruction to upper airways is not relieved, then the child can develop obstructive sleep apnea and its consequences. Treatment is simply to remove the obstruction thereby restoring patency of upper airway

General physicians\u27 perspective of sleep apnea from a developing country

To assess the knowledge of general physicians about the diagnosis and management of obstructive sleep apnea (OSA), a self-administered questionnaire, containing 15 questions, was distributed to 160 doctors attending a pulmonary CME program in March 2002. After 15 minutes of response time, the questionnaires were collected. The data were entered and analyzed using SPSS (Version 10.0) software. One hundred and twenty (75%) questionnaires were returned. Only 41% of responders had ever read an article about OSA and 36% had suspected it at least once in their practice. The majority (61-77%) of responders were aware of the common symptoms of OSA, but 55% did not recognize its association with hypertension. A significant number of doctors were not aware that OSA could occur in non-obese individuals (33%), women (42%) and children (39%). Only 25% of responders recognized that a history and blood tests were insufficient to make a reliable diagnosis of OSA. Half of the responders were aware of CPAP therapy for OSA, whereas 18% would have prescribed sedatives to treat sleep disturbances in OSA

Eccrine porocarcinoma and Bowen\u27s disease with fatal metastasis to the lung

The term eccrine porocarcinoma was introduced by Mishima and Morioka in 1969 for the malignant counterpart of eccrine poroma. We report an uncommon and a rare case of an invasive adnexal carcinoma like porocarcinoma coexisting with Bowen\u27s disease with extremely rapid progression, metastatic spread to the lungs, leading to death in weeks

Non-invasive ventilation in the management of acute respiratory failure in Pakistan

Data were collected from hospital records on all patients who received non-invasive ventilation (NIV) during the period 1999-2000. Patients were treated with NIV if they had type I or type II respiratory failure or if they had respiratory distress with a respiratory rate above 30/min. A total of 68 patients (35 males) were studied. NIV was applied using a Respironics Bi-PAP device mostly on a high-dependency unit (HDU). A successful outcome with NIV was achieved in 70% (26/37) of patients with type II failure, 65% (11/17) patients with type I failure and 64% (9/14) patients with respiratory distress. Of the 16 patients considered to be inappropriate for invasive ventilation on admission, eight were treated successfully with NIV. NIV can be applied successfully in developing countries