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   2014| October-December  | Volume 31 | Issue 4  
    Online since October 1, 2014

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Palliation in metastatic non-small cell lung cancer: Early integration with standard oncological care is the key
Navneet Singh, Digambar Behera
October-December 2014, 31(4):317-319
DOI:10.4103/0970-2113.142089  PMID:25378836
  1,883 9,593 -
Ease-of-use, preference, confidence, and satisfaction with Revolizer ® , a novel dry powder inhaler, in an Indian population
Sujeet K Rajan, Jaideep A Gogtay
October-December 2014, 31(4):366-374
DOI:10.4103/0970-2113.142122  PMID:25378845
Context: While prescribing an inhaler device, it is important to take into account the usability, preference, confidence, and satisfaction of the patients. Aims: The present study assessed these parameters with Revolizer ® , a novel dry powder inhaler (DPI), in patients with obstructive airway diseases and in device-naïve healthy participants. Settings and Design: In this open-label, prospective, multicentre study with 100 participants [n = 50 healthy participants, n = 45 mild asthma patients, and n = 5 mild chronic obstructive pulmonary disease (COPD) patients], all participants were instructed and trained on the use of Revolizer and then the participants subsequently demonstrated the inhalation technique at two visits. Materials and Methods: The average time required to execute three correct consecutive attempts and the number of errors (including critical errors) were recorded. Participants were asked about the ease of use, preference, confidence, and satisfaction by means of a questionnaire at each visit. Results: The average time required by the participants to achieve three correct consecutive attempts at visit 1 was 3.75 ± 2.10 min, which significantly reduced at visit 2 (3.07 ± 1.32 min, P < 0.01). The number of errors decreased from visit 1 to visit 2. More than 85% participants found the Revolizer easy to use, and it was preferred by more than 75% participants. Revolizer scored high on the confidence and satisfaction of all participants at both visits. Conclusions: Revolizer is an easy-to-use and a preferred device in patients with mild asthma and COPD, as well as in healthy participants with no previous experience of using inhalation devices. The participants felt confident and satisfied using the Revolizer.
  10,628 590 -
Laying the ground for research of interstitial lung disease in our country: ILD India registry
Virendra Singh, Bharat Bhushan Sharma
October-December 2014, 31(4):320-322
DOI:10.4103/0970-2113.142091  PMID:25378837
  1,931 2,852 -
Spectrum of diffuse parenchymal lung diseases with special reference to idiopathic pulmonary fibrosis and connective tissue disease: An eastern India experience
Somenath Kundu, Subhra Mitra, Joydeep Ganguly, Subhasis Mukherjee, Souvik Ray, Ritabrata Mitra
October-December 2014, 31(4):354-360
DOI:10.4103/0970-2113.142115  PMID:25378843
Objective: To evaluate the clinical spectrum of diffuse parenchymal lung diseases (DPLD) encountered in the Indian setting and to compare idiopathic pulmonary fibrosis (IPF) and connective tissue disease associated DPLD (CTD-DPLD), the two commonest aetiologies. Materials and Methods: A prospective study of clinical, imaging and laboratory parameters of patients diagnosed as DPLD and followed up in the Pulmonary Medicine Department of a tertiary-care teaching institution in eastern India was conducted over a period of one year. Results: 92 patients of DPLD were diagnosed in the study period with IPF (n = 35, 38.04%), CTD-DPLD (n = 29, 31.5%), hypersensitivity pneumonitis (n = 10, 10.9%), sarcoidosis (n = 5, 5.4%) and silicosis (n = 5, 5.4%) being the common causes. The CTD-DPLD group had a lower mean age (39.5 ± 1.86 vs 56.9 ± 1.12 years), a longer duration of symptoms (3.5 ± 0.27 vs 2.5 ± 0.26 years), more extra pulmonary manifestations, significantly more base line FVC and 6-minute-walk-distance than the IPF patients. 19 patients of IPF (54%) opted for treatment. All the IPF patients had a significant fall in FVC after six months (mean change -0.203 ± 0.01 litres) compared to the CTD-DPLD group (mean change - 0.05 ± 0.04 litres.) Conclusion: CTD-DPLD patients belong to a younger age group, with longer duration of symptoms, more extrapulmonary features, better physiological parameters and better response to therapy than IPF patients. Larger prospective epidemiological studies and enrolment in clinical trials are necessary for better understanding of the spectrum of diffuse parenchymal lung disorders and their therapeutic options.
  3,979 676 -
Shrinking lung syndrome in systemic lupus erythematosus-scleroderma overlap
Vivek S Guleria, Pradeep K Singh, Puneet Saxena, Shankar Subramanian
October-December 2014, 31(4):407-409
DOI:10.4103/0970-2113.142152  PMID:25378855
Shrinking lung syndrome (SLS) is a infrequently reported manifestation of systemic lupus erythematosus (SLE). Reported prevalence of SLS is about 0.5% in SLE patients. Pathogenesis is not fully understood and different therapeutic modalities have been employed with variable results, as only 77 cases of SLS have been documented in literature. SLS in SLE-Scleroderma overlap has not been reported yet. We report a patient of SLE - scleroderma overlap presenting with dyspnea, intermittent orthopnea and pleuritic chest pain. Evaluation revealed elevated hemidiaphragms and severe restrictive defect. She was eventually diagnosed as a case of SLS. This case report is a reminder to the medical fraternity that SLS although a rare complication must be thought of in the special subset of patients of SLE having respiratory symptoms.
  4,003 437 -
Utility of FDG-PET-CT scanning in assessing the extent of disease activity and response to treatment in sarcoidosis
Randeep Guleria, Amudhan Jyothidasan, Karan Madan, Anant Mohan, Rakesh Kumar, Ashu Seith Bhalla, Arun Malhotra
October-December 2014, 31(4):323-330
DOI:10.4103/0970-2113.142092  PMID:25378838
Background: Radionuclide imaging modalities have increasingly been evaluated in the assessment of organ involvement in sarcoidosis. Fluoro-deoxyglucose positron emission tomography-computed tomography (FDG-PET-CT) scanning has received increasing attention in the recent years. The aim of our study was to evaluate the utility of FDG-PET-CT in determining the extent of organ involvement and disease activity in patients of sarcoidosis and to assess its utility in the evaluation of response to therapy. The secondary objective was to compare the agreement between clinical, radiological (HRCT) and metabolic indices (FDG-PET-CT) of disease activity. Materials and Methods: This was a prospective observational study conducted between March 2007 and December 2008 at a tertiary care referral center in north India. Twenty-five symptomatic and histopathologically proven cases of sarcoidosis underwent FDG-PET-CT scanning at baseline and a follow-up scan in 21 patients at 6-9 months post-treatment with glucocorticoids. Results: FDG-PET-CT scan detected metabolic disease activity in 24 of the 25 patients with clinically active sarcoidosis. It also demonstrated many clinically inapparent sites of disease activity. Complete or partial metabolic response was seen in 17 of the 21 patients in whom a follow-up scan was available. Substantial degree of agreement was found between the metabolic response and the radiological response, whereas moderate agreement was found between clinical and metabolic responses. Conclusions: FDG-PET-CT scanning is a useful imaging modality to assess disease activity, extent of disease involvement and response to treatment in clinically active sarcoidosis. There is substantial agreement between the HRCT and metabolic parameters of disease activity. Further, large sample size studies are proposed in order to identify the subset of patients who are likely to benefit the most from this sensitive modality of imaging, especially in developing countries where the cost of the procedure is an important concern.
  2,858 1,516 -
Multidrug-resistant-tuberculosis treatment in the Indian private sector: Results from a tertiary referral private hospital in Mumbai
Zarir F Udwadia, Gautam Moharil
October-December 2014, 31(4):336-341
DOI:10.4103/0970-2113.142101  PMID:25378840
Background: There is very limited data on the experience and outcome of multidrug-resistant tuberculosis (MDR-TB) patients treated privately out of the DOTS plus program. Goal of this study is to provide characteristics and treatment outcomes of a prospective cohort of MDR-TB patients managed at a private tertiary referral institute. Materials and Methods: A prospective analysis of a cohort of MDR-TB patients treated in a tertiary private hospital, with the back-up of a Level 2 mycobacterial laboratory, which has recently received recognition by the Revised National Tuberculosis Control Program (RNTCP) for second-line drug susceptibility (DST). All patients received an individualized MDR regimen on an ambulatory basis. Results: Our 68% success rates are respectable and show that given the right laboratory backing, MDR-TB can be managed successfully in selected private practice settings.
  3,171 721 -
Common variable immunodeficiency disorder - An uncommon cause for bronchiectasis
Manoj Kumar Panigrahi
October-December 2014, 31(4):394-396
DOI:10.4103/0970-2113.142138  PMID:25378851
Bronchiectasis continues to be a common respiratory problem of varied etiology. Common variable immunodeficiency disorder (CVID) is an uncommon cause for bronchiectasis. However, the prevalence of bronchiectasis remains very high in patients with CVID. This remains largely an underdiagnosed entity as primary immunodeficiency is not suspected in adults as a cause of bronchiectasis and hence, serum immunoglobulin (Ig) levels are not measured routinely. In addition to bronchiectasis, patients with CVID usually present with various extrapulmonary symptoms. I report here a case of young man who presented with bronchiectasis and multisystem complains who was diagnosed as CVID.
  3,409 413 -
Correlation of exhaled nitric oxide, nasal nitric oxide and atopic status: A cross-sectional study in bronchial asthma and allergic rhinitis
Nitesh Gupta, Nitin Goel, Raj Kumar
October-December 2014, 31(4):342-347
DOI:10.4103/0970-2113.142107  PMID:25378841
Objective: Exhaled nitric oxide (FE NO ) and nasal nitric oxide (n NO) measurement is an area of ongoing research in the study of airway inflammation. The atopic status is known to influence the levels of FE NO and n NO. This study was undertaken to study the relationship between nitric oxide measurements in bronchial asthma and allergic rhinitis along with their correlation with atopic profile of Indian population. Materials and Methods: Ninety subjects were recruited for the study comprising of 25 each of bronchial asthma (BA), allergic rhinitis (AR), bronchial asthma with allergic rhinitis (BA-AR) and 15 healthy controls. These were assessed for atopy and exhaled breath analysis of nitric oxide. The measurements of FE NO and n NO levels were done using NIOX chemiluminescence analyzer. Atopy was assessed by skin prick testing (SPT) against 58 common aero-allergens and subjects with ≥1 positive SPT were labeled as atopic. Results: The BA-AR and BA groups had higher FE NO levels in comparison to the control (P < 0.05) and AR group (P < 0.05). The AR and BA-AR groups had higher n NO levels compared to the control group (P < 0.05) and BA group (P < 0.05). The increasing FE NO levels significantly correlated with the increase in the number of allergen sensitization in patients suffering from BA-AR (P < 0.05). However, the BA group showed a weaker positive correlation (P = 0.07). Conclusion: FE NO is a non-invasive marker of airway inflammation. Also, FE NO levels correlate with presence and degree of atopy in BA and AR. Simultaneously, n NO could be a surrogate marker of rhinitis.
  2,523 440 -
Potential impact of fireworks on respiratory health
Caroline Gouder, Stephen Montefort
October-December 2014, 31(4):375-379
DOI:10.4103/0970-2113.142124  PMID:25378846
The world-wide use of fireworks with their consequent detrimental effect on the air quality is widely recognized with elevated ambient air levels of particulate matter and its several metallic components and gases identified in several studies carried out during such events. Exposed individuals may be at risk following inhalation of such produced pollutants. This review focuses on the impact of fireworks on air quality and the potential effect of fireworks on the respiratory system of healthy individuals as well as those suffering from underlying respiratory diseases, particularly asthma and chronic obstructive pulmonary disease (COPD). This applies not only to spectators including children but also to pyrotechnicians themselves. An extensive Medline search revealed that a strong evidence of the impact of fireworks on respiratory health is lacking in susceptible as well as healthy individuals with no formal studies on COPD or asthma, other than a few case reports in the latter. The implementation of global strategies to control the use of fireworks and hence improve air quality could possibly reduce their likely detrimental effect on human respiratory health in exposed individuals, but clearly a more targeted research is needed.
  2,319 520 -
Bhang - beyond the purview of the narcotic drugs and psychotropic substances act
Yatan Balhara, Shachi Mathur
October-December 2014, 31(4):431-432
DOI:10.4103/0970-2113.142109  PMID:25378867
  1,957 227 -
An extremely unusual presentation of isolated extrathoracic sarcoidosis of submandibular lymph node in a child
Anand Agrawal, Kulwant Singh, Dheeraj Parihar, Chandermani
October-December 2014, 31(4):413-415
DOI:10.4103/0970-2113.142154  PMID:25378857
A 12-year-old male child presented with left submandibular lymphadenopathy; excision biopsy revealed noncaseating granuloma with numerous Schaumann bodies in histopathology, suggestive of isolated extrathoracic sarcoidosis, which is an extremely rare entity in the pediatric age group.
  1,879 258 -
Utility of noninvasive ventilation in high-risk patients during endoscopic retrograde cholangiopancreatography
Miguel Angel Folgado, Carlos De la Serna, Alfonso Llorente, SJ Rodríguez, Carlos Ochoa, Salvador Díaz-Lobato
October-December 2014, 31(4):331-335
DOI:10.4103/0970-2113.142097  PMID:25378839
Background: There is little evidence on noninvasive ventilation (NIV) preventing respiratory complications in high-risk patients undergoing endoscopy procedures. Objectives: The objective of this study is to demonstrate that the application of NIV through a nasal interface can prevent the appearance of ventilatory alterations during endoscopic retrograde cholangiopancreatography (ERCP) in patients with risk factors associated with the development of hypoventilation. Patients and Methods: A non-randomized interventional study was performed on 37 consecutive high-risk patients undergoing ERCP. During the procedure, 21 patients received oxygen by nasal cannula (3 L/minute) and sixteen received NIV through a nasal mask. Arterial blood gas analyses were conducted before and immediately after the ERCP. An Acute Physiology and Chronic Health Evaluation (APACHE) score pre-ERCP was recorded. The complications during the procedure were recorded. Results: The groups with and without NIV were comparable. A post-ERCP pH of <7.35 was found in eight patients, who did not receive ventilatory support (38.1%) compared to zero patients in the NIV group (P = 0.006). A post-ERCP pCO 2 >45 mmHg was found in one case (6.3%) in the NIV-group and in nine cases in the nasal cannula group (42.9%; P = 0.01). The median pCO 2 post-ERCP was lower (36.5 ± 6.2 vs. 44.5 ± 6.8 mmHg) (P = 0.001) and median pH post-ERCP was higher (7.41 ± 0.4 vs. 7.34 ± 0.5) (P = 0.001) in patients treated with NIV. In the multivariate analysis, after adjusting for gender, the APACHE score, pH and pCO 2 pre-ERCP, age, propofol doses, and procedure duration, the following differences were maintained (pCO 2 difference = 5.54, 95% Confidence Interval (CI) =2.3 - 8.7, pH difference = 0.047, and 95% CI = 0.013 - 0.081). Among the 37 procedures, four complications occurred: One in the NIV group and three in the nasal cannula group. None of them was related to NIV. Conclusions: Our preliminary results demonstrate that in high-risk patients undergoing ERCP, hypercapnia and respiratory acidosis are frequent. NIV prevents the appearance of these complications.
  1,356 743 -
Superior vena caval syndrome and ipsilateral pleural effusion: A rare presentation of anterior mediastinal thymoma
Anirban Das, Sudipta Pandit, Sabyasachi Choudhury, Sibes K Das, Sumitra Basuthakur
October-December 2014, 31(4):383-386
DOI:10.4103/0970-2113.142126  PMID:25378848
Incidence of thymic malignancies is very low. Thymoma, a tumor of thymus gland, is of epithelial origin and is most common anterior mediastinal tumor. In most cases, thymomas are localized and locally advanced thymomas may rarely present with superior vena caval obstruction (SVCO) and malignant pleural deposits. Microscopically, capsular invasion is noted in case of locally advanced thymomas, which behave like a malignant neoplasm. Complete surgical removal of the tumor along with intact capsule is the treatment modality of choice in case of localized tumors. Neoadjuvant radiotherapy (RT) and chemotherapy followed by surgical resection of residual tumor is useful in case of locally advanced tumors. RT is especially useful in case of SVCO to relieve the distressing respiratory symptoms. Here, we report a rare case of locally advanced thymoma, complicated by SVCO and ipsilateral pleural effusion in a 53-year-old male patient.
  1,783 252 -
Granulomatosis with polyangitis with mononeuritis multiplex-immunosuppressives playing a double-edged sword
Subhasis Mukherjee, Debabani Biswas, Shabana Begum, Pulakesh Bhanja, Amartya Kumar Misra, Partha Chatterjee
October-December 2014, 31(4):397-400
DOI:10.4103/0970-2113.142143  PMID:25378852
A 52-year-old female was diagnosed with rheumatoid arthritis and was on methotrexate and prednisolone. She developed fever, cough, hemoptysis, and cavitary lesion on chest skiagram. She was put on antitubercular therapy without any improvement, meanwhile she developed painful right foot drop. Clinicoradiology and C-ANCA study confirmed the diagnosis of granulomatosis with polyangitis (GPA). She was started on cyclophosphamide, corticosteroid, and co-trimoxazole. While her treatment was being continued she showed significant improvement of pulmonary manifestations. About 1 year later, there was reappearance of fever, cough, and radiological opacity with oropharyngeal candidiasis. She became very ill with disseminated intravascular coagulation (DIC)-like features. Immunological markers were negative but bronchoalveolar lavage fluid study showed growth of Aspergillus spp. The patient was promptly put on intravenous voriconazole but unfortunately she succumbed to her illness.
  1,660 314 -
Completely opaque hemithorax
Rakesh K Chawla, Arun Madan, Kamanasish Das, Aditya Chawla
October-December 2014, 31(4):416-418
DOI:10.4103/0970-2113.142095  PMID:25378858
  1,508 343 -
Pulmonary tumor thrombotic microangiopathy in an unknown primary cancer
Gayathri P Amonkar, Kusum D Jashnani, Sandhya Pallewad
October-December 2014, 31(4):410-412
DOI:10.4103/0970-2113.142153  PMID:25378856
Pulmonary tumor thrombotic microangiopathy (PTTM) is a highly fatal complication of cancer leading to acute cor pulmonale and pulmonary hypertension. We present a case of 47-year-old male patient who developed acute breathlessness and died suddenly. The pulmonary vessels at autopsy on histopathologic examination showed the presence of fibrocellular intimal proliferation, fibrin thrombi and few tumor emboli consisting of malignant adenocarcinoma cells. There was associated lymphangiosis carcinomatosis. No primary visceral tumor was found despite extensive search. The patient had died following acute cor pulmonale with sudden pulmonary hypertension due to PTTM. This entity (PTTM) must be kept as a differential diagnosis in patients presenting with acute breathlessness especially in cases of cancers.
  1,466 268 -
Bilateral pleural effusion with APLA positivity in a case of rhupus syndrome
Kaushik Saha, Arnab Saha, Mrinmoy Mitra, Prabodh Panchadhyayee
October-December 2014, 31(4):390-393
DOI:10.4103/0970-2113.142133  PMID:25378850
Rhupus syndrome is a rare syndrome characterized by overlap of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Our patient was a diagnosed case of RA and developed SLE 2 years after. She was a middle-aged woman, presented with bilateral pleural effusion with exacerbation of skin and joint symptoms of SLE. We diagnosed the case as tubercular pleural effusion by positive Mycobacterium tuberculosis in bactec 460 culture. She had also anti-phospholipid antibody positivity without any symptoms and signs of thrombosis.
  1,455 277 -
A comparative study of different dose fractionations schedule of thoracic radiotherapy for pain palliation and health-related quality of life in metastatic NSCLC
Sourav Sau, Saikat Sau, Premnath Dutta, Ganesh Chandra Gayen, Sanatan Banerjee, Avijit Basu
October-December 2014, 31(4):348-353
DOI:10.4103/0970-2113.142111  PMID:25378842
Introduction: To investigate the effect of different hypo fractionated thoracic radiotherapy schedules in relation to thoracic pain relief, overall survival and post radiotherapy HRQOL in metastatic NSCLC. Material and methods: Stage IV NSCLC and had intra-thoracic symptoms, included in the study. Patients were randomly assigned to three treatments arms. (i) 17 Gy in 2 fractions in one week (ii) 20 Gy in five fractions in one week. (iii) 30 Gy in 10 fractions in two weeks. BPI module was used to assess pain score before and after the thoracic radiotherapy. Functional assessment of cancer therapy-G (FACT-G) used to investigate changes in HRQOL. Clinicians' assessment of symptom improvement were recorded at 2 nd , 6 th and 12 th weeks after completion of TRT. Results: Pain relief, HRQOL and OS were equivalent in all the three arms. The median OS were 6 months, 5 months, 6 months in arm A, B and arm C, respectively. Conclusion: Protracted palliative thoracic radiotherapy renders no added advantage of relief of symptoms, HRQOL and overall survival compared to short course palliative TRT in metastatic NSCLC.
  1,364 295 -
Primary amyloidoma of lung treated with radiation: A rare case report
Rakesh Kapoor, Tapesh Bhattacharyya, Amit Bahl, Ritesh Agarwal, Amanjit Bal, Ajay Gulati
October-December 2014, 31(4):404-406
DOI:10.4103/0970-2113.142151  PMID:25378854
Amyloidosis is a collection of diseases in which different proteins are deposited as insoluble beta-pleated sheets, disrupting organ function. Distribution of these deposits may be diffuse or localized throughout the body, depending on the pathophysiology of the underlying amyloid type. Isolated deposition of amyloid proteins in lung is a very rare entity. They are frequently misdiagnosed as bronchogenic carcinoma, metastatic disease, or focal fungal infections. The treatment of solitary pulmonary amyloidosis is not well-defined. We have treated a 65-year-old female patient with external beam radiation and corticosteroids in palliative intent and she is leading a good quality of life after six months of follow up.
  1,387 263 -
Pleuro-peritoneal lymphomatosis with concurrent tonsillar involvement in T-cell nonHodgkin's lymphoma: Clinical presentation mimicking disseminated tuberculosis
Pavan Tiwari, Karan Madan, Deepali Jain, Rakesh Kumar, Anant Mohan, Randeep Guleria
October-December 2014, 31(4):380-382
DOI:10.4103/0970-2113.142125  PMID:25378847
A young male patient had been evaluated for pleural effusion at another center wherein on the basis of exudative, lymphocyte predominant pleural effusion with high pleural fluid adenosine deaminase (ADA) levels and tuberculin skin test (TST) reactivity, antituberculous medications had been administered. Reevaluation in view of worsening symptoms led to confirmation of the diagnosis of T-cell lymphoblastic lymphoma with pleuro-peritoneal lymphomatosis and tonsillar involvement. This case highlights the fact that elevated ADA levels should not be taken as surrogate for a diagnosis of TB in the absence of histopathological/microbiological confirmation even in countries with high tuberculosis (TB) prevalence. Tonsil in an uncommon site of involvement in patients with T-cell lymphoma. As the diagnosis in our patient was confirmed from biopsy of a tonsillar mass, a thorough physical examination should be performed in all patients with a suspected diagnosis of lymphoma.
  1,345 298 -
Mobile vegetation leading to septic pulmonary embolism
Imran Haider, Raghav Gupta, Shuang Song
October-December 2014, 31(4):429-430
DOI:10.4103/0970-2113.142105  PMID:25378864
  1,431 211 -
Evaluation of the effect of pulmonary hydatid cyst location on the surgical technique approaches
Ali Sadrizadeh, Seyed Ziaollah Haghi, Seyed Hossein Fattahi Masuom, Reza Bagheri, Marziyeh Nouri Dalouee
October-December 2014, 31(4):361-365
DOI:10.4103/0970-2113.142118  PMID:25378844
Purpose: A hydatid cyst is the most common lung parasitic disease and is endemic in Iran. A hydatid cyst is more common in the right lung and lower lobes. Objective: The aim of this study was to assess surgical treatment of pulmonary hydatid cysts and whether the location of cyst affects surgical technique approaches. Materials and Methods: This study was performed on 87 patients with a pulmonary hydatid cyst who were referred to Qaem Hospital from 2010 to 2012. Selection of surgical technique was according to size, location, and the number of cysts. Patients were divided into two groups: (1) surgery with preserving lung parenchyma and (2) lobectomy. Afterward, the relationship between the location of cyst and surgical technique approaches was evaluated. Data was analyzed by Chi-square and Fisher exact tests. Results: In this study, no significant relation was found between the size (P = 0.682) and number (P = 0.344) of cysts and lobectomy necessity. But, there was a significant relation between the occurrence of cyst in middle lobe and lobectomy necessity (P = 0.016). Conclusions: According to the results, type of surgical technique does not depend on the size and number of cysts, but it may be related to the location of the cyst and the ratio of lung destruction.
  1,372 247 -
Endobronchial ultrasound guided needle aspiration of a paraspinal mass with prior failed multiple diagnostic interventions: A case report and literature review
Nishant Sinha, Vivek Padegal, Deepthi Jermely, Satish Satyanarayana, HK Santosh
October-December 2014, 31(4):401-403
DOI:10.4103/0970-2113.142149  PMID:25378853
The increasing frequency of tuberculosis (TB) in both developed and developing countries has continued to make spinal TB an important health problem. The present case report is about a patient who presented to us with progressive back pain and paraspinal mass. We performed endobronchial ultrasound guided needle aspiration from the paraspinal mass. The cytology showed granulomatous inflammation suggestive of TB.
  1,365 247 -
Surgical lung biopsy to diagnose Behcet's vasculitis with adult respiratory distress syndrome
Ravikanth Vydyula, Charles Allred, Mariana Huartado, Bushra Mina
October-December 2014, 31(4):387-389
DOI:10.4103/0970-2113.142127  PMID:25378849
A 34-year-old female presented with fever and abdominal pain. Past medical history includes Crohn's and Behcet's disease. Examination revealed multiple skin ulcerations, oral aphthae, and bilateral coarse rales. She developed respiratory distress with diffuse bilateral alveolar infiltrates on chest radiograph requiring intubation. PaO 2 /FiO 2 ratio was 132. The chest computed tomography revealed extensive nodular and patchy ground-glass opacities. Bronchoalveolar lavage demonstrated a predominance of neutrophils. Methylprednisolone 60 mg every 6 h and broad-spectrum antimicrobials were initiated. No infectious etiologies were identified. Surgical lung biopsy demonstrated diffuse alveolar damage (DAD) mixed with lymphocytic and necrotizing vasculitis with multiple small infarcts and thrombi consistent with Behcet's vasculitis. As she improved, steroids were tapered and discharged home on oral cyclophosphamide. Pulmonary involvement in Behcet's is unusual and commonly manifests as pulmonary artery aneurysms, thrombosis, infarction, and hemorrhage. Lung biopsy findings demonstrating DAD are consistent with the clinical diagnosis of adult respiratory distress syndrome. The additional findings of necrotizing vasculitis and infarcts may have led to DAD.
  1,228 266 -
Eventration of the right hemidiaphragm with multiple associations: A rare presentation
Ashok Kumar Mehrotra, Khyati Vaishnav, Prahlad Rai Gupta, Trilok Kumar Khublani, Anupam , Shridha Soni, Asif Feroz
October-December 2014, 31(4):421-422
DOI:10.4103/0970-2113.142098  PMID:25378860
  1,192 237 -
Tracheal compression due to anomalous innominate artery in an adult
Krishna B Gupta, Diksha Tyagi, Deepak Prajapat, Vipul Kumar
October-December 2014, 31(4):419-420
DOI:10.4103/0970-2113.142096  PMID:25378859
A 47-year-old-female presented with dyspnea and unproductive cough for 4 months. General examination revealed pulsatile swelling in the midline below the thyroid cartilage present since childhood. Computed tomography-angiography of the neck showed right innominate artery dilated, elongated and coursing above downward, anterior to the trachea below the thyroid, compressing the trachea and origin of the right subclavian artery higher up. A case of anomalous innominate artery causing symptomatic compression of the trachea in adults is a rare entity.
  1,096 221 -
Protecting ourselves from tuberculosis. Describing a historic poster printed in italy on 1937
Francesco Inzirillo, Casimiro Giorgetta, Eugenio Ravalli, Simon Tiberi, Claudio Della Pona, Mario Robustellini
October-December 2014, 31(4):425-427
DOI:10.4103/0970-2113.142102  PMID:25378862
  960 200 -
An increasingly breathless patient
Richard S Bodington, Shoaib Faruqi
October-December 2014, 31(4):427-429
DOI:10.4103/0970-2113.142104  PMID:25378863
  944 212 -
A case of recurrent massive right sided pleural effusion-an unusual presentation of carcinoma prostate
Pranay Ashok Bajpai, Prakash Joshi, Dolly Joseph, Ashok Bajpai
October-December 2014, 31(4):423-424
DOI:10.4103/0970-2113.142100  PMID:25378861
  872 201 -
Relationship between lung function and indoor air pollution
Sora Yasri, Viroj Wiwanitkit
October-December 2014, 31(4):430-430
DOI:10.4103/0970-2113.142106  PMID:25378865
  832 207 -
Author's reply
Victor Aniedi Umoh, Etete Petersa
October-December 2014, 31(4):431-431
  816 157 -
Adenosine deaminase in exudative pleural effusions
Somsri Wiwanitkit, Viroj Wiwanitkit
October-December 2014, 31(4):433-434
DOI:10.4103/0970-2113.142114  PMID:25378869
  731 239 -
Author's reply
Surender Kashyap, Kartikeya Kashyap
October-December 2014, 31(4):433-433
  792 164 -
Comments on non-utilising of rapid onsite evaluation with transbronchial needle aspiration
Girish Sindhwani, Rakhee Khanduri
October-December 2014, 31(4):435-435
DOI:10.4103/0970-2113.142117  PMID:25377212
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Author's reply
Asmita Anilkumar Mehta, Amit Satish Gupta, Subin Ahmed, Rajesh Venkitakrishnan
October-December 2014, 31(4):434-434
  751 164 -