Diagnostic utility of N-terminal-proBNP in differentiating acute pulmonary embolism from heart failure in patients with acute dyspnea.

BACKGROUND: The plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) level is frequently elevated in dyspnoeic patients and increasingly used in emergency departments to assess the cause of acute dyspnea. In this study we prospectively tested NT-proBNP levels in patients with congestive heart failure (CHF) and/or acute pulmonary embolism (APE) and determined the utility of NT-proBNP for discriminating APE from CHF. METHODS: A cohort of 177 dyspnoeic patients with a diagnosis of APE and/or CHF was prospectively studied between June 2010 and March 2013. NT-proBNP was measured by the electrochemiluminescence immunoassay (ECLIA). All patients were evaluated with transthoracic echocardiography (TTE). APE was diagnosed in the presence of thrombi signs in the pulmonary arteries with computed tomographic pulmonary angiography (CTPA) or a high-probability lung ventilation/perfusion scan. Risk stratification was based on the evaluation on admission according to the ESC guidelines from 2008. The diagnosis of CHF was based on the guidelines of the American College of Cardiology/American Heart Association and the European Society of Cardiology. Two physicians independently reviewed the records to determine the final diagnosis. RESULTS: Fifty-nine patients met the criteria for dyspnea caused by APE, and 113 patients were diagnosed with CHF. Most of the APE patients (41, 69.5%) were intermediate-risk. The symptoms and signs, such as orthopnea, paroxysmal nocturnal dyspnea and rales in the lungs, were more common in patients with CHF than in patients with APE (P < 0.01). Median NT-proBNP was significantly lower in patients with APE compared to those in patients with CHF (2 855.9 pg/ml vs. 6 911.4 pg/ml, P < 0.01). We constructed the receiver operating characteristics (ROC) curve in predicting the diagnosis of APE. At a cut point = 1 582.750 pg/ml, NT-proBNP provided a specificity of 93% and a true positive rate (sensitivity) of 17% for the diagnosis. At a cut point = 3 390.000 pg/ml, NT-proBNP had a specificity of 83% and a sensitivity of 84% for the diagnosis of APE. At a cut point = 6 486.500 pg/ml, they were 54% and 93% respectively. CONCLUSIONS: NT-proBNP can assist in excluding CHF patients from those admitted to the emergency department with acute dyspnea and identifying patients with a high probability of APE, which would reduce the missed diagnosis of APE. Larger studies are necessary to validate these findings.

[The value of thoracoscopy for diagnosis and management of refractory hepatic hydrothorax].

OBJECTIVE: To study the value of thoracoscopy for diagnosis and management of refractory hepatic hydrothorax (HH). METHODS: Twenty-six patients with refractory HH were enrolled in this study. Twenty-four of them underwent therapeutic thoracoscopy to achieve pleurodesis by application of talc poudrage. RESULTS: Nineteen of the 26 patients had dilated chest wall veins, 6 had dilated azygos veins, and 16 had diaphragm blebs. Of the 24 patients who received pleurodesis via thoracoscope, 14 cases showed complete response, and 8 showed partial response. Mild chest pain and temperature elevation were the most complaints during or after the procedure. Liver function abnormalities were the most serious side effects after pleurodesis. During the follow-up period ranging from 6 months to 3 years, 1 patient died of upper gastrointestinal hemorrhage and encephalopathy in 1 month, 3 patients died of hemorrhage in 6, 12, 18 months respectively, and 1 case experienced recurrence in 18 months. CONCLUSIONS: Defects in the diaphragm seemed to be the main cause for the development of HH. Pleurodesis achieved by thoracoscopy and talc poudrage was effective in the treatment of HH, but complications and impaired liver functions should be considered.

[The relationship between transforming growth factor-beta1, platelet derived growth factor and airway remodeling in eosinophilic bronchitis].

OBJECTIVE: To study the relationship between the expression of transforming growth factor-beta(1) (TGF-beta(1)) and platelet derived growth factor (PDGF) and airway remodeling in eosinophilic bronchitis (EB). METHODS: Bronchial biopsy specimens were obtained from 12 patients with EB (A group), 10 asthmatic patients (B group) and 10 patients (C group) with peripheral lung cancer in early stage. The subepithelial basement membrane (SBM) thickness was measured by light microscopy using HE staining. The expressions of TGF-beta(1) and PDGF in the bronchial mucosa were examined by immunostaining. RESULTS: The SBM of A group [(6.3 +/- 1.4) micro m] was significantly thicker than that of C group [(4.1 +/- 1.2) micro m, P < 0.05], but significantly thinner than that of B group [(8.2 +/- 1.5) micro m]. The numbers of positive cells for TGF-beta(1) and PDGF in A group (59 +/- 9, 47 +/- 7 respectively) and B group (85 +/- 12, 76 +/- 11, respectively) were significantly higher than those in C group (31 +/- 4, 20 +/- 3, respectively), and were positively correlated with SBM thickness (r = 0.76, 0.52, P < 0.05). CONCLUSION: These results suggest that TGF-beta(1) and PDGF expressions in bronchial mucosa may play a role in bronchial subepithelial fibrosis in EB patients.