A total of 38 smear positive confirmed multidrug resistant (MDR) pulmonary tuberculosis patients belonging to both sexes were inducted in this study. Their culture sensitivity tests to Mycobacterium tuberculosis revealed resistance to 2-5 drugs concomitantly. Initially the patients were admitted in the ward for detailed investigations and to examine the acceptability of pneumoperitoneum (PP) therapy, afterwards the patients were put on PP on weekly basis plus two drugs daily chemo-therapy in the form of isoniazid and thiacetazone or isoniazid and ethambutol irrespective irrespective of their culture sensitivity report. Out of 38, only 16 could complete PP therapy of two years duration as 16 patients defaulted and PP was terminated prematurely in six patients due to side effects. Out of 16 patients who completed PP therapy, the disease got arrested completely in 13 and their subsequent follow-up for one year revealed bacteriological relapse in two cases. Thus only 11 of 38 i.e 29% were found to be with healed diseases after one year of follow-up although amelioration of toxaemia, weight gain and sputum conversion were observed during therapy in 30, 21 and 17 cases respectively.

Bronchoalveolar lavage (BAL) is a useful and safe method for the sampling of cellular and bio-chemical components from the bronchoalveolar lung units. We have evaluated its diagnostic utility in 175 patients, who were subjected to BAL for various types of lung lesions. BAL was done in a standard technique using Olympus fibreoptic bronchoscope by instilling 200 ml of sterile 0.9% saline solution at room temperature. The recovery of the fluid varied from 45% to 67%. The total cell count varied from 4 to 25 X 106/dl with varying amounts of macrophages (77 to 93%), lymphocytes (3-18%) and neutrophils (0.8-13%). The most common condition diagnosed was lung cancer, in whom BAL provided the diagnosis in 78.6% of cases. Pulmonary tuberculosis (PTB) was diagnosed in 32% of smear negative suspected cases of PTB. BAL findings were suggestive of idiopathic pulmonary fibrosis in 11 cases (68.%). Lower respiratory tract infection was diagnosed in 31 cases by BAL, while four cases of fungal infections were also diagnosed. Thus, the overall diagnostic yield for BAL was 81.8% and it was inconclusive in 18.2% of cases. There were minor side effects. Thus BAL is a safe technique and can be utilized for the routine workup of different lung diseases.

Patient education programme (PEP) in bronchial asthma, a common concept in Western Medical literature, is rarely discussed or practiced in our country. Since a state of “controlled asthma� is now achievable in Indian setting, PEP for years should be attempted by a team of committed medical and paramedical personnel. Adequate pre-planned arrangements for finance, removal of misconceptions regarding metered-dose inhalers (MDIs) from the minds of patients (and their attending physicians), judicious combination of MDIs of ‘relievers’ like β2 agonists and ‘protectors’ like steroid aerosols and other drugs, basic information about inciting factors and day to day self-management, regular follow up regarding therapy and related problems, proper way of taking MDIs, daily check for nasal block and existence of post-nasal drip, proper way to measure the peak flow meter recordings at home (to judge any deterioration) and self-assessment and immediate ‘crisis management at home’ etc. are some of the issues which need to be discussed in PEP sessions repeatedly. Considering the poor medical infra-structure, inadequate health-care services, overcrowding in hospitals, insufficient para-medical staff-pattern etc. in our country, PEP may, at present, be undertaken only in adequately financed asthma clinics with involved and well-trained medical and para-medical staff. Financial burden for long treatment, inadequate support from Governmental sources (as provided in cases with tuberculosis), illiteracy, language barrier, ignorance , superstition and misconceptions of patients on asthma and MDIs etc. are some of the obstacles, one will have to face while continuing with PEP in India.

A case of acute and long term respiratory damages following accidental inhalation of ammonia gas in a young adult is reported. In acute phase the patient had effects of mucus membrane irritation due to inhalation of the toxic gas which subsided within two weeks. The patient later developed fixed airways obstruction and bilateral bronchiectasis.

A female patient with cor pulmonale due to chronic lung disease (treated pulmonary tuberculosis) and multinodular goiter causing upper airway obstruction is reported. Subtotal thyroidectomy improved pulmonary hypertension and arterial blood gases by relieving upper airway obstruction. Patients with goiter should be evaluated for compressive symptoms and may be subjected to surgical intervention.