Saurabh Kumar Singh

Relative and additional bronchodilator response of salbutamol and ipratropium in smoker and nonsmoker asthmatics.

Purpose. This study was conducted in the Department of Tuberculosis and Respiratory Diseases, J. N. Medical College, Aligarh, India, from January 2006 to December 2007. The fact that smoker asthmatics can behave like chronic obstructive pulmonary disease (COPD) patients encourages the researcher to therapeutically exploit the important cholinergic influence in these patients. To clarify the clinical importance of the issue, the present nonblind and nonrandomized study was aimed at relative bronchodilator response to adrenergic and cholinergic agents. Methods. Ninety-six patients of asthma, 48 nonsmokers and 48 smokers, were given sequential doses of inhaled salbutamol and after achieving maximum bronchodilation, ipratropium was administered to observe the additional bronchodilation. On the next day, the sequence of drugs was reversed. Ipratropium was given first and after achieving maximal response, salbutamol was given. Results. On giving salbutamol first, maximal improvement in forced expiratory volume in one second (FEV1) was 67.04% ± 12.98% in nonsmokers and 60.64% ± 13.6% in smokers. The additional improvement with ipratropium was 9.22% ± 2.08% in smokers and was significantly higher (p <.001) than in nonsmokers (0.13% ± 2.14%). When ipratropium was given first, maximum improvement in FEV1 was 41.95% ± 4.57% in smokers, which was significantly higher (p <.001) than in nonsmokers (20.06% ± 7.06%). The additional improvement with salbutamol was 23.16% ± 5.07% and 19.09% ± 4.9%, respectively, in nonsmokers and smokers. Conclusions. With the above results, the authors concluded that in smoker asthmatics, cholinergic tone was more prominent and there was down-regulation of adrenergic receptors, as both drugs caused significant additional dilatation. So in smoker asthmatics, addition of a cholinergic agent will result in better control of asthma. In nonsmoker asthmatics, addition of cholinergic agent is of little or no value.

Bronchial thermoplasty: a non-pharmacological approach

Asthma is a chronic inflammatory disorder of the airway characterized by the episodic symptoms of breathlessness, wheezes and cough. Even with the use of maximum anti‐asthmatic pharmacological treatment sometimes it remains uncontrolled. For such patients, bronchial thermoplasty is the new mode of treatment.

Traumatic pulmonary pseudocyst: a case report.

Traumatic pulmonary pseudocyst is a rare clinical event that may occur following chest trauma. This complication usually occurs as a result of blunt trauma and rarely, due to a penetrating injury. We report an unusual case of a 10-year-old boy who developed a left-sided pneumothorax along with a traumatic pulmonary pseudocyst when he was hit by a cricket ball while playing.

Role of fine-needle aspiration cytology in evaluating mediastinal masses.

Background: Fine-needle aspiration cytology is an important and useful investigation and is considered next to imaging in the diagnosis of mediastinal lesions. We carried out this study in the Department of TB and respiratory diseases JNMC Aligarh from March 2000 to March 2002 with the following aims. Objectives: To make etiological diagnosis of mediastinal lesions, determine the pathological type of the tumor in cases of malignancy and evaluate the role of fine-needle aspiration cytology in staging of bronchogenic carcinoma. Materials and Methods: A total of 56 patients were included in this study who had mediastinal mass with or without lung lesions on chest X-ray or computed tomography scan. Of these patients, 36 had mediastinal mass only and 20 had mediastinal mass with parenchymal lesion. Results: In the present study, of 56 patients, 36 had mediastinal masses and 20 had pulmonary mass. Conclusion: Percutaneous fine-needle aspiration is an easy and reliable method for reaching a quick tissue diagnosis in pulmonary and mediastinal masses.

Role of positron emission tomography-computed tomography in non-small cell lung cancer

Lung cancer is the leading cause of cancer-related mortality worldwide. Non-small cell carcinoma and small cell carcinoma are the main histological subtypes and constitutes around 85% and 15% of all lung cancer respectively. Multimodality treatment plays a key role in the successful management of lung cancer depending upon the histological subtype, stage of disease, and performance status. Imaging modalities play an important role in the diagnosis and accurate staging of the disease, in assessing the response to neoadjuvant therapy, and in the follow-up of the patients. Last decade has witnessed voluminous upsurge in the use of positron emission tomography-computed tomography (PET-CT); role of PET-CT has widened exponentially in the management of lung cancer. The present article reviews the role of 18-fluoro-deoxyglucose PET-CT in the management of non small cell lung cancer with emphasis on staging of the disease and the assessment of response to neoadjuvant therapy based on available literature.

Unusual presentation of tuberculosis

Mediastinal mass is not an unusual entity. It occurs mostly due to lymphoma, thymoma, germ cell tumours, granulomatous diseases, and so on. Tuberculosis is an uncommon cause of mediastinal mass. It is rarely suspected when it is presented in such an unusual way. We report here a case of a 35-year-old male who presented with mediastinal mass, which was later confirmed as a case of tuberculosis on histopathological examination. He was successfully treated with anti-tubercular drugs.

Improvement in quality of life in pulmonary tuberculosis patients: a prospective study.

A cohort of 50 newly diagnosed patients with pulmonary tuberculosis was prospectively studied and compared with controls to assess and quantify their quality of life using the World Health Organization’s (WHO) Quality of Life (QOL)–BREF score before and after a Directly Observed Therapy Short (DOTS) course. It was concluded that health-related quality of life is impaired by tuberculosis and shows significant improvement with the DOTS treatment.

Herniation of pulmonary bulla--a case report.

Herniation of lung is an abnormal protrusion of the lung beyond the confines of the thoracic cage. Thoracic lung hernias are classified as cervical, intercostal, diaphragmatic or mediastinal. Each of these types can be either congenital or acquired. Acquired hernias can be spontaneous, posttraumatic or pathologic as a result of neoplastic or inflammatory process. Bullae are thin walled structures with a diameter more than 1 cm. They are most commonly seen in the upper portion of the lung. The underlying disease process is characterized by abnormal enlargement of the air spaces distal to the terminal bronchioles accompanied by destruction of their walls. These anatomic changes result in decreased elastic recoil, increased airway resistance and decreased maximal expiratory flow rate. The lung became hyperinflated and may demonstrate focal areas of bulla formation.. This causes overinflation and even burst of bulla into pleural cavity resulting in pneumothorax. We report a case where overinflated bulla herniated across the anterior mediastinum into the opposite hemithorax. This case is the first of its kind.

Safety of Ipratropium Bromide

www.chestpubs.org Last, of the nine additional cases diagnosed with HRCT scans, seven had clinical symptoms suggestive of a diagnosis of active TB and a positive g interferon test result. The three culture-proven cases were all in this group. Even with a negative chest radiograph, it is debatable whether these patients would have been diagnosed and treated as latent infections in an outbreak investigation without the additional HRCT scan. Only two cases were asymptomatic patients with a positive g interferon test. In neither of these was active TB proven, leading to the possibility that these may represent false-positive test results. In conclusion, the previously documented higher accuracy of HRCT scans compared with chest radiographs in the detection of active pulmonary TB 4 is again noted in this study. However, as a result of study design and the methodologic fl aws described previously, the aim of the study to elucidate the role of HRCT scanning in outbreak investigation is not met. The conclusion that HRCT scans may differentiate active TB from latent TB infection in outbreak investigation is insuffi ciently supported by the data. As the authors mention in their discussion, the impact of additional HRCT scanning in TB outbreak investigation can only be assessed by randomized controlled trials with the incidence of active TB in each group of patients as the end point. In view of the high cost of CT scanning, particularly in a screening environment, such trials should include assessment of cost effectiveness. Risks associated with increased exposure to radiation will also have to be taken into account. At present, there is insuffi cient evidence to justify the inclusion of HRCT scanning in TB outbreak investigation.

Analysis of clinical and radiological features of tuberculosis associated pneumothorax

AIM To investigate the demographic and clinico-radiological characteristic of patients of tuberculosis presented with pneumothorax in relation to the patients of active pulmonary tuberculosis. MATERIAL AND METHODS The retrospective study was conducted between January 2013 to June 2014 and records of 78 patients of pulmonary tuberculosis with pneumothorax (TP) and 156 patients of pulmonary tuberculosis without pneumothorax (NPT) were analyzed. Demographic, etiologic, clinical, radiographic, and outcome data were collected. RESULTS The mean age of tuberculous pneumothorax patients was 38.0±14.3 years and that of non-pneumothorax was 39.5±12.3 years. Most common presenting clinical feature was cough (76.9%) followed by dyspnoea (74.4%), chest pain (64.0%) and fever (56.4%) in TP patients. Chest radiograph showed cavity in 38 (48.7%) TP patients followed by consolidation in 32 (41.0%) patients and infiltration in 33 (42.3%) patients. All the TP patients had undergone underwater seal intercostal tube drainage procedure for the management of pneumothorax. The mean duration between chest drain insertion and removal was 17.14±6.37 days. Twenty-five (32.1%) of the cases developed chest tube drainage related complications. CONCLUSION Patients of tuberculous pneumothorax required prolonged period of chest tube drainage and usually showed good response to the treatment.