Paradoxical movement of vocal cords in guillain – barre syndrome: Report a case and review of the literature.

This is a report of a 50 year-old Thai male who was admitted to Siriraj hospital because of progressive weakness of all extremities and increase shortness of breath. Endotracheal tube intubation was introduced for ventilatory support and secretion clearance. The diagnosis of Guillain-Barre syndrome was made based on typical presentation and CSF finding. The patient responsed well to intravenous immunoglobulin with successful extubation but developed upper airway obstruction from paradoxical movement of vocal cords which resolved in 5 days later. The review of the literature was done.

Comparison of telomerase activity between malignant and tuberculous pleural effusions.

OBJECTIVE: To determine if telomerase activity can differentiate malignant from tuberculous pleural effusions. DESIGN: Telomerase activity in malignant and tuberculous pleural effusions was measured in a blinded manner using a PCR-based telomeric repeat amplification protocol (TRAP) assay. MATERIAL AND METHOD: Fifty-two patients with lymphocytic exudative pleural effusions were identified on thoracocentasis over a period of 18 months. RESULTS: Telomerase activity was detected in 34% of malignant pleural fluid samples and 50% of tuberculous pleural effusions. The positive rate of telomerase activity was 30.7% for primary lung cancer and 37.5% for metastatic pleural effusion. The sensitivity and specificity of telomerase activity assay were extremely low (35.7% and 52.9%, respectively), compared with that of cytological examination (52.6% and 65.4%, respectively). Moreover the diagnostic accuracy of telomerase activity in combination with cytology was even lower than cytological examination alone (46.7% vs. 60%, respectively). This finding was in contrast to previous reports and demonstrated that the detection rate of telomerase activity in tuberculous pleural effusions was greater than that observed in malignant pleural exudates. CONCLUSION: Telomerase activity does not appear to be a useful marker for differentiating malignant from tuberculous effusions.

Medical thoracoscopy: experiences in Siriraj Hospital.

OBJECTIVE: Medical thoracosopy is the investigational and therapeutic procedure for many kinds of pleural diseases. One of its indications is for the diagnosis of undetermined pleural effusion. We report our experience in using medical thoracoscopy in investigating undiagnosed pleural effusion. MATERIAL AND METHOD: Thirty four consecutive patients had thoracoscopy done for this indication from 1999 to 2005. RESULT: Malignancy was diagnosed in 21 patients. Pleural biopsies showed chronic pleuritis in 7 patients. Normal thoracoscopy was found in 2 cases and the procedures were unsuccessful in 4 cases because of extensive pleural adhesion. In patients with malignancy, pleural nodules had a tendency to be localized in the lower part of the pleural cavity. Better selection of the patient should lower the unsuccessful procedure. CONCLUSION: The review of the indication for thoracoscopy will increase the use of this procedure in respiratory medicine practice and shorten the investigation time.

Tranexamic acid in patients with hemoptysis.

Hemoptysis is a common respiratory symptom leading to admission to hospital. The main management of hemoptysis depends on treating the underlying cause. The use of tranexamic acid is recommended by many doctors without much information available. MATERIAL AND METHOD: This study was a randomized double blinded placebo controlled trial in using tranexamic acid (Transamine) in hemoptysis patients. The study period was one week. Patients with hemoptysis were separated into 3 groups depending on the amount of blood. Group 1 consisted of patients with blood streak sputum. Group 2 coughed up less than 20 ml of frank blood. Patients in Group 3 were those who coughed up 20-500 ml of blood per day. A record of the amount of bleeding and drug side effects was done. RESULTS: From June 1994 to May 1997, 46 patients with hemoptysis completed the study. There were 21 in the tranexamic acid group and 25 in the placebo group. The placebo group had a tendency not to have underlying lung disease and more patients who had a normal chest X-ray. The benefit of tranexamic acid in shortening the days of hemoptysis is not shown in this study. There was a low incidence of side effects of tranexamic acid in this study. CONCLUSION: This randomized double blinded placebo controlled trial could not demonstrate the benefit of tranexamic acid in shortening the days of hemoptysis and confirm the low incidence of side effects of this drug.

Endobronchial hamartoma treated by laser resection.

A 42 years old male was transferred to the hospital for the treatment of endobronchial mass. He had a history of cough with initial hemoptysis. The endoscopic finding showed endobronchial mass totally occluded left upper lobe bronchus. The initial biopsy revealed chronic inflammation. The patient was scheduled for bronchoscopic laser photoresection and the mass was removed with the stump left at superior segment of lingular lobe. Endobronchial hamartoma was diagnosis from pathological section. The case is reported and the review of endobronchial hamartoma is presented.