Background: Nasal side effects are often reported during nasal continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea syndrome (OSAS) and may make the use of nasal CPAP difficult. Objective: The aim of this study was to evaluate the effect of nasal CPAP on nasopharyngeal symptoms in OSAS patients. Methods: The frequency and severity of nasopharyngeal symptoms and signs were prospectively evaluated in 49 consecutive OSAS patients (37 men, 12 women, mean (SD) age 54 (7) years, body mass index 35 (6) kg/m²) immediately before and after 6 months’ treatment with nasal CPAP. Results: Nasopharyngeal symptoms were common already before starting nasal CPAP: 74% of patients reported dryness, 53% sneezing, 51% mucus in the throat, 45% blocked nose, and 37% rhinorrhea. During nasal CPAP treatment, severity and frequency of sneezing (75%) and rhinorrhea (57%) increased. This increase was related to the season when nasal CPAP was applied, and was more profound in winter than in summer. Mild abnormalities on rhinoscopy and paranasal sinus X-rays were common both at baseline and at follow-up with no significant change during treatment. Conclusions: Nasopharyngeal problems were found to be frequent in patients with OSAS before nasal CPAP treatment, and tended to increase during the treatment.

Cytological results of US-guided fine needle aspiration biopsies of enlarged lymph nodes from 179patients were analyzed retrospectively. The final diagnoses were benign lymphadenopathy in 90 cases, metastasis in 56, and malignant lymphoma in 33 cases. The material was sufficient for cytological analysis in 174 cases (97.2%). Correct diagnosis of malignant (C IV-V) and benign (C I-II) lymphadenopathy in the whole material was possible in 80 percent of cases. Correct subtyping of lymphoma was possible in 63.6 percent of the cases. There was one (0.6%) false positive (C IV), 6 (8.5%) false negative (C I-II), and 24 (13.8%) suspicious (C III) cytological findings. All but one of the false negative cytological findings were from superficial lymph nodes. No complications occurred. USguided lymph node aspiration biopsy is safe and accurate in the superficial, anterior mediastinal, abdominal, and retroperitoneal lymphonodal areas. Lymph nodes with a C 0 cytological result should undergo rebiopsy and suspicious (C III) or clinically doubtful cases should be referred for a surgical biopsy.

Ultrasonically guided fluid collection and abscess drainage have become routine procedures in various parts of the body. In most cases ultrasound is the only imaging and guidance modality needed; however, it is of the utmost importance to remember that CT and fluoroscopy with contrast often give invaluable information when the true extent of the process has to be determined and when assessing the safest route for the catheter in anatomically complicated areas. The importance of irrigation of the abscess cavity with fluids and the ready use of urokinase should be emphasized. Ethanol sclerotherapy is a simple and safe procedure to treat symptomatic hepatic or renal cysts. Parathyroid adenomas and cysts, as well as thyroid cysts, can also be treated with ethanol sclerotherapy in selected cases. Purified mineral talc has been used in pleurodesis and hydrocele sclerotherapy, whereas doxycycline or ethanol is used for postoperative lymphoceles. Both abscess drainages and sclerotherapy procedures are minimally invasive, simple, safe, inexpensive and reasonably efficacious treatment in many clinical instances and may be at least an alternative to surgical treatment, often offering significant advantages over surgery.

We reviewed the results of US-guided fine-needle biopsies of peripheral pulmonary, pleural, mediastinal and chest wall lesions in 200 patients. Sufficient material for cytological analysis was obtained in 95%, 92%, 96% and 100%, respectively. Sensitivity was 88%, 94%, 96%, 100% and specificity 89%, 100% and 100%, respectively. The ratio of false-negative results was 7%. A cutting needle biopsy was additionally performed in 24 patients. All but two of the histological samples (92%) were adequate for diagnostic purposes and a correct diagnosis was established in 86% (19/22) of these. 8 patients (4%) with pleural or pulmonary targets had minor complications (5 pneumothorax, 3 haemoptysis), which did not require treatment. Cutting needle biopsies and biopsy of mediastinal lesions proved safe. Due to the many advantages US may be considered for guidance in peripheral larger-sized pulmonary lesions, particularly those abutting the pleura, and also in pleural, thoracic wall and mediastinal masses.

Five anterior mediastinal tumors were biopsied with a fine needle under ultrasound guidance. All the tumors were solid, hypoechoic, perivascularly situated masses. Their mean diameter was 7.2 cm. Cytologically there were 2 mediastinal metastatic carcinomas, 1 poorly differentiated carcinoma or non-Hodgkin lymphoma, 1 germ-cell tumor (embryonal cell carcinoma), and 1 malignant lymphoma or thymoma. There were no complications. Ultrasound-guided anterior mediastinal aspiration biopsy is a safe and rapid procedure in the evaluation of anterior mediastinal masses. Biopsy of a mediastinal mass enables simultaneous diagnosis and staging. Mediastinoscopy and diagnostic thoracotomy can be avoided.

Sixteen patients with biochemically proven primary hyperparathyroidism (PHPT) underwent ultrasonography (US), fine-needle aspiration (FNA) for cytologic sampling (n = 9), or intact parathormone assay (n = 3) before operation (n = 15) in order to determine the accuracy of the methods. Pre-operative US was found sensitive (100 per cent), but two thyroid lesions were initially diagnosed as parathyroid tumours by US (i.e. false positives). Parathyroid cells were detected in six cytologic specimens, one sample was insufficient and another inconclusive, while one was diagnosed as thyroid tissue. Parathormone assay revealed a high hormone content in all three patients who underwent the procedure. We conclude that US is sufficiently sensitive to detect enlarged parathyroid tumours. Specificity can be improved by US-guided FNA for cytology or parathormone assay prior to neck exploration.

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The case report by Brander and colleagues diaphragm weakness due to one of the many causes listed by Brander and colleagues remain of severe diaphragm weakness due to phrenic nerve damage from radiotherapy given many undiagnosed despite diaphragm dysfunction contributing to symptoms of breathlessness and years earlier is of considerable interest. 1 It provides yet another cause of diaphragm dys-disability? This question can only be answered if we are prepared, when clinically appropriate, function to add to an already long list. The authors comment that the potential causes of to make specific measurements of respiratory muscle strength. diaphragm weakness include motor neurone disease, poliomyelitis, myasthenia, muscular Brander and co-workers treated their patient with nocturnal non-invasive ventilation with dystrophies, polyneuropathy, neuralgic amyotrophy, malignant invasion of the phrenic good control of symptoms; for patients with severe orthopnoea the achievement of com-nerves, chest wall trauma, cardiothoracic surgery, connective tissue diseases, amyloid, and fortable sleep is most welcome. Such symptomatic control is a good indication for non-thyroid disease. There are other causes that could be added to this list and it is therefore invasive ventilation. A second indication would be established chronic ventilatory failure. This an important clinical point that diaphragm weakness is unusual, but it is not rare. Any did not occur in the case presented because the respiratory muscle weakness was largely respiratory physician with a busy clinical practice can expect to see patients with diaphragm confined to the diaphragm. 4 In patients with more widespread and severe respiratory muscle weakness, of varying severity, on an infrequent but regular basis. An important issue therefore weakness, ventilatory failure first develops at night (hence the importance of sleep studies) is how diaphragm weakness is diagnosed and how its severity is accurately assessed. and often occurs rather suddenly when the degree of weakness becomes sufficiently pro-When diaphragm weakness is severe the diagnosis-in a qualitative sense-is not a problem, found. Thus, patients may have a reduction of 30%, 40%, 50%, 60%, or even 70% in and the key features, as in this case presentation, are orthopnoea, paradoxical ab-respiratory muscle strength without developing ventilatory failure unless, in addition, there is dominal movement, and a fall in vital capacity when supine. However, these are late symptoms increased ventilatory load. At a relatively sharp cut off point, when inspiratory muscle strength and signs that only occur when diaphragm strength is reduced to approximately 25% of is approximately 25-30% of normal, ventilatory failure then becomes quite common. Clearly, normal. 2 From the history of the patient described in this case report it is clear that dia-if an accurate diagnosis of respiratory muscle weakness at an earlier stage has not been made, phragm weakness was slowly progressing over several years. Eventually the diagnos...