Twenty patients with pulmonary tuberculosis and ten patients with abdominal tuberculosis of duration less than 3 years were evaluated for adrenal function by standard ACTH (synacthen) test. Eleven healthy individuals were taken as control group. The basal plasma cortisol values were significantly higher in patient groups than that in control group. All patients with pulmonary tuberculosis and abdominal tuberculosis had normal post-ACTH cortisol value indicating intact adrenal function. However, the functional reserve of adrenal gland as assessed by the area under the response curve showed lower functional reserve in both patient's group in comparison with control group. Inspite of normal adrenal function in pulmonary tuberculosis patients, hyponatremia was present in 25% of cases. This reflects that serum sodium is a poor marker and predictor of adrenal function in patients with pulmonary tuberculosis. None of the patients with abdominal tuberculosis had hyponatremia. Adrenal function is intact in patients with pulmonary and abdominal tuberculosis of duration less than 3 years inspite of lower functional reserve of adrenal gland than in healthy individuals.

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An underwater seal is required for providing closed intercostal drainage for managing pleural pathologies and following elective thoracic operations. Though underwater seal is an effective means of chest drainage, there are limitations. Not only it carries risk of total lung collapse from accidental disconnection from the chest drainage tube, it hinders the patient’s movement by confining him to the bed, specially in the presence of persistent air leak. Delayed ambulation leads to increase in hospital stay. A urinary collecting bag with a flutter valve connected directly to the chest drainage tube was found to be safe alternative to the underwater seal for closed chest drainage. It found high acceptance by the patients due to freedom of movement it provides. The case of management of the chest drainage with this system helped in bringing down the hospital stay by allowing out-patient management.

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Ventilator associated pneumonia (VAP) is a major cause of mortality and morbidity, in mechanically ventilated surgical patients. Recent studies have validated the accuracy of non-bronchoscopic, quantitative deep tissue culture techniques, protected specimen brushings (PSB) and bronchoalveolar lavage (BAL) in the diagnosis of VAP. We assessed the efficacy of using quantitative PSB cultures versus standard tracheal aspirate cultures in the treatment of VAP. In 18 equally matched surgical intensive care unit patients, using PSB cultures as compared to tracheal aspirate cultures we noted a significant reduction in antibiotic treatment days (4.66 ± 3.50 days versus 31.89 ± 10.56days, p<0.0001) and antibiotic patient charges ($3,077 ± 1,080 versus $ 422 ± 370, p<0.0001). We also noted a reduction in the incidence of subsequent pneumonia.

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A case of massive haemoptysis in pulmonary tuberculosis effectively controlled with bronchial artery embolization is presented. The material used was Hydrogel microspheres instead of routinely used Gelfoam. There was no complication due to the procedure and there has been no recurrence of haemoptysis during followup of over 2 years after completing antituberculosis chemotherapy.

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