value of use of amino-terminal brain naturitic peptide as marker in cases of pleural effusion of different etiologies

Background: The criteria of Light et al. have been used to make the differentiation between transudate and exudate effusion for the past 25 years. The main problem with those criteria is that although they identify nearly all exudates correctly, they misidentify about 20-25% of transudates as exudates. The plasma NT-proBNP level is a sensitive marker of cardiac dysfunction and has proved to be a useful tool for the identification and management of systolic and diastolic cardiac dysfunction

Objective: The aim of this work was to study the value of pleural NT-pro brain natriuretic peptide in the diagnosis of pleural effusion of different causes in comparison to the conventional diagnostic procedures in cases of pleural effusion

Subjects and methods: The present study was conducted on 32 patients who suffered from pleural effusion, they were classified according to Light's criteria into two groups namely transudate, exudate, and the third group of 10 normal healthy subjects as control group

Results: The levels of both serum and pleural fluid pro-BNP in group I patients with transudate effusion were significantly higher than group II patients with exudate effusion [P > 0.001, 0.003] respectively

Conclusion: The results support the feasibility of using the pleural fluid amino terminal proBNP measurement in thoracentesis that would enhance discrimination among the different causes of pleural effusion especially for heart failure patients. Serum and pleural fluid levels of NT-pro BNP were closely correlated and measurement of NT-pro BNP in serum showed equally good diagnostic properties

Assessment of emphysema and bronchial asthma by computed tomography density mask program and correlation with pulmonary function tests

The aim of this work is to assess the presence and extent of emphysema using "CT density mask" program and to find out if CT scans can differentiate emphysema from bronchial asthma, correlation of the CT scan finding of emphysema with pulmonary function test was tried

Effect of histamine inhalational challenge on airway responsiveness, breathing pattern and arterial oxygenation in stable asthmatic patients

The effect of histamine inhalational challenge on airway responsiveness, breathing pattern and oxygen saturation of the arterial blood was investigated in 10 stable asthmatic patients. 5 healthy normal volunteers were choosen as a control group. It was found that before histamine inhalation: There was a significant decrease in FVC, FEV1, MEFR, MMFR% of predicted values in the asthmatic patients compared to the control group. No significant difference in S[a]O[2] was found between the asthmatic patients and the controls. Breathing pattern recorded a significant shortening of T[i]/Ttot [fractional;l inspiratory time] and decrease in VT/Ttot in the asthmatic patients compared to the controls. Breath period [T tot] was significantly prolonged in patients with bronchil asthma. On the other had no significant difference was found in VT, f, V[m], T[i] [inspiratory time] and VT/T[i] [respiratory center drive] between the asthmatics and the control group. After histamine inhalation: There was a significant increase in f, V[m], T[i], and T tot in the asthmatic patients compared to the controls. A highly significant decrease in VT/T[i] was found in the asthmatic. On the other hand no significant changes in VT, VT/Ttot and T[i]/t tot were found in the asthmatic patients. Changes in timing following histamine inhalation perhaps may be due to stimulation of airway afferents by histamine that modulate breathing pattern. There was a significant decrease in S[a]O[2] following histamine inhalation in the asthmation patients. This hypoxia induced by histamine inhalation in stable asthmatic patients might result from alteration in alvealar ventilation/perfusion relationship following induced bronchoconstriction. The mean value of provocation concentration of histamine producing 20% fall or more in FEV[1]% pared, P[c]20, was 3.4 mg/ml. There was a significant, but weak, positive correlation between values of P[c]20 [The degree of non specific airway hypereactivity] and values of FEV1% of pared. [The degree of airway obstruction] r= +0.6359 P< 0.05 but no correlation was found between P[c]20 and MEFR or MMFR% pred. r= +0.09709 and + 0.1276 respectively. In bronchial asthma the term primary airway hyperresponsiveness might be applied, and it is present frequently in the absence of resting airflow obstruction. Airway hyperresponsiveness in the more severe range may actually be the determinant of resting airflow obstruction rather than vice versa. Bronchial hyperresponsiveness in Br. Asthma may probably results from airway inflammation. Breathing pattern in asthma should help elucidate the natural history of an asthmatic attack, and clarify and differentiate the physiologic compensatory responses from the pathophysiologic abnormalities which precede acute respiratory failure and respiratory arrest

Respiratory muscle performance and breathing pattern in patients with bronchial asthma, chronic obstructive pulmonary disease, interstitial pulmonary fibrosis and in normal subjects

Respiratory muscle performance and breathing pattern were studied in 40 subjects divided into four groups: group I included 10 patients with bronchial asthmas during the attack, group II 10 patients with chronic obstructive pulmonary disease, group III 10 patients with interstitial pulmonary fibrosis and group IV 10 normal volunteers as a control group. Data of the present study revealed that patients with bronchial asthma and COPD had respiratory muscle weakness and diminished endurance as evidenced by decreased in PE max, PI max and impaired tension time index of the diaphragm compared to that of the control group. The pattern of breathing in COPD patients and asthmatic subjects revealed an increase in tidal volume VT, respiratory frequency, minute ventilation VE min and the mean inspiratory flow VT/Ti denoting an increase in respiratory centre discharge, while there was a decrease in the inspiratory duty cycle Ti/Ttot. Breathing pattern may help to differentiate symptomatic asthmatic patients from patients with COPD who have similar degree of pulmonary hyperinflation and increased airway resistance breath with faster rates and slightly elevated tidal volumes. Patients with interstitial pulmonary fibrosis I.P.F had respiratory muscle dysfunction manifested by decreased PF max, PI max and endurance Tdi. Breathing pattern in IPF showed decrease in VT, increase in F and VE/min, while Ti/Ttot was within normal. There was an increase in respiratory center drive VT/Ti. Respiratory muscle dysfunction and abnormal breathing pattern are important features in patients with bronchial asthma, COPD and IPF, therefore should be included in the clinical and physiological evaluation of these patients

Study of ventilatory, cardiovascular and metabolic effects of inhaled salbutamol, terbutaline, fenoterol and isoprenaline in stable asthmatic subjects

Forty, non smoking stable asthmatic subjects, 27 male and 13 female, were choosen to study the ventilatory, cardiovascular and metabolic effects of B2 agonists; salbutamol, terbutaline, fenoterol and isoprenaline. The drugs were administered by metered dose inhalers 400 ug [dose that asthmatic patients may use during the attack]. Measurements of heart rate, blood pressure, Q-T interval, serum Na, K, glucose and pulmonary function test [PFT[s]] were made before and 15 minutes after the inhalation. There was a significant increase in PFT[s], FVC, FEV1, FEV1/FVC, MEFR and MMFR following inhalation of bronchodilators. No difference in the bronchodilating effect of salbutamol, trebutaline, fenoterol or isoprenaline was observed. A significant increase in heart rate was found after terbutaline, fenoterol and isoprenaline inhalation with an insignificant change after inhalation of salbutamol. There was significant rise in systolic blood pressure, significant prolongation in Q.T. interval following bronchodilators inhalation with significant fall in diastolic blood pressure. Serum Na and K demonstrated significant increase and decrease respectively after bronchodilators inhalation, while blood glucose showed significant increase. From the present study, we conclude that a great attention should be paid for cardiovascular and metabolic effects of B2 agonists when taken by metered dose inhalers in recommended therapeutic dose and should be used with caution in patients prone to cardiovascular disorders, hypokalaemia and/or diabetes mellitus

Neoplasms and cysts of the mediastinum, clinical presentation, methods of diagnosis and management

This study included fifty five patients, thirty one males and twenty four females, who were admitted for mediastinal masses in Alexandria main University Hospital during the period from 1980 to 1988. Symptoms and signs were present in 60.5% of patients, such as cough in 18.2% Dyspnoea in 10%, Chest pain in 10%, superior vena canal obstruction in 7.3%, Dysphagia in 5%, and other. 42 of the presenting patients required thoracotomy for diagnosis and treatment, 9 patients were diagnosed by mediastinoscopy and mediastinotomy, the remaining cases were diagnosed by lasser procedures such as cervical lymph node biopsy in two patients, fiberoptic bronchoscopy was done in two and the remaining patient diagnosed by CT guided needle biopsy. The primary mediastinal masses included mediastinal lymphadenopathy [41.8%], mediastinal cysts [14.55%], thymic tumors [10.9%], retrosternal goitre [7.27%], carcinoma of the mediastinum [5.45%], germ cell tumors [5.45%], mesenchymal tumors [3.64%], and neurogenic tumors [7.27%]. The anterosuperior mediastinum was the most commonly involved site of mediastinal masses [65.5%], followed by the posterior mediastinum [21.8] and the middle mediastinum [10.9%]. 45.5% of the cases were treated by excision, 45.5% were treated by excision followed by radio therapy and chemotherapy and 9.1% were treated medically by antituberculous drugs and steroids