Pleural effusion is a commonly encountered problem in clinical practice, and pleural fluid analysis is usually the first step towards identifying the underlying etiology. Numerous studies have been published analyzing the potential utility of measuring biomarkers in pleural fluid as possible indicators of a malignant effusion; however, there are no studies that have examined the presence of human epididymis 4 (HE4) in pleural effusions. The aims of this study were to assess pleural effusion and serum concentrations of HE4 in patients with different types of pleural effusions and to evaluate the diagnostic performance of HE4 in detecting malignant pleural effusion. A prospective cohort study was carried out of 88 consecutive patients presenting with pleural effusions. The patients were divided into three groups: 22 patients with transudative effusions, 32 patients with non-malignant exudative effusions, and 34 patients with malignant pleural effusions. Blood and pleural fluid HE4 levels were measured using immunoassay. Both serum HE4 levels and pleural effusion HE4 levels were significantly higher in patients with malignant effusions than in patients with transudative or non-malignant exudative effusions. A pleural fluid HE4 cutoff value of 1,675 pmol/L was found to predict malignant pleural effusions with a diagnostic sensitivity of 85.3 % and specificity of 90.7 %. The current study reports a novel finding of increased serum and pleural fluid HE4 levels in patients with malignant effusions compared to non-malignant effusions. This finding has the potential to strengthen the diagnostic performance of tumor markers in detecting malignant pleural effusions.

Six patients with watery postvagotomy diarrhoea and 4 patients with intractable diabetic diarrhoea were treated with cholestyramine. The diarrhoea responded completely to therapy, during which the stool content of water, sodium, postassium and magnesium fell. Two of the patients, while receiving cholestyramine, had a rise in faecal fat, but this was not accompanied by diarrhoea, the stools being well formed. Evidence is presented which suggests that the mechanism of diarrhoea is similar in both disorders and is due to division or neuropathy of the hepatic fibres of the vagus nerve. This results is distension of the gallbladder, contraction of which expels increased quantities of bile salts, which swamp the reabsorptive capacity of the small intestine and induce diarrhoea by direct action on the colon. If this theory is valid, cholecystectomy, by preventing large quantities of concentrated bile salts from suddenly entering the gut, may result in improvement of postvagotomy and diabetic diarrhoea.

Kratak sadr`aj: Poreme}eni nivoi fosfata u serumu mogu dodatno oslabiti respiratorne mi{i}e, {to negativno uti~e na pacijente sa hroni~nom opstruktivnom bole{}u plu}a (HOBP). Nedavno je pokazano da faktor rasta fibroblasta 23 (FGF-23) ima va`nu ulogu u regulisanju nivoa fosfata u telu. Ova studija obuhvatila je dve grupe: 70 pacijenata sa HOBP i 34 kontrolna subjekta. Uzeti su uzorci krvi za panel rutinskih laboratorijskih testova. FGF-23 meren je pomo}u komercijalnih ELISA testova. Nivoi FGF-23 u plazmi bili su zna~ajno vi{i u grupi pacijenata nego u kontrolnoj grupi (P=0,000). Maksimalna tubularna apsorpcija fosfata bila je zna~ajno sni`ena kod pacijenata sa HOBP u pore|enju sa kontrolnom grupom (P=0,04). FGF-23 u plazmi bio je u negativnoj korelaciji sa FEV1 i albuminom u serumu. Povi{eni nivoi FGF-23 u plazmi kod obolelih od HOBP u korelaciji su sa stadijumom oboljenja i mo`da predstavljaju dodatni faktor odgovoran za nizak nivo fosfata u serumu.

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