We report a rare case of brucellosis presenting with PLEURAL and pericardial EFFUSIONS in a 35 year-old male rancher in Iran with fever and dyspnea. Such findings should prompt inclusion of brucellosis in the differential diagnosis in endemic areas.

Background: The cause of PLEURAL effusion in some patients can not be found even after biochemical, bacteriologic and cytological examinations of the PLEURAL fluid and closed needle biopsy of the pleura. In this group of patients the next diagnostic step would be an open PLEURAL biopsy through a limited thoracotomy or video-assisted thoracoscopic surgery (VATS), the latter procedure has replaced the former in many centers due to its advantages.Materials and Methods: In order to evaluate these advantages, 59 patients with undiagnosed PLEURAL effusion were operated on through either limited thoracotomy or thoracoscopy form April 1998 to September 2000, in a prospective clinical trial. There were 40 males and 19 females in the age range of 10 to 89 yrs. There was no significant statistical difference between the two groups in terms of sex and age.Results: There was no statistical difference between the two groups in terms of diagnostic accuracy, postoperative pain, hospitalization, morbidity and mortality.Conclusion: Based on these results and minimal scar, VATS is a safe diagnostic procedure in this group of patients replacing limited thoracotomy.

One of the main problems facing pulmonologists and internists is differentiating tuberculous EFFUSIONS from malignant EFFUSIONS. To help in this decision making we prospectively evaluated the PLEURAL (P) cholesterol and its serum (S) ratio in 39.63 patients suspected either of malignancy or tuberculosis.Method: In 39 patients whose clinical presentation suggested either malignant or tuberculous effusion chest X-ray was taken to determine the size and the site of the effusion. In a fasting state, fluid was drawn for cytology, A.F.B. smear and culture, LDH, protein, glucose, cholesterol, and triglyceride. Simultaneously blood was sent for evaluation of the same biochemistry parameters. In all cases the definitive diagnosis was made by PLEURAL biopsy.Results: Of 39 patients 21 had tuberculosis and 18 had malignancy. Using SPSS-Pc+program it chose PLEURAL to serum cholesterol ratio as a variable with significant difference. The mean ratio for tuberculous patients was 0.52 and the patients with malignancy had ratio of 0.44 with P<0.01. Plugging P/S cholesterol ratio into two formulas (1) T.B=P.S cholesterol×60.38-16.45: (2) malignancy=P/S cholesterol × 50.64-11.91. Our diagnosis is most likely the one with higher value (P<0.007).Conclusion: In difficult cases where diagnosis of either a malignant PLEURAL effusion or tuberculosis is either a malignant PLEURAL effusion or tuberculosis is difficult use of cholesterol level or its ratio can play a pivoting role.

Background: Despite the advances in diagnosis and treatment of lung cancer, its survival rate has only improved in those with early stages of disease. Telomerase is a tumor marker that has been focused on recently as a novel tool for early diagnosis of lung cancer. This study aimed to compare telomerase activity in cases with malignant and benign PLEURAL EFFUSIONS.Materials and Methods: Telomerase activity was assessed in 28 consecutive cases of PLEURAL EFFUSIONS (19 cases with malignant and 9 cases with benign histopathologic diagnosis) with telomeric repeat amplification protocol (TRAP) between Apr. 2006 and Sep.2007. Data analysis was performed by using Chi-square test and t-test. Results: Twenty (71.4%) out of 28 cases with PLEURAL EFFUSIONS were positive for telomerase activity. Telomerase activity was positive in all 19 malignant EFFUSIONS, while only one case with effusion due to a benign condition (TB) had positive telomerase activity (p<0.0001). The sensitivity, specificity and diagnostic accuracy of telomerase activity for detecting malignant PLEURAL EFFUSIONS were 100%, 88.9% and 96.4%, respectively. Positive and negative predictive values of telomerase activity were 95% and 100%, respectively. Mean relative telomerase activity was not significantly different in malignant and benign EFFUSIONS (24.3±5.2% vs. 15.05%; p>0.05).Conclusion: Telomerase activity is a highly sensitive and specific diagnostic biomarker for malignancy and may be used as an adjunct to other diagnostic tools such as cytology for malignant PLEURAL EFFUSIONS.