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Objective Obstructive Sleep Apnea Syndrome (OSAS) causes multiple breathing interruptions during sleep and increases mortality if left untreated. Continuous positive airway pressure (CPAP) therapy improves the prognosis of OSAS; however, patient adherence is often poor. This study investigated the relationship between monthly hospital visits and CPAP adherence to CPAP therapy in patients with OSAS. Methods We studied 119 patients (93 men and 26 women) at the Minami Kyoto Hospital between June 2022 and May 2023. CPAP adherence was measured daily. Hospital/clinic visits were categorized as "Last minute visits at the end of the month" (≥25th of the month) and analyzed in relation to CPAP adherence. Results The average duration of CPAP use duration were 5 h, 47 min, and 43 s. Patients visiting on or after the 25th of month had significantly lower CPAP use (4 h, 17 min, 05 s) compared to those visiting before the 25th of month (6 h, 01 min, 47 s, p=0.003). No significant correlation was found between the visit frequency and adherence to CPAP therapy, with a lower visit frequency unexpectedly corresponding to longer CPAP use (p=0.04). Conclusion The timing of monthly clinic visits significantly affected CPAP adherence, with late-month visits associated with poorer adherence. Visit frequency showed no clear correlation with adherence, suggesting that other factors may have influenced CPAP use. Further supportive interventions can enhance adherence and improve the treatment outcomes.

A 74-year-old man with no overt symptoms was referred for a chest computed tomography (CT) that revealed multiple bilaterally pulmonary ground-glass nodules (GGNs) with subtle changes in size over eight months. Surgical lung biopsies were performed in the left upper lobe. A pathologic study confirmed the intravascular large B-cell lymphoma (IVLBCL). This lesion was a nodule-like cluster of atypical cells, meaning that it had been localized for several months. Pulmonary IVLBCL may form focal lesions presenting as GGN on chest CT and progress slowly without apparent symptoms.

Objective Chronic pulmonary aspergillosis (CPA) is an important complication of nontuberculous mycobacterial pulmonary disease (NTM-PD). However, its diagnosis is challenging, as both CPA and NTM-PD present as chronic cavitary disease. The present study evaluated the impact of CPA on the survival of patients with NTM-PD and revealed the key computed tomography findings for a prompt diagnosis. Methods We retrospectively reviewed patients newly diagnosed with NTM-PD in Tenri Hospital (Tenri City, Nara Prefecture, Japan) between January 2009 and March 2018; the patients were followed up until May 2021. Clinical and radiological characteristics were assessed, and patients with CPA were identified. Results A total of 611 patients were diagnosed with NTM-PD. Among them, 38 (6.2%), 102 (17%), and 471 (77%) patients were diagnosed with NTM-PD with CPA, cavitary NTM-PD without CPA, and non-cavitary NTM-PD without CPA, respectively. The 5-year survival rate of the NTM-PD with CPA group (42.8%; 95% confidence interval: 28.7-64.0%) was lower than that of the cavitary NTM-PD without CPA group (74.4%; 95% confidence interval: 65.4-84.6%). A multivariate analysis revealed that fungal balls and cavities with adjacent extrapleural fat were significant predictive factors for NTM-PD with CPA. Conclusion NTM-PD with CPA patients exhibited a worse prognosis than cavitary NTM-PD without CPA patients. Therefore, an unerring diagnosis of CPA is essential for managing patients with NTM-PD. Computed tomography findings, such as fungal balls and cavities with adjacent extrapleural fat, may be valuable diagnostic clues when CPA is suspected in patients with NTM-PD.