Pleural fluid analysis

1. Clinical chemistry: protein, glucose, PH, LDH, amylase
2. cytology
3. bacteriology: Microscopy and culture, TB culture
4. Immunology: ANCA, RF, ANA, complement

Obstructive sleep apnoea

OSA definition: sleeps apnoeas caused by obstruction of the airway.

Clinical features: obese, middle age man who presents with snoring, daytime somnolence. Partner reports apnoeic episodes.

Ix: polysomnography

Mx:

1. weight reduction
2. CPAP ( gold standard)
3. Surgical procedures (uvulopalatopharyngoplasty, tonsilectomy)

UPPP: provides benefit for snoring in 80% at 5 years. provides benefit for OSA by 50% at 5 years. However, benefit after that is variable. UPPP are not indicated for OSA because removal of palate makes CPAP ineffective.