The therapeutic implications of diagnosing cor pulmonale versus left ventricular failure are well understood. Cor pulmonale and left ventricular failure termed in this article as congestive heart failure (CCF) are considered as differential diagnosis when patients with chronic respiratory illness, particularly chronic obstructive pulmonary disease (COPD), present with respiratory failure and peripheral oedema. Another entity, proposed to be termed "fluid retention in association with secondary pulmonary hypertension", should be added to the differential diagnosis. We studied 29 consecutive patients who were admitted with exacerbations of COPD and respiratory failure. Eight of these patients had peripheral oedema. Two D-Echocardiography confirmed cor pulmonale in four patients, whereas another four had mild pulmonary hypertension and hence termed as "pulmonary hypertension associated oedema". No patient had left ventricular dysfunction to be categorized as CCF. Treatment of the primary problem with oxygen therapy was adequate, and digoxin or diuretics were not required.

A retrospective analysis was done to evaluate the diagnostic yield of transbronchial lung biopsy (TBLB) in diffuse infiltrative lung disorders. A total of 49 patients were eligible for the procedure. Adequate lung tissue could be obtained in 46. Histopathology revealed idiopathic pulmonary fibrosis in 13, silicosis in 11, granulomatous disease in-nine, vasculitis in three, chronic inflammation consistent with tuberculosis in four, acute inflammation consistent with pneumonia of bacterial origin in two and non specific fibrosis in four. Thus the diagnostic yield of the procedure was 86%. Complications in the form of haemoptysis (2), and pneumothorax (3) were of minor nature and self limiting. TBLB is a safe, simple and effective procedure in the evaluation of diffuse lung infiltrative disorders.

Bronchoalveolar lavage (BAL) was carried out in 15 patients of lung cancer and 10 nonmalignant lung diseases which included patients of sarcoidosis, chronic obstructive pulmonary disease (COPD) and haemoptysis. In lung cancer patients BAL was carried out on the diseased lung and from the opposite normal lung. The total cell count in the malignant lobe of lung cancer patients was significantly greater as compared to that of disease free lobe and non-malignant lung diseases. The predominant cell was the macrophages constituting greater than 92% in all the three groups followed by lymphocytes (4-5%) and then the polymorphs (1-2%). Since alveolar macrophages are the main cellular components of the defense system in the lungs and they are known to produce numerous secretory products including reactive oxygen metabolites it needs further study whether an increase in these cells could be contributory for the development of lung cancer or they help the enhancement of already existing pathogenesis.

Forty four consecutive patients of pleural effusion were analyzed for pleural fluid protein, lactate dehydrogenase (LDH) and cholesterol levels. The patients were classified into transudates (n=16) and exudates (n=28) based on the Lights criterion. Pleural fluid cholesterol levels (PCHOL) determined in the transudative and exudative groups were found to be 35.4 ± 6.8 mg/100 ml and 80.3 ± 11.6 mg/100 ml respectively. This difference was found to be statistically significant (p<0.001). Similarly the ratio of pleural fluid to serum cholesterol values (P/SCHOL) was 0.17 ± 0.02 and 0.63 ± 0.09 in the transudative and exudative groups respectively which was also statistically significant (p< 0.001). With a cut off value of 55 mg/l00 ml for pleural fluid cholesterol and 0.3 for P/SCHOL ratio, the number of patients misclassified was one and none respectively, thereby showing that PCHOL and P/SCHOL determinations provide a sensitivity of 96.6% and 100% respectively. It is, therefore, suggested that PCHOL (value of > 50 mg/100 ml and P/SCHOL ratio of > 0.3 might be considered as indicative of exudative pleural effusion.

A patient with miliary tuberculosis who presented as a case of pneumothorax is reported.