Arnab Maji

The Incidence of Hyponatraemia and Its Effect on the ECOG Performance Status among Lung Cancer Patients.

CONTEXT Hyponatraemia is one of the common electrolytic disorders which are associated with lung cancer. Hyponatraemia may influence the ECOG performance status at presentation. Also, to the best of our knowledge, we found only limited Indian studies where the ECOG score was correlated with the serum sodium status in lung cancer patients on presentation. AIM To assess the incidence of hyponatraemia among the patients of carcinoma of the lung before putting them into the specific treatment category for cancer and to check the effects on their ECOG performance status. SETTINGS AND DESIGN A cross-sectional, observational study was conducted on 116 consecutive patients of lung cancer during the period from November 2011 to October 2012. MATERIAL AND METHODS The patients with a histologically proven diagnosis of lung cancer were grouped initially according to their ECOG performance statuses. The serum sodium value of each patient was measured and the hyponatraemic patients were given treatment according to the protocol. The correlation of the ECOG performance status with the serum sodium of the lung cancer patients was measured. To check for any laboratory error in serum sodium, we selected (n = 58) age, sex and socioeconomic matched control patients. RESULTS At presentation 44.8% of the lung cancer patients showed hyponatraemia [52/116]. The ECOG score was significantly poor in the advanced clinical stages (ECOG ≤2 Vs ECOG ≥ 3 in NSCLC cases, χ(2) =11.25, P=.0008). The ECOG performance status score at admission showed a negative correlation with the serum sodium status which was measured on admission among all the patients (Pearson correlation coefficient = - 0.186). The clinical stage of the lung cancer also showed a positive correlation with the ECOG score at admission in our study (Pearson correlation coefficient = 0.295). CONCLUSION Hyponatraemia is not an uncommon condition and it should be suspected and screened in each patient, as it may influence the ECOG performance status score, which serves as an important factor in the prognosis of lung cancer.

Role of common investigations in aetiological evaluation of exudative pleural effusions.

BACKGROUND Pleural effusion is a common problem encountered in daily practice. To Establish aetiology of exudative effusions is a diagnostic challenge to general practitioners and even to pulmonologists especially in resource poor government hospitals with lack of investigations like thoracoscopy. Some recent studies had shown that around 2% of patients remained undiagnosed even after these investigations. AIMS AND OBJECTIVE To evaluate the role of the commonly available investigations such as pleural fluid study, blind pleural biopsy, sputum examination, CT scan thorax, bronchoscopy in the aetiological evaluation of exudative effusions and to ascertain the proportion of cases which remain undiagnosed after all the above investigations. MATERIAL AND METHODS This was a prospective single-centred cross-sectional study carried out at the NRS Medical College, Kolkata, India from February 2008 to February 2013 which included 568 patients of exudative pleural effusions. We performed commonly available procedures like pleural fluid study, blind pleural biopsy, sputum examination, CT scan thorax, bronchoscopic procedures to the diagnosis. RESULTS Total number of patients studied were 568. Tuberculosis was the most common cause (54.57%) followed by malignancy (28.17%), empyema (10.56%), parapneumonic effusion (5.28%) and others. Carcinoma of the lung was the commonest cause of malignant effusions and bronchoscopic biopsy was given the highest yield of histological diagnosis (84.6%) followed by CT guided FNAC (77.6%) and pleural fluid cytology (55%). Highest yield to diagnose tubercular effusion was found in lymph node FNAC (81.5%) followed by pleural biopsy (62%). Sputum smear for AFB was positive in only 27.4% cases. Bleeding followed by pneumothorax were the most common complications. Complications are very less (1.3% and 0.9% respectively). 2 patients (0.34%) remained undiagnosed even after these all above said investigations. CONCLUSION Above mentioned commonly available investigations can ascertain diagnosis in most of the cases in the aetiological evaluation of exudative effusions and they are relatively safe procedures.

Correlation of six minute walk test with spirometric indices in chronic obstructive pulmonary disease patients: A tertiary care hospital experience

Background: Six-minute walk test (6MWT) is a simple, objective, reproducible test which correlated well with different spirometric indices, and thus able to predict severity of chronic obstructive pulmonary disease (COPD) and can replace spirometry in resource poor set-up. Aims and Objectives: To find out correlation between spirometric indices (forced expiratory volume in 1 s (FEV 1 ), forced vital capacity (FVC), and peak expiratory flow rate (PEFR)) and 6-minute walk distance (6MWD) in COPD patients, and thus to assess whether 6MWT can replace spirometry. Settings and Design: Institution based cross-sectional observational study. Materials and Methods: Eighty patients of COPD (diagnosis confirmed by Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2010 criteria) were enrolled for the study after applying exclusion criteria. All patients underwent spirometric measurement of FEV 1 , FVC, PEFR, and ratio of FEV 1 and FVC and test repeated after bronchodilation by 200-400 μg of salbutamol. 6MWT was performed following American Thoracic Society (ATS) protocol of 6MWT and distance was measured in meters. Results: We found significant linear correlation of 6MWT with post-FEV 1 (r = 0.478, P < 0.001), post-FVC (r = 0.454, P < 0.001), and post-PEFR (r = 0.408, P < 0.001), but no correlation with FEV 1 /FVC (r = 0.250, P = 0.025). We also found significant correlation of 6MWT with BODE (body mass index (BMI), airway obstruction, dyspnea, and exercise capacity) index (r = −0.419, P < 0.001). Conclusions: 6MWT can be a useful replacement of spirometry in assessment of severity of COPD.

Diagnosis of sclerosing hemangioma of lung: Don't rely on fine-needle aspiration cytology diagnosis alone

Sclerosing hemangioma is a rare variety of benign pulmonary neoplasm. It usually presents as asymptomatic, solitary, peripheral, circumscribed lesions in middle-aged women. Here, we describe a 46-year-old woman presenting to us for evaluation of right parahilar lung mass. Previous chest radiography done 10 years back showed a lung mass of almost similar size. Computed Tomography (CT)-guided fine-needle aspiration cytology (FNAC) was suggestive of adenocarcinoma of lung. A well-circumscribed, capsulated, ovoid mass measuring 5.6 cm × 4 cm × 3 cm, adjacent to the transverse fissure of the right lung was excised by lateral thoracotomy. Histopathological examination along with immunohistochemistry was suggestive of sclerosing hemangioma of lung. A pathologist must consider the clinicoradiological features before coming to a final diagnosis of lung malignancy from FNAC. Whenever there is any confusion regarding lung mass, thoracotomy must be done for arriving at an exact diagnosis from histopathology.

Unexplained dyspnea in a patient of chronic arsenicosis: A diagnostic challenge and learning curve for physicians.

Chronic arsenic exposure causes cutaneous effects like hyperkeratosis, peripheral vascular disease, hypertension, ischemic heart disease, non-cirrhotic portal hypertension, hepatomegaly, peripheral neuropathy, respiratory involvement, bad obstetrical outcome, hematological disturbances, and diabetes mellitus. Here we present a case of a 24-year-old lady, with chronic exposure to arsenic, presenting to us with progressive dyspnea. We found pulmonary arterial hypertension (PAH) as a cause of her dyspnea. PAH can occur in arsenicosis, secondary to arsenic-induced chronic obstructive pulmonary disease (COPD), lung fibrosis, and portal hypertension, which we excluded by appropriate investigations in our case. We also excluded a familial or heritable form of PAH. Thus, with the exclusion of all these secondary causes of PAH, as well as a hereditary cause, we came to a conclusion that this PAH might be due to chronic arsenic exposure. To the best of our knowledge, no case of PAH in chronic arsenicosis has been reported to date.

Non‑resolving pneumonia: A rare presentation of progressive disseminated histoplasmosis

Histoplasmosis, a fungal disease caused by Histoplasma capsulatum, is endemic in North and South America. Except few scattered cases, the disease is considered to be a non-entity in India. Furthermore, disseminated histoplasmosis is rare in the immunocompetent individuals. We report an adolescent boy presenting as middle lobe consolidation which did not respond to antibiotics. His condition deteriorated with the development of mediastinal lymphadenopathy, pleural effusion and hepatosplenomegaly. A diagnosis of progressive disseminated histoplasmosis was established by his clinical findings as well as bronchoscopic biopsy, transbronchial needle aspiration cytology and bronchoalveolar lavage culture demonstrating Histoplasma capsulatum. The case represents a unique example of progressive disseminated histoplasmosis in an immunocompetent individual in India.

Hypertrophic pulmonary osteoarthropathy: In coexistent lung cancer with pulmonary tuberculosis

Association of lung cancer with pulmonary tuberculosis is approximately 1-2% and pulmonary tuberculosis is associated with lung cancer in approximately 1-5% of cases. A 46-year-old male presented to us with low-grade fever for 3 months, increased severity of cough for 2 months, and painful swelling of fingers with both wrist joints for 1 month. Chest X-ray PA view revealed a homogenous opacity in the right upper and mid zone. Contrast-enhanced CT scan of the thorax showed soft tissue density, enhancing lesion (11.5 × 8.6 cm) with areas of necrosis in the right upper lobe. The patient suffered from squamous cell lung cancer as well as active pulmonary tuberculosis. As a complication of these two coexisting conditions, the patient developed hypertrophic pulmonary osteoarthropathy.