Bilateral spontaneous pneumothorax, pneumomediastinum and cervical emphysema complicating cryptogenic fibrosing alveolitis

Cryptogenic Fibrosing Alveolitis is a progressive infiltrative disease of lung parenchyma, and carries high morbidity and mortality. The prevalence of the disease is much higher than what is believed. We wish to present a case who had a short but rapidly deteriorating disease. During the course of illness he developed myocardial infarction, left ventricular failure and rare complication of spontaneous bilateral pneumothorax, pneumomediastinum and cervical emphysema

audit on the utility of fibreoptic bronchoscopy

Bronchoscopies were performed in 212 patients [M: F = 2.7: 1]. Diagnostic information was obtained in 85 [40.5%] patients through 176 procedures, for a variety of malignant and non-malignant conditions. Yield of bronchial lavage, bronchial biopsy and brushing biopsy was, 67.9%, 57.3% and 18.5% respectively. Twenty-six patients [12%] were diagnosed as having neoplasm, 25 [11.7%] had tuberculosis, while only 4 [1.8%] were reported to have interstitial lung disease. Nineteen patients [9%] revealed chronic inflammatory changes consistent with chronic bronchitis or brochiectasis. During the initial part of the study a high incidence [9%] of morbidity through major complications was recorded; however, there was no procedure-related mortality. In view of high clinical suspicion, overall diagnostic yield of 40.5% is lower than expected. To increase the diagnostic utility of such an invaluable tool, there is need to improve the quality of specimen collection and establish better coordination with the laboratory services

Comprehensive management of patients with chronic obstructive pulmonary disease

Mortality and morbidity associated with chronic obstructive pulmonary disease [COPD] is rising in developing as well as developed countries. Rapid urbanisation and spreading network of roads and no measure to control pollution is a matter of concern for a developing country like Pakistan. Additive adverse effect of smoking is universal. It is unfortunate that despite better understanding of functional alternation in chronic obstructive pulmonary disease the care of many patients remain suboptimal. At present all our resources are directed towards treatment of established disease which is largely irreversible. Today, goal of therapy could be to improve pulmonary functions and make life as comfortable as possible. Timely advice regarding exercise training programme, occupational rehabilitation and giving up smoking may be given. Cessation of smoking while recognising and avoiding other risk factors can slow down the decline in lung function and progress of the disease. The ultimate aim is to gain maximum function within the limits of the disease and promote comfort for the patient1 rather than prolonged survival or improved lung function testing. Such a goal can be achieved, only through a comprehensive management approach

Neuromuscular manifestations in Wegener's granulomatosis

A 30 year old woman suffering from Wegener's Granulomatosis, presented with generalised convulsions and inability to walk. Other symptoms include; progressive deafness, deformed nose, hypertension and recurrent sinopulmonary infections. Convulsive fits and myopathy as manifestation of Wegener's Granulomatosis have not been reported before, to the best of our knowledge