Sarcoidosis is a multi-system granulomatous disorder of unknown aetiology rarely encountered in our country. A retrospective study was carried out to compare the characteristics of Indian sarcoidosis as observed at Armed forces tertiary care centres with that reported from West and other Indian studies. In this study sarcoidosis appears to occur more commonly in the affluent classes (62%), in males (83%) in the fourth and fifth decades (70%) and in North Indians (72%). Type 1 sarcoidosis was the most frequent presentation (62%). Extra thoracic conditions commonly were lymphadenopathy (30%), arthritic (18%), and ocular (15%) manifestations. Serum angiotensin converting enzyme (SACE) levels were raised in only one case (1.6%), hypercalcaemia was not seen and hyperglobulinaemia was seen only in 5% of cases. The disease was relatively benign, as 47% patients were cured and 53% were in remission with glucocorticoids.

To evaluate respiratory symptoms of workers to marble stone dust, a total of two hundred marble sculptors of Chandpole area in Jaipur were surveyed to detect respiratory symptoms in them. Forty-two individuals with the same environment and socio-economic background but engaged in professions other than sculpturing were taken as control subjects. The controls were non-smokers and non-tobacco chewers. A modified version of the ATS-DLD-78 questionnaire1 translated in Hindi was administrated to the persons and their peak expiratory flow rates were measured. Clinical symptoms in the form of chronic cough, chronic phlegm, dyspnoea and wheezing were found in 45% of the sculptors as compared to 24% of the control group. The abnormalities observed had a direct relationship with occupational exposure to marble dust and to the tobacco chewing and smoking habits of the subjects. A synergistic effect existed between smoking, tobacco chewing and exposure to marble dust.

A retrospective study of organophosphate and carbamate poisoning, its management and outcome in 36 patients admitted in intensive respiratory care unit (IRCU) over a period of one year was carried out in an urban tertiary care hospital. The mortality was 11.11% and there was no significant correlation with the type of poison consumed. Proximal muscle weakness, neck muscle weakness and weak gag reflex are good clinical indicators to predict the possibility of requiring ventilator support. Majority of the intubated patients in organophosphate and carbamate compound poisoning will require artificial ventilation. 5 patients (9.09%) developed intermediate syndrome and all patients recovered. Tracheostomy was done in 68% patients for prolonged ventilator support. Aspiration pneumonia, low pH values (= or < 7.012) and arterial PCO2 levels (= or > 79.9 mm Hg) at presentation were significant factors associated with mortality.

Scar carcinoma arising from old pulmonary scars is an established entity pathologically and is not uncommon in clinical practice. Presumably, it originates in epithelial metaplasia with ultimate carcinoma. Recent evidences suggest that central scars develop within pre-existing tumors rather than the reverse. Studies of collagen type indicates that collagen type III, characteristics of recent fibrogensis, is abundant in the center of 'scar cancers' whereas mature pre-existing lung scars in other situations show little type III collagen but abundant type I and V collagen. Further studies indicates that scar represents a desmoplastic reaction to tumour or arises within the tumour following collapse and/or necrosis. Although there is general belief that most scar cancers are adenocarcinoma, however in Indian studies, squamous cell carcinoma is more common scar cancer, possibly indicating supplement role of smoking. The present review also highlights on the biological behaviour and clinical implications of these tumours.

Clinically an unusual case of spontaneous rupture of oesophagus into right pleural cavity resulting in hydropneumothorax following radiotherapy for squamous cell carcinoma of oesophagus is reported. The oesophagopleural fistula was suspected because of swallowed fluid appearing in pleural space and draining though the chest tube. The diagnosis was confirmed by barium swallow study. The classical signs and symptoms of spontaneous rupture of oesophagus were absent.

The case history is presented of a 25 years old female with cough and dyspnoea on exertion for 31/2 yrs, an advanced pulmomary alveolar microlithiasis (PAM) with an atypical chest radiograph. The importance of family study is stressed as two of her sisters were found to have the same disease at an earlier stage with classic radiographs, clearing doubts about diagnosis in the index case. We think apical bullae in cases of PAM to be associated with advanced disease and a poor prognostic sign.