Recent advances on CT scan imaging followed by further investigation techniques (if applicable) such as endobronchial ultrasound (EBUS), fiberoptic bronchoscopy (FOB), video assisted thoracoscopy (VATS), surgery and pathological diagnosis have played a key role in the early and accurate diagnosis Abstract OBJECTIVE: To determine whether the American College of Chest Physicians' lung nodule screening recommendation is an effective tool in diagnosing Asian patients with pulmonary nodules. MATERIALS AND METHODS: This is a retrospective study of 36 patients from 2012-2014 that were identified to have had pulmonary nodules through chest CT scan results. The data collected from patients were evaluated then illustrated to find out the nature of lung nodules among Asian population. The pulmonary nodule is based on size alone regardless of other morphology for instance border, calcification etc. RESULTS: Out of 36 patients, 23 were diagnosed with tuberculosis (TB), 19 tested positive for lung malignancy, 5 cases of TB co existing with cancer and 6 cases of non-tuberculous mycobacterium (NTM) infection. The types of lung cancer found were 7% small cell lung cancer, 7% squamous cell lung cancer and 86% adenocarcinoma. Nodule sizes were classified into 3 groups according to measurement. 4.5-11 mm (100% TB and 0% cancer), 12-20 mm (60% TB and 40% cancer) and 21-88 mm (52% TB and 48% cancer). CONCLUSION: Lung nodule evaluation among Asian patients requires specific guidelines that consider the high prevalence of tuberculosis and other infections. The statistical results from our study proves that the American College of Chest Physicians' lung nodule screening recommendation, if practiced by Asian physicians, should be revised according to the current health status and presence of other diseases of the Asian population.

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Narrowing of the airway caused by different diseases is a serious condition manifesting varying signs and symptoms. Immediate attention and treatment must be performed as this is a lifethreatening condition. In the past decade, there has been massive advancement on the management of airway stenosis. Some of these are stent placement, tracheal reconstruction and tumor debulking. This article focuses on 5 different cases with distinct strategies in conducting treatment and management of airway stenosis.

Background The arguments are discussed as to whether or not to proceed with multivessel percutaneous coronary intervention, with or without a drug-eluting stent, in patients with diabetes mellitus (DM), including (1) surgeons unable to complete revascularization because of smaller native arteries; and (2) diabetic patients being sicker and having higher operative mortality rates than nondiabetic patients (non-DM), particularly with the conventional coronary artery bypass surgery (on-pump) technique. To support or dispute the claims, a retrospective review of 480 consecutive patients at a single institution (195 DM and 285 non-DM) was carried out. Observations were made to see whether diabetes is a predictor of poor outcomes. Materials and Methods The preoperative comorbidity, intraoperative measurement of the size of the artery at the site of anastomosis with different gauged probes, and the number of grafts per patient were recorded. Intraoperative and postoperative variables between two groups were compared. The observed number of grafts (O) after surgery was compared with the number of grafts predicted (P) before surgery. The O/P ratio or “completion index” of ≥1 signifies complete revascularization. Logistic regression analysis was used to test the possibility that diabetes is a predictor of poor outcomes. Results Diabetic patients were older, with more comorbidity (congestive heart failure, peripheral vascular diseases, dialysis-dependent). The number of grafts per patient was 4.2 ± 1.3 (DM) and 4.2 ± 1.3 (non-DM). The size of 742 DM and 949 non-DM arteries were gauged. There was no statistical difference in size between DM and non-DM (in millimeters) at each artery. All ratios ranged from 0.9 to 1.2, indicating similarity between DM and non-DM. The only significant risk factor for operative death was low left ventricular ejection fraction (P = 0.001). Conclusions Patients with DM were sicker but tolerated off-pump coronary artery bypass grafting as well as non-DM patients. The number of grafts per patient and O/P ratio signify the ability to perform complete revascularization. We are able to bypass the small target vessels, as anticipated. Diabetes is not a predictor of the outcomes.

iffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a generalized proliferation of scattering single cells, small nodules (neuroendocrine bodies) or linear proliferations of neuroendocrine cells of lung. They may be confined to the bronchial and bronchiolar epithelium, include local extraluminal proliferation (tumorlets), or progress to the development of carcinoid tumor. Sometimes DIPNECH is accompanied by intra-and extraluminal fibrosis of the involved airways. 1,2 It is rare and presents typically in the fifth or sixth decades and is more common in woman. The great majority of pulmonary tumorlets are found incidentally and show no clinical consequence. Only rare occasions bronchopulmonary lymph node metastasis were reported. 3,4,5 DIPNECH and tumorlets may associated with Cushing syndrome, 6,7 elevated serum CEA. 8 Case report A 60-year-old asymptomatic Thai female with history of mild hyperglycemia, hyperlipidemia and hyperuricemia had high and rising serum CEA levels (Figure 1). The chest x-ray and tomosynthesis (Figure 2a-b) showed subsegmental atelectasis and reticular infiltration at the right middle lobe. CT Chest (Figure 3) showed small pulmonary atelectasis at right middle lobe.