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060			_aTHS00019
100			_aShrestha, Sudip. _91597
245			_aStudy of clinical and Biochemical profiles and closed needle pleural biopsy findings in patients with exudative pleural effusion.
260			_ac1998.
300			_axxxii, 86p.
500			_aThesis Report.
520			_aABSTRACT: Exudative pleural effusion is a common presentation of different intrathoracic or extrathoracic etiology. The purpose of this cross-sectional descriptive study were: i. to find out the pleural biopsy histopathology in patients with exudative pleural effusion, ii. to compare the clinical profiles in different etiological groups of the patients presenting with exudative pleural effusion and iii. to compare the biochemical profile (sugar, protein, LDH) in different etiological groups of the patients presenting with exudative pleural effusion. 40 consecutive subjects of exudative pleural effusion attending the outpatient department and indoor patient of the Department of Medicine of TUTH and Bir Hospital in the period of July 1997 to April 1998 were studied. Two patients were excluded from the study. After taking history and through physical examination the chest x-ray posterior-anterior view diagnostici pleural tapping done. Serum protein, sugar and LDH were estimated. The patients were subjected to pleural biopsy by using Abrams pleural biopsy needle. The histological findings are grouped into following headings: (a). Granulomatous, (b). Neoplastic, (c). Non specific, and (d). Normal. The mean age of the study group was 42 years (SD= 20.6). Male were more than female (Male=68.4%). Histologic finding of the pleural biopsy were: granulomatous 42.1%, neoplastic 13.2% while 44.7% were found to be non specific inflammation. The pleural biopsy was most useful in the diagnosis of tubercular pleural effusion followed by malignant pleural effusion. The clinical profiles of the three different histopathological groups had been compared and found that there was no significant different in age, sex and duration of symptoms. The symptoms like anorexia and weight loss, respiratory symptoms like cough dyspnea, chest pain were common in all. Fever was less common in neoplastic group and more common in tubercular and nonspecific group, which was statically significant. It was also found that, the emaciated, pale and ill looking patients were more often due to malignant pleural effusion. Pleural biopsy was more often diagnostic in such situation. Radiological massive pleural effusion occupying whole hemthorax was more often malignant. Pleural biopsy has high success rate to diagnose such effusion. The study of pleural fluid revealed that the serosanguinous and bloody pleural effusion in tuberculosis was rare. They were commonly straw colour: Frankly haemorrhagic effusion in the absence of trauma was commonly due to malignancy. None of the group revealed any significant difference in serum and pleural fluid ratio of sugar. LDH and protein. But when considering the parameter(sugar. LDH and protein.) individually. in granulomatous effusion (tubercular) always had sugar level > 3.33 mmol /L. Malignant pleural effusion almost always had LDH > 200 IU. The result also concluded that pleural fluid protein level through raised more than 3 gm/L most of the time not useful for etiological diagnosis in exudaative effusions. The procedure was simple and safe with minimal complication. The diagnostic vield was in the tune of 52%. Being simple and safe procedure with good diagnostic vield it should be a part of the initial investigation of every patient with pleural effusion of uncertain aetiologies.
546			_aEng.
650			_aClinical. _91619
650			_aBiochemical. _91620
650			_a Pleural Biopsy. _91621
650			_a Pleural Effusion. _91622
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942			_2NLM _cTR