Role of CRP as a marker for discrimination of exudative and transudative pleural effusion.

Differentiation between exudative and transudative pleural effusion is sometime problematic. This study aimed to evaluate the diagnostic value of C-reactive protein (CRP) in differentiation of exudative and transudative pleural effusion. This is an analytical epidemiologic cross-sectional study that evaluates the role of CRP in differentiating transudative and exudative pleural effusion. Patients were divided into two groups of exudates and transudates, based on Light's criteria. The pleural effusion CRP levels were compared between the two groups. SPSS software version 16 was used for statistical analysis. The significance level was considered p<0.05. A total of 169 patients with pleural effusion enrolled in the study. Based on Light's criteria, 108 patients (63.9%) had exudative pleural effusion and 61 (36.1%) had transudative pleural effusion. The level of CRP in the pleural fluid of patients in the exudative and transudative groups was 13.3±37.1 and 3.5±4.3mg/dl, respectively (p=0.008). The 3.31 mg/dl cut-off point of CRP level of pleural effusion had the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 96.3%, 72.1%, 86% and 91.7% respectively.  The results obtained in our study shows that the level of CRP in the effusion fluid can be helpful in differentiating exudative from transudative pleural effusions.

Comparing the diagnostic accuracy of semi-rigid and rigid pleuroscopy in diagnosis of exudative lymphocyte dominant pleural effusion with.

BACKGROUND AND OBJECTIVES: Pleuroscopy is an appropriate technique for visualization and biopsy of the pleural lesions, performed by two different techniques. In this study, we aimed to investigate the diagnostic accuracy of semi-rigid and rigid pleuroscopy in patients with lymphocyte dominant exudative pleural effusion. MATERIALS AND METHODS: In this study, patients with lymphocyte dominant pleural effusion with negative results for tuberculosis who referred to Imam Khomeini Hospital, Ahvaz, Iran; from 2018 to 2019 were selected by census method and randomized to undergo semi-rigid or rigid pleuroscopy (30 in each group). Patients' demographic, such as age and gender, were recorded and the pathologic results reported by the two pleuroscopy methods were compared and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were reported for each method. All statistical analyses were performed using SPSS v. 21. RESULTS: Thirty patients were included in each group. The frequency of tuberculosis, malignancy, and other causes of pleural effusion had no difference between the two methods (P > 0.05). Semirigid pleuroscopy had a sensitivity of 81.5%, specificity of 66.6%, PPV of 75.6%, and NPV of 74%, while the relevant values in rigid pleuroscopy were 87.2%, 68.4%, 87.2%, and 68.4%, respectively. CONCLUSION: These results, consistent with previous studies, indicated that both semi-rigid and semi-flexible pleuroscopy methods are accurate for diagnosis of lymphocyte dominant pleural effusion when performed by skilled specialists and other considerations, such as availability and costs, can be used for selection of each method.

Toothbrush: A Report of an Unusual Foreign Body.

INTRODUCTION: Ingestion of a foreign body is a common problem among all age groups. Most of the foreign bodies in the pharynx are usually lodged at the level of cricopharynx. The diagnosis is based on history, clinical, and radiological examination. Most foreign-body ingestions are accidental, but there may be contributory factors such as mental disorder, alcoholism, and prison incarceration. Toothbrush ingestion is uncommon and requires prompt medical attention. CASE REPORT: In this article, a rare case of a toothbrush foreign body is presented. The ingestion was caused by a seizure and the toothbrush was removed through surgical management. CONCLUSION: An ingested toothbrush will not pass spontaneously. The best management is early endoscopy performed by a skilled surgeon. If this is unsuccessful, surgical management can be performed.

Rigid bronchoscopy and tracheostomy compared to repeated dilatation of tracheal stenosis prior to tracheal resection and anastomosis; a pilot study.

UNLABELLED: The aim of the study was to compare the results of tracheostomy of the site of stenosis and repeated RB & D in previously published papers. MATERIAL AND METHODS: This prospective study examined the treatment of tracheal stenosis with tracheostomy at the site of stenosis. The recurrence rates, duration of hospitalization before and after tracheal resection, the number of tracheal rings removed, prognosis,and complications were evaluated. RESULTS: It seems that a tracheostomy at the site of stenosis instead of repeated RB & D reduces the recurrence rate and duration of hospital stay, the need for a constant presence of a chest surgeon in the hospital, hospitalization costs. Also, the implementation of this method is possible in more centers. CONCLUSION: Tracheostomy at the site of tracheal stenosis can reduce the recurrence rate of stenosis, and prevent prolonged hospitalization, repeated anesthesia and inappropriate emergency tracheostomy.

The Role of Esophagogastric Anastomotic Technique in DecreasingBenign Stricture Formation in the Surgery of Esophageal Carcinoma.

INTRODUCTION: Postoperative stenosis and dysphagia after esophageal carcinoma resection is the major problem. The aim of this study is to compare two types cervical esophagogastric anastomosis in reduction of stricture formation in esophageal cancer surgery. METHODS: The subjects of this study were 223 patients undergoing esophageal carcinoma resection during 1998 to 2007. Twenty two patients were excluded from the study because of recurrent malignancy of anastomosis, mortality and losing in follow up period. Two hundred and one patients remained by the end of study were classified into two groups: 98 patients were treated by routinely transverse hand-sewn cervical esophagogastric anastomosis (group 1); and 103 patients were treated by the proposed oblique hand-sewn esophagogastric anastomotic technique (group 2). All the operations were with high abdominal and left cervical incisions (Transhiatal esophagectomy). All patients of both groups were followed up at least 6-month for detection of anastomotic strictures. RESULTS: Postoperative dysphagia occurred in 20 patients of group 1 versus 5 patients of group 2. In working up by rigid esophagoscopy, two patients of group 2 and four patients of group 1 had not true strictures. Anastomotic strictures occurred in 16 cases of group 1, versus 3 cases of group 2. Statistical comparative analysis results of two groups about stricture formation were significant (3% versus 16% P= 0.003). CONCLUSION: The oblique hand-sewn esophagogastric anastomostic techniques reduce markedly the rate of stricture formation after esophagectomy.

Determination of safe margin in the surgical pathologic specimens of non-small cell carcinoma of the lung.

BACKGROUND AND AIM: Local recurrences of the tumor at the surgical margin are serious problems in pulmonary resections for lung cancer. The aim of this study is to determine the involved margins and safe distances of the resection sites from tumor for prevention of local recurrences. MATERIAL AND METHODS: In this prospective study, 66 patients operated for non-small cell lung carcinoma (NSCLC) from Jan 2006 to Sep 2008 were evaluated. After performing pulmonary resections, multiple biopsies were taken up from 5 mm (A), 10 mm (B), 15 mm (C), and 20 mm (D) distance from tumor. The specimens were studied histopathologically. RESULTS: From a total of66 patients with NSCLC admitted to our referral hospital, 25 (38%) had adenocarcinoma, 18 (27.3%) squamous cell carcinoma, 5 (7.5%) large cell carcinoma, 4 (6%) bronchoalveolar cell carcinoma, 4 (6%) adenoid cystic carcinoma, 3 (4.6%) malignant carcinoid tumor and 7 (10.6%) had metastasis. The most common symptoms were dyspnea and cough. Histopathologically tumor positive margins were found in 84.8% (A), 10.6% (B), 4.5% (C), and 0% (D). There was a significant statistically difference between tumor involvement at distances 5 mm (A) versus 10-20 mm (B-D) (P <0.001). CONCLUSION: A 20 mm distance from the gross tumor is considered as a safe surgical margin in any type of malignant pulmonary resections for prevention of local surgical recurrences if there was no pathologic examination before surgery.