Combined pleural fluid cholesterol and total protein in differentiation of exudates and transudates.

BACKGROUND: The management strategy to be adopted in pleural effusion depends on whether an effusion is a transudate or exudate. OBJECTIVE: To evaluate the usefulness of pleural fluid cholesterol and/or total protein measurements for differentiating between exudates and transudates, and to compare it with Light's criteria. METHODS: In this prospective study 60 patients with pleural effusion were included. Pleural fluid total protein, lactate dehydrogenase (LDH) and cholesterol as well as serum total protein and LDH levels along with other investigations were studied. Clinical classification of transudate or exudate was done on the basis of aetiology. RESULTS: Based on clinical signs and symptoms, chest radiograph, other investigations and response to treatment, 49 of these effusions were classified as exudates and 11 as transudates. Using pleural fluid cholesterol levels at a cut-off point of greater than 60 mg/dL and/or total protein at a cut-off point of greater than 3 g/dL for distinguishing transudates and exudates, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), were 100 percent. Using Light's criteria for discriminating transudates and exudates, sensitivity, specificity, PPV and NPV were found to be 98%; 100%; 100% and 92%, respectively. The differences resulted from a mis-classification of one expected exudate as transudate by Light's criteria. CONCLUSION: Pleural fluid cholesterol and total protein are simple, cost-effective, and useful parameters in distinguishing pleural transudates from exudates, with the advantage of requiring only two laboratory determinations and no simultaneous blood sample, compared to the use of Light's criteria.

Clinical and laboratory profile of patients with TB/HIV coinfection: A case series of 50 patients.

BACKGROUND: Tuberculosis (TB) is said to be one of the commonest opportunistic infection in patients with HIV/AIDS. OBJECTIVE: To study the clinical and laboratory profile of patients with HIV/TB coinfection. MATERIALS AND METHODS: Fifty adult TB patients having confirmed HIV seropositivity were included in randomized manner. A detailed history and thorough physical examination was done. Laboratory and radiological investigations were carried out as appropriately warranted. RESULTS: Most of the patients were farm workers (30%) followed by manual laborers (22%) and transport drivers (16%). Heterosexual route was found in 86% of patients. Cough was present in 94% while fever and weight loss in 86% and 78% of patients, respectively. Out of 50 patients, 40% had only pulmonary TB (PTB), 46% had pulmonary and extra-pulmonary TB (EPTB), 10% had only EPTB and 4% had multisystemic EPTB. Mediastinal lymphadenopathy was present in 34% while pleural effusion and extra-thoracic lymph nodes was present in 20% and 18% of patients, respectively. Positive smear for acid-fast bacilli (AFB) was found in 25.58% while positive Mantoux test was found in 32.14% of patients. CONCLUSION: HIV/TB coinfection is more common in sexually active age group and commonest mode of HIV infection is heterosexual transfer. Sputum smear AFB and Mantoux test positivity is low in TB patients having HIV. Disseminated TB is common in HIV. Mediastinal lymphadenopathy is common site among extra-pulmonary tuberculosis.

Partial duplication of the trachea in an adult: an accidental finding on bronchoscopy.

Partial duplication of the trachea is a very rare congenital tracheal anomaly that is detected during infancy. To our knowledge, there are only 3 reported cases of partial duplication of the trachea in the literature, which were all detected during infancy. We are reporting the first case of partial duplication of the trachea in an adult, which was detected accidentally during routine diagnostic bronchoscopy. Partial duplication of the trachea can easily be misdiagnosed as an accessory bronchus or congenital tracheal diverticulum, if it is not carefully evaluated. It is possible that similar cases in the past may have been misdiagnosed as tracheal bronchus or congenital tracheal diverticulum on bronchoscopy.

Urodynamics in the management of female stress incontinence--which test and when?

PURPOSE OF REVIEW: This article reviews the literature from the last 12 months in the context of our existing knowledge base and reviews the contentious issue of the role of preoperative urodynamics for stress urinary incontinence, with particular reference to the choice of urodynamic investigations for diagnostic differentiation between intrinsic sphincter deficiency and urethral hypermobility, assessing symptom severity and predicting postoperative prognosis. RECENT FINDINGS: While there are significant conflicting data regarding the role of urodynamics, particularly in the functional assessment of the urethra, it is clear that these diagnostic techniques can provide clinically useful data. It is in this context that recent guidelines advising on restricted use of invasive urodynamics preoperatively should be carefully reviewed. SUMMARY: There is a pressing need for randomized controlled trials to be performed to fully assess the role of urodynamics in the preoperative assessment of stress urinary incontinence, especially at this time of rapid change in the surgical treatments available.

Medical management of lower urinary tract symptoms in men: current treatment and future approaches.

Lower urinary tract symptoms (LUTS) are extremely common in men and, in addition to causing considerable bother, can lead to the development of complications, such as acute urinary retention. Over the past couple of decades, developments in the medical management of LUTS in men have led to a substantial decline in the number of surgical procedures being performed to treat associated disorders, such as prostatectomy for benign prostatic enlargement. In this Review we summarize the available treatments and discuss the latest data on the use of anticholinergics and phosphodiesterase type-5 inhibitors for this indication. We also review the various combinations of medical therapies that have been reported in the literature to optimize the management of LUTS in men. In addition, there is a growing realization that LUTS in men are not synonymous with prostatic disease, and in many patients overactive bladder syndrome is the cause or a component of the LUTS experienced; we have, therefore, taken the opportunity to try to clarify the terminology used in LUTS in men, since there is the potential for considerable confusion with the terms that are currently in common usage in any discussion of this disorder.

Current and future trends in the management of overactive bladder.

Urinary incontinence is a common problem which increases in prevalence in association with advancing age and has a significant adverse effect upon well-being and quality of life. It is not the "benign" condition that many take it for. Overactive bladder (frequency-urgency syndrome) is the commonest bladder problem in late life, affecting up to 41% of over-75-year-old individuals, and the elderly experience more severe disease. This small series should provide the reader with a comprehensive overview of the current thinking in the assessment and management of patients with overactive bladder syndrome, explores the history of the condition and current approaches to its medical and surgical management and explores where management may change in more complex populations. The current state and future developments in pharmacological therapy are also outlined.

Botulinum toxin injections for neurogenic and idiopathic detrusor overactivity: A critical analysis of results.

OBJECTIVE: In recent years there has been an increasing use of the botulinum neurotoxins for the management of conditions characterised by detrusor overactivity. Early studies showed promising results in an area where few options previously existed between pharmacotherapy and surgery. This has led to an urgent need to assess the wide range of techniques and therapies available, as well as the efficacy and tolerability of the treatment. We performed a critical analysis of the numerous clinical studies for this novel treatment option in the management of neurogenic and idiopathic detrusor overactivity, with a view to directing further research and assisting urologists in the management of these conditions. METHODS: A systematic review of the literature, as well as a search for abstracts presented to relevant peer-reviewed meetings, was performed. All articles from 1988 onwards were included, prior to which no articles describing urologic use of botulinum neurotoxins had been published, although the majority of the articles have been published since 2000. RESULTS AND CONCLUSIONS: Although many of the studies were small, overwhelming evidence supports the efficacy, safety, and tolerability of the botulinum toxins, specifically serotype A, for the management of these conditions. Before this is accepted as a widespread treatment modality, good-quality evidence from large-scale randomised controlled trials is needed. These studies should identify not only the most appropriate patients to treat but also the best dose, administration technique, and frequency for treatment.

Female urethral diverticula.

PURPOSE OF REVIEW: The purpose of this review is to summarize the presentation, investigation and management of female urethral diverticulum, a condition often overlooked and frequently misdiagnosed. Hopefully, greater awareness will lead to more timely diagnosis and appropriate treatment. RECENT FINDINGS: Recently there has been considerable emphasis on correctly identifying this condition. Newer imaging modalities such as magnetic resonance imaging are now widely available and urethral diverticula that previously were unrecognized, such as noncommunicating diverticula, can now be more easily detected. The character of the diverticula can be accurately determined with appropriate imaging and this can lead to improved preoperative planning. SUMMARY: Traditional contrast studies are now being superseded by advanced cross-sectional imaging such as magnetic resonance imaging and even virtual computed tomography urethroscopy. These provide much greater tissue definition; however, very few studies directly compare the myriad of contrast-based, ultrasonographic and cross-sectional investigations that are available. Therefore, although the condition is eminently treatable, there remains little standardization in the investigation of this condition. The greatest single improvement, however, in management would come from more widespread clinical awareness of the condition and its presentation.