Background: Immunotherapy (IT) was first described by Noon and Freeman in 1911. The mechanism underlying successful immunotherapy is however not known. The protection from allergy is achieved long before IgE levels are de­creased, and they are indeed not frequently increased. Continued therapy may decrease IgE and skin reaction, although it may take years. Objective: The evaluation of effect of immunotherapy with specific pollen Gyn­andropsis gynandra. Material & Methods: Clinical subjects like skin test response, symptoms score, drugs intake and total sIgE levels were studied in sixty patients. Results: Both immediate and delayed skin test responses were highly significant. The intensity of symptoms score and medication was reduced and total sIgE levels were inconsistent after the course of IT. Conclusion: The decrease in clinical subjects may be attributed to the beneficial effect of immunotherapy with Gynandropsis gynandra.

Background: Tuberculosis remains the major cause of morbidity and mortality in India and affects largely the most productive members of the society. The major concern is increasing number of MDR TB cases due to inadequate and improper treatment of primary and post primary TB cases. However Directly observed ther­apy, short course (DOTS) is emerging as standard of care for the majority of TB patients and results from various parts of country are encouraging. Objective: To study the effectiveness of directly observed therapy and to compare it with self administered therapy in patients with tuberculosis. Design: Prospective randomized uncontrolled study The study was conducted on the patients attending the OPD or indoor patients at J N Medical College and hospital A M U Aligarh from October2004 to June 2006. Patients included pulmonary and extra-pulmonary TB cases diagnosed on the ba­sis of sputum smear, culture, chest radiograph, cytological and histopathological examination. Patients were assigned into two groups to receive either treatment under DOTS or self administered treatment. We compared the treatment outcomes in these patients between the two groups. Results: Patients treated by directly observed therapy DOT (n=495) had a similar cure rate compared with patients treated by self- administered therapy (n=450) (81% vs 81.6%, p > 0.05). The overall default rate was significantly more in the self administered group when compared to DOT (7.5% vs 5.3%, p < 0.05), but this was mainly due to high default rate among category II patients while the default rate among category I & III patients was comparable in the two groups. In our study mortality rate was found to be significantly high in the DOT group compared to SAT group (4% vs. 1.8%, p<0.01).This was also attributed largely by the category II patients with mortality rate 13.4% among the DOT compared to 6.2% in The SAT group (p<0.01). Mortality rates in the category I & III patients were comparable in the two groups. Rates of treatment failure, relapse and acquired drug resistance were similar between the two groups. Conclusion: Patients treated by DOT have excellent cure rates with lesser default rates. Thus we conclude that treatment plans that emphasize directly observed therapy from the start of treatment, have greatest success in improving tubercu­losis treatment outcomes, thereby preventing the transmission of disease in com­munity.

Objective : To compare the standard medical therapy (SMT) and noninvasive posi­tive pressure ventilation (NPPV) in acute on chronic hypercapnic respiratory fail­ure due to exacerbation of chronic obstructive pulmonary disease (COPD). Method : Between June 2002 and May 2003, 19 patients with acute on chronic hypercapnic respiratory failure were prospectively and randomly recruited to re­ceive either SMT (n=10) or NPPV plus SMT (n=9) in a general respiratory ward and followed up after 4 to 6 weeks after discharge. NPPV was given with a silicone cushioned nasal mask via a bilevel ventilator with initial pressure support of 5 cm of H ₂ O. Results : At the time of randomization there was no significant difference in respiratory rate, PaO ₂ , PaCO ₂ , pH and HCO3 ^- , between the two groups. At 2 hours with SMT, there was significant improvement only in respiratory rate (p = 0.0000) and PaO ₂ (p=0.0014). However with NPPV, respiratory rate (p=0.0000), PaO2 (p=0.0011), pH (0.0002), pulse rate (p=0.0329) and mean arterial pressure (p=0.0096) improved significantly at 2 hours while PaCO2 (p=0.0008 significantly improved at24 hours. Hospital stay was significantly shorter for NPPV group as compared to SMT group (9.63 + 1.4 days vs. 13.33 + 4.69 days, p < 0.05). There was 1 failure (12.5%) in NPPV group as compared to 2 failures (20%) in SMT group of which one was salvaged by NPPV. Conclusion : The study suggests that early application of NPPV in acute on chronic hypercapnic respiratory failure due to COPD facilitates improvement, favors early mobiliation and discharge from hospital.

Objective : To evaluate the usefulness and cost effectiveness of bronchial washing in addition to endobronchial biopsies and/or bronchial brushing for the diagnosis of endoscopically visible lung cancer. Material and method : We retrospectively analyzed the medical records of all fi­beropticbronchoscopies at Himalayan institute of medical sciences from January 2002 to August 2005. All patients with endoscopically visible tumours in whom a definite cytological or histological diagnosis of pulmonary malignancy was made were included in the study. We analyzed usefulness and cost effectiveness of three potential specimen collection stragetgies. These stratgies were (1) Bronchoscopy with biopsy, brushing, and washing (2) Bronchoscopy with biopsy and washing; and (3) Bronchoscopy with biopsy and brushing. Results : 107 cases of endoscopically visible abnormality underwent forceps biopsy, brushing and washing. Ninety-nine of these 107 patients had atleast one of the three endoscopic procedures (bronchial washing, endobronchial biopsies and bronchial brushing) positive for lung cancer (92.52%). The sensitivity of endobronchial biop­sy, brushing and bronchial washing for diagnosing lung cancer was 83.17%, 69.15% and 47.66% respectively. Bronchial washing was the only diagnostic procedure in two patients (1.86%). Cost effectiveness analysis revealed that bronchial washing as an additional diagnostic tool to endobronchial biopsies/or bronchial washing for diagnosis of endoscopically visible lung cancer may not be cost effective. Conclusion : The best yields for diagnosis of lung cancer is obtained with endobronchial biopsy and brushing. The addition of bronchial washing to either endobronchial biopsy or bronchial brushing is beneficial, but it may not be cost effective.

Allergic bronchopulmonary aspergillosis (ABPA) is the best recognized manifesta­tion of Aspergillus associated hypersensitivity to Aspergillus antigens in patients with long standing atopic asthma. Originally considered a rarity, ABPA is currently recognized with much greater frequency. ABPA with varied clinical presentation has been reported to occur in 20% of asthmatic patients admitted to hospitals and in 5% of all rhinitis cases. ABPA is frequency misdiagnosed as pulmonary tubercu­losis. Here we report a case of young female having cough, hemoptysis, fever and dyspnoea. She was taking antituberculosis treatment (RHEZ) for last two month with no significant improvement, and was found to have ABPA.

We describe a case of circumferential primary squamous cell carcinoma of trachea presenting as non-responding Asthma.

We present a clinical case of congenital adenomatoid malformation associated with a pneumonitic process of tubercular character operated successfully by means of right lower lobectomy. Congenital adenomatoid malformations generally are as­ymptomatic detected accidentally on skiagrams done for some other purpose, or may present as compressive phenomena affecting the surrounding structures, or sometimes by secondary infection due to supervening bacterial, mycotic or as in our case tubercular infection. Similar presentation of congenital adenomatoid mal­formations secondarily infected with tuberculosis is very rare.

Pulmonary lymphangioleiomyomatosis (PLAM) is a rare idiopathic, progressive multisystem disorder that predominantly affects women of childbearing age. Here is a report of pulmonary lymphangioleiomyomatosis in 28 years old female who presented with intial complaints of breathlessness, dry cough and chest pain for 2 years.

A case of primary pulmonary leiomyosarcoma presenting as right upper lobe mass is presented. The tissue diagnosis was made by microscopic examination following percutaneous trans-thoracic needle biopsy from the lesion and subsequently by surgical resection.