Mechanical ventilation as a means to provide basic lifesaving ventilatory support has grown leaps and bounds in the recent years. The basic modes of ventilation have seen a sea change and in addition other innovative techniques have been developed to prevent lung injury, ease of weaning and improve patient comfort. These modes and techniques though easily available are not adequately utilized for benefits of patient usually due to lack of knowledge about them. This article reviews some of these newer modes and innovations in mechanical ventilatory support.

Background: In a high tuberculosis (TB) burden county like India with different regional demography, knowledge about patient profile has a pivotal role in determining and identifying the factors associated with poor treatment outcomes among TB re-treatment cases. Aim: The aim was to describe the demography and clinical characteristics of TB re-treatment cases and to evaluate the factors associated with poor treatment outcomes among those patients. Settings and Design: A prospective longitudinal cohort study was carried out at chest medicine outdoor from February, 2011 to 2014 in a district medical college of West Bengal, India. Materials and Methods: Sputum smear positive re-treatment pulmonary TB patients attending our chest medicine outdoor during the 3 years study period were evaluated for demographic and clinical characteristics on the basis of previous treatment history and records at the beginning of the study. Patients were followed-up during the 8 months treatment period (Category II treatment regimen under Revised National TB Control Program). At the end of the study period, treatment outcomes were analyzed and factors associated with poor treatment outcomes were identified. Statistical Analysis: All variables were described by proportions, and differences between independent groups were compared using the Chi-square test and Fisher's exact test, as applicable. Results: Among 74 patients, re-treatment was successful in 75.7% of relapse case, 66.7% of loss to follow-up cases and 53.8% of failure cases. Re-treatment failure was higher (38.5%) in treatment failure cases compare to relapse cases (10.8%) and initial loss to follow-up cases (16.7%). Young age, male, unmarried, employed who work outside appears to be the risk factors for loss to follow-up. Low body mass index, treatment from the private sector, history of alcoholism, radiological cavitory lesion, larger duration of previous treatment, lesser gap from previous treatment has unfavorable outcome. Conclusion: Patients relapses after a single course of anti-TB treatment are likely to be cured with the Category II re-treatment regimen and failure cases have a high risk of re-treatment failure. Loss to follow-up patients should be educated, and extra care must be taken to prevent further loss to follow-up during re-treatment.

Tuberculosis presenting as acute lung injury is distinctly uncommon, even in India where tuberculosis an endemic disease. Simultaneously, acute lung injury is a highly fatal complication of tuberculosis. A high index of suspicion is needed to diagnose tuberculosis in such cases. Failure to initiate early treatment can have disastrous consequences as exemplified in this case report. This case attempts to highlight the need to consider tuberculosis as one of the likely causative factors for acute lung injury and the importance of starting empirical antituberculous therapy in suspected cases early.

Lobar or segmental collapse and secondary spontaneous pneumothorax are two unusual presentations of allergic bronchopulmonary aspergillosis (ABPA). First one is found in acute and exacerbation phases of ABPA due to "mucoid impaction" into damaged bronchi, and latter one is due to rupture of sub-pleural fibro-cystic spaces of pulmonary parenchyma, mainly in the fibrotic stage of ABPA. Clinical presentation of these two in the background of poorly controlled asthma in compliant individuals confuses the diagnosis, and ABPA should be searched for. Here, we report a rare case of right upper lobe collapse and right sided pneumothorax in separate occasions in an 18-year-old male, suffering from asthma with ABPA.

Pulmonary involvement in Wegener's granulomatosis (WG) usually starts with nonspecific symptoms such as cough, dyspnea, hemoptysis, and pleuritis. Spontaneous pneumothorax as initial presentation is extremely rare. Although its real incidence is unknown, according to different classic series, it ranges between 3 and 5% of the cases. In this case, a 28-year-old male presented with complaints of epistaxis and breathlessness, which was diagnosed as WG with pneumothorax on the basis of chest X-ray and computed tomography (CT) chest and pathological confirmation by high level of serum cytoplasmic antineutrophil cytoplasmic antibody (ANCA).

Hermansky-Pudlak syndrome (HPS) is a rare autosomal recessive disorder, which results in oculocutaneous albinism, bleeding disorders, and storage of abnormal fat protein compound (liposomal accumulation of ceroid lipofuscin). The major complications of this disorder are pulmonary fibrosis (PF) and colitis. This is a case report of an HPS patient with PF.

Peripheral primitive neuroectodermal tumor (PNET) of the chest wall is considered akin to Ewing's sarcoma in terms of histology, immunohistology and cytogenetics. These tumors usually occur in children and young adults. These tumors usually present with cough, fever, chest pain and hemoptysis. Initial presentation as superior vena cava syndrome (SVCS) is rarely seen. Complete blockage of venous drainage in SVCS may lead to fatal outcome. These tumors are highly aggressive with a high incidence of local recurrence and distant metastases. Combination therapy comprising of chemotherapy, radiotherapy and surgery can be lifesaving in these patients. We present a case of primary mediastinal PNET in a 12-year-old girl. To the best of our knowledge, this is the first case of PNET presenting with SVCS in children.

Bronchial carcinoids comprise of <3% of lung tumours. Though typical carcinoids are usually benign, they may, uncommonly, metastasise to regional lymph nodes as well as to distant sites, and a few cases have been associated with active tuberculosis. We report an unusual case of a typical bronchial carcinoid with regional metastasis and tuberculosis. The metastatic deposits were present in small lymph nodes, emphasizing the need for careful sampling, while grossing. In addition, coexisting tuberculosis in the same lung of the patient make the case an extremely rare one.

Hamartoma is one of the common benign tumor of lung. These lesions represent an abnormal proliferation and mixing of the normal components of the lung tissue. Most hamartomas are asymptomatic. We report a rare case of giant pulmonary hamartoma (12 cm in diameter) occupied almost whole of left hemithorax. Computed tomography guided fine-needle aspiration cytology revealed a benign cartilaginous neoplasm, suggestive of chondroid hamartoma. Tru-cut biopsy of the tumor confirmed the diagnosis. Complete resection of the tumor was performed. Patient was on a regular follow-up postoperatively for 6 months without any clinical and radiological relapse.

Bronchoscopy in this modern era has proved its utility and superiority far beyond imagination and has surpassed and replaced the majority of the surgical procedures. However, there have been certain limitations to the applicability of this vital technique especially in a country where we face lack of proper equipments and trained personnel at all health centers. This case series with review of literature examines the spectrum of limitations of bronchoscopy and the rare cases encountered, which leads to the surgical alternatives for managing intrabronchial pathology based on relevant current literature.