Faxton St. Luke's Healthcare

Bariatric surgery is established as a relatively safe, cost-effective, and powerful treatment for extreme obesity and its associated health conditions. Since its inception in 1991, important advances in the knowledge of the physiology of extreme obesity as well as advances in bariatric procedures and surgical expertise have fueled this evolution. Despite the growth of bariatric surgery, this treatment is only available to a very small percentage of those afflicted with extreme obesity.

Three months after diagnosis of Wegener granulomatosis, an 84-year-old woman who was treated with cyclophosphamide (CPY) and prednisone developed deranged liver function tests (LFTs). Treatment with CPY was held, which led to normalization of LFTs, but after reinitiating of CPY, LFTs started increasing. Liver biopsy showed noncaseating epithelioid granulomas within liver lobules consistent with granulomatous hepatitis. Patient died within 2 months secondary to liver failure. This elevation of transaminases was considered to be secondary to CPY-induced hepatotoxicity. Involvement of liver in patients with Wegener granulomatosis is seen but it presents with necrotizing granulomatous vasculitis. CPY-induced hepatitis is an extremely rare phenomenon with only 1 case reported in literature. Clinicians and hepatologists should be aware of this potentially serious complication when CPY therapy is initiated. Baseline LFTs and periodic assessment are recommended before and during treatment with CPY.

The clinical importance of obstructive sleep apnea (OSA) is gradually rising to the extent that many clinicians now consider OSA as an underlying etiology or precipitating factor for many cardiovascular and pulmonary events. Although the incidence and pathophysiology underlying these cardiopulmonary structural and functional abnormalities are not well defined, various mechanisms are hypothesized. These include but are not limited to sympathetic activation, oxidative stress, inflammation, and endothelial dysfunction. Given the rising awareness of OSA, it is timely to review the effects of OSA on cardiovascular complications like arrhythmias and ventricular remodeling. In the later part of the review, we focused on the role of therapeutics in the management of patients with OSA. Although the role of medical therapeutics is not well defined, we reviewed the available literature focusing on the available options, supporting evidence and their role in specific subgroup of patients with OSA.