Sentinel node mapping for intra-thoracic malignancies: systematic review of the best available evidence

Introduction: Sentinel node mapping is a new technique of lymph nodal staging in solid tumors, which can decrease the morbidity of regional lymph node dissection considerably. Intra-thoracic tumors including non-small cell lung cancer [NSCLC] and esophageal carcinoma [EC] are among the solid tumors in which sentinel node [SN] mapping has been applied. In the current systematic review, we gathered the best available evidence [systematic reviews] in this regard and presented the results in a systematic review format

Material and methods: We searched MEDLINE and SCOPUS since the inception till 13 December 2014 using the following keywords: [lung OR esophagus OR esophageal] AND sentinel AND [systematic review OR meta-analysis OR metaanalysis]. No language limit was imposed on the search strategy. Systematic reviews and meta-analyses on SN mapping in EC or NSCLC were included in the current study. Narrative review articles were excluded from the study

Results: Overall five systematic review were included. One of the included studies was on SN mapping in NSCLC and four were on EC. Overall detection rate and sensitivity for EC and NSCLC were high and both were related to mapping technique, pathological involvement of the mediastinal nodes, size and location of the tumors

Conclusion: SN mapping is feasible and highly accurate in EC and NSCLC. Attention to the technique [using radiotracers, peri-tumoral injection] and restriction of the patients to less advanced cases [cN0 and T1, 2] would ensure the best results with high detection rate and sensitivity

evaluation of diastolic hypertension in sleep overlap syndrome

Introduction: The overlap syndrome, consisting of obstructive sleep apnea hypopnea syndrome [OSAHS] and chronic obstructive pulmonary disease [COPD] is a major problem in COPD patients. OSHAS corresponds to the likelihood of systemic hypertension. The present study was aimed to evaluate the association between apnea-hypopnea index and diastolic blood pressure [DBP] in overlap patients

Materials and Methods: We conducted a cross-sectional study involving overnight polysomnography after measurement of resting diastolic blood pressure [DBP] in patients with overlap syndrome in Sleep Laboratory of Imam Reza Hospital, Mashhad, Iran from November 2010 to July 2012. Participants were divided into four subgroups regarding to their Apnea-Hypopnea Index [AHI] [AHI <5, AHI: 5-15, AHI: 15-30 and AHI >30]. Descriptive statistics included age, body mass index [BMI], OSA, Apnea-Hypopnea Index [AHI], DBP, and neck circumference

Results: Sixty participants ranged between from 46 to 82 years old were entered into this study. There was statistically significant difference in mean DBP among different AHI subgroups [80 +/- 0.50, 95 +/- 0.60, and 105 +/- 0.65, respectively] [P<0.001]. Additionally, there was statistically significant correlation between AHI and DBP [r= 0.60, P=0.01]

Conclusion: According to the findings of our study, DBP is an important cardiovascular concern in COPD patients with OSAHS and has a direct correlation with AHI

Evaluation of superiority of FEV1/VC Over FEV1/FVC for classification of pulmonary disorders

Introduction: Forced expiratory value in one score [FEV1]/ Forced vital capacity [FVC] was used in classical literature for primary classifications of pulmonary disorders. American Thoracic Society/ European Respiratory Society guidelines recommended using FEV1/VC instead of FEV1/FVC. The aim of study was determination of the extent of superiority of FEV1/VC over the FEV1/FVC

Materials and Methods: Two hundred seven subjects whom suffered from different pulmonary disorders were evaluated by standard spirometry, lung volume and Carbon mono-oxide lung diffusion capacity [DLCO]. Accuracy of FEV1/VC and FEV1/FVC for diagnosing lung disease was compared by area under the ROC curve, sensitivity and specificity analysis including Kraemer efficiency and likelihood ration methods. Gold standards were diagnosis confirmed by over-all clinical and para-clinical judgment

Results: Primary classification of FEV1/FVC and FEV1/VC according to gold standards showed that FEV1/FVC detected obstructive and restrictive lung disease better than FEV1/VC. FEV1/FVC was able to detect the obstructive and restrictive lung disease correctly in 61% and 34% and FEV1/VC in 56% and 33% respectively. FEV1/FVC showed 100% agreement with forced expiratory flow [FEF]=25-75%, and Maximum expiratory flow [MEF]=50% but this agreement for FEV1/VC was 95-96%. Accuracy assessments revealed the superiority of FEV/FVC in the likelihood ratio method. Also, based on the ROC curve and Kraemer's coefficient, more accurate results were obtained by FEV1/FVC, compared to FEV1/VC

Conclusion: FEV1/FVC showed marginally higher accuracy for detecting lung disease than FEV1/VC

Lipid profile status in mustard lung patients and its relation to severity of airflow obstruction

Introduction: Chronic obstructive pulmonary disease [COPD] secondary to sulfur mustard gas poisoning, known as mustard lung, is a major late pulmonary complications in chemical warfare patients. Serious comorbidities like dyslipidemia are frequently encountered in COPD. The aim of this study was to measure the serum lipid profile and evaluate the relation of lipid parameters with the severity of airway obstruction in mustard lung patients

Materials and Methods: Thirty-six non-smoker mustard lung patients with no history of cardiovascular disease, diabetes mellitus, and dyslipidemia were entered into this cross-sectional study. Control group consisted of 36 healthy non-smoker men were considered in this study. Serum lipid profile was performed in the patients and the controls. Spirometry was done in mustard lung patients

Results: The mean age of the patients was 47 +/- 6.80 SD years. The mean duration of COPD was 18.50 +/- 7.75 SD years. There were statistically significant differences in mean serum triglycerides and total cholesterol levels between patients and controls [P=0.04 and P=0.03, respectively].The mean levels of lipid parameters were not statistically significant different among the 4 stages of COPD severity [P>0.05]

Conclusion: The current study revealed that the serum levels of triglycerides and cholesterol are elevated in mustard lung patients compared with the healthy controls. Since lipid profile abnormalities are considered as a major risk factor for cardiovascular disease, especial attention to this matter is recommended in mustard lung patients

comparison of HTLV-1 infection frequency in patients with or without tuberculosis

Introduction: To recognize the predisposing factors in tuberculosis as an endemic infection in Northeast province of Iran, this study was aimed to evaluate whether HumanT-lymphocyte type 1 [HTLV-I] as an immunosuppressive factor increases the risk of tuberculosis

Materials and Methods: A Case-control study was conducted in 278 tuberculosis patients from 2007 to 2010, in Mashhad, Iran. Tuberculosis has been diagnosed by gold standard tests like sputum culture, bronchoalveolar lavage [BAL] culture or cytology. For detection of HTLV-I antibody, Enzyme Linked Immunosorbant Assay method and western Blot as the confirming test were performed. Then 276 healthy cases were matched for gender and age

Results: The mean age of tuberculosis patients was 49.67 +/- 21.36 years and for control cases was 48.36 +/- 20.74. In patients group, 114 [41.6%] were male, 160 [58.4%] were female and in controls 123 [44.6%] were male and 153 [55.4%] were female. Pulmonary tuberculosis was presented in 84.2% of the patients. The frequency of HTLV-1 was 2.9% and 3.3% in patients and controls, respectively. HTLV-I frequency was higher in male patients and it increased by age

Conclusion: Regarding to this study, HTLV-I infection is not stand-alone sufficient for increasing the risk of tuberculosis

The assessment of health-related quality of life in scleroderma-interstitial lung disease

Introduction: Pulmonary involvement is the most common cause of mortality and disability in patients with systemic sclerosis and it significantly affects the quality of life in these patients. Therefore, early diagnosis and treatment of pulmonary involvement seems necessary in patients with SSc. In this study, we aimed to assess the health-related quality of life [HRQoL] in patients with Scleroderma-Interstitial Lung Disease [SSc-ILD] and its relationship with pulmonary function parameters

Materials and Methods: Considering the inclusion and exclusion criteria, 25 patients with SSc-ILD were enrolled in this cross-sectional study from April 2012 to June 2013. Full tests of lung function, including body plethysmography and diffusing capacity of the lungs for carbon monoxide [DLCO], 6-minute walk distance [6MWD], and pulse oximetry were performed. The HRQoL was assessed using St. George's and CAT questionnaires; also, dyspnea was evaluated for all the patients, using modified medical research council [MMRC] scale. Afterwards, the relationship between the total scores of HRQoL questionnaires and the severity of lung disease was analyzed, based on the recorded variables

Results: The mean age of the patients was 40.36 +/- 9.50 years and the mean duration of the disease was 7.16 +/- 4.50 years. A statistically significant inverse correlation was observed between 6MWD [r=-0.50, P=0.01], DLCO [r=-0.67, P<0.001], and CAT total score. In addition, there was a statistically significant negative association between CAT score and total lung capacity [r=-0.46, P=0.01]. Finally, a significant direct relationship was observed between the total scores of CAT and St. George's questionnaires [r=0.75, P<0.001]

Conclusion: The results of this study showed that CAT questionnaire is a suitable tool for assessing the quality of life in SSc patients; moreover, it is significantly related to the factors associated with pulmonary function. Therefore, the CAT questionnaire may be used to track pulmonary function in SSc patients

relationship between serum pro-brain natriuretic peptide [Pro-BNP] levels and pulmonary arterial hypertension [PAH] in patients with limited scleroderma

Introduction: Pulmonary arterial hypertension [PAH] is a late progressive sclerodermarelated complication, which can lead to right heart failure and cor pulmonale. Given that cardiac catheterization is a diagnostic method of choice for PAH, and considering the high risks of this method, the purpose of this study was to evaluate the relationship between serum Pro-Brain natriuretic peptide [Pro-BNP] Levels and PAH in patients with limited scleroderma

Materials and Methods: In this cross sectional study, during June 2011- Dec 2013, referring patients to two major educational hospitals, Mashhad- Iran, with scleroderma, who were afflicted with the disease for at least two years [or more], were enrolled in the study if they met the inclusion and exclusion criteria. All the patients underwent echocardiography to determine the pulmonary artery pressure [PAP]. Afterwards, the subjects were referred to a lung center for performing body plethysmography, carbon monoxide diffusing capacity [DLCO], and 6-minute walk test [6MWT]. Pro-BNP Serum level was determined using flourescent immune assay method

Results: The present study included 20 patients [18 female subjects] with the mean age of 43.28 +/- 9.56 yrs, and the mean pro-BNP level of 138 pg/ml. The logarithmic correlation between PAP values, Forced Vital Capacity /DLCO ratio, and pro-BNP level, which was measured using Pearson's correlation coefficient, showed a significant association among these variables[ respectively, r=0.76, P=0.001; r=0.677, P=0.011]. Moreover, the DLCO decrease was associated with increasing pro-BNP level, though this relationship was not significant

Conclusion: This study showed that there was a significant relationship between the serum levels of pro-BNP marker and increased PAP in the echocardiography, DLCO reduction, and FVC/DLCO increase. In fact, this serum marker can be used in patients with systemic scleroderma [SSc] to evaluate the status of PAH

relationship between diaphragmatic movements in sonographic assessment and disease severity in patients with stable chronic obstructive pulmonary disease [COPD]

Introduction: Pulmonary hyperinflation in patients with chronic obstructive pulmonary disease [COPD] can increase the breathing rate and reduce diaphragmatic movements by pushing the diaphragms downward and limiting their movements; this, in fact, can affect the breathing process. The purpose of this study was to compare diaphragmatic movements in COPD patients and healthy ones and to evaluate the relation of diaphragmatic movements and COPD severity in patients

Materials and Methods: This cross- sectional study was performed in Ghaem hospital, Mashhad Iran. Twenty-five COPD patients [case group] were selected, based on the inclusion and exclusion criteria. The patients' demographic and clinical characteristics along with factors related to pulmonary function were recorded. Patients were referred for sonography after pulmonary evaluation. The status of the left portal vein or one of its branches at the end of a deep expiration and a deep inspiration was considered as a marker. Twenty-five healthy non-smoker subjects, who were matched with the patients in terms of age and sex, were studied as the control group for the comparison of sonographic findings of the diaphragms

Results: The current study included 25 healthy subjects and 25 COPD patients, with the mean age of 59.2 +/- 12 years; approximately 84% of the subjects were males. Evaluation of the rate of diaphragmatic movements by sonography showed the mean of 42.08 +/- 12.15mm and 73.28 +/- 15.19mm in the case and control groups, respectively, which showed a statistically significant difference between them [P=0.02]. Statistical analysis indicated the relationship between the rate of diaphragmatic movements with factors related to airway obstruction. However, no relationship was observed between the rate of diaphragmatic movements and the factors associated with pulmonary hyperinflation or air retention

Conclusion: The rate of diaphragmatic movements as a parameter for determining exercise capacity in COPD patients could help with a better understanding of activity limitations in these patients

Metabolic syndrome in chemical warfare patients with chronic obstructive pulmonary disease

Introduction: Sulfur mustard [SM], a toxic alkylating gas, can cause serious long-term pulmonary complications such as chronic obstructive pulmonary disease [COPD]. Metabolic syndrome [MetS] is one of the important comorbidities of COPD. This study was designed to evaluate the frequency of metabolic syndrome in Iranian chemical warfare patients [CWPs] with COPD

Materials and Methods: Thirty CWPs with a mean age of 46.93 +/- 6.8 were enrolled in this study. The following parameters were studied in: complete pulmonary function tests, health-related quality of life, serum triglycerides [TG], high density lipoprotein [HDL] and fasting blood sugar [FBS] levels. Additionally, 32 COPD patients and 56 healthy persons were considered as control groups who were matched to CWPs

Results: We found a statistically significant difference in the frequency of MetS between the COPD patients and the healthy control group [P=0.04]. Additionally, we observed a statistically significant difference in the mean HDL levels among these groups [P=<0.001]. In the CWPs, the frequency of MetS was significantly decreased in severe to very severe stages [P<0.001]

Conclusion: Our data indicate that metabolic syndrome is frequent in chemical warfare patients, and special attention to this condition in mild to moderate stages is recommended

evaluation of pulmonary function tests in patients with polycystic ovary syndrome

Introduction: Recently a relation between female sex hormones and severity of asthma symptoms has been proposed. As a common endocrine dysfunction, polycystic ovary syndrome [PCOS] could significantly influence the level of sex hormones in PCOS patients. Regarding the possible role of sex hormones in airway physiology, the present study was conducted to survey the effects of PCOS on pulmonary function test parameters

Materials and Methods: In this cross-sectional study 30 recently diagnosed patients with PCOS without history of pulmonary disease were enrolled and 20 healthy women were considered as the control group according to their age, weight, and height. The patients and the controls underwent body plethysmography to measure pulmonary function tests

Results: The mean age of the patients and the controls were 29.43 +/- 7.8 and 30.0 +/- 7.6 years respectively. There were no statistically significant differences in all pulmonary function test parameters between the patients and the controls [p>0.05]. After dividing the patients into 2 groups based on their body mass index [BMI], BMI<25 and BMI>/=25, we found statistically significant differences only in expiratory reserve volume [ERV] and thoracic gas volume [p=0.01 and p=0.01, respectively].Moreover there was statistically moderate inverse correlation between BMI and ERV [r=-0.5, p=0.03]

Conclusion: Our results showed that pulmonary function test parameters are not different in PCOS patients comparing to healthy women. Only the deleterious effects of high BMI on pulmonary function can be occurred in these patients

Effects of Ramadan fasting on spirometric values and clinical symptoms in asthmatic patients

Ramadan is the 9th Islamic lunar month during which Muslims avoid eating and drinking from sunrise to sunset. The effect of Ramadan intermittent fasting on asthma control is controversial. The aim of this study was to investigate the effects of Ramadan fasting on the spirometric variables and clinical symptoms on well-controlled asthmatic patients during Ramadan. A cohort study was conducted in Mashhad, Khorasan Razavi, Iran. Twenty-nine [19 females and 10 males] well-controlled asthmatic patients aged 47 [12] years completed the study. The average duration of fasting was 26.5 days. Assessment of spirometric variables [daily peak expiratory flow, peak expiratory flow variability, peak expiratory flow home monitoring] as well as asthma clinical symptoms including dyspnea, cough, wheezing, and chest tightness were carried out. No significant changes in clinical symptoms were reported in asthmatic patients at the end of Ramadan fasting. Among spirometric variables, only peak expiratory flow improved after Ramadan [p<0.05]. There was a reduction in the mean peak expiratory flow variability from 13% at the first week of fasting to 10% at the fourth week [p<0.05]. In well-controlled asthmatic patients, Ramadan fasting resulted in improvement in peak expiratory flow and peak expiratory flow variability

diagnostic values of protein to lactate dehydrogenase ratio in serum and pleural fluid in exudate pleural effusions

Different etiologies of pleural effusion are diagnosed based on serum and plural fluid characteristics. The aim of this study was to assess and compare the serum and pleural fluid protein to lactate dehyrogenase [Pr/LDH] ratio in exudative pleural effusions. This study was conducted on 60 patients with exudative pleural effusion including: 20 cases with parapneumonic, 20 cases with Tuberculosis [TB], and 20 cases with malignancy. The serum and pleural Pr/LDH were measured and compared among 3 groups. The mean age of the patients was 55 +/- 19SD [years] and male to female ratio was 36/24. There was no statistically significant difference in mean age of the patients among 3 groups [p=0.08]. There were statistically significant differences in serum and pleural Pr. /LDH ratios among groups [p=0.04 and p= 0.1, respectively]. Additionally the comparisons of serum and pleural Pr. /LDH ratios between malignancy and tuberculosis groups were significant [p=0.02 and p=0.001, respectively]. The serum and pleural Pr. /LDH ratios were higher in TB group. The results of our study showed that serum and pleural Pr. /LDH ratio can be used in differentiating the etiology of exudative pleural effusion, but needs to be confirmed by larger study

significance of BODE [BMI, obstruction, dyspnea, exercise] index in patients with mustard lung

Chronic Obstructive Pulmonary Disease [COPD] secondary to sulfur mustard exposure, known as mustard lung, is an important late pulmonary complication. The BODE [Body mass index, Obstruction, Dyspnea, and Exercise] index has been established as a valuable tool for determining the adverse consequences of COPD. The aim of this study was to evaluate the role of the BODE index in patients with mustard lung. Eighty-two consecutively stable patients with mustard lung with all levels of severity were entered this study. The following parameters were recorded in all patients: standard spirometry, pulse oximetry, health-related quality of life, the BODE index. Additionally, the severity of COPD was determined by GOLD [Global initiative for chronic Obstructive Lung Disease] staging. The correlation of the BODE index with pulmonary parameters was determined. The mean age of the patients was 47.30 -/+ 7.08 SD years. The mean BODE index was 3.16 -/+ 2.25 SD. There was a statistically significant inverse correlation between the BODE index and oxygen saturation [r=-0.30, p=0.007]. Also a statistically significant correlation was found between the BODE index and quality of life [r=0.80, p=0.001]. The BODE index was not correlated with age of the patients and duration of disease. The results of this study showed that the BODE index is correlated with important clinical parameters and can be used in clinical practice

Bronchial artery embolization for massive hemoptysis: a retrospective study

To assess the efficacy and safety of bronchial artery embolization in the treatment of massive hemoptysis. A retrospective study on 46 patients [26 males and 20 females] who were referred to the Razavi Hospital from April 2009 to May 2012 with massive hemoptysis and had bronchial artery embolization procedures. General characteristics of the patients including age, gender, etiology, and thorax computed tomograms, findings of bronchial angiographic, results of the embolization, complications related to bronchial artery embolization and clinical outcome during follow-up were reviewed. The etiology included previous pulmonary tuberculosis in 20 cases, previous tuberculosis with bronchiectasis in 16 cases, bronchiectasis in 6 cases, and active pulmonary tuberculosis in one case. No identifiable causes could be detected in three patients. Moreover, massive hemoptysis was successfully and immediately controlled following the embolization procedure in all patients. One patient developed recurrent hemoptysis during one month following the procedure and was treated by re-embolization. No major procedure-related complication such as bronchial infarction was identified. However none of the patientsexperienced neurological complications. Bronchial artery embolization is a safe and effective means of controlling massive hemoptysis and should be regarded as the first-line treatment for this condition

Pattern of pulmonary function test abnormalities in anthracofibrosis of the lungs

The objective of this study was to discuss the spirometric characteristics of anthracofibrosis which is a from of bronchial anthracosis associated with deformity. Forty anthracofibrosis subjects who were diagnosed with bronchoscopy were enrolled in this prospective study. Static and dynamic spirometry plus lung volumes and diffusion capacity were measured in this group and compared to a healthy control group. Dyspnea [95%], cough [86%] and wheezing [68%] were the most frequent clinical findings. Spirometry showed significant decrease in all parameters including VC [FVC], FEV1, FEV1/FVC, FEF25-75 and FEF25-75 /FVC. The low value of FEV1/FVC and FEF25-75 and the increment of RV were in favor of obstructive patterns in 95% of subjects. Improving the obstruction with bronchodilator was not significant and diffusion capacity was mostly normal. Anthracofibrosis should be added to the list of chronic obstructive pulmonary diseases

Prevalence of asthma in children of chemical warfare victims

Exposure of DNA to sulfur mustard gas may increase the inheritance of asthma in chemical warfare victims' [CWV] offspring. The objective of this study was to determine the prevalence of asthma in children of CWV and compare it to asthmatic children in the general population. Four hundred and nine children from 130 CWV fathers and 440 children from 145 asthmatic parents from two cities in Iran participated in this study. The prevalence of asthma was determined by standard questionnaire released for epidemiological survey of asthma in children and compared between two groups. The prevalence of asthma in the CWV group was 15%; this was not significantly different from the control group [12.5%]. The children of the CWV group reported a significantly greater incidence of wheezing [1.2 +/- 3.1 attacks] per year, but the control group reported more severe attacks leading to speech difficulties [3%] and coughing [7%]. Regression analysis showed that with increasing family size in the control group, the number of subjects suffering from asthmatic symptoms decreases significantly [r=0.86, P=0.001]

Evaluation of polymerase chain reaction for diagnosis of "tuberculous pleurisy"

Differential diagnosis between tuberculous pleurisy [TBP] and non-tuberculosis pleural effusion represents a critically important clinical problem. In recent years, several noninvasive methods have been found for diagnosis of tuberculous pleurisy. This study aimed to evaluate the value of detection of the genome of Mycobacterium tuberculosis [MTB] by polymerase chain reaction [PCR] method for the diagnosis of tuberculous pleurisy and compare the results with those of conventional methods. In this cross-sectional study, we studied 62 patients [42 men and 20 women] with pleural effusion in Ghaem Hospital, affiliated to Mashhad University of Medical Sciences from January 2006 to June 2007. A total of 20 patients had tuberculous pleurisy [45.4%], 15 patients had malignant pleural effusion [34%], 3 patients had pleural effusion with various "non-tuberculosis non-malignant" etiologies [6.8%] and 6 patients had transudative pleural effusion [13.6]. The sensitivity, specificity, positive predictive value and negative predictive value of PCR in tuberculous pleurisy were 85%, 100%, 100% and 88.8%, respectively. The value of PCR test and pleural biopsy was similar in the diagnosis of TBP. However, PCR detected MTB in pleural effusion when conventional pleural biopsy failed to do so

[Evaluation of gamma-interferon in diagnosis of tuberculosis pleurisy]

Differential diagnosis between Tuberculosis pleurisy and Non Tuberculoses pleural effusion can be sometimes difficult and needs invasive diagnostic methods. In recent years, several biological markers have been found to be diagnostic markers of Tuberculosis pleurisy. The aim of this study was assessment of the value of Gamma-Interferon in the diagnosis of TB pleurisy. We studied 70 patients with pleural effusion who had been admitted to Ghaem hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Interferon gamma level was measured by "ELISA' method. The diagnosis of tuberculosis was based on microbiologic study of pleural fluid plus pleural biopsy. Altogether Twenty patients had tuberculosis pleurisy [44.44%], 21 patients had malignant pleural effusion [46.67%] and 4 patients had pleural effusion with various non TB non malignant etiologies [8.9%]. The sensitivity, specificity of Gamma-Interferon in TB pleurisy were 60% and 96% respectively. INF gamma is a valuable indicative marker for diagnosis of tuberculosis pleurisies' but we should consider situations with high level of INF gamma without any evidence of TB and also Tuberculosis pleurisy patients with INF gamma level lower than diagnostic threshold

Level of eosinophil cationic protein in sputum of chemical warfare victims

Considering fair response to inhaled corticosteroids and reports of severe air way hyper responsiveness in chemical warfare victims [CWV], a role for eosinophilic inflammation [i.e. asthma] was postulated. The objective of this study was to determine the presence of eosinophilic inflammation in CWV by evaluation of Sputum cellularity and eosinophil cationic protein [ECP]. Forty CWV and 15 control subjects entered this cross sectional study. Demographic data, dyspnea severity scale, spirometry results and 6 min walk test were determined. Sputum was collected with inducing by nebulizing hypertonic saline and analyzed for total inflammatory cell count, the cellular differential count and ECP level. Control group was normal volunteers with PC[20] more than 8 mg/ml. Mean +/- SD of eosinophil percentage [11.7 +/- 11.1%] and ECP level in sputum of CWV [46.1 +/- 19.5 ng/ml] were significantly more than control group. Regression analysis showed significant correlation between ECP level and percentage of eosinophils in sputum [r= +0.43, P< 0.01]. ECP level of CWV subjects with obstructive pattern did not show any significant difference from CWV with normal spirometry. ECP level in CWV subjects who revealed more than 12% improvement in forced expiratory volume in one second [FEV1] was significantly higher than CWV who had improvement less than 12% [P= 0.01]. BO and asthma as final clinical diagnosis of CWV did not show any significant difference of sputum ECP. Bronchial inflammation in different types of pulmonary complication of CWV is eosinophil dependent. ECP level of sputum in CWV could guide physician to select CWV who would respond to corticosteroids

Tissue PCR diagnosis of patients suspicious for tuberculous pleurisy

This study planned to assess the value of PCR IS6110 assay in tissue specimens of needle pleural biopsy in patients suspicious to pleural tuberculosis. Sixty eight patients with lymphocytic exudative pleural effusion underwent pleural biopsy. Tissue samples were sent for pathologic examination and PCR IS6110 assay. The results of PCR reported as positive/ negative and assessed according to the current gold standard pathologic diagnosis. Twenty nine patients had tuberculous and 12 had malignant pleural involvement, respectively. The remaining 27 samples were reported as non-specific pleurisy. Results of PCR were positive in 35 out of 68 total subjects and in 19 out of 29 TB patients. Sensitivity and specificity of PCR were calculated as 67.9% and 62.5%, respectively. An acceptable sensitivity and specificity for PCR examination of pleural tissue can serves it as a useful adjunct in undergoing needle pleural biopsy for possibility of tuberculosis