Letters to the Editor Sleep apnoea syndromea too frequent misdiagnosis Sir, A 45 year old woman, experienced progressive deterioration of memory, loss of concentration, anxiety, tiredness, insomnia with nightmares and arousals characterized by unexplained fear and, rarely, thoughts of suicide. She developed a profound depression, so that 2 months later in November 1987 she decided to discontinue herjob in the stock market. A diagnosis of menopausal-related anxious depressive syndrome was made by her general practitioner and confirmed by two psychiatrists. However neither ethynyl oestradiol, imipramine or diazepam relieved her symptoms. From January to April 1988 two further therapeutic trials with trazodone and tranylcypromine were unsuccessful. In January 1988, she consulted an internist who noticed that her voice had a peculiar timbre, consistent with upper airway obstruction. Examination revealed narrowing of the oropharyngeal airway by excessive folds of the soft palate: fibreoptic examination excluded any coexistent hypopharyngeal or laryngeal obstruction. Polysomnography demonstrated a typical pattern of obstructive apnoea,' with 49 obstructive episodes per hour characterized by arterial oxygen desaturation up to 35%. The most severe of these episodes were terminated by sudden arousal and the presenting symptoms. Application of continuous positive airway

Statistical comparison of tumour recurrence rate showed no significant difference between treatment groups. Radiotherapy had the lowest recurrence rate (2%), but required an average of 9 out-patient treatment attendances. Excision with primary closure carried the highest recurrence rate (93%), whilst excision with defect closure by flap or graft, which needed a mean in-patient stay of 8-2 days, and cryosurgical treatment had similar recurrence rates of 5 to 6%. Comparing the modes of treatment, cryosurgery was quickest to perform, required no hospitalization and less than 2 out-patient treatment sessions per patient and gave the best cosmetic result. It appears to be a safe technique for treating basal cell cancers and may prove to be the most cost effective method.

Summary:Spontaneous rupture of the oesophagus is an uncommon surgical emergency. A case is presented in which the extensive nature of the rupture precluded standard methods of treatment and was treated by transhiatal oesophagectomy.