Examination of cilia for structure and function may be included in the investigation of patients with recurrent nasal or pulmonary disease or both. In recent years a number of defects of ciliary structure and function have been described. These may be hereditary (primary) as in Kartagener's syndrome1 or acquired (secondary) as may follow local inflammation.2 These findings have prompted a search for further defects and the need for quantification of the range of ciliary structure which may be found in normal subjects. Most previous studies have used nasal mucosal biopsies but the relative invasiveness of this procedure has limited the number of samples available for study in both normal subjects and patients. Rutland and Cole described a non-invasive technique employing nasal brushing suitable for the study of ultrastructure and ciliary beat frequency3 and we now report in detail the method used for electron microscopy. Material and methods Samples

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Physician Assistants (PAs) are frequently delegated the task of performing invasive procedures. While there is a nearly 40 year record of PAs performing procedures of various types, limited published information is available that verifies the safety of delegating these medical responsibilities. As the scope of practice expands for the PA profession, research data will be necessary to document the safety and effectiveness of PAs performing invasive procedures. This prospectivestudy followed 9 PAs inserting central venous catheter (CVC) lines in pulmonary critical care and cardiothoracic surgery settings in a large urban hospital from June 1, 2002 through December 1, 2002. Each PA required general supervision for the procedures. The most common complication of CVC placement is pneumothorax. None of these occurred during the study period in 233 CVC lines inserted by PAs. Additionally, during the study period, this group of PAs inserted 75 Swan-Ganz catheters, performed 25 thoracenteses, 30 endotracheal intubations, and 10 chest tube placements. Complications were noted and recorded via the on site researcher. The only complication noted during the study period was a single pneumothorax while performing a thoracentesis. This research study demonstrates that with the proper training and supervision from a physician, PAs can perform invasive medical procedures with a complication rate comparable to that of physicians in a similar setting.

We report a patient with chronic respiratory tract disease and ultrastructural abnormalities of nasal cilia at first interpreted as being consistent with a primary ciliary defect. Subsequent sampling of nasal ciliated epithelium from the same area failed to reveal the defects of structure. Abnormalities of ciliary ultrastructure found on a single occasion, especially in the presence of acute inflammation, should be interpreted with caution.