Profile and outcome of unilateral tuberculous lung destruction in Ilorin, Nigeria.

BACKGROUND: Unilateral tuberculous lung destruction is a serious chronically disabling and often fatal complication of pulmonary tuberculosis. A few previous studies have dealt with some aspects of this entity among Nigerians with pulmonary tuberculosis but these studies may not truly reflect its current trends. OBJECTIVE: To describe the presenting profiles and outcome of unilateral tuberculous lung destruction among patients with pulmonary tuberculosis. METHODS: The study was a chart review of the medical records of adult patients with pulmonary tuberculosis complicated by unilateral lung destruction seen between January 1999- December 2008. Data extracted included demographic, and outcome of treatment. The clinical features, sputum results and illustrative cases are presented. RESULTS: Unilateral lung destruction complicated 74(1.3%) of 5,926 pulmonary tuberculosis cases seen over the review period. Most cases occurred in males [45(60.8%)] and they were predominantly [51(68.9%)] below 40 years of age. Most of them [52(70.2%)] presented after six months of symptoms. Forty-seven (63.5%) of them had had previous exposure to antituberculosis drugs. The left lung was affected in 49 (66.2%) patients. Only 25 (33.8%) of them were cured while the adjusted mortality rate was 25.5%. Male gender, presence of dyspnoea on mild exertion and right ventricular failure were significantly associated with increased mortality. CONCLUSION: Unilateral tuberculous lung destruction has unacceptably high mortality rate which can be prevented by patient presenting early to the hospital, prompt diagnosis and strict adherence to the standard treatment.

General practitioner reported follow-up visits among asthma patients in North Central Nigeria.

BACKGROUND: Despite the benefits of regular follow-up in the long-term care of asthma, no previous study has reported on it among asthma patients in Nigeria. OBJECTIVE: This survey was designed to evaluate GP-reported follow-up visits among asthma patients in North Central Nigeria. METHODS: It was a cross-sectional survey conducted among GPs in three North Central states of Nigeria. RESULTS: Overall, 48.3% of the GPs reported that their patients usually come for follow-up visits. About 63.6%, 40.0%, and 55.3% of the GPs in Kwara, Kogi, and Niger states, respectively, reported that their patients came for follow-up visits in the month prior to this study. Less than two-third of GPs in both private (55.1%) and public (56.8%) hospitals reportedly attended to patients on follow-up visits. About 46.5%, 37.5%, and 52.0% of the GPs who attended to patients <1 week, 1-2 weeks and >2 weeks prior to the study reported that their patients came for follow-up visits. There was significant difference (P = 0.04) in the reported follow-up visits by GPs who attended to ≥10 asthma patients compared to others. None of the nine GPs who reportedly treated ≥ 10 patients in the preceding month of the study attended to any patient on follow-up visits. CONCLUSION: The GP-reported rates of follow-up visits in patients that are accessing asthma care from GPs practicing in the North Central part of Nigeria are low. Further studies to identify barriers to follow-up visits and how to correct them are therefore recommended.

Utilisation of spirometry among hospitalised patients with clinical findings of COPD in a tertiary hospital in Nigeria.

AIMS AND OBJECTIVE: The aim of this study was to determine the rate of spirometry utilisation among hospitalised patients with clinical findings of chronic obstructive pulmonary disease (COPD) in a tertiary hospital in Nigeria. PATIENTS AND METHODS: A case record review of hospitalised patients with clinical findings of COPD from January 2002 to June 2009 from the record of the cardiopulmonary unit of the University of Ilorin Teaching Hospital Ilorin, Nigeria was carried out. Age and sex, hospital stay, admitting physician, and outcome of admission were obtained. RESULTS: A total of 228 patients were hospitalised with clinical findings of COPD, 185 (81. 1%) were males and 43(18.9 %) were females. The rate of utilisation of spirometry in hospitalised patients (228) with clinical findings of COPD was 8.3%. More than half of those that had spirometry were aged ≥ 65 years. Majority (16; 84.2%) of those that underwent spirometry were under the care of the pulmonologist (p

Sickle cell chronic lung disease among young adult Nigerians.

BACKGROUND: Sickle cell chronic lung disease (SCLD) is often underappreciated by health care providers because its exact prevalence and methods of diagnosis have not been well studied. OBJECTIVE: To describe the pattern of SCLD among young adult Nigerians with sickle cell anaemia (SCA).its exact prevalence and methods of diagnosis have not been well studied. OBJECTIVE: To describe the pattern of SCLD among young adult Nigerians with sickle cell anaemia (SCA). METHODS: Ninety (43 males and 47 females) patients with SCA who were selected by balloting and 90 (54 males and 36 females) healthy subjects with normal adult haemoglobin were studied. Their ventilatory function test (spirometry and peak expiratory flow rates), radiological and electocardiographic parameters were obtained and analyzed for SCLD. RESULTS: Seventeen (18.9%) of the patients had SCLD. Majority (94.1%) of them were in stage1 disease, 5.9% in stage two, and none in the more advanced stages3 and 4. The number of patients with SCLD increased with increasing age. SCLD was associated with more than five previous hospital admissions: 82.4%, (OR of 10.02; CI:4.51 to 22.22) and presence of symptoms suggesting previous acute chest syndrome: dyspnoea in 58.8% (OR of 33.33, CI 7.39 to 150.30); chest pain in 94.1%, (OR of 81.33, CI 9.83 to 672.85); and cough in 47.1%, (OR of 64.00, CI 7.15 to 572.60). CONCLUSION: SCLD may not be a rare event in Nigeria. Therefore efforts should be made to diagnose it in the early asymptomatic stage so as to offer effective intervention therapy to halt progression to the more disabling advanced stages.

Sickle Cell Chronic Lung Disease among Young Adult Nigerians

BACKGROUND: Sickle cell chronic lung disease (SCLD) is often underappreciated by health care providers because its exact prevalence and methods of diagnosis have not been well studied. OBJECTIVE: To describe the pattern of SCLD among young adult Nigerians with sickle cell anaemia (SCA). METHODS: Ninety (43 males and 47 females) patients with SCA who were selected by balloting and 90 (54 males and 36 females) healthy subjects with normal adult haemoglobin were studied. Their ventilatory function test (spirometry and peak expiratory flow rates); radiological and electocardiographic parameters were obtained and analyzed for SCLD. RESULTS: Seventeen (18.9) of the patients had SCLD. Majority (94.1) of them were in stage1 disease; 5.9in stage two; and none in the more advanced stages3 and 4. The number of patients with SCLD increased with increasing age. SCLD was associated with more than five previous hospital admissions (82.4; OR=10.02; CI=4.51-22.22) and presence of symptoms suggesting previous acute chest syndrome (dyspnoea in 58.8; OR=33.33; CI=7.39-150.30; chest pain in 94.1; OR=81.33; CI= 9.83-672.85; cough in 47.1; OR=64.00; CI=7.15-572.60). CONCLUSION: SCLD may not be a rare event in Nigeria. Therefore efforts should be made to diagnose it in the early asymptomatic stage so as to offer effective intervention therapy to halt progression to the more disabling advanced stages

Prevalence of self reported allergic rhinitis and its relationship with asthma among adult Nigerians.

OBJECTIVES: The aims of the study were to establish the prevalence of self-reported allergic rhinitis in an adult Nigerian population and to examine the relationship between asthma and allergic rhinitis. METHODS: We conducted an epidemiological study of adults aged between 18 and 45 years in Ilorin, Nigeria from 2005 to 2006. An adaptation of the European Community Respiratory Health Survey questionnaire was administered by trained assistants to obtain information on demographics, history of nasal allergies, asthma symptoms, and smoking history. The participants also underwent spirometry. RESULTS: Of the 761 individuals screened, 733 were recruited, giving a participation rate of 96.3%; 441 (60.2%) were men and 292 (39.8%) were women. The prevalence of allergic rhinitis and asthma was 29.6% (n = 217) and 14.7% (n = 108), respectively. Of the individuals with allergic rhinitis, 31.8% (n = 69) had asthma and of those with asthma, 63.9% (n = 69) had allergic rhinitis. The mean (SD) age of those with allergic rhinitis was 31 (7.5) years and 65% (n = 141) were men. The determinants of asthma in individuals with allergic rhinitis were a family history of asthma (odds ratio [OR], 3.38), a history of smoking (OR, -2.58), high socioeconomic status (OR, 3.82) obesity (OR, 3.32), and wheezing (OR, 250). Lung volumes were reduced in those with both asthma and allergic rhinitis compared to those with allergic rhinitis alone. CONCLUSION: Our study revealed a high prevalence of allergic rhinitis in individuals with asthma. It is therefore important to increase awareness of the existence of allergic rhinitis and asthma as a common airway disease to ensure adequate management and control of both conditions.

Prevalence and determinants of tobacco smoking among HIV patients in North Eastern Nigeria.

People living with human immune deficiency virus (HIV) infection who smoke tobacco are more likely to develop several opportunistic infections, and also suffer complications from antiretroviral medication than the non smokers of tobacco. The burden of tobacco smoking amongst people living with this infection is poorly understood in the African population. The aim of this study was to establish the prevalence and determinants of tobacco smoking among HIV patients in North Eastern Nigeria. We enrolled 312 adult HIV sero-positive patients attending the Federal Medical Centre Yola, Nigeria. A modified World Health Organisation (WHO) recommended questionnaire was used to obtain information from consented subjects. The prevalence of current cigarette smoking among HIV patients was 22.1%. The male to female ratio of smokers was 2:1. Peer pressure (25.8%) and pleasure (25.8%) were reported as the most common reasons for smoking tobacco. Multivariate analysis shows that male gender, age ranged 40-49 years, alcohol drinking and CD4 T lymphocyte count <200 cells/mm3 were positively associated with tobacco smoking. The prevalence of tobacco smoking among HIV patients in North Eastern Nigeria was high. Therefore, smoking should be discouraged in people living with HIV to reduce their morbidity and mortality.

The prevalence of bronchial asthma among adults in Ilorin, Nigeria.

Few data exist on the prevalence of asthma among Nigerian adults. The aim of this study was to determine the prevalence of bronchial asthma among adults in Ilorin, Nigeria. This study was conducted in Ilorin east and west local governments of Kwara State, Nigeria from October 2005 to April 2006. We recruited 810 subjects by the cluster sampling method. The European Community Respiratory Health Survey (ECRHS) asthma-screening questionnaire was used to collect data. The peak expiratory flow rate (PEFR), force expiratory volume in one second (FEV1,), force vital capacity (FVC) and FEV1/FVC ratio were measured. Subjects with FEV1 <80% of predicted, FEV/FVC < 80%, or one asthma symptom were subjected to PEF variability testing over the course of one week. Asthma was diagnosed in subjects with either two or more recurrent asthma symptoms (current asthma) or physician-diagnosed asthma, as well as PEF variability of > or =10%. The prevalence of bronchial asthma was 15.2%, the male to female ratio was nearly 2:1, and the mean age of the asthmatics was 32 +/- 10.12 years. Current asthma and physician-diagnosed asthma were 12.7% and 2.0%, respectively. The most common complaint reported by the asthmatics was wheezing. The prevalence of bronchial asthma among adults in Ilorin in North Central Nigeria was high. It is important to increase awareness of the disease in this region.

Health care workers and risk of hospital-related tuberculosis.

OBJECTIVE: To determine the incidence and risk of hospital-related TB amongst the health care workers and trainee students of this institution. DESIGN: Retrospective study. METHOD: Chart review of PTB and EPTB diagnosed by AAFB in sputum, suggestive chest X-ray features of TB and aspiration cytology or tissue histology. RESULTS: Thirty-two (1.5%) of the 2,173 total staff strength developed occupation-related TB in a 15 year period, 15 (47.0%) of which presented as HIV/TB co-infection. Junior HCWs were mostly affected and the male:female ratio was about 1:2. PTB occurred in 25 staffs (78.1%), EPTB occurred in 5 (15.6%) and 2 (6.3%) had disseminated TB. HCWs directly caring for patients; 24 (75.0%) were mostly affected. They were HCWs from nursing, 15 (47.0%) and clinical services, 9 (28.0%). Duration of employment of the affected HCWs varied from half a year to 11.5 years and the rate of diagnosis of cases varied from nil to 3 per year. Identified risks for acquiring and developing active TB in the hospital were; HIV infection 47.%, diabetes mellitus 9.4%, "alcoholic" liver cirrhosis; 6.3% and chronic obstructive pulmonary disease 3.1%. CONCLUSION: Incidence of hospital-related TB is low amongst the staffs of UITH; however, all the HCWs of the hospital were at risk of exposure. Staffs at the clinical sections had the highest frequency of developing occupation-related TB, and HIV infection was the commonest risk factor.

Bacterial pneumonia in the AIDS patients.

OBJECTIVE: To determine the incidence, microbiological pattern and prognostic factor of bacterial pneumonia in AIDS patients. STUDY DESIGN: Prospective study of AIDS patients from July 2001 to Dec 2002. METHODOLOGY: Adults AIDS patients on HAART drugs that develop acute fever, cough with bronchial breathing or lung crepitations had diagnostic evaluation that included chest x-ray, paired sputum microscopy, culture and sensitivity, paired blood culture and haematological profiles including CD4' cell count. RESULTS: Twenty-one patients (22.6%), 9 males and 12 females developed community acquired pneumonia during this 16-month period. Pneumonia was confirmed in 9 patients (42.9%), presumed in 4 (19%) and probable in 8 (38%). Streptococcus pneumoniae accounted for 22% of the cases when immunity was less impaired. Staplhylococcus aureus accounted for another 22 % while Klebsiella pneumoniae, Pseudomonas aeraginosa and Escherichial coli were isolated in 11% each when immunity was severely compromised. Fifteen patients (71.4%) were successfully treated with routine antibiotics. Six cases (28.6%) died. All had anaemia, leucopoenia and low CD4 cell count. Four (66.7%) of this had positive bacterial culture with bacteremia in three of them. CONCLUSION: Bacterial pneumonia in HIV-infected patients has similar presentation to that in the general population, Staphylococcus aureus and gram-negative bacilli especially Klebsiella pneumoniae were seen in a good proportion of the cases. Outcome of treatment was poor in the presence of positive bacterial culture, anemia, leucopoenia and very low CD4+ lymphocytes.

Spectrum and prognostic significance of opportunistic diseases in HIV/AIDS patients in Ilorin, Nigeria.

BACKGROUND: Opportunistic diseases (ODs) of varying types and severities have been reported amongst HIV infected patients around the world, this made us to define the incidence, spectrum and effects of ODs on HIV infected Nigerians' CD4+cells count and survival rate. DESIGN: Retrospective analyses of HIV register from February 2002 to July 2004. RESULTS: ODs developed in 201 (68.6%) patients, 107 (53.2%) were AIDS-defining viz; TB, HIV-encephalopathy, scopulariopsis meningitis, cutaneous kaposis sarcoma and pulmonary candidiasis. Mean CD4+ count was lower with ODs compared to the controls, 138/ul vs 211/ul, p < -0.0006. It was low with non-AIDS-defining infection, 221.6/ul, lower with non-infectious AIDS-defining diseases, 192.4/ul and lowest with AIDS-defining infections, 117.7/ul. Mortality rate was 29.4%; 51 infectious and 8 non-infectious ODs against 19 (18.4%) from the controls. Risk of death was four folds higher with ODs over the controls, 59 vs 19, OR=3.98, 95%CI= 2.20- 7.27, X=24.2, p-<0.0001. This risk was also higher with infectious AIDS-defining illnesses compared to non-infectious ones, 48 vs 8, RR=4.83, 95 %CI=2.80- 8.34, X= 51.7, p-<0.0001. Death from TB was over 2(1/2) times higher than deaths from other AIDS-defining diseases, 45 vs 14, RR=2.7,95%CI=2.01-3.73,x=37.3, p-<0.0001. Average survival was shorter with ODs; 12.3weeks compared to controls, 37.8weeks, p-< -0.039. Mean survival was longest with EPTB, 29.8weeks and shortest with fungal meningitis, 1.9weeks. CONCLUSION: incidence of ODs was high, 68.6%; it was associated with lower CD4+ count and shorter patient's survival especially when it was infectious and AIDS defining.

Concomitant sarcoidosis in a patient with tuberculosis: first report of association in Africa.

Sarcoidosis occasionally develops in patients previously treated for tuberculosis. Less commonly, tuberculosis develops as an opportunistic infection in patients following corticosteroid treatment for sarcoidosis. Rarely do you find sarcoidosis and tuberculosis coexisting in the same patient. This report in an African, documents the co-existence of both diseases in a patient, highlighting this relationship and reviews the literature on the possible aetiologic relationship between tuberculosis and sarcoidosis.

Management outcome of pulmonary tuberculosis: a nine year review in Ilorin.

OBJECTIVE: This study evaluates the management outcome of patients with pulmonary tuberculosis (PTB) over a nine year period. Essentially the cure rate, rate of default and fatality rate were all estimated. Factors predisposing to poor drug compliance were also reviewed. METHODS: This was conducted by analysing the medical records of all newly diagnosed cases of PTB. Patients' demographic data, their social and past medical histories were obtained from their records. The extents of the lung lesions were determined from their chest X-rays. Criteria were set to define those that were (a) cured, (b) defaulted (c) transferred (d) had treatment failure and (e) died. The chi-square test of significance was used to estimate the difference between those that were cured and those that defaulted therapy. Multiple regression models were used to determine the level of interplay among the various factors contributing to patients' poor therapy compliance; the best of these was recorded. RESULTS: Out of the 1,741 cases of PTB treated over the studied period, 43.7% were cured, 0.3% had treatment failure, 44.2% defaulted therapy, 0.2% were transferred to other treatment centers while a fatality rate of 11.6% was recorded. Male gender, old age (> or =) 65 years), unmarried status, and previous default from therapy were found associated with poor therapy compliance. Others were unemployment, cigarette smoking and the use of alcohol. CONCLUSION: The cure rate of PTB in this study was very low, while the rate of default from therapy was quite high. These are in contrast to WHO target for TB control. To improve on these, directly observed therapy short course (DOTS) strategy for treating TB has to be adopted and implemented at all our treatment points for PTB. There should be emphasis on the Primary health Care (PHC) centers, because majority of PTB patients are grass root people and PHC set-ups are closer to them.

The usefulness of serum albumin and urinary creatinine as biochemical indices for monitoring the nutritional status of Nigerians with pulmonary tuberculosis.

The objective is to evaluate the relative roles of urinary creatinine and serum albumin as biochemical markers for monitoring the nutritional status of pulmonary tuberculosis patients during treatment. Thirty-one newly diagnosed pulmonary tuberculosis patients were placed on six months short course regimen. Their weight, body mass index, serum albumin and 24-hour urinary creatinine excretion were determined before treatment, at the end of the 1st, 2nd, 4th and 6th month of treatment. Subjecting the mean values of the weight, BMI and Urinary Creatinine excretion and serum albumin to Friedman test showed significant changes for all the four indices. Further analysis with paired student t-test of the pre-treatment values with end of 6th month values confirmed significant changes in the mean values of weight, BMI and serum albumin. Of these three indices serum albumin with chi-square value of 103.515 demonstrated the most significant changes, while the minimal change observed in urinary creatinine excretion could not be confirmed with paired t-test. We recommend serum albumin (as a more sensitive index) for monitoring the nutrition of patient with pulmonary tuberculosis.

Hospital prevalence of pulmonary tuberculosis and co-infection with human immunodeficiency virus in Ilorin: a review of nine years (1991-1999).

This is a hospital based retrospective study that determines the prevalence of pulmonary tuberculosis (PTB) and seroprevalence of Human Immunodeficiency Virus (HIV) infection amongst PTB cases. The study was over a nine year period. The annual distribution of all PTB and PTB/HIV co-infected cases were estimated, so was the annual distribution of all medical cases seen over the same period. A total of 104,240 medical cases were seen, out of which 9697 were confirmed PTB. This gives a prevalence rate of 9.2%. Their sex ratio was M:F 1.3:1 and about 81.6% of them were between 15-54 years of age. Only 189 out of 1496 cases of PTB screened for HIV antibody were seropositive giving a seroprevalence rate of 12.6%. The annual distribution of PTB/HIV co-infection showed a rising trend from only one case in 1991 to 20 cases in 1999. Majority of those who were seropositive were traders, housewives and drivers.

Effect of drug-induced hyperuricaemia on renal function in Nigerians with pulmonary tuberculosis.

Some anti-tuberculosis chemotherapeutic agents have been established as causing hyperuricaemia. Hyperuricaemia in turn causes renal damage. This study therefore aims at establishing the effect of anti-tuberculosis drugs-induced hyperuricaemia on renal function of the patients. Fifty patients with newly diagnosed pulmonary tuberculosis with mean age of 36.8 years (SD 13.69) consisting of 14 females and 17 males were longitudinally studied each for 6 months to determine the effect of drug-induced hyperuricaemia on their renal function. The Biochemical indices determined included serum urate level, serum creatinine level, and creatinine clearance of newly diagnosed patient with tuberculosis, before and during treatment with anti-tuberculosis therapy. Serum urate level revealed that 16 (51.6%) and 15 (48.4%) of the patients were hyperuricaemic at the end of the first and second months of anti-tuberculosis therapy. There was no significant difference in the mean serum creatinine level of the control group 96 micromol/L when compared with both the pre-treat value 89 micromol/L (P > 0.25) as well as the value at the end of the sixth month of treatment 91 micromol/L (P > 0.40). However, there was a statistically significant difference in the mean creatinine clearance of the control group 102 ml/min/1.73 m2 when compared with the patient's mean pre-treatment value (89 ml/min/1.73 m2) P < 0.05. Also the mean creatinine clearance increased to (103 ml/min/1.73 m2) by the end of the 6th month of treatment, a value that is statistically significant when compared with the pretreatment value of (89 ml/min/1.73 m2) P < 0.05. We submit as follows: that pulmonary tuberculosis as a disease with significant impairment of renal function; despite the associated drug-induced hyperuricaemia recorded during the treatment, renal function steadily improved with the treatment of pulmonary tuberculosis to the extent that comparable values with control was obtained at the end of treatment. We conclude therefore that drug-induced hyperuricaemia associated with treatment of pulmonary tuberculosis has no detectable negative effect on renal function of the patient.

Typhoid fever masquerading as functional psychosis.

While acute confusional states are frequently encountered in typhoid fever, initial manifestation of this illness as "functional psychosis" is very rarely encountered. We describe our experience of three patients seen within a 15-month period, who initially presented as various forms of psychiatric disorders with little evidence of impairment of consciousness, well before the appearance of pyrexia which led to the correct diagnosis. The possible role of less severe or self limiting organic conditions in the genesis of "functional" psychosis in the African population is discussed. The importance of a high index of suspicion in the functional-type psychosis, that might be due to typhoid fever and the need to institute therapy for typhoid fever while investigating (the late appearing fever) in such cases are emphasized.

The significance of glucose intolerance in pulmonary tuberculosis.

We performed a sequential follow-up of oral glucose tolerance tests on 54 Nigerian patients with active pulmonary tuberculosis in order to determine the significance of glucose intolerance in tuberculosis. Twenty-three patients (42.6%) were found to have abnormal results, including three (5.6%) with a diabetic pattern and 20 (37.0%) with impaired glucose tolerance; 15 (75%) of the latter group had normal results after 3 months treatment while one each of the former group was diabetic, intolerant of glucose and normal respectively. Two patients with normal results initially had impaired glucose tolerance at the second test. Three months after full anti-tuberculosis medication, only one of the eight patients with impaired glucose tolerance at the second oral glucose tolerance test remained intolerant of glucose. Only one patient was frankly diabetic. Our results suggest that glucose intolerance in pulmonary tuberculosis is secondary to infection and is reversible.

The role of fiberoptic transbronchial lung biopsy in diagnosis of chronic infiltrative pulmonary disease in Nigeria.

Over a three-year period, fibreoptic transbronchial lung biopsy (FTLB) was performed in 28 adult Nigerian patients with chronic infiltrative lung disease after sputum examination, haematological, biochemical and serological tests failed to provide a definite diagnosis. Definitive histological diagnosis was obtained in 11 patients (39.3 per cent) while another seven (25 per cent) had distinct histological abnormalities but no specific diagnosis. Tuberculosis and sarcoidosis were the commonest findings. No patient had haemorrhage of more than 50mls while only one had asymptomatic mild pneumothorax. FTLB is very safe and spares a substantial proportion of patients with chronic diffuse lung infiltrates more invasive and expensive diagnostic procedures. This is especially very relevant in developing countries where there is a shortage of surgeons, theatre space and other relevant facilities.

Flexible fibre optic bronchoscopy in Ibadan: report of 6 years' experience.

This study describes 6 years' experience of flexible fibre optic bronchoscopy (FFB) at the University College Hospital, Ibadan. Ninety-three bronchoscopies were carried out in 83 patients. The study revealed 22 patients with primary lung malignancies, four with tuberculosis, three with secondary malignancies, three with sarcoidosis, and two with interstitial fibrosis. The yield from FFB was 44% and complications were encountered in only three patients, with no mortality.