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08 ArijitD Medicine Discussion

08 ArijitD Medicine Discussion

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Published by: Lakshya J Basumatary on Jul 14, 2009
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DISCUSSION
n the evaluation of a pleural effusion the first step is to differentiate thetransudates & exudates. It bears its implication in arriving at an etiologicaldiagnosis as the diagnostic and the therapeutic strategies for the transudatesand exudates are different. An exudative effusion requires extensivesometimes invasive procedures for its etiological diagnosis, on the other handa transudative pleural effusion requires treatment directed only towards the primary disease process. Histopathological examinations are confirmatory, butit has its limitations ions as the specimen yield is very low, sometimes up to30% [Escudero
et al 
1990] and being an invasive technique it has itshazards.The laboratory parameters such as Light’s criteria [Light
et al 
1972], pleural fluid protein value has variable results in the differential diagnosis asreported by many workers.
i
Keeping all these factors in mind the present study wasundertaken to study the significance of serum–effusion albumin gradient indifferential diagnosis of pleural effusion and compare with the alreadyestablished Light’s criteria.The present study comprised of 40 cases of pleural effusion inwhich the etiology was established by clinical examination, Radiologicalinvestigations, pleural fluid cytology, special laboratory methods andhistopathological examination of pleural biopsy specimen in selected cases. In the present series 75% were male and 25% cases were females belonged to age groupof 13–83 years. Among 40 cases of transudates and exudates, 50% had right sided pleural effusion, 30% had left sided and 20% had bilateral pleural effusions.
 Differential Diagnosis of Transudates and Exudates:
Classically pleural effusion are divided into transudates andexudates. In the present study of 40 cases of pleural effusion 65% wereestablished as exudates and 35% as
 
transudates.
 
 Pleural Fluid Proteins in Differential Diagnosis of Pleural  Effusion:
In the present study of 40 cases of pleural 55% of exudates &45% of transudates were differentiated by a pleural fluid protein value of 3g/dl. The sensitivity and specificity of these parameters is 80% & 70%respectively. Total misclassification of 25% occurred with this parameter ie23.07% misclassified exudates and 28.52% of treansudates.In a study, Carr & Power [1958] showed that a pleural fluid protein value of 3 g/dl could differentiate 64% of exudates & 50% of transudates with total misclassification of 21%.In a study by K.B. Gupta
et al 
showed that pleural fluid proteinvalue of 3 g/dl misclassified 25% of exudates and 18.7% of transudate withsensitivity and specificity of 83.3% and 75% with total misclassification of 20%.
 Pleural Fluid to Serum Protein in Differential Diagnosis of  Pleural Effusion:
In the present study of 40 cases of pleural effusion pleural fluidto serum protein ratio of.5 separated 57.5% as exudates & 42.5% astransudates with sensitivity and specificity of 85% & 73.7% with totalmisclassification rate of 20%. This parameter correctly classified 81% of exudates and 85% of transudates. Misclassification rate for transudates21.42% and for exudates is 1.9%.Light
et al 
[1972]; in their study reported that a pleural fluid toserum protein ratio of >0.5 correctly classified 92% of transudates & 90% of exudates.Valdes
et al 
[1991] also found in their study that this parameter correctly classified 89% of transudates and 84% of exudates.
DISCUSSION
 
76
 
Ram
et al 
[1995] also reported that the pleural fluid protein toserum protein ratio of 0.5 correctly classified 81.5% of transudates and allexudates with a misclassification rate of 15%.K.B.
et al 
found a sensitivity and specificity of 85% and 66.6%with this parameter and are total misclassification of 18%.From the above results by the above results by the other workersit is found that results obtained in the present study are comparable. Themisclassification rate is higher in the present study.
 Pleural Fluid Protein and Pleural Fluid to Serum Protein Ratio in Differential Diagnosis of Pleural Effusion:
In the present study of 40 cases of pleural effusion pleural fluid protein of 3 g/dl and p/s of.5 separated 55% as exudates and 45% astransudates with true classification rate of 82% as exudates and 83.3% astransudates. Total misclassification rate of 17.5% occurred.
 Pleural Fluid LDH in Differential Diagnosis of Pleura Effusion:
In the present study of 40 cases of pleural effusion pleural fluidLDH of 200 U/L separated 60% as exudates and 40% as transudate. Trueclassification was 87% for exudates and 82% for transudates. Totalmisclassification of 17.5% occurred. The sensitivity and specificity of this parameter is 86% & 77%.K.B. Gupta
et al 
found a sensitivity and specificity of 80% &75% with this parameter with total misclassification of 21.6% occurred.From the above results by other workers it is found that resultsfound in the present study are comparable. The misclassification rate in the present study is 17.5% ie low compared to the above study.
DISCUSSION
 
77

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