07 arijitd medicine results

8/14/2019 07 ArijitD Medicine Results

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In the present study 75% cases were male and 25% were

females.

Pleural effusion affects either one or both sides. From the

present study the distribution of affection are shown in the Table3.

TABLE3

SHOWING THE DISTRIBUTION OF 40 CASES OF PLEURAL

EFFUSION AFFECTING ONE OR BOTH SIDES OF CHEST

SIDES OF

PLEURAL

EFFUSION

NUMBER

OF CASES

(N = 40 )

PERCENTAGE

(%)

Right 20 50.0

Left 12 30.0

Bilateral 8 20.0

Right sided pleural effusion was found in 50% of cases as

compared to 30% on left sides. Bilateral effusion was found in 20% of cases.

The patients of the present study were presented with various

symptoms which are shown in the following table.

TABLE4

SHOWING PRESENTING SYMPTOMS OF

THE 40 CASES OF PLEURAL EFFUSION

SYMPTOMS

NUMBER

OF CASES

(N = 40 )

PERCENTAGE

(%)

Breathlessness 35 87.5

Chest pain 21 52.5

Dry cough 26 65.0

Cough with expectoration 12 30.0

Fever 24 60.0

Night Sweat ]2 30.0

Hemoptysis 5 12.5

Others 18 45.0

RESULTS AND OBSERVATIONS 62


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The commonest symptom of presentation was breathlessness

(87.5%). Dry cough and fever were present in 65% and 60% of cases

respectively.

The erythrocyte sedimentation rates (ESR) were examined in all

40 cases of pleural effusion and the findings are shown in the following table.

TABLE 5

SHOWING ESR OF 40 CASES OF PLEURAL EFFUSION

ESR(mmAEFH)

NUMBER

OF CASES(N = 40 )

PERCENTAGE(%)

010 1 2.5

1120 3 7.5

2130 6 15.0

3140 7 17.5

4150 4 10.0

5160 6 15.0

61 70 2 5.0

7180 1 2.5

8190 1 2.5

90100 4 10.0

> 100 5 12.5

In the present study 90% of patients had an ESR above 20 mm

AEFH.

Sputum was examined for cytology in all the 40 cases of pleural

effusion irrespective of parenchymal lesions present or absent and the results

are shown in the following table.



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TABLE6

SHOWING THE RESULTS OF CYTOLOGICAL EXAMINATION OF SPUTUM

SPUTUM EXAMINATION

NUMBER

OF CASES

(N = 40 )

PERCENTAGE

(%)

Positive Gram stain for Pyogenic bacteris

Positive ZiehlNeelsen Stain for AFB

Positive pap smear for malignant cells

Negative for pyogenic organism, AFB or malignant cells

2

5

4

29

5.0

12.5

10.0

72.5

In the present study only 27.5% of 40 cases of pleural effusion

had positive cytological examination of sputum for pyogenic organism, AFB

and malignant cells. All other patients had a negative cytology.

TABLE7

SHOWING THE RESULTS OF THE SKIAGRAM

OF CHEST OF PARENCHYMAL LESIONS ONLY

RESULTS OF THE

SKIAGRAM OF CHEST

NUMBEROF CASES

(N = 40 )

PERCENTAGE

(%)

Tuberculosis 8 20.0

Malignancy 3 7.5

Pneumonic consolidation 2 5.0

No lung parenchymal changes 27 67.5

In the present study 8 patients had tubercular lesions present inchest Xray and 3 had evidence of malignancy. Pneumonic consolidations

were seen in two patients. In 67.5% of the cases (27) had no associated lung

parenchymal changes.

The pleural fluids from the 40 cases of pleural effusions on

gross examination appeared as follows.

TABLE8



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SHOWING THE PLEURAL FLUID APPEARANCES

OF THE 40 CASES OF PLEURAL EFFUSION

PLEURAL FLUID

APPEARANCE

NUMBEROF CASES

(N = 40 )

PERCENTAGE

(%)

Pale Yellow 30 75.0

Hemorrhagic 7 17.5

Turbid 3 7.5

The pleural fluid appeared pale yellow coloured in 75% of cases

and hemorrhagic in 17.5% of cases. In other 7.5% cases the pleural fluid was

turbid.

The pleural fluid was examined for cytology in all 40 cases of

pleural effusion and the results obtained are shown in table 10.

TABLE 9

SHOWING THE RESULTS OF CYTOLOGICAL EXAMINATION

OF PLEURAL FLUID OF 40 CASES OF PLEURAL EFFUSION

Cells

NUMBER

OF CASES(N = 40 )

PERCENTAGE

(%)

Lymphocytes:

Few 29 72.5

Plenty 7 17.5

Pus Cells:

Few 12 30.0

Plenty 2 5.0

RBC's: Few 6 15.0

Plenty 7 17.5

In majority of cases (72.5%) the pleural fluid contained few

lymphocytes. Plenty of RBC's and pus cells were present in 17.5% and 5%

cases respectively.



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The pleural fluid was examined for AFB, malignant cells and

culture for pyogenic organism and result are shown in the following table.

TABLE11

RESULTS OF POSITIVE PLEURAL FLUID EXAMINATION FOR AFB,

MALIGNANT CELLS AND CULTURE FOR PYOGENIC ORGANISMS

Pleural fluid for

NUMBER

OF CASES

(N = 40 )

PERCENTAGE

(%)

Acid fast bacilli 4 10.0

Malignant cells 3 7.5

Culture for pyrogenic organism 2 5.0

The etiologic diagnosis could be made in 22.5% of cases. Acid

fast bacilli and malignant cells were demonstrated in 10% & 7.5% each and

pyogenic organism was isolated in 5% of cases. In 31 cases (77.5%) all the

smear studies were negative for AFB, malignant cells and culture for poygenic

organism.

Pleural biopsy was done in 11 cases of pleural effusion in thepresent study and the results are shown in the Table12.

TABLE 12

RESULTS OF THE PLEURAL BIOPSY IN

SELECTED CASES OF PLEURAL EFFUSION

PLEURAL BIOPSY

RESULTS

NUMBER

OF CASES

PERCENTAGE

(%)

Tuberculosis 8 20.0

Adenocarcinoma 2 5.0

Non Hodgkin's lymphoma 1 2.5

TOTAL 11 27.5

Pleural Biopsy was done in 11 cases & on comparing with the

etiological diagnosis of 40 cases of pleural effusion, 20% of biopsy came out

to be tuberculosis & 7.5% were malignancies.



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TABLE 13

THE CAUSES OF THE 40 CAUSES OF PLEURAL EFFUSION

CAUSESNUMBEROF CASES

(N = 40 )

PERCENTAGE

(%)

Transudates:

Heart failure

Cirrhosis

Nephrotic syndrome

Pericardial effusion

6

4

3

1

15.0

10.0

7.5

2.5

Exudates :

Tuberculosis

Neoplasm

Parapneumonic effusion

Rheumatoid Arthritis

15

8

2

1

37.5

20.0

5.0

2.5

Among the transudates 15% cases are caused by congestive

heart failure and 37.5% of exudates are caused by tuberculosis.

TABLE 14

PLEURAL FLUID PROTEIN CONCENTRATION

OF THE 40 CASES OF PLEURAL EFFUSION

PROTEIN

CONCENTRATION IN

PLEURAL FLUID

(g/dl)

NUMBER

OF CASES

(N = 40 )

PERCENTAGE

(%)

1.02.0

2.13.0

3.14.0

4.15.0

3

15

0

22

7.5

37.5

0.0

55.0

In 55% of cases pleural fluid protein concentrations were above

3 g/dl & in 45% the protein concentration was 3 or below 3 g/dl.

The graphical representation of the above table is shown in

Fig. 1.



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TABLE 15

SHOWING THE DISTRIBUTION OF PLEURAL FLUID

TO SERUM PROTEIN RATIO

PLEURAL FLUID

TO SERUM

PROTEIN RATIO

NUMBER

OF CASES

(N = 40 )

PERCENTAGE

(%)

0.010.25

0.260.50

0.510.75

0.761.00

0

17

17

6

0.0

42.5

42.5

15.0

In 57.5% of cases pleural fluid protein to serum protein was

above .5 & in 42.5% cases it was 0.5 or below 0.5


Fig. 2.

TABLE16

SHOWING THE DISTRIBUTION OF PLEURAL FLUID LDH

PLEURAL

FLUID LDH

(U/L)

NUMBER

OF CASES

(N = 40 )

PERCENTAGE

(%)

0200

201400

401600

601800

16

3

16

5

40.0

7.5

40.0

12.5

In 60% of cases Pleural Fluid LDH is greater than 200 U/L & in

40% cases it is equal or less than 200 U/L.


Fig. 3.

TABLE 17



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SHOWING THE DISTRIBUTION OF PLEURAL FLUID LDH TO SERUM LDH

PLEURAL FLUIDLDH/SERUM LDH

NUMBER

OF CASES(N = 40 )

PERCENTAGE(%)

0.000.30

0.310.60

0.610.90

0.911.20

1.211.50

2

11

10

6

11

5.0

17.5

25.0

15.0

27.5

In 67.5% of cases Pleural fluid LDH to serum LDH is above 0.6& in 32.5% it is equal or less than 0.6


Fig. 4.

TABLE 18

SHOWING DISTRIBUTION OF SEAG [SERUMEFFUSION ALBUMIN

GRADIENT] IN 40 CASES OF PLEURAL EFFUSION

SEAG

NUMBER

OF CASES(N = 40 )

PERCENTAGE(%)

0.300.60

0.610.90

0.911.20

1.211.50

1.511.80

1.812.10

2.112.40

3

4

19

10

3

0

1

7.5

10

47.5

25

7.5

0

2.5

In 35% of cases SerumEffusion Albumin gradient is above 1.2

g/dl & in 65% of cases it is equal or less than 1.2 g/dl.


Fig. 5.

TABLE 19



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SHOWING EXUDATES & TRANSUDATES SEPARATED BY PLEURAL

FLUID PROTEIN OF 3 gms/dl IN COMPARISON TO THE

ESTABLISHED DIAGNOSIS OF TRANSUDATES & EXUDATES

TYPES OF

PLEURAL

FLUID

ETIOLOGICALLY

DIAGNOSED

(N = 40)

NUMBER OF

CASES

DIFFERENTIATED

BY PLEURAL

FLUID PROTEIN

OF 3 g/dl

NUMBER

OF CASES

TRULY

CLASSIFIED

NUMBER OF

CASES

FALSELY

CLASSIFIED

Exudate

Transudate

26

14

22

18

16

14

6

4

The Pleural fluid Protein of 3g/dl separated 22 cases (55%) as

exudates & 18 (45%) as transudate. When etiology was reviewed 6 of the

exudates & 4 of the transudates were fa lsely classified. A total

misclassification of 25% occurred.


Fig. 6.

TABLE 20

SHOWING EXUDATES & TRANSUDATES SEPARATED BY PLEURALFLUID PROTEIN TO SERUM PROTEIN OF .5 IN COMPARISON TO THE

ESTABLISHED. DIAGNOSIS OF TRANSUDATES & EXUDATES

TYPES OF

PLEURAL

FLUID

ETIOLOGICALLY

DIAGNOSED.

(N = 40)

NUMBER OF

CASES

DIFFERENTIATED

BY P/S PROTEIN

OF 0.5

NUMBER

OF CASES

TRULY

CLASSIFIED

NUMBER OF

CASES

FALSELY

CLASSIFIED

Exudate

Transudate

26

14

23

17

18

14

5

3

The pleural fluid to serum protein ratio of .5 separated 23 cases

(57.5%) as exudates & 17 (42.5%) as transudates. When etiology was

reviewed 5 of the exudates & 3 transudates were falsely classified. Total


The graphical representation of the above Table20 is shown in



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Fig. 7.

TABLE 21

SHOWING EXUDATES & TRANSUDATES SEPARATED BY PLEURAL

FLUID PROTEIN OF 3g/dl & PLEURAL FLUID TO SERUM PROTEIN

RATIO OF .5 IN COMPARISON TO THE ESTABLISHED.

DIAGNOSIS OF EXUDATES & TRANSUDATES

TYPES OF

PLEURAL

FLUID

ETIOLOGICAL

DIAGNOSIS

(N = 40)

NUMBER OF

CASES

DIFFERENTIATED

BY P.F. PROTEIN

3g/dl & P/S OF 0.5

NUMBER OF

CASES

TRULY

CLASSIFIED

NUMBER OF

CASES

FALSELY

CLASSIFIED

Exudate

Transudate

26

14

22

18

18

15

4

3

Pleural fluid protein of 3g/dl & p/s of .5 separated 22(55%)

cases as exudates & 18(45%) as transudates. When the etiology was reviewed

4 of the exudates & 3 of the transudates were falsely classified. Total

misclassification rate of 17.55% occurred.


Fig. 8.

TABLE 22

SHOWING EXUDATES & TRANSUDATES SEPARATED BY

PLEURAL FLUID LACTATE DEHYDROGENASE (LDH) OF 200 U/L

TYPES OF

PLEURAL

FLUID

AETIOLOGICAL

DIAGNOSIS

(N = 40)

NUMBER OF

CASES

DIFFERENTIATED

BY PLEURAL

FLUID LDH OF

200 U/L

NUMBER OF

CASES

TRULY

CLASSIFIED

NUMBER OF

CASES

FALSELY

CLASSIFIED

Exudate

Transudate

26

14

24

16

20

13

4

3

Pleural fluid LDH of 200 U/L separated 24 (60%) as exudates &

16 (40%) as transudates. When etiology was reviewed 4 of exudates & 3 of

transudates were falsely classified. Total misclassification of 17.5% occurred.

The graphical representation of the above Table22 is shown in



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Fig. 9.

TABLE 23

SHOWING EXUDATES AND TRANSUDATES SEPARATED BY PLEURAL

FLUID LDH TO SERUM LDH OF O.6 IN COMPARISON TO THE ESTABLISHED


TYPES OF

PLEURAL

FLUID

AETIOLOGICAL

DIAGNOSIS

(N = 40)

NUMBER OF

CASES

DIFFERENTIATED

BY P/S LDH OF 0.6

NUMBER

OF CASES

TRULY

CLASSIFIED

NUMBER OF

CASES

FALSELY

CLASSIFIED

Exudates

Transudates

26

14

27

13

24

11

3

2

Pleural fluid LDH to Serum LDH of .6 separated 27 (67.5%) as

exudates & 13 (32.5%) as transudates. When the etiology was reviewed 3 of

the Exudates & 2 transudates were falsely classified. Total misclassification

of 12.5% occurred.


Fig. 10.

TABLE 24

SHOWING EXUDATES & TRANSUDATES SEPARATED BY

PLEURAL FLUID LDH OF 200 U/L & PLEURAL FLUID LDH

TO SERUM LDH OF 0.6 IN COMPARISON TO THE

ESTABLISHED DIAGNOSIS OF EXUDATE & TRANSUDATE

TYPE OFPLEURAL

FLUID

ETIOLOGICALDIAGNOSIS

( N = 40 )

NUMBER OF CASES

DIFFERENTIATED BYPLEURAL FLUID LDH

OF 200 U/L &

P/S LDH OF 0.6

NUMBER

OF CASESTRULY

CLASSIFIED

NUMBER OF

CASESFALSELY

CLASSIFIED

Exudate 26 28 26 2

Transudate 14 12 10 2

Pleural fluid LDH of 200 U/L & pleural fluid LDH to serum

LDH of .6 seperated 28 ( 70% ) cases as exudates & 12 ( 30% ) as transudates



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when etiology was reviewed 2 of the exudates & 2 of the transudates were

falsely classified. Total misclassification of 10% occurred.


Fig. 11.

TABLE 25

SHOWING NUMBER OF CASES SEPARATED BY SERUMEFFUSION

ALBUMIN GRADIENT OF 1.2 g/dl IN COMPARISON TO THE ESTABLISHED


TYPE OF

PLEURAL

FLUID

AETIOLOGICAL

DIAGNOSIS

NUMBER OF CASES

DIFFERENTIATED

BY SEAG

OF 1.2 G/DL

NUMBER

OF CASES

TRULY

CLASSIFIED

NUMBER OF

CASES

FALSELY

CLASSIFIED

Exudate 26 26 25 1

Transudate 14 14 13 1

SerumEffusion Albumin gradient of 1.2 g/dl separated 26

(65%) cases as exudates & 14 (35%) as transudates when etiology was

reviewed only 1 exudate & 1 transudate was falsely classified. Total



Fig. 12.



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TABLE 26

MEAN (M) VALUES, RANGES (R), STANDARD DEVIATIONS (SD),

OF PARAMETERS STUDIED IN 40 CASES OF PLEURAL EFFUSIONS

Parameter CharacterTransudates(N = 14)

Exudates(N = 26)

Tubercular(N = 15)

Non

Tubercular(N = 2)

Neoplasm(N = 8)

Others(N = 1)

pvalue

PleuralFluid

Proteinof 3g/dl

M 2.534 4.344 3.33 3.78 3.69

R 1.923 4.184.69 1.924.69 2.734.63 2.414.52

SD 0.344 0.143 0.946 1.34 0.898

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07 arijitd medicine results

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