Impact of HRCT pattern on six-minute walk test in patients with interstitial lung disease-An observational study.

Background: Forced vital capacity (FVC) and six-minute walk distance (6MWD) are robust markers in interstitial lung diseases (ILD) to assess severity and prognosis. It is unknown whether high-resolution computed tomography pattern has any independent effect on the exercise capacity in ILD. We compared six-minute walk test (6MWT) parameters between usual interstitial pneumonia (UIP) and non-UIP ILD after adjusting for FVC. Methods: Data from a tertiary care ILD clinic were retrospectively analysed. Based on HRCT, patients were classified as UIP and non-UIP. 6MWT parameters and FVC were recorded for enrolled patients. 6MWD, distance-saturation product (DSP) and exertional desaturation were compared between UIP and non-UIP, using analysis of covariance (ANCOVA), with per cent predicted FVC as covariate. Patients were grouped as mild (≥70%), moderate (51%-69%) and severe (≤50%) based on FVC severity. Results: Out of 169 patients enrolled, only patients with all three data points: spirometry, 6MWT and HRCT were included in the analysis (n = 139). UIP group comprised 56 (40.3%), while non-UIP group had 83 (59.7%) patients. More females and lesser smokers were present in non-UIP group. Mean predicted FVC% was similar between the two HRCT groups (P = 0.611) and had a statistically significant, though very weak to weak correlation with 6MWT parameters {6MWD (r = 0.138); pred 6MWD% (r = 0.170); desaturation (r = -0.227); DSP index (r = 0.166)}. Analysis of covariance showed no statistically significant difference in the 6MWT parameters between UIP and non-UIP groups for similar FVC levels. Conclusion: For a similar level of lung function, exercise capacity was similar for patients with UIP and non-UIP pattern ILD.

Recurrent haematospermia: an unusual presentation of autosomal dominant polycystic kidney disease.

Haematospermia, even though alarming, is usually benign and self-limiting, especially in a sexually active male. Nevertheless recurrent, refractory or painful haematospermia is troublesome and warrants thorough evaluation. In this context, we describe a rare case of recurrent haematospermia whereby evaluation revealed haemorrhage in seminal vesicle cysts and consequently established the aetiology of autosomal dominant polycystic kidney disease.

Favourable outcome in a child with acute lymphoblastic leukaemia and pulmonary mucormycosis managed with combination antifungal therapy of liposomal amphotericin B and caspofungin.

Pulmonary mucormycosis (PM) accounts for more than half the cases of mucormycosis in paediatric haematological malignancies, with mortality reaching as high as 90%. Surgical debridement of lesion along with liposomal amphotericin B (L-AMB) constitutes the mainstay of management of mucormycosis and offers best chances of survival. There are no reliable data available in the literature justifying the use of combination antifungal therapy (CAfT). We describe a child with acute lymphoblastic leukaemia (ALL) who developed multiple localised PM during induction chemotherapy. He was managed with CAfT with L-AMB and caspofungin in view of progressive PM on high-dose L-AMB monotherapy. There was complete resolution of PM after 6 months of CAfT at the end of intensive chemotherapy of ALL. There were no significant side effects of CAfT. CAfT may be of value in cases of mucormycosis refractory to high doses of L-AMB, where surgical debridement is not feasible.

Ultrasound evaluation of cervical lymphadenopathy: Can it reduce the need of histopathology/cytopathology?

BACKGROUND: The differentiation between the causes of cervical lymphadenopathy is of paramount importance as these have different modalities of treatment with varying prognosis. The aim of this study was to evaluate the efficacy of B Mode and colour Doppler ultrasound (CDUS) to differentiate between benign and metastatic lymph nodes. METHODS: 100 patients of clinically palpable lymph nodes were evaluated with B Mode and CDUS. B Mode assessment included short-long (S:L) axis ratio, hilum, nodal border, echogenicity, intranodal necrosis and ancillary features. CDUS assessment included distribution of vascularity, resistive index (RI) and pulsatility index (PI). Statistical analysis was carried out with histopathological or cytological diagnosis as gold standard. RESULTS: B-Mode US correctly diagnosed 22/25 (88%) of the reactive lymph nodes giving it a sensitivity of 88% and specificity of 97.3%. Colour Doppler US diagnosed 23/25 (92%) reactive lymph nodes with a sensitivity of 92% and specificity of 97.3%. B-Mode underdiagnosed one case each of granulomatous disease and metastasis as reactive node while CDUS missed out two cases of granulomatous disease as reactive lymph node. CONCLUSION: Individual parameters of B Mode when used alone were not found to be very effective in differentiating benign and malignant lymph nodes. However features of B-Mode combined together as well as color Doppler ultrasound, help in the detection of reactive lymph nodes and can be used as a diagnostic tool with good accuracy. However, they cannot be used as a diagnostic method for metastatic or tubercular nodes and cytopathology/histopathology remains the gold standard in such situations.