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2015| November-December | Volume 32 | Issue 6
Online since
October 23, 2015
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SYSTEMATIC REVIEW
Hemophagocytic lymphohistiocytosis: An unusual complication in disseminated
Mycobacterium tuberculosis
Somanath Padhi, Kandasamy Ravichandran, Jayaprakash Sahoo, Renu G’Boy Varghese, Aneesh Basheer
November-December 2015, 32(6):593-601
DOI
:10.4103/0970-2113.168100
PMID
:26664166
Background:
Hemophagocytic lymphohistiocytosis (HLH) is an uncommon, potentially fatal, hyperinflammatory syndrome that may rarely complicate the clinical course of disseminated
Mycobacterium tuberculosis
(MTB). The clinical course of tuberculosis-associated HLH (TB-HLH) has been reported to be unpredictable.
Materials and Methods:
Here we describe the clinicopathological features, laboratory parameters, management, and outcome data of a patient who satisfied the 2004 diagnostic criteria for HLH secondary to disseminated MTB; we also do a systematic review of the international literature on TB-HLH. The literature review (January 1975–March 2014) found that HLH complicated the clinical course of 63 tuberculosis patients (41 males, 22 females, mean age = 45 ± 23.5 years) with a high mortality rate of 49% (31/63 died). The mean serum ferritin level (
n
= 44/63) was 5963 ng/mL (range 500–38,539 ng/mL); and a higher proportion (54.2%) of patients had pancytopenia at presentation. On univariate analysis (
n
= 53/63), age >30 years [hazard ratio (HR): 2.79, 95% confidence interval (CI):1.03–7.56,
P
= 0.03], presence of comorbidities (HR 4.59, CI: 1.08–19.52,
P
= 0.04), marked hemophagocytosis in bone marrow (HR: 2.65, CI: 1.16–6.05,
P
= 0.02), and nonusage/delayed usage of antitubercular therapy (ATT) (HR: 3.44, CI: 1.51–7.87,
P
= 0.003) were associated with decreased survival, though none of these parameters attained statistical significance (
P
> 0.05) in multivariate analysis. Usage of corticosteroids and/or immunomodulator drugs (HR 1.00, CI: 0.66–3.22,
P
= 0.35) did not alter the outcome in these patients.
Conclusion:
HLH should be considered as a differential diagnosis in patients with tuberculosis who present with cytopenias, organomegaly, and coagulopathy. Strong clinical suspicion and early usage of ATT might be useful in reducing the morbidity and mortality. The utility of immunosuppressive/immunomodulator therapy lacks general concensus among treating physicians, and warrants further studies.
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ORIGINAL ARTICLES
Cost-effectiveness of noninvasive ventilation for chronic obstructive pulmonary disease-related respiratory failure in Indian hospitals without ICU facilities
Shraddha P Patel, Margarita E Pena, Charlene Irvin Babcock
November-December 2015, 32(6):549-556
DOI
:10.4103/0970-2113.168137
PMID
:26664158
Introduction:
The majority of Indian hospitals do not provide intensive care unit (ICU) care or ward-based noninvasive positive pressure ventilation (NIV). Because no mechanical ventilation or NIV is available in these hospitals, the majority of patients suffering from respiratory failure die.
Objective:
To perform a cost-effective analysis of two strategies (ward-based NIV with concurrent standard treatment vs standard treatment alone) in chronic obstructive pulmonary disease (COPD) respiratory failure patients treated in Indian hospitals without ICU care.
Materials and Methods:
A decision-analytical model was created to compare the cost-effectiveness for the two strategies. Estimates from the literature were used for parameters in the model. Future costs were discounted at 3%. All costs were reported in USD (2012). One-way, two-way, and probabilistic sensitivity analysis were performed. The time horizon was lifetime and perspective was societal.
Results:
The NIV strategy resulted in 17.7% more survival and was slightly more costly (increased cost of $101 (USD 2012) but resulted in increased quality-adjusted life-years (QALYs) (1.67 QALY). The cost-effectiveness (2012 USD)/QALY in the standard and NIV groups was $78/QALY ($535.02/6.82) and $75/QALY ($636.33/8.49), respectively. Incremental cost-effectiveness ratio (ICER) was only $61 USD/QALY. This was substantially lower than the gross domestic product (GDP) per capita for India (1489 USD), suggesting the NIV strategy was very cost effective. Using a 5% discount rate resulted in only minimally different results. Probabilistic analysis suggests that NIV strategy was preferred 100% of the time when willingness to pay was >$250 2012 USD.
Conclusion:
Ward-based NIV treatment is cost-effective in India, and may increase survival of patients with COPD respiratory failure when ICU is not available.
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COMMENTARY
Clinical application of spirometry in asthma: Why, when and how often?
Sunil K Chhabra
November-December 2015, 32(6):635-637
DOI
:10.4103/0970-2113.168139
PMID
:26664177
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ORIGINAL ARTICLES
Prevalence and outcome of epidermal growth factor receptor mutations in non-squamous non-small cell lung cancer patients
Rajesh Kota, Sadashivudu Gundeti, Muralidhar Gullipalli, Vijay Gandhi Linga, Lakshmi Srinivas Maddali, Raghunadharao Digumarti
November-December 2015, 32(6):561-565
DOI
:10.4103/0970-2113.168099
PMID
:26664160
Background:
Epidermal growth factor receptor (EGFR) mutation analysis has become an important part of the initial workup of non-squamous non-small cell lung cancer (NS-NSCLC) patients as it is now recognized both as a prognostic and predictive marker to therapy with EGFR tyrosine kinase inhibitors (TKI).
Aim:
In this retrospective study conducted at a University hospital, we evaluated the prevalence of EGFR mutations in patients with NS-NSCLC, clinico-pathological correlation and outcome to treatment with EGFR TKIs.
Materials and Methods:
Case records of 147 patients of NS-NSCLC in whom EGFR mutation status was tested were screened. EGFR mutation analysis was done using DNA sequencing by real time polymerase chain reaction method from tissue and cell blocks prepared from core biopsy, fine needle aspiration cytology and pleural fluid specimens.
Results:
EGFR mutations were seen in 30.6% of the 111 evaluable specimens, with a significantly higher rate in females (44% vs 19.6%
P
= 0.0072) as compared to men and non-smokers (41% vs 12%
P
= 0.0013) as against smokers. Most common mutations were observed in exons 19 (71%) and 21 (25%). The estimated median progression free survival for patients with and without mutations when treated with upfront TKIs was 12 months and 3 months respectively and the estimated median overall survival for patients with and without mutations was 20 and 9 months respectively.
Conclusion:
This study from India, further establishes the importance of upfront EGFR mutation testing in all NS-NSCLC patients, not only to prognosticate, but also to identify that subset of patients who could benefit from EGFR TKI therapy, early in the course of their disease.
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Impact of overlap syndrome on severity of acute exacerbation of chronic obstructive pulmonary disease
Dipti Gothi, Shiv Sagar Gupta, Nishith Kumar, Kartik Sood
November-December 2015, 32(6):578-583
DOI
:10.4103/0970-2113.168132
PMID
:26664163
Background:
The severity of exacerbation in chronic obstructive pulmonary disease (COPD) due to the overlap of obstructive sleep apnea syndrome (OSAS) is not known.
Aims:
To find out the 1) severity of acute exacerbation of COPD (AECOPD) in patients with overlap syndrome compared to only COPD, 2) prevalence of overlap syndrome in AECOPD, and 3) clinical characteristics of COPD compared to overlap syndrome.
Materials and Methods:
Fifty-one patients admitted with AECOPD were classified into; Mild exacerbation: Normal arterial blood gases (ABG) treated with antibiotics, Moderate: Normal ABG treated with parenteral corticosteroids, Severe: Type 1 respiratory failure, Very severe: Type 2 respiratory failure with normal pH and Life-threatening: Type 2 respiratory failure with pH <7.35. They were evaluated for OSAS with full polysomnography after the exacerbation subsided and analysed depending on presence or absence of overlap syndrome.
Results:
The majority of only COPD cases (26/38) had mild and moderate exacerbations whereas majority of overlap patients (9/13) had severe, very severe and life-threatening exacerbations (statistically significant,
P
= 0.021). Of 51 patients, 13 had OSAS i.e. the prevalence of overlap in AECOPD was 25.5%. The mean BMI in only COPD and overlap syndrome was 20.70 ± 8.03 kg/m
2
and 31.82 ± 5.80 kg/m
2
(
P
< 0.001), respectively. Metabolic syndrome was recorded in 2/36 (5.3%) patients in only COPD and 6/13 (46.2%) patients in overlap (
P
< 0.001).
Conclusion:
Overlap syndromes are more likely have respiratory failure compared to only COPD during AECOPD. AECOPD have a high prevalence of OSAS. Overlap syndrome have significantly higher likelihood of obesity and metabolic syndrome compared to only COPD.
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CASE REPORTS
Pulmonary cement embolization after vertebroplasty, an uncommon presentation of pulmonary embolism: A case report and literature review
Nishant Sinha, Vivek Padegal, Satish Satyanarayana, Hassan Krishnamurthy Santosh
November-December 2015, 32(6):602-605
DOI
:10.4103/0970-2113.168119
PMID
:26664167
Pulmonary Cement Embolization (PCE) is a rare complication of vertebroplasty surgery. There is no clear guideline for management of this entity. There is no definite protocol for anticoagulation in PCE. This is a case report of our patient who was diagnosed to have Pulmonary Cement Embolization, which was quite significant involving both lungs. She was successfully managed without long term anticoagulation.
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2,681
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Rituximab-induced interstitial lung disease in a patient with follicular lymphoma: A rare case report
Suhas Aagre, Apurva Patel, Pradip Kendre, Asha Anand
November-December 2015, 32(6):620-623
DOI
:10.4103/0970-2113.168135
PMID
:26664173
Rituximab is a chimeric monoclonal antibody that targets CD-20 antigen expressed in more than 90% of all B cell non-Hodgkin's lymphoma (NHL). We report a case of 33-year-old female without any comorbidities, newly diagnosed with stage IIIB follicular lymphoma treated with rituximab-based chemotherapy. Patient developed exertional dyspnea and dry cough after the fourth cycle of rituximab-based chemotherapy. Diagnostic high-resolution computed tomography (HRCT) of the lungs revealed bilateral patchy ground glass opacities suggestive of interstitial lung disease (ILD). It was managed successfully with supplemental oxygen and corticosteroids with discontinuation of the Rituximab. Extensive review of the literature did not reveal ample of material on rituximab-induced ILD (RTX-ILD).
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2,662
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PICTORIAL CME
A 35-year old woman with productive cough and breathlessness
Umasankar Kalai, Vijay Hadda, Karan Madan, Sudheer Arava, Firdaus Ali, Neetu Jain, Anant Mohan
November-December 2015, 32(6):651-654
DOI
:10.4103/0970-2113.168106
PMID
:26664183
A 35-year-old lady was seen in the outpatient clinic owing to fever, cough with mucopurulent expectoration, and breathlessness for the duration of 1 month. She had history of similar episodes treated with antibiotics four times during last 2 years. There was no history of recurrent sinusitis, diarrhea, and skin or soft tissue infection. She had no history of diabetes mellitus or steroid intake. She denied any history of facial trauma or dental infection in the past. There was no history of tuberculosis in her or in the family. Radiograph and CT scan of the chest revealed right upper lobe consolidation. Flexible fibreoptic bronchoscopy revealed multiple nodules at opening of right upper lobe bronchus. This clinicopathological conference describes the details of differential diagnoses, difficulties in achieving the final diagnosis and management of such patient.
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ORIGINAL ARTICLES
The incidence of recurrence of tuberculosis and its related factors in smear-positive pulmonary tuberculosis patients in Iran: A retrospective cohort study
Mahmood Moosazadeh, Abbas Bahrampour, Mahshid Nasehi, Narges Khanjani
November-December 2015, 32(6):557-560
DOI
:10.4103/0970-2113.168113
PMID
:26664159
Background and Aim:
Studying the recurrence of smear-positive pulmonary tuberculosis (TB) is a convenient way to evaluate the effectiveness of TB control programs and identify vulnerable patients. In the present study, the rate of recurrence of TB and its predictors were determined in Iran.
Materials and Methods:
This study was a retrospective cohort. Eligible people were patients with smear-positive TB who were diagnosed from 2002 to 2011. The end of the follow-up time was December 2013. The number of people who entered the cohort was 1,271 subjects. In order to determine the predictors of recurrence, multivariate logistic regression was used. Analysis was done using SPSS 20.
Results:
The recurrence incidence was 8.3% and in 85.9% of these patients, it occurred in the time interval of 1-5 years after successful treatment. The recurrence rate was not significantly related to gender, age group, and diabetes. But it was significantly higher in patients whose sputum smear grading before treatment was 2 + or more, patients with positive sputum smear at the end of the second month of the treatment, patients who had completed treatment, and patients who were smokers (
P
< 0.05).
Conclusions:
Our study showed that a considerable percentage of smear-positive pulmonary TB patients experience recurrence and that some patients are at a higher risk of recurrence.
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PICTORIAL CME
A case of young woman with recurrent right pleural effusion
Asmita A Mehta, Amit Gupta, Rajesh Venkitakrishnan
November-December 2015, 32(6):648-650
DOI
:10.4103/0970-2113.168097
PMID
:26664182
Endomterisois is usually found in women of child-bearing age. A case is presented of massive right-sided pleural effusion caused by endometriosis. The final diagnosis was made by thoracoscopic pleural biopsy. Physicians should be aware of this potentially treatable cause of pleural effusion having excluded other possibilities such as malignancy and tuberculosis.
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EDITORIAL
Palliative care in COPD patients: A challenge in modern medicine
Salvador Díaz Lobato, Sagrario Mayoralas Alises
November-December 2015, 32(6):547-548
DOI
:10.4103/0970-2113.168109
PMID
:26664157
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CASE REPORTS
Chyliform effusion without pleural thickening in a patient with rheumatoid arthritis: A case report
Crina Muresan, Lucian Muresan, Ioana Grigorescu, Dan L Dumitrascu
November-December 2015, 32(6):616-619
DOI
:10.4103/0970-2113.168127
PMID
:26664172
Pseudochylothorax, also known as chyliform effusion rich in cholesterol crystals, is a rare entity that sometimes occurs in long-standing rheumatoid arthritis (RA) and is usually associated with thickened pleura. There have only been a few case reports in the literature on pseudochylothorax unassociated with pleural thickening and with a short duration of articular symptoms in patients with RA. We report the case of a 70-year-old male patient with a history of RA and heart failure due to severe aortic stenosis, who presented with signs and symptoms of decompensated heart failure due to a moderate right-sided pleural effusion that was consequently proved to be pseudochylothorax unassociated with pleural thickening on chest computed tomography (CT) scan. The patient's outcome was favorable after thoracocentesis was carried out and leflunomide was added to the standard heart failure treatment.
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Phenytoin-induced acute hypersensitivity pneumonitis
Pallavi Periwal, Sharad Joshi, Rajesh Gothi, Deepak Talwar
November-December 2015, 32(6):631-634
DOI
:10.4103/0970-2113.168126
PMID
:26664176
Lungs are target organs for toxic effects of various drugs due to many reasons. Diphenylhydantoin (DPH) is reported to have many extrapulmonary side effects. We are presenting a case of acute hypersensitivity pneumonitis (HP) secondary to DPH, presenting with respiratory failure. Acute HP with respiratory failure is an uncommon drug side effect of the DPH therapy and is a diagnosis of exclusion. It requires detailed workup and exclusion of other causes along with evidence of improvement in the patient's condition after withholding DPH.
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ORIGINAL ARTICLES
Burden of obstructive lung disease study in Tehran: Prevalence and risk factors of chronic obstructive pulmonary disease
Hooman Sharifi, Mohammad Reza Masjedi, Habib Emami, Mostafa Ghanei, Alireza Eslaminejad, Golnar Radmand, Sonia Buist
November-December 2015, 32(6):572-577
DOI
:10.4103/0970-2113.168129
PMID
:26664162
Background:
Chronic obstructive pulmonary disease (COPD) was ranked the sixth-most common cause of death worldwide in 1990, but now it is the third-most common cause. The goal of the present study was to assess the prevalence and determine the causes and risk factors of COPD in Tehran.
Materials and Methods:
This study followed a stratified cluster sampling strategy with proportional allocation within strata. The target population was all non-institutionalized inhabitants, aged 18 to 40 in one group and over 40 in another who resided in Tehran in 2013. The core questionnaire was developed from pre-existing validated questionnaires that had already been used in multi-national studies. The single most important outcome measure obtained as part of this protocol was spirometry before and after the administration of 200 mg (two puffs) of salbutamol.
Results:
The most commonly reported respiratory symptoms were: sputum production in 291 patients (16.2%) [95% confidence interval (CI): 14.5-17.9%], chronic cough in 171 (9.5%) (95% CI: 8.2-10.9%), wheezing in 377 (21.0%) (95%CI: 19.1-22.9%) and dyspnea in 388 patients (21.6%) (95% CI: 19.7-23.5%). The overall COPD prevalence defined by the post-bronchodilator spirometric functional criteria was 9.2%. This value in men (10.1%) was higher than in women (8.5%); the prevalence was significantly higher in subjects aged over 55 years (
P
≤ 0.002). The prevalence of COPD was strongly dependent on smoking status, especially in ex-smokers, and increased considerably with age. 69% of patients with COPD were non-smoker.
Conclusion:
The high prevalence of verified COPD, a great deal of which was undiagnosed before by a physician, highlights the necessity of raising awareness of this disease among health professionals, and use of spirometry in the primary care setting. A future cross-sectional and prospective cohort study should be performed to explore all risk factors and their impact on decline in lung function and worsening of respiratory symptoms especially in non-smokers.
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CASE REPORTS
Trans-mediastinal herniation of bulla: Semilunar sign
Sheetu Singh, Nishtha Singh, Virendra Singh
November-December 2015, 32(6):611-613
DOI
:10.4103/0970-2113.168128
PMID
:26664170
Trans-mediastinal herniation of lung is seen occasionally but herniation of bulla across the mediastinum is rare. We report two cases with trans-mediastinal herniation of bullae leading to an unusual line appearing near the mediastinum. We propose the name 'Semilunar sign'for this radiological sign because of its resemblance to the half-moon shape.
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ORIGINAL ARTICLES
Unusual lesions of the mediastinum
Fatima Shamsuddin, Urmila N Khadilkar, Debarshi Saha
November-December 2015, 32(6):566-571
DOI
:10.4103/0970-2113.168104
PMID
:26664161
Objectives:
To study unusual lesions in the mediastinum, which do not originate from the thymus, lymph nodes, neural tissues or germ cells, and tissues that normally engender pathologic lesions in the mediastinum.
Materials and Methods:
Of the 65 cases seen, 12 unusual lesion were encountered in a 5
½
year period from 2006 to 2011.
Results:
Two cases of nodular colloid goiter and one each of the mediastinal cyst, undifferentiated carcinoma, and Langerhans cell histiocytosis (LCH) affected the anterosuperior mediastinum. In the middle mediastinum, one case each of the mesothelioma, malignant gastrointestinal stromal tumor (GIST), squamous cell carcinoma (SCC), solitary fibrous tumor (SFT), and pleomorphic sarcoma (PS) was seen. One case of meningeal melanocytoma (Mme) and primary pleural liposarcoma (PL) involved the posterior mediastinum. Persistent disease was seen in LCH after 2 years. Of all the cases with malignant lesions, only the patient with SCC was alive after 1 year.
Conclusion:
The cases of primary and SCC, LCH, melanocytoma, liposarcoma and PS, and GIST are unexpected and very rarely have paradigms in the mediastinum. Radiologic impression and knowledge of the compartment where these lesions arose from hardly assisted in arriving at a definitive opinion as the lesions were not typical of this location. A high index of suspicion and the immunohistochemical profile facilitated the final diagnosis.
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The correlation of symptoms, pulmonary function tests and exercise testing with high-resolution computed tomography in patients with idiopathic interstitial pneumonia in a tertiary care hospital in South India
Barney Thomas Jesudason Isaac, Balamugesh Thangakunam, Rekha A Cherian, Devasahayam Jesudas Christopher
November-December 2015, 32(6):584-588
DOI
:10.4103/0970-2113.168131
PMID
:26664164
Context:
For the follow-up of patients with idiopathic interstitial pneumonias (IIP), it is unclear which parameters of pulmonary function tests (PFT) and exercise testing would correlate best with high-resolution computed tomography (HRCT).
Aim:
To find out the correlation of symptom scores, PFTs and exercise testing with HRCT scoring in patients diagnosed as idiopathic interstitial pneumonia.
Settings and Design:
Cross-sectional study done in pulmonary medicine outpatients department of a tertiary care hospital in South India.
Materials and Methods:
Consecutive patients who were diagnosed as IIP by a standard algorithm were included into the study. Cough and dyspnea were graded for severity and duration. Pulmonary function tests and exercise testing parameters were noted. HRCT was scored based on an alveolar score, an interstitial score and a total score. The HRCT was correlated with each of the clinical and physiologic parameters. Pearson's/Spearman's correlation coefficient was used for the correlation of symptoms and parameters of ABG, PFT and 6MWT with the HRCT scores.
Results:
A total of 94 patients were included in the study. Cough and dyspnea severity (
r
= 0.336 and 0.299), FVC (
r
= −0.48), TLC (
r
= −0.439) and DLCO and distance saturation product (DSP) (
r
= −0.368) and lowest saturation (
r
= −0.324) had significant correlation with total HRCT score. Among these, DLCO, particularly DLCO corrected % of predicted, correlated best with HRCT score (
r
= −0.721).
Conclusion:
Symptoms, PFT and exercise testing had good correlation with HRCT. DLCO corrected % of predicted correlated best with HRCT.
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CASE REPORTS
An unusual cause of posterior mediastinal cyst
Sahajal Dhooria, Valliappan Muthu, Ritesh Agarwal
November-December 2015, 32(6):609-610
DOI
:10.4103/0970-2113.168123
PMID
:26664169
Cystic lesions of the mediastinum may be congenital or acquired. The differential diagnosis depends on their location in the mediastinum. Cysts in the posterior mediastinum are generally developmental cysts and are neurogenic or of foregut origin. We report the case of a 14-year-old boy, who presented with dry cough and progressively increasing breathlessness, and was found to have a cystic lesion in the posterior mediastinum. Fine needle aspiration from the cyst helped make a diagnosis of tuberculosis.
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Bronchial artery embolization in chronic pulmonary thromboembolism: A therapeutic dilemma
Madhurima Sharma, Mandeep Garg, Mandeep S Ghuman, Rakesh Kocchar, Niranjan Khandelwal
November-December 2015, 32(6):624-626
DOI
:10.4103/0970-2113.168138
PMID
:26664174
Bronchial artery embolization is the treatment of choice for the management of life-threatening massive hemoptysis. Chronic pulmonary thromboembolism (PTE) is one of the rare causes of hemoptysis. Management of hemoptysis in chronic PTE is a point of debate. In this article, we have reported one case of hemoptysis in chronic PTE managed successfully with bronchial artery embolization.
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Diagnosis of pulmonary embolism by endobronchial ultrasound
Rajiv Goyal, Vaibhav Chachra, Pratibha Gogia
November-December 2015, 32(6):606-608
DOI
:10.4103/0970-2113.168130
PMID
:26664168
This is a case report of a young 20-year-old male who was referred for an endobronchial ultrasound (EBUS) procedure to investigate a fever and a left hilar lymph node and patchy pleural-based opacities seen on CT of the chest. During the EBUS procedure besides the left hilar node, a large thrombus was noticed in the main pulmonary artery and another one in the right pulmonary artery. EBUS proved invaluable in making a diagnosis in an unsuspected case of pulmonary embolism.
[ABSTRACT]
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1,814
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DEBATES/POINT-COUNTERPOINT
Are the days of closed pleural biopsy over? No
Balamugesh Thangakunam
November-December 2015, 32(6):641-643
DOI
:10.4103/0970-2113.168140
PMID
:26664179
Closed pleural biopsy used to be a popular method of evaluation of pleural effusion. With the advent of thoracoscopy, this valuable method is being neglected. Studies have shown that closed pleural biopsy especially done with image guidance has high yield and low complication rate as compared to thoracoscopy. Given the ease of the procedure and the less cost involved, imaged guided closed pleural biopsy should be considered as the initial diagnostic step in undiagnosed pleural biopsy especially in developing countries with high prevalence of tuberculosis.
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1,773
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CASE LETTERS
Nocardia farcinica
as a causative agent of lung abscess
Manoj Meena, Ramakant Dixit, Sabarigirivasan Harish, Govind Narayan Srivastava, Lalit Prashant Meena
November-December 2015, 32(6):657-659
DOI
:10.4103/0970-2113.168121
PMID
:26664185
[FULL TEXT]
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1,790
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CASE REPORTS
Benign emptying of the postpneumonectomy space
Hasan Volkan Kara, Mohan K Mallipeddi, Jeffrey Javidfar, Mark W Onaitis
November-December 2015, 32(6):614-615
DOI
:10.4103/0970-2113.168136
PMID
:26664171
A drop in the air-fluid level in the postpneumonectomy space on a chest radiogram is an early sign of bronchopleural fistula (BPF). Any suspicion of BPF points to the need for urgent evaluation and appropriate management. Very rarely may this drop occur without the existence of a fistula, but such a condition is defined as benign emptying of the postpneumonectomy space. We share our successful conservative management in a case of postpneumonectomy space emptying with a suspicion of BPF.
[ABSTRACT]
[FULL TEXT]
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1,813
165
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DEBATES/POINT-COUNTERPOINT
Are the days of closed pleural biopsy over? Yes
Dharmesh Patel
November-December 2015, 32(6):638-640
DOI
:10.4103/0970-2113.168114
PMID
:26664178
In the modern management of pleural diseases, thoracoscopy has a clear advantage over closed pleural biopsy. By way of its high yield, both in malignant pleural disease and pleural Tuberculosis – the two commonest cause of undiagnosed pleural effusion, thoracoscopy has the added advantage of faster symptom relief and offering effective pleurodesis. This makes it an attractive diagnostic and therapeutic procedure of choice and features high in the algorithms of many international guidelines on the approach to pleural diseases.
[ABSTRACT]
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[PubMed]
1,735
242
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ORIGINAL ARTICLES
Increased metabolic activity of neutrophils in patients with chronic obstructive pulmonary disease
Ashwin Vaidyanathan, Komaladevi Sampath Damodar
November-December 2015, 32(6):589-592
DOI
:10.4103/0970-2113.168134
PMID
:26664165
Aims:
To compare the metabolic activity of peripheral neutrophils in patients diagnosed with chronic obstructive pulmonary disease (COPD) with that of healthy, nonsmoking volunteers.
Materials and Methods:
Venous blood samples were taken from patients diagnosed with COPD as well as from healthy nonsmokers. Each sample was subjected to the nitro blue tetrazolium (NBT) test in which neutrophils exhibiting elevated metabolic activity were detected by light microscopy. The test was repeated after stimulation with
Escherichia coli (E. coli)
endotoxin with fresh samples. Neutrophils showing dye uptake were then counted in each case.
Results:
We found that the mean numbers of activated neutrophils without and with the addition of endotoxin were 19% and 23%, respectively, in the control group and 56% and 62%, respectively, in the test group. Two-sample
t
-test statistic revealed that there was a significant (
P
< 0.01) increase in neutrophilic metabolic activity in patients with COPD as compared to that in healthy volunteers. This significance remained even after stimulation using
E. coli
endotoxin.
Conclusion:
The results hint at a potentially relevant pathogenic mechanism in COPD related to the metabolic activity of neutrophils. By exhibiting enhanced metabolic activity, neutrophils in the COPD patients are more likely to be involved in damaging lung tissues.
[ABSTRACT]
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1,752
224
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CASE REPORTS
Left carinal pneumonectomy through median sternotomy: Surgical experience of two patients
Pankaj Kumar Garg, SH Chandrashekhara, Vikas Kumar Keshri, Durgatosh Pandey
November-December 2015, 32(6):627-630
DOI
:10.4103/0970-2113.168125
PMID
:26664175
Endobronchial tumors infiltrating the carina is a formidable challenge to surgeons in view of difficult surgical access to the carina, especially on the left side, problems of securing the airway intra-operatively, technically challenging anastomosis due to anatomical location, and high post-operative morbidity and mortality. We present our surgical experience of two cases of left carinal pneumonectomy which was undertaken for resectable primary salivary gland type tumors of lung.
[ABSTRACT]
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1,752
169
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LETTERS TO EDITOR
Limitations of CBA study: Controlled before after study
Anjali Mahajan
November-December 2015, 32(6):670-671
DOI
:10.4103/0970-2113.168102
PMID
:26664193
[FULL TEXT]
[PDF]
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[EPub]
[PubMed]
1,543
354
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Chronic cough: An Indian perspective
Shoaib Faruqi, Woo-Jung Song
November-December 2015, 32(6):668-669
DOI
:10.4103/0970-2113.168108
PMID
:26664191
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,555
245
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RADIOLOGY QUIZ
Round atelectasis
Chandan Kakkar, Prakashini Koteshwara, Rajagopal Kadavigere
November-December 2015, 32(6):646-647
DOI
:10.4103/0970-2113.168105
PMID
:26664181
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,513
275
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CASE LETTERS
Pulmonary histoplasmosis mimicking carcinoma lung
Paul George, Nileena Nayak, TM Anoop, Nikhil Gopi, HP Vikram, Arun Sankar
November-December 2015, 32(6):663-665
DOI
:10.4103/0970-2113.168133
PMID
:26664188
[FULL TEXT]
[PDF]
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[EPub]
[PubMed]
1,585
199
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LETTERS TO EDITOR
Small cell carcinoma lung presenting as life-threatening hypercalcemia - A rare association
Arjun Khanna, Pallavi Periwal, Deepak Talwar
November-December 2015, 32(6):671-673
DOI
:10.4103/0970-2113.168101
PMID
:26664194
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,453
212
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CASE LETTERS
Pulmonary arteriovenous malformation: An unusual cause of hemothorax
Manohar Lal Gupta, Mridul Gupta, Dinesh Kumar Vijay, Rajeev Bagarhatta
November-December 2015, 32(6):655-657
DOI
:10.4103/0970-2113.168116
PMID
:26664184
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,451
196
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Isolated pulmonary manifestation of IgG4 disease with response to steroids and relapse: A rare case report
Ranjit Kumar Singh, Thomas Jesudason Barney Isaac, Balamugesh Thangakunam, Nittin Mathews, Anila Korula
November-December 2015, 32(6):659-661
DOI
:10.4103/0970-2113.168110
PMID
:26664186
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,433
178
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Mediastinal hamartoma - A rare presentation
Jayaprakash Balakrishnan, Deepu Maniyan, Nileena Nayak, Anila Kunjulekshmi Amma Raveendran Nair
November-December 2015, 32(6):665-666
DOI
:10.4103/0970-2113.168111
PMID
:26664189
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,451
157
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RADIOLOGY QUIZ
Air in unusual location after contrast-enhanced computed tomography
Ujjwal Gorsi, Kushaljit S Sodhi, Budhi S Yadav, Niranjan Khandelwal
November-December 2015, 32(6):644-645
DOI
:10.4103/0970-2113.168124
PMID
:26664180
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,408
182
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CASE LETTERS
Pulmonary metastases from intracranial meningioma
Phani Chakravarty Mutnuru, Syed Fayaz Ahmed, Shantveer G Uppin, Pavan Kumar Lachi
November-December 2015, 32(6):661-663
DOI
:10.4103/0970-2113.168120
PMID
:26664187
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,366
187
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LETTERS TO EDITOR
Clinicopathological profile and course of malignant pleural effusion in a tertiary care teaching hospital in western Uttar Pradesh with special reference to lung cancer
Anurag Agrawal, Rajiv Tandon, Lalit Singh, Aakanksha Chawla
November-December 2015, 32(6):678-679
DOI
:10.4103/0970-2113.168122
PMID
:26664199
[FULL TEXT]
[PDF]
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[EPub]
[PubMed]
1,341
199
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Tracheobronchial nebulizer DIVO
™
Nikolay Efimovich Kurnosov, Konstantin Valerevich Lebedinskiy
November-December 2015, 32(6):669-670
DOI
:10.4103/0970-2113.168103
PMID
:26664192
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,192
316
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Significance of viral infections detected by reverse-transcriptase - multiplex PCR on hospital-related outcomes in acute exacerbations of chronic obstructive pulmonary disease
Anant Mohan, Arvind Uniyal, Subhash Chandra, Molu C Ozukum, Bharti Gaur, Shobha Broor, Kriti Upadhyaya, Ashraf Ali, Ashish Upadhyaya, Randeep Guleria
November-December 2015, 32(6):667-668
DOI
:10.4103/0970-2113.168098
PMID
:26664190
[FULL TEXT]
[PDF]
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[EPub]
[PubMed]
1,264
175
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Pathogenesis of bilateral chylothorax after injury of thoracic duct during central venous catheterization
Animesh Ray
November-December 2015, 32(6):673-675
DOI
:10.4103/0970-2113.168115
PMID
:26664195
[FULL TEXT]
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1,256
163
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Randomization in a hospital-based study
Sunil Kumar Raina
November-December 2015, 32(6):679-679
DOI
:10.4103/0970-2113.168112
PMID
:26664200
[FULL TEXT]
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[PubMed]
1,084
261
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Bilateral chylothorax as a complication of internal jugular vein cannulation
Puneet Saxena, Subramanian Shankar, Vivek Kumar, Nardeep Naithani
November-December 2015, 32(6):675-676
DOI
:10.4103/0970-2113.168118
PMID
:26664196
[FULL TEXT]
[PDF]
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[EPub]
[PubMed]
1,164
152
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Malignant pleural effusions: Differentiating pelvic malignancies
Mukesh Sharma, Anjna Sharma, Purnima Thakur, Vikas Fotedar
November-December 2015, 32(6):677-678
DOI
:10.4103/0970-2113.168117
PMID
:26664198
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,155
134
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Miliary tuberculosis disease complicated by Pott's abscess in an infant: Seven-year follow-up
Mahmood Dhahir Al-Mendalawi
November-December 2015, 32(6):676-677
DOI
:10.4103/0970-2113.168107
PMID
:26664197
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,127
149
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