Hossein Movahed

Airway observations during upper endoscopy predicting obstructive sleep apnea

Background This pilot study examined airway characteristics during upper endoscopy to determine who is at high risk for obstructive sleep apnea. Methods Patients undergoing routine upper endoscopy were divided into 2 groups according to the Berlin Questionnaire (high and low risk for sleep disordered breathing). Patients underwent routine upper endoscopy using propofol sedation. The airway was then evaluated for no, partial, or complete collapse at the levels of the palate/uvula/tonsils, the tongue base, the hypopharynx, and the larynx. They were given a score of 0 for no collapse, 1 for partial collapse, and 2 for complete collapse. The score for each of these levels was added to give a total score or severity index. The larynx was also evaluated for lateral pharyngeal collapse (minimal, up to 50%, >50%, or 100%). Results We found that patients with a partial obstruction at the level of the palate/uvula/tonsils, tongue base, hypopharynx, or larynx, or complete obstruction at any level more often had a positive Berlin questionnaire. Patients with a positive Berlin questionnaire were more often of increased weight (mean 197 vs 175 lbs, P=0.19), increased body mass index (31.2 vs 27.42 kg/m2, P=0.11), increased neck circumference (36.7 vs 34.7 cm, P=0.23), and had a higher total airway score (2.61 vs 1.67, P=0.09). Conclusions The results of our pilot study represent preliminary data regarding the use of upper endoscopy as a potential tool to evaluate patients for obstructive sleep apnea.

Successful management of a very large common hepatic duct stone in a patient with pancreaticoduodenectomy by use of cholangioscopy and electrohydraulic lithotripsy

re 1. A, Large filling defect in common hepatic duct on MRCP. B, Dilated intrahepatic ducts on MRCP. C, Unsuccessful attempt at removal of stone extraction balloon. D, Electrohydraulic lithotripsy probe could not be lined up with a large fragment of the stone due to the stone’s location. E, Use hincterotome to guide the electrohydraulic lithotripsy probe. F, Electrohydraulic lithotripsy. G, Two stents placed after second ERCP. H, Removal of fragments with extraction balloon. I, No residual stone on occlusion cholangiogram at the end of the third ERCP.

Beneficial Effects of Exercise Training in Patients with Chronic Heart Failure

Several human and experimental studies have been performed to show the effects of exercise training on chronic heart failure (CHF). These studies have shown that exercise improves the adverse pathophysiologic changes which occur with CHF, including enhanced exercise capacity, ventilation, skeletal muscle metabolism, cardiac function, quality of life, and peripheral blood flow. In addition, there is an improved modulation of inflammatory, autonomic, and hormonal dysregulation after exercise training. This review focuses on the current evidence surrounding the beneficial effects of exercise training in CHF patients.