Tumour necrosis factor, interleukin-1 and adenosine deaminase in tuberculous pleural effusion

AbstractTumour necrosis factor (TNF) and interleukin-1 (IL-1) are powerful mediators with a key role in inflammation. This study was undertaken to study the presence of TNF and IL-1 in tuberculous effusion where there is marked inflammation and where examination of the pleural fluid may give information about the local inflammatory reaction. Adenosine deaminase activity (ADA, a marker of TB pleurisy) was also tested. Tumour necrosis factor, IL-1 and ADA levels were measured in the pleural fluid and serum of 97 patients; 33 with tuberculous effusion, 33 with malignant effusion, and 31 patients with benign non-tuberculous effusion. Pleural fluid TNF and ADA levels were higher in tuberculous (TB) patients than in patients with benign disorders or cancer (P<0·01). Serum TNF levels were also higher in TB patients than other benign (P<0·01) or malignant (P<0·05) effusions. There was a positive correlation between serum and pleural fluid values (r=0·998–0·999, P<0·001) although pleural fluid concentration was higher (P<0·001), possibly suggesting local production in the pleural cavity. Pleural fluid IL-1 levels were not raised in any patient group but there was a positive correlation between TNF and IL-1. In addition, a positive correlation was found between TNF and ADA levels, probably indicating some common production mechanism. Furthermore, ADA sensitivity in the diagnosis of tuberculous effusion was augmented by the combined use of TNF and ADA. The use of both these markers may prove useful in the differential diagnosis of TBC pleurisy

Non-invasive measurement of the mean alveolar O-2 tension from the oxygen uptake versus tidal volume curve

Aims: The classical equations for measuring the mean and the ideal alveolar O-2 tension are based on assumptions, which are shown to be invalid. So we thought to develop a new, non-invasive method for measuring the mean alveolar P,O-2 within the volume domain (PA,O-2(Bohr)). This method is based on the oxygen uptake vs. tidal volume curve (VO2 vs. VT) obtained during tidal breathing of room air and/or air enriched with oxygen. Methods: PA,O-2(Bohr) and the ideal alveolar PO2 (PA,O-2(ideal)) were simultaneously measured in 10 healthy subjects and 34 patients suffering from chronic obstructive pulmonary disease (COPD) breathing tidally room air at rest. Additionally, 10 subjects (three healthy subjects and seven COPD patients) were studied while breathing initially room air and subsequently air enriched with oxygen. Results: According to the results, PA,O-2(Bohr) considerably differed from PA,O-2(ideal) (P = 0.004). The cause of the difference, at the individual’s R, is: (1) the difference between the arterial and Bohr’s alveolar CO2 tension, mainly in COPD patients, and (2) the inequality between Bohr’s alveolar part of the tidal volume for CO2 and O-2. Furthermore, end-tidal gas tension (PET,CO2 and PET,O-2) differed from Pa,CO2 and PA,O-2(Bohr) respectively. Conclusion: The deviation of PA,O-2(Bohr) from PA,O-2(ideal) has a definite impact on Bohr’s dead space ratio for O-2 and CO2, and on the alveolar-arterial O-2 difference. The difference (PA,O-2(Bohr) - PA,O-2(ideal)) is not related to the pathology of the disease. So, gas exchange within the lungs should be assessed at the subject’s R from PA,O-2(Bohr) and PA,CO2(Bohr) but not from PA,O-2(ideal) nor Pa,CO2

Clinical and microbiological evaluation of pefloxacin in lower respiratory tract infections

Patients with Gram-negative lower respiratory tract infections (acute exacerbation of chronic bronchitis (n = 23), pneumonia (n = 4), and bronchiectasis (n = 5) were treated with pefloxacin, 400 mg twice daily, given either intravenously or orally. Symptoms, signs and sputum volume and colour were monitored daily, Chest X-rays, sputum culture and Gram-stain examinations were carried out on days 1 and 5, and immediately alter the end of the treatment. There was a clinical improvement, as indicated by the incidence of cough, dyspnoea and rales, and by sputum volume and colour in 31 patients (97%). Microbiological improvement. as indicated by the complete elimination of sputum pathogens and pus cells, was achieved in 28 of the patients (88%), In one patient, an adverse effect, renal failure, occurred. These results suggest that pefloxacin is both clinically and microbiologically effective for the treatment of Gram-negative lower respiratory tract infections