Background: The World Health Organization-Government of India (WHO-GOI) Guidelines - 2003 for management of chronic obstructive pulmonary diseases (COPD) is a consensus statement. However, the outcome and impact of its implementation on quality of life (QOL) among COPD patients has not been studied so far. Materials and Methods: The patients were randomized to intervention group (n = 50) and control group (n = 40). All were treated and followed up for 6 months. A pulmonary physician reviewed patients of both the groups, at least 3 times in 6 months period. St. George's Respiratory Questionnaire was measured at baseline and at 6 months. Patients in control group visited the center on a "need to" basis and were prescribed conventional treatment by the doctor on duty. Results: Forty-two patients in the intervention group and 32 in the control group completed 3 visits over the period of 6 months and were included in analysis. The severity as per the guidelines was moderate in 74% and severe in 26% in intervention group while it was moderate in 64% and severe in 36% cases in control group. Follow-up QOL scores were significantly better as compared with baseline values ( P< 0.001).The QOL of the patients treated according to the guidelines were significantly better ( P< 0.001) than those in the control group with conventional treatment. Conclusion: The consensus derived recommendations of WHO-GOI Guidelines for COPD-2003 are beneficial for management of COPD patients over conventional management.

Background/Aim: To study the prevalence and trend of acquired drug resistance to the first line antitubercular drugs . Materials and Methods: Sputum of 215 previously treated adult pulmonary tuberculosis (TB) patients over a period of 2002-2006 were subjected to culture and sensitivity testing against common antitubercular drugs. Result: Growth of Mycobacterium tuberculosis was obtained from sputum specimen of 184 (85.58%) of the 215 patients who were studied; Overall, 113 (62.77%) of these were resistant to at least one antitubercular drug. Resistance to isoniazid was most common (62.22%) followed by rifampicin (57.22%). Multidrug resistance (MDR) was observed in 103 (57.22%) cases. During the five-year study period, an increasing trend in drug resistance including MDR-TB was observed. Conclusion: This study showed increasing trend in drug resistance including MDR-TB in five years.

Background: The Revised National Tuberculosis Control programme (RNTCP), India. Aim: To assess the impact of the expansion of the RNTCP in the case detection and treatment outcome. Materials and Methods: Reports of patients with tuberculosis (TB) diagnosed and treated under RNTCP from 2001 to 2005 under Bagbazar TB unit (TU), Kolkata, reviewed retrospectively. Results: Of 2814 cases registered between 2001 and 2005, 1268 were new smear-positive pulmonary TB (PTB), 308 were new smear-negative PTB and 536 were new extrapulmonary TB (EPTB). During that period, the new smear-positive case detection rate increased from 41 to 61 per lakh population, the annual total case detection rate increased from 87 to 142 per lakh and the treatment success rate reduced from 90% to 76%. The default and failure rates increased from 7% to 10% and from 3% to 10%, respectively. Conclusion: A steady increase was observed in the annual total case detection rate and annual new smear-positive case detection rate from 2001 to 2005, but the 3-month conversion rate and cure rate of new smear-positive patients were progressively decreased. Default rate and treatment failure rate of new smear-positive patients were also increased. So it needs extra attention and evaluation of this disappointing treatment outcome.

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 m0 ethods: 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.

To understand normal sleep pattern and physiological changes during sleep, sleep and breathing interaction, nomenclature and scales used in sleep study, discuss the effect of rapid eye movements and non-rapid eye movements while sleep and to review the effects of obstructive and restrictive lung disease on gas exchange during sleep and sleep architecture.

This is a case report of a 48-year-old man, followed up for nearly 30 years who initially developed sarcoidosis at the age of 18 that went into remission after 8 years of treatment. Ten years later, he developed sputum-positive tuberculosis and was cured with anti-tubercular treatment. Following this, there was progression of sarcoidosis to stage IV fibrocystic disease. Ten years later, he had massive hemoptysis during which time, aspergilloma was detected in a sarcoid cystic cavity.

von Recklinghausen neurofibromatosis (NF-1) is the most common inherited syndrome predisposing to neoplasia, particularly neural crest-derived tumors. However, lung malignancies reported in association with neurofibromatosis are sparse. We present a case of a 48-year-old man with NF-1 that manifested as carcinoma of lung, in order to discuss the linkage between these two entities.

The simultaneous occurrence of pulmonary carcinoid tumor and tuberculosis is very rare. A case of pulmonary carcinoid tumor is described in a 35-year-old male patient who had concomitant ipsilateral pulmonary tuberculosis. The importance of dual pathological diagnosis in clinical practice is also emphasized.

We report a case of primary pulmonary Hodgkin's disease presenting as an endobronchial mass. Tissue diagnosis was made by microscopic examination following open thoracotomy and excision biopsy of the mass. The patient responded well to the chemotherapy regimen.

We report a case of a patient who presented with anterior mediastinal mass, seizure disorder, and mental retardation. Computerized tomography-guided fine-needle aspiration biopsy of the mass showed nonseminomatous germ cell tumor. Chromosomal analysis showed XXY karyotype. A diagnosis of Klinefelter syndrome and mediastinal germ cell tumor was made.

Immotile-cilia syndrome is a rare disorder characterized by chronic recurrent sino-pulmonary infection, impaired tracheobronchial clearance, situs inversus in about 50% of cases, and living but immotile spermatozoa of normal morphology in semen analysis. In this report, we describe an unusual presentation of immotile-cilia syndrome with azoospermia in a 32-year-old male patient. The diagnosis was based on history of recurrent respiratory tract infection, bronchiectasis, maxillary sinusitis, hypoplasia of frontal sinuses, dextrocardia with situs inversus, impaired nasal mucociliary clearance, etc. Semen analysis revealed azoospermia without any evidence of obstruction in epididymides or vas deference. Normal spermatogenesis was seen on testicular biopsy.

We describe a rare case of pneumothorax due to Marfan syndrome associated with fibrous dysplasia of the mandible. Marfan syndrome and fibrous dysplasia were possibly due to a common etiological factor. The association between the two and other tumors described in literature related to Marfan syndrome is discussed.

We present a series of three cases of survival following inhalation of nitric acid fumes, which resulted in acute respiratory distress. Inhalation of nitric acid fumes and its decomposition gases such as nitrogen dioxide results in delayed onset of acute respiratory distress syndrome. Intensive respiratory management, ventilatory support, and steroids can help in survival.

Secondary pulmonary alveolar proteinosis (PAP) is rare but may occur in association with malignancy, certain infections, and exposure to inorganic or organic dust and some toxic fumes. This case report describes the second recorded case of PAP due to exposure to cotton dust. A 24-year-old man developed PAP after working as a spinner for eight years without respiratory protection. He was admitted as an emergency patient with very severe dyspnea for four months and cough for several years. Chest X-ray showed bilateral diffuse alveolar consolidation. He died 16 days later, and a diagnosis of acute pulmonary alveolar proteinosis was made at autopsy. The histopathology demonstrated alveoli and respiratory bronchioles filled with characteristic periodic acid Schiff-positive material, which also revealed birefringent bodies of cotton dust under polarized light. Secondary PAP can be fatal and present with acute respiratory failure. The occupational history and characteristic pathology can alert clinicians to the diagnosis.

Drug-induced respiratory diseases are difficult to diagnose and therefore usually not identified, probably underestimated and under-reported. We report a case of diphenylhydantoin/phenytoin-induced chronic pulmonary disease in a 62-year-old male patient presenting with progressive dyspnea, eosinophilia, and pulmonary abnormalities. The importance of drug history in clinical history-taking and early diagnosis of drug-induced respiratory diseases is emphasized so as to prevent permanent pulmonary damage.

Intralobar pulmonary sequestration is characterized by the presence of nonfunctional parenchymal lung tissue, receiving systemic arterial blood supply. It lacks normal communication with tracheobronchial tree. Failure to diagnose and treat this condition can lead to recurrent pneumonia and fatal hemoptysis. The aim of this case report is to increase awareness about the condition and to review criteria of its definitive diagnosis and subsequent treatment.

Endotracheal metastases of primary lung cancer are rare. Only one case of tracheal metastasis from small cell lung cancer has been reported in literature. Here, we report a rare case of a 45-year-old woman who was admitted for sudden-onset breathlessness with respiratory failure and required ventilatory support. Endotracheal growth was identified during bronchoscopy, and biopsy revealed endotracheal metastasis of small cell lung cancer.