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   Table of Contents - Current issue
September-December 2021
Volume 4 | Issue 3
Page Nos. 93-133

Online since Thursday, May 12, 2022

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Pleurodesis p. 93
R Narasimhan
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Utility of ariscat (Assess respiratory risk in surgical patients in catalonia) score in predicting postoperative pulmonary complications in patients undergoing elective/emergency surgery in a tertiary care Hospital in India p. 94
Vaseema Thabassum Shaik, RP Ilangho, K Bhaskaran
Introduction: Postoperative pulmonary complications (PPCs) account for a substantial proportion of risk related to surgery and anesthesia and are a major cause of postoperative morbidity, mortality and longer hospital stays. Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score is a risk prediction model developed for predicting PPCs. Objectives: To calculate the Sensitivity, Specificity of ARISCAT score in predicting postoperative pulmonary complications in patients undergoing Elective/Emergency surgery in a tertiary care hospital in India and to find out the incidence of postoperative pulmonary complications in various surgeries. Materials and Methods: Study Site: Apollo Main Hospital, Greams Road, Chennai. Study Design: Prospective Observational Study. Study Period: September 2018 to March 2019. Sample Size: Three hundred and thirty cases (330). Methodology: Patients undergoing non-Obstetric Elective or Emergency surgical procedure under general, neuraxial or plexus block anaesthesia were recruited through simple random sampling technique. After taking informed written consent, demographic details and clinical history were collected. Risk for post-operative pulmonary complications was assessed based on ARISCAT score. These patients were followed in the post-operative period till discharge to look for the following postoperative pulmonary complications -1. Respiratory failure 2. Pulmonary infection 3. Pleural effusion 4. Atelectasis 5. Pneumothorax 6. Bronchospasm 7. Aspiration pneumonitis. Results: The incidence of postoperative pulmonary complications in this study was 9.4%.The incidence of postoperative pulmonary complications in peripheral surgeries, upper abdominal and intrathoracic surgeries was 2.9 %, 14.1 % and 55.6 % respectively. The Sensitivity, Specificity, PPV and NPV of ARISCAT score were 83.9 %, 80.3 %, 30.6 % and 98 % respectively. Conclusion: ARISCAT score can be used as a routine screening tool for predicting the risk of developing PPCs.
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Role of flexi-rigid thoracoscopy in undiagnosed pleural effusions and correlation of visual appearance of pleura on thoracoscopy with the final diagnosis p. 104
Pallavi Periwal, Arjun Khanna, Deepak Talwar
Background: Undiagnosed pleural effusions (UPE) account for roughly 25% of cases of all pleural effusions. Minimally invasive flexi-rigid thoracoscopy has high diagnostic yield. Some previous studies have looked into the correlation of the thoracoscopic findings and the final etiological diagnosis, however, data are scarce. This study is aimed to know the role of flexi-rigid thoracoscopy in establishing etiological diagnosis in undiagnosed, treatment naïve pleural effusion patients and the correlation of thoracoscopic findings with the final diagnosis. Materials and Methods: A retrospective descriptive observational study was conducted on 84 newly diagnosed patients in whom pleural effusion remained undiagnosed at the Department of Respiratory, Sleep, Allergy and Critical Care Medicine at the Metro Centre for Respiratory Diseases, Metro Hospital, Noida. Data from hospital records of patients, who were subjected to flexi-rigid thoracoscopy, was collected between January 2010 and December 2013 and analyzed. The diagnostic yield of pleural biopsy using flexi-rigid thoracoscope in UPEs was assessed and the visual appearance of pleura on thoracoscopy was correlated with the final diagnosis. Results: The diagnostic yield of flexi-rigid thoracoscopy in UPEs is 89.28%. When nonspecific pleuritis is considered as a diagnosis, the diagnostic yield increases to 97.6%. The pleural biopsy histopathological examination revealed Nonspecific pleuritis in 14.2% of patients, granuloma consistent with tuberculosis (TB) in54.8%, malignancy in 28.6% of patients confirmed on immunohistochemistry and in 2.3% the diagnosis remained inconclusive. Out of the 12 patients, two were diagnosed to have TB on the basis of pleural biopsy acid-fast bacilli culture showing mycobacterium TB. Post coronary artery bypass graft pleuropericardial effusion, chylothorax, and congestive heart failure were diagnosed in 1 case each, while the diagnosis remained uncertain in 7. The thoracoscopic finding of adhesions had negligible and no statistically significant correlation to the final diagnosis. The presence of pleural nodularity had a negative correlation with nonspecific pleuritis and a positive correlation with malignancy although statistically insignificant. It was seen that small and uniform nodules had a positive correlation with TB. The presence of large and variable-sized nodules had a strong positive correlation with malignancy. The presence of diaphragmatic nodules has a positive correlation with malignancy. Pleural infiltration has a strong positive correlation with malignancy and negative correlation with TB. Conclusion: Flexi-rigid pleuroscopy is an excellent modality to investigate UPE since it has a high diagnostic yield, is minimally invasive and safe procedure. The presence of a variable distribution of nodules, large nodules, diaphragmatic nodules, visceral pleural infiltration has a strong positive correlation with malignancy and increases the likelihood of malignancy as the final diagnosis. However, the visual appearance of the pleura is a subjective finding and possibly more informative when used by an experienced pulmonologists in combination with the pleural biopsy for the final diagnosis.
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Pleurodesis: A review of the indications, techniques, and complications p. 112
Venkata Nagarjuna Maturu, Narendra Kumar Narahari
Pleurodesis is a procedure which obliterates the pleural cavity with the intent of preventing reaccumulation of fluid or air in the pleural cavity. The common indications for performing pleurodesis include malignant pleural effusions and recurrent pneumothorax. Various techniques to perform pleurodesis have been described in the literature. Pleurodesis can be classified as chemical pleurodesis, where in a chemical sclerosant is introduced into the pleural cavity, or mechanical pleurodesis, where in physical abrasion of the pleura is performed during a pleuroscopic intervention. It is important for practicing pulmonary physicians to be abreast with the techniques of performing pleurodesis and its possible complications. The current review article describes the indications of pleurodesis, the technique of performing pleurodesis, possible complications postpleurodesis and their management.
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Interesting case of esophageal perforation due to foreign body p. 119
Padam Kumar Bhawarlal, Gnanasekar Murugaiyan, Saravana Krishna Raj, Mohan Venkataraman, . Gopalakrishnan, Jeykumar Thirukonda, Pranesh Ravichandran
A 75 year old gentleman, who is a chronic heavy smoker and edentulous person who used to swallow his food rather than proper mastication, presented with chest pain and dysphagia. CT scan revealed foreign body penetrating the oesophagus and invading the mediastinum leading to a mediastinal collection. Upper gastrointestinal endoscopy to remove the foreign body was not successful, and hence open surgery was done by specialist in thoracic and surgical Gastroenterology. The foreign body was removed successfully and treated with appropriate antibiotics. Patient was discharged home as per plan and followed up in out patient clinic. He has been keeping well.
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Mycobacterium genavense Causing Lung Abscess in an Immunocompetent Individual p. 122
Ria Lawrence, R Narasimhan
Mycobacterium genavense is a rare nontuberculous mycobacterium, known to cause serious infections in HIV-infected patients and immunocompromised individuals. The diagnosis of M. genavense is challenging because of its slow-growing nature in the routine acid-fast culture methods. Here, we present the case of lung abscess caused by M. genavense in an immunocompetent individual.
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Unilateral opaque hemithorax secondary to teratoma p. 124
Yogeshwari Manivannan, K Anupama Murthy
Mediastinal teratoma makes nearly 8%–13% of all mediastinal tumors, with peak incidence seen in young patients. A 26-year-old male presented with complaints of nonproductive cough, breathlessness, right side chest pain, and fever for 1-week duration. Chest X-ray showed homogeneous opacity of the right hemithorax with blunting of the right costophrenic angle. Contrast-enhanced computed tomography thorax showed multiloculated cystic lesion with the area of fat calcification in the right side of the upper mediastinum. Ultrasonography-guided biopsy shows feature suggestive of benign teratoma. Most teratoma tends to exhibit heterogeneous attenuation on computer tomography imaging.
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Pneumopericardium in a patient with pulmonary tuberculosis: A case report and review of literature p. 126
G E Sri Raja Gopal, K Krishnamoorthy, T Joseph Pratheeban, E Mathan, OM Rahman, Shahul Hameed
Pneumopericardium is defined as the presence of gas in pericardial space. In adults, it may be seen in the context with severe blunt or penetrating chest trauma. The incidence of pneumopericardium is 0.8% and nearly 60% of the cases are due to trauma. A 55-year-old female admitted with the complaints of cough, breathlessness, left-sided chest pain – a case of left secondary spontaneous pneumothorax with the Intercostal drainage tube (ICD) in situ, her computed tomography image revealed pneumopericardium, residual left pneumothorax with ICD tube in the subcutaneous plane. After successful repositioning of ICD tube, pneumopericardium and left pneumothorax both got resolved. Her sputum examination results were positive for Mycobacterium tuberculosis, and she started on Anti-tubercular treatment (ATT). Her condition was gradually improved; the ICD tube was removed and discharged from the hospital in stable condition. On follow-up, both clinical and radiological improvement was there. A severe bout of cough (Macklin effect) and fistulous communication could be the two possible mechanisms for spontaneous pneumopericardium. Treatment of the underlying condition will resolve the pneumopericardium.
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Are common things always common? p. 129
Vinod Kumar Viswanathan
One axiom that we teach medical students is that “common things are always common” and physicians who make common diagnosis are almost always correct. However, it is also important to keep a watchful eye to identify rare diseases so that a timely diagnosis is made for the patient's benefit and that a disease is identified before it becomes too late. Presented here is a rare case of pleural angiosarcoma in a young male presenting as pleural effusion who was initially thought to have tuberculosis pleural effusion.
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What is the airway abnormality? p. 132
M Vishnu Sharma, MB Sohail Mohammed, Uzair Baig
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