ABSTRACT
Lung cancer is generally diagnosed during late stage of the disease; so, early diagnosis of lung cancer is very important to reduce lung cancer death rate. Flexible fibreoptic bronchoscopy (FOB) is an important diagnostic technique performed in patients with suspected malignant lung lesion as it provides sufficient cytologic and histologic specimens in the form of bronchial washing, bronchial brushing and bronchial forceps biopsy.METHODSThe present descriptive study analysed cytology of bronchial washing, bronchial brushing and histology of bronchial biopsy in 100 patients with suspected lung cancer. Patients in whom clinical and radiological findings suggested lung carcinoma, were included in the study. Patients with coagulopathy, refractory hypoxemia, cardiac instability, poor ability to cooperate with the procedure were excluded from this study. Age, gender, smoking habits, clinical and radiological findings, various histological types of malignancies, and yield of various bronchoscopic diagnostic techniques in the diagnosis of lung cancer were evaluated.RESULTSOf the 100 cases, 86 (86%) were males and 14 (14%) were females with male to female ratio of 6.14:1. The mean age in this study group was 58 years. Overall diagnostic yield by means of all techniques during bronchoscopy was 90% (90/100 patients). Squamous cell carcinoma was the most common primary bronchogenic tumour 36.67% (33/90 patients) followed by Adenocarcinoma 25.56% (23/90 patients), small cell carcinoma 24.44% (22/90 patients), Undifferentiated Non-Small Cell Carcinoma (NSCLC) 12.22% (11/90 patients), poorly differentiated carcinoma 1 patient. No evidence of malignancy was found in 10 patients by all techniques during bronchoscopy.CONCLUSIONSLung cancer is a common malignancy with male preponderance. Bronchial washing and brushing cytology in combination with bronchial biopsy has a very high diagnostic yield. Therefore, all these techniques may be used concurrently to diagnose lung malignancy.
ABSTRACT
Background: Patients with COPD often have exacerbations which frequently require hospitalization, resulting in higher mortality rates and costs than patients managed at OPD. Some easily available blood parameters in both stable COPD and AECOPD patients are measured that can be done in every patient even in poor resource settings. Finally, Results were analysed statistically to find out if there is any presence of significant difference of biochemical profile in stable COPD patients and AECOPD patients with or without any prognostic significance.Methods: In institution based observational case control study, authors measured 1. FBS and PPBS 2. Serum Urea and Creatinine 3. Serum Electrolytes- Na+, K+, Cl- 4. LFT 5. Uric acid in both stable COPD(n=50) and AECOPD (n=50) patients. Finally, Results were analysed statistically to find out if there is any presence of significant difference of biochemical profile in stable COPD patients and AECOPD patients.Results: AECOPD patients had statistically significant higher urea, uric acid levels and higher fasting hyperglycemia than stable COPD patients. Hypernatremia, hyponatremia and hyperkalemia, hypokalemia - all were significantly higher in AECOPD group. Low level of serum bilirubin and higher level of AST and ALP were common in AECOPD patients. AECOPD patients with high urea value (>50 mg/dl) (but not high creatinine) was associated with poor patient outcome in respect to ICU transfer, death and prolonged hospital stay. Low bilirubin, high ALP and AST level in AECOPD patients was associated with higher ICU transfer and mortality but only high ALP level was associated with prolonged hospital stay. High uric acid level (>6 mg/dl) was a major determinant of ICU transfer, mortality and prolonged hospital stay.Conclusions: Predicting exacerbation by these parameters early in the course of disease can decrease morbidity and mortality as well as health care cost to great extent. By measuring the changes in it can also be predicted early who will need ICU support in future and who can be treated at ward.