Search

A 28-year-old male presented with progressive dyspnoea, fever, and chest pain. We diagnosed a right pleural effusion, did a pleurocentesis, and started antitubercular treatment. However, 2 weeks later we were obliged to repeat the pleurocentesis, rapidly aspirating 1·5 L of fluid. Immediately after the procedure, the patient started coughing and became breathless. CT of the chest done within 2 h of onset of symptoms showed right-sided confluent alveolar opacities (figure), suggesting a diagnosis of reexpansion pulmonary oedema. We gave the patient oxygen, and he improved. Re-expansion pulmonary oedema is a rare complication that arises shortly after rapid removal of fluid or air from the pleural cavity. Treatment is largely supportive. Mortality rates approach 20% in young patients with a large pneumothorax or longer duration of lung collapse.

Lung cancer is one of the leading causes of cancer death worldwide. Survival has not improved significantly in spite of newer therapies. In view of the high-symptom burden and severe morbidity, evaluation of quality of life (QOL) becomes important in these patients. Several instruments are now available for this purpose, and have demonstrated good correlation with performance status, symptoms, and survival. Quality of life assessments also help in comparing different therapeutic regimes, thus allowing selection of the appropriate modality. Problems of inconsistent interpretability and high-patient dropout rate poses a challenging problem that needs to be tackled. In spite of these drawbacks, QOL is now considered to be an essential component of lung cancer management and should be performed routinely. Such a practice will help the physician plan appropriate treatment strategies and set practical therapeutic goals.

Accepted 15 September 1995 A 40-year-old man presented with complaints of persistent vomiting for six months, periorbital puffiness for four months, ankle swelling for one month and chest pain for three days. He was apparently asymptomatic prior to the onset of these symptoms. He had experienced persistent vomiting two to three times a day, which was non-projectile and non-bilious with no constant relation to meals. He had noticed increasing puffiness of face, maximally in the morning for the past four months. One month prior to admission he had noticed swelling around his ankles. Along with these complaints he also noticed a decrease in his urine output. The patient had been diagnosed as suffering from chronic renal failure due to chronic glomerulonephritis at another hospital and had received peritoneal dialysis. He had then been referred to this hospital for further management. Examination revealed a pale man of average build with anasarca. He had a pulse rate of 112 beats/min, blood pressure of 180/115 mmHg, respiratory rate of 20 breaths/min and a temperature of 99'F. His jugular venous pressure was 11 cm above the sternal angle with normal wave patterns. The thumb and index nails were hypoplastic as were all the toe nails. Other findings included fixed flexion deformity of bilateral elbows, excessive lumbar lardosis with high iliac crests, genu varum and bilateral absent patellae. Abdominal examination revealed a firm non-tender spleen 6 cm in size. The rest of the systemic examination was unremarkable. Investigations showed him to be in renal failure. The patient was subjected to peritoneal dialysis following which there was improvement in biochemical parameters. X-rays of the left knee, right knee and pelvis are shown in figures 1, 2 and 3, respectively. Ultrasound examination of the abdomen revealed bilateral contracted kidneys with loss of corticomedullary differentiation and small cortical cysts in both kidneys.

BACKGROUND: Predictors of survival and response to treatment in patients with small cell lung cancer (SCLC) are ill-defined and unclear. In an attempt to assess the impact of common presenting symptoms and laboratory values on survival, we undertook this retrospective review of patients with SCLC. To our knowledge, there is no study on survival in SCLC patients from the Indian subcontinent. DESIGN: Retrospective Cohort study. MATERIALS AND METHODS: All newly diagnosed small cell lung cancer cases from December 2001 through December 2004, were identified and clinical data on presenting symptoms and laboratory findings from their hospital records, noted. The influence of various pretreatment factors on survival was investigated using Kaplan-Meier plots and Cox multivariate regression model. RESULTS: 76 subjects were included (84% males, 91% smokers). 57% patients had five or more symptoms at presentation. Cumulative symptom burden was strongly associated with survival (P=0.02). Survival was also significantly related with Karnofsky performance status (KPS) (P=0.04), disease extent (P=0.03) and symptomatic response to treatment (P

Background Omalizumab is a recombinant humanized anti-IgE monoclonal antibody, indicated for add-on therapy for moderate- to severe-persistent allergic (IgE-mediated) asthma. Interim results at the 16 weeks time point of this 52 week study have previously been presented. We present a subgroup analysis looking at the efficacy of omalizumab at 16 weeks in relation to the serum IgE levels at baseline. Methods This open-label, multi-center, observational, prospective study, recruited 72 patients with moderate-to-severe persistent allergic asthma. Clinical efficacy was evaluated on the basis of improvement in asthma exacerbations, days missed at work/college, hospitalizations, ACQ 5, ACT scores, and FEV1. Safety and tolerability were also assessed. Qualitative and quantitative variables are analyzed using Chi-Square tests and paired t-tests, respectively. All parameters are comparing results at week 16 of omalizumab treatment with those at baseline. Results Mean serum-IgE levels at baseline were 437.45 kIU L–1 (range 32-1599 kIU L–1). For analysis purposes patients were categorized into three groups, according to their baseline serum-IgE levels. Group 1 (n=31), comprised patients with baseline serum-IgE levels of 32-250 kIU L–1), and in group 2 (n=24) and 3 (n=17), patients with baseline serum-IgE levels of 251-600 and >600 kIU L–1; respectively. Mean (SD) age in three groups was 53.5 (9.6), 43.8 (15.3) and 60.5 (13.5) years; correspondingly. In group 1, FEV1 levels improved by 0.27 liters (0.88 vs. 1.15, 95%CI ; p=0.000) and in group 2 and 3 by 0.67 liters (1.32 vs. 2.00, 95%CI ; p=0.001) and by 0.55 liters (1.27 vs. 1.46, 95%CI ; p=0.002); respectively. Improvement in FEV1 levels was more prominent amongst patients with serum-IgE levels >600 kIU L–1. This change in FEV1 levels in 3 groups, was significantly different, as determined by one-way ANOVA (F (2,23)=7.959, p=0.002). Conclusion In these patients add-on therapy with omalizumab improved lung function, quality of life and other clinical measures. In this small sub group analysis, the improvement was more marked in patients with a higher IgE level at baseline.