impact of repeated thoracentesis on the outcome of chemical pleurodesis in malignant pleural effusion

Repeated thoracentesis may cause pleural inflammation and induce local release of proinfammatory cytokine as tumor necrosis factor-alpha [TNF-alpha] which may subsequently enhance the release of plasminogen activator inhibitor-1 [PAI-1] and lead to fibrin formation in malignant effusion. The presence of fibrin strands after repeated thoracentesis may be of considerable value in predicting the success of subsequent pleurodesis in patients with malignant pleural effusions [MPEs]. So, the aim of this work is to study the impact of repeated thoracentesis on the outcome of chemical pleurodesis in MPE. This is a retrospective study included 116 patients with MPE, they were diagnosed finally by pleural fluid [PF] cytology and/or either computed tomography [CT]-guided biopsy or tissue biopsy [Abram's or thoracoscopic biopsy]. These patients were admitted and subjected to the following: a] Pleural tapping and the aspirated fluid was sent for chemical, cytological and bacteriological examinations for determination of the inclusion criteria, [b] Tube thoracostomy insertion, [c] Pleurodesis, and assessment of the response to pleurodesis was done once after 30 days and another after 60 days. Regarding pleurodesis success or failure in this work, there was statistically highly significant decrease in the duration of chest tube before pleurodesis in patients with successful pleurodesis than that in patients with failed one. But, statistically non-significant decrease was observed in the duration of chest tube after pleurodesis in patients with successful pleurodesis than that in patients with failed one. There was statistically significant negative correlation between the number of pleural fluid [PF] aspiration and the duration of chest tube after pleurodesis and statistically nonsignificant negative correlation between the number of PF aspiration and the duration of chest tube before pleurodesis. Also, to predict the success of the pleurodesis, after 30 days of pleurodesis with cut-point of PF aspiration number >7 times, sensitivity and specificity were 75.3% and 65.7% respectively and after 60 days of pleurodesis, also, at cut-point of PF aspiration number >7 times, sensitivity of 80.3% was higher than that after 30 days of pleurodesis and specificity of 64.4% which was near that after 30 days of pleurodesis. Repeated thoracentesis may be of considerable value in predicting the success of subsequent chemical pleurodesis in MPE. Repeated thoracentesis of MPE >7 times has good sensitivity, but low specificity in predicting success of subsequent chemical pleurodesis. Measurement of PF glucose levels and PF cytology provide information about the outcome of chemical pleurodesis in MPE

Can brain natriuretic peptide predict the outcome in patients with acute pulmonary embolism?

Risk of death is high in patients with pulmonary embolism [PE] because of right ventricular [RV] failure. Plasma levels of brain natriuretic peptide [BNP] are increased in cases of isolated chronic right ventricular dysfunction [RVD] and chronic pulmonary hypertension. However, little is known about BNP secretion during acute RVD caused by acute PE. The aim of this study is to determine BNP levels in patients with acute PE with and without RVD and to assess its role in prediction of severity and outcome of these patients. This study was conducted on 47 patients with confirmed acute PE who were admitted to the intensive care unit [ICU] of Chest Department, Zagazig University Hospitals. Patients enrolled in this study were subjected to: [a] Transthoracic echocardiography, [b] Measurement of BNP plasma levels, [c] Measurement of D-dimer serum levels and d] Computed tomography pulmonary angiography [CTPA]. There was statistically highly significant increase in plasma level of BNP [pg/mL] in patients with RVD than those without it. There were highly significant positive correlations between plasma level of BNP [pg/mL] and both RV diameter [mm] and RVSP [mmHg]. A plasma BNP level >72.5 pg/mL can predict occurrence of RVD, while a plasma level of BNP >150 pg/mL can predict death in patients with acute PE. An elevated plasma level of BNP is a prognostic factor for short-term mortality and overall short-term complicated clinical outcome, and it is a powerful indicator of RVD in patients with acute PE in the absence of left ventricular dysfunction [LVD]