Effectiveness of medical thoracoscopy and thoracoscopic talc poudrage in patients with exudative pleural effusion

INTRODUCTION

This study aimed to assess the effectiveness of medical thoracoscopy (MT) and thoracoscopic talc poudrage (TTP) in patients with exudative pleural effusion.

METHODS

We evaluated the diagnostic yields, complications and outcomes of MT and TTP in 41 consecutive patients with symptomatic pleural effusions who were planned to undergo both procedures from 1 December 2011 to 30 November 2012. Data was reviewed retrospectively and prospectively up to March 2013.

RESULTS

Among the 41 patients, 36 underwent MT with the intent of biopsy and talc pleurodesis, 2 underwent MT for pleurodesis only and 3 had failed MT. Aetiologies of pleural effusion included lung cancer (n = 14), tuberculosis (n = 9), breast cancer (n = 7), ovarian cancer (n = 2), malignant mesothelioma (n = 1), congestive cardiac failure (n = 1), peritoneal dialysis (n = 1) and hepatic hydrothorax (n = 1); pleural effusion was undiagnosed in five patients. The overall diagnostic yield of MT, and the yield in tubercular and malignant pleural effusions were 77.8%, 100.0% and 82.6%, respectively; it was inconclusive in 22.2%. Complications that occurred were self-limiting, with no procedure-related mortality. The 30-day mortality rate was 17.1%. A total of 15 patients underwent TTP. The 30-, 60- and 90-day success rates were 77.8%, 80.0% and 80.0%, respectively, with one patient having complications (i.e. empyema). The 30-day mortality was 40.0%.

CONCLUSION

MT is a safe procedure with high diagnostic yields in undiagnosed pleural effusions. TTP is an effective method to stop recurrence of pleural effusions.     

Improved Strength and Toughness of Carbon Woven Fabric Composites with Functionalized MWCNTs

This investigation examines the role of carboxyl functionalized multi-walled carbon nanotubes (COOH-MWCNTs) in the on- and off-axis flexure and the shear responses of thin carbon woven fabric composite plates. The chemically functionalized COOH-MWCNTs were used to fabricate epoxy nanocomposites and, subsequently, carbon woven fabric plates to be tested on flexure and shear. In addition to the neat epoxy, three loadings of COOH-MWCNTs were examined: 0.5 wt%, 1.0 wt% and 1.5 wt% of epoxy. While no significant statistical difference in the flexure response of the on-axis specimens was observed, significant increases in the flexure strength, modulus and toughness of the off-axis specimens were observed. The average increase in flexure strength and flexure modulus with the addition of 1.5 wt% COOH-MWCNTs improved by 28% and 19%, respectively. Finite element modeling is used to demonstrate fiber domination in on-axis flexure behavior and matrix domination in off-axis flexure behavior. Furthermore, the 1.5 wt% COOH-MWCNTs increased the toughness of carbon woven composites tested on shear by 33%. Microstructural investigation using Fourier Transform Infrared Spectroscopy (FTIR) proves the existence of chemical bonds between the COOH-MWCNTs and the epoxy matrix.     

Relationships between intestinal parasitosis and handedness

The aim of the study was to investigate if there is a possible relation between intestinal parasitosis and handedness in patients with suspected intestinal parasitosis. Hand preference was assessed on the Edinburgh Handedness Inventory. Stool samples were examined microscopically for the presence of parasite. In the present study right-handers had many more helminth infections and left-handers had many more protozoon infections. Lower rate of helminth infections in the present study, and higher asthma incidences in the left-handed population in literature, may be associated with different immune machinery in left-handed people than in right-handed ones.     

Chronic meningococcemia cutaneous lesions involve meningococcal perivascular invasion through the remodeling of endothelial barriers

Chronic meningococcemia is a form of sepsis with frequent polymorphous skin lesions. Both in vivo and in vitro data suggest that, in these lesions, meningococci gain access from the capillary lumen to the peripheral extravascular compartment, in the absence of vascular dislocation, through a paraendothelial route.