June 24, 2004

Steven Mucci, MD
65 Cedar Street
 Hyannis, MA 02601

RE: Lucille Iacovelli

Dear Steve:
This patient returns in follow-up after having complete PFI's performed. Pulmonary function studies showed normal spirometry, normal lung volumes and a normal diffusing capacity. The flow volume loop, however, suggests a fixed upper airway obstruction with flattening of both the inspiratory and expiratory limbs. Compared with a previous complete PFT from February 2002, the total lung capacity and the diffusing capacities have actually improved although the flattened flow volume loop is a new finding.

Assessment:  Positional upper airway obstruction related to postoperative changes in the neck. The flow volume loop on the most recent PFI' supports the clinical impression that this patient has a degree of fixed extrathoracic airway obstruction. She was again encouraged to follow-up with her ENT surgeon in Boston to review her options. I have not scheduled the patient for a follow-up visit at this time. Thank you for allowing me to see this patient.

Sincerely,
Timothy Herrick, M.D.