Comparison of Pleural Fluid Cholinesterase estimation Vs Abbreviated Lights Criteria in Diagnosing Pleural Effusions.

Logamurthy, R (2006) Comparison of Pleural Fluid Cholinesterase estimation Vs Abbreviated Lights Criteria in Diagnosing Pleural Effusions. Masters thesis, Madras Medical College, Chennai.


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BACKGROUND : Pleural effusions are collections of fluid in the pleural spaces. The major function of the pleura and the pleural space is to permit the lungs to expand and deflate within the chest. Since the pleural space is subatmospheric with no barrier to liquid movement the space can occupy large volume of fluid. These fluid collections (Pleural effusions) are very common clinical entity. These abnormal collections of pleural fluid in the pleural spaces are either because of an increased entry of pleural fluid into the space, a decrease in exit of fluid from the space or both. These effusions are quite common clinical problems and they are associated with a myriad of clinical diseases. Traditionally pleural effusions are classified into exudates and transudates after thoracentesis. Two thirds of pleural effusions are caused by congestive cardiac failure, pneumonia, malignancy and pulmonary embolism according to literature available. It is of considerable clinical importance to differentiate between exudates and a transudates as the latter does not need any treatment . Transudates resolves by itself where as an exudative pleural effusion clearly needs an intervention. AIMS OF THE STUDY : 1. To evaluate the efficacy of Pleural fluid to Serum Cholinesterase Ratio in diagnosing pleural effusions. 2. To Compare Pleural fluid to Serum Cholinesterase Ratio with Abbreviated Light’s Criteria. MATERIALS AND METHODS : This study is a Prospective case study undertaken during a period of 8 months (Feb 2005-Sep 2005) done at Institute of Thoracic Medicine, Chetput, chennai-31 & Dept of Thoracic Medicine, Madras Medical College and Govt. General Hospital, Chennai-3. The criteria for the patients taken up for study are as follows: Inclusion Criteria : 1. Tuberculosis pleural effusions, 2. Malignant Pleural effusions, 3. Para pneumonic effusions, 4. Effusions with cardiac failure, 5. Effusions with renal failure. Exclusion Criteria : 1. Pleural effusion with more than one etiology, 2. Pleural effusion in patients with hepatic disease, 3. Pts on Oral contraceptives, 4. Pts on anticancer drug, MAOls, Neostigmine, 5. Pts on chlorpromazine. 6. Pleural effusion in patients pregnant 7. Pts with H/O exposure to pesticides. (organophosphorous compounds). A study population 80 patients with clinical and radiological evidence of Pleural effusion of diverse etiology were studied after exclusion. A relevant history and detailed clinical examination was done. RESULTS : In the present study 80 cases of patients who had pleural effusions of diverse etiology was selected. The clinical, radiological and relevant laboratory investigations and diagnostic pleural aspiration were done in all these cases. The pleural fluid was analyzed by looking for the color of the fluid, microscopy, cytology and relevant biochemical parameters which included the estimation of serum cholinesterase and pleural fluid cholinesterase. The patients were divided into 5 groups depending on the etiology of the pleural effusion. They are tuberculosis, malignant, parapneumonic, CCF, and CRF, the first three being exudates and the last two transudates. The criteria for tuberculous effusion included a clinical presentation, history of contact, radiological evidence, and sputum for AFB and culture. For transudative effusions cardiac and renal decompensation was taken into account. The inclusion criteria were pleural effusions with protein content less than 3 Gm% and no evidence suggestive of inflammatory or infectious cause. CONCLUSION : 1. The results of the present study suggest that pleural fluid to serum cholinesterase ratio is one of the most accurate criteria in classifying pleural effusion. 2. Pleural fluid to serum cholinesterase ratio has more discriminatory capacity than the pleural fluid to serum protein ratio (Abbreviated lights criteria) for the same purpose. 3. It is also simple to perform as well as more economical than the tests done for light’s criteria.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Pleural Fluid Cholinesterase estimation ; Abbreviated Lights Criteria ; Diagnosing Pleural Effusions.
Subjects: MEDICAL > Tuberculosis and Respiratory Medicine
Depositing User: Subramani R
Date Deposited: 17 Jun 2017 05:28
Last Modified: 28 Feb 2018 15:42

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