6 research outputs found
Post tracheostomy and post intubation tracheal stenosis: Report of 31 cases and review of the literature
<p>Abstract</p> <p>Background</p> <p>Severe post tracheostomy (PT) and post intubation (PI) tracheal stenosis is an uncommon clinical entity that often requires interventional bronchoscopy before surgery is considered. We present our experience with severe PI and PT stenosis in regards to patient characteristics, possible risk factors, and therapy.</p> <p>Methods</p> <p>We conducted a retrospective chart review of 31 patients with PI and PT stenosis treated at Lahey Clinic over the past 8 years. Demographic characteristics, body mass index, co-morbidities, stenosis type and site, procedures performed and local treatments applied were recorded.</p> <p>Results</p> <p>The most common profile of a patient with tracheal stenosis in our series was a female (75%), obese (66%) patient with a history of diabetes mellitus (35.4%), hypertension (51.6%), and cardiovascular disease (45.1%), who was a current smoker (38.7%). Eleven patients (PI group) had only oro-tracheal intubation (5.2 days of intubation) and developed web-like stenosis at the cuff site. Twenty patients (PT group) had undergone tracheostomy (54.5 days of intubation) and in 17 (85%) of them the stenosis appeared around the tracheal stoma. There was an average of 2.4 procedures performed per patient. Rigid bronchoscopy with Nd:YAG laser and dilatation (mechanical or balloon) were the preferred methods used. Only 1(3.2%) patient was sent to surgery for re-stenosis after multiple interventional bronchoscopy treatments.</p> <p>Conclusion</p> <p>We have identified putative risk factors for the development of PI and PT stenosis. Differences in lesions characteristics and stenosis site were noted in our two patient groups. All patients underwent interventional bronchoscopy procedures as the first-line, and frequently the only treatment approach.</p
Comparison of cognitive performance among different age groups in patients with obstructive sleep apnea
The aim of this study was to evaluate the effect of obstructive sleep
apnea syndrome on the cognitive performance of young and middle-aged
patients. Patients were divided into two groups, one consisting of 30
patients less than 50 years of age and the other consisting of 28
patients 50 years and over. Normal subjects were similarly divided into
two groups, composed of 17 younger and 24 older controls. Patients and
controls were examined with all-night polysomnography and subsequently
underwent cognitive testing via attention-alertness tests. Comparing
young to middle-aged patients, there were statistically significant
differences in cognitive performance, especially in attention tests.
Younger patients’ cognitive performance was similar to their age-matched
controls, while middle-aged patients showed cognitive decline in
comparison with their age-matched controls. Although we studied only two
age groups using 50 years of age as a cut-off, we could demonstrate that
cognitive deterioration of untreated sleep apnea patients is age
dependent, and several factors may contribute to this effect including
brain hypoxia, sleep fragmentation, or comorbidities. Aging patients
with sleep apnea demonstrate cognitive decline, while younger patients
with the same disease severity are (somehow) able to compensate for this
effect