Emphysematous bullae in a lung can coalesce into a large lucency and may cause a shift of mediastinal structures. The present report describes a case of multiple emphysematous bullae in a 35 years old man that occupied the entire left hemi­thorax with mediastinal compression of the right lung. The patient underwent a left sided thoracotomy with a left pneumonectomy. The patient had an uneventful recovery.

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We are describing a case of idiopathic pulmonary artery aneurysm, which pre­sented to us with complaints of shortness of breath and chest pain. Chest -X ray showed a homogenous opacity occupying left mid and lower zone, CECT thorax revealed a pulmonary artery aneurysm which was compressing the left bronchus and causing atlectasis. The patient was managed surgically

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It is important to assess patients of difficult/therapy resistant asthma carefully in order to identify whether there are any correctable factors that may contribute to their poor control. It is critical to make a diagnosis of asthma and to exclude other airway diseases. A 65-years-old lady presented with repeated acute episodes of dyspnoea and wheezing. She was on regular medication for bronchial asthma for 18 years. There was no history of foreign body aspiration or loss of consciousness. Her chest radiograph was normal. She showed poor response to corticosteroids and bronchodilators. Fibreoptic bronchoscopy (FOB) showed intracordal cyst of the left vocal cord and 1cm size irregular piece of betel nut in right main bronchus, which was removed endoscopically with the help of dormia basket, following which her condition improved and asthma was controlled on inhaled bronchodilators.

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Adenoid cystic carcinoma is a rare but distinctive salivary gland type malignant neoplasm that arises infrequently in the respiratory tract, where it is largely seen in the trachea or large airways. A 29-year-old female who presented with a peripheral lung mass due to pulmonary adenoid cystic carcinoma is reported in view of its unusual location, early age of presentation and lack of such reports in the recent literature. Lung India 2007; 24 : 28-29

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Background : The success of immunotherapy for allergies has always been contro­versial. Some of the factors, which can affect the efficacy of immunotherapy, are the type and number of allergens in the vial, concentration, time, storage tempera­ture, volume of the vial, diluent used and preservatives added. Objective : To decipher the role of combination of allergens administered in Spe­cific immunotherapy (SIT). Material and methods- patients who had a confirmed diagnosis of bronchial asthma, based on skin test and IgE were studied (n=50). Symptoms score on the scale of 1 to 4 were based on 2 factors- the frequency and the intensity. Results : Based on the guidelines of Joint Task Force on Practice Parameters (USA), it was observed that 58% of the patients, who did not benefit, received the incor­rect combination of allergens. On the other hand, the symptoms improved in all the patients who received the correct combination. Conclusion : These results clearly lay emphasis on the nature of allergens and their combination used for immunotherapy. Therefore factors such as combination of allergens should be taken into consideration for management of allergies.

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Objectives: To ascertain the validity of anatomic diagnostic protocol in determin­ing the etiology of chronic cough in tropics and a cost analysis of the protocol to ascertain effective ways of managing patients with chronic cough. Methods: A prospective, descriptive, study of non-smoking patients with chronic cough. All patients were evaluated by a validated anatomic diagnostic protocol. The diagnostic protocol was modified to include sputum examination for acid-fast bacilli, absolute eosinophil count and stool examination. The final diagnosis was based on radiological, laboratory findings and a successful response to therapy. Results: Eighty-seven consecutive patients with chronic cough were evaluated from February 2000 to February 2002 using the modified diagnostic protocol. The mean age ±S.D. was 35.00±11.85 years. Forty-nine patients were males. Etiology of chronic cough was established in 86 (99%) patients. Cough resolved in 99% of patients after successful diagnosis and treatment. The three most common causes were Postnasal drip syndrome (PNDS), 52%, Asthma, 41%, and Loeffler's syn­drome, 8%. Pulmonary tuberculosis was confirmed in 5% of patients. Hence, 13% of patients had conditions more prevalent in the tropics. Gastroesophageal reflux disease (GERD) was seen in 6%. Rare causes of chronic cough included congestive cardiac failure (CCF) 2%. Cough was due to multiple causes in 15%. The average cost per patient was Rupees (RS) 878.55 (1US$=RS 45). However if we use the pro­tocol proposed at the end of study the average cost per patient will be RS 743.55. Using the modified diagnostic protocol 90% of patients were diagnosed with mini­mal investigations making it cost effective. Conclusion: The three most common causes of chronic cough in the tropics are different from the west. Pulmonary tuberculosis and Loeffler's syndrome are more prevalent and need to be considered. Using a modified diagnostic protocol etiology of chronic cough can be determined successfully in tropical countries in most patients. A cost effective way of evaluating cough has been proposed.

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Setting: Department of Tuberculosis and Respiratory diseases, Pt. B.D. Sharma PGIMS, Rohtak. Aim: Study was carried out to evaluate the diagnostic yield of fibreoptic bronchos­copy in patients of smear negative tubercular pleural effusion. Methodology: Flexible fibreoptic bronchoscopy under local anaesthesia was car­ried out and bronchoalveolar lavage was stained by Z-N staining for AFB and en­dobronchial biopsy was sent for histopathological examination and direct staining for AFB. Results: Endobronchial abnormalities were visualised in nearly 50% cases in right sided pleural effusion and 38% cases in left sided pleural effusion. Bronchoalveolar lavage was positive for AFB in 8% of cases. Endobronchial biopsy for histopathol­ogy and staining for AFB was positive in 12% of cases. Conclusion: Flexible fibreoptic bronchoscopy is very safe and novel technique in increasing bacteriological yield of patients with tubercular pleural effusion.

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Objectives: This study, using a questionnaire and pulmonary function tests (PFTs), was aimed at assessing the prevalence of respiratory diseases and the impact of environmental factors on these diseases. Materials and Methods: 201 schoolteachers, residing in an urban area at moderate altitude (2200m), were administered a standardized questionnaire and subjected to PFTs. The data obtained was statistically analyzed. Results: 28.35% subjects had one or more chronic symptoms. Shortness of breath was present in 16.41%; wheeze in 14.43%; cough in 8.46%; sputum production in 8.46%; and wheeze with shortness of breath in 6.97%. The frequency of symptoms increased with age and smoking. Pulmonary functions were lower in subjects with symptom(s) as compared to those who were asymptomatic; forced expiratory vol­ume in one second (FEV1) showed the greatest reduction amongst the parameters studied. Functions were significantly lower in smokers and those using hydrocar­bon fuels. 3.98% had bronchial asthma; the prevalence was higher in females at 4.48%. The overall prevalence of chronic bronchitis was 8.46%; however among smokers this was 29.16% and in non-smokers 5.65%.

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Adenoid cystic carcinoma is a rare but distinctive salivary gland type malignant neoplasm that arises infrequently in the respiratory tract, where it is largely seen in the trachea or large airways. A 29-year-old female who presented with a peripheral lung mass due to pulmonary adenoid cystic carcinoma is reported in view of its unusual location, early age of presentation and lack of such reports in the recent literature.

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