ABSTRACT
Background and Objectives: Rapid and early differential diagnosis between tuberculous and nontuberculous pleural effusion [TPE and NTPE] is a critically important clinical problem. The paucibacillary nature of TPE and inefficiency of conventional biochemical and microbiological investigations challenge the application of more comprehensive markers. In this study we evaluated the relevance of applying polymerase chain reaction [PCR], for detection of Mycobacteria Tuberculosis- DNA [TB-DNA], in association with interferon gamma [IFN-gamma] and soluble IL-2 receptor [sIL-2R] levels in pleural fluid for differential diagnosis of TPE
Patients and Methods: Study population included 60 patients with pleural effusion [PE]; 40 patients with TPE [7 patients with confirmed tuberculosis [TB] and 33 patients with probable TB], and 20 patients with non-tubrculous, non-infectious pleural effusion [NTPE] [10 cases due to malignancy and 10 cases due to heart failure]. PE samples were assessed for: biochemical markers [total protein and glucose], lymphocytic count, presence of acid fast bacilli in Ziehl-Neelsen [Z.N.] stained direct smears and by culture on Lowenstein Jensen [L.J.] medium], TB-DNA using conventional PCR, as well as levels of IFN-gamma and sIL-2R using commercial ELISA kits
Results: Biochemical markers, in particular total protein level, confirmed the exudative nature of TPE and malignant PE. The percentage of lymphocytes in PE was significantly higher in patients with confirmed TB [>80%] than all patients in other studied groups. All patients with confirmed TB were positive for TB-DNA PCR and had IFN-gamma and sIL-2R levels more than calculated cut off points. However, probable TB group showed a wide range of variability. None of patients with malignant PE but three of heart failure patients were positive for TB-DNA PCR. All patients with NTPE had IFN-gamma level less than cut off point. On the other hand, all patients with heart failure but 50% of patients with malignancy had sIL-2R level less than cut off point
Conclusion: Clinical data together with simultaneous detection of TB-DNA by PCR and measurement of IFN-gamma and sIL-2R levels as well as lymphocytosis [>80 %] in PE could provide the basis for rapid and efficient diagnosis of pleural TB in different clinical settings
ABSTRACT
High morbidity and mortality rates in cirrhotic patients undergoing intraabdominal surgery underscore the need for identifying a therapy that will decrease postoperative hepatic dysfunction and enhance hepatic regenerative activity. Perioperative administration of pentoxifylline [PTX] is suggested to decrease liver fibrosis and enhance hepatic regenerative activity in cirrhotic patients. Hepatocyte growth factor [HGF] is hepatocyte mitogen, that is suggested to play a role in liver regeneration during injury. The aim of this study is to investigate the value of perioperative administration of PTX on reducing liver injury as reflected by changes in serum level of hepatocyte growth factor [HGF], and standard liver functions in cirrhotic patients undergoing Splenectomy and decongestion. 20 adult patients with cirrhotic liver were randomly allocated into two equal groups. Patients in the first group [PTX Gp], received 300 mg i.v. PTX before induction of general anesthesia followed by 100 mg /h PTX in 500 ml glucose 5% infused in 10 hours. Patients in the second group [control Gp], received 15ml i.v. glucose 5% solution before induction of general anesthesia followed by 500 ml glucose 5% infused in 10 hours. All patients' were Child class A. Hepatocyte growth factor increased significantly at postoperative time when it was compared with preoperative value in control group. Liver enzymes SGOT, SGPT, prothrombin activity, total bilirubin, serum albumin, blood urea and creatinine did not significantly change in the studied groups when postoperative values were compared with preoperative ones or when the studied groups were compared with each other. White blood count and platelets increased significantly postoperatively compared with preoperative values in the studied groups. The current study suggested that perioperative administration of PTX could produce hepatocyte protection during intra-abdominal surgery as hepatocyte growth factor did not significantly increase at postoperative time in PTX group meanwhile, it increased significantly at postoperative time compared to preoperative value in control group. It did not influence liver or kidney functions, as SGOT, SGPT, prothrombin activity, serum albumin, total bilirubin as well as blood urea and creatinine did not significantly change postoperatively compared with preoperative values in both studied groups