Endovascular stenting for malignant superior vena cava syndrome - Case series and review of literature.

The treatment of malignant superior vena cava syndrome (SVCS) revolves around radiotherapy and chemotherapy to relieve symptoms with surgery being ruled out due to the advanced stage of malignancy. Primary placement of endovascular stent for palliation of malignant SVCS is not commonly reported in the literature. Here, we present two cases of malignant superior vena cava syndrome with successful relief of symptoms after the placement of endo vascular stent.

An interesting case of tonsillar tuberculosis in a 10-year-old boy.

Tuberculosis of the tonsils is a rare type of extra pulmonary tuberculosis. The secondary form is more common than the primary, usually caused by the contact with the infected sputum or saliva from a sputum smear positive case of tuberculosis. We report a primary form of tonsillar tuberculosis in 10-year-old boy, with no remote history suggestive of documented pulmonary tuberculosis. Local examination revealed Grade IV tonsillar hypertrophy and congestion of posterior pharyngeal wall. Management included, Coblation assisted adenotonsillectomy under general anaesthesia. Histopathological examination revealed features suggestive of chronic adenotonsillitis, multiple epithelioid granulomas with caseous necrosis, langhans type of giant cells with scant inflammatory infiltrate in the background.

Predictors of asthma-chronic obstructive pulmonary disease overlap syndrome in patients with chronic obstructive pulmonary disease from a tertiary care center in India.

BACKGROUND: There is dearth of literature on asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) in India. The aim was to compare clinical characteristics between patients with ACOS and non-ACOS COPD and to identify clinical predictors of ACOS in patients with COPD. METHODS: We conducted a retrospective study by reviewing data collected from patients performing spirometry at our hospital. Those with postbronchodilator FEV1/FVC <70% were included in the study. Among them, those with significant reversibility (change in FEV1or FVC by 12% and 200 ml postbronchodilator) were diagnosed with ACOS and the rest were considered to have non-ACOS COPD. Data on the 2 groups were compared and statistical analysis was performed. RESULTS: Out of a total of 324 patients, 100 of them had postbronchodilator FEV1/FVC <70%. Of them, 45 and 55 were diagnosed with ACOS and non-ACOS COPD, respectively. Patients with ACOS had significantly higher postbronchodilator FVC volumes and FVC % predicted values (P < 0.05), had higher reported wheeze (P = 0.02) and ankle edema (P < 0.05), were more likely to be smokers (P = 0.01) with lower smoking index (P = 0.03), and had frequent (≥2) ER visits (P = 0.04). However, very frequent (≥3 per year) hospital admissions (P < 0.01) with higher rates of invasive mechanical ventilation (P = 0.02), and pulmonary hypertension diagnosed by two-dimensional echocardiography (P < 0.01) were significantly higher in the non-ACOS group. The two groups did not differ with respect to history of atopy, family history of wheeze, compliance to inhaler therapy, or blood absolute eosinophil counts. CONCLUSION: Our study highlights how the ACOS phenotype may clinically differ from their counterparts elsewhere, making it a clinical challenge to identify them in India.