The patient’s perioperative perspective during the treatment of obstructive sleep apnea: a pilot study

© 2018, Springer International Publishing AG, part of Springer Nature. Purpose: This study aims to determine patients’ pre-operative and post-operative experiences relating to surgical treatment for obstructive sleep apnea (OSA), while understanding how patients’ perceptions influence their outcome and satisfaction. Methods: This is a phenomenological qualitative study using a semi-structured interview to evaluate patients who failed continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea and underwent airway surgery. Meaningful codes from the interviews were organized into overarching themes of patient experiences. The same surgeon in a tertiary care otolaryngology practice treated all patients. All patients underwent a modified or traditional uvulopalatopharyngoplasty (UPPP) between 2009 and 2013. Patients were diagnosed with OSA by polysomnogram and had failed CPAP use. Patients were interviewed regarding their experience with OSA, CPAP, and surgery. Thematic saturation was reached after 17 patients. Results: Six themes exemplify patient’s experience of OSA and treatment: (1) OSA impacted patients personally and professionally, (2) CPAP discomfort limited its therapeutic use, (3) patients had personal motivations for undergoing surgery, (4) patient knowledge influenced their perceptions, (5) post-operative challenges exceeded patient expectations, and (6) post-operative outcomes reflected positive effect on patients. Conclusions: Patients’ experiences prior to surgery can largely influence their perceived outcome and satisfaction. Post-operative sleep studies may not capture the full outcome of the patients’ response to surgery. This study suggests that the patient’s subjective reported outcomes should be used in conjunction with objective post-operative sleep studies

The patient\u27s perioperative perspective during the treatment of obstructive sleep apnea: a pilot study.

© 2018, Springer International Publishing AG, part of Springer Nature. Purpose: This study aims to determine patients’ pre-operative and post-operative experiences relating to surgical treatment for obstructive sleep apnea (OSA), while understanding how patients’ perceptions influence their outcome and satisfaction. Methods: This is a phenomenological qualitative study using a semi-structured interview to evaluate patients who failed continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea and underwent airway surgery. Meaningful codes from the interviews were organized into overarching themes of patient experiences. The same surgeon in a tertiary care otolaryngology practice treated all patients. All patients underwent a modified or traditional uvulopalatopharyngoplasty (UPPP) between 2009 and 2013. Patients were diagnosed with OSA by polysomnogram and had failed CPAP use. Patients were interviewed regarding their experience with OSA, CPAP, and surgery. Thematic saturation was reached after 17 patients. Results: Six themes exemplify patient’s experience of OSA and treatment: (1) OSA impacted patients personally and professionally, (2) CPAP discomfort limited its therapeutic use, (3) patients had personal motivations for undergoing surgery, (4) patient knowledge influenced their perceptions, (5) post-operative challenges exceeded patient expectations, and (6) post-operative outcomes reflected positive effect on patients. Conclusions: Patients’ experiences prior to surgery can largely influence their perceived outcome and satisfaction. Post-operative sleep studies may not capture the full outcome of the patients’ response to surgery. This study suggests that the patient’s subjective reported outcomes should be used in conjunction with objective post-operative sleep studies

Nasolacrimal Duct Management During Endoscopic Sinus and Skull Base Surgery

Objective: To evaluate rates of epiphora after transection and marsupialization of the nasolacrimal duct (NLD) during endoscopic sinus and skull base surgery. Introduction: The nasolacrimal canal forms part of the medial wall of the maxillary sinus. Transecting the NLD is sometimes necessary for tumor resection or surgical access to maxillary sinus and infratemporal fossa pathology. There is no consensus for the endoscopic management of the NLD when only the duct is transected without involving the nasolacrimal sac. Methods: Medical records of 29 patients from 2 academic institutions who underwent endoscopic sinus and skull base surgery with transection of the NLD were retrospectively reviewed. Whether the duct was marsupialized or simply transected was recorded, and the postoperative rate of epiphora was calculated. Results: Mean age was 59 years (range, 14-86 years). Mean follow-up was 10.5 months (range, 1-33 months). The NLD was marsupialized in 16 (55%) and simply transected in 13 (45%) patients. Six patients underwent postoperative radiation. No patients in the marsupialization group had epiphora postoperatively, all with Munk score of 0. One patient in the transection group developed postoperative epiphora with Munk score of 1. Pathology included inverted papilloma (8), acute on chronic inflammation (6), B-cell lymphoma (3), juvenile nasopharyngeal angiofibroma (2), squamous cell carcinoma (2), Schneiderian papilloma (2), metastatic melanoma (1), HPV-related carcinoma (1), adenocarcinoma (1), benign epithelial cyst (1), adenoid cystic carcinoma (1), and erosive chronic sinusitis without nasal polyposis (1). Conclusion: Management after transection of the NLD varies widely. The duct may be simply transected or marsupialized, or a formal dacryocystorhinostomy can be performed. The surgeon must also choose whether to place a stent. Based on our small series and review of the literature, marsupialization or simple transection of the NLD results in a low rate of postoperative epiphora in the setting of endoscopic sinus and skull base surgery

Toxic effect of emerging aquatic micropollutants on marine microalgae through the analysis of cytotoxicity biomarkers

Programa Oficial de Doutoramento DO*MAR Marine Science, Technology and Management . 564V01[Resumen] Debido a la creciente presencia de microcontaminantes emergentes en el medio marino, ha surgido la necesidad de estudiar la potencial toxicidad de estos compuestos sobre organismos acuáticos como las microalgas, utilizadas como indicadores de la contaminación debido a su papel fundamental como productores primarios. En este trabajo se propone una aproximación metodológica basada en el análisis citómico, para caracterizar las alteraciones producidas por distintos compuestos pertenecientes a las principales clases de fármacos y productos de cuidado e higiene personal, en la microalga marina Tetraselmis suecica, y establecer marcadores específicos de contaminación que sean sensibles y de respuesta rápida. Esta microalga verde es de crecimiento rápido, fácil de cultivar en laboratorio y muy utilizada en acuicultura como cultivo auxiliar. Todos los contaminantes emergentes ensayados, los antibióticos cloranfenicol, florfenicol y oxitetraciclina, el fármaco omeprazol, el filtro solar benzofenona‐3, el conservante triclosán y la fragancia tonalide, provocaron alteraciones fisiológicas en T. suecica. La autoflurescencia celular, la actividad esterasa y el potencial de membrana citoplasmático, han sido los parámetros más sensibles, mostrando alteraciones significativas en las células transcurridas sólo 24 h de exposición a los contaminantes, antes de poder detectar cambios en el crecimiento o viabilidad celular de los cultivos.[Resumo] Debido á crecente presenza de microcontaminantes emerxentes no medio mariño, xurdiu a necesidade de estudar a potencial toxicidade destes compostos sobre organismos acuáticos como as microalgas, utilizadas como indicadores da contaminación debido ao seu papel fundamental como produtores primarios. Neste traballo proponse unha aproximación metodolóxica baseada na análise citómica, para caracterizar as alteracións producidas por distintos compostos pertencentes ás principais clases de fármacos e produtos de coidado e hixiene persoal, na microalga mariña Tetraselmis suecica, e establecer marcadores específicos de contaminación que sexan sensibles e de resposta rápida. Esta microalga verde é de crecemento rápido, fácil de cultivar en laboratorio e moi utilizada en acuicultura como cultivo auxiliar. Todos os contaminantes emerxentes ensaiados, os antibióticos cloranfenicol, florfenicol e oxitetraciclina, o fármaco omeprazol, o filtro solar benzofenona‐3, o conservante triclosán e a fragrancia tonalide, provocaron alteracións fisiolóxicas en T. suecica. A autoflurescencia celular, a actividade esterasa e o potencial de membrana citoplasmático, foron os parámetros máis sensibles, mostrando alteracións significativas nas células transcorridas só 24 h de exposición aos contaminantes, antes de poder detectar cambios no crecemento ou viabilidade celular dos cultivos.[Abstract] Due to the growing presence of emerging micropollutants in the marine environment, the need to study the potential toxicity of these compounds on aquatic organisms such as microalgae has arisen. These microorganisms are used as indicators of pollution due to their fundamental role as primary producers. This study suggest a methodological approach based on the cytometric analysis, to characterize the alterations produced by different compounds belonging to the main classes of pharmaceuticals and personal care products, on the marine microalga Tetraselmis suecica, and to establish sensitive and fast specific markers of pollution. This green microalga is fast‐growing, easy to culture in the laboratory and widely used in aquaculture as auxiliary culture. All the assayed emerging pollutants, the antibiotics chloramphenicol, florphenicol and oxytetracycline, the pharmaceutical omeprazole, the ultraviolet filter benzophenone‐3, the disinfectant triclosan and the fragrance tonalide, caused physiological alterations in T. suecica. Cell autofluorescence, esterase activity and cytoplasmic membrane potential were the most sensitive parameters, showing significant alterations in the cells after only 24 h of exposure to the pollutants, before being able to detect changes in cell growth or viability of the cultures