Concurrent pulmonary zygomycosis and Mycobacterium tuberculosis infection: a case report

A non-smoking 77-year old gentleman of Indian origin was admitted with a 4-month history of intermittent night sweats, haemoptysis and 6 kg of weight loss. CT scan of thorax demonstrated a 2.5 cm mass in the right middle lobe with multiple small nodules within the right lung and confirmed the presence of mediastinal and hilar lymph nodes

Investigation and assessment of chronic cough

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Surgical options for management of malignant pleural mesothelioma in the current era

© 2016 Bentham Science Publishers. Malignant pleural mesothelioma is an asbestos-linked cancer associated with a very poor prognosis. Surgical interventions form an important aspect of the management of this aggressive form of cancer. However, debate continues regarding the different treatment options available. Video assisted thoracoscopic surgery (VATS) has been the procedure of choice for the diagnosis of malignant pleural mesothelioma as big samples can be taken from multiple areas of the chest under direct vision. It may also be used as a palliative procedure to drain pleural effusion and perform pleurodesis. Other surgical options include extrapleural pneumonectomy, radical pleurectomy or extended pleurectomy decortication and pleurectomy and decortication. Frequently, these surgical procedures are performed in conjunction with chemotherapy and/or radiotherapy. In this review we will discuss the developments and remaining controversies of surgery in the context of malignant pleural mesothelioma

Management of patients with chronic cough using a clinical protocol: A prospective observational study

Background and aims: Chronic cough is a common symptom the aetiology of which can be challenging to diagnose. Diagnostic protocols for chronic cough have required the use of specialist investigations which are not always easily available. We wanted to determine whether patients with chronic cough can be successfully managed using a clinical algorithm.Methods: 112 consecutive patients with chronic cough were prospectively recruited into this study. They were assessed by history, physical examination, chest radiograph, spirometry and reversibility to nebulised salbutamol. A clinical diagnosis was made and the patient had an 8-week trial of appropriate therapy. Further therapeutic trials were carried out depending on response to treatment and the possible differential diagnoses. Investigations were carried out in cases of failed clinical trials and to exclude specific pathology. The " clinical arm" comprised patients managed on the basis of clinical assessment and without any investigations. The " investigative arm" comprised those who needed further investigations.Results: 81 (72%) were managed in the clinical arm. Of these 74 (66%) were discharged following response to therapy. 31 (28%) patients were converted to the investigative arm after failure of diagnosis in the clinical protocol. The commonest causes of cough were gastroesophageal reflux, asthma and chronic rhinitis. 51 (45.5%) patients responded to therapy based on diagnosis at initial assessment while a further 23 (20.5%) patients responded to sequential clinical trials for the commonest causes of cough. Cough severity score improved by a mean of 3.6 points on a numeric response score (from 0-10, p < 0.0001).Conclusion: It is possible to manage a majority of chronic cough patients successfully using a protocol based on presenting symptoms and therapeutic trials for the common causes of cough. © 2013 Ojoo et al.; licensee BioMed Central Ltd