Synthèse diastéréo- et énantiosélective de buténolides par interaction des complexes carbéniques du chrome et du tungtène avec les dihydropyridines et les nucléophiles

PARIS-BIUSJ-Thèses (751052125) / SudocPARIS-BIUSJ-Physique recherche (751052113) / SudocSudocFranceF

Revisão abrangente sobre tratamento cirúrgico para a síndrome de apneia obstrutiva do sono

Existem várias modalidades cirúrgicas utilizadas no tratamento da síndrome de apneia obstrutiva do sono (SAOS). Esta afecção pode causar sonolência diurna excessiva, bem como aumentar o risco de morbidade e mortalidade cardiovascular. Os doentes que não aderem ao tratamento médico convencional são frequentemente encaminhados para tratamento por procedimento cirúrgico. OBJETIVO: Recapitular e descrever as principais opções cirúrgicas, do foro otorrinolaringológico, disponíveis para o tratamento de SAOS, bem como apresentar os resultados em termos de melhoria do índice de apneia/hipopneia e benefícios sobre a mortalidade. MÉTODO: Revisão bibliográfica acerca dos diferentes tratamentos cirúrgicos, tanto de tecidos moles como de tecidos esqueléticos. Foram apenas incluídos os artigos que apresentavam as descrições originais. Revisões sistemáticas e artigos que apresentavam resultados funcionais das cirurgias também foram incluídos nesta análise. RESULTADOS: Vinte e nove modalidades cirúrgicas foram identificadas, tendo sido apresentados os autores dos artigos originais e o seu ano de descrição. Foram, ainda, apresentados dados polissonográficos relativos ao índice de apneia, índice de apneia/hipopneia e dados sobre a mortalidade. CONCLUSÃO: Existe uma grande heterogeneidade nos resultados da cirurgia no tratamento de SAOS. A combinação de diversos procedimentos cirúrgicos parece melhorar as taxas de sucesso bem como as taxas de cura. A tecnologia neste domínio evolui rapidamente, e os cirurgiões que se dedicam a esta afecções devem manter-se atualizados e integrar equipes multidisciplinares, a fim de maximizar os resultados

Mathematical Equations to Predict Positive Airway Pressures for Obstructive Sleep Apnea: A Systematic Review

Objective. To systematically review the international literature for mathematical equations used to predict effective pressures for positive airway pressure (PAP) devices. Methods. Google Scholar, PubMed, Scopus, Embase, Web of Science, CINAHL, and The Cochrane Library were searched through June 27, 2015. The PRISMA statement was followed. There was no language limitation. Results. 709 articles were screened, fifty were downloaded, and twenty-six studies presented equations that met the inclusion and exclusion criteria. In total, there were 4,436 patients in the development phases and 3,489 patients in the validation phases. Studies performed multiple linear regressions analyses as part of the equation(s) development and included the following variables: physical characteristics, polysomnography data, behavioral characteristics, and miscellaneous characteristics, which were all predictive to a variable extent. Of the published variables, body mass index (BMI) and mean oxygen saturation are the most heavily weighted, while BMI (eighteen studies), apnea-hypopnea index (seventeen studies), and neck circumference (eleven studies) were the variables most frequently used in the mathematical equations. Ten studies were from Asian countries and sixteen were from non-Asian countries. Conclusion. This systematic review identified twenty-six unique studies reporting mathematical equations which are summarized. Overall, BMI and mean oxygen saturation are the most heavily weighted

Eficácia a longo prazo das ossiculoplastias com prótese de titânio

BACKGROUND: Titanium prosthesis ossiculoplasty has increased in recent years. These prostheses are lightweight, carry the sound effectively, providing good audiometric results. The aims of this study were to assess the long term effectiveness of titanium prosthesis ossiculoplasty and the evaluation of potential prognostic factors. METHODS: Retrospective study of titanium prosthesis (KurzR) ossiculoplasty performed at the Department of Otorhinolaryngology, of our institution between 2000 and 2005. Ossiculoplasty success was determined by audiometric analysis conducted in the first 12 months postoperatively (defined by air-bone gap - ABG - postoperative .20 dB). Patiens with inicial success were evaluated audiometry at least 7 years after surgery. We performed a statistical analysis to try to determine the factors that could influence the long-term results. RESULTS: In the studied period were conducted with 57 titanium prosthesis ossiculoplasty that fulfilled the criteria for inclusion and exclusion. The early success rate was 71.9% (41 patients). The early postoperative mean ABG was 12.84 dB. The average difference between early and late postoperative ABG was 3.78 dB. The late audiometric evaluation determined 30 patients maintained audiometric criteria of success. Comparative analysis of the difference between the postoperatives ABG�fs revealed a statistically significant difference when stapes superstruture was present (p = 0.027). CONCLUSIONS: In the patients who achieved surgical success, the long-term success rates showed to be elevated. The presence of stapes superstruture appears to positively influence the long-term success.INTRODUCAO: A utilizacao de proteses de titanio na realizacao de ossiculoplastias tem aumentado nos ultimos anos. Estas proteses sao leves, conduzem o som de forma eficaz, levando a bons resultados audiometricos. Os objectivos deste trabalho foram: avaliar a eficacia a longo prazo das ossiculoplastias com protese de titanio e possiveis factores de prognostico dessa eficacia. METODOS: Estudo retrospectivo das ossiculoplastias com protese de titanio (KurzR) realizadas no Servico de Otorrinolaringologia da nossa instituicao entre 2000 e 2005. Os doentes, em que a ossiculoplastia foi um sucesso (Gap Aero-Osseo . GAO: posoperatorio . 20 dB) determinado pelo estudo audiometrico realizado nos primeiros 12 meses de pos-operatorio, foram avaliados audiometricamente pelo menos 7 anos depois do procedimento cirurgico. Foi realizada uma analise estatistica dos resultados para tentar determinar os factores que poderiam influenciar os resultados a longo prazo. RESULTADOS: No periodo estudado foram realizadas 57 ossiculoplastias com proteses de titanio que cumpriam os criterios de inclusao e exclusao. A taxa de sucesso precoce foi de 71,9% (41 doentes). A avaliacao tardia do sucesso determinou que 30 doentes mantinham critérios audiométricos de sucesso. A diferença média entre os GAO pós-operatórios precoces e tardios foi de 3,78 dB. Apenas a presença de supraestrutura do estribo se revelou significativa (p = 0,027) como preditora do sucesso tardio. CONCLUSÕES: Nos doentes em que se conseguiu sucesso cirúrgico precoce, o sucesso a longo prazo apresentou taxas elevadas. A presença da supra-estrutura do estribo parece influenciar positivamente o sucesso a longo prazo

Inferior Turbinate Size and CPAP Titration Based Treatment Pressures: No Association Found among Patients Who Have Not Had Nasal Surgery

Objective. To evaluate the effect of turbinate sizes on the titrated continuous positive airway pressure (CPAP) therapeutic treatment pressures for patients with obstructive sleep apnea (OSA) who have not had nasal surgery. Study Design. Retrospective case series. Methods. A chart review was performed for 250 consecutive patients. Results. 45 patients met inclusion criteria. The mean ± standard deviation (M ± SD) for age was 54.6±22.4 years and for body mass index was 28.5±5.9 kg/m2. The Spearman’s rank correlation coefficient (rs) between CPAP therapeutic treatment pressures and several variables were calculated and were weakly correlated (age rs=0.29, nasal obstruction rs=-0.30), moderately correlated (body mass index rs=0.42 and lowest oxygen saturation rs=-0.47), or strongly correlated (apnea-hypopnea index rs=0.60 and oxygen desaturation index (rs=0.62)). No statistical significance was found with one-way analysis of variance (ANOVA) between CPAP therapeutic treatment pressures and inferior turbinate size (right turbinates p value = 0.2012, left turbinate p value = 0.3064), nasal septal deviation (p value = 0.4979), or mask type (p value = 0.5136). Conclusion. In this study, CPAP titration based therapeutic treatment pressures were not found to be associated with inferior turbinate sizes; however, the CPAP therapeutic treatment pressures were strongly correlated with apnea-hypopnea index and oxygen desaturation index

Mini Tracheostomy for Obstructive Sleep Apnea: An Evidence Based Proposal

Objective. To search for articles evaluating the use of tracheostomies (either permanent stomas or tracheostomy tubes) in adult obstructive sleep apnea (OSA) patients and to evaluate the potential for the use of mini tracheostomies as treatment for OSA. Study Design. Systematic review. Methods. Nine databases were searched from inception through July 21, 2015. Results. The overall tracheostomy search yielded 516 articles, of which eighteen studies provided polysomnographic data. No study was identified (empty review) for the use of mini tracheostomies for treating OSA. The mini tracheostomy search yielded ninety-five articles which describe findings for either mini tracheostomy kits (inner cannula diameter of 4 mm) or the performance of mini tracheotomies. Six articles described the use of mini tracheostomies as a temporary procedure to relieve acute upper airway obstruction and none described the use for OSA. For tracheostomy stomal sites, suturing the skin directly to the tracheal rings with defatting can minimize stomal site collapse. The smallest tracheostomy stomal size that can successfully treat OSA has not been described. Conclusion. Mini tracheostomies as small as 4 mm have been successfully used in the short term to relieve upper airway obstruction. Given that polysomnography data are lacking, additional research is needed

Dexmedetomidine versus propofol during drug-induced sleep endoscopy and sedation: a systematic review

Background The purpose of the present study is to review the international literature, using a systematic review, for studies comparing propofol and dexmedetomidine for drug-induced sleep endoscopy (DISE) or sedation in which there is a description of the effect of the agents on the upper airway and associated variables (e.g., vital signs, sedation scores). Methods This is a systematic review through October 4, 2016. PubMed/MEDLINE and four additional databases were accessed for this study. Results Two hundred twenty studies were screened. 79 were downloaded, and 10 met criteria. The majority of the studies identified dexmedetomidine as the preferred pharmacologic agent for DISE due to an overall safer and more stable profile based upon hemodynamic stability. However, propofol provided greater airway obstruction with oxygen desaturations. With either agent, the degree of obstruction in the upper airway lacks some degree of validity as to whether the obstructions accurately represent natural sleep or are simply a drug induced effect. Conclusion Dexmedetomidine and propofol have their advantages and disadvantages during DISE. Generally, dexmedetomidine was preferred and seemed to provide a more stable profile based upon cardiopulmonary status. However, propofol has a quicker onset, has a shorter half-life, and can demonstrate larger degrees of obstruction, which might more accurately reflect what happens during REM sleep. Additional research is recommended

Supraglottoplasty for laryngomalacia with obstructive sleep apnea: A systematic review and meta-analysis

To determine if apnea-hypopnea index (AHI) and lowest oxygen saturation (LSAT) improve following isolated supraglottoplasty for laryngomalacia with obstructive sleep apnea (OSA) in children. Systematic review and meta-analysis. Nine databases, including PubMed/MEDLINE, were searched through September 30, 2015. A total of 517 studies were screened; 57 were reviewed; and 13 met criteria. One hundred thirty-eight patients were included (age range: 1 month-12.6 years). Sixty-four patients had sleep exclusive laryngomalacia, and in these patients: 1) AHI decreased from a mean (M) ± standard deviation (SD) of 14.0 ± 16.5 (95% confidence interval [CI] 10.0, 18.0) to 3.3 ± 4.0 (95% CI 2.4, 4.4) events/hour (relative reduction: 76.4% [95% CI 53.6, 106.4]); 2) LSAT improved from a M ± SD of 84.8 ± 8.4% (95% CI 82.8, 86.8) to 87.6 ± 4.4% (95% CI 86.6, 88.8); 3) standardized mean differences (SMD) demonstrated a small effect for LSAT and a large effect for AHI; and 4) cure (AHI < 1 event/hour) was 10.5% (19 patients with individual data). Seventy-four patients had congenital laryngomalacia, and in these patients: 1) AHI decreased from a M ± SD of 20.4 ± 23.9 (95% CI 12.8, 28.0) to 4.0 ± 4.5 (95% CI 2.6, 5.4) events/hour (relative reduction: 80.4% [95% CI 46.6, 107.4]); 2) LSAT improved from a M ± SD of 74.5 ± 11.9% (95% CI 70.9, 78.1) to 88.4 ± 6.6% (95% CI 86.4, 90.4); 3) SMD demonstrated a large effect for both AHI and LSAT; and 4) cure was 26.5% (38 patients with individual data). Supraglottoplasty has improved AHI and LSAT in children with OSA and either sleep exclusive laryngomalacia or congenital laryngomalacia; however, the majority of them are not cured. Laryngoscope, 126:1246-1255, 2016

Predictors of Nasal Obstruction: Quantification and Assessment Using Multiple Grading Scales

Objective. To evaluate the association between nasal obstruction and (1) demographic factors, (2) medical history, (3) physical tests, and (4) nasal exam findings. Study Design. Case series. Methods. Chart review at a tertiary medical center. Results. Two hundred-forty consecutive patients (52.1±17.5 years old, with a Nasal Obstruction Symptom Evaluation (NOSE) score of 32.0±24.1) were included. Demographic factors and inferior turbinate sizes were not associated with NOSE score or Nasal Obstruction Visual Analog Scale (NO-VAS). A significant association was found between higher NOSE score on univariate analysis and positive history of nasal trauma (p=0.0136), allergic rhinitis (p<0.0001), use of nasal steroids (p=0.0108), higher grade of external nasal deformity (p=0.0149), higher internal nasal septal deviation grade (p=0.0024), and narrow internal nasal valve angle (p<0.0001). Multivariate analysis identified the following as independent predictors of high NOSE score: NO-VAS: ≥50 (Odds Ratio (OR) = 17.6 (95% CI 5.83–61.6), p<0.0001), external nasal deformity: grades 2–4 (OR = 4.63 (95% CI 1.14–19.9), p=0.0339), and allergic rhinitis: yes (OR = 5.5 (95% CI 1.77–18.7), p=0.0041). Conclusion. Allergic rhinitis, NO-VAS score ≥ 50, and external nasal deformity (grades 2–4) were statistically significant independent predictors of high NOSE scores on multivariate analysis. Inferior turbinate size was not associated with NOSE scores or NO-VAS