Background: Allergic fungal rhinosinusitis (AFRS), the most common form of fungal rhinosinusitis (FRS) results from an allergy to fungus in immunocompetent patients. There is no consensus on the diagnostic criteria for AFRS and confusion prevails due to difficulty in demonstrating fungal hyphae in the mucin. Methods: We classified patients with FRS (n=30) using various clinical, histopathological and microbiological parameters. The patients underwent computed tomography of nasal and para-nasal sinuses, absolute eosinophil count and testing of serum immunoglobulin E levels. Fungal elements were identified in nasal lavage and polyp samples from 30 patients with chronic rhinosinusitis using potassium hydroxide (KOH), culture, histopathological examination, polymerase chain reaction (PCR) and were categorised into eosinophilic mucin rhinosinusitis, eosinophilic fungal rhinosinusitis, AFRS and fungus ball categories. Results: Allergic fungal rhinosinusitis was evident in 5 (20.8%) patients (EMRS 1; EFRS 4, based on histological examination). Diagnosing the aetiological agent in suspected cases of FRS requires not only a high index of clinical suspicion, but a thorough microbiological and pathological work-up of the samples also and should always be supported by computed tomography findings and immunological work-up for atopy as these not only constitute important diagnostic criteria in cases of AFRS, but also are important pre-operative predictor for the condition. Conclusions: Histopathological examination remains the gold standard for diagnosing chronic FRS but speciation can be possible only with culture or PCR on appropriate samples. The rapid methodology of PCR with appropriate primer pairs has shown promising results in our study and in collaboration with radiological and immunological work-up would provide the complete picture for the diagnosis of FRS.

Background: In clinical practice pleural effusions often remain undiagnosed despite repeated thoracentesis and closed needle biopsy. Methods: We prospectively studied the diagnostic yield and complications of medical thoracoscopy performed using semi-rigid thoracoscope under conscious sedation in patients presenting with undiagnosed exudative pleural effusions. Results: During the period from June 2013 to May 2014, 25 patients presenting with moderate to massive pleural effusions who remained undiagnosed after initial pleural fluid analysis were enrolled for the study. Overall diagnostic yield of medical thoracoscopy was 88%. Malignancy was confirmed in 40%, tuberculosis in 48% and non-specific pleuritis was diagnosed in 12%. Diagnostic yield of the medical thoracoscopy in cases suspected to have malignancy was 88.9% and in tubercular suspect cases was 85.7%. No major complication other than minor bleeding (n=2) and empyema (n=2) occurred during the study. Conclusion: Medical thoracoscopy being a very simple and safe procedure is an essential investigation unless contraindicated in all cases of undiagnosed pleural effusions.

Background: Wheezing in children is one of the common problems in pediatrics. Recent research has shown that hypertonic saline has shown potential benefit in children with bronchiolitis. Methods: In this randomised, double-blind controlled trial (n=72), children aged two months to eight years, presenting with wheeze were block randomised to receive salbutamol with 3% hypertonic saline (3%) (Group A) or salbutamol with normal saline (0.9%) (Group B). Wang et al1 clinical severity score was used to assess severity. The primary outcome was length of stay in the hospital. Secondary outcomes were to know the adverse effects in both the groups, to assess the rate of re-admission within seven days. Results: Between the two groups there was no statistically significant difference with respect to demographic data, risk factors studied and the underlying pathology. Salbutamol with hypertonic saline nebulisation reduces the length of stay. There was statistically significant difference in the mean number of doses of salbutamol required in both the groups (p=0.03). Conclusions: We recommend that nebulised hypertonic saline (3%) with salbutamol to be considered more effective and safe alternative to nebulisation with normal (0.9%) saline and salbutamol. Trial registration. ClinicalTrials.gov identifier number: Trial REF/2013/03/004799.

Lung cancer is the most rapidly spreading cancer worldwide as well as in India. The major cause of development of such malignancy is the cigarette or bidi smoke being inhaled by the smokers as well as their family members passively, leading to predominantly squamous or the small cell variety of tumours. Lung cancer is regarded as one of the most common cancers in the world.¹ In 2012, lung cancer occurrence worldwide was approximately 1.8 million patients with an estimated mortality of 1.6 million.¹ Immunohistochemistry (IHC) and fluorescence in-situ hybridisation (FISH) are molecular techniques involved in the diagnosis of particular mutations in lung cancer which would affect the therapeutic outcome of the tumour. The earliest known sputum cytology was performed in the year 1970, when it was mooted as non-invasive screening methodology for lung cancers. This review is an attempt to elucidate the role of sputum cytology to diagnose lung cancer as well as the ancilliary techniques available to improve the sensitivity and specifity of diagnosis of cancer by sputum cytology.

Primary pulmonary synovial sarcoma is a very rare tumour. The recommended treatment includes surgery and chemotherapy with or without radiotherapy. We report the case of a 29-year-old female who presented with leftsided chest pain and heaviness, pleural effusion and a large mass filling left hemithorax. She was treated by surgical excision, histopathological and immunohistochemical findings confirmed the diagnosis of synovial sarcoma (monophasic type).

Congenital diaphragmatic eventration is a common condition in infancy but a rare anomaly in adults. The association of this condition with a wandering spleen in the thoracic cavity is even rare. Here we report a case of total congenital eventration of left diaphragm with wandering spleen in an adult which mimicked like a pleural effusion at first presentation.

Ortner's syndrome is an uncommon condition presenting as hoarseness of voice due to left recurrent laryngeal nerve palsy caused by mechanical affection of the nerve from enlarged cardiovascular structures. Here, we report a case of a 42-year-old male, presented with hoarseness of voice (Ortner's syndrome) due to sequelae of treated pulmonary tuberculosis.

A 15-year-old boy presented with bilateral spontaneous pneumothorax and diabetes insipidus.

Systemic sclerosis sine scleroderma is a rare form of limited systemic sclerosis, but without skin involvement. It does not differ in its clinical or laboratory features and prognosis from classical systemic sclerosis. In the absence of cutaneous signs/symptoms, its diagnosis is delayed leading to significant morbidity and mortality. We report the case of a 28-year-old male who presented with dyspnoea on exertion and Raynaud's phenomenon. Diagnostic evaluation confirmed systemic sclerosis sine scleroderma and pulmonary artery hypertension.

Fibreoptic bronchoscopic biopsy specimens traditionally suffer the disadvantage of recovering small biopsy specimens. The determination of histopathological cell type and stage of primary lung carcinoma is of paramount importance, especially if these are diagnosed at stage I and II, so that these can be surgically removed and the patient be cured. Now-a-days, the use of endobronchial ultrasound (EBUS)-guided biopsy is getting well established. The radial probe EBUS allows for evaluation of central airways, accurate definition of airway invasion, and facilitates the diagnosis of peripheral lung lesions. It has been observed that the tissue samples collected with the cryo-probes are of high quality and are larger than conventional biopsy samples. We have combined these three procedures (EBUS bronchoscopy, use of radial probe for localisation and cryo-probe for biopsy specimen) successfully and achieved a confirmed diagnosis of non-small cell lung cancer by removing a very large tissue specimen without any complications.

The yield of acid-fast bacillus (AFB) in tissues is usually low in conventional formalin fixed tissues. We carried out a simple technique to increase the chances of AFB detection in tissue sections. AFB staining was done on the lung tissue of 100 consecutive autopsy lung specimens of pulmonary tuberculosis over a period of three years. In addition, we carried out the step AFB technique in which the AFB procedure was carried out after 10 serial re-cuts in all the cases. AFB appeared as pink/red in a blue background. Grading was done as negative, 1+, 2+ and 3+. AFB positivity was observed in 55% cases with the first tissue cut. However, step AFB technique increased the tissue AFB positivity yield to 66% (p=0.002). The remaining 34% cases were negative for both AFB and step AFB. Grade I positivity was observed in 91% cases, Grade 2 in 6% and Grade 3 in 3%. The results show a better edge for picking up AFB with step AFB technique as compared with the conventional method that could be attributed to the greater concentration of TB bacilli in deeper part of the tissue, hence decreasing the chance of obtaining false negative results. We conclude that Step AFB technique can be used as an adjunct to routine AFB technique to increase the chances of obtaining a positive result.