Positive Chest X-ray Findings Research Articles

Evaluation of risk factors for morbidity and mortality in children aged 1 month- 6 years presenting with lower respiratory tract infection to a referral hospital

Background: Acute lower respiratory tract infection (LRTI) is the single largest cause of death in children in most developing countries. It can be prevented by simple interventions and treated with low-cost medication and care. Hence we undertook this study with the aim to assess the severity of LRTI in children using the respiratory index of severity in children (RISC) scoring system and to evaluate the prognosis of these children using this scoring model and to evaluate which are the risk factors that consistently predict mortality and morbidity in LRTI in young children. Methods: It was a prospective observational study which included 104 children aged 1 month-6 years presenting with LRTI. Data was collected using a pre-coded proforma and analysed using R 2.6.2 (2008-02-08) and Microsoft excel. Results: The risk factors for adverse outcome in children with LRTI were age <6 months, refusal of feeds, hypoxemia (SpO2 <90% in room air), and positive chest X-ray findings for prolonged hospitalization, age <6 months for need for assisted ventilation. 62.79% of children with a RISC score of ≤0, were managed as outpatients and all children with a RISC score of ≥3 required hospitalization, of which, 88.89% required prolonged hospitalization and 19.4% required ventilation. Conclusions: A high RISC score (≥3) can determine poor outcome in children with LRTI with high specificity and sensitivity. This study may be used to limit hospital referrals to those most in need, especially in resource limited regions, thereby improving the number of children receiving appropriate treatment.

485. Pediatrics Institutional COVID-19 Review

BackgroundCoronavirus disease (COVID-19) caused by SARS-COV2 represents global public health concern, with varied severity of illness in different ages and racial groups. This study aims to describe clinical presentation and outcomes in children aged 0-21 years in a community hospital setting in New Jersey.MethodsThis is a retrospective medical record review of pediatric patients (0-21 years) admitted to Saint Barnabas Medical Center between March 2020- December 2020 with confirmed diagnosis of COVID-19 infection. Diagnosis of COVID-19 infection is based on ICD-10 diagnosis code. Data was extracted from electronic medical records, including demographics, pre-existing conditions, presenting symptoms, treatments used and outcomes. ResultsWe identified 48 cases of pediatric COVID-19 patients at Saint Barnabas Medical Center during period of 03/20-12/20. Review of demographic data showed 29 patients (60%) were female, and 19 (40%) were male. Race distribution was 38% black, 17% white, 4 % Asian Indian, and 41% others/unknown. Age distribution was as follows: 40% >15 yrs, 15% 11-15 yrs, 15% 0-1 yrs, 13% 6-10 yrs, 13% 1-5 yrs, and 6% newborn. Fever (65%) was the most frequent symptom identified, followed by cough (31%), nausea/vomiting (29%), abdominal pain (19%), shortness of breath (17%), rash (15%), diarrhea (10%), headache (10%), myalgia/body-aches (8%), chest pain (6%), red eyes (6%), and loss of taste/smell (2%). Of 48 patients, 10 (21%) had positive chest X-ray findings of lung infiltrates or opacities, 4 (8%) had abnormal echocardiogram findings, and 1 (2%) had abnormal CT chest. 21 of 48 patients had underlying comorbid conditions, with Diabetes and Asthma being the most common. No deaths were reported. 8 of 48 COVID-19 patients were diagnosed with MIS-C. Of these MIS-C patients, 5 (63%) were male and 3 (38%) were female. 6 of 8 affected patients were black (75%). 50% of MIS-C patients were between 6-10 years. 3 of 8 patients (38%) had abnormal echocardiogram findings. ConclusionThis review supports clinical findings from other studies and also suggests certain racial ethnicities may be disproportionately impacted, which warrants further exploration to determine genetics vs environmental factors that lead to increased predisposition to severe illness.Disclosures All Authors: No reported disclosures

Chest X-Ray Findings in COVID-19 Patients Presenting to Primary Care during the Peak of the First Wave of the Pandemic in Qatar: Their Association with Clinical and Laboratory Findings.

When managing coronavirus disease 2019 (COVID-19) patients, radiological imaging complements clinical evaluation and laboratory parameters. We aimed to assess the sensitivity of chest radiography findings in detecting COVID-19, describe those findings, and assess the association of positive chest radiography findings with clinical and laboratory findings. A multicentre, cross-sectional study was conducted involving all primary health care corporation-registered patients (2485 patients) enrolled over a 1-month period during the peak of the 2020 pandemic wave in Qatar. These patients had reverse transcription-polymerase chain reaction-confirmed COVID-19 and underwent chest radiography within 72 hours of the swab test. A positive result on reverse transcription-polymerase chain reaction was the gold standard for diagnosing COVID-19. The sensitivity of chest radiography was calculated. The airspace opacities were mostly distributed in the peripheral and lower lung zones, and most of the patients had bilateral involvement. Pleural effusion was detected in some cases. The risk of having positive chest X-ray findings increased with age, Southeast Asian nationality, fever, or a history of fever and diarrhoea. Patients with cardiac disease, obesity, hypertension, diabetes, and chronic kidney disease were at a higher risk of having positive chest X-ray findings. There was a statistically significant increase in the mean serum albumin, white blood cell count, neutrophil count, and serum C-reactive protein, hepatic enzymes, and total bilirubin with an increase in the radiographic severity score.

The Role of HRCT chest in COVID-19 Pneumonia

COVID-19 pneumonia is a recently identified lung infection, the hazardous factor of this pneumonia is pandemic dissemination of infection by corona virus. Due to its high mortality and morbidity it has become a threat to the human life. As pneumonia is the commonest manifestation chest x-ray becomes the primary modality of investigation however many symptomatic patients do not have a positive chest X-ray findings hence, HRCT is used as primary modality for both screening as well as a diagnosing COVID-19 pneumonia. It has been observed that in many situations RT-PCR test are negative or inconclusive but the HRCT in such cases is useful and conclusive.
 Aim of the article is to highlight the role of HRCT in diagnosing COVID-19 pneumonia and providing proper guidance to the Clinicians for assessing the response and therapeutic purpose for covid19 pneumonia. recently, HRCT score have also been used to provide the clinicians an idea about the Prognosis of this disease progress.

Are chest X-rays valuable for patients presenting to emergency departments with acute abdominal pain?

BackgroundEmergency department patients presenting with acute abdominal pain are often prescribed a chest X-ray; however, the value of chest X-rays in acute abdominal pain is poorly understood. The aim of this study was to assess the value of chest X-rays in acute abdominal pain. MethodsA retrospective analysis of 944 chest X-rays performed for acute abdominal pain was conducted. Patient clinical information, radiology reports, and findings of other diagnostic investigations were also collected. MedCal® software was used to calculate diagnostic performance of chest X-rays. A Chi-Square test was used to assess the association between positive chest X-ray findings and both age and gender. ResultsOf the 944 chest X-rays identified as satisfying inclusion factors, only 10 cases (approximately 1%) demonstrated pathology that was likely to be the cause of the abdominal pain. Further analysis demonstrated the following performance metrics at 95%CI: sensitivity (12.8; 8.78–17.72); specificity (100; 98.4–100); positive predictive value (100%); negative predictive value (52.76; 51.54–53.98); accuracy (55.82; 51.17–60.40). ConclusionChest X-ray has limited sensitivity and diagnostic value in patients presenting to the emergency department with abdominal pain and does not appear to be a useful diagnostic investigation for abdominal pain.

Dysphagia after Stroke: An Unmet Antibiotic Stewardship Opportunity.

The goal of antibiotic stewardship is to improve antibiotic use, often by reducing unnecessary treatment. Bedside dysphagia screening tools help identify patients at high risk of aspiration following stroke. Presence of dysphagia does not indicate a need for antibiotic treatment. Therefore, this retrospective, cohort study was developed to evaluate the association of dysphagia and antibiotic prescribing following stroke. There were 117 patients included. Patients were placed into 2 cohorts based on the results of the dysphagia screening, with 55 patients positive for dysphagia and 62 patients negative for dysphagia. Patients with dysphagia tended to be older, had higher National Institutes of Health stroke scores, and lower renal function. Patients with dysphagia were prescribed more empiric antibiotics than those without dysphagia (18.2% vs. 3.2%, p = 0.01). This resulted in 53 antibiotic days of therapy in the dysphagia cohort compared to 19 antibiotic days of therapy in the no dysphagia cohort (p = 0.1). No patients later developed pneumonia and only one patient was started antibiotics after 48h. Two cases of Clostridioides difficile were reported. Both patients were in the dysphagia cohort and received antibiotics. Multivariable logistic regression demonstrated that positive chest x-ray findings and failed dysphagia screen were independent conditions associated with initiating antibiotics. These findings indicate that antibiotic use was higher in patients following stroke with a positive dysphagia screen. Close monitoring of stroke patients, particularly when positive for dysphagia, might be an under-recognized antibiotic stewardship opportunity.

Chest radiography patterns of COVID-19 pneumonia in Kumasi, Ghana.

To document the pattern of chest radiographic findings in coronavirus disease 2019 (COVID-19) patients with moderate to severe disease. Retrospective cross-sectional study. The study site was Komfo Anokye Teaching Hospital (KATH) located at Bantama in Kumasi, the capital town of the Ashanti Region. It is the second largest hospital in the country and the major referral site for Ashanti region and the northern part of the country. The hospital hosts a highly infectious isolation unit (HIIU) for COVID-19 patients with moderate to severe infections and receives referred cases from the region and within the hospital. The study involved 27 patients admitted to the HIIU at KATH with COVID-19 infection who underwent chest X-ray as part of their investigations. The study enrolled 12 males and 15 females. The common comorbidities were hypertension and diabetes. Chest x-ray findings in most of the patients (81.5%) revealed ground-glass opacities while a few of them (18.5%) had lung consolidations without ground-glass opacities. For those with ground-glass opacities, eight (29.6%) had superimposed consolidation. All the participants had positive chest x-ray findings. The chest x-ray findings in the 27 COVID-19 positive patients with moderate to severe disease on admission at the KATH HIIU enrolled in this study showed significant pulmonary abnormalities. The predominant pulmonary abnormalities were bilateral peripheral ground-glass opacities with the lower lung zones being mostly affected. Funding from the Radiology Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana.

Epidemiological, clinical characteristics and drug resistance situation of culture-confirmed children TBM in southwest of China: a 6-year retrospective study

BackgroundSichuan is a province located in southwestern China, which have a higher incidence of tuberculosis (TB). This study aimed to analyze the epidemiological and clinical characteristics, as well as drug resistance in culture-confirmed children with Tuberculosis meningitis (TBM) in Southwest of China.MethodsWe performed a retrospective study on children (< 14 years old) with cerebrospinal fluid (CSF) culture-confirmed TBM between January 2013 and December 2018 at Public Health Clinical Center of Chengdu (PHCCC). Mycobacterium tuberculosis (MTB) drug sensitivity testing (DST) was performed using the MicroDST™ method. The age, gender, family history of tuberculosis, status of Bacillus Calmette–Guérin (BCG) vaccination, residential areas information, clinical, laboratory, and radiological features were recorded. Data were analyzed using SPSS Statistics Client 25.0, and the change in drug resistance rate was examined using the Cruskal-Wallis test.ResultsAmong 319 patients clinically diagnosed with TBM, 42 (13.2%) were Mycobacterial culture positive. Their median age was nine years, and the distribution was equal among female and male patients. Among 42 patients who were enrolled in the study, 1/42 (2.38%) passed away. Children with TBM were concentrated in the minority areas of western Sichuan, where 34/42 (81.0%) patients with TBM belonged to ethnic minorities, and only 2/42 (4.76%) received BCG vaccination in the past. Chest X-rays changes were observed in all patients. Fever and headache were the most common presenting symptom. Thirty-five (83.3%) patients suffered from neck stiffness, and 30/42 (71.4%) had high CSF pressure. DST results showed that the resistance rate was high; resistance to any anti-tuberculosis drug (ATD) was observed in 13 (31.0%) patient isolates, while multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) were found in 2 (4.8%) and 1 (2.4%) patients, respectively.ConclusionsTBM among children in Southwest China was mainly concentrated in the minority areas of western Sichuan and more than 95% of patients did not receive BCG vaccination at birth. The most common symptoms were fever, headache, and neck stiffness and all patients had positive chest X-ray findings. In addition, high rates of drug resistance were found.

381 Diagnostic Accuracy of Point-of-Care Lung Ultrasound Among Patients Suspected of Having Pulmonary Tuberculosis

Pulmonary tuberculosis (PTB) is one of the leading causes of morbidity in the Philippines. Its prevalence is 438/100,000 population. The key to stopping the spread of the disease is accurate diagnosis and consistency of treatment. Diagnosis is based on clinical findings and confirmation of infection by chest x-ray, sputum analysis and molecular testing. This standard work-up is hampered by its cost, availability of diagnostic centers and the tediousness of testing especially in resource-limited areas. Recently, lung ultrasound (LUS) has become a valuable modality in diagnosing pulmonary diseases because of its portability, accuracy and cost-effectiveness. PTB is one of the few diseases that have not been extensively studied with regards to sonographic diagnosis. It is our intention to determine the diagnostic accuracy of LUS in patients with suspected PTB using chest radiography, sputum microscopy and nucleic acid amplification testing as the reference standard. If proven accurate, LUS can potentially simplify the detection of PTB in patients, facilitating quick diagnosis and dispensing of treatment. We conducted a cross-sectional, single-center, prospective observational study of 131 consecutive adult patients with presumptive PTB in a tertiary hospital outpatient clinic from September to November 2018. After securing consent, LUS was performed on all subjects to detect previously observed findings suggestive of PTB, namely: subpleural nodules, pleural effusion, consolidation and C-lines. A single emergency physician trained in LUS performed all the scans and a senior emergency medicine consultant with formal training in point-of-care ultrasound (POCUS) interpreted the clips. All patients subsequently underwent x-ray studies of the chest, direct sputum microscopy and nucleic acid amplification testing using a commercially available assay to confirm presence of tuberculosis infection. The sonographers were blinded to the results of the diagnostic work-up. Out of 131 patients, 102 patients had positive LUS findings of PTB. LUS compared to standard work-up had a specificity of 92.59% (75.71% to 99.09%), sensitivity of 55.77% (45.70% to 65.50%) and accuracy of 63.36% (54.50% to 71.60%) at 95% confidence interval (CI). Positive and Negative Likelihood ratios were 7.53 (1.96 to 28.88) and 0.48 (0.38 to 0.61), respectively. Furthermore, LUS had a positive predictive value of 96.67% and a negative predictive value of 25.21%. Our study demonstrated that LUS has robust specificity and can be an acceptable, simplified diagnostic test to detect PTB infection. This is compared to a reference standard consisting of positive chest x-ray findings, sputum microscopy and nucleic acid amplification testing. Follow-up studies comparing LUS to the current gold standard of TB diagnosis - the sputum culture, should be done in various stages of the disease to further validate the accuracy of LUS in PTB diagnosis.

Clinical, radiological and laboratory findings in 185 children with tuberculous meningitis at a single centre and relationship with the stage of the disease.

BackgroundA delay in the diagnosis and treatment of tuberculosis meningitis (TBM) may lead to increased mortality and morbidity. The aim of this study was to describe the clinical, radiological and laboratory findings of TBM on a cohort of 185 pediatric patients at a single centre over a 10 year period and to investigate relationship between the stage of the disease.MethodsThe hospital records of 185 TBM children that presented to the Pediatric Clinics of Dicle University Hospital were retrospectively evaluated. The age, gender, family history of tuberculosis, result of Mantoux skin test, status of BCG vaccination, stage of TBM at hospitalization, and clinical, laboratory and radiological features were recorded. Clinical staging of TBM was defined as follows: Stage I, no focal neurological findings and Glasgow Coma Scale (GCS) score 15; Stage II, GCS 15 presenting with focal neurological deficit or all the patients with GCS 10–14; Stage III, all the patients with GCS < 10. Relationships between results and stages of TBM were investigated.ResultsThe mean age of the patients was 53.5 ± 44.9 months (4 months–18 years). 121 (65.4 %) of the patients were male and 64 (34.6 %) female. Family history of tuberculosis was defined in 62 (33.5 %) patients. Forty five (24.3 %) children had BCG vaccination scar. Mantoux skin test was interpreted as positive in 35 (18.9 %) patients. Sixty-eight (36.8 %) children were at stage I TBM, 57 (30.8 %) at stage II and 60 (32.4 %) were at stage III on admission. Mean duration of hospitalization was 23.9 ± 14.1 days. Totally, 90 patients (48.6 %) had abnormal chest X-ray findings (parenchymal infiltration in 46 (24.9 %), mediastinal lymphadenopathy in 36 (19.5 %), miliary opacities in 25 (13.5 %), pleural effusion in 2 (1.1 %), and atelectasis in 2 (1.1 %) patients). One hundred sixty seven (90.3 %) patients had hydrocephalus in cranial computerized tomography. There were 24 (13.0 %) patients with positive culture for Mycobacterium tuberculosis and 3 (1.6 %) patients with positive acid-fast bacilli in cerebrospinal fluid. Overall mortality rate was 24 (13.0 %). Among the findings; patients at Stage III had less frequent positive chest X-ray abnormality, miliary opacities and BCG vaccination scar when compared with patients at Stage I and II (p = 0,005; p = 0,007, p = 0.020, respectively).ConclusionsChildren with TBM and positive chest X-ray findings at hospital admission were more frequently diagnosed at Stage I, and BCG vaccination might be protective from the Stage III of the disease.

Impact of positive chest X-ray findings and blood cultures on adverse outcomes following hospitalized pneumococcal lower respiratory tract infection: a population-based cohort study.

BackgroundLittle is known about the clinical presentation and outcome of pneumococcal lower respiratory tract infection (LRTI) without positive chest X-ray findings and blood cultures. We investigated the prognostic impact of a pulmonary infiltrate and bacteraemia on the clinical course of hospitalized patients with confirmed pneumococcal LRTI.MethodsWe studied a population-based multi-centre cohort of 705 adults hospitalized with LRTI and Streptococcus pneumoniae in LRT specimens or blood: 193 without pulmonary infiltrate or bacteraemia, 250 with X-ray confirmed pneumonia, and 262 with bacteraemia. We compared adverse outcomes in the three groups and used multiple regression analyses to adjust for differences in age, sex, comorbidity, and lifestyle factors.ResultsPatients with no infiltrate and no bacteraemia were of similar age but had more comorbidity than the other groups (Charlson index score ≥1: no infiltrate and no bacteraemia 81% vs. infiltrate without bacteraemia 72% vs. bacteraemia 61%), smoked more tobacco, and had more respiratory symptoms. In contrast, patients with a pulmonary infiltrate or bacteraemia had more inflammation (median C-reactive protein: no infiltrate and no bacteraemia 82 mg/L vs. infiltrate without bacteraemia 163 mg/L vs. bacteraemia 316 mg/L) and higher acute disease severity scores. All adverse outcomes increased from patients with no infiltrate and no bacteraemia to those with an infiltrate and to those with bacteraemia: Length of hospital stay (5 vs. 6 vs. 8 days); intensive care admission (7% vs. 20% vs. 23%); pulmonary complications (1% vs. 5% vs. 14%); and 30-day mortality (5% vs. 11% vs. 21%). Compared with patients with no infiltrate and no bacteraemia, the adjusted 30-day mortality rate ratio was 1.9 (95% confidence interval (CI) 0.9-4.1) in patients with an infiltrate without bacteraemia and 4.1 (95% CI 2.0-8.5) in bacteraemia patients. Adjustment for acute disease severity and inflammatory markers weakened these associations.ConclusionsHospitalization with confirmed pneumococcal LRTI is associated with substantial morbidity and mortality even without positive chest X-ray findings and blood cultures. Still, there is a clinically important outcome gradient from LRTI patients with pneumococcal isolation only to those with detected pulmonary infiltrate or bacteraemia which is partly mediated by higher acute disease severity and inflammation.

Functioning pulmonary metastases of thyroid cancer: does radioiodine influence the prognosis?

Functioning pulmonary metastases are the most common distant lesions of differentiated thyroid cancer. About 50% of patients with such metastases die within 10 years. The impact of iodine-131 therapy is controversial. In this study we examined: (1) the early diagnostic value of post-surgery (131)I ablation for lung invasion and (2) the survival of patients receiving periodic (131)I therapy. Between January 1970 and December 1995 we provided initial treatment for 509 patients with thyroid cancer. Most of them (74%) underwent total thyroidectomy and (131)I ablation. Functioning pulmonary metastases occurred in 20 patients. All these patients received periodic (131)I therapy for as long as (131)I uptake persisted. Additional therapy consisted of lung surgery in three patients and local treatment of bone lesions in four patients. Follow-up data were recorded up to December 2001. Functioning pulmonary metastases occurred late in one patient, and were visible on the post-surgery (131)I therapy scan in the other 19 patients. At diagnosis of lung invasion, 11 patients had negative chest X-ray findings, and serum thyroglobulin levels were not suggestive of metastatic disease in 56% of these cases. One of the 11 patients with negative chest X-ray findings died with a neck recurrence, two have persistent pulmonary (131)I uptake, and the other eight are in apparent remission after receiving an average cumulative (131)I activity of 338 mCi (12.51 GBq). The nine patients with positive chest X-ray findings received an average of 939 mCi (34.74 GBq); two of them died, five are continuing to receive therapy and two are in apparent remission. Overall survival at 10 years is 84%. The average follow-up of the 17 survivors is 12.7 years. These results suggest that patients with functioning pulmonary metastases, even in advanced stages, may survive for many years on (131)I therapy. Early diagnosis, during post-surgery (131)I scanning, of radiologically inapparent metastases is associated with a better prognosis.

The admission of patients with pneumonia directly from the Emergency Department to Hospital in the Home.

Acute respiratory infection is often the commonest reason for patients to be admitted to hospital from the Emergency Department (ED). Hospital in the Home Units (HHUs) deliver acute hospital type care to patients at home. This study sought to review the safety and effectiveness of HHU care for patients with pneumonia referred directly from an ED to a HHU using standard selection criteria. A retrospective clinical audit of all patients with acute pneumonia referred from the ED to the HHU from March 2000 to March 2002. 45 episodes in 44 patients were identified. 19 patients were female and the mean age was 53 years. Seven (15.6%) patients were residents of nursing homes.In 23 (51.1%) episodes, patients had presented to ED already taking oral antibiotics for their current condition. In 30 patients, significant co-morbidities were identified.The mean temperature on presentation was 37.7° Centigrade. The range of oxygen saturation was 89-100%, with a mean of 95%. Positive chest xray findings were reported in 41 (91.1%) of 45 episodes. In 9 (20%) cases an effusion was also reported.Length of stay ranged from 1-20 days with a mean of 6.2 days. In all 45 episodes, patients were treated with ceftriaxone. Adjuvant oral therapy was initiated in 28 episodes. Other adjuvant therapy was initiated at admission: nebulised salbutamol (7); oral prednisolone (1).Intravenous crystalloid fluids were required at home for rehydration in 2 episodes. Antibiotic therapy was altered in two cases. Oral prednisolone was commenced in 4 episodes, nebulised salbutamol commenced in 7 episodes, and fluconazole and frusemide were each commenced in a single episode.In three cases the primary discharge diagnosis was not related to respiratory infection.In 5 episodes (11.1%), patients made an unplanned telephone call to HHU staff. In 4 (8.9%) episodes, an unplanned staff visit was required. One patient required a return to hospital to complete her inpatient treatment. Two patients were readmitted within 1 month of discharge from EHHU. Patients who present to EDs with respiratory infection requiring intravenous therapy may be safely referred directly into Hospital in the Home care.

Lung inflammation in patients with systemic lupus erythematosus detected by quantitative 67Ga-citrate lung scanning

The severity of lung inflammation in 34 patients with systemic lupus erythematosus (SLE) was measured by quantitative 67Ga-citrate lung scanning. The severity of lung inflammation in SLE was represented by the 67Ga uptake index (GUI). Quantitative 67Ga lung scanning was also performed on 20 normal controls for comparison with the SLE patients. The patients were divided into two subgroups according to the following two criteria: (a) stable or flare stage according to clinical features; or (b) positive or negative results of chest X-ray. The GUI values of the subgroups were also compared. The results revealed a trend towards higher values of GUI in SLE patients than in the normal controls. The GUI values were also higher for SLE cases with a flare stage or a negative chest X-ray than in SLE cases with a stable stage or a positive chest X-ray. The statistical results reveal that the differences in the GUI values are not significant. However, we found that (1) positive chest X-ray findings may be a later manifestation of a lung inflammation and (2) the values of GUI parallel clinical features in SLE patients.

Early hilar lung cancer: Its clinical aspect

Early hilar lung cancers are rare, but are curable if they are properly diagnosed and treated. In the past 14 years, we have treated 27 patients with early hilar cancers that fulfilled the criteria proposed by the Japanese Lung Cancer Society (JLCS). Eighteen patients presented with symptoms and 9 were detected by the mass screening examination of sputum cytology. All lesions in both groups were finally diagnosed by bronchoscopy. Twenty patients (74%) had positive sputum cytology, whereas only 7 (26%) had positive chest X-ray findings. All the patients underwent surgery, and bronchoplasty was the most frequent operative procedure. The 5-year survival rate was 100%, and the 10-year survival rate was 91.7%, as one patient died of a second primary lung cancer in the 6th postoperative year. In conclusion, the definition of early hilar lung cancer proposed by the JLCS is thought to be reasonable, and early hilar lung cancer is a curable disease, if it is properly diagnosed and treated.

Incidence of tuberculosis in enlarged neck nodes, our experience

To determine the incidence of tuberculous lymphadenitis in enlarged neck nodes. Continuous prospective study is carried out in the department of otorhinolaryngology head & neck surgery, Kathmandu Medical College, Kathmandu, during two years, from January 2006 to January 2008. The study included a group of 155 patients with cervical lymphadenopathy. Each patient underwent a detail clinical Ear, Nose and Throat (ENT) examination and a battery of investigations which included Fine Needle Aspiration Cytology (FNAC) of the nodes, Montoux's test, blood Erythrocyte Sedimentation Rate (ESR) and chest X-ray. Those patients with tubercular lymphadenitis were referred to Directly Observed Therapy System (DOTS) clinic for anti-tubercular therapy. Others with reactive lymphadenitis were treated with antibiotic and those with metastatic neck nodes were treated accordingly. Of the 155 cases with enlarged neck nodes, 83 (54%) had tubercular lymphadenitis. Fifty two (33%) cases had reactive lymphadenitis and 17 (11%) cases were diagnosed with metastatic neck nodes. Fine needle aspiration cytology was found to be highly effective in the diagnosis of tubercular lymphadenitis with 94% accuracy. Majority of patients were otherwise healthy adults, aged between 8 - 71 years. No difference was observed between male and female in this study. Posterior triangle (PT) nodes were most commonly affected group of nodes accounting for 35 (42%) cases and preauricular region 1 (1%) case being the least commonly affected site. Fifteen (18%) cases presented with abscess formation. Only 42 (50%) cases had family history of tuberculosis but 8 (9%) patients had previous history of various forms of tuberculosis. Twelve (14%) patients had positive chest X-ray findings suggesting of concurrent pulmonary tuberculosis. All the patients were referred to DOTS clinic and were treated with category (CAT) - III anti tubercular therapy (ATT). Others with concurrent pulmonary tuberculosis were treated with CAT I regime. None of the patients required surgical treatment. There is high incidence of tubercular cervical lymphadenitis in patients with enlarged neck nodes in developing countries like Nepal. Involvement of cervical lymphnodes are the most commonly affected group of nodes. Therefore, it is important that otolaryngologists are aware of tuberculosis in the head and neck region.