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.

Background: Adenosine deaminase (ADA) is already used for the differential diagnosis of tuberculosis pleurisy. Tumour necrosis factor-α (TNF) is another marker which has been investigated for this purpose. Objective: We evaluated the diagnostic value of pleural fluid and serum TNF concentrations in tuberculous pleuritis and compared them to ADA. Methods: Sixty-two patients (24 tuberculous pleuritis, 38 non-tuberculous pleuritis) with exudative pleurisy were included. Serum and pleural fluid TNF concentrations were determined in all patients and ADA activity in 54 patients. Pleural fluid TNF concentrations and pleural fluid/serum TNF were compared to pleural fluid ADA activity and pleural fluid/serum ADA. Results: When the tuberculous and non-tuberculous groups were compared, pleural fluid TNF concentrations (65.4 ± 136.9 pg/ml vs. 54.5 ± 144.2 pg/ml, respectively; p < 0.001), pleural fluid ADA activity (74.2 ± 33.3 U/l vs. 23 ± 16.3 U/l; p < 0.0001), pleural fluid/serum TNF (2.55 ± 5.23 vs. 0.26 ± 0.2; p < 0.001) and pleural fluid/serum ADA (4.58 ± 8.14 vs. 1.15 ± 0.7; p < 0.0001) were significantly higher in the tuberculous group. When cut-off points were assessed, 8 pg/ml and 40 U/l were found for pleural fluid TNF concentrations and pleural fluid ADA activity, respectively. Sensitivity, specificity, area under the curve were 87.5%, 76.3%, 0.772 for pleural fluid TNF concentrations and 90.9%, 89.5%, 0.952 for pleural fluid ADA activity, respectively; the difference between these areas under the curves was significant (p < 0.05). Conclusions: Pleural fluid TNF levels and pleural fluid/serum TNF were higher in tuberculous effusions than in other exudates, but their diagnostic value appears to be poorer than that of ADA.

Eighty-four patients (25 tb, 30 lung cancer and 29 COPD) were included in the study. ADA activity in sputum and serum was measured. Sputum ADA activities of tb patients were significantly higher than the other two groups (P < 0.05). Sputum/serum ADA ratios were similar in all groups. Sputum ADA activities between 150 and 200 U/L were the measurements with the best test performance according to the ROC curve. Sensitivity, specificity, positive predictive value, and negative predictive value were 44.0, 86.4, 57.8, 78.4% for 150 U/L and 32.0, 96.6, 80.0, 77.0% for 200 U/L, respectively. Area under the curve was 0.663. Because of low sensitivity, routine determination of ADA activity in sputum for the diagnosis of pulmonary tb is not recommended. However, it can be helpful in the diagnosis of smear-negative cases who are strongly suspected of tb.

Background and aim: Intelligent volume-assured pressure support (iVAPS) is a relatively new hybrid mode of non-invasive ventilation (NIV). There is still limited evidence for iVAPS. The aim of this study was to compare the effectiveness of iVAPS to that of bi-level positive airway pressure spontaneous/timed (BPAP S/T) in patients with acute hypercapnic respiratory failure or acute-on-chronic hypercapnic respiratory failure caused by acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in the emergency department. Material and methods:This was an observational, retrospective study. Eighty-two patients with hypercapnic respiratory failure caused by AECOPD, who were admitted to our emergency department, were analysed. Arterial blood gas (ABG) parameters, length of hospital stay and rate of intensive care unit (ICU) admission were compared between iVAPS and BPAP S/T.Results: A total of 82 patients (26 females, 56 males, mean age 68.26 ± 11.63 years) who were treated with iVAPS (N = 26) or BPAP S/T (N = 56) were enrolled. There were no significant differences between two modes with respect to demographics such as age, gender, presence of comorbidity, usage of long-term oxygen therapy or NIV, and the baseline ABG parameters. The presence of pneumonia was significantly higher in BPAP S/T (P = .01). The rate of ICU admission was 26.9% in iVAPS vs 25% in BPAP S/T. The mean length of hospital stay was 11.5 ± 12.3 days in iVAPS and 9.7 ± 7.4 days in BPAP S/T (P = .53). The mean values of ABG parameters at the 1st and 24th hours of NIV therapy did not differ in both groups. Conclusion:Both modes were similarly effective in the management of appropriately selected patients with hypercapnic respiratory failure caused by AECOPD. Hence, we underline that NIV mode selection in the emergency department should be performed in line with experiences of clinicians/institutions and accessibility of ventilator devices/modes. How to cite this article: Söyler Y, Akın Kabalak P, Saral Öztürk Z, Uğurman F. Comparing effectiveness of intelligent volumeassured pressure support (iVAPS) vs bi-level positive airway pressure spontaneous/timed (BPAP S/T) for hypercapnic respiratory failure in chronic obstructive pulmonary disease.

ulmonary alveolar microlithiasis (PAM) is a rare, chronic lung disease with unknown etiology characterized by extensive intra-alveolar spherical calcium and phosphate deposition.1 Patients with PAM have micronodular infiltration marked in the lower zones and are asymptomatic.1,2 Uptake of Tc-99m on bone scintigraphy of the lung is regarded as a pathognomonic finding. 2,3 This case report reviews the clinical, radiological and scintigraphic manifestations of PAM, and the lack of technetium uptake of the lung. Case Report A AB BS S T TR RA AC CT T Pul mo nary al ve o lar mic ro lit hi a sis (PAM) is a ra re di se a se of unk nown eti o logy charac te ri zed by ex ten si ve in tra al ve o lar cal ci um and phosp ha te de po si ti on. He re, we pre sent a case of PAM in a 26-ye ar-old fe ma le. The pa ti ent had per sis tent dry co ugh. Cli ni cal pre sen ta ti on, ra di o lo gi cal fin dings and trans bronc hi al bi opsy re sults we re con sis tent with PAM. Scin tig raphy re ve a led the ab sen ce of Tc-99m meth yle ne dip hosp ho na te up ta ke of lungs. Fa mi li al oc cur ren ce was ob ser ved. Ra di o lo gi cal fin dings, pul mo nary func ti ons, and cli ni cal sta tus of the pa ti ent have re ma i ned stab le for 24 months. Tc-99m up ta ke may not be ob ser ved at the early sta ges of this di se a se. Our ca se is at the early sta ge of the di se a se with re gar d to cli nic, ra di og rap hic and scintig rap hic fin dings. Fa mily scre e ning of PAM in dex ca ses to de tect the di se a se in early asym ptoma tic sta ge is im por tant.