The aims of the study were to assess whether C-reactive protein (CRP) is a sensitive marker for discriminating between transudative and exudative and pleural effusions to evaluate whether it can be used to distinguish inflammatory pleural effusions from other types of effusion. Pleural fluid and serum CRP levels were obtained in 97 patients with pleural effusion, using an immunoturbidimetric method (Olympus AU-600 autoanalyser). We compared CRP levels between transudates and exudates, inflammatory effusions and other types of effusion. According to the criteria used, 16 patients were included in the transudate group and 81 patients in the exudate group. Pleural fluid CRP levels were significantly lower in the transudate group (P<0.04; 14.9 +/- 4.9 mg l(-1) and 35.5 +/- 4.9 mg l(-1) respectively). Also, the ratio of pleural fluid to serum was significantly lower in the transudate group (P<0.009; 0.8 +/- 0.5 mg l(-1) and 2.8 +/- 0.7 mg l(-1), respectively). In the exudate group, 35 patients had neoplastic effusions, 10 chronic non-specific pleurisy, 19 tuberculous pleurisy, 16 parapneumonic effusion and one Dressler Syndrome. When these sub-groups were compared, the parapneumonic effusion subgroup CRP levels (mean 89 +/- 16.3 mg l(-1)) were significantly higher than those in the other subgroups, other exudate of neoplastic effusion, tuberculous pleurisy and chronic non-specific effusion and the transudate group (P<0.0001; P<0.0001; P<0.0004 and P<0.0001, respectively). The ratio between pleural fluid and serum CRP was significantly higher in the parapneumonic effusion subgroup than in the neoplastic subgroup (P<0.0002; 6.6 +/- 2.7 mg l(-1) and 1 +/- 0.2 mg l(-1), respectively). Pleural fluid CRP levels > 30 mg l(-1) had a high sensitivity (93.7%) and specificity (76.5%) and a positive predictive value of 98.4%. In the differential diagnosis of pleural effusions, higher CRP levels may prove to be a rapid, practical and accurate method of differentiating parapneumonic effusions from other exudate types. Although the high level of CRP obtained in the exudate group may be due to the number of patients with parapneumonic effusion who were included, the pleural CRP level may also be helpful in discriminating between exudative and transudative pleural effusions.
In this paper, electrical impedance tomography (EIT) ventilation images from a group of 12 patients (11 patients with emphysema and one patient with only chronic obstructive pulmonary disease (COPD) (chronic bronchitis) and a group of 15 normal subjects were acquired using a Sheffield mark 1 EIT system, at the levels of second, fourth and sixth intercostal spaces. Patients were diagnosed based on CT scans of the thorax, pulmonary function tests and posteroanterior x-ray graphs. One of the patients with emphysema has also a malignant lung tumour. Ventilation-related conductivity changes at total lung capacity (TLC) relative to residual volume were measured quantitatively in EIT images. These quantitative values demonstrate marked differences compared to those values obtained from the EIT images of 15 normal subjects. The EIT images of the patients were also compared with the CT images. In addition to the visual examination of the EIT images a statistical confidence test is applied to compare the images of the patients with the images of the normal subjects. Prior to statistical analysis all images are normalized with TLC to minimize the effect of mismatch between the TLC of different subjects. A normal mean image is created by averaging the normalized images from the normal subjects, at each intercostal space level. Than a 95% confidence interval is defined for each normal mean image. For each image of the patients, a confidence test image, which represents the deviations from the 95% confidence interval of the normal mean image, is created. The regions with emphysematous bulla and parencyhma are detectable in the confidence test images as regions of positive and negative deviations from the confidence interval of the normal mean, respectively. In the test images, it is possible to differentiate emphysematous parenchyma from emphysematous bulla, tumour structure, and COPD. However, the emphysematous bulla, the tumour structure, and COPD result in the same type of defect in the test images and are therefore indistinguishable from each other. In some case, off-plane contributions in the EIT images may result in underestimation of the defects. EIT may be a useful screening device in detecting emphysema rather than a diagnostic tool.
A field experiment was conducted during summer season of 2005 at the Research Station (altitude 180 m above sea level, 41 degrees 21' N and 36 degrees 15'E) Faculty of Agriculture, Ondokuz Mayis University, Samsun, Turkey. Experiment consisted of three irrigation levels and a non-irrigation level. Drip irrigation treatments consisted of three soil water deficits in the 90 cm soil profile depth was replenished to field capacity. Irrigation treatments were A: no irrigation, B: irrigation at 50% of available soil water capacity, C: irrigation at 30% of available soil water capacity, D: irrigation at 15% of available soil water capacity. The average seasonal water use values ranged from 257.14 to 285.71 mm in corn treatments. Irrigation frequencies (intervals) significantly affected corn crop yields. The average corn grain yields varied from 7.98 to 29.16 t ha(-1). The treatment D was recorded significantly higher corn grain yield 29.16 t ha(-1) compared to B (21.59 t ha(-1)); C (19.15 t ha(-1)) and A (7.98 t ha(-1)), respectively. According to research results, the maximum corn grain yield was obtained when the corn plants were irrigated at 15% of available soil water capacity to field capacity.
Background: The use of nasal intermittent positive pressure ventilation (NIPPV) would be expected to ameliorate dyspnea, ventilatory capacity and exercise tolerance durably in individuals with hypercapnic respiratory failure secondary to restrictive thoracic disease. Objectives: The purpose of this study was to determine the short-term effect of NIPPV on respiratory muscle endurance, exercise capacity and respiratory functions in patients with chronic respiratory failure due to restrictive thoracic disease. Methods: Twelve patients with chronic ventilatory failure due to restrictive thoracic disease underwent nasal bilevel positive airway pressure (BiPAP) ventilation for 2 h a day during 15 consecutive days. The effects were assessed by spirometry, arterial blood gas analysis, 6-min walking test, sensation of dyspnea according to the American Thoracic Society dyspnea scoring scales (ATS) and surface electromyogram of the diaphragm (EMGdi) before and after the study (on day 15). Results: Nasal BiPAP reduced the ATS dyspnea score from 2.5 ± 0.9 to 1.6 ± 0.4 (p < 0.01). Distances walked in 6 min increased from 320.66 ± 93.56 to 382.41 ± 121.20 m (p < 0.05). Comparison of baseline with levels after nasal BiPAP ventilation showed a statistically significant improvement in PaCO2 (p < 0.05). Forced vital capacity increased from 35 to 50% of the predicted value (p < 0.01). There were no statistically significant reductions in the amplitude of EMGdi after the therapy. Conclusion: These results indicate that NIPPV delivered via nasal BiPAP improves respiratory functions, exercise capacity, and reduces dyspnea in the short term in patients with chronic respiratory failure due to restrictive thoracic disease. Whether such short-term improvements can be sustained merits further study.
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