Autoimmune and rheumatic manifestations and antinuclear antibody study in HIV-infected Thai patients

BACKGROUND: There have been reports concerning an association between human immunodeficiency virus (HIV) infection and autoimmune and rheumatic diseases. OBJECTIVE: The purpose of this study was to examine autoimmune and rheumatic manifestations in HIV-infected patients and their correlation with antinuclear antibody (ANA) tests. METHODS: The clinical and laboratory results of HIV-infected patients attending the Department of Dermatology, Siriraj Hospital, Bangkok, Thailand, from February 1999 to January 2000, were analyzed. Laboratory studies included serum CD4 lymphocyte count and ANA tests. RESULTS: Sixty-two patients were enrolled prospectively in the study. Myalgia was the most common clinical presentation (50%). Others included photosensitivity (on history) (39%), arthralgia (26%), vasculitis (18%), sicca complex (10%), arthritis (7%), and Reiter's syndrome (2%). A history of hair loss was given by 23% of patients. A positive ANA test was detected in 3%. No cases of systemic lupus erythematosus, scleroderma, or dermatomyositis were seen. CONCLUSIONS: Autoimmune and rheumatic manifestations were not uncommonly detected in patients with HIV infection. HIV infection may sometimes mimic systemic lupus erythematosus clinically.     

Primary polymorphous low-grade adenocarcinoma of the bronchus: complete tumor removal with bronchoscopic resection

Primary polymorphous low-grade adenocarcinoma (PLGA) is an uncommon malignant tumor arising from the minor salivary glands, but its occurrence as a primary tumor of the tracheobronchial tree is very rare. Herein, we have reported a rare case of endobronchial PLGA in a 56-year-old woman presenting with chronic cough and progressive exertional dyspnea. Chest CT clearly demonstrated an endobronchial tumor obstructing the distal part and bifurcation of the left main bronchus and causing distal atelectasis. She underwent rigid bronchoscope with electrocautery and bronchoscopic resection of the tumor. PLGA was diagnosed histologically. Subsequent left pneumonectomy was performed and showed no evidence of residual tumor.     

Homemade talc spray atomizer dedicated to flexible-rigid pleuroscope

Background: Thoracoscopic talc poudrage is the preferred technique for medical pleurodesis. However, commercial talc spray atomizers are not applicable with the flexible‐rigid pleuroscope. Therefore, we developed a simple and cheap homemade talc spray atomizer dedicated to flexible‐rigid pleuroscope. Objective: To describe the experience in performing talc poudrage using our homemade talc spray atomizer. Methods: A retrospective review was performed in 22 consecutive patients with symptomatic malignant pleural effusion undergoing thoracoscopic talc poudrage by our talc spray atomizer with the aim of performing a palliative pleurodesis. Results: Under direct flexible‐rigid pleuroscopic guidance, we could instill talc throughout the pleural cavity with our talc spray atomizer in all cases. The median procedure time to instill the whole talc was 4 min 15 s. The successful pleurodesis was achieved in 77.3%. Conclusions: We have introduced a homemade talc spray atomizer dedicated to the flexible‐rigid pleuroscope. Uniform distribution of talc could be achieved without additional port placement. Please cite this paper as: Boonsarngsuk V, Juthakarn S and Boonsarngsuk W. Homemade talc spray atomizer dedicated to flexible‐rigid pleuroscope. Clin Respir J 2012; 6: 40–45.     

Bronchial anthracostenosis with mediastinal fibrosis associated with long-term wood-smoke exposure

Bronchial anthracostenosis describes a disease entity consisting of bronchial destruction, deformity and stenosis related to dark pigmentation on bronchoscopy in patients with a history of coal workers' pneumoconiosis or chronic exposure to biomass smoke. The combined occurrence of bronchial anthracostenosis and mediastinal fibrosis in association with wood-smoke exposure has not been previously reported. This case report describes a non-cigarette smoking elderly woman who developed bronchial anthracostenosis and mediastinal fibrosis after long-term exposure to wood smoke. Clinical and radiological improvements were achieved after treatment with corticosteroid and tamoxifen. Awareness of this unusual entity will help to avoid misdiagnosis of malignancy or unnecessary thoracotomy.     

Postcoital antifertility effect of Mentha arvensis

A uterotonic fraction of $\text{Mentha arvensis}$ (UM-fraction) was tested for antifertility effect in rats. Subcutaneous administration of the UM-fraction to rats pregnant from day 1 to day 10 caused a significant interruption of pregnancy. The effect was pronounced during the post-implantation period. At the effective dose, the UM-fraction did not exhibit significant estrogenic or antigonadotropic activities. However, it enhanced the estrogenic effect of estradiol when administered concurrently.     

Eosinophilic pleural effusion after gastric variceal obliteration with cyanoacrylate

Pleuropulmonary complications after endoscopic injection sclerotherapy for treatment of esophagogastric varices are not uncommon but are usually mild and self-limited. Herein we report a male patient with liver cirrhosis who underwent endoscopic injection sclerotherapy, using a mixture of n-butyl-2-cyanoacrylate and ethiodized oil for obliteration of gastric varices. After the procedure, he developed moderate amount of left pleural effusion that persisted for a period of time and required thoracentesis and medical treatment. We believed that the inadvertent retrograde reflux of the embolized glue and ethiodized oil via the portosystemic venous collateral into the left pleura might be the possible mechanism for the development of left pleural effusion as the droplets of ethiodized oil were seen along the left pleura on the imaging studies.