Post-tuberculous chronic obstructive pulmonary disease

To determine the frequency of chronic obstructive pulmonary disease [COPD] as a sequel of treated pulmonary tuberculosis. A case series. Department of Pulmonology, Military Hospital, Rawalpindi, from April to November 2007. Forty seven adults, previously treated for pulmonary tuberculosis and presenting subsequently with chronic exertional dyspnoea for which no other alternate cause was found were included. Those having a probability of re-activated TB, having history of current or previous smoking or occupational exposure, asthmatics and cases of interstitial lung disease and ischemic heart disease were excluded. Pre- and post-dilator FVC, FEV1 and FEV1/FVC were recorded in each case through simple spirometry on Spirolab-II - MIR S/N 507213. Stage and pattern of COPD was recorded. There were 76.5% [n=36] males. Mean age was 56.4 and 44.2 years in males and females respectively. Twenty six [55.3%] were found to have an obstructive ventilatory defect of different degrees: severe/stage III in 69.2% [n=18], moderate/stage II in 23.0% [n=6] and mild/stage I in 5.9% [n=2]. Fourteen [29.7%] were found to have a restrictive pattern and 7 [14.8%] revealed a mixed obstructive and restrictive pattern. Chronic obstructive pulmonary disease can occur as one of the chronic complications of pulmonary tuberculosis and the obstructive ventilatory defect appears more common among various pulmonary function derangements

Diagnostic yield of transbronchial needle aspiration analysis of 30 cases

In our clinical set up transbonchial needle aspiration of lymph node and parenchymal lesions is an underutilized technique. This study was done to highlight the usefulness of this technique in the pulmonologists armamentarium. Thirty procedures were performed on patients with intrathoracic lymphadenopathy or parenchymal lung lesions in this study from October, 2006 to April, 2007. Patients with an easily accessible peripheral lymph node, bleeding diathesis and an already confirmed diagnosis were excluded from the study as were patients with a well visualized biopsiable endobronchial lesion. Nineteen patients [63.3%] on whom transbonchial needle aspirations were performed had intrathoracic lymphadenopathy while 11 [36.6%] had parenchymal lesions without endobronchial lesions which could be biopsied. Adequate samples were obtained in 23 patients [76.6%] chronic granulomatous inflammations which was diagnosed as tuberculosis in corroboration with other clinical and laboratory evidence was seen in 3 cases [10%]. Carcinoma was diagnosed in 6 cases [20%]. Thirteen cases [43%] were reported as normal and inadequate samples were obtained in 7 cases [23%]. Transbronchial Needle Aspiration [TBNA] is an effective method of obtaining cytological material from intrathoracic lymph nodes and parenchymal lesions and can provide a safe alternative to invasive mediastinotomy/mediastinoscopy and open lung biopsya