Visceral pleural biopsy with fenestrated cup biopsy forceps versus parietal pleural biopsy with abram's needle and fluid cytology in the diagnosis of pleural effusion

A study on 30 patients with pleural effusion had been carried out to evaluate the usefulness of visceral pleural biopsy using fenestrated cup biopsy forceps in comparison with parietal pleural biopsy using the Abrams, needle and fluid cytology with its complications. Cytological examination of the pleural fluid revealed the diagnosis in 6 cases [20%]. Parietal pleural biopsy by the Abram needle estalished the diagnosis in 13 cases [43.3%] whether the visceral pleural biopsy using fenestrated cup biopsy forceps established the diagnosis in 11 cases [36.6%]. Final-diagnosis was achieved in 18 cases [60%] and 12 cases [40%] remained undiagnosed fourteen cases of them were malignant conditions [3 cases of mesothelioma and 11 cases of metastatic malignant conditions] and 4 cases of tuberculosis. Complications were observed in 7 cases [23.3%]. Six cases developed a small bronchopleural fistula [20%] which was absorbed spontaneously requiring no further management and one case [3.33%] developed a large bronchopleural fistula that required intercostal tube drainage followed by pleurodesis by autologous blood

Tumour markers quantitation in pleural effusion

The aim of this study is to measure the concentrations of the tumour. markers: Carcinoembryonic antigen [CEA], alpha1 acid glycoprotein [AGP] and B[2]- microglobulin [B2 - m] both in serum and pleural fluid of patients with pleural effusion to illucidate the aetiogenesis of this effusion. Serum and pleural fluid samples, collected from 15 patients with malignant effusion and 15 patients with non malignant effusion [due to liver cell failure, congestive heart failure, tuberculosis or post-pneumonic effusion] were subjected to quantitative determination of these markers. Serum, and pleural fluid values of CEA and B2-m were significantly higher in malignant cases when compared with the non malignant ones [serum CEA levels were 18. 0 +/- 5 .2 ng/ml: mean +/- SEM versus 0.8 +/- 0. 3 ng/ml; P < 0.01 and pleural CEA concentrations were 16.4 +/- 5.3 ng/ml versus 2.3 +/- 1 .0 ng/mI; P < 0. 01 respectively Serum B2-m levels were 7. 5 +/- 1. 1 mg/L versus 2.3 +/- 0.3; P < 0. 05 while pleural fluid values were 2.8 +/- 0.4 mg/L versus 1 .5 +/- 0. 3 mg/L; P < 0.05 respectively]. Serum and pleural alpha[1] AGP levels showed no significant difference between malignant and non malignant conditions [Table 1]. In conclusion, there was significant association between malignancy and raised serum or pleural fluid values of both CEA and B[2]-m

Combination chemotherapy and thoracic radiotherapy for limited-stage small cell carcinoma of the lung

Fifty patients with limited stage small cell lung cancer [SCLC] were given six courses of combination chemotherapy [CAV]. Thoracic irradiation was administered cocurrently with the second course of chemotherapy. Prophylactic cranial irradiation was given after the termination of chemotherapy. No maintenance was used. Seventy six percent of patients achieved a complete clinical response. The median survival was 78 weeks and the 2-year survival rate was 32% Combination chemotherapy can be administered concurrently with thoracic irradiation with acceptable toxicity