RESUMO
Adenosine deaminase (ADA) and lymphocyte proportion are known to be independently elevated in tuberculous effusions, but are non-specific, and false positive results are frequent. To overcome this problem the combined use of both parameters was prospectively studied in 276 patients with pleural effusion seen at Porto Alegre, Brazil. Using a cut-off level of 40 U/l at 37 degrees C (method of Giusti19) for ADA activity and lymphocyte proportion of more than 50%, the correct diagnosis of tuberculosis (sensitivity) was made in 90.7% (CI 87.3-94.1%) of 54 patients. A specificity of 97.7% (CI 95.9-99.5%) was recorded. Five false positive diagnoses of tuberculous effusion were made. Five false negative diagnoses were made: three cases with haematogenous tuberculous dissemination with low ADA levels, and two other patients with low lymphocyte proportion. The combined use of ADA activity determination and lymphocyte proportion is a highly efficient diagnostic strategy of low cost, that merits wider use.
Assuntos
Adenosina Desaminase/análise , Contagem de Leucócitos , Linfócitos , Derrame Pleural/citologia , Derrame Pleural/enzimologia , Tuberculose/diagnóstico , Brasil , Ensaios Enzimáticos Clínicos , Humanos , Valor Preditivo dos Testes , Tuberculose Pleural/diagnósticoRESUMO
The case of a 15-month-old patient with Shone's anomaly is reported. This anomaly includes supravalvar mitral ring, parachute mitral valve, subaortic stenosis and coarctation. The patient underwent a corrective surgery with resection of the supravalvar mitral ring, mitral comissurotomy and resection of the subaortic stenosis, anatomically significant lesions, with good postoperative development. A bibliographical review on the anomaly was undertaken.