ABSTRACT
A case of localized tracheobronchial primary amyloidosis masquerading as "bronchial asthma" is presented. Computed tomography of the chest and fiberoptic bronchoscopy image are included. Tracheobronchial primary amyloidosis is a rare, but potentially curable cause of airway obstruction mimicking asthma.
Subject(s)
Amyloidosis/diagnosis , Asthma/diagnosis , Bronchial Diseases/diagnosis , Diagnosis, Differential , Humans , Male , Middle Aged , Tracheal Diseases/diagnosisABSTRACT
OBJECTIVE: Tuberculosis is a major public health problem in India. Haematological changes associated with tuberculosis have been incompletely investigated. To the best of our knowledge, there is no comprehensive study assessing the haematological abnormalities in these patients from the Indian subcontinent. In the present study, we have compared peripheral blood and bone marrow findings in patients with disseminated/miliary tuberculosis (DTB/MTB) as well as pulmonary tuberculosis (PTB). An attempt has also been made to assess the effect of antituberculosis therapy on the haematologic abnormalities. MATERIAL AND METHODS: Thirty two patients with disseminated/miliary tuberculosis and 23 patients with pulmonary tuberculosis were prospectively studied to determine the various haematological manifestations in tuberculosis and the effect of antituberculosis therapy. All patients received standard antituberculosis treatment. They were subjected to a detailed haemogram including peripheral blood examination, which was repeated on completion of antituberculosis therapy. Bone marrow aspiration and biopsy was also done in all patients before starting antituberculosis treatment. RESULTS: Normocytic normochromic anaemia was the most common abnormality observed in all the groups and subgroups (DTB/MTB 84%, PTB 86%). Other haematological abnormalities of the white blood cells include leucopenia (DTB/MTB 25%, PTB 0%; p < 0.02), neutropenia (DTB/MTB 22%, PTB 0%; p < 0.04), lymphocytopenia, monocytopenia, leukocytosis, neutrophilia, lymphocytosis and monocytosis. Pancytopenia was observed only in patients with disseminated/miliary tuberculosis (p < 0.05). Thrombocytopenia was more common in patients with disseminated/miliary tuberculosis (p < 0.007), whereas thrombocytosis was more common in patients with pulmonary tuberculosis (p < 0.04). The patients of disseminated/miliary tuberculosis with granulomas in the bone marrow had certain significant differences as compared to patients without granulomas. These patients showed severe anaemia, peripheral monocytopenia and bone marrow histiomonocytosis. The haemogram reverted to normal with antituberculosis therapy in these patients. CONCLUSIONS: In view of the varied haematological abnormalities observed in patients with tuberculosis in this part of the world, it is concluded that the differential diagnosis of tuberculosis should be entertained in patients with varied haematological disorders.
Subject(s)
Adult , Antitubercular Agents/therapeutic use , Bone Marrow/drug effects , Female , Hematologic Diseases/blood , Humans , India , Male , Prospective Studies , Tuberculosis, Miliary/blood , Tuberculosis, Pulmonary/bloodABSTRACT
The objective of the study was to validate and refine the APACHE II (acute physiology and chronic health evaluation II) prognostic system in the Indian context. We prospectively collected data on 79 patients admitted in the medical intensive care unit. We have studied APACHE II and 11 other physiological variables and sought to improve the risk prediction by developing a new score to be governed by the rule of thumb at the bed side. The new score included the following five variables: pH and serum albumin at admission and heart rate, bilirubin and Glasgow coma scale at 48 hours. A score below 3.5 was independently associated with a statistically significant increase in the risk of hospital death. This model resulted in a pseudo r2 of 0.43 in comparison to pseudo r2 of 0.02 and 0.12 for APACHE II scores on the day of admission and after 48 hours, respectively.
Subject(s)
APACHE , Cohort Studies , Critical Illness , Female , Humans , Logistic Models , Male , Middle Aged , Prognosis , Prospective StudiesABSTRACT
Transbronchial lung biopsy using the fibreoptic videobronchoscope was carried out in 25 patients with diffuse pulmonary disease. There were no serious complications. Satisfactory specimens were obtained in 20 of the 25 patients. A histological diagnosis was made in 10 patients. The problems of interpreting pulmonary fibrosis have been highlighted. Fibreoptic transbronchial lung biopsy is a safe and useful adjunct to the diagnosis of diffuse parenchymal pulmonary disease.