Prevalence of pulmonary hypertension in chronic simple silicosis patients and its correlation with smoking history, occupation type, age and duration of silica exposure.

Silicosis is a preventable occupational health hazard with potential for permanent physical disability and increased socio-economic burden. Pulmonary hypertension (PH) secondary to chronic respiratory diseases signifies poorer prognosis and transthoracic echocardiography (TTE) has proven its usefulness as a screening tool for PH diagnosis. The objectives were to determine PH prevalence in chronic simple silicosis patients through TTE screening and correlate PH prevalence with smoking status, occupation type, age and duration of silica exposure (DSE). We enrolled 104 patients in the study based on occupational exposure to silica dust and radiologic confirmation of chronic simple silicosis. The study sample was divided into significant smokers (SS group) and insignificant smokers (InS group) on the basis of ≥10 pack years smoking history, and into drillers and dressers based on occupation type. TTE examination was performed to measure resting mean pulmonary artery pressure (mPAP) and the patients were classified into: no PH (mPAP≤20 mm Hg), borderline PH (mPAP>20 and <25 mmHg), and PH (mPAP≥25). PH prevalence was 25% in study subjects (26/104); 29.6% (16/54) among SS group versus 20% (10/50) among InS group (.52) ; and 34.2% (14/41) among drillers versus 19.1% (12/63) among dressers (p=.024). Mean age and mean duration of silica exposure among SS and InS groups were comparatively similar, while they had lower values among dressers against dressers with no statistical significance. Logistic regression analysis established a significant association of PH prevalence with higher age in the study sample, SS group and drillers group, while a significant association of PH prevalence with longer DSE was only seen in the study sample. PH prevalence was significantly associated (p=.007) with SS-driller group on comparing TTE findings with combined smoking and occupation type based groups. This study has shown PH prevalence in chronic simple silicosis patients at alarming levels, having associations with driller occupation, older age and longer DSE with varying results among groups and complex interplay with smoking exposure, suggesting the need for large sample-based molecular and genetic studies. Including TTE in the initial work-up of silicosis patients will promote timely intervention and reduce morbidity and mortality with a high benefit-cost ratio.

Diagnostic accuracy of semirigid thoracoscopy in exudative pleural effusions and relationship of thoracoscopic findings with probability of malignant diagnosis.

Semirigid thoracoscopy is increasingly becoming the procedure of choice for evaluation of undiagnosed exudative pleural effusions. Few studies have reported relationship of thoracoscopic appearances of pleural abnormalities and etiological diagnoses. We aimed our study to assess the diagnostic utility and safety of semirigid thoracoscopy for evaluation of patients with undiagnosed exudative pleural effusion. Further, we also pursued to find any relation of various thoracoscopic findings with the final diagnosis. We prospectively enrolled hospitalized patients with undiagnosed exudative pleural effusion who underwent semirigid thoracoscopy. Demographic, clinical and laboratory data along with data on thoracoscopic appearance of various pleural abnormalities and histopathological diagnosis of pleural biopsy specimens were collected and analysed. Semirigid thoracoscopy was diagnostic in 46 (N=55) patients (83.64%). Malignancy was diagnosed in 31 patients (56.36%), of which adenocarcinoma was the most common histopathological diagnosis (45.16%).  Sensitivity, specificity, PPV, NPV LR+ and LR- of thoracoscopy were 93.87%, 100%, 100%, 66.67%, 40.30 and 0.06, respectively. Pleural nodules, masses and hemorrhagic pleural fluid significantly increased the diagnosis yield of malignancy [OR= 37.16 (95%CI = 3.61-382.65),  =0.002]. The procedure related complications were mild and transient. Post- procedural pain (20%) was most commonly reported followed by dry cough (18.18%), sub-cutaneous emphysema (7.27%) and anaesthesia related complication (1.82%). Semirigid thoracoscopy is simple, safe and effective procedure in diagnosing exudative pleural effusion of unknown etiology with high diagnostic accuracy and minor procedure related complications. The likelihood of diagnosing malignancy is high if combination of pleural nodules, masses and hemorrhagic pleural fluid is present.

Benign Endobronchial Inflammatory Polyp with Cystic Degeneration: A Case Report.

Endobronchial lesions causing luminal obstruction are mostly found in bronchogenic carcinoma. Inflammatory polyps originating from the tracheobronchial tree are rarely found. Here we report a case of an elderly male presenting with prolonged cough who was found to have an endobronchial inflammatory polyp. The polyp was resected completely with the use of the flexible bronchoscope and electrocautery snare.

Spontaneous Partial Regression of a Carcinoid Tumor: Radiology May Not Capture the Real Picture.

A partial or complete resolution of the neoplastic lesion, either spontaneously or in the presence of therapy that is considered inadequate to exert significant influence on the growth of the neoplastic lesion, is considered a spontaneous regression. This phenomenon is extremely rare in lung neoplasms. A close follow up with imaging along with bronchoscopy and a biopsy of the lesion is essential, as they may have potential for distant spread even during radiological regression. Here, we report a case of a partial resolution of a bronchial carcinoid tumor that had a high mitotic activity and was resected.

Comparison of Diagnostic Potential of Narrow Band Imaging Bronchoscopy Over White Light Bronchoscopy in Lung Cancer.

BACKGROUND: Worldwide, lung cancer is the largest contributor to new cancer diagnoses and to death from cancer. Narrow band imaging (NBI) is a novel bronchoscopic technique which enables detailed examination of submucosal microcapillary grid and showed great potential in early detection of malignant lesions of the bronchial mucosa. The aim of this study was to compare diagnostic potential of NBI bronchoscopy over white light (WL) bronchoscopy in lung cancer. METHODS: We enrolled 187 patients having clinical and radiologic findings highly suspicious of lung cancer. Patients were further divided into 2 groups: NBI group (n=102), and control WL group (n=85). Bronchoscopy examination was performed with respective visualization modes and all pathologic lesions were biopsied and histologically confirmed. RESULTS: On NBI bronchoscopy, malignancy was suspected in 69 patients, of whom 62 had malignancy, and 33 patients were suspected of inflammation, of whom 32 had inflammation and only 1 patient had malignancy. Under WL bronchoscopy, 54 patients were suspected of malignancy, of whom 36 had malignancy, and 31 patients were suspected of inflammation, of whom 23 had inflammatory disease and 8 had malignancy. NBI bronchoscopy had sensitivity 98.1%, specificity 82.05%, positive predictive value 89.86% and negative predictive value 96.97% in comparison to standard WL bronchoscopy which had sensitivity 81.82%, specificity 56.10%, positive predictive value 66.67% and negative predictive value 74.19%. CONCLUSION: NBI bronchoscopy demonstrated better results in comparison to WL bronchoscopy. The presence of pathologic vascularization of the tumor helps to better identify the malignant process. Inflammatory changes in the mucosa can be easily differentiated from malignant changes by the appearance of vessels.