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Ultrasonografija pluća u dijagnostici i praćenju pneumonija kod dece / Lung ultrasonography in the diagnosis and follow-up of pneumonia in childrenBalj Barbir Svetlana 29 September 2016 (has links)
<p>Uvod: Pneumonije su jedne od najčešćih infekcija u dečjem uzrastu, a rendgenografija (RTG) grudnog koša se još uvek smatra metodom izbora za potvrđivanje dijagnoze. Cilj istraživanja je bio ispitivanje uloge ultrasonografije (US) pluća u dijagnostici i praćenju pneumonija kod dece. Materijal i metode: Istraživanje prospektivnog karaktera sprovedeno je u Institutu za zdravstvenu zaštitu dece i omladine Vojvodine i obuhvatilo je 130 pacijenata uzrasta od 3 meseca do 18 godina kod kojih je zbog kliničke sumnje na pneumoniju bio načinjen RTG i US pregled pluća, u vremenskom razmaku do 24h. Kao referentni standard za utvrđivanje pouzdanosti US, RTG i auskultatornog pregleda u dijagnostici pneumonije korišćena je završna dijagnoza pneumonije pri otpustu iz bolnice. US kriterijum za postavljanje dijagnoze pneumonije bio je nalaz subpleuralne konsolidacije plućnog parenhima. Deca sa US znacima pneumonije praćena su do potpune normalizacije US nalaza, a kod većine su kontrolni pregledi rađeni u vremenskim intervalima od 7-10 dana. Rezultati: Dijagnoza pneumonije je ustanovljena kod 105/130 (80,8%) pacijenata. US nalaz je ukazivao na pneumoniju kod 99/105 (senzitivnost 94,3%), a bio je negativan kod 25/25 pacijenata koji nisu imali pneumoniju (specifičnost 100%), dok je RTG bio pozitivan kod 98/105 (senzitivnost 93,3%), a negativan kod 23/25 pacijenata (specifičnost 92%). US je bila osetljivija od RTG metode u detekciji plućnih konsolidacija manjih od 15mm. Promene plućnog intersticijuma su registrovane ultrasonografijom kod 50/105 (47,62%), a rendgenografijom kod 21/105 (20%) pacijenata. Pleuralni izliv je registrovan ultrasonografijom kod 24/105 (22,86%), a rendgenografijom kod 14/105 (13,33%) pacijenata. Tokom kontrolnih pregleda utvrđeno je umereno do značajno slaganje US i kliničke procene toka bolesti (k=0,406-0,621). Kod pacijenata sa potpunom kliničkom, a nepotpunom US regresijom pneumonije, najčešće su bile zastupljene konsolidacije manje od 15mm. Prosečan broj dana do potpune regresije US nalaza je iznosio 16,3±10,24 dana. Zaključak: Ultrasonografija pluća u dijagnostici pneumonija kod dece je pouzdana kao i rendgenografija. Ultrasonografija pluća treba da postane deo standardnog protokola dijagnostike pneumonije kod dece.</p> / <p>Background: Pneumonia is one of the most common infections in the pediatric population and chest radiography (CR) is still considered the method of choice to confirm the diagnosis. The aim of the study was to investigate the role of lung ultrasonography (LUS) in the diagnosis and follow-up of pneumonia in children. Methods: A prospective study was carried out in the Institute for Children and Youth Health Care of Vojvodina and it included 130 children with clinically suspected pneumonia, aged 3 months to 18 years, in whom CR and LUS were performed within 24h. The final diagnosis of pneumonia at discharge was used as a reference test to determine the reliability of LUS, CR and auscultatory findings in the diagnosis of pneumonia. A LUS finding of subpleural lung consolidation was considered a diagnostic sign for pneumonia. The children with LUS signs of pneumonia were followed up until complete resolution of the LUS findings. In most children, the follow-up LUS examinations were performed in time intervals of 7-10 days. Results: A final diagnosis of pneumonia was confirmed in 105/130 (80.8%) patients. LUS was positive in 99/105 patients (sensitivity 94.3%) and negative in 25/25 (specificity 100%), whereas CR was positive in 98/105 (sensitivity 93.3%) and negative in 23/25 (specificity 92%). LUS was superior to CR in the detection of lung consolidations less than 15mm. Interstitial lung changes were detected by LUS in 50/105 (47.62%) patients and by CR in 21/105 (20%). LUS was able to detect pleural effusion in 24/105 (22.86%) patients, whereas CR detected pleural effusion in 14/105 (13.33%). During the follow-ups, moderate to substantial agreement between LUS and clinical evaluation of the course of the disease was obtained (k=0.406-0.621). In children with complete clinical and incomplete US regression of pneumonia, consolidations less than 15 mm were the most prevalent finding. The average time period until complete resolution of the LUS findings was 16.3 ±10.24 days. Conclusions: Lung ultrasonography in the diagnosis of pneumonia in children is just as reliable as radiography. Lung ultrasonography should be included in the standard diagnostic protocol of pneumonia in children.</p>
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Talkum-PleurodeseLuplow, Silke 03 February 2006 (has links)
Die Talkumpleurodese stellt ein effektives Verfahren zur Behandlung von rezidivierenden malignen Pleuraergüssen dar. Sie ist ein rein palliatives Verfahren. Das Auftreten des malignen Pleuraergusses stellt den Beginn des letzten Lebensabschnittes eines Tumorpatienten dar. Es ist verbunden mit dem Kardinalsymptom Dyspnoe. Um diese zu lindern, wird im blinden Aktionismus die operative Pleurodese angeboten. Dieses führt zu einer hohen perioperativen Mortalität. In 36 Monaten (1997-1999) wurden in unserer Klinik 115 operative Talkum-Pleurodesen durchgeführt. Die perioperative Letalität lag bei 7,8 %. Die häufigsten Primärtumoren waren Mammakarzinom (MÜL 12,4 Monate), Bronchialkarzinm (MÜL 6,2 Monate), CUP (MÜL 10,7 Monate) Ovarialkarzinom (MÜL 2,2 Monate) und Mesotheliom (MÜL 10,9 Monate). Die Patienten mit Mammakarzinom, Bronchialkarzinom und Ovarialkarzinom litten postoperativ deutlich gehäufter unter erneuter Luftnot. Es ist daher nötig, Standards festzulegen, um ein geeignetes Patientengut zu behandeln. In der Literatur finden sich eindeutige Zusammenhänge zum Karnofsky-Index des Patienten sowie zu den Laborparametern pH (kritisch / Talc pleurodesis is the most effective treatment für malignant pleural effusions. It is a palliative procedure. The appearance of a malignant pleural effusions marks the beginning of the last part of life of a patient with cancer. The cardinal symptom is dyspnoea. To allay, we offer surgical pleurodesis, offen in blind action. This is causing high mortality. We performed 115 thoracoscopic talc pudrages between 1997 and 1999 (36 month). The inpatient mortality was 7,8%. The most offen origins of metastatic carcinoma were Breast cancer (MS 12,4 month), Lung cancer (MS 6,2 month), Carcinoma of unknown primary (MS 10,7 month), Malignant mesothelioma (MS 10,9 month) and Ovarian cancer (MS 2,2 month). The patients with Breast-, Lung- and Ovarian cancer suffered the must from dyspnoea after pleurodesis. That''s why it is necessary, to find standards to choose suitable patients, which profit. In literature there are definite connection between Karnofsky Performance Scale of a patient, pleural fluid pH (critically
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Estudo comparativo de diferentes formas de protecao em modelo de fistula bronquica em ratosSchneider, Airton January 1995 (has links)
Os autores apresentam os resultados obtidos no desenvolvimento de um modelo experimental de fístula brônquica e na comparação de diferentes formas de proteção no modelo de fístula brônquica desenvolvido. Para isso, foram utilizados ratos submetidos a pneumonectomia esquerda e o coto brônquico protegido com músculo intercostal ou gordura pericárdica pediculados. Os resultados demonstraram ser possível o desenvolvimento de um modelo de fístula brônquica em ratos com 65% de confiança e que não há diferença estatística (p>0,05) entre tecidos utilizados na proteção brônquica, desde que sejam pediculados. / The authors present the resulte obtained after the development of an experimental model of bronchíal fistula and the comparison among different forms of post-pneumonectomy bronchial fistula protection. In order to achieve 'ha',were used rats that undergone left pneumonectomy whose bronchial stump was protected with either pedided muscle or pedicled fat. The results showed that it was possible to develop a bronchial fistula model with 65% of certainty and there was no slatistical difference (p>0,05) among the tissues used for bronchial protection, once they were pedicled.
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Extrapulmonary tuberculosis in HIV-positive and HIV-negative children in Haiti: A hospital-based InvestigationDenis, Marie F 01 June 2005 (has links)
Introduction: Globally, one in four persons infected with the human immunodeficiency virus (HIV) who are living with the acquired immunodeficiency syndrome (AIDS) will die of tuberculosis (TB). The estimated number of HIV-infected children who die of tuberculosis, especially extrapulmonary TB (EPTB), in Haiti, is only loosely based on facts or investigation. This study proposes to describe demographics of children with EPTB in a pediatric TB hospital in Haiti. The objectives are two-fold. The first objective is to describe the population of children discharged from Grace Children's Hospital with a confirmed diagnosis of tuberculosis overall, and broken down by whether or not the child had an extrapulmonary manifestation of the TB disease. Specifically, we describe the demographic characteristics and the prevalence of HIV and other co-morbidities of the children, in-hospital mortality, and the diagnostic tools used to determine TB infection including the sputum test, and th
e documentation of family members also infected. As part of the descriptive process, by examining those with only pulmonary TB (PTB) and EPTB separately, we investigate if they appear to be different sub-populations based on demographic characteristics and clinical measures. The second objective of this work is to determine if there is a positive association between HIV infection and the EPTB manifestation in children with a confirmed diagnosis of TB, both crudely and after adjusting for demographic variables and co-morbidities. Methods: A cross-sectional study design was used to review medical charts of clinically diagnosed pediatric TB cases for a five-year period (January 1, 1999 --
December 31, 2003). This included 492 pulmonary TB and 210 extrapulmonary TB cases. Variables measured included clinical measures and demographic characteristics. Results: Data for 615 hospitalized, clinically diagnosed pediatric TB cases were reviewed. There were 315 (51.4%) males and 298 (48.6%) females with a mean age of 5.40 years (range 0.17 - 14 years), with 214 (37.9%) of the patients aged 0-2 years. Percent males were 47.8% and 57.9% in PTB and EPTB groups respectively (p<0.05). One hundred and seven (17.4%) of patients were HIV positive. Three hundred eighty-eight (63%) of the patients had one or more additional co-morbidities: [anemia 299 (48.6%), intestinal parasites 93 (15.1%), malaria 58 (9.4%) and gastroenteritis 19 (3.1%)]. Nearly 85% of the children were undernourished. Eighty-three child patients (13.5%) died in the hospital. Children with EPTB were much more likely to be over the age of two (74% vs. 56% in PTB group), resulting in a highly significant Chi-square stati
stic. The overall difference in mean age, however, was only borderline significant with children with EPTB being slightly older [p=0.059] and age was only weakly associated with TB group. They were much less likely to be HIV positive (8.6% vs. 22%, p<0.01). Children in the EPTB group were somewhat less likely to die in the hospital (10.0% vs. 15.4%, p=0.066). The OR was greater than 4 for HIV and was greater than 2 for poor nutrition status [p<0.01 for each]. Conclusion: There was no association in this model between EPTB and mortality. The apparent univariate association between EPTB and reduced mortality can be explained by lower prevalence of HIV and poor nutrition status in this sub-sample. This study has implications for hospital-based pediatric TB diagnosis and epidemiology in resource-poor countries.
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The function of the human diaphragm as a volume pump and measurement of its efficiencySingh, Bhajan January 2004 (has links)
[Truncated abstract] The function of the diaphragm as a volume pump has not been adequately evaluated because there are no accurate methods to measure the volume displaced by diaphragm motion (ΔVdi). As a consequence, the work done, power output and efficiency of the diaphragm have not been measured. Efficiency of the diaphragm could be measured by relating the power output of the diaphragm to its neural activation. The aims of this thesis were to (a) develop a new biplanar radiographic method to measure ΔVdi and use this to evaluate the effect of costophrenic fibrosis and emphysema on ΔVdi, (b) develop a new fluoroscopic method to enable breath-by-breath measurements of ΔVdi, (c) evaluate a method for quantifying neural activation of the diaphragm, and (d) combine measurements of transdiaphragmatic pressure, ΔVdi, inspiratory duration and neural activation of the diaphragm to quantify the neuromechanical efficiency of the diaphragm
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Aetiology and outcome of pleural empyema in children admitted to Pietersburg Hospital Limpopo, South AfricaTshamiswe, Mbilaelo January 2022 (has links)
Thesis (M.Med. (Paediatrics and Child Health)) -- University of Limpopo, 2022 / Introduction: Pleural empyema in children is associated with high morbidity and high
mortality. Staphylococcus aureus has been shown to be the most common causative
organism in developing countries.
Study design: This study applied a retrospective quantitative descriptive study
design.
Study population: The population of the study is comprised of children (between 1
years and 13 years) admitted to Pietersburg Provincial Hospital with pleural
empyema from January 2016 until December 2020.
Objectives: The study aimed to determine the causative organisms of pleural
empyema, the treatment outcomes, and the relationship between pleural empyema,
TB, and HIV infection.
Data collection: The National Health Laboratory Services database was used to
identify patients who had pleural empyema. A self-generated data collection tool was
used to obtain secondary data related to all patients who met the operational definition
of pleural empyema during the defined time period.
Results: Eleven participants met inclusion criteria. The mean age of participants was
42 months with 43.8 standard deviation and 64% were males and females were 36%
. Of these participants, 40% cultured S. Aureus in the pleural fluid, 10% Streptococcus
pneumoniae, 30% were sterile and 20% cultured other organisms such as Klebsiella
pneumoniae and Haemophilus influenzae. Cloxacillin was the most prescribed
antibiotic. Intercostal drainage was inserted in 91% of the participants of which 18%
were successful, no further surgical intervention needed,73% had thoracotomy and
VATS was offered to 91% of participants and it was followed by thoracotomy.
Fibrinolytics were not offered to the participants in this study. The majority of patients,
55%, were discharged back to their peripheral hospitals and 27% of them died. PCV
immunisation status of the children was not documented hence the relationship
between pleural empyema and PCV immunisation could not be established. There
was a positive correlation between age of patients with pleural empyema and ICU
length of stay (r=89%; p=0,01) while another strong correlation was depicted between
HIV status and hospital length of stay (r=88%, p=0,019). Results further show a
positive association between outcome and surgery intervention offered (Chi=7,00;
p=0,02).
Conclusion: Our study showed that S. aureus is the leading cause of pleural
empyema, with a predominance of thoracocentesis and thoracotomy offered as
surgical interventions.
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Refinements and innovations in biopsy and analysis techniques for pleural and lung diseaseDiacon, Andreas Henri 12 1900 (has links)
Thesis (PhD (Medicine. Internal medicine))--University of Stellenbosch, 2007. / 1.1. Background
Tumors arising from the lung, pleura, or chest wall are a frequent problem in clinical
pulmonary medicine. Most lesions are either infectious, neoplastic or granulomatous in
nature, but a variety of other differential diagnoses must be considered. An accurate diagnosis
is important because the available treatments differ substantially, and because any delay will
impair the prognosis in potentially curable patients with lung carcinoma. The investigations
involve the disciplines of radiology, pulmonology, surgery, microbiology, and anatomical
pathology and consume a respectable amount of resources. The aim of the work covered in
this thesis was to optimize the available diagnostic methods for the routine use in a health
care setting with limited resources.
1.2. Methods
The general idea of this work was to identify conventional sampling methods that could be
developed further to become more useful for the diagnosis of chest tumors in a low resource
health care setting. The key method was research performed: a) to revise and expand the
indication for a sampling method, b) to technically improve the sampling process, and c) to
optimize sample transport, preparation and analysis in collaboration with the analytical
laboratory.
1.3. Results
A list of invasive diagnostic procedures, imaging methods and analytical processes were
developed, evaluated and integrated into clinical practice. A) transbronchial needle
aspiration, B) transthoracic cutting needle biopsy, C) transthoracic fine needle aspiration, D)
transthoracic ultrasound, and E) rapid on-site evaluation of needle aspirates by a
cytopathologist. Five studies pertaining to this thesis were published in international peerreviewed
journals:
â ¢ Safety and yield of ultrasound-assisted transthoracic biopsy performed by
pulmonologists (Respiration 2004;71:519-22) This paper established that ultrasound-assisted transthoracic biopsy performed by
pulmonologists is feasible, safe, practical, low-cost and has a high yield.
â ¢ Utility of rapid on-site evaluation of transbronchial needle aspirates (Respiration
2005;72:182-8)
This paper demonstrated the economical advantages of on-site evaluation of transbronchial
specimens in a low-resource setting.
â ¢ Transbronchial needle aspirates: comparison of two preparation methods (Chest
2005;127:2015-8)
This paper demonstrated that preparing smears on-site has a far better yield than pooling
samples into a vial. This means that the yield is improved over the current standard at no
additional cost.
â ¢ Transbronchial needle aspirates: how many passes per target site? (European
Respiratory Journal 2007;29:112-6)
This paper investigated the most economical and effective approach to serial sampling with
transbronchial needle aspiration during flexible bronchoscopy.
â ¢ Ultrasound assisted transthoracic biopsy: fine needle aspiration or cutting needle
biopsy? (European Respiratory Journal 2007;29:357-62)
This paper compared two common methods of sampling and demonstrates that the less
expensive method is sufficient in the majority of cases.
1.4. Conclusion
This work has impacted on current practice in multiple ways. Conventional methods have
been optimized by improving technical factors and with the integration of interdisciplinary
collaboration. The initiated research is ongoing with the aim to achieve continued technical
and economical improvements in the diagnosis of chest tumors.
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Computer-assisted volumetric tumour assessment for the evaluation of patient response in malignant pleural mesotheliomaChen, Mitchell January 2011 (has links)
Malignant pleural mesothelioma (MPM) is a form of aggressive tumour that is almost always associated with prior exposure to asbestos. Currently responsible for over 47,000 deaths worldwide each year and rising, it poses a serious threat to global public health. Many clinical studies of MPM, including its diagnosis, prognostic planning, and the evaluation of a treatment, necessitate the accurate quantification of tumours based on medical image scans, primarily computed tomography (CT). Currently, clinical best practice requires application of the MPM-adapted Response Evaluation Criteria in Solid Tumours (MPM-RECIST) scheme, which provides a uni-dimensional measure of the tumour's size. However, the low CT contrast between the tumour and surrounding tissues, the extensive elongated growth pattern characteristic of MPM, and, as a consequence, the pronounced partial volume effect, collectively contribute to the significant intra- and inter-observer variations in MPM-RECIST values seen in clinical practice, which in turn greatly affect clinical judgement and outcome. In this thesis, we present a novel computer-assisted approach to evaluate MPM patient response to treatments, based on the volumetric segmentation of tumours (VTA) on CT. We have developed a 3D segmentation routine based on the Random Walk (RW) segmentation framework by L. Grady, which is notable for its good performance in handling weak tissue boundaries and the ability to segment any arbitrary shapes with appropriately placed initialisation points. Results also show its benefit with regard to computation time, as compared to other candidate methods such as level sets. We have also added a boundary enhancement regulariser to RW, to improve its performance with smooth MPM boundaries. The regulariser is inspired by anisotropic diffusion. To reduce the required level of user supervision, we developed a registration-assisted segmentation option. Finally, we achieved effective and highly manoeuvrable partial volume correction by applying a reverse diffusion-based interpolation. To assess its clinical utility, we applied our method to a set of 48 CT studies from a group of 15 MPM patients and compared the findings to the MPM-RECIST observations made by a clinical specialist. Correlations confirm the utility of our algorithm for assessing MPM treatment response. Furthermore, our 3D algorithm found applications in monitoring the patient quality of life and palliative care planning. For example, segmented aerated lungs demonstrated very good correlation with the VTA-derived patient responses, suggesting their use in assessing the pulmonary function impairment caused by the disease. Likewise, segmented fluids highlight sites of pleural effusion and may potentially assist in intra-pleural fluid drainage planning. Throughout this thesis, to meet the demands of probabilistic analyses of data, we have used the Non-Parametric Windows (NPW) probability density estimator. NPW outperforms the histogram in terms of its smoothness and kernel density estimator in its parameter setting, and preserves signal properties such as the order of occurrence and band-limitedness of the sample, which are important for tissue reconstruction from discrete image data. We have also worked on extending this estimator to analysing vector-valued quantities; which are essential for multi-feature studies involving values such as image colour, texture, heterogeneity and entropy.
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Análise do processo inflamatório agudo no líquido pleural pós-cirurgias de revascularização do miocárdio / -Chibante, Antonio Monteiro da Silva 18 March 2004 (has links)
O derrame pleural pós-revascularização do miocárdio é uma situação freqüente, porém, ainda de etiologia desconhecida, apesar da tendência atual de responsabilizar a agressão direta da pleura como principal fator desencadeante. O objetivo deste estudo é avaliar a participação e comportamento das citocinas TNF-alfa, IL-1E, IL-2, IL-6, IL-8, VEGF e TGF-beta nos derrames pleurais imediatamente após o ato cirúrgico, em três intervalos distintos (2, 24 e 48horas). Foram analisados 43 indivíduos submetidos a revascularização miocárdica e 16 com derrames pleurais transudativos. Na comparação com os transudatos, os resultados obtidos mostraram que TNFbeta e IL-2 não são mobilizados neste tipo de derrame, nas primeiras 48 horas. A IL- 1E se eleva a partir das primeiras 24 horas. As IL-6 e IL-8 se mantêm elevadas, assim como VEGF, enquanto que o TGF-beta se inicia em níveis altos, que decaem a partir das 24 horas e atingem o valor dos transudatos em 48 horas. Quando confrontados com variáveis que poderiam interferir na análise global dos pacientes (sexo, faixa etária, complicações pós-operatórias, CEC e tempo de cirurgia), foram observados níveis elevados de IL-6 e TGF-beta que se relacionaram nas primeiras 2 horas no sexo feminino. O VEGF apresentou-se reduzido, nas primeiras duas horas, em paciente submetidos à circulação extra-corpórea. Concluímos, que o derrame pleural pós-revascularização do miocárdio é um exsudato associado à mobilização das citocinas IL-1E, IL-6, IL-8, VEGF e TGF-beta nas primeiras 48 horas, não parecendo haver relação com circulação extracorpórea nem com faixa etária, tempo de cirurgia e complicações pós-operatórias / Pleural effusion after coronary artery bypass graft (CABG) is a very common finding. Its origin remains unknown, despites the tendency to consider pleural injury as the responsible cause. The purpose of this study is to evaluate the participation and behavior of cytokines TNF-alfa, IL-1E, IL-2, IL-6, IL-8, VEGF and TNF-beta in pleural fluid immediately after 2, 24 and 48 hours after the surgical procedure. Were evaluated 43 surgical patients and 16 transudates (control group). The obtained results showed that TNF-beta and IL-2 are not mobilized and that IL-1E increases after 2 hours from the procedure. Interleukyn-6 and IL-8 presented in expressive levels during 48 hours as well as VEGF. Nevertheless, TGF-beta values increase in the first time (2 hours) and decrease significantly in subsequent times until the transudates levels after 48 hours. The cytokines were confronted with some variables (sex, age, complications, extra-corporal circulation and time of surgical intervention). Interleukin-6 and TGF-beta values increased on the first time (2 hours) in females. In a similar way, only VEGF presented high levels in the firs time (2 hours) in patients not submitted to extracorporeal procedure. We concluded that pleural effusions after CABG are associated with the presence of some cytokines (IL-1E, IL-6, IL-8, VEGF and TGF-beta) on the first 48 hours that do not correlate with age, extra-corporeal circulation, post-surgical complications and time of surgical intervention
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Análise do processo inflamatório agudo no líquido pleural pós-cirurgias de revascularização do miocárdio / -Antonio Monteiro da Silva Chibante 18 March 2004 (has links)
O derrame pleural pós-revascularização do miocárdio é uma situação freqüente, porém, ainda de etiologia desconhecida, apesar da tendência atual de responsabilizar a agressão direta da pleura como principal fator desencadeante. O objetivo deste estudo é avaliar a participação e comportamento das citocinas TNF-alfa, IL-1E, IL-2, IL-6, IL-8, VEGF e TGF-beta nos derrames pleurais imediatamente após o ato cirúrgico, em três intervalos distintos (2, 24 e 48horas). Foram analisados 43 indivíduos submetidos a revascularização miocárdica e 16 com derrames pleurais transudativos. Na comparação com os transudatos, os resultados obtidos mostraram que TNFbeta e IL-2 não são mobilizados neste tipo de derrame, nas primeiras 48 horas. A IL- 1E se eleva a partir das primeiras 24 horas. As IL-6 e IL-8 se mantêm elevadas, assim como VEGF, enquanto que o TGF-beta se inicia em níveis altos, que decaem a partir das 24 horas e atingem o valor dos transudatos em 48 horas. Quando confrontados com variáveis que poderiam interferir na análise global dos pacientes (sexo, faixa etária, complicações pós-operatórias, CEC e tempo de cirurgia), foram observados níveis elevados de IL-6 e TGF-beta que se relacionaram nas primeiras 2 horas no sexo feminino. O VEGF apresentou-se reduzido, nas primeiras duas horas, em paciente submetidos à circulação extra-corpórea. Concluímos, que o derrame pleural pós-revascularização do miocárdio é um exsudato associado à mobilização das citocinas IL-1E, IL-6, IL-8, VEGF e TGF-beta nas primeiras 48 horas, não parecendo haver relação com circulação extracorpórea nem com faixa etária, tempo de cirurgia e complicações pós-operatórias / Pleural effusion after coronary artery bypass graft (CABG) is a very common finding. Its origin remains unknown, despites the tendency to consider pleural injury as the responsible cause. The purpose of this study is to evaluate the participation and behavior of cytokines TNF-alfa, IL-1E, IL-2, IL-6, IL-8, VEGF and TNF-beta in pleural fluid immediately after 2, 24 and 48 hours after the surgical procedure. Were evaluated 43 surgical patients and 16 transudates (control group). The obtained results showed that TNF-beta and IL-2 are not mobilized and that IL-1E increases after 2 hours from the procedure. Interleukyn-6 and IL-8 presented in expressive levels during 48 hours as well as VEGF. Nevertheless, TGF-beta values increase in the first time (2 hours) and decrease significantly in subsequent times until the transudates levels after 48 hours. The cytokines were confronted with some variables (sex, age, complications, extra-corporal circulation and time of surgical intervention). Interleukin-6 and TGF-beta values increased on the first time (2 hours) in females. In a similar way, only VEGF presented high levels in the firs time (2 hours) in patients not submitted to extracorporeal procedure. We concluded that pleural effusions after CABG are associated with the presence of some cytokines (IL-1E, IL-6, IL-8, VEGF and TGF-beta) on the first 48 hours that do not correlate with age, extra-corporeal circulation, post-surgical complications and time of surgical intervention
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