Common pleuro-pulmonary complications of uremic patients under hemodialysis

The current study was conducted in hemodialysis unit - Minufiya University Hospital to detect common pleuro-pulmonary complications in uremic patients under regular hemodialysis. This study included 20 patients [8 males, 12 females] with mean age of [44.6 -/+ 13.78] years on regular thrice weekly hemodialysis for a period 6 months .We excluded from the study smokers,other diseases that affect chest, non compliant patients during the period of study and patients who received recombinant human erythropoietin. All patients were subjected to full history taking, full clinical examination, renal function tests, complet blood picture, arterial blood gases analysis, radialogical study of chest and heart, spirometric study. In this study about 55% of the patients showed pulmonary complications in the form of bronchopneumonia, acute bronchitis, lobar pneumonia, pleural effusion, tuberculosis and pulmonary oedema. The caustive organisms in these cases of pulmonary infection were Staphylococcus aureus, Streptococcus viridans haemophillus, pneumococci and tuberculous bacilli. Pleural effusion was transudative in nature. The PaO[2] was significantly decrease after 1 hour from begining of hemodialysis. This was due to hypoventilation caused by decrease CO[2] due to its loss in dialysis fluid, alkalosis and use of bioincompatable membranes. As regards spirometric measures, there was no significant improvement of VC, FVC, FEV[1] /FVC, MMV where as improvement in FEF [25-75%] was significant: This is due to removal of interstial, peribronchial fluid by hemodialysis with removal of toxins that impair distensibility and causes reversible spasm to smaller airways. Also there was signifcant fall in PEFR one hour after the start of hemodialysis. This is correlated with occurence of hypoxaemia and broncho-constriction which occur at that time, although there was significant improvement of PEFR after hemodialysis but not correlated to normal values. Recommendations include use of non complement activating membrane and a dialysis system in which loss of carbon dioxide can be prevented, measuring spirometric variables before and after dialysis and close observation both clinically and radiologically, for these patients

Assessment of Il-8 and TNF-alpha in serum and BAL of patients with COPD and lung cancer

There is an increasing evidence for the role of cytokines, especially interlukin-8 [IL-8] and tumor necrosis factor-alpha [TNF-alpha] in the pathogenesis of many chest diseases especially chronic obstructive pulmonary disease [COPD] and to some extent lung cancer. Tins study was conducted on three groups comprising 70 smoker subjects; 25 patients [21 males and 4 female] with mild to moderate degree of COPD, 25 patients [21 males and 4 females] with lung cancer and 20 asymptomatic control subject [17 males and 3 females], All subjects were subjected to full history taking, clinical examination, radiological assessment, pulmonary function testing, tissue diagnosis of lung cancer, blood sampling and bronchoscopic bronchoalveolar lavage [BAL] for assessment of TNF-alpha and IL-8 levels both in scrum and BAL fluid using the enzyme linked immunosorbant assay [ELISA] method. There was a highly significant [P < 0.05] elevation in both serum and BAL levels of IL-8 in COPD and lung cancer patients compared to the healthy control subjects but the difference between the COPD and lung cancer patients was insignificant [P > 0.05], Also, there was a highly significant elevation in both serum and BAL levels of TNF-alpha in COPD and lung cancer patients compared to the control group and the serum as well as the BAL levels of TNF-alpha were significantly higher in lung cancer patients compared to the COPD ones. The BAL levels of IL-8 and TNF-alpha were always significantly higher than the serum levels of the same cytokine in the same group of patients or control subjects. This study concludes that IL-8 and TNF-a levels are increased both in BAL and serum of COPD and lung cancer patients and their assessment may add to the understanding of the ongoing pathogenic inflammatory processes occurring in the smoker's airways till the development of COPD or lung cancer