ABSTRACT
Morphology and movements of vocal cords should be checked during bronchoscopy. In past literature, unilateral vocal paralysis is considered as benign. Evaluation of major underlying disease in patients with unilateral vocal cord paralysis diagnosed during bronchoscopy. A cross sectional case control study design was used to evaluate all patients who underwent bronchoscopy during the year 2003 for various causes. Sample size was 194 patients [0.01 error and 80% potency]. Data including patient's respiratory complaints and radiological findings were gathered in a questionnaire. Bronchoscopy was performed in standard condition using local anesthesia. During procedure, vocal cord movement was examined with appropriate maneuver, and complete study of trachobronchial tree with bronchial lavage was done. Appropriate biopsy was performed when indicated. Specimens were sent for evaluation of AFB, cytology, histopathology and culture for mycobacterium tuberculosis. Unilateral vocal cord paralysis was observed in 10% [19 of total 189 patients who underwent bronchoscopy], Male to female ratio was 3:2 and average age of patients was 65 years [range= 37-76]. Cough was the main complaint in 94%, dyspnea in 100% and hemoptysis in 32%. Smoking was present in 9 patients [47%]. Vocal cord paralysis in left side was predominant and it was seen in 68% [13/19]. Twelve patients [63%] with unilateral vocal cord paralysis had significant lung disease, eight had pulmonary tuberculosis, and four had lung cancer [one SCC, one SmCC, and two undifferentiated carcinoma]. Confirmed lung disorders in case group was significantly more than control group [chi square=4.92; p=0.026; Odd ratio= 2.93, 95% Cl=1.01-8.76]]. In the remaining patients with vocal cord paralysis [7], one had old healed tuberculosis and 5 had chest roentgenogram strongly suggestive of malignancy who were referred for further evaluation. The bronchoscopist should pay special attention to unilateral vocal cord paralysis observed during routine bronchoscopy. We observed significant lung disorders present in 63% of these patients
ABSTRACT
Anthracosis is black pigment discoloration of bronchi which can cause bronchial destruction and deformity [anthracofibrosis]. A prospective, case-control study was performed to evaluate potential underlying causes of anthracosis on 190 subjects who referred for various indications. Age of patients ranged from 10-85 yrs. 46% of male patients were farmers and 27% were manual workers, whereas 91% of female patients were housewives. During bronchoscopy, special attention was given to anthracotic plaque, bronchial deformity, infiltration, or vegetation. Broncho-alveolar lavage was performed for further cytopathological, acid-fast bacilli staining [AFB] and culture in all cases. No correlation between occupational exposure to dust and two kinds of anthracosis [anthracotic plaque and antracofibrosis] was present. In anthracofibrotic patients, 81% were nonsmokers. The principal finding in bronchoscopy was simple plaque of anthracosis in 21% and anthracofibrosis in 12%. Sputum smear showed macrophages containing anthracotic granules in 71%. Patients with anthracosis had positive histopathology for tuberculosis [21%] that was not significantly different from subjects without anthracosis. Of 40 patients with simple anthracotic plaque and 22 with anthracofibrosis, only two and one patients, respectively were proven to have bronchogenic carcinoma that was not statistically more common than in the control group. Other etiology for anthracofibrosis should be investigated