Self-injection with olive oil. A cause of lipoid pneumonia

A 48-year-old man with unipolar depression and a psychosexual problem concerning his body image was injecting his scrotum repeatedly with olive oil to increase the size of his genitals. He developed respiratory failure following accidental intravenous injection of olive oil and was found to have lipogranulomatous lesions in the lung and the scrotum.

Central bronchiectasis in allergic bronchopulmonary aspergillosis: comparative evaluation of computed tomography of the thorax with bronchography

Demonstration of central bronchiectasis (CB) with normal peripheral bronchi is an essential requirement for the diagnosis of allergic bronchopulmonary aspergillosis (ABPA). Although the results of bronchography remain the gold standard for demonstration of central bronchiectasis they are not always diagnostic. Moreover, it is an unpleasant invasive procedure which may be difficult to perform in a patient of allergic bronchopulmonary aspergillosis with acute severe asthma. In an attempt to find a safe and effective alternative to demonstrate central bronchiectasis computed tomography (CT) of the thorax was evaluated against bronchography. Twenty one patients with allergic bronchopulmonary aspergillosis underwent computed tomography of the thorax followed by bronchography. Of the 378 bronchopulmonary segments available for analysis, 42 had to be excluded because of consolidation or non-filling of the contrast dye, leaving 336 segments for evaluation. CB was identified on CT in all 21 patients. Detailed analysis of the visualized segments revealed that computed tomography (using 8 mm contiguous scans) identified 146 of the 212 segments showing central bronchiectasis on bronchography (sensitivity 70%) and 114 of the 124, read as normal on bronchography (specificity 92%). Supplemental 4 mm scans, used in 8 out of 21 patients improved the overall sensitivity of computed tomography to 83%, whilst the specificity remained unchanged at 92%. Thus, computed tomography of the thorax, being more acceptable to the patient, has the potential of being the investigation of choice for the demonstration of central bronchiectasis in patients with allergic bronchopulmonary aspergillosis.

Growth response of Pseudomonas stutzeri RS34 to ethylenediaminetetraacetic acid (EDTA) and its interaction with zinc

Pseudomonas stutzeri RS34 is a less sensitive member of pseudomonads to toxic effect of EDTA, the effect of EDTA is more bacteristatic than bactericidal, and can be reversed by divalent cations. Zn2+ provides more specific protection than Mg2+. EDTA-treated cells show higher sensitivity to lysozyme confirming the chelating mode of action of EDTA that leads to destabilization of the outer membrane. Such metal resistant bacteria can be profitably employed in the removal of metals from polluted ecosystems.

Allergic bronchopulmonary aspergillosis with middle lobe syndrome and allergic Aspergillus sinusitis

A 55 year old male, who had a 12 yr history of rhinorrhoea and nasal blockage, presented with a middle lobe syndrome. Evaluation of the patient led to the diagnosis of concomitant allergic bronchopulmonary aspergillosis with allergic Aspergillus sinusitis, a rarely reported association.

Allergic bronchopulmonary aspergillosis with middle lobe syndrome and allergic Aspergillus sinusitis

A 55 year old male, who had a 12 yr history of rhinorrhoea and nasal blockage, presented with a middle lobe syndrome. Evaluation of the patient led to the diagnosis of concomitant allergic bronchopulmonary aspergillosis with allergic Aspergillus sinusitis, a rarely reported association.

Pulmonary developmental anomaly associated with Klippel-Feil syndrome and anomalous atrioventricular conduction

We report the findings in a patient with Klippel-Feil syndrome and associated agenesis of right upper and middle lobes, hypoplasia of the right lower lobe of the lung, and Lown-Ganong-Levine syndrome. To our knowledge, such an association has not been previously described.

CT in childhood allergic bronchopulmonary aspergillosis

CT of the thorax done during acute severe asthma in two paediatric patients demonstrated central bronchiectasis, a sine qua non for the diagnosis of allergic bronchopulmonary aspergillosis. Bronchography, regarded as the gold standard, was done subsequently on recovery. A comparative segmental analysis revealed that CT was able to identify immediately 24 of 27 segments which showed central bronchiectasis on bronchography. Early diagnosis with the aid of CT enabled immediate intervention which may have helped to prevent further lung damage in the paediatric patients.

Clindamycin in the treatment of anaerobic lung abscess

A case of anaerobic lung abscess who had treatment failure after 4 weeks of supervised parenteral penicillin and oral metronidazole is described. Anaerobic pathogens resistant to one or the other of the above drugs were isolated. The patient had a striking clinical response to subsequent therapy with oral clindamycin. Failure of therapy should alert physicians to the possibility of infection with resistant anaerobic pathogens and in such situations, clindamycin is considered as an effective alternative.

Allergic bronchopulmonary aspergillosis and Candida albicans colonization of the respiratory tract in corticosteroid-dependent asthma

Fungal studies were conducted on 35 patients with corticosteroid-dependent asthma (CSDA) and 20 asthmatics who had never received prednisolone. Candida albicans was repeatedly cultured from the sputa of 12 patients with CSDA. Isolation was more frequent in those patients who were receiving more than 10 mg prednisolone for more than six months. Nearly half of these patients demonstrated a positive immediate cutaneous reaction and precipitating antibodies against C. albicans. Although no pathological significance, beside colonization, could be attributed to this finding, it was felt that it would be prudent to restrict the daily dose of prednisolone to less than 10 mg, when administered for more than six moths. Two patients with allergic bronchopulmonary aspergillosis (ABPA), were identified, one from each group. The possibility of ABPA, however, remained open in two other patients with CSDA. It is probable that some patients with CSDA may be suffering from ABPA but characteristic features of the disease are masked by costicosteroid therapy, making it difficult to diagnose.

Phrenomediastinal echinococcosis

A patient with the rare presentation of posterior mediastinal echinococcosis is reported. Magnetic resonance imaging (MR) demonstrated the extension of a primary retroperitoneal cyst into the posterior mediastinum which was subsequently confirmed surgically to be of echinococcal origin. Such a case of phrenomediastinal echinococcosis has been described only once before in literature.

Fibrebronchoscopy in pulmonary sarcoidosis--an Indian experience

Twenty-four patients suspected to have sarcoidosis were subjected to fibrebronchoscopy. Histopathological support for the diagnosis was ultimately obtained in 20 patients. Fibrebronchoscopy provided the diagnosis in 17 patients, while histopathological confirmation was obtained from extrapulmonary biopsy sites in 3 patients. Transbronchial lung biopsy, attempted without fluoroscopic guidance, revealed non-caseating granulomata in 15 patients. The only complication encountered was a small pneumothorax, not requiring intervention, in one patient. Lack of fluoroscopic guidance did not compromise the diagnostic yield or increase the complication rate of the procedure. Bronchial biopsy confirmed the diagnosis in 2 patients with a non-specific lung biopsy. It was positive in 6 of 8 patients with an abnormal appearing mucosa and in 5 of 12 patients with a normal bronchial tree. Random bronchial biopsy in all patients, irrespective of mucosal changes, made an important contribution to the yield of fibrebronchoscopy. Fibrebronchoscopy confirmed the diagnosis of tuberculosis in 2 patients with an atypical radiological picture, thereby differentiating the two conditions which occasionally mimic each other.

Primary carcinoid tumour of trachea

Tracheal carcinoid is a rare entity. A patient with a primary carcinoid tumour of trachea treated as a case of bronchial asthma for over a decade, is presented.

Chronic anaerobic pneumonitis

A case of chronic anaerobic pneumonitis, without any predisposing factors, nor the classical features often associated with it, which masqueraded as pulmonary tuberculosis is described. Therapy with metronidazole resulted in striking improvement.