BackgroundMalignant pleural effusions continue to be a common problem in patients with metastatic disease, leading to a significant reduction in quality of life with progressive dyspnea, dry cough, chest pain and reduced physical activity. This study was conducted to compare the efficacy, safety, and outcome of Talc Powder Pleurodesis (TPP) with Povidone-iodine Pleurodesis (PIP) through a chest drain as a palliative preventive treatment of recurrent malignant pleural effusion.MethodsA total of 39 neoplastic patients with recurrent malignant pleural effusion were enrolled in a prospective randomized trial. Twenty-one patients received Talc pleurodesis (group A), and eighteen patients (group B) received Povidone-iodine pleurodesis. The continuous variables were expressed as mean values ± standard deviation (SD) and compared using the unpaired t-test. The discrete variables were expressed as percentage and compared using the chi-square test (χ2) test. p-values of less than 0.05 were considered significant.ResultsOur study included 11 males and 28 females, the mean age was (71.0 ± 5.0) years for group A and (70.9 ± 5.1) years for group B (non-significant). Post-procedure analgesic requirements were recorded in both groups. Four patients in each group had fever (>38°C) within 48 hours of the procedure. Both groups achieved good symptomatic relief. There were no in-hospital deaths. The mean post-procedure hospital stay was (4.7 ± 1.2) days for group A and (4.2 ± 1.0) for group B (non-significant). At follow-up recurrence of significant pleural effusion requiring intervention was noted in four and five patients in group A and group B, respectively (non-significant difference).ConclusionPovidone-iodine pleurodesis can be considered as a good alternative to Talc pleurodesis for recurrent malignant pleural effusion. The drug is available, cost effective, safe and can be administered through an intercostal drain and repeated if necessary.

Background: Aspiration of foreign body is popular in pediatric age group and is considered as an important cause of respiratory distress and chocking in these children. Management strategies are different according to the mode of presentation. This study aims to assess the efficacy of rigid bronchoscopy and the role of bronchotomy as a safe alternative for failed removal of inhaled foreign body. Methods: We enrolled 254 patients with foreign body aspiration (FBA) up to 14 years old in a retrospective observational study. Our patients were reviewed from the Cardiothoracic Surgery Department and cases referred from Otorhinolaryngology Department, Menoufia University Hospital between June 2010 and July 2017. Using jet ventilation technique, foreign body was removed by the rigid bronchoscopy with either extracting forceps or postural drainage. Surgical interference such as bronchotomy needed in distally impacted foreign bodies (FBs). Results: Our study included 254 patients prepared for bronchoscopic FBs extraction. Most of cases (68.8%) presented early within first week (174 cases). No FBs detected in 44 cases by rigid bronchoscopy, although it was successful in 176 (69.5%) cases with nonimpacted inhaled FBs. 14 cases only needed postural drainage due to inaccessible FBs, another 12 cases failed to extract FB with rigid bronchoscopy but they were managed with flexible bronchoscopy. Bronchotomy was needed for impacted FBs in eight cases (3%). Conclusion: This study's findings support that rigid bronchoscopy is the gold standard in the diagnosis and removal of foreign body aspirations in pediatrics, but rigid bronchoscopy demonstrated less capability in the diagnosis and removal of small distally located foreign bodies. Bronchotomy is safe and effective alternative.

Background: COPD is a great challenge as it is a main cause of morbidity and mortality around the world. COPD exacerbations increasing airway and systemic inflammation. Aim of this study: the study aimed to assess the role of MPV as a marker of inflammation in COPD patients and to evaluate its role as a prognosis parameter in AE COPD. Patients and Methods: This study was conducted at Zagazig University Hospitals, Chest Department, during the period from April 2017 till October 2017, the study included 25 stable and 25 exacerbated chronic obstructive pulmonary disease (COPD) patients, selected in non randomized manner. Results: showed that there was no significant statistical difference in RBCs, hemoglobin and hematocrit content and a highly statistical significant increase in white blood cells (WBCs) count, neutrophils count, while lymphocytes shows significant statistical increase among stable COPD group among studied groups. The results showed that the Validity of MPV cutoff value, Sensitivity was 76.0%, Specificity was 80.0%, +VE predictive was 79.1%, -VE predictive was 76.9% and the accuracy was 78.0%.Conclusion: MPV is an easily accessible low cost marker of inflammation in AECOPD. Decreased MPV values can be used as indicator for negative acute-phase reaction in the exacerbated COPD patients. Cut off-point of MPV<9.4 fl can be used as a threshold mean of bad outcome. Keywords; Mean Platelet volume, COPD exacebations, prognosis INTRODUCTION hronic Obstructive Pulmonary Disease (COPD) is a disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive, associated with an abnormal inflammatory response of the lungs to noxious particles or gases and associated with systemic manifestations. [1] .COPD is a serious disease cause airflow obstruction. COPD also, associated with systemic inflammation such as blood leukocytes increase, inflammatory cytokines and C. reactive protein (CRP) [2] .The Mean platelet volume (MPV), blood count test which is important indicator the production rate of platelet and stimulation [3] .Many authors have reported that the increase in MPV can be considered as prognostic factor for pulmonary hypertension and thromboembolism in COPD patients. [4,5] However the association between Mean platelet Volume and Chronic Obstructive Pulmonary Disease is still controversial. Some authors reported that there were an C Mostafa I. et al….

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Background: Minimal invasive approaches are used more frequently for aortic valve replacement (AVR). This study aimed to compare the outcomes of both minimally invasive upper mini-sternotomy and full sternotomy for AVR. Methods: 100 patients with isolated aortic valve disease were enrolled in this prospective observational study. We grouped the patients according to the technique, group A (n=40) underwent upper J-shaped mini-sternotomy, and group B (n=60) underwent full sternotomy. Study endpoints were operative times and pain score. Results: The mean age of the patients was 46.4±10.1 years. There was no difference in preoperative data between both groups. There was a significant difference in aortic cross-clamp time (87.2± 8.6 vs. 59.2± 6.6  min in group A and B, respectively, p= 0.001), and total bypass time (115.1± 9.2 vs. 75.3± 4.3 min in group A and B, respectively, p= 0.001) between both groups. The total operative time was 341±11.7 and 196.1±18.4 min in groups A and B, respectively (p= 0.001). The ICU stay was 29.4±8.2 hours in group A and 41.2±13.3 hours in group B (p= 0.001). Patients who had mini-sternotomy had lower pain (p= 0.001) and better patient satisfaction score (p< 0.001). Conclusion: J-shaped upper mini-sternotomy is a safe and effective strategy for aortic valve replacement. The procedure may be associated with decreased pain and comparable morbidity to the conventional approach.