2) Abrams’ needle biopsy and thoracoscopy were positive in 7/8 patients (87.5%) with tuberculosis with non significant difference, while Abrams was positive in 14/21 patients (66.7%) of malignant group when compared to thoracoscopy which revealed positive in 19/21 patients (90.5%) of the same group with statistically significant improved yield with thoracoscopy (p0.05).3) CT guided biopsy was inferior with significant statistical difference to thoracoscopy in the diagnosis of tuberculous effusions, as it diagnosed 3 patients (37.5%) while thoracoscopy was positive in 7 patients (87.5%) of the same group (p0.05).4) As regard the total sensitivity of both Abrams’ biopsy and CT guided biopsy; it was 87.5% in TB, 75% in primary lung cancer, 80% in metastatic carcinoma, 50% in hematological malignancy, 100% in mesothelioma and 80.95% in total malignancy.5) Thoracoscopy was the only positive tool in the case of rheumatoid arthritis.Comparison of the diagnostic yield of Abrams’ needle biopsy versus CT guided biopsy in different groups:Abrams’ needle biopsy is superior significantly to CT guided biopsy in the diagnosis of tuberculous effusions (pConclusion1. The available Abrams’ needle biopsy is still an excellent and relatively safe procedure in the diagnosis of exudative pleural effusion especially tuberculous one.2. Percutaneous CT-guided cutting needle biopsy is safe and less invasive and diagnostic tool in patients with exudative pleural effusion.3. CT-guided biopsy is the diagnostic modality of choice in patients with mesothelioma and should precede thoracoscopy in those patients.4. CT-guided biopsy and Abrams’ needle biopsy are complementary to each others in the diagnosis of malignant pleural effusion especially mesothelioma.Recommendation1. Abrams’ needle biopsy should never be neglected as an invaluable diagnostic tool in the diagnosis of exudative pleural effusion that never to be abandoned.2. Based on routine investigations and clinical suspicions, the priority of CT-guided or blind Abrams’ pleural biopsies should be individualized as shown in the following algorithm (fig-11).3. Multiple CT-guided cutting needle pleural biopsies are advisable to be tried in patients with exudative pleural effusion as this guided technique may improve the total sensitivity of this procedure.4. The conclusion of the current study should be challenged widely on larger groups of patients for each of the items included.Fig (6): The suggested algorithm of diagnosis of exudative pleural effusionsSummaryThirty patients with exudative pleural effusions were 17 males and 13 females. Their age ranged from 18-77 years, according to Light’s criteria, were fit for pleural biopsy and didn’t have any of the following; bleeding disorders, positive culture of pleural fluid, frank pus, chylothorax, recent history of chest trauma, recent abdominal operation or recent coronary artery bypass, were selected from Patients with pleural effusions, who were admitted at Chest and Internal Medicine Departments, Zagazig University Hospitals, in the period from July 2004 to August 2005, and subjected to the following:1) Thorough medical history2) Full clinical examination.3) Plain Chest X- ray (postero-anterior and lateral views).4) Hematological investigations including:a) Complete blood picture.b) Liver function tests (total proteins, albumin, SGOT, SGPT, and total and direct bilirubin).c) Kidney function tests (blood urea and serum creatinine).d) Prothrombin time and partial thromboplastin time.e) Erythrocyte sedimentation rate (ESR).f) Fasting blood sugar; simultaneous with measurement of pleural fluid glucose level.g) Serum LDH simultaneous with measurement of pleural fluid value of LDH.h) Bone marrow biopsy from the sternum, under local anesthesia, was done in one case which diagnosed as chronic lymphocytic leukemia.5) Sputum analysis: was done for 5 patients with expectoration• Z.N. staining.• Cytological examination for malignant cells.6) Tuberculin skin test. (Mantoux method)7) Serological studies including some selected tests:a) Serum rheumatoid factor (RF).b) Serum antinuclear antibody (ANA)8) Pelvi-abdominal ultrasound.9) Ultrasound guided thoracocentesis.10) Pleural fluid analysis:(pH, protein, glucose, LDH, total and differential leukocytic count, gram stain, culture and sensitivity for aerobic, anaerobic organisms and AFB, ZN staining and cytological examination for malignant cells)11) Blind pleural biopsy by Abrams’ needle: biopsy taken was sent for culture for AFB and histopathological examination.12) Contrast enhanced CT chest.13) CT guided pleural biopsy: from the maximum area of parietal pleural thickening detected in CT chest and sent for histopathological examination.14) Fiberoptic bronchoscope: was done for 8 patients with parenchymal lesions detected in radiological examination and one patient with hemoptysis. The biopsy was sent for histopathological examination and BAL was sent for both ZN staining and cytological examination.15) Medical thoracoscope: with biopsy taken using the ”Storz” rigid thoracoscope 9 mm diameter was performed. The procedure of thoracoscopy was done under local anaesthesia and through a single puncture, that was made before for Abrams’ needle, at the posterior axillary line in the 6th-8th intercostal space while the patient lying in the lateral decubitus position with affected hemithorax up.The results of current study were as follow:1) The final diagnosis as established by different diagnostic tools was reached in 30 cases (100%) and distributed as follow; 8 patients (26.7%) with tuberculosis, one patient (3.3%) with rheumatoid arthritis, 4 patients (13.3%) with primary lung cancer (3 adenocarcinoma and 1 small cell carcinoma), 10 patients (33.3%) with metastatic carcinoma, 2 patients (6.7%) with hematological malignancies (one lymphoma and the other leukemia), and 5 patients (16.7%) with mesothelioma.2) Pleural fluid cytology achieved the diagnosis in 8 /21cases with sensitivity (38 %) of malignant pleural effusion, among them 2 cases (50%) with primary lung cancer, 5 cases (50%) with metastatic carcinoma and one case (20%) with mesothelioma.3) Abrams’ pleural biopsy yielded an overall sensitinity in 21 patients (70%) was obtained. It was positive (pathology and culture for AFB) in 7 patients of tuberculous pleural effusion (87.5%), while the corresponding result for malignancy was 14 patients (66.7%) which distributed as follow; 3 patients (75%) with primary lung cancer, 8 patients (80%) with metastatic carcinoma and 3 patients (60%) with malignant pleural mesothelioma.4) The magnitude of the maximum site of the parietal pleural thickening, detected by CT chest, ranged from 2-28 mm (9.4 ± 6). CT guided cutting needle biopsy from the maximum site of the parietal pleural thickening was positive for the diagnosis in 15/30 patients with overall sensitivity (50%) and was distributed as follow; 3 patients (37.5%) with tuberculosis, and 12 patients (57.1%) with malignant group that distributed as follow; 2 cases (50%) with primary lung cancer, 5 patients (50%) with metastatic carcinoma, 4 cases (80%) with malignant pleural mesothelioma and 1 case (50%) with hematological malignancy (lymphoma). No complication was reported in the procedure of CT-guided cutting needle biopsy.5) Diagnosis was reached by thoracoscopic pleural biopsy in 27 patients with overall sensitivity (90%), amoung them 7/8 patients (87.5%) tuberculous pleural effusion, 19/21 patients (90.5%) malignant pleural effusion and one patient with rheumatoid arthritis. Thoacoscopy was negative in 3/30 patients (10%); one patient in tuberculous group was diagnosed by Abrams’needle, one patient with metastatic carcinoma was diagnosed by cytological examination of pleural fluid and the third patient with lymphoma was diagnosed by bronchoscopic biopsy and CT-guided. 2/30 cases were persistent pneumothorax post thoracoscopy, these two cases were shown to have metastatic carcinoma to the pleura.Comparison of the diagnostic yield of different diagnostic tool versus the diagnostic yield of medical thoracoscopy in the studied patients:1) Pleural fluid cytology was positive in 8/21 patients (38%) with malignancy while thoracoscopic biopsy was positive in 19/21 patients (90.5%) with the same group (p<0.001).2) Abrams’ needle biopsy and thoracoscopy were positive in 7/8 patients (87.5%) with tuberculosis with non significant difference, while Abrams was positive in 14/21 patients (66.7%) of malignant group when compared to thoracoscopy which revealed positive in 19/21 patients (90.5%) of the same group with statistically significant improved yield with thoracoscopy (p0.05).3) CT guided biopsy was inferior with significant statistical difference to thoracoscopy in the diagnosis of tuberculous effusions, as it diagnosed 3 patients (37.5%) while thoracoscopy was positive in 7 patients (87.5%) of the same group (p0.05).4) As regard the total sensitivity of both Abrams’ biopsy and CT guided biopsy; it was 87.5% in TB, 75% in primary lung cancer, 80% in metastatic carcinoma, 50% in hematological malignancy, 100% in mesothelioma and 80.95% in total malignancy.5) Thoracoscopy was the only positive tool in the case of rheumatoid arthritis.Comparison of the diagnostic yield of Abrams’ needle biopsy versus CT guided biopsy in different groups:Abrams’ needle biopsy is superior significantly to CT guided biopsy in the diagnosis of tuberculous effusions (pConclusion1. The available Abrams’ needle biopsy is still an excellent and relatively safe procedure in the diagnosis of exudative pleural effusion especially tuberculous one.2. Percutaneous CT-guided cutting needle biopsy is safe and less invasive and diagnostic tool in patients with exudative pleural effusion.3. CT-guided biopsy is the diagnostic modality of choice in patients with mesothelioma and should precede thoracoscopy in those patients.4. CT-guided biopsy and Abrams’ needle biopsy are complementary to each others in the diagnosis of malignant pleural effusion especially mesothelioma.Recommendation1. Abrams’ needle biopsy should never be neglected as an invaluable diagnostic tool in the diagnosis of exudative pleural effusion that never to be abandoned.2. Based on routine investigations and clinical suspicions, the priority of CT-guided or blind Abrams’ pleural biopsies should be individualized as shown in the following algorithm (fig-11).3. Multiple CT-guided cutting needle pleural biopsies are advisable to be tried in patients with exudative pleural effusion as this guided technique may improve the total sensitivity of this procedure.4. The conclusion of the current study should be challenged widely on larger groups of patients for each of the items included.Fig (6): The suggested algorithm of diagnosis of exudative pleural effusionsSummaryThirty patients with exudative pleural effusions were 17 males and 13 females. Their age ranged from 18-77 years, according to Light’s criteria, were fit for pleural biopsy and didn’t have any of the following; bleeding disorders, positive culture of pleural fluid, frank pus, chylothorax, recent history of chest trauma, recent abdominal operation or recent coronary artery bypass, were selected from Patients with pleural effusions, who were admitted at Chest and Internal Medicine Departments, Zagazig University Hospitals, in the period from July 2004 to August 2005, and subjected to the following:1) Thorough medical history2) Full clinical examination.3) Plain Chest X- ray (postero-anterior and lateral views).4) Hematological investigations including:a) Complete blood picture.b) Liver function tests (total proteins, albumin, SGOT, SGPT, and total and direct bilirubin).c) Kidney function tests (blood urea and serum creatinine).d) Prothrombin time and partial thromboplastin time.e) Erythrocyte sedimentation rate (ESR).f) Fasting blood sugar; simultaneous with measurement of pleural fluid glucose level.g) Serum LDH simultaneous with measurement of pleural fluid value of LDH.h) Bone marrow biopsy from the sternum, under local anesthesia, was done in one case which diagnosed as chronic lymphocytic leukemia.5) Sputum analysis: was done for 5 patients with expectoration• Z.N. staining.• Cytological examination for malignant cells.6) Tuberculin skin test. (Mantoux method)7) Serological studies including some selected tests:a) Serum rheumatoid factor (RF).b) Serum antinuclear antibody (ANA)8) Pelvi-abdominal ultrasound.9) Ultrasound guided thoracocentesis.10) Pleural fluid analysis:(pH, protein, glucose, LDH, total and differential leukocytic count, gram stain, culture and sensitivity for aerobic, anaerobic organisms and AFB, ZN staining and cytological examination for malignant cells)11) Blind pleural biopsy by Abrams’ needle: biopsy taken was sent for culture for AFB and histopathological examination.12) Contrast enhanced CT chest.13) CT guided pleural biopsy: from the maximum area of parietal pleural thickening detected in CT chest and sent for histopathological examination.14) Fiberoptic bronchoscope: was done for 8 patients with parenchymal lesions detected in radiological examination and one patient with hemoptysis. The biopsy was sent for histopathological examination and BAL was sent for both ZN staining and cytological examination.15) Medical thoracoscope: with biopsy taken using the ”Storz” rigid thoracoscope 9 mm diameter was performed. The procedure of thoracoscopy was done under local anaesthesia and through a single puncture, that was made before for Abrams’ needle, at the posterior axillary line in the 6th-8th intercostal space while the patient lying in the lateral decubitus position with affected hemithorax up.The results of current study were as follow:1) The final diagnosis as established by different diagnostic tools was reached in 30 cases (100%) and distributed as follow; 8 patients (26.7%) with tuberculosis, one patient (3.3%) with rheumatoid arthritis, 4 patients (13.3%) with primary lung cancer (3 adenocarcinoma and 1 small cell carcinoma), 10 patients (33.3%) with metastatic carcinoma, 2 patients (6.7%) with hematological malignancies (one lymphoma and the other leukemia), and 5 patients (16.7%) with mesothelioma.2) Pleural fluid cytology achieved the diagnosis in 8 /21cases with sensitivity (38 %) of malignant pleural effusion, among them 2 cases (50%) with primary lung cancer, 5 cases (50%) with metastatic carcinoma and one case (20%) with mesothelioma.3) Abrams’ pleural biopsy yielded an overall sensitinity in 21 patients (70%) was obtained. It was positive (pathology and culture for AFB) in 7 patients of tuberculous pleural effusion (87.5%), while the corresponding result for malignancy was 14 patients (66.7%) which distributed as follow; 3 patients (75%) with primary lung cancer, 8 patients (80%) with metastatic carcinoma and 3 patients (60%) with malignant pleural mesothelioma.4) The magnitude of the maximum site of the parietal pleural thickening, detected by CT chest, ranged from 2-28 mm (9.4 ± 6). CT guided cutting needle biopsy from the maximum site of the parietal pleural thickening was positive for the diagnosis in 15/30 patients with overall sensitivity (50%) and was distributed as follow; 3 patients (37.5%) with tuberculosis, and 12 patients (57.1%) with malignant group that distributed as follow; 2 cases (50%) with primary lung cancer, 5 patients (50%) with metastatic carcinoma, 4 cases (80%) with malignant pleural mesothelioma and 1 case (50%) with hematological malignancy (lymphoma). No complication was reported in the procedure of CT-guided cutting needle biopsy.5) Diagnosis was reached by thoracoscopic pleural biopsy in 27 patients with overall sensitivity (90%), amoung them 7/8 patients (87.5%) tuberculous pleural effusion, 19/21 patients (90.5%) malignant pleural effusion and one patient with rheumatoid arthritis. Thoacoscopy was negative in 3/30 patients (10%); one patient in tuberculous group was diagnosed by Abrams’needle, one patient with metastatic carcinoma was diagnosed by cytological examination of pleural fluid and the third patient with lymphoma was diagnosed by bronchoscopic biopsy and CT-guided. 2/30 cases were persistent pneumothorax post thoracoscopy, these two cases were shown to have metastatic carcinoma to the pleura.Comparison of the diagnostic yield of different diagnostic tool versus the diagnostic yield of medical thoracoscopy in the studied patients:1) Pleural fluid cytology was positive in 8/21 patients (38%) with malignancy while thoracoscopic biopsy was positive in 19/21 patients (90.5%) with the same group (p<0.001).2) Abrams’ needle biopsy and thoracoscopy were positive in 7/8 patients (87.5%) with tuberculosis with non significant difference, while Abrams was positive in 14/21 patients (66.7%) of malignant group when compared to thoracoscopy which revealed positive in 19/21 patients (90.5%) of the same group with statistically significant improved yield with thoracoscopy (p0.05).3) CT guided biopsy was inferior with significant statistical difference to thoracoscopy in the diagnosis of tuberculous effusions, as it diagnosed 3 patients (37.5%) while thoracoscopy was positive in 7 patients (87.5%) of the same group (p0.05).4) As regard the total sensitivity of both Abrams’ biopsy and CT guided biopsy; it was 87.5% in TB, 75% in primary lung cancer, 80% in metastatic carcinoma, 50% in hematological malignancy, 100% in mesothelioma and 80.95% in total malignancy.5) Thoracoscopy was the only positive tool in the case of rheumatoid arthritis.Comparison of the diagnostic yield of Abrams’ needle biopsy versus CT guided biopsy in different groups:Abrams’ needle biopsy is superior significantly to CT guided biopsy in the diagnosis of tuberculous effusions (pConclusion1. The available Abrams’ needle biopsy is still an excellent and relatively safe procedure in the diagnosis of exudative pleural effusion especially tuberculous one.2. Percutaneous CT-guided cutting needle biopsy is safe and less invasive and diagnostic tool in patients with exudative pleural effusion.3. CT-guided biopsy is the diagnostic modality of choice in patients with mesothelioma and should precede thoracoscopy in those patients.4. CT-guided biopsy and Abrams’ needle biopsy are complementary to each others in the diagnosis of malignant pleural effusion especially mesothelioma.Recommendation1. Abrams’ needle biopsy should never be neglected as an invaluable diagnostic tool in the diagnosis of exudative pleural effusion that never to be abandoned.2. Based on routine investigations and clinical suspicions, the priority of CT-guided or blind Abrams’ pleural biopsies should be individualized as shown in the following algorithm (fig-11).3. Multiple CT-guided cutting needle pleural biopsies are advisable to be tried in patients with exudative pleural effusion as this guided technique may improve the total sensitivity of this procedure.4. The conclusion of the current study should be challenged widely on larger groups of patients for each of the items included.Fig (6): The suggested algorithm of diagnosis of exudative pleural effusionsSummaryThirty patients with exudative pleural effusions were 17 males and 13 females. Their age ranged from 18-77 years, according to Light’s criteria, were fit for pleural biopsy and didn’t have any of the following; bleeding disorders, positive culture of pleural fluid, frank pus, chylothorax, recent history of chest trauma, recent abdominal operation or recent coronary artery bypass, were selected from Patients with pleural effusions, who were admitted at Chest and Internal Medicine Departments, Zagazig University Hospitals, in the period from July 2004 to August 2005, and subjected to the following:1) Thorough medical history2) Full clinical examination.3) Plain Chest X- ray (postero-anterior and lateral views).4) Hematological investigations including:a) Complete blood picture.b) Liver function tests (total proteins, albumin, SGOT, SGPT, and total and direct bilirubin).c) Kidney function tests (blood urea and serum creatinine).d) Prothrombin time and partial thromboplastin time.e) Erythrocyte sedimentation rate (ESR).f) Fasting blood sugar; simultaneous with measurement of pleural fluid glucose level.g) Serum LDH simultaneous with measurement of pleural fluid value of LDH.h) Bone marrow biopsy from the sternum, under local anesthesia, was done in one case which diagnosed as chronic lymphocytic leukemia.5) Sputum analysis: was done for 5 patients with expectoration• Z.N. staining.• Cytological examination for malignant cells.6) Tuberculin skin test. (Mantoux method)7) Serological studies including some selected tests:a) Serum rheumatoid factor (RF).b) Serum antinuclear antibody (ANA)8) Pelvi-abdominal ultrasound.9) Ultrasound guided thoracocentesis.10) Pleural fluid analysis:(pH, protein, glucose, LDH, total and differential leukocytic count, gram stain, culture and sensitivity for aerobic, anaerobic organisms and AFB, ZN staining and cytological examination for malignant cells)11) Blind pleural biopsy by Abrams’ needle: biopsy taken was sent for culture for AFB and histopathological examination.12) Contrast enhanced CT chest.13) CT guided pleural biopsy: from the maximum area of parietal pleural thickening detected in CT chest and sent for histopathological examination.14) Fiberoptic bronchoscope: was done for 8 patients with parenchymal lesions detected in radiological examination and one patient with hemoptysis. The biopsy was sent for histopathological examination and BAL was sent for both ZN staining and cytological examination.15) Medical thoracoscope: with biopsy taken using the ”Storz” rigid thoracoscope 9 mm diameter was performed. The procedure of thoracoscopy was done under local anaesthesia and through a single puncture, that was made before for Abrams’ needle, at the posterior axillary line in the 6th-8th intercostal space while the patient lying in the lateral decubitus position with affected hemithorax up.The results of current study were as follow:1) The final diagnosis as established by different diagnostic tools was reached in 30 cases (100%) and distributed as follow; 8 patients (26.7%) with tuberculosis, one patient (3.3%) with rheumatoid arthritis, 4 patients (13.3%) with primary lung cancer (3 adenocarcinoma and 1 small cell carcinoma), 10 patients (33.3%) with metastatic carcinoma, 2 patients (6.7%) with hematological malignancies (one lymphoma and the other leukemia), and 5 patients (16.7%) with mesothelioma.2) Pleural fluid cytology achieved the diagnosis in 8 /21cases with sensitivity (38 %) of malignant pleural effusion, among them 2 cases (50%) with primary lung cancer, 5 cases (50%) with metastatic carcinoma and one case (20%) with mesothelioma.3) Abrams’ pleural biopsy yielded an overall sensitinity in 21 patients (70%) was obtained. It was positive (pathology and culture for AFB) in 7 patients of tuberculous pleural effusion (87.5%), while the corresponding result for malignancy was 14 patients (66.7%) which distributed as follow; 3 patients (75%) with primary lung cancer, 8 patients (80%) with metastatic carcinoma and 3 patients (60%) with malignant pleural mesothelioma.4) The magnitude of the maximum site of the parietal pleural thickening, detected by CT chest, ranged from 2-28 mm (9.4 ± 6). CT guided cutting needle biopsy from the maximum site of the parietal pleural thickening was positive for the diagnosis in 15/30 patients with overall sensitivity (50%) and was distributed as follow; 3 patients (37.5%) with tuberculosis, and 12 patients (57.1%) with malignant group that distributed as follow; 2 cases (50%) with primary lung cancer, 5 patients (50%) with metastatic carcinoma, 4 cases (80%) with malignant pleural mesothelioma and 1 case (50%) with hematological malignancy (lymphoma). No complication was reported in the procedure of CT-guided cutting needle biopsy.5) Diagnosis was reached by thoracoscopic pleural biopsy in 27 patients with overall sensitivity (90%), amoung them 7/8 patients (87.5%) tuberculous pleural effusion, 19/21 patients (90.5%) malignant pleural effusion and one patient with rheumatoid arthritis. Thoacoscopy was negative in 3/30 patients (10%); one patient in tuberculous group was diagnosed by Abrams’needle, one patient with metastatic carcinoma was diagnosed by cytological examination of pleural fluid and the third patient with lymphoma was diagnosed by bronchoscopic biopsy and CT-guided. 2/30 cases were persistent pneumothorax post thoracoscopy, these two cases were shown to have metastatic carcinoma to the pleura.Comparison of the diagnostic yield of different diagnostic tool versus the diagnostic yield of medical thoracoscopy in the studied patients:1) Pleural fluid cytology was positive in 8/21 patients (38%) with malignancy while thoracoscopic biopsy was positive in 19/21 patients (90.5%) with the same group (p<0.001).2) Abrams’ needle biopsy and thoracoscopy were positive in 7/8 patients (87.5%) with tuberculosis with non significant difference, while Abrams was positive in 14/21 patients (66.7%) of malignant group when compared to thoracoscopy which revealed positive in 19/21 patients (90.5%) of the same group with statistically significant improved yield with thoracoscopy (p0.05).3) CT guided biopsy was inferior with significant statistical difference to thoracoscopy in the diagnosis of tuberculous effusions, as it diagnosed 3 patients (37.5%) while thoracoscopy was positive in 7 patients (87.5%) of the same group (p0.05).4) As regard the total sensitivity of both Abrams’ biopsy and CT guided biopsy; it was 87.5% in TB, 75% in primary lung cancer, 80% in metastatic carcinoma, 50% in hematological malignancy, 100% in mesothelioma and 80.95% in total malignancy.5) Thoracoscopy was the only positive tool in the case of rheumatoid arthritis.Comparison of the diagnostic yield of Abrams’ needle biopsy versus CT guided biopsy in different groups:Abrams’ needle biopsy is superior significantly to CT guided biopsy in the diagnosis of tuberculous effusions (pConclusion1. The available Abrams’ needle biopsy is still an excellent and relatively safe procedure in the diagnosis of exudative pleural effusion especially tuberculous one.2. Percutaneous CT-guided cutting needle biopsy is safe and less invasive and diagnostic tool in patients with exudative pleural effusion.3. CT-guided biopsy is the diagnostic modality of choice in patients with mesothelioma and should precede thoracoscopy in those patients.4. CT-guided biopsy and Abrams’ needle biopsy are complementary to each others in the diagnosis of malignant pleural effusion especially mesothelioma.Recommendation1. Abrams’ needle biopsy should never be neglected as an invaluable diagnostic tool in the diagnosis of exudative pleural effusion that never to be abandoned.2. Based on routine investigations and clinical suspicions, the priority of CT-guided or blind Abrams’ pleural biopsies should be individualized as shown in the following algorithm (fig-11).3. Multiple CT-guided cutting needle pleural biopsies are advisable to be tried in patients with exudative pleural effusion as this guided technique may improve the total sensitivity of this procedure.4. The conclusion of the current study should be challenged widely on larger groups of patients for each of the items included.الاستنتاج :-من الشائع نقص الألبومين من الدم لدى مرضى الحالات الحرجة بعد الدخول إلى العناية المركزة لكل من الأحياء و الوفيات.توجد علاقة بين نسبة الوفيات وتركيز الألبومن ، ولكنه مؤشر غير دقيق للتفريق بينهم.ملخص عربىالألبومين هو أكثر البروتينات وفرة في البلازما يمثل حوالي 60% من البروتين المقاس و له شكل القلب و يوفر حوالي 80% من الضغط الاسموزى الغروانى داخل الأوعية في الأشخاص الطبعين.تركيز الألبومين فى الدم يتأثر بمعدلات التصنيع و التكثير و التوزيع بين جزئى ما داخل و ما خارج الاوعية. و يتم تصنيع الالبومين فقط داخل الكبد و يتأثر ذلك وفقا للبيئة الغذائية و الهرمونية و الاسموزية و الحالة المرضية.بعكس المحاليل الغر وانية المصنعة فان للالبومين العديد من الوظائف الفسيولوجية الاخرى فله وظيفة نقل و حمل الانيون (سالب الشحنه) و الكاتيون (موجب الشحنه) و ايضا العديد من الادوية. وازاحة الدواء من مكان حملة على الالبومين بواسطة ادوية اخرى قد يؤدى الى تغيير التأثير الدوائى واخراج الدواء المزاح. ايضاً يعمل الالبومين كمعادل بلازمى مؤثر لموازنة الحمض و القلوى و له دور مهم كمضاد للاكسده و له ايضاً وظيفه فى المحافظه على سلامة الاوعيه الدمويه الدقيقه و له خضائص مضاده للتجلط و مضاد للتخثر .يستخدم الألبومين فى علاج الحروق و الاصابات الحرارية .و التعويض الالبومين فى حالات فقدان البروتين المزمن كما فى تليف الكبد او اى دواء كلوى .ومع استخدام الألبومين يجب اتخاذ الاحتياطات اللازمه منعاًً لحدوث حمل زائد على الدوره الدمويه و الارتشاح الرئوى .يقل الالبومين فى الدم نتيجه الى نقص معدل او زيادة التكسيد و لكن هذه الحالات بطيئه بينما يقل الالبومين رئيسياً نتيجه لتغيير نفاذية الاوعيه الدمويه .تهدف هذه الدراسة الى تقييم تأثير الأبومين الدم على التطور المرضى لمرض الحالات الحرجةو نسب انتشاره بينهم .اجريت هذه الدراسه بوحدة العنايه المركزه بجامعة الزقازيق اختير بها حوالى 100 مريض قسموا الى اربع مجموعات هىمرض الانسداد الرئوي المزمن – مرض الصدمة الانتانيه - مرض ما بعد العمليات الجراحية – مرض متعددى الاصابات .اجريت هذه الفحوصات عليهم1 – قياس تركيز البومين الدم2 – العدد المحرز من الاباتشى عند الدخول و الثلاث ايام التاليه .و قسم المرض بعد زلك الى أحياء و وفيات .وجد من خلال هذه الدراسة ان الألبومين الدم ينقص عند مرضى الحالات الحرجه بعد دخولهم الى وحدة العنايه .وقد لوحظ ان شكل الهبوط للمنحنى عند الأحياء تدريجياً أكثر منه عند الوفيات .و أيضاً لوحظ أن تركيز الألبومين عند الدخول فى مرضى الأحياء أعلى من الوفيات .و لوحظ أيضاً أن مرضى الصدمة الأنتانية كانوا أكثر المجموعات هبوطاً و عند الدخول و أكثرهم وفيات بينما مرضى الأنسداد الرئوى كانوا الأقل فى نسبة الوفيات و لكن نسبة الألبومين لديهم عند الدخول وبعد ذلك كانت أعلى من مجموعة الصدمة الأنتانية. بينما المجموعتان الآخريتان وسط بين ذلك . أما بالنسبة للقيمة للألبومين لتقييم الحالة المرضية تبين من أنه مؤشر غير دقيق للتفريق بين نسبة الوفيات و الأحياء بين المجموعات المختلفة نظراً لأنه أقل حساسية و تخصيص من العدد المحرز من الأباتشى عند الدخول بينما بعد ذلك فإن تخصيصة الألبومين أعلى من عند العدد المحرز من الأباتشى فى الأيام التاليه.الاستنتاج :-من الشائع نقص الألبومين من الدم لدى مرضى الحالات الحرجة بعد الدخول إلى العناية المركزة لكل من الأحياء و الوفيات.توجد علاقة بين نسبة الوفيات وتركيز الألبومن ، ولكنه مؤشر غير دقيق للتفريق بينهم.