M. Abouda

Is obstructive sleep apnea a problem in Parkinson's disease?

BACKGROUND Parkinsons disease (PD) is associated with sleep disorders and daytime sleepiness. Upper airway dysfunction in PD may promote obstructive sleep apnea. However, the frequency and clinical relevance of sleep-disordered breathing in PD remains unclear. METHODS Sleep apnea symptoms, cardiovascular events and treatment were collected in 100 patients with PD (50 unselected, consecutive patients matched for age, sex and body mass index with 50 patients referred for sleepiness) and 50 in-hospital controls. The motor and cognitive status was evaluated in patients with PD. The 150 subjects underwent a video-polysomnography. RESULTS Sleep apnea (defined as an apnea-hypopnea index greater than 5) was less frequent in the PD group (27% patients, including 6% with mild, 11% with moderate and 10% with severe sleep apnea) than in the control group (40% in-hospital controls, p<0.002). Sleep apnea was not associated with increased sleepiness, nocturia, depression, cognitive impairment and cardiovascular events in patients with PD. Sleep apnea was more frequent and severe in the most disabled patients. Patients with PD did not display sleep hypoventilation, stridor and abnormal central sleep apnea. In patients with REM sleep behavior disorders, snoring and obstructive sleep apnea occurred during REM sleep, although the chin muscle tone was maintained. CONCLUSION Obstructive sleep apnea does not seem to be a clinically relevant issue in PD. Daytime sleepiness, nocturia and cognitive impairment are mostly caused by other, non-apneic mechanisms. The maintenance of chin muscle tone during REM sleep behavior disorder has no influence on the frequency of apneic events.

Sleep-Related Painful Erections in a Patient With Obstructive Sleep Apnea Syndrome

Sleep-related painful erection (SRPE) is a rare sleep disorder characterized by recurrent, painful penile erections occurring when awakening from rapid eye movement sleep, while erections are painless during wakefulness. Almost 35 cases have been reported worldwide, and only two of them had an associated obstructive sleep apnea syndrome (OSAS). We report a new case of a 61-year-old man suffering from SRPE associated with OSAS. The adequate treatment of respiratory events with continuous positive airway pressure did not alleviate the SRPE symptoms and excessive daytime sleepiness. The SRPE diagnosis was made by polysomnography coupled with video surveillance when the patient was referred to the sleep laboratory for residual excessive daytime sleepiness. The patient had 2–4 episodes of SRPE/night. Beta-blocker did not alleviate the SRPE, but a transient improvement was noted when the patient was treated with paroxetine. In contrast with the two previously published cases of SRPE plus OSAS, continuous positive airway treatment did not improve SRPE symptoms in our patient.

Giant Mandibular Ameloblastoma

CASE PRESENTATION A 28-year-old African woman presented with a giant painless mass in the left mandible for 8 years. The mass had gradually developed after the extraction of a left inferior premolar. The ovoid swelling was well-limited, nontender and measured 24 cm 18 cm 15 cm, extending to the lower orbital margin and involving the complete left side of the jaw. Computed tomography scan demonstrated the presence of a multilocular cystic mass located on the left side of the mandible passing over the median line, invading the left maxillary sinus and preserving the floor of the left orbit (Figure A). The treatment was subtotal segmental mandibulectomy (Figure B) with immediate reconstruction using a nonvascularized bone graft from the iliac crest. The pathologic examination confirmed the diagnosis of a benign predominantly follicular ameloblastoma (Figure C). Good postoperative functional and esthetic results were obtained. Ameloblastoma or adamantinoma is a locally aggressive and histologically benign tumor of the jaw, arising from the oral ectoderm. It accounts for 1% of all maxillomandibular and oral tumors and constitutes about 10% of odontogenic tumors. It has a high rate of local recurrence that can reach up to 50% when treated inadequately and can become malignant in less than 1% of cases. This epithelial odontogenic neoplasm, more

Tracheobronchopathia osteochondroplastica: an unusual cause of chronic cough

Learning point for clinicians Chronic cough is a common reason for consultation and management presents a challenge for the clinician. Various rare causes of chronic cough should be considered when the classical etiologies have been eliminated. These rare causes of chronic cough include benign lesions of the trachea such as Tracheobronchopathia osteochondroplastica (TO).1 TO is a rare disease of unknown origin characterized by multiple submucosal nodules osteocartilaginous of the trachea and major airways. We report a case of TO incidentally discovered at imaging in old woman suffering of chronic cough. …

Distant peer-tutoring for developing countries

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Multifocal Thoracic Tuberculosis

FIGURE 1. Chest X-ray showing alveolar opacity in the left upper lobe, a bilateral medisatinal enlargement, and bone destruction of the sixth right rib. A 44-year-old North African woman was admitted for a 4-month history of weight loss, dry cough, and back pain. Physical examination showed a temperature of 39 C and a 4-cm painless elastic mass in her right chest wall. Laboratory data showed lymphopenia (552/mm), high erythrocyte sedimentation rate (123 mm/h), and high C-reactive protein (162 mg/dL) with negative HIV test result. Anteroposterior chest X-ray showed a widening of the posterior mediastinum with increased prevertebral soft tissue shadow, alveolar opacity in the left upper lobe, and lytic lesion involving the sixth right rib anteriorly (Figure 1). Tuberculin test and sputum smears for acid fast staining were negative. The chest computed tomography scan revealed a chestwall collection in front of the sixth rib with bone destruction (Figure 2, A), large paravertebral fluid mass of soft tissue surrounding the vertebra, extending from T1 to T6measuring120 27mm,destructionof vertebral bodies from T3 to T5 (Figure 2, B), and parenchymal condensation in the upper left lobe. Magnetic resonance imaging of the spine showed thoracic paraspinal abscess with severe spondylodiscitis, diffuse spine destruction, and prevertebral sacral spine collection with

Pulmonary Hydatid Cyst Mimicking a Lung Cancer

http://dx.doi.org/10.1016/j.jtho.2015.12.112 A 54-year-old, previously healthy, male smoker was admitted with a 3-month history of cough and hemoptysis. The physical examination results were normal. Chest radiography revealed a right upper lobe (RUL) consolidation. Laboratory examinations showed an elevated erythrocyte sedimentation rate and C-reactive protein level. The result of the sputum smear examination for acid-fast bacilli was negative. Computed tomography (CT) of the chest showed a cavitating mass in the RUL with moderate enhancement after

Sleep apnea in Chiari I malformation

A 36-year-old non-obese woman consulted her physician for recent excessive daytime sleepiness (EDS) with Epworth sleepiness scale (ESS) at 13/24, morning headache and heavy snoring. Polysomnography revealed moderate mixed sleep apnea syndrome with an Apnoea–Hypopnoea Index (AHI) of 23/h (Figure 1). Despite adequate continuous positive airway pressure (CPAP) therapy, the patient reported an aggravation of EDS and headache. A second polysomnography with CPAP, conclude to moderate complex sleep apnea syndrome by revealing the persistence of numerous central sleep apnea (AHI of 21/h) but no evidence of obstructive events. The patient reported a sensation of unrefreshing sleep and EDS (ESS at 17/24) with no symptoms suggesting cardiac failure, periodic limb movement disorder or narcolepsy. Physical examination, including neurologic and cardiac examinations, was normal. Routine blood tests, arterial blood gas analysis and echocardiography were performed and showed no significant abnormalities.

Pleural effusions after cardiac surgery: Etiology and outcomes

Background: Pleural effusions (PE) occur commonly after cardiac surgery (CS). However little is known about risk factors for their developing. Objective: the aim of our study was to investigate the prevalence, the clinical course and risk factors of PE after CS. Methods: It was a retrospective study from January 2011 to December 2016. We enumerate patients who developed pleural effusion after a CS and studied epidemiological clinical, biological and radiological data. Results: Among 75 patients included in the study, 31 patients(41%) developed a PE. The mean age was 57 years (28 males and 3 females). Seventeen patients were smokers. The Most common comorbidities were hypertension (55%), diabetes (55%).The most of these effusions occurred 15 days post surgery (early onset). The mean time of occurrence was by the seventh post operative day. PE were on the left side (51%), and bilateral (22%). The etiology of most of PE remains unclear. Eight of the effusions were a pneumonitis reaction, 3 were attributed to congestive heart failure and 1 was an empyema. Pleural fluid was hemorrhagic and fluid analysis showed an exudate in most cases. The volume of effusion was under 120 ml in 80% of patients. Coronary artery bypass grafting (CAPG) (71%) and valvular replacement (VR) (22%) were the most common indications for CS. The PE occurred in 40% of cases after a CAPG and in 14% of cases after a VR. The mean duration of CBP in patients who developed PE was 99,11min.The treatment was based on the etiology and pleural physiotherapy. The evolution was favorable in most cases. Conclusion: PE is common complication of CS. The cause of many of PE remains unclear. CAPG is associated with greater proportion of them.

Correlation between Arabic version of the asthma control test, forced expiratory volume at 1 s and exhaled nitric oxide in Tunisian asthmatic patients

Background Numerous markers of asthma severity and activity are available. Among them, functional parameters, clinical assessment and biomarkers of inflammation are the most widely used. It is difficult to establish a clear correlation among theses parameters, as each of them measure a particular aspect of the disease. Objective The aim of the study was to clarify the correlation between Asthma Control Test (ACT) scores, exhaled nitric oxide (eNO) levels and forced expiratory volume at 1s (FEV1). Methods It was a cross sectional study including patients treated for asthma for at least 3 months. All patients completed the ACT questionnaire and underwent testing for eNO and spirometry. Results A total of 148 asthmatic patients were included. The mean age was 44.2 ±14.7 years and 55.4% of patients were female. The ACT scores varied from 5 to 25 (median 22), and asthma control was obtained in 71.7% of patients. The percentage of predicted FEV1 ranged from 42% to 121% (mean 86%) and eNO varied between 10 and 175 ppb (mean 30.4 ppb). ENO values in the controlled group were significantly better than in uncontrolled group (27 ppb vs 42.1, p=0.01). The ACT score was negatively correlated with eNO values (r= - 0.33, p=0,001) and positively correlated with percentage of predicted FEV1 (r=0.1, p= 0.08). However, the association was weak in view of each correlation coefficient value. There was no correlation between FEV1 and eNO ( r=0.06, p=0.4). Conclusion ACT, FEV1 and eNO quantify variables that evaluate asthma in different ways and they are complementary. Thus, ACT should be used in combination with pulmonary function tests and/or eNO measurements.