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Sample records for fiebre derrame pleural

  1. Derrame pleural de origem indeterminada

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    Eduardo Genofre; Antonio Monteiro da Silva Chibante; Alex Gonçalves Macedo

    2006-01-01

    Apesar do progresso nos métodos diagnósticos, cerca de 20% dos derrames pleurais podem permanecer sem diagnóstico etiológico definido após os exames convencionais. Para tentar determinar a origem destes derrames, métodos não convencionais e procedimentos mais invasivos devem ser utilizados com o objetivo de tentar esclarecer a etiologia do derrame pleural e instituir a terapêutica mais adequada.In spite of the progress in the diagnostic methods, about 20% of the pleural effusions may remain w...

  2. Fiebre, derrame pleural y lesión osteolítica en paciente con infección por VIH Fever, pleural effusion and osteolytic lesion in a patient with HIV infection

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    J.I. Aláez

    2007-08-01

    Full Text Available Presentamos el caso de una paciente de 28 años que consultó por fiebre de hasta 40,8ºC, dolor pleurítico en costado derecho y aparición de una masa dolorosa en la extremidad inferior izquierda de cuatro días de evolución. Mediante tomografía axial computerizada (TAC se objetivó la existencia de una condensación en el lóbulo medio del pulmón derecho con derrame pleural asociado y patrón miliar bilateral. El estudio ecográfico de la extremidad inferior izquierda mostró una masa de partes blandas de aspecto quístico con destrucción de la cortical del peroné y destrucción ósea. La resonancia magnética confirmó la presencia de osteomielitis en el peroné izquierdo y de un absceso de partes blandas asociado. En el material obtenido por punción del citado absceso así como en tres muestras de esputo se aisló Mycobacterium tuberculosis, estableciéndose el diagnóstico de tuberculosis diseminada con afectación pulmonar miliar, osteomielitis peronea y absceso tuberculoso de partes blandas. Se inició tratamiento antituberculoso (rifampicina, isoniacida y pirazinamida seguido, dos semanas después, de tratamiento antirretroviral (AZT, 3TC y NVP. La paciente desarrolló un cuadro de erupción cutánea generalizada que desapareció tras la sustitución de la rifampicina por etambutol. Ante la persistencia de la masa de partes blandas, tras cinco semanas de tratamiento antituberculoso se procedió al drenaje quirúrgico del absceso. La evolución posterior fue favorable, permaneciendo la paciente asintomática al mes de ser dada de alta.We present the case of a 28 year old patient who came for consultation on a fever of up to 40.8º C, pleuritic pain on the right side and the appearance of a painful mass in the lower left extremity of four days evolution. Computerised axial tomography (CAT showed the existence of a condensation in the middle lobe of the right lung with associated pleural effusion and bilateral miliary pattern. The

  3. Derrame pleural neoplásico

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    Lisete Ribeiro Teixeira; José Antonio Figueiredo Pinto; Evaldo Marchi

    2006-01-01

    O derrame pleural neoplásico é uma complicação freqüente nos pacientes portadores de tumores avançados. A presença de células malignas no líquido pleural ou na biópsia da pleura é indicativa de disseminação da doença primária, com conseqüente redução da expectativa de vida. O diagnóstico e tratamento precoce do derrame pleural maligno são fundamentais para promover uma melhor qualidade de vida aos pacientes portadores de câncer avançado.The malignant pleural effusion is a frequent complicatio...

  4. Derrame pleural neoplásico

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    Teixeira, Lisete Ribeiro; Pinto,José Antonio de Figueiredo; Marchi,Evaldo

    2006-01-01

    O derrame pleural neoplásico é uma complicação freqüente nos pacientes portadores de tumores avançados. A presença de células malignas no líquido pleural ou na biópsia da pleura é indicativa de disseminação da doença primária, com conseqüente redução da expectativa de vida. O diagnóstico e tratamento precoce do derrame pleural maligno são fundamentais para promover uma melhor qualidade de vida aos pacientes portadores de câncer avançado.

  5. Derrame pleural de origem indeterminada Undiagnosed pleural effusion

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    Eduardo Genofre

    2006-08-01

    Full Text Available Apesar do progresso nos métodos diagnósticos, cerca de 20% dos derrames pleurais podem permanecer sem diagnóstico etiológico definido após os exames convencionais. Para tentar determinar a origem destes derrames, métodos não convencionais e procedimentos mais invasivos devem ser utilizados com o objetivo de tentar esclarecer a etiologia do derrame pleural e instituir a terapêutica mais adequada.In spite of the progress in the diagnostic methods, about 20% of the pleural effusions may remain without a proper diagnosis after the use of conventional exams. In order to determine the origin of these effusions, alternative methods and invasive procedures shall be used aiming to determine the etiology of the undiagnosed pleural effusions and institute the most appropriate therapeutics.

  6. Derrame pleural neoplásico Malignant pleural effusion

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    Lisete Ribeiro Teixeira

    2006-08-01

    Full Text Available O derrame pleural neoplásico é uma complicação freqüente nos pacientes portadores de tumores avançados. A presença de células malignas no líquido pleural ou na biópsia da pleura é indicativa de disseminação da doença primária, com conseqüente redução da expectativa de vida. O diagnóstico e tratamento precoce do derrame pleural maligno são fundamentais para promover uma melhor qualidade de vida aos pacientes portadores de câncer avançado.The malignant pleural effusion is a frequent complication in patients with of advanced tumors. The presence of malignant cells in the pleural fluid or in the pleural biopsy is indicative of dissemination of the primary disease, with consequent reduction of life expectancy. The early diagnosis and treatment of the malignant effusion is pivotal in promoting a better quality of life to patients with advanced cancer.

  7. Derrame pleural en enfermedad de Milroy

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    Juan José Celis-Jiménez

    2013-01-01

    Full Text Available La enfermedad de Milroy, también conocida como linfedema congénito primario, fue descrita inicialmente en 1892 por William Forsyth Milroy. Es una afección que se presenta generalmente en el nacimiento, o bien durante la infancia, de origen genético con patrón de herencia autosómico dominante, causada por un defecto en el receptor 3 del factor de crecimiento endotelial vascular VEGFR3, lo que conlleva a hipoplasia o aplasia de vasos linfáticos, mayormente de miembros inferiores hecho que se manifiesta por aumento de volumen de las mismas. Esta condición en ocasiones extraordinarias se complica con derrame pleural, motivo por el cual reportamos el caso de paciente femenino, de 39 años de edad, diagnosticada a través de clínica y paraclínica, y revisión de la literatura con el propósito de establecer formas de presentación, complicaciones presentes, diagnóstico diferencial y terapéutica Pleural effusions in Milroy’s disease Abstract Milroy´s disease, also known as primary congenital lymphedema, was described in 1892 by William Forsyth Milroy, and is an affection, that usually occurs at birth, or during the infancy, genetic with autosomal dominant inheritance, caused by a defects in caused by mutation in vascular endothelial growth factor receptor 3 (VEGFR3, leading to aplasia or hypoplasia of lymphatic vessels, mainly in the lower limbs, fact manifested by swelling thereof. This entity sometimes extraordinary complicated with pleural effusion, which is why we report a case of a Female patient, 39 years old, diagnosed through clinical and paraclinical, review the literature in order to establish ways of presentation, present complications, differential diagnosis and therapy

  8. Derrame pleural parapneumônico e empiema

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    Marchi,Evaldo; Lundgren,Fernando; Mussi, Ricardo

    2006-01-01

    O derrame infeccioso, uma das causas mais freqüentes de derrame pleural obervados na pratica clinica, é um sinal de complicação do quadro pneumônico. O reconhecimento precoce do derrame parapneumônico é fundamental para determinar a melhor forma de tratamento, reduzindo o risco de morbidade e mortalidade. A evolução dos métodos diagnósticos e a experiência dos diversos estudos publicados na literatura permitiram estabelecer diretrizes baseadas em evidencias que orientam a conduta de abordagem...

  9. DERRAME PLEURAL NUMA POPULAÇÃO PEDIÁTRICA

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    Vera Baptista; Carla Moreira; Jorge Correia Pinto; Augusta Gonçalves

    2016-01-01

    Introdução: o derrame pleural é uma complicação da pneu- monia que aumenta a sua morbilidade. Pretendemos descrever as características clínicas, estratégias diagnósticas e terapêutica do derrame pleural parapneumónico numa população pediátrica no hospital de Braga. Método: análise retrospetiva dos internamentos num período de 5 anos (2010-2015). Resultados: foram diagnosticados 50 derrames pleurais, com distribuição de género análoga, idade entre 6 meses e 15 anos e 9 meses (média 6 ano...

  10. Procedimientos quirúrgicos en 156 casos de derrame pleural. Resultados inmediatos

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    Raúl Cicero-Sabido; Rafael F. Páramo-Arroyo; Francisco Pascual Navarro-Reynoso; Lorenzo Pimentel-Ugarte

    2006-01-01

    Introducción: el derrame pleural es una entidad clínica frecuente, su estudio y manejo son importantes para resolverlo. El objetivo fue evaluar los resultados inmediatos de los procedimientos diagnósticos y terapéuticos en casos consecutivos de derrame pleural. Material y métodos: durante un periodo de 12 meses, de 787 pacientes hospitalizados, 156 (19.8 %) presentaron derrame pleural. También se evaluaron 22 casos de neumotórax considerados como derrame gaseoso y 10 con empiema crónico. Resu...

  11. ENFOQUE DIAGNÓSTICO EN EL PACIENTE CON DERRAME PLEURAL

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    Maite Oyonarte W., DRA.

    2015-05-01

    Full Text Available En el estudio diagnóstico del paciente con derrame pleural se deben considerar la historia clínica y el análisis de las imágenes para acotar el diagnóstico diferencial. El uso adecuado de las técnicas de imágenes contribuye a realizar procedimientos en forma segura. Se debe realizar una toracocentesis diagnóstica y/o evacuadora y se debe analizar completamente el líquido pleural. A veces es necesario realizar biopsia pleural para lo cual existen diversas técnicas disponibles. En los pacientes con pleuritis crónica inespecífica se debe hacer seguimiento por dos años para evaluar el desarrollo de malignidad.

  12. Rol del laboratorio inmunológico en el estudio de pacientes con derrame pleural

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    2013-01-01

    Todo paciente con derrame pleural de causa no clara debe ser sometido a pleurocentesis para estudio de las características del líquido pleural. El laboratorio inmunológico está entre los análisis solicitados en forma optativa. Se revisa la utilidad de la determinación de ANA, células LE, factor reumatoideo, complemento y sus fracciones en el diagnóstico etiológico de los pacientes con derrame pleural Any patient with pleural effusion of unc...

  13. Mixoma de átrio esquerdo associado a derrame pleural

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    MEIRA Enoch Brandão de Souza

    2000-01-01

    Full Text Available Homem de 65 anos apresentando emagrecimento, dispnéia e derrame pleural (DP recorrente. A avaliação cardiológica evidenciou ruflar diastólico (3/6 no foco mitral e hiperfonese da 1ª bulha. O ecocardiograma e o estudo hemodinâmico mostraram uma grande massa tumoral no átrio esquerdo (AE, sugerindo mixoma e hipertensão pulmonar. A biópsia pleural revelou pleurite crônica inespecífica. O paciente foi submetido à operação com circulação extracorpórea para exérese do tumor de AE e o estudo histopatológico confirmou o diagnóstico de mixoma. O DP tem sido manifestação muito rara do mixoma cardíaco (MC, que às vezes apresenta somente sinais e sintomas inespecíficos de doença inflamatória crônica.

  14. Doença de Castleman associada a derrame pleural Castleman's disease accompanied by pleural effusion

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    Valéria Góes Ferreira Pinheiro

    2008-08-01

    Full Text Available A doença de Castleman é uma rara afecção do tecido linfóide. Relatamos o caso de uma paciente do sexo feminino com otosclerose bilateral, sem sintomas respiratórios e com achado incidental de derrame pleural esquerdo em uma radiografia de tórax. A tomografia computadorizada de tórax revelou uma massa mediastinal. A biópsia demonstrou tratar-se de variante plasmocitária da doença de Castleman. A paciente foi submetida à ressecção da massa mediastinal. Houve regressão do derrame, o qual persistiu como pequena loculação no espaço pleural esquerdo.Castleman's disease is a rare disorder of the lymphoid tissue. We report the case of a female patient with bilateral otosclerosis, no respiratory symptoms, and pleural effusion discovered as an incidental finding on a chest X-ray. Computed tomography of the chest revealed a mediastinal mass. The biopsy findings demonstrated that it was a plasmacytic variant of Castleman's disease. The patient underwent mediastinal mass resection. This resulted in near-total resolution of the effusion, which remained as a small loculation within the left pleural space.

  15. Valor de la videotoracoscopia en el derrame pleural Value of video-assisted thoracoscopy in the pleural effusion

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    Edelberto Fuentes Valdés

    2004-12-01

    Full Text Available El derrame pleural es una de las lesiones que con frecuencia son consultadas al cirujano: en demanda de obtención de material tisular para biopsia, tras el fallo reiterado de la punción citológica o para tratar enfermos con derrame incontrolable. Objetivos: Evaluar la utilidad de la videotoracoscopía en el diagnóstico y tratamiento de pacientes portadores de un derrame pleural. Métodos: Estudio retrospectivo sobre una base de datos prospectiva, que comprende 73 pacientes consecutivos a quienes se les practicó una videotoracoscopía para diagnóstico y tratamiento de un derrame pleural, tratados entre enero de 1997 y julio de 2004. Resultados: Al sexo masculino correspondieron 43 pacientes y 30 al femenino. Treinta y nueve (52,4 % tenían una enfermedad maligna, con predominio de pulmón y mama, como causa del derrame. El 71,2 % de los casos fueron operados con intención diagnóstica. Entre las causas no tumorales sobresalen la inflamación pleural crónica (10, empiema (7, pleuritis aguda y subaguda (5 y tuberculosis pleural (4. El proceder terapéutico más frecuente fue la pleurodesis con talco en derrames malignos. En 69 pacientes (94,5 % el proceder fue útil. Tres sufrieron complicaciones posoperatorias, 2 insuficiencia respiratoria y 1 enfisema subcutáneo. Fallecieron 3 (4,1 %, 2 de ellos por insuficiencia respiratoria que no permitió la separación del ventilador mecánico. Conclusiones: La videotoracoscopía es una herramienta útil en el manejo de los casos portadores de un derrame pleural, cuando no se ha logrado obtener el diagnóstico y para realizar la pleurodesis con talcoThe pleural effusion is one of the lesions that are frequently consulted with the surgeon to obtain tissue material for biopsy after the reiterated failure of the cytological puncture, or to treat patients with uncontrollable effusion. Objective: to evaluate the usefulness of the video-assisted thoracoscopy in the diagnosis and treatment of patients

  16. DERRAME PLEURAL NUMA POPULAÇÃO PEDIÁTRICA

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    Vera Baptista

    2016-07-01

    Conclusões: A ecografia torácica foi o exame que confirmou e avaliou as caraterísticas do derrame. O TC foi pouco usado, reservado para casos complicados ou com necessidade de tratamento cirúrgico. A taxa de identificação do agente foi baixa (4%. A duração do internamento e da drenagem torácica foi inferior à relatada noutros hospitais centrais portugueses.

  17. Derrame pleural como debut de síndrome linfoproliferativo

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    Ochoa Ramírez Á

    2017-07-01

    Full Text Available Extranodal MALT lymphomas are a type of lymphoproliferative syndrome belonging to non-Hodgkin's lymphomas. The most common affectation of these types of lymphomas is the digestive tract (80%, the lung being only 14% of cases. We present the case of a 73 years old woman who goes to progressive dyspnea, with a large right pleural effusion on the chest x-ray. After screening and differential diagnosis of the different types of pleural effusion and the clinical etiological processes involved in its production, the diagnosis of lymphoproliferative process was reached, starting chemotherapy treatment with good evolution of both the pleural effusion and the patient's clinic.

  18. Classificação ultra-sonográfica do derrame pleural e do empiema parapneumônico

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    Cirino Luís Marcelo Inaco; Francisco Neto Miguel José; Tolosa Erasmo Magalhães de Castro

    2002-01-01

    Os autores correlacionam as alterações anatomopatológicas da cavidade pleural com os achados ultra-sonográficos no derrame pleural e no empiema parapneumônico e apresentam uma classificação baseada nestes dados. Concluem que a ultra-sonografia é método diagnóstico fidedigno para inferir a fase anatomopatológica da doença pleural, bem como auxiliar na escolha da alternativa de tratamento.

  19. Pseudocisto de pâncreas associado a derrame pleural maciço

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    MAGALHÃES EVANDRO MONTEIRO S. DE

    2002-01-01

    Full Text Available Os autores relatam um achado de derrame pleural maciço decorrente de pseudocisto de pâncreas. Para auxílio de diagnóstico foram realizadas radiografia, ultra-sonografia, REED, tomografia computadorizada toracoabdominal e dosagem de amilase no líquido pleural. O paciente foi submetido a tratamento clínico com suporte nutricional e toracocentese com esvaziamento pleural de 3.200ml. Após estabilização clínica/nutricional, foi indicada laparotomia, com a retirada do pseudocisto. O paciente apresentou boa evolução no pós-operatório, recebendo alta em boas condições clínicas. A partir do caso relatado, é feita uma revisão da literatura sobre a ocorrência de derrames pleurais associados à doença pancreática e seu diagnóstico.

  20. Tratamiento paliativo de los derrames pleurales malignos mediante abrasión química

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    Juan Antonio Castellanos González

    Full Text Available Introducción: el tratamiento del derrame pleural maligno constituye un reto para los cirujanos. Su erradicación permanente ha constituido un largo bregar, y para ello se ha utilizado un numeroso grupo de sustancias. Objetivo: mostrar los resultados del uso de diferentes sustancias químicas para conseguir la fusión de las pleuras en el derrame pleural maligno. Métodos: fueron estudiados 116 pacientes con derrames malignos de pleura tratados mediante toracocentesis y escleroterapia química en el Hospital Universitario "Comandante Manuel Fajardo" entre enero de 2001 y el 2013. El diagnóstico del 100 % de los pacientes fue clínico e imaginológico, con estudio del líquido pleural. Después de la toma de muestra se evacuó todo el contenido mediante un catéter colector y la instilación de la solución esclerosante. Como agentes irritantes se utilizó bleomicina, tetraciclina, amoxicilina y povidona yodada. Resultados: la causa más frecuente de derrame pleural resultó ser el cáncer de mama, seguido por el de pulmón y el ovario. En el hombre fue más frecuente el cáncer de pulmón y en la mujer el cáncer de mama. Predominó el sexo femenino y, específicamente, la sexta década de la vida. El 52,4 % de los pacientes necesitó dos sesiones terapéuticas y el 15,6 % no presentó recidiva después de la primera sesión. Conclusiones: los resultados fueron similares con todas las sustancias utilizadas. La intervención paliativa logró mejorar la calidad de vida al aliviar los síntomas de los pacientes y disminuir la hospitalización.

  1. Contribución del análisis del líquido pleural al diagnóstico de los derrames pleurales

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    San José Capilla, María Esther

    2016-01-01

    El derrame pleural es una complicación común en numerosas enfermedades, y el diagnóstico diferencial es frecuentemente difícil de obtener sin la utilización de técnicas invasivas, lo que se intenta evitar. Aunque hay una amplia variedad de pruebas de laboratorio, un porcentaje significativo de pacientes con derrame pleural permanecen sin diagnosticar, o el diagnóstico se basa exclusivamente en evidencias clínicas, como son la experiencia del clínico o la respuesta al tratamiento empírico; ...

  2. Contribución del análisis del líquido pleural al diagnóstico de los derrames pleurales

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    San José Capilla, María Esther

    2016-01-01

    El derrame pleural es una complicación común en numerosas enfermedades, y el diagnóstico diferencial es frecuentemente difícil de obtener sin la utilización de técnicas invasivas, lo que se intenta evitar. Aunque hay una amplia variedad de pruebas de laboratorio, un porcentaje significativo de pacientes con derrame pleural permanecen sin diagnosticar, o el diagnóstico se basa exclusivamente en evidencias clínicas, como son la experiencia del clínico o la respuesta al tratamiento empírico; ...

  3. Classificação ultra-sonográfica do derrame pleural e do empiema parapneumônico

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    Cirino Luís Marcelo Inaco; Francisco Neto Miguel José; Tolosa Erasmo Magalhães de Castro

    2002-01-01

    Os autores correlacionam as alterações anatomopatológicas da cavidade pleural com os achados ultra-sonográficos no derrame pleural e no empiema parapneumônico e apresentam uma classificação baseada nestes dados. Concluem que a ultra-sonografia é método diagnóstico fidedigno para inferir a fase anatomopatológica da doença pleural, bem como auxiliar na escolha da alternativa de tratamento.We correlated the anatomopathological abnormalities of the pleural space with the ultrasound findings in pa...

  4. Derrame pleural como complicación respiratoria de la ingesta de kerosene en niños.

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    Lucrecia Monsante

    1997-01-01

    Full Text Available Objetivo: Determinar la frecuencia de derrame pleural como complicación de la neumonitis química por ingesta de kerosene, en niños menores de 2 años. Material y métodos: Se realizó un estudio retrospectivo en el Hospital Nacional Cayetano Heredia durante el período 1988-1995. Se revisaron las historias clínicas y las radiografías de los pacientes hospitalizados en el Servicio de Lactantes con diagnóstico de derrame pleural asociado a ingesta de kerosene. Además, se revisó el libro de registros de emergencias pediátricas de 1995 consignando el número de pacientes menores de 24 meses que llegaron por ingesta de kerosene y luego se evaluó cuantos de estos pacientes fueron hospitalizados y además presentaron derrame pleural. Resultados: El 14.5% de los hospitalizados durante el período 1988-1995 presentaron derrame pleural como complicación a la neumonitis; durante el año 1995, el 10.9% de los pacientes que llegaron a emergencia por ingesta de kerosene se hospitalizaron. (Rev Med Hered 1997; 8: 19-22.

  5. Derrame pleural tuberculoso: diagnóstico mediante videotoracoscopia Derrame pleural tuberculoso: diagnóstico mediante videotoracoscopia Tuberculous pleural effusion: diagnosis by videothoracoscopy

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    Edelberto Fuentes Valdés; Miguel A Martín González

    2006-01-01

    El diagnóstico de la tuberculosis pleural es difícil por la presentación inespecífica y la pobre eficiencia de los métodos diagnósticos tradicionales cuando de esta se trata. Se realizó un estudio retrospectivo de 6 pacientes a quienes se realizó el diagnóstico de tuberculosis pleural mediante videotoracoscopia, ante el fracaso de los métodos tradicionales. El objetivo fue conocer el valor de la videotoracoscopia en el diagnóstico de la tuberculosis pleural. Cinco de los 6 pacientes eran del ...

  6. Derrame pleural parapneumônico complicado na fase fibrinopurulenta em crianças: comparação entrea toracoscopia precoce e tardia

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    Rodrigo Romualdo Pereira

    2014-01-01

    Derrame pleural é caracterizado pelo desequilíbrio entre a formação e a remoção do fluido pleural, com acúmulo de líquido no espaço pleural. O derrame pleural pode ocorrer em decorrência de processos locais pleuropulmonares (infecciosos, auto-imunes ou neoplásicos) ou de doenças sistêmicas (cardíacas, renais, hepáticas ou pancreáticas).

  7. Derrame pleural parapneumônico complicado na fase fibrinopurulenta em crianças: comparação entrea toracoscopia precoce e tardia

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    Rodrigo Romualdo Pereira

    2014-01-01

    Derrame pleural é caracterizado pelo desequilíbrio entre a formação e a remoção do fluido pleural, com acúmulo de líquido no espaço pleural. O derrame pleural pode ocorrer em decorrência de processos locais pleuropulmonares (infecciosos, auto-imunes ou neoplásicos) ou de doenças sistêmicas (cardíacas, renais, hepáticas ou pancreáticas).

  8. Cytological diagnosis of a metastatic canine mammary tumor in pleural effusion Diagnóstico citológico de tumor mamário metastático canino em derrame pleural

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    G.D. Cassali

    1999-08-01

    Full Text Available Descrevem-se os achados citomorfológicos de um tumor maligno de mama em uma cadela Poodle de sete anos de idade, o qual foi observado inicialmente pelo exame citológico do derrame pleural. Comparam-se os aspectos citológicos do derrame pleural e punção aspirativa com agulha fina do tumor com aqueles descritos para o câncer de mama na espécie humana.

  9. Derrame pleural complicado en el niño: una urgencia quirúrgica

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    Alberto Rubén Piriz-Assa

    2011-01-01

    Full Text Available El tratamiento óptimo del DerramePleural Complicado es controversial por lo que la aplicación y evaluaciónde una estrategia de intervención para optimizar su tratamiento fue el objetivo del estudio. Se realizó un estudio cuasiexperimental con un grupo control y uno de estudio, en el Hospital Pediátrico Provincial deHolguín, Cuba. La estrategia se aplicó a 22 pacientes, conformando el grupo de estudio, comparados con 22 niños de una cohorte histórica, que fue el grupo control. En el de estudiodisminuyó a 13 días la media de estadía hospitalaria, sólo se cambió de antimicrobiano en el (63.8% de los pacientes, siendo su principal causa la inefectividad del mismo, el (95.4% y el (91% no presentaron complicaciones pulmonares ni extrapulmonares respectivamente, disminuyó la necesidad de toracotomía, se pudo establecer con mayor rapidez el alta radiológica y el total de los pacientes egresaron vivos lo que quedó demostrada la eficacia de la aplicación de la cirugía videotoracoscopía de forma precoz .

  10. Valor de las subpoblaciones de las células natural killer y del receptor de citotoxicidad natural NKp44 como biomarcadores de malignidad en derrames pleurales

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    Herrera Lara, Susana

    2015-01-01

    El derrame pleural maligno es un problema clínico común en los pacientes con enfermedad neoplásica y su aparición es un signo de enfermedad avanzada ya que implica la afectación del espacio pleural por parte de dicho proceso maligno. La citometría de flujo es una técnica que permite un análisis rápido, preciso y reproducible de las células del líquido pleural, pudiendo complementar a la citología en el estudio de los derrames pleurales sospechosos de malignidad. Las células NK están e...

  11. Derrame pleural como efeito adverso do tratamento da leucemia mielóide crônica com dasatinibe e seu manejo sem resposta satisfatória

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    Ivan Fernandes Filho

    2014-10-01

    Full Text Available Introdução: A Leucemia Mieloide Crônica (LMC é uma desordem clonal de células hematopoiéticas com translocação t(9;22 (q34;q11 que culmina em proliferação maligna. No tratamento da LMC, o Dasatinibe pode causar derrames pleurais. Objetivos: relatar o caso de intolerância ao derrame pleural recidivante e ineficácia da pleurodese em usuário de Dasatinibe. Metodologia: as informações foram obtidas através de prontuários e revisão da literatura Relato de caso: Relatamos o caso de um paciente de 64 anos, com diagnóstico de LMC há 15 anos, tratava-se com Hidroxicarbamida. Foi introduzido o tratamento com Imatinibe (2003-2008 cujo término decorre da perda de resposta molecular. Este foi trocado pelo nilotinibe (18 meses, sendo substituído devido à obstrução vascular. O uso de Dasatinibe 100 mg/dia obteve resposta maior. Após 15 dias, apresentou derrame pleural, tratado com diuréticos, corticosteróides e suspensão do Dasatinibe, com pequena melhora. Porém, houve recidiva durante o tratamento que impediram o tratamento adequado e levaram a perda da resposta molecular. Em 2014, foi feita a pleurodese com melhora transitória, mas com aparecimento de derrame contra- lateral sintomatológico. O Dasatinibe foi suspenso e substituído por interferon- alfa. Ainda não dispomos do BCR-ABL quantitativo para a avaliação do último medicamento. Conclusão: O derrame pleural recidivante impediu o tratamento adequado. A pleurodese não foi tão eficaz pelo derrame pleural contra-lateral.

  12. Resultados preliminares de la pleurodesis con talco para el tratamiento de los derrames pleurales de causa maligna Preliminary results of talc pleurodesis for the treatment of pleural effusions of malignant origin

    OpenAIRE

    Juan Carlos Collado Otero; José Manuel Vázquez González; Ricardo Almeida Varela; José Luís Guerra Mesa; Yoel Rodríguez Borges

    2007-01-01

    Se realizó un corte preliminar de un estudio descriptivo y prospectivo que se lleva a cabo en el Instituto Nacional de Oncología y Radiobiología, con el objetivo de conocer la efectividad de la pleurodesis con talco para evitar las recidivas de los derrames pleurales de causa maligna, aplicado a través de una pleurotomía mínima baja o por videotoracoscopia. Además, para valorar la ocurrencia de efectos adversos y complicaciones. Catorce individuos fueron incluidos tras presentar derrames secu...

  13. Teratoma do mediastino simulando derrame pleural no estudo radiológico do tórax Mediastinal teratoma mimicking pleural effusion on chest X-rays

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    Miguel Angelo Martins de Castro Júnior

    2007-02-01

    Full Text Available Teratomas mediastinais representam 8 a 13% dos tumores nesta região. Uma paciente de 27 anos apresentou-se com dor torácica e dispnéia de evolução arrastada. O radiograma de tórax revelou opacidade quase total do hemitórax direito, levando à suspeita de derrame pleural. A tomografia de tórax evidenciou coleção pleural heterogênea, de contornos regulares (10,1 x 11,7 cm, nos dois terços inferiores do hemitórax direito, sem envolvimento de estruturas adjacentes. Na toracotomia exploradora, pela hipótese de teratoma cístico benigno do mediastino, realizou-se ressecção total da lesão, com boa evolução pós-operatória. A apresentação atípica e grande crescimento do tumor dificultaram o diagnóstico pré-operatório.Teratomas account for 8-13% of all mediastinal tumors. A 27-year-old patient presented with chest pain and dyspnea of prolonged evolution. A chest X-ray revealed near total opacification of the right hemithorax. On a tomography scan of the chest, a collection of heterogeneous fluid, with irregular borders and 10.1 x 11.7 cm in size, was seen in the pleura of the lower two-thirds of the right hemithorax but was not encroaching on any of the adjacent structures. Based on the hypothesis that these findings represented a benign mediastinal teratoma, an exploratory thoracotomy was performed, during which such a teratoma was found and completely excised. The post-operative evolution was favorable. The atypical presentation and considerable growth of the tumor hindered the pre-operative diagnosis.

  14. Derrame pleural complicado en el niño: guía práctica cubana Complicated pleural leakage: Cuban practice guide

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    Alberto Rubén Piriz Assa

    2009-03-01

    Full Text Available Durante el tratamiento actual del niño con derrame pleural paraneumónico complicado se detectan insuficiencias y contradicciones debidas a la diversidad de formas de presentación de dicho trastorno y a la ausencia de consenso con respecto al tratamiento adecuado. Se propone una guía de práctica clínica validada mediante un estudio cuasiexperimental desarrollado en la provincia de Holguín, durante 4 años. La guía está compuesta por 4 capítulos e incluye recomendaciones precisas ante cada forma de presentación de la enfermedad.During present treatment of a child presenting with complicated parapneumonic leakage, it is possible to detect insufficiencies and contraindications due to different ways of presentation of such disorder, and to lack of consensus regarding appropriate treatment. We propose a valid clinical practice by means a quasi-experimental study developed in Holguín province during 4 years. Guide include 4 chapters and precise recommendations in face of each way of presentation of this disease.

  15. Toracoscopia em crianças com derrame pleural parapneumônico complicado na fase fibrinopurulenta: estudo multi-institucional

    OpenAIRE

    Sérgio Freitas; José Carlos Fraga; Fernanda Canani

    2009-01-01

    OBJETIVO: Determinar a eficácia da toracoscopia em crianças com derrame pleural parapneumônico complicado (DPPC) na fase fibrinopurulenta. MÉTODOS: Estudo retrospectivo de 99 crianças submetidas à toracoscopia para tratamento de DPPC na fase fibrinopurulenta entre novembro de 1995 e julho de 2005. A média de idade foi de 2,6 anos (variação, 0,4-12 anos) e 60% eram do sexo masculino. A toracoscopia foi realizada em três hospitais diferentes utilizando-se o mesmo algoritmo de tratamento. RESULT...

  16. Antígeno carcinoembrionário no diagnóstico diferencial dos derrames pleurais Carcinoembryonic antigen in differential diagnosis of pleural effusion

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    Miguel Angelo Martins de Castro Junior

    2005-02-01

    Full Text Available OBJETIVO: Analisar a sensibilidade e a especificidade da dosagem do CEA no diagnóstico diferencial do derrame pleural de pacientes portadores de doenças benígnas e malígnas. MÉTODO: Estudo contemporâneo de série de casos, realizado do Serviço de Cirurgia Torácica do Hospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul. Entre julho de 2000 e julho de 2001, 64 pacientes foram submetidos à investigação etiológica de efusão pleural,e submetidos aos seguintes exames: pH, LDH, dosagem protêica, densidade, glicose, citologia diferencial, pesquisa de fungos e BAAR, gram e cultura com antibiograma, citopatologia, dosagem de CEA e biópsia pleural. RESULTADOS: Pacientes com derrames de etiologia maligna (n=26 tiveram resultado do CEA variando de zero a 5000ng/ml, enquanto nos de etiologia benígna os valores variaram de zero a 4,8ng/ml. Nível médio de CEA na efusão carcinomatosa foi de 431 ± 1237 ng/ml (média ± desvio padrão, significativamente maior que nos benignos (1,1 ± 1,0 ng/ml; pBACKGROUND: To analyze patients with diagnosis of benign or malignant diseases, in whose evolution develop pleural effusion, in which CEA measurement was questioned in relation to sensitivity and specificity in the differentiation of these two groups. METHODS: Prospective consecutive case series of the Department of Thoracic Surgery, Conceição Hospital, Porto Alegre, Brazil. From July 2000 to December 2001, 64 patients were subjected to clinical investigation in search for a pleural effusion aetiology. All patients underwent the following laboratory evaluation of pleural fluid: pH, LDH, proteins, density, glucose, differential cytology, bacterial culture, search for fungus and acid-fast bacilli, cytology, CEA determination and pleural biopsy. RESULTS: Patients with malignant etiologic diagnosis (n=26, had CEA results ranging from zero to 5000 ng/ ml, while benign cases results were from zero to 4.8 ng/ml. CEA level in malignant

  17. Toracoscopia em crianças com derrame pleural parapneumônico complicado na fase fibrinopurulenta: estudo multi-institucional Thoracoscopy in children with complicated parapneumonic pleural effusion at the fibrinopurulent stage: a multi-institutional study

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    Sérgio Freitas

    2009-07-01

    Full Text Available OBJETIVO: Determinar a eficácia da toracoscopia em crianças com derrame pleural parapneumônico complicado (DPPC na fase fibrinopurulenta. MÉTODOS: Estudo retrospectivo de 99 crianças submetidas à toracoscopia para tratamento de DPPC na fase fibrinopurulenta entre novembro de 1995 e julho de 2005. A média de idade foi de 2,6 anos (variação, 0,4-12 anos e 60% eram do sexo masculino. A toracoscopia foi realizada em três hospitais diferentes utilizando-se o mesmo algoritmo de tratamento. RESULTADOS: A toracoscopia foi eficaz em 87 crianças (88% e 12 (12% necessitaram de outro procedimento cirúrgico: nova toracoscopia (n = 6 ou toracotomia/pleurostomia (n = 6. O tempo médio de drenagem torácica foi de 3 dias nas crianças em que a toracoscopia foi efetiva e de 10 dias naquelas que precisaram de outro procedimento (p OBJECTIVE:To determine the efficacy of thoracoscopy in the management of children with complicated parapneumonic pleural effusion at the fibrinopurulent stage. METHODS: Retrospective study of 99 children submitted to thoracoscopy for the treatment of complicated parapneumonic pleural effusion at the fibrinopurulent stage between November of 1995 and July of 2005. The mean age was 2.6 years (range, 0.4-12 years, and 60% were males. Thoracoscopy was performed at three different hospitals following the same treatment algorithm. RESULTS: Thoracoscopy was effective for 87 children (88%. In 12 (12%, a second surgical procedure was required: another thoracoscopy (n = 6 or thoracotomy/thoracostomy (n = 6. Mean duration of chest tube drainage following successful thoracoscopy was 3 days vs. 10 days in patients submitted to a second procedure (p < 0.001. In all of the children, the pleural infection resolved after treatment. Thoracoscopy-related complications included air leak (30%, chest tube bleeding (12%, subcutaneous emphysema associated with trocar insertion (2% and surgical wound infection (2%. None of the children required

  18. Estudo prospectivo do derrame pleural pós-cirurgia abdominal e dos fatores de risco associados: avalição por ultra-sonografia Pleural effusion following abdominal surgery and associated risk factors: ultrasound assessment

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    Luiz Antonio Rossi

    2005-04-01

    Full Text Available MOTIVAÇÃO: Derrame pleural é alteração pulmonar comumente observada em exames de imagem após cirurgias abdominais eletivas, sem repercussão clínica na maioria dos enfermos, devendo ser individualizada das complicações pulmonares que requerem tratamento. Sua incidência, bem como os indicadores de risco, são desconhecidos em nosso meio. OBJETIVO: Determinar, pela ultra-sonografia, a incidência de derrame pleural pós-operatório (DPPO em cirurgias abdominais eletivas e averiguar suas possíveis associações com fatores de risco relacionados aos doentes e procedimentos anestésico-cirúrgicos. MATERIAIS E MÉTODOS: Estudaram-se 21 (56,8% mulheres e 16 (43,2% homens, entre 29 e 76 anos, submetidos a cirurgias abdominais eletivas. Os exames ecográficos foram realizados no pré-operatório e 48 horas após a cirurgia. Foram estudados os fatores de risco associados ao paciente - idade maior de 60 anos, sexo, obesidade, tabagismo, etilismo e presença de doenças associadas -, e ao procedimento anestésico-cirúrgico - cirurgia para ressecção de câncer, classe ASA > 2, tempo anestésico-cirúrgico, incisão longitudinal e incisão > 15 cm. A litíase biliar (43,2% e a presença de câncer gastrintestinal (43,2% foram os principais responsáveis pela indicação cirúrgica. O DPPO foi graduado de pequeno, médio e grande. RESULTADOS: A incidência de DPPO foi de 70,3% (26/37. Dois (5,4% desses doentes evoluíram com complicações pulmonares graves, um deles vindo a falecer. Idade maior de 60 anos, tabagismo, etilismo, obesidade e presença de doenças associadas não influenciaram o aparecimento de DPPO. Cirurgia para ressecção de câncer, classe ASA > 2, incisão longitudinal e incisão > 15 cm associaram-se de modo significante à presença de DPPO, que ocorreu mesmo na vigência de antibioticoprofilaxia. O tempo de permanência hospitalar foi 2,4 vezes maior nos doentes com DPPO. CONCLUSÃO: A ocorrência de derrame pleural em p

  19. Fiebre postoperatoria en pacientes del Cardiocentro Ernesto Che Guevara / Postoperative fever in patients of the Cardiocentro Ernesto Che Guevara

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    Alina Ceballos Álvarez

    2015-08-01

    Full Text Available Introducción: La fiebre es una de las dificultades que se presentan en el período pos-quirúrgico. Objetivo: Caracterizar la incidencia de fiebre en el postoperatorio de cirugía cardio-vascular. Método: Estudio observacional descriptivo, longitudinal, prospectivo, en 31 pacientes con fiebre en el postoperatorio. Resultados: Un 15,6 % del total de pacientes operados de cirugía cardiovascular (31 casos presentó fiebre en el postoperatorio y en 20 de ellos la causa fue séptica. Apareció más frecuentemente en el sexo masculino (74,2 %, tras cirugía de dos vál-vulas o de revascularización miocárdica (67,7 %, y en el grupo etario de 30-49 años (48,9 %. Fueron más encontrados los derrames pleurales (29,0 % y pericárdicos (19,4 %, y las lesiones inflamatorias pulmonares (25,8 %; la mayoría de los enfermos tenían colocados 2 catéteres venosos centrales (77,4 % y llevaban más de tres días con sonda vesical (51,6 % o línea arterial (48,4 %; al 87,1 % de los pacientes se le administró metamizol, al 58,1 % antimicrobianos y al 25,8 % se le tomó muestra para hemocultivo. Los gérmenes más encontrados fueron la pseudomona y el acinetobác-ter y predominó la evolución satisfactoria (solo 1 paciente fallecido. Conclusiones: La frecuencia de aparición de la fiebre en el postoperatorio de cirugía cardiovascular no fue elevada y predominó en hombres, entre 30 y 49 años de edad, con cirugía compleja. Fueron más encontrados los derrames pericárdico y pleural, así como la utilización de varios procedimientos invasivos. El hemocultivo fue útil para determinar la causa de la fiebre y el germen. La mayoría de los pacientes evolucionó satisfactoriamente.

  20. Fatores clínicos e anatomopatológicos que influenciam a sobrevida de pacientes com câncer de mama e derrame pleural neoplásico Clinical and pathological factors influencing the survival of breast cancer patients with malignant pleural effusion

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    Giovana Tavares dos Santos

    2012-08-01

    Full Text Available OBJETIVO: O objetivo deste estudo foi identificar os fatores clínicos e anatomopatológicos que possam influenciar o prognóstico de pacientes com câncer de mama e sintomas clínicos de derrame pleural neoplásico. MÉTODOS: Trata-se de um estudo clínico de coorte, no qual foram analisados os prontuários médicos de pacientes que receberam diagnóstico de derrame pleural neoplásico entre 2006 e 2010. Por meio da análise dos prontuários, identificamos as pacientes com história de câncer de mama. Para essas pacientes, coletamos dados anatomopatológicos relacionados ao tumor primário e dados citopatológicos relacionados à metástase pleural. RESULTADOS: Das 145 pacientes avaliadas, 87 (60% apresentaram, no exame citológico, resultado positivo para células neoplásicas no líquido pleural; além disso, 119 (82% apresentaram tipo histológico ductal. O fenótipo triplo-negativo foi observado em 25 pacientes (17%, as quais apresentaram o pior prognóstico, com queda acentuada na curva de sobrevida. Das 25 pacientes, 20 (80% evoluíram a óbito durante o período de seguimento (até junho de 2011. A sobrevida média após a identificação de derrame pleural neoplásico foi de 6 meses. CONCLUSÕES: Em pacientes com câncer de mama triplo-negativo e exame citológico com resultado positivo para células neoplásicas no líquido pleural, o prognóstico é ruim e a sobrevida é menor.OBJECTIVE: The objective of this study was to identify the clinical and pathological factors that can influence the prognosis of breast cancer patients with clinical symptoms of malignant pleural effusion. METHODS: This was a clinical cohort study, in which we analyzed the medical charts of patients diagnosed with malignant pleural effusion between 2006 and 2010. By examining the charts, we identified the female patients with a history of breast cancer. For those patients, we collected pathology data related to the primary tumor and cytopathology data related

  1. Fiebre tifoidea

    OpenAIRE

    Reyes S., Álvaro A.; Sierra, Fernando; Racines A., Dorman; Saravia, Jaime

    2012-01-01

    Se revisa la experiencia del Hospital San Juan de Dios de Bogotá Universidad Nacional en fiebre tifoidea entre 1979 y 1986. Se presentaron 24 casos; 17 hombres y 7 mujeres con edad promedio de 22.2 años (rango entre 15 y 40 años), la mayoría proveniente de aéreas urbanas. La duración promedio de la sintomatología antes de consultar fue de 18.7 días y la estancia hospitalaria promedio fue de 19.5 días.

  2. Pneumonia adquirida na comunidade e derrame pleural parapneumônico relacionados a Mycoplasma pneumoniae em crianças e adolescentes Mycoplasma pneumoniae-related community-acquired pneumonia and parapneumonic pleural effusion in children and adolescents

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    Letícia Alves Vervloet

    2012-04-01

    Full Text Available OBJETIVO: Determinar a prevalência e as características da pneumonia adquirida na comunidade (PAC e derrames pleurais parapneumônicos (DPP relacionados a Mycoplasma pneumoniae em um grupo de crianças e adolescentes. MÉTODOS: Estudo observacional retrospectivo com 121 pacientes hospitalizados com PAC e DPP em um hospital de referência terciária, entre 2000 e 2008, divididos em seis grupos (G1 a G6 segundo o agente etiológico: M. pneumoniae com ou sem coinfecção, em 44 pacientes; outros agentes que não M. pneumoniae, em 77; M. pneumoniae sem coinfecção, em 34; Streptococcus pneumoniae, em 36; Staphylococcus aureus, em 31; e coinfecção M. pneumoniae/S. pneumoniae, em 9, respectivamente. RESULTADOS: Na comparação entre os grupos, G1 apresentou frequências maiores em gênero feminino, tosse seca, uso prévio de beta-lactâmicos e na duração dos sintomas até a admissão, assim como menor uso de assistência ventilatória e de drenagem torácica que G2, enquanto G3 teve maiores frequências em uso prévio de beta-lactâmicos e tosse seca, maior duração dos sintomas antes da admissão e menor frequência de uso de drenos torácicos que G4 e G5, ao passo que G3 teve média de idade maior e menor frequência de náuseas/vômitos que G4, assim como menor uso de assistência ventilatória que G5. A coinfecção M. pneumoniae/S. pneumoniae aumentou a duração dos sintomas até a admissão. CONCLUSÕES: Nesta amostra, a prevalência de PAC e DPP por M. pneumoniae foi de 12,75%. Embora a doença apresentasse quadros mais leves que aquela por outros organismos, a evolução foi mais prolongada. Nossos dados sugerem a necessidade de uma maior diligência na investigação de M. pneumoniae em crianças e adolescentes com PAC e DPP em nosso meio.OBJECTIVE: To determine the prevalence and the characteristics of Mycoplasma pneumoniae-related community-acquired pneumonia (CAP and parapneumonic pleural effusion (PPE in children and adolescents

  3. Mesotelioma pleural en Costa Rica

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    José Alberto Maineri-Hidalgo

    2006-03-01

    Full Text Available El mesotelioma es una neoplasia originada en las membranas serosas que tapizan las cavidades celómicas y recubren las vísceras que contienen, cuyo desarrollo se ha relacionado con la exposición al asbesto. El presente estudio describe las características de los casos de mesotelioma pleural diagnosticados en los 3 hospitales nacionales de adultos de Costa Rica. Se revisaron los archivos de patología de los 3 hospitales nacionales generales del Seguro Social de Costa Rica y se encontraron 29 casos reportados de mesotelioma pleural, durante el período comprendido entre 1972 y 2002. Se estimó una tasa para 2002, de 1 caso por cada 2 millones de habitantes. Quince casos estudiados fueron mujeres y 14, hombres, con una edad promedio de 54 años. La presentación clínica fue, en 20 casos, derrame pleural, y los síntomas más frecuentes fueron disnea, dolor torácico, tos, fiebre y deterioro del estado general. La enfermedad se detectó en todos los pacientes por radiografía de tórax y el método para obtener la muestra para diagnóstico histológico, en 15 casos, fue la toracotomía; en 8, la biopsia pleural; en 4, la toracoscopía, y en 2, la autopsia. En 5 casos la biopsia pleural fue reportada inicialmente como adenocarcinoma. El diagnóstico histológico fue de mesoteliomas fibrosos en 16, (10 malignos y 6 benignos; 11 mesoteliomas epiteliales, todos malignos, y 2 mesoteliomas mixtos malignos. El tratamiento en los casos benignos fue cirugía y ninguno recidivó. Dos casos de mesoteliomas malignos se resecaron, uno de ellos con una neumonectomía extrapleural con pericardiectomía y resección del diafragma, pero la supervivencia no fue mejor que del resto de los malignos, ya que ningún caso superó los 6 meses. La quimioterapia y la radioterapia tampoco demostraron mejorar significativamente la evolución de la enfermedad.

  4. Efusiones pleurales en pequeños animales

    OpenAIRE

    M. Suárez; González-Martínez, A.; Vila, M.; González-Cantalapiedra, A.; G. Santamarina

    2012-01-01

    El derrame pleural es una acumulación anormal de líquidos en la cavidad pleural y constituye una manifestación clínica común a numerosos procesos. El derrame pleural es relativamente frecuente en perros y gatos. Su presentación clínica es variable, depende de la enfermedad subyacente, del volumen del derrame y de la rapidez en su formación. En ocasiones puede ser asintomático e identificarse como un hallazgo accidental, mientras que en otras es de tal magnitud que los signos de dificultad res...

  5. Mesotelioma pleural en Costa Rica

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    José Alberto Maineri-Hidalgo

    2006-03-01

    Full Text Available El mesotelioma es una neoplasia originada en las membranas serosas que tapizan las cavidades celómicas y recubren las vísceras que contienen, cuyo desarrollo se ha relacionado con la exposición al asbesto. El presente estudio describe las características de los casos de mesotelioma pleural diagnosticados en los 3 hospitales nacionales de adultos de Costa Rica. Se revisaron los archivos de patología de los 3 hospitales nacionales generales del Seguro Social de Costa Rica y se encontraron 29 casos reportados de mesotelioma pleural, durante el período comprendido entre 1972 y 2002. Se estimó una tasa para 2002, de 1 caso por cada 2 millones de habitantes. Quince casos estudiados fueron mujeres y 14, hombres, con una edad promedio de 54 años. La presentación clínica fue, en 20 casos, derrame pleural, y los síntomas más frecuentes fueron disnea, dolor torácico, tos, fiebre y deterioro del estado general. La enfermedad se detectó en todos los pacientes por radiografía de tórax y el método para obtener la muestra para diagnóstico histológico, en 15 casos, fue la toracotomía; en 8, la biopsia pleural; en 4, la toracoscopía, y en 2, la autopsia. En 5 casos la biopsia pleural fue reportada inicialmente como adenocarcinoma. El diagnóstico histológico fue de mesoteliomas fibrosos en 16, (10 malignos y 6 benignos; 11 mesoteliomas epiteliales, todos malignos, y 2 mesoteliomas mixtos malignos. El tratamiento en los casos benignos fue cirugía y ninguno recidivó. Dos casos de mesoteliomas malignos se resecaron, uno de ellos con una neumonectomía extrapleural con pericardiectomía y resección del diafragma, pero la supervivencia no fue mejor que del resto de los malignos, ya que ningún caso superó los 6 meses. La quimioterapia y la radioterapia tampoco demostraron mejorar significativamente la evolución de la enfermedad.After reviewing the pathology service archives of the 3 national general hospitals of the Costarrican Social

  6. Pleurodese nos derrames pleurais malignos: um inquérito entre médicos em países da América do Sul e Central Pleurodesis for malignant pleural effusions: a survey of physicians in South and Central America

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    Evaldo Marchi

    2010-12-01

    Full Text Available OBJETIVO: A pleurodese é uma alternativa eficaz no controle dos derrames pleurais malignos, mas existem controvérsias a respeito de sua indicação e técnica. O objetivo deste estudo foi avaliar como é realizada a pleurodese em países da América do Sul e Central. MÉTODOS: Profissionais que realizam pleurodese responderam um questionário sobre critérios de indicação para pleurodese, técnicas utilizadas e desfechos. RESULTADOS: Nossa amostra envolveu 147 profissionais no Brasil, 49 em outros países da América do Sul e 36 em países da América Central. Mais de 50% dos participantes realizavam pleurodese somente se confirmada a malignidade no derrame pleural. Entretanto, escalas de dispneia e de status de performance eram raramente utilizadas para indicar o procedimento. Aproximadamente 75% dos participantes no Brasil e na América Central preferiam realizar a pleurodese somente no caso de recidiva do derrame, e a expansão pulmonar deveria variar de 90% a 100%. O talco slurry foi o agente mais utilizado, instilado via drenos de calibre intermediário. A toracoscopia foi realizada em menos de 25% dos casos. Febre e dor torácica foram os efeitos adversos mais comuns, e empiema ocorreu em OBJECTIVE: Pleurodesis is an effective alternative for the control of malignant pleural effusions. However, there is as yet no consensus regarding the indications for the procedure and the techniques employed therein. The objective of this study was to evaluate how pleurodesis is performed in South and Central America. METHODS: Professionals who perform pleurodesis completed a questionnaire regarding the indications for the procedure, the techniques used therein, and the outcomes obtained. RESULTS: Our sample comprised 147 respondents in Brazil, 49 in other South American countries, and 36 in Central America. More than 50% of the respondents reported performing pleurodesis only if pleural malignancy had been confirmed. However, scores on dyspnea and

  7. Enfermedades infecciosas: fiebre tifoidea

    OpenAIRE

    José Elías GARCÍA SÁNCHEZ; Enrique GARCÍA SÁNCHEZ; Enrique GARCÍA MERINO

    2013-01-01

    [ES] Albert Nobbs (Glenn Close) es una mujer, hija bastarda de madre desconocida, que desde los 14 años asumió la condición de varón para poder trabajar de camarero, empleo en el que alcanzó un prestigio tanto en el Reino Unido como en Irlanda. Durante la trama lo hace en un hotel de Dublín en el que vive y en el que hay un brote de fiebre tifoidea. Premios: tres nominaciones. [EN] Albert Nobbs (Glenn Close) is a woman, bastard daughter of unknown mother. Since she was...

  8. Pesquisa de IgA contra o antígeno recombinante HspX de Mycobacterium tuberculosis no diagnóstico de tuberculose pleural

    OpenAIRE

    Limongi,Loanda Carvalho Sant' Ana; Olival,Liliane; Conde, Marcus Barreto; Junqueira-Kipnis, Ana Paula

    2011-01-01

    OBJETIVO: Avaliar a acurácia da dosagem de IgA contra o antígeno recombinante HspX no líquido pleural e no soro de pacientes com derrame pleural para o diagnóstico de tuberculose pleural. MÉTODOS: Estudo transversal de teste diagnóstico. Amostras de líquido pleural e de soro de pacientes com derrame pleural e suspeita de tuberculose pleural foram avaliadas para a determinação da densidade óptica de IgA contra HspX utilizando ELISA indireto. RESULTADOS: Foram avaliadas amostras de líquido pleu...

  9. La fiebre en los niños

    OpenAIRE

    Madriñan T., Jorge; Fundación Valle de Lili

    2007-01-01

    ¿Por qué se produce la fiebre?/¿Para qué sirve la fiebre?/¿Qué es la fiebre-fobia?/Factores que contribuyen a la "fiebre-fobia"/¿Cómo se maneja la fiebre?/¿La fiebre produce convulsiones febriles?/¿Cuándo llamar al médico?

  10. Bartoneliasis: fiebre verrucosa del guaitara en colombia

    OpenAIRE

    Patiño Camargo, Luis

    2011-01-01

    En Colombia, al descubrirla, diósele (1) a esta dolencia los siguientes nombres: Bartonellosis, Fiebre verrucosa del Guaitara y Verruga, análoga a la enfermedad de Carrión, Fiebre de Oroya y Verruga Peruana.

  11. Fiebre amarilla: un peligro latente

    Directory of Open Access Journals (Sweden)

    Marvin Yglesias-Rosales

    2005-07-01

    Full Text Available La fiebre amarilla es una zoonosis, aguda, febril que se encuentra catalogada como una fiebre hemorrágica potencialmente mortal. Es causada por un arbovirus y transmitida por un artrópodo del cual se conocen dos modalidades epidemiológicas, con un área endémica que corresponde a la mayoría de América del Sur y parte del continente africano. En Costa Rica la última epidemia de fiebre amarilla ocurrió a principios de los años cincuenta. La fisiopatología de la fiebre amarilla no es bien conocida. La mayoría de las infecciones son sintomáticas, y tienen una alta mortalidad que varia según la epidemia. El diagnóstico se confirma de forma definitiva con la serología y aunque éste examen no se realiza en el país, las muestras de los casos sospechosos son enviadas a laboratorios panameños. Con base en su gran mortalidad y a la ausencia de un tratamiento específico, es obvio que el camino a seguir en el manejo de la fiebre amarilla es la prevención mediante las vacunaciones masivas en las áreas endémicas y grupos de riesgo, así como el control del vector. La fiebre amarilla sigue siendo una entidad que afecta considerablemente la salud pública en varios países del mundo; Costa Rica reúne un conjunto de condiciones que facilitarían su aparición y propagación, por lo que es una patología cuyas características convendría mantener en mente

  12. Cariótipo Fetal em Líquido Pleural Obtido por Toracocentese

    OpenAIRE

    Cabral Antonio Carlos Vieira; Machado Isabela Nelly; Leite Henrique Vitor; Pereira Alamanda Kfoury; Vitral Zilma Nogueira Reis

    2001-01-01

    Objetivos: avaliar a efetividade da realização de cariótipo em líquido pleural obtido por toracocentese de um grupo de fetos portadores de derrame pleural. Métodos: foram avaliados 15 fetos com derrame pleural uni ou bilateral nos quais se realizou uma punção da cavidade torácica. A idade gestacional variou entre 19 e 34 semanas. Os fetos foram estudados com ultra-sonografia morfológica para determinar a presença de anomalias associadas. Nos casos em que não se obteve o cultivo em líquido ple...

  13. Fiebre amarilla: un peligro latente

    Directory of Open Access Journals (Sweden)

    Marvin Yglesias-Rosales

    2005-07-01

    Full Text Available La fiebre amarilla es una zoonosis, aguda, febril que se encuentra catalogada como una fiebre hemorrágica potencialmente mortal. Es causada por un arbovirus y transmitida por un artrópodo del cual se conocen dos modalidades epidemiológicas, con un área endémica que corresponde a la mayoría de América del Sur y parte del continente africano. En Costa Rica la última epidemia de fiebre amarilla ocurrió a principios de los años cincuenta. La fisiopatología de la fiebre amarilla no es bien conocida. La mayoría de las infecciones son sintomáticas, y tienen una alta mortalidad que varia según la epidemia. El diagnóstico se confirma de forma definitiva con la serología y aunque éste examen no se realiza en el país, las muestras de los casos sospechosos son enviadas a laboratorios panameños. Con base en su gran mortalidad y a la ausencia de un tratamiento específico, es obvio que el camino a seguir en el manejo de la fiebre amarilla es la prevención mediante las vacunaciones masivas en las áreas endémicas y grupos de riesgo, así como el control del vector. La fiebre amarilla sigue siendo una entidad que afecta considerablemente la salud pública en varios países del mundo; Costa Rica reúne un conjunto de condiciones que facilitarían su aparición y propagación, por lo que es una patología cuyas características convendría mantener en menteYellow fever is an acute febrile zoonosis, catalogued as a hemorrhagic fever that is potentially deadly. It is caused by an arbovirus and transmitted by an arthropod; there are two known epidemiologic modalities, and it has an endemic area that comprises most of South America and part of the African continent. In Costa Rica the last outbreak of yellow fever was in the fifties. The physiopathology of yellow fever is not well known. Most of the infections are symptomatic and have a high mortality that varies from outbreak to outbreak. The diagnosis is definitely confirmed by serology and

  14. Fiebre reumática

    OpenAIRE

    Ríos, Aníbal; Chalem, Fernando; Jiménez, Víctor; Rocha, Hernando

    2011-01-01

    En el presente estudio se analizan en forma prospectiva todos los pacientes no diagnosticados previamente como fiebre reumatica y que asistieron al Centro Hospitalario San Juan de Dios, hospital general para adultos, en el período comprendido entre el 1 ̜de marzo/68 y el 28 de febrero/69. Con ello intentamos valorar la magnitud del problema en nuestro medio y divulgar algunos aspectos, Vg. frecuencia, tratamiento y profilaxis. En el período mencionado asistieron al centro hospitalario nombrad...

  15. Fiebre Reumática

    OpenAIRE

    2013-01-01

    La fiebre reumática es un grave problema de salud en los países en vías de desarrollo, debido fundamentalmente a la probreza y falta de educación adecuadas, que producen por un lado hacinamiento con mayor predisposición a las infecciones producidas por el Estreptococo. A (orofaringitis) y por otro a la falta de solicitud oportuna y contínua de atención médica.

  16. Toracoscopia em crianças com derrame parapneumônico complicado na fase fibrinopurulenta

    OpenAIRE

    Sergio Luiz Oliveira de Freitas

    2006-01-01

    Introdução: Apesar de a toracoscopia ser o procedimento preconizado em crianças com derrame pleural parapneumônico complicado (DPPC) na fase fibrinopurulenta, a grande maioria dos trabalhos citados na literatura é de relato de casos ou revisão de pequeno número de pacientes. Este estudo interinstitucional foi realizado para determinar a eficácia deste procedimento em número significativo de crianças com DPPC na fase fibrinopurulenta. Métodos: Estudo retrospectivo de 99 crianças (0,4 a 11 anos...

  17. Freqüência de adenocarcinomas em derrames cavitários

    Directory of Open Access Journals (Sweden)

    Longatto Filho A.

    1999-01-01

    Full Text Available OBJETIVO: Identificação de freqüência de adenocarcinomas de diferentes sítios primários em derrames cavitários. MATERIAL E MÉTODOS: Foram estudados 2.317 casos: 1.146 de derrame pleural (943 mulheres e 203 homens, 1.168 de ascite (727 mulheres e 441 homens e três de pericárdio (duas mulheres e um homem e realizada análise retrospectiva dos prontuários dos pacientes e correlação dos achados clínico-laboratoriais. RESULTADOS: Os sítios primários mais freqüentes em derrames pleurais foram: mama (N = 586 - 51,1%, pulmão (N = 185 - 16,1%: 102 homens e 83 mulheres, ovário (N = 124 - 10,8%; em ascites: estômago (N= 473 - 40,5%: 300 homens e 173 mulheres, ovário (N= 306 - 26.2% e mama (N = 83 - 7,1%. Desses, 555 casos foram citologicamente positivos para malignidade em derrames pleurais, 541 em ascite e dois em pericárdio. Os sítios primários mais freqüentes em derrames pleurais citologicamente positivos foram: mama (N=288 - 51,9%, pulmão (N=92, 16,6%: 45 homens e 47 mulheres e ovário (N=54, 9,7%; e, em ascites: ovário (N=205 - 37,9%, estômago (N=202, 37,3%: 119 homens e 83 mulheres e mama (N=31 - 6,8%. Em 47 derrames pleurais (8,5% e 37 ascites (6,8%, a origem dos adenocarcinomas persistiu indeterminada. CONCLUSÃO: As freqüências estabelecidas poderão, em associação a dados clínicos,orientar a investigação dos sítios primários de adenocarcinomas metastáticos.

  18. Enfermedades pleurales benignas inducidas por asbesto Benign pleural diseases induced by asbestos

    Directory of Open Access Journals (Sweden)

    J. Boldú

    2005-01-01

    Full Text Available La exposición al asbesto es una causa importante de patología pleural y se puede producir con intensidades moderadas o ligeras dada la capacidad del asbesto de concentrarse en la pleura. Ello motiva junto a la prolongada latencia existente entre la exposición y la enfermedad, que sigamos viendo durante muchos años manifestaciones clínicas pleurales de exposición previa, a pesar del uso del asbesto cada vez más limitado en las últimas décadas. Dicha exposición puede presentarse con distintas manifestaciones tanto malignas como el mesotelioma como benignas, siendo las principales de éstas el derrame pleural benigno, las placas pleurales, la fibrosis pleural difusa y la atelectasia redonda.Exposure to asbestos is an important cause of pleural pathology and can be produced with light or moderate tendencies given the capacity of asbestos to concentrate in the pleura. Together with the prolonged latency existing between exposure and the disease, this means that for many years we will continue to see pleural clinical manifestations from past exposure, in spite of the increasingly limited use of asbestos in recent decades. This exposure can show itself in different manifestations, both malign, such as mesothelioma, and benign, principally benign pleural effusion, pleural plaques, diffuse pleural fibrosis and massive atelectasis.

  19. Derrame pericárdico con inminente taponamiento cardiaco secundario a inhibidor de la tirosina quinasa. Reporte de un caso

    Directory of Open Access Journals (Sweden)

    Andrés F. Buitrago, MD

    2011-03-01

    Full Text Available La leucemia es una enfermedad maligna que se caracteriza por una proliferación no controlada de una clona iniciada en una etapa precoz de la diferenciación linfoide. Es importante determinar si hay una alteración genética conocida como cromosoma Filadelfia, para pronóstico y tratamiento. El imatinib, un inhibidor de la tirosina kinasa, tiene buena respuesta terapéutica y pocos efectos adversos. Uno de frecuente aparición es la serositis manifestada como derrame pleural, aunque es de menor incidencia asociada con derrame pericárdico. El tratamiento se debe individualizar, pero en caso de inminente taponamiento cardiaco se realiza pericardiocentesis.

  20. Fatores preditivos para drenagem de derrames pleurais parapneumônicos em crianças

    Directory of Open Access Journals (Sweden)

    MOCELIN HELENA TERESINHA

    2001-01-01

    Full Text Available Objetivo: Avaliar os critérios de Light et al. para drenagem em derrames pleurais parapneumônicos (DPP em crianças. Métodos: Estudo transversal prospectivo realizado com 85 crianças admitidas no Hospital da Criança Santo Antônio, Porto Alegre, no Estado do Rio Grande do Sul, região Sul do Brasil, que apresentaram pneumonia e derrame pleural confirmado por radiografia de tórax e/ou ultra-sonografia. Os critérios de exclusão foram: drenagem prévia, derrame associado com outras doenças. A análise do pH foi em aparelho de gasometria. Glicose e desidrogenase láctica foram analisadas por espectrofotometria. A indicação de drenagem foi feita pelo médico assistente sem participação dos pesquisadores. Resultados: Neste estudo, os DPP com pH menor que 7,2 e glicose igual ou inferior a 40mg/dl apresentaram índices de drenagem superiores aos da DHL > 1.000UI/l. O pH e a glicose apresentaram especificidades elevadas na predição de drenagem (89% e 88% e superiores às da DHL (65%. Os mesmos resultados foram observados quando líquidos não purulentos foram analisados (pH 1.000 -- 68%. Em pacientes com pH 1.000UI/l e glicose < 40mg/dl predominaram líquidos com aspecto turvo ou purulento. Em torno de 21% dos pacientes com indicação de drenagem, segundo os critérios bioquímicos, encontrou-se líquido com aspecto límpido. Conclusões: Estes dados indicam que os exames bioquímicos podem apoiar a decisão de drenagem torácica de derrame pleural parapneumônico em líquidos não purulentos. A especificidade para drenagem foi de 89% para o pH, 88% para glicose e em torno de 65% para DHL.

  1. Antígeno carcinoembrionário no diagnóstico diferencial dos derrames pleurais

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    Miguel Angelo Martins de Castro Junior

    Full Text Available OBJETIVO: Analisar a sensibilidade e a especificidade da dosagem do CEA no diagnóstico diferencial do derrame pleural de pacientes portadores de doenças benígnas e malígnas. MÉTODO: Estudo contemporâneo de série de casos, realizado do Serviço de Cirurgia Torácica do Hospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul. Entre julho de 2000 e julho de 2001, 64 pacientes foram submetidos à investigação etiológica de efusão pleural,e submetidos aos seguintes exames: pH, LDH, dosagem protêica, densidade, glicose, citologia diferencial, pesquisa de fungos e BAAR, gram e cultura com antibiograma, citopatologia, dosagem de CEA e biópsia pleural. RESULTADOS: Pacientes com derrames de etiologia maligna (n=26 tiveram resultado do CEA variando de zero a 5000ng/ml, enquanto nos de etiologia benígna os valores variaram de zero a 4,8ng/ml. Nível médio de CEA na efusão carcinomatosa foi de 431 ± 1237 ng/ml (média ± desvio padrão, significativamente maior que nos benignos (1,1 ± 1,0 ng/ml; p<0,001. A sensibilidade, para um ponto de corte de 5 ng/ml, foi de 61,5% e a especificidade de 100%. CONCLUSÃO: Em pacientes com efusão pleural, quando investigados do ponto de vista etiológico, a dosagem do CEA pode ser útil para critério diagnóstico.

  2. Histoplasma com derrame pleural: relato de um caso Histoplasmoma and pleural effusion: a case report

    Directory of Open Access Journals (Sweden)

    Marcos C. de Almeida

    1990-10-01

    Full Text Available Efusões pleurais surgem raramente em associação com a histoplasmose capsu-lata, ocorrendo em geral nas formas agudas da doença. Relatamos e discutimos um caso clínico em que um histoplasmoma subpleural acompanhou-se de dor pleurítica, hidrotórax e pleurite fibrosante.

  3. Pesquisa de IgA contra o antígeno recombinante HspX de Mycobacterium tuberculosis no diagnóstico de tuberculose pleural Determination of levels of specific IgA to the HspX recombinant antigen of Mycobacterium tuberculosis for the diagnosis of pleural tuberculosis

    Directory of Open Access Journals (Sweden)

    Loanda Carvalho Sant' Ana Limongi

    2011-06-01

    Full Text Available OBJETIVO: Avaliar a acurácia da dosagem de IgA contra o antígeno recombinante HspX no líquido pleural e no soro de pacientes com derrame pleural para o diagnóstico de tuberculose pleural. MÉTODOS: Estudo transversal de teste diagnóstico. Amostras de líquido pleural e de soro de pacientes com derrame pleural e suspeita de tuberculose pleural foram avaliadas para a determinação da densidade óptica de IgA contra HspX utilizando ELISA indireto. RESULTADOS: Foram avaliadas amostras de líquido pleural e de soro de 132 pacientes: 97 com tuberculose pleural (grupo de estudo e 35 com derrame pleural por outras causas (grupo controle. A dosagem de IgA em líquido pleural foi capaz de discriminar os pacientes com tuberculose pleural dos controles. A sensibilidade do teste em líquido pleural e em soro foi, respectivamente, de 69% e 30%, enquanto a especificidade foi de 83% e 84%, respectivamente. CONCLUSÕES: Os dados sugerem o potencial da utilização deste teste no diagnóstico de tuberculose pleural. Estudos com amostras maiores e em diferentes cenários epidemiológicos são necessáriosOBJECTIVE: To evaluate the accuracy of determining specific IgA to HspX recombinant antigen in pleural fluid and serum samples for the diagnosis of pleural tuberculosis in patients with pleural effusion. METHODS: This was a cross-sectional study. Serum and pleural fluid samples of patients with pleural effusion and suspected of having pleural tuberculosis were tested with indirect ELISA in order to determine the optical density of specific IgA to HspX. RESULTS: We evaluated serum and pleural fluid samples from 132 patients: 97 diagnosed with pleural tuberculosis (study group and 35 diagnosed with pleural effusion due to other causes (control group. The determination of IgA in pleural fluid satisfactorily discriminated between pleural tuberculosis patients and control patients. The sensitivity of the test in pleural fluid and in serum was 69% and 30

  4. Utilidad del cisplatino intrapericárdico en el tratamiento del derrame pericárdico maligno

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    Marcelo Zylberman

    2010-01-01

    Full Text Available RESUMENIntroducciónEl derrame pericárdico maligno recidiva en hasta el 62% de los pacientes luego de unapericardiocentesis. Debido a ello, se ha intentado completar el tratamiento con la instilaciónintrapericárdica de drogas luego del drenaje de la cavidad. El cisplatino ha demostradoque es útil y seguro para ese propósito.ObjetivoPresentar la experiencia en nuestra institución del uso del cisplatino intrapericárdico en eltratamiento del derrame pericárdico maligno.Material y métodosSe incluyeron los pacientes ingresados en el Instituto Alexander Fleming entre enero de2005 y mayo de 2009 con diagnóstico de taponamiento cardíaco o de derrame pericárdicograve tratados con drenaje percutáneo e instilación de cisplatino intrapericárdico (10 mg en20 ml de solución fisiológica por 5 días. Se requirió: a confirmación citológica de malignidado b hallazgo ecocardiográfico de lesiones compatibles con invasión neoplásica del sacopericárdico y c poca expectativa de respuesta a un tratamiento sistémico.ResultadosSe incluyeron 9 pacientes (6 hombres y 3 mujeres, edad media 60 años (51-69. El tumorprimario fue pulmonar (n = 4, de mama (n = 1, de vejiga (n =1, de esófago (n = 1, deriñón (n = 1 y de próstata (n = 1. La citología fue positiva en 6 casos. El tiempo de permanenciadel catéter fue de 7 días. Hubo efectos adversos en tres casos: dolor, fiebre y fibrilaciónauricular. Un solo paciente tuvo recidiva del derrame al mes. Ocho pacientes fallecieron[tiempo medio a la muerte: 50 días (7-83] y uno vive.ConclusionesEl cisplatino intrapericárdico resulta factible de realizar, se tolera bien y se observa unporcentaje bajo de recidivas, lo cual cumple con el objetivo del tratamiento.REV ARGENT CARDIOL 2010;78:114-117.

  5. La fiebre: Conceptos básicos

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    Lourdes B. Alpízar Caballero

    1998-06-01

    Full Text Available Se presenta una revisión en relación con la fiebre como manifestación de enfermedad. Se señala la importancia del hipotálamo en el control de la temperatura corporal y las diferentes formas de medir ésta, para lo cual se proponen valores normativos o referenciales para nuestro medio. Se exponen las principales causas de aparición de fiebre e hipertermia en la edad pediátrica y las diferencias entre estos 2 estados.A review concerning fever as a disease manifestation in made. It is stressed the importance of the hypothalamus in the control of body tempearture, as well as the different ways to measure it, for which normative or reference values are proposed for our enviroment. The main causes of fever and hyperthermia at pediatric age and the differences existing between these two states are explained.

  6. Endometriose pleural: achados na ressonância magnética Pleural endometriosis: findings on magnetic resonance imaging

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    Edson Marchiori

    2012-12-01

    Full Text Available A endometriose é uma doença ginecológica benigna associada à dor pélvica e infertilidade que afeta principalmente mulheres em idade reprodutiva. A endometriose torácica afeta o parênquima pulmonar ou a pleura. Relatamos os casos de duas pacientes com endometriose pleural que apresentaram pneumotórax recorrente. Em ambos os casos, a ressonância magnética de tórax mostrou hidropneumotórax à direita e nódulos redondos, bem definidos, na superfície pleural à direita. A ressonância magnética é uma boa opção para a caracterização dos nódulos de endometriose pleural e de derrame pleural hemorrágico.Endometriosis is a benign gynecological disorder associated with pelvic pain and infertility, primarily affecting women of reproductive age. Thoracic endometriosis affects the pulmonary parenchyma or pleura. We report the cases of two patients with pleural endometriosis who presented with recurrent pneumothorax. In both cases, magnetic resonance imaging (MRI of the chest showed right hydropneumothorax and well-defined, rounded nodules on the pleural surface in the right hemithorax. We conclude that MRI is a good option for the characterization of pleural endometriotic nodules and hemorrhagic pleural effusion.

  7. Pleural malignancies.

    Science.gov (United States)

    Friedberg, Joseph S; Cengel, Keith A

    2010-07-01

    Pleural malignancies, primary or metastatic, portend a grim prognosis. In addition to the serious oncologic implications of a pleural malignancy, these tumors can be highly symptomatic. A malignant pleural effusion can cause dyspnea, secondary to lung compression, or even tension physiology from a hydrothorax under pressure. The need to palliate these effusions is a seemingly straightforward clinical scenario, but with nuances that can result in disastrous complications for the patient if not attended to appropriately. Solid pleural malignancies can cause great pain from chest wall invasion or can cause a myriad of morbid symptoms because of the invasion of thoracic structures, such as the heart, lungs, or esophagus. This article reviews pleural malignancies, the purely palliative treatments, and the treatments that are performed with definitive (curative) intent.

  8. Notas sobre fiebre amarilla en colombia

    OpenAIRE

    Patiño Camargo, Luis

    2011-01-01

    I-Introducción ll.-Datos clínicos anteriores al período de las investigaciones de laboratorio. Época colonial. III-Período de laboratorio anterior al descubrimiento de los animales receptivos. IV.-Período posterior al descubrimiento de los animales receptivos y a la prueba de protección. V.-Trabajos en Colombia durante el período de las investigaciones. VI. El servicio de fiebre amarilla cooperativo entre el Departamento Nacional de Higiene y la Fundación Rockejeller. VIl.-Consideraciones gen...

  9. Patogenesis de la fiebre Pathogenesis of fever

    Directory of Open Access Journals (Sweden)

    Diana García de Olarte

    1990-03-01

    Full Text Available

    La fiebre es una manifestación fundamental de enfermedad que no se presenta en forma aislada sino, casi siempre, asociada a una serle de cambios fisiológicos en el huésped, conocidos como la respuesta de fase aguda. La aparición de la fiebre, así como de muchos otros componentes de tal respuesta, se debe a la producción endógena de varias sustancias, cuya secreción es Inducida por diversos estímulos, tanto propios como ajenos al organismo. Las moléculas más Importantes Involucradas en estas respuestas son la interleuquina 1 y el Factor Necrosante de Tumores, las cuales actúan en forma sinérgica sobre todos los órganos y tejidos. La fiebre se debe al efecto que ejercen estas proteínas sobre el hipotálamo, donde Inducen la producción de Prostaglandina E2 (PGE2 Incrementadota directa del punto de control del termostato corporal. Antes de Intervenir terapéuticamente en un episodio febril, es necesario considerar los diferentes aspectos de la respuesta de fase aguda, ya que algunos de ellos son esenciales para la supervivencia frente a la agresión.

    Fever, a fundamental manifestation of disease, is almost always associated with a series of physiologic changes of the host, collectively known as the acute phase response. Appearance of fever and of many of the other elements of such response is due to the production of several substances, whose secretion is induced by different stimuli both endogenous and exogenous. The most important molecules involved in these processes are Interleukin 1 (IL-1 and Tumor Necrosis Factor (TNF, which act synergically on every organ and tissue. Fever is due to the effect of these proteins on the hypothalamus, where they Induce production of Prostaglandin E2, the direct elevator of the control point of the body thermo. stat. Before therapeutically acting on a

  10. Fiebre amarilla en Mazatlán, 1883

    OpenAIRE

    Javier E. García de Alba García; Ana L. Salcedo Rocha

    2006-01-01

    A propósito de una serie de telegramas emitidos durante la epidemia de fiebre amarilla de 1883 en Mazatlán, reproducidos en el semanario médico de la ciudad de México La Voz de Hipócrates, se hace una reflexión histórico-epidemiológica sobre el desarrollo de la fiebre amarilla en esta área del país y acerca del conocimiento prevaleciente.

  11. Compromiso pleural en la leucemia de células plasmáticas: Reporte de un caso Pleural effusion in plasma cell leukemia: A case report

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    JORGE YÁÑEZ V

    2008-12-01

    Full Text Available El mieloma múltiple es una neoplasia maligna de células plasmáticas que invade la médula ósea y otros tejidos. Las manifestaciones extramedulares son relativamente raras. El derrame pleural en el mieloma múltiple es poco frecuente (6% de los casos, y el derrame pleural neoplásico es extremadamente raro. La leucemia de células plasmáticas, que se produce de novo o en pacientes con mieloma múltiple, es la variedad menos común de discrasia de células plasmáticas. Los autores describen el cuadro clínico de un paciente de 63 años con leucemia de células plasmáticas, donde la primera manifestación de la enfermedad fue una neumonía neumocócica bacteriémica asociado a un derrame pleural contralateral, que correspondió a un exudado predominio mononuclear. El examen citológico reveló abundantes células plasmáticas inmaduras en el líquido pleural y la sangre periférica. El derrame pleural desapareció después del primer ciclo de quimioterapia (vincristina, adriamicina, dexametasona. Después de tres meses de remisión, la enfermedad neoplásica recidivó, siendo el paciente sometido a trasplante autólogo de médula ósea. El paciente se ha mantenido en remisión completa un año después del diagnóstico. El derrame pleural es una complicación poco común, pero importante, del mieloma múltiple y no necesariamente conlleva un mal pronóstico.Multiple myeloma is a low malignant, non-Hodgkin's lymphoma, which is characterized by infiltration of the bone marrow by clonal proliferation of atypical plasma cells. Extramedullary manifestations are relatively rare. Serous effusions in multiple myeloma are uncommon (6% of cases but a myelomatous pleural effusion occurring in these patients is extremely rare. Plasma cell leukemia, occurring either de novo or in patients with long standing multiple myeloma, is the least common type of plasma cell dyscrasia. The authors describe the course of plasmacellular leukemia in a 63-year-old male

  12. Linfoma primário de cavidade pleural em paciente imunocompetente Primary effusion lymphoma in an immunocompetent patient

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    Leila Antonangelo

    2005-12-01

    Full Text Available O linfoma primário de cavidade é um tipo raro de linfoma não-Hodgkin que acomete principalmente pacientes imunocomprometidos e, mais raramente, pacientes imunocompetentes. Neste relato de caso são apresentados os achados clínicos e laboratoriais de um paciente imunocompetente com derrame pleural diagnosticado como linfoma primário de cavidade pleural.Primary effusion lymphoma is an unusual non-Hodgkin's lymphoma rarely seen in immunocompetent patients. Herein, we present clinical and biochemical data obtained from an immunocompetent patient diagnosed with primary effusion lymphoma.

  13. Pleural ultrasound for clinicians.

    Science.gov (United States)

    Porcel, J M

    2016-11-01

    Pleural ultrasonography is useful for identifying and characterising pleural effusions, solid pleural lesions (nodules, masses, swellings) and pneumothorax. Pleural ultrasonography is also considered the standard care for guiding interventionist procedures on the pleura at the patient's bedside (thoracentesis, drainage tubes, pleural biopsies and pleuroscopy). Hospitals should promote the acquisition of portable ultrasound equipment to increase the patient's safety. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  14. Abordagem cirúrgica da efusão pleural parapneumônica e suas complicações Surgical treatment of parapneumonic pleural effusion and its complications

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    José Carlos Fraga

    2002-12-01

    Full Text Available Objetivos: o tratamento cirúrgico do derrame parapneumônico na criança é controverso, sendo a abordagem baseada fundamentalmente na experiência pessoal e no pequeno número de casos relatados. O objetivo deste artigo é o de apresentar uma revisão bibliográfica dos principais trabalhos e experiência dos autores no tratamento cirúrgico do derrame parapneumônico na criança. Fonte dos dados: foram utilizados dados de artigos científicos pesquisados através dos bancos de dados Medline e Lilacs. Síntese dos dados: o derrame parapneumônico tem indicação de drenagem cirúrgica quando apresenta, à toracocentese, aspecto purulento, bactéria no Gram ou cultura, e análise bioquímica com pH menor que 7,0 e glicose menor que 40mg/dl. A drenagem cirúrgica depende da fase do derrame. Na fase aguda, é suficiente a drenagem torácica fechada; na fase fibrinopurulenta, é indicada toracoscopia; na fase organizada, a toracotomia é realizada em crianças com condições anestésicas, e a pleurostomia, naquelas debilitadas e com estado geral comprometido. A ecografia é útil, e, na maioria das vezes, fundamental, para definir a fase do derrame pleural. Conclusões: o tratamento cirúrgico do derrame parapneumônico complicado deve ser feito o mais precocemente possível, e o tipo de procedimento a ser realizado depende da fase do derrame pleural. Nas crianças que necessitam de drenagem cirúrgica, a ecografia é fundamental, para determinar a fase evolutiva do derrame parapneumônico.Objective: surgical treatment of parapneumonic pleural effusion in children is controversial. The type of intervention is based mainly on personal experience and on the small number of reported cases. This article aims at presenting a literature review and the authors' experience in the surgical management of parapneumonic pleural effusion in children. Sources: data were searched in the Medline and Lilacs databases. Summary of the findings: complicated

  15. [Fibrinolytics in the Treatment of Complicated Pleural Effusions].

    Science.gov (United States)

    Coelho, Ana; Coelho, Margarida; Pereira, Joana; Lavrador, Vasco; Morais, Lurdes; Carvalho, Fátima

    2016-11-01

    Introdução: A instilação intrapleural de fibrinolítico, no tratamento dos derrames pleurais parapneumónicos complicados, tem demonstrado resultados equivalentes ao tratamento cirúrgico. Este estudo foi realizado para avaliar e descrever os resultados da aplicaçãode fibrinolítico no tratamento de derrame pleural parapneumónico complicado, nos doentes seguidos no nosso hospital. Material e Métodos: Revisão retrospetiva, entre janeiro de 2005 e dezembro de 2013, dos doentes (idade superior a um mês e inferior a 18 anos) com diagnóstico de derrame pleural parapneumónico complicado, submetidos a colocação de dreno torácico e instilação intrapleural de fibrinolítico. Resultados: Identificaram-se um total de 37 doentes. A duração média do internamento foi de 17 ± 7,60 dias. Na maioria dos doentes (89,2%) o dreno torácico foi colocado nas primeiras 48 h após admissão, com seis dias de média de drenagem. Verificou-se falência terapêutica em 2,7% dos casos, por recidiva do derrame. Este doente foi submetido a toracoscopia videoassistida com necessidade de conversão do procedimento para toracotomia. A evolução clínica foi favorável em 96,9% dos casos. Discussão: Na nossa revisão a taxa de sucesso terapêutico encontra-se dentro do esperado, com uma percentagem de falência inferior ao descrito na literatura. Apresentamos a instilação intrapleural de fibrinolítico e a toracoscopia videoassistida num mesmo protocolo de atuação, tendo como primeira linha terapêutica o fibrinolítico. Conclusão: A opção terapêutica apresentada teve uma baixa taxa de falência e permitiu evitar um procedimento cirúrgico mais agressivo. Consideramos que esta é uma opção de tratamento eficaz e que, na nossa amostra, cursou com uma baixa taxa de sequelas.

  16. Cariótipo Fetal em Líquido Pleural Obtido por Toracocentese Fetal Karyotyping of Pleural Fluid Obtained by Thoracocentesis

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    Antonio Carlos Vieira Cabral

    2001-05-01

    Full Text Available Objetivos: avaliar a efetividade da realização de cariótipo em líquido pleural obtido por toracocentese de um grupo de fetos portadores de derrame pleural. Métodos: foram avaliados 15 fetos com derrame pleural uni ou bilateral nos quais se realizou uma punção da cavidade torácica. A idade gestacional variou entre 19 e 34 semanas. Os fetos foram estudados com ultra-sonografia morfológica para determinar a presença de anomalias associadas. Nos casos em que não se obteve o cultivo em líquido pleural foi realizada cordocentese para a realização do cariótipo. O líquido pleural obtido foi enviado para cultura de linfócitos e cariótipo, sendo a técnica de cultivo semelhante à realizada com sangue. Resultados: dos 15 casos estudados foi obtido cariótipo em 12, e destes, em quatro se encontrou a trissomia do cromossomo 21 e os outros 8 foram normais. Em todos os casos, normais ou alterados, o cariótipo foi confirmado no sangue dos recém-nascidos e por meio do exame neonatal ou da necropsia. Não ocorreram complicações maternas ou fetais relacionadas ao procedimento invasivo. Conclusões: o cariótipo em líquido pleural obtido por toracocentese mostrou ser procedimento eficaz e seguro, devendo ser empregado nos casos de fetos com derrame pleural.Purpose: to evaluate the possibility and accuracy of fetal karyotyping in pleural effusions. Methods: we studied fifteen fetuses with unilateral or bilateral pleural effusions. All of these fetuses underwent intrauterine thoracocentesis guided by ultrasound examinations. The gestational age varied from 19 to 34 weeks. A morphogenetic ultrasound examination was performed in each case by the authors in order to identify associated structural anomalies. When the cellular cultures of pleural effusion samples were negative, an alternative karyotype was obtained by cordocentesis. A fetal lymphocyte culture was made of pleural effusion samples for karyotype in a similar technique as for fetal

  17. Malignant Pleural Effusion

    Science.gov (United States)

    ... lungs, and low blood pressure . Indwelling pleural catheter (IPC) An indwelling pleural catheter (IPC) is a small tube that is inserted and ... done each time draining is needed. Risks of IPCs include infection and blockage of the catheter. Pleurodesis ...

  18. Tuberculous Pleural Effusion

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    Shira A. Schlesinger

    2012-09-01

    Full Text Available Pleural effusions are a common finding in emergency departments, with cytologic analysis traditionally required for definitive diagnosis. This article describes a classic sonographic appearance of tuberculous pleural effusion.

  19. Pleural Fluid Analysis Test

    Science.gov (United States)

    ... Home Visit Global Sites Search Help? Pleural Fluid Analysis Share this page: Was this page helpful? Formal name: Pleural Fluid Analysis Related tests: Pericardial Fluid Analysis , Peritoneal Fluid Analysis , ...

  20. Módulo pleuroscopía Patología pleural: Toracoscopía y videotoracoscopía Video assisted thoracic surgery (VATS and medical thoracoscopy in pleural diseases

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    JOSE M CLAVERO R

    2008-03-01

    Full Text Available En los últimos años se han producido importantes avances en las técnicas quirúrgicas que permiten tratar prácticamente todas las patologías pleurales y pulmonares por videotoracoscopía, con una rápida recuperación postoperatoria y mínima morbi-mortalidad. Se ha perfeccionado además por médicos internistas la toracoscopía médica, técnica utilizada para el estudio de las enfermedades de la pleura, que permite también realizar algunos procedimientos terapéuticos. En el presente artículo se comenta brevemente la historia de la videotoracoscopía y la toracoscopía médica y sus aplicaciones actuales. Se realiza un análisis crítico de las principales indicaciones de la toracoscopía médica: estudio de derrames pleurales, manejo del derrame pleural de origen neoplásico y del neumotorax espontáneo. Sus resultados se comparan, a la luz de la evidencia existente, con otros procedimientos quirúrgicos menos complejos y con la videotoracoscopíaIn the last years important advances have taken place in the surgical field allowing to treat practically all pleural pathologies by video-assisted thoracic surgery (VATS, with prompt recovery and minimal morbidity and mortality. Internists had also perfected the medical thoracoscopy, a technique used for the study of pleural diseases, which also allows performing some therapeutic procedures. The present article briefly comments the history of medical thoracoscopy and VATS and their current applications. A critical analysis of the principal indications of medical thoracoscopy is presented: study of pleural effusions, management of malignant pleural effusion and spontaneous pneumothorax. The results are compared, in view of the existing evidence, with other less complex surgical procedures and VATS

  1. Derrame pericárdico con inminente taponamiento cardiaco secundario a inhibidor de la tirosina quinasa: Reporte de un caso Pericardial effusion secondary to tyrosine kinase inhibitor with imminence of cardiac tamponade: case report

    Directory of Open Access Journals (Sweden)

    Andrés F Buitrago

    2011-04-01

    Full Text Available La leucemia es una enfermedad maligna que se caracteriza por una proliferación no controlada de una clona iniciada en una etapa precoz de la diferenciación linfoide. Es importante determinar si hay una alteración genética conocida como cromosoma Filadelfia, para pronóstico y tratamiento. El imatinib, un inhibidor de la tirosina kinasa, tiene buena respuesta terapéutica y pocos efectos adversos. Uno de frecuente aparición es la serositis manifestada como derrame pleural, aunque es de menor incidencia asociada con derrame pericárdico. El tratamiento se debe individualizar, pero en caso de inminente taponamiento cardiaco se realiza pericardiocentesis.Leukemia is a malignant disease characterized by uncontrolled proliferation of a clone initiated at an early stage of lymphoid differentiation. It is important to determine if there is a genetic disorder known as the Philadelphia chromosome, for both prognosis and treatment. Imatinib, a tyrosine kinase inhibitor has good therapeutic response and few adverse effects. An adverse event is the frequent occurrence of serositis manifested as pleural effusion, but its association with pericardial effusion has a lower incidence. Treatment should be individualized, but in case of imminent cardiac tamponade pericardiocentesis is performed.

  2. Use of indwelling pleural catheters for the definitive treatment of malignant pleural effusion.

    Science.gov (United States)

    Abrão, Fernando Conrado; Abreu, Igor Renato Louro Bruno de; Cavalcanti, Maria Gabriela; Pompa-Filho, José Franklin Soares

    2017-01-01

    To evaluate the safety and feasibility of the use of indwelling pleural catheters (IPCs) in patients with malignant pleural effusion (MPE). We prospectively collected data from patients with MPE undergoing IPC placement between January of 2014 and July of 2015. All patients submitted to IPC placement had a life expectancy > 30 days, in accordance with the MPE treatment guidelines established by the British Thoracic Society. The data collected included gender, age, body mass index, primary cancer site, duration of IPC drainage, IPC-related complications, length of hospital stay, pleural effusion recurrence, and occurrence of spontaneous pleurodesis. A total of 19 patients underwent IPC placement during the study period. Median overall survival after IPC insertion was 145 days. The median follow-up among the surviving patients was 125 days (range, 53-485 days), and the median time between catheter insertion and removal was 31 days (range, 2-126 days). There were IPC-related complications in 5 patients (26.2%), and spontaneous pleurodesis was achieved in 8 (42.0%). Among those 8 patients, the IPC was removed between days 30 and 126 in 4, and spontaneous pleurodesis occurred within the first 30 days in 4. The use of IPCs seems to be feasible and safe in patients with MPE. Avaliar a segurança e a viabilidade do uso de cateter pleural de longa permanência (CPLP) em pacientes com derrame pleural neoplásico (DPN). Dados referentes a pacientes com DPN que receberam CPLP entre janeiro de 2014 e julho de 2015 foram colhidos prospectivamente. Todos os pacientes que receberam CPLP tinham expectativa de vida > 30 dias, em conformidade com as diretrizes de tratamento de DPN da Sociedade Torácica Britânica. Foram colhidos dados sobre sexo, idade, índice de massa corporal, local do câncer primário, tempo de drenagem com o CPLP, complicações relacionadas com o CPLP, tempo de internação hospitalar, recidiva do derrame pleural e ocorrência de pleurodese espont

  3. Ultrasound guided pleural biopsy in undiagnosed exudative pleural effusion patients

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    Adel S. Ahmed

    2016-04-01

    In conclusion: Thoracic ultrasound (TUS guided pleural biopsy had a diagnostic yield which was slightly lower but comparable to both CT guided pleural biopsy and medical thoracoscopic pleural biopsy (MT.

  4. Persistent benign pleural effusion.

    Science.gov (United States)

    Porcel, J M

    In this narrative review we describe the main aetiologies, clinical characteristics and treatment for patients with benign pleural effusion that characteristically persists over time: chylothorax and cholesterol effusions, nonexpansible lung, rheumatoid pleural effusion, tuberculous empyema, benign asbestos pleural effusion and yellow nail syndrome. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  5. Iatrogenia institucional y muerte materna: semmelweis y la fiebre puerperal

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    Oswaldo Salaverry García

    Full Text Available La fiebre puerperal es una enfermedad que asume carácter epidémico en el siglo XVIII como consecuencia de dos factores: las masas trabajadoras urbanas generadas por la revolución industrial, y la progresiva hegemonización y medicalización de la atención del parto en grandes hospitales públicos. La mortalidad materna institucionalizada alcanza cifras superiores al 30%, en tanto con la atención por parteras es menor al 2%. Semmelweis, médico húngaro, postula que los médicos contaminaban a las parturientas por insuficiente higiene luego de realizar necropsias, e implanta medidas profilácticas en el Hospital de Viena, las cuales reducen dramáticamente la mortalidad, pero sus ideas son rechazadas por que afectan el proceso de institucionalización de la medicina basado en el altruismo y honor, por los que supuestamente era imposible que causen daño a sus pacientes. Es obligado a retirarse del Hospital de Viena, y continua su lucha en Budapest, pero el rechazo y la incomprensión de sus colegas por su doctrina afecta su salud mental. Muere en un asilo, pocos años antes que Pasteur y Koch demuestren las bacterias causantes de enfermedades como la fiebre puerperal.

  6. Iatrogenia institucional y muerte materna. Semmelweis y la fiebre puerperal

    Directory of Open Access Journals (Sweden)

    Oswaldo Salaverry García

    Full Text Available La fiebre puerperal es una enfermedad que asume carácter epidémico en el siglo XVIII como consecuencia de dos factores: las masas trabajadoras urbanas generadas por la revolución industrial, y la progresiva hegemonización y medicalización de la atención del parto en grandes hospitales públicos. La mortalidad materna institucionalizada alcanza cifras superiores al 30%, en tanto con la atención por parteras es menor al 2%. Semmelweis, médico húngaro, postula que los médicos contaminaban a las parturientas por insuficiente higiene luego de realizar necropsias, e implanta medidas profilácticas en el Hospital de Viena, las cuales reducen dramáticamente la mortalidad, pero sus ideas son rechazadas por que afectan el proceso de institucionalización de la medicina basado en el altruismo y honor, por los que supuestamente era imposible que causen daño a sus pacientes. Es obligado a retirarse del Hospital de Viena, y continua su lucha en Budapest, pero el rechazo y la incomprensión de sus colegas por su doctrina afecta su salud mental. Muere en un asilo, pocos años antes que Pasteur y Koch demuestren las bacterias causantes de enfermedades como la fiebre puerperal.

  7. Fiebre de origen desconocido, una forma de presentarse la tuberculosis

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    Lázaro Arturo Vidal Tallet

    2012-12-01

    Full Text Available La tuberculosis es una causa importante de fiebre de origen desconocido. Dentro de los factores de riesgo para estar infectado por el bacilo tuberculoso se encuentra la edad, la presencia de comorbilidades, la competencia inmunológica y la alta prevalencia de la enfermedad en el área geográfica. Los hallazgos clínicos, radiológicos, epidemiológicos y la respuesta a la terapéutica antimicrobiana, pueden orientar en el diagnóstico de esta enfermedad infecciosa. Se presenta un caso en el que los elementos clínicos y epidemiológicos (padre con diagnóstico de tuberculosis llevaron finalmente a la sospecha diagnóstica de tuberculosis extra pulmonar, que no pudo ser demostrada por cultivo, pero la respuesta terapéutica resultó concluyente, ya que, una vez iniciada esta, hubo total remisión del cuadro clínico y recuperación nutricional. La terapia antituberculosa con carácter terapéutico y diagnóstico debe ser considerada en todo paciente con fiebre de origen desconocido, que, además, presente elementos clínicos y epidemiológicos que justifiquen la posibilidad de infección por el bacilo.

  8. Atypical pleural tuberculosis presenting as an isolated pleural tuberculoma

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Sook Min; Rho, Ji Young; Yoo, Seung Min; Jung, Hae Kyoung (Department of Radiology, CHA Bundang Medical Center, CHA University, Gyeonggi-do (Korea, Republic of)), Email: rhoji@naver.com; Cho, Sang Ho (Department of Pathology, CHA Bundang Medical Center, CHA University, Gyeonggi-do (Korea, Republic of))

    2012-02-15

    Pleural tuberculosis is the most common extrapulmonary manifestation of tuberculosis, and is generally characterized by an effusion. The effusion is usually unilateral and residual pleural thickening or calcification is also observed in some cases. Manifestations of multiple pleural tuberculomas without associated effusion and history of tuberculosis or antituberculous therapy are rare and an isolated pleural tuberculoma is exceedingly rare. Herein, we report the first documented case of an isolated pleural tuberculoma, diagnosed by chest CT and pathological findings. Although rare, an isolated pleural tuberculoma should be added to the differential diagnosis of focal nodular pleural tumors, particularly in areas of high tuberculosis prevalence

  9. Toracoscopia no tratamento do empiema pleural em pacientes pediátricos Thoracoscopy in the treatment of pleural empyema in pediatric patients

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    Davi Wen Wei Kang

    2008-04-01

    Full Text Available OBJETIVO: Apresentar resultados obtidos com a toracoscopia no tratamento do empiema pleural em pacientes pediátricos. MÉTODOS: Foram avaliados 117 empiemas pleurais, utilizando-se o mediastinoscópio ou a videotoracoscopia, com anestesia geral e sonda de intubação simples. As indicações para a intervenção cirúrgica foram: derrame pleural com ausência de resposta clínica e radiológica ao tratamento clínico (antibióticos, fisioterapia e toracocentese ou sepse grave, e derrame pleural loculado (documentado por ultrassonografia ou tomografia computadorizada do tórax. RESULTADOS: De fevereiro de 1983 a julho de 2006, 117 toracoscopias foram realizadas em pacientes com idade entre 5 meses e 17 anos (média, 4 anos. O tempo médio de permanência do dreno torácico foi de 9 dias (2 a 33, e o tempo de internação hospitalar foi de 16,44 dias (4 a 49. Houve apenas um óbito (0,8%, e 33 pacientes (28% tiveram como complicação fístula aérea prolongada. Em 7 pacientes (6%, houve necessidade de conversão para toracotomia com decorticação pulmonar em decorrência da organização do empiema. CONCLUSÕES: Não existe consenso para o tratamento do empiema pleural nesta faixa etária. A terapêutica cirúrgica é geralmente requisitada tardiamente no curso da doença, particularmente quando já existem múltiplas loculações ou quadro séptico grave. A toracoscopia indicada mais precocemente no tratamento do empiema pleural em pacientes pediátricos proporcionou uma melhor resposta à terapêutica clínica, aparentemente reduzindo o índice de morbi-mortalidade, o tempo de permanência do dreno torácico, o tempo de internação hospitalar e o tempo de antibioticoterapia.OBJECTIVE: To evaluate the results of thoracoscopy for the treatment of pleural empyema in pediatric patients. METHODS: A retrospective study of 117 patients who underwent mediastinoscopy or video-assisted thoracoscopy for pleural empyema treatment. General anesthesia and

  10. Las fiebres manchadas y su importancia en Costa Rica

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    Laya Hun-Opfer

    2008-06-01

    Full Text Available La Fiebre Manchada de la Montañas Rocosas es una zoonosis transmitida por garrapatas y causada por una bacteria intracelular obligatoria, la Rickettsia rickettsii. Es una enfermedad sistémica, de moderada a severa, producida por la infección del endotelio vascular de pequeños vasos de la mayoría de órganos y tejidos. Es la más letal de las infecciones transmitidas por garrapatas y desde su descubrimiento, hace cerca de 100 años, todavía se presenta, aunque esporádicamente, de forma persistente, y a pesar de que se cuenta con antibióticos efectivos, la mortalidad sigue siendo de mas del 10% y los pacientes requieren terapia intensiva durante la infección si esta no es diagnosticada y tratada a tiempo. En tiempo recientemente se han descrito otras especies de garrapatas que pueden transmitir rickettsias a humanos así como nuevas especies de rickettsias que pueden producir cuadros de fiebres manchadas y aunque se ha dilucidado parte de sus mecanismos patogénicos, persisten muchas dudas respecto a su virulencia. Desde 1975 se han reportado brotes de esta enfermedad en Costa Rica y el agente etiológico causal, la Rickettsia rickettsii, fue aislada e identificada en la mayoría de los casos en el Laboratorio de Virología de la Facultad de Microbiología de la Universidad de Costa Rica.

  11. Mesotelioma pericárdico primario manifestado como derrame pericárdico severo

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    Viviana Quintero

    2015-01-01

    Conclusiones: El derrame pericárdico severo y recurrente puede ser la primera manifestación de un mesotelioma primario pericárdico y deberá considerarse como diagnóstico diferencial en esta presentación clínica.

  12. Clinical and laboratory parameters in the differential diagnosis of pleural effusion secondary to tuberculosis or cancer Parâmetros clínicos e laboratoriais no diagnóstico diferencial de efusões pleurais secundárias à tuberculose ou ao cancer

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    Leila Antonangelo

    2007-01-01

    Full Text Available PURPOSE: To evaluate the clinical and laboratory characteristics of pleural effusions secondary to tuberculosis (TB or cancer (CA. METHODS: A total of 326 patients with pleural effusion due to TB (n=182 or CA (n=144 were studied. The following parameters were analyzed: patient gender, age and pleural effusion characteristics (size, location, macroscopic fluid aspect, protein concentration, lactate dehydrogenase (DHL and adenosine deaminase activity (ADA and nucleated cell counts. RESULTS: Young male patients predominated in the tuberculosis group. The effusions were generally moderate in size and unilateral in both groups. Yellow-citrine fluid with higher protein (p @ 80%. In this context, we suggest thoracocentesis with fluid biochemical and cytological examination as the first diagnostic approach for these patients.OBJETIVO: Avaliar as características clínicas e laboratoriais de derrames pleurais secundários à tuberculose ou câncer. MÉTODOS: Um total de 326 pacientes com derrame pleural por tuberculose (n=182 ou câncer (n=144 foi avaliado. Os seguintes parâmetros foram analisados: sexo e idade dos pacientes e características do líquido pleural (tamanho, localização, aspecto macroscópico, concentração de proteínas, atividade da desidrogenase lática (DHL e da adenosina deaminase (ADA e contagem de células nucleadas. RESULTADOS: A tuberculose pleural predominou nos pacientes mais jovens e do sexo masculino. Em ambos os grupos, os derrames pleurais foram de tamanho moderado e unilaterais. Derrames com aspecto amarelo-citrino com níveis mais elevados de proteínas predominaram na tuberculose (5,3 ± 0,8 g/dL, quando comparados aos neoplásicos (4,2 ± 1,0 g/dL, enquanto que níveis mais elevados de DHL foram observados nos derrames neoplásicos (1.177 ± 675 x 1.030 ± 788 UI; p = 0,003. Conforme esperado, a atividade da ADA foi maior na tuberculose que no câncer (107,6 ± 44,2 x 30,6 ± 57,5 U/L; p @ 80%. Neste contexto

  13. Derrame pericárdico grave. Ventana pericárdica percutánea con balón

    OpenAIRE

    Carlos A. Bruno; Norberto Peñaloza; Félix Ramírez; Gabriel Scattini; Jorge Miano; María A. Oxilia Estigarribia; Juan Medrano

    2008-01-01

    La mayoría de los pacientes con derrame pericárdico crónico son mujeres y mayores de 50 años. En esta presentación se describe el caso de una paciente de 63 años con derrame pericárdico crónico grave, con antecedente de carcinoma de mama izquierda irradiado, diagnóstico presuntivo no confirmado de tuberculosis pulmonar e hipotiroidea sustituida. Ante la recurrencia del derrame luego de pericardiocentesis y el fracaso del tratamiento antiinflamatorio con AINE se decidió realizar una ventana pe...

  14. Developing a 'pleural team' to run a reactive pleural service.

    Science.gov (United States)

    Bhatnagar, Rahul; Maskell, Nick

    2013-10-01

    Pleural disease is increasingly recognised as an important subspecialty within respiratory medicine, especially as cases of pleural disease continue to rise internationally. Recent advances have seen an expansion in the options available for managing patients with pleural disease, with access to local-anaesthetic thoracoscopy, indwelling pleural catheters and thoracic ultrasound all becoming commonplace. Pleural teams usually consist of a range of practitioners who can optimise the use of specialist services to ensure that patients with all types of pleural disease - who have traditionally needed extended admissions - are managed efficiently, often entirely as outpatients. A pleural service can also provide improved opportunities for enhancing procedural skills, engaging in clinical research, and reducing the costs of care. This article explores the justification for dedicated pleural services and teams, as well as highlighting the various roles of hospital personnel who might be most useful in ensuring their success.

  15. Pleural Fluid Cholesterol in Differentiating Exudative and Transudative Pleural Effusion

    OpenAIRE

    Hamal, A. B.; Yogi, K. N.; N. Bam; Das, S. K.; Karn, R.

    2013-01-01

    Objectives. To study the diagnostic value of pleural fluid cholesterol in differentiating transudative and exudative pleural effusion. To compare pleural fluid cholesterol level for exudates with Light's criteria. Design. Cross sectional descriptive study. Settings. Medical wards of Tribhuvan University Teaching Hospital. Methods. Sixty two cases of pleural effusion with definite clinical diagnosis admitted in TUTH were taken and classified as transudates (19) and exudates (43). The parameter...

  16. Pleurisy and Other Pleural Disorders

    Science.gov (United States)

    ... the NHLBI on Twitter. What Are Pleurisy and Other Pleural Disorders? Pleurisy (PLUR-ih-se) is a ... Many conditions can cause pleurisy, including viral infections. Other Pleural Disorders Pneumothorax Air or gas can build ...

  17. Pleural Fluid Cholesterol in Differentiating Exudative and Transudative Pleural Effusion

    Directory of Open Access Journals (Sweden)

    A. B. Hamal

    2013-01-01

    Full Text Available Objectives. To study the diagnostic value of pleural fluid cholesterol in differentiating transudative and exudative pleural effusion. To compare pleural fluid cholesterol level for exudates with Light’s criteria. Design. Cross sectional descriptive study. Settings. Medical wards of Tribhuvan University Teaching Hospital. Methods. Sixty two cases of pleural effusion with definite clinical diagnosis admitted in TUTH were taken and classified as transudates (19 and exudates (43. The parameters pleural fluid protein/serum protein ratio (pfP/sP, pleural fluid LDH/ serum LDH ratio, pleural fluid LDH (pfLDH and pleural fluid cholesterol (pCHOL were compared with clinical diagnosis with regard to their usefulness for distinguishing between pleural exudates and transudates. Results. The pCHOL values determined were for exudates, for transudates, the differences between the transudates and others are statistically significant (. It is seen that pfP/sP ratio has a sensitivity of 81.4% and specificity of 82.6%; pfLDH/sLDH ratio has a sensitivity of 86% and specificity of 94.7% and pCHOL with sensitivity of 97.7% and specificity of 100% for differentiating exudative and transudative PE. Conclusion. The determination of pCHOL is of great value for distinguishing between pleural exudates and transudates and should be included in routine laboratory analysis of pleural effusion.

  18. Pleural Fluid Cholesterol in Differentiating Exudative and Transudative Pleural Effusion

    Science.gov (United States)

    Hamal, A. B.; Yogi, K. N.; Bam, N.; Das, S. K.; Karn, R.

    2013-01-01

    Objectives. To study the diagnostic value of pleural fluid cholesterol in differentiating transudative and exudative pleural effusion. To compare pleural fluid cholesterol level for exudates with Light's criteria. Design. Cross sectional descriptive study. Settings. Medical wards of Tribhuvan University Teaching Hospital. Methods. Sixty two cases of pleural effusion with definite clinical diagnosis admitted in TUTH were taken and classified as transudates (19) and exudates (43). The parameters pleural fluid protein/serum protein ratio (pfP/sP), pleural fluid LDH/ serum LDH ratio, pleural fluid LDH (pfLDH) and pleural fluid cholesterol (pCHOL) were compared with clinical diagnosis with regard to their usefulness for distinguishing between pleural exudates and transudates. Results. The pCHOL values determined were 1.92 ± 0.75 for exudates, 0.53 ± 0.28 for transudates, the differences between the transudates and others are statistically significant (P exudative and transudative PE. Conclusion. The determination of pCHOL is of great value for distinguishing between pleural exudates and transudates and should be included in routine laboratory analysis of pleural effusion. PMID:23365740

  19. Tendencias de la mortalidad por fiebre amarilla, Colombia, 1998-2009

    Directory of Open Access Journals (Sweden)

    Ángela María Segura

    2013-08-01

    Full Text Available Introducción. La fiebre amarilla es una enfermedad tropical desatendida, razón por la cual el conocer las tendencias de mortalidad por fiebre amarilla en Colombia, constituye una importante fuente de información para la toma de decisiones y las intervenciones en salud pública. Objetivo. Analizar las tendencias de mortalidad fiebre amarilla en Colombia (1998-2009 y las diferencias que presentan las fuentes de información de morbilidad y mortalidad en el país, que afectan indicadores como el de letalidad. Materiales y métodos. Es un estudio descriptivo de las muertes por fiebre amarilla, según el Departamento Administrativo Nacional de Estadística, y de la incidencia de la enfermedad, según el Instituto Nacional de Salud. Se usaron fuentes secundarias de información en el cálculo de proporciones de las características sociodemográficas de los fallecidos y las medidas epidemiológicas de letalidad, incidencia y mortalidad por fiebre amarilla, por departamento de residencia de los fallecidos. Resultados. Las muertes por fiebre amarilla se presentan principalmente en hombres, en edad de trabajar, residentes en zonas rurales dispersas, afiliados al régimen vinculado, residentes en las zonas oriental, suroriental, norte y central del país. Se observaron inconsistencias en los informes reportados que afectan el análisis comparativo. Conclusión. Los habitantes de los departamentos ubicados en los territorios nacionales y en Norte de Santander presentan mayor riesgo de enfermar y de morir por fiebre amarilla, pero esta información pudiera estar subestimada, según la fuente de información utilizada en su cálculo.   doi: http://dx.doi.org/10.7705/biomedica.v33i0.698

  20. Efectos derrame interestatales y transfronterizos de la red de carreteras: Un estudio para México

    Directory of Open Access Journals (Sweden)

    Inmaculada C. Álvarez Ayuso

    2011-01-01

    Full Text Available El objetivo de esta investigación es identificar la existencia de efectos derrame de la infraestructura carretera nacional y transfronteriza de Estados Unidos sobre la producción en México, a través de la implementación de un modelo de fronteras estocásticas. Para ello, se han elaborado indicadores espaciales que capturan estos efectos y que recogen la influencia de las entidades federativas contiguas a cada una de ellas. Los resultados muestran que tanto las carreteras nacionales como las transfronterizas generan un efecto favorable para la producción, reduciendo la ineficiencia técnica estatal, generando efectos derrame entre las entidades federativas contiguas.

  1. [Sarcoid pleural effusion].

    Science.gov (United States)

    Rodríguez-Núñez, Nuria; Rábade, Carlos; Valdés, Luis

    2014-12-09

    Pleural effusion (PE) is a very uncommon manifestation of sarcoidosis. It is equally observed in men and women, can appear at any age and in all radiologic stages, though it is more common in stages i and ii. Effusions have usually a mild or medium size and mainly involve the right side. Various mechanisms can be implicated. PE will be a serous exudate if there is an increase in the capillary permeability due to direct involvement of the pleural membrane, a chylothorax if mediastinum lymph nodes compress the thoracic duct and/or the lymphatic drainage from the pleural cavity, an hemothorax if granuloma compress or invade pleural small vessels or capillaries, and even a transudate if there is compression of the inferior vena cava, atelectasis due to complete bronchial obstruction or when the resolution of the PE is incomplete with chronic thickening of visceral pleura (trapped lung). It manifests biochemically as a pauci-cellular exudate with a predominance of lymphocytes, though there can be a preponderance of eosinophils or neutrophils. Protein concentrations are usually proportionately higher than lactate dehidrogenase, adenosine deaminase is normally low and it is possible to find increased levels of CA-125 in women. The tuberculin test is negative and pleural or lung biopsies yield the diagnosis by confirming the presence of non-caseating granulomata. These PE can have a favorable self-limited outcome, even though in most cases treatment with corticosteroids is needed, while surgery is required in a few cases. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  2. Manejo de los derrames pericárdicos benignos por videotoracoscopia

    Directory of Open Access Journals (Sweden)

    José M. Galbis

    2007-01-01

    Conclusiones: La pericardiectomía parcial practicada por CVT es un procedimiento de utilidad en los derrames pericárdicos no malignos donde el estado general del paciente, la expectativa de vida, la posibilidad de respuesta a un tratamiento específico y la ausencia de un diagnóstico histológico apoyan la elección de la técnica.

  3. Differentiating Pleural Effusions: Criteria Based on Pleural Fluid Cholesterol

    OpenAIRE

    Srinath Dhandapani; Sivakumar Reddy; Rajalakshmi Rajagopalan

    2016-01-01

    Objective: To assess the efficacy of pleural fluid cholesterol in differentiating transudates and exudates as compared with Light’s criteria. Methods: Patients with pleural effusion during a 6-month period were enrolled in the study and underwent thoracentesis. Pleural fluid was analyzed for the levels of protein, lactate dehydrogenase (LDH), and cholesterol. Etiological diagnosis, which was established after considering clinical and biochemical factors, was the gold standard for com...

  4. La fiebre amarilla en Piura. Breves consideraciones acerca de su naturaleza

    OpenAIRE

    Zapata, Carlos Enrique; Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú

    2014-01-01

    De poco tiempo a esta parte, una de las zonas más ricas del país, el departamento de Piura, viene siendo cruelmente azotada por las epidemias más terribles: la peste bubónica, la fiebre tifoidea, el paludismo, etc., a las que ha venido a sumarse desde el año pasado la fiebre amarilla amarilla. Estas anormales condiciones por las que atraviesa el departamento de Piura y las serias proyecciones que ha tenido, y tiene actualmente, la epidemia de que me ocupo, constituyen un peligro inevitable y ...

  5. Caracterización de dos brotes de fiebre tifoidea en Apartadó, Antioquia, 2005

    OpenAIRE

    Nora María Cardona-Castro; Miryan Margot Sánchez-Jiménez; Luz Yaned Usuga-Silva; Margarita Arboleda-Naranjo; Eliana Garzón; Aminta Vélez; Magdalena Wiesner; Nélida Muñoz; Clara Inés Agudelo

    2007-01-01

    Introducción. La caracterización de los brotes de fiebre tifoidea es importante epidemiológicamente, debido a que esto permite la búsqueda de la fuente y el desarrollo de medidas de control. Objetivo. Describir un brote de fiebre tifoidea en el municipio de Apartadó y caracterizar fenotípica y genotípicamente los aislamientos de Salmonella Typhi relacionados con él. Materiales y métodos. Se estudiaron 44 pacientes, a 15 de ellos se les tomaron muestras para hemocultivos y a 7, muestras ...

  6. Dos nuevos registros de vectores de fiebre amarilla y Mayaro en Ecuador

    OpenAIRE

    Navarro, Juan Carlos

    2013-01-01

    http://www.scielo.org.ve/scielo.php?script=sci_abstract&pid=S1690-46482013000100011&lng=es&nrm=iso&tlng=en Se registran por primera vez en el Ecuador dos especies de mosquitos (Diptera: Culicidae), vectores potenciales de los virus de la Fiebre Amarilla y Mayaro. Sabethes amazonicus Gordon and Evans y Haemagogus anastasionis Dyar fueron colectados en fase adulta en una localidad de la provincia de Zamora-Chinchipe, en la cual se han presentado casos de Fiebre Amarilla selvática con anterio...

  7. Tuberculous pleural effusion.

    Science.gov (United States)

    Ferreiro, Lucía; San José, Esther; Valdés, Luis

    2014-10-01

    Tuberculous pleural effusion (TBPE) is the most common form of extrapulmonary tuberculosis (TB) in Spain, and is one of the most frequent causes of pleural effusion. Although the incidence has steadily declined (4.8 cases/100,000population in 2009), the percentage of TBPE remains steady with respect to the total number of TB cases (14.3%-19.3%). Almost two thirds are men, more than 60% are aged between 15-44years, and it is more common in patients with human immunodeficiency virus. The pathogenesis is usually a delayed hypersensitivity reaction. Symptoms vary depending on the population (more acute in young people and more prolonged in the elderly). The effusion is almost invariably a unilateral exudate (according to Light's criteria), more often on the right side, and the tuberculin test is negative in one third of cases. There are limitations in making a definitive diagnosis, so various pleural fluid biomarkers have been used for this. The combination of adenosine deaminase and lymphocyte percentage may be useful in this respect. Treatment is the same as for any TB. The addition of corticosteroids is not advisable, and chest drainage could help to improve symptoms more rapidly in large effusions. Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.

  8. Presentación clínica y evolución alejada de los derrames

    Directory of Open Access Journals (Sweden)

    Roberto R. Favaloro

    2007-01-01

    Full Text Available ObjetivoDeterminar la frecuencia, la presentación clínica, los métodos diagnósticos, el tratamiento,la evolución y el pronóstico alejado en pacientes con derrame pericárdico crónico severo idiopático.Material y métodosSe analizaron prospectivamente todos los pacientes con sospecha de derrame pericárdico severo, desde junio de 1992 a abril de 2005. Fueron evaluados de acuerdo con un protocolo de enfermedad pericárdica que se aplica en nuestra Institución. De un total de 152 pacientes, 54 presentaron derrame crónico severo, de los cuales 28 (52% fueron catalogados como idiopáticos e incluidos en el presente estudio.ResultadosLa edad media fue de 67 ± 11 años, el 82% eran hombres, 25 (89,3% se encontraban sintomáticos por disnea, 4 (16% con taponamiento cardíaco y 10 (35,7% con signos ecocardiográficos incipientes de taponamiento. El seguimiento promedio fue de 60 meses(3-128 meses. Los 3 pacientes asintomáticos no fueron drenados y tuvieron una evolución favorable (seguidos en promedio durante 42 meses. Los 25 pacientes sintomáticos se trataron con drenaje pericárdico y se realizó seguimiento en 23 (2 perdidos. En 14 (60,8% de ellos no hubo recidiva de derrame, 3 (13% presentaron derrame leve, 2 (8,6% derrame moderado y 4 (17,2% derrame severo. De estos últimos, 3 estaban con disnea III-IV, por lo que requirieron pericardiectomía, con buena evolución ulterior. El paciente restante permaneció asintomático.ConclusionesLos pacientes con derrame pericárdico crónico severo idiopático pueden permanecer asintomáticos durante largo tiempo. El drenaje pericárdico es eficaz en la mayoría de los casos en los que se desarrollan síntomas graves. En los pacientes sintomáticos con recidivas de derrame severo posterior al drenaje, la pericardiectomía resulta una solución eficaz.

  9. Zinc Determination in Pleural Fluid

    OpenAIRE

    Nazan DEMİR; DEMİR, Yaşar

    2000-01-01

    In this study, an enzymatic zinc determination method was applied to pleural fluid, the basis of which was the regaining of the activity of apo carbonic anhydrase by the zinc present in the sample. The method was used for pleural fluid zinc determination in order to show the application to body fluids other than serum. For this purpose, pleural fluids were obtained from 20 patients and zinc concentrations were determined. Carbonic anhydrase was purified by affinity chromatography from bovine ...

  10. Mesotelioma pleural maligno Malign pleural mesothelioma

    Directory of Open Access Journals (Sweden)

    B. Fernández Infante

    2005-01-01

    Full Text Available El mesotelioma maligno es una neoplasia pleural relacionada con la exposición laboral a amianto, aunque otros factores pudieran estar implicados, con una incidencia en aumento en Europa Occidental. El dolor torácico y la disnea son sus manifestaciones clínicas más frecuentes. Las técnicas de imagen juegan un papel importante en la evaluación de la enfermedad, siendo la TAC las más ampliamente utilizada, si bien la RM y el PET se postulan como técnicas que pueden aportar información adicional en el diagnóstico y pronóstico de estos pacientes. La supervivencia es corta y no existe un consenso en la literatura que guíe el tratamiento de estos pacientes debido a la falta de datos que apoyen un aumento de supervivencia de ninguna modalidad terapéutica, si bien, recientemente los esfuerzos realizados han llevado al desarrollo de nuevos tratamientos que podrían cambiar la actual visión pesimista de la enfermedad por parte de médicos y pacientes.Malign mesothelioma is a pleural neoplasia related to the occupational exposure to asbestos, although other factors can be involved; its incidence is increasing in Western Europe. Pain in the thorax and dyspnoea are its most frequent clinical manifestations. An important role in the evaluation of the disease is played by imaging techniques, of which CAT is the most widely used, although MR and PET are suggested as techniques that can provide additional information in the diagnosis and prognosis of these patients. Survival is short and there is no consensus in the literature that would orientate treatment of these patients. This is due to a lack of data that would confirm an increase of survival with any therapeutic method, although recent efforts have led to the development of new treatments that could change the present pessimistic view of the disease held by doctors and patients.

  11. Tao jovens e tao ameacados: aumenta o numero de casos de derrame cerebral entre os brasileiros mais mocos. Tambem, com a vida que eles levam

    National Research Council Canada - National Science Library

    Dias Lopes, Adriana

    2009-01-01

    .... Sua mae, medica, entendeu o que estava acontecendo e agiu rapidamente: em apenas meia hora, a residente recebeu o diagnostico de derrame cerebral em um pronto-socorro hospitalar. A cada ano, no Brasil, cerca de 20000 jovens como Lucia sao acometidos por derrame cerebral, doenca que se caracteriza pela interrupcao do fluxo sanguineo no cerebro. O numer...

  12. Enfermedad mixta del tejido conectivo como causa de fiebre de origen por determinar.

    OpenAIRE

    Trejo Ayala, Rafael; Montúfar, Rubén

    2013-01-01

    La Fiebre de Origen por Determinar,constituye un verdadero reto para el médico,ya que puede ser causada y desarrollada por múltiples causas entre las que se pueden mencionar: las enfermedades infecciosas, neopáticas, colágeno vascular, misceláneas e idiopáticas.

  13. Differentiating Pleural Effusions: Criteria Based on Pleural Fluid Cholesterol

    Directory of Open Access Journals (Sweden)

    Srinath Dhandapani

    2016-08-01

    Full Text Available Objective: To assess the efficacy of pleural fluid cholesterol in differentiating transudates and exudates as compared with Light’s criteria. Methods: Patients with pleural effusion during a 6-month period were enrolled in the study and underwent thoracentesis. Pleural fluid was analyzed for the levels of protein, lactate dehydrogenase (LDH, and cholesterol. Etiological diagnosis, which was established after considering clinical and biochemical factors, was the gold standard for comparison. Cut-off values for pleural fluid cholesterol were taken as 60 mg/dL and 45 mg/dL. Results: A total of 53 patients were included for final analysis. Of them, 19 were with transudates and 34 with exudates in their pleural fluids. The sensitivity, specificity, positive predictive value, and negative predictive value of the pleural fluid cholesterol (cut-off >45 mg/dL were 97.06%, 94.74%, 97.06%, and 94.74%, respectively, for identifying exudates. These values were differentiating better than those obtained by Light’s criteria for pleural fluid cholesterol (cut-off >60 mg/dL (p45 mg/dL gave a higher specificity (100% and positive predictive value (100% but a lower sensitivity (82.93% and negative predictive value (63.16%. Conclusion: Pleural fluid cholesterol is better than Light’s criteria for the differentiation of transudates and exudates and is less cumbersome as it does not require a simultaneous blood sampling. Cut-off value of pleural fluid cholesterol for differentiating transudates and exudates should be 45 mg/dL. Further studies are warranted to assess the efficacy of the combination of pleural fluid protein and cholesterol as criteria for classifying effusions.

  14. Management of malignant pleural effusions.

    LENUS (Irish Health Repository)

    Uzbeck, Mateen H

    2010-06-01

    Malignant pleural effusions are a common clinical problem in patients with primary thoracic malignancy and metastatic malignancy to the thorax. Symptoms can be debilitating and can impair tolerance of anticancer therapy. This article presents a comprehensive review of pharmaceutical and nonpharmaceutical approaches to the management of malignant pleural effusion, and a novel algorithm for management based on patients\\' performance status.

  15. Estrategia diagnóstica y terapéutica en el paciente con derrame pericárdico

    OpenAIRE

    Mercé Klein, Jordi

    2002-01-01

    Descripció del recurs: 2 juny 2003 Consultable des del TDX Títol obtingut de la portada digitalitzada Esta tesis se presenta como compendio de publicaciones en revistas científicas. En ellas se analizan varios aspectos referentes al diagnóstico y manejo de pacientes con derrame pericárdico. Incluímos 322 pacientes con derrame moderado o severo, definido como la suma de espacios libres de ecos en sacos anterior y posterior de 10 a 20 mm o de más de 20 mm, respectivamente. Diagnóstico ...

  16. Empleo del bagazo como material absorbente en derrames de petróleo

    OpenAIRE

    Alejandro Armada; Eduardo Barquinero; Elaine Capote

    2008-01-01

    Se muestra el procedimiento de obtención de un material adsorbente a partir de un subproducto biodegradable que constituye un subproducto de la industria azucarera, el bagazo, para ser empleado en el tratamiento de derrames de hidrocarburos en cuerpos de agua y suelos. Se clasificó el bagazo según la Norma (ISO 2591 - 1,1988 E, denominada "Ensayo de Tamizado". Se caracterizaron, posteriormente, cada una de sus fracciones por la Norma ACTM F729 - 99 (Standard Test Method for Sorbent Performanc...

  17. Biomateriales sorbentes para la limpieza de derrames de hidrocarburos en suelos y cuerpos de agua

    OpenAIRE

    2010-01-01

    Este estudio esta encaminado a identificar y evaluar materiales orgánicos naturales que puedan ser utilizados como sorbentes en las operaciones de limpieza de derrames de hidrocarburos tanto en suelos como en cuerpos de agua. Se evaluó la capacidad de sorción de tres materiales: fibra de caña, fibra de coco y buchón de agua, con tres hidrocarburos: 35, 30 y 25°API, y dos tipos de agua: destilada y marina artificial, adaptando la norma ASTM F-726 y siguiendo la metodología sugerida por el pr...

  18. Pleural biopsy: A superior procedure than pleural fluid cytology in diagnosing pleural malignancy

    Directory of Open Access Journals (Sweden)

    Biswajit Biswas

    2015-01-01

    Full Text Available Background: The present study is designed to evaluate the role of pleural fluid cytology and pleural biopsy in diagnosing pleural diseases and to study the advantages and disadvantages of thoracocentasis and pleural biopsy. Materials and Methods: We prospectively included 66 consecutive indoor patients over a duration of 1-year. Pleural fluid was collected, cytological smears were made from the fluid. Plural biopsy was obtained in the same patient by Cope′s needle. Adequate pleural biopsy tissue yielding specific diagnosis was obtained in 47 (71.2% of cases. Results: Tuberculosis was the commonest nonneoplastic lesion followed by chronic nonspecific pleuritis comprising 60% and 33.3% of the nonneoplastic cases respectively and tuberculosis was predominantly diagnosed in younger age group. Majority (70.8% of malignancy were in the age group of >50-70. Adenocarcinoma was found to be the commonest (66.7% malignant neoplasm in the pleurae followed by small cell carcinoma (20.8%. Conclusion: Pleural biopsy is a useful and minimally invasive procedure. It is more sensitive and specific than pleural fluid smears.

  19. Usefulness of CT in diffuse pleural disease

    Energy Technology Data Exchange (ETDEWEB)

    Ashizawa, Kazuto; Uetani, Masataka; Mori, Masaichi; Matsunaga, Naofumi; Hayashi, Kuniaki; Kawahara, Katsunobu; Ayabe, Kimiji; Tsuda, Nobuo (Nagasaki Univ. (Japan). School of Medicine)

    1993-01-01

    Alterations of the pleura and extrapleural fat were assessed by CT in 114 patients with diffuse pleural disease. The diseases included malignant pleural mesothelioma, pleuritis carcinomatosa, acute and chronic empyema, asbestosis and transudatory effusion. The pleural changes were classified into five types according to the degree, extent and contour of pleural thickening. Each type was relatively specific for the diagnosis of diffuse pleural diseases. Increased thickness of the extrapleural fat was seen in malignant pleural disease and empyema, and homogenous increased attenuation of extrapleural was a relatively characteristic finding in acute empyema. CT was useful in evaluating diffuse pleural disease. (author).

  20. Update on pleural diseases - 2007

    Directory of Open Access Journals (Sweden)

    Bishay Ayman

    2007-01-01

    Full Text Available Background : New information is available on pleural diseases. The authors selected articles to make recommendations on diagnostic and treatment aspects of pleural diseases. Materials and Methods: Eleven articles published in the English language between 2004 and 2007 were chosen. The basis of selection of the articles was the impact on daily practice, change in prior thinking of a disease process or specific treatment modality, as well as proper design and execution of the study. 5-amino-laevulinic acid with fluorescent light combined with white light may allow further diagnostic yield in undiagnosed pleural disease. FDG-PET may allow prognostication of patients with pleural tumors. Utilizing ultrasound by trained Emergency Department physicians is a rapid and effective technique to evaluate non-traumatic pleural effusions in symptomatic patients. Serum osteopontin levels may distinguish patients exposed to asbestos with benign disease from those with pleural mesothelioma. Administration of streptokinase in patients with empyema does not need for surgical drainage, length of hospital stay, or mortality as compared to conventional treatment with chest tube drainage and intravenous antibiotics. Silver nitrate may be an alternative agent to talc for producing pleurodesis. Routine use of graded talc (50% particles greater than 25 microns is recommended to reduce the morbidity associated with talc pleurodesis. Study design does not permit us to conclude that aspiration of spontaneous pneumothorax is as effective as chest tube drainage. Pleural catheter may prove to be an important palliative modality in treating debilitated patients or patients with trapped lung who show symptomatic improvement with drainage; however, at the present time, these catheters cannot be considered a first line treatment option for patients with malignant pleural effusion. One of the studies reviewed showed no significant difference in tract metastasis in patients with

  1. Derrame pericárdico grave. Ventana pericárdica percutánea con balón

    Directory of Open Access Journals (Sweden)

    Carlos A. Bruno

    2008-01-01

    Full Text Available La mayoría de los pacientes con derrame pericárdico crónico son mujeres y mayores de 50 años. En esta presentación se describe el caso de una paciente de 63 años con derrame pericárdico crónico grave, con antecedente de carcinoma de mama izquierda irradiado, diagnóstico presuntivo no confirmado de tuberculosis pulmonar e hipotiroidea sustituida. Ante la recurrencia del derrame luego de pericardiocentesis y el fracaso del tratamiento antiinflamatorio con AINE se decidió realizar una ventana pericárdica percutánea, sin que se presentaran complicaciones técnicas. Se inició tratamiento con colchicina y se evaluaron las posibles causas: tuberculosa, oncológica, secundaria a hipotiroidismo o por radiación. Por exclusión se llegó a la etiología radiante. Al mes de la realización de la ventana pericárdica no se observaba derrame pericárdico en el ecocardiograma.

  2. Pleural effusion: Role of pleural fluid cytology, adenosine deaminase level, and pleural biopsy in diagnosis

    Directory of Open Access Journals (Sweden)

    Biswajit Biswas

    2016-01-01

    Full Text Available Objective: The present study is designed to evaluate the role of pleural fluid analysis in diagnosing pleural diseases and to study the advantages and disadvantages of thoracocentasis and pleural biopsy. Materials and Methods: We prospectively included 66 consecutive indoor patients over a duration of 1 year. Pleural fluid was collected and cytological smears were made from the fluid. Plural biopsy was done in the same patient by Cope needle. Adequate pleural biopsy tissue yielding specific diagnosis was obtained in 47 (71.2% cases. Results: Tuberculosis was the commonest nonneoplastic lesion followed by chronic nonspecific pleuritis comprising 60% and 33.3% of the nonneoplastic cases respectively and tuberculosis was predominantly diagnosed in the younger age group. Majority (70.8% of malignancy cases were in the age group of >50-70. Adenocarcinoma was found to be the commonest (66.7% malignant neoplasm in the pleurae followed by small-cell carcinoma (20.8%. Conclusion: Pleural biopsy is a useful and minimally invasive procedure. It is more sensitive and specific than pleural fluid smears.

  3. OcorrÃncia e gÃnese de derrame alterado sob rocha sà no Planalto de Palmas (PR)/Ãgua Doce (SC)

    OpenAIRE

    Jacson Gosman Gomes de Lima

    2013-01-01

    Esta dissertaÃÃo de mestrado apresenta o mapeamento e caracterizaÃÃo de derrame alterado sob rocha sà no Planalto de Palmas (PR)/Ãgua Doce (SC). A metodologia de trabalho para atingir tal objetivo foi conduzida em duas linhas principais, uma visando mapear o derrame alterado sob rocha sà e outro visando caracteriza-lo, em ambas empregou-se tÃcnicas de campo e laboratÃrio. Em campo o derrame foi mapeado percorrendo-se as estradas da Ãrea de estudo, registrando sua localizaÃÃo em GPS e posterio...

  4. Thoracoscopy in undiagnosed pleural effusions

    African Journals Online (AJOL)

    diagnostic thoracoscopy for pleural effusions of unknown origin. Design. Retrospective review of consecutive patients referred for diagnostic thoracoscopy ... symptoms such as fever and sweats is highly associated with a final diagnosis of ...

  5. Pleural effusion in liver disease.

    Science.gov (United States)

    Alonso, José Castellote

    2010-12-01

    Hepatic hydrothorax is the paradigmatic pleural effusion in liver cirrhosis. It is defined as a pleural effusion in a patient with portal hypertension and no cardiopulmonary disease. The estimated prevalence of this complication in patients with liver cirrhosis is 5 to 6%. Its pathophysiology involves movement of ascitic fluid from the peritoneal cavity into the pleural space through diaphragmatic defects. Thoracentesis and pleural fluid analysis are necessary for diagnosis. Initial management consists of sodium restriction, diuretics, and therapeutic thoracentesis. A transjugular intrahepatic portosystemic shunt may provide a bridge prior to liver transplantation. Spontaneous bacterial empyema is the infection of a preexisting hydrothorax. The more frequent bacteria involved are ENTEROBACTERIACEAE and gram-positive cocci. Antibiotic therapy is the cornerstone of therapy. This article reviews etiology, clinical manifestations, and therapy of these two complications of liver cirrhosis and portal hypertension.

  6. SERUM CHOLINESTERASE AND PLEURAL CHOLINESTERASE LEVELS AND ITS USAGE TO DIFFERENTIATE PLEURAL TRANSUDATES AND EXUDATES

    National Research Council Canada - National Science Library

    Suresh S; Shoukath

    2014-01-01

    AIMS AND OBJECTIVES: Evaluation of pleural fluid cholinesterase level and comparison of study of pleural fluid cholinesterase levels and serum cholinesterase levels to differentiate transudates from exudates...

  7. Tuberculosis hepática primaria como causa de fiebre de origen desconocido

    Directory of Open Access Journals (Sweden)

    Manuel Antonio Villalobos-Zúñiga

    2007-10-01

    Full Text Available Se presenta el caso de un paciente de 29 años de edad, quien se presentó con un cuadro de fiebre, sudoración nocturna y pérdida de peso, el que inicialmente fue catalogado como dengue clásico, pero que al persistir, fue abordado como fiebre de origen desconocido. Debido a que las pruebas de laboratorio y gabinete iniciales no fueron concluyentes, fue necesario realizar una laparotomía exploratoria para obtener material histológico en el que se demostraron granulomas caseosos en el hígado y formas similares a micobacterias con las tinciones especiales. Con el tratamiento antifímico, se observó una respuesta clínica favorable, por lo que se concluye que el cuadro corresponde a una probable TB hepática.

  8. Management of malignant pleural effusion

    OpenAIRE

    Boshuizen, R.C.

    2017-01-01

    The first part of this thesis focuses on IPCs (indwelling pleural catheters) in malignant pleural effusion (MPE) management. In an invited review, the (dis)advantages and prejudices of IPCs are described (Chapter1.1). Since costs and reimbursement issues are the main reasons in the Netherlands to withhold patients from IPCs, we performed a retrospective analysis of a prospectively collected database. In this database, we registered patient characteristics (gender, tumor type), survival data a...

  9. Update on pleural diseases - 2007

    OpenAIRE

    Bishay Ayman; Raoof Suhail; Esan Adebayo; Sung Arthur; Wali Siraj; Lee Leonard; George Liziamma; Saleh Anthony; Baumann Michael

    2007-01-01

    Background : New information is available on pleural diseases. The authors selected articles to make recommendations on diagnostic and treatment aspects of pleural diseases. Materials and Methods: Eleven articles published in the English language between 2004 and 2007 were chosen. The basis of selection of the articles was the impact on daily practice, change in prior thinking of a disease process or specific treatment modality, as well as proper design and execution of the study. 5-amino-l...

  10. Pleural effusion following ovarian hyperstimulation.

    Science.gov (United States)

    Junqueira, Jader Joel Machado; Bammann, Ricardo Helbert; Terra, Ricardo Mingarini; Castro, Ana Cristina P; Ishy, Augusto; Fernandez, Angelo

    2012-01-01

    Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication that occurs in the luteal phase of an induced hormonal cycle. In most cases, the symptoms are self-limited and spontaneous regression occurs. However, severe cases are typically accompanied by acute respiratory distress. The objective of the present study was to describe the clinical presentation, treatment, and outcome of pleural effusion associated with OHSS in three patients undergoing in vitro fertilization. The patients ranged in age from 27 to 33 years. The onset of symptomatic pleural effusion (bilateral in all cases) occurred, on average, 43 days (range, 27-60 days) after initiation of hormone therapy for ovulation induction. All three patients required hospitalization for massive fluid resuscitation, and two required noninvasive mechanical ventilation. Although all three patients initially underwent thoracentesis, early recurrence of symptoms and pleural effusion prompted the use of drainage with a pigtail catheter. Despite the high output from the pleural drain (mean, 1,000 mL/day in the first week) and prolonged drainage (for 9-22 days), the outcomes were excellent: all three patients were discharged from hospital. Although pleural effusion secondary to OHSS is probably underdiagnosed, the associated morbidity should not be underestimated, especially because it affects potentially pregnant patients. In this study, early diagnosis and appropriate supportive measures yielded favorable results, limiting the surgical approach to adequate pleural drainage.

  11. Empleo del bagazo como material absorbente en derrames de petróleo

    Directory of Open Access Journals (Sweden)

    Alejandro Armada

    2008-01-01

    Full Text Available Se muestra el procedimiento de obtención de un material adsorbente a partir de un subproducto biodegradable que constituye un subproducto de la industria azucarera, el bagazo, para ser empleado en el tratamiento de derrames de hidrocarburos en cuerpos de agua y suelos. Se clasificó el bagazo según la Norma (ISO 2591 - 1,1988 E, denominada "Ensayo de Tamizado". Se caracterizaron, posteriormente, cada una de sus fracciones por la Norma ACTM F729 - 99 (Standard Test Method for Sorbent Performance of Adsorbents. Para la fracción de 0.5 mm en malla se lograron los mejores resultados de adsorción de agua y aceites para más de un 90 % de flotabilidad.

  12. STUDY OF 200 CASES OF PLEURAL FLUID

    Directory of Open Access Journals (Sweden)

    Ramakrishna R

    2016-09-01

    Full Text Available BACKGROUND We have studied 200 patients of pleural fluid presenting to our tertiary care centre. Presence of cases of pleural fluid is a common presentation both in pulmonary and extrapulmonary diseases. We analysed the patients having both exudates and transudates and studied the results. MATERIALS AND METHODS We selected patients above 20 years of age and classified the patients with pleural fluid as having transudates and exudates. We studied the causes of transudates and exudates. A total of 200 patients are studied in this prospective study. Diagnosis of pleural exudates is made on the basis of Light’s criteria, chest x-ray, pleural fluid analysis, CT scan in selected patients, sputum examination, bronchoscopy and bronchial washings. Moribund and non-cooperative patients and HIV positives were excluded from the study. RESULTS Among the 200 patients, 91% have exudates. 9% have transudates by Light’s criteria. Tuberculosis is the commonest cause of effusions (64.83% followed by malignancy (13.73% and sympneumonic or parapneumonic effusions (9.89%. Pleural effusions occurred predominantly in males. Prevalence of diabetes Mellitus among cases of tuberculous pleural effusions is 13.56%. Tuberculous effusions are predominantly right-sided. CONCLUSION Predominant cases of pleural fluid are exudates. Commonest cause of pleural effusion is Tuberculosis followed by malignancy both pulmonary and extrapulmonary and sym. and parapneumonic effusions. Prevalence of Diabetes among Tuberculous pleural effusion cases is more or less same as in general population. Cough, expectoration fever, chest pain and breathlessness are the common symptoms occurring in three fourths of the patients of tuberculous pleural effusion. Most of the cases of Tuberculous effusion are above 30 years of age. In the diagnosis of tuberculous pleural effusion, Pleural fluid ADA is very important. Pleural fluid cytology, pleural biopsy, bronchoscopy, bronchial washings and sputum

  13. Nonchylous idiopathic pleural effusion in the newborn

    Directory of Open Access Journals (Sweden)

    Geeta Gathwala

    2011-01-01

    Full Text Available Congenital isolated pleural effusion is a rare cause of respiratory distress in neonates. It is usually chylous. Herein, we report a rare case of nonchylous congenital idiopathic pleural effusion.

  14. Secondary pleural hydatidosis: Complication of intrapulmonary echinococcosis

    Directory of Open Access Journals (Sweden)

    Walid Feki

    2014-01-01

    Full Text Available Hydatid disease has a wide geographic distribution around the world. In human, the liver is the most commonly affected organ, followed by the lungs. Intrathoracic extrapulmonary locations are generally the mediastinum, pleura, pericardium and chest wall. Pleural involvement usually follows the rupture of a pulmonary or hepatic cyst inside the pleural space causing secondary pleural hydatidosis. We report four cases of patients who were referred to our hospital for management of pleural hydatid disease as a complication of intrapulmonary echinococcosis.

  15. Minoxidil-associated exudative pleural effusion.

    Science.gov (United States)

    Siddiqui, Atif; Ansari, Mohammed; Shakil, Jawairia; Chemitiganti, Rama

    2010-05-01

    Recurrent pleural effusions are associated with significant morbidity and mortality. Drug-related reactions causing pleural effusions are not common, but their identification can potentially improve patient outcome. Minoxidil has been implicated in pleuropericardial effusions in patients with chronic kidney disease. The exact mechanism by which pleural effusion occurs is still unclear. We report a case of isolated exudative pleural effusion associated with minoxidil in a patient without underlying kidney disease that almost completely resolved after the drug was discontinued.

  16. Ultrasound-guided intrapleural positioning of pleural catheters: influence on immediate lung expansion and pleurodesis in patients with recurrent malignant pleural effusion.

    Science.gov (United States)

    Araujo, Pedro Henrique Xavier Nabuco de; Terra, Ricardo Mingarini; Santos, Thiago da Silva; Chate, Rodrigo Caruso; Paiva, Antonio Fernando Lins de; Pêgo-Fernandes, Paulo Manuel

    2017-01-01

    To evaluate the role of intrapleural positioning of a pleural catheter in early lung expansion and pleurodesis success in patients with recurrent malignant pleural effusion (RMPE). This was a retrospective study nested into a larger prospective cohort study including patients with RMPE recruited from a tertiary university teaching hospital between June of 2009 and September of 2014. The patients underwent pleural catheter insertion followed by bedside pleurodesis. Chest CT scans were performed twice: immediately before pleurodesis (iCT) and 30 days after pleurodesis (CT30). Catheter positioning was categorized based on iCT scans as posterolateral, anterior, fissural, and subpulmonary. We used the pleural volume on iCT scans to estimate early lung expansion and the difference between the pleural volumes on CT30 and iCT scans to evaluate radiological success of pleurodesis. Clinical pleurodesis success was defined as no need for any other pleural procedure. Of the 131 eligible patients from the original study, 85 were included in this nested study (64 women; mean age: 60.74 years). Catheter tip positioning was subpulmonary in 35 patients (41%), anterior in 23 (27%), posterolateral in 17 (20%), and fissural in 10 (12%). No significant differences were found among the groups regarding early lung expansion (median residual pleural cavity = 377 mL; interquartile range: 171-722 mL; p = 0.645), radiological success of pleurodesis (median volume = 33 mL; interquartile range: -225 to 257 mL; p = 0.923), and clinical success of pleurodesis (85.8%; p = 0.676). Our results suggest that the position of the tip of the pleural catheter influences neither early lung expansion nor bedside pleurodesis success in patients with RMPE. Avaliar o papel do posicionamento intrapleural do cateter pleural na expansão pulmonar precoce e no sucesso da pleurodese em pacientes com derrame pleural maligno recorrente (DPMR). Trata-se de um estudo retrospectivo aninhado em um estudo prospectivo de

  17. Las lecciones del derrame de Luisiana en voz de dos expertos. Entrevista por Jorge Aguilar y Mónica Orozco

    Directory of Open Access Journals (Sweden)

    Marc LeCalvez

    2013-09-01

    Full Text Available El equipo de la Revista Letras Verdes entrevistó a dos expertos para conocer los impactos sociales, económicos y ambientales tras la explosión de la plataforma Deepwater Horizon en el Golfo de México, a cargo de la firma British Petroleum (BP que generó el peor derrame de petróleo en la historia de los EE.UU. El derrame se registró el pasado 20 de abril y hasta el cierre de esta edición aún no era completamente controlado. En la explosión e incendio 11 trabajadores de la plataforma murieron y otros resultaron heridos. Fotografías e información de los medios de prensa muestran que hasta ahora el impacto del vertido de crudo en la vida marina ha sido devastador.

  18. Un Acercamiento al conocimiento de la fiebre Amarilla en el Perú

    Directory of Open Access Journals (Sweden)

    Manuel Espinoza S

    2005-10-01

    Full Text Available Se realiza un acercamiento histórico y epidemiológico de la presencia de la fiebre amarilla en Sudamérica y en particular en Perú, remarcando la diferencia entre fiebre amarilla urbana (FAU y fiebre amarilla selvática (FAS. La FAU asoló toda la costa peruana afectando mayormente los principales puertos costeros, dejando a su paso miles de muertos en los grandes asentamientos urbanos. Actualmente el Perú es el país que en América del Sur notifica la mayor cantidad de casos de FAS. Desde el punto de vista epidemiológico existen áreas enzoóticas plenamente identificadas, especialmente del nicho ecológico denominado selva alta (rupa-rupa. La población afectada por FAS mayoritariamente corresponde a varones jóvenes (agricultores-migrantes, con antecedente negativo de inmunización antiamarílica. El análisis de dos periodos de vigilancia de FAS en el Perú, 1994 - 1999 y 2000 - 2004, no revela mayores cambios epidemiológicos a excepción de la letalidad que de 38% se incrementó a 56%, recordando los niveles de letalidad de periodos anteriores, 1991 - 1994 (54%. Desde hace cinco años se inició en el Perú la estrategia de vacunar al 100% de los niños que cumplen su primer año de edad y desde hace dos años se ha comenzado a vacunar masivamente en regiones expulsoras de emigrantes, además de los pobladores de regiones endémicas, con el objetivo de eliminar la FAS del ámbito nacional.

  19. Análisis genético del virus peruano de la fiebre amarilla

    OpenAIRE

    Carlos Yábar V; Yván Campos B; Kelly Quispe T; Carlos Carrillo P; Ysabel Montoya P

    2002-01-01

    Objetivo: Determinar las variantes genéticas de aislamientos del virus peruano de la Fiebre Amarilla (FA). Materiales y métodos: la región carboxiterminal del gen de la envoltura (E) de cinco aislamientos de FA obtenidas de pacientes provenientes de Ayacucho 1978 (PER1), Junín 1995 (PER2), Cerro de Pasco (PER3), Cusco (1998) y San Martín (1999) fue amplificada por PCR, secuenciada y analizada con programas software de ADN. Resultados: el índice de similaridad de la secuencia de nucleótidos en...

  20. [Malignant pleural mesothelioma with multiple nodules].

    Science.gov (United States)

    Asano, Michiko; Gemba, Kenichi; Fujimoto, Nobukazu; Nishi, Hideyuki; Taguchi, Koji; Kishimoto, Takumi

    2011-12-01

    A 62-year-old man with left chest pain had left pleural effusion pointed out on a chest radiograph. Chest CT scans showed multiple nodules on the left parietal pleura and pleural effusion. He was referred to our hospital and we performed thoracoscopic examination. Malignant pleural mesothelioma (biphasic type) was diagnosed, based on the pathological findings of a parietal nodular mass, including immunohistological analysis. Chemotherapy using carboplatin and pemetrexed reduced the size of tumor and left pleural effusion. This is a rare case with atypical CT findings of malignant pleural mesothelioma.

  1. Fiebre petequial experimental de las montañas rocosas: resultado del tratamiento con algunas drogas (1)

    OpenAIRE

    Steinhaus, Edward A.; Parker, R. R.

    2011-01-01

    En 1939, Topping informó que el Prontosil y la sulfadiazina aparentemente no tenían valor en el tratamiento de la fiebre petequial de las Montañas Rocosas, en los curíes. Estudios recientes han conducido a los autores a la misma observación con respecto al Sulfatiazol, Sulfatiazol sódico, Sulfaguanidina, Sulfadiazina, Atebrina y Tirotricina (2). Se usó una cepa de alta y fatal virulencia, de Fiebre Petequial de las Montañas Rocosas del oeste de Montana. La dosificación de cada una de las drog...

  2. Pleural Intensity-Modulated Radiotherapy for Malignant Pleural Mesothelioma

    Energy Technology Data Exchange (ETDEWEB)

    Rosenzweig, Kenneth E., E-mail: ken.rosenzweig@mountsinai.org [Department of Radiation Oncology, Mount Sinai Medical Center, New York, NY (United States); Zauderer, Marjorie G. [Department of Medicine, Thoracic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Laser, Benjamin [Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI (United States); Krug, Lee M. [Department of Medicine, Thoracic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Yorke, Ellen [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Sima, Camelia S. [Department of Epidemiology/Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Rimner, Andreas [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Flores, Raja [Department of Surgery, Mount Sinai Medical Center, New York, NY (United States); Rusch, Valerie [Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)

    2012-07-15

    Purpose: In patients with malignant pleural mesothelioma who are unable to undergo pneumonectomy, it is difficult to deliver tumoricidal radiation doses to the pleura without significant toxicity. We have implemented a technique of using intensity-modulated radiotherapy (IMRT) to treat these patients, and we report the feasibility and toxicity of this approach. Methods and Materials: Between 2005 and 2010, 36 patients with malignant pleural mesothelioma and two intact lungs (i.e., no previous pneumonectomy) were treated with pleural IMRT to the hemithorax (median dose, 46.8 Gy; range, 41.4-50.4) at Memorial Sloan-Kettering Cancer Center. Results: Of the 36 patients, 56% had right-sided tumors. The histologic type was epithelial in 78%, sarcomatoid in 6%, and mixed in 17%, and 6% had Stage I, 28% had Stage II, 33% had Stage III, and 33% had Stage IV. Thirty-two patients (89%) received induction chemotherapy (mostly cisplatin and pemetrexed); 56% underwent pleurectomy/decortication before IMRT and 44% did not undergo resection. Of the 36 patients evaluable for acute toxicity, 7 (20%) had Grade 3 or worse pneumonitis (including 1 death) and 2 had Grade 3 fatigue. In 30 patients assessable for late toxicity, 5 had continuing Grade 3 pneumonitis. For patients treated with surgery, the 1- and 2-year survival rate was 75% and 53%, and the median survival was 26 months. For patients who did not undergo surgical resection, the 1- and 2-year survival rate was 69% and 28%, and the median survival was 17 months. Conclusions: Treating the intact lung with pleural IMRT in patients with malignant pleural mesothelioma is a safe and feasible treatment option with an acceptable rate of pneumonitis. Additionally, the survival rates were encouraging in our retrospective series, particularly for the patients who underwent pleurectomy/decortication. We have initiated a Phase II trial of induction chemotherapy with pemetrexed and cisplatin with or without pleurectomy

  3. Tuberculosis hepática primaria como causa de fiebre de origen desconocido

    Directory of Open Access Journals (Sweden)

    Manuel Antonio Villalobos-Zúñiga

    2007-10-01

    Full Text Available Se presenta el caso de un paciente de 29 años de edad, quien se presentó con un cuadro de fiebre, sudoración nocturna y pérdida de peso, el que inicialmente fue catalogado como dengue clásico, pero que al persistir, fue abordado como fiebre de origen desconocido. Debido a que las pruebas de laboratorio y gabinete iniciales no fueron concluyentes, fue necesario realizar una laparotomía exploratoria para obtener material histológico en el que se demostraron granulomas caseosos en el hígado y formas similares a micobacterias con las tinciones especiales. Con el tratamiento antifímico, se observó una respuesta clínica favorable, por lo que se concluye que el cuadro corresponde a una probable TB hepática.We present herein the case of a 29 a year old patient with fever, night sweats and weight loss. At the beginning he was thought to be suffering from classic dengue. Since the situation persisted for 3 weeks he was treated as classic fever of unknown origin. Due to non conclusive laboratory tests he underwent an exploratory laparotomy in order to get histologic samples, these showed caseous granulomas. This finding leads us to the diagnosis y hepatic tuberculosis. The patient was treated and the fever disappeared and 2 months later he started to gain weight.

  4. Isolated secondary fungal infections of pleural cavity

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    Makbule Ergin

    2013-12-01

    Full Text Available Objectives: Pleural fungal infections are rare, but the incidence has been increasing with immunosuppressant diseases and use of immunosuppressive medications. In this report, we present 6 patients with pleural effusions that have been determined fungal infection. Methods: The medical records of patients with followed and treated due to fungal infection of the pleural were retrospectively reviewed. Result: The 6 cases whom was 58 of the value median for age were treated as surgical and medical due to fungal infection of the pleural cavity. Dyspnea, cough and chest pain were the most common symptoms. Fever, night sweats and expectoration are relatively rare. In 4 patients, the infections of pleural cavity developed on the bases of rheumatoid arthritis, tuberculosis, pleural mesothelioma and esophagopleural fistula. In two patients had isolated fungal infections. Cultural positivity was seen in 5 patients. Fungal hyphae were determined by cytopathology in all of the patients. As a surgical procedure, all of the patients underwent decortication or pleural biopsy and pleural irrigation. In all patients, antifungal agents were added to surgical procedures. Full recovery of infection was seen in 5 patients. One patient died. Conclusion: In immunosuppressive patients, the incidence of pleural effusions due to or associated with fungal infections are more common. Addition to culture of pleural fluid, histopathological evaluation of pleura will aid diagnosis. J Clin Exp Invest 2013; 4 (4: 443-446

  5. Closed pleural biopsy is still useful in the evaluation of malignant pleural effusion

    Directory of Open Access Journals (Sweden)

    Somnath Bhattacharya

    2012-01-01

    Full Text Available Background: Pleural fluid cytology for malignant cells is the easiest way to diagnose malignant pleural effusion with good sensitivity and specificity. With the introduction of medical thoracoscopy, the use of closed pleural biopsy for the diagnosis of cytology negative malignant pleural effusion is gradually decreasing. However use of thoracoscopy is limited due to its high cost and procedure related complications. Aims: The aim was to assess the usefulness of closed pleural biopsy in the diagnosis of malignant pleural effusion. Materials and Methods: Sixty-six patients of pleural effusion associated with malignancy were selected from the patients admitted in the chest ward of a tertiary care hospital over a period of 1 year. Pleural fluid aspiration for cytology and closed pleural biopsy were done in all the patients. Results: Out of 66 patients, 46 (69% patients showed malignant cells in pleural fluid cytology examination. Cytology was positive in 35 (52%, 10 (15%, and 1 (1.5% patients in the first, second, and third samples respectively. Closed pleural biopsy was positive in 32 (48% patients. Among them, 22 also had positive cytology. Additional 10 cytology negative patients were diagnosed by pleural biopsy. Cytology-histology concordance was seen in 12 patients. Definite histological diagnosis could be achieved in five patients with indeterminate cytology. Pleural biopsy was not associated with any major postoperative complication. Conclusion: Closed pleural biopsy can improve the diagnostic ability in cytology negative malignant pleural effusion. Closed pleural biopsy has still a place in evaluation of malignant pleural effusion especially in a resource-limited country like India.

  6. Differential diagnosis between calcified pleural adhesion and persistent pleural exudate

    Energy Technology Data Exchange (ETDEWEB)

    Shmitt, V.G.; Frommkhol' d, V.; Khyubener, K.N. (Tuebingen Univ. (Germany, F.R.))

    It is shown that pleural residual cavities with calcified walls are perfectly diagnosed by means of standard and sighting pictures in radioscopy and computerized tomography. At the analysis of 3000 roentgenograms of lungs in 75 cases pleura calcifications have been found. Computerized tomography permits to receive an exact idea of the content of cavities and tissue located between the calcified parietal pleura and internal thoracic wall as well as avoid diagnostic pleurocentesis.

  7. Combined blood and pleural levels of mesothelin and osteopontin for the diagnosis of malignant pleural mesothelioma

    Directory of Open Access Journals (Sweden)

    Wafaa M. Ashour

    2012-07-01

    Conclusion: The performance of serum and pleural mesothelin in diagnosing MPM was improved when combined with plasma and pleural osteopontin (respectively through logistic regression analysis model. This will be a great advance in screening and management of MPM.

  8. Rapidly Regressive Unilateral Fetal Pleural Effusion

    Directory of Open Access Journals (Sweden)

    Tuncay Yuce

    2015-03-01

    Full Text Available Intrauterine pleural effusion of fetal lungs rarely regresses without intervention. In our case we treated a women at 32th weeks of gestation. Her pregnancy was complicated with fetal pleural effusion and polyhydramniosis. A therapeutic thoracocentesis was planned and she received two courses of betamethasone prior to procedure. On the day of planned procedure, a substantial regression of pleural effusion was observed and procedure was postponed. During her antenatal follow-up a complete regression of pleural effusion was observed. After delivery pleural effusion did not relapse. These findings hint there may be a role of antenatal steroids in treatment of fetal pleural effusion, which is known to be resistant to treatment modalities both during antenatal and postnatal period. [Cukurova Med J 2015; 40(Suppl 1: 25-28

  9. Computed tomography findings of malignant pleural mesothelioma

    Energy Technology Data Exchange (ETDEWEB)

    Shiota, Yutaro; Sato, Toshio; Yamaguchi, Kazuo; Ono, Tetsuya; Kaji, Masaro; Niiya, Harutaka (Kure Kyosai Hospital, Hiroshima (Japan))

    1994-04-01

    Computed tomography (CT) findings were assessed in 7 patients with malignant mesothelioma. CT findings were also reviewed in 9 patients with lung cancer and pleuritis carcinomatosa and in 11 patients with tuberculous pleuritis. Five patients with malignant mesothelioma underwent CT scans twice, on admission and from 1 to 7 months after admission. Tuberculous pleuritis could be distinguished from pleuritis carcinomatosa and malignant mesothelioma by the presence or absence of pleural nodularity and chest wall invasion. Although it was difficult to identify specific CT features clearly distinguishing malignant mesothelioma from pleuritis carcinomatosa, characteristic findings of malignant mesothelioma appeared to include the rapid development and progression of pleural rind and a tendency to spread directly into the chest wall. We divided the pleural into the four regions; upper anterior, upper posterior, lower anterior and lower posterior regions. Pleural changes were more frequently seen in the lower pleural regions than in the upper pleural regions in malignant mesothelioma. (author).

  10. Malignant pleural mesothelioma in Italy

    OpenAIRE

    Bianchi Claudio; Bianchi Tommaso

    2009-01-01

    This study reviews a series of 811 malignant pleural mesothelioma cases, diagnosed at hospitals in Trieste and Monfalcone districts of north eastern Italy, a narrow coastal strip with a population of about three lakh, in the period 1968-2008. The diagnosis was based on histological examination in 801 cases, and cytological findings in 10. Necropsy was performed in 610 cases. Occupational histories were obtained directly from the patients or their relatives through personal or telephone interv...

  11. Osteosarcoma relapse as pleural metastasis

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    Debabrata Saha

    2013-01-01

    Full Text Available Osteosarcoma is the most common primary bone tumor in children and young adults arising from primitive mesenchymal bone-forming cells. The lung is the most common site of metastasis of osteosarcoma. Here, we report a case of a 14-year-old male patient having osteosarcoma of tibia presenting to us for evaluation of left-sided pleural effusion after 4 years of mid-thigh amputation. Contrast-enhanced computed tomography thorax revealed a large, heterogeneous, calcified mass (+277 H.U at left upper and middle lobe along with massive left-sided pleural effusion. Thoracoscopy revealed a lung metastasis in the right upper and middle lobe along with 2-cm diameter mass found on the surface of parietal pleura. Lung tumor was resected and biopsy of the pleural mass was carried out. Histopathological examination from both the masses was suggestive of metastatic osteosarcoma. The case underlines the importance of performing thoracoscopy in patients of osteosarcoma who recur with lung metastasis.

  12. Etiologies of bilateral pleural effusions

    Science.gov (United States)

    Puchalski, Jonathan T.; Argento, A. Christine; Murphy, Terrence E.; Araujo, Katy L.B.; Oliva, Isabel B.; Rubinowitz, Ami N.; Pisani, Margaret A.

    2017-01-01

    Summary Background To evaluate the safety, etiology and outcomes of patients undergoing bilateral thoracentesis. Methods This is a prospective cohort study of 100 consecutive patients who underwent bilateral thoracenteses in an academic medical center from July 2009 through November 2010. Pleural fluid characteristics and etiologies of the effusions were assessed. Mean differences in levels of fluid characteristics between right and left lungs were tested. Associations between fluid characteristics and occurrence of bilateral malignant effusions were evaluated. The rate of pneumothorax and other complications subsequent to bilateral thoracentesis was determined. Results Exudates were more common than transudates, and most effusions had multiple etiologies, with 83% having two or more etiologies. Bilateral malignant effusions occurred in 19 patients, were the most common single etiology of exudative effusions, and were associated with higher levels of protein and LDH in the pleural fluid. Among 200 thoracenteses performed with a bilateral procedure, seven resulted in pneumothoraces, three of which required chest tube drainage and four were ex vacuo. Conclusions More often than not, there are multiple etiologies that contribute to pleural fluid formation, and of the combinations of etiologies observed congestive heart failure was the most frequent contributor. Exudative effusions are more common than transudates when bilateral effusions are present. Malignancy is a common etiology of exudative effusions. This study suggests that the overall complication rate following bilateral thoracentesis is low and the rate of pneumothorax subsequent to bilateral thoracentesis is comparable to unilateral thoracentesis. PMID:23219348

  13. Elevated pleural copeptin levels can distinguish to exudate from transudates

    National Research Council Canada - National Science Library

    Gümüş, Aziz; Çınarka, Halit; Karataş, Mevlüt; Kırbaş, Aynur; Kayhan, Servet; Şahin, Ünal

    2014-01-01

    ... and malignacy.Tuberculosis is one of the other major causes of pleural effusion in developing countries. In this study, we aimed to assess whether pleural copeptin level may be a new discriminative biomarker for exudates and transudates pleural effusions...

  14. SERUM CHOLINESTERASE AND PLEURAL CHOLINESTERASE LEVELS AND ITS USAGE TO DIFFERENTIATE PLEURAL TRANSUDATES AND EXUDATES

    OpenAIRE

    Suresh S.; Shoukath

    2014-01-01

    AIMS AND OBJECTIVES: Evaluation of pleural fluid cholinesterase level and comparison of study of pleural fluid cholinesterase levels and serum cholinesterase levels to differentiate transudates from exudates. Light’s criteria were used to compare transudate from exudate. MATERIALS AND METHODS: 56 patients of pleural effusion of different diseases like tuberculosis, malignancy, Para pneumonic effusion, congestive heart failure, nephrotic syndrome, pancreatitis were selected...

  15. Advanced medical interventions in pleural disease

    Directory of Open Access Journals (Sweden)

    Rahul Bhatnagar

    2016-06-01

    Full Text Available The burden of a number of pleural diseases continues to increase internationally. Although many pleural procedures have historically been the domain of interventional radiologists or thoracic surgeons, in recent years, there has been a marked expansion in the techniques available to the pulmonologist. This has been due in part to both technological advancements and a greater recognition that pleural disease is an important subspecialty of respiratory medicine. This article summarises the important literature relating to a number of advanced pleural interventions, including medical thoracoscopy, the insertion and use of indwelling pleural catheters, pleural manometry, point-of-care thoracic ultrasound, and image-guided closed pleural biopsy. We also aim to inform the reader regarding the latest updates to more established procedures such as chemical pleurodesis, thoracentesis and the management of chest drains, drawing on contemporary data from recent randomised trials. Finally, we shall look to explore the challenges faced by those practicing pleural medicine, especially relating to training, as well as possible future directions for the use and expansion of advanced medical interventions in pleural disease.

  16. Diagnosis and Management of Pleural Transudates.

    Science.gov (United States)

    Ferreiro, Lucía; Porcel, José M; Valdés, Luis

    2017-06-19

    Various clinical trials have been published on the optimal clinical management of patients with pleural exudates, particularly those caused by malignant tumors, while little information is available on the diagnosis and treatment of pleural transudates. The etiology of pleural transudates is wide and heterogeneous, and they can be caused by rare diseases, sometimes constituting a diagnostic challenge. Analysis of the pleural fluid can be a useful procedure for establishing diagnosis. Treatment should target not only the underlying disease, but also management of the pleural effusion itself. In cases refractory to medical treatment, invasive procedures will be necessary, for example therapeutic thoracentesis, pleurodesis with talc, or insertion of an indwelling pleural catheter. Little evidence is currently available and no firm recommendations have been made to establish when to perform an invasive procedure, or to determine the safest, most efficient approach in each case. This article aims to describe the spectrum of diseases that cause pleural transudate, to review the diagnostic contribution of pleural fluid analysis, and to highlight the lack of evidence on the efficacy of invasive procedures in the management and control of pleural effusion in these patients. Copyright © 2017 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Are the days of closed pleural biopsy over? Yes

    Directory of Open Access Journals (Sweden)

    Dharmesh Patel

    2015-01-01

    Full Text Available In the modern management of pleural diseases, thoracoscopy has a clear advantage over closed pleural biopsy. By way of its high yield, both in malignant pleural disease and pleural Tuberculosis – the two commonest cause of undiagnosed pleural effusion, thoracoscopy has the added advantage of faster symptom relief and offering effective pleurodesis. This makes it an attractive diagnostic and therapeutic procedure of choice and features high in the algorithms of many international guidelines on the approach to pleural diseases.

  18. Los Derrames y las transferencias de tecnología en los sectores minero y eléctrico-energético en Chile

    OpenAIRE

    Ranestad, Kristin

    2008-01-01

    Esta investigación abarca los derrames (efectos de la presencia de las multinacionales y las IED) y las transferencias de tecnología en los sectores minero y eléctrico-energético en Chile desde el año 1999 hasta el año 2006. Se realiza el trabajo en los sectores minero y eléctrico-energético, por medio de un estudio de caso que examina los derrames horizontales y otros cuatro casos que analizan proyectos de transferencias tecnológicas, que son el resultado de la colaboración entre empresas c...

  19. Fiebre postoperatoria en cirugía ortopédica y urológica Postoperative fever in orthopedic and urologic surgery

    OpenAIRE

    Federico Saavedra; Cristina Myburg; Marisa B. Lanfranconi; Martín Urtasun; Luis Montes De Oca; Andres Silberman; Alberto Lambierto; César A. Gnocchi

    2008-01-01

    La incidencia de fiebre en el postoperatorio varía ampliamente. En la cirugía limpia y la limpia-contaminada, la fiebre no infecciosa es más frecuente que la infecciosa. Fueron estudiados prospectivamente 303 pacientes operados en forma programada de cirugía ortopédica y urológica. Se investigó la incidencia de fiebre postoperatoria, su etiología, la relación entre el momento de su aparición y su origen y la utilidad del pedido empírico de estudios para determinar infección postoperatoria. El...

  20. Detección molecular del virus de la fiebre amarilla en muestras de suero de casos fatales humanos y en cerebros de ratón.

    OpenAIRE

    Méndez, Jairo A; Gerzaín Rodríguez; María del Pilar Bernal; Dora Calvache; Jorge Boshell

    2003-01-01

    Hemos adaptado un método molecular basado en la técnica de transcripción reversa seguida de la reacción en cadena de la polimerasa (RT-PCR) para diagnóstico alternativo de la infección por el virus de la fiebre amarilla. Se tomaron tres sueros liofilizados de casos fatales de fiebre amarilla y cuatro sueros frescos, de los cuales tres pertenecían a casos fatales de la enfermedad y el cuarto a un paciente sintomático con serología IgM positiva para fiebre amarilla; los sueros fueron tratados c...

  1. Detección, manejo y percepción materna de la fiebre en niños cali-colombia

    OpenAIRE

    Figueroa, Fabio Nelson; Forero, Jousetp; León, Jaime Alberto; Londoño, Andrés Camilo; Echandía, Carlos Armando

    2012-01-01

    Antecedentes. La fiebre es uno de los principales motivos de consulta médica en la edad pediátrica. Por falta de información algunos padres pueden padecer de fobia a la fiebre. Esta se caracteriza por miedo irracional y exagerado frente a la fiebre, asociado a creencias erróneas sobre su origen y desenlace, llevándolos a asumir conductas inapropiadas para detectar y manejar los episodios febriles en el hogar.Objetivos. Identificar las formas utilizadas por un grupo de madres para detectar y t...

  2. Fiebre Tifoidea Diagnóstico por pruebas inmunoenzimáticas: Elisa

    OpenAIRE

    Miguel Guzmán; Moisés Wasserman

    1981-01-01

    Este trabajo describe el desarrollo y normalización de una técnica inmunoenzimática para el diagnóstico indirecto de la Fiebre Tifoidea. El método permite un análisis simple y objetivo de los resultados. La reacción enzimática es proporcional a la concentración de anticuerpos en el suero contra el antígeno somático-0, por tanto, el método es cuantitativo. Por lo demás, la técnica tiene un alto grado de especificidad para Salmonella typhi, ya que los sueros de pacientes con Salmonelosis causad...

  3. Pleuroscopia com mediastinoscópio em crianças com derrame parapneumônico complicado

    OpenAIRE

    Fraga,José Carlos Soares; Lima, Angevaldo; Schopf, Luciano Ferraz; Antunes, Carlos Roberto Heredia

    1999-01-01

    Objetivo: Avaliar nossa experiência com a pleuroscopia com mediastinoscópio em crianças com derrame parapneumônico complicado. Métodos: Foi realizada revisão retrospectiva de prontuários de sete crianças submetidas à pleuroscopia no Hospital de Clínicas de Porto Alegre, no período de Julho/1995 a Junho/1997. O procedimento foi realizado com mediastinoscópio especialmente constru- ído para uso em crianças. Resultados: Foram estudados seis meninos e uma menina. O procedimento foi realizado sob ...

  4. Estudio de los derrames pleurales paraneumónicos complicados y de los empiemas. Evolución en los últimos 20 años.

    OpenAIRE

    2015-01-01

    1. Objetivo El espectro clínico de los empiemas ha ido variando en las últimas décadas, influenciado por varios factores, como son el aumento de la esperanza de vida, el número cada vez mayor de pacientes inmunodeprimidos (pacientes con neoplasia, transplantados, en tratamiento inmunosupresor, etc.) y el descenso de pacientes con manifestaciones secundarias a la infección por VIH o a la tuberculosis, gracias a las nuevas terapias antirretrovirales en el primer caso y al mejor control de la...

  5. Comparison of diagnostic yield and complications of bronchoscopy, closed pleural biopsy and medical thoracoscopic pleural biopsies in undiagnosed pleural effusions

    Directory of Open Access Journals (Sweden)

    Kizhakkepeedika Davis Rennis

    2017-01-01

    Conclusions: Medical thoracoscopy is a comparatively safe procedure which has got the highest sensitivity for the diagnosis of undiagnosed exudative pleural effusions. Bronchoscopy combined with closed pleural biopsy, the diagnostic yield was increased (than that of individual yield, but cannot be a substitute for medical thoracoscopy.

  6. The pleural sandwich sign in two cases of primary pleural lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yoo Kyung; Lee, Myung Jae; Ryu, Yon Ju; Cho, Min Sun [School of Medicine, Ewha Womans University, Seoul (Korea, Republic of)

    2015-02-15

    The sandwich sign is used to describe mesenteric lymphoma in which mesenteric vessels and fat are enveloped by enlarged mesenteric lymph nodes. We present two cases of primary pleural lymphoma demonstrating the 'pleural sandwich sign'. Contrast-enhanced computed tomography showed conglomerated parietal pleural and extrapleural masses encasing the intercostal arteries. Histopathological examinations confirmed low grade marginal zone B-cell lymphoma in an 80-year-old man and diffuse large B-cell lymphoma in a 68-year-old man. The pleural sandwich sign may suggest the diagnosis of primary pleural lymphoma.

  7. Factors influencing pleural drainage in parapneumonic effusions.

    Science.gov (United States)

    Porcel, J M; Valencia, H; Bielsa, S

    2016-10-01

    The identification of parapneumonic effusions (PPE) requiring pleural drainage is challenging. We aimed to determine the diagnostic accuracy of radiological and pleural fluid findings in discriminating between PPE that need drainage (complicated PPE (CPPE)) and those that could be resolved with antibiotics only (uncomplicated PPE (UPPE)). A retrospective review of 641 consecutive PPE, of which 393 were categorized as CPPE and 248 as UPPE. Demographics, radiological (size and laterality on a chest radiograph) and pleural fluid parameters (pus, bacterial cultures, biochemistries) were compared among groups. Logistic regression was performed to determine variables useful for predicting chest drainage, and receiver-operating characteristic curves assisted in the selection of the best cutoff values. According to the likelihood ratios (LR), findings increasing the probability of chest tube usage the most were: effusions occupying ≥1/2 of the hemithorax (LR 13.5), pleural fluid pH ≤7.15 (LR 6.2), pleural fluid glucose ≤40mg/dL (LR 5.6), pus (LR 4.8), positive pleural fluid cultures (LR 3.6), and pleural fluid lactate dehydrogenase >2000U/L (LR 3.4). In the logistic regression analysis only the first two were selected as significant predictors of CPPE. In non-purulent effusions, the effusion's size and pleural fluid pH retained their discriminatory properties, in addition to a pleural fluid C-reactive protein (CRP) level >100mg/L. Large radiological effusions and a pleural fluid pH ≤7.15 were the best predictors for chest drainage in patients with PPE. In the subgroup of patients with non-purulent effusions, pleural fluid CRP also contributed to CPPE identification. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  8. Primary pulmonary/pleural melanoma in a 13 year-old presenting as pleural effusion.

    Science.gov (United States)

    Baniak, Nick; Podberezin, Mark; Kanthan, Selliah C; Kanthan, Rani

    2017-02-01

    Melanoma in children, adolescents, and young adults is uncommon and reported almost exclusively as cutaneous melanoma. Melanoma presenting as a pleural effusion is very rare in adults and not reported in the pediatric population. Additionally, primary pulmonary melanoma is overall very rare and undocumented in pediatric patients. Furthermore, the distinction between a primary pulmonary/pleural melanoma versus a regressed cutaneous melanoma with pulmonary/pleural metastases remains extremely challenging. We discuss a case of a previously healthy 13-year-old girl that presented with a left-sided pleural effusion. Investigations revealed a large mediastinal mass, left-sided pleural and pulmonary nodules, a sacral mass, and bone marrow infiltration. The neoplasm was subsequently diagnosed by morphology and immunocytochemistry with histological correlation as malignant melanoma. As no mucosal, eye, or cutaneous lesions were identified, we deliberate the likelihood of a regressed cutaneous melanoma with metastases versus primary pulmonary/pleural melanoma with pleural effusion and discuss its diagnostic approach.

  9. Postoperative pleural effusion following upper abdominal surgery

    DEFF Research Database (Denmark)

    Nielsen, P H; Jepsen, S B; Olsen, A D

    1989-01-01

    Of 128 patients who underwent upper abdominal surgery, examined by standard preoperative and postoperative chest roentgenograms for the formation of postoperative pleural effusions, 89 had postoperative pleural effusions. Their presence was not related to the type of operation, infection, serum a...

  10. Postoperative pleural effusion following upper abdominal surgery

    DEFF Research Database (Denmark)

    Nielsen, P H; Jepsen, S B; Olsen, A D

    1989-01-01

    Of 128 patients who underwent upper abdominal surgery, examined by standard preoperative and postoperative chest roentgenograms for the formation of postoperative pleural effusions, 89 had postoperative pleural effusions. Their presence was not related to the type of operation, infection, serum a...

  11. Diagnosis exjuvantibus of a persistent pleural effusion

    Directory of Open Access Journals (Sweden)

    José M. Porcel

    2013-12-01

    Full Text Available The diagnosis of uremia-associated effusion is one of exclusion. A patient with an unexplained chronic pleural exudate, which cleared with dialysis, is reported. The differential diagnosis of pleural effusions in patients with chronic kidney disease and the management of uremic pleuritis is briefly discussed.

  12. Asbestos-related pleural disease

    Directory of Open Access Journals (Sweden)

    Stephen A. Geller

    2013-06-01

    Full Text Available The image shows asbestos plaques on the right parietal pleura of a 58-year-old former shipyard worker who died of acute suppurative bronchitis. He also had cor pulmonale and congestive heart failure. Histologically, pulmonary interstitial fibrosis with asbestos bodies was demonstrated. The pleural plaques consist predominantly of dense collagen. This photograph was taken after removal of the lung with the camera held in the lower right thorax, at approximately the level of the diaphragm, looking up toward the apex of the chest cavity.

  13. Osteosarcoma relapse as pleural metastasis

    OpenAIRE

    Debabrata Saha; Kaushik Saha; Arpita Banerjee; Debraj Jash

    2013-01-01

    Osteosarcoma is the most common primary bone tumor in children and young adults arising from primitive mesenchymal bone-forming cells. The lung is the most common site of metastasis of osteosarcoma. Here, we report a case of a 14-year-old male patient having osteosarcoma of tibia presenting to us for evaluation of left-sided pleural effusion after 4 years of mid-thigh amputation. Contrast-enhanced computed tomography thorax revealed a large, heterogeneous, calcified mass (+277 H.U) at left up...

  14. Pleural effusion: diagnosis, treatment, and management

    Directory of Open Access Journals (Sweden)

    Karkhanis VS

    2012-06-01

    Full Text Available Vinaya S Karkhanis, Jyotsna M JoshiDepartment of Respiratory Medicine, TN Medical College and BYL Nair Hospital, Mumbai, IndiaAbstract: A pleural effusion is an excessive accumulation of fluid in the pleural space. It can pose a diagnostic dilemma to the treating physician because it may be related to disorders of the lung or pleura, or to a systemic disorder. Patients most commonly present with dyspnea, initially on exertion, predominantly dry cough, and pleuritic chest pain. To treat pleural effusion appropriately, it is important to determine its etiology. However, the etiology of pleural effusion remains unclear in nearly 20% of cases. Thoracocentesis should be performed for new and unexplained pleural effusions. Laboratory testing helps to distinguish pleural fluid transudate from an exudate. The diagnostic evaluation of pleural effusion includes chemical and microbiological studies, as well as cytological analysis, which can provide further information about the etiology of the disease process. Immunohistochemistry provides increased diagnostic accuracy. Transudative effusions are usually managed by treating the underlying medical disorder. However, a large, refractory pleural effusion, whether a transudate or exudate, must be drained to provide symptomatic relief. Management of exudative effusion depends on the underlying etiology of the effusion. Malignant effusions are usually drained to palliate symptoms and may require pleurodesis to prevent recurrence. Pleural biopsy is recommended for evaluation and exclusion of various etiologies, such as tuberculosis or malignant disease. Percutaneous closed pleural biopsy is easiest to perform, the least expensive, with minimal complications, and should be used routinely. Empyemas need to be treated with appropriate antibiotics and intercostal drainage. Surgery may be needed in selected cases where drainage procedure fails to produce improvement or to restore lung function and for closure of

  15. Resumen de notas históricas sobre la fiebre amarilla en Colombia

    Directory of Open Access Journals (Sweden)

    Hernando Groot

    2004-03-01

    Full Text Available

    Dos formas epidemiológicas, la urbana y la selvática, de hecho íntimamente ligadas. En cuanto a la primera, transmitida de hombre a hombre por Aedes aegypti, debe recordarse que se observaba frecuentemente en los poblados de la costa del Caribe desde el siglo XVII, produciendo a veces epidemias como la que sufrieron las tropas de Vernon en 1741 cuando al intentar tomar a Cartagena se vieron atacadas por la enfermedad; de los 23.000 invasores, 9.000 perecieron en la empresa, la mayoría de ellos por causa de la fiebre amarilla. En épocas más recientes durante el siglo XIX y a principios del XX, el mal siguió siendo azote común del litoral Atlántico y causó también diversas epidemias a lo largo del Río Magdalena y en algunas poblaciones aisladas, como El Carmen y Ocaña. Igualmente se registraron casos de la enfermedad en Buenaventura. Las dos últimas epidemias urbanas que sufrió Colombia, fueron las de Bucaramanga en 1923 y la del Socorro en 1928. Es de notar que la desaparición de la fiebre amarilla de las ciudades se debió sin duda a las vigorosas campañas para eliminar el mosquito transmisor que culminaron en 1960 con su erradicación, exceptuada Cúcuta. Sin embargo, años más tarde el país se reinfestó con el Aedes y, por consiguiente, quedó nuevamente expuesto a las epidemias de fiebre amarilla urbana, pero con riesgo mayor por cuanto el mosquito se había dispersado por todo el país y se había establecido en lugares donde nunca había existido antes. Afortunadamente hasta el momento actual no se ha presentado brote alguno del famoso vómito negro urbano.

    En cambio se han observado gigantescas epidemias de dengue (1.

    En lo referente a la fiebre amarilla selvática lo primero por indicar es que

  16. Multidetector CT Findings and Differential Diagnoses of Malignant Pleural Mesothelioma and Metastatic Pleural Diseases in Korea

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yoon Kyung [Department of Radiology, Gachon University Gil Medical Center, Incheon 21565 (Korea, Republic of); Kim, Jeung Sook [Department of Radiology, Dongguk University Ilsan Hospital, Goyang 10326 (Korea, Republic of); Lee, Kyung Won [Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620 (Korea, Republic of); Yi, Chin A [Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351 (Korea, Republic of); Koo, Jin Mo [Department of Radiology, Seoul National University College of Medicine, Seoul 03080 (Korea, Republic of); Jung, Soon-Hee [Department of Pathology, Yonsei University Wonju College of Medicine, Wonju 26426 (Korea, Republic of)

    2016-11-01

    To compare the multidetector CT (MDCT) features of malignant pleural mesothelioma (MPM) and metastatic pleural disease (MPD). The authors reviewed the MDCT images of 167 patients, 103 patients with MPM and 64 patients with MPD. All 167 cases were pathologically confirmed by sonography-guided needle biopsy of pleura, thoracoscopic pleural biopsy, or open thoracotomy. CT features were evaluated with respect to pleural effusion, pleural thickening, invasion of other organs, lung abnormality, lymphadenopathy, mediastinal shifting, thoracic volume decrease, asbestosis, and the presence of pleural plaque. Pleural thickening was the most common CT finding in MPM (96.1%) and MPD (93.8%). Circumferential pleural thickening (31.1% vs. 10.9%, odds ratio [OR] 3.670), thickening of fissural pleura (83.5% vs. 67.2%, OR 2.471), thickening of diaphragmatic pleura (90.3% vs. 73.4%, OR 3.364), pleural mass (38.8% vs. 23.4%, OR 2.074), pericardial involvement (56.3% vs. 20.3%, OR 5.056), and pleural plaque (66.0% vs. 21.9%, OR 6.939) were more frequently seen in MPM than in MPD. On the other hand, nodular pleural thickening (59.2% vs. 76.6%, OR 0.445), hilar lymph node metastasis (5.8% vs. 20.3%, OR 0.243), mediastinal lymph node metastasis (10.7% vs. 37.5%, OR 0.199), and hematogenous lung metastasis (9.7% vs. 29.2%, OR 0.261) were less frequent in MPM than in MPD. When we analyzed MPD from extrathoracic malignancy (EMPD) separately and compared them to MPM, circumferential pleural thickening, thickening of interlobar fissure, pericardial involvement and presence of pleural plaque were significant findings indicating MPM than EMPD. MPM had significantly lower occurrence of hematogenous lung metastasis, as compared with EMPD. Awareness of frequent and infrequent CT findings could aid in distinguishing MPM from MPD.

  17. NT-brain natriuretic peptide levels in pleural fluid distinguish between pleural transudates and exudates.

    Science.gov (United States)

    Tomcsányi, János; Nagy, Erzsébet; Somlói, Miklós; Moldvay, Judit; Bezzegh, Attila; Bózsik, Béla; Strausz, János

    2004-10-01

    Pleural effusion is not pathognomic and distinguishing between transudates and exudates often presents a diagnostic dilemma. The purpose of our study was to examine whether the inclusion of pleural fluid brain natriuretic peptide (BNP) measurement into the analysis improves the diagnostic accuracy of pleural effusion. The pleural effusion of 14 patients with CHF (group A) and 14 subjects with different pleural pathology (group B) were analyzed. Samples of pleural fluid and serum were obtained from all patients on admission and biochemical analysis, bacterial and fungal culture, acid-fast bacilli smear and culture and cytology were performed on the pleural fluid. In vitro quantitative determination of N-terminal pro-Brain natriuretic peptide (NT-proBNP) in serum and pleural fluid were performed by electrochemiluminescence immunoassay proBNP method on an Elecsys 2010 (Roche) analyzer. The median NT-proBNP levels in groups A and B were 6295 pg/ml and 276 pg/ml, respectively: (P=0.0001). There was no overlap between the two groups. While the Light's criteria had a sensitivity of 93% and specificity of 43% for transudates, the pleural fluid NT-proBNP level accurately differentiated between the two groups. The pleural NT-proBNP levels were elevated in all patients who had transudate. Therefore if the NT-proBNP levels of pleural effusion are within the normal range, transudate resulting from congestive heart failure can be ruled out. Our results suggest that the inclusion of pleural fluid NT-proBNP measurement in the routine diagnostic panel would enhance discrimination among the different causes of pleural effusions.

  18. Multidetector CT findings and differential diagnoses of malignant pleural mesothelioma and metastatic pleural diseases in Korea

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yoon Kyung [Dept. of Radiology, Gachon University Gil Medical Center, Incheon (Korea, Republic of); Kim, Jeung Sook [Dept. of Radiology, Dongguk University Ilsan Hospital, Goyang (Korea, Republic of); Lee, Kyung Won [Dept. of Radiology, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Yi, Chin A [Dept. of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Koo, Jin Mo [Dept. of Radiology, Seoul National University College of Medicine, Seoul (Korea, Republic of); Jung, Soon Hee [Dept. of Pathology, Yonsei University Wonju College of Medicine, Wonju (Korea, Republic of)

    2016-07-15

    To compare the multidetector CT (MDCT) features of malignant pleural mesothelioma (MPM) and metastatic pleural disease (MPD). The authors reviewed the MDCT images of 167 patients, 103 patients with MPM and 64 patients with MPD. All 167 cases were pathologically confirmed by sonography-guided needle biopsy of pleura, thoracoscopic pleural biopsy, or open thoracotomy. CT features were evaluated with respect to pleural effusion, pleural thickening, invasion of other organs, lung abnormality, lymphadenopathy, mediastinal shifting, thoracic volume decrease, asbestosis, and the presence of pleural plaque. Pleural thickening was the most common CT finding in MPM (96.1%) and MPD (93.8%). Circumferential pleural thickening (31.1% vs. 10.9%, odds ratio [OR] 3.670), thickening of fissural pleura (83.5% vs. 67.2%, OR 2.471), thickening of diaphragmatic pleura (90.3% vs. 73.4%, OR 3.364), pleural mass (38.8% vs. 23.4%, OR 2.074), pericardial involvement (56.3% vs. 20.3%, OR 5.056), and pleural plaque (66.0% vs. 21.9%, OR 6.939) were more frequently seen in MPM than in MPD. On the other hand, nodular pleural thickening (59.2% vs. 76.6%, OR 0.445), hilar lymph node metastasis (5.8% vs. 20.3%, OR 0.243), mediastinal lymph node metastasis (10.7% vs. 37.5%, OR 0.199), and hematogenous lung metastasis (9.7% vs. 29.2%, OR 0.261) were less frequent in MPM than in MPD. When we analyzed MPD from extrathoracic malignancy (EMPD) separately and compared them to MPM, circumferential pleural thickening, thickening of interlobar fissure, pericardial involvement and presence of pleural plaque were significant findings indicating MPM than EMPD. MPM had significantly lower occurrence of hematogenous lung metastasis, as compared with EMPD. Awareness of frequent and infrequent CT findings could aid in distinguishing MPM from MPD.

  19. Médicos y policías durante la epidemia de fiebre amarilla (Buenos Aires, 1871

    Directory of Open Access Journals (Sweden)

    Diego Galeano

    2009-01-01

    Full Text Available Este trabajo analiza la actuación de médicos y policías durante la epidemia de fiebre amarilla que tuvo lugar en la ciudad de Buenos Aires en 1871. Aunque las embestidas de enfermedades infectocontagiosas fueron recurrentes durante el siglo XIX, la epidemia de fiebre amarilla constituye un quiebre, no solo por sus dimensiones cuantitativas y por los efectos materiales sobre la ciudad, sino también por las querellas que suscitó entre discursos en pugna. En particular, se intenta mostrar aquí cómo las figuras de los médicos y los policías fueron posicionadas en relación al tema del héroe y del sacrificado en cumplimiento del deber.

  20. Outbreak of Paratyphoid Fever Among Naval Personnel in Peru (Brote de Fiebre Paratifoidea Entre Personal de la Marina Del Peru.)

    Science.gov (United States)

    1992-01-01

    histo- bre o ambos foe S. 1wrathypllr B. ria clfnica (presunta y confirmada) Se traz6 una curva de la epidemnia basada en [a fecha Instrunmn de encuesta ...apatentemnente sanos queacccdieron acon fiebre. Dadas las m~dtiples pi-esentacio- participat en la encuesta . En el cuestionano nes dinicas dejla...Ofotin Da Cnkimia d V = nuimero de voluntarios que partic- nwal and itteraipwtic ettiaunj c 411 badere peron en la encuesta deexcretoree sn. 9h95 79 F

  1. Determinaciòn de actividad viral de fiebre aftosa en bovinos de la Provincia del Azuay: estudio preliminar

    OpenAIRE

    Vaca Vaca, Carlos; López, Gonzalo

    2003-01-01

    Se llevò a cabo la investigaciòn con la finalidad de relievar la actividad viral de la Fiebre A ftosa para establecer la prevalencia de los mismos para la totalidad de la provincia y determinar la actividad viral por àreas y confirmar las presunciones epidemiològicas para cada cantòn Magister en Producciòn Animal. Mención bovinos Cuenca

  2. Modelos animales de fiebres hemorrágicas humanas producidas por arenavirus

    Directory of Open Access Journals (Sweden)

    Juan D. Rodas

    2004-03-01

    Full Text Available

    En ciertas áreas endémicas para el virus de la fiebre de Lassa en África, este agente representa una amenaza importante para la salud pública. El agente etiológico de la fiebre de Lassa es transmitido de ratas a humanos a través de la sangre o de la exposición de las mucosas a aerosoles y causa cerca de 300.000 casos cada año. El virus de la coriomeningitis linfocítica (LCMV, estrechamente relacionado con el virus de la fiebre de Lassa, produce variados resultados después de su inoculación en primates. En nuestro laboratorio hemos empleado la especie Macaca mulata de mono Rhesus como modelo de fiebre de Lassa en el hombre, usando una variante patogénica (WE y una no patogénica (Armstrong de LCMV.

    Nuestros objetivos fueron determinar el resultado de la infección en monos después de la exposición oral y el desafío letal posterior, caracterizar la respuesta inmune protectora y probar protección cruzada usando las dos cepas virales mencionadas.

    El experimento inicial utilizando las vías de inoculación intravenosa (experimental clásica y oral (hipotética permitieron describir cómo, la vía oral. Produce una “aparente” infección asintomática, mientras la intravenosa es uniformemente letal; permitiendo concluir por lo tanto, que la ruta de exposición influencia dramáticamente el resultado clínico de la infección.

    En un segundo experimento, dos dosis altas (107 o 108 unidades formadoras de placa de la cepa WE del virus LCMV fueron

  3. Avaliação da adenosina desaminase no diagnóstico da tuberculose pleural: uma metanálise brasileira Evaluation of adenosine deaminase in the diagnosis of pleural tuberculosis: a Brazilian meta-analysis

    Directory of Open Access Journals (Sweden)

    Patrizio Morisson

    2008-04-01

    Full Text Available OBJETIVO: Avaliar trabalhos brasileiros resumindo a acurácia da adenosina desaminase no diagnóstico da tuberculose pleural, com o intuito de contribuir para a concretização do exame como rotina na investigação dos derrames pleurais. MÉTODOS: Depois de realizada uma busca por trabalhos brasileiros referentes à dosagem da adenosina desaminase no líquido pleural, estes foram avaliados e incluídos no estudo. A análise dos dados foi feita por meio da curva summary receiver operating characteristic (SROC que possibilitou a reunião dos estudos quanto a acurácia para o diagnóstico. Com os valores globais de sensibilidade e especificidade foi aplicado o teorema de Bayes para calcular as probabilidades pós-teste em diferentes prevalências da doença. RESULTADOS: Entre 1987 e 2005 foram encontrados 25 estudos contendo informações suficientes que poderiam ser utilizadas na metanálise. Após avaliação, foram incluídos nove estudos, totalizando 1.674 pacientes. De acordo com a curva SROC, foi encontrada uma sensibilidade de 91,8% (IC95%: 89,8-93,6% e uma especificidade de 88,4% (IC95%: 86,0-90,5%, com uma área abaixo da curva de 0,969. O odds ratio global foi de 112,0 (IC95%: 51,6-243,2. Considerando uma prevalência da tuberculose pleural de 50% (considerada neutra, a probabilidade do diagnóstico pós-teste positivo é de 88,7% e sua exclusão após resultado negativo de 91,5%. CONCLUSÕES: Apesar das diferenças encontradas entre os estudos, é possível concluir que a adenosina desaminase possui alta acurácia no diagnóstico da tuberculose pleural, devendo ser utilizada de rotina em sua investigação.OBJECTIVE: To evaluate Brazilian studies by summarizing the accuracy of adenosine deaminase in the diagnosis of pleural tuberculosis, with the objective of lending support to the movement to make the test part of the routine investigation of pleural effusions. METHODS: A search for Brazilian studies related to the determination of

  4. Mast cells mediate malignant pleural effusion formation

    Science.gov (United States)

    Giannou, Anastasios D.; Marazioti, Antonia; Spella, Magda; Kanellakis, Nikolaos I.; Apostolopoulou, Hara; Psallidas, Ioannis; Prijovich, Zeljko M.; Vreka, Malamati; Zazara, Dimitra E.; Lilis, Ioannis; Papaleonidopoulos, Vassilios; Kairi, Chrysoula A.; Patmanidi, Alexandra L.; Giopanou, Ioanna; Spiropoulou, Nikolitsa; Harokopos, Vaggelis; Aidinis, Vassilis; Spyratos, Dionisios; Teliousi, Stamatia; Papadaki, Helen; Taraviras, Stavros; Snyder, Linda A.; Eickelberg, Oliver; Kardamakis, Dimitrios; Iwakura, Yoichiro; Feyerabend, Thorsten B.; Rodewald, Hans-Reimer; Kalomenidis, Ioannis; Blackwell, Timothy S.; Agalioti, Theodora; Stathopoulos, Georgios T.

    2015-01-01

    Mast cells (MCs) have been identified in various tumors; however, the role of these cells in tumorigenesis remains controversial. Here, we quantified MCs in human and murine malignant pleural effusions (MPEs) and evaluated the fate and function of these cells in MPE development. Evaluation of murine MPE-competent lung and colon adenocarcinomas revealed that these tumors actively attract and subsequently degranulate MCs in the pleural space by elaborating CCL2 and osteopontin. MCs were required for effusion development, as MPEs did not form in mice lacking MCs, and pleural infusion of MCs with MPE-incompetent cells promoted MPE formation. Once homed to the pleural space, MCs released tryptase AB1 and IL-1β, which in turn induced pleural vasculature leakiness and triggered NF-κB activation in pleural tumor cells, thereby fostering pleural fluid accumulation and tumor growth. Evaluation of human effusions revealed that MCs are elevated in MPEs compared with benign effusions. Moreover, MC abundance correlated with MPE formation in a human cancer cell–induced effusion model. Treatment of mice with the c-KIT inhibitor imatinib mesylate limited effusion precipitation by mouse and human adenocarcinoma cells. Together, the results of this study indicate that MCs are required for MPE formation and suggest that MC-dependent effusion formation is therapeutically addressable. PMID:25915587

  5. OCTOGESIMO ANIVERSARIO DEL DESCUBRIMIENTO DE LA FIEBRE AMARILLA SELVÁTICA POR EL DOCTOR ROBERTO FRANCO

    Directory of Open Access Journals (Sweden)

    Carlos Sanmartín Barberi

    1989-09-01

    Full Text Available

    La reunión que hoy nos congrega en esta sesión conjunta tiene por objeto conmemorar una importante efemérides de la medicina universal y tributar homenaje a la memoria de un excepcional galeno de nuestra patria.

    Me permitiré leer una breve comunicación que el 8 de octubre del año pasado dirigí al Presidente de nuestra Academia, pues resume el motivo central de esta ceremonia:
    “El año próximo venidero se cumplen ochenta de la trascendental comunicación del Dr. Roberto Franco sobre una epidemia febril que estudió en las Minas de Muzo.
    Tal investigación constituye uno de los hitos más importantes de la medicina tropical. Las novedosas conclusiones del Dr. Franco, basadas en un juicioso estudio de campo y en una sagaz observación clínica y epidemiológica, fueron puestas en duda y aún negadas en su época. Sólo el tiempo y las investigaciones posteriores dieron razón a su notable afirmación de la existencia de la fiebre amarilla de los bosques.

    Me parece que sería justo y oportuno que la Academia celebre tal aniversario de manera apropiada y que se aproveche la ocasión para exaltar la memoria del que fue, sin duda, una de las figuras cimeras de la medicina nacional”.
    Tanto la Academia como nuestra Sociedad histórica, a las que me honro en pertenecer, acogieron favorablemente la sugerencia. Me enaltece sobremanera ser yo quien esta noche las representa.

    En el número 331 de Noviembre de 1907 de la Revista Médica de Bogotá, órgano de la Academia Nacional de Medicina, se publicó el informe presentado al Presidente del Sindicato de las Minas de Muzo, por la misión encargada de estudiar la epidemia de fiebres observada en la mina en los meses de Marzo y Abril de 1907. Tal documento tiene fecha del 14 de Mayo del mismo año y está suscrito por el Dr. Roberto Franco, quien deja constancia de la invaluable colaboración de dos de sus estudiantes que le acompañaron a Muzo y que fueron los

  6. Pleural effusion: An unusual cause and association

    Directory of Open Access Journals (Sweden)

    Alam K Navaz

    2013-01-01

    Full Text Available Filaria has a wide spectrum of presentation. We hereby present a case of Filarial pleural effusion that is a rarity in itself. Filarial lung involvement is usually in the form of tropical pulmonary eosinophilia with pulmonary infiltrates and peripheral eosinophilia, unlike our case where isolated pleural effusion of Filarial etiology was detected. Microfilaria has been isolated from Pleural fluid in very few cases, and ours was one such. Of late, there have been many incidental detections of Filarial parasites from varied anatomical sites in association with malignancy. Even in our case, we had one such unusual association.

  7. High IL-35 Pleural Expression in Patients with Tuberculous Pleural Effusion

    OpenAIRE

    2015-01-01

    Background IL-35 is a novel anti-inflammatory and immunosuppressive cytokine primarily produced by Treg cells, and is involved in inflammatory diseases and autoimmune diseases. However, its roles in tuberculous pleural effusion (TPE) remain unknown. We aimed to investigate the potential involvement of IL-35 in TPE. Material/Methods Thirty TPE patients and 20 lung cancer patients with malignant pleural effusion (MPE) were recruited. Samples of pleural effusion (100 mL) were collected after tra...

  8. The clinical utility of pleural YKL-40 levels in diagnosing pleural effusions

    Science.gov (United States)

    Gumus, Aziz; Cinarka, Halit; Murat, Naci; Yilmaz, Adnan; Bedir, Recep; Sahin, Unal

    2013-01-01

    Background and objective Recent evidence suggests that YKL-40 is a relatively new biomarker of inflammation and it is involved in the pathogenesis of several pulmonary diseases. Details of serum and pleural YKL-40 in pleural effusions however, remain unknown. We aimed to assess whether serum and pleural YKL-40 is an accurate biomarker of pleural effusions. Methods This clinical study was prospective, observational and cross-sectional. The concentrations of serum and pleural fluid YKL-40 and conventional pleural marker levels were measured in 80 subjects with pleural effusions, including 23 transudates caused by congestive heart failure (CHF), and 57 exudates including 23 parapneumonic, 22 malignant and 12 tuberculous pleural effusions (TBPEs). Results Median pleural fluid YKL-40 levels were higher in exudates than in transudates (219.4 and 205.9 ng/mL, respectively, P215 ng/mL, yielded a 73% sensitivity, 73% specificity, likelihood ratio 2.8 for diagnosing exudate, with an area under the curve of 0.770 [95% confidence intervals (CI): 0.657-0.884]. Pleural YKL-40/serum YKL-40 ratio >1.5 yielded a 75% sensitivity, 72% specificity and likelihood ratio 2.6 for diagnosing TBPE, with an area under the curve of 0.825 (95% CI: 0.710-0.940). Conclusions High concentrations of pleural YKL-40 level may help to differentiate exudate from transudate and a high pleural YKL-40/serum YKL-40 ratio may be helpful in seperating TBPE from non-tuberculous effusions. PMID:24255777

  9. Pleural LDH as a prognostic marker in adenocarcinoma lung with malignant pleural effusion

    OpenAIRE

    Verma, Akash; Phua, Chee Kiang; Sim, Wen Yuan; Algoso, Reyes Elmer; Tee, Kuan Sen; Lew, Sennen J. W.; Lim, Albert Y.H.; Goh, Soon Keng; Tai, Dessmon Y. H.; Kor, Ai Ching; Ho, Benjamin; Abisheganaden, John

    2016-01-01

    Abstract To study the performance of serum and pleural lactate dehydrogenase (LDH) level in predicting survival in patients with adenocarcinoma lung presenting with malignant pleural effusions (MPE) at initial diagnosis. Retrospective cohort study of the patient hospitalized for adenocarcinoma lung with MPE in year 2012. Univariate analyses showed lower pleural fluid LDH 667 (313–967) versus 971 (214–3800), P = 0.04, female gender 9 (100%) versus 27 (41.5%), P = 0.009, never smoking status 9 ...

  10. Diagnostic Utility of Pleural Fluid Cell Block versus Pleural Biopsy Collected by Flex-Rigid Pleuroscopy for Malignant Pleural Disease: A Single Center Retrospective Analysis

    Science.gov (United States)

    Sasada, Shinji; Izumo, Takehiro; Matsumoto, Yuji; Tsuchida, Takaaki

    2016-01-01

    Background Some trials recently demonstrated the benefit of targeted treatment for malignant disease; therefore, adequate tissues are needed to detect the targeted gene. Pleural biopsy using flex-rigid pleuroscopy and pleural effusion cell block analysis are both useful for diagnosis of malignancy and obtaining adequate samples. The purpose of our study was to compare the diagnostic utility between the two methods among patients with malignant pleural disease with effusion. Methods Data from patients who underwent flex-rigid pleuroscopy for diagnosis of pleural effusion suspicious for malignancy at the National Cancer Center Hospital, Japan between April 2011 and June 2014 were retrospectively reviewed. All procedures were performed under local anesthesia. At least 150 mL of pleural fluid was collected by pleuroscopy, followed by pleural biopsies from the abnormal site. Results Thirty-five patients who were finally diagnosed as malignant pleural disease were included in this study. Final diagnoses of malignancy were 24 adenocarcinoma, 1 combined adeno-small cell carcinoma, and 7 malignant pleural mesothelioma (MPM), and 3 metastatic breast cancer. The diagnostic yield was significantly higher by pleural biopsy than by cell block [94.2% (33/35) vs. 71.4% (25/35); p = 0.008]. All patients with positive results on cell block also had positive results on pleural biopsy. Eight patients with negative results on cell block had positive results on pleural biopsy (lung adenocarcinoma in 4, sarcomatoid MPM in 3, and metastatic breast cancer in 1). Two patients with negative results on both cell block and pleural biopsy were diagnosed was sarcomatoid MPM by computed tomography-guided needle biopsy and epithelioid MPM by autopsy. Conclusion Pleural biopsy using flex-rigid pleuroscopy was efficient in the diagnosis of malignant pleural diseases. Flex-rigid pleuroscopy with pleural biopsy and pleural effusion cell block analysis should be considered as the initial diagnostic

  11. A CASE OF RECURRENT PLEURAL EFFUSION FROM PANCREATICO PLEURAL FISTULA: DIAGNOSIS AND MANAG E MENT

    Directory of Open Access Journals (Sweden)

    Uma Maheswara Rao

    2015-02-01

    Full Text Available Pleural effusion and mediastinal pseudo cysts in Acute Pancreatitis are common but that of in association with chronic pancreatitis and trauma is rare and occurs only if fistulous communication develops between pancreatic ductal system and p leural space or due to direct extension of pseudo cyst into pleural cavity through mediastinum. The diagnosis of fistula can be made with high index of clinical suspicion and can be confirmed by elevated amylase and protein content in pleural fluid. The ac tual fistulous tract can be demonstrable by MDCT , MRCP (Magnetic resonance cholangio pancreaticography and (Endoscopic retrograde Pancreatico cholangiography ERCP Usually these fistulae resolve with conservative treatment. If not , Endoscopic retrograde c holangio pancreaticography (ERCP guides sphincterotomy , stricture dilatation or endoprosthesis placement across the fistulous communication or surgery are the choices of treatment. We present a case of a pancreatic pleural fistula in a 30 year – old man wi th recurrent episodes of Left pleural effusion Radiological and biochemical investigations were performed and he was diagnosed to have a Pancreatico pleural fistula. The patient was initially treated conservatively with somatostatin analogs , symptomatic and supportive treatment including repeated pleurocentesis. for his symptoms which include recurrent pleural taping also. Finally , endoscopic retrograde cholangio pancreatography was performed due to failed conservative treatment and a stent wa s placed in the pancreatic duct for healing of the fistulous communication. KEYWORDS: A case of recurrent pleural effusion from pancreatico pleural fistula: diagnosis and management.

  12. Pleural effusion following ventriculo-pleural shunt: Case reports and review of the literature

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    Kupeli Elif

    2010-01-01

    Full Text Available Ventriculo-pleural shunt (VPLS is an acceptable alternative in the management of hydrocephalus. Imbalance between the production and absorption of cerebrospinal fluid an lead to formation of pleural effusion in patient with VPLS and on occasion produce symptoms. Pleural effusion could be a transudate or a non-specific exudate. We report our experience with this modality in relation to formation of pleural effusion and review the literature to make recommendation for its management. Information related to patients′ demographics, smoking history, prior pulmonary and occupational history, indication, duration and complications of the VPLS and their management was gathered to substantiate current recommendation with our experience.

  13. Observaciones en el Ornithodoros Forcosus sobre su posible rol como vector de la Fiebre Recurrente

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    Arístides Herrer

    1957-12-01

    Full Text Available Tratando de verificar la posible infección por borrelias en el Ornithodoros Forcosus Neumann, 1908, se realizaron observaciones experimentales en las que se utilizó un total de 1,655 especímenes de esta garrapata. En tales estudios se emplearon pericotes blancos y cobayos. Con triturado de garrapatas fueron inoculados 68 animales (64 pericotes y 4 cobayos y 37 (16 pericotes y 21 cobayos fueron empleados para alimentar sobre ellos varios lotes de garrapatas. Los resultados de todas estas observaciones fueron negativas. Las garrapatas con las que se han efectuado estos estudios procedían de las localidades de Limabamba, Mariscal Benavides, Camporredondo, Ocalli y Luya, todas en el departamento de Amazonas, y a altitudes que varían entre 1,400 y 2,300 metros sobre el nivel del mar. Desde que la fiebre recurrente parece ser endémica en el Perú, especialmente en localidades de considerable altitud, es de suponer que en este país sea trasmitida principalmente por piojos.

  14. Enfoque desde la ciencia post-normal de la epizootia fiebre aftosa

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    Schütz Gabriel Eduardo

    2003-01-01

    Full Text Available Este trabajo pretende analizar la epizootia de fiebre aftosa del invierno británico de 2001 desde el enfoque de la ciencia post-normal. Serán analizadas las participaciones de los diferentes actores sociales y las interacciones de las categorías: confianza, gobernanza, incertidumbre, valores e intereses. Todos estos factores formaron parte de una crisis que, por un lado, conjugó los intereses políticos de un gobierno en campaña electoral junto con los intereses económicos de un estado miembro de la Unión Europea y por el otro, los intereses de la población afectada junto con todos aquellos problemas relacionados con la salud y el medio ambiente. Las medidas tomadas para detener esta enfermedad 'económica' se transformaron en un verdadero experimento heterogéneo a gran escala social, un fenómeno típico de la modernidad que exige nuevas formas de abordar la ciencia y los procesos decisorios.

  15. Fiebre Tifoidea Diagnóstico por pruebas inmunoenzimáticas: Elisa

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    Miguel Guzmán

    1981-06-01

    Full Text Available Este trabajo describe el desarrollo y normalización de una técnica inmunoenzimática para el diagnóstico indirecto de la Fiebre Tifoidea. El método permite un análisis simple y objetivo de los resultados. La reacción enzimática es proporcional a la concentración de anticuerpos en el suero contra el antígeno somático-0, por tanto, el método es cuantitativo. Por lo demás, la técnica tiene un alto grado de especificidad para Salmonella typhi, ya que los sueros de pacientes con Salmonelosis causada por Salmonella enteritidis serotipos paratyphi A, B y typhimurium dieron resultados negativos, en forma similar a los presentados por el grupo control antes de la vacunación específica. Los resultados obtenidos con esta técnica permitieron definir el nivel de anticuerpos que puede presentar una población control supuestamente sana frente a los niveles inducidos por la enfermedad. Los resultados postvacunales en el grupo control mostraron títulos sorprendentemente bajos; un análisis de este fenómeno se presentó en forma amplia. Igualmente se proponen futuras investigaciones sobre este campo.

  16. Bartonelosis (Fiebre de la Oroya o Verruga Peruana: ¿Enfermedad ocupacional?

    Directory of Open Access Journals (Sweden)

    R. Cesar Gonzáles

    Full Text Available La Bartonella bacilliformis es un parásito bacteriano intracelular facultativo de los eritrocitos humanos y de las células endoteliales. La enfermedad de Carrión, fiebre de La Oroya y Verruga Peruana son todos términos que describen las consecuencias patológicas de la infección humana por Bartonella bacilliformis. (1 Aunque las infecciones que involucran especies de Bartonella, tales como Bartonella henselae y Bartonella quintana, ocurren en todo el mundo, la enfermedad de Carrión es endémica únicamente en Sudamérica. (14 Las infecciones por B. bacilliformis son un problema de salud en numerosas áreas rurales de Sudamérica y para los viajeros que visitan esas regiones. Se han reportado brotes de bartonelosis en las regiones montañosas de Perú, Ecuador y Colombia. (1 La Lutzomyia verrucarum es el principal vector para la transmisión de la bacteria al ser humano; la hembra del mosquito transmite el patógeno durante su alimentación nocturna de sangre humana. Presumiblemente el insecto se alimenta de sangre de un individuo infectado y disemina el patógeno por medio de su saliva durante la siguiente ingesta de sangre. La bacteria no es contagiosa entre humanos. (1 Presentamos un enfoque laboral de la enfermedad en trabajadores que realizan desplazamientos continuos a zonas endémicas y analizamos sus posibles consecuencias.

  17. Geologia do derrame Salto do Lontra e gênese dos pegmatitos básicos associados, Província Magmática do Paraná, sudoeste do Estado do Paraná

    OpenAIRE

    Ferreira, Carlos Henrique Nalin

    2012-01-01

    Resumo: O derrame Salto do Lontra localiza-se no sudoeste do Estado do Paraná, a norte do município de Salto do Lontra. O derrame possui 50 m de espessura e apresenta distribuição, arranjo de suas estruturas internas e padrões de fraturas bem definidos. A variação destas estruturas possibilita a divisão do derrame em: nível vesicular de topo, nível maciço central e nível vesicular de base. Estas características sugerem que o derrame foi formado por processos de inflamento e se resfriou como u...

  18. CT findings of pleural dissemination in primary lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jei Hee; Kim, Sang Jin; Ryu, Young Hoon [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of); Ahn, Chang Soo [Pochon Cha Univ. College of Medicine, Sungnam (Korea, Republic of)

    1998-12-01

    To evaluate the CT findings of pleural dissemination in primary lung cancer and the limitations of CT scanning in detecting pleural dissemination in primary lung cancer. Primary lung cancer with pleural dissemination was diagnosed in 68 patients and confirmed by pleural biopsy, cytology and surgery, and these cases were the subject of this study. Adenocarcinoma accounted for 49, squamous cell carcinoma for 13 and small cell carcinoma for six. Eight CT features, namely the amount of pleural effusion, the contour, extent and location of pleural thickening, the shortest distance between pleura and mass, pleural calcification, pleural tail sign and the extent of extrapleural fat proliferation, were evalusted. Pleural effusion was noted in 51 of 68 patients(75%), though in most case(70%), the amount of this was small. Among 42 patients(62%) in whom thickened pleura, were noted, pleural thickening was thin and irregular in 22(52%), thick and irregular in 16(38%), and thin and regular in 4(10%). The extent of pleural thickening was multifocal in 22 patients(52%), diffuse in 16(38%), and circumferential and single in two(5%). Pleural thickening was more frequently noted at the posterior than the anterior pleura. Pleural abutting was seen in 53 patients(78%). In ten patients(15%), chest CT scans revealed no perceptible pleural abnormalities. If in primary lung cancer, the primary lung mass contacts the pleura, and if pleural thickening, even when slight, shows marginal irregularity, pleural dissemination should be considered. Although CT scanning is very useful for the detection of pleural dissemination in primary lung cancer, about 15% of patients showed no perceptible pleural abnormalities. Other diagnostic modalitie such as thoracoscopy are mandatory for the correct diagnossis of pleural dissemination in primary lung cancer.=20.

  19. Incision for pleural tissue biopsy (image)

    Science.gov (United States)

    ... the pleural tissue is removed through a surgical incision in the chest. After the sample is obtained, a chest tube is placed and the incision is closed with stitches. Abnormal results may indicate ...

  20. Pancreatic Pseudocyst Pleural Fistula in Gallstone Pancreatitis

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    Sala Abdalla

    2016-01-01

    Full Text Available Extra-abdominal complications of pancreatitis such as pancreaticopleural fistulae are rare. A pancreaticopleural fistula occurs when inflammation of the pancreas and pancreatic ductal disruption lead to leakage of secretions through a fistulous tract into the thorax. The underlying aetiology in the majority of cases is alcohol-induced chronic pancreatitis. The diagnosis is often delayed given that the majority of patients present with pulmonary symptoms and frequently have large, persistent pleural effusions. The diagnosis is confirmed through imaging and the detection of significantly elevated amylase levels in the pleural exudate. Treatment options include somatostatin analogues, thoracocentesis, endoscopic retrograde cholangiopancreatography (ERCP with pancreatic duct stenting, and surgery. The authors present a case of pancreatic pseudocyst pleural fistula in a woman with gallstone pancreatitis presenting with recurrent pneumonias and bilateral pleural effusions.

  1. Pleural effusion and sarcoidosis: an unusual combination.

    Science.gov (United States)

    Ferreiro, Lucía; San José, Esther; González-Barcala, Francisco Javier; Suárez-Antelo, Juan; Toubes, M Elena; Valdés, Luis

    2014-12-01

    Pleural involvement in sarcoidosis is uncommon and appears in several forms. To document the incidence and characteristics of pleural effusion in sarcoidosis patients, a review of the cases diagnosed in our centre between January 2001 and December 2012 was carried out. One hundred and ninety-five patients with sarcoidosis were identified; three (two men and one woman) presented with unilateral pleural effusion (1.5%): one in the right side and two in the left. Two were in stageii and one was in stageiv. The pleural fluid of the two patients who underwent thoracocentesis was predominantly lymphocytic. One of these patients presented chylothorax and the other had high CA-125levels. In general, these effusions are lymphocyte-rich, paucicellular, serous exudates (sometimes chylothorax) and contain proportionally higher levels of protein than LDH. Most cases are treated with corticosteroids, although it may resolve spontaneously. Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.

  2. Massive pleural effusion in a young woman

    Directory of Open Access Journals (Sweden)

    Paolo Ghiringhelli

    2012-12-01

    Full Text Available Pleural effusion is a clinical manifestation shared by several underlying pathologies. The differential diagnosis is based on the clinical history, the physical examination, the analysis of the pleural fluid, and the laboratory data (mainly blood tests. There are cases, such as the patient described, where TC is not enough, and unusual imaging techniques are required for the study of pleural effusion, i.e. magnetic resonance cholangiography, cholangiopancreatography (MRCP and endoscopic retrograde cholangiopancreatography (ERCP.This case analyses a 42-year-old female patient who arrived with progressive dyspnoea, chest pain, cough, a history of alcohol abuse, and a recent episode of acute pancreatitis. The physical examination revealed signs of right-sided pleural effusion. These features, together with laboratory data, made it possible to pose the diagnosis of pancreaticopleural fistula, to treat it, and to obtain a complete healing in a two-month period.

  3. Extravasamento de líquido no mediastino e derrame pleural durante artroscopia de ombro: relato de caso Fluid leakage into the mediastinum and pleural effusion during shoulder arthroscopy: a case report

    Directory of Open Access Journals (Sweden)

    Leandro Cardoso Gomide

    2007-08-01

    Full Text Available O presente trabalho tem o objetivo de apresentar uma rara, porém possível complicação respiratória durante uma artroscopia de ombro executada na posição de "cadeira de praia". Houve extravasamento de líquido para o mediastino durante o procedimento quando se usava a bomba de infusão, ocasionando dificuldade respiratória. O tratamento foi conservador, com retardamento da extubação, internação em unidade de terapia intensiva, diuréticos e medidas de suporte. No quarto dia de pós-operatório, a paciente estava assintomática em relação a tal complicação.This study is intended to present a rare but possible respiratory complication during a shoulder arthroscopy performed in the beach chair position. Fluid leaked into the mediastinum during the procedure when the infusion pump was being used, which caused respiratory difficulty. Treatment was conservative, with extubation delay, stay at the Intensive Care Unit, diuretic drugs, and support action. In the fourth postoperative day, the patient was asymptomatic regarding such complication.

  4. [Trichomonas tenax in pulmonary and pleural diseases].

    Science.gov (United States)

    Chiche, L; Donati, S; Corno, G; Benoit, S; Granier, I; Chouraki, M; Arnal, J-M; Durand-Gasselin, J

    2005-11-05

    Trichomonas is a protozoan rarely incriminated in pulmonary or pleural disorders. An 84-year-old man, under treatment for chronic lymphoid leukemia with hypogammaglobulinemia, was hospitalized for respiratory distress and fever due to bilateral pulmonary and pleural disorders. Direct examination of the bronchoalveolar lavage fluid revealed a flagella protozoan identified as Trichomonas tenax. Although Trichomonas is rare in pulmonary disorders, when it occurs, T. tenax appears to be the most common species. Treatment with metronidazole was effective.

  5. ASBESTOS EXPOSURE AND SARCOMATOID MALIGNANT PLEURAL MESOTHELIOMA

    OpenAIRE

    Gorantla,; Namballa; Tupakula Suresh

    2014-01-01

    Malignant pleural mesothelioma (MPM) is commonly associated with documented asbestos exposure. The mean interval between exposure and death is around 40 years. Sarcomatoid mesothelioma is the least common form of MPM. It is more aggressive and associated with worst prognosis. Adequate sampling is important for accurate diagnosis. Both VATS and image guided core needle biopsy have higher diagnostic yield compared to the closed pleural biopsy. IHC markers are used as an adju...

  6. Validity of pleural lactate dehydrogenase measurements in assessment of pleural effusions

    Directory of Open Access Journals (Sweden)

    Elisna Syahruddin

    2012-08-01

    Full Text Available Background Pleural effusions are classified into transudates and exudates based on Light’s criteria, but the main disadvantage of Light’s criteria is the misclassification of transudates as exudates in about 20% of cases. The aim of this study was to determine the validity of various biochemical parameters to differentiate pleural exudates and transudates. Methods An observational study to evaluate diagnostics tests was conducted at the emergency department of Persahabatan Hospital, Jakarta, from September 2010 until December 2011. In total, 119 patients with pleural effusion were evaluated. Simultaneous pleural effusion and blood samples were examined for lactate dehydrogenase (LDH, total protein, cholesterol and albumin, with the clinical diagnosis as the gold standard. Results There were 104 exudative and 15 transudative pleural effusions. Light’s criteria achieved a higher overall accuracy (sensitivity 97%, specificity 80%, accuracy 95%. The optimum cut off values were pleural fluid to serum ratio of LDH 0.4 (sensitivity 95%, specificity 87%, accuracy 94% and pleural fluid LDH of 178 IU/L (sensitivity 92%, specificity 87%, accuracy 92%. Pleural fluid cholesterol was 50 mg/dL (sensitivity 89%, specificity 53%, accuracy 85%, pleural fluid to serum cholesterol ratio 0.41 (sensitivity 75%, specificity 53%, accuracy 72% and serum-effusion albumin gradient 1.3 g/dL (sensitivity 91%, specificity 73%, accuracy 89%. Combination of biochemical tests did not improve sensitivity or accuracy. Conclusions Light’s criteria remain superior to other biochemical tests, but the new cut off values of LDH pleural fluid to serum ratio of 0.4 and pleural fluid LDH of 178 IU/L appears to yield a slight improvement in diagnostic accuracy.

  7. A Study on Tuberculous Pleural Effusion

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    Zay Soe

    2010-03-01

    Full Text Available Background: Nearly one third of the global population i.e. two billion people are infected with mycobacteria tuberculosis and are at risk of developing the disease. Pleural effusion is one of the common complications of pulmonary tuberculosis. In this study, the clinical features, the positivity rate of microbiological procedures and blind pleural biopsies, radiological manifestations, biochemical and hematological profiles of serum and pleural fluid were analyzed. Objectives: To report our experience of 108 patients with tuberculous pleural effusion and discuss the clinical features, radiological findings, biochemical, cytological and microbiological analysis of pleural fluid, hematological and biochemical profiles of serum and positivity rate of microbiological procedures and blind pleural biopsies in these patients. Methods: This study was a hospital based descriptive cross sectional study performed at Chest Medical Ward, Yangon General Hospital, Myanmar, of study period from January 2004 through January 2005. A total of 108 patients were included. Thorough history taking and physical examinations, radiological findings, hematological and serum biochemical profiles were recorded. Pleural aspiration and biopsy were also performed. At least two pieces of pleural tissue were taken and one piece of each sample of pleural tissue was cultured for mycobacteria and the rest was sent for histological examination. Macroscopic findings, cytological, microbiological and biochemical analysis of pleural fluid were analyzed. Results: A total of 108 patients, 74 males and 34 females were included. Their mean age was 42.60 ± 16.34 (range 12-81 years. Common presentations were breathlessness (82.4%, cough (81.5%, fever (80.6%, and night sweat (78.7%, loss of appetite (74.1%, significant weight loss (72.2% and chest pain (67.6%. Only 39.3% of TB patients produced sputum in their history. Haemoptysis was present in only 7.4% of the patients. Regarding the

  8. An IR Navigation System for Pleural PDT

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    Timothy C Zhu

    2015-03-01

    Full Text Available Pleural photodynamic therapy (PDT has been used as an adjuvant treatment with lung-sparing surgical treatment for malignant pleural mesothelioma (MPM. In the current pleural PDT protocol, a moving fiber-based point source is used to deliver the light. The light fluences at multiple locations are monitored by several isotropic detectors placed in the pleural cavity. To improve the delivery of light fluence uniformity, an infrared (IR navigation system is used to track the motion of the light source in real-time at a rate of 20 - 60 Hz. A treatment planning system uses the laser source positions obtained from the IR camera to calculate light fluence distribution to monitor the light dose uniformity on the surface of the pleural cavity. A novel reconstruction algorithm is used to determine the pleural cavity surface contour. A dual-correction method is used to match the calculated fluences at detector locations to the detector readings. Preliminary data from a phantom shows superior light uniformity using this method. Light fluence uniformity from patient treatments is also shown with and without the correction method.

  9. An IR Navigation System for Pleural PDT.

    Science.gov (United States)

    Zhu, Timothy C; Liang, Xing; Kim, Michele M; Finlay, Jarod C; Dimofte, Andreea; Rodriguez, Carmen; Simone, Charles B; Friedberg, Joseph S; Cengel, Keith A

    2015-03-01

    Pleural photodynamic therapy (PDT) has been used as an adjuvant treatment with lung-sparing surgical treatment for malignant pleural mesothelioma (MPM). In the current pleural PDT protocol, a moving fiber-based point source is used to deliver the light. The light fluences at multiple locations are monitored by several isotropic detectors placed in the pleural cavity. To improve the delivery of light fluence uniformity, an infrared (IR) navigation system is used to track the motion of the light source in real-time at a rate of 20 - 60 Hz. A treatment planning system uses the laser source positions obtained from the IR camera to calculate light fluence distribution to monitor the light fluence uniformity on the surface of the pleural cavity. A novel reconstruction algorithm is used to determine the pleural cavity surface contour. A dual-correction method is used to match the calculated fluences at detector locations to the detector readings. Preliminary data from a phantom shows superior light uniformity using this method. Light fluence uniformity from patient treatments is also shown with and without the correction method.

  10. An IR Navigation System for Pleural PDT

    Science.gov (United States)

    Zhu, Timothy; Liang, Xing; Kim, Michele; Finlay, Jarod; Dimofte, Andreea; Rodriguez, Carmen; Simone, Charles; Friedberg, Joseph; Cengel, Keith

    2015-03-01

    Pleural photodynamic therapy (PDT) has been used as an adjuvant treatment with lung-sparing surgical treatment for malignant pleural mesothelioma (MPM). In the current pleural PDT protocol, a moving fiber-based point source is used to deliver the light. The light fluences at multiple locations are monitored by several isotropic detectors placed in the pleural cavity. To improve the delivery of light fluence uniformity, an infrared (IR) navigation system is used to track the motion of the light source in real-time at a rate of 20 - 60 Hz. A treatment planning system uses the laser source positions obtained from the IR camera to calculate light fluence distribution to monitor the light dose uniformity on the surface of the pleural cavity. A novel reconstruction algorithm is used to determine the pleural cavity surface contour. A dual-correction method is used to match the calculated fluences at detector locations to the detector readings. Preliminary data from a phantom shows superior light uniformity using this method. Light fluence uniformity from patient treatments is also shown with and without the correction method.

  11. MASSIVE PLEURAL EFFUSION: A CASE REPORT

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    Putu Bayu Dian Tresna Dewi

    2013-03-01

    Full Text Available Pleural effusion is abnormal fluid accumulation within pleural cavity between the parietal pleura and visceralis pleura, either transudation or exudates. A 47 year-old female presented with dyspneu, cough, and decreased of appetite. She had history of right lung tumor. Physical examination revealed asymmetric chest movement where right part of lung was lagged during breathing, vocal fremitus on the right chest was decreased, dullness at the right chest, decreased vesicular sound in the right chest, enlargement of supraclavicular and colli dextra lymph nodes, and hepatomegali. Complete blood count showed leukocytosis. Clinical chemistry analysis showed hipoalbumin and decreased liver function. Blood gas analysis showed hypoxemia. Pleural fluid analysis showed an exudates, murky red liquid color filled with erythrocytes, number of cells. Cytological examination showed existence of a non-small cell carcinoma tends adeno type. From chest X-ray showed massive right pleural effusion. Based on history, physical examination and investigations, she was diagnosed with massive pleural effusion et causa suspected malignancy. She had underwent pleural fluid evacuation and treated with analgesics and antibiotics.

  12. Clinical Investigation of Benign Asbestos Pleural Effusion.

    Science.gov (United States)

    Fujimoto, Nobukazu; Gemba, Kenichi; Aoe, Keisuke; Kato, Katsuya; Yokoyama, Takako; Usami, Ikuji; Onishi, Kazuo; Mizuhashi, Keiichi; Yusa, Toshikazu; Kishimoto, Takumi

    2015-01-01

    There is no detailed information about benign asbestos pleural effusion (BAPE). The aim of the study was to clarify the clinical features of BAPE. The criteria of enrolled patients were as follows: (1) history of asbestos exposure; (2) presence of pleural effusion determined by chest X-ray, CT, and thoracentesis; and (3) the absence of other causes of effusion. Clinical information was retrospectively analysed and the radiological images were reviewed. There were 110 BAPE patients between 1991 and 2012. All were males and the median age at diagnosis was 74 years. The median duration of asbestos exposure and period of latency for disease onset of BAPE were 31 and 48 years, respectively. Mean values of hyaluronic acid, adenosine deaminase, and carcinoembryonic antigen in the pleural fluid were 39,840 ng/mL, 23.9 IU/L, and 1.8 ng/mL, respectively. Pleural plaques were detected in 98 cases (89.1%). Asbestosis was present in 6 (5.5%) cases, rounded atelectasis was detected in 41 (37.3%) cases, and diffuse pleural thickening (DPT) was detected in 30 (27.3%) cases. One case developed lung cancer (LC) before and after BAPE. None of the cases developed malignant pleural mesothelioma (MPM) during the follow-up.

  13. Clinical Investigation of Benign Asbestos Pleural Effusion

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    Nobukazu Fujimoto

    2015-01-01

    Full Text Available There is no detailed information about benign asbestos pleural effusion (BAPE. The aim of the study was to clarify the clinical features of BAPE. The criteria of enrolled patients were as follows: (1 history of asbestos exposure; (2 presence of pleural effusion determined by chest X-ray, CT, and thoracentesis; and (3 the absence of other causes of effusion. Clinical information was retrospectively analysed and the radiological images were reviewed. There were 110 BAPE patients between 1991 and 2012. All were males and the median age at diagnosis was 74 years. The median duration of asbestos exposure and period of latency for disease onset of BAPE were 31 and 48 years, respectively. Mean values of hyaluronic acid, adenosine deaminase, and carcinoembryonic antigen in the pleural fluid were 39,840 ng/mL, 23.9 IU/L, and 1.8 ng/mL, respectively. Pleural plaques were detected in 98 cases (89.1%. Asbestosis was present in 6 (5.5% cases, rounded atelectasis was detected in 41 (37.3% cases, and diffuse pleural thickening (DPT was detected in 30 (27.3% cases. One case developed lung cancer (LC before and after BAPE. None of the cases developed malignant pleural mesothelioma (MPM during the follow-up.

  14. Validity of pleural lactate dehydrogenase measurements in assessment of pleural effusions

    Directory of Open Access Journals (Sweden)

    Elisna Syahruddin

    2015-12-01

    Light’s criteria remain superior to other biochemical tests, but the new cut off values of LDH pleural fluid to serum ratio of 0.4 and pleural fluid LDH of 178 IU/L appears to yield a slight improvement in diagnostic accuracy.

  15. Pleural LDH as a prognostic marker in adenocarcinoma lung with malignant pleural effusion.

    Science.gov (United States)

    Verma, Akash; Phua, Chee Kiang; Sim, Wen Yuan; Algoso, Reyes Elmer; Tee, Kuan Sen; Lew, Sennen J W; Lim, Albert Y H; Goh, Soon Keng; Tai, Dessmon Y H; Kor, Ai Ching; Ho, Benjamin; Abisheganaden, John

    2016-06-01

    To study the performance of serum and pleural lactate dehydrogenase (LDH) level in predicting survival in patients with adenocarcinoma lung presenting with malignant pleural effusions (MPE) at initial diagnosis.Retrospective cohort study of the patient hospitalized for adenocarcinoma lung with MPE in year 2012.Univariate analyses showed lower pleural fluid LDH 667 (313-967) versus 971 (214-3800), P = 0.04, female gender 9 (100%) versus 27 (41.5%), P = 0.009, never smoking status 9 (100%) versus 36 (55.3%), P = 0.009, and epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) therapy 8 (89%) versus 26 (40%), P = 0.009 to correlate with survival of more than 1.7 year versus less than 1.7 year. In multivariate analysis, low pleural fluid LDH and female gender maintained significance. The pleural LDH level of ≤1500 and >1500 U/L discriminated significantly (P = 0.009) between survival.High pleural LDH (>1500 IU/L) predicts shorter survival (less than a year) in patients with adenocarcinoma lung presenting with MPE at the time of initial diagnosis. This marker may be clinically applied for selecting therapeutic modality directed at prevention of reaccumulation of MPE. Patients with low pleural LDH may be considered suitable for measures that provide more sustained effect on prevention of reaccumulation such as chemical pleurodesis or tunneled pleural catheter.

  16. C-Reactive Protein, Sialic Acid and Adenosine Deaminase Levels in Serum and Pleural Fluid from Patients with Pleural Effusion

    Science.gov (United States)

    Kim, Ji Woon; Yang, In Ae; Oh, Eun A; Rhyoo, Young Gun; Jang, Young Ho; Ryang, Dong Wook; Yoo, JooYong

    1988-01-01

    Laboratory analysis of pleural fluids is essential to determine underlying diseases. The authors evaluated the clinical significance of C-reactive protein (C-RP), sialic acid (SA), and adenosine deaminase (ADA) determinations in sera and pleural fluids from 37 patients with pleural effusion. (FP12)C-RP and sialic acid levels and ADA activities were higher in exudates than in transudates of pleural fluids. Serum and pleural fluid C-RP levels were high in patients with pyothorax. Determinations of serum sialic acid and the pleural fluid to serum ratio were useful for the differential diagnosis of pulmonary tuberculosis and malignancy. ADA activities of pleural fluid and serum are useful for the differentiation of malignancy from tuberculosis and nonspecific pyothorax. C-RP concentrations of pleural fluid correlated to serum levels. However, concentrations of sialic acid and ADA activities were not correlated to serum levels and only correlated to protein concentrations of pleural fluids. PMID:3154188

  17. Delayed internal pancreatic fistula with pancreatic pleural effusion postsplenectomy

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    The occurrence of pancreatic pleural effusion,secondary to an internal pancreatic fistula,is a rare clinical syndrome and diagnosis is often missed.The key to the diagnosis is a dramatically elevated pleural fluid amylase.This pancreatic pleural effusion is also called a pancreatic pleural fistula.It is characterized by profuse pleural fluid and has a tendency to recur.Here we report a case of delayed internal pancreatic fistula with pancreatic pleural effusion emerging after splenectomy.From the treatment ...

  18. [Could pleural aspergillosis happen to be a complication of pleural drainage?].

    Science.gov (United States)

    Bellamy, J; Onea, F; N'Guyen Huu, P

    2013-12-01

    Four cases of nosocomial aspergillosis are described where the responsibility of pleural drainage is advocated. Infection was pulmonary once, pleural three times. Pleural suction had been long lasting with incomplete re-expansion of the lung and major air leaks. The hypothesis of the responsibility of pleural drainage in the advent of aspergillosis is reinforced by the revision of medical papers, which leads to the conviction that similar cases have been described yet, even though the mechanism of the contamination had not been understood. Prevention needs to limitate the lasting of the suction, especially if there are major air leaks. Cure needs total re-expansion of the lung and suppression of any pleural cavity, even if a thoracoplasty is needed. An anti-fungal therapy is not always needed. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  19. Análisis genético del virus peruano de la fiebre amarilla

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    Carlos Yábar V

    2002-01-01

    Full Text Available Objetivo: Determinar las variantes genéticas de aislamientos del virus peruano de la Fiebre Amarilla (FA. Materiales y métodos: la región carboxiterminal del gen de la envoltura (E de cinco aislamientos de FA obtenidas de pacientes provenientes de Ayacucho 1978 (PER1, Junín 1995 (PER2, Cerro de Pasco (PER3, Cusco (1998 y San Martín (1999 fue amplificada por PCR, secuenciada y analizada con programas software de ADN. Resultados: el índice de similaridad de la secuencia de nucleótidos entre los cinco aislamientos reveló valores oscilantes entre 94,3% y 99,3%, mientras que la secuencia de aminoácidos presentó valores entre 97,6% y 99,7% de similaridad. El análisis filogenético demostró una distancia genética entre 0,40 y 6,50 mediante la secuencia de nucleótidos y a través de la secuencia de aminoácidos se observó un rango de 0,30 y 4,29. Sin embargo, las secuencias correspondientes a los sitios de glicosilación y a los epítopes de reconocimiento humoral fueron conservadas entre los cinco aislamientos, con excepción de algunos aislamientos de referencia reportados por otros autores. Conclusiones: los virus de FA peruanos forman un grupo filogenético distinto a otros virus de FA sudamericanos, basados en el análisis genéticos del gen E.

  20. Expression of soluble Toll-like receptors in pleural effusions

    Institute of Scientific and Technical Information of China (English)

    YANG Hai-bo; XIE Kai-qing; DENG Jing-min; QIN Shou-ming

    2010-01-01

    Background The Toll-like receptors (TLRs) represent a group of single-pass transmembrane receptors expressed on sentinel cells that are central to innate immune responses.The aim of this study was to investigate the presence of soluble TLRs in pleural effusions, and the diagnostic values of TLRs for pleural effusion with various etiologies.Methods Pleural effusion and serum samples were collected from 102 patients (36 with malignant pleural effusion, 36with tuberculous pleural effusion, 18 with bacterial pleural effusion, and 12 with transudative pleural effusion).The concentrations of TLR1 to TLR10 were determined in effusion and serum samples by enzyme linked immunosorbent assay.Four classical parameters (protein, lactate dehydrogenase, glucose and C-reactive protein (CRP)) in the pleural fluid were also assessed.Receiver-operating characteristic curves were used to assess the sensitivity and specificity of pleural fluid TLRs and biochemical parameters for differentiating bacterial pleural effusion.Results The concentrations of TLR1, TLR3, TLR4, TLR7 and TLR9 in bacterial pleural effusion were significantly higher than those in malignant, tuberculous, and transudative groups, respectively.Analysis of receiver operating characteristic curves revealed that the area under the curves of TLR1, TLR3, TLR4, TLR7 and TLR9 were 0.831, 0.843,0.842, 0.883 and 0.786, respectively, suggesting that these TLRs play a role in the diagnosis of bacterial pleural effusion.Also, the diagnostic value of TLRs for bacterial pleural effusions was much better than that of biochemical parameters (protein, lactate dehydrogenase, glucose and CRP).Conclusions The concentrations of TLR1, TLR3, TLR4, TLR7 and TLR9 appeared to be increased in bacterial pleural effusion compared to non-bacterial pleural effusions.Determination of these pleural TLRs may improve the ability of clinicians to differentiate pleural effusion patients of bacterial origin from those with other etiologies.

  1. Impacto ambiental generado por los derrames de petróleo en el sote en el tramo comprendido entre Lago Agrio y Baeza

    OpenAIRE

    Castro, Gonzalo

    2009-01-01

    Elaborar el Diagnóstico Ambiental – Línea Base de los componentes físico, biótico y antrópico. La presente investigación ¿Impacto ambiental generado por los derrames de petróleo en el sote en el tramo comprendido entre Lago Agrio y Baeza¿ plantea un Plan de Manejo Ambiental, que cuenta con todas las medidas de mitigación y remediación que deberían ser incorporadas en el tramo bajo de estudio, a fin de evitar al máximo los derrames de crudo, dentro de lo que se incluye: control de la corros...

  2. El derrame de petróleo en Quintero, V región de Chile. Una mirada desde las organizaciones sociales

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    Pablo Saravia Ramos

    2016-01-01

    Full Text Available El derrame de petróleo de 2014 en la bahía de Quintero (V región de Chile, es un hecho habitual en un territorio que ha vivido múltiples episodios de crisis medioambientales. El estudio buscó conocer cómo se desenvolvieron los actores sociales a propósito de la catástrofe a través de una metodología de tipo cualitativa. Los resultados indican que el derrame tuvo efectos en diferentes direcciones: actuó como facilitador de la creación de nuevas organizaciones, significó el resurgimiento de antiguas disputas, evidenció la dinámica de la trama relacional entre la comunidad, autoridades y el parque industrial e hizo visible la normalización con que son interpretados este tipo de crisis.

  3. Evaluation of CT findings for diagnosis of pleural effusions

    Energy Technology Data Exchange (ETDEWEB)

    Arenas-Jimenez, J.; Alonso-Charterina, S.; Fernandez-Latorre, F.; Gil-Sanchez, S. [Hospital General Universitario de Alicante (Spain). Dept. of Radiology; Sanchez-Paya, J. [Hospital General Universitario de Alicante (Spain). Dept. of Preventive Medicine; Lloret-Llorens, M. [Hospital Universitario La Fe, Valencia (Spain). Dept. of Radiology

    2000-04-01

    Computed tomography studies are usually used to assess patients with pleural effusions, and radiologists should be aware of the significance of different CT findings for the diagnosis of the effusion. The purpose of this study was to evaluate CT findings for etiological diagnosis of pleural effusions. Contrast-enhanced CT of the chest of 211 patients with pleural effusion of definite diagnosis were evaluated. The CT images were evaluated for the presence and extent of pleural effusion, thickening or nodules, extrapleural fat and other changes in the mediastinum or lung. The CT scans were read by two independent observers and correlation between them was evaluated. Comparison of CT findings between benign and malignant effusions, between exudates and transudates, and between empyemas and the other parapneumonic effusions were carried out. Kappa values for most CT findings were >0.85. Loculation, pleural thickening, pleural nodules, and extrapleural fat of increased density were only present in exudative effusions. Multiple pleural nodules and nodular pleural thickening were the only pleural findings limited to malignant pleural effusions. The signs were also more frequently seen in empyemas than in other parapneumonic effusions. Computed tomography findings can help to distinguish between transudates and exudates. Although there is some overlap between benign and malignant pleural effusions, pleural nodules and nodular pleural thickening were present almost exclusively in the latter. Although differences between CT findings of empyemas and the other parapneumonic effusions exist, there is no finding which can definitely differentiate between them. (orig.)

  4. Estado actual del manejo de la fiebre en niños. Current status of management of fever in children

    OpenAIRE

    Fabian Alberto Rueda Zambrano, MD; Paola Caceres Corredor, MD

    2010-01-01

    Es muy frecuente en el ambiente médico y entre los padres de familia el uso y abuso de antipiréticos buscando disminuir abruptamente la temperatura, mejorar los síntomas derivados de la fiebre y contrarrestar las reacciones adversas de la misma. Por otro lado, existen diferentes conceptos acerca de la elección del antipirético más eficaz y seguro en niños y su ruta de administración, así como su utilidad en la prevención de convulsiones febriles, entre otras. Este artículo pretende dar clar...

  5. [Elevated pleural copeptin levels can distinguish to exudate from transudates].

    Science.gov (United States)

    Gümüş, Aziz; Çınarka, Halit; Karataş, Mevlüt; Kırbaş, Aynur; Kayhan, Servet; Şahin, Ünal

    2014-01-01

    Copeptin is released simultaneously along with arginine-vasopressine as a result of different stimuli from the neurohypophysis. Physiological function of copeptin is still unclear. Increased blood copeptin levels is associated with poor prognosis in many diseases. Pleural effusion is a common clinical condition. The most common causes of pleural effusions are heart failure, parapneumonic effusion, pulmonary embolism and malignacy.Tuberculosis is one of the other major causes of pleural effusion in developing countries. In this study, we aimed to assess whether pleural copeptin level may be a new discriminative biomarker for exudates and transudates pleural effusions. Research was done at Recep Tayyip Erdogan University School of Medicine in the Department of Chest Diseases. The concentrations of pleural copeptin and typical pleural and serum marker levels were measured in 76 subjects with pleural effusions including 22 transudates caused by congestive heart failure (CHF), and 54 exudates including 18 parapneumonic (PPE), 18 tuberculous pleural effusions (TBPEs), 18 malignant effusions (MPEs). Median pleural fluid copeptin levels were higher in exudates than in transudates (1936 ng/mL and 1313 pg/mL, p value exudates (n= 54). Pleural copeptin levels of exudates, with a cut off value of 1469 ng/mL, yielded a 79.6% sensitivity, 81.8% specificity, with an are a under the curve of 0.851. Pleural copeptin level is a new biomarker to separate exudates from transudates. Pleural effusion discriminative effect of copeptin is lower than plasma protein level and plasma lactat dehydrogenase (LDH). Pleural copeptin measurement is not recommended for routine clinical use. Pleural copeptin level is not contribute to different iate exudative pleural fluids from each other like PPE, TBPE and MPE.

  6. Malignant pleural mesothelioma in Italy.

    Science.gov (United States)

    Bianchi, Claudio; Bianchi, Tommaso

    2009-08-01

    This study reviews a series of 811 malignant pleural mesothelioma cases, diagnosed at hospitals in Trieste and Monfalcone districts of north eastern Italy, a narrow coastal strip with a population of about three lakh, in the period 1968-2008. The diagnosis was based on histological examination in 801 cases, and cytological findings in 10. Necropsy was performed in 610 cases. Occupational histories were obtained directly from the patients or their relatives through personal or telephone interviews. Routine lung sections were examined for asbestos bodies in 500 cases. In 143 cases asbestos bodies were isolated and counted by chemical digestion of the lung tissue using the Smith-Naylor method. The series included 717 men and 94 women aged between 32 and 93 years (mean 69.2 years). Detailed occupational data was obtained for 732 cases.The majority of patients had marine jobs - shipbuilding (449 cases), maritime trades (56 cases), and port activities (39 cases). The nature of work of other patients included a variety of occupations, with non-shipbuilding industries being the most common. Thirty-four women cleaned the work clothes of family members occupationally exposed and hence had a history of asbestos exposure at home. Most of the patients had their first exposure to asbestos before 1960. The latency period ranged between 13 and 73 years (mean 48.2). Latency period among insulators and dock workers were shorter than other categories. Asbestos bodies were detected on routine lung sections in 343 cases (68.6%). Lung asbestos body burdens after isolation ranged between two to 10 millions bodies per gram of dried tissue. Despite some limitations in the use of asbestos in this area since the 1970s, the incidence of tumor remained high during the last years.

  7. Malignant pleural mesothelioma in Italy

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    Bianchi Claudio

    2009-01-01

    Full Text Available This study reviews a series of 811 malignant pleural mesothelioma cases, diagnosed at hospitals in Trieste and Monfalcone districts of north eastern Italy, a narrow coastal strip with a population of about three lakh, in the period 1968-2008. The diagnosis was based on histological examination in 801 cases, and cytological findings in 10. Necropsy was performed in 610 cases. Occupational histories were obtained directly from the patients or their relatives through personal or telephone interviews. Routine lung sections were examined for asbestos bodies in 500 cases. In 143 cases asbestos bodies were isolated and counted by chemical digestion of the lung tissue using the Smith-Naylor method. The series included 717 men and 94 women aged between 32 and 93 years (mean 69.2 years. Detailed occupational data was obtained for 732 cases. The majority of patients had marine jobs - shipbuilding (449 cases, maritime trades (56 cases, and port activities (39 cases. The nature of work of other patients included a variety of occupations, with non-shipbuilding industries being the most common. Thirty-four women cleaned the work clothes of family members occupationally exposed and hence had a history of asbestos exposure at home. Most of the patients had their first exposure to asbestos before 1960. The latency period ranged between 13 and 73 years (mean 48.2. Latency period among insulators and dock workers were shorter than other categories. Asbestos bodies were detected on routine lung sections in 343 cases (68.6%. Lung asbestos body burdens after isolation ranged between two to 10 millions bodies per gram of dried tissue. Despite some limitations in the use of asbestos in this area since the 1970s, the incidence of tumor remained high during the last years.

  8. Tuberculose pleural após uso de adalimumabe na doença de Crohn: relato de caso Pleural tuberculosis after using adalimumab in Crohn's disease: a case report

    Directory of Open Access Journals (Sweden)

    Rodrigo Rocha Batista

    2011-03-01

    Full Text Available O tratamento da doença de Crohn perineal é feito pela combinação da terapia medicamentosa e da cirúrgica. A terapia biológica é importante devido à eficácia clínica na indução e manutenção de remissão da doença. No entanto, devido à ação imunomoduladora e imunossupressora, o uso de biológicos como infliximabe e adalimumabe eleva o risco de infecções oportunistas. Relatou-se o caso de paciente feminino, 28 anos, diagnosticada com doença de Crohn perineal, em uso de azatioprina e adalimumabe. Há sete dias com tosse seca, febre vespertina e dispneia. Ao exame físico, febril, desidratada, diminuição do murmúrio vesicular nos campos médio e inferior do hemitoráx direito e cicatriz de fistulotomia anorretal sem sinais flogísticos. A radiografia de tórax mostrou derrame pleural em hemitórax direito, e a análise do líquido pleural constatou adenosina deaminase elevada, nível de glicose normal e citologia diferencial com 88% de monomorfonucleares. Foi estabelecido o diagnóstico de tuberculose pleural, e a paciente foi medicada com esquema tríplice (rifampicina, isoniazida e pirazinamida por seis meses associada à prednisona 40 mg/dia, por um mês, com posterior desmame do corticoide. Atualmente, encontra-se assintomática e em uso de ciprofloxina 1 g/dia para a doença de Crohn perineal.The Crohn's disease perineal treatment is made by the combination of drug and surgery therapy. The biological therapy is important due to clinical efficacy in inducing and maintaining disease remission. However, because of immunomodulating and immunosuppressive effects, the use of biological as infliximab and adalimumab increases the risk of opportunistic infections. We report a case of a 28-year-old, female patient, diagnosed with Crohn's perineal disease, taking azathioprine and adalimumab, complaining of dry cough, evening fever, and dyspnea for seven days. On physical examination, febrile, dehydrated, decreased, breath sounds in

  9. Pleural fluids associated with chest infection.

    Science.gov (United States)

    Quadri, Amal; Thomson, Anne H

    2002-12-01

    Pleural effusions are commonly associated with pneumonias and a small number of these progress to empyema. An understanding of the physiology and pathophysiology of pleural fluid aids the clinician in the management of empyema. There remains much debate about the optimal treatment of empyema in children. Early recognition of the condition is important since delayed therapy may result in unnecessary morbidity. Conventional management with high dose parenteral antibiotics and chest tube drainage remains the mainstay of therapy. However, this treatment modality may fail if the pleural fluid becomes viscous and loculated and, therefore, a more aggressive approach is required. Intrapleural fibrinolytic therapy has been shown to decrease the length of hospital stay and may reduce the need for surgical intervention. The prognosis in children with parapneumonic empyema is excellent with the vast majority retaining normal lung function at long term follow-up.

  10. [Pleural trichomoniasis due to trichomonas tenax].

    Science.gov (United States)

    Porcheret, H; Maisonneuve, L; Estève, V; Jagot, J L; Le Pennec, M P

    2002-02-01

    Thoracic infections due to Trichomonas species often go unrecognised as they are seldom described in the literature. We describe a case that, to our knowledge, is the first reported case of empyema caused by this organism. A 59 year old man with metastatic adenocarcinoma of the lung developed a right pyopneumothorax following treatment with corticosteroids and radiotherapy. The pleural fluid was purulent and fetid, and contained large numbers of Trichomonas tenax amongst a mixed bacterial flora. Pleural drainage and antibiotic therapy with metronidazole, ciprofloxacin and gentalline were instituted immediately, but the patient died 4 days later. Trichomonas tenax is part of the normal oral floral and may on occasions colonize the airways. It can thus become involved during aspiration pneumonia or cause pleural infection following the rupture of a pulmonary abscess. Such infection tends to be associated with concurrent respiratory pathology or with immunodepression. The significance Trichomonas tenax when found in the airways is unclear and their pathogenic role is discussed.

  11. Recurrent pleural effusion as a clinical manifestation of multiple myeloma

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    Marcelo Torquato Toneline

    2013-12-01

    Multiple myeloma is a hematologic malignant tumor of plasma cells, sometimes associated with pleural effusion. This, in most cases, is associated to infectious complications. Pleural effusion as the onset or progression of the disease itself is rare. This case reports a young male, who presented recurrent pleural effusions, diagnosed with multiple myeloma at diagnosis.

  12. Normal apical pleural tenting: CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Sung, Dong Wook; Yoon, Yup; Jeong, Yu Mee; Park, Joo Chul; Cho, Kyu Seok; Ahn, Hee Kyung; Lee, Won Kyu [Kyunghee Univ. College of Medicine, Seoul (Korea, Republic of)

    1996-07-01

    To define the anatomy of apical pleural tenting commonly seen in computed tomography(CT) of the upper posterior thorax. Chest CTs of 393 patients with no pleural disease clinically and radiographically were analyzed. GE-9800 Quick and Toshiba-900S were used, employing the usual contrast enhanced CT technique. CT findings of focal pleural tenting on the inner side of the upper posterior thorax(apical pleural tenting) were evalvated and analysed in terms of location and shape. The CT findings were compared with the gross findings of the inner aspect of the posterior cadaveric thorax. Apical pleural tenting was formed by the upper border of the subcostal muscle. It's incidence was 44%(n=171), with bilaterality in 29%(n=49), and unilaterality in 71% of cases(n=122). This tenting was most frequently found between the third rib and the fourth intercostal space(81%), and seen in the outer third(42%) or central third(41%) part of the posterior costal pleura. In fifteen cases(7%), it was directed obliquely and had changed its location from the inner to the central or the central to the outer part. The shapes of the tenting were classified as follows:type 1(convex inner border with sharp apex, 62%); type 2(convex inner border with broad apex, 23%);type 3(undulated contour of apex, 13%);and type 4(two-spike apices, 1%). Apical pleura tenting is a normal CT finding probably demonstrated by the upper border of the subcostal muscle. Misdiagnosis of pleural disease can be avoided by recognition of the location and type of this tenting.

  13. Bartonelosis (Fiebre de la Oroya o Verruga Peruana: ¿Enfermedad ocupacional?

    Directory of Open Access Journals (Sweden)

    R. Cesar Gonzáles

    2007-12-01

    Full Text Available La Bartonella bacilliformis es un parásito bacteriano intracelular facultativo de los eritrocitos humanos y de las células endoteliales. La enfermedad de Carrión, fiebre de La Oroya y Verruga Peruana son todos términos que describen las consecuencias patológicas de la infección humana por Bartonella bacilliformis. (1 Aunque las infecciones que involucran especies de Bartonella, tales como Bartonella henselae y Bartonella quintana, ocurren en todo el mundo, la enfermedad de Carrión es endémica únicamente en Sudamérica. (14 Las infecciones por B. bacilliformis son un problema de salud en numerosas áreas rurales de Sudamérica y para los viajeros que visitan esas regiones. Se han reportado brotes de bartonelosis en las regiones montañosas de Perú, Ecuador y Colombia. (1 La Lutzomyia verrucarum es el principal vector para la transmisión de la bacteria al ser humano; la hembra del mosquito transmite el patógeno durante su alimentación nocturna de sangre humana. Presumiblemente el insecto se alimenta de sangre de un individuo infectado y disemina el patógeno por medio de su saliva durante la siguiente ingesta de sangre. La bacteria no es contagiosa entre humanos. (1 Presentamos un enfoque laboral de la enfermedad en trabajadores que realizan desplazamientos continuos a zonas endémicas y analizamos sus posibles consecuencias.Bartonella bacilliformis is a facultative intracellular bacterial parasite of human erythrocytes and endotelial cells. Carrion’s disease, Oroya fever and Peruvian wart are all terms describing the pathological consequences of human infection with Bartonella bacilliformis. (1 Although infections involving the Bartonella species, such as Bartonella henselae and Bartonella Quintana occur worldwide, Carrion’s disease is uniquely endemic to South America. (14 Bartonella baciliformis infections are a health problem in many rural areas of South America and to travellers who visit these regions. Outbreaks of

  14. A propósito de un caso de Fiebre de Chikungunya importada de América

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    F.J. Membrillo de Novales

    2015-09-01

    Full Text Available Presentamos el caso de un varón de 41 años que tras viajar como VFR (Visiting Friends and Relatives a Valencia, Venezuela, presentó a su regreso a España un cuadro de fiebre y artromialgias. El paciente cumplía criterios clínicos para el diagnosticado de fiebre de Chikungunya, recientemente introducida en América y donde se desarrolla en la actualidad una epidemia que afecta al país que viajó. El estudio serológico por el laboratorio de referencia confirmó esta sospecha al detectar IgM frente a virus Chikungunya (CHIKV. Al tratarse de una arbovirosis poco conocida en nuestro medio y de interés militar, aprovechamos el caso, primero diagnosticado en nuestro Hospital en el contexto de esta epidemia, para revisar la situación de esta enfermedad y la epidemiología del brote actual.

  15. Fiebre amarilla en Africa: su impacto en salud pública y perspectivas para su control en el siglo XXI

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    Oyewale Tomori

    2002-06-01

    Full Text Available Durante las últimos dos décadas, la fiebre amarilla ha vuelto a emerger con fuerza hasta constituirse en un grave problema de salud pública en Africa, trayendo indecibles sufrimientos a mucha de su población y convirtiéndose en un obstáculo más para su desarrollo social y económico. A pesar de los destacados logros alcanzados en el conocimiento de la epidemiología de esta enfermedad y de la disponibilidad de una vacuna segura y eficaz, la fiebre amarilla continúa siendo un serio problema de salud pública tanto en Africa como en América en donde anualmente afecta a 200.000 personas, aproximadamente, y causa alrededor de 30.000 muertes. Africa contribuye con más del 90% de la morbilidad y mortalidad por fiebre amarilla en el planeta. Además de la severidad de la morbilidad y la mortalidad, que muestran un acusado subregistro, los sucesivos brotes y las medidas de control han traumatizado la prestación de los servicios de salud disponibles, sobrecargando los ya exiguos recursos internos, abusando de las donaciones y llevando a un lamentable desperdicio de vacunas. Las epidemias recientes en Africa han afectado predominantemente a los niños menores de 15 años. La fiebre amarilla es una enfermedad de fácil control, lo cual puede ilustrarse con dos situaciones ocurridas en Africa. Entre 1939 y 1952, la enfermedad virtualmente desapareció en varias zonas del continente en las que se adelantaron programas de vacunación masiva de manera regular. Más recientemente, después de la epidemia de 1978-1979 en Gambia, se llevó a cabo una campaña masiva de vacunación contra la fiebre amarilla, logrando un cubrimiento de 97% de la población mayor de seis meses de edad, a partir de la cual la vacuna se incorporó permanentemente al programa de inmunización. Desde entonces, Gambia ha mantenido cubrimientos de más del 80%, sin notificación de nuevos casos, a pesar de tener frontera con Senegal que padeció brotes en 1995 y 1996. La

  16. Chest wall, lung, and pleural space trauma.

    Science.gov (United States)

    Miller, Lisa A

    2006-03-01

    Chest radiographs frequently underestimate the severity and extent of chest trauma and, in some cases, fail to detect the presence of injury. CT is more sensitive than chest radiography in the detection of pulmonary, pleural, and osseous abnormalities in the patient who has chest trauma. With the advent of multidetector CT (MDCT), high-quality multiplanar reformations are obtained easily and add to the diagnostic capabilities of MDCT. This article reviews the radiographic and CT findings of chest wall, pleural, and pulmonary injuries that are seen in the patient who has experienced blunt thoracic trauma.

  17. Toxocariasis: An unusual cause of pleural effusion.

    Science.gov (United States)

    Vallentin, Blandine; Carsin, Ania; Dubus, Jean-Christophe

    2015-10-01

    Toxocara canis, one of the most frequent parasites worldwide, rarely triggers respiratory symptoms. We report the case of a 5-year-old girl hospitalized for a unilateral eosinophilic pleural effusion due to Toxocara canis. Besides the fact that she was living in a squat, no other medical condition was reported. There was no other site of infection caused by the parasite and she was successfully treated with albendazole. This case report is obviously unique as very few cases of pleural effusion due to Toxocara canis are reported in literature, all in adult patients.

  18. [Clinical aspects and diagnosis of pleural fibromas].

    Science.gov (United States)

    Smati, B; Djilani, H; Boudaya, M S; Ghrib, B S; Mestiri, T; Mezni, F; Bouacha, H; Kilani, T

    2005-12-01

    Pleural fibromas are rare malignant or benign tumors requiring pathology study for certain diagnosis. From January 1985 to January 2001, 7 patients underwent surgery in our unit for pleural fibroma: 4 females and 3 males, mean age 60 years. The inaugural symptoms were chest pain (3 patients), dyspnea (2 patients), joint pain in a patient with Pierre-Marie pneumonic hypertrophic osteo-arthropathy, and acute hypoglycemia. Radiological investigations were decisive in orienting the diagnosis (chest X-ray, ultrasound, computed tomography and MRI). Surgical resection and pathological study of the surgical specimen is required to confirm the diagnosis. Patients should be carefully followed due to the risk of malignant recurrence.

  19. Pleural Empyema due to Group D Salmonella

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    Jennifer C. Kam

    2012-01-01

    Full Text Available Non-typhi Salmonella normally presents as a bacteremia, enterocolitis, and endovascular infection but rarely manifests as pleuropulmonary disease. We present a case of a 66-year-old female with underlying pulmonary pathology, secondary to an extensive smoking history, who presented with a left-sided pleural effusion. The causative agent was identified as being group D Salmonella. Decortication of the lung was performed and the patient was discharged on antibiotics with resolution of her symptoms. This case helps to support the inclusion of Salmonella group D as a possible etiological agent of infection in the differential causes of exudative pleural effusions.

  20. Translational therapies for malignant pleural mesothelioma.

    Science.gov (United States)

    Belli, Carmen; Anand, Santosh; Tassi, Gianfranco; Fennell, Dean; Mutti, Luciano

    2010-04-01

    Malignant pleural mesothelioma is a highly invasive tumor arising from the mesothelial cells of serosal surfaces. Several chemotherapeutic agents have been tested for the treatment of this disease and doublet cisplatin with antifolates has been demonstrated to have significant efficacy in Phase III studies. However, the benefit of these treatments remains poor and the median survival time of patients is low, ranging between 9 and 17 months. Targeted therapies are being developed in oncology and emerging evidence suggests that they offer disease control in several tumors. This article reviews the knowledge on the malignant pleural mesothelioma molecular pathway and focuses on results of clinical trials conducted on this devastating disease.

  1. Evaluation of pleural and pericardial effusions by magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Tscholakoff, D.; Sechtem, U.; De Geer, G.; Schmidt, H.; Higgins, C.B.

    1987-08-01

    MR examinations of 36 patients with pleural and/or pericardial effusions were retrospectively evaluated. The purpose of this study was to determine of MR imaging is capable of differentiating between pleural and pericardial effusions of different compositions using standard electrocardiogram (ECG)-gated and nongated spin echo pulse sequences. Additional data was obtained from experimental pleural effusions in 10 dogs. The results of this study indicate that old haemorhages into the pleural or pericardial space can be differentiated from other pleural or pericardial effusions. However, further differentiation between transudates, exudates and sanguinous effusions is not possible on MR images acquired with standard spin echo pulse sequences. (orig./MG)

  2. A CASE OF RECURRENT PLEURAL EFFUSION FROM PANCREATICO PLEURAL FISTULA: DIAGNOSIS AND MANAG E MENT

    OpenAIRE

    2015-01-01

    Pleural effusion and mediastinal pseudo cysts in Acute Pancreatitis are common but that of in association with chronic pancreatitis and trauma is rare and occurs only if fistulous communication develops between pancreatic ductal system and p leural space or due to direct extension of pseudo cyst into pleural cavity through mediastinum. The diagnosis of fistula can be made with high index of clinical suspicion and can be confirmed by elevated amylase and protein content in...

  3. Pleural fluid MDA and serum-effusion albumin gradient in pleural effusion

    OpenAIRE

    Mangaraj, Manaswini; Kumari, S.; Nanda, R; Pattnaik, M. R.; Mohapatra, P. C.

    2008-01-01

    Pleural fluid malondialdehyde (PMDA) and serum effusion albumin gradient(SEAG) were estimated in 60 patients of pleural effusion of diverse etiologies. The results were compared with Light’s criteria to distinguish between transudates and exudates. The mean PMDA level was 0.68±0.24nmol/ml and 1.17±0.25nmol/ml in transudates and exudates respectively showing a statistically significant (p

  4. Remediación del derrame de hidrocarburos en el caso Barreal-Belén, Costa Rica

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    Luis Carlos Vargas Fallas

    2009-11-01

    Full Text Available Se presenta el estado de avance en la atención del caso de derrame dehidrocarburos ocurrido en Barreal-Belén, Costa Rica, consistente en la fuga de cerca de 30.000 litros compuestos por gasolina y diesel, que están contenidos en un acuífero colgado ubicado a una profundidad de 20 a 22 metros. A este acuífero le subyace una capa de toba calcinada que ha funcionado como un sello e impedido el flujo hacia los acuíferos colima que le subyacen y que son utilizados para el abastecimiento de poblaciones.Se presenta la estrategia de trabajo para lograr la remediación establecida por la Comisión Interinstitucional en el 2005. A dos meses de iniciados los procesos extractivos, se presenta las medidas adoptadas para separar los hidrocarburos de las aguas y se establece un pronóstico en años de operación, de acuerdo con dos posibles escenarios de limpieza.

  5. Malignant pleural mesothelioma: an update on investigation, diagnosis and treatment

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    Anna C. Bibby

    2016-12-01

    Full Text Available Malignant pleural mesothelioma is an aggressive malignancy of the pleural surface, predominantly caused by prior asbestos exposure. There is a global epidemic of malignant pleural mesothelioma underway, and incidence rates are predicted to peak in the next few years. This article summarises the epidemiology and pathogenesis of malignant pleural mesothelioma, before describing some key factors in the patient experience and outlining common symptoms. Diagnostic approaches are reviewed, including imaging techniques and the role of various biomarkers. Treatment options are summarised, including the importance of palliative care and methods of controlling pleural effusions. The evidence for chemotherapy, radiotherapy and surgery is reviewed, both in the palliative setting and in the context of trimodality treatment. An algorithm for managing malignant pleural effusion in malignant pleural mesothelioma patients is presented. Finally new treatment developments and novel therapeutic approaches are summarised.

  6. Role of blind closed pleural biopsy in the managment of pleural exudates.

    Science.gov (United States)

    Pereyra, Marco F; San-José, Esther; Ferreiro, Lucía; Golpe, Antonio; Antúnez, José; González-Barcala, Francisco-Javier; Abdulkader, Ihab; Álvarez-Dobaño, José M; Rodríguez-Núñez, Nuria; Valdés, Luis

    2013-01-01

    The performance of blind closed pleural biopsy (BCPB) in the study of pleural exudates is controversial. To assess the diagnostic yield of BCPB in clinical practice and its role in the study of pleural exudates. Data were retrospectively collected on all patients who underwent BCPB performed between January 1999 and December 2011. A total of 658 BCPBs were performed on 575 patients. Pleural tissue was obtained in 590 (89.7%) of the biopsies. A malignant pleural effusion was found in 35% of patients. The cytology and the BCPB were positive in 69.2% and 59.2% of the patients, respectively. Of the patients with negative cytology, 21 had a positive BCPB (diagnostic improvement, 15%), which would have avoided one pleuroscopy for every seven BCPBs that were performed. Of the 113 patients with a tuberculous effusion, granulomas were observed in 87 and the Lowenstein culture was positive in an additional 17 (sensitivity 92%). The overall sensitivity was 33.9%, with a specificity and positive predictive value of 100%, and a negative predictive value of 71%. Complications were recorded in 14.4% of patients (pneumothorax 9.4%; chest pain 5.6%; vasovagal reaction, 4.1%; biopsy of another organ 0.5%). BCPB still has a significant role in the study of a pleural exudate. If an image-guided technique is unavailable, it seems reasonable to perform BCPB before resorting to a pleuroscopy. These results support BCPB as a relatively safe technique.

  7. Palliative Treatment of Malignant Pleural Effusion

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    Chenyang Liu

    2015-01-01

    Full Text Available Malignant pleural effusion (MPE is a common clinical problem caused by cancers. Pleural effusion can be the first sign of cancer in more than 25% of patients. Lung cancer and breast cancer are the most common cancers that metastasize to the pleura in men and women, respectively. Other cancers, including, but not limited to, lymphomas, ovarian cancer, stomach cancer, and several unknown primary cancers can also lead to MPE. Dyspnea and chest pain are the most common symptoms of MPE along with other symptoms such as a cough, weight loss, anorexia, fatigue, and weakness. Aggravation of these symptoms is closely related to the rate of accumulation of pleural effusion. Treatment options to MPE are determined by the type and extent of the underlying malignancy. The major goals of the treatment are to relieve symptoms, restore functions, improve the quality of life, and minimize the duration of hospital stay and costs. Although some patients can be treated with systemic therapies, most of these treatments are temporary, and MPE would recur soon. Hence, further palliative treatments to effectively control pleural effusions and relieve symptoms are necessary. This review addresses the pathophysiology of MPE and the treatment options for patients with MPE.

  8. Diaphragmatic hernia masquerading as pleural effusion

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    Z Nalladaru

    2012-01-01

    Full Text Available Rupture of the diaphragm is almost always due to major trauma. We present here an unusual and rare case of late presentation of diaphragmatic hernia after an innocuous injury. The patient was initially misdiagnosed as a left pleural effusion on the basis of chest X-ray and ultrasound findings. Finally, the diagnosis was confirmed on computerized scanning.

  9. Pleural Mass Lesion Containing Calcium Sludge

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    Can Kurkcuoglu

    2012-01-01

    Full Text Available   A 30 year-old man was admitted with of chest pain. Had a x-ray and computed tomography showed calcified pleural mass . Lesions in the white-colored, dense mud was the consistency of the material.

  10. The role of PET in the evaluation of pleural effusion

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jae Cheol; Ryoo, Baek Yeol

    2000-12-01

    The evaluation of pleural abnormality in patients with lung cancer is very important to decide whether curative resection is indicated or not. We investigated the diagnostic validity of FDG-PET to differentiate benign and malignant pleural disease. Sixteen patients with pleural irregularity or fluid in CT or simple Chest X-ray were enrolled (12 men and 4 women; age range 39-71 years; median age 59 years). FDG-PET was interpreted as positive if pleural activity was greater than background mediastinal activity (FDG-PET uptake ratio of pleura to mediastinum > 1). The results of FDG-PET were compared to cytological or histological data. Twelve patients had a pleural metastasis of lung cancer and 4 patients had a benign pleural disease such as empyema, tuberculosis. FDG-PET uptake in pleura revealed positive findings in 8 of the 12 patients with metastatic pleural disease and in 3 of the 4 patients without malignant pleural lesion. We could not find the cut-off point in FDG-PET uptake ratio of pleura to mediastinum to differentiate benign and malignant pleural lesion. FDG-PET uptake was higher in patients with high tumor burden (LDH > 10000 IU/L and glucose < 60mg/dl in pleural fluid). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FDG-PET for detecting pleural metastasis were 67%, 25%, 73%, 20% and 56%, respectively. These preliminary results show that FDG-PET is not useful to differentiate benign inflammatory pleural disease and malignant pleural lesion. However, because the number of patients with benign pleural disease was small, re-evaluation with larger groups of patients is needed to draw a definite conclusion.

  11. Determinación mediante inmunohistoquímica de infección por virus de la fiebre amarilla y virus de la hepatitis b

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    Cecilia Morón C

    2003-03-01

    Full Text Available La inmunohistoquímica (IHQ constituye una herramienta para definir la etiología en el síndrome icterohemorrágico. Objetivo: Identificar mediante IHQ la presencia en hígado del antígeno de superficie de la hepatitis B y del virus de la fiebre amarilla. Materiales y métodos: Se incluyeron muestras de tejido hepático procedentes de 55 fallecidos por síndrome icterohemorrágico, remitidos entre enero de 2000 y diciembre de 2001 al Instituto Nacional de Salud, (Lima, Perú. Resultados: La prueba se realizó únicamente en 46 muestras, 33% (15/46 fueron diagnosticados por histopatología como fiebre amarilla, de ellos, 9 casos fueron positivos por IHQ para fiebre amarilla, siendo 2 de ellos también positivos para HBsAg. Histológicamente, se reportaron 6 casos como hepatitis con necrosis submasiva o masiva, que por IHQ fueron sólo 2 casos positivos para fiebre amarilla. En 39% (18/46 no se llegó al diagnóstico etiológico de la hepatitis, y finalmente hubo 2 casos con diagnóstico histopatológico de ádenocarcinoma hepático y sólo se obtuvo positividad por IHQ para HBsAg en uno. Conclusión: La IHQ es una alternativa para la confirmación diagnóstica de hepatitis B y fiebre amarilla.

  12. Inversión extranjera directa, movilidad laboral y derrames de conocimiento en Costa Rica Foreign direct investment, labor mobility and knowledge spillovers in Costa Rica

    Directory of Open Access Journals (Sweden)

    Ricardo Monge González

    2012-11-01

    Full Text Available Este trabajo busca determinar la existencia e importancia de los derrames de conocimiento asociados con la movilidad laboral desde las multinacionales (MNCS que operan bajo el régimen de zonas francas (ZF en Costa Rica; es decir, el impacto de tales derrames de conocimiento sobre el desempeño de las empresas locales que contratan ex empleados de MNCS. Se observó que, de un total de 41 149 empleados de MNCS que dejaron de laborar para estas empresas entre el 2001 y el 2007, un tercio se trasladó a empresas locales (15 139. El impacto de los derrames de conocimiento sobre el desempeño de empresas locales se midió en términos de tres variables: ventas, empleo y productividad media del trabajo; para esto se empleó un panel de empresas locales para el periodo que va del 2007 al 2009. Mediante el empleo de modelos econométricos sugeridos por la literatura en este campo, se encontró evidencia de que las empresas locales que han contratado ex empleados de MNCS obtienen un mejor desempeño en términos de crecimiento de sus ventas y empleo, que aquellas empresas locales que no contratan ex empleados de MNCS. Es decir, se obtuvo una clara evidencia de la externalidad positiva asociada con los derrames de conocimiento para Costa Rica, producto de la movilidad laboral desde las MNCS. No se encontró esta evidencia cuando el desempeño de las empresas locales se mide en términos de la productividad media del trabajador. Finalmente, los resultados señalan la importancia de llevar a cabo nuevas investigaciones sobre la capacidad de absorción de las empresas locales para potenciar más los impactos positivos de los derrames de conocimiento, así como respecto al impacto de tales derrames sobre la productividad total de los factores.This paper aims to determine the existence of knowledge spillovers associated to labor mobility from multinational companies (MNCS operating in Costa Rica. That is, the impact of such knowledge spillovers over the

  13. Epidemiología molecular de la fiebre amarilla en Colombia: análisis filogenético

    OpenAIRE

    Jorge Boshell; D. Calvache; Bernal, M.P.; Méndez, Jairo A.

    2004-01-01

    El virus de la fiebre amarilla pertenece a la familia Flaviviridae, género Flavivirus, y es el responsable de una enfermedad hemorrágica aguda que aún hoy en día afecta a más de 200.000 personas al año en regiones tropicales de África y Suramérica. El virus puede ser transmitido de un humano infectado a un humano susceptible por el mosquito doméstico Aedes aegypti o de primates no humanos a primates humanos por...

  14. «Epidemia»: Un repaso a la fiebre hemorrágica por Ébola

    Directory of Open Access Journals (Sweden)

    José Francisco CAMACHO AGUILERA

    2016-04-01

    Full Text Available A través de la película Outbreak (1995 de Wolfgang Peterson, se repasan en este artículo a la fiebre hemorrágica por Ébola, dado su gran parecido con la enfermedad ficticia creada en esta película producida por el virus Motaba. Se presenta una revisión de la historia, las características del virus, transmisión del virus, las manifestaciones clínicas, el diagnóstico, la mortalidad, el tratamiento y la prevención, contrastándose con lo presentado en la película. Finalmente, se muestran los niveles de bioseguridad para el manejo de los agentes infecciosos

  15. Epidemiología molecular de la fiebre amarilla en Colombia: análisis filogenético

    OpenAIRE

    Jorge Boshell; D. Calvache; Bernal, M.P.; Méndez, Jairo A.

    2004-01-01

    El virus de la fiebre amarilla pertenece a la familia Flaviviridae, género Flavivirus, y es el responsable de una enfermedad hemorrágica aguda que aún hoy en día afecta a más de 200.000 personas al año en regiones tropicales de África y Suramérica. El virus puede ser transmitido de un humano infectado a un humano susceptible por el mosquito doméstico Aedes aegypti o de primates no humanos a primates humanos por...

  16. Correlación clínica-ecocardiográfica-hemodinámica en los pacientes con derrame pericárdico severo sometidos a pericardiocentesis

    OpenAIRE

    Sánchez Hidalgo, Antonio

    2013-01-01

    Introducción: El taponamiento cardiaco es el síndrome causado por la compresión del corazón por el derrame pericárdico a tensión. Previamente a la introducción del ecocardiograma solo se reconocían los taponamientos que tenían una clara repercusión clínica y que, por tanto, eran los más severos. Asimismo, la pericardiocentesis con monitorización de las presiones intrapericárdicas e intracavitarias ha permitido identificar grados de taponamiento poco severos que no se reconocen clínicamente...

  17. El caso de derrame de mercurio en Choropampa y los daños a la salud en la población rural expuesta

    OpenAIRE

    2009-01-01

    El año 2000, un derrame de mercurio metálico que se evaporó en el ambiente, afectó la salud de más de mil campesinos, quienes, ocho años después, siguen sufriendo las consecuencias en su salud. La minería moderna no garantiza adecuados mecanismos de manejo, control y mitigación del impacto ambiental y la autoridad pública no otorga el derecho a la salud de poblaciones de los entornos mineros las cuales, desde el punto de vista del derecho a la salud ambiental, debieran ser consideradas como s...

  18. Correlación clínica-ecocardiográfica-hemodinámica en los pacientes con derrame pericárdico severo sometidos a pericardiocentesis

    OpenAIRE

    Sánchez Hidalgo, Antonio

    2012-01-01

    Introducción: El taponamiento cardiaco es el síndrome causado por la compresión del corazón por el derrame pericárdico a tensión. Previamente a la introducción del ecocardiograma solo se reconocían los taponamientos que tenían una clara repercusión clínica y que, por tanto, eran los más severos. Asimismo, la pericardiocentesis con monitorización de las presiones intrapericárdicas e intracavitarias ha permitido identificar grados de taponamiento poco severos que no se reconocen clínicamente...

  19. [Contribution of pleural fluid analysis to the diagnosis of pleural effusion].

    Science.gov (United States)

    Ferreiro, Lucía; Toubes, María Elena; Valdés, Luis

    2015-08-21

    Analysis of pleural fluid can have, on its own, a high diagnostic value. In addition to thoracocentesis, a diagnostic hypothesis based on medical history, physical examination, blood analysis and imaging tests, the diagnostic effectiveness will significantly increase in order to establish a definite or high probable diagnosis in a substantial number of patients. Differentiating transudates from exudates by the classical Light's criteria helps knowing the pathogenic mechanism resulting in pleural effusion, and it is also useful for differential diagnosis purposes. An increased N-terminal pro-brain natriuretic peptide, both in the fluid and in blood, in a due clinical context, is highly suggestive of heart failure. The presence of an increased inflammatory marker, such as C-reactive protein, together with the presence of over 50% of neutrophils is highly suggestive of parapneumonic pleural effusion. If, in these cases, the pH is 45 U/L and>50% lymphocytes is suggestive of tuberculosis. If a malignant effusion is suspected but the cytological result is negative, increased concentrations of some markers in the pleural fluid can yield high specificity values. Increased levels of mesothelin and fibruline-3 are suggestive of mesothelioma. Immunohistochemical studies can be useful to differentiate reactive mesothelial cells, mesothelioma and metastatic adenocarcinoma. An inadequate use of the information provided by the analysis of pleural fluid would results in a high rate of undiagnosed effusions, which is unacceptable in current clinical practice.

  20. "Fluid color" sign: a useful indicator for discrimination between pleural thickening and pleural effusion.

    Science.gov (United States)

    Wu, R G; Yang, P C; Kuo, S H; Luh, K T

    1995-10-01

    Color Doppler imaging has been applied traditionally in the evaluation of cardiovascular diseases. Recently it was observed that color signal may appear within the fluid collection in the pleural space during respiratory and cardiac cycles ("fluid color sign"). We performed this applicability of fluid color sign to the detection of pleural fluid capable of being removed to assess needle aspiration. From July 1992 to February 1994, we prospectively analyzed 76 patients who were suspected of having minimal pleural effusion on the basis of their chest radiographs. All patients were examined by color Doppler ultrasonography for the presence of fluid color sign, which was followed by needle aspiration to verify the presence of pleural effusion. Among the 65 patients with aspiratable fluid, 58 demonstrated positive fluid color sign (sensitivity 89.2%). None of the patients with solid pleural thickening showed fluid color sign (specificity 100%). With its relatively high sensitivity and specificity, the fluid color sign may be a useful diagnostic aid to real-time, gray scale ultrasonography for minimal or loculated effusion.

  1. Pleural Fluid Pentraxin-3 for the Differential Diagnosis of Pleural Effusions

    Science.gov (United States)

    Yeo, Chang Dong; Kim, Jin Woo; Cho, Mi Ran; Kang, Ji Young; Kim, Young Kyoon; Lee, Sang Haak; Park, Chan Kwon; Kim, Sang Ho; Park, Mi Sun; Yim, Hyeon Woo; Park, Jong Y.

    2013-01-01

    Background Conventional biomarkers cannot always establish the cause of pleural effusions; thus, alternative tests permitting rapid and accurate diagnosis are required. The primary aim of this study is to assess the ability of pentraxin-3 (PTX3) in order to diagnose the cause of pleural effusion and compare its efficacy to that of other previously identified biomarkers. Methods We studied 118 patients with pleural effusion, classified as transudates and exudates including malignant, tuberculous, and parapneumonic effusions (MPE, TPE, and PPE). The levels of PTX3, C-reactive protein (CRP), procalcitonin (PCT) and lactate in the pleural fluid were assessed. Results The levels of pleural fluid PTX3 were significantly higher in patients with PPE than in those with MPE or TPE. PTX3 yielded the most favorable discriminating ability to predict PPE from MPE or TPE by providing the following: area under the curve, 0.74 (95% confidence interval, 0.63-0.84), sensitivity, 62.07%; and specificity, 81.08% with a cut-off point of 25.00 ng/mL. Conclusion Our data suggests that PTX3 may allow improved differentiation of PPE from MPE or TPE compared to the previously identified biomarkers CRP and PCT. PMID:24416055

  2. A study to compare the diagnostic efficacy of closed pleural biopsy with that of the thoracoscopic guided pleural biopsy in patients of pleural effusion

    Science.gov (United States)

    Mishra, Ashwini Kumar; Verma, Sanjeev Kumar; Kant, Surya; Kushwaha, Ram Awadh; Garg, Rajiv; Kumar, Santosh; Prakash, Ved; Verma, Ajay; Sagar, Mala

    2016-01-01

    Background: The diagnostic approach to exudative pleural effusion remains an underappreciated aspect of modern thoracic medicine. 15-20% of the pleural effusions remain undiagnosed. The most efficient approach to pleural exudates remains uncertain and controversial particularly if acquisition of pleural tissue is required. The clinician needs to consider various factors when confronted with the choice between closed pleural biopsy (CPB) and thoracoscopy. Hence this study was planned to compare the diagnostic efficacy of CPB and Thoracoscopic pleural biopsy (TPB). Materials and Methods: This was a prospective interventional study in patients of exudative pleural effusion. CPB was performed by Cope's biopsy needle. Then inspection of the pleural cavity was performed by single port rigid thoracoscope (KARL, STORZ TELECAM DX II 20 2330 20) with viewing angle of zero (0) degrees and biopsy taken from the diseased or unhealthy parietal pleura. Accordingly we compared the results of CPB and TPB. Results: 46 Patients underwent this study. In all 46 patients both CPB and TPB were performed. TPB was diagnostic in 36 cases (78.2%) while CPB was diagnostic only in 10 cases i.e. 21.7%. 10 (21,7%) cases remained undiagnosed. On thoracoscopic examination 30 patients were having nodularity, 25 (54.3%) were having adhesions and 20 (43.5%) were having hyperemia. 79.3% of the patients with nodularity turned out to be malignant and 71.4% of patients with adhesions and hyperemia tubercular. Conclusions: TPB has much greater diagnostic efficacy than CPB. PMID:27169119

  3. Incremento del valor calórico del bagazo a partir de su empleo en derrames de hidrocarburos

    Directory of Open Access Journals (Sweden)

    Adolfo Brown-Gómez

    2015-01-01

    Full Text Available Se realizó un estudio con bagazo integral a la salida del tándem de la empresa azucarera “Héctor Molina” ”para evaluar sus potencialidades como material adsorbente con prestaciones en el control para derrames de hidrocarburos que pueden producirse como resultado de las deficiencias operacionales en las empresas azucareras. Para un bagazo con una densidad aproximada de 80 kg/m3, se evaluó la incidencia del contenido de humedad y la granulometría de la fibra en su capacidad de adsorción. Los resultados alcanzados indican que la humedad promedio del bagazo integral oscila alrededor de 47,63 % a la salida del tándem y que el valor más efectivo pertenece al tamiz de 3,15 mm, donde el 55,85 % del bagazo logra pasar, demostrando así el alto grado de preparación que recibe la caña en los molinos o tándem de ese central. De igual forma se comprobó la incidencia de los contenidos de humedad de la fibra en la adsorción de hidrocarburos, donde el bagazo con un contenido promedio de humedad de 31,57 % es capaz de adsorber 4,94 g hidrocarburo/ g bagazo, valores que se incrementan cuando el contenido de humedad promedio es de 11,48 % hasta 5,68 g hidrocarburo/g bagazo. Se demostró que no se existe una proporcionalidad directa entre la reducción del contenido de humedad y los niveles de adsorción, sobre el cual inciden también, otros aspectos como la viscosidad del hidrocarburo.

  4. [Autopsy case of sarcomatoid malignant pleural mesothelioma].

    Science.gov (United States)

    Ogura, Hiromi; Naoki, Katsuhiko; Togashi, Ikuko; Kunikane, Hiroshi; Okamoto, Hiroaki; Hida, Naoya; Narita, Yuusuke; Kase, Masahiro; Oosawa, Hiroshi; Oomori, Takahiro; Watanabe, Koshiro

    2006-10-01

    A 61-year-old man with a sensation of chest compression was admitted to our hospital. He had hemothorax. After drainage with a chest tube, chest CT scan revealed multiple bilateral pulmonary nodules with slight pleural thickening. Open pleural biopsy was performed and the biopsy specimens showed tumor cells with sarcomatoid proliferation, but no definite epithelial pattern. Initial immunohistochemical staining was negative for keratin and carletinin, but positive for desmin, suggesting rhabdomyosarcoma. After supportive care, he died due to progression of the disease. Autopsy revealed extensive invasion suggesting mesothelioma, so the immunohistochemical staining was repeated. Because it revealed patchy staining for keratin and carletinin, this case was diagnosed as sarcomatoid mesothelioma. Differential diagnosis of sarcomatoid mesothelioma or rhabdomyosarcoma is made by immunohistochemical staining, but it is sometimes difficult. For the selection of the best treatment strategy for mesothelioma especially in the early stage, we should be aware of this difficulty.

  5. ASBESTOS EXPOSURE AND SARCOMATOID MALIGNANT PLEURAL MESOTHELIOMA

    Directory of Open Access Journals (Sweden)

    Gorantla

    2014-05-01

    Full Text Available Malignant pleural mesothelioma (MPM is commonly associated with documented asbestos exposure. The mean interval between exposure and death is around 40 years. Sarcomatoid mesothelioma is the least common form of MPM. It is more aggressive and associated with worst prognosis. Adequate sampling is important for accurate diagnosis. Both VATS and image guided core needle biopsy have higher diagnostic yield compared to the closed pleural biopsy. IHC markers are used as an adjunct to tumour histopathology. The primary treatment options for sarcomatoid type are surgery, chemotherapy and radiotherapy. Median survival for patients with sarcomatoid tumours is typically less than six months. Patients in whom the diagnosis is made early have a survival benefit from multimodality therapeutic approach.

  6. Eosinophilic Pleural Effusion: A Rare Manifestation of Hypereosinophilic Syndrome

    Directory of Open Access Journals (Sweden)

    Ndubuisi C. Okafor

    2009-01-01

    Full Text Available Several causes of eosinophilic pleural effusions have been described with malignancy being the commonest cause. Hypereosinophilic syndrome (HES is a rare disease and very few cases have been reported of HES presenting as eosinophilic pleural effusion (EPE. We report a case of a 26-year-old male who presented with shortness of breath. He had bilateral pleural effusions, generalized lymphadenopathy, splenomegaly, and leukocytosis with marked peripheral blood eosinophilia. The pleural fluid was exudative, with 25%–30% eosinophilis, and absence of neoplastic cells. Hypereosinophilic syndrome was diagnosed after other causes of eosinophilia were excluded. He continued to be dyspneic with persistent accumulation of eosinophilic pleural fluid, even after his peripheral eosinophil count had normalized in response to treatment. This patient represents a very unusual presentation of HES with dyspnea and pleural effusions and demonstrates that treatment based on response of peripheral eosinophil counts, as is currently recommended, may not always be clinically adequate.

  7. Isolated pleural metastases from renal cell carcionoma

    DEFF Research Database (Denmark)

    Eckardt, Jens; Ladegaard, Lars; Licht, Peter Bjorn

    2011-01-01

    A 71-year-old female was referred with three right-sided intrathoracic tumours. In 2003, she underwent radical left nephrectomy for renal cell cancer (RCC) clinical stage 1. She was since followed at her local hospital with annual computed tomography (CT)-scans during the first five years and did....... Histology demonstrated metastases from RCC which apparently can reach the parietal pleura without lung metastases. Keywords: Pleural metastasis; Renal cell cancer....

  8. Asbestos Burden Predicts Survival in Pleural Mesothelioma

    OpenAIRE

    Christensen, Brock C; Roelofs, Cora R.; Longacker, Jennifer L.; Marsit, Carmen J; Nelson, Heather H.; Kelsey, Karl T.; Godleski, John Joseph; Bueno, Raphael; Sugarbaker, David John

    2008-01-01

    Background: Malignant pleural mesothelioma (MPM) is a rapidly fatal asbestos-associated malignancy with a median survival time of < 1 year following diagnosis. Treatment strategy is determined in part using known prognostic factors. Objective: The aim of this study was to examine the relationship between asbestos exposure and survival outcome in MPM in an effort to advance the understanding of the contribution of asbestos exposure to MPM prognosis. Methods: We studied incident cases of MPM...

  9. [Pulmonary, pleural and pericardial manifestations of rickettsiosis].

    Science.gov (United States)

    Piéron, R; Lesobre, B; Mafart, Y; Meyniel, D; Coppin, M

    1976-01-01

    The authors report four observations of rickettsioses with R. conori (3 cases) or R. mooseri (1 case) with pericardial, pleural or pulmonary manifestations (2 cases). On this occasion, they recall that diagnosis of rickettsiosis can only be made on precise conditions: compatible clinical syndrome, significantly increasing then decreasing antibodies level, negative bacteriological and viral investigations and effectiveness of particular antibiotics. They also recall the main characteristics of pericardites, pleurisies, and pneumopathies produced by rickettsiae, probably more frequently than previously thought.

  10. The Pleural Mesothelium in Development and Disease

    Directory of Open Access Journals (Sweden)

    Hitesh eBatra

    2014-08-01

    Full Text Available The pleural mesothelium, derived from the embryonic mesoderm, is formed by a metabolically active monolayer of cells that blanket the chest wall and lungs on the parietal and visceral surfaces, respectively. The pleura and lungs are formed as a result of an intricate relationship between the mesoderm and the endoderm during development. Pleural Mesothelial Cells (PMCs are known to express Wilms tumor-1 (Wt1 gene and in lineage labeling studies of the developing embryo, PMCs were found to track into the lung parenchyma and undergo mesothelial-mesenchymal transition (MMT to form α-smooth muscle actin (α-SMA-positive cells of the mesenchyme and vasculature. There is definite evidence that mesothelial cells can differentiate and this seems to play an important role in pleural and parenchymal pathologies. Mesothelial cells can differentiate into adipocytes, chondrocytes and osteoblasts; and have been shown to clonally generate fibroblasts and smooth muscle cells in murine models. This supports the possibility that they may also modulate lung injury-repair by re-activation of developmental programs in the adult reflecting an altered recapitulation of development, with implications for regenerative biology of the lung.

  11. Management of Parapneumonic Pleural Effusion in Adults.

    Science.gov (United States)

    Ferreiro, Lucía; San José, María Esther; Valdés, Luis

    2015-12-01

    Pleural infections have high morbidity and mortality, and their incidence in all age groups is growing worldwide. Not all infectious effusions are parapneumonic and, in such cases, the organisms found in the pleural space are not the same as those observed in lung parenchyma infections. The diagnostic difficulty lies in knowing whether an infectious effusion will evolve into a complicated effusion/empyema, as the diagnostic methods used for this purpose provide poor results. The mainstays of treatment are to establish an early diagnosis and to commence an antibiotic regimen and chest drain as soon as possible. This should preferably be carried out with fine tubes, due to certain morphological, bacteriological and biochemical characteristics of the pleural fluid. Fluid analysis, particularly pH, is the most reliable method for assessing evolution. In a subgroup of patients, fibrinolytics may help to improve recovery, and their combination with DNase has been found to obtain better results. If medical treatment fails and surgery is required, video-assisted thoracoscopic surgery (VATS) is, at least, comparable to decortication by thoracotomy, so should only undertaken if previous techniques have failed. Further clinical trials are needed to analyze factors that could affect the results obtained, in order to define new evidence-based diagnostic and therapeutic strategies that provide more effective, standardized management of this disease. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  12. Diagnosis and treatment of malignant pleural mesothelioma.

    Science.gov (United States)

    Rodríguez Panadero, Francisco

    2015-04-01

    There are three major challenges in the diagnosis of malignant pleural mesothelioma: mesothelioma must be distinguished from benign mesothelial hyperplasia; malignant mesothelioma (and its subtypes) must be distinguished from metastatic carcinoma; and invasion of structures adjacent to the pleura must be demonstrated. The basis for clarifying the first two aspects is determination of a panel of monoclonal antibodies with appropriate immunohistochemical evaluation performed by highly qualified experts. Clarification of the third aspect requires sufficiently abundant, deep biopsy material, for which thoracoscopy is the technique of choice. Video-assisted needle biopsy with real-time imaging can be of great assistance when there is diffuse nodal thickening and scant or absent effusion. Given the difficulties of reaching an early diagnosis, cure is not generally achieved with radical surgery (pleuropneumonectomy), so liberation of the tumor mass with pleurectomy/decortication combined with chemo- or radiation therapy (multimodal treatment) has been gaining followers in recent years. In cases in which surgery is not feasible, chemotherapy (a combination of pemetrexed and platinum-derived compounds, in most cases) with pleurodesis or a tunneled pleural drainage catheter, if control of pleural effusion is required, can be considered. Radiation therapy is reserved for treatment of pain associated with infiltration of the chest wall or any other neighboring structure. In any case, comprehensive support treatment for pain control in specialist units is essential: this acquires particular significance in this type of malignancy. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  13. Alveolar‐filling growth pattern of sarcomatoid malignant pleural mesothelioma

    OpenAIRE

    Hayakawa, Takamitsu; Tajima, Shogo; Takanashi, Yusuke; Takahashi, Tsuyoshi; Neyatani, Hiroshi; Funai, Kazuhito

    2016-01-01

    A case of sarcomatoid malignant pleural mesothelioma showing extremely rare growth pattern is described. A 63‐year‐old man presented to our hospital with left pleural effusion. A computed tomography (CT) scan of the chest showed diffusely thickened left visceral and parietal pleura associated with intermingled pulmonary infiltrative shadowing. Biopsy of the pleura under general anaesthesia confirmed the diagnosis of sarcomatoid malignant pleural mesothelioma. The patient underwent left extra‐...

  14. Pleural vasculitides of microscopic polyangiitis with asbestos‐related plaques

    OpenAIRE

    Hara, Ayako; Kinoshita, Yoshinori; Hosoi, Keita; Okumura, Yoshitomo; Song, Misa; Min, Kyongyob

    2015-01-01

    Abstract A 69‐year‐old man who had been exposed to asbestos for approximately 40 years presented with the complaint of fever and pleuritic chest pain on the right side on deep inspiration. Chest X‐ray films showed pleural effusion in the right side. Initial antibiotic treatment was ineffective. The hyaluronic acid level was high in the pleural effusion but no malignant mesotheliomal cells were seen with blind pleural biopsy. Blood chemistry showed a remarkable high titer of myeloperoxidase an...

  15. Brote de fiebre amarilla selvática en Colombia 2004

    Directory of Open Access Journals (Sweden)

    Pilar Bernal M.

    2004-03-01

    Full Text Available

    Antecedentes: el 9 de enero se confirma un caso de fiebre amarilla en la sierra nevada de Santa Marta cuya circulación viral es la continuación de la presentada en el 2003 en la región del Catatumbo. En la región no se confirmaban casos desde el año 1979 y el comportamiento del brote es similar al presentado en dicho año.

    Metodología: estudio descriptivo longitudinal de casos captados mediante vigilancia activa comunitaria, estudio de casos y vigilancia pasiva. Los casos son confirmados por IgM, inmunohistoquímica y patología. Se realizaron acciones del fortalecimiento de la vigilancia de febriles icterohemorrágicos, entomológica, vectorial y de epizootias. Igualmente acciones de intensificación de la inmunización de susceptibles y educación a la comunidad.

    Resultados: se confirmó la circulación del virus en epizootias ocurridas en tres zonas de la región (Municipios de Valledupar, La Paz y Santa Marta. Por fecha de inicio de síntomas los casos comenzaron en la semana 51 de 2003 y el pico epidémico fue en la semana 1 de 2004; el último caso se confirmó el 22 de enero de 2004. Se confirmaron 29 casos de 787 notificados (15 del distrito de Santa Marta, 8 del departamento del Cesar y 6 de La Guajira; 20% de los casos fueron captados por vigilancia activa. El 28% fue confirmado por patología e inmunohistoquímica y el restante por IgM. El grupo de edad con mayor incidencia fue 15 a 44 años (75%, hombres (72% y agricultores (45%. La letalidad fue 28%.

    La vigilancia entomológica reportó la presencia de Sabethes s.p en Valledupar y los índice médicos, excepto en esta última ciudad, fueron mayores del 10%. Las coberturas de

  16. The utility of ultrasound-guided thoracentesis and pleural biopsy in undiagnosed pleural exudates.

    Science.gov (United States)

    Koegelenberg, Coenraad Frederik N; Irusen, Elvis Malcom; von Groote-Bidlingmaier, Florian; Bruwer, Johannes Willem; Batubara, Enas Mansour A; Diacon, Andreas Henri

    2015-10-01

    We assessed the utility of ultrasound to guide the selection of closed pleural biopsy technique and site and to assess the respective contributions of repeat thoracentesis and closed pleural biopsy in 100 consecutive patients with undiagnosed pleural exudates. Thoracentesis was more likely to be diagnostic in TB than malignancy (77.8% vs 31.0%, p<0.001). The addition of ultrasound-guided biopsy increased the combined yield for all diagnoses from 48.0% to 90.0% (p<0.001), for malignancy from 31.0% to 89.7% (p<0.001) and for TB from 77.8% to 88.9% (p=0.688). Our findings suggest that this minimally invasive approach has a high diagnostic yield. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  17. Toracocentese e biópsia pleural Thoracentesis and pleural biopsy

    Directory of Open Access Journals (Sweden)

    Roberta Sales

    2006-08-01

    Full Text Available A toracocentese é o método de escolha para a obtenção de amostras de líquido pleural. Embora seja considerado um procedimento pouco invasivo, é fundamental que a toracocentese obedeça a uma técnica padronizada com a finalidade de aprimorar a chance de diagnóstico e minimizar riscos. A biópsia de pleura tem por objetivo ampliar e complementar a chance de diagnóstico das doenças pleurais, sendo indicada em casos selecionados.Thoracentesis is the method of choice for obtaining samples of pleural fluid. Although it is considered a minimum invasive procedure, it is crucial to follow a standardized technique with the purpose of optimizing the chance of diagnosis and minimizing risks. The pleura biopsy may enlarge and complement the chance of diagnosis of the pleural diseases and is indicated in selected cases.

  18. Soluble mesothelin-related protein in pleural effusion from patients with malignant pleural mesothelioma.

    Science.gov (United States)

    Fujimoto, Nobukazu; Gemba, Kenichi; Asano, Michiko; Wada, Sae; Ono, Katsuichiro; Ozaki, Shinji; Kishimoto, Takumi

    2010-03-01

    Malignant pleural mesothelioma (MPM) is a highly aggressive neoplasm primarily arising from surface serosal cells of the pleura and is strongly associated with asbestos exposure. Patients with MPM often develop pleural fluid as initial presentation. However, cytological diagnosis using pleural fluid is usually difficult and has limited utility. A useful molecular marker for differential diagnosis particularly with lung cancer (LC) is urgently needed. The aim of the present study was to investigate the diagnostic value of soluble mesothelin-related protein (SMRP) in pleural fluid. Pleural fluids were collected from 23 patients with MPM, 38 with LC, 26 with benign asbestos pleurisy (BAP), 5 with tuberculosis pleurisy (TP) and 4 with chronic heart failure (CHF), and the SMRP concentration was determined. All data were analyzed by using non-parametric two-sided statistical tests. The median concentration of SMRP in MPM, LC, BAP, TP and CHF were 11.5 (range 0.90-82.80), 5.20 (0.05-36.40), 6.65 (1.45-11.25), 3.20 (1.65-6.50) and 2.03 (1.35-2.80) nmol/l, respectively. The SMRP concentration was significantly higher in MPM than in the other diseases (P=0.001). The area under the ROC curve (AUC) values of the MPM diagnosis was 0.75 for the differential diagnosis from the other groups. Based on the cut-off value of 8 nmol/l, the sensitivity and specificity for diagnosis of MPM were 70.0 and 68.4%, respectively. These results indicate that the SMRP concentration in pleural fluid is a useful marker for the diagnosis of MPM.

  19. Diffusion-weighted MR imaging of pleural fluid: differentiation of transudative vs exudative pleural effusions

    Energy Technology Data Exchange (ETDEWEB)

    Baysal, T.; Bulut, T.; Dusak, A.; Dogan, M. [Department of Radiology, Inoenue University School of Medicine, Turgut Oezal Medical Center, 44069, Malatya (Turkey); Goekirmak, M.; Kalkan, S. [Department of Pulmonary Diseases, Inoenue University School of Medicine, Turgut Oezal Medical Center, 44069, Malatya (Turkey)

    2004-05-01

    The aim of this study was to evaluate the ability of diffusion-weighted MRI in differentiating transudative from exudative pleural effusions. Fifty-seven patients with pleural effusion were studied. Diffusion-weighted imaging (DWI) was performed with an echo-planar imaging (EPI) sequence (b values 0, 1000 s/mm{sup 2}) in 52 patients. The apparent diffusion coefficient (ADC) values were reconstructed from three different regions. Subsequently, thoracentesis was performed and the pleural fluid was analyzed. Laboratory results revealed 20 transudative and 32 exudative effusions. Transudates had a mean ADC value of 3.42{+-}0.76 x 10{sup -3} mm{sup 2}/s. Exudates had a mean ADC value of 3.18{+-}1.82 x 10{sup -3} mm{sup 2}/s. The optimum cutoff point for ADC values was 3.38 x 10{sup -3} mm{sup 2}/s with a sensitivity of 90.6% and specificity of 85%. A significant negative correlation was seen between ADC values and pleural fluid protein, albumin concentrations and lactate dehydrogenase (LDH) measurements (r=-0.69, -0.66, and -0.46, respectively; p<0.01). The positive predictive value, negative predictive value, and diagnostic accuracy of ADC values were determined to be 90.6, 85, and 88.5%, respectively. The application of diffusion gradients to analyze pleural fluid may be an alternative to the thoracentesis. Non-invasive characterization of a pleural effusion by means of DWI with single-shot EPI technique may obviate the need for thoracentesis with its associated patient morbidity. (orig.)

  20. Vascular endothelial growth factor in diagnosis of pleural effusion

    Directory of Open Access Journals (Sweden)

    Nasr H. Khalil

    2017-01-01

    Conclusion: VEGF pleural fluid level could differentiate between malignant and non malignant effusion, while could not differentiate between tuberculous and nontuberculous, or between parapneumonic and nonparapneumonic exudative effusions.

  1. Eosinophilia in Pleural Effusions: a Speculative Negative Predictor for Malignancy.

    Science.gov (United States)

    Chu, Fang-Yeh; Liou, Ching-Biau; Sun, Jen-Tang; Bei, Chia-Hao; Liou, Tse-Hsuan; Tan, N-Chi; Yu, Yun-Chieh; Chang, Chih-Chun; Yen, Tzung-Hai; Su, Ming-Jang

    2016-01-01

    Eosinophilic pleural effusion (EPE) is an eosinophil count more than 10% on cytology of pleural samples. Recently, it was reported that malignancy had been the most prevalent cause inducing EPE. Therefore, we conducted an analysis on the prevalence and etiology of EPE and investigated the relationship between EPE and malignancy. Data for pleural cell differential count from patients receiving thoracentesis during the period from January 2008 to December 2013 were compared with clinical data and established diagnosis of patients obtained via electronic chart review. A total of 6,801 requests of pleural cytology from 3,942 patients with pleural effusion who had received thoracentesis were available at Far Eastern Memorial Hospital from 2008 to 2013, and of these subjects, 115 (2.9%) were found to have EPE. The most frequent cause of EPE was malignancy (33.0%, n=38), followed by parapneumonic effusions (27.8%, n=32), tuberculosis pleuritis (13.9%, n=16), transudate effusions (12.2%, n=14) and the presence of blood or air in pleural space (10.4%, n=12). Additionally, an inverse relationship of eosinophilia in pleural fluid was identified in patients with malignancy and EPE. The cut-off eosinophil count in pleural fluid was 15% for the most accurate discrimination between malignancy and benign disorders in patients with EPE. At the cut-off level, the sensitivity and specificity were 65.8% and 67.5%, respectively. Pleural fluid eosinophilia was a speculative negative predictor for malignancy, despite the fact that cancers, including lung cancers and metastatic cancers to lung, were the most leading cause of pleural fluid eosinophilia. An inverse correlation was observed between the pleural eosinophil percentage and the likelihood of malignancy in patients with EPE.

  2. Effect of aquaporin-q deletion on pleural fluid transport

    Institute of Scientific and Technical Information of China (English)

    JIANGJin-Jun; HONGQun-Ying; 等

    2003-01-01

    AIM:To investigate the role of aquaporin-1(AQP1)and sodium channel on pleural fluid transport.METHODS:Wild-type and AQP1 null mice were used in this study.After the mice were briefly anesthetized,0.25mL of hyperosmolar or isosmolar solution(containing terbutaline,amiloride or saline only)was infused into the pleural space.Then mice were sacrificed at scheduled times for measurement of pleural fluid osmolality or volume,RESULTS:After instillation of hyperosmolar fluid into the pleural space,the osmolality of pleural fluid in wild-type mice was higher than that in AQP1 null mice killed at the same time(1,2,5min).There was no difference in the isosmolar clearance between the wild-type and AQP1 null mice after injection of 0.25mL isosmolar fluid into the pleural space.Terbutaline increased the osmotic and isosmolar fluid transport across pleura,but these effects were not influenced by AQP1 dfeletion.In contrast,amiloride reduced osmotic and isosmolar pleural fluid transport and these effects were not influenced by AQP1 deletion.CONCLUSION;AQP1 water channels facilitated osmotic fluid transport across the pleural surface,However,AQP1 did not play an important role in pleural isosmolar fluid clearance.Sodium channel may play a role in osmotic and isosmolar pleural fluid transport.The effects of sodium channel on fluid transport across pleural space were not influenced by aquaporin-1 deletion.

  3. Epidemiología molecular de la fiebre amarilla en Colombia: análisis filogenético

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    Jorge Boshell

    2004-03-01

    Full Text Available

    El virus de la fiebre amarilla pertenece a la familia Flaviviridae, género Flavivirus, y es el responsable de una enfermedad hemorrágica aguda que aún hoy en día afecta a más de 200.000 personas al año en regiones tropicales de África y Suramérica. El virus puede ser transmitido de un humano infectado a un humano susceptible por el mosquito doméstico Aedes aegypti o de primates no humanos a primates humanos por vectores selváticos, principalmente del género Haemagogus spp. (1-5. La infección con el virus puede ser asintomática o cursar con fiebre moderada en 40% a 65% de los pacientes, hasta convertirse en una infección fatal fulminante caracterizada por postración, daño hepático, renal, cardíaco y choque en 35-60% de los casos; la letalidad en casos graves varía entre 20% y 50%.(1-2.

    Aunque el virus puede ser detectado mediante técnicas serológicas (MAC-ELISA o virológicas (aislamiento viral en células o en ratón (1,6, estos sistemas no ofrecen ninguna información acerca del origen epidemiológico de las cepas analizadas, ni ponen en evidencia relaciones genéticas inter-cepa; por esta razón y para mejorar la sensibilidad de la clasificación viral, hemos realizado un análisis filogenético de las cepas del virus fiebre amarilla que han circulado en nuestro país y que han generado brotes epidémicos durante el último año.

    Se procesaron 20 muestras de pacientes (incluyendo suero y tejido hepático con diagnóstico previo de fiebre amarilla, obtenidas entre el 1º de junio de 2003 y el 20 de enero de 2004 y 4 muestras obtenidas entre 1954 y 1973, las cuales fueron tratadas con Trizol LS para la extracción del ARN; mediante RT-PCR utilizando iniciadores previamente reportados (6, se amplificaron

  4. Pulmonary and pleural cysticercosis: a case report; Cisticercose pulmonar pleural: relato de um caso

    Energy Technology Data Exchange (ETDEWEB)

    Rodacki, Marco Antonio; Toni, Xisto A. de; Meira, Lisiane A.; Goncalves, Nelson L.; Oliveira, Godofredo G. [Hospital Santa Isabel, Blumenau, SC (Brazil); Toni, Guilherme de [Parana Univ., Curitiba, PR (Brazil). Faculdade de Medicina

    1995-07-01

    The authors report a case of disseminated cysticercosis involving the lungs, pleura, brain and subcutaneous tissues. Plain chest X-rays and chest computed tomography showed multiple round ill defined nodular lesions scattered through the lungs and pleural surface, identified as cystic lesions by ultrasound. Calcified cysticerci were visualized in the subcutaneous tissues of the arms and thorax at the plain chest X-rays. Biopsy of subcutaneous nodes was performed, which results revealed cysticercosis. Brain CT demonstrated multiple calcified intraparenchymatous lesions, associated with cystic lesions, compatible with cysticercosis. Due to the rarity of the lung involvement by cysticercosis, an open lung biopsy was performed with partial resection of the lingula and two cystic lesions, which anatomo-pathological results revealed pleural and pulmonary cysticercosis. The pleural and pulmonary involvement is extremely rare manifestation of a rather common disease, usually due to heavy infestation of Taenia solium larvae. As a far as we know, we did not see clear illustration of proved lung and pleural cysticercosis fully documented in the world literature. (author). 5 refs., 7 figs.

  5. Evidencia serológica de la presencia de Rickettsias del grupo de la fiebre manchada en la Amazonía del Perú

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    Moisés Sihuincha M

    2006-10-01

    Full Text Available Con el objetivo de demostrar la existencia de transmisión de Rickettsias del grupo de la fiebre manchada en la Amazonía peruana, se tomaron muestras de sangre a pacientes febriles agudos en establecimientos de salud de la ciudad de Iquitos, la ciudad más poblada de la Amazonía del Perú. Las muestras fueron procesadas mediante inmunofluorescencia indirecta para medir anticuerpos totales e IgG específica para el grupo de fiebre de las manchadas. Entre enero y julio de 2006, se obtuvieron muestras de 250 pacientes. El 37% de las muestras tuvieron títulos positivos de IgG, demostrando así haber tenido contacto con el agente, de ellas, nueve fueron clasificadas como casos agudos, en los que se descartó otras infecciones endémicas como dengue, malaria y leptospirosis. Los casos presentaron una enfermedad febril acompañada de síntomas como tos, sarpullido y hemoptisis. Cuatro casos fueron hospitalizados, dos fueron graves y uno de ellos falleció. En conclusión, existe evidencia serológica de la circulación de Rickettsias del grupo de las fiebre manchada en la Amazonía peruana, por su frecuencia y potencial gravedad debería ser tomada en cuenta como diagnóstico diferencial del síndrome febril agudo en esta región.

  6. Las fiebres manchadas y su importancia en Costa Rica Spotted fever and their importance in Costa Rica

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    Laya Hun-Opfer

    2008-06-01

    Full Text Available La Fiebre Manchada de la Montañas Rocosas es una zoonosis transmitida por garrapatas y causada por una bacteria intracelular obligatoria, la Rickettsia rickettsii. Es una enfermedad sistémica, de moderada a severa, producida por la infección del endotelio vascular de pequeños vasos de la mayoría de órganos y tejidos. Es la más letal de las infecciones transmitidas por garrapatas y desde su descubrimiento, hace cerca de 100 años, todavía se presenta, aunque esporádicamente, de forma persistente, y a pesar de que se cuenta con antibióticos efectivos, la mortalidad sigue siendo de mas del 10% y los pacientes requieren terapia intensiva durante la infección si esta no es diagnosticada y tratada a tiempo. En tiempo recientemente se han descrito otras especies de garrapatas que pueden transmitir rickettsias a humanos así como nuevas especies de rickettsias que pueden producir cuadros de fiebres manchadas y aunque se ha dilucidado parte de sus mecanismos patogénicos, persisten muchas dudas respecto a su virulencia. Desde 1975 se han reportado brotes de esta enfermedad en Costa Rica y el agente etiológico causal, la Rickettsia rickettsii, fue aislada e identificada en la mayoría de los casos en el Laboratorio de Virología de la Facultad de Microbiología de la Universidad de Costa Rica.Rocky Mountain Spotted fever is a tick vector disease caused by an obligated intracellular bacteria, Rickettsia rickettsii. It is a severe systemic illness caused by the infection of endothelial cells of small vessels of most organs and tissues of the human body. It is the most lethal tick-born disease and since its discovery more than 100 years ago it still appears sporadically, but persistently. Although there is treatment with effective antibiotics, mortality rates are near 10% and infected patients require intensive care when the illness is misdiagnosed and there is a delay in treatment. Other species of ticks and new species of rickettsia have been

  7. Investigación de un brote de fiebre de origen desconocido en una localidad colombiana del Caribe

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    José Laguado

    2005-12-01

    Full Text Available Objetivo. Realizar un estudio serológico de un brote de fiebre tropical de origen desconocido (FOD en una zona del departamento de Córdoba, donde hay agentes etiológicos comunes de la región como Plasmodium, Leptospira, Rickettsia, Salmonella, Brucella y Orienta. Materiales y métodos. En el municipio de Chimá (Córdoba se presentó un brote de FOD. Los casos se recopilaron de un grupo de 209 pacientes sintomáticos que asistieron a la consulta. De ellos, en 89 (42.6% se obtuvo información clínica, epidemiológica y exámenes paraclínicos. Para establecer la causa de la FOD, se hicieron estudios serológicos y de laboratorio para leptospirosis, dengue, salmonelosis, rickettsiosis, Orienta, brucelosis y malaria. Resultados. Los siguientes síntomas y signos se presentaron en 30.4% del total de la población estudiada: cefalea (66%, artralgias (40% fiebre y cefalea (62.9%. A pesar de serologías positivas para Rickettsia, Salmonella y Leptospira, se consideró que la causa de la FOD en la población fue una infección aguda producida por un flavivirus y que se sospechó como dengue. La positividad de anticuerpos anti-dengue IgM fue en 45% de los casos (40/89. La IgG se encontró en 89% de los pacientes antes negativos para IgM. Además, 44% de los pacientes fueron positivos para IgG e IgM; 30% de los casos se presentaron asociados con Leptospira (n=8, pero no se pudo determinar si estas infecciones fueron recientes o pasadas. Conclusión. Después de un estudio epidemiológico, serológico y de laboratorio de siete enfermedades tropicales, se estableció que el brote de FOD se debió presumiblemente al virus de dengue.

  8. Investigación de un brote de fiebre de origen desconocido en una localidad colombiana del Caribe.

    Directory of Open Access Journals (Sweden)

    José Laguado

    2009-11-01

    Full Text Available OBJETIVO: Realizar un estudio serológico de un brote de fiebre tropical de origen desconocido (FOD en una zona del departamento de Córdoba, donde hay agentes etiológicos comunes de la región como Plasmodium, Leptospira, Rickettsia, Salmonella, Brucella y Orienta. MATERIALES Y MÉTODOS: En el municipio de Chimá (Córdoba se presentó un brote de FOD. Los casos se recopilaron de un grupo de 209 pacientes sintomáticos que asistieron a la consulta. De ellos, en 89 (42.6% se obtuvo información clínica, epidemiológica y exámenes paraclínicos. Para establecer la causa de la FOD, se hicieron estudios serológicos y de laboratorio para leptospirosis, dengue, salmonelosis, rickettsiosis, Orienta, brucelosis y malaria. RESULTADOS: Los siguientes síntomas y signos se presentaron en 30.4% del total de la población estudiada: cefalea (66%, artralgias (40% fiebre y cefalea (62.9%. A pesar de serologías positivas para Rickettsia, Salmonella y Leptospira, se consideró que la causa de la FOD en la población fue una infección aguda producida por un flavivirus y que se sospechó como dengue. La positividad de anticuerpos anti-dengue IgM fue en 45% de los casos (40/89. La IgG se encontró en 89% de los pacientes antes negativos para IgM. Además, 44% de los pacientes fueron positivos para IgG e IgM; 30% de los casos se presentaron asociados con Leptospira (n=8, pero no se pudo determinar si estas infecciones fueron recientes o pasadas. CONCLUSIÓN: Después de un estudio epidemiológico, serológico y de laboratorio de siete enfermedades tropicales, se estableció que el brote de FOD se debió presumiblemente al virus de dengue.

  9. The clinical relevance of asbestos-induced pleural fibrosis

    Energy Technology Data Exchange (ETDEWEB)

    Schwartz, D.A. (Department of Internal Medicine, The University of Iowa, Iowa City, (United States))

    1991-12-31

    Asbestos-induced pleural fibrosis is the most common radiographic abnormality among asbestos-exposed persons. Circumscribed pleural plaques and diffuse pleural thickening account for more than 90% of the asbestos-induced chest wall abnormalities, and their prevalence is expected to increase for the next 15 to 20 years. Several investigators have recently found that pleural plaques and diffuse pleural thickening independently contribute to the development of restrictive lung function. The work presented in this paper indicates that asbestos-induced pleural fibrosis is also associated with evidence of interstitial lung abnormalities, even among those with normal parenchyma on chest X-ray film. These parenchymal abnormalities include an increased percentage of lymphocytes on bronchoalveolar lavage and an increase in the interstitial changes observed on high-resolution chest computerized tomography (HRCT) scan. However, neither a lymphocytic alveolitis nor an interstitial parenchymal fibrosis influenced the relationship between pleural fibrosis and restrictive lung function. We conclude that asbestos-induced pleural disease contributes to the development of restrictive lung function and identify a group of exposed individuals who are at excess risk of asbestosis.

  10. Pleural mesothelioma and venous thrombosis: the eosinophilia link

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    Aye Win

    2008-04-01

    Full Text Available Abstract Peripheral blood eosinophilia and vascular occlusions are rare occurrences in patients with pleural mesothelioma whereas eosinophilia may associate with thrombosis. We describe a patient with mesothelioma who developed peripheral blood eosinophilia followed by deep vein thrombosis despite being on low molecular weight heparin prophylaxis. We discuss the genesis of peripheral blood eosinophilia and thrombosis in pleural mesothelioma.

  11. The Differential Diagnostic Values of Cytokine Levels in Pleural Effusions

    Science.gov (United States)

    Akarsu, Saadet; Kurt, A. Nese Citak; Dogan, Yasar; Yilmaz, Erdal; Godekmerdan, Ahmet; Aygun, A. Denizmen

    2005-01-01

    The aim is to examine whether the changes in pleural fluid interleukin (IL)-1β, IL-2, IL-6, and IL-8 levels were significant in differential diagnosis of childhood pleural effusions. IL-1β, IL-2, IL-6, and IL-8 levels in pleural fluids of all 36 patients were measured. The levels of IL-1β, IL-2, IL-6, and IL-8 in pleural fluids were statistically significantly higher in the transudate group compared with those of the exudate group. The levels of IL-1β, IL-6, and IL-8 were also found to be statistically significantly higher in the empyema group compared with both the parapneumonic and the tuberculous pleural effusion groups. The levels of IL-2 and IL-6 were detected to be statistically significantly higher in the tuberculous pleural effusion group in comparison with those of the parapneumonic effusion group. The results showed that pleural fluids IL-1β, IL-2, IL-6, and IL-8 could be used in pleural fluids exudate and transudate distinction. PMID:15770060

  12. In vivo light dosimetry for pleural PDT

    Science.gov (United States)

    Dimofte, Andreea; Zhu, Timothy C.; Finlay, Jarod C.; Culligan, Melissa; Edmonds, Christine E.; Friedberg, Joseph S.; Cengel, Keith; Hahn, Stephen M.

    2009-02-01

    In-vivo light Dosimetry for patients undergoing photodynamic therapy (PDT) is one of the important dosimetry quantities critical for predicting PDT outcome. This study examines the light fluence (rate) delivered to patients undergoing pleural PDT as a function of treatment time, treatment volume and surface area, and its accuracy as a function of the calibration accuracies of each isotropic detector and the calibration integrating sphere. The patients studied here were enrolled in Phase II clinical trial of Photofrin-mediated PDT for the treatment of non-small cell lung cancer with pleural effusion. The ages of the patients studied varied from 34 to 69 year old. All patients were administered 2mg per kg body weight Photoprin 24 hours before the surgery. Patients undergoing photodynamic therapy (PDT) are treated with laser light with a light fluence of 60 J/cm^2 at 630nm. Fluence rate (mW/cm^2) and cumulative fluence (J/cm^2) was monitored at 7 different sites during the entire light treatment delivery. Isotropic detectors were used for in-vivo light dosimetry. The anisotropy of each isotropic detector was found to be within 30%. The mean fluence rate delivery varied from 37.84 to 94.05 mW/cm^2 and treatment time varied from 1762 to 5232s. We have established a correlation between the treatment time and the treatment volume. The results are discussed using an integrating sphere theory and the measured tissue optical properties. The result can be used as a clinical guideline for future pleural PDT treatment.

  13. Duodenal Metastasis of Malignant Pleural Mesothelioma

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    Huang-Chi Chen

    2008-12-01

    Full Text Available Metastatic malignant mesothelioma of the pleura is uncommon at the time of initial diagnosis. The gastrointestinal lumen is rarely found at autopsy in patients with widespread disease. Here, we describe an extremely rare case of isolated duodenal metastasis of sarcomatoid mesothelioma of the pleura in a 73-year-old man, without memory of any direct exposure to asbestos. The possibility of gastrointestinal tract metastasis should be considered in the presence of anemia or positive occult blood test in patients with malignant pleural mesothelioma.

  14. Alveolar-filling growth pattern of sarcomatoid malignant pleural mesothelioma.

    Science.gov (United States)

    Hayakawa, Takamitsu; Tajima, Shogo; Takanashi, Yusuke; Takahashi, Tsuyoshi; Neyatani, Hiroshi; Funai, Kazuhito

    2016-09-01

    A case of sarcomatoid malignant pleural mesothelioma showing extremely rare growth pattern is described. A 63-year-old man presented to our hospital with left pleural effusion. A computed tomography (CT) scan of the chest showed diffusely thickened left visceral and parietal pleura associated with intermingled pulmonary infiltrative shadowing. Biopsy of the pleura under general anaesthesia confirmed the diagnosis of sarcomatoid malignant pleural mesothelioma. The patient underwent left extra-pleural pneumonectomy. Histopathologically, the sarcomatoid spindle tumour cells changed their morphology to polygonal cells in the pulmonary parenchyma and grew upwards, filling the alveolar space without the destruction of its septa, showing an alveolar-filling growth pattern. The current report indicates a case of sarcomatoid pleural mesothelioma that shows an alveolar-filling growth pattern, despite having not been thoroughly categorized in the World Health Organization (WHO) classification.

  15. Pleural vasculitides of microscopic polyangiitis with asbestos-related plaques.

    Science.gov (United States)

    Hara, Ayako; Kinoshita, Yoshinori; Hosoi, Keita; Okumura, Yoshitomo; Song, Misa; Min, Kyongyob

    2015-12-01

    A 69-year-old man who had been exposed to asbestos for approximately 40 years presented with the complaint of fever and pleuritic chest pain on the right side on deep inspiration. Chest X-ray films showed pleural effusion in the right side. Initial antibiotic treatment was ineffective. The hyaluronic acid level was high in the pleural effusion but no malignant mesotheliomal cells were seen with blind pleural biopsy. Blood chemistry showed a remarkable high titer of myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) and open renal biopsy suggested crescentic glomerulonephritis. The precise pathological examination on the pleura obtained by the open pleural biopsy showed vasculitides and plaque leading to diagnosis of microscopic polyangiitis (MPA). This is a rare case of MPA seen in the pleural arteries.

  16. Recommendations of diagnosis and treatment of pleural effusion. Update.

    Science.gov (United States)

    Villena Garrido, Victoria; Cases Viedma, Enrique; Fernández Villar, Alberto; de Pablo Gafas, Alicia; Pérez Rodríguez, Esteban; Porcel Pérez, José Manuel; Rodríguez Panadero, Francisco; Ruiz Martínez, Carlos; Salvatierra Velázquez, Angel; Valdés Cuadrado, Luis

    2014-06-01

    Although during the last few years there have been several important changes in the diagnostic or therapeutic methods, pleural effusion is still one of the diseases that the respiratory specialist have to evaluate frequently. The aim of this paper is to update the knowledge about pleural effusions, rather than to review the causes of pleural diseases exhaustively. These recommendations have a longer extension for the subjects with a direct clinical usefulness, but a slight update of other pleural diseases has been also included. Among the main scientific advantages are included the thoracic ultrasonography, the intrapleural fibrinolytics, the pleurodesis agents, or the new pleural drainages techniques. Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.

  17. INVESTIGATION ON MODEL OF INFLAMMATORY PLEURAL EFFUSION IN GUINEA PIGS

    Institute of Scientific and Technical Information of China (English)

    冯源; 殷凯生; 王祥

    2002-01-01

    Objective To establish an animal model of inflammatory pleural effusion.Methods Forty guinea pigs were divided into two groups: experimental group with 7 subgroups and control group. In the experimental group the right chest cavity of each guinea pig was injected with 0.8~1.0 ml of 1% carrageenan, and guinea pigs of each subgroup were killed and observed respectively on day 1, 2, 3, 5, 7, 10 and day 14 after injection.Results Occurring on day 1(within 24 hours), pleural effusion reached the maximum on day 2~3 after injection, so did the neutrophil count in pleural effusion and inflammation of both pleura and lungs and then gradually decreased. The fibrosis and adhesion of pleura appeared on day 7 and were obvious on day 10. The encysted pleurisy was formed on day 14.Conclusion The carrageenan is an ideal pleural inflammatory inducer. This animal model is useful for studying pleural effusion.

  18. Pleural effusion: characterization with CT attenuation values and CT appearance.

    Science.gov (United States)

    Abramowitz, Yigal; Simanovsky, Natalia; Goldstein, Michael S; Hiller, Nurith

    2009-03-01

    The purpose of this study was to assess the utility of CT in characterizing pleural effusions on the basis of attenuation values and CT appearance. We retrospectively analyzed 100 pleural effusions in patients who underwent chest CT and diagnostic thoracentesis within 48 hours of each other. On the basis of Light's criteria, effusions were classified as exudates or transudates using laboratory biochemistry markers. The mean value in Hounsfield units of an effusion was determined using a region of interest on the three slices with the greatest quantity of fluid. All CT scans also were reviewed for the presence of additional pleural features such as fluid loculation, pleural thickening, and pleural nodules. Twenty-two of the 100 pleural effusions were transudates and 78 were exudates. The mean attenuation of the exudates (7.2 HU; [SD] 9.4 HU; range, 21-28 HU) was not significantly lower than the mean attenuation of the transudates (10.1 HU; 6.9 HU; range, 0.3-32 HU), (p = 0.24). None of the additional CT features accurately differentiated exudates from transudates (p > 0.1). Fluid loculation was found in 58% of exudates and in 36% of transudates. Pleural thickening was found in 59% of exudates and in 36% of transudates. The clinical use of CT attenuation values to characterize pleural fluid is not accurate. Although fluid loculation, pleural thickness, and pleural nodules were more commonly found in patients with exudative effusions, the presence of these features does not accurately differentiate between exudates and transudates.

  19. Pleural fluid cell-free DNA integrity index to identify cytologically negative malignant pleural effusions including mesotheliomas

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    Sriram Krishna B

    2012-09-01

    Full Text Available Abstract Background The diagnosis of malignant pleural effusions (MPE is often clinically challenging, especially if the cytology is negative for malignancy. DNA integrity index has been reported to be a marker of malignancy. The aim of this study was to evaluate the utility of pleural fluid DNA integrity index in the diagnosis of MPE. Methods We studied 75 pleural fluid and matched serum samples from consecutive subjects. Pleural fluid and serum ALU DNA repeats [115bp, 247bp and 247bp/115bp ratio (DNA integrity index] were assessed by real-time quantitative PCR. Pleural fluid and serum mesothelin levels were quantified using ELISA. Results Based on clinico-pathological evaluation, 52 subjects had MPE (including 16 mesotheliomas and 23 had benign effusions. Pleural fluid DNA integrity index was higher in MPE compared with benign effusions (1.2 vs. 0.8; p Conclusion Pleural fluid DNA integrity index is a promising diagnostic biomarker for identification of MPEs, including mesothelioma. This biomarker may be particularly useful in cases of MPE where pleural aspirate cytology is negative, and could guide the decision to undertake more invasive definitive testing. A prospective validation study is being undertaken to validate our findings and test the clinical utility of this biomarker for altering clinical practice.

  20. Comparison of interferon-gamma release assays and adenosine deaminase of pleural fluid for the diagnosis of pleural tuberculosis

    Institute of Scientific and Technical Information of China (English)

    刘菲

    2014-01-01

    Objective To compare the diagnostic performance of interferon gamma releasing assays(T-SPOT.TB)and adenosine deaminase(ADA)in pleural tuberculosis,and therefore to evaluate the value of T-SPOT.TB in a high tuberculosis burden country.Methods From June 2011to November 2012,111 patients with pleural fluid in Beijing Chest Hospital,Capital Medical University were

  1. Evaluation of Serum and Pleural Levels of Angiopoietin-1 and Angiopoietin-2 in Children with Transudative and Exudative Pleural Effusions

    Science.gov (United States)

    Sanad, Mohammed; Shouman, Waheed; Gharib, Amal F.

    2011-01-01

    Objective Angiopoietins are involved in the pathogenesis of a variety of human diseases. We tried to evaluate the application of pleural and serum Angiopoietin-1 and 2 in categorizing pleural effusions (PEs) into exudates and transudates in children. Methods Pleural fluid (PF) and serum Angiopoietin (Ang)-1 and Ang-2 were measured in 80 children with PEs (40 transudative and 40 exudative) by using enzyme-linked immunosorbent assay. Findings PF Ang-2 levels were significantly higher in pleural exudates than in transudates (P 0.012). PF Ang-2 levels were significantly higher than serum Ang-2 levels in patients with pleural exudates and transudates (Pexudates and those with transudates (Ptransudative and exudative effusions were 3ng/ml and 8ng/ml respectively. Predictive potentials of serum and PF Ang-2 cutoff points were: Sensitivity 90% and 95% respectively, specificity 92.50% and 97.50% respectively, positive predictive value 92.30% and 97.40% respectively and negative predictive value 90.20% and 95.10% respectively. Conclusion Ang-2 levels were elevated in exudative PEs and correlated with levels of markers of pleural inflammation and pleural vascular hyperpermeability. It could categorize PE to exudates and transudates with valuable discriminative properties. That was detected more obviously in pleural fluids than in serum. PMID:23056802

  2. Does selective pleural irradiation of malignant pleural mesothelioma allow radiation dose escalation. A planning study

    Energy Technology Data Exchange (ETDEWEB)

    Botticella, A.; Defraene, G. [KU Leuven - University of Leuven, Department of Oncology, Experimental Radiation Oncology, Leuven (Belgium); Nackaerts, K. [KU Leuven - University of Leuven, University Hospitals Leuven, Department of Respiratory Medicine, Leuven (Belgium); Deroose, C. [KU Leuven - University of Leuven, University Hospitals Leuven, Nuclear Medicine, Leuven (Belgium); Coolen, J. [KU Leuven - University of Leuven, University Hospitals Leuven, Radiology Department, Leuven (Belgium); Nafteux, P. [University Hospitals Leuven, Department of Thoracic Surgery, Leuven (Belgium); Vanstraelen, B. [University Hospitals Leuven, Department of Radiation Oncology, Leuven (Belgium); Joosten, S.; Michiels, L.A.W. [Fontys University of Applied Science, Institute Paramedical Studies, Medical Imaging and Radiotherapeutic Techniques, Eindhoven (Netherlands); Peeters, S. [KU Leuven - University of Leuven, Department of Oncology, Experimental Radiation Oncology, Leuven (Belgium); University Hospitals Leuven, Department of Radiation Oncology, Leuven (Belgium); Ruysscher, D. de [KU Leuven - University of Leuven, Department of Oncology, Experimental Radiation Oncology, Leuven (Belgium); Maastricht University Medical Center, GROW - School for Oncology and Developmental Biology, Department of Radiation Oncology (MAASTRO Clinic), Maastricht (Netherlands)

    2017-04-15

    After lung-sparing radiotherapy for malignant pleural mesothelioma (MPM), local failure at sites of previous gross disease represents the dominant form of failure. Our aim is to investigate if selective irradiation of the gross pleural disease only can allow dose escalation. In all, 12 consecutive stage I-IV MPM patients (6 left-sided and 6 right-sided) were retrospectively identified and included. A magnetic resonance imaging-based pleural gross tumor volume (GTV) was contoured. Two sets of planning target volumes (PTV) were generated for each patient: (1) a ''selective'' PTV (S-PTV), originating from a 5-mm isotropic expansion from the GTV and (2) an ''elective'' PTV (E-PTV), originating from a 5-mm isotropic expansion from the whole ipsilateral pleural space. Two sets of volumetric modulated arc therapy (VMAT) treatment plans were generated: a ''selective'' pleural irradiation plan (SPI plan) and an ''elective'' pleural irradiation plan (EPI plan, planned with a simultaneous integrated boost technique [SIB]). In the SPI plans, the average median dose to the S-PTV was 53.6 Gy (range 41-63.6 Gy). In 4 of 12 patients, it was possible to escalate the dose to the S-PTV to >58 Gy. In the EPI plans, the average median doses to the E-PTV and to the S-PTV were 48.6 Gy (range 38.5-58.7) and 49 Gy (range 38.6-59.5 Gy), respectively. No significant dose escalation was achievable. The omission of the elective irradiation of the whole ipsilateral pleural space allowed dose escalation from 49 Gy to more than 58 Gy in 4 of 12 chemonaive MPM patients. This strategy may form the basis for nonsurgical radical combined modality treatment of MPM. (orig.) [German] Beim malignen Pleuramesotheliom (MPM) ist nach lungenschonender Radiotherapie das lokale Scheitern an Stellen eines frueheren, sichtbaren Tumors die dominierende Form des Scheiterns. Unser Ziel ist es, zu untersuchen, ob die selektive

  3. Light dose verification for pleural PDT.

    Science.gov (United States)

    Sandell, Julia L; Liang, Xing; Zhu, Timothy

    2012-02-13

    The ability to deliver uniform light dose in Photodynamic therapy (PDT) is critical to treatment efficacy. Current protocol in pleural photodynamic therapy uses 7 isotropic detectors placed at discrete locations within the pleural cavity to monitor light dose throughout treatment. While effort is made to place the detectors uniformly through the cavity, measurements do not provide an overall uniform measurement of delivered dose. A real-time infrared (IR) tracking camera is development to better deliver and monitor a more uniform light distribution during treatment. It has been shown previously that there is good agreement between fluence calculated using IR tracking data and isotropic detector measurements for direct light phantom experiments. This study presents the results of an extensive phantom study which uses variable, patient-like geometries and optical properties (both absorption and scattering). Position data of the treatment is collected from the IR navigation system while concurrently light distribution measurements are made using the aforementioned isotropic detectors. These measurements are compared to fluence calculations made using data from the IR navigation system to verify our light distribution theory is correct and applicable in patient-like settings. The verification of this treatment planning technique is an important step in bringing real-time fluence monitoring into the clinic for more effective treatment.

  4. [Benign pleural effusion caused by asbestos exposure].

    Science.gov (United States)

    Vieira, J R; Alfarroba, E; Viegas, J; Freitas e Costa, M

    1992-05-01

    The Authors present the first case described among us of benign pleural effusion of an asbestotic origin. They stress the importance of thoracoscopy (pleuroscopy) in the diagnosis of this situation. Attention is drawn to the fact that asbestotic lesions and asbestotic bodies have been found in the lung and, in particular, in the parietal pleura as well. They emphasize the fact that exposure to asbestos was not realized by the patient, which made the clarification of the situation more difficult. It was a CT scan that showed the signs suggestive of exposure to asbestos which raised the diagnostic suspicion. They conclude that every patient with a pleural effusion must be thoroughly questioned about exposure to asbestos. Even if the exposure is accepted, they consider that one should proceed to a pleuro-pulmonar biopsy by thoracoscopy. This biopsy allows demonstration of the characteristic histopathological lesions and rule out other etiologies, namely malignancy and tuberculosis. They suggest that these patients must be highly motivated to stop any smoking and kept under periodic surveillance.

  5. Failure Patterns After Hemithoracic Pleural Intensity Modulated Radiation Therapy for Malignant Pleural Mesothelioma

    Energy Technology Data Exchange (ETDEWEB)

    Rimner, Andreas, E-mail: rimnera@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Spratt, Daniel E. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Zauderer, Marjorie G. [Department of Medicine, Thoracic Oncology Service, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, New York (United States); Rosenzweig, Kenneth E. [Department of Radiation Oncology, Mount Sinai Medical Center, New York, New York (United States); Wu, Abraham J.; Foster, Amanda [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Yorke, Ellen D. [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Adusumilli, Prasad; Rusch, Valerie W. [Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Krug, Lee M. [Department of Medicine, Thoracic Oncology Service, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, New York (United States)

    2014-10-01

    Purpose: We previously reported our technique for delivering intensity modulated radiation therapy (IMRT) to the entire pleura while attempting to spare the lung in patients with malignant pleural mesothelioma (MPM). Herein, we report a detailed pattern-of-failure analysis in patients with MPM who were unresectable or underwent pleurectomy/decortication (P/D), uniformly treated with hemithoracic pleural IMRT. Methods and Materials: Sixty-seven patients with MPM were treated with definitive or adjuvant hemithoracic pleural IMRT between November 2004 and May 2013. Pretreatment imaging, treatment plans, and posttreatment imaging were retrospectively reviewed to determine failure location(s). Failures were categorized as in-field (within the 90% isodose line), marginal (<90% and ≥50% isodose lines), out-of-field (outside the 50% isodose line), or distant. Results: The median follow-up was 24 months from diagnosis and the median time to in-field local failure from the end of RT was 10 months. Forty-three in-field local failures (64%) were found with a 1- and 2-year actuarial failure rate of 56% and 74%, respectively. For patients who underwent P/D versus those who received a partial pleurectomy or were deemed unresectable, the median time to in-field local failure was 14 months versus 6 months, respectively, with 1- and 2-year actuarial in-field local failure rates of 43% and 60% versus 66% and 83%, respectively (P=.03). There were 13 marginal failures (19%). Five of the marginal failures (38%) were located within the costomediastinal recess. Marginal failures decreased with increasing institutional experience (P=.04). Twenty-five patients (37%) had out-of-field failures. Distant failures occurred in 32 patients (48%). Conclusions: After hemithoracic pleural IMRT, local failure remains the dominant form of failure pattern. Patients treated with adjuvant hemithoracic pleural IMRT after P/D experience a significantly longer time to local and distant failure than

  6. The case against performing pleural biopsies for the aetiological diagnosis of exudates.

    Science.gov (United States)

    Porcel, J M

    2017-04-19

    In most cases, the etiological diagnosis of pleural exudates does not require a pleural biopsy. However, when it is considered necessary, the biopsy should seldom be conducted using invasive methods such as thoracoscopy. Two paradigmatic examples are pleural tuberculosis and malignant effusions. In many centres, pleural fluid adenosine deaminase measurement has replaced closed pleural biopsies in the diagnosis of tuberculosis. Similarly, pathological and molecular studies on pleural fluid cell blocks or alternatively, image-guided pleural biopsies have drastically reduced the need for thoracoscopy. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  7. Allergic bronchopulmonary aspergillosis: a rare cause of pleural effusion.

    LENUS (Irish Health Repository)

    O'Connor, T M

    2012-02-03

    Aspergillus fumigatus is one of the most ubiquitous of the airborne saprophytic fungi. Allergic bronchopulmonary aspergillosis (ABPA) is a syndrome seen in patients with asthma and cystic fibrosis, and is characterized by hypersensitivity to chronic colonization of the airways with A. fumigatus. We report the case of a patient with ABPA presenting with pleural effusion. A 27-year-old male was referred with recurrent right pleural effusion. Past medical history was remarkable for asthma, allergic sinusitis, and recurrent pleurisy. Investigations revealed peripheral eosinophilia with elevated serum immunoglobulin E and bilateral pleural effusions with bilateral upper lobe proximal bronchiectasis. Precipitating serum antibodies to A. fumigatus were positive and the A. fumigatus immediate skin test yielded a positive reaction. A diagnosis of ABPA associated with bilateral pleural effusions was made and the patient was commenced on prednisolone. At review, the patient\\'s symptoms had considerably improved and his pleural effusions had resolved. ABPA may present with diverse atypical syndromes, including paratracheal and hilar adenopathy, obstructive lung collapse, pneumothorax and bronchopleural fistula, and allergic sinusitis. Allergic bronchopulmonary aspergillosis is a rare cause of pleural effusion and must be considered in the differential diagnosis of patients presenting with a pleural effusion, in particular those with a history of asthma.

  8. Thoracoscopic evaluation of 129 cases having undiagnosed exudative pleural effusions

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    Chetan Basavaraj Patil

    2016-01-01

    Full Text Available Background: Medical thoracoscopy is a minimally invasive procedure used in diagnostic and therapeutic applications for pleural diseases. In this study, we describe our experience in the outcome and analysis of thoracoscopy in undiagnosed pleural effusion presenting to our center. Materials and Methods: This is a prospective study conducted over last 2 years. We performed thoracoscopy in 129 cases of undiagnosed exudative pleural effusions using rigid thoracoscope. Clinical, radiological, cyto and histopathological data of the patients were collected prospectively and analyzed. Results: The overall diagnostic yield of thoracoscopic pleural biopsy was 110/129 (85.2% in patients with undiagnosed pleural effusion, and 19/129 (14.8% patients remained unexplained. Histopathological diagnosis confirmed malignancy in 66.4% patients (both primary and metastatic pleural carcinoma, tuberculosis in 28.2%, others including parapneumonic effusion in 4 cases followed by multiple myeloma, lupus pleuritis, and pulmonary langerhans cell histiocytosis in one case each. Procedure-related mortality was nil. Minor complications related to the procedure include hemorrhage, subcutaneous emphysema, etc. Conclusion: Thoracoscopy is relatively a safe and well-tolerated procedure with high diagnostic accuracy in undiagnosed pleural effusions, decreasing the need of formal diagnostic thoracotomy. Every chest physician must, therefore, consider this procedure to decrease the time lag in achieving the final diagnosis and to initiate the treatment as early as possible.

  9. El caso de derrame de mercurio en Choropampa y los daños a la salud en la población rural expuesta

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    Marco Arana-Zegarra

    2009-01-01

    Full Text Available El año 2000, un derrame de mercurio metálico que se evaporó en el ambiente, afectó la salud de más de mil campesinos, quienes, ocho años después, siguen sufriendo las consecuencias en su salud. La minería moderna no garantiza adecuados mecanismos de manejo, control y mitigación del impacto ambiental y la autoridad pública no otorga el derecho a la salud de poblaciones de los entornos mineros las cuales, desde el punto de vista del derecho a la salud ambiental, debieran ser consideradas como sitios potencialmente peligrosos para la salud.

  10. Comparison of hormone transfer to pleural and synovial exudates.

    Science.gov (United States)

    Rovensky, Jozef; Simorova, Elizabet; Radikova, Zofia; Imrich, Richard; Greguska, Ondrej; Vigas, Milan; Macho, Ladislav

    2006-06-01

    Local effects of hormones on immune and connective tissues could play some role in the development of local inflammation processes. The aim of this study was to investigate the levels of selected hormones in pleural exudates of patients with pleurisy and lung tumours, and compare these levels with hormone concentration in knee synovial fluid. Eleven patients with pleural exudate (mean age 62+/-3) and l9 subjects with rheumatoid arthritis (of the same mean age) participated in the observations. Plasma, pleural exudates and synovial fluid levels of cortisol, prolactin, aldosterone, testosterone, 17-beta-estradiol, dehydroepiandrosterone, progesterone, insulin and C-peptide were determined by specific radioimmunoassay. It was noted that all estimated hormones are transferred into pleural exudates and synovial fluid. Higher levels of dehydroepiandrosterone and C-peptide were observed in pleural exudates as compared to plasma. The concentrations of testosterone, prolactin and estradiol in males were lower in exudates as compared to plasma. Mean levels of cortisol, aldosterone, progesterone and insulin in plasma were similar to these found in pleural exudates. The comparison of hormone levels in pleural exudates and synovial fluid showed that the levels of cortisol, progesterone and dehydroepiandrosterone tended to be higher in the exudates as compared to synovial fluid. However, the levels of insulin, testosterone and estradiol in exudates were lower than these in inflammatory synovial fluid from patients with rheumatoid arthritis. This study showed the presence of hormones in pleural exudates. The differences in hormone concentrations in pleural exudates and synovial fluid were observed suggesting a specificity of hormone transfer from plasma to these exudates.

  11. Limbic Encephalitis Driven by a Pleural Mesothelioma: A Paraneoplastic Complication

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    Jacob O. Day

    2016-10-01

    Full Text Available Paraneoplastic neurological syndromes have only been described with pleural mesothelioma in five cases. We have described a 72-year-old man who developed anterograde amnesia 27 months after diagnosis of epithelioid pleural mesothelioma. Investigations revealed a limbic encephalitis with no alternative causes identified. Limbic encephalitis is a classical paraneoplastic syndrome and presentation within five years of a cancer with no other causes identified is sufficient to diagnose a paraneoplastic etiology. This is the first case of isolated paraneoplastic limbic encephalitis driven by a pleural mesothelioma.

  12. Lymphangitic Carcinomatosis as a Cause of Malignant Transient Pleural Transudate

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    Raquel Garcia Sevila

    2009-01-01

    Full Text Available Although it is generally accepted that a malignant transient pleural transudate may appear during the early stages of lymphatic obstruction, cases demonstrating such probability are rare in literature. A 67-year-old woman was admitted to hospital because a lymphangitic carcinomatosis and a transudative infrapulmonary pleural effusion with a cytology positive for adenocarcinoma. One month later the effusion keeps being positive for adenocarcinoma but exudative in character. Lymphatic obstruction appears as the cause of the initial transudative characteristics of the pleural effusion.

  13. Apleural loose body mimicking a pleural tumor: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yoo Kyung; Shim, Sung Shine; Chun, Eun Mi; Won, Tae Hee; Park, Sang Hui [Ewha Womans University, Seoul (Korea, Republic of)

    2015-10-15

    We present a rare case of a pleural loose body, thought to be a pedunculated pleural tumor, found incidentally in a 58-year-old female. Computed tomography showed a non-enhancing mass, which migrated along the mediastinum and paravertebral area. Thoracoscopic surgery revealed a 4 cm, soap-like mass that was found to be a fibrin body consisting of hyalinized collagen histopathologically. Mobility and the lack of contrast enhancement of a pleural mass are important clues to diagnosing this benign condition.

  14. Static mechanics of excised whole lung: pleural mechanics.

    Science.gov (United States)

    Ligas, J R; Primiano, F P; Saidel, G M

    1984-01-01

    Continuum analyses of lung mechanics require that the boundary condition of stress transmitted to the outermost alveoli be known. Depending upon the exact geometry of the pleural-parenchymal coupling, this stress could possibly be influenced by the pleural mechanical properties. The relation between pleural tension and extension ratio was obtained from tissue specimens from mongrel dog lungs. Using the worst-case geometry, this relationship was compared with the equivalent relation between pressure and volume ratio for the whole lung of the same mongrel dogs. The results of this comparison and a suitable mathematical analysis indicate that the pleura transmits applied pressure differences to the underlying alveolar walls essentially without modification.

  15. Use of indwelling pleural catheters for the definitive treatment of malignant pleural effusion

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    Fernando Conrado Abrão

    Full Text Available ABSTRACT Objective: To evaluate the safety and feasibility of the use of indwelling pleural catheters (IPCs in patients with malignant pleural effusion (MPE. Methods: We prospectively collected data from patients with MPE undergoing IPC placement between January of 2014 and July of 2015. All patients submitted to IPC placement had a life expectancy > 30 days, in accordance with the MPE treatment guidelines established by the British Thoracic Society. The data collected included gender, age, body mass index, primary cancer site, duration of IPC drainage, IPC-related complications, length of hospital stay, pleural effusion recurrence, and occurrence of spontaneous pleurodesis. Results: A total of 19 patients underwent IPC placement during the study period. Median overall survival after IPC insertion was 145 days. The median follow-up among the surviving patients was 125 days (range, 53-485 days, and the median time between catheter insertion and removal was 31 days (range, 2-126 days. There were IPC-related complications in 5 patients (26.2%, and spontaneous pleurodesis was achieved in 8 (42.0%. Among those 8 patients, the IPC was removed between days 30 and 126 in 4, and spontaneous pleurodesis occurred within the first 30 days in 4. Conclusions: The use of IPCs seems to be feasible and safe in patients with MPE.

  16. Status of Exudative Pleural Effusion in Adults of South Khorasan Province, Northeast Iran: Pleural Tuberculosis Tending toward Elderly

    Science.gov (United States)

    Mortazavi-Moghaddam, Sayyed Gholam Reza; Sharifzadeh, Gholam Reza; Rezvani, Mohammad Reza

    2016-01-01

    The causes and situation of exudative pleural effusion vary from one area to another. A cross-sectional study was conducted on 327 patients with exudative pleural effusion in South Khorasan province (Iran). The patients were older than 12 years and comprised 172 (52.6%) males and 155 (47.4%) females. The study commenced in 2007 with seven years duration. The Light’s criteria were used to define exudative effusion. Procedures including pleural fluid analysis, microbiological study, pleural biopsy, and systemic investigations were conducted to determine the special cause of pleural effusion. The mean age of the patients was 63.4±18.4 years. Malignancies, tuberculosis, and parapneumonia pleural exudation were diagnosed in 125 (38.2%), 48 (14.7%), and 45 (13.8%) cases, respectively. Among malignant effusions, metastasis from lung cancer made 48 (38.4%) of the cases. The origin of metastasis was not determined in 44 (35.2%) patients. The mean age of patients was not significantly different between malignant (66.9±14.3 years) and tuberculosis (63.9±19.7 years) cases (P=0.16). The older age of tuberculosis patients could be a new discussion point on the overall impression created on the subject of tuberculosis pleural exudation (TB-PLE) occurring in young people. PMID:27365554

  17. Status of Exudative Pleural Effusion in Adults of South Khorasan Province, Northeast Iran: Pleural Tuberculosis Tending toward Elderly

    Directory of Open Access Journals (Sweden)

    Sayyed Gholam Reza Mortazavi-Moghaddam

    2016-07-01

    Full Text Available The causes and situation of exudative pleural effusion vary from one area to another. A cross-sectional study was conducted on 327 patients with exudative pleural effusion in South Khorasan province (Iran. The patients were older than 12 years and comprised 172 (52.6% males and 155 (47.4% females. The study commenced in 2007 with seven years duration. The Light’s criteria were used to define exudative effusion. Procedures including pleural fluid analysis, microbiological study, pleural biopsy, and systemic investigations were conducted to determine the special cause of pleural effusion. The mean age of the patients was 63.4±18.4 years. Malignancies, tuberculosis, and parapneumonia pleural exudation were diagnosed in 125 (38.2%, 48 (14.7%, and 45 (13.8% cases, respectively. Among malignant effusions, metastasis from lung cancer made 48 (38.4% of the cases. The origin of metastasis was not determined in 44 (35.2% patients. The mean age of patients was not significantly different between malignant (66.9±14.3 years and tuberculosis (63.9±19.7 years cases (P=0.16. The older age of tuberculosis patients could be a new discussion point on the overall impression created on the subject of tuberculosis pleural exudation (TB-PLE occurring in young people.

  18. Broncho-pleural fistula with hydropneumothorax at CT: Diagnostic implications in mycobacterium avium complex lung disease with pleural involvement

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    Yoon, Hyun Jung; Chung, Myung Jin; Lee, Kyung Soo; Park, Hye Yun; Koh, Won Jung [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Kim, Jung Soo [Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon (Korea, Republic of)

    2016-04-15

    To determine the patho-mechanism of pleural effusion or hydropneumothorax in Mycobacterium avium complex (MAC) lung disease through the computed tomographic (CT) findings. We retrospectively collected data from 5 patients who had pleural fluid samples that were culture-positive for MAC between January 2001 and December 2013. The clinical findings were investigated and the radiological findings on chest CT were reviewed by 2 radiologists. The 5 patients were all male with a median age of 77 and all had underlying comorbid conditions. Pleural fluid analysis revealed a wide range of white blood cell counts (410-100690/µL). The causative microorganisms were determined as Mycobacterium avium and Mycobacterium intracellulare in 1 and 4 patients, respectively. Radiologically, the peripheral portion of the involved lung demonstrated fibro-bullous changes or cavitary lesions causing lung destruction, reflecting the chronic, insidious nature of MAC lung disease. All patients had broncho-pleural fistulas (BPFs) and pneumothorax was accompanied with pleural effusion. In patients with underlying MAC lung disease who present with pleural effusion, the presence of BPFs and pleural air on CT imaging are indicative that spread of MAC infection is the cause of the effusion.

  19. Malignant pleural mesothelioma in a child

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    Jed Brendan Scharf

    2015-10-01

    Full Text Available Malignant pleural mesothelioma (MPM is an aggressive malignancy that occurs extremely rarely in the pediatric population. It carries a dismal prognosis. Adult studies are often used to guide therapy in the pediatric population, as a limited number of case reports form the body of pediatric literature. Herein, we document the course and treatment of an 8-year old male diagnosed with MPM. The diagnosis came after he presented to his family physician with dyspnea and was found to have a large right-sided chest mass on subsequent imaging. Through an initial right pneumonectomy and subsequent chest wall excision, followed by chemotherapy with Pemetrexed and Cisplatin he remains virtually disease free today, almost 2 years following surgery.

  20. Vacuna contra la fiebre hemorrágica argentina Candid#1 producida en la Argentina: Inmunogenicidad y seguridad

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    Delia A. Enria

    2010-06-01

    Full Text Available Se realizó un estudio clínico en 946 voluntarios humanos sanos, donde se comparó la vacuna Candid#1 producida en Argentina con la elaborada en EE.UU., que había sido utilizada en estudios previos. Como objetivo primario se evaluó la equivalencia en la eficacia utilizando como marcador subrogante a la inmunogenicidad medida por detección de anticuerpos neutralizantes. Como objetivo secundario se evaluó la equivalencia en inocuidad comparando las tasas de reacciones adversas. Ambas vacunas mostraron una tasa equivalente de inmunogenicidad ligeramente superior al 95.5%, que es la eficacia estimada para Candid #1 en estudios previos. No se observaron eventos adversos graves relacionados con la vacuna. Los eventos adversos generales considerados relacionados fueron de escasa significación clínica y de resolución espontánea o con tratamiento sintomático; se presentaron en los receptores de ambas vacunas en tasas equivalentes (29.9% para la vacuna fabricada en la Argentina y 35.0% para la fabricada en EE.UU., e incluyeron: cefalea, decaimiento, mialgias, plaquetopenia leve (< 150 000 plaquetas/mm³, náuseas y/o vómitos, leucopenia leve (< 4 000 blancos/mm³, fiebre, dolor retroocular, mareos, microhematuria, lumbalgia y exantema. Estos resultados indican que la vacuna Candid #1 elaborada en la Argentina es equivalente a la elaborada en los EE.UU. Este estudio permitió el registro del biológico producido en la Argentina ante la autoridad regulatoria del país (ANMAT.

  1. Comparación de los perfiles de transcripción de pacientes con fiebre de dengue y fiebre hemorrágica por dengue que muestra diferencias en la respuesta inmunitaria y claves en la inmunopatogénesis

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    Natalia Houghton-Triviño

    2010-12-01

    Conclusiones. Los resultados podrían indicar que durante la fiebre de dengue, los inhibidores de citocinas y del complemento logran controlar el daño al endotelio y el aumento de la permeabilidad vascular, mientras que, en los pacientes con fiebre hemorrágica por dengue, la disfunción de las células inmunitarias y la acción no regulada del complemento y de las citocinas, conducen a un estado de "hipercoagulacion" y daño endotelial. La identificación del papel patógeno de las moléculas encontradas podría contribuir a la interpretación de la patogenia y al desarrollo de fármacos terapéuticos.

  2. Aberrant DNA methylation profile in pleural fluid for differential diagnosis of malignant pleural mesothelioma.

    Science.gov (United States)

    Fujii, Masanori; Fujimoto, Nobukazu; Hiraki, Akio; Gemba, Kenichi; Aoe, Keisuke; Umemura, Shigeki; Katayama, Hideki; Takigawa, Nagio; Kiura, Katsuyuki; Tanimoto, Mitsune; Kishimoto, Takumi

    2012-03-01

    Malignant pleural mesothelioma (MPM) usually develops pleural fluid. We investigated the value of DNA methylation in the pleural fluid for differentiating MPM from lung cancer (LC). Pleural fluid was collected from 39 patients with MPM, 46 with LC, 25 with benign asbestos pleurisy (BAP) and 30 with other causes. The methylation of O(6)-methylguanine-DNA methyltransferase (MGMT), p16(INK4a) , ras association domain family 1A (RASSF1A), death-associated protein kinase (DAPK), and retinoic acid receptor β (RARβ) was examined using quantitative real-time PCR. DNA methylation of RASSF1A, p16(INK4a), RARβ, MGMT and DAPK was detected in 12 (30.8%), 3 (7.7%), 11 (28.2%), 0 (0.0%) and five patients (12.8%) with MPM, and in 22 (47.8%), 14 (30.4%), 24 (52.2%), 1 (2.2%) and six patients (13.0%) with LC, respectively. The mean methylation ratios of RASSF1A, p16(INK4a) and RARβ were 0.37 (range 0.0-2.84), 0.11 (0.0-2.67) and 0.44 (0.0-3.32) in MPM, and 0.87 (0.0-3.14), 1.16 (0.0-5.35) and 1.69 (0.0-6.49) in LC, respectively. The methylation ratios for the three genes were significantly higher in LC than in MPM (RASSF1A, P = 0.039; p16(INK4a), P = 0.005; and RARβ, P = 0.002). Patients with methylation in at least one gene were 3.51 (95% confidence interval, 1.09-11.34) times more likely to have LC. Hypermethylation seemed no greater with MPM than with BAP. Extended exposure to asbestos (≧30 years) was correlated with an increased methylation frequency (P = 0.020). Hypermethylation of tumor suppressor genes in pleural fluid DNA has the potential to be a valuable marker for differentiating MPM from LC.

  3. Pleural gas analysis for the identification of alveolopleural fistulae.

    Science.gov (United States)

    Fernandez, Ramiro; Bharat, Ankit

    2016-07-01

    The method for identification of alveolopleural fistulae (APF) by visual inspection of air bubbles in the chest drainage system has several limitations and suffers from poor accuracy. Here we discuss the use of a novel technique of pleural gas analysis in the identification and management of APF. We found that pleural gas analysis has higher sensitivity and specificity than visual inspection in identifying APF. Additionally, we demonstrated that intrapleural gas milieu impacts lung healing and reduction of intrapleural carbon dioxide can promote resolution of APF. Pleural gas analysis is a novel technique to identify and manage APF. Integration of gas analysis in chest drainage systems would provide a more objective method for managing chest tubes and providing a favorable pleural gas environment for lung healing.

  4. Prognosis related clinical and molecular factors in malignant pleural mesothelioma

    Institute of Scientific and Technical Information of China (English)

    王玉艳

    2013-01-01

    Objective To identify potential prognosis related clinical and molecular factors in malignant pleural mesothelioma(MPM).Methods Seventy-nine patients with MPM treated in Beijing Cancer Hospital from June 1996

  5. Fiebre manchada por rickettsias en el Delta del Paraná: Una enfermedad emergente Rickettsial spotted fever in the Paraná Delta: An emerging disease

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    Alfredo Seijo

    2007-12-01

    Full Text Available Se comunica un caso de fiebre manchada por rickettsia autóctono del delta del Paraná correspondiente a la provincia de Buenos Aires. Luego de cinco días de haber permanecido en una región cercana a la localidad de ingeniero Otamendi, partido de Campana, el paciente presentó un síndrome febril agudo caracterizado por hipertermia con escalofríos y sudoración, mialgias, cefalea, astenia y discreta odinofagia, seguido a las 72 horas por un exantema maculopapuloso congestivo con elementos purpúricos, de distribución universal. En la región preauricular izquierda se observaba una lesión papuloerosiva, producida cinco días antes de iniciada la fiebre por una garrapata adquirida en el lugar. El cuadro clínico remitió rápidamente con la administración de doxiciclina. Por inmunofluorescencia indirecta se identificaron anticuerpos reactivos contra el grupo de rickettsias causantes de fiebres manchadas (CDC, Atlanta, EE.UU.. Se realizan consideraciones sobre la especie de rickettsia, el vector involucrado y la posibilidad que la enfermedad fuera debida a Rickettsia parkeri.We describe a case of rickettsial spotted fever in the Paraná Delta region of Buenos Aires province in Argentina. The patient developed an acute febrile syndrome characterized by myalgias, headache, asthenia and moderate odynophagia, followed by a diffuse macular, papular, and purpuric exanthema. The patient had been bitten recently by a tick on the left preauricular region and an erosive papular lesion was evident at the bite site. An indirect immunofluorescence antibody assay identified antibodies reactive with spotted fever group rickettsiae in the patient's serum. The patient improved rapidly with doxycycline. Several considerations relating to the identity of the rickettsial species and tick vector are discussed, including the possibility that this patient's illness may have been caused by Rickettsia parkeri.

  6. Pleural effusions in patients with acute leukemia and myelodysplastic syndrome.

    Science.gov (United States)

    Faiz, Saadia A; Bashoura, Lara; Lei, Xiudong; Sampat, Keeran R; Brown, Tiffany C; Eapen, George A; Morice, Rodolfo C; Ferrajoli, Alessandra; Jimenez, Carlos A

    2013-02-01

    Pleural effusions are rarely observed in patients with acute myelogenous leukemia (AML), acute lymphocytic leukemia (ALL) and myelodysplastic syndrome (MDS)/myeloproliferative neoplasm (MPN). Therefore the underlying etiology of pleural effusions and the efficacy and safety of pleural procedures in this population has not been well studied. In a retrospective review of cases from 1997 to 2007, we identified 111 patients with acute leukemia or MDS/MPN who underwent pleural procedures. Clinical characteristics were reviewed, and survival outcomes were estimated by Kaplan-Meier methods. A total of 270 pleural procedures were performed in 111 patients (69 AML, 27 ALL, 15 MDS/MPN). The main indications for pleural procedures were possible infection (49%) and respiratory symptoms (48%), and concomitant clinical symptoms included fever (34%), dyspnea (74%), chest pain (24%) and cough (37%). Most patients had active disease (61%). The most frequent etiology of pleural effusions was infection (47%), followed by malignancy (36%). Severe thrombocytopenia (platelet count < 20 × 10(3)/µL) was present in 43% of the procedures, yet the procedural complication rate was only 1.9%. Multivariate analysis revealed that older age, AML, MDS/MPN and active disease status were associated with a shorter median overall survival. Infection and malignant involvement are the most common causes of pleural effusion in patients with acute leukemia or MDS. After optimizing platelet count and coagulopathy, thoracentesis may be performed safely and with high diagnostic yield in this population. Survival in these patients is determined by the response to treatment of the hematologic malignancy.

  7. Pleural Mesothelioma Surveillance: Validity of Cases from a Tumour Registry

    Directory of Open Access Journals (Sweden)

    France Labrèche

    2012-01-01

    Full Text Available BACKGROUND: Pleural mesothelioma is a rare tumour associated with exposure to asbestos fibres. Fewer than than one-quarter of cases registered in the Quebec Tumour Registry (QTR have been compensated as work-related. While establishing a surveillance system, this led to questioning as to whether there has been over-registration of cases that are not authentic pleural mesotheliomas in the QTR.

  8. Fiebre postoperatoria en cirugía ortopédica y urológica Postoperative fever in orthopedic and urologic surgery

    Directory of Open Access Journals (Sweden)

    Federico Saavedra

    2008-02-01

    Full Text Available La incidencia de fiebre en el postoperatorio varía ampliamente. En la cirugía limpia y la limpia-contaminada, la fiebre no infecciosa es más frecuente que la infecciosa. Fueron estudiados prospectivamente 303 pacientes operados en forma programada de cirugía ortopédica y urológica. Se investigó la incidencia de fiebre postoperatoria, su etiología, la relación entre el momento de su aparición y su origen y la utilidad del pedido empírico de estudios para determinar infección postoperatoria. El 14% (42/303 de los pacientes tuvieron fiebre postoperatoria. En el 81% (34/42 su etiología fue no infecciosa y en el 19% (8/42 infecciosa. Su origen fue siempre no infeccioso dentro de las primeras 48 horas del postoperatorio (pPost-operative fever incidence varies widely. In clean and clean-contaminated surgery the non-infectious fever is more frequent than the infectious fever. We performed a prospective study including 303 patients who underwent orthopedic and urologic elective surgery. The aims of our study were to investigate the incidence of post-operative fever, its etiology, the relationship between time of onset and the etiology, and the usefulness of extensive fever work-up to determine post-operative infection. The incidence of post-operative fever was 14% (42/303 of which 81% (34/42 was noninfectious and 19% (8/42 was infectious. The etiology of the fever in the first 48 hours after surgery was always non-infectious (p<0.001. An extensive fever work-up was performed in patients who presented fever only after the initial 48 hours of surgery with normal physical examination (n=19 consisting of chest x-ray, blood (2 and urine cultures. The chest x-ray was normal in all the patients, the urine cultures were positive in four cases (21%, IC 95%: 6-45 and the blood cultures in only one case (5%, IC 95%: 0.1-26. Seven patients had post-operative infections without fever as a clinical sign. The most frequently observed etiology of post

  9. Estudio seroepidemiológico de fiebre tifoidea en población escolar en el área norte de Lima Metropolitana.

    OpenAIRE

    Clendenes, Martin; Carrillo,Carlos; Gotuzzo, Eduardo; Benavente, Luis

    2013-01-01

    Entre los meses de setiembre y noviembre de 1989, se realizó un estudio transversal en 1322 escolares supuestos sanos, del distrito de San Juan de Lurigancho, sin antecedente de inmunización contra fiebre tifoidea, seleccionado mediante muestreo por conglomerados, con el objetivo de estimar las prevalencias de serología positiva para antígeno O y H de Salmonella typhi y su distribución según sexo, grupo etáreo y tipo de colegio. La determinación de los títulos se hizo con la técnica de microa...

  10. Receptores de la prostaglandina E2 implicados en los trastornos motores digestivos y la fiebre inducidos por endotoxinas en la oveja: Papel de los macrófagos

    OpenAIRE

    Gimeno Soriano, Aurora; Plaza Carrión, Miguel Ángel; Castro López, Marta

    2014-01-01

    El objetivo general de este trabajo ha sido el estudio de los mecanismos fisiopatológicos implicados en la fiebre y en las alteraciones motoras digestivas inducidas por una endotoxina bacteriana: el lipopolisacárido (LPS) de Escherichia coli en la oveja. Se ha estudiado la participación de los receptores de la prostaglandina (PG) E2 (EP1, EP2, EP3 y EP4), los tipos celulares que están implicados en la síntesis y liberación de PGs en el hipotálamo y bulbo raquídeo y la posible participación de...

  11. Derrame isquêmico como a primeira manifestação de hipertrabeculação/não-compactação ventricular grave Ischemic stroke as the first manifestation of severe ventricular hypertrabeculation/non-compaction

    OpenAIRE

    Arturo Jaramillo; Alfredo Ramírez; Lorna Galleguillos; José Vallejos; Sergio Illanes

    2010-01-01

    Um raro defeito congênito do miocárdio, conhecido como hipertrabeculação/não-compactação do ventrículo esquerdo (HTVE/NCVE) tem sido ocasionalmente descrito em associação com a formação de trombos com um potencial risco embólico sistêmico, mas sua associação com derrames isquêmicos permanece controversa. Reportamos o caso de um derrame isquêmico em paciente com grave (HTVE/NCVE) e disfunção ventricular como uma possível associação sinérgica etiológica. Na ausência de outras fontes embólicas, ...

  12. Mitigación y Biorremediación de Suelos Contaminados por el Derrame de Combustible Diésel 2 en la Quebrada del Toro, Camaná, 2009

    OpenAIRE

    Rodríguez Bazan, José Miguel; Universidad Alas Peruanas

    2009-01-01

    El derrame de combustible es considerado uno de los accidentes ambientales más difíciles de mitigar o remediar. Asimismo, estos tipos de derrames se están volviendo más frecuentes debido a diversos factores, entre los cuales se halla el mal estado de las vías de circulación.En el mes de mayo de 2009, un vehículo cisterna que transportaba 9000 galones de diesel (D2), que transitaba por la Quebrada del Toro, rumbo a la provincia de Camaná, se despistó y colisionó con el cerro en la parte izquie...

  13. Black Pleural Effusion: A Unique Presentation of Metastatic Melanoma

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    Akansha Chhabra

    2015-05-01

    Full Text Available Metastatic melanoma is a rare form of skin cancer, but one that comes with a high mortality rate. Pulmonary involvement is frequently seen in metastatic melanoma with only 2% of malignant melanoma patients with thorax metastasis presenting with pleural effusions. Herein, we report an extremely rare case of black pleural effusion from thoracic metastasis of cutaneous malignant melanoma. A 74-year-old man with known metastatic melanoma presented with a 1-month history of worsening lower back and hip pain and was found to have extensive osseous metastatic disease and multiple compression fractures. The patient underwent an uneventful kyphoplasty; however, the following day, he became acutely hypoxic and tachypneic with increased oxygen requirements. Radiographic evaluation revealed new bilateral pleural effusions. Bedside thoracentesis revealed a densely exudative, lymphocyte-predominant black effusion. Cytological examination showed numerous neoplastic cells with melanin deposition. A diagnosis of thoracic metastasis of malignant melanoma was established based on the gross and microscopic appearance of the pleural fluid. To the best of our knowledge, this is the first reported case of black pleural effusions secondary to metastatic melanoma in the United States. Despite the rarity of this presentation, it is important to determine the etiology of the black pleural effusion and to keep metastatic melanoma as a differential diagnosis.

  14. Long-term Outcome of Patients With Undiagnosed Pleural Effusion.

    Science.gov (United States)

    Gunluoglu, Gulsah; Olcmen, Aysun; Gunluoglu, Mehmet Zeki; Dincer, Ibrahim; Sayar, Adnan; Camsari, Gungor; Yilmaz, Veysel; Altin, Sedat

    2015-12-01

    The cause of exudative pleural effusion cannot be determined in some patients. The longterm outcomes of patients with undiagnosed pleural effusion were analyzed. Patients with exudative pleural effusion whose diagnostic procedures included pleural biopsy using video-assisted thoracoscopic surgery carried out between 2008 and 2012 were evaluated retrospectively. Patients diagnosed with non-specific pleuritis were included. Fifty-three patients with available follow-up data were included in the study. Forty men and 13 women (mean age 53.9±13.9 years) were included. Median follow-up time was 24 months. No diagnosis was given in 27 patients (51%), and a clinical diagnosis was given in 26 patients (49%) during the follow-up period. Malignant disease (malignant mesothelioma) was diagnosed in 2 (3.7%) patients. Other diseases were parapneumonic effusion in 12, congestive heart failure in 8, and miscellaneous in 4 patients. Volume of effusion at the time of initial examination and re-accumulation of fluid after video-assisted thoracoscopic surgery were associated with malignant disease (P=.004 and .0001, respectively). Although the probability is low, some patients with exudative pleural effusion undiagnosed after pleural biopsy via video-assisted thoracoscopic surgery may have malignant disease. Patients with an initially large volume of effusion that re-accumulates after examination should be closely monitored. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  15. Protocol of the Australasian Malignant Pleural Effusion (AMPLE) trial: a multicentre randomised study comparing indwelling pleural catheter versus talc pleurodesis

    OpenAIRE

    Fysh, Edward T. H.; Thomas, Rajesh; Read, Catherine A; Lam, Ben C H; Yap, Elaine; Horwood, Fiona C; LEE, Pyng; Piccolo, Francesco; Shrestha, Ranjan; Garske, Luke A; Lam, David C.L.; Rosenstengel, Andrew; Bint, Michael; Murray, Kevin; Smith, Nicola A

    2014-01-01

    Introduction Malignant pleural effusion can complicate most cancers. It causes breathlessness and requires hospitalisation for invasive pleural drainages. Malignant effusions often herald advanced cancers and limited prognosis. Minimising time spent in hospital is of high priority to patients and their families. Various treatment strategies exist for the management of malignant effusions, though there is no consensus governing the best choice. Talc pleurodesis is the conventional management b...

  16. Protocol of the Australasian Malignant Pleural Effusion (AMPLE) trial: a multicentre randomised study comparing indwelling pleural catheter versus talc pleurodesis

    OpenAIRE

    Fysh, ETH; Thomas, R; Read, CA; Lam, BCH; Yap, E.; Horwood, FC; Lee, P.; Piccolo, F; R Shrestha; Garske, LA; Rosenstengel, A; Bint, M; Murray, K.; Smith, NA; Lee, YCG

    2014-01-01

    INTRODUCTION: Malignant pleural effusion can complicate most cancers. It causes breathlessness and requires hospitalisation for invasive pleural drainages. Malignant effusions often herald advanced cancers and limited prognosis. Minimising time spent in hospital is of high priority to patients and their families. Various treatment strategies exist for the management of malignant effusions, though there is no consensus governing the best choice. Talc pleurodesis is the conventional management ...

  17. Detección por reacción en cadena de la polimerasa de transcriptasa inversa del virus de la fiebre amarilla en monos silvestres: una herramienta sensible para la vigilancia epidemiológica

    OpenAIRE

    Méndez, Jairo A; Édgar Parra; Marcela Neira; Rey,Gloria J

    2007-01-01

    Introducción. La fiebre amarilla es una enfermedad zoonótica mantenida en la naturaleza por primates no humanos; su vigilancia por técnicas sensibles de laboratorio es necesaria para hacer evidente la actividad viral en territorio selvático. Objetivo. Detectar el virus de la fiebre amarilla en muestras de tejido hepático de primates no humanos, mediante la técnica de reacción en cadena de la polimerasa de transcriptasa inversa (RT-PCR) con iniciadores diagnósticos específicos. Materiale...

  18. Parapneumonic pleural effusion: early versus late thoracoscopy.

    Science.gov (United States)

    Pereira, Rodrigo Romualdo; Alvim, Cristina Gonçalves; Andrade, Cláudia Ribeiro de; Ibiapina, Cássio da Cunha

    2017-07-31

    To evaluate the best time to perform thoracoscopy for the treatment of complicated parapneumonic pleural effusion in the fibrinopurulent phase in patients ≤ 14 years of age, regarding the postoperative evolution and occurrence of complications. This was a retrospective comparative study involving patients with parapneumonic pleural effusion presenting with septations or loculations on chest ultrasound who underwent thoracoscopy between January of 2000 and January of 2013. The patients were divided into two groups: early thoracoscopy (ET), performed by day 5 of hospitalization; and late thoracoscopy (LT), performed after day 5 of hospitalization. We included 60 patients, 30 in each group. The mean age was 3.4 years; 28 patients (46.7%) were male; and 47 (78.3%) underwent primary thoracoscopy (no previous simple drainage). The two groups were similar regarding gender, age, weight, and type of thoracoscopy (p > 0.05 for all). There was a significant difference between the ET and the LT groups regarding the length of the hospital stay (14.5 days vs. 21.7 days; p sexo masculino, e 47 (78,3%) foram submetidos à toracoscopia primária, sem realização de drenagem simples prévia. Os grupos TP e TT foram semelhantes quanto ao sexo, idade, peso e tipo de toracoscopia (p > 0,05 para todos). Observou-se uma diferença significativa quanto à média de duração da internação nos grupos TP e TT (14,5 dias vs. 21,7 dias; p < 0,001). Houve também diferenças significativas entre os grupos quanto ao total de dias com febre, total de dias entre internação e início da drenagem e total de dias com dreno. Oito pacientes (13,6%) apresentaram alguma complicação após a toracoscopia, sem diferença entre os grupos. Não houve óbitos. A TP, realizada até o 5º dia da admissão hospitalar, associou-se a menor duração da internação, menor tempo de drenagem e menor duração da febre, sem estar associada a maior frequência de complicações, necessidade de CTI ou

  19. Pharmacokinetics of Linezolid and Ertapenem in experimental parapneumonic pleural effusion

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    Tsatsakis Aristidis

    2010-05-01

    Full Text Available Abstract Objective To determine the extent of linezolid and ertapenem penetration into the empyemic fluid using a rabbit model of empyema. Methods An empyema was created via the intrapleural injection of Escherichia coli bacteria (ATCC 35218 into the pleural space of New Zealand white rabbits. After an empyema was verified by thoracocentesis, 24 hours post inoculation, linezolid (10 mg/kg and ertapenem (60 mg/kg were administered intravenously into 10 and 8 infected empyemic rabbits, respectively. Antibiotic levels were determined in samples of pleural fluid and blood serum, collected serially at 1, 2, 4, 6 and 8 hours, after administration each of the two antibiotics. Results Linezolid as well as ertapenem penetrate well into the empyemic pleural fluid, exhibiting a slower onset and decline compared to the corresponding blood serum levels. Equilibration between blood serum and pleural fluid compartments seems to occur at 1.5 hours for both linezolid and ertapenem, with peak pleural fluid levels (Cmaxpf of 2.02 ± 0.73 «mu»g/ml and Cmaxpf of 3.74 ± 1.39 «mu»g/ml, correspondingly occurring 2 hours post antibiotics administration and decreasing very slowly thereafter. The serum concentrations for both antibiotics were significantly lower from the corresponding pleural fluid ones during the 8 hours collecting data, with the exception of samples collected at the 1st hour (Cmaxserum of 2.1 ± 1.2 «mu»g/ml for linezolid and Cmaxserum of 6.26 ± 2.98 «mu»g/ml for ertapenem. Conclusion Pleural fluid levels of both antibiotics are inhibitory for common specified pathogens causing empyema.

  20. Behaviour of nucleated cells in various types of pleural effusion.

    Science.gov (United States)

    Ferreiro, L; Pereiro, T; San José, E; Toubes, M E; Suárez-Antelo, J; Álvarez Dobaño, J M; González Barcala, F J; Rodríguez Núñez, N; Lama, A; Valdés, L

    2017-04-01

    To know the behavior of cellular components of pleural fluid can help focus the differential diagnosis of a pleural effusion. Our objective was to assess their composition in different types of pleural effusions and assess whether it provides relevant clinical information. Observational, cross-sectional and retrospective study in which the cellular components of pleural effusions of different etiology were analyzed. Pleural effusions were classified as neutrophilic, lymphocytic (≥50% of each one of them), eosinophilic (≥10%) or mesothelial (>5%) and were grouped into six diagnostic categories RESULTS: 1.467 patients were studied (354 heart failure; 59 other transudates; 349 paraneumonic; 133 tuberculous; 397 malignant and 175 other exudates). The predominance cell was lymphocytic in heart failure (44,4%), uncomplicated parapneumonic (29,2%), tuberculosis (88%) and malignant (49,6%); neutrophilic in parapneumonic (57%) and malignant (9,6%); eosinophilic in malignant (6,3%) and mesotelial in tuberculosis (12%). The most frequent etiologies with lymphocyte count ≥80% were tuberculosis (35,1%) and malignant (23,3%). Parameters with higher discriminating accuracy were: leukocytes (transudates: AUC 0,835) and percentage of neutrophils (empyemas: AUC 0,906 and complicated parapneumonic+empyemas: AUC 0,907). Nucleated cell counts will help focus the etiology of pleural effusions, since each etiology often have a characteristic cell predominance. The percentage of nucleated cells in pleural fluid not ruled out tuberculosis if there is a high count of mesothelial cells, nor a parapneumonic effusion with lymphocytic predominance, or malignancy with ≥80% lymphocytes. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  1. Cholesterol in pleural exudates depends mainly on increased capillary permeability.

    Science.gov (United States)

    Valdés, Luis; San-José, Esther; Estévez, Juan Carlos; González-Barcala, Francisco Javier; Alvarez-Dobaño, José Manuel; Golpe, Antonio; Valle, José Manuel; Penela, Pedro; Vizcaíno, Luis; Pose, Antonio

    2010-04-01

    Pleural fluid (PF) cholesterol is a useful parameter to differentiate between pleural transudates and exudates, although the pathophysiologic mechanisms for its increase in exudates are not fully understood. We aim to elucidate the cause of this increase by analyzing the levels of cholesterol-high-density lipoproteins (HDLs), low-density lipoproteins (LDLs), apolipoprotein A (ApoA), and apolipoprotein B (ApoB)-in PF and blood as well as the number of leucocytes and red cells in the PF. We studied 259 patients with pleural effusion (57 transudates and 202 exudates). The correlations of the pleural and serum (S) levels of these parameters were analyzed, with the pleural cholesterol fractions as the dependent variables and their levels in blood and the pleural/serum protein ratio (P/S prot ratio) as the independent variables. The pleural fluid cholesterol levels (PFCHOL) correlated with their blood levels and the capillary permeability (r=0.885). No significant differences were found between the percentage of LDL, with regard to total cholesterol in the serum [SCHOL], and the same percentage in the exudates, between the PF/S LDL ratio (0.46) and the PF/S CHOL ratio (0.48), or between the PF/S ApoB ratio and the PF/S LDL ratio. The percentage of PF cholesterol bound to HDL and LDL was significantly higher (91.9%) than in the blood (90%). No significant correlations were found between any of the lipids studied and the number of erythrocytes and leucocytes. In conclusion, the PFCHOL may be predicted from the SCHOL, and the capillary permeability may be reflected by the PF/S prot ratio. Copyright 2010 Mosby, Inc. All rights reserved.

  2. New therapy of pleural empyema by deoxyribonuclease

    Directory of Open Access Journals (Sweden)

    Grzegorz Kacprzak

    2013-02-01

    Full Text Available Empyema is a severe complication of different diseases and traumas. Management of this complication is difficult and should comprise general and local procedures. The general procedure is mainly based on administering wide-spectrum antibiotics. Local management depends on patient general condition, but in all cases the essential procedure is to insert a drain into the pleural cavity and to evacuate the pus. Sometimes pus is very thick and its evacuation and following re-expansion of the lung is rather impossible. In these patients surgical intervention is needed. The use of intrapleural enzymes to support the drainage was first described in 1949 by Tillett and Sherry using a mixture of streptokinase and streptococcal deoxyribonuclease. Nowadays, purified streptokinase has come into widespread use, but recent studies reported no streptokinase effect on pus viscosity. On the other side, deoxyribonuclease reduces pus viscosity and may be more useful in treatment. We report two cases of intrapleural administration of Pulmozyme (alfa dornase - deoxyribonuclease (HOFFMANN-LA ROCHE AG in dosage 2 × 2.5 mg with a significant improvement caused by changes in pus viscosity.

  3. Modern management of malignant pleural mesothelioma

    Directory of Open Access Journals (Sweden)

    Patel SC

    2016-05-01

    Full Text Available Shivani C Patel,1 Jonathan E Dowell1,2 1Division of Hematology and Oncology, University of Texas Southwestern, 2Section of Hematology and Oncology, Veterans Affairs North Texas Healthcare System, Dallas, TX, USA Abstract: Malignant pleural mesothelioma (MPM is a deadly disease that produces a significant worldwide health care burden. The majority of cases are associated with prior asbestos exposure, but recent studies have identified a possible genetic predisposition in a minority of patients. Historically, obtaining a pathologic diagnosis of MPM was challenging, but with current pathological techniques, a secure diagnosis is possible in the majority of patients. Curative therapy for MPM remains elusive, and the primary treatment option for fit patients is platinum-based chemotherapy. Encouraging recent reports suggest that there may be a benefit to the addition of bevacizumab to standard chemotherapy as well as with the use of immune checkpoint inhibitors in MPM. Selected patients may be considered for aggressive surgical approaches, but there is considerable controversy regarding the true benefit of surgery and multimodality therapy in this disease. Keywords: mesothelioma, asbestos, chemotherapy, surgery

  4. PDT dose dosimeter for pleural photodynamic therapy

    Science.gov (United States)

    Kim, Michele M.; Darafsheh, Arash; Ahmad, Mahmoud; Finlay, Jarod C.; Zhu, Timothy C.

    2016-03-01

    PDT dose is the product of the photosensitizer concentration and the light fluence in the target tissue. For improved dosimetry during plural photodynamic therapy (PDT), a PDT dose dosimeter was developed to measure both the light fluence and the photosensitizer concentration simultaneously in the same treatment location. Light fluence and spectral data were rigorously compared to other methods of measurement (e.g. photodiode, multi-fiber spectroscopy contact probe) to assess the accuracy of the measurements as well as their uncertainty. Photosensitizer concentration was obtained by measuring the fluorescence of the sensitizer excited by the treatment light. Fluence rate based on the intensity of the laser spectrum was compared to the data obtained by direct measurement of fluence rate by a fiber-coupled photodiode. Phantom studies were done to obtain an optical property correction for the fluorescence signal. Measurements were performed in patients treated Photofrin for different locations in the pleural cavity. Multiple sites were measured to investigate the heterogeneity of the cavity and to provide cross-validation via relative dosimetry. This novel method will allow for accurate real-time determination of delivered PDT dose and improved PDT dosimetry.

  5. Primary Pleural Angiosarcoma in a 63-Year-Old Gentleman

    Directory of Open Access Journals (Sweden)

    Ahmed Abu-Zaid

    2013-01-01

    Full Text Available Primary pleural angiosarcomas are extremely rare. As of 2010, only around 50 case reports have been documented in the literature. Herein, we report the case of a 63-year-old gentleman who presented with a 3-month history of right-sided chest pain, dyspnea, and hemoptysis. Chest X-ray showed bilateral pleural effusion with partial bibasilar atelectasis. Ultrasound-guided thoracocentesis showed bloody and exudative pleural fluid. Cytologic examination was negative for malignant cells. An abdominal contrast-enhanced computed tomography (CT scan showed two right diaphragmatic pleural masses. Whole-body positron emission tomography/computed tomography (PET/CT scan showed two hypermetabolic fluorodeoxyglucose- (FDG- avid lesions involving the right diaphragmatic pleura. CT-guided needle-core biopsy was performed and histopathological examination showed neoplastic cells growing mainly in sheets with focal areas suggestive of vascular spaces lined by cytologically malignant epithelioid cells. Immunohistochemical analysis showed strong positivity for vimentin, CD31, CD68, and Fli-1 markers. The overall pathological and immunohistochemical features supported the diagnosis of epithelioid angiosarcoma. The patient was scheduled for surgery in three weeks. Unfortunately, the patient died after one week after discharge secondary to pulseless ventricular tachycardia arrest followed by asystole. Moreover, we also present a brief literature review on pleural angiosarcoma.

  6. Percutaneous treatment of subarachnoid-pleural fistula with Onyx.

    Science.gov (United States)

    Knafo, Steven; Parker, Fabrice; Herbrecht, Anne; Court, Charles; Saliou, Guillaume

    2013-04-01

    Subarachnoid-pleural fistula is a well-described complication after anterior surgery for thoracic disc herniation, but is difficult to treat by means of traditional chest and lumbar drains due to interference by positive ventilation pressures that may keep the fistula open and prevent proper closure. Current treatment strategies include surgical repair, which is technically challenging, and noninvasive positive pressure ventilation, which can take several weeks to be effective. In this report, the authors describe a novel treatment for subarachnoid-pleural fistula using percutaneous obliteration with Onyx. Surgery for removal of a T7-8 disc herniation associated with ossification of the posterior longitudinal ligament was performed in a 56-year-old woman via an anterior transthoracic transpleural approach. Ten days after surgery, she presented with diplopia due to a subarachnoid-pleural fistula that was confirmed by CT myelography. Percutaneous injection of Onyx was performed under local anesthesia. Postprocedure CT showed complete obliteration of the fistula with no adverse events. A CT scan obtained 1 month later showed complete resolution of the pleural effusion. Neurological examination at 3 months postsurgery was normal. Clinical and radiological follow-up at 1 year showed complete recovery and no sign of fistula recurrence. Percutaneous treatment for subarachnoid-pleural fistula is an easy, safe, and effective strategy and can therefore be proposed as a first-line option for this challenging complication.

  7. The past, current and future of diagnosis and management of pleural disease

    OpenAIRE

    Akulian, Jason; Feller-Kopman, David

    2015-01-01

    Pleural disease is frequently encountered by the chest physician. Pleural effusions arise as the sequelae of underlying disease processes including pressure/volume imbalances, infection and malignancy. In addition to pleural effusions, persistent air leaks after surgery and bronchopleural fistulae remain a challenge. Our understanding of pleural disease including its diagnosis and management, have made tremendous strides. The introduction of the molecular detection of organism specific infect...

  8. Eosinophilic pleural effusion and giardiasis: A causal or a casual relationship?

    Science.gov (United States)

    Singh, Urvinderpal; Garg, Nishi; Chopra, Vishal

    2013-01-01

    A case of bilateral eosinophilic pleural effusion with coincidental intestinal infestation of giardia lamblia is being reported. After reviewing the possible causes of this type of pleural effusion, no clinical or laboratory data were obtained which could explain this condition except giardiasis. Moreover the clearance of pleural effusion with the treatment of giardia with metronidazole suggests giardia as the probable cause of bilateral eosinophilic pleural effusion.

  9. Detection of EpCAM-positive microparticles in pleural fluid: A new approach to mini-invasively identify patients with malignant pleural effusions

    Science.gov (United States)

    Roca, Elisa; Lacroix, Romaric; Judicone, Coralie; Laroumagne, Sophie; Robert, Stéphane; Cointe, Sylvie; Muller, Alexandre; Kaspi, Elise; Roll, Patrice; Brisson, Alain R.; Tantucci, Claudio

    2016-01-01

    Pleural biomarkers allowing to mini-invasively discriminate benign from malignant pleural effusions are needed. Among potential candidates, microparticles (MPs) are extracellular vesicles that vectorize antigen derived from the parent cell. We hypothesized that tumor-derived MPs could be present in the pleural liquid and help to identify patients with malignant pleural effusions. Using highly sensitive flow cytometry and cryo-electron microscopy, we showed that large amounts of MPs from hematopoïetic and vascular origin could be detectable in pleural fluids. Their level did not differ between benign (n = 14) and malignant (n = 71) pleural effusions. Analysis of selected tumoral associated antigens (podoplanin, mucin 1 and EpCAM, epithelial-cell-adhesion-molecule) evidenced for the first time the presence of tumor-derived MPs expressing EpCAM in malignant pleural fluids only (Specificity = 93%, Sensitivity = 49% and 45% for flow cytometry and ELISA, respectively). The detection of EpCAM-positive-MPs (EpCAM + MPs) by flow cytometry showed a better specificity and sensitivity than ELISA to distinguish between pleural carcinoma and the others malignant pleural effusions (MPE; Sp: 96% vs 89%; Se: 79% vs 66%). Combining EpCAM+ MPs and cytology improved the diagnosis of MPE compared to cytology alone. This study establishes the basis for using EpCAM+ MPs as a promising new biomarker that could be added to the armamentarium to mini-invasively identify patients with malignant pleural effusions. PMID:26689993

  10. Evaluación serológica de una proteína recombinante a partir de una cepa aislada del virus de la fiebre amarilla en el Perú: un estudio piloto

    Directory of Open Access Journals (Sweden)

    Carlos Yábar V

    2003-10-01

    Full Text Available Objetivo: Evaluar serológicamente una proteína recombinante de 66 kDa (Er66 de una cepa del virus de la fiebre amarilla aislada en el Perú usando anticuerpos inmunoreactivos. Material y métodos: La proteína Er66 fue expresada in vitro en la bacteria Escherichia coli y enfrentada a títulos de 1/100, 1/50 y 1/25 de anticuerpos monoclonales, y a sueros con anticuerpos IgM e IgG inmunoreactivos contra el virus de la fiebre amarilla mediante ensayos de Western blot (WB. Asimismo, se evaluaron proteínas totales de las cepas de referencia del virus dengue (DEN y fiebre amarilla como controles de antigenicidad. Resultados: La proteína recombinante Er66 presentó antigenicidad contra títulos de 1/50 y 1/25 de anticuerpo monoclonal (MAB8701; sin embargo, no se observó inmunoreactividad en sueros positivos para fiebre amarilla y dengue. Los ensayos con extractos crudos de la cepa de fiebre amarilla Asibi 17D (PTFA revelaron que la antigenicidad de las proteínas virales comprendidas entre 60 y 80 kDa fue afectada negativamente a temperaturas desnaturalizantes de 100°C. En cambio, tratamientos con ß-mercaptoetanol sin calor generó un aumento de la antigenicidad de dichas proteínas. Siguiendo este mismo principio, la proteína Er66 fue sometida a tratamientos desnaturalizantes con ß-mercaptoetanol sin incluir calor y fue enfrentada nuevamente a los sueros reactivos. El resultado final reveló que la proteína Er66 generó inmunoreactividad frente a sueros con altos títulos de anticuerpos IgM e IgG para fiebre amarilla mientras que en otras muestras se observó una débil señal. Conclusiones: Los datos obtenidos en este trabajo demuestran que la Er66 pudo ser reconocida por anticuerpos IgM e IgG específicos para fiebre amarilla presentes en sueros de pacientes infectados. Los datos presentados en este artículo sugieren el uso de proteínas recombinantes como posibles candidatas de valor diagnóstico para la FA.

  11. Cautious application of pleural N-terminal pro-B-type natriuretic peptide in diagnosis of congestive heart failure pleural effusions among critically ill patients.

    Directory of Open Access Journals (Sweden)

    Jiann-Horng Yeh

    Full Text Available Several studies on diagnostic accuracy of pleural N-terminal pro-B-type natriuretic peptide (NT-pro-BNP for effusions from congestive heart failure (CHF conclude that pleural NT-pro-BNP is a useful biomarker with high diagnostic accuracy for distinguishing CHF effusions. However, its applicability in critical care settings remains uncertain and requires further investigations.NT-proBNP was measured in pleural fluid samples of a prospective cohort of intensive care unit patients with pleural effusions. Receiver operating characteristic curve analysis was performed to determine diagnostic accuracy of pleural NT-proBNP for prediction of CHF effusions.One hundred forty-seven critically ill patients were evaluated, 38 (26% with CHF effusions and 109 (74% with non-CHF effusions of various causes. Pleural NT-proBNP levels were significantly elevated in patients with CHF effusions. Pleural NT-pro-BNP demonstrated the area under the curve of 0.87 for diagnosing effusions due to CHF. With a cutoff of 2200 pg/mL, pleural NT-proBNP displayed high sensitivity (89% but moderate specificity (73%. Notably, 29 (27% of 109 patients with non-CHF effusions had pleural NT-proBNP levels >2200 pg/mL and these patients were more likely to experience septic shock (18/29 vs. 10/80, P<0.001 or acute kidney injury (19/29 vs. 9/80, P<0.001.Among critically ill patients, pleural NT-proBNP measurements remain a useful diagnostic aid in evaluation of pleural effusions. However, patients with non-CHF effusions may exhibit high pleural NT-proBNP concentrations if they suffer from septic shock or acute kidney injury. Accordingly, it is suggested that clinical context should be taken into account when interpreting pleural NT-proBNP values in critical care settings.

  12. Advance of Therapeutic Methods for Malignant Pleural Effusion

    Institute of Scientific and Technical Information of China (English)

    XU Tao-tao

    2016-01-01

    Malignant pleural effusion (MPE) is a condition caused by primary malignant tumors in the pleura or other malignant tumors metastasis to the pleura. It is also one of common serious complications of middle-late malignant tumor, which has severe impact on the quality of life, even threatening the life of the patients. The selection of treatments for MPE depends on many factors, including the symptoms, performance status, primary tumor types, response to systemic therapy, and degree of lung recruitment maneuvers (LRM) after drainage of pleural effusion. Generally, the treatment methods include thoracentesis, indwelling pleural catheter, pleurodesis, intrapleural injection of drugs, chemotherapy, radiotherapy, anti-angiogenesis therapy, surgery, and thermotherapy. With the in-depth study on pathogenesis of MPE, the treatments of MPE have continuous improvements. This study mainly reviewed the treatment methods for MPE so as to provide the basis for clinical practice in the future.

  13. Advance of Therapeutic Methods for Malignant Pleural Effusion

    Directory of Open Access Journals (Sweden)

    Tao-tao XU

    2016-06-01

    Full Text Available Malignant pleural effusion (MPE is a condition caused by primary malignant tumors in the pleura or other malignant tumors metastasis to the pleura. It is also one of common serious complications of middle-late malignant tumor, which has severe impact on the quality of life, even threatening the life of the patients. The selection of treatments for MPE depends on many factors, including the symptoms, performance status, primary tumor types, response to systemic therapy, and degree of lung recruitment maneuvers (LRM after drainage of pleural effusion. Generally, the treatment methods include thoracentesis, indwelling pleural catheter, pleurodesis, intrapleural injection of drugs, chemotherapy, radiotherapy, anti-angiogenesis therapy, surgery, and thermotherapy. With the in-depth study on pathogenesis of MPE, the treatments of MPE have continuous improvements. This study mainly reviewed the treatment methods for MPE so as to provide the basis for clinical practice in the future.

  14. Severe “sweet” pleural effusion in a continuous ambulatory peritoneal dialysis patient

    Directory of Open Access Journals (Sweden)

    Rapeephan R. Maude

    2014-01-01

    Conclusion: A high glucose concentration in the pleural fluid is pathognomonic for hydrothorax from dialysis fluid after rule out other possible causes of pleural effusion. Patients who are on CAPD presenting with marked pleural effusion should prompt clinicians to consider the differential diagnosis of pleuroperitoneal communications.

  15. Diagnostic value of interferon gamma and adenosine deaminase for tuberculous pleural effusion

    Institute of Scientific and Technical Information of China (English)

    Hou-rongCai; Chen-hongSun; Lin-juenDai; Zai-rongCheng

    2001-01-01

    To explore the significance of interferon gamma(IFN-γ) and adenosine deaminase (ADA)in differential diagnosis of pleural effusions. Methods: Levels of IFN-γ was measured by enzyme-linked immunosorbent assay, ADA activity was measured by colorimetric method. 37 patients with tuberculous pleural effusion and 36 patients with non-tuberculous pleurai effusions including 25 patients with malignant pleural effusions and 8 patients with pleural transudates were studied. Results: The levels of IFN-γ in patients with tuberculous pleural effusions(490.83±384.67 pg.mL-1) were higher than those with malignant pleural effusions(36.40±90.85 pg. mL-1) and pleural transudates(14.87±5.96 pg. mL-1) (P<0.01). Mean ADA activity was 52.69±17.78 U. L-1 in tuberculous pleural effusion; 19.53±13.59 in malignant pleural effusions; 9.43±4.06 inpleural transudates. The difference is significant (P<0.001). The diagnostic sensitivity of IFN-γ for tuberculous pleural effusions is 81%, specifity is 97%, the over accuracy is 90.4%. The diagnostic efficiency of ADA as following: sensitivity 89%, specifity 97%, and the over accuracy 94.5%. Conclusions: Assessments of IFN-γ and ADA in pleural effusions are of clinically diagnostic value in distinguishing tuberculous from non-tuberculous pleural effusions.

  16. Usefulness of pleural effusion antinuclear antibodies in the diagnosis of lupus pleuritis.

    Science.gov (United States)

    Toworakul, C; Kasitanon, N; Sukitawut, W; Wichinun, R; Louthrenoo, W

    2011-10-01

    We performed this study to determine sensitivity and specificity of pleural effusion antinuclear antibodies (ANA) at a titer of ≥1 : 160, and the ratio of pleural effusion to serum ANA of ≥1, to distinguish between pleural fluid from lupus pleuritis and other causes. A prospective study of 54 patients with pleural effusion (12 lupus pleuritis, seven parapneumonic effusion, 26 malignancy-associated pleural effusions, nine transudative effusions) was performed. ANA at a titer of ≥1 : 160 were found in 11 of 12 lupus pleuritis samples, and in four of 42 pleural effusions from non-systemic lupus erythematosus (SLE) patients. The pleural effusion ANA at a titer of ≥1 : 160 gave a sensitivity of 91.67% for lupus pleuritis, with a specificity of 83.33% when compared with all other pleural effusions, 90.91% when compared with exudative effusion (parapneumonic effusion and malignancy-associated effusion) and 55.56% when compared with the transudative pleural effusion group. Using the ratio of pleural effusion to serum ANA of ≥1, the sensitivity and the specificity decreased to 75.00% and 78.57%, respectively. This study provides further evidence that the pleural effusion ANA at a titer of ≥1 : 160 is a sensitive and specific diagnostic biomarker for lupus pleuritis in patients with lupus. However, pleural effusion ANA can occasionally be found in other conditions.

  17. Antinuclear antibody testing in pleural fluid for the diagnosis of lupus pleuritis.

    Science.gov (United States)

    Porcel, J M; Ordi-Ros, J; Esquerda, A; Vives, M; Madroñero, A B; Bielsa, S; Vilardell-Tarrés, M; Light, R W

    2007-01-01

    We sought to determine whether measuring antinuclear antibodies (ANA) and their specificities [dsDNA, extractable nuclear antigens (ENA)] on pleural fluid may contribute to the differential diagnosis of pleural effusions. ANA were tested by indirect immunofluorescence on Hep-2 cells in the pleural fluid of 266 patients with effusions of different etiologies, including 15 lupus pleuritis. The cutoff value for diagnostic use was set at 1:160. Pleural fluid analysis of specific autoantibodies, such as anti-dsDNA and anti-ENA, was also performed if a positive ANA test was obtained. All patients with lupus pleurisy and 16 of 251 (6.4%) patients with pleural effusions secondary to other causes were ANA positive. Fifty-six percent of the positive ANAs in non-lupus pleural fluids were due to neoplasms. The pleural fluid ANA titers were low (pleuritis from non-lupus etiologies, the absence of pleural fluid anti-dsDNA or anti-ENA favored the latter. ANAs in pleural fluid provided no additional diagnostic information beyond that obtained by the measurement in serum and, therefore, these tests need not be routinely performed on pleural fluid samples. However, in patients with SLE and a pleural effusion of uncertain etiology, lack of ANAs or specific autoantibodies in pleural fluid argues against the diagnosis of lupus pleuritis.

  18. Diagnostic utility of soluble triggering receptor expression on myeloid cells-1 in complicated parapneumonic pleural effusion

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    Adel H.A. Ghoneim

    2013-10-01

    In conclusion: Combination of classical criteria with pleural fluid sTREM-1 could be useful in discrimination between nonpurulent complicated and non complicated parapneumonic pleural effusions and hence early pleural drainage in patients with complicated parapneumonic effusions which may affect disease outcome.

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  7. Prevalencia de Leptospirosis y factores de riesgo en personas con antecedentes de fiebre en la Provincia de Manu, Madre de Dios, Perú

    Directory of Open Access Journals (Sweden)

    Manuel Céspedes Z

    2003-10-01

    Full Text Available Objetivos: Determinar la prevalencia de leptospirosis y los factores de riesgo en personas con antecedentes de fiebre en localidades dedicadas a actividades mineras (lavaderos de oro y la prevalencia de infección en perros en la provincia de Manu, departamento de Madre de Dios, Perú. Material y métodos: Estudio transversal analítico. Se tomaron 71 muestras de sangre de personas con antecedentes de fiebre, provenientes de cinco localidades dedicados a la actividad minera, en ellos se evaluaron la presencia de anticuerpos IgM e IgG contra leptospiras en suero por el método de ELISA y la prueba de microaglutinación (MAT. Los factores asociados a la infección por leptospiras fue evaluada a partir de una encuesta. Además se tomaron muestras de sangre a 27 perros que evaluados por el método de MAT Resultados: Se enrolaron 71 personas de las cuales 47 (66,2% fueron mujeres y 24 (33,8 % varones, 26 (36,6% pobladores presentaron anticuerpos contra leptospiras. Los factores asociados a la infección por leptospiras en los pobladores fueron: consumo de agua de río en el hogar (OR=9,09 p=0,017, consumo de agua de río en el campo (OR=7,13 p=0,042, nadar en el río (OR=4,60 p=0,13, habitar en una vivienda con techo de plástico y paja (OR=4,04 p=0,013. En canes, 18 (66,6% tuvieron serología positiva a leptospiras. Conclusiones: Existe una alta prevalencia de leptospirosis en personas con antecedentes de fiebre y condiciones favorables para la presencia de leptospiras en las localidades estudiadas. En estas zonas se recomienda realizar actividades educativas preventivas, tomando en cuenta los factores de riesgo identificados.

  8. A rare pleural effusion in a young male

    Directory of Open Access Journals (Sweden)

    Shabana Begum

    2015-01-01

    Full Text Available A 28-year-old male presented with fever with right-sided chest pain for 2 weeks. Clinicoradiological picture was suggestive of right-sided pleural effusion. He had history of polytrauma following a road traffic accident and had to undergo emergency laparotomy a month ago. Microscopic and culture examination of the pleural fluid showed neutrophilia, high bilirubin content and presence of gram-negative bacilli. Ultrasound of the abdomen showed the presence of biloma in the liver and right subdiaphragmatic space with fistulous communication into the right thoracic cavity. The patient was managed successfully with complete recovery.

  9. Empiema Pleural: Etiología, tratamiento y complicaciones

    OpenAIRE

    Salguero A,Jorge; Cardemil H,Gonzalo; MOLINA F,JUAN CARLOS; LEMBACH J,HANNS; FERNÁNDEZ R,JAIME

    2009-01-01

    Introducción: Definido como la presencia de infección bacteriana en el espacio pleural, determina una importante morbimortalidad a pesar de los avances en el tratamiento antibiótico y las nuevas técnicas quirúrgicas. Objetivos: Comparar resultados de las distintas estrategias terapéuticas para el Empiema Pleural (EP). Material y Métodos: Revisión retrospectiva de fichas clínicas de pacientes con diagnóstico de EP manejados en el Hospital Clínico Universidad de Chile entre enero de 1994 y juni...

  10. Biphasic Malignant Pleural Mesothelioma Masquerading as a Primary Skeletal Tumor

    Science.gov (United States)

    Diacovo, Maria Julia

    2016-01-01

    Biphasic malignant pleural mesothelioma is a rare malignant tumor, usually presenting as a pleural-based mass in a patient with history of chronic asbestos exposure. We herein report a case of a 41-year-old man who presented with chest pain and had a chest computed tomography (CT) scan suggestive of a primary skeletal tumor originating from the ribs (chondrosarcoma or osteosarcoma), with no history of asbestos exposure. CT-guided core needle biopsies were diagnosed as malignant sarcomatoid mesothelioma. Surgical resection and chest wall reconstruction were performed, confirming the diagnosis and revealing a secondary histologic component (epithelioid), supporting the diagnosis of biphasic malignant mesothelioma. PMID:27660729

  11. Biphasic Malignant Pleural Mesothelioma Masquerading as a Primary Skeletal Tumor

    Directory of Open Access Journals (Sweden)

    James Benjamin Gleason

    2016-01-01

    Full Text Available Biphasic malignant pleural mesothelioma is a rare malignant tumor, usually presenting as a pleural-based mass in a patient with history of chronic asbestos exposure. We herein report a case of a 41-year-old man who presented with chest pain and had a chest computed tomography (CT scan suggestive of a primary skeletal tumor originating from the ribs (chondrosarcoma or osteosarcoma, with no history of asbestos exposure. CT-guided core needle biopsies were diagnosed as malignant sarcomatoid mesothelioma. Surgical resection and chest wall reconstruction were performed, confirming the diagnosis and revealing a secondary histologic component (epithelioid, supporting the diagnosis of biphasic malignant mesothelioma.

  12. Use of pleural fluid ceruloplasmin in the differentiation of exudative and transudative pleural effusion

    Science.gov (United States)

    Shanthaveeranna, Girish K.; Thykadavil, Vinod G.; D’souza, George A.

    2015-01-01

    Background: Differentiating into transudate or exudate is the first step in the evaluation of effusions. Light's criteria is the standard but a significant number of transudates may not be differentiated based on these criteria. Acute phase proteins (APP) are present in plasma, which increase or decrease by about 25% during an acute inflammatory response. Ceruloplasmin (CP) is a positive APP. Hence, this study was done to know the diagnostic value of pleural fluid (pf) CP and pf to serum ceruloplasmin ratio (CPr) to differentiate the pleural effusion (PE) into exudate and transudate as compared to Light's criteria. Materials and Methods: Setting: Medical wards of St John's Medical College Hospital, Bangalore. Design: Cross-sectional descriptive study. Patients with PE were divided into exudate and transudate by definitive diagnosis. pfCP, CPr and Light's criteria were compared with definitive diagnosis for the differentiation of pf into exudate and transudate. Results: The mean value of the pfCP and CPr was found to be significantly different between exudates and transudates. Sensitivity and specificity of pfCP at ≥ 13.34 mg/dl is 89.7% and 83.3%, CPr at ≥ 0.37 is 91.4% and 83.3%, Light's criteria 94.82% and 83.3%, respectively. Light's criteria, pfCP and CPr have similar PPV (98%) with Light's criteria having higher NPV (62.5%) than pfCP (45%) and CPr (50%), respectively. CPr has higher NPV than pfCP. Conclusions: pfCP and CPr can differentiate pf into exudate and transudate with comparable PPV to Light's criteria. PMID:25624589

  13. Use of pleural fluid ceruloplasmin in the differentiation of exudative and transudative pleural effusion

    Directory of Open Access Journals (Sweden)

    Girish K Shanthaveeranna

    2015-01-01

    Full Text Available Background: Differentiating into transudate or exudate is the first step in the evaluation of effusions. Light′s criteria is the standard but a significant number of transudates may not be differentiated based on these criteria. Acute phase proteins (APP are present in plasma, which increase or decrease by about 25% during an acute inflammatory response. Ceruloplasmin (CP is a positive APP. Hence, this study was done to know the diagnostic value of pleural fluid (pf CP and pf to serum ceruloplasmin ratio (CPr to differentiate the pleural effusion (PE into exudate and transudate as compared to Light′s criteria. Materials and Methods: Setting: Medical wards of St John′s Medical College Hospital, Bangalore. Design: Cross-sectional descriptive study. Patients with PE were divided into exudate and transudate by definitive diagnosis. pfCP, CPr and Light′s criteria were compared with definitive diagnosis for the differentiation of pf into exudate and transudate. Results: The mean value of the pfCP and CPr was found to be significantly different between exudates and transudates. Sensitivity and specificity of pfCP at ≥ 13.34 mg/dl is 89.7% and 83.3%, CPr at ≥ 0.37 is 91.4% and 83.3%, Light′s criteria 94.82% and 83.3%, respectively. Light′s criteria, pfCP and CPr have similar PPV (98% with Light′s criteria having higher NPV (62.5% than pfCP (45% and CPr (50%, respectively. CPr has higher NPV than pfCP. Conclusions: pfCP and CPr can differentiate pf into exudate and transudate with comparable PPV to Light′s criteria.

  14. Estudio epidemiológico de la fiebre porcina clásica en granjas del altiplano en México

    OpenAIRE

    2003-01-01

    En México se ha promovido la vacunación de los animales y las medidas de bioseguridad, para reducir el riesgo de entrada del virus de la fiebre porcina clásica (FPC) a las granjas. Con objeto de establecer la asociación entre diversos factores de riesgo que pudieran haber influido en la infección a partir de una piara infectada índice en una zona porcícola del altiplano, se compararon 14 piaras en las que había animales enfermos de FPC y 23 en las que no los había. Se determinó que la cercaní...

  15. A meta-analysis assessing the benefits of concomitant pleural tent procedure after upper lobectomy.

    Science.gov (United States)

    Uzzaman, Mohammed M; Daniel Robb, J; Mhandu, Peter C E; Khan, Habib; Baig, Kamran; Chaubey, Sanjay; Whitaker, Donald C

    2014-01-01

    A meta-analysis comparing outcomes of upper lobectomies with or without pleural tenting was performed. Five trials comprising 396 patients were selected. There was significantly reduced duration of hospital stay, chest drain use, and air leak in the pleural tenting group compared with the group without the pleural tent. There was also a significant reduction in number of patients with prolonged air leak more than 7 days in pleural tenting group. No other difference was noted in other outcomes such as total drainage, operative time, or hospital costs. In patients at high-risk of air leak, we advocate concomitant use of the pleural tent after upper lobectomies.

  16. Spatial context learning approach to automatic segmentation of pleural effusion in chest computed tomography images

    Science.gov (United States)

    Mansoor, Awais; Casas, Rafael; Linguraru, Marius G.

    2016-03-01

    Pleural effusion is an abnormal collection of fluid within the pleural cavity. Excessive accumulation of pleural fluid is an important bio-marker for various illnesses, including congestive heart failure, pneumonia, metastatic cancer, and pulmonary embolism. Quantification of pleural effusion can be indicative of the progression of disease as well as the effectiveness of any treatment being administered. Quantification, however, is challenging due to unpredictable amounts and density of fluid, complex topology of the pleural cavity, and the similarity in texture and intensity of pleural fluid to the surrounding tissues in computed tomography (CT) scans. Herein, we present an automated method for the segmentation of pleural effusion in CT scans based on spatial context information. The method consists of two stages: first, a probabilistic pleural effusion map is created using multi-atlas segmentation. The probabilistic map assigns a priori probabilities to the presence of pleural uid at every location in the CT scan. Second, a statistical pattern classification approach is designed to annotate pleural regions using local descriptors based on a priori probabilities, geometrical, and spatial features. Thirty seven CT scans from a diverse patient population containing confirmed cases of minimal to severe amounts of pleural effusion were used to validate the proposed segmentation method. An average Dice coefficient of 0.82685 and Hausdorff distance of 16.2155 mm was obtained.

  17. Efficacy of Computed Tomography (CT) Attenuation Values and CT Findings in the Differentiation of Pleural Effusion

    Science.gov (United States)

    Yalçin-Şafak, Kadihan; Umarusman-Tanju, Neslihan; Ayyıldız, Muhammet; Yücel, Nihal; Baysal, Tamer

    2017-01-01

    Summary Background The aim of this study was to investigate the efficacy of computed tomography (CT) findings for characterizing pleural effusions with the use of attenuation values. Material/Methods One hundred and twenty eight patients with pleural effusions on thoracic CT who underwent thoracentesisis within two weeks were studied. Pleural effusions were classified as exudates or transudates according to the Light’s criteria. A region of interest was placed for the measurement of Hounsfield Unit (HU) values in the area of the greatest amount of effusion on each slice of the three slices used. CT features that were evaluated for distinguishing pleural exudates from transudates included pleural nodules, pleural thickening and loculation. Results Thirty three (26%) of the 128 pleural effusions were transudates and 95 (74%) were exudates. The mean HU values of the exudates (8.82±7.04) were significantly higher than those of the transudates (2.91±8.53), (ptransudate and exudate patients in terms of pleural thickness, pleural nodules and loculation (p>0.05). Conclusions HU values can help in differentiating exudative pleural effusions from transudative pleural effusions. Because of overlapping HU values, correlation with clinical findings is essential. PMID:28289482

  18. Incidência de empiema pleural nos ferimentos tóraco-abdominais Incidence of pleural empyema after thoracoabdominal injuries

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    Mauro José Fontelles

    2004-10-01

    Full Text Available OBJETIVO: Os ferimentos penetrantes com comprometimento simultâneo das cavidades torácica e abdominal (FTA, além da dificuldade diagnóstica, merecem especial atenção em relação à conduta adotada para o tratamento do espaço pleural. O objetivo do presente estudo foi identificar os principais fatores relacionados à incidência de empiema pleural em pacientes com ferimentos penetrantes localizados na transição toracoabdominal. MÉTODO: Utilizando-se o modelo estatístico de regressão logística múltipla, os autores analisaram 110 pacientes com ferida toracoabdominal penetrante, submetidos à drenagem pleural fechada e laparotomia. A complicação empiema pleural foi estudada quanto à incidência e fatores envolvidos. Considerou-se o nível alfa igual a 0,05. RESULTADOS: Do total, 91 (82,7% pacientes eram do sexo masculino e 19 (17,3% do feminino. A faixa etária situou-se entre 13 e 63 anos. Os FTA foram causados por projétil de arma de fogo em 60 casos (54,5% e por arma branca em 50 casos (45,5%. O empiema pleural incidiu em quatro (3,6% dos pacientes estudados. Na análise estatística a incidência de empiema pleural esteve relacionada com: lesão de víscera oca (OR=3,1386, p=0.4005; lesão do lado esquerdo do diafragma (OR= 12,98, p=0,1178 e choque hemorrágico à admissão (OR=23,9639, p=0,0250. CONCLUSÕES: A chance da ocorrência de empiema pleural foi cerca de três vezes maior em pacientes com lesão de víscera oca e, de 13 vezes se a esta lesão estava associada à lesão do lado esquerdo do diafragma; aumentando para 24 vezes se estes pacientes apresentavam, concomitantemente, estado de choque hemorrágico à admissão.BACKGROUND: Penetrating Thoracoabdominal trauma, besides the diagnosis difficulty, deserve special attention with respect to the adopted strategy for the pleural space treatment. METHODS: Using the logistic regression model the authors analyzed 110 patients with penetrating Thoracoabdominal trauma

  19. A case of recurrent pleural effusion: Can we think beyond tuberculosis and malignancy?

    Directory of Open Access Journals (Sweden)

    Bhumika Vaishnav

    2014-01-01

    Full Text Available Pleural effusion can occur due to a variety of causes such as infectious, neoplastic, inflammatory, autoimmune, traumatic, etc. Recurrent pleural effusions have always been a diagnostic challenge. Here, we present a case of recurrent exudative pleural effusion in a male patient, which was the first clinical manifestation of rheumatoid arthritis. Of note was the absence of articular involvement at the onset of the disease. The low glucose concentration, low pH and low C4 level in the pleural fluid were the most valuable findings to distinguish it from tuberculous and malignant pleural effusions. Pleural biopsy also helped in making such a distinction. Thus, in a patient with recurrent pleural effusion, rheumatoid etiology should also be kept in mind as a differential diagnosis.

  20. Abordagem cirúrgica da efusão pleural parapneumônica e suas complicações

    OpenAIRE

    José Carlos Fraga; Peter Kim

    2002-01-01

    Objetivos: o tratamento cirúrgico do derrame parapneumônico na criança é controverso, sendo a abordagem baseada fundamentalmente na experiência pessoal e no pequeno número de casos relatados. O objetivo deste artigo é o de apresentar uma revisão bibliográfica dos principais trabalhos e experiência dos autores no tratamento cirúrgico do derrame parapneumônico na criança. Fonte dos dados: foram utilizados dados de artigos científicos pesquisados através dos bancos de dados Medline e Lilacs. Sín...

  1. VEGF Correlates with Inflammation and Fibrosis in Tuberculous Pleural Effusion

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    Mauo-Ying Bien

    2015-01-01

    Full Text Available Objective. To investigate the relationship among angiogenic cytokines, inflammatory markers, and fibrinolytic activity in tuberculous pleural effusion (TBPE and their clinical importance. Methods. Forty-two patients diagnosed with TBPE were studied. Based on chest ultrasonography, there were 26 loculated and 16 nonloculated TBPE patients. The effusion size radiological scores and effusion vascular endothelial growth factor (VEGF, interleukin- (IL- 8, plasminogen activator inhibitor type-1 (PAI-1, and tissue type plasminogen activator (tPA were measured. Treatment outcome and pleural fibrosis, defined as radiological residual pleural thickening (RPT, were assessed at 6-month follow-up. Results. The effusion size and effusion lactate dehydrogenase (LDH, VEGF, IL-8, PAI-1, and PAI-1/tPA ratio were significantly higher, while effusion glucose, pH value, and tPA were significantly lower, in loculated than in nonloculated TBPE. VEGF and IL-8 correlated positively with LDH and PAI-1/tPA ratio and negatively with tPA in both loculated and nonloculated TBPE. Patients with higher VEGF or greater effusion size were prone to develop RPT (n=14; VEGF, odds ratio 1.28, P=0.01; effusion size, odds ratio 1.01, P=0.02, and VEGF was an independent predictor of RPT in TBPE (receiver operating characteristic curve AUC=0.985, P<0.001. Conclusions. Effusion VEGF correlates with pleural inflammation and fibrosis and may be targeted for adjunct therapy for TBPE.

  2. New tetratrichomonas species in two patients with pleural empyema.

    Science.gov (United States)

    Lopez-Escamilla, Eduardo; Sanchez-Aguillon, Fabiola; Alatorre-Fernandez, Cynthia Pamela; Aguilar-Zapata, Daniel; Arroyo-Escalante, Sara; Arellano, Teresa; Moncada-Barron, David; Romero-Valdovinos, Mirza; Martinez-Hernandez, Fernando; Rodriguez-Zulueta, Patricia; Maravilla, Pablo

    2013-09-01

    Two unusual occurrences of pleural trichomonosis due to a new Tetratrichomonas species previously reported but not named were confirmed. In one patient, Trichomonas tenax and a Tetratrichomonas species were also detected in the oral cavity by molecular methods. We suggest that this new Tetratrichomonas species be named Tetratrichomonas empyemagena.

  3. How Are Pleurisy and Other Pleural Disorders Treated?

    Science.gov (United States)

    ... tube will be connected to a box that suctions out the fluid. Your doctor will use a chest x ray to check the tube's position. Your doctor also can use a chest tube to drain blood and air from the pleural space. This ...

  4. [Fusarium pleural effusion after a ventricular assist device].

    Science.gov (United States)

    Villacorta, J; Blancard, A; Kerbaul, F; Guidon, C; Gouin, F

    2002-05-01

    We report the case of a 36-year-old man with a pleural effusion that complicates the postoperative period after the implantation of a ventricular assist device (VAD). The epidemiological, etiologic and therapeutic features of Fusarium infections were reviewed. Complete recovery of the infection was obtained after a treatment by liposomal amphotericine B (AmBisome) and 5 fluorocytosine.

  5. How Are Pleurisy and Other Pleural Disorders Diagnosed?

    Science.gov (United States)

    ... an inflamed pancreas), kidney disease, or lupus. Arterial Blood Gas Test For this test, a blood sample is taken from an artery, usually in ... after the procedure to check for complications. Fluid Analysis The ... can cause fluid or blood to build up in the pleural space. Biopsy ...

  6. PET for the evaluation of pleural thickening observed on CT

    NARCIS (Netherlands)

    Kramer, H; Pieterman, RM; Slebos, DJ; Timens, W; Vaalburg, W; Koeter, GH; Groen, HJM

    2004-01-01

    Early discrimination between benign and malignant pleural diseases is vital for the treatment and prognosis of a patient. Imaging is traditionally performed with CT or MRI, with an accuracy of 50%-75%. PET has proven to be superior as a diagnostic tool in several malignancies. In this prospective st

  7. [Usefulness of bronchofiberscopy in the study of pleural effusion].

    Science.gov (United States)

    Jurado Gámez, B; Sánchez Osuna, L; Sánchez Simón-Talero, R; García Gil, F L; Cosano Povedano, A; Muñoz Cabrera, L

    1995-05-01

    We revised our own experience in 208 patients with pleural effusion to whom fiberoptic bronchoscopy was made in part of the diagnostic study. In our population the most frequent cause was neoplastic origen, observing that in 97 patients (46%), 60 of them were due to bronchogenic carcinoma. In relation to the presentation symptoms, just when haemoptysis was present bronchoscopy exhibited bigger diagnostic profitability (17 of 29), p < 0.001. There were 106 patients (51%) who had some or several parenchymatic injuries going with the pleural effusion. In this group, in 55 cases, fiberoptic bronchoscopy was useful to the diagnosis; on the contrary when the only radiologic abnormality was pleural effusion, 102 cases, in 96 of them the procedure was not diagnostic, p < 0.001. A close relationship was noticed between diagnostic profitability of bronchoscopy with the existence of pulmonary neoplasm; about the 61 diagnosed patients using bronchoscopy, 53 of them had bronchogenic carcinoma, p < 0.001. We conclude then in our experience bronchoscopy is useful to the diagnosis of pleural effusion if it goes with haemoptysis or parenchymatic lesions in the radioly. Its diagnostic profitability has close relationship with the existence of bronchogenic carcinoma.

  8. Derrame isquêmico como a primeira manifestação de hipertrabeculação/não-compactação ventricular grave Ischemic stroke as the first manifestation of severe ventricular hypertrabeculation/non-compaction

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    Arturo Jaramillo

    2010-03-01

    Full Text Available Um raro defeito congênito do miocárdio, conhecido como hipertrabeculação/não-compactação do ventrículo esquerdo (HTVE/NCVE tem sido ocasionalmente descrito em associação com a formação de trombos com um potencial risco embólico sistêmico, mas sua associação com derrames isquêmicos permanece controversa. Reportamos o caso de um derrame isquêmico em paciente com grave (HTVE/NCVE e disfunção ventricular como uma possível associação sinérgica etiológica. Na ausência de outras fontes embólicas, uma grave HTVE/NCVE associada com disfunção ventricular poderia constituir uma fonte potencial de embolismo cerebral, especialmente em pacientes com alta suspeita de um mecanismo embólico de derrame sistêmico.A rare congenital myocardial defect, known as left ventricular hypertrabeculation/non-compaction (LVHT, has been occasionally described associated with thrombus formation with a potential systemic embolic risk, but its association with ischemic strokes remains controversial. We report a case of ischemic stroke in a patient with severe LVHT and ventricular dysfunction as a possible etiologic synergistic association. In absence of other embolic sources, a severe LVTH associated with ventricular dysfunction could constitute a potential source of brain embolism, especially in patients with high suspicion of an embolic mechanism of ischemic stroke.

  9. DETECCIÓN, MANEJO Y PERCEPCIÓN MATERNA DE LA FIEBRE EN NIÑOS CALI - COLOMBIA Detecting, managing and maternal perception of fever in children, Cali, Colombia

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    Fabio Nelson Figueroa

    2012-03-01

    Full Text Available Antecedentes. La fiebre es uno de los principales motivos de consulta médica en la edad pediátrica. Por falta de información algunos padres pueden padecer de fobia a la fiebre. Esta se caracteriza por miedo irracional y exagerado frente a la fiebre, asociado a creencias erróneas sobre su origen y desenlace, llevándolos a asumir conductas inapropiadas para detectar y manejar los episodios febriles en el hogar. Objetivos. Identificar las formas utilizadas por un grupo de madres para detectar y tratar la fiebre en el hogar, además de las percepciones que tienen frente a esta. Material y métodos. Se realizó un estudio transversal con 208 madres que refirieron fiebre en sus hijos menores a 15 años en la última semana, entre mayo-agosto de 2008 y que consultaron al servicio de urgencias del Centro de Salud Siloé o la Fundación Clínica Infantil Club Noel en Cali-Colombia. Se abordaron temas relacionados, con la detección, manejo de la fiebre en el hogar y las percepciones frente a esta. También se identificaron las técnicas aplicadas por las madres según dispusieran o no de un termómetro para cuantificar la fiebre en su hijo. Resultados. Se analizaron 202 encuestas. El método más utilizado solo o combinado para detectar fiebre fue la palpación (87%, con una sensibilidad del 54%. Los medicamentos fueron la terapia antipirética preferida (98%, seguido de los métodos físicos: paños húmedos (78% y baños (55%. El acetaminofén fue el medicamento más usado (97%, encontrándose sobredosificación en el 15%. El 79% de las madres aceptaronn sentir miedo frente a la fiebre, 65% experimentaron ansiedad. El riego de convulsiones fue su mayor preocupación (65%. EL 95% consideró fiebre grave a temperaturas menores de 40°C. Conclusiones. El temor a la fiebre ("fiebre fobia" para algunos estuvo presente en la mayoría de madres. Se evidenciaron algunas conductas inapropiadas; como la preferencia del método palpatorio al uso del term

  10. Intervention for pleural effusions and ascites following liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Adetiloye, V.A. [Radiology Department, Birmingham Children`s Hospital NHS Trust, Ladywood Middleway, Birmingham B16 8ET (United Kingdom)]|[Radiology Department, College of Health Sciences, Obafemi Awolowo University, Ile-Ife (Nigeria); John, P.R. [Radiology Department, Birmingham Children`s Hospital NHS Trust, Ladywood Middleway, Birmingham B16 8ET (United Kingdom)

    1998-07-01

    Background. Small volumes of fluid in the pleural and peritoneal cavities are common after paediatric liver transplantation. Occasionally, larger fluid collections develop and need intervention by aspiration or insertion of a drain. Objective. To assess the incidence of moderate and large pleural and peritoneal fluid collections following paediatric liver transplantation, the need for intervention and the outcome following radiological and non-radiological treatment, with the ultimate objective of recommending a treatment protocol for such post-operative fluid collections. Materials and methods. A total of 184 consecutive liver grafts in 164 children were reviewed. Results. Of 184 grafts, 31 (16.8 %) developed excessive fluid collections requiring intervention (19 pleural effusions, 8 ascites and 4 effusions and ascites). The effusions were first diagnosed between days 1 and 44 after transplant and the ascites between days 1 and 14. The initial diagnosis was made radiologically in 21 (91 %) of 23 pleural effusions and in 10 (83 %) of 12 ascites. No identifiable cause or association was seen in 18 (58 %) of 31 cases. The mean duration of the pleural effusions and ascites, from onset of treatment to resolution, ranged from 33 {+-} 42 days (SD) to 35 {+-} 48 days and from 36 {+-} 47 days to 39 {+-} 46 days respectively. Comparison of the modes of interventional treatment (i. e. unguided, radiological and surgical) showed no statistically significant difference in the outcome of the management. Conclusions. Post-transplantation pleural effusions and ascites requiring intervention are often without definite cause. They are more common with reduced grafts, but this cannot completely explain the occurrence or the protracted duration of accumulation in spite of combined interventional management. The outcome of treatment is not significantly influenced by the mode of intervention except in cases where surgical intervention is indicated. Patients could be managed

  11. Evaluation of real-time PCR of patient pleural effusion for diagnosis of tuberculosis

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    Zaha Arnaldo

    2011-08-01

    Full Text Available Abstract Background Pleural tuberculosis (TB diagnosis often requires invasive procedures such as pleural biopsy. The aim of this study was to evaluate the role of real-time polymerase chain reaction (PCR for the IS6110 sequence of M. tuberculosis in pleural fluid specimens as a rapid and non-invasive test for pleural TB diagnosis. Findings For this cross-sectional study, 150 consecutive patients with pleural effusion diagnosed by chest radiography, who were referred for diagnostic thoracocentesis and pleural biopsy and met eligibility criteria, had a pleural fluid specimen submitted for real-time PCR testing. Overall, 98 patients had pleural TB and 52 had pleural effusion secondary to other disease. TB diagnosis was obtained using acid-fast bacilli (AFB smear or culture for mycobacteria and/or histopathologic examination in 94 cases and by clinical findings in 4 cases. Sensitivity, specificity, positive and negative predictive values of PCR testing for pleural TB diagnosis were 42.8% (95% CI 38.4 - 44.8, 94.2% (95% CI 85.8 - 98.0, 93.3% (95% CI 83.6 - 97.7, and 48.5% (95% CI 44.2 - 50.4, respectively. The real-time PCR test improved TB detection from 30.6% to 42.9% when compared to AFB smear and culture methods performed on pleural fluid specimens, although the best sensitivity was achieved by combining the results of culture and histopathology of pleural tissue specimens. Conclusion The real-time PCR test of pleural fluid specimens is a useful and non-invasive additional assay for fast diagnosis of pleural TB.

  12. Evaluation of cholinesterase to differentiate pleural exudates and transudates.

    Science.gov (United States)

    Sharma, Manju; Gupta, K B; Goyal, Kirori M; Nand, Nitya

    2004-05-01

    The present study was undertaken to evaluate the usefulness of pleural fluid cholinesterase (PChE) level in pleural fluid and its ratio to serum cholinesterase (P/SChE) in order to differentiate transudates and exudates and to compare their diagnostic efficacy with the Light's criteria. A total of 110 patients of pleural effusion of diverse etiology were studied. Eighty patients were of exudative pleural effusion of tubercular, malignant or parapneumonic origin and 30 patients were of transudative effusion. Cholinesterase was estimated in the pleural fluid and serum in all the patients. The mean PChE and P/S ChE were significantly higher in exudates as compared to transudates (p exudates and transudates, respectively. When a cut-off value of 469 IU/L for PChE was taken for the diagnosis, it was found that 10% of exudates and 2.5% of transudates were misclassified. However percentage of misclassification decreased to 1.25% in exudates and 3.3% in transudates when the cut-off value of 0.24 for P/S ChE ratio was used. Using Light's criteria, a sensitivity of 91.25% and specificity of 90% with positive predictive value (PPV) of 96.05% and negative predictive value (NPV) of 79.42% was observed. However using P/S ChE, the PPV was 98.75% and NPV was 96.67%. The estimation of PChE and P/SChE ratio had better discriminatory capacity than Light's criteria. It is cost effective and more specific, therefore its routine estimation is recommended.

  13. PRONÓSTICO DEL DERRAME ANUAL DE RÍO LIMAY CON MODELOS EMPÍRICOS BASADOS EN ÍNDICES CLIMÁTICOS

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    Arnobio G. Poblete

    2008-12-01

    Full Text Available Los modelos climáticos globales y regionales pronostican un decrecimiento en el recurso hídrico del Comahue. Los derrames medios de los ríos de dicha región se han reducido en aproximadamente dos terceras partes, en base a los del siglo pasado. Esto coincide con las mediciones realizadas por los modelos climáticos globales (CGM. Por otra parte, la medición directa o evaluación y estimación de la superficie nival a partir de imágenes satelitales, no son todavía satisfactorias para hacer un pronóstico en tiempo y forma, por lo que se podrían reemplazar por modelos basados en variables climáticas y así obtener una mayor anticipación y precisión. En este trabajo se propone formular modelos empíricos predictivos basados en índices climáticos que superen el límite de varianza explicada lograda por otros autores e instituciones, empleando herramientas estadísticas más sofisticadas. Como resultado de la investigación se elaboran e implementan modelos, que tomaron como variables predictoras a los índices climáticos medidos en el período nival, los que mostraron una performance significativa de acuerdo a los rigurosos tests objetivos a los que fueron sometidos. Los mismos mejoraron el porcentaje de varianza obtenido por otros autores llevándolo aproximadamente a un 75% en el caso de los multivariantes, y a un 65% en el caso univariante.

  14. Cut-off value of pleural fluid C-reactive protein in etiologic diagnosis of pleural fluid

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    Mona Mansour Ahmed

    2014-07-01

    Conclusion: CRP could be a useful diagnostic marker for differentiation between exudative and transudative pleural effusions and also it is more accurate than protein in distinguishing those transudative effusions receiving diuretic therapy which are falsely diagnosed by Light’s criteria to be exudates.

  15. AETIOLOGICAL STUDY OF PLEURAL EFFUSION BY CONVENTIONAL METHODS-ITS CLINICAL PRESENTATION ALONG WITH RADIOLOGICAL, BIOCHEMICAL AND CYTOLOGICAL CORRELATION OF 60 CASES OF PLEURAL EFFUSION

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    Midde Ranga

    2016-06-01

    Full Text Available BACKGROUND Pleural effusion is the excessive or abnormal accumulation of fluid in the pleural space. Pleural effusion is routinely facing problem in practice by general physician and chest physician. Pleural effusion often present as common diagnostic dilemma as no cause can be found in many cases in spite of careful evaluation. For better management of cases to obtain knowledge of clinical history and clinical signs of pleural effusion along with radiological, biochemical, and cytological evaluation of pleural fluid help in narrowing the diagnosis. METHODS In this prospective study of 60 patients with pleural effusion with respect to age, sex, presenting complaint, clinical history with radiological, biochemical, and cytological examination of pleural fluid are considered. RESULTS In this prospective study of 60 patients with pleural effusion, their age is 11 to 75 years and two third were men. The most common type of pleural effusion is exudative effusion. The most common cause of exudative effusion in this study were tuberculosis (36, followed by malignancy (9, transudative (8, synpneumonic (5, and 2 cases of empyema (2. Pleural effusion was commonly seen in male patient with maximum number of cases in age group 31-50. Pleuritic chest pain, fever, cough, and breathlessness were common presenting complaint. The commonest clinical sign was stony dullness to percussion. Right-sided effusions were more common. Majority had moderate amount of pleural effusions. Blood count and ESR were significantly elevated in exudatives. Pleural fluid cytology revealed elevated lymphocytes in tubercular and polymorphs in acute infections. Cytology for malignant cells were diagnostic in 4 cases. ADA was significantly elevated in tubercular pleural effusion. Exudatives had decreased glucose, but increased protein, LDH, and cholesterol compared to transudatives. CONCLUSION Tubercular effusion remains the commonest aetiology of all exudative effusions in our study

  16. Assessment of the N-PCR assay in diagnosis of pleural tuberculosis: detection of M. tuberculosis in pleural fluid and sputum collected in tandem.

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    Parameet Kumar

    Full Text Available BACKGROUND: The nonspecific clinical presentation and paucibacillary nature of tuberculous pleuritis remains a challenge for diagnosis. Diagnosis of tuberculous pleural effusion depends on the demonstration of the presence of tubercle bacilli in the sputum, pleural fluid, or pleural biopsy specimen, or demonstration of granuloma in pleura by histological examination. We examined the clinical utility of the diagnosis of pleural tuberculosis using the in house N-PCR assay, AFB smear microscopy and culture. Besides pleural fluid the inclusion of sputum in the efficacy of diagnosis of pleural tuberculosis was scrutinized. METHODOLOGY/PRINCIPAL FINDINGS: Pleural fluid and sputum samples of 58 tuberculous and 42 non-tuberculous pleural effusion patients were processed for AFB smear microscopy, culture and the N-PCR assay. Mycobacteria were detected exclusively in tuberculous pleural effusion samples. None of the non-tuberculous pleural effusion samples were positive for mycobacteria. Comparative analysis showed that the N-PCR assay had the highest sensitivity. Inclusion of sputum along with pleural fluid increased N-PCR sensitivity from 51.7 to 70.6% (p<0.0001.This improved sensitivity was reflected in AFB smear microscopy and isolation by culture. The sensitivity enhanced on inclusion of sputum from 3.4 (p = 0.50 to 10.3% (p = 0.038 for AFB smear microscopy and for isolation of mycobacteria from 10.3(p = 0.03 to 22.4% (p = 0.0005. Thirteen isolates were obtained from 58 pleural tuberculosis patients. Eleven mycobacterial isolates were identified as M. tuberculosis and two as M. fortuitum and M. chelonae. Complete concordance was seen between the biochemical identification of isolates and the N-PCR identification of mycobacterial species prior to isolation. CONCLUSIONS/SIGNIFICANCE: To the best of our knowledge this is the first PCR based report on utility of sputum for diagnosis of pleural tuberculosis. The present study demonstrates that a

  17. Clinic and echocardiographic characteristics of pericardial effusions in a university hospital, Medellín, Colombia Características clínicas y ecocardiográficas de los derrames pericárdicos en pacientes del Hospital Universitario San Vicente de Paúl

    Directory of Open Access Journals (Sweden)

    Carlos José Jaramillo G.

    2002-03-01

    Full Text Available Purpose: To determine the clinical and echocardiographic characteristics of pericardial effusions. Methods: Retrospective information was obtained from medical records of all patients who were diagnosed with echocardiographic pericardial effusions. Results: We studied 62 medical records of patients with echocardiographic pericardial effusions. We obtained medical records of 28 (45.2% patients with mild effusion, 19 (30.6% with moderate effusion and 15 (24.2% with severe effusion. Fourteen patients (22.6% showed inflammatory signs of pericarditis. Inflammatory signs had an Odds Ratio of 5.1. (CI 95% 1.28 to 23 wich was significant (p = 0.006. Uremia was the most common diagnosis in all patients (22.6% followed by metastatic tumors (14.5%, pyogenic pericarditis (11.3%, acute idiopathic pericarditis (11.3% and others. Conclusions: In almost all patients, etiology of pericardial effusion is the same of the underlying condition, but if the cause is unknown, the size of effusion, inflammatory signs and the presence of cardiac tamponade may help suggest etiology. Objetivos: determinar las características clínicas y ecocardiográficas de los derrames pericárdicos. Metodología: revisar retrospectivamente las historias clínicas de los pacientes con diagnóstico de derrame pericárdico hecho por ecocardiografía transtorácica entre febrero de 2000 y agosto de 2001. Resultados: se evaluaron las historias clínicas de 62 pacientes con diagnóstico de derrame pericárdico; 28 (45.2% presentaron derrames leves, 19 (30.6% derrames moderados y 15 (24.2% derrames severos; 21 (33.9% pacientes presentaron taponamiento cardíaco y el 50% de éstos tenían derrame severo. Se buscó la presencia de signos inflamatorios y se encontró que 14 (22.6% de los pacientes los presentaban. Además, estos pacientes tuvieron 5 veces más probabilidad de presentar taponamiento cardíaco (OR = 5.40. La principal causa de derrames pericárdicos fue la uremia (22.6%, seguida

  18. Untargeted mass spectrometry-based metabolomic profiling of pleural effusions: fatty acids as novel cancer biomarkers for malignant pleural effusions.

    Science.gov (United States)

    Lam, Ching-Wan; Law, Chun-Yiu

    2014-09-05

    Untargeted mass spectrometry-based metabolomic profiling is a powerful analytical method used for broad-spectrum identification and quantification of metabolites in biofluids in human health and disease states. In this study, we exploit metabolomic profiling for cancer biomarker discovery for diagnosis of malignant pleural effusions. We envisage the result will be clinically useful since currently there are no cancer biomarkers that are accurate enough for the diagnosis of malignant pleural effusions. Metabolomes of 32 malignant pleural effusions from lung cancer patients and 18 benign effusions from patients with pulmonary tuberculosis were analyzed using reversed-phase liquid chromatography tandem mass spectrometry (LC-MS/MS) using AB SCIEX TripleTOF 5600. MS spectra were analyzed using XCMS, PeakView, and LipidView. Metabolome-Wide Association Study (MWAS) was performed by Receiver Operating Characteristic Curve Explorer and Tester (ROCCET). Insignificant markers were filtered out using a metabolome-wide significance level (MWSL) with p-value < 2 × 10(-5) for t test. Only compounds in Human Metabolome Database (HMDB) will be used as cancer biomarkers. ROCCET analysis of ESI positive and negative MS spectra revealed free fatty acid (FFA) 18:1 (oleic acid) had the largest area-under-ROC of 0.96 (95% CI = 0.87-1.00) in malignant pleural effusions. Using a ratio of FFA 18:1-to-ceramide (d18:1/16:0), the area-under-ROC was further increased to 0.99 (95% CI = 0.91-1.00) with sensitivity 93.8% and specificity 100.0%. Using untargeted metabolomic profiling, the diagnostic cancer biomarker with the largest area-under-ROC can be determined objectively. This lipogenic phenotype could be explained by overexpression of fatty acid synthase (FASN) in cancer cells. The diagnostic performance of FFA 18:1-to-ceramide (d18:1/16:0) ratio supports its use for diagnosis of malignant pleural effusions.

  19. Extramedullary Acute Myeloid Leukemia (AML: Leukemic Pleural Effusion, Case Report and Review of the Literature

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    Naveen ePemmaraju

    2014-06-01

    Full Text Available Objective and Importance: Malignant pleural effusions occur in the setting of both solid and hematologic malignancies. Pleural effusion caused by leukemic infiltration is an unusual extramedullary manifestation of acute myeloid leukemia (AML with fewer than 20 cases reported.1-11 We report a case of pericardial and pleural effusions in a patient with AML and review the literature. Clinical presentation: In this case, a 55 year old man with previous history of myeloproliferative neoplasm (MPN experienced transformation AML, heralded by appearance of leukemic pleural effusions. The patient was identified to have leukemic pleural effusion based upon extended cytogenetic analysis of the pleural fluid, as morphologic analysis alone was insufficient. Intervention: The patient was treated with hypomethylator-based and intensive chemotherapy strategies, both of which maintained resolution of the effusions in the remission setting. Conclusion: Due to the rarity of diagnosis of leukemic pleural effusions, both cytogenetic and fluorescence in situ hybridization (FISH testing are recommended. Futhermore, systemic chemotherapy directed at the AML can lead to complete resolution of leukemic pleural effusions. Objective and ImportancePleural effusion caused by leukemic infiltration is an unusual extramedullary manifestation of acute myeloid leukemia (AML, but may be more common than previously thought. Fewer than 20 cases have been reported.1-11 We report a case of pericardial and pleural effusions in a patient with AML and review the literature.

  20. Computed Tomography in Differential Diagnosis of Exudative and Transudative Pleural Effusions

    Directory of Open Access Journals (Sweden)

    Phakphoom Thiravit

    2017-03-01

    Full Text Available Objective: To differentiate between exudative and transudative pleural effusions by using CT attenuation values and CT appearances. Methods: The retrospective study reviewed 132 patients who were diagnosed of pleural effusions in 2007-2014. All patients were evaluated by chest CT images before or after pleural tapping within 2 days. Pleural effusions were classified as exudates or transudates based on Light’s criteria.1 Pre-contrast and post-contrast CT images were reviewed by measuring the mean attenuation values of pleural effusions and the associated CT findings. Results: Pleural effusions were 112 exudates and 20 transudates. Exudate group had significant higher mean attenuation values, compared with a transudate, in both pre-contrast (12.8±5.0 HU vs. 9.4±5.2 HU; p<0.001 and post-contrast images (13.8±5.1 HU vs. 10.2±5.7 HU; p=0.006. For differentiation between types of pleural effusions, the CT attenuation cutoff value of 8.5 HU showed highest sensitivity of 84.5% and the cutoff value of 16 HU showed highest specificity of 95%, respectively. The CT findings of pleural nodule, pleural thickening and loculation were more common in exudates, compared with transudates with the statistical significance and specificity of those findings as high as 100%, 90%, and 75%, respectively. Conclusion: The mean attenuation values of ≥16 HU favor exudates. However, the use of CT attenuation values for differentiating types of pleural effusions alone, showed poor diagnostic performance. Correlation with clinical context and pleural fluid analysis are still essential. We suggest the three helpful CT findings for diagnosis of exudates which are pleural thickening, pleural nodules and loculation.

  1. Manejo escalonado en la supuración pleural

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    Bruk Bekele Jembere

    2002-12-01

    Full Text Available Se realizó un estudio de 36 enfermos con empiema pleural, atendidos por el grupo de Cirugía Torácica del Hospital Universitario "Comandante Manuel Fajardo" entre enero de 1995 y diciembre del 2000. Los enfermos se clasificaron en 3 estadios evolutivos: exudativo, fibrinopurulento y organizado, los que sirvieron de guías para establecer el proceder quirúrgico que se debía realizar. La principal causa fue la neumopatía inflamatoria seguida por las posquirúrgicas. Los gérmenes hallados con mayor frecuencia en los cultivos fueron: el estafilococo, las bacterias gran negativas y el estreptococo. Las intervenciones más realizadas fueron: la pleurotomía mínima con lavado pleural y sin él y la decorticación pleural en sus diferentes variantes. A 3 pacientes se les realizó algún tipo de resección pulmonar. En la fase fibrinopurulenta el 50 % requirió decorticación precoz con el 100 % de curación. En la fase organizada el tratamiento de elección fue la decorticación clásica (62,5 % o la tardía (18,8 %; los 2 fallecidos fueron de esta fase. Las complicaciones fueron escasas, infecciosas en su gran mayoría; el índice de mortalidad quirúrgica fue 5,6 %A study of 36 patients with pleural empyema that were attended by the Group of Thoracic Surgery from Comandante Manuel Fajardo Teaching Hospital from January, 1995, to December, 2000, was conducted. Patients were classified into 3 evolutive stages:exudative, fibrinopurulent and organized, which were used as guides to determine the surgical procedure to be performed. The main cause was inflammatory pneumopathy followed by the postsurgical ones. The germs most commonly found in cultures were: staphylococcus, Gram-negative bacteria and streptococcus. The most used operations were: minimum pleurotomy with and without pleural lavage and pleural decortication in its different variants. 3 patients underwent some type of lung resection. In the fibrinopurulent stage, 50 % required early

  2. F-18-FDG-PET for differential diagnosis of pleural processes; F-18-FDG-PET zur Primaerdiagnostik und Dignitaetsbeurteilung pleuraler Prozesse

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    Buchmann, I.; Guhlmann, C.A.; Schirrmeister, H.; Kotzerke, J.; Buck, A.; Reske, S.N. [Ulm Univ. (Germany). Abt. Nuklearmedizin; Elsner, K. [Ulm Univ. (DE). Abt. Radiologie 2 (Strahlentherapie); Gfroerer, W. [Universitaetsklinik Ulm (Germany). Abt. fuer Allgemeinchirurgie

    1999-07-01

    Purpose: Positron emission tomography (PET) with 18-fluorodeoxyglucose (FDG) has been shown to be accurate for differentiating benign from malignant pulmonary lesions. Therefore, we evaluated the capability of FDG-PET in the characterisation of pleural lesions. Patients and methods: PET was performed in thirteen patients with pleural or intrapulmonal tumors (three with additional pleural effusion) and in three patients with aetiologically unclear pleural effusion demonstrated by CT. In all cases the diagnosis was confirmed histologically. The PET-imaging was carried out in fasted patients 50 minutes after injection of 400-670 MBq F-18-FDG without attenuation correction. Results: Twelve patients were found to have pleural or pulmonal malignomas (9 pleural mesotheliomas, 3 bronchogenic adenocarcinoma with carcinomatous pleurisy). Four patients had benign pleural changes (1 fibroma, 1 tuberculous pleurisy, 1 pleural fibrosis, 1 empyema). With FDG-PET, all 12 pleural or intrapulmonal malignomas had high FDG-uptake and were classified correctly. Due to very low or virtually deficient FDG-uptake, four histologically benign lesions were correctly interpreted as nonmalignant. Conclusion: These preliminary results suggest that FDG-PET is accurate in detecting malignant pleural tumors. (orig.) [German] Ziel: Zahlreiche Studien belegen die hohe Treffsicherheit der Positronen-Emissions-Tomographie (PET) mit 2-[F-18]-Fluoro-2-desoxy-D-Glukose (FDG) bei der Dignitaetsbeurteilung nicht-verkalkter Lungenrundherde. Ziel dieser Untersuchung war die Evaluation der Wertigkeit der FDG-PET in der Primaerdiagnostik und Dignitaetsbeurteilung pleuraler Veraenderungen. Patienten/Methode: Dreizehn Patienten mit computertomographisch bekannten pleuralen Raumforderungen, von denen drei zusaetzlich einen Pleuraerguss aufwiesen, sowie drei Patienten mit aetiologisch unklarem Pleuraerguss wurden einer FDG-PET unterzogen. Die PET wurde 50 min nach i.v. Injektion von 400-670 MBq F-18-FDG in

  3. Libre comercio y política exterior en materia de derechos humanos en América del Norte. Una evaluación de la tesis del "derrame" (spillover

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    Alejandro Anaya Muñoz

    2009-01-01

    Full Text Available La tesis del "derrame" (spillover plantea que niveles crecientes de asociación económica podrán propiciar procesos de integración en las esferas social y política. Este argumento ha sido retomado por algunos autores, que lo han aplicado al área de la política exterior de los países integrantes del tlcan. Este artículo evalúa la hipótesisde que el establecimiento de un esquema de libre comercio en América del Norte ha tenido algo que ver con recientescambios en la política de México en el área de los derechos humanos, alineándose con la de Estados Unidos y Canadá. El artículo concluye que la tesis de la alineación por"derrame" no se sostiene, y ofrece explicaciones alternativas.

  4. Avances en la remediación del derrame de hidrocarburos en Barreal-Belén. Propuesta de medidas para la protección de acuíferos

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    Luis Carlos Vargas Fallas

    2011-09-01

    Full Text Available En la revista Tecnología en Marcha Vol. 22. N.º 4 se presentaron estimaciones de duración de la operación, de acuerdo con dos posibles escenarios de remediación. En esta publicación se muestran los avances logrados al 2009 y se indican los costos alcanzados en el proceso. En el Valle Central del país se ubican cerca de 160 estaciones gasolineras sobre importantes acuíferos, en las que se destacó el riesgo de contaminación, a la luz del caso del derrame de hidrocarburos ocurrido en Barreal-Belén en el 2004, descubierto por casualidad durante la inspección a un pozo cercano. Se analizan los instrumentos de estudio de la vulnerabilidad a la contaminación de acuíferos y se presenta una propuesta de medidas que se deberían adoptar para asegurar el control sobre el riesgo de otros derrames y para una gestión adecuada de las aguas.

  5. A case of ruptured descending thoracic aortic aneurysm into the right pleural cavity: importance of preoperative drainage of the right pleural cavity.

    Science.gov (United States)

    Akiyama, K; Takazawa, A; Hirota, J; Yamagishi, H; Akazawa, T

    1998-12-01

    We present an unusual case of a ruptured descending thoracic aortic aneurysm into the right pleural cavity of a patient with pectus carinatum. The presence of pectus carinatum played an important role in the development of the aneurysm at the atypical site and the rupture into the right pleural cavity. A small amount of right pleural bleeding on admission can increase and develop to massive hemothorax until emergency operation. Massive bleeding in the right pleural cavity where the dependent lung is located causes atelectasis and increased shunt fraction under one lung ventilation. Therefore, continuous drainage of the right pleural cavity is essential to prevent serious hypoxia during graft replacement in a case of ruptured descending thoracic aneurysm into the right hemithorax.

  6. Empiema pleural causado por tricomonas: Caso clínico

    OpenAIRE

    Ramírez M,Alejandro; PALMA M,ALEJANDRO; AVILES C,ELIZABETH; VILLARROEL M,LEOPOLDO

    2010-01-01

    La formación de un empiema pleural es una de las potenciales complicaciones de las infecciones de la vía aérea inferior, y se caracteriza por la observación de bacterias en la tinción de Gram, o la aspiración de pus en la toracocentesis. Muy infrecuentemente el empiema puede ser causado por alguna de las especies de tricomonas, de las cuales Trichomonas Tenax parece ser la causa más común. En este artículo, reportamos el caso de un hombre de 51 años que desarrolló un empiema pleural causado p...

  7. Early dislodgement of Indwelling Pleural Catheter (IPC): a balancing act.

    Science.gov (United States)

    Tung, Alvin Hon Man; Ngai, Jenny Chun Li; Ng, Susanna So Shan; Ko, Fanny Wai San; Hui, David Shu-Cheong

    2014-03-01

    A 63-year-old nonsmoker with right malignant pleural effusion derived symptomatic benefit following drainage of his effusion. Following insertion of indwelling pleural catheter (IPC), 1.3 L of blood-stained fluid was drained into underwater sealed bottle (Atrium®), but the IPC dislodged 26 h after continuous connection. We believe that the weight of the drainage bottle (including the un-emptied fluid) and the prolonged connection time contributed to this uncommon event reported in the literature. There was no recurrence when his second IPC was connected to a drainage bag which was emptied at every 500 mL, capped at 2 h each time. An anchoring stitch should also be considered when drainage devices heavier than the manufacturer bottles are used to drain IPC.

  8. Right Pleural Effusion in Fitz-Hugh-Curtis Syndrome

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    Tajiri,Takuma

    2006-10-01

    Full Text Available Right pleural effusion was diagnosed in a 36-year-old woman with right upper quadrant pain and fever. Enhanced pelvic computed tomography performed because of irregular genital bleeding revealed the pelvic inflammatory disease. Upon further questioning, the patient confirmed that she had recently undergone therapy for Chlamydia trachomatis infection. Therefore she was given an injection of tetracycline because we suspected Fitz-Hugh-Curtis syndrome (FHCS, a pelvic inflammatory disease characterized by perihepatitis associated with chlamydial infection. A remarkable clinical response to antibiotics was noted. The right upper quadrant pain was due to perihepatitis, and the final diagnosis was FHCS. Right pleural effusion may be caused by inflammation of the diaphragm associated with perihepatitis. Once chlamydial infection reaches the subphrenic liver, conditions in the closed space between the liver and diaphragm due to inflammatory adhesion may be conductive to chlamydial proliferation. The possibility of FHCS should be considered in patients and carefully distinguished from other abdominal diseases.

  9. [Pleural hernia of an esophageal graft--late postoperative complication].

    Science.gov (United States)

    Grabowski, K; Lewandowski, A; Moroń, K; Strutyńska-Karpińska, M; Błaszczuk, J; Machała, R

    1997-01-01

    Pleural hernia of the oesophageal substitute from pedicled intestinal segment is one of the late postoperative complications. 13 cases of patients with oesophagus reconstructed because of lye ingestion stenosis are presented. Problems concerning diagnosis and treatment of pleural hernia are analysed. Eight patients with minor symptoms were treated conservatively. Five patients were operated, two of them from acute necrosis of the substitute. Necrosis was caused by incarceration of the bowel and torsion of the mesentery. Elective operative treatment consisted of reduction of hernia sac contents, closing of the hernia orifice, chest drainage and temporary gastronomy. In patient operated as an emergency cases necrotic part of substitute was removed. This resulted in oesophageal exclusion in the neck, creating gastronomy. Chest drainage was also performed.

  10. Pleural effusion Due to Streptococcus milleri: Case descriptions.

    Science.gov (United States)

    Madrid-Carbajal, Claudia Janeth; Molinos, Luis; García-Clemente, Marta; Pando-Sandoval, Ana; Fleites, Ana; Casan-Clarà, Pere

    2014-09-01

    In this study we analyzed the characteristics of patients with pleural effusion secondary to Streptococcus milleri studied retrospectively between January and March 2013 and found seven patients with a mean age of 60 years, 43% of which were smokers and 57% with a drinking habit. The most common associated factors were alcoholism, previous pneumonia and diabetes. Other bacteria were identified as Enterobacter aerogenes, Bacteroides and Prevotella intermedia capillosus in two patients. The mean duration of antibiotic therapy was 28 days; six patients underwent pleural drainage by chest tube and one patient needed surgery due to poor clinical progress. The mean duration of hospitalization was 30 days with satisfactory outcome in all cases, despite some changes in residual function. Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.

  11. PET positive pleural plaques decades after pleurodesis: mesolthelioma?

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    Williams K

    2011-02-01

    Full Text Available A 59-year-old patient was evaluated for abnormal chest CT and hypermetabolic pleural foci on FDG-PET scan. The scans were obtained as routine surveillance for resection of an in situ pancreatic tumor. The patient had a remote history of automobile manufacturing and the abnormalities were suggestive of asbestos exposure. Because hypermetabolic areas were concerning for pleural malignancy, a VATS lung biopsy was performed and revealed chronic talc-induced pleuritis. The patient had a history of pnemothoraces with bilateral talc pleurodesis at the age of 16. As cancer screening and surveillance increasingly relies on extensive imaging modalities, physicians should be aware of the chronic complications of talc pleurodesis and the possibility of false positive imaging tests.

  12. Pleural, peritoneal and pericardial effusions – a biochemical approach

    Science.gov (United States)

    Kopcinovic, Lara Milevoj; Culej, Jelena

    2014-01-01

    The pathological accumulation of serous fluids in the pleural, peritoneal and pericardial space occurs in a variety of conditions. Since patient management depends on right and timely diagnosis, biochemical analysis of extravascular body fluids is considered a valuable tool in the patient management process. The biochemical evaluation of serous fluids includes the determination of gross appearance, differentiation of transudative from exudative effusions and additional specific biochemical testing to assess the effusion etiology. This article summarized data from the most relevant literature concerning practice with special emphasis on usefulness of biochemical tests used for the investigation of pleural, peritoneal and pericardial effusions. Additionally, preanalytical issues concerning serous fluid analysis were addressed and recommendations concerning acceptable analytical practice in serous fluid analysis were presented. PMID:24627721

  13. Intrapleural instillation of radioactive chromic phosphate in malignant pleural effusion

    Energy Technology Data Exchange (ETDEWEB)

    Nori, D.; Moorthy, C.R.; Hilaris, B.S.; Batata, M.A.; Chu, F.; Martini, N. (Memorial Sloan-Kettering Cancer Center, New York (USA))

    1981-12-01

    Eighty-five patients with pleural effusion were analyzed to determine the degree of response to intrapleural instillation of /sup 32/P colloidal suspension. Worthwhile palliation of either complete fluid suppression or definite diminution in the rate of accumulation was achieved in slightly more than one-half of the patients (51/85). It is not evident whether the primary site and histologic nature of the neoplasm are important or not in predicting the results of treatment. Patients with pleural adhesions and those with sanguinous effusions, are less likely to be benefited by the /sup 32/P instillation. The beneficial effect appears quite promptly in some patients, while in others, it may be delayed for several weeks.

  14. Bilateral pleural effusion after central venous catheterization- A rare complication.

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    Reyaz Ahmed Para

    2015-12-01

    Full Text Available Central venous Catherization (CVC is rarely complicated by pleural effusion. It is usually due to malpositioned catheter. Our patient was a 35-year-old man admitted with Menningoencephalitis.A cervical central vein catheter was placed into his right jugular vein after induction of anaesthesia in Emergency Room. In chest x ray we encountered bilateral pleural effusion and drained it with a chest tube. During following days the patient has daily drainage of almost 1.7 liter of clear yellowish fluid from chest tube. Fluid analysis was not diagnostic. We removed the central vein catheter and plural drainage was stopped. [Natl J Med Res 2015; 5(4.000: 329-331

  15. Asociación de índices infecciosos del virus de la fiebre aftosa a receptores celulares en el ganado criollo bon

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    Ariza Botero Manuel Fernando

    2006-06-01

    Full Text Available Los miembros de la familia de receptores celulares, integrinas (·V‚1, ·V‚3 ·V‚6, han sido identificados como factores de adhesión de diferentes virus a las células del hospedero. Para el caso del virus de la Fiebre Aftosa, estas integrinas se unen al sitio de reconocimiento celular en la secuencia tripéptidica Arg-Gly-Asp (RGD e igualmente están localizadas en la proteína VP1 del virus. Evidencia genética de esta interacción ha sido obtenida mediante la mutación de la secuencia RGD en clones infecciosos de ADNc, identificando partículas virales no infectivas incapaces de absorberse a células susceptibles. Cierta clase de resistencia genética natural al virus de la fiebre aftosa ha sido descrita en el ganado bovino Blanco Orejinegro, considerándose que cierto grado de esta resistencia podría ser causado por mutaciones en estos receptores celulares responsables por la adhesión del virus. Uno de los objetivos del estudio fue la identificación de genes candidatos (integrinas, específicamente marcadores moleculares asociados a genes  potencialmente responsables por la adhesión del virus aftoso a la célula hospedera. Un total de 106 individuos pertenecientes al núcleo de ganado criollo (banco de germoplasma bovino, Corpoica fueron genotipados con dos marcadores tipo microsatélite (ILS030 y BM2113 y dos SNPs (SLC11A1 y ITGB6 encontrados en el cromosoma 2 bovino. Estos genotipos fueron asociados a índices de infecciosidad, obtenidos a partir de la infección de cultivos BHK y de fibroblastos con los serotipos O1 Campos y A24 Cruzeiro, para cada uno de los individuos. Dos de los cuatro marcadores (ITGB6 e ILST030S se asociaron significativamente con el fenotipo Índice de Resistencia y mostraron un amplio efecto aditivo (p=0,025 y p=0,001 respectivamente. El presente estudio permitirá identificar aquellas líneas familiares que segregan aquellos alelos benéficos dentro de un programa de selección asistida por marcadores

  16. Fiebre de origen desconocido, una forma de presentarse la tuberculosis Fever of unknown origin as a form of presentation of tuberculosis

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    Lázaro Arturo Vidal Tallet

    2012-12-01

    Full Text Available La tuberculosis es una causa importante de fiebre de origen desconocido. Dentro de los factores de riesgo para estar infectado por el bacilo tuberculoso se encuentra la edad, la presencia de comorbilidades, la competencia inmunológica y la alta prevalencia de la enfermedad en el área geográfica. Los hallazgos clínicos, radiológicos, epidemiológicos y la respuesta a la terapéutica antimicrobiana, pueden orientar en el diagnóstico de esta enfermedad infecciosa. Se presenta un caso en el que los elementos clínicos y epidemiológicos (padre con diagnóstico de tuberculosis llevaron finalmente a la sospecha diagnóstica de tuberculosis extra pulmonar, que no pudo ser demostrada por cultivo, pero la respuesta terapéutica resultó concluyente, ya que, una vez iniciada esta, hubo total remisión del cuadro clínico y recuperación nutricional. La terapia antituberculosa con carácter terapéutico y diagnóstico debe ser considerada en todo paciente con fiebre de origen desconocido, que, además, presente elementos clínicos y epidemiológicos que justifiquen la posibilidad de infección por el bacilo.Tuberculosis is an important cause of fever of unknown origin. Among the risk factors of getting infected by the tuberculosis bacillus are age, presence of comorbidities, immunological competence and high prevalence of the disease in a geographical area. The clinical, radiological and epidemiological findings along with the response to antimicrobial treatment can guide the physician to the correct diagnosis of this infectious disease. Here is a case in which the clinical and epidemiological elements (the father of the patient diagnosed with tuberculosis led to diagnostic suspicion of extrapulmonary tuberculosis. It was not possible to demonstrate it by culturing, but the response to therapy was conclusive, since once the treatment began, there were total remission of the clinical picture and nutritional recovery. The therapeutically and

  17. Modified TB rapid test by proteinase K for rapid diagnosis of pleural tuberculosis.

    Science.gov (United States)

    Yari, Shamsi; Hadizadeh Tasbiti, Alireza; Ghanei, Mostafa; Shokrgozar, Mohammad Ali; Fateh, Abolfazl; Yari, Fatemeh; Bahrmand, Ahmadreza

    2016-03-01

    The diagnosis of pleural tuberculosis continues to be a challenge due to the low sensitivity of traditional diagnostic methods. Better and more rapid tests are needed for diagnosis of pleural TB. In this study, pleural fluids were tested with rapid test to determine Mycobacterium tuberculosis (MTB antigen). Affinity chromatography was used to purify specific polyclonal antibodies against MTB antigen. Pleural samples after decontamination were treated with proteinase K. Rapid test for pleural fluids was prepared by specific antibody. Rapid test was performed on 85 pleural fluid patients. The patients had a mean age of 46.55 ± 15.96 years and 38 were men. The performance of rapid test, using proteinase K, was found to be the most impressive: sensitivity 93%, specificity 94%, PPV 90%, and NPV 96% compared with adenosine deaminase test (ADA), PCR, smear, and culture. The present study did demonstrate that modified TB rapid test can substantially improve the diagnosis of extrapulmonary TB.

  18. Localized malignant pleural sarcomatoid mesothelioma misdiagnosed as benign localized fibrous tumor.

    Science.gov (United States)

    Kim, Kwan-Chang; Vo, Hong-Phuc

    2016-06-01

    Localized malignant pleural mesothelioma (LMPM) is a rare tumor with good prognosis by surgical resection. We report an atypical case of malignant pleural sarcomatoid mesothelioma (SM) in an asymptomatic 65-year-old woman, who had no history of exposure to asbestos. She presented with a small pleural mass without pleural effusion and was misdiagnosed as a benign localized fibrous tumor (BLFT) on pathologic examination through a surgical tumor specimen. However, seven months later, the patient returned with serious cancerous symptoms. A large recurrent tumor mass was found within the chest wall invading at the old surgical resection site. SM, a subtype of LMPM, was confirmed with histopathogy and immunohistochemisty. In conclusion, malignant pleural mesothelioma (MPM) can present with typical radiologic finding similar to a BLFT, and has a wide histopathologic presentation in biopsy specimen. A thorough pathologic investigation should be attempted even when a pleural mass resembles benign, localized, and small on radiologic studies.

  19. [Influence of pleural fluid red blood cell count on the misidentification of transudates].

    Science.gov (United States)

    Porcel, José Manuel; Esquerda, Aureli; Martínez, Montserrat; Rodríguez-Panadero, Francisco; Bielsa, Silvia

    2008-12-06

    Light's criteria misclassify a quarter of transudates as exudates. We assessed the influence of red blood cell counts on pleural lactate dehydrogenase (LDH) levels and, thereby, on the specificity of Light's criteria. We retrospectively reviewed 1,312 consecutive patients with pleural effusion, of whom 1,014 were exudates and 298 transudates according to clinical criteria. The relationship between pleural erythrocytes and LDH using simple linear regression analysis, as well as the operating characteristics of Light's criteria, were assessed. Finally, a formula to correct pleural LDH levels, according to the erythrocyte count, was generated. There was a linear relationship between the pleural erythrocyte count and LDH levels (r = 0.44; p exudates. A high pleural erythrocyte count, through its influence on the LDH levels, may lead to a transudate being misclassified as an exudate after applying Light's criteria.

  20. Diagnostic importance of zinc in the clarification of pleural effusions etiology

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    Ranković Boško

    2002-01-01

    Full Text Available Concentration of zinc in blood serum and effusion was determined in 104 patients with the pleural effusion of different etiology. The importance of zinc concentration in serum and effusion was analyzed, as well as their relation regarding the differential diagnosis of pleural effusion. It was established that the isolated zinc concentrations in serum and pleural effusion could not be used separately either in differing transudates from exudates or in the diagnosis of the pleural diseases. The average value of zinc in the pleural effusion in relation to the serum value in patients with tuberculosis effusion was 1.37, higher than 1 in all patients and was significantly different from the average value of the ratio 0,74 in patients with nonspecific and malignant pleural effusions. The relation of zinc concentration in the effusion and serum higher than 1.0 reliably indicated the presence of tuberculous pleurisy.

  1. Ewing’s Sarcoma Presenting as Pleural Effusion

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    Nuzhat Husain

    2011-09-01

    Full Text Available  A 20-year-old female presented to the Pulmonary Medicine Department with complaints of fever, left sided chest pain and progressive dyspnoea of four months duration. Radiological examination revealed a mass lesion with massive pleural effusion and rib erosion. Histopathology showed neoplastic cells with scanty cytoplasm, hyperchromatic nuclei and rosette formation suggestive of Ewing sarcoma. The rarity of this tumor and its unusual presentation prompted this report.

  2. Pleuropulmonary blastoma presenting as a complicated pleural effusion.

    LENUS (Irish Health Repository)

    O'Brien, J

    2012-02-01

    Pleuropulmonary blastoma (PPB) is a rare tumour of mesenchymal cells. We present a case of PPB in a child, which presented to the emergency department with an extensive pleural effusion. We discuss the radiological features, pathology, classification and treatment of this condition. This case reiterates the importance of considering this diagnosis prior to surgical intervention, to improve the long term prognosis of this aggressive disease.

  3. Morphologic and functional imaging of malignant pleural mesothelioma

    Energy Technology Data Exchange (ETDEWEB)

    Yamamuro, Masaki; Gerbaudo, Victor H.; Gill, Ritu R.; Jacobson, Francine L.; Sugarbaker, David J. [Department of Radiology and Surgery, Brigham and Women' s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115 (United States); Hatabu, Hiroto [Department of Radiology and Surgery, Brigham and Women' s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115 (United States)], E-mail: hhatabu@partners.org

    2007-12-15

    Malignant pleural mesothelioma (MPM) is an aggressive tumor that arises from the pleura and frequently extends to adjacent structures. MPM cells produce and respond to many angiogenic factors, such as vascular endothelial growth factor (VEGF). VEGF expression in MPM is correlated with microvascular density, which is associated with poor survival. CT has been widely used as the primary imaging modality for the clinical evaluation of MPM. Major findings include nodular pleural thickening, unilateral pleural effusion, and tumor invasion of adjacent structures. CT tends to underestimate early chest wall invasion and peritoneal involvement and has well-known limitations in the evaluation of lymph node metastases. Perfusion CT can evaluate the microvasculature of tumors, while its disadvantages, such as high radiation exposure or side effects from iodinated contrast, limit its use in both research and clinical settings. MRI can provide additional information to CT. Because of its excellent contrast resolution, MRI is superior to CT, both in the differentiation of malignant from benign pleural disease, and in the assessment of chest wall and diaphragmatic involvement. Perfusion MRI is the most promising technique for the assessment of the tumor microvasculature. In MPM, therapeutic effects of chemotherapy can be monitored with perfusion MRI. It has been shown that FDG-PET is useful for the differentiation of benign from malignant lesions, for staging and monitoring metabolic response to therapy against MPM, and that it has prognostic value. An initial report on PET/CT imaging of MPM has shown increased accuracy of overall staging, improving the assessment of tumor resectability. PET/CT seems to be superior to other imaging modalities in detecting more extensive disease involvement, and identifying unsuspected occult distant metastases.

  4. Morphologic and functional imaging of malignant pleural mesothelioma.

    Science.gov (United States)

    Yamamuro, Masaki; Gerbaudo, Victor H; Gill, Ritu R; Jacobson, Francine L; Sugarbaker, David J; Hatabu, Hiroto

    2007-12-01

    Malignant pleural mesothelioma (MPM) is an aggressive tumor that arises from the pleura and frequently extends to adjacent structures. MPM cells produce and respond to many angiogenic factors, such as vascular endothelial growth factor (VEGF). VEGF expression in MPM is correlated with microvascular density, which is associated with poor survival. CT has been widely used as the primary imaging modality for the clinical evaluation of MPM. Major findings include nodular pleural thickening, unilateral pleural effusion, and tumor invasion of adjacent structures. CT tends to underestimate early chest wall invasion and peritoneal involvement and has well-known limitations in the evaluation of lymph node metastases. Perfusion CT can evaluate the microvasculature of tumors, while its disadvantages, such as high radiation exposure or side effects from iodinated contrast, limit its use in both research and clinical settings. MRI can provide additional information to CT. Because of its excellent contrast resolution, MRI is superior to CT, both in the differentiation of malignant from benign pleural disease, and in the assessment of chest wall and diaphragmatic involvement. Perfusion MRI is the most promising technique for the assessment of the tumor microvasculature. In MPM, therapeutic effects of chemotherapy can be monitored with perfusion MRI. It has been shown that FDG-PET is useful for the differentiation of benign from malignant lesions, for staging and monitoring metabolic response to therapy against MPM, and that it has prognostic value. An initial report on PET/CT imaging of MPM has shown increased accuracy of overall staging, improving the assessment of tumor resectability. PET/CT seems to be superior to other imaging modalities in detecting more extensive disease involvement, and identifying unsuspected occult distant metastases.

  5. Overexpression of Aquaporin-1 in lung adenocarcinomas and pleural mesotheliomas

    OpenAIRE

    López-Campos, José Luis; Sánchez Silva, Rocío; Gómez Izquierdo, Lourdes; Márquez, Eduardo; Ortega Ruiz, Francisco; Cejudo, Pilar; Barrot Cortés, Emilia; Toledo Aral, Juan José; Echevarría, Miriam

    2011-01-01

    Aquaporin-1 (AQP1) is the main water channel responsible for water transport through many epithelia and endothelia. The latest evidence pointed toward an important role of this protein also in gas permeation, angiogenesis, cell proliferation and migration. In the present work we studied the expression of AQP1 by immunohistochemical staining of 92 lung biopsies from patients diagnosed with a pleuropulmonary tumor (71 lung and 21 pleural neoplasms). AQP1 expression wa...

  6. Monitoring and assessment of tumor hemodynamics during pleural PDT

    Science.gov (United States)

    Ong, Yi Hong; Kim, Michele M.; Penjweini, Rozhin; Rodriguez, Carmen E.; Dimofte, Andrea; Finlay, Jarod C.; Busch, Theresa M.; Yodh, Arjun G.; Cengel, Keith A.; Singhal, Sunil; Zhu, Timothy C.

    2017-02-01

    Intrapleural photodynamic therapy (PDT) has been used in combination with lung sparing surgery to treat patients with malignant pleural mesothelioma. The light, photosensitizers and tissue oxygen are the three most important factors required by type II PDT to produce singlet oxygen, 1O2, which is the main photocytotoxic agent that damages the tumor vasculature and stimulates the body's anti-tumor immune response. Although light fluence rate and photosensitizer concentrations are routinely monitored during clinical PDT, there is so far a lack of a Food and Drug Administration (FDA)-approved non-invasive technique that can be employed clinically to monitor tissue oxygen in vivo. In this paper, we demonstrated that blood flow correlates well with tissue oxygen concentration during PDT and can be used in place of [3O2] to calculate reacted singlet oxygen concentration [1O2]rx using the macroscopic singlet oxygen model. Diffuse correlation spectroscopy (DCS) was used to monitor the change in tissue blood flow non-invasively during pleural PDT. A contact probe with three source and detectors separations, 0.4, 0.7 and 1.0-cm, was sutured to the pleural cavity wall of the patients after surgical resection of the pleural mesothelioma tumor to monitor the tissue blood flow during intraoperative PDT treatment. The changes of blood flow during PDT of 2 patients are found to be in good correlation with the treatment light fluence rate recorded by the isotropic detector placed adjacent to the DCS probe. [1O2]rx calculated based on light fluence, mean photosensitizer concentration, and relative blood flow was found to be 32% higher in patient #4 (0.50mM) than that for patient #3 (0.38mM).

  7. Role of therapeutic thoracentesis in tuberculous pleural effusion

    Directory of Open Access Journals (Sweden)

    Sourin Bhuniya

    2012-01-01

    Full Text Available Context: Prevalence of tuberculous pleural effusion is very high in the Asian subcontinent but very few studies have come up from this part of the world about the course of recovery of pulmonary functions after institution of anti-tubercular therapy (ATT and thoracentesis. Aims: To study initial lung function impairment, changes over time after institution of ATT and thoracentesis and residual abnormalities left at the end of six months of treatment. Settings and Design: Randomized open level interventional study over two years in 52 patients at a tertiary level teaching hospital. Methods: The study population was divided into two equal groups, A (therapeutic thoracentesis and B (diagnostic thoracentesis. Spirometry, chest radiograph and ultrasonography of thorax were done initially and at each follow-up visit up to six months. Statistical analysis was done (P value < 0.05 considered significant. Results: Both groups were comparable initially. After six months none in group A and five patients in group B had minimal pleural effusion. During follow up, mean percentage predicted of FEV1 and FVC increased more in A than in B and the differences were statistically significant (P < 0.05. Pleural thickening, initially absent in both groups, was found to be more in B as compared to A at subsequent follow-up visits and this was statistically significant (P < 0.05. Conclusions: Thoracentesis should be considered in addition to anti-TB treatment, especially in large effusions, in order to relieve dyspnea, avoid possibility of residual pleural thickening and risk of developing restrictive functional impairment.

  8. Eosinophilic Endomyocarditis Combined With Pericardial and Pleural Effusion

    OpenAIRE

    You, Sung-Hye; Hong, Soon Jun; Ahn, Chul Min; Lim, Do-Sun

    2009-01-01

    Eosinophilic endomyocarditis is a manifestation of hypereosinophilic syndrome, characterized by prolonged (>6 months), unexplained peripheral blood eosinophilia (>1,500 cells/mm3) with end-organ damage in unknown causes. We report a case of a 42-year-old patient who developed eosinophilic endomyocarditis following upper respiratory tract symptoms for 2 months. Additionally, endomyocarditis was combined with massive pleural effusion and pericardial effusion, which have not been reported in Korea.

  9. Dosagem de proteínas totais e desidrogenase lática para o diagnóstico de transudatos e exsudatos pleurais: redefinindo o critério clássico com uma nova abordagem estatística Determination of total proteins and lactate dehydrogenase for the diagnosis of pleural transudates and exudates: redefining the classical criterion with a new statistical approach

    Directory of Open Access Journals (Sweden)

    Bernardo Henrique Ferraz Maranhão

    2010-08-01

    Full Text Available OBJETIVO: Propor um novo critério de classificação para a diferenciação entre exsudatos e transudatos pleurais através da dosagem de proteínas totais no líquido pleural (PT-LP e de desidrogenase lática no líquido pleural (DHL-LP exclusivamente, assim como comparar o rendimento diagnóstico entre esse novo critério com o critério clássico. MÉTODOS: Estudo observacional, transversal de tipo individualizado, no qual foram selecionados 181 pacientes com derrame pleural tratados em dois hospitais universitários no estado do Rio de Janeiro (RJ entre 2003 e 2006. Os parâmetros diagnósticos incluídos no critério clássico, assim como os do novo critério, foram determinados. RESULTADOS: Dos 181 pacientes, 152 e 29 foram diagnosticados, respectivamente, com exsudato pleural e transudato pleural. A sensibilidade, especificidade e acurácia do critério clássico para o diagnóstico de exsudato pleural foram, respectivamente, de 99,8%, 68,6% e 94,5%, enquanto, para o diagnóstico de transudato pleural, essas foram de 76,1%, 90,1% e 87,6%. Utilizando-se os pontos de corte de 3,4 g/dL para a dosagem de PT-LP e de 328,0 U/L para aquela de DHL-LP (novo critério, a sensibilidade, especificidade e acurácia foram de, respectivamente, 99,4%, 72,6% e 99,2%, para o diagnóstico de exsudato, e de 98,5%, 83,4% e 90,0%, para o diagnóstico de transudato. A acurácia do novo critério proposto para o diagnóstico de exsudato pleural foi significativamente maior que aquela do critério clássico (p = 0,0022. CONCLUSÕES: O rendimento diagnóstico dos dois critérios estudados foi semelhante. Portanto, esse novo critério de classificação pode ser utilizado na prática diária.OBJECTIVE: To propose a new classification criterion for the differentiation between pleural exudates and transudates-quantifying total proteins in pleural fluid (TP-PF and lactate dehydrogenase in pleural fluid (LDH-PF exclusively-as well as to compare this new criterion with

  10. La decorticación pulmonar en el empiema pleural Pulmonary decortication in the pleural empyema

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    Orestes Noel Mederos Curbelo

    2008-12-01

    Full Text Available INTRODUCCIÓN. Se realizó un estudio descriptivo, retrospectivo y longitudinal, de tipo serie de casos, con 69 pacientes atendidos en el Hospital Universitario «Manuel Fajardo» entre 1995 y 2007, que requirieron decorticación pulmonar como tratamiento de un empiema pleural. MÉTODOS. Se seleccionaron los expedientes clínicos de 29 pacientes, a los cuales fue necesario realizar una decorticación pulmonar como tratamiento quirúrgico y estos constituyeron la muestra de la investigación. RESULTADOS. Diez de los 29 pacientes estaban en fase fibrinopurulenta y 19, en la organizada (hubo 13 pacientes en la fase organizada temprana, la cual coincide con el período subagudo de la enfermedad, y 6, en la tardía, que corresponde con el período de conicidad de la enfermedad. El sexo más afectado fue el masculino (relación de 8:1. Hubo fuga aérea en todos los pacientes, con diferente duración según el tipo de decorticación (más duradera en la clásica y la tardía. Las complicaciones fueron escasas en la decorticación temprana. En las decorticaciones clásica y tardía se presentaron 4 complicaciones sépticas respiratorias y falleció un paciente en fase organizada tardía. A este se practicó una decorticación tardía, paquipleurectomía y resección pulmonar. CONCLUSIONES. La decorticación temprana es una opción terapéutica segura, de poca morbilidad, que evita las complicaciones presentes en las decorticaciones clásicas y tardías.INTRODUCTION. A case series descriptive, retrospective and longitudinal study that included 69 patients attended at «Manuel Fajardo» University Hospital from 1995 to 2007 was undertaken. These patients required pulmonary decortication to treat a pleural empyema. METHODS. The clinical histories of 29 patients who underwent pulmonary decortication and were taken as a sample for the investigation were selected. RESULTS. Ten of the 29 patients were in fibrinopurulent stage and 19 in the organized (13

  11. Pleural controversy: optimal chest tube size for drainage.

    Science.gov (United States)

    Light, Richard W

    2011-02-01

    In recent years, a higher and higher percentage of patients with pleural effusions or pneumothorax are being treated with small-bore (10-14 F) chest tubes rather than large-bore (>20 F). However, there are very few randomized controlled studies comparing the efficacy and complication rates with the small- and large-bore catheters. Moreover, the randomized trials that are available have flaws in their design. The advantages of the small-bore catheters are that they are easier to insert and there is less pain with their insertion while they are in place. The placement of the small-bore catheters is probably more optimal when placement is done with ultrasound guidance. Small-bore chest tubes are recommended when pleurodesis is performed. The success of the small-bore indwelling tunnelled catheters that are left in place for weeks documents that the small-bore tubes do not commonly become obstructed with fibrin. Patients with complicated parapneumonic effusions are probably best managed with small-bore catheters even when the pleural fluid is purulent. Patients with haemothorax are best managed with large-bore catheters because of blood clots and the high volume of pleural fluid. Most patients with pneumothorax can be managed with aspiration or small-bore chest tubes. If these fail, a large-bore chest tube may be necessary. Patients on mechanical ventilation with barotrauma induced pneumothoraces are best managed with large-bore chest tubes.

  12. In vivo light dosimetry for HPPH-mediated pleural PDT

    Science.gov (United States)

    Dimofte, Andreea; Zhu, Timothy C.; Finlay, Jarod C.; Cullighan, Melissa; Edmonds, Christine E.; Friedberg, Joseph S.; Cengel, Keith; Hahn, Stephen M.

    2010-02-01

    This study examines the light fluence (rate) delivered to patients undergoing pleural PDT as a function of treatment time, treatment volume and surface area. The accuracy of treatment delivery is analyzed as a function of the calibration accuracies of each isotropic detector and the calibration integrating sphere. The patients studied here are enrolled in a Phase I clinical trial of HPPH-mediated PDT for the treatment of non-small cell lung cancer with pleural effusion. Patients are administered 4mg per kg body weight HPPH 24-48 hours before the surgery. Patients undergoing photodynamic therapy (PDT) are treated with light therapy with a fluence of 15-60 J/cm2 at 661nm. Fluence rate (mW/cm2) and cumulative fluence (J/cm2) is monitored at 7 different sites during the entire light treatment delivery. Isotropic detectors are used for in-vivo light dosimetry. The anisotropy of each isotropic detector was found to be within 15%. The mean fluence rate delivery and treatment time are recorded. A correlation between the treatment time and the treatment volume is established. The result can be used as a clinical guideline for future pleural PDT treatment.

  13. [Clinical Pathological Diagnosis, and Treatment for Pleural Mesothelioma].

    Science.gov (United States)

    Kishimoto, Takumi; Fujimoto, Nobukazu; Nishi, Hideyuki

    2016-05-01

    For the differential diagnosis between fibrous pleuritis and other malignancies such as lung cancer, multiple immunostaining is essential to diagnose pleural mesothelioma. For cytological diagnosis of pleural effusions, differentiation between mesothelioma cells and reactive mesothelial cells is very difficult. Therefore, histological diagnoses of tumor tissues obtained via biopsy are essential. To diagnose epthelioid mesothelioma, more than 2 positive and negative markers must be consistent with those known for mesothelioma. To diagnose sarcomatoid mesothelioma, keratin is usually positive, differentiating the diagnosis from that for real sarcoma. For surgical treatment for pleural mesothelioma, extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D) are usually performed. The proportion of P/D increases because of the low death rates with surgery and similar survivals. However, a trimodal approach, such as EPP with chemotherapy and radiotherapy, is best for longer survival and expected to be curative. For chemotherapy, only cisplatin (CDDP) combined with pemetrexed (PEM) is effective, and no other agents have been identified for this disease. Nowadays, clinical immunotherapy trials start with phase II study.

  14. Pleural Gas Analysis for Detection of Alveolopleural Fistulae.

    Science.gov (United States)

    Bharat, Ankit; Graf, Nicole; Cassidy, Emily; Smith, Sean; Gillespie, Colin; Meyerson, Shari; Sporn, Peter H S; Sznajder, Jacob I; DeCamp, Malcolm M

    2015-06-01

    Visual inspection (VI) of bubbles in the chest drainage unit does not differentiate a true leak of alveolopleural fistula (APF) from a false leak. We hypothesized that detection of elevated levels of carbon dioxide, increase in oxygen content, or both, in pleural gas upon the administration of supplemental oxygen would accurately identify APF. Prospective study comparing pleural gas analysis (GA) with VI to detect APF after surgical lobectomy (n = 50). APF was found in 22 (44%) patients at the time of analysis. VI revealed air bubbles in 31 (62%) patients, indicating the presence of APF, of whom 12 (38.7%) were false leaks. VI failed to identify APF in 3 (6%) patients that resulted in post-tube removal pneumothorax. By contrast, GA accurately demonstrated APF in 21 patients, with only one false negative and no false positives. GA demonstrated better sensitivity (95.5% vs 86.4%), specificity (100% vs 57.1%), positive predictive value (100% vs 61.3%), and negative predictive value (96.6% vs 84.2%) compared to VI. Pleural gas analysis is an effective technique to detect APF and can facilitate timely and safe chest tube removal. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  15. Clinical consequences of asbestos-related diffuse pleural thickening: A review

    OpenAIRE

    Sandrini Alessandra; Miles Susan E; Johnson Anthony R; Yates Deborah H

    2008-01-01

    Abstract Asbestos-related diffuse pleural thickening (DPT), or extensive fibrosis of the visceral pleura secondary to asbestos exposure, is increasingly common due to the large number of workers previously exposed to asbestos. It may coexist with asbestos related pleural plaques but has a distinctly different pathology. The pathogenesis of this condition as distinct from pleural plaques is gradually becoming understood. Generation of reactive oxygen and nitrogen species, profibrotic cytokines...

  16. Utility of semi-rigid thoracoscopy in undiagnosed exudative pleural effusion

    Directory of Open Access Journals (Sweden)

    Loganathan Nattusamy

    2015-01-01

    Full Text Available Background: Semi-rigid thoracoscopy is a safe and efficacious procedure in patients with undiagnosed pleural effusion. Literature on its utility from developing countries is limited. We herein describe our initial experience on the utility of semi-rigid thoracoscopy from a tertiary care teaching and referral center in north India. We also perform a systematic review of studies reporting the utility of semi-rigid thoracoscopy from India. Patients and Methods: The primary objective was to evaluate the diagnostic utility of semi-rigid thoracoscopy in patients with undiagnosed exudative pleural effusion. Semi-rigid thoracoscopy was performed under local anesthesia and conscious sedation in the bronchoscopy suite. Results: A total of 48 patients underwent semi-rigid thoracoscopy between August 2012 and December 2013 for undiagnosed pleural effusion. Mean age was 50.9 ± 14.1 years (range: 17-78 years. Pre-procedure clinico-radiological diagnoses were malignant pleural effusion [36 patients (75%], tuberculosis (TB [10 (20.83% patients], and empyema [2 patients (4.17%]. Patients with empyema underwent the procedure for pleural biopsy, optimal placement of intercostal tube and adhesiolysis. Thoracoscopic pleural biopsy diagnosed pleural malignancy in 30 (62.5% patients and TB in 2 (4.17% patients. Fourteen (29.17% patients were diagnosed with non-specific pleuritis and normal pleura was diagnosed on a pleural biopsy in 2 (4.17% patients. Overall, a definitive diagnosis of either pleural malignancy or TB was obtained in 32 (66.7% patients. Combined overall sensitivity, specificity, positive predictive value and negative predictive value of thoracoscopic pleural biopsy for malignant pleural effusion were 96.77%, 100%, 100% and 66.67%, respectively. There was no procedure-related mortality. On performing a systematic review of literature, four studies on semi-rigid thoracoscopy from India were identified. Conclusion: Semi-rigid thoracoscopy is a safe and

  17. A Study on Significance of Serum Effusion Albumin Gradient in The Differential Diagnosisof Pleural Effusion

    OpenAIRE

    Arijit Kumar Das; Krishna Baruah

    2009-01-01

    To evaluate serum pleural effusion albumin gradient (SEAG) as method of differentiating pleural transudatesfrom exudates.Cases admitted in AMCH with diagnosed pleural effusion were divided into 2 groups basedon etiology. Group I (transudates): Comprising 14 patients of congestive heart failure (n=6) and nephroticsyndrome (n=3), Cirrhosis (n=4), pericardial effusion (n=1). Group II (exudates): comprising 26 cases oftuberculous (n=15), malignant (n=8) and parapneumonic effusion (n=2), rheumatoi...

  18. Pleurotomy with subxyphoid pleural drain affords similar effects to pleural integrity in pulmonary function after off-pump coronary artery bypass graft

    Directory of Open Access Journals (Sweden)

    Guizilini Solange

    2012-01-01

    Full Text Available Abstract Background Exacerbation of pulmonary dysfunction has been reported in patients receiving a pleural drain inserted through the intercostal space in comparison to patients with an intact pleura undergoing coronary artery bypass grafting (CABG. Evidence suggests that shifting the site of pleural drain insertion to the subxyphoid position minimizes chest wall trauma and preserves respiratory function in the early postoperative period. The aim of this study was to compare the pulmonary function parameters, clinical outcomes, and pain score between patients undergoing pleurotomy with pleural drain placed in the subxyphoid position and patients with intact pleural cavity after off-pump CABG (OPCAB using left internal thoracic artery (LITA. Methods Seventy-one patients were allocated into two groups: I (n = 38 open left pleural cavity and pleural drain inserted in the subxyphoid position; II (n = 33 intact pleural cavity. Pulmonary function tests and clinical parameters were recorded preoperatively and on postoperative days (POD 1, 3 and 5. Arterial blood gas analysis and shunt fraction were evaluated preoperatively and in POD1. Pain score was assessed on POD1. To monitor pleural effusion and atelectasis chest radiography was performed routinely 1 day before operation and until POD5. Results In both groups a significant impairment was found in lung function parameters until on POD5. However, no significant difference in forced vital capacity and forced expiratory volume in 1 second were seen between groups. A significant decrease in partial pressure of arterial oxygen and an increase in shunt fraction values were observed on POD1 in both groups, but no statistical difference was found when the groups were compared. Pleural effusion and atelectasis until on POD5 were similar in both groups. There were no statistical differences in pain score, duration of mechanical ventilation and postoperative hospital stay between groups. Conclusion Subxyphoid

  19. Nuevas aportaciones a la gestión informatizada de derrames de hidrocarburos: su aplicación a “zonas refugio”

    Directory of Open Access Journals (Sweden)

    José Ramón Bergueiro

    2011-06-01

    sistemas de bombeo, tiempo de vaciado de los hidrocarburos a los depósitos de almacenamiento, trasvase a otro petrolero, etc.. Además, dicho programa permite estimar los costes de limpieza y restauración, así como las pérdidas en el sector turístico. Palabras claves: Hidrocarburos; Zona refugio; Derrames de hidrocarburos

  20. Use of artificial intelligence techniques for diagnosis of malignant pleural mesothelioma

    National Research Council Canada - National Science Library

    Orhan Er; A. Çetin Tanrikulu; Abdurrahman Abakay

    2015-01-01

    .... Therefore epidemiological studies are difficult to perform in Turkey. Methods: In this paper, a study on malignant pleural mesothelioma disease diagnosis was realized by using artificial immune system...

  1. Pelvic and lumbar metastasis detected by bone scintigraphy in malignant pleural mesothelioma

    Energy Technology Data Exchange (ETDEWEB)

    Ruiz Hernandez, G.; Castillo Pallares, F.J.; Llorens Banon, L.; Romero de Avila y Avalos, C. [Hospital Clinic Universitari de Valencia (Spain). Servei de Medicina Nuclear; Garcia Garc`ia, T.; Azagra Ros, P. [Hospital Clinic Universitari de Valencia (Spain). Servei d`Oncologia; Maruenda Paulino, J.I. [Hospital Clinic Universitari de Valencia (Spain). Servei Traumatologia; Ferrer Albiach, C. [Hospital Clinic Universitari de Valencia (Spain). Servei Radioterapia

    1999-05-01

    A case of a 43-year-old man suffering from pleural mesothelioma with distant bone metastasis is reported. The results of bone scintigraphy and NMR findings allowed the diagnosis. The current case describes a hematogenous metastasis to the pelvis and vertebral column from a malignant pleural mesothelioma that was detected initally by bone scintigraphy. (orig.) [Deutsch] Fallbericht ueber einen 43jaehrigen Mann mit Pleural-Mesotheliom und Knochenmetastasen. Die Diagnose wurde durch Knochenszintigraphie und NMR gestellt. Der vorliegende Fall beschreibt die haematogene Metastasierung ins Becken und in die Wirbelsaeule, ausgehend von einem malignen Pleural-Mesotheliom, das urspruenglich durch Knochenszintigraphie diagnostiziert wurde. (orig.)

  2. Characteristics of pleural effusions in systemic lupus erythematosus: differential diagnosis of lupus pleuritis.

    Science.gov (United States)

    Choi, B Y; Yoon, M J; Shin, K; Lee, Y J; Song, Y W

    2015-03-01

    We investigated the clinical characteristics of pleural effusion in systemic lupus erythematosus (SLE). A prospective analysis of 17 SLE patients with pleural effusion (seven lupus pleuritis, eight transudative effusions and two parapneumonic effusions) was performed. Thirty non-SLE patients with pleural effusion were recruited as controls. A pleural fluid ANA titer ≥1:160 was found in 8/17 (47.1%) SLE patients and none of the 30 non-SLE patients (p = 0.0001). Pleural fluid to serum C3 ratios were significantly lower in SLE than in non-SLE (median (minimum-maximum) 0.29 (0.03-0.43) versus 0.52 (0.26-0.73), p = 0.0002). Among SLE patients, pleural fluid ANA titers ≥1:160 were more frequently found in patients with lupus pleuritis than in those with pleural effusion from causes other than lupus itself (85.7% versus 20.0%, p = 0.0152). Serum CRP levels were significantly increased in patients with lupus pleuritis compared with SLE patients with transudative pleural effusion (2.30 (0.30-5.66) versus 0.7 (0.12-1.47) mg/dl, p = 0.0062). In conclusion, pleural fluid ANA titer and serum CRP levels are significantly increased in lupus pleuritis. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  3. A new approach to pleural effusion in cats: markers for distinguishing transudates from exudates.

    Science.gov (United States)

    Zoia, Andrea; Slater, Linda A; Heller, Jane; Connolly, David J; Church, David B

    2009-10-01

    Classification of pleural effusion (PE) is central to diagnosis. Traditional veterinary classification has distinguished between transudates, modified transudates and exudates. In human medicine PEs are divided into only two categories: transudates and exudates. The aim of this study was to evaluate, in 20 cats presented with PE, paired samples of serum and pleural fluid for the following parameters: Light's criteria (pleural fluid lactate dehydrogenase concentration (LDHp), pleural fluid/serum LDH ratio, pleural fluid/serum total protein ratio (TPr)), pleural fluid total protein, pleural fluid cholesterol concentration, pleural fluid/serum cholesterol ratio (CHOLr), serum-effusion cholesterol gradient (serum cholesterol minus PE cholesterol concentration (CHOLg)), PE total nucleated cells count (TNCCp) and pleural fluid glucose (GLUp). LDHp and TPr were found most reliable when distinguishing between transudates and exudates, with sensitivity of 100% and 91% and specificity of 100%, respectively. When conflict between the clinical picture and laboratory results exists, calculation of CHOLr, CHOLg and TNCCp measurement may help in the classification of the effusion. Measurement of serum albumin (in the case of a transudate) may provide additional information regarding the pathogenesis of the effusion.

  4. Differentiation of Exudates from Transudate Pleural Effusion by Measuring Cholesterol and Bilirubin

    Directory of Open Access Journals (Sweden)

    B Ataei

    2007-10-01

    Full Text Available Introduction & Objective: Differentiating exudates from transudate is the first step in examining pleural effusion. Moreover, it is a guide for determination of pathologic trend of background diseases and differential diagnosis. Although Light’s criteria are considered as standard in differentiating exudates from transudate, in some studies pleural fluid cholesterol, ratio of pleural fluid cholesterol to serum and ratio of pleural fluid bilirubin to serum have been considered. This study was performed to investigate the diagnostic efficacy of cholesterol and bilirubin of pleural fluid in differentiating exudates from transudate pleural effusion. Materials & Methods: This cross-sectional study was performed in Al-Zahra Hospital, Isfahan in 1384, where 86 cases of pleural effusion were assessed by easy and consecutive sampling method. After differentiation of patients with exudates from transudate pleural effusion, based on light’s criteria, related parameters were measured. Using ROC (Receiver Operative Characteristics curves, area under the curve was determined following by determination of sensitivity, specificity and positive and negative predictive values. Results were analyzed by MC Nemar test. Results: From 86 studied patients, 59 cases were exudates and 27 cases were transudates. Considering the pleural cholesterol above 43 mg/dl as cut off, a sensitivity of 73.8% and specificity of 92% were obtained for the method. Decreasing the cut off level to 35.5 mg/dl, the sensitivity was increased and reached to 81.4%. Ratio of pleural fluid cholesterol to serum more than 0.3 had a sensitivity of 65%, 88% specificity and 85% efficiency for differentiation of pleural effusion while ratio of pleural fluid bilirubin to serum more than 0.6 had 76.3% sensitivity, 74.1% specificity and 75.6% efficacy. Conclusion: The criterion on 3 g/dl protein had the highest sensitivity and specificity in differentiating exudates from transudate pleural effusion

  5. Desarrollo de un método de transcripción inversa seguida de reacción en cadena de la polimerasa para la detección del virus de la fiebre amarilla

    Directory of Open Access Journals (Sweden)

    María C. Méndez

    2013-08-01

    Full Text Available Introducción. La fiebre amarilla se considera una enfermedad reemergente y endémica en regiones tropicales de África y Suramérica. Actualmente, no existen estuches estandarizados o comerciales disponibles para la detección del virus de la fiebre amarilla y, por lo tanto, el diagnóstico debe hacerse mediante técnicas de rutina que consumen mucho tiempo y algunas veces no garantizan la detección del virus o de sus proteínas. Además, la cocirculación con otros flavivirus, incluyendo el del dengue, hacen el diagnóstico más complicado. Objetivo. Desarrollar un ensayo específico de amplificación basado en transcripción inversa seguida de reacción en cadena de la polimerasa, con el fin de mejorar la detección y el diagnóstico de la fiebre amarilla, tanto a partir de suero como de tejido fresco. Materiales y métodos. Se diseñaron iniciadores específicos para amplificar un fragmento conservado del virus de la fiebre amarilla. Un segundo par de iniciadores se usó en una reacción de amplificación anidada para incrementar la sensibilidad. Se probaron 33 muestras clínicas con la técnica estandarizada. Resultados. El amplímero esperado se obtuvo en 25 de las 33 muestras analizadas usando este método y 2 más resultaron positivas después de la reacción anidada. Conclusión. Esta técnica mejorada garantiza la detección de todos los genotipos virales de fiebre amarilla y puede incrementar la sensibilidad del ensayo introduciendo una segunda etapa de amplificación, lo cual permite el diagnóstico diferencial con infección por dengue y otros flavivirus, lo cual es de gran importancia para la vigilancia y la toma de medidas epidemiológicas oportunas. doi: http://dx.doi.org/10.7705/biomedica.v33i0.1452

  6. Traumatic subarachnoid-pleural fistula causing tension pneumocephalus; Traumatische subarachnoidal-pleurale Fistel mit der Folge eines Spannungspneumenzephalons

    Energy Technology Data Exchange (ETDEWEB)

    Moll, R.; Schindler, G. [Abt. fuer Roentgendiagnostik in der Chirurgischen Universitaetsklinik Wuerzburg (Germany)

    2004-07-01

    Uncommon subarachnoid-pleural fistula can be caused by a blunt or penetrating trauma and can also occur after a thoracal or neurosurgical operation, ending to a progredient pneumocephalus. Clinical findings might be an enlarging tension pneumocephalus without a cranial fracture, but in most times they will be overlayed by other accompanied injuries, neurologic symptoms can dominate, also rapidly filling clear pleural effusions with obscure cause. Opportune identification of the reason of the pneumocephalus and mostly early surgical intervention prevent neurological deficit, CNS infection and other complications. (orig.) [German] Die seltene subarachnoidal-pleurale Fistel tritt durch ein stumpfes oder ein penetrierendes Trauma bzw. nach einer thorax- oder neurochirurgischen Operation auf und fuehrt zu einem progredienten Pneumenzephalon. Die klinische Symptomatik manifestiert sich als Spannungspneumenzephalon ohne kranielle Fraktur. Sie wird haeufig durch Begleiterkrankungen ueberlagert. Neurologische Symptome koennen auftreten, ebenso nichtblutige, nachlaufende Pleuraerguesse unklarer Aetiologie. Die rechtzeitige Erkennung der Ursache des Pneumenzephalons, die Antibiotikaprophylaxe und die meist chirurgische Therapie verhindern infektioese Komplikationen und neurologische Defizite. (orig.)

  7. Síntesis in vitro de la proteína de la envoltura del virus peruano de la fiebre amarilla

    Directory of Open Access Journals (Sweden)

    Carlos Yábar V

    2001-01-01

    Full Text Available Objetivo: Sintetizar la proteína recombinante de la envoltura (Er del virus peruano de la Fiebre Amarilla (FA utilizando técnicas moleculares. Materiales y métodos: El gen de la proteína de interés fue amplificado por transcripción reversa - reacción en cadena de la polimerasa (RT-PCR y clonado en un vector plasmídico para ser analizado mediante secuenciamiento de ADN. El inserto de ADN fue subdonado en un vector de expresión para ser traducido a proteína. Se purificó la proteína mediante cromatografía de afinidad bajo condiciones denaturantes, siendo visualizada por electroforesis en SDS-PAGE. Resultados: Se sintetizó y purificó la pr E del virus de la FA. Presentó un peso de 66 kDa, y luego de tres horas de inducción a partir de 1x108 células (OD=0.5 se obtuvo 10 mg/mL de la proteína a miniescala. Conclusión: El análisis de la secuencia de aminoácidos demostró que Er podría ser un buen candidato a ser evaluado serológicamente y luego ser usado como herramienta de diagnóstico específico para la FA.

  8. La fiebre del oro en Sonora durante la década de 1850 y sus repercusiones diplomáticas con Estado Unidos

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    Lawrence Douglas Taylor

    1996-01-01

    Full Text Available Mientras que, para principios de la década de 1850, la atención del mundo entero se enfocaba en los campos auríferos en California, ocurría un movimiento semejante, aunque de proporciones menores, con respecto al territorio de Altar en el norte de Sonora. El artículo comienza con una breve descripción de los intentos de explotar los depósitos de oro y plata en la región durante el virreinato, así como su papel en la creación de ciertos mitos y leyendas referentes a la gran riqueza que supuestamente existía debajo del subsuelo sonorense. Se examina en particular, la expedición procedente de California que penetró a la zona en la primavera de 1851 en busca de oro, y que constituyó un antecedente importante relativo a las expediciones filibusteras encabezadas por Joseph Morehead, Charles de Pindray y otros aventureros extranjeros a lo largo de los cincuenta. El artículo concluye con una evaluación del significado de la fiebre del oro de este periodo con referencia al desarrollo posterior del noroeste de Sonora, y de la integración del estado a los mercados comerciales de Estados Unidos y de otras regiones de México.

  9. Evaluación de un método inmunohistoquímico para el diagnóstico de la fiebre amarilla

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    Orlando Ricaurte

    1993-03-01

    Full Text Available La confirmación diagnóstica de casos fatales de fiebre amarilla (FA es esencial en los programas de vigilancia epidemiológica de la entidad, en regiones endémicas. Se evaluó un método inmunohistoquímico para la detección de antígeno viral de FA en cortes de tejido fijados en formo1 e incluidos en parafina. Aplicamos el procedimiento a 59 casos, con criterios clínico-patológicos y epidemiológicos de FA, dos de ellos con aislamiento viral, ocurridos en Colombia entre 1934 y 1992, incluyendo casos típicos y tardíos. La sensibilidad del método fue del 98,30% : 58 casos fueron positivos mientras que un caso con importantes cambios de autólisis fue negativo. Por Otra parte, se seleccionaron 10 hígados con patologías diferentes, incluyendo 4 con hepatitis fulminante por coinfección de virus de la hepatitis B y delta, ninguno de los cuales mostró inmunorreactividad (especificidad: 100%. Estos resultados indican que este método es un recurso útil para la confirmación del diagnóstico histopatológico de la FA.

  10. CLINICAL PROFILE OF PLEURAL EFFUSION PATIENTS: A TERTIARY CARE HOSPITAL STUDY

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    Harish

    2016-02-01

    Full Text Available OBJECTIVE Pleural effusion refers to the excessive or abnormal accumulation of fluid in the pleural space. Pleural effusion is commonly encountered medical problem and caused by a variety of underlying pathological conditions. It is important to establish an accurate etiological diagnosis, so that the patient may be treated in the most appropriate and rational manner. METHODS This was a prospective study of 56 pleural effusion patients who are attending OPD and admitted cases in the Pulmonary Medicine department in Bhagwan Mahaveer Jain Hospital, Bangalore. The patients were subjected to through clinical history and examination. Thoracocentesis did under aseptic conditions and pleural fluid sent for investigations like protein, sugar, LDH (Lactate Dehydrogenase, ADA (Adenosine Deaminase, gram staining, AFB smear and culture by BACTEC method, cell type, cell count, and malignant cytology. Pleural biopsy was done for those who are willing for the same. Depending upon the history and clinical examinations and laboratory investigations, patients were classified as having exudates and transudates. RESULTS The total of 56 patients with pleural effusion was studied. Mean age of the study group was 43±14.6 years. 39(69.42% patients were male and 17(30.58% patients were female. The commonest type of effusion being tuberculosis (34 followed by malignancy (8, transudative effusion (7, synpneumonic (5 and 2 cases of empyema. The commonest presenting complaints were cough (78.32% and breathlessness (74.76%. Polymorphs were predominant in synpneumonic effusion and empyema and lymphocytes in tubercular effusion. Pleural fluid cytology revealed elevated lymphocytes in tubercular and polymorphs in acute infections. Cytology for malignant cells was positive in 4 cases. The mean increase in ADA level in tubercular pleural effusion, malignant pleural effusion and transudative pleural effusion were 79±19.9 IU/L, 42.6±9.3 and 28.4±8.2 respectively and it was

  11. Comparison of pleural responses of rats and hamsters to subchronic inhalation of refractory ceramic fibers.

    Science.gov (United States)

    Everitt, J I; Gelzleichter, T R; Bermudez, E; Mangum, J B; Wong, B A; Janszen, D B; Moss, O R

    1997-09-01

    In the present subchronic study, we compared pleural inflammation, visceral pleural collagen deposition, and visceral and parietal pleural mesothelial cell proliferation in rats and hamsters identically exposed to a kaolin-based refractory ceramic fiber, (RCF)-1 by nose-only inhalation exposure, and correlated the results to translocation of fibers to the pleural cavity. Fischer 344 rats and Syrian golden hamsters were exposed to 650 fibers/cc of RCF-1, for 4 hr/day, 5 days/week for 12 weeks. Following 4 and 12 weeks of exposure, and after a 12-week recovery period, pleural lavage fluid was analyzed for cytologic and biochemical evidence of inflammation. Visceral and parietal pleural mesothelial cell proliferation was assessed by immunocytochemical detection of bromodeoxyuridine incorporation. Pleural collagen was quantitated using morphometric analysis of lung sections stained with Sirius Red. Fiber-exposed rats and hamsters had qualitatively similar pleural inflammation at each time point. Mesothelial cell proliferation was more pronounced in hamsters than in rats at each time point and at each site. In both species, the mesothelial cell labeling index was highest in the parietal pleural mesothelial cells lining the surface of the diaphragm at each time point. Hamsters but not rats had significantly elevated collagen in the visceral pleura at the 12-week postexposure time point. Fibers were found in the pleural cavities of both species at each time point. These fibers were generally short and thin. These results suggest that mesothelial cell proliferation and fibroproliferative changes in the pleura of rodents following short-term inhalation exposure are associated with fiber translocation to the pleura and may be predictive of chronic pleural disease outcomes following long-term exposure.

  12. Expression of soluble triggering receptor expression on myeloid cells-1 in pleural effusion

    Institute of Scientific and Technical Information of China (English)

    HUANG Lu-ying; SHI Huan-zhong; LIANG Qiu-li; WU Yan-bin; QIN Xue-jun; CHEN Yi-qiang

    2008-01-01

    Background Tdggedng receptors expressed on myeloid cells(TREM)proteins are a family of cell surface receptors expressed broadly by cells of the myeloid lineage.The aim of this study was to investigate the clinical significance of soluble TREM-1(sTREM-1)in pleural effusions,and to determine the effects of pneumonia on pleural sTREM-1 concentrations.Methods PleuraI fluid was collected from 109 patients who presented to the respiratory institute (35 with malignant pleural effusion,31 with tuberculous pleural effusion,21 with bacteriaI pleural effusion,and 22 with transudate).The concentrations of sTREM-1,tumor necrosis factor-o(TNF-α)and interleukin-1β(IL-1β)were determined jn effusion and serum samples by enzyme Iinked immunosorbent assay(ELISA).Results The concentrations of sTREM-1 in bacterial pleural effusion were significantly higher than those in malignant.tuberculous,and transudative groups(all P<0.001).An sTREM-1 cutoff value of 768.1 ng/L had a sensitivity of 86%and a specificity of 93%.Pleural sTREM-1 Ievels were positively correlated with Ievels of TNF-α and IL-1β.Patients with complicating bacterial pneumonia did not have elevated concentration of STREM-1 jn pleural effusion when compared with patients without pneumonia.Conclusions Determination of pleural sTREM-1 may improve the ability of clinicians to differentiate pleural effusion patients of bacterial origin from those with other etiologies.The occurrence of bacterial pneumonia did not affect pleural sTREM-1 concentrations.

  13. Diagnostic Utility of Pleural Effusion and Serum Cholesterol, Lactic Dehydrogenase and Protein Ratios in the Differentiation between Transudates and Exudates

    National Research Council Canada - National Science Library

    O. Fagere, Muaz

    2015-01-01

    ...) ratios in the differentiation between exudate and transudate pleural effusion. As a part of the investigation, 135 serum and pleural effusion samples were collected from patients with accumulated plural effusion...

  14. Coarse pleural calcification in a mesothelioma patient raises the possibility of a rare tumour subtype: osteoblastic sarcomatoid mesothelioma.

    Science.gov (United States)

    Mortimer, A M; Rowlands, J; Murphy, P

    2011-05-01

    It is often suggested that calcification seen in association with pleural thickening implies benign disease. However, we present a case of a patient presenting with coarse pleural calcification associated with a pleural effusion and thickening, which following biopsy was shown to represent osteoblastic sarcomatoid mesothelioma. We describe the imaging features associated with this and differentiate these findings from those seen with benign pleural calcification. Similarities are drawn to other rare cases described in the literature.

  15. Coarse pleural calcification in a mesothelioma patient raises the possibility of a rare tumour subtype: osteoblastic sarcomatoid mesothelioma

    OpenAIRE

    Mortimer, A M; Rowlands, J; P. Murphy

    2011-01-01

    It is often suggested that calcification seen in association with pleural thickening implies benign disease. However, we present a case of a patient presenting with coarse pleural calcification associated with a pleural effusion and thickening, which following biopsy was shown to represent osteoblastic sarcomatoid mesothelioma. We describe the imaging features associated with this and differentiate these findings from those seen with benign pleural calcification. Similarities are drawn to oth...

  16. Efficacy of pleural fluid alkaline phosphatase and its ratio to serum levels in distinguishing exudates from transudates

    OpenAIRE

    Gupta K; Ghalaut Veena; Gupta Prem; Arora Puneet; Tandon S

    2004-01-01

    The objective of present study was to evaluate the efficacy of pleural fluid alkaline phosphatase and its ratio to serum levels to classify pleural fluids. A total of 80 patients were divided in transudates and exudates on the basis of extensive clinical, radiological and biochemical evaluation. The efficacy of pleural fluid alkaline phosphatase (P ALP) and pleural fluid / serum alkaline phosphatase ratio (P/S ALP) assessment along with that of Light′s criteria to accurately classify t...

  17. Pleural effusion during acute myeloid leukemia induction chemotherapy: A perplexing case

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    Chandran K Nair

    2013-01-01

    Full Text Available We are reporting a case of pneumonia associated with pleural effusion during the neutropenic phase of induction chemotherapy. In spite of being Adenosine deaminase negative, the pleural effusion responded only to empiric therapy with antitubercular agents. The diagnosis was confirmed with positive PCR testing for mycobacterium tuberculosis.

  18. Evaluation and outcomes of pediatric pleural effusions in over 10 years in Northwest, Iran

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    Mohammad Hassan Kargar maher

    2014-08-01

    Full Text Available Abstract Background: Pleural effusion is the accumulation of excess fluid in the pleural cavity. Most information available about pleural effusion is obtained from studies on adults and little evidence is available in children. Therefore, it is necessary to identify the existing status and explain the disease process, signs, treatment, and prognosis. Children with pleural effusion who were admitted to children’s university hospital during the last ten years were studied in this research. Methodology: In this descriptive research, children with pleural effusion who were admitted and undergone thoracocentesis in the children’s university hospital during the last ten years were studied. The data obtained from in vitro experiments and the information questionnaire was analyzed using SPSS-18 through descriptive statistics of frequency, percent, and mean. Findings: Ninety-four children with pleural effusion were admitted during 10 years. Pleural effusion was exudate in 56.38% and transudate in 43.61% of children. The most common symptoms were tachypnea, fever, and cough. Antibiotic administration was the most performed therapeutic action. Conclusion: The mode of addressing pleural effusion in this research was similar to other studies. Considering the results, better planning can be performed regarding preventing this disease or improving its prognosis.

  19. Late postoperative pleural effusion following lung transplantation: characteristics and clinical implications.

    Science.gov (United States)

    Shitrit, David; Izbicki, Gabriel; Fink, Gershon; Bendayan, Daniel; Aravot, Dan; Saute, Milton; Kramer, Mordechai R

    2003-04-01

    Pleural effusions are extremely common in the early postoperative period after lung transplantation (LTX). It occurs in all transplant recipients, and like pleural fluid following other cardiothoracic surgery is bloody, exudative and neutrophil predominant. There was no information, however, on the characteristics of the late (14-45 days) postoperative pleural fluid after LTX. The purpose of this study was to describe the characteristics and the clinical implications of late postoperative pleural effusion after LTX. Thirty-five patients underwent TX between May 1997 and May 2001. Seven patients (20%) developed late postoperative pleural effusion. Thoracentesis were performed in these patients and the white blood cell counts, cell differential as well as biochemical parameters were determined. The median time for late pleural effusion appearance was 23 days (range, 14-34 days) after TX. The pleural effusions were medium in size (700 ml, range, 100-1300), exudative in all the patients and had lymphocyte predominance. No evidence of fluid recurrence or clinical deterioration was noted in these patients. Late-onset exudative lymphocytic pleural effusion after LTX is not uncommon. When there is no evidence of rejection or infection, it usually has a benign, favorable outcome.

  20. Diagnostic and therapeutic value of thoracoscopy for pleural effusions: experience from 628 consecutive cases in China

    Institute of Scientific and Technical Information of China (English)

    JIANG Shu-juan; ZHANG Song; SU Li-li; LIU Yi

    2009-01-01

    @@ Pleural effusions, the excessive accumulations of fluid in pleural space, are frequently associated with a variety of clinical diseases, such as cancer, tuberculosis,pneumonia, etc.1,2 This means that both malignant and benign diseases can cause pleural effusions. Therefore, it is essential for clinicians to determine the etiology prior to the treatment of patients with pleural effusions.Whereas certain pleural fluid tests are helpful for the differential diagnosis, they usually give rise to low accuracy. In recent years, early detection approaches have been developed to timely recognize pleural effusions.Thoracoscopy is still one of such widely employed approaches for surgical detection of unknown origin of pleural effusions. Most importantly, it allows physicians to directly observe lesions, perform biopsies, and conduct necessary therapies. Moreover, the introduction of thoracoscopy3 amplifies the function of conventional thoracoscopy. Thus, thoracoscopy is an extremely useful tool for diagnosis and treatment of benign and malignant pleural effusions,4,5 especially in the developing counties.

  1. The role of tumor necrosis factor alpha in differentiation between malignant and non malignant pleural effusion

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    Heba M. Atef

    2016-07-01

    Conclusion: Pleural fluid level of TNF-α can be used in differentiating malignant from non malignant effusion. Also levels of TNF-α in the serum and pleural fluid could be useful as a complementary marker in the differential diagnosis of two most common types of exudates (tuberculous and malignant.

  2. Clinical consequences of asbestos-related diffuse pleural thickening: A review

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    Sandrini Alessandra

    2008-09-01

    Full Text Available Abstract Asbestos-related diffuse pleural thickening (DPT, or extensive fibrosis of the visceral pleura secondary to asbestos exposure, is increasingly common due to the large number of workers previously exposed to asbestos. It may coexist with asbestos related pleural plaques but has a distinctly different pathology. The pathogenesis of this condition as distinct from pleural plaques is gradually becoming understood. Generation of reactive oxygen and nitrogen species, profibrotic cytokines and growth factors in response to asbestos is likely to play a role in the formation of a fibrinous intrapleural matrix. Benign asbestos related pleural effusions commonly antedate the development of diffuse pleural thickening. Environmental as well as occupational exposure to asbestos may also result in pleural fibrosis, particularly in geographic areas with naturally occurring asbestiform soil minerals. Pleural disorders may also occur after household exposure. High resolution computed tomography (CT is more sensitive and specific than chest radiography for the diagnosis of diffuse pleural thickening, and several classification systems for asbestos-related disorders have been devised. Magnetic resonance imaging and fluorodeoxyglucose positron emission tomography (PET scanning may be useful in distinguishing between DPT and malignant mesothelioma. DPT may be associated with symptoms such as dyspnoea and chest pain. It causes a restrictive defect on lung function and may rarely result in respiratory failure and death. Treatment is primarily supportive.

  3. Bosutinib induced pleural effusions: Case report and review of tyrosine kinase inhibitors induced pulmonary toxicity

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    Natalia I. Moguillansky, MD

    2017-01-01

    Full Text Available Tyrosine kinase inhibitors are known to cause pulmonary complications. We report a case of bosutinib related bilateral pleural effusions in a patient with chronic myeloid leukemia. Characteristics of the pleural fluid are presented. We also discuss other tyrosine kinase inhibitors induced pulmonary toxicities, including pulmonary hypertension and interstitial lung disease.

  4. Clinical utility of interferon-γ compared to ADA in tuberculous pleural effusion

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    Nariman A. Helmy

    2012-10-01

    Result: Our results demonstrate that the pleural fluid concentrations of ADA, INF-γ in patients with tuberculous pleural effusions are significantly higher than in other effusions. Most importantly, ROC analysis clearly demonstrated ADA to be more sensitive and specific than INF-γ for diagnosis of tuberculous pleuritis.

  5. [Reappraisal of the standard method (Light's criteria) for identifying pleural exudates].

    Science.gov (United States)

    Porcel, José M; Peña, José M; Vicente de Vera, Carmina; Esquerda, Aureli

    2006-02-18

    Light's criteria remain the best method for separating pleural exudates from transudates. We assessed their operating characteristics, as well as those resulting from omitting the pleural fluid to serum lactate dehydrogenase (LDH) ratio from the original criteria (abbreviated Light criteria), in a large series of patients. We also searched for the best combination of pleural fluid parameters, including protein, LDH and cholesterol that identify exudates. We conducted a retrospective study of 1,490 consecutive patients with pleural effusion who underwent a diagnostic thoracentesis. There were 1,192 exudates and 298 transudates. Sensitivity, specificity, area under ROC curve, and odds ratio for both individual and combined pleural fluid parameters were calculated. Light's criteria yielded 97.5% sensitivity and 80% specificity. Both abbreviated Light criteria (sensitivity: 95.4%; specificity: 83.3%) and the combined use in an "or" rule of pleural fluid protein and LDH (sensitivity: 95.4%; specificity: 80,2%) had similar discriminative properties than standard criteria. Diagnostic separation of pleural effusions into exudates or transudates can be done effectively thorough the abbreviated Light criteria when the serum LDH value is not available. On the other hand, if venipuncture wants to be avoided (an unusual circumstance) the combination of pleural fluid protein and LDH represents an alternative to Light's criteria.

  6. Enhanced CT in the patients with pleural effusion : differential findings between exudates and transudates

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Soo Hyun; Han, Young Min; Chung, Jin Young [Chonbuk National Univ. Medical School, Chonju (Korea, Republic of)

    1996-10-01

    To evaluate the differential findings of CT in the differention of pleural exudates and transudates. One hundred and thirteen consecutive patients (113 effusions) underwent enhanced thoracic CT ; the scans were evaluated for the presence or absence and apearance of enhancing parietal pleural thickening and extrapleural fat thickening. Thoracentesis was performed to measure pleural and serum total protein and lactate dehydrogenase(LDH) values. Effusions were classified as exudates by using Light's criteria. Eighty-eight effusions were exudates and 25 were transudates. Eighty-three of the 88 exudates (93 %) were associated with enhanced parietal pleural thickening;seventy of the 88 (80%) were associated with extrapleural fat thickening. Four of the 25 transudates were associated with parietal pleural thickening and extrapleural fat thickening, both of which were the most important factors in differentiating between pleural exudates and transudates(p<0.05). Parietal pleural thickening and extrapleural fat thickening on contrast-enhanced CT almost always indicate the presence of pleural exudates.

  7. Pleural fluid IL-8 as an inflammatory mediator for discriminating transudates and exudates.

    Science.gov (United States)

    Zaki, Sanaa M; Ashour, Laila

    2007-01-01

    The differential diagnosis of pleural effusion is a frequent clinical problem. The possible role of pleural fluid cytokines in discriminating transudates from exudates has not been studied adequately. The aim of this study was to evaluate serum and pleural fluid levels of interleukin-8 (IL-8) and compare it with common biochemical parameters such as total protein lactate dehydrogenase (LDH). Forty patients with pleural effusion were studied. IL-8 was measured simultaneously in serum and pleural fluid using a commercially available ELISA kit. Standard laboratory methods were employed for biochemical parameters. Serum IL-8 levels were higher in the exudative group (8.1 +/- 0.2), but without statistical difference, when compared with transudate patients (6.8 +/- 0.1) (p > 0.05). Pleural IL-8 levels were significantly increased in exudate effusion when compared with transudate (26.6 +/- 3.7, 7.1 +/- 0.04 respectively, p exudates from transudates, with sensitivity of 100%, low specificity (from 50 to 66.7%) and good PPV (from 94.4 to 94.7%). Regarding pleural protein, the best discriminating value was 3 g/dl, while that for LDH was 200 IU/L. It is concluded that IL-8 could be considered as a sensitive, but not specific marker in differentiating pleural effusion into exudate and transudate, specially when used together with other criteria such as protein and LDH levels.

  8. In-vivo Light dosimetry for pleural PDT.

    Science.gov (United States)

    Dimofte, Andreea; Zhu, Timothy C; Finlay, Jarod C; Cullighan, Melissa; Edmonds, Christine E; Friedberg, Joseph S; Cengel, Keith; Hahn, Stephen M

    2009-01-24

    In-vivo light dosimetry for patients undergoing photodynamic therapy (PDT) is one of the critical dosimetry quantities for predicting PDT outcome. This study examines the relationship between the PDT treatment time and thoracic treatment volume and surface area for patients undergoing pleural PDT. In addition, the mean light fluence (rate) and its accuracy were quantified. The patients studied here were enrolled in Phase II clinical trial of Photofrin-mediated PDT for the treatment of non-small cell lung cancer with pleural effusion. The ages of the patients studied varied from 34 to 69 years old. All patients were administered 2mg per kg body weight Photoprin 24 hours before the surgery. Patients undergoing photodynamic therapy (PDT) are treated with laser light with a light fluence of 60 J/cm(2) at 630nm. Fluence rate (mW/cm(2)) and cumulative fluence (J/cm(2)) was monitored at 7 different sites during the entire light treatment delivery. Isotropic detectors were used for in-vivo light dosimetry. The anisotropy of each isotropic detector was found to be within 30%. The mean fluence rate deliver varied from 37.84 to 94.05 mW/cm(2) and treatment time varied from 1762 to 5232s. We found a linear correlation between the total treatment time and the treatment area: t (sec) = 4.80 A (cm(2)). A similar correlation exists between the treatment time and the treatment volume: t (sec) = 2.33 V (cm(3)). The results can be explained using an integrating sphere theory and the measured tissue optical properties assuming that the saline liquid has a mean absorption coefficient of 0.05 cm(-1). Our long term accuracy studies confirmed light fluence rate measurement accuracy of ±10%. The results can be used as a clinical guideline for future pleural PDT treatment.

  9. In-vivo Light dosimetry for pleural PDT

    Science.gov (United States)

    Dimofte, Andreea; Zhu, Timothy C.; Finlay, Jarod C.; Cullighan, Melissa; Edmonds, Christine E.; Friedberg, Joseph S.; Cengel, Keith; Hahn, Stephen M.

    2015-01-01

    In-vivo light dosimetry for patients undergoing photodynamic therapy (PDT) is one of the critical dosimetry quantities for predicting PDT outcome. This study examines the relationship between the PDT treatment time and thoracic treatment volume and surface area for patients undergoing pleural PDT. In addition, the mean light fluence (rate) and its accuracy were quantified. The patients studied here were enrolled in Phase II clinical trial of Photofrin-mediated PDT for the treatment of non-small cell lung cancer with pleural effusion. The ages of the patients studied varied from 34 to 69 years old. All patients were administered 2mg per kg body weight Photoprin 24 hours before the surgery. Patients undergoing photodynamic therapy (PDT) are treated with laser light with a light fluence of 60 J/cm2 at 630nm. Fluence rate (mW/cm2) and cumulative fluence (J/cm2) was monitored at 7 different sites during the entire light treatment delivery. Isotropic detectors were used for in-vivo light dosimetry. The anisotropy of each isotropic detector was found to be within 30%. The mean fluence rate deliver varied from 37.84 to 94.05 mW/cm2 and treatment time varied from 1762 to 5232s. We found a linear correlation between the total treatment time and the treatment area: t (sec) = 4.80 A (cm2). A similar correlation exists between the treatment time and the treatment volume: t (sec) = 2.33 V (cm3). The results can be explained using an integrating sphere theory and the measured tissue optical properties assuming that the saline liquid has a mean absorption coefficient of 0.05 cm−1. Our long term accuracy studies confirmed light fluence rate measurement accuracy of ±10%. The results can be used as a clinical guideline for future pleural PDT treatment. PMID:25914792

  10. Pleural mesothelioma surveillance: Validity of cases from a tumour registry

    Science.gov (United States)

    Labrèche, France; Case, Bruce W; Ostiguy, Gaston; Chalaoui, Jean; Camus, Michel; Siemiatycki, Jack

    2012-01-01

    BACKGROUND: Pleural mesothelioma is a rare tumour associated with exposure to asbestos fibres. Fewer than than one-quarter of cases registered in the Quebec Tumour Registry (QTR) have been compensated as work-related. While establishing a surveillance system, this led to questioning as to whether there has been over-registration of cases that are not authentic pleural mesotheliomas in the QTR. OBJECTIVE: To assess whether registered cases of pleural mesothelioma could be confirmed. METHODS: A medical chart review was designed to assess the proportion of mesothelioma cases newly registered in the QTR in 2001/2002 that could be confirmed. For each registered case, clinical, medical imaging and pathology information were sought and, occasionally, additional immunohistochemistry staining was obtained. Three specialists – a chest physician, a radiologist and a pathologist – reviewed the available information and material, coding each mesothelioma case as to degree of certainty of the mesothelioma diagnosis. RESULTS: The QTR reported 190 incident cases of mesothelioma (81% males) for the period. The specialists classified 81% of charts as ‘certain/probable’or ‘possible’ mesotheliomas, 8% as ‘unlikely to be a mesothelioma’ and 11% as ‘not a mesothelioma’. After excluding chart summaries of unsatisfactory quality, 87% to 88% of the charts were classified as ‘certain/probable’ or ‘possible’ mesotheliomas, and 9% to 11% were still considered ‘not a mesothelioma’. CONCLUSION: Tumour registry data are a valid source of information for mesothelioma surveillance. While there is some over-registration of mesothelioma cases in the QTR, a significant majority of registered cases appeared to be authentic. Over-registration cannot explain the greater proportion of cases that were not compensated. PMID:22536579

  11. Efficacy of fluorescence diagnosis for pleural tumors with alasens

    Directory of Open Access Journals (Sweden)

    O. V. Pikin

    2013-01-01

    Full Text Available The study of efficacy of thoracoscopy-assisted fluorescence diagnosis with Alasens is described in the article. The results of fluorescence diagnosis in 27 patients with suspicion on pleral tumor are represented. Before thoracoscopy-assisted fluorescence diagnosis in 21 patients according to radiological studies there was a fluid in pleural ca, in 19 patients of them tumor cells were found by cytological study of pleural fluid, in 10 patients differential diagnosis was performed between mesothelioma and adenogenic cancer. For fluorescence diagnosis fluorescence system by company Кarl Storz and xenon lamp with set of light filters was used: fluorescence study was performed by excitation at wavelength 380–460 nm. 3 h before investigation the patient received alasens per os in dose of 30 mg/kg body weight in 100 ml of water. For routine thoracoscopy tumor lesions were determined in 20 (87.0% patients, other 3 (13.0% patients had no tumors. In the group of patients with tumor lesions determined by routine thoracoscopy the fluorescence during fluorescence study was registered in all lesions determined in white light, besides this 24 additional foci of fluorescence were noticed, according to morphological study 21 of them had tumor nature, 3 lesions were inflammatory. In 1 of 3 patients with no lesion in white light there was one focus of fluorescence, morphological study proved the metastasis of adenocarcinoma in this area. According to morphological study of pleural biopsy specimens the true-positive results for fluorescence thoracoscopy accounted for 82, false-negative – 10, true-negative – 23, false-positive – 3. The sensitivity of the method was 89,1%, the specificity – 88,4%, the diagnostic accuracy – 88,9%. 

  12. A Case of Haemorrhagic Constrictive Pericarditis with Bilateral Pleural Effusions

    Science.gov (United States)

    Islam, Julie; Talebi, Soheila; Cativo, Eder; Mushiyev, Savi; Pekler, Gerald; Visco, Ferdinand

    2016-01-01

    Presentation of pericardial disease is diverse, with the viral aetiology being the most common cause; however, when haemorrhagic pericardial effusion is present, these causes are narrowed to few aetiologies. We present a case of a young female of African descent who presented with diffuse abdominal pain and vomiting. Initial work-up showed pericardial effusion with impending echocardiographic findings of cardiac tamponade and bilateral pleural effusions. Procedures included a left video-assisted thoracoscopic surgery (VATS) with pericardial window. We consider that it is important for all physicians to be aware of not only typical presentation but also atypical and unusual clinical picture of pericardial disease.

  13. Ultrasound for identification of pleural fluid in pneumonia

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    M. Chagani*

    2013-12-01

    Discussion: Sonographic evaluation of the lungs is well described in medical literature and has been used in patients to assess for pneumothorax, pleural effusion, pulmonary oedema, and lung consolidation. Even in settings where advanced imaging options are available, emergency sonography has several features that make it an attractive option for the acute care provider. In the resource-limited setting, the utility of emergency sonography is enhanced, especially when other imaging modalities are unavailable or cost prohibitive. Focused point-of-care sonography is a useful adjunct to clinical examination that may augment clinical decision-making and safely avoid unnecessary invasive procedures.

  14. Medical image of the week: esophageal-pleural fistula

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    Alzoubaidi M

    2014-03-01

    Full Text Available A 51 year old woman with rheumatoid arthritis, diabetes mellitus and gastroesophageal reflux disease had a transoral incisionless fundoplication for a hiatal hernia 6 months before admission. She presented with left lower lobe pneumonia and empyema. The esophagram showed a fistulous tract communicating with the pleural space (Figure 1. CT scan of the chest also showed air in the mediastinum (Figure 2 as well a fistulous tract in the three dimensional reconstruction (Figure 3. Esophagogastroduodenoscopy (EGD showed an esophageal defect 5 cm above the gastroesophageal junction. An esophageal stent was placed with success.

  15. A Case of Haemorrhagic Constrictive Pericarditis with Bilateral Pleural Effusions

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    Hans A. Reyes

    2016-01-01

    Full Text Available Presentation of pericardial disease is diverse, with the viral aetiology being the most common cause; however, when haemorrhagic pericardial effusion is present, these causes are narrowed to few aetiologies. We present a case of a young female of African descent who presented with diffuse abdominal pain and vomiting. Initial work-up showed pericardial effusion with impending echocardiographic findings of cardiac tamponade and bilateral pleural effusions. Procedures included a left video-assisted thoracoscopic surgery (VATS with pericardial window. We consider that it is important for all physicians to be aware of not only typical presentation but also atypical and unusual clinical picture of pericardial disease.

  16. Clozapine-induced liver injury and pleural effusion

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    Joseph P.M. Kane

    2014-09-01

    Full Text Available Clozapine, whilst associated commonly with a transient and benign increase in liver enzymes, has also been associated with varying presentations of hepatitis in existing case reports. This report describes what we believe to be the first documented case of acute liver injury and pleural effusion associated with clozapine, resolving after cessation of the agent. The case supports existing literature in advocating a high index of suspicion, particularly in the 4-5 weeks following clozapine initiation, when considering nonspecific clinical symptoms and signs.

  17. Levels of PEDF in Pleural Effusions from Lung Adenocarcinoma and Benign Disease Patients

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    Nuria Sánchez-Otero

    2013-01-01

    Full Text Available Anti-tumor properties assigned to PEDF, beside its role as an inhibitor of angiogenesis, make it a promising candidate in the search of new biomarkers for malignancy. In this study levels of PEDF were investigated in pleural effusions from lung adenocarcinoma and benign inflammatory disease patients. The mean PEDF concentration in the malignant group was slightly superior to that in patients suffering benign diseases (4.59 μg/mL vs 3.97 μg/mL, although the difference did not reach statistical significance (P 0.166. Pleural effusion PEDF levels were not related to gender, age, smoking habit or pleural effusion size. We also investigated the possible relationship of PEDF levels in pleural effusion regarding clinicopathological features. Correlations were found for monocytes (P 0.010 and polymorphonuclear leukocytes (P 0.023 with PEDF levels in pleural effusion of malignant origin.

  18. Primary pleural angiosarcoma as a mimicker of mesothelioma: a case report **VS**

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    Kao Yu-Chien

    2011-12-01

    Full Text Available Abstract Primary pleural angiosarcoma is a rare and clinically aggressive tumor. Patients usually present with chest pain, dyspnea, hemoptysis and/or cough. Radiologic studies reveal diffuse pleural thickening and pleural effusion with or without mass lesion. The clinical and radiological features both resemble those of mesothelioma, and its definite diagnosis requires careful histologic examination. However, frequent epithelioid feature and immunoreactivity to cytokeratin in primary pleural angiosarcoma further complicate the pathologic diagnosis. The use of proper immunohistochemical stains is often needed to support endothelial differentiation in the tumor cells and to exclude metastatic carcinoma and mesothelioma. We report the case of a 49-year-old male patient with primary pleural angiosarcoma, who presented with initial hemothorax, followed by a rapid progress to an inoperable status.

  19. Does pleural fluid appearance really matter? The relationship between fluid appearance and cytology, cell counts, and chemical laboratory measurements in pleural effusions of patients with cancer

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    Ozcakar Bulent

    2010-08-01

    Full Text Available Abstract Background Previous reports have suggested that the appearance of pleural effusions (i.e., the presence or absence of blood might help to establish the etiology of the effusions. This study explores the relationship between pleural fluid appearance and the results of chemical and cytological analyses in a group of patients with recurrent symptomatic pleural effusions and a diagnosis of cancer. Methods Medical records were reviewed from all 390 patients who were diagnosed with cancer, who underwent thoracentesis before placement of an intrapleural catheter (IPC between April 2000 and January 2006. Adequate information for data analysis was available in 365 patients. The appearance of their pleural fluid was obtained from procedure notes dictated by the pulmonologists who had performed the thoracenteses. The patients were separated into 2 groups based on fluid appearance: non-bloody and bloody. Group differences in cytology interpretation were compared by using the chi square test. Cellular counts, chemical laboratory results, and survival after index procedure were compared by using the student's t test. Results Pleural fluid cytology was positive on 82.5% of the non-bloody effusions and on 82.4% of the bloody ones. The number of red blood cells (220.5 × 103/μL vs. 12.3 × 103/μL and LDH values (1914 IU/dl vs. 863 IU/dl were statistically higher in bloody pleural effusions. Conclusion The presence or absence of blood in pleural effusions cannot predict their etiology in patients with cancer and recurrent symptomatic pleural effusions.

  20. Significado de la fiebre persistente o recurrente durante el tratamiento de la endocarditis infecciosa Clinical significance of persistent or recurrent fever during the treatment of infective endocarditis

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    José Carena

    2004-06-01

    Full Text Available Se evaluaron 81 pacientes con endocarditis infecciosa con el objeto de establecer la significación clínica de la presencia de fiebre persistente (FP y/o fiebre recurrente (FR durante el tratamiento. Un total de 46 pacientes (56.8% (Grupo 1 tuvieron FP y/o FR durante el tratamiento: 35 FP y 16 FR, que se compararon con 35 sin FP/FR (Grupo 2. No hubo diferencias en la edad, sexo, permanencia hospitalaria, origen nosocomial, demora diagnóstica y comorbilidad asociada. El compromiso aórtico (47.8 vs 34.2% y tricuspídeo (21.7 vs 11.4% y la infección por Staphylococcus aureus (55.5 vs 28% fueron más frecuentes en el Grupo 1, aunque no significativamente. El S. aureus meticilino resistente (SAMR (22.2 vs 4%, las complicaciones (95.6 vs 65.7%, la disfunción renal (58.6 vs 31.4%, el embolismo mayor (60.8 vs 34%, los fenómenos microvasculares (43.4 vs 17.1% y la cirugía valvular (34.7 vs 11.4% ocurrieron significativamente en el Grupo 1 (pPatients with infective endocarditis (IE were studied to assess incidence, clinical features and mortality in a population with either persistent (PF or recurrent fever (RF during treatment. A sample of 81 patients was evaluated. Of these, 46 patients (56.8% had fever during treatment: 35 had PF and 16 had RF (Group 1. This group was compared with 35 patients with IE without fever (Group 2. Age, sex, in-hospital days, nosocomial acquisition, delay in diagnosis, and co-morbidities were similar among each group. The aortic and tricuspid valve compromise, and Staphylococcus aureus as etiologic agent were more frequent in Group 1 (although not significantly. However, the development of complications (95.6 vs. 65.7%, renal dysfunction (58.6 vs. 31.4%, major vessel embolization (60.8 vs. 34%, microvascular phenomena (43.4 vs. 17.1%, infections with MRSA (22.2 vs. 4% and valvular surgery (34.7 vs. 11.4% were significantly higher in Group 1(p<0.05. The most common causes of PF were microvascular phenomena (14

  1. Caracterización de zonas contaminadas por derrames recientes de hidrocarburos mediante métodos geofísicos

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    Fabiana Elizabeth Robledo

    2011-12-01

    Full Text Available Los sistemas de inducción electromagnética multifrecuencial, formados por dos pequeñas espiras coplanares separadas entre sí una distancia fija (EMI, del inglés electromagnetic induction, o SLEM, del inglés small loop electromagnetic induction, son de gran utilidad para la prospección de las primeras decenas de metros del subsuelo y permiten detectar de manera rápida y eficiente una gran variedad de estructuras enterradas. Una de las espiras genera un campo magnético inductor conocido y la otra registra las variaciones del campo inducido mientras el sistema se va desplazando sobre el área estudiada, a lo largo de líneas de adquisición, generalmente paralelas entre sí. Usualmente, la interpretación se basa en la visualización directa de los gráficos en planta de los datos medidos a cada frecuencia. Además, para obtener información cuantitativa se aplican métodos de inversión 1D y luego, combinando esos resultados se obtienen imágenes del subsuelo 2D y 3D. Sin embargo, debido a la falta de correlación entre las inversiones 1D correspondientes a puntos vecinos, estas imágenes suelen presentar numerosas variaciones laterales espurias que dificultan la visualización de las estructuras de interés e inclusive pueden llegar a impedir su detección. La importancia de este problema generalmente es mayor cuando lo que se busca caracterizar son anomalías resistivas y cuando la relación señal-ruido es pobre. En este trabajo se presentan los resultados de dos estudios EMI realizados en un sitio contaminado por un derrame de hidrocarburos. El primero tuvo lugar dos semanas después del derrame y el segundo tres meses después del primero, una vez comenzadas las tareas de remediación. En la segunda ocasión se adquirieron además tres líneas geoeléctricas dipolo-dipolo, para comparar. A los datos EMI se les aplicó un método de inversión 1D convencional, en combinación con técnicas novedosas de filtrado lateral que permitieron

  2. Value of ultrasound in the determination of drainage methods in patients with tuberculous pleural effusion

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Eun Young; Suh, Bo Kyoung; Shim, Jae Jeong [Korea Univ. College of Medicine, Seoul (Korea, Republic of)

    1997-01-01

    To evaluate the utility of ultrasonography (US) as a guide in deciding drainage methods and as a prognostic factor in the prediction of pleural fibrosis, and to compare the effects of drainage methods in patients with tuberculous pleural effusions. In 51 patients with tuberculous pleural effusion, US patterns of pleural effusion were classified according to degree of septa into three groups, as follows : anechoic (n=5), linear septa (n=15), and honeycomb septa (n=31). US-guided drainage methods, including thoracentesis (n=17), percutaneous catheter insertion (n=12), catheter insertion with urokinase instillation (n=22) were employed. Therapeutic effects were evaluated with follow-up chest radiographs after 3 and 6 months. Three months after the procedure, 43 of 51 effusions had drained effectively. US guided drainage failed in eight patients including two of six with linear septated effusion treated with thoracentesis, four of seven with honeycomb septated effusion treated with thoracentesis, and two of six with honeycomb septated effusion treated with catheter drainage. There was no drainage failure in patients with anechoic effusions and in patients with urokinase instillation. Late effects were assessed in 39 patients after 6 months. Follow-up radiographs available in 39 patients demonstrated pleural fibrosis with intercostal space narrowing in 7 patients with honeycomb septated effusion, 3 patients with linear septated effusion, and none of the patients with anechoic effusions. The pattern of septa seen on US could be a useful factor for determining drainage methods and predicting late results in tuberculous pleural effusion. Percutaneous catheter drainage with urokinase instillation was a good drainage modality for patients with septated pleural effusions. Pleural fibrosis is more frequently induced by septated pleural effusion than by anechoic pleural effusion.

  3. Comunicación, movilización y participación: lecciones aprendidas en la prevención y control de la fiebre dengue (fd

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    Mario Mosquera

    2006-01-01

    Full Text Available Este artículo presenta los resultados de un estudio de intervención- investigación ejecutado durante 2003-2005 en el Atlántico (Colombia, con el propósito de mejorar la efectividad y sostenibilidad de los programas de control de Fiebre Dengue (FD, a través de una estrategia de comunicación participativa basada en los recursos comunicacionales locales y en los conocimientos, prácticas y percepciones de la comunidad; se exponen las lecciones aprendidas en torno a dimensiones críticas de las intervenciones en comunicación y salud organizadas en dos áreas: dimensiones político-técnicas y dimensiones teóricas y de investigación. El proyecto se desarrolló partir de la metodología combi, abordaje de comunicación y movilización social que incluye un proceso estratégico para identificar, promover y facilitar comportamientos que puedan repercutir en forma positiva y significativa y que sean factibles de lograr. Como variante al combi, se introdujeron componentes de participación social en la implementacion del proceso. Las lecciones aprendidas incluyen re- flexiones sobre el rol de los organismos rectores, la integralidad de las estrategias, el impacto de las intervenciones de comunicación en los indicadores entomológicos, la expansión de referentes teóricos en dengue y la posibilidad de abordar otras problemáticas de salud a partir de procesos participativos centrados en dengue.

  4. Manifestaciones clínicas y complicaciones de la fase aguda de bartonelosis o Fiebre de la Oroya en pacientes atendidos en el Hospital Nacional Cayetano Heredia.

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    Ciro Peregrino Maguiña Vargas

    2008-07-01

    Full Text Available Objetivos: Determinar las características clínicas, epidemiológicas y de laboratorio de la bartonelosis aguda, así como las complicaciones en una serie de pacientes atendidos en el Hospital Nacional Cayetano Heredia. Material y métodos: Estudio descriptivo de tipo serie de casos de pacientes mayores de 15 años con bartonelosis aguda hospitalizados en el Hospital Nacional Cayetano Heredia entre 1993 y 2006. Resultados: La edad promedio fue 27,8 años, 72,7% fueron varones, 51,5% procedía de Lima y 33,3% de Ancash. Los síntomas principales fueron: fiebre 90,9%, cefalea 87,9%, hiporexia 75,5%, baja de peso 63,6%, e ictericia 57,6%. Dos pacientes presentaron alteraciones en el fondo de ojo: retinitis exudativa y retinopatía hemorrágica. El hematocrito promedio fue 20,8% y 63,6% cursaron hematocrito £20%. Hubo desviación izquierda en 24,2%, hiperbilirrubinemia a predominio indirecto 62,5% e hipoalbuminemia (< 3mg/dl 56,5%. Se presentaron complicaciones en 84,8%, el 27,2% requirió internamiento en UCI. Las complicaciones no infecciosas ocurrieron en 84,8%, hematológicas 81,8% y gastrointestinales 78,7%. Las complicaciones infecciosas se presentaron en 12,1%. Los antibióticos más utilizados fueron ciprofloxacina 66,6% y cloranfenicol 42,4%, se administró corticoides en 9,1% y se transfundió paquete globular en 42,4%. Conclusiones: Los pacientes de UCI tuvieron más complicaciones cardiovasculares, trombocitopenia y mayor severidad de la anemia. No se registró mortalidad. (Rev. Med Hered 2008;19:87-95

  5. Brote de Fiebre Hemorrágica por el virus del Ébola en Uganda Hemorrhagic Fever outbreak due to Ebola virus in Uganda

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    MªC. Aríñez Fernández

    2012-03-01

    Full Text Available En Uganda se está llevando a cabo la Misión de la Unión Europea (EUTM Somalia, en la que participan efectivos de las Fuerzas Armadas españolas. En mayo de 2011 el Ministerio de Sanidad de Uganda notificó un brote de fiebre hemorrágica por el virus del bola a 70 km de distancia de Kampala. El caso índice y único caso confirmado, fue una niña de 12 años que falleció. La investigación epidemiológica se llevó a cabo por un equipo internacional que incluyó personal del Ministerio de Sanidad de Uganda y de la OMS. Tras mantener la vigilancia del brote durante un tiempo igual a dos veces el periodo de incubación y no confirmar otros casos, fue declarado finalizado el brote el 17 de junio de 2011. Se distribuyó información sobre el brote y recomendaciones de actuación tanto a profesionales de la salud como a la población general.The European Mission (EUTM Somalia is being conducted in Uganda. Military personnel of the Spanish Armed Forces participate in that mission. On 13 May 2011, The Ministry of Health of Uganda notified a case of Ebola hemorrhagic fever in a district 70 kilometers far from Kampala. The index case and only confirmed case, was a 12-year-old girl who finally died. Epidemiologic surveillance was conducted by an international team including representatives of the Ugandan Ministry of Health and WHO. The Ministry of Health of Uganda declared the end of the outbreak on the 17 June 2011, since the epidemiological investigations, including twofold the incubation period surveillance, did not confirm new cases. Guidelines to control the outbreak and information on the disease were distributed to health professionals and general population.

  6. 'La fiebre de Malta': An Interface of Farmers and Caprine Brucellosis Control Policies in the Bajío Region, Mexico.

    Science.gov (United States)

    Oseguera Montiel, D; Udo, H M J; Frankena, K; van der Zijpp, A

    2017-02-01

    This article shows that socio-economic factors, defined here as practices, knowledge, interests, beliefs and experiences have a role in the adoption of brucellosis control strategies in the Bajío region, Mexico. We combined qualitative and quantitative methods to show that socio-economic factors with regard to goat husbandry and brucellosis control are not taken into account in the current policy to combat the disease in Mexico. Farmers ranked constraints like the price of goat milk more important than the control of the disease. The impact of brucellosis in goats is hidden to farmers, and the term brucellosis is still a strange name to them; it is better known as 'la fiebre de Malta' (Malta fever), which farmers are aware of and which they avoid by not drinking goat milk. Brucellosis control measures cause losses such as abortion due to vaccination and ear infections due to ear tagging. In the villages of the state of Michoacán, the uptake of a vaccination and testing programme was almost complete because it was offered for free, whereas in villages of Jalisco, vaccination was not adopted thoroughly because the cost of vaccination was high for farmers and because of a lack of veterinarians offering the service. Neither compensation for culling suspected infected goats does exist nor the infrastructure, like slaughterhouses, to ensure that goats that are brucellosis seropositive are not resold to neighbouring farmers. This article disputes the idea that brucellosis is confined to the lack of awareness and participation of farmers in control measures, but rather that policies are promulgated without a good knowledge of goat husbandry and farmers' perceptions. We claim that governmental authorities should reformulate the policy to take into account socio-economic factors shaping farmers' behaviour so that effective control measures will be adopted by goat farmers.

  7. Tru-cut needle pleural biopsy and cytology as the initial procedure in the evaluation of pleural effusion.

    Science.gov (United States)

    Botana Rial, Maribel; Briones Gómez, Andrés; Ferrando Gabarda, José Ramón; Cifuentes Ruiz, José Fernando; Guarín Corredor, María Juliana; Manchego Frach, Nuria; Cases Viedma, Enrique

    2014-08-01

    The evaluation of pleural effusion (PE) includes various techniques, including pleural biopsy (PB). Our aim was to study the diagnostic yield of Tru-Cut needle PB (TCPB) and to define clinical/radiological situations in which TCPB might be indicated as an initial procedure. Retrospective study of TCPB in a hospital centre (2010-2012). Cases of pleural lesions without effusion were excluded. Clinical and radiological variables, diagnostic yield, TCPB complications and factors associated with the diagnostic yield of the combination of TCPB and thoracocentesis as initial procedure were analysed. One hundred and twenty-seven (127) TCPB were reviewed: 29.1% were cases of malignant PE and in 18.9% the cause of the PE could not be determined. The diagnostic yield of TCPB for tuberculosis was 76.5% (13/17) and 54% (20/37) for malignant PE. Complications occurred in 4.7% of the cases. In 72 patients with a final definitive diagnosis, TCPB was performed at the same time as the initial thoracocentesis. Diagnostic yield for the combination of TCPB/cytology as an initial technique was 43% (31/72) compared to 12.5% (9/72) for cytology only (p=0.01). The only predictive variable for the indication of TCBP as an initial technique was a PE volume>2/3 (P=.04). TCPB is safe and provides an acceptable diagnostic yield, particularly when combined with simultaneous cytology in the evaluation of PE of various aetiologies. Radiological criteria may help guide the selection of patients who could benefit from this technique as an initial procedure combined with thoracocentesis. Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.

  8. Toracostomia triirradiada no tratamento do empiema pleural crônico Triiradiated thoracostomy in the treatment of chronic pleural empyema

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    Manoel Ximenes Neto

    1998-10-01

    Full Text Available Empiema é uma doença comum e representa um problema cirúrgico de grande importância em virtude das dificuldades no diagnóstico e tratamento. Foram descritas três fases do empiema pleural, e o estágio final é a fase três ou crônica, a qual usualmente começa quatro a seis semanas após o desenvolvimento do empiema, quando o pulmão é encarcerado. Esta fase crônica representa a maioria das controvérsias relacionadas ao tratamento. Das diversas formas de drenagem permanente do abscesso pleural, nós concentramos mais recentemente num novo tipo de procedimento, que consiste numa toracostomia triirradiada, a qual permite posicionamento dos retalhos em qualquer porção da cavidade empiemática, assim recobrindo o espaço pleural. Este tipo de toracostomia em janela triirradiada foi descrita por Galvin em 1988. Foram analisados 27 pacientes portadores de infecção do espaço pleural tratados através de um retalho pleurocutâneo confeccionado à semelhança do emblema da marca automotiva Mercedes Benz. A idade média foi de 35,9 anos, sendo 22 homens e cinco mulheres. A infecção pleural foi devida ao staphylococcus aureus em 40,7% (n= 11, sem crescimento bacteriano em 29,6% (n=8, flora mista 1I % (n=3,E. coli7,4% (n=2,Proteus3,7% (n=1. O trauma foi responsável por 40,7% (n=11, pneumonia em 33,3% (n=9, câncer em 11 % (n=3, tuberculose em 7,4% (n=2, empiema pós-operatório e corpo estranho um cada,7 ,4% (n=2. O período de internação variou entre três meses e três dias, com uma média de 25 dias. O tempo médio para a resolução do processo foi de 35 dias (± 10 dias. Não houve mortalidade nesta série. Os objetivos do tratamento do empiema crônico, os quais incluem controle da infecção sistêmica e local, reexpansão do pulmão e melhoria da função pulmonar, restauração da parede torácica e mobilidade diafragmática, foram todos conseguidos com esta operação simples. Conclui-se que este método de drenagem permanente

  9. Mixed lubrication after rewetting of blotted pleural mesothelium.

    Science.gov (United States)

    Bodega, Francesca; Sironi, Chiara; Porta, Cristina; Pecchiari, Matteo; Zocchi, Luciano; Agostoni, Emilio

    2013-01-15

    Coefficient of kinetic friction (μ) of pleural mesothelium blotted with filter paper, and rewetted with Ringer solution markedly increases; this increase is removed if a sufficient amount of sialomucin or hyaluronan is added to Ringer (Bodega et al., 2012. Respiratory Physiology and Neurobiology 180, 34-39). In this research we found that μ of pleural mesothelium blotted, rewetted, and sliding at physiological velocities and loads, decreased with increase of velocity, mainly at low velocities. Despite this decrease, μ at highest velocity was still double that before blotting. With small concentration of sialomucin or hyaluronan μ was markedly smaller at each velocity, decreased less with increase of velocity, and at highest velocity approached preblotting value. These findings indicate a regime of mixed lubrication in post-blotting Ringer, at variance with boundary lubrication occurring before blotting or postblotting with sufficient macromolecule addition. Greater roughness of mesothelial surface, caused by blotting, likely induces zones of elastohydrodynamic lubrication, which increase with velocity, while contact area decreases.

  10. Malignant pleural mesothelioma risk among nuclear workers: a review.

    Science.gov (United States)

    Metz-Flamant, C; Guseva Canu, I; Laurier, D

    2011-03-01

    Exposure to ionising radiation has been suggested as a causal risk factor for malignant pleural mesothelioma (MPM). Studies of patients treated by radiotherapy for primary cancers have suggested that radiation contributes to the development of secondary MPM. Here we examined the risk to nuclear workers of MPM related to exposure to low doses of occupational radiation at low dose rates. All results concerning MPM risk in published studies of nuclear workers were examined for their association with radiation exposure and potential confounders. We found 19 relevant studies. Elevated risks of pleural cancer were reported in most (15/17) of these studies. Eight reported risks higher for radiation monitored workers than for other workers. However, of 12 studies that looked at associations with ionising radiation, only one reported a significant dose-risk association. Asbestos was an important confounder in most studies. We conclude that studies of nuclear workers have not detected an association between ionising radiation exposure and MPM. Further investigations should improve the consideration of asbestos exposure at the same time as they address the risk of MPM related to occupational exposure of nuclear workers to low doses of ionising radiation at low dose rates.

  11. [Primary heterotopic pleural hydatid cyst presenting as a pneumothorax].

    Science.gov (United States)

    Marghli, A; Ayadi-Kaddour, A; Ouerghi, S; Boudaya, M S; Zairi, S; Smati, B; Mestiri, T; Kilani, T

    2011-03-01

    Hydatid cyst is a parasitic disease that is endemic in many countries. Pneumothorax may be a presentation of this disease that presents urgent problems of diagnosis and treatment. We report the case of a 23-year-old woman, amenorrheic for 22 weeks, who presented with chest pain and dyspnoea. Chest x-ray revealed a right-sided tension pneumothorax. A check x-ray after drainage showed a homogeneous opacity of water density occupying the lower 2/3 of the right hemithorax. Thoracic ultrasound suggested an uncomplicated hydatid cyst at the right base. Surgical exploration revealed a hydatid cyst 14cm in diameter in the pleural space, and a cavity in the right lower lobe with two bronchial fistulae. Treatment consisted of removal of the cyst intact, closure of the bronchial fistulae and capitonnage of the residual cavity. The postoperative course was uncomplicated. Primary heterotopic pleural hydatid cyst is an exceptional cause of pneumothorax that should considered in countries where hydatid disease is endemic. Treatment is surgical following drainage of the pneumothorax. Copyright © 2011 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  12. Kissing pleural metastases from metastatic osteosarcoma of the lung.

    Science.gov (United States)

    Mori, Takeshi; Yoshioka, Masakazu; Iwatani, Kazunori; Kobayashi, Hironori; Yoshimoto, Kentaro; Nomori, Hiroaki

    2006-04-01

    Two patients with osteosarcoma lung metastases of which migrated to the parietal pleura due to contact are reported. The first patient was a 16-year-old male who had a pleural metastasis in the diaphragm within an area in contact with a single lung metastasis. Both of the tumors were resected, followed by systemic chemotherapy. Nine months after the resection of the first metastases, two other lung metastases were found which were resected after chemotherapy. The patient is alive without recurrence 84 months after the first resection of the metastases. The second patient was an 11-year-old female with a pleural metastasis of osteosarcoma which was within an area in contact with a single lung metastasis, which had been resected 4 months before. We concluded (1) that a lung metastasis of osteosarcoma occasionally metastasizes to the pleura due to contact; and (2) that because this kissing metastases of osteosarcoma could be cured by a complete resection, the intrathoracic cavity should be thoroughly observed.

  13. Pleural procedures in the management of malignant effusions

    Science.gov (United States)

    Ferreiro, Lucía; Suárez-Antelo, Juan; Valdés, Luis

    2017-01-01

    Malignant pleural effusion (MPE) is common in clinical practice, and despite the existence of studies to guide clinical decisions, it often poses diagnostic and therapeutic dilemmas. Once it is diagnosed, median survival does not usually exceed 6 months. The management of these patients focuses on symptom relief since no treatments have been shown to increase survival to date. Conversely, poor management can shorten survival. The approach must be multidisciplinary and allow for individualized care. Initial diagnostic procedures should be minimally invasive and, according to the results and other factors, procedures of increasing complexity will be selecting. Likewise, the treatment of MPEs should be individualized according to factors such as type of tumor, patient functional status, means available, benefits of each procedure, or life expectancy. Currently, treatment seems to tend toward less interventional approaches, in which patients can be managed on an outpatient basis, thus minimizing both the discomfort that more aggressive approaches involve and the costs of care associated with this disease. This article reviews the pleural procedures employed in the management of MPEs with special emphasis on the indication for each one, its usefulness, benefits, and complications.

  14. Real-time treatment feedback guidance of Pleural PDT

    Science.gov (United States)

    Zhu, Timothy C.; Kim, Michele M.; Liang, Xing; Liu, Baochang; Meo, Julia L.; Finlay, Jarod C.; Dimofte, Andreea; Rodriguez, Carmen; Simone, Charles B.; Cengel, Keith; Friedberg, Joseph S.

    2015-01-01

    Pleural photodynamic therapy (PDT) has been used as an adjuvant treatment with lung-sparing surgical treatment for mesothelioma with remarkable results. In the current intrapleural PDT protocol, a moving fiber-based point source is used to deliver the light and the light dose are monitored by 7 detectors placed in the pleural cavity. To improve the delivery of light dose uniformity, an infrared (IR) camera system is used to track the motion of the light sources. A treatment planning system uses feedback from the detectors as well as the IR camera to update light fluence distribution in real-time, which is used to guide the light source motion for uniform light dose distribution. We have improved the GUI of the light dose calculation engine to provide real-time light fluence distribution suitable for guiding the surgery to delivery light more uniformly. A dual-correction method is used in the feedback system, so that fluence calculation can match detector readings using both direct and scatter light models. An improved measurement device is developed to automatically acquire laser position for the point source. Comparison of the effects of the guidance is presented in phantom study. PMID:25999647

  15. Photodynamic therapy for lung cancer and malignant pleural mesothelioma.

    Science.gov (United States)

    Simone, Charles B; Cengel, Keith A

    2014-12-01

    Photodynamic therapy (PDT) is a form of non-ionizing radiation therapy that uses a drug, called a photosensitizer, combined with light to produce singlet oxygen ((1)O2) that can exert anti-cancer activity through apoptotic, necrotic, or autophagic tumor cell death. PDT is increasingly being used to treat thoracic malignancies. For early-stage non-small cell lung cancer (NSCLC), PDT is primarily employed as an endobronchial therapy to definitively treat endobronchial or roentgenographically occult tumors. Similarly, patients with multiple primary lung cancers may be definitively treated with PDT. For advanced or metastatic NSCLC and small cell lung cancer (SCLC), PDT is primarily employed to palliate symptoms from obstructing endobronchial lesions causing airway compromise or hemoptysis. PDT can be used in advanced NSCLC to attempt to increase operability or to reduce the extent of operation intervention required, and selectively to treat pleural dissemination intraoperatively following macroscopically complete surgical resection. Intraoperative PDT can be safely combined with macroscopically complete surgical resection and other treatment modalities for malignant pleural mesothelioma (MPM) to improve local control and prolong survival. This report reviews the mechanism of and rationale for using PDT to treat thoracic malignancies, details prospective and major retrospectives studies of PDT to treat NSCLC, SCLC, and MPM, and describes improvements in and future roles and directions of PDT.

  16. Real-time treatment feedback guidance of Pleural PDT

    Science.gov (United States)

    Zhu, Timothy C.; Kim, Michele M.; Liang, Xing; Liu, Baochang; Meo, Julia L.; Finlay, Jarod C.; Dimofte, Andreea; Rodriguez, Carmen; Simone, Charles; Cengel, Keith; Friedberg, Joseph

    2013-03-01

    Pleural photodynamic therapy (PDT) has been used as an adjuvant treatment with lung-sparing surgical treatment for mesothelioma with remarkable results. In the current intrapleural PDT protocol, a moving fiber-based point source is used to deliver the light and the light dose are monitored by 7 detectors placed in the pleural cavity. To improve the delivery of light dose uniformity, an infrared (IR) camera system is used to track the motion of the light sources. A treatment planning system uses feedback from the detectors as well as the IR camera to update light fluence distribution in real-time, which is used to guide the light source motion for uniform light dose distribution. We have improved the GUI of the light dose calculation engine to provide real-time light fluence distribution suitable for guiding the surgery to delivery light more uniformly. A dual-correction method is used in the feedback system, so that fluence calculation can match detector readings using both direct and scatter light models. An improved measurement device is developed to automatically acquire laser position for the point source. Comparison of the effects of the guidance is presented in phantom study.

  17. Coleta e preservação do líquido pleural e biópsia pleural Collection and preservation of the pleural fluid and pleural biopsy

    Directory of Open Access Journals (Sweden)

    Leila Antonangelo

    2006-08-01

    Full Text Available As amostras de líquido pleural obtidas por toracocentese para o diagnóstico de transudatos e exsudatos devem obedecer a uma rotina de coleta e preservação para a realização de uma análise laboratorial adequada. Igualmente, fragmentos de biópsia de pleura obtidos para o diagnóstico diferencial dos exsudatos devem ser coletados de forma sistemática com o objetivo de otimizar o diagnóstico e facilitar a instituição da terapêutica adequada.The samples of pleural fluid obtained by thoracentesis for the diagnosis of transudates and exudates shall follow a routine of collection and preservation for an appropriate laboratorial analysis. Equally, fragments of pleura biopsy obtained for the differential diagnosis of the exudates should be collected in a systematic way in order to optimize the diagnosis and facilitate the institution of appropriate therapeutics actions.

  18. Useful tests on pleural fluid that distinguish transudates from exudates.

    Science.gov (United States)

    Porcel, J M; Vives, M; Vicente de Vera, M C; Cao, G; Rubio, M; Rivas, M C

    2001-11-01

    We aimed to compare the classic Light's criteria with different testing strategies in an effort to improve the accuracy of pleural fluid (PF) categorization. Thirty-two patients with transudates and 140 with exudates on the basis of their clinical diagnosis were entered into the study. We examined the discriminative properties of 10 analytes in the identification of PF, both singly and in combination with an 'or' rule, to see which was best in distinguishing a transudate from an exudate. A combination of PF lactate dehydrogenase (LD) > 307 U/L (two-thirds of the upper limit of the serum LD reference range) with either PF cholesterol > 1.55 mmol/L or PF to serum protein ratio > 0.5 had a diagnostic accuracy similar to that of Light's criteria. We suggest the use of PF LD and cholesterol in combination as an alternative method for distinguishing pleural transudates from exudates. This test combination avoids the need for venepuncture and the simultaneous collection of a blood sample.

  19. CYTOLOGICAL STUDY OF PLEURAL FLUIDS AND ITS CLINICOBIOCHEMICAL CORRELATION

    Directory of Open Access Journals (Sweden)

    Shikha

    2015-10-01

    Full Text Available A study of analysis of 50 pleural fluids was carried out at major teaching hospital, in Mumbai over a period of three years . Of these 50 fluids were 33 were transudates and 17 exudates. Male predominance (72% was observed with the majority in 3 rd decade. Tuberculosis (30 cases was the commonest conditions associated with exudates followed by synpneumonic effusions. Majority of the tuberculous cases (80% showed WBC count between 1000 - 5000 cells/cmm. Polymorphs were predominant in synpneumonic effusions. Of the 2 cases of malignant effusion, malignant cells (well differentiated adenocarcinoma were detected in both the cases, with total WBC counts ranging between 1000 - 5000cell/cmm. The correct diagnosis of the fluid as transudate or exudate is important be cause if the fluid is exudative then further diagnostic procedures like cytopathology , pleural biopsy and other invasive procedure can be done for definite diagnosis . On the other hand, if the fluid is transudative then treatment for underlying conditions like CCF, nephrotic syndrome, cirrhosis is given. The presence of cancer cells in the fluid is a proof positive of malignancy related fluid but in 30 to 60 percent of cancer cases, cancer cells are not detected. Exfoliative cytology for malignant cells is highly specific though less sensitive (40 - 60%. Definitive diagnosis may depend upon clinical correlation and histological examination

  20. Pleural mesothelioma in a nine-month-old dog

    Directory of Open Access Journals (Sweden)

    Vural Sevil

    2007-01-01

    Full Text Available Abstract This paper reports on an unusual case of pleural epitheloid mesothelioma in a nine-month-old male, mixed breed dog. The dog was presented in-extremis and, on post mortem examination, multiple, exophytic, frequently pedunculated, yellowish-red, soft to firm masses ranging from 3 mm to 6 cm in diameter were diffusely distributed over, and attached to, the pericardial and parietal pleural surfaces. Microscopically, these masses consisted of round to partially polygonalshaped, anaplastic cells with minimal cytoplasm and hyperchromatic nuclei covering papillomatous projections or as part of more densely cellular masses. A supporting fibrovascular stroma and mitotic figures were also evident. Constituent tumour cells were labeled positively with antibodies against both vimentin and cytokeratin. In contrast, the same cells exhibited equivocal labeling with an antibody directed against calretinin antigen and did not label with antibodies against carcinoembryonic antigen (CEA and milk fat globule-related antigen (MFGRA. Such tumours are rare in dogs, particularly in such a young animal.