Bronchoscopic closure of bronchopleural fistula using gelfoam.

Management of a persistent bronchopleural fistula (BPF) can be a therapeutic challenge. The etiological factors responsible for BPF include pulmonary tuberculosis, post-thoracic resection surgeries, trauma, malignancy, necrotising infections and rupture of lung abscess. The immediate management of BPF is drainage of the pleural cavity with insertion of an intercostal drainage tube. Patients with BPF may also require surgical intervention in the form of a wedge resection or lobectomy or muscle flap surgery. We report a case of a peripheral BPF secondary to a bacterial infection, which was successfully managed by the instillation of gelfoam via flexible bronchoscopy.

Clinical and pathological profile of 73 patients with lung carcinoma: is the picture changing?

OBJECTIVE: A prospective study was undertaken to study the clinical features and pathological cell type of primary lung carcinoma in our institute. METHODS: Seventy three patients were included in the study over a period of three years. These were investigated according to a study protocol which included a detailed history regarding the onset and progress of the disease, smoking habits, x-ray chest, computed tomography of the chest and upper abdomen, and flexible bronchoscopy with brushings and biopsy. RESULTS AND CONCLUSIONS: 32.85% of patients were non-smokers. The male-female ratio was 4.2:1. Male sex, age > 50 years and history of smoking are still a risk factor for lung carcinoma. Tobacco smoking of 20 pack-years or more is significantly associated with the incidence of squamous cell carcinoma compared to other cell types. Adenocarcinoma (28.8%) was the most common cell type observed. It was also the most common cell type in central location (32.8%). Adenocarcinoma was the most common cell type diagnosis amongst females (50%) and non-smokers (43.5%). Computed tomography done in 47 patients diagnosed additional eleven patients with rib or vertebral metastases in addition to the three diagnosed by chest roentgenology. Computed tomography diagnosed significant mediastinal lymphadenopathy in 16 patients in whom mediastinal lymphadenopathy was not suspected on chest roentgenology. Computed tomography confirmed liver metastases in four patients diagnosed by ultrasonography and additionally in three more patients. Bronchial brushing cytology yielded positive results in 51.72% of central tumours and 40% in peripheral tumors. Yield of endobronchial biopsy was 59% and transbronchial biopsy was sixty percent. At presentation 74.1% patients with non-small cell carcinoma were inoperable and in case of small cell carcinoma 75% had extensive disease. Fiberoptic bronchoscopy with brushings and biopsy, and computed tomography of the chest and upper abdomen are useful investigations in the diagnosis of lung carcinoma.

Bronchoalveolar lavage (BAL) in newly diagnosed patients with collagen vascular diseases.

Collagen vascular diseases (CVD) are commonly associated with interstitial lung diseases. Bronchoalveolar lavage (BAL) fluid analysis has important diagnostic value when considered in conjunction with other information. The present study was undertaken in newly diagnosed patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) at presentation to characterise BAL cellular constituents and elucidate the cellular picture in patients with and without pulmonary symptoms and in those with and without radiological (high resolution computed tomography) features of interstitial lung disease. All the patients were non-smokers and had not received any form of treatment for their diseases. The means of percentages of lymphocytes, neutrophils, and macrophages were 23.3%, 6.2%, 70.5% respectively. There was a significant BAL lymphocyte predominance in patients with pulmonary symptoms, and a lymphocyte and neutrophil predominance in those having radiological evidence of interstitial lung disease.

Approach to aerosol therapy in management of asthma at primary care level.

Present day management of bronchial asthma focuses on use of inhaled drugs. To find out the acceptability of aerosol therapy at primary care level, a questionnaire survey was conducted on practical acceptance of aerosol therapy in management of asthma. Seven clinically relevant questions were asked regarding management modalities followed in bronchial asthma. Amongst the group of general practitioners (n = 60) studied, it was found that in treatment of chronic stable asthma inhaled steroids are used by only 50% and inhaled bronchodilators by 86.7%, whereas 93.3% use oral bronchodilators and 60% use oral steroids to treat the same. During exacerbation injectable bronchodilators are preferred to inhaled drugs. Poor compliance to aerosol therapy was reported by 33.3%. Reasons for non-compliance are discussed, important ones are cost and technique. Spacer was reported to be useful by 20% and lung functions are carried out occasionally by only 5% of practitioners.

Intensive respiratory care service--our eight-year experience.

Intensive respiratory care service has come a long way from the beginning in Scandinavia in early 1952. Intensive care service (IRCU) was started at our institute in 1983 as tetanus and respiratory care ward which has developed into Department of respiratory diseases over years. We are reporting our experience of 886 cases of acute respiratory failure (ARF) treated from Jan, 1983 upto April 1990.

Intensive respiratory care service. Organisation, orientation, system and future. Our experience of management of 288 cases.

Between Jan. 1983 and Dec. 1986, 288 patients with acute respiratory failure of varied aetiologies were admitted to tetanus and respiratory care ward. One hundred and twenty patients (41.66%) had primary respiratory diseases, 107 (37.15%) of poisoning, 24 (8.3%) had neuromuscular diseases and 37 (12.48%) had miscellaneous disorders. Ventilatory support was given for more than 6 hours to 118 patients. The overall survival was 61.81% and on ventilator 38.13%. The mortality was high with ARDS (100%), miscellaneous (100%) pneumonia with septicaemia (75%) and COAD (54.28%). Patient with COAD had high mortality with acidosis (pH less than 7.1, P less than 0.01), hypotension (systolic BP less than 90 mm of Hg, p less than 0.05) and oliguria (urine out put less than 400 ml/24 hours, p less than 0.05). Organophosphorus compound was the commonest poison (89.75%) and patients who had moderate to severe hypoxia (pO2 less than 60 mm of Hg), hypotension and an interval of more than 4 hours between the consumption of poison and admission (all P less than 0.05) expired; 68.18% expired within the first 72 hours. All the patients with primary neuromuscular paralysis and bronchial asthma survived. Hospital acquired infections (160 patients), retained secretions (108 patients) and hypotension (64 patients) were the commonest complications seen in the 288 patients. Staphylococcus aureus (32.14%) was the commonest organism isolated. Financial constraints, drug shortages and frequent failure of machines were other major problems in the intensive respiratory care unit.