Pulmonary amyloidosis: A case series.

Amyloidosis is a spectrum of diseases, in which various proteins which are usual components of plasma are deposited as insoluble beta-pleated sheets extracellularly, disrupting function of various organs. Amyloid light-chain amyloidosis occurs due to the deposition of proteins, derived from immunoglobulin light chains, routinely manifesting with multisystem involvement. Pulmonary involvement is seen in about 50% of cases. Three common patterns of pulmonary amyloidosis on computed tomography (CT) chest are tracheobronchial, nodular parenchymal, and diffuse alveolar septal variety. We hereby report two cases of pulmonary amyloidosis, one being a case of diffuse alveolar septal pulmonary amyloidosis, which is an extremely rare pattern of involvement, with a very poor prognosis, and the other one being tracheobronchial pattern of involvement, which usually results due to the localized deposition of amyloid in the tracheobronchial tree. Knowledge about pulmonary amyloidosis is important due to its poor prognosis and nonspecific findings in CT chest.

Erosion of esophageal stent into left main bronchus causing airway compromise.

Covered or uncovered self-expanding metal stents are currently used for the palliative treatment of neoplastic esophageal strictures or compressions and esophageal leaks or fistulas due to malignancies. Erosion of esophageal stents into the respiratory tract is a rare complication and that too has been reported mostly as an early complication within few days or weeks. Here, we present the case of a 31-year-old female, who presented with a late complication of an esophageal stent eroding into the left main bronchus causing respiratory distress. She was stented for a benign corrosive esophageal stricture following caustic soda ingestion 3 years ago. She underwent a thoracotomy and closure of esophagobronchial fistula along with laparoscopic esophagectomy and gastric pull through. Postoperatively, patient developed an anastomotic leak which was corrected by placing a temporary stent.

Pulmonary cryptococcosis: An unusual presentation.

Cryptococcal infection of the lung is usually asymptomatic in immunocompetent hosts. Symptomatic cryptococcal lung infection presenting as an endobronchial mass lesion in an immunocompetent host is rare. We report our experience with an immunocompetent young patient presenting with an endobronchial mass lesion caused by cryptococcal infection. This male patient presented with left sided collapse, consolidation on computed tomography scanning, and was found to have a polypoid lesion in the left main bronchus. The diagnosis was confirmed by bronchial biopsy and the patient responded well to parenteral antifungal therapy. The case report is followed by a review of pulmonary cryptococcosis including clinical features, diagnosis, and treatment.

Dangerous deliveries: lessons learned during retroperitoneal specimen retrieval.

Laparoscopy is now a standard technique in pediatric surgery and urology. Unique complications have been reported during port/instrument insertion and dissection, often relating to issues of visibility or working space. Complications during specimen retrieval are currently unreported. We describe our experience of 2 serious complications occurring during attempted retrieval of a specimen through a port site at the end of the laparoscopic procedure.

Effectiveness of outpatient pulmonary rehabilitation in elderly patients with chronic obstructive pulmonary disease.

PURPOSE: Pulmonary rehabilitation (PR) has been shown to be an effective intervention in the management of patients with chronic obstructive pulmonary disease (COPD), but its role in elderly patients is not clearly defined. We investigated the effectiveness of rehabilitation in elderly patients with COPD. METHODS: Patients underwent multidisciplinary PR in a hospital outpatient gym twice weekly for 6 weeks. Lung function, shuttle walk distance, breathlessness (using a 10-point Borg scale), and responses to the Chronic Respiratory Questionnaire (CRQ) were assessed before and after rehabilitation. RESULTS: Patients (N = 200; 131 male) were divided into 2 groups: group A, those 70 years or older (n = 102, mean age 76 years); and group B, those younger than 70 years (n = 98, mean age 61.4 years). Shuttle walk distance increased significantly (P < .05) by a mean 33.6 m in group A and 50.1 m in group B. Borg score significantly improved (P < .05) by a mean -0.35 in both groups. There were significant improvements in CRQ components within the older and younger groups: dyspnea 0.9 and 1.1; fatigue 1.0 and 1.1; emotion 0.7 and 0.8; and mastery 1.0 and 1.2; respectively. Differences in improvement in CRQ components between groups A and B were not significantly different. CONCLUSION: Elderly patients with COPD gain similar improvements from PR as younger patients and should not be excluded from rehabilitation based on age alone.