Plasma cell leukaemia--a report of two cases.

Two cases of plasma cell leukaemia--a rare form of leukaemia are described. Both cases presented with anaemia and hepatosplenomegaly. Investigations revealed leucocytosis with increased plasma cells (> 20%). Skeletal survey revealed a few osteolytic lesions in both cases.

Pneumocystis carinii pneumonia in human immunodeficiency virus infected patients in Bombay: diagnosed by bronchoalveolar lavage cytology and transbronchial lung biopsy.

We report Pneumocystis carinii pneumonia (PCP) diagnosed by bronchoalveolar lavage cytology and transbronchial lung biopsy in three out of five human immunodeficiency virus (HIV) positive adult patients presenting with interstitial pneumonitis. One of these patients was serologically positive for HIV at the time of presentation and the remaining two patients were detected to be HIV positive on follow up after the diagnosis had been established. All the three patients were treated with co-trimoxazole. One patient recovered and was discharged; another patient improved with treatment but died after jugular vein cannulation and the third patient succumbed to cryptosporidial diarrhoea. The remaining two patients with non-specific interstitial pneumonitis treated with prednisolone and bronchodilators were recovered and were discharged from the hospital.

PIP: In developing countries, the proportion of Pneumocystis carinii pneumonia (PCP) cases, compared to other opportunistic infections associated with AIDS, is low partly because of underdiagnosis. PCP cases are reported that were diagnosed by bronchoalveolar lavage (BAL) cytology and transbronchial lung biopsy (TBLB) in 3 out of 5 HIV-positive adult patients presenting with interstitial pneumonitis at the Department of Chest Medicine, KEM Hospital, Bombay. One of these patients was serologically positive for HIV at the time of presentation and the remaining 2 patients were detected to be HIV-positive on follow-up after the diagnosis had been established. All patients had elevated erythrocyte sedimentation rate. CD4+ lymphocyte analysis was done in 1 patient and revealed 360 CD4+ cells/cu. mm. BAL cytology using Giemsa stained smears confirmed the presence of cysts diagnostic of Pneumocystis carinii. TBLBs of the 3 patients who revealed P. carinii in their BAL fluid also evinced foamy intra-alveolar eosinophilic exudates, and the GMS stain showed the presence of ovoid or cup-shaped structures consistent with P. carinii within these exudates. Biopsies from the 2 PCP-negative, HIV-positive patients showed evidence of interstitial pneumonitis. All 3 patients were treated with cotrimoxazole (20 mg/kg body weight). Only 1 patient recovered and was discharged; another patient improved with treatment and was started on cefotaxime (50 mg/kg body weight) and amikacin (15 mg/kg body weight), but died after jugular vein cannulation. The third patient developed cryptosporidial diarrhea and died. The remaining 2 PCP-negative patients with nonspecific interstitial pneumonitis treated with prednisolone and bronchodilators recovered and were discharged from the hospital. BAL cytology and TBLB were useful tools in detecting PCP, one of the few treatable AIDS-related infections.

Anti-inflammatory action of steroid inhalers.

With mucosal inflammation contributing to the pathogenesis of asthma, it is increasingly accepted that long term steroid inhalers may induce remission in chronic long standing asthmatics. The present study involved 44 stable asthmatics who were randomly given either beclomethasone dipropionate inhaler (50 ug) 2 puffs qds or salbutamol inhaler (100 mcg) 2 puffs tds in addition to their oral bronchodilators. Pulmonary function testing, bronchoalveolar lavage and complete blood count were done at basal and weekly intervals and at the end of the study. The absolute eosinophil count showed a significant drop in the beclomethasone group as compared to the salbutamol group. Serial lung functions showed a significant improvement in the pre-bronchodilator PEFR and the pre-bronchodilator FVC in the beclomethasone group as compared to the salbutamol group. There was no significant change in the lavage eosinophil count pre and post-bronchodilator in both groups. Steroid inhalers are thus useful in long term management of bronchial asthma especially with respect to reducing bronchodilator requirement.

Evaluating computed tomography and broncho alveolar lavage in early diagnosis of pulmonary asbestosis.

Forty-eight male asbestos workers were studied with clinical interrogation and examination, chest radiograph, lung function, body box studies, blood gases at rest and after exercise, BAL and in 40 cases by CT scan. Mean age was 40:1 (+/- 5.2) and work exposure 18.1 (+/- 4.0) years. There were 52% smokers. We found rales in 93%. Lung functions and clinical picture were not related to smoking (FEV1 was lower). There was evidence of airway obstruction by FEV1/FVC% (58% as below 80%), bronchodilator improvement (18% as over 10%), Raw (45% as over 2 cm H2O/l/sec) or RV/TLC% (39.5% as above 40%). Arterial pO2 decreased (over 2 mm) on exercise in 18%. By ILO classification chest radiographs were up to 1/1 in 10 (21%) and 2/2 or above in 19 (40%). Pleural abnormalities were seen by X-ray in 20 (42%) and by CT Scan in 26 (54%). The scan was abnormal in 92%. Lung function was not related to radiographic ILO grading but was lower with abnormal CT scan. BAL revealed normal (or low) cell counts, fewer macrophages (35%) and more polymorphs (23%) and lymphocytes (29%) over values for controls reported earlier (8); only 9 (19%) showed high cell counts. Asbestos body count was high (28.4) and was unrelated to other abnormalities. In some departments asbestos (respirable) fibre load was high (mean 0.61 to 3.12: maximum 0.84 to 6.78). It is concluded that in a proportion, early asbestosis can be diagnosed by CT scanning and high asbestos body count in BAL.

Congenital aneurysms of the sinus of Valsalva with dissection into the interventricular septum.

Four cases of congenital aneurysm of sinus of Valsalva (CASV) with rupture and dissection into the intraventricular septum are described. Their incidence (26.6%) in 15 consecutive cases of CASV is unusually high. Only one of these showed secondary rupture into the left ventricle. If these aneurysms remain unruptured, their diagnosis during life is difficult as in the case of other unruptured aneurysms of CASV. The occurrence of conduction abnormalities in young patients should be one of the indications, and 2-D echocardiography would help to arrive at a definite diagnosis and aid in the institution of appropriate surgical treatment.