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Middle lobe syndrome is a term that refers to a recurrent collapse of a lung segment, typically the right middle lobe. We discuss a case that middle lobe syndrome occurred in an unusual lung segment and related to an unusual cause.

Wegener's granulomatosis (WG) is a relatively uncommon collagen vascular disease that can lead to both upper and lower airway disease. Subglottic stenosis is one manifestation of the airway disease and can occur even during the quiescent phase of the disease, independent of an active inflammatory response. A high index of suspicion is necessary for this complication in patients with known WG who complain of dyspnoea, and WG should be high on the differential diagnosis in those found to have "idiopathic" subglottic stenosis. We report the case of a patient who presented with this problem, and we review the prevalence, diagnosis, symptoms, and treatment.

Background: The qualitative presence of microsleep during the multiple sleep latency test (MSLT) has been shown to correlate with an increased incidence of subjective complaints of sleepiness, tiredness, accidents/near accidents, and gap driving. However, there is no data on how to quantify microsleep and effectively incorporate it as a diagnostic tool in the measurement of sleepiness. The purpose of this study was to integrate microsleep with the MSLT score and determine if it improved the correlation between the MSLT and symptomatic sleepiness., Methods: The charts of 54 patients who had an MSLT score of greater than 5min and the presence of microsleep on at least one nap were reviewed. If microsleep was present in a given nap it was used as a surrogate for sleep onset. This MSLT plus microsleep score (MSL-M) was then averaged into the total sleep latency and compared to the MSLT score to determine if it improves correlation with the Epworth sleepiness scale (ESS). A microsleep nap percentage (MNP) was also obtained and correlated with ESS to determine if a better association could be derived., Results: Using the Spearman correlation the MSL-M improved the correlation with the ESS when compared to MSLT (r=0.106 versus r=0.063), but the results were not statistically significant. Of note, both the MSLT and MSL-M were only weakly correlated to the ESS. The MNP also did not have a good correlation with ESS (r=-0.099)., Conclusions: The addition of microsleep onset to the MSLT score as a quantitative assessment tool failed to significantly enhance the correlation between subjective and objective accounts of sleepiness, beyond the improvement seen in the MSLT value by the simple presence of microsleep alone.

We describe the case of a 22-year-old HIV-negative male who was diagnosed with tuberculous meningitis and subsequently went on to develop two highly unusual after effects of the meningitis. The first was a tuberculoma, which was discovered 28 days after the meningitis and occurred while the patient was taking a four-drug therapeutic regimen, despite adequate drug susceptibilities. The second was an even more unique sequela: tuberculous radiculomyelitis. This transpired only after the patient's glucocorticoids, which were initiated to treat the tuberculoma, were tapered off. These manifestations were successfully treated with the addition of corticosteroids to the antituberculous regimen. The typical clinical presentations of these diseases are reviewed and various means of pathogenesis proposed.