An Evaluation of the Nutrition Services for the Elderly

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Repeatability of pleural adenosine deaminase measurements in diagnostic evaluation of pleural effusions

Background

A follow‐up thoracentesis is proposed in suspected atypical tuberculosis cases. The study aimed to define the variability of pleural ADA values across repeated thoracenteses in different types of pleural effusions (PEs) and to evaluate whether ADA variance, in regard to the cutoff value of 40 U/L, affected final diagnosis.

Methods

A total of 131 patients with PEs of various etiologies underwent three repeated thoracenteses. ADA values were subsequently estimated.

Results

82% and 55% of patients had greater than 10% and 20% deviation from the highest ADA value, respectively. From those patients who had a variance of 20%, 36% had only increasing ADA values, while 19% had only decreasing values. Considering the cutoff value of 40 U/L, only in two cases, ADA decreased below this threshold, which concerned a man with tuberculous pleurisy and a woman with lymphoma both in the course of treatment. Furthermore, only in two cases with rising values, ADA finally exceeded the cutoff limit, which concerned a man with rheumatoid pleurisy and a man with tuberculous pleurisy. Surprisingly, malignant PEs (MPEs) showed a higher percentage of increasing values compared to all other exudates that did not, however, exceed the threshold.

Conclusion

The determination of pleural ADA levels is a reproducible method for rapid tuberculosis diagnosis. The detected measurement deviations do not appear to affect final diagnosis. In specific situations, repeated ADA measurements may be valuable in directing further diagnostic evaluation. More investigation is needed to elucidate the possible prognostic significance of the increasing trend in ADA values in MPEs.

     

经腹胃充盈超声造影对功能性消化不良患者胃动力障碍的诊断价值

目的 探讨经腹胃充盈超声造影对功能性消化不良患者胃动力障碍的诊断价值。方法 应用经腹胃充盈超声造影分别检查功能性消化不良患者150例（功能性消化不良组）和健康志愿者50例（对照组）,应用三维超声计算机辅助虚拟器官分析（virtual organ computer-aided analysis,VOCAL)技术测量胃体、胃窦容积,二维超声测量胃窦部胃壁蠕动波幅度、速度、频率等,并计算胃窦收缩分数和胃窦动力指数,比较两组上述测量参数的差异。绘制受试者工作特征（ROC）曲线获得胃窦蠕动波幅度、胃窦收缩分数、胃窦动力指数诊断功能性消化不良的界值,并计算其诊断效能。结果 功能性消化不良组的年龄、胃体体积、胃窦体积、胃壁蠕动频率、胃窦蠕动波速度与对照组比较,差异均无统计学意义;胃窦蠕动波幅度、胃窦收缩分数、胃窦动力指数在两组间比较,差异均有统计学意义（均P＜0.05）。ROC曲线获得胃窦蠕动波幅度、胃窦收缩分数、胃窦动力指数的诊断界值分别为8.5 mm、55.5%、24.9 mm2/s,曲线下面积分别为79.97%、77.63%、77.84%, 诊断敏感性分别为78.67%、69.33%、77.33%,特异性分别为78.00%、78.00%、80.00%,诊断符合率分别为78.50%、71.50%、78.00%,三项指标联合诊断的敏感性、特异性、诊断符合率分别为81.33%、78.00%、80.50%。结论 经腹胃充盈超声造影对功能性消化不良患者的胃动力障碍具有一定的诊断价值。