Objective.To evaluate the quantitative measurement of diaphragmatic motion in healthy subjects and to investigate the effects of different variables such as body mass index and waist circumference on the diaphragmatic motion. Methods. The study included 164 healthy subjects. The subjects were grouped according to age, sex, body mass index, and waist circumference. Measurements of diaphragmatic motion were made by a 3.5-MHz sonographic unit in the M-mode of the system. The posterior diaphragm on both sides was identified, and measurements were performed during deep inspiration. Results. The mean diaphragmatic motion measurements ± SD were 49.23 ± 10.98 and 50.17 ± 11.73 mm on right and left sides, respectively. Female subjects had statistically significantly (P < .05) decreased diaphragmatic motion (right, 46.93 ± 10.37 mm; left, 47.57 ± 10.36 mm) than male subjects. The mean diaphragmatic motion (right, 40.90 ± 8.89 mm; left, 39.37 ± 9.15 mm) was less in subjects who were underweight (P < .05) when compared with subjects who were of normal weight, overweight, and obese. Subjects who had a waist circumference of less than 70 cm showed a statistically significant decrease (P < .05) in diaphragmatic motion (right, 42.55 ± 9.12 mm; left, 42.24 ± 9.73 mm) when compared with subjects who had a waist circumference of 70 to 85, 85 to 100, and greater than 100 cm. Also, subjects younger than 30 years had statistically significantly (P < .05) decreased diaphragmatic motion (right, 44.57 ± 10.57 mm; left, 44.44 ± 11.37 mm). Conclusions. Sex, body mass index, waist circumference, and age may affect the diaphragmatic motion to some extent. Healthy persons of younger age with a smaller body mass index and waist circumference may show a decreased amount of diaphragmatic motion.

No abstract

No abstract

GirişPlörezi plevral boşlukta anormal sıvı birikmesi olarak tanımlanır ve her zaman altta yatan bir hastalığın varlığına işaret eder (1). Sıvının biyokimyası ve oluşum mekanizmasına bağlı olarak transuda ya da eksuda olarak sınıflanır. Eksüdatif sıvılarda, plevral boşluğa inflamatuar hücre-lerin toplanması söz konusudur. İnflamatuar hücre kompozisyonu ise altta yatan hastalığa göre değişkenlik gösterir. Parapnömonik sıvı ve ampiyemde hakim hücre tipi nötrofil iken malignite ve tüberkuloz'a (TB) bağlı olanlarda çoğunlukla lenfosit hakimiyeti görülür (2). Plevra sıvının nötrofil ya da lenfositden zengin olması aslında sıvının plevra boşluğunda kaldığı süre ile ilişkilidir (akutkronik inflamasyon). Klinik pratikde eksudatif plörezinin en sık nedenleri; pnömoni, TB ve malignitedir. Parapnömonik efüzyonu ve ampiyemi klinik ve plevral sıvı bulguları (nötrofil hakim sıvı yada püy) ile ayırmak kolaydır (2, 3). Bununla birlikte TB ve malignite ayrımı klinisyen için zorluk teşkil eder. Konvansiyonel plevral biokimyasal incelemelerin ayırıcı tanıda katkısı sınırlıdır. Kapalı plevra biopsisinin tanısal değeri ise yaklaşık olarak, TBP için %60-80, malign plörezi (MP) için % 50'dir (4). Bununla beraber doku kültürü, sitoloji gibi incelemelerin eklenmesiyle tanı oranları artmaktadır.Adenozin deaminaz (ADA) vücutta yaygın olarak bulunan bir enzimdir. Bu enzim sırasıyla adenozin ve deoksadenozin'in deaminasyonunu katalize eder. Lenfosit farklılaşması ve proliferasyonuyla yakın ilişkilidir. Aktivitesi lenfositlerin antijenik yanıtı süresince artar (5). Mevcut çalışmalar TBP ayırıcı tanısında ADA'nın değerli bir biokimyasal parametre olduğuna işaret etmektedir. Artmış plevral ADA düzeyinin TBP tanısında sensitivitesi %47-100, spesifitesi %50-100 arasında değişmektedir (6). Objective: To evaluate the diagnostic performance of adenosine deaminase (ADA) levels in patients with exudative lymphocytic pleurisy for the differential diagnosis of tuberculous pleurisy (TBP) and malignant pleural effusion (MPE).Methods: Data on patients with exudative lymphocytic pleurisy were retrospectively analyzed. The study population comprised 54 patients. Thirtyseven were diagnosed with TBP and 17 were diagnosed with MPE.Results: Significant differences were determined in terms of age and ADA, total protein, albumin, and LDH levels between the TBP and MPE groups. The optimal cut-off value of ADA levels was 35.1 U/L for diagnosing TBP. Sensitivity and specificity were 92% and 100%, respectively. Logistic regression analysis was performed to assess independent variables associated with TBP. Independent predictive factors in the model were ADA (OR: 1.21, 95% CI: 1.06-1.39, p=0.006)], and (OR: 0.92, 95% CI: 0.84-1.00, p = 0.052)]. The AUC value by the regression equation was 0.979 (p<0.001). When patients were categorized according to age (<50 ve ≥50), two different cut-off values (>13.51 and >35.1) for each age range were found in all, but one, TBP patients. Conclusion:ADA levels are useful for the diagnosis of TBP in cases where pleural biopsy cannot be...