الفهرس 
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Abstract
A pleural effusion is an abnormal collection of fluid in the pleural space resulting from excess fluid production or decreased absorption or both. Diagnosing the etiology of PE is sometimes a challenging medical problem because of a lack accuracy in non-invasive investigations.
Vascular endothelial growth factor (VEGF) is a glycoprotein which is an important mediator of angiogenesis and vascular permeability. It stimulates capillary formation and has specific mitogenic and chemotactic effects on vascular endothelial cells.
Differing VEGF levels were found in carcinomatous, inflammatory and tuberculous pleural effusions, implying a varying degree of influence on the process of fluid accumulation in the pleural space in different disease states.
This study was a prospective study conducted in Chest Department, Faculty of Medicine, Menoufia University and El Mahlla El Kobra Chest hospital from June 2013 to Jenuary 2014. It was carried on 40 patients with pleural effusion, they were 19 males and 21 females, their ages ranged from 45 to 75 years with a mean age of 55.960+6.835 years.
The patients were classified according to their final diagnosis into:
Transudative group: included (15) patients with transudative pleural effusion; (5) males and (10) females, their ages ranged from 52 to 75 years with a mean age of 59.000+6.835 years. This group was classified into:
- Hepatic pleural effusion: (6); 2 males and 4 females.
- Cardiac pleural effusion: (6); 2 males and 4 females.
- Renal failure pleural effusion: (3); 1 male and 2 females..
Exudative group: included (25) patients with exudative pleural effusion; (14) males and (11) females, their ages ranged from 45 to 70 years with a mean age of 55.960+5.560 years. This group was classified into:
- Malignant pleural effusion: (10); 5 males and 5 females.
- Tuberculous pleural effusion: (6); 3 male and 3 females.
- Parapneumonic pleural effusion: (7); 6 males and 1 female.
- Collagen disorders pleural effusion: 2 females.
The aim of this study was:
1- To asses the role of VEGF in differentiation between transudative and exudative pleural effusion.
2- To asses if VEGF can differentiate between different aetiologies of pleural effusion.
All patients were subjected to the following:
1- Detailed history taking.
2- Thorough clinical examination: General and local chest examinations were done.
3- Radiological investigations:
- Chest x-ray (CXR) posteroanterior and lateral views.
- CT scanning of the chest, CT brain and abdomen were done when needed and bone scan for the cancer group.
- Abdominal ultrasound (US) when needed.
4- ECG (electrocardiogram).
5- Routine laboratory investigations:
i. CBC (complete blood count).
ii. ESR (erythrocyte sedimentation rate).
iii. Fasting and post-prandial blood glucose.
iv. Kidney function tests (urea and creatinine).
v. Liver function tests (serum protein and serum albumin).
vi. Serum and pleural fluid LDH, protein, and albumin.
vii. Sputum smear for AFB (acid fast bacilli) by Zeil-Neelsen stain (Z-N) for 3 successive days.
viii. Tuberculin skin test.
ix. Diagnostic thoracocentesis was done and pleural fluid was subjected to:
•Physical examination: by inspection for colour, odour and specific gravity.
•Biochemical examination (LDH, protein, glucose, ADA, Ph) when needed.
•Microbiological examination (Z-N stain, bacterial culture) when needed.
•Cytological examination (differential cell count and cytological examination for malignant cells) when needed.
6- Pleural biopsy and/or thoracoscopy (when needed) to reach the final diagnosis of etiology of pleural effusion.
7- Both serum and pleural fluid VEGF levels were measured in all patients.
The present work revealed:
There was a significant difference between exudate and transudate as regard to serum and pleural fluid VEGF levels that were higher in exudate than transudate. In comparison between the subtypes of exudative effusion, the highest mean values of VEGF in both serum and pleural fluid were in the malignant group, followed by parapneumonic group followed by tuberculous group. VEGF pleural fluid level could differentiate between malignant and non malignant exudative effusions, and between tubeculous and parapneumonic exudative effusions.
There was a significant positive correlation between serum levels of VEGF and LDH. And a significant positive correlation in pleural fluid between VEGF and LDH, VEGF and protein , and between LDH and protein.
The cut off values for differentiation between transudate and exudate as regards VEGF in serum were 290 (pg/ml) with a sensitivity of 72.0%, specificity of 73.3%, PPV= 81.8%, NPV= 61.1%, and with accuracy of 79.1%. And the cut off values for differentiation between transudate and exudate as regards VEGF in pleural fluid were 500 (pg/ml) with a sensitivity of 84.0%, specificity of 93.3%, PPV= 95.5%, NPV= 77.8%, and with accuracy of 92.8%. VEGF could differentiate between transudative and exudative pleural effusions with high accuracy when measured in pleural fluid than serum.
The cut off value between malignant and non-malignant exudative pleural effusion as regards VEGF level in pleural fluid was 720 pg/ml with a sensitivity of 100.0%, specificity of 53.3%, PPV= 58.8%, NPV= 100.0%, and with accuracy of 75.3%.