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Original papers

Variability of cardiac rate in patients with obstructive sleep apnea/hypopnea syndrome

SinzianaLovin, T. Mihaescu, G.I. Pandele, Fl. Mitu
Variability of cardiac rate in patients with obstructive sleep apnea/hypopnea syndrome
Abstract

Background. Obstructive sleep apnea-hypopnea syndrome (OSAHS) is characterized by repeated breathing pauses caused by upper airway collapseduring sleep, leading to intermittent hypoxemia, sleep fragmentation and autonomic dysfunction. The gold standard for the treatment of OSAHS is

ventilation with continuous positive airway pressure (CPAP). Aim. To study the effect of CPAP on autonomic dysfunction in patients OSAHS, byassessing the heart rate variability (HRV) parameters before the initiation of CPAP and under CPAP during the first week and at 3 months. Material,

methods: We have assessed HRV parametrs by 24 hours ECG Holter monitoring in 42 patients with moderate and severe OSAHS (apnea-hypopneaindex AHI ≥ 15∕h) without other causes of autonomic neuropathy. The assessment was made at diagnosis, during the first week of CPAP use and at

3 months of CPAP use. Results. Both time domain and frequency domain HRV parameters decreased significantly during the first week of CPAP useand increased back to normal values at 3 months. Initially and during the first week of treatment, HRV parameters correlated negatively with the severity

of OSAHS expressed by AHI. Conclusions. Patients with OSAHS present an alteration of HRV present an alteration of HRV, proportionally withdisease severity. The decrease in HRV is revealed by the absence of apneas during the initiation of CPAP. After 3 months of CPAP treatment, the HRVpapar=meters are normalized independently of the disease severity.

Keywords: sleep apnea, heart rate variability

Efficacy and safety of iodopovidone pleurodesis through chesttube in spontaneous pneumothorax

Rahim Mahmodlou, Mohammad Hossein Rahimi-Rad,Hatef Alizadeh
Efficacy and safety of iodopovidone pleurodesis through chesttube in spontaneous pneumothorax
Abstract

Pleurodesis is one of the best methods of controlling malignant pleural effusions and pneumothorax. Recently Iodopovidone (IP) which is cheapand easily available was used for pleurodesis and demonstrated low morbidity with good results similar to talcum powder. However, in those studies awide range of pleural diseases were included, and heterogeneity makes it difficult to draw conclusions about spontaneous pneumothorax (SP). The aimof this study was to evaluate the efficacy and safety of IP pleurodesis in SP. Methods. In 29 patients, we instilled 20 ml IP 10% diluted with 80 ml ofnormal saline through a chest tube, clamped for 4 h. Data on adverse events including chest pain, respiratory distress, allergic reactions, hypotensionand failure of PD (the requirement for additional pleural procedures and recurrence) were collected. The follow-up period was 3 to 21 months. Results.Complete response with no recurrence was obtained in 27 (93% percent) patients. One patient with bone marrow transplantation with cystic lungchanges in lungs returned two months later with bilateral pneumothoraces. A case of Wegener's granulomatosis on corticosteroids and immunosuppressivetherapy returned with SP on the same side four months later. Five (13%) patients experienced chest pain with visual scale measurment 1 to 5. Nohypotension, allergic reaction, visual impairment were observed. Conclusions. Pleurodesis with IP was successful and was associated with only minorcomplication. It appears to be a good option for the pleurodesis in SP.

Keywords: pleurodesis, iodopovidone, efficacy, safety, pneumothorax