FUNCTIONAL SEQUELAE OF TUBERCULOUS PLEURAL EFFUSION
Journal Title: Journal of Evidence Based Medicine and Healthcare - Year 2017, Vol 4, Issue 14
Abstract
BACKGROUND In patients with pleural effusion, irrespective of aetiology, the alterations in physiological states leading to restrictive lung functions and hypoxemia. In this study, we have aimed to study the effects of tuberculous pleural effusion on the pulmonary function and the predictive value of the initial severity of pleural effusion on chest x-ray and the residual pleural thickening in the severity of the restrictive abnormality. Also, we have compared the various pleural fluid characteristics in predicting the restrictive abnormality in tuberculous pleural effusion. MATERIALS AND METHODS The patients selected for the study, were initially subjected to diagnostic and therapeutic pleural tap on admission. They were then put on standard DOTS therapy. Their PFT was done on admission, then at one month, then two months and at the end of therapy at six months. Their chest X-ray was taken at monthly intervals and the residual pleural thickening was estimated. The resultant data was analysed statistically by ANOVA test, paired-t test and by Pearson’s correlation. RESULTS In our study, we have found a significant restrictive abnormality in lung function testing in our selected patients of tuberculous pleural effusion. They had a FVC% value of less than 80%. An interesting finding in our study was that, there was an element of small airway disease in our patients. This was manifested as an abnormal FET 25-75%. Also, we have found no relationship of the initial severity of pleural effusion with the final restrictive abnormality. Also, we found no correlation between the pleural fluid characteristics and the RPT. We had compared the protein concentration, ADA and lymphocyte counts with the RPT. There was no statistical difference in the group with RPT and the group without any RPT as far as these parameters is applied. So, the finding from our study does support the theory of increased hypersensitivity as the origin of RPT. In our patients, we have done therapeutic thoracocentesis on admission. PFT done immediately after this found a significant restrictive abnormality though the patients had a subjective relief of dyspnoea. On follow-up, subsequent PFTs revealed that there was significant improvement in all the parameters of PFT. All values showed statistically significant improvement after six months of treatment. The small airway obstruction is a significant finding in our study. This compels us to speculate about its pathogenesis. So far in literature no clear-cut explanation has been offered. However, endobronchial fibrosis in small airways as a result of tubercular parenchymal disease may be responsible for this. This suggests that tuberculous pleural effusion is no more a compartmentalized affection of the pleura, but also has some parenchymal component difficult to demonstrate clinically and radiologically. CONCLUSION a. Tuberculous pleural effusion causes a restrictive abnormality and small airway obstruction. b. These abnormalities improve gradually over a period of six months when the patient is on AKT. c. These abnormalities have no relation with the pleural fluid cytochemical and biochemical characteristics. d. These abnormalities also have no relationship with the initial severity of the pleural effusion or the RPT. As we can see that, one of the highlights of this study was small airway obstruction, shown uniformly in all the thirty study subjects. The mechanism of which is difficult to explain and definitely needs undertaking of further long-term and large-scale studies.
Authors and Affiliations
Sachin Venugopal Menon, Rahul Abbas, Suresh Padmini, Rakesh Pulichikkat
Keywords
Related Articles
- EP ID EP214167
- DOI 10.18410/jebmh/2017/149
- Views 63
- Downloads 0
MAST CELL PROFILE IN DISORDERS OF SKIN PIGMENTATION
Mast cell is a connective tissue element which is found throughout the body, particularly in association with blood vessels and nerves. Though the mast cells are distributed throughout the body. Increased proportion of m...
PEDIATRIC HEAD INJURIES, MECHANISM TO MANAGEMENT: EXPERIENCE OF A SINGLE CENTER
INTRODUCTION Head injury is very common in modern life. Patients of any age group may have head injury however mechanism of head injury, pathophysiology and outcome of head injury is quite different in adults as compared...
MEDICAL MANAGEMENT OF MISSED MISCARRIAGES USING VAGINAL MISOPROSTOL- A PROSPECTIVE OBSERVATIONAL STUDY
BACKGROUND Missed miscarriage is one of the common cases encountered by the practicing obstetricians all over the world. Diagnosis is made early due to increased use of ultrasound. Medical management is as effective as s...
STUDY OF EFFECT OF PER RECTAL BUSCOPAN SUPPOSITORY (10 MG) ON DURATION OF ACTIVE STAGE OF LABOUR, FROM 3 CM CERVICAL DILATATION TO DELIVERY OF BABY
BACKGROUND Term “active management of labour” means codified approach to manage women in labour. It aims at reducing discomfort and pain of mother, shortening duration of labour, and reducing cesarean section rate. Recen...
ANAESTHETIC IMPLICATIONS FOR PARTURIENT WITH GESTATIONAL DIABETES MELLITUS, THYROTOXICOSIS AND HYPERTENSION
The presence of co-morbidities during pregnancy can pose numerous challenges to the attending anesthesiologist during operative deliveries. We describe a case of a parturient who had conceived after five years of married...