OBJECTIVETo evaluate the efficacy of tonsillectomy and adenoidectomy (T & A) in Asian childhood obstructive sleep apnea/hypopnea syndrome (OSAHS).

METHODSThe medical data of the OSAHS patients in the Sleep Center of the Duchess Kent Children's Habilitation Institute from May 1999 to May 2003 were retrospectively reviewed. OSAHS was diagnosed according to the abnormal sleep monitoring results. The clinical outcomes were followed up and compared between the Operation and Non-operation groups (Control) in OSAHS children with adenotonsillar hypertrophy (ATH). Sleep endoscopy was performed for those who had residual OSAHS for the purpose of detecting the underlying causes.

RESULTSSixty-one patients were diagnosed with OSAHS. Among the OSAHS patients, 39 were associated with ATH, and 25 of the 39 patients underwent T & A. The desaturation dip rate and minimum saturation in the Operation group were significantly improved after T & A. Six out of 25 (24%) patients in the Operation group had residual OSAHS whereas 11 out of the 13 (85%) patients in the Control group had unchanged or worsening clinical symptoms (OR=15.4, 95%CI 2.7- 87.5). Residual OSAHS after surgery were attributable to obesity, achondroplasia, upper airway structure anomaly and airway dynamic problems.

CONCLUSIONST & A was effective in the majority of Asian childhood OSAHS associated with ATH. Upper airway structure or dynamic abnormalities can result in residual OSAHS in parts of children. Further investigation is required to detect the underlying problems.

Adenoidectomy ; Case-Control Studies ; Child ; Child, Preschool ; Female ; Humans ; Male ; Oximetry ; Retrospective Studies ; Sleep Apnea, Obstructive ; surgery ; Tonsillectomy

OBJECTIVES: To study the early clinical efficacy of combined therapy of stage 4 neuroblastoma. METHODS: A retrospective analysis was performed on the medical data and follow-up data of 14 children with stage 4 neuroblastoma who were diagnosed in Hong Kong University-Shenzhen Hospital from January 2016 to June 2021. RESULTS: The median age of onset was 3 years and 7.5 months in these 14 children. Among these children, 9 had positive results of bone marrow biopsy, 4 had N-Myc gene amplification, 13 had an increase in neuron-specific enolase, and 7 had an increase in vanilmandelic acid in urine. Based on the results of pathological examination, differentiated type was observed in 6 children, undifferentiated type in one child, mixed type, in one child and poorly differentiated type in 6 children. Of all the children, 10 received chemotherapy with the N7 regimen (including 2 children receiving arsenic trioxide in addition) and 4 received chemotherapy with the Rapid COJEC regimen. Thirteen children underwent surgery, 14 received hematopoietic stem cell transplantation, and 10 received radiotherapy. A total of 8 children received Ch14.18/CHO immunotherapy, among whom 1 child discontinued due to anaphylactic shock during immunotherapy, and the other 7 children completed Ch14.18/CHO treatment without serious adverse events, among whom 1 child was treated with Lu177 Dotatate 3 times after recurrence and is still undergoing chemotherapy at present. The median follow-up time was 45 months for all the 14 children. Four children experienced recurrence within 2 years, and the 2-year overall survival rate was 100%; 4 children experienced recurrence within 3 years, and 7 achieved disease-free survival within 3 years. CONCLUSIONS Multidisciplinary combined therapy is recommended for children with stage 4 neuroblastoma and can help them achieve better survival and prognosis.
Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Child ; Child, Preschool ; Combined Modality Therapy ; Humans ; Infant ; Neuroblastoma/drug therapy* ; Positron-Emission Tomography ; Radionuclide Imaging ; Retrospective Studies ; Treatment Outcome