Amita Athavale

Serial lobar lung lavage in pulmonary alveolar proteinosis.

Pulmonary alveolar proteinosis (PAP) is a rare disease with worldwide distribution and an estimated incidence of 0.36 cases per million. We report a case of a PAP coexisting with Pneumocystis jiroveci pneumonia and Mycobacterium tuberculosis infection. The patient was treated with serial lobar lung lavages, GM-CSF, cotrimoxazole, and antituberculosis drugs. His PaO2 on room air improved from 45.7 to 63.8 torr and pulmonary functions normalized (FVC 81.2%, FEV1 95.3%, FEV1/FVC 91.8). A high-resolution computed tomography scan of the thorax showed clearing of both lower lobes. Whole-lung lavage is used in the treatment of PAP, but it may worsen the hypoxemia and lead to hemodynamic instability during the procedure. To the best of our knowledge, there are no reports of bronchoscopic serial lobar lung lavages in cases of PAP performed in India. This method can be performed in bronchoscopic suites having general anesthesia facilities without the requirement of special gadgets.

Incidence of silicosis in flourmill workers

Background: Silicosis is an ancient occupational illness reported in silica mill workers, agate stone workers, slate pen workers and mining industry. However its association in flour mill workers has not been established. Aims: To study the incidence of silicosis and respiratory morbidity in flour mill workers. Settings and Design: A prospective study of 56 flour mill workers working with open silica grinding stones was undertaken. Materials and Methods: 56 flour mill workers who volunteered following information regarding the study purpose were recruited from the community. Detailed clinical and occupational history, lung functions, chest x-ray, and high resolution computed tomography (HRCT) were done. Diagnosis was made on the basis of radiological findings. Statistical Analysis: Data analysis was done with the help of the statistical package for social sciences software. The Chi-square test was used for determining the relationship between qualitative data and descriptive statistics was used where required. Results: 93% had respiratory symptoms that included cough (66.1%), dyspnea (75%), chest pain (17.1%), and rhinorrhea (46.4%). Radiological abnormalities were noted in chest X-ray (60.7%) and HRCT (81.48%). A significant correlation was seen between duration of exposure and HRCT abnormalities. Lung functions revealed obstruction in 28.5% subjects, restriction in 19%, mixed ventilatory defects in 21.4%, while 18.9% had a reduced diffusion capacity. Conclusion: Incidence of silicosis in our study on flour mill workers working with silica containing grinding stones was 30.4%. They had high respiratory morbidity (93%) cough and dyspnea being predominant symptoms. Duration of exposure correlates with radiological findings and increased incidence of silicosis.

Bronchoscopy in pulmonary hydatidosis: retrospective analysis.

The diagnosis of unruptured pulmonary hydatidosis is based on classical radiologic features. However, ruptured or complicated hydatid cysts alter the radiologic signs and lead to delayed or incorrect diagnosis. The role of flexible bronchoscopy was assessed as a diagnostic tool in the evaluation in such cases. Between 2002 and 2008, 14 patients (7 female, 7 male), aged between 18 and 55 years, with a mean age of 36 years, were evaluated for pulmonary hydatidosis. Clinical history, radiologic findings, and other investigations of the patients were reviewed retrospectively at a tertiary referral center. All 14 patients were symptomatic, with cough, hemoptysis, and chest pain being the most common symptoms. Seven patients had right lung involvement, whereas 6 patients had left-sided predilection, and the remainder presented with pleural disease. At flexible bronchoscopy, white glistening membrane could be observed in 9 patients, whereas cytologic evaluation of bronchial washing did not show cuticular particles, degenerated scoleces, or hooklets in any of the cases. Twelve patients underwent uneventful surgical intervention. Surgical specimens showed 2 unruptured pulmonary hydatid cysts (uncomplicated), 1 pleural hydatid, and 9 ruptured pulmonary hydatid cysts. Of the 9 ruptured hydatid cyst cases, evidence of fungal (aspergillus) colonization, bacterial infection, and coexistent tuberculous granuloma was reported in 2 cases each. Bronchoscopy is an important tool that aids in confirming the diagnosis before surgery, especially in complicated pulmonary hydatidosis. Special stains for cytologic specimen should be used if the possibility of ruptured hydatid is thought to improve the diagnostic yield. The histopathology of the surgical specimen should be reviewed for associated secondary infection and fungal colonization.