An interesting case of Empyema necessitans in an old case of pulmonary tuberculosis with chronic loculated pyopneumothorax In a male aged 28 years is reported. His skiagram chest revealed a soft tissue opacity with air - fluid level under the chest wall much below the fluid level in the left pleural cavity. Following an incision and drainage of the chest wall abscess, the loculated pus in the left pleural cavity completey disappeared. Specimens of sputum and drained pus were positive for acid fast bacilli, thus establishing a tuberculous etiology. There was good clinical response to anti-tubercular treatment leaving a puckered scar at the site of the incised chest wall abscess and a residual unobliterated left pleural space due to non-expansion of the atelectatic lung.

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A case of Limited Wegeners Granulomatosis, with migratory pulmonary shadows, relatively benign course and good response to cytotoxic agents is reported.

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Serum zinc and copper levels and erythrocyte sedimentation rates were determined in 25 healthy controls and 50 bacteriologically proven pulmonary tuberculosis patients to assess their response to antitubercular treatment and their relationship with radiographic extent of disease. There was a significant fall In serum zinc (p<0.001) and a significant rise In serum copper (p<0.001) levels In untreated pulmonary tuberculosis patients. The rise in serum copper level was related to the radiologically moderately and far advanced disease; however, serum zinc and ESR did not have any such relationship. The elevated serum copper and ESR had shown a significant fall and the decreased serum zinc had shown a significant rise following antituberculosis treatment.

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Hundred pathologically confirmed cases of bronchogenic carcinoma were analysed retrospectively based on the W.H.O. International Histological Classification, 1981. The relative frequency was: squamous cell carcinoma 27%,adenocarcinoma 21%, small cell carcinoma 1%, large cell carcinoma 10%, anaplastic 3%, carcinoid 1%, adenoid cystic carcinoma 3% (bronchial gland tumour) and adenosquamous carcinoma 1%. Thirty-three were grouped as undifferentiated.

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130 Patients attending allergy clinic were screened for skin test response to specific allergens using histamine phosphate as a positive control. Immediate reaction after 20 to 30 minutes and late phase reaction (LPCR) after six to eight hours of allergen Injection were noted. Profile and significance of the late phase cutaneous reaction were determined in asthmatics having high serum IgE level. Analysis of the data demonstrated that 3/4 th of the patients had LPCR.33.8% developed only LPCR and 41.5% also had Immediate reactions, 17% of the patients developed only immediate reactions, whereas 8% were non reactive to any of the antigens. Serum immunoglobulin levels are not significantly different from that in patients with immediate reactions. There was no significant elevation of C-reactive proteins. The leukocyte migration inhibition test was negative in the majority. The relationship of LPCR to immediate hypersensitivity is discussed.

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Thirty two transthoracic needle aspiration biopsies were performed on 25 patients with localised pulmonary lesions from June 1987 to December 1988. Two X-ray projections, frontal and lateral, were used for localisation of the lesion. Blind biopsy technique was adopted in all the patients. Definite diagnosis was established in 21 out of the 25 patients. 15 were malignant and six were benign lesions, four patients remained undiagnosed. Repeat biopsies yielded the diagnosis of malignancy in three out of six patients. Overall diagnostic accuracy was 84%. Complications like pneumothorax, hemoptysis and localised hematoma were observed in a total of five patients (20%) but no major complications occurred. The technique is simple and safe. It may facilitate early definite diagnosis in peripheral institutions lacking advanced investigational facilities.

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Reports of lung abscess due to organisms not primarily causing pulmonary disease are relatively scarce. Such an abscess due to S. typhl harbouring a fungus ball is probably being reported for the first time. A young man of 28 years adequately treated for pulmonary tuberculosis presented with haemoptysis which was thought to be due to post - TB bronchiectasis. The sputum examination showed S. typhl in abundance and the serum Salmonella O and H titres were significantly high. The constitutional symptoms ameliorated after a course of antibiotics (chloramphenicol and ampicillin) and the antibody titres showed a drop. But, his haemoptysis persisted, though less in amount and warranted surgery in the form of left upper lobectomy. The patient has no symptoms presently and the sputum is negative for S. typhl.

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The purpose of this study was to determine the optimal number of biopsy specimens required to diagnose the endoscopically visible bronchogenic carcinoma, using fiberoptic bronchoscope. Twenty six patients were Included In the study, three biopsy specimens were taken from each growth, and subjected for histopathoiogical examination. Eight out of 78 biopsy samples were negative for growth and all the tumors could be diagnosed with in the first two biopsy samples. The estimated probability of diagnosis after one biopsy was 0.8974, after two biopsies 0.9894 and after three It was 0.9989. Our experience suggests that two biopsy samples are good enough to diagnose a case of bronchogenic carcinoma and the complications related with the prolonged procedure and risk of bleeding can be reduced.

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Chest Skiagrams of 50 patients of primary liver carcinoma (32 males, 18 females, mean age 45.2+6.8 years) revealed appreciable changes in 45 cases (90%). Thirty six cut of 45 (80%) patients revealed elevation of the diaphragm and in 28 of them it was associated with ascites. The ‘humping’ of right hemidiaphragm was seen in five patients. The left hemidiaphragm was raised in two patients of whom one had ascites and other appreciable hepatomegaly. The changes in the lung fields mainly consisted of right basal parallel lines in 27 patients and obliteration of right cardiophrenic angle. Pulmonary deposits were mainly over the both lung fields as small, multiple rounded shadows without clear cut edges in 19 patients while single large (3-5cms) round deposit in two patients showed clear edges, pleural effusion, an uncommon finding, was seen in two patients whose pleural aspirates revealed undifferentiated large tumor cells (malignant cells) and red blood cells.

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In short course chemotherapy cash dose counts and the success of therapy lies on the completion rate of treatment. A short course regimen was implemented in pondicherry since 1984. Of the 1436 put on chemotherapy 390(27%) were lost to treatment. Distance did not seem to be a problem. Male proportion of defaulters were significantly higher than females; an increasing trend was observed with age. Lower income group patients, lost proportion was significantly higher. Socio economic factors were the main causes for these lost to treatment. By postal or in combination with home visits 179(46%) patients were retrieved and offered standard regimens. But 90(50%) were lost again. Family and community involvement with active social participation alone can contribute to the successful completion of treatment.

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Exposure to cotton dust produces acute changes In FEV1 over a shift and chronic changes as evidenced by loss of percentage of predicted value. In this report pre- and post- shift difference in FEF25-75% value and percentage of predicted FEF25-75% in control and exposed workers (non-byssinotics and byssinotics) were evaluated and related to blood histamine levels. The results revealed that the percentage of predicted FEF25-75% showed higher reduction in byssinotics than non-byssinotics and acute changes in FEF25-75% also showed greater decline in byssinotics, than non-byssinotics. This study suggests that FEF25-75% is an early Indicator of airway (small airway) obstruction in byssinotics.

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