A study was conducted to investigate if regular saline irrigation in patients with tubercular bronchopleural fistula (BPF) and pyopneumathorax (PPT) could achieve healing, when administered as an adjunct to first line anti-tubercular treatment. The study group consisted of 14 patients (8 females and 6 males) with ages ranging between 12-46 years. All were sputum positive pulmonary tuberculosis patients and were considered to be unfit for major surgery. In three patients, the BPF healed during the first month of observation period. The remaining 11 patients were treated with the conventional chest tube in the mid-axillary line and additional catheter inserted into the lower most point of the empyema. Daily saline irrigation through the catheter was performed in each patient. The bronchopleural fistula closed in 10 patients after a mean of 35 days (range 49-105 days). One patient refused further irrigation after 32 days. Sequelae following the procedure were fibrothorax in five, hydrothorax in three, and pneumothorax in two. There were seven patients (four males and three females) who were studied as controls. These were patients admitted consecutively in the hospital with a diagnosis of BPF and PPT during a period of one year just prior to the commencement of this study and were treated with conventional chest tube drainage and anti-tubercular treatment. There was healing of bronchopleural fistula and raexpansion of lung in two patients of the control group. In addition, three patients died and two patients did not report for follow up after four and seven months respectively in the control group.

A case control study was done to evaluate the risk imposed by various smoking habits in the development of bronchogenic carcinoma. All the consecutive 52 newly diagnosed and histopathologically proven bronchogenic carcinoma patients who had come to the hospital over one calendar year for treatment, were included in the study and 156 healthy by-standers of patients matched for age, sex and socioeconomic status were included as controls. A pretested questionnaire was used to seek information on socio-demographic and smoking habits of cases and controls. A fairly strong association was found between smoking and lung cancer. Out of 52 lung cancer patients, 39 (75%) had consistently smoked and only 55 (35.3%) of 156 controls had smoked. Of 39 smokers in cases, 26 (66.7%) smoked bidis and of the total 55 smokers in control group, 40 (72.7%) smoked bidis. Tobacco smokers on the whole had 5.5 times greater risk of developing lung cancer than nonsmokers (OR: 5.51, 95% CI 2.56 - 12.02; X2 = 23.29; p < 0.001). Bidi smokers had 5 times greater risk of developing lung cancer than nonsmokers (OR: 5.05, 95% CI2.21- 11.7; X2 = 17.68; p < 0.001). The risk increased with the number of bidis smoked per day and the duration of smoking. A comparative risk factor for lung cancer in cigarette as opposed to bidi smokers could not be assessed because of the small number of cigarette smokers in the study population.

The effect of temperature and humidity on pulmonary function was studied in 25 patients of bronchial asthma and 10 normal subjects. The effect was studied by recording the influence of cold dry air, cold humid air, warm dry air, and warm humid air inhalations on pulmonary function in each subject. The average fall in forced expiratory volume in one second (FEV1) and peak expiratory flow rate (PEFR) from pre-test value with cold dry air inhalation was 12.9% and 10.9% respectively, and with cold humid air 3.9% and 3.7% respectively. Warm dry air produced a fall of 6.4% and 3.6% in FEV1 and PEFR respectively. However, warm humid air inhalations registered an increase of 1.6% and 1.9% in FEV1 and PEFR respectively. All these changes were statistically significant. No significant change was observed in control subjects. This study suggests that the adverse effects of temperature and humidity on pulmonary function were more with cold dry air inhalations than with cold humid, warm dry or warm humid air inhalations in patients with bronchial asthma.

Unusual manifestations of sarcoidosis reported in India include parotid and lacrimal gland enlargement, superior vena caval obstruction, cirrhosis of liver with portal vein obstruction, portal hypertension, breast lumps, sarcoid nephritis, transient paralysis of phrenic and recurrent laryngeal nerves (especially left), miliary lesions in lungs, gross clubbing, insignificant or massive pleural effusions (either unilateral or bilateral), sarcoidoma, nodular sarcoidosis and Heerfordt, Lofgren, sicca, Marie- Bamberger and Monge's syndromes. Some of these features are however, not uncommon. The unusual features may cause diagnostic delay and inappropriate therapy.

Vocal cord dysfunction can mimic asthma or sometimes co-exist with asthma. Asthma which responds poorly to usual therapy has been termed “difficult asthma�. Vocal cord dysfunction is one of the several causes for difficult asthma. A high index of suspicion is necessary for appropriate diagnosis. We present a case of vocal cord dysfunction in a 40 year old nurse who also had mild asthma.

Pulmonary alveolar microlithiasis is an uncommon lung disorder. We present two cases with a review of relevant Indian literature.