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Hot tub lung likely represents hypersensitivity pneumonitis due to inhalational exposure to M. avium complex. Antimycobacterial therapy does not appear to be required in the management of this disease. Although corticosteroids may be helpful in the treatment of severely affected patients, others can be managed by avoidance of additional exposure alone.

Background and objectives: Microscopic polyangiitis (MPA) is a systemic small-vessel vasculitis associated with antineutrophil cytoplasmic antibodies (ANCA), often targeting myeloperoxidase (MPO). Cyclophosphamide (CYC) plus corticosteroids (CS) is considered standard therapy for patients with renal involvement, but treatment response is not satisfactory in all patients and CYC has well recognized toxicity. This prospective pilot trial explored whether mycophenolate mofetil (MMF) represents an effective alternative to CYC for induction and maintenance of remission in MPA with mild to moderate renal involvement.Design, setting, participants, & measurements: Seventeen P-ANCA/MPO-ANCA-positive patients with MPA with mild to moderate renal involvement received MMF (1000 mg orally, twice daily) and CS (intravenous methylprednisolone, 1 to 3 g, followed by oral prednisone at 1 mg/kg per day). Oral CS were discontinued by month 6; MMF was continued through month 18. The primary outcome measure was remission by month 6 and stable renal function. Secondary endpoints included major relapses necessitating a switch to CYC plus CS, minor relapses requiring an increase in CS dosage, and adverse events.Results: Thirteen of 17 patients enrolled achieved the primary outcome, and 4 failed because of insufficient response, relapse, or MMF intolerance. Twelve patients remained in remission through month 18, renal function remained stable, and proteinuria improved. Side effects of MMF were mild, transient, and responsive to dose adjustments in all patients except one.Conclusions: MMF represents an alternative to CYC for induction and maintenance of remission in patients with MPO-ANCA-associated MPA with mild to moderate renal disease.

The purpose of this work was to demonstrate an ultrasound based surface wave elastography (SWE) technique for generating and detecting surface waves on the lung. The motivation was to develop a noninvasive technique for assessing superficial lung tissue disease including interstitial lung disease (ILD). ILD comprises a number of lung disorders in which the lung tissue is stiffened and damaged due to fibrosis of the lung tissue. Currently, chest radiographs and computed tomography (CT) are the most common clinical methods for evaluating lung disease, but they are associated with radiation and cannot measure lung mechanical properties. The novelty of SWE is to develop a noninvasive and nonionizing technique to measure the elastic properties of superficial lung tissue. We propose to generate waves on the lung surface through wave propagation from a local harmonic vibration excitation on the chest through an intercostal space. The resulting surface wave propagation on the lung is detected using an ultrasound probe through the intercostal space. To demonstrate that surface waves can be generated on the lung, an ex vivo muscle-lung model was developed to evaluate lung surface wave generation and detection. In this model, swine muscle was laid atop a swine lung. A vibration excitation of 0.1 second 100 Hz wave was generated on the muscle surface and the surface waves on the lung were detected using a linear array ultrasound probe at 5 MHz. To test its feasibility for patient use, SWE was used to measure both lungs of an ILD patient through eight intercostal spaces. The mean wave speed was 1.71 ± 0.20 m/s (± SD) at the functional residual capacity, while the mean wave speed was 2.36 ± 0.33 m/s at the total lung capacity. These studies support the feasibility of SWE for noninvasive measurement of elastic properties of lung and demonstrate potential for assessment of ILD.

A lung ultrasound surface wave elastography (LUSWE) technique is developed to measure superficial lung tissue elastic properties. The purpose of this study was to translate LUSWE into clinical studies for assessing patients with interstitial lung disease (ILD) and present the pilot data from lung measurements on 10 healthy subjects and 10 patients with ILD. ILD includes multiple lung disorders in which the lung tissue is distorted and stiffened by tissue fibrosis. Chest radiography and computed tomography (CT) are the most commonly used techniques for assessing lung disease, but they are associated with radiation and cannot directly measure lung elastic properties. LUSWE provides a noninvasive and nonionizing technique to measure the elastic properties of superficial lung tissue. LUSWE was used to measure regions of both lungs through six intercostal spaces for patients and healthy subjects. The data are presented as wave speed at 100 Hz, 150 Hz, and 200 Hz at the six intercostal spaces. As an example, the surface wave speeds are, respectively, 1.88 ± 0.11 m/s at 100 Hz, 2.74 ± 0.26 m/s at 150 Hz, and 3.62 ± 0.13 m/s at 200 Hz for a healthy subject in the upper right lung; this is in comparison to measurements from an ILD patient of 3.3 ± 0.37 m/s at 100 Hz, 4.38 ± 0.33 m/s at 150 Hz, and 5.24 ± 0.44 m/s at 200 Hz in the same lung space. Significant differences in wave speed between healthy subjects and ILD patients were found. LUSWE is a safe and noninvasive technique which may be useful for assessing ILD.

Thyroid nodules are common. Thyroid cancer is rarer. No guidelines exist for management of thyroid nodules in the Indian context and these recommendations are intended for this purpose. The consensus committee reviewed important articles, including previously published consensus statements. Management points were scored according to the level of evidence. These guidelines cover the clinical evaluation and include the interpretation of imaging and fine needle aspiration cytology of thyroid nodules. The guidelines also cover the management of special situations like thyroid incidentalomas, cystic thyroid lesion and nodules detected during pregnancy. The consensus guidelines represent a summary of current medical evidence for thyroid nodule management and the committee has attempted to optimize the guidelines for the clinical practice setting in India.

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