Triangular cord sign in detection of biliary atresia: is it a valuable sign?

BACKGROUND: Early detection of biliary atresia (BA) has a vital role in prevention of liver cirrhosis in these patients. There are some evidences that triangular cord (TC) sign, i.e., triangular structure located cranial to the portal vein bifurcation on ultrasonographic examination, is suggestive of BA in suspected cases. The aim of this study is to evaluate and compare the sensitivity, specificity, and accuracy of TC sign with other methods of diagnosis such as hepatobiliary scan. METHODS: Fifty-eight infants referred to pediatric gastroenterology ward with diagnosis of infantile cholestasis from March 2004 to March 2008 were evaluated to find the cause of cholestasis. Diagnosis was made by means of history, clinical examination, hepatobiliary scan, and liver biopsy. Ultrasonographic examination was focused on presence of TC sign in patients. If the diagnosis was in favor of BA, patient was sent for direct cholangiography as a gold-standard test for confirmation of the diagnosis. The sensitivity, specificity, and accuracy of the tests were compared with golden standard. RESULTS: Among 58 infants with infantile cholestasis, BA was diagnosed and confirmed in 10 infants (17.2%). Hepatobiliary scintigraphy had 80% sensitivity, 72.9% specificity, and 74.1% accuracy. TC sign had 70% sensitivity, 95.8% specificity, and 91.3% accuracy. CONCLUSION: TC sign is more accurate than hepatobiliary scan and has acceptable sensitivity and specificity for diagnosis of BA.

The value of BAL fluid LDH level in differentiating benign from malignant solitary pulmonary nodules.

PURPOSE: Serum lactate dehydrogenase (LDH) concentration is an indicator of tissue injury. It may be locally secreted in some conditions. This study was performed in order to investigate the value of LDH levels in bronchoalveolar lavage fluid (BALF) in the differentiation of a bening, from a malignant solitary pulmonary nodules (SPN) and to assess its relationship with serum LDH levels. METHODS: The study was a prospective clinical study. It included 59 patients with a SPN. They underwent bronchoscopy with bronchoalveolar lavage (BAL). Both total serum and BAL LDH levels were measured. RESULTS: BALF LDH level was increased in all patients with malignant SPN. The mean BALF LDH level was significantly higher in patients with malignant SPN (342.23 +/- 89.98) as compared to the benign ones (17.62 +/- 7.90) (P < 0.001). There was no correlation between BALF LDH and serum LDH level in patients with SPNs (P = 0.595). CONCLUSION: BALF LDH levels are increased in patients with malignant SPN, but had no significant rise in benign SPN. This factor is useful in differentiating the benign SPNs from malignant SPNs.

Elevated levels of MCP-1, MIP-alpha and MIP-1 beta in the bronchoalveolar lavage (BAL) fluid of patients with mustard gas-induced pulmonary fibrosis.

OBJECTIVE: Role of chemokines in the pathogenesis of pulmonary fibrosis (PF) due to sulfur mustard (SM) gas inhalation. PATIENTS: 18 veterans with SM gas-induced PF, 15 patients with IPF and 18 normal as controls. INTERVENTION: Chest roentgenograms, PFTs, the percentage DLCO, high-resolution CT scans of the chest, and analyses of BAL fluids for chemokines (MCP-1, MIP-1 alpha, and MIP-1 beta) were performed in all cases. RESULTS: There were significant differences in chemokines (MCP-1, MIP-1 alpha, and MIP-1 beta) levels of BAL fluid between patients with PF and healthy controls (p<0.0006). MCP-1 and MIP-1 alpha levels in BAL fluid correlate only with the percentage and the absolute number lymphocytes of the BAL fluid in patients with PF due to SM gas inhalation (p=0.0006/p=0.03; p=0.04/p=0.02; respectively). The BAL fluid level of MIP-alpha in SM gas-induced PF was significantly correlated with the number of lymphocytes (r=-0.56, p=0.01), neutrophils (r=-0.50, p=0.03) and eosinophils (r=-0.49, p=0.03). A significant negative correlation was observed between the percentage of Dlco and MCP-1 and MIP-1 alpha levels in BAL fluid in patients with PF (r=-0.65, p=0.003; r=-0.48, p=0.04; respectively). CONCLUSION: Neutrophils alveolitis, presence of eosinophils, and higher concentrations of interleukin MCP-1, MIP-1 alpha, and MIP-1 beta in BAL fluid are associated with the development of fibrosis in SM victims.