Mixed connective tissue disease (MCTD) is a frequently recognized rheumatic syndrome. A young female with this disease who showed marked restrictive ventilatory impairment, hypoxaemia, CO2 retention and marked weakness of the skeletal muscles of the neck and thorax is reported. Alveolar hypoventilation causing CO2 retention in blood is rare in MCTD. The patient improved with steroid therapy. The underlying mechanism of pulmonary function impairment in MCTD is discussed.

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Adult patients with active pulmonary tuberculosis who were given ethambutol (E 20mg/kg) rifampicin (R 10 mg/ kg), pyrazinamide (Z 25mg/ kg), isoniazid (H 5 mg/kg) daily for two months and later twice weekly for four to six months (E 40mg/kg; H 14 mg/kg), were extensively evaluated for response and drug toxicity. Of 126 patients, 110 completed two months and 92 patients finished six or eight months of therapy; at the respective stage 72 (65%) 90, (98%) showed sputum conversion and radiographic improvement was seen in 66% and 95%. Over the next six months, 4 (4.4%) relapsed with INH resistant bacilli. Clinical jaundice was seen in 20 patients after a mean 18 (5-37 days of treatment; in 18, drugs) (R, Z) could be restarted, though bilirubin rose again in three patients. In later months, 15 patients, showed increased bilirubin. Fifteen patients had arthralgia while one developed joint swellings and one skin rash. Ocular toxicity was seen in 13 patients of whom five had temporary subjective or objective changes. In five, persisting diminished visual acuity, field restriction and scotoma were seen and ethambutol was discontinued; two recovered fully in three weeks, one partially but two did not recover. EHRZ regime seems to be effective, acts a little slowly and has some toxicity.

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Evaluation of inhalant corticosteroids was thought necessary in view of the wide variation of published reports. Beclomethasone dipropionate and betamethasone valerate were evaluated in nonsteroid dependent and steroid-dependent asthmatics separately. In the stubborn cases of non-steroid-dependent asthma, it was found that aerosol and oral steroids were equally effective and that 400μg of beclomethasone was equipotent with 7.5 mg prednisolone. In the cases of true steroid dependent asthmatics good short-term results deteriorated when along follow-up was done after replacement of oral steroids with aerosol forms. In general, chances of total replacement were better in children, in females and in those taking oral steroids at a dose of less than 0.6 mg/kg or 15 mg/day for less than three years. Oral candidiasis was conspicuously absent.

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Successful removal of a plastic whistle from the right upper lobe bronchus in a ten year old child is reported. Auscultation revealed abnormal whistling sounds during expiratory phase which disappeared after removal of the foreign body which was 2.25 cm long and 1 cm in diameter.

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In patients with spinal deformity, the stature is generally reduced and so height becomes an unreliable measurement to predict the vital capacity (VC). Hence this study has been undertaken to show that an alternative physical measurement of arm span may be utilized to predict the lung volumes in these subjects as there is a highly significant positive correlation between height, arm span and lung volumes. An attempt has been made to see the relationship between arm length and lung volume also.

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A 58 year old female with respiratory symptoms since three years of age was admitted to Thoracic Medicine ward on 14-7-84 with complaints of cough, expectoration, dyspnoea, dysphagia and pain in the abdomen. She was moderately obese, had no clubbing but was cyanosed and had extensive rales and occasional expiratory rhonchi. The proceedings of a clinico pathological conference discussion held at the Government General Hospital, Madras leading to the final diagnosis of the case are presented in this report.

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