Diagnostic yield of closed pleural brushing.

The aim of this study was to assess the diagnostic yield of closed pleural brushing (CPBR) in the diagnosis of malignant pleural effusion. Twenty-one adult patients (20 men and 1 woman); aged 62.9 +/- 8.6 were participated to this prospective study. Thoracentesis, CPBR and closed pleural biopsy (CPB) following the brushing were applied to every patient. While CPBR provided diagnosis in 12 (57.1%) of 21 cases, in 3 of these 12 cases, pleural fluid cytology (PFC) and CPB were negative. The sensitivities of PFC, CPBR and CPB in the diagnosis of malignant effusions were 33%, 57% and 52%, respectively. When three procedures were used in combination, the sensitivity increased to 67%. When CPBR is performed in addition to PFC and CPB, the yield of the diagnosis increased 14% additionally. There was no mortality due to these interventions. Complications were chest pain in 3 (14.2%) cases, hypotension in 2 (9.5%) cases, cough in 1 (4.8%) case, pneumothorax in 1 (4.8%) case, and hemothorax in 1 (4.8%) case. In conclusion, CPBR as a safe, simple and well tolerated procedure provides high diagnostic yield in diagnosis of patients with malignant pleural effusion.

Dental technician's pneumoconiosis: mineralogical analysis of two cases.

Pneumoconiosis was diagnosed by open lung biopsy in two dental technicians who had interstitial lung disease. Mineralogical analysis was performed to investigate the origin of the dust that had been inhaled. A marked accumulation of silicon and phosphorus was found in both cases. The hard metals chromium and cobalt were also found. Dental technician's pneumoconiosis is a complex pneumoconiosis in which such dust and hard metals may play a role.

Adjuvant resectional surgery improves cure rates in multidrug-resistant tuberculosis.

OBJECTIVE: Multidrug-resistant tuberculosis still continues to be a major health problem. Adjuvant surgical resection combined with antituberculous drug management is the most favorable treatment modality for patients with multidrug-resistant tuberculosis. In this article we report the results of surgical resections we performed during the years 1993 through 2005. METHODS: We performed 81 lung resections in 79 patients with multidrug-resistant tuberculosis. All these patients had at least 2 months of medical therapy before resection. Bronchial reinforcement was performed in 4 of the 81 operations. We present here the surgical results of the 81 procedures. Because 5 of 79 patients were lost to follow-up, we provide the medical treatment results on 74 of the patients. RESULTS: During this period, we performed 4 completion pneumonectomies, 39 pneumonectomies, 7 lobectomies with segmentectomy, 30 lobectomies, and 1 segmentectomy. Operative mortality was 2.5% (2/81). Bronchopleural fistula developed in 4 (4.9%) cases. Our overall cure rate was 94.5% (70/74). Relapse and treatment failure were 1.3% (1/74) and 1.3% (1/74), respectively. All but 5 patients are still under our follow-up. CONCLUSIONS: Surgical resection of patients with multidrug-resistant tuberculosis combined with chemotherapy provides a favorable outcome. Our results will need to be validated more strongly by using randomized clinical trials that compare surgical resection plus chemotherapy with chemotherapy alone.

[The effect of antibiotic therapy on lung pathology in experimental models of sepsis]. / Deneysel sepsis modelinde akciger patolojisi ve antibiyotiklerin etkisi.

AIMS: In this study, the effect of an extra-lung sepsis model on lung histopathology is evaluated. METHODOLOGY: In this study 20 Wistar-Albino rats were used. Following the ether anesthesia laparotomy was done. Caecum was ligated by a silk thread and was perforated by 18 gauge needle. It is squeezed until feces emerged. Abdominal wall is closed. By this method peritoneal sepsis was performed. The rats are divided into two groups (n:10). 0.5 ml of serum physiologic is applied to the control group, and imipenem is applied to the antibiotic group as 15 mg/kg/tid. 48 hours later rats were sacrificed by extreme ether anesthesia. Relaparatomy was done and diaphragm was open. Multiple biopsies were made from the lung. Biopsy materials was cultured and examined histopathologically. RESULTS: In control group; rats died in 48 hours (%100), but antibiotic group were alive (%0). The results of lung biopsy cultures are; in all rats in control group, Escherichia coli (E. coli) and Bacteroides fragilis (B. fragilis) were cultured (%100). Whereas in antibiotic group there is no bacteria cultured (p < 0.001). Histopathologic results are: in control group there was wide spread edema and congestion and inflammatory reaction. In antibiotic group there was slight edema, congestion and inflammatory reaction. CONCLUSION: In septic condition sings of adult respiratory distress syndrome occurs. Large spectrum antibiotics can prevent bacterial translocation in lungs and could minimize the lung injury.