Introduction:Bronchoalveolar lavage (BAL) is a diagnostic procedure by which cells and other components from bronchial and alveolar spaces are obtained for various studies. One of the main advantages of BAL is that it can be done as a day care procedure. Material obtained by BAL can give a definite diagnosis in conditions such as infections and malignancies.Aims:The aims and objective of this study were to assess the utility of BAL as a diagnostic tool to determine the diagnostic accuracy of the material obtained from BAL in various infections and neoplastic lesions to study the limitations of BAL in certain lung disorders.Materials and Methods:This study was done in a tertiary care center in Hyderabad. Bronchoscopy was done as an outpatient procedure and lavage fluid obtained analyzed. This is a prospective study done from January 2012 to Jun 2013. Ninety-one BALs were analyzed for total and differential count, microbiological examination and cytological evaluation. Cases selected included nonresolving pneumonias, diffuse lung infiltrates, infiltrates in immunosuppressed hosts and ventilator-associated pneumonias.Results:Bronchoalveolar lavage was done in 91 cases over a period of 1½ years. Definite diagnosis was not given in 7 cases. Four cases were inadequate. Tuberculosis was diagnosed in 22 cases, fungal infections in 7 cases. Thirty-eight cases of bacterial pneumonias were diagnosed, Klebsiella was the most common organism. Malignancy was diagnosed in 13 cases.Conclusion:Definite diagnosis can be made in tuberculosis, fungal infections, bacterial pneumonias and in malignancies.

Objectives: Lung diseases contribute to a major cause of morbidity & mortality worldwide in current scenario. Though invasive & expensive, lung transplantation (single/double) is a definitive treatment option for End-Stage-Lung-Disease (ESLD) patients who show survival of more than 80% up to year which then drops down to 50% after 3 years. Despite advancements in surgical techniques, complications are inevitable with scarcity of donor lung availability, lung preservation, immunosuppression, management of ischemia/reperfusion, injury, infections, acute & chronic allograft rejection, more commonly called Bronchiolitis Obliterans Syndrome (BOS), which is major impediment to their longtime survival after an year. Thus Autologous Bone-marrow derived Mesenchymal-Stromal/ Stem-Cells (BM-MSCs) therapy emerged as a new frontier in the field of regenerative-medicine to mitigate the symptoms & improve patients HRQOL. They exert immunomodulatory, anti-proliferative & anti-inflammatory effects, circumvenes immune-rejection. It is a non-surgical method with no significant adverse-effects. Based on some preclinical-clinical studies, a few drawbacks which have been proposed for this procedure includes:-stem-cell-ageing, diminished functional capacity, increased senescence during their culture. Methods: The study enrolled subjects of ESLD (n=7) both male & female, aged 40-70 years and have been assessed for safety, feasibility, efficacy of stem-cell procedure & HRQOL in a 6 month follow up period by use of instruments like-SGRQ questionnaire, Modified MRC dyspnoea scale, Borg-Dyspnoea-index, 6 minute walk test, spirometry, diffusing capacity of lung for Carbon-monoxide (DL CO ). Results: The results showed that Autologous-MSC therapy in these patients is free of adverse effects. It was also observed that there has been improvement in these patients condition by way of reduced exacerbations, reduced pathological degeneration, improvement in clinical condition by reduction in duration of Long-Term-Oxygen-Therapy. A few (4) of them have also reported a decline in level of C-reactive-protein thus exhibiting anti-inflammatory-effect of the therapy. Conclusions: Thus,the promising results from above studies show the beneficence of Autologous-BM-MSCs therapy in ESLD patients which indicate that this procedure serves as a potent adjunct along with drug-therapy, thereby increasing the therapeutic-window period for lung transplantation. Nevertheless, several challenges in clinical setting remain to be addressed which include: determining the standard-treatment-protocol of MSCs therapy, their optimal dose, Time, Route-of-administration.