RESUMO
OBJECTIVE: We tested the hypothesis that a 6-week course of a nasal glucocorticoid spray would decrease the severity of obstructive sleep apnea in children with adenotonsillar hypertrophy. STUDY DESIGN: We conducted a randomized, triple-blind, placebocontrolled, parallel-group trial of nasal fluticasone propionate versus placebo in 25 children aged 1 to 10 years with obstructive sleep apnea proven on polysomnography. The primary outcome was the change from baseline in the frequency of mixed and obstructive apneas and hypopneas. RESULTS: Thirteen children received fluticasone, and 12 received placebo. The mixed/obstructive apnea/hypopnea index decreased from 10.7 +/- 2.6 (SE) to 5.8 +/- 2.2 in the fluticasone group but increased from 10.9 +/- 2.3 to 13.1 +/- 3.6 in the placebo group, P =.04. The mixed/obstructive apnea/hypopnea index decreased in 12 of 13 subjects treated with fluticasone versus 6 of 12 treated with placebo, P =.03. The frequencies of hemoglobin desaturation and respiratory movement/arousals also decreased more in the fluticasone group. Changes from baseline in tonsillar size, adenoidal size, and symptom score were not significantly different between groups. CONCLUSION: Nasal fluticasone decreased the frequency of mixed and obstructive apneas and hypopneas, suggesting that topical corticosteroids may be helpful in ameliorating pediatric obstructive sleep apnea.
Assuntos
Androstadienos/administração & dosagem , Anti-Inflamatórios/administração & dosagem , Apneia Obstrutiva do Sono/tratamento farmacológico , Administração Intranasal , Pré-Escolar , Feminino , Fluticasona , Seguimentos , Glucocorticoides , Humanos , Masculino , Polissonografia , Resultado do TratamentoRESUMO
We report a case of ischemic colitis with pseudomembrane formation in a 6 1/2-year-old boy with sickle cell disease that responded to medical management including exchange transfusion. This case was not associated with Clostridium difficile infection but with an elevation of serum levels of tumor necrosis factor alpha. This rare complication of sickle cell disease has been reported only in adults.
Assuntos
Anemia Falciforme/terapia , Enterocolite Pseudomembranosa/terapia , Transfusão Total , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Doença Aguda , Anemia Falciforme/complicações , Criança , Clostridioides difficile , Infecções por Clostridium/diagnóstico , Diagnóstico Diferencial , Enterocolite Pseudomembranosa/diagnóstico , Enterocolite Pseudomembranosa/etiologia , Humanos , MasculinoRESUMO
The association of pulmonary edema with upper airway obstruction occurs in three clinical settings: acute and chronic upper airway obstruction and immediately after the relief of acute upper airway obstruction. Iatrogenic causes, such as adenotonsillectomy and tracheal intubation, were the most frequently encountered in the authors' series of 21 pediatric patients with such an association. The pathogenesis of this kind of pulmonary edema is multifactorial. The application of moderate continuous positive airway pressure in conjunction with the administration of diuretics rapidly clears pulmonary edema in all three clinical settings, usually within 24 hours, and can probably prevent pulmonary edema immediately after acute obstruction is relieved.