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Sample records for recurrent pleural effusion

  1. 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.

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

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    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.

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

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    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.

  4. 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...

  5. 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.

  6. A patient on RIPE therapy presenting with recurrent isoniazid-associated pleural effusions: a case report

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    Varenika Vanja

    2011-11-01

    Full Text Available Abstract Introduction The clinical scenario of a new or worsening pleural effusion following the initiation of antituberculous therapy has been classically referred to as a 'paradoxical' pleural response, presumably explained by an immunological rebound phenomenon. Emerging evidence suggests that there also may be a role for a lupus-related reaction in the pathophysiology of this disorder. Case presentation An 84-year-old Asian man treated with isoniazid, along with rifampin, pyrazinamide and ethambutol for suspected extrapulmonary tuberculosis, presented with a recurrent pleural effusion, his third episode since the initiation of this therapy. The first effusion occurred one month after the start of treatment, without any prior evidence of pulmonary tuberculosis involvement. Follow-up testing, including thoracoscopic pleural biopsies, never confirmed tuberculosis infection. Further evaluation yielded serological evidence suggesting drug-induced lupus. No effusions recurred following the discontinuation of isoniazid, although other antituberculosis medications were continued. Conclusion The immunological rebound construct is inconsistent with the evolution of this case, which indicates rather that drug-induced lupus may explain at least some cases of new pleural effusions following the initiation of isoniazid.

  7. Minoxidil-associated exudative pleural effusion.

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    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.

  8. Talc Pleurodesis Through Very-Small-Bore Catheters in Patients with Recurrent Malignant Pleural Effusion

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    Ali Özgen

    2016-04-01

    Full Text Available Objective: Malignant pleural effusion (MPE is a frequent and disturbing complication of metastatic disease. Talc pleurodesis via percutaneosly placed 12–18F catheters is an effective procedure to treat recurrent MPE. We aimed to determine the efficiency of talc pleurodesis through very-small-bore catheters in the treatment of recurrent malignant pleural effusion. Methods: We performed 13 talc pleurodesis procedures in 10 patients with recurrent MPE via pre-existing 7F (6 patients and 8F (4 patients pig-tail catheters. We analyzed technical and clinical success of the procedure. Results: All procedures were performed successfully. Complete or partial clinical success was achieved in 8 out of 10 patients. No major complication was observed. Conclusion: Talc pleurodesis through 7F or 8F catheters may be performed in selected patients with reduced patient discomfort, and similar success rates that was obtained using higher caliber catheters in the treatment of recurrent MPE.

  9. Persistent benign pleural effusion.

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    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.

  10. High-grade primary myxoid lung sarcoma presenting as recurrent hemorrhagic pleural effusions in a young woman.

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    Tahir, Hassan; Coleman, Cinthia; Sagi, Jahnavi; Wani, Adil; Daruwalla, Vistasp

    2015-01-01

    Primary lung sarcomas are rare but aggressive tumors accounting for less than 0.5% of all lung tumors. The diagnosis of primary lung sarcoma should only be considered after exclusion of other sites. A 32-year-old female presented with recurrent hemorrhagic pleural effusions, shortness of breath and persistent cough. Pleural effusion was drained twice, and each time its analysis was normal. Patient developed atelectasis of left lung with hemothorax for which she underwent video-assisted thoracoscopic surgery. A large mass was found compressing the entire lower lobe of left lung with extension into mediastinum, the biopsy of which showed myxoid sarcoma. The tumor was inoperable and options of chemotherapy or radiotherapy were discussed with the patient. Primary lung sarcoma can rarely present with recurrent hemorrhagic pleural effusion. A high degree of suspicion is required for early diagnosis as large hemothorax on computed tomography or chest X-ray may obscure lung mass and make its diagnosis difficult.

  11. Pleural effusion following ovarian hyperstimulation.

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    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.

  12. Tuberculous pleural effusion.

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    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.

  13. PROSPECTIVE RANDOMIZED TRIAL OF EFFICACY AND SAFETY OF IODOPOVIDONE VS OXYTETRACYCLINE FOR PLEURODESIS IN SPONTANEOUS PNEUMOTHORAX AND RECURRENT PLEURAL EFFUSIONS

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    Uday C

    2016-02-01

    Full Text Available BACKGROUND Recurrent malignant pleural effusion and spontaneous pneumothorax can be treated by a procedure called pleurodesis by which the pleural space is obliterated. This can be done by surgical means using mechanical force or by introducing any one of the recommended agents into the pleural space via tube thoracostomy or during thoracoscopy. Examples of agents used are talc as powder or as slurry, tetracycline derivatives, antineoplastic agents (Bleomycin, mitoxantrone, quinacrine, silver nitrate, Corynebacterium parvum and iodopovidone. The aim of the present study was to evaluate the safety and efficacy of iodopovidone as a sclerosing agent in the treatment of recurrent pleural effusion and spontaneous pneumothorax. This was a randomized prospective interventional study comparing iodopovidone with oxytetracycline as the latter is now sparingly available for clinical use. MATERIAL AND METHODS Study was conducted in 44 patients above 12 years of age, admitted in the Dept. of Pulmonary Medicine, Goa Medical College. Patients with a diagnosis of spontaneous pneumothorax or recurrent malignant pleural effusion were randomly allocated to either iodopovidone or oxytetracycline group and pleurodesis was done as per British Thoracic Society Guidelines (BTS. 1 RESULTS Among 44 patients 23 were secondary spontaneous pneumothorax, 9 were primary spontaneous pneumothorax and 12 were malignant pleural effusion; 2 patients did not report for follow-up visits and the remaining 42 patients were followed up for 6 months. The success rate of oxytetracycline and iodopovidone pleurodesis is 81% and 95.2% respectively. All the patients had chest pain of varying severity during the procedure in either groups; 8 patients in oxytetracycline group and 6 patients in iodopovidone group had fever after the procedure; 2 patients in iodopovidone group developed hypotension after the procedure and there was no mortality in either group attributable to the procedure

  14. Pleural effusion: diagnosis, treatment, and management

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    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. [Sarcoid pleural effusion].

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    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.

  16. High-grade primary myxoid lung sarcoma presenting as recurrent hemorrhagic pleural effusions in a young woman

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    Hassan Tahir

    2015-12-01

    Full Text Available Primary lung sarcomas are rare but aggressive tumors accounting for less than 0.5% of all lung tumors. The diagnosis of primary lung sarcoma should only be considered after exclusion of other sites. A 32-year-old female presented with recurrent hemorrhagic pleural effusions, shortness of breath and persistent cough. Pleural effusion was drained twice, and each time its analysis was normal. Patient developed atelectasis of left lung with hemothorax for which she underwent video-assisted thoracoscopic surgery. A large mass was found compressing the entire lower lobe of left lung with extension into mediastinum, the biopsy of which showed myxoid sarcoma. The tumor was inoperable and options of chemotherapy or radiotherapy were discussed with the patient. Primary lung sarcoma can rarely present with recurrent hemorrhagic pleural effusion. A high degree of suspicion is required for early diagnosis as large hemothorax on computed tomography or chest X-ray may obscure lung mass and make its diagnosis difficult.

  17. 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.

  18. A 54-Year-Old Man With Anasarca, Dyspnea, and Recurrent Bilateral Pleural Effusions.

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    Patil, Pradnya D; Cua, Yvette M; Farver, Carol; Perez, Rafael L; Mehta, Atul C; Panchabhai, Tanmay S

    2017-08-01

    A 54-year-old African-American man presented with 2 years of progressively worsening dyspnea and anasarca. Over the past 6 months he gained 30 lbs with worsening lower extremity, abdominal wall, and scrotal edema. A recent workup for cardiac, renal, and liver disease, including two-dimensional echocardiogram, liver and renal function tests, and abdominal ultrasound, was unremarkable. He reported a 15-pack year history of smoking and quit 3 years ago. Chest radiograph at that time revealed bilateral pleural effusions that were both reportedly milky in appearance when drained by thoracenteses. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  19. 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 ...

  20. 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 ...

  1. Etiologies of bilateral pleural effusions

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    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

  2. Nonchylous idiopathic pleural effusion in the newborn

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    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.

  3. Pleural effusion in liver disease.

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    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.

  4. 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...

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

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    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

  6. 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.

  7. Rapidly Regressive Unilateral Fetal Pleural Effusion

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    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

  8. 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...

  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

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    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. 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

  13. 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.

  14. 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

  15. 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.

  16. 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...

  17. 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.

  18. 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.

  19. Massive pleural effusion in a young woman

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    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.

  20. Vascular endothelial growth factor in diagnosis of pleural effusion

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    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. 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.

  2. 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.)

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

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

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    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.

  9. 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

  10. 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.

  11. 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.

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

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    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)

  13. 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.

  14. 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

  15. 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 ...

  16. 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.

  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. 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.

  19. Polycystic liver disease presenting with an exudative pleural effusion: a case report

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    Woolnough Kerry

    2012-04-01

    Full Text Available Abstract Introduction Polycystic liver disease is asymptomatic in 95% of patients. In the remaining 5% it causes symptoms due to the local mass effect of the polycystic liver. We describe the case of a patient who presented with symptoms of a pleural effusion and was also found to have polycystic liver disease. The effusion recurred despite repeated efforts at drainage and only resolved following surgical debridement of the cystic liver. Case presentation A 50-year-old Caucasian woman presented with a two-week history of increasing dyspnoea. An examination revealed a large right pleural effusion and gross hepatomegaly. An ultrasound confirmed a large polycystic liver and diagnostic thoracocentesis revealed an exudate, which was sterile to culture. The pleural effusion proved refractory to drainage and our patient underwent surgery to deroof the main hepatic cysts in an attempt to reduce the pressure on her right diaphragm. The histology was compatible with that of polycystic liver disease. No evidence of malignancy was found. After surgery, our patient had no recurrence of her effusion and, to date, has remained asymptomatic from her polycystic liver disease. Conclusion The case in this report illustrates that an exudative pleural effusion is a rare complication of polycystic liver disease. We feel that the mechanical effects of a large polycystic liver, and subsequent disruption of sub-diaphragmatic capillaries, resulted in a persistent exudative pleural effusion. Thus, surgical debulking of the hepatic cysts is required to manage these effusions.

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

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    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.

  1. 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...

  2. [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.

  3. 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.

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

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    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.

  5. Meig’s Syndrome:A Triad of Pleural Effusion, Abdominal Ascites, and Benign Ovarian Fibroma

    Institute of Scientific and Technical Information of China (English)

    Yaseen Ali; Amila M. Parekh; Rahul K. Rao; Taseen Ali; Linda S. Schneider; Jordan Garvey; Mirza R. Baig

    2015-01-01

    Background:Meig’s syndrome is a rare syndrome characterized by a triad of recurrent pleural effusions, ascites, and the finding of a benign ovarian fibroma on diagnostic imaging and histopathological evaluation. Patients can present with any of the constellation of symptoms attributing to the disease state. With pleural effusions they can present with shortness of breath, chest pressure, dyspnea on exertion; symptoms that can be confused with the exacerbation of congestive heart failure. Ascites can present with abdominal tenseness, pain, bloating, cramping, constipation, and elevated liver enzymes. The ifnding of a benign ovarian ifbroma is found only during diagnostic imaging and histopathological evaluation. Case report:The patients was an 85-year-old female with a recent history of coronary artery bypass graft surgery for her severe coronary artery disease presented with the chief complaint of generalized malaise, abdominal pain, constipation of few days. She was initially scheduled to have her second therapeutic thoracentesis for her recurrent pleural effusion as an outpatient procedure but complained of the former symptoms and was admitted for observation and treatment of her abdominal symptoms. Her recurrent pleural effusions were initially attributed to the complications of her coronary artery bypass graft surgery for her severe coronary artery disease. During the admission and evaluation she was diagnosed with Meig’s syndrome. She underwent a left oophorectomy with total abdominal hysterectomy that led to the resolution of all her symptoms. Conclusion:Meig’s syndrome is a rare syndrome characterized by the triad of recurrent pleural effusions, ascites, and the ifnding of a benign ovarian ifbroma. The diagnosis and knowledge of this syndrome holds the key to its treatment. The treatment generally involves the resection of the ovarian ifbroma. After the resection of the ovarian ifbroma patients recover from the inconvenient pleural effusions and

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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.

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

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    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.

  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. 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.

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

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    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

  16. Parapneumonic pleural effusion: early versus late thoracoscopy.

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    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

  17. 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.

  18. Bilateral Pleural Effusions as an Initial Presentation in Primary Sjögren's Syndrome

    Science.gov (United States)

    Makimoto, Go; Asano, Michiko; Fujimoto, Nobukazu; Fuchimoto, Yasuko; Ono, Katsuichiro; Ozaki, Shinji; Taguchi, Koji; Kishimoto, Takumi

    2012-01-01

    Sjögren's syndrome (SS) is a systemic autoimmune disease characterized by sicca symptoms. Interstitial pulmonary fibrosis and tracheobronchial sicca are the most common symptoms of pulmonary involvement in primary SjS, and they are rarely accompanied by serositis such as pleuritis or pericarditis. We report a case of SS presenting initially with bilateral pleural effusions. A 63-year old man was admitted to our hospital with a one-month history of cough, dyspnea, and right chest pain. Chest-computed tomography revealed bilateral pleural effusions. Serum anti-SS-A antibody titer was 1 : 256. Ophthalmological examination revealed a positive Schirmer test. Lip biopsy showed atrophy and plasmacytic infiltration of the salivary gland. Corticosteroid treatment was initiated. Pleural effusions were almost completely resolved by day 30. The patient has not experienced any recurrence. PMID:23198246

  19. Bilateral Pleural Effusions as an Initial Presentation in Primary Sjögren’s Syndrome

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    Go Makimoto

    2012-01-01

    Full Text Available Sjögren’s syndrome (SS is a systemic autoimmune disease characterized by sicca symptoms. Interstitial pulmonary fibrosis and tracheobronchial sicca are the most common symptoms of pulmonary involvement in primary SjS, and they are rarely accompanied by serositis such as pleuritis or pericarditis. We report a case of SS presenting initially with bilateral pleural effusions. A 63-year old man was admitted to our hospital with a one-month history of cough, dyspnea, and right chest pain. Chest-computed tomography revealed bilateral pleural effusions. Serum anti-SS-A antibody titer was 1 : 256. Ophthalmological examination revealed a positive Schirmer test. Lip biopsy showed atrophy and plasmacytic infiltration of the salivary gland. Corticosteroid treatment was initiated. Pleural effusions were almost completely resolved by day 30. The patient has not experienced any recurrence.

  20. 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.

  1. 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.

  2. Recurrent massive bloody pleural effusion caused by pancreatic pleural fistula in a case%胰腺胸膜瘘致反复大量血性胸腔积液一例

    Institute of Scientific and Technical Information of China (English)

    李惠民; 赵顺英; 周锦; 曾琪; 曾津津; 江载芳

    2009-01-01

    Objective To introduce the early clinical features and the main points of diagnosis and treatment of children with pancreatic pleural fistula presenting massive bloody pleural effusion. Method The clinical data of symptoms, signs, laboratory examination, diagnosis and treatment methods of pancreatic pleural fistula in a child axe presented. Result A 4-year-old boy presented with one month history of intermittent fever, cough, chest tightness and chest pain. His pleural effusion collected from three thoracic closed drainage was hemorrhagic. He had no positive abdominal signs. His abdominal B-mode ultrasonography showed rough pancreatic echo. The levels of amylase in blood and pleural fluid were 495 U/L and 35 938 U/L, respectively. There was a fistulous tract from the thoracic cavity leading to the pancreas at thoracic surgical exploration. The child was cured by total parenteral nutrition, intravenous infusion of somatostatin and a stent placed in the pancreatic duct by endoscopic retrograde cholangiopancreatography (ERCP). Condusion The child with pancreatic pleural fistula in early stage mainly present respiratory symptoms and lack abdominal symptoms, so the diagnosis and treatment is often delayed. Significant increase of pancreatic amylase level in pleural effusion can be an important clue and basis for the diagnosis. If conservative therapy fails, the examination and treatment with ERCP should be considered.%目的 介绍胰腺胸膜瘘引起大量血性胸腔积液患儿的早期临床特点及诊治要点.方法 报道1例胰腺胸膜瘘患儿临床症状、体征、辅助检查及诊治方法.结果 4岁男孩,间断发热、咳嗽、胸闷和胸痛1个月,胸腔闭式引流3次均为血性胸液,腹部无阳性体征,腹部B超提示胰腺回声粗糙,血和胸腔积液胰淀粉酶分别为495 U/L和35 938 U/L,开胸探查发现有一瘘管从胸腔通向胰腺,经全胃肠外营养、静脉滴注生长抑素以及内镜逆行胰胆管造影在胰管

  3. 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

  4. 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.

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

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    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.

  6. 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

    Directory of Open Access Journals (Sweden)

    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.

  7. 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 ...

  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. 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.

  10. 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.

  11. 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.

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  20. Diagnostic importance of zinc in the clarification of pleural effusions etiology

    Directory of Open Access Journals (Sweden)

    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. 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.

  2. A Case of Haemorrhagic Constrictive Pericarditis with Bilateral Pleural Effusions

    Directory of Open Access Journals (Sweden)

    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.

  3. 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.

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

    Directory of Open Access Journals (Sweden)

    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

  5. [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.

  6. [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.

  7. [Diagnostic value of tumor markers in pleural effusions].

    Science.gov (United States)

    Botte, G; Laferrere, L; Etchepare, S; Dalurzo, D; Duhart, J E; Adaro, F V

    1990-01-01

    In order to discriminate between benign and malignant effusions, the value of alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA) and beta subunit of human chorionic gonadotropin (GNCH Sub-beta) has been estimated in pleural exudates. A sample of 65 patients, 33 with a malignant (histologically and/or cytologically established) and 32 with a benign effusion was analysed. Only mean CEA in malignant effusions was significantly higher than in benign effusions (p less than 0.01). In the detection of malignant effusion CEA showed a sensitivity of 57% and a specificity of 97%; AFP a sensitivity of 9% and a specificity of 97% and GNCH Sub beta a sensitivity of 9% and a specificity of 90%.

  8. 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

  9. 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.

  10. 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.

  11. 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.

  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. 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. [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.

  15. 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

  16. A rare pleural effusion in a young male

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    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.

  17. 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

  18. 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.

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

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    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.

  20. 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.

  1. 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.

  2. Intrapleural instillation of radioactive chromic phosphate in malignant pleural effusion

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    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.

  3. 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

  4. 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.

  5. 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.

  6. "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.

  7. A Systematic Review of Talc Compared with Bleomycin for Patients with Malignant Pleural Effusions

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    Yonggang WEI

    2009-03-01

    Full Text Available Background and objective Malignant pleural effusions are a common complication in advanced malignancy. Talc, bleomycin and the tetracyclines are the three most frequently used sclerosants. The aim of this study is to evaluate the efficacy and adverse effects of patients with malignant pleural effusions treated with talc and bleomycin. Methods We searched PubMed, Embase, the Cochrane Library, Chinese biomedicine literature database (CBM, CNKI, VIP, references of included studies for randomized controlled trials comparing talc with bleomycin for patients with malignant pleural effusions. The quality of included studies was assessed independently by two reviewers, discrepancies were resolved by discussion with the third person. We analyzed the data using Review Manager (version 5.0 software. Results Six studies totaling 224 patients were included. Meta analysis results were as follows: there was significantdifference in treatment success (RR=1.22, 95%CI: 1.05-1.42, recurrence rate (RR=0.31, 95%CI: 0.11-0.87 between talc group and bleomycin group, there was no significant difference between the two groups in case fatality rate (RR=1.39, 95%CI: 0.84-2.30, fever (RR=0.68, 95%CI: 0.24-1.94, pain (RR=0.22, 95%CI: 0.01-4.32. Conclusion Current evidence indicate that talc is super to bleomycin for patients with malignant pleural effusions in terms of improvingtreatment success and reducing recurrence rate, there is no significant difference between the two group with regard to casefatality rate, fever, pain, the results mentioned above still need to be confirmed by high quality, large sample, multicenter randomized controlled trial.

  8. Value of ultrasound in the determination of drainage methods in patients with tuberculous pleural effusion

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    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.

  9. 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.)

  10. 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.

  11. 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...

  12. 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 ...

  13. Role of therapeutic thoracentesis in tuberculous pleural effusion

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    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.

  14. 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

  15. 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

  16. Effusion under the microscope.

    LENUS (Irish Health Repository)

    Chong, S G

    2012-03-01

    Pseudochylothorax is a very rare form of pleural effusion. It is also called chyliform or cholesterol pleural effusion. It is usually a unilateral process and approximately one-third of patients are asymptomatic at presentation. We report a case of a 60 year old man with a background of rheumatoid arthritis who presented with progressive dyspnea. Chest X-ray revealed a new left pleural effusion and a small persistent right pleural effusion. He presented 5 years prior due to recurrent pleural effusion and no diagnosis was made. Repeat thoracentesis yielded 350 milliliters of thick, milky, tan-colored fluid.

  17. 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.

  18. 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.

  19. 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

  20. 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.

  1. 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.

  2. 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.

  3. Characteristics of pleural effusions in systemic lupus erythematosus: differential diagnosis of lupus pleuritis.

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    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.

  4. A STUDY ON ETIOLOGY AND PROFILE OF PLEURAL EFFUSION IN CHRONIC KIDNEY DISEASE

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    Prem Kumar

    2015-08-01

    Full Text Available BACKGROUND: Chronic Kidney disease is characterized by decreased glomerular filteration rate. Most pleural effusions occurring in CKD are attributed to renal failure & heart failure and are left alone, but there are other causes responsible for many effusions such as parapneumonic effusion, atelectasis, tuberculosis and other infections and malignancies due to immunosuppression, hence presence of pleural effusion in CKD deserves further evaluation. Our study is conducted to find the etiology and profile of patients with chronic Kidney disease developing pleural effusion. MATERIALS AND METHODS: Study was conducted among 35 patients with CKD and pleural effusion who attended Government hospital for chest and communicable diseases affiliated to Andhra Medical College, from M arch 2013 to September 2014. The clinical course of pleural effusions and their biochemical characteristics were studied together with radiographs and other relevant investigations. Study design - hospital based prospective study. OBSERVATIONS AND RESULTS: Of the 35 patients, 57% developed unilateral effusi on, 43% bilateral effusion. Among unilateral effusions - minimal effusions were 25%, moderate were 60%, massive were 15%. Patients with transudative effusion were 31%, exudative were 69%. Causes of effusion were as follows: Cardiac failure 31%, Tuberculosis 28%, Malignancy 9%, uremic effusion 14%, parapneumonic 11%, connective tissue disorders 2%. CONCLUSIONS: Apart from cardiac failure, tuberculosis is a major cause of pleural effusion in CKD patients, especially if the effusion is unilateral, exudative in nature, blood tinged, and lymphocyte predominant. ATT produced improvement in clinical and radiological status in these patients. KEYWORDS: CKD (C hronic K idney D isease, P leural effusion, C ardiac failure, T uberculosis.

  5. 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.

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

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    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.

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

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    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.

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

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    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

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

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    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.

  10. 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.

  11. Transudative vs exudative pleural effusions: differentiation using Gd-DTPA-enhanced MRI

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    Frola, C. [IV Divisione Radiologica, Ospedale S. Martino, V. le Benedetto XV, 10, I-16132 Genova (Italy); Cantoni, S. [IV Divisione Radiologica, Ospedale S. Martino, V. le Benedetto XV, 10, I-16132 Genova (Italy); Turtulici, I. [IV Divisione Radiologica, Ospedale S. Martino, V. le Benedetto XV, 10, I-16132 Genova (Italy); Leoni, C. [Divisione di Chirurgia Toracica, Ospedale S. Martino, V. le Benedetto XV, 10, I-16132 Genova (Italy); Loria, F. [IV Divisione Radiologica, Ospedale S. Martino, V. le Benedetto XV, 10, I-16132 Genova (Italy); Gaeta, M. [Servizio di Radiologia, Ospedale Piemonte, I-98100 Messina (Italy); Derchi, L.E. [Cattedra di Radiologia, Universita degli Studi, V. le Benedetto XV, 10, I-16132 Genova (Italy)

    1997-08-01

    The aim of this study was to investigate the capability of Gd-DTPA-enhanced MRI to differentiate between exudative and transudative pleural effusions. An MRI examination was performed on 22 patients with different types of pleural effusion (10 transudative and 12 exudative effusions). T1-weighted SE images were obtained before and 20 min after administration of Gd-DTPA (0.1 mmol/kg). The degree of enhancement of pleural effusions was evaluated both by visual assessement and by quantitative analysis of images. None of 10 transudative effusions showed significative enhancement, whereas 10 of 12 exudative effusions showed enhancement (sensitivity 83 %, specificity 100 %, positive predictive value 100 %). The postcontrast signal intensity ratios (SIRs) of exudates were significantly higher than corresponding precontrast ratios (P = 0.0109) and the postcontrast SIRs of exudates were significantly higher than those of transudates (P = 0.0300). Exudative pleural effusions show a significant enhancement following administration of Gd-DTPA. We presume that this may be caused by increased pleural permeability and more rapid passage of a large amount of Gd-DTPA from the blood into the pleural fluid in case of exudative effusions. In our limited group of patients, signal enhancement proved the presence of an exudative effusion. Absence of signal enhancement suggests a transudate, but does not exclude an exudate. (orig.). With 5 figs., 2 tabs.

  12. Dissecting aneurysm of arch and descending thoracic aorta presenting as a left sided hemorrhagic pleural effusion

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    Shamim Shelley

    2010-01-01

    Full Text Available The most common cause of massive hemorrhagic effusion is malignancy. Herein we present a case of dissecting aneurysm of descending thoracic aorta presenting initially with shortness of breath due to left sided massive pleural effusion. Effusion was hemorrhagic in nature with high hematocrit value. CT scan of thorax with CT angiogram was done and that revealed the diagnosis.

  13. 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.

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

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    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.

  15. 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.

  16. Utility of semi-rigid thoracoscopy in undiagnosed exudative pleural effusion

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    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. Thoracentesis-reverting cardiac tamponade physiology in a patient with myxedema coma and large pleural effusion

    Science.gov (United States)

    Werlang, Monia E.; Pimentel, Mario R.

    2017-01-01

    A large pleural effusion causing cardiac tamponade physiology and severe hemodynamic compromise is an uncommon event. We report a case of a 53-year-old woman with severe hypothyroidism presenting with myxedema coma and refractory shock. Her hemodynamic status failed to respond to fluid resuscitation and vasopressors. A transthoracic echocardiogram and chest radiograph demonstrated a pericardial fluid accumulation associated with a large left-sided pleural effusion. Thoracostomy tube insertion resulted in prompt improvement of the patient's hemodynamic status. Our finding demonstrates that a large pleural effusion may play an important role in cardiac tamponade physiology. PMID:28670061

  18. 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.

  19. Pleural procedures in the management of malignant effusions

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    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.

  20. Eosinophilic pleural or peritoneal effusions in dogs and cats: 14 cases (1986-1992).

    Science.gov (United States)

    Fossum, T W; Wellman, M; Relford, R L; Slater, M R

    1993-06-01

    Case records of 9 dogs and 5 cats with eosinophilic effusions were reviewed. The animals ranged from 11 months to 13 years old. Seven animals had pleural effusions, 5 had peritoneal effusions, and 2 had pleural and peritoneal effusions. Neoplasia was confirmed in 6 animals and suspected in 1. Eosinophilic pleural effusion was diagnosed 2 days after pneumothorax developed as a consequence of thoracic tube placement in a cat, and pneumothorax was diagnosed in another cat with eosinophilic peritoneal effusion. Other abnormalities seen in 1 or 2 animals associated with eosinophilic effusion were radiographic signs of interstitial or peribronchial pulmonary infiltrates, a history of allergic respiratory tract and skin disease, intestinal lymphangiectasia and lung lobe torsion, chylothorax, bite wounds causing intestinal perforation, and feline leukemia virus infection. Based only on the protein concentration of the effusion, 7 effusions were classified as transudates and 7 were classified as exudates. Five of the 14 animals had eosinophilia (> 1,200 eosinophils/microliters); 3 of these animals had neoplastic disease. Mean eosinophil count in blood samples was not significantly different between animals with neoplasia and those without. Eosinophil counts in blood samples were not linearly related to counts in effusions; however, in some animals the number of eosinophils in the effusion was much higher than the eosinophil count in blood, suggesting concentration of eosinophils in the effusion.

  1. 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.

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

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    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.

  3. Diagnostic accuracy and safety of semirigid thoracoscopy in exudative pleural effusions in Denmark

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    Willendrup, Fatin; Bødtger, Uffe; Colella, Sara

    2014-01-01

    BACKGROUND: To assess the diagnostic accuracy and the safety of medical thoracoscopy (MT) performed with the semirigid thoracoscope. METHODS: We retrospectively evaluated patients who underwent MT with semirigid thoracoscope under local anesthesia for unexplained exudative pleural effusion from...

  4. Unsuspected multiples myeloma presenting as bilateral pleural effusion – a cytological diagnosis

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    Dhingra Kajal

    2007-01-01

    Full Text Available Abstract Background Multiple Myeloma presenting as a pleural effusion is extremely rare. It is usually a late complication and is associated with a poor prognosis. Case Presentation A 40-year-old male presented with dyspnea and fever of six months duration. Clinical diagnosis of pulmonary tuberculosis was considered. X-ray chest showed bilateral pleural effusion. Pleural cytology revealed numerous plasma cells, some of which were binucleated and atypical. Cytological differential diagnosis included: Myelomatous effusion and Non-Hodgkin's Lymphoma deposit (Immunoblastic type. Bone marrow biopsy, serum protein electrophoresis and bone scan confirmed the diagnosis of multiple myeloma (Plasmablastic type. Conclusion Myelomatous pleural effusion as an initial presentation although extremely rare, should always be considered in presence of atypical plasma cells irrespective of age.

  5. Factors related to pleural effusion following hepatectomy for primar y liver cancer

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    Kai-Jian Chu; Xiao-Ping Yao; Xiao-Hui Fu

    2007-01-01

    BACKGROUND:Pleural effusion frequently complicates hepatectomy and multiple factors contribute to its development following hepatectomy for primary liver cancer. The purpose of this study was to evaluate these factors. METHODS:From March 2003 to May 2005, 228 consecutive patients with primary liver cancer underwent hepatectomy in our department were evaluated retrospec-tively to identify factors related to postoperative pleural effusion. RESULTS: Among the 228 patients, postoperative pleural effusions arose in 58 (25.4%). Univariate analysis showed signiifcant differences in postoperative ascites, subphrenic collection, Pringle manoeuvre length, drainage amount on postoperative day 1, albumin level on postoperative day 7, alanine aminotransferase (ALT) level on postoperative days 1 and 3, prealbumin level on postoperative days 3 and 7, and tumor size (P CONCLUSION: Subphrenic collection and operative injury to the liver appeared to be signiifcantly related to pleural effusion after hepatectomy for primary liver cancer.

  6. Chronic eosinophilic pneumonia presenting with ipsilateral pleural effusion: a case report

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    Sriratanaviriyakul, Narin; La, Hanh H.; Albertson, Timothy E.

    2016-01-01

    Background Chronic eosinophilic pneumonia is a rare idiopathic interstitial lung disease. The nearly pathognomonic radiographic finding is the peripheral distribution of alveolar opacities. Pleural effusions are rarely seen. We report a case of chronic eosinophilic pneumonia with transudative eosinophilic pleural effusion. Case presentation A 57-year-old Hispanic woman, a nonsmoker with a history of controlled asthma, presented to the hospital with unresolving pneumonia despite three rounds o...

  7. Lymphoproliferative disorder in pleural effusion in a subject with past asbestos exposure

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    Naofumi Hara

    2015-01-01

    Full Text Available Primary effusion lymphoma (PEL is a subtype of non-Hodgkin lymphoma that presents as serous effusions without detectable masses or organomegaly. Here we report a case of PEL-like lymphoma in a patient with past asbestos exposure. A 65-year-old man was referred to our hospital due to dyspnea upon exertion. He had been exposed to asbestos for three years in the construction industry. Chest X-ray and CT images demonstrated left pleural effusion. Cytological analysis of the pleural effusion revealed large atypical lymphocytes with distinct nuclear bodies and high nucleus-to-cytoplasm ratio. Immunohistochemical analyses showed that the cells were CD20+, CD3−, CD5−, and CD10−. These findings led to a diagnosis of diffuse large B-cell lymphoma. PEL or PEL-like lymphoma should be considered a potential cause of pleural effusion in subjects with past asbestos exposure.

  8. ACE/ACE2 Ratio and MMP-9 Activity as Potential Biomarkers in Tuberculous Pleural Effusions

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    Hsieh, Wen-Yeh; Kuan, Tang-Ching; Cheng, Kun-Shan; Liao, Yan-Chiou; Chen, Mu-Yuan; Lin, Pei-Heng; Hsu, Yuan-Chang; Huang, Chen-Yi; Hsu, Wei-Hua; Yu, Sheng-Yao; Lin, Chih-Sheng

    2012-01-01

    Objective: Pleural effusion is common problem, but the rapid and reliable diagnosis for specific pathogenic effusions are lacking. This study aimed to identify the diagnosis based on clinical variables to differentiate pleural tuberculous exudates from other pleural effusions. We also investigated the role of renin-angiotensin system (RAS) and matrix metalloproteinase (MMPs) in the pathogenesis of pleural exudates. Experimental design: The major components in RAS and extracellular matrix metabolism, including angiotensin converting enzyme (ACE), ACE2, MMP-2 and MMP-9 activities, were measured and compared in the patients with transudative (n = 45) and exudative (n = 80) effusions. The exudative effusions were come from the patients with tuberculosis (n = 20), pneumonia (n = 32), and adenocarcinoma (n = 28). Results: Increased ACE and equivalent ACE2 activities, resulting in a significantly increased ACE/ACE2 ratio in exudates, were detected compared to these values in transudates. MMP-9 activity in exudates was significantly higher than that in transudates. The significant correlation between ACE and ACE2 activity that was found in transudates was not found in exudates. Advanced analyses showed significantly increased ACE and MMP-9 activities, and decreased ACE2 activity in tuberculous pleural effusions compared with those in pneumonia and adenocarcinoma effusions. The results indicate that increased ACE and MMP-9 activities found in the exudates were mainly contributed from a higher level of both enzyme activities in the tuberculous pleural effusions. Conclusion: Interplay between ACE and ACE2, essential functions in the RAS, and abnormal regulation of MMP-9 probably play a pivotal role in the development of exudative effusions. Moreover, the ACE/ACE2 ratio combined with MMP-9 activity in pleural fluid may be potential biomarkers for diagnosing tuberculous pleurisy. PMID:23091417

  9. [Two cases of IgG4-related disease with pleural effusion].

    Science.gov (United States)

    Suzuki, Nobuaki; Saeki, Takako; Shimaoka, Yuichi; Kuriyama, Hideyuki; Nishibori, Takeaki; Ebe, Yusuke; Sato, Kazuhiro

    2011-02-01

    We describe 2 cases of IgG4-related disease with pleural effusion in elderly men. Both patients had elevated serum IgG4 levels, and the characteristics of their pleural effusion were similar. Patient 1 had pericardial effusion and retroperitoneal fibrosis, and a biopsy specimen from the pericardium showed infiltration of abundant IgG4-positive plasma cells with fibrosis. Because his pleurisy, pericarditis and retroperitoneal fibrosis responded to steroid therapy, we diagnosed pleurisy associated with IgG4-related disease. Patient 2 had been treated with steroids because of IgG4-related sialadenitis and interstitial pneumonitis, but pleural effusion developed. Although histopathological examination of the pleura showed infiltration of abundant IgG4-positive plasma cells with fibrosis, Mycobacterium tuberculosis was cultured from the pleural effusion, and histologic examination also showed epithelioid granuloma. Chemotherapy for tuberculosis was effective for the pleurisy, and we diagnosed tuberculous pleurisy as a complication of IgG4-related disease. In cases of IgG4-related disease associated with pleural effusion, the clinical course should be considered together with the serum IgG4 levels and pleural histology.

  10. Efficacy of CT in diagnosis of transudates and exudates in patients with pleural effusion.

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    Çullu, Neşat; Kalemci, Serdar; Karakaş, Ömer; Eser, İrfan; Yalçin, Funda; Boyacı, Fatıma Nurefşan; Karakaş, Ekrem

    2014-01-01

    We aimed to evaluate the efficacy of multidetector computed tomography (CT) imaging in diagnosis of pleural exudates and transudates using attenuation values. This retrospective study included 106 patients who were diagnosed with pleural effusion between January 2010 and June 2012. After the patients underwent chest CT, thoracentesis was performed in the first week. The attenuation values of the pleural effusions were measured in all patients. According to Light's criteria, 30 of 106 patients with pleural effusions had transudates, and the remaining patients had exudates. The Hounsfield unit (HU) value of the exudates (median, 12.5; range, 4-33) was significantly higher than that of the transudates (median, 5; range, 2-15) (P = 0.001). Additionally, when evaluated by disease subgroups, congestive heart failure and empyema were predictable in terms of median HU values of the pleural effusions with high and moderate sensitivity and specificity values (84.6% and 81.2%, respectively; 76.9% and 66.7%, respectively). Compared with other patients, the empyema patients had significantly more loculation and pleural thickening. CT attenuation values may be useful in differentiating exudates from transudates. Although there is an overlap in most effusions, exudate can be considered when the CT attenuation values are >15 HU. Because of overlapping HU values, close correlation with clinical findings is essential. Additional signs, such as fluid loculation and pleural thickness, should be considered and may provide further information for the differentiation.

  11. Neonatal pleural effusions in a Level III Neonatal Intensive Care Unit

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    Mariana Barbosa

    2015-04-01

    Full Text Available Pleural effusions are rare in the newborn. Still, being familiar with this condition is relevant given its association with a wide range of disorders. Only two large series of cases on this matter have been published, with no solid conclusions established. The aim of this study is to determine the etiology, management and prognosis of pleural effusions in a population of high-risk neonates.The authors performed a retrospective study in the Neonatal Intensive Care Unit of "Hospital de São João", Porto (Portugal, between 1997 and 2014, of all newborns with the diagnosis of pleural effusion, chylothorax, hemothorax, empyema, fetal hydrops or leakage of total parenteral nutrition (TPN.Eighty-two newborns were included, 48 males and 34 females. Pleural effusions were congenital in 19 (23.2% newborns and acquired in 63 (76.8%. Fetal hydrops was the most frequent cause (15 cases, 78.9% of congenital effusions while postoperative after intrathoracic surgery was the most common cause (39 cases, 61.9% of acquired effusions, followed by leakage of TPN (13 cases, 20.6%. Chylothorax was the most common type of effusion (41.5% of cases. Pleural effusions after intrathoracic surgery were mainly (64.1% chylothoraces. Regarding use of octreotide for treatment of acquired chylous effusions, the comparative analysis showed no statistical differences between the group of alive newborns who received octreotide and the group who did not. Twenty-seven (32.9% newborns died; the causes of death were related to underlying diseases and not to the pleural effusion. Clinical outcome is generally good, except in hydropic neonates. Blood albumin level appears to be predictive of prognosis and further investigation on its clinical significance should be encouraged.

  12. Efficacy and safety of povidone-iodine pleurodesis in malignant pleural effusions

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    Hadi Kahrom

    2017-01-01

    Full Text Available Introduction: Malignant pleural effusion (MPE is determined by the detection of malignant cells in pleural fluid or pleural tissue. Neoplasm of lung, breast, ovary and lymphoma are the causes of more than 75% of MPE. Pleurodesis is a usual technique in the management of MPE to achieve a symphysis between two layers of the pleura, and various chemical agents have been used in an attempt to produce pleurodesis. With regard to complications and limitations of these sclerosing agents, efficacy and safety of povidone-iodine have been investigated in this study. Materials and Methods: Between June 2014 and June 2016, 63 consecutive patients were admitted to the Department of Thoracic Surgery because of symptomatic MPE. After insertion of a chest tube, pleurodesis with instillation of povidone-iodine was performed. Thyroid and renal function tests were checked, and success rate as well as recurrence of MPE was monitored in the next follow-up visits. Results: The complete response to this procedure was about 53.57%, and failure of treatment was 10.71% with efficacy of 82.2%. The most common complication was pain during instillation (26.9%. Changes in thyroid and renal function tests were not significant. Conclusion: Povidone-iodine is a safe and effective agent with minor side effects in pleurodesis of patients with MPEs and can be used as an accessible and low-cost alternative than other sclerosing agents.

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

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    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

  14. Differentiation of Exudates from Transudate Pleural Effusion by Measuring Cholesterol and Bilirubin

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    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

  15. 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.

  16. 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.

  17. 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

  18. Pleural Effusion in Spinal Deformity Correction Surgery- A Report of 28 Cases in a Single Center.

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    Weiqiang Liang

    Full Text Available To analyze the occurrence, risk factors, treatment and prognosis of postoperative pleural effusion after spinal deformity correction surgery.The clinical and imaging data of 3325 patients undergoing spinal deformity correction were collected from the database of our hospital. We analyzed the therapeutic process of the 28 patients who had postoperative pleural effusion, and we identified the potential risk factors using logistic regression.Among the 28 patients with postoperative pleural effusion, 24 (85.7% suffered from hemothorax, 2 (7.1% from chylothorax, and 2 (7.1% from subarachnoid-pleural fistula. The pleural effusion occurred on the convex side in 19 patients (67.9%, on the concave side in 4 patients (14.3%, and on both sides in 4 patients (14.3%. One patient with left hemothorax was diagnosed with kyphosis. The treatment included conservative clinical observation for 5 patients and chest tube drainage for 23 patients. One patient also underwent thoracic duct ligation and pleurodesis. All of these treatments were successful. Logistic regression analysis showed that adult patients(≥18 years old, congenital scoliosis, osteotomy and thoracoplasty were risk factors for postoperative pleural effusion in spinal deformity correction surgery.The incidence of postoperative pleural effusion in spinal deformity correction surgery was approximately 0.84% (28/3325, and hemothorax was the most common type. Chest tube drainage treatment was usually successful, and the prognosis was good. Adult patients(≥18 years old, congenital scoliosis, and had undergone osteotomy or surgery with thoracoplasty were more likely to suffer from postoperative pleural effusion.

  19. Incidence of Pleural Effusion in Patients with Pulmonary Embolism

    Institute of Scientific and Technical Information of China (English)

    Min Liu; Ai Cui; Zhen-Guo Zhai; Xiao-Juan Guo; Man Li; Lei-Lei Teng; Li-Li Xu

    2015-01-01

    Background:No data on the incidence of pleural effusion (PE) in Chinese patients with pulmonary embolism are available to date.The aim of the current study was to investigate the frequency of PE in a Chinese population of patients with pulmonary embolism.Methods:This was a retrospective observational single-center study.All data of computed tomography pulmonary angiography (CTPA)performed over 6-year period on adult patients with clinically suspected pulmonary embolism were analyzed.Results:From January 2008 until December 2013,PE was identified in 423 of 3141 patients (13.5%) with clinically suspected pulmonary embolism who underwent CTPA.The incidence of PE in patients with pulmonary embolism (19.9%) was significantly higher than in those without embolism (9.4%) (P < 0.001).Majority of PEs in pulmonary embolism patients were small to moderate and were unilateral.The locations of emboli and the numbers of arteries involved,CT pulmonary obstruction index,and parenchymal abnormalities at CT were not associated with the development of PE.Conclusions:PEs are present in about one fifth of a Chinese population of patients with pulmonary embolism,which are usually small,unilateral,and unsuitable for diagnostic thoracentesis.

  20. 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

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

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    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.

  2. Left pleural effusion and fever of unknown origin--a clue to thoracic arterial pathology.

    Science.gov (United States)

    Schattner, Ami; Klepfish, Abraham

    2012-08-01

    The subset of patients who have both fever of unknown origin (FUO) and a nondiagnostic pleural effusion on presentation has not been previously investigated. A retrospective search of all patients classified as 'classic' FUO one week after admission to a department of general internal medicine identified 71 patients over 15 years. Seven were found to have associated pleural effusion(s) on admission (9.8%). In three patients thoracic large vessel pathology was diagnosed (chronic aortic dissection, giant cell arteritis and Takayasu arteritis). In these patients, the pleural effusion was predominantly left-sided, small to moderate in amount and nondiagnostic on thoracentesis. The effusions resolved spontaneously or with appropriate treatment. Thus, in patients with prolonged fever and systemic symptoms, a 'bland' left-sided pleural effusion may be a diagnostic clue to underlying inflammation of large thoracic arteries. Pleural irritation due to its anatomical proximity to the large arteries on the left side of the thorax may underlie the pathogenesis. Recognition of this sign may lead to a more timely diagnosis of occult thoracic large vessel pathology.

  3. Beta-2-transferrin to detect cerebrospinal fluid pleural effusion: a case report

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    Smith Jennifer C

    2009-03-01

    Full Text Available Abstract Introduction Pleural effusion secondary to ventriculoperitoneal shunt insertion is a rare and potentially life-threatening occurrence. Case presentation We describe a 14-month-old Caucasian boy who had a ventriculoperitoneal shunt inserted for progressive hydrocephalus of unknown etiology. Two and a half months post-shunt insertion, the patient presented with mild respiratory distress. A chest radiograph revealed a large right pleural effusion and a shunt series demonstrated an appropriately placed distal catheter tip. A subsequent abdominal ultrasound revealed marked ascites. Fluid drained via tube thoracostomy was sent for beta-2-transferrin electrophoresis. A positive test was highly suggestive of cerebral spinal fluid hydrothorax. Post-externalization of the ventriculoperitoneal shunt, the ascites and pleural effusion resolved. Conclusion Testing for beta-2-transferrin protein in pleural fluid may serve as a useful technique for diagnosing cerebrospinal fluid hydrothorax in patients with ventriculoperitoneal shunts.

  4. Does the Evaluation of Coagulation Factors Contribute to Etiological Diagnosis of Pleural Effusions?

    Science.gov (United States)

    Vaz, Marcelo Alexandre Costa; Vargas, Francisco Suso; de Andrade Marinho, Felipe Costa; D’Amico, Élbio Antonio; Rocha, Tânia Rubia Flores; Teixeira, Lisete Ribeiro

    2009-01-01

    OBJECTIVE The aim of this study was to identify the participation of the coagulation system in the differential diagnosis of pleural effusions. INTRODUCTION Imbalance between immunologic and metabolic factors triggers a sequence of events resulting in pleural reactions and accumulation of fluid. The coagulation system, which is fundamental for the maintenance of homeostasis, contributes to the inflammatory process responsible for pleural effusions, and participates in cellular proliferation and migration as well as in the synthesis of inflammatory mediators. METHODS We evaluated the laboratory profile of coagulation and fibrinolysis in 54 pleural fluids (15 transudates and 39 exudates). RESULTS The coagulation system acts according to the pathophysiologic mechanisms involved in the development of pleural effusions. In inflammatory effusions (exudates), there is activation of coagulation with increased levels of fragment 1+2 and thrombin-antithrombin complex in addition to reduction of fibrinogen levels due to fibrinolysis and fibrin tissue incorporation. As a consequence, there is activation of the fibrinolytic system with increased levels of fibrin degradation products, including the D-dimer. These changes are not sufficient for differentiation of different subgroups of exudates. In transudates, these events were observed to a lesser degree. CONCLUSION The coagulation system plays an important role in the development of pleural diseases. Coagulation tests show differences between transudates and exudates but not among exudate subgroups. Understanding the physiopathological mechanisms of pleural disorders may help to define new diagnostic and therapeutic approaches. PMID:19759883

  5. Does the evaluation of coagulation factors contribute to etiological diagnosis of pleural effusions?

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    Marcelo Alexandre Costa Vaz

    2009-01-01

    Full Text Available OBJECTIVE: The aim of this study was to identify the participation of the coagulation system in the differential diagnosis of pleural effusions. INTRODUCTION: Imbalance between immunologic and metabolic factors triggers a sequence of events resulting in pleural reactions and accumulation of fluid. The coagulation system, which is fundamental for the maintenance of homeostasis, contributes to the inflammatory process responsible for pleural effusions, and participates in cellular proliferation and migration as well as in the synthesis of inflammatory mediators. METHODS: We evaluated the laboratory profile of coagulation and fibrinolysis in 54 pleural fluids (15 transudates and 39 exudates. RESULTS: The coagulation system acts according to the pathophysiologic mechanisms involved in the development of pleural effusions. In inflammatory effusions (exudates, there is activation of coagulation with increased levels of fragment 1+2 and thrombin-antithrombin complex in addition to reduction of fibrinogen levels due to fibrinolysis and fibrin tissue incorporation. As a consequence, there is activation of the fibrinolytic system with increased levels of fibrin degradation products, including the D-dimer. These changes are not sufficient for differentiation of different subgroups of exudates. In transudates, these events were observed to a lesser degree. CONCLUSION: The coagulation system plays an important role in the development of pleural diseases. Coagulation tests show differences between transudates and exudates but not among exudate subgroups. Understanding the physiopathological mechanisms of pleural disorders may help to define new diagnostic and therapeutic approaches.

  6. Systemic lupus erythematosus presenting as pleural effusion: report of a case.

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    Wang, D Y; Chang, D B; Kuo, S H; Yang, S; Shiah, D C; Chou, H T; Luh, K T

    1995-12-01

    Systemic lupus erythematosus (SLE) presenting as a pleural effusion in a young male is not common. This paper describes a 20-year-old man who was admitted to hospital with a spiking fever, chills and cough. A chest x-ray showed alveolar infiltration and a moderate right-sided pleural effusion. The patient was treated for parapneumonic effusion. Thoracentesis was performed and cytology of the aspirated fluid was initially interpreted as showing only numerous polymorphonuclear (PMN) leukocytes. However, in spite of antibiotic treatment the symptoms persisted. A careful review of the cytology specimen showed classic lupus erythematosus (LE) cells in addition to PMN cells. Subsequent investigation, including antinuclear antibodies titer, confirmed the diagnosis of LE pleurisy. Therapy with antibiotics was discontinued and treatment with prednisolone 20 mg daily was begun. There was a rapid clinical response including resolution of the fever and pleural effusion.

  7. Effect of using pump on postoperative pleural effusion in the patients that underwent CABG

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    Mehmet Özülkü

    2015-08-01

    Full Text Available Abstract Objective: The present study investigated effect of using pump on postoperative pleural effusion in patients who underwent coronary artery bypass grafting. Methods: A total of 256 patients who underwent isolated coronary artery bypass grafting surgery in the Cardiovascular Surgery clinic were enrolled in the study. Jostra-Cobe (Model 043213 105, VLC 865, Sweden heart-lung machine was used in on-pump coronary artery bypass grafting. Off-pump coronary artery bypass grafting was performed using Octopus and Starfish. Proximal anastomoses to the aorta in both on-pump and off-pump techniques were performed by side clamps. The patients were discharged from the hospital between postoperative day 6 and day 11. Results: The incidence of postoperative right pleural effusion and bilateral pleural effusion was found to be higher as a count in Group 1 (on-pump as compared to Group 2 (off-pump. But the difference was not statistically significant [P>0.05 for right pleural effusion (P=0.893, P>0.05 for bilateral pleural effusion (P=0.780]. Left pleural effusion was encountered to be lower in Group 2 (off-pump. The difference was found to be statistically significant (P<0.05, P=0.006. Conclusion: Under the light of these results, it can be said that left pleural effusion is less prevalent in the patients that underwent off-pump coronary artery bypass grafting when compared to the patients that underwent on-pump coronary artery bypass grafting.

  8. Genetic profiling of putative breast cancer stem cells from malignant pleural effusions.

    Science.gov (United States)

    Tiran, Verena; Stanzer, Stefanie; Heitzer, Ellen; Meilinger, Michael; Rossmann, Christopher; Lax, Sigurd; Tsybrovskyy, Oleksiy; Dandachi, Nadia; Balic, Marija

    2017-01-01

    A common symptom during late stage breast cancer disease is pleural effusion, which is related to poor prognosis. Malignant cells can be detected in pleural effusions indicating metastatic spread from the primary tumor site. Pleural effusions have been shown to be a useful source for studying metastasis and for isolating cells with putative cancer stem cell (CSC) properties. For the present study, pleural effusion aspirates from 17 metastatic breast cancer patients were processed to propagate CSCs in vitro. Patient-derived aspirates were cultured under sphere forming conditions and isolated primary cultures were further sorted for cancer stem cell subpopulations ALDH1+ and CD44+CD24-/low. Additionally, sphere forming efficiency of CSC and non-CSC subpopulations was determined. In order to genetically characterize the different tumor subpopulations, DNA was isolated from pleural effusions before and after cell sorting, and compared with corresponding DNA copy number profiles from primary tumors or bone metastasis using low-coverage whole genome sequencing (SCNA-seq). In general, unsorted cells had a higher potential to form spheres when compared to CSC subpopulations. In most cases, cell sorting did not yield sufficient cells for copy number analysis. A total of five from nine analyzed unsorted pleura samples (55%) showed aberrant copy number profiles similar to the respective primary tumor. However, most sorted subpopulations showed a balanced profile indicating an insufficient amount of tumor cells and low sensitivity of the sequencing method. Finally, we were able to establish a long term cell culture from one pleural effusion sample, which was characterized in detail. In conclusion, we confirm that pleural effusions are a suitable source for enrichment of putative CSC. However, sequencing based molecular characterization is impeded due to insufficient sensitivity along with a high number of normal contaminating cells, which are masking genetic alterations of

  9. Pleural Effusion in Meigs' Syndrome-Transudate or Exudate?: Systematic Review of the Literature.

    Science.gov (United States)

    Krenke, Rafal; Maskey-Warzechowska, Marta; Korczynski, Piotr; Zielinska-Krawczyk, Monika; Klimiuk, Joanna; Chazan, Ryszarda; Light, Richard W

    2015-12-01

    Although Meigs' syndrome is regarded as a well-defined entity, contradictory data on pleural fluid characteristics have been presented, with some papers classifying it as a transudate, whereas others stating that it is an exudate.The aims of the study were: (1) to evaluate pleural fluid characteristics in patients with Meigs' syndrome and (2) to analyze the prevalence of transudative and exudative pleural effusion in relation to the applied definition of the syndrome.We performed a search through medical databases (MEDLINE, EMBASE, SCOPUS, and GOOGLE SCHOLAR) to identify papers on Meigs' syndrome published between 1940 and 2013. Two authors independently reviewed each paper searching for prespecified data: (1) signs and symptoms, (2) tumor characteristics, (3) clinical and laboratory data on ascites, (4) clinical, radiological, and laboratory data on pleural fluid, (5) clinical course after tumor removal. All case reports were reclassified according to a new unequivocal classification of Meigs' syndrome-related entities.A total of 653 papers were initially identified, and 454 articles reporting 541 patients were included in the final analysis. After reclassification according to our case definitions, there were 196, 113, and 108 patients defined as classic Meigs' syndrome, nonclassic Meigs' syndrome, and pseudo-Meigs' syndrome, respectively. Significantly more patients presented with right-sided than left-sided and bilateral pleural effusions (P  3.0 g/dL was applied as a criterion of pleural exudate, 88.8% (80/90) of effusions were classified as exudates. Increasing the cut-off level to 3.5 g/dL resulted in only a modest decrease in the percentage of exudative effusions (81%, 73/90).Surprisingly few reports on Meigs' syndrome present data reliably defining the character of pleural effusion. The available data indicate, however, that the majority of pleural effusions in patients with this entity are exudates. This finding may be a prerequisite for the

  10. The diagnostic role of glycosaminoglycans in pleural effusions: A pilot study

    Science.gov (United States)

    Vavetsi, Rozina; Bonovas, Stefanos; Polizou, Paraskevi; Papanastasopoulou, Chrysanthi; Dougekou, Georgia; Sitaras, Nikolaos M

    2009-01-01

    Background Pleural effusions are classified into transudates and exudates. Various criteria have been used with Light's et al being the most accepted ones. Glycosaminoglycans (GAGs) have been detected during pleural fluids (PF) analysis in various causes. In this pilot study, we investigated: (a) the usefulness of GAGs in the assessment of pleural effusions, and (b) whether and in what way GAGs correlate with established criteria used to indicate an exudate. Methods LDH, total protein, cholesterol and GAG levels were measured in pleural fluid and serum from 50 patients with pleural effusion. GAG levels were defined by the photometric method of Hata. The discriminative properties of pleural GAGs (pGAG), pleural fluid/serum GAG ratio (GAGR), serum GAGs (sGAG) and serum LDH (sLDH) were explored with ROC analysis. Results According to ROC analysis, pGAG and GAGR exhibited satisfactory discriminative properties in the separation of pleural effusions. For GAGR, at a 1.1 cut off point, sensitivity and specificity reached 75.6%; 95%CI: 60.5–87.1 and 100%; 95%CI: 47.8–100, respectively. For pGAG at a cut off value of 8.4 μg/ml, these percentages changed to 86.7%; 95%CI: 73.2–94.9 and 100%; 95%CI: 47.8–100. The study also revealed the differential role of sGAG between malignancies and benign cases, scoring 68.8%; 95%CI: 50.0–83.9 for sensitivity, and 84.6%; 95%CI: 54.5–97.6 for specificity at a 7.8 μg/ml cut off. Conclusion Our results suggest that glycosaminoglycan measurement of both serum and pleural effusions could be useful for simultaneous differentiation of exudates from transudates, and of malignant from benign exudates. PMID:19226451

  11. The diagnostic role of glycosaminoglycans in pleural effusions: A pilot study

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    Dougekou Georgia

    2009-02-01

    Full Text Available Abstract Background Pleural effusions are classified into transudates and exudates. Various criteria have been used with Light's et al being the most accepted ones. Glycosaminoglycans (GAGs have been detected during pleural fluids (PF analysis in various causes. In this pilot study, we investigated: (a the usefulness of GAGs in the assessment of pleural effusions, and (b whether and in what way GAGs correlate with established criteria used to indicate an exudate. Methods LDH, total protein, cholesterol and GAG levels were measured in pleural fluid and serum from 50 patients with pleural effusion. GAG levels were defined by the photometric method of Hata. The discriminative properties of pleural GAGs (pGAG, pleural fluid/serum GAG ratio (GAGR, serum GAGs (sGAG and serum LDH (sLDH were explored with ROC analysis. Results According to ROC analysis, pGAG and GAGR exhibited satisfactory discriminative properties in the separation of pleural effusions. For GAGR, at a 1.1 cut off point, sensitivity and specificity reached 75.6%; 95%CI: 60.5–87.1 and 100%; 95%CI: 47.8–100, respectively. For pGAG at a cut off value of 8.4 μg/ml, these percentages changed to 86.7%; 95%CI: 73.2–94.9 and 100%; 95%CI: 47.8–100. The study also revealed the differential role of sGAG between malignancies and benign cases, scoring 68.8%; 95%CI: 50.0–83.9 for sensitivity, and 84.6%; 95%CI: 54.5–97.6 for specificity at a 7.8 μg/ml cut off. Conclusion Our results suggest that glycosaminoglycan measurement of both serum and pleural effusions could be useful for simultaneous differentiation of exudates from transudates, and of malignant from benign exudates.

  12. Enhanced CT in the patients with pleural effusion : differential findings between exudates and transudates

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    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.

  13. 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.

  14. Multivariate modelling with 1H NMR of pleural effusion in murine cerebral malaria

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    Ghosh Soumita

    2011-11-01

    Full Text Available Abstract Background Cerebral malaria is a clinical manifestation of Plasmodium falciparum infection. Although brain damage is the predominant pathophysiological complication of cerebral malaria (CM, respiratory distress, acute lung injury, hydrothorax/pleural effusion are also observed in several cases. Immunological parameters have been assessed in pleural fluid in murine models; however there are no reports of characterization of metabolites present in pleural effusion. Methods 1H NMR of the sera and the pleural effusion of cerebral malaria infected mice were analyzed using principal component analysis, orthogonal partial least square analysis, multiway principal component analysis, and multivariate curve resolution. Results It has been observed that there was 100% occurrence of pleural effusion (PE in the mice affected with CM, as opposed to those are non-cerebral and succumbing to hyperparasitaemia (NCM/HP. An analysis of 1H NMR and SDS-PAGE profile of PE and serum samples of each of the CM mice exhibited a similar profile in terms of constituents. Multivariate analysis on these two classes of biofluids was performed and significant differences were detected in concentrations of metabolites. Glucose, creatine and glutamine contents were high in the PE and lipids being high in the sera. Multivariate curve resolution between sera and pleural effusion showed that changes in PE co-varied with that of serum in CM mice. The increase of glucose in PE is negatively correlated to the glucose in serum in CM as obtained from the result of multiway principal component analysis. Conclusions This study reports for the first time, the characterization of metabolites in pleural effusion formed during murine cerebral malaria. The study indicates that the origin of PE metabolites in murine CM may be the serum. The loss of the components like glucose, glutamine and creatine into the PE may worsen the situation of patients, in conjunction with the enhanced

  15. Recurrence of thymoma after 11 years presenting as diffuse pleural thickening.

    Science.gov (United States)

    Köksal, Deniz; Bayiz, Hülya; Gülgösteren, Mahmut; Başay, Nihal; Mutluay, Neslihan; Boyacı, Ebru; Berktaş, Bahadır; Çakır, Ebru; Berkoğlu, Mine

    2012-01-01

    A 50-year-old man presented with a 1-month history of dyspnea, weight loss, and pleuritic chest pain. He had environmental asbest exposure from birth to 12 years-old. Past medical history revealed maximal thymectomy operation and adjuvant radiotherapy with the diagnosis of minimally invasive lymphocytic thymoma 11 years ago. Thorax computerized tomography demonstrated a circumferential pleural thickening encasing the entire left lung and pleural effusion. VATS-pleural biopsy revealed the diagnosis invasive tymoma, Type B1, stage IVA. In conclusion, the diagnosis of invasive thymoma must be kept in mind in the differential diagnosis of diffuse pleural lesions. The recurrence of thymomas may be as long as 10 years after complete resection.

  16. 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

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

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    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.

  18. 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

  19. Empyema Necessitans Complicating Pleural Effusion Associated with Proteus Species Infection: A Diagnostic Dilemma

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    M. S. Yauba

    2015-01-01

    Full Text Available Background. Empyema necessitans, a rare complication of pleural effusion, could result in significant morbidity and mortality in children. It is characterized by the dissection of pus through the soft tissues and the skin of the chest wall. Mycobacterium tuberculosis and Actinomyces israelii are common causes but Gram negative bacilli could be a rare cause. However, there were challenges in differentiating between Mycobacterium tuberculosis and nontuberculous empyema in a resource poor setting like ours. We report a child with pleural effusion and empyema necessitans secondary to Proteus spp. infection. Methods. We describe a 12-year-old child with empyema necessitans complicating pleural effusion and highlight management challenges. Results. This case was treated with quinolones, antituberculous drugs, chest tube drainage, and nutritional rehabilitation. Conclusion. Empyema necessitatis is a rare condition that can be caused by Gram negative bacterial pathogens like Proteus species.

  20. Clinically Amyopathic Dermatomyositis Complicated by Pleural Effusion Case Report, Literature Review, and Proposed Mechanism.

    Science.gov (United States)

    Wu, Ying; Chhaya, Sheetal; Hurowitz, Bert; Ardiles, Thomas; Carlson, Richard

    2015-07-01

    Polymyositis-dermatomyositis (PM-DM) is a chronic inflammatory disorder that mainly involves muscles and skin. Clinically amyopathic dermatomyositis (CADM) is a unique subset of PM-DM with typical skin manifestations but little or no evidence of musculoskeletal involvement. Many cases of dermatomyositis and CADM are associated with internal malignancy, but pulmonary manifestations can also been seen; the most common of which is interstitial lung disease. Pleural effusion is a rare complication and may be difficult to differentiate from other causes, such as infections, heart failure, or malignancy. We report a patient with CADM complicated by rapidly progressive pleural effusions. Based on findings of this patient, as well as literature review, we suggest that the etiology of massive pleural effusion in this setting is most likely related to local immune pleuritis associated with underlying interstitial lung disease due to dermatomyositis. Optimal management should be individualized and may include immunosuppressive agents, as well as antimicrobials, and potentially other agents.

  1. Thoraco-amniotic shunting for fetal pleural effusion--a case series.

    LENUS (Irish Health Repository)

    Walsh, J

    2011-11-15

    Fetal pleural effusion is a rare occurrence, with an incidence of 1 per 10-15,000 pregnancies. The prognosis is related to the underlying cause and is often poor. There is increasing evidence that in utero therapy with thoraco-amniotic shunting improves prognosis by allowing lung expansion thereby preventing hydrops and pulmonary hypoplasia. This is a review of all cases of fetal pleural effusion managed over an eight year period the National Maternity Hospital Dublin. Over the nine year period there were 21 cases of fetal pleural effusion giving an overall incidence of 1 per 9281 deliveries. Of these, 15 underwent thoraco-amniotic shunting. There were associated anomalies diagnosed in 5 (33%) of cases. The overall survival in our cohort was 53%. The presence of hydrops was a poor prognostic factor, with survival in cases with hydrops of 33% (3\\/9) compared to 83% (5\\/6) in those cases without associated hydrops.

  2. Co-existence of cutaneous leishmaniasis with pleural effusion: a case report from Iran.

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    Hossein Mortazavi

    2014-03-01

    Full Text Available Herein, a 12-year-old Afghan boy with chronic cutaneous leishmaniasis on the face and verrucous lesions on the body and pleural effusion suspected of having co-existent tuberculosis has been presented. The cutaneous lesions were appeared for five years before his admission. Leishman-Donovan bodies were seen in H&E (Hematoxylin and eosin slide of skin lesion specimens. The pathogenic species was proved to be Leishmania tropica using Polymerase Chain Reaction (PCR method. Purified Protein Derivative (PPD and Leishmanin Skin Test (LST were strongly positive. The patient was treated with systemic and intralesional meglumine antimoniate (Glucantime for cutaneous leishmaniasis and then with anti-tuberculosis drugs for pleural effusion. Afterwards, pleural effusion was disappeared and cutaneous leishmaniasis cured.

  3. A Case of Hemophilia A Associated with Spontaneous Hemorrhagic Pleural Effusion and Intracranial Hem

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    Nuri Tutar

    2014-03-01

    Full Text Available Hemophilia A is a sex-linked recessive coagulation disorder almost exclusively occurring in male subjects and caused by a deficiency of factor VIII. It  is a rare disorder characterized by spontaneous hemorrhages. Spontaneous bleeding in the pleural space is very rare in hemophilia both in children and adults. Here in, we present the case of a 56-year-old hemophilia A patient with hemorrhagic pleural effusion and intracranial hematoma.

  4. Unilateral pleural effusion in an animal model: evaluation of lung function with EBCT

    Science.gov (United States)

    Recheis, Wolfgang A.; Pallwein, Leo; Soegner, Peter; Faschingbauer, Ralph; Schmidbauer, Georg; Kleinsasser, Axel; Loeckinger, Alexander; Hoermann, Christoph; zur Nedden, Dieter

    2003-05-01

    The purpsoe was to evaluate the influence of a right-sided pleural effusion on the lung aeration dynamics in the respiratory cycle during pressure controlled ventilation. Pleural effusion was simulated by infusion of 3% gelatin into the pleural cavity in steps of 300ml totaling 1200ml in four anesthetized pigs. After each step, volume scans and respirator gated 50ms scans at a constant table position (carina niveau) were taken. The dynamic changes of the previously defined air-tissue ratios (in steps of 100HU) were evaluated in three separate regions of left and right lung: a ventral, an intermediate and a dorsal area. The affected side revealed dramatic alveolar collapse. There was a shift of the lung density to higher air-tissue ratios (+200HU) but showing the same air-tissue ratio dynamics. A slight lateral shift of 32mm (+/-14mm) the mediastinum was measured. The unaffected side showed no increase in the air-tissue ratios caused by hyperinflation but an increase of density due to mediastinal shift. Air-tissue ratio dynamics remained unchanged on the unaffected side compared to baseline measurements. We visualized the ventilation mismatch caused by pleural effusion. The contra-lateral lung is not affected by unilateral pleural effusion. Pressure controlled ventilation prevents hyper-inflation of non-dependent lung areas.

  5. Bilateral pleural effusion with APLA positivity in a case of rhupus syndrome

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    Kaushik Saha

    2014-01-01

    Full Text Available Rhupus syndrome is a rare syndrome characterized by overlap of rheumatoid arthritis (RA and systemic lupus erythematosus (SLE. Our patient was a diagnosed case of RA and developed SLE 2 years after. She was a middle-aged woman, presented with bilateral pleural effusion with exacerbation of skin and joint symptoms of SLE. We diagnosed the case as tubercular pleural effusion by positive Mycobacterium tuberculosis in bactec 460 culture. She had also anti-phospholipid antibody positivity without any symptoms and signs of thrombosis.

  6. Bilateral pleural effusion with APLA positivity in a case of rhupus syndrome.

    Science.gov (United States)

    Saha, Kaushik; Saha, Arnab; Mitra, Mrinmoy; Panchadhyayee, Prabodh

    2014-10-01

    Rhupus syndrome is a rare syndrome characterized by overlap of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Our patient was a diagnosed case of RA and developed SLE 2 years after. She was a middle-aged woman, presented with bilateral pleural effusion with exacerbation of skin and joint symptoms of SLE. We diagnosed the case as tubercular pleural effusion by positive Mycobacterium tuberculosis in bactec 460 culture. She had also anti-phospholipid antibody positivity without any symptoms and signs of thrombosis.

  7. Relevance of adenosine deaminase as a marker for tubercu-lous pleural effusion in developing countries

    Institute of Scientific and Technical Information of China (English)

    Rishad A; Patil BS; Das KK

    2009-01-01

    Objective:Relevance of estimation of pleural adenosine deaminase (PADA)and serum adenosine deaminase (SADA)levels in pleural effusion especially in cases of lymphocytic predominant exudative tubercular effu-sions.Methods:Fifty patients (33 male and 17 female;age:44.12 ±11.51 years)with pleural effusions were selected to assay adenosine deaminase (ADA)activity in pleural fluid and serum in adjunct to pleural fluid analysis.Effusions were individually classified as transudates or exudates after careful evaluation of all the biochemical parameters of pleural fluid and serum of patients and on the basis of Light's criteria.Cutoff val-ue for PADA was taken as 60U /L and that for pleural /serum ADA ratio (P/S ADA)was 1.8.Results:Four-ty-three patients had exudative effusions among which 38 patients had tuberculous pleural effusions and 5 had nontubercular effusions.7 cases were transudates.Mean PADA levels in tubercular group (78.95 ±25.32 U /L)were found to be much higher P =0.000 0)than nontubercular (23.00 ±5.22 U /L)group.SADA levels in tubercular group (31.05 ±6.42 U /L)were significantly higher (P =0.000 0)as compared to nontubercu-lar group (15.58 ±8.35 U /L).PADA cutoff at 60 U /L yielded sensitivity and specificity of 81.5% and 100% respectively,whereas P/S ADA ratio at 1.8 gave sensitivity and specificity of 84.2% and 75% respec-tively.A positive correlation (r =0.507,P =0.001 1)between PADA and SADA was found in tubercular group but no such correlation (r =0.302,P =0.340 7)was observed in nontubercular group.Conclusion:The measurement of ADA in tubercular pleural effusions has not only relevance but also a high diagnostic utility when other clinical and laboratory tests are either negative or confusing.

  8. CD4+CD25+ regulatory T lymphocytes in tuberculous pleural effusion

    Institute of Scientific and Technical Information of China (English)

    QIN Xue-jun; SHI Huan-zhong; LIANG Qiu-li; HUANG Lu-ying; YANG Hai-bo

    2008-01-01

    Background Active suppression by CD4+CD25+ regulatory T lymphocytes plays an important role in the down-regulation of T cell responses to foreign and self-antigens.This study was conducted to analyze whether the CD4+CD25+ regulatory T cells exist and function normally in tuberculous pleural effusion.Methods The percentages of CD4+CD25+ T cells in pleural effusion and peripheral blood from patients with tuberculous pleurisy and peripheral blood from healthy control subjects were determined by flow cytometry.The expression of forkhead transcription factor Foxp3 was also examined.CD4+CD25+ and CD4+CD25- T cells from pleural effusion and blood were isolated,and were cultured to observe the effects Of CD4+CD25+ T cells on proliferation response of CD4+CD25- T cells in Vitro.Results There were increased numbers of CD4+CD25+ T cells in tuberculous pleural effusion compared with peripheral blood from both patients with tuberculous pleurisy and normal subjects,and these cells demonstrated a constitutive high-level expression of Foxp3.Moreover,CD4+CD25+ T cells mediated potent inhibition of proliferation response of CD4+CD25- T cells.Conclusion The increased CD4+CD25+ T cells in tuberculous pleu ral effusion express a high level of Foxp3 transcription factor,while potently suppressing the proliferation of CD4+CD25- T cells.

  9. Diagnostic Value and Safety of Medical Thoracoscopy in the Management of Exudative Pleural Effusion

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    Mehmet Akif Özgül

    2016-12-01

    Full Text Available Objective: Medical thoracoscopy is a minimally invasive procedure that is performed by experienced pulmonologists under local anesthesia and conscious intravenous sedation. It allows direct observation and evaluation of the pleural space. Our aim is to evaluate the diagnostic efficacy and safety of this procedure while presenting our results of medical thoracoscopy performed by rigid thoracoscopy in our clinic. Methods: Thirty-seven patients who had gone thorough medical thoracoscopy between March 2011 and August 2014 were evaluated retrospectively. Results: Of these 37 patients, 26 were male and the average age was 50.94±15.38 years. Fourteen patients had right-sided pleural effusion, whereas 23 had left-sided pleural effusion. Closed pleural biopsy was performed previously in 16 patients with no diagnostic results. In 36 patients (97.3%, a specific diagnosis was achieved. One patient, diagnosed as lymphocytic pleuritis by medical thoracoscopy, underwent decortication and the pathology was consistent with biphasic malignant pleural mesothelioma. Another patient, diagnosed as chronic nonspecific pleuritis with medical thoracoscopy, underwent decortication and the diagnosis was fibrinous pleuritis characterized by extensive fibrosis. Three patients had expansion defects during the post-operative period. Hemothorax occurred in one patient that died of respiratory failure on day 34 of hospitalization. The median length of stay in the hospital after the procedure was 5 days (1–34. Conclusion: Medical thoracoscopy is a secure procedure with high diagnostic value in the management of exudative pleural effusion.

  10. The etiology of extensive pleural effusions with troublesome clinical course among children

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    Luís Marcelo Inaco Cirino

    Full Text Available CONTEXT: In São Paulo, pneumonia is the main infectious cause of death among children. Parapneumonic pleural effusion is a possible complication and has to be treated surgically when the patient does not respond to antibiotics. OBJECTIVE: Assessment of the etiology of complicated parapneumonic pleural effusions that needed surgical intervention. TYPE OF STUDY: Retrospective study. SETTING: University hospital of the University of São Paulo. METHOD: Analysis of 4,000 files on children hospitalized with pneumonia from November 1986 to November 1996 had shown that 115 of these children presented a total of 117 cases of pleural empyema that required surgical procedures. The children's clinical condition was assessed in relation to radiological findings and to their nutrition and immunization status. Previous antimicrobial therapy and pleural effusion bacterioscopy were also evaluated. RESULTS: Streptococcus pneumoniae was the agent found most commonly, as frequently in blood cultures as in pleural effusions. DISCUSSION: Data on vaccination coverage, birth weight and nutritional status are analyzed and compared to other publications. We observed that pleural effusion has a high potential for discomfort, and in most cases it is not a complication of the first pulmonary disease episode. Previous use of antibiotics interfered with culture positivity. The agent most frequently found was Streptococcus pneumoniae, which is in accordance with the findings from other authors. Nonetheless, the antibiotics used to treat the patients after the procedure were the same used in non-complicated pneumonias, which has led us to conclude that the worse outcome in this cases was not due to drug resistance. CONCLUSION: The bacteriological profile in our series of complicated pneumonia cases was similar to what has been described for non-complicated pneumonia cases. Future studies will be necessary to determine why these children presented a worse outcome.

  11. Adhesion therapy for lung cancer with massive Pleural effusion (pleuritis carcinomatosa) adhesion therapy and evaluation by CT scan

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    Sugiyama, Akira; Katayama, Motoyuki; Kokubo, Mitsuharu; Tateyama, Kenichirou [National Tohsei Hospital, Shimizu, Shizuoka (Japan)

    1996-06-01

    Ten patients with pleuritis carcinomatosa due to lung cancer accompanied by massive effusion were treated by tube drainage of effusion followed by instillation of MMC and OK-432 (adhesion therapy). Pleural effusion was controlled in all patients without recurrence but one showed reaccumulation 2 months later. Acute side effects of fever and chest pain were tolerable. The average hospital stay for patients receiving adhesion therapy alone was 34 days, versus 93 days for patients receiving tube drainage therapy and radiotherapy. The average survival time for 7 patients who died of this disease was 273 days. Serial CE-CT scans were useful to evaluate the stage of the disease and decide on therapeutic and follow-up policy. All cases had mediastinal metastasis (N2-3). On follow up CT scan, marked pleural thickening and varying degree of loss of lung volume were noticed. Individual cases with life expectancy several months are best managed by tube drainage and instillation of adhesion-inducing agents. (author)

  12. The utility of multi-detector computed tomography in the diagnosis of malignant pleural effusion in the patients with ovarian cancer

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    Kim, Kyung Won [Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul (Korea, Republic of); Choi, Hyuck Jae, E-mail: hjchoi@ncc.re.k [Department of Radiology, Asan Medical Center, University of Ulsan, Seoul (Korea, Republic of); Kang, Sokbom; Park, Sang-Yoon; Jung, Dae Chul [Research Institute and Hospital, National Cancer Center (Korea, Republic of); Cho, Jeong Yeon [Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul (Korea, Republic of); Cho, Kyung-Sik [Department of Radiology, Asan Medical Center, University of Ulsan, Seoul (Korea, Republic of); Kim, Seung Hyup [Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2010-08-15

    Purpose: The purpose of this study was to retrospectively assess possible clinical predictors of malignant pleural effusion in patients with ovarian cancer. Materials and methods: This review was performed on 38 ovarian cancer patients that showed pleural effusion in a CT scan and who underwent thoracocentesis before treatment. CT scans were obtained using a 4-channel multi-detector CT scanner. Fisher's exact test was used to determine the probability of malignant pleural effusion as a function of; amount of ascites, lymph node enlargement, amount of pleural effusion, pleural nodules, and pleural thickening. Results: Sixteen (42.1%) of the 38 patients had malignant pleural effusion and malignant pleural effusion amounts were greater than those with nonmalignant effusion. Pleural nodules were more frequently found in the malignant pleural effusion group (eight [50%] patients) than in the nonmalignant group (zero [0%] patient) (p < 0.001). Supradiaphragmatic lymph node enlargement (with short axis diameter 1 cm or more) was more frequent in malignant group (12 [75%] patients) than in the nonmalignant group (two [9.1%] patients) (p < 0.001). Conclusion: The probability of malignant pleural effusion in patients with ovarian cancer was found to be correlated with the amount of pleural effusion, the presence of pleural nodules, and supradiaphragmatic lymph node enlargement.

  13. [A Case of Renal Cell Carcinoma with Malignant Pleural Effusion Showing Marked Response to Axitinib].

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    Ishizuya, Yu; Okusa, Takuya; Hatano, Koji; Nakai, Yasutomo; Nakayama, Masashi; Kakimoto, Ken-Ichi; Nishimura, Kazuo

    2016-10-01

    A 36-year-old woman had undergone left radical nephrectomy followed by interferon-α and sunitinib for the treatment of renal cell carcinoma with para-aortic lymph node and lung involvements (papillary renal cell carcinoma, G3, cT3aN1M1) in the previous hospital. She was referred to our hospital for further treatment and received serial molecular targeted agents (everolimus, sorafenib, sunitinib) and radiation therapy for right ischial and femoral bone metastases. Then she was found to have multiple metastatic lesions in the lungs and carcinomatous pleural effusion associated with dyspnea. After failure of pleurosclerosis with OK-432, the pleural effusion markedly reduced by axitinib administration, but the pleural effusion relapsed a few days after axitinib was discontinued. For this reason, axitinib was maintained in spite of appearance of new metastatic lesions in the brain. The pleural effusion was well-controlled for 16 months but she died of progressive disease, including metastatic lesions in the brain and in the lungs.

  14. CD163+CD14+ macrophages, a potential immune biomarker for malignant pleural effusion.

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    Wang, Fei; Yang, Li; Gao, Qun; Huang, Lan; Wang, Liping; Wang, Jing; Wang, Shengdian; Zhang, Bin; Zhang, Yi

    2015-08-01

    Malignant pleural effusion (MPE) is a common complication caused by malignant diseases. However, subjectivity, poor sensitivity, and substantial false-negative rates of cytology assay hamper accurate MPE diagnosis. The aim of this study was to assess whether CD163+CD14+ tumor-associated macrophages (TAMs) could be used as a biomarker for enabling sensitive and specific MPE diagnosis. Pleural effusion samples and peripheral blood samples were collected from 50 MPE patients and 50 non-malignant pleural effusion (NMPE) patients, respectively. Flow cytometry was performed to analyze cell phenotypes, and RT-qPCR was used to detect cytokine expression in these monocytes and macrophages. A blinded validation study (n = 40) was subsequently performed to confirm the significance of CD163+CD14+ TAMs in MPE diagnosis. Student's t test, rank sum test, and receiver operating characteristic curve analysis were used for statistical analysis. Notably, CD163+CD14+ cell frequency in MPE was remarkably higher than that in NMPE (P CD163+CD14+ TAMs as a MPE biomarker. In total (n = 140), by using a cutoff level of 3.65 %, CD163+CD14+ cells had a sensitivity of 81.2 % and a specificity of 100 % for MPE diagnosis. Notably, MPE diagnosis by estimating CD163+CD14+ cells in pleural effusion could be obtained one week earlier than that obtained by cytological examination. CD163+CD14+ macrophages could be potentially used as an immune diagnostic marker for MPE and has better assay sensitivity than that of cytological analysis.

  15. Semi-rigid thoracoscopy for undiagnosed exudative pleural effusions: a comparative study

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    WANG Zhen; WANG Chen; TONG Zhao-hui; LI Hong-jie; ZHAO Ting-ting; LI Xu-yan; XU Li-li; LUO Jing; JIN Mu-lan; LI Rui-sheng

    2008-01-01

    Background Thoracoscopy is highly sensitive and accurate for detecting pleural effusions. However, most respiratory physicians are not familiar with the use of the more common rigid thoracoscope or the flexible bronchoscope, which is difficult to manipulate within the pleural cavity. The semi-rigid thoracoscope combines the best features of the flexible and rigid instruments. Since the practice with this instrument is limited in China, the diagnostic utility of semi-rigid thoracoscopy (namely medical thoracoscopy) under local anesthesia for undiagnosed exudative pleural effusions was evaluated.Methods In 50 patients with undiagnosed pleural effusions who were studied retrospectively, 23 received routine examinations between July 2004 and June 2005 and the rest 27 patients underwent medical thoracoscopy during July 2005 and June 2006. Routine examinations of the pleural effusions involved biochemistry and cytology, sputum cytology, and thoracentesis. The difference in diagnostic sensitivity, costs related to pleural fluid examination and complications were compared directly between the two groups.Results Medical thoracoscopy revealed tuberculous pleurisy in 6 patients, adenocarcinoma in 7, squamous-cell carcinoma in 2, metastatic carcinoma in 3, mesothelioma in 2, non-Hodgkin's lymphoma in 1, and others in 4. Only 2 patients could not get definite diagnoses. Diagnostic efficiency of medical thoracoscopy was 93% (25/27). Only 21% patients were diagnosed after routine examinations, including parapneumonic effusion in 2 patients, lung cancer in 2 and undetermined metastatic malignancy in 1. Twelve patients with tuberculous pleurisy were suspected by routine examination. Costs related to pleural effusion testing showed no difference between the two groups (P=0.114). Twenty-three patients in the routine examination group underwent 97 times of thoracentesis. Two pleural infection patients and 2 pneumothorax patients were identified and received antibiotic treatment and

  16. Clinical diagnostic of pleural effusions using a high-speed viscosity measurement method

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    Hurth, Cedric; Klein, Katherine; van Nimwegen, Lena; Korn, Ronald; Vijayaraghavan, Krishnaswami; Zenhausern, Frederic

    2011-08-01

    We present a novel bio-analytical method to discriminate between transudative and exudative pleural effusions based on a high-speed video analysis of a solid glass sphere impacting a liquid. Since the result depends on the solution viscosity, it can ultimately replace the battery of biochemical assays currently used. We present results obtained on a series of 7 pleural effusions obtained from consenting patients by analyzing both the splash observed after the glass impactor hits the liquid surface, and in a configuration reminiscent of the drop ball viscometer with added sensitivity and throughput provided by the high-speed camera. The results demonstrate distinction between the pleural effusions and good correlation with the fluid chemistry analysis to accurately differentiate exudates and transudates for clinical purpose. The exudative effusions display a viscosity around 1.39 ± 0.08 cP whereas the transudative effusion was measured at 0.89 ± 0.09 cP, in good agreement with previous reports.

  17. Chyliform effusion without pleural thickening in a patient with rheumatoid arthritis: A case report

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    Crina Muresan

    2015-01-01

    Full Text Available Pseudochylothorax, also known as chyliform effusion rich in cholesterol crystals, is a rare entity that sometimes occurs in long-standing rheumatoid arthritis (RA and is usually associated with thickened pleura. There have only been a few case reports in the literature on pseudochylothorax unassociated with pleural thickening and with a short duration of articular symptoms in patients with RA. We report the case of a 70-year-old male patient with a history of RA and heart failure due to severe aortic stenosis, who presented with signs and symptoms of decompensated heart failure due to a moderate right-sided pleural effusion that was consequently proved to be pseudochylothorax unassociated with pleural thickening on chest computed tomography (CT scan. The patient's outcome was favorable after thoracocentesis was carried out and leflunomide was added to the standard heart failure treatment.

  18. Microfilaria in malignant pleural effusion: an unusual incidental finding or causative association?

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    Anandkumar P. Chordiya

    2015-10-01

    Full Text Available Lymphatic filariasis is common in tropical countries and is endemic in India. Filaria has a wide spectrum of presentation. Filarial lung involvement is usually in the form of tropical pulmonary eosinophilia with pulmonary infiltrates and peripheral eosinophilia. Filariasis presenting with pleural effusion is an unusual presentation. Malignancy in association with filarial pleural effusion is extremely rare and its role in tumorigenesis is controversial. In this context, we hereby report a case of 60 year old male, chronic smoker, who presented with left sided chest pain, cough, breathlessness, generalized weakness and swelling over left infrascapular region. Pleural fluid cytology repeated thrice due to degenerative changes, finally revealed malignant cells along with microfilaria. FNAC from left infrascapular swelling showed cytological features suggestive of metastatic deposits of Adenocarcinoma. [Int J Res Med Sci 2015; 3(10.000: 2889-2991

  19. Talc pleurodesis in the management of persistent pleural effusion in an infant

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    Ali Ozdemir

    2016-06-01

    Full Text Available Pleural effusion is excessive fluid that accumulates in the pleural cavity. It predominantly occurs by infectious agents. Other various causes include congestive heart diseases, malignancies, viral diseases, trauma, hypoalbuminemia, connective tissue diseases and chromosomal abnormalities. Treatment strategies should target the responsible cause. Herein, we present a 16-month old male infant with persistent pleural effusion occuring after uncomplicated Morgagni hernia surgery who had no response to antibiotics, parenteral nutritional support and octreotide therapy that was eventually treated by pediatric surgery with talc pleurodesis. No significant advers effect was observed after administration of talc as a sclerozing agent for pleurodesis. This procedure has been rarely reported at this age group. [Cukurova Med J 2016; 41(2.000: 390-392

  20. DIAGNOSTIC VALUE OF DENSITY GRADIENT CENTRIFUGATION FOR EXFOLIATIVE TUMOR CELLS IN MALIGNANT PLEURAL EFFUSIONS

    Institute of Scientific and Technical Information of China (English)

    郭胤仕; 朱任之

    2004-01-01

    Objective To find out a specific method for diagnosis of malignant pleural effusions( MPEs )with higher sensitivity and practicality. Methods The diagnosis of MPEs were made using density gradient centrifugation ( DGC ) , smear cytologic examination (SCE) and pleural needle biopsy (PNB). Comparisons between these results and those of benign pleural effusions were also made. Results The positive rates of DGC,SCE and PNB for diagnosing MPEs were 94. 3% ,62.9% and 44.6% , respectively, and the positive rate of SCE combined with PNB for diagnosing MPEs was 73.2 %. The positive rate of the exfoliative tumor cells ( ETCs ) by DGC was much higher than that of SCE or/and PNB with no false-positive. Conclusion The ETCs isolated by DGC from the MPEs is quite specific for the diagnosis of malignant tumors with higher sensitivity and practicality in clinico-pathological practice.

  1. Rheumatoid pleural effusion with nodular pleuritis. A rare presentation of rheumatoid arthritis.

    Science.gov (United States)

    Emmungil, H; Yıldız, F; Gözükara, M Y; Açıkalın, A

    2015-02-01

    Rheumatoid pleural effusion and lung nodules are unusual complications of rheumatoid disease that typically present subsequently to other more common manifestations of rheumatoid illness. However, these complications may occasionally occur before or concurrently with the development of joint manifestations of disease. We report the case of a 41-year-old female patient with rheumatoid pleural effusion and lung nodule arising simultaneously with the onset of joint symptoms. The patient underwent thoracentesis followed by video-assisted thoracoscopic biopsy to result in a diagnosis of rheumatoid pleuritis and nodular disease. A high index of suspicion and coexistence of the cytologic and histopathologic effusion picture characteristic of rheumatoid pleuritis are of clinical importance in making a diagnosis.

  2. 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.

  3. The role of liquid-based cytology and ancillary techniques in pleural and pericardic effusions: an institutional experience.

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    Rossi, Esther Diana; Bizzarro, Tommaso; Schmitt, Fernando; Longatto-Filho, Adhemar

    2015-04-01

    Fine-needle aspiration cytology (FNAC) of serous membrane effusions may fulfil a challenging role in the diagnostic analysis of both primary and metastatic disease. From this perspective, liquid-based cytology (LBC) represents a feasible and reliable method for empowering the performance of ancillary techniques (ie, immunocytochemistry and molecular testing) with high diagnostic accuracy. In total, 3171 LBC pleural and pericardic effusions were appraised between January 2000 and December 2013. They were classified as negative for malignancy (NM), suspicious for malignancy (SM), or positive for malignancy (PM). The cytologic diagnoses included 2721 NM effusions (2505 pleural and 216 pericardic), 104 SM effusions (93 pleural and 11 pericardic), and 346 PM effusions (321 pleural and 25 pericardic). The malignant pleural series included 76 unknown malignancies (36 SM and 40 PM effusions), 174 metastatic lesions (85 SM and 89 PM effusions), 14 lymphomas (3 SM and 11 PM effusions), 16 mesotheliomas (5 SM and 11 SM effusions), and 3 myelomas (all SM effusions). The malignant pericardic category included 20 unknown malignancies (5 SM and 15 PM effusions), 15 metastatic lesions (1 SM and 14 PM effusions), and 1 lymphoma (1 PM effusion). There were 411 conclusive immunocytochemical analyses and 47 molecular analyses, and the authors documented 88% sensitivity, 100% specificity, 98% diagnostic accuracy, 98% negative predictive value, and 100% positive predictive value for FNAC. FNAC represents a primary diagnostic tool for effusions and a reliable approach with which to determine the correct follow-up. Furthermore, LBC is useful for ancillary techniques, such as immunocytochemistry and molecular analysis, with feasible diagnostic and predictive utility. © 2015 American Cancer Society.

  4. Utility of adenosine deaminase (ADA, PCR & thoracoscopy in differentiating tuberculous & non-tuberculous pleural effusion complicating chronic kidney disease

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    Sravan Kumar

    2015-01-01

    Full Text Available Background & objectives: Pleural effusion is a common occurrence in patients with late-stage chronic kidney disease (CKD. In developing countries, many effusions remain undiagnosed after pleural fluid analysis (PFA and patients are empirically treated with antitubercular therapy. The aim of this study was to evaluate the role of adenosine deaminase (ADA, nucleic acid amplification tests (NAAT and medical thoracoscopy in distinguishing tubercular and non-tubercular aetiologies in exudative pleural effusions complicating CKD. Methods: Consecutive stage 4 and 5 CKD patients with pleural effusions underwent PFA including ADA and PCR [65 kDa gene; multiplex (IS6110, protein antigen b, MPB64]. Patients with exudative pleural effusion undiagnosed after PFA underwent medical thoracoscopy. Results: All 107 patients underwent thoracocentesis with 45 and 62 patients diagnosed as transudative and exudative pleural effusions, respectively. Twenty six of the 62 patients underwent medical thoracoscopy. Tuberculous pleurisy was diagnosed in six while uraemic pleuritis was diagnosed in 20 subjects. The sensitivity and specificity of pleural fluid ADA, 65 kDa gene PCR, and multiplex PCR were 66.7 and 90 per cent, 100 and 50 per cent, and 100 and 100 per cent, respectively. Thoracoscopy was associated with five complications in three patients. Interpretation & conclusions: Uraemia remains the most common cause of pleural effusion in CKD even in high TB prevalence country. Multiplex PCR and thoracoscopy are useful investigations in the diagnostic work-up of pleural effusions complicating CKD while the sensitivity and/or specificity of ADA and 65 kDa gene PCR is poor.

  5. Massive Pleural Effusion in an 18-Year-Old Girl with Ewing Sarcoma

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    Cengiz Özge

    2004-01-01

    Full Text Available Ewing sarcoma is a bone tumour that commonly appears between ages five and 10 in the diaphysis of the long bones and predominantly presents with pain and swelling. The case of an 18-year-old girl who presented with back pain, cough, dyspnea, weakness and fever is described. Chest radiograph showed a homogenous density in the middle and inferior zones of the right hemithorax. Thoracic computed tomography revealed a diffuse pleural effusion and a 6.99 cmx4.45 cm solid mass composed of lobulated, small cystic lesions and calcifications in the right hemithorax. Biochemical analysis of pleural fluid showed hemorrhagic effusion and exudate. A pleural needle biopsy demonstrated solid uniform tumour cells with narrowed cytoplasm, round nuclei and uncertain nucleoli. All of the tumour cell cytoplasms stained with CD99. The pathological examination supported Ewing sarcoma. Three-phase Tc-99m methylene diphosphonate scintigraphy of the whole body showed pathological tracer uptake in a broad area of the eighth costal bone and in smaller areas of the ninth and 10th costal bones. This case is reported because Ewing sarcoma is a rare cause of pleural effusion in clinical practice among younger adults.

  6. STUDY OF ADENOSINE DEAMINASE AND LYMPHOCYTE/NEUTROPHIL RATIO IN COMBINATION AS DIAGNOSTIC TOOL FOR TUBERCULAR PLEURAL EFFUSION

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    Md. Faizur

    2015-10-01

    Full Text Available Adenosine deaminase, considered one of the key enzyme of purine metabolism, has been used in work up of lymphocytic pleural effusion. Low level of ADA 50IU/L specially when combined with Lymphocytic/neutrophil ratio >0.75 in pleural fluid is useful test in the diagnosis of tubercular pleurisy. AIM AND OBJECTIVE: To suggest a better diagnostic tool in the diagnosis of pleural effusion of tubercular origin by estimating the activity of ADA along with L/N ratio in pleural effusion. METHOD: Biochemical, cytological and microbiology studies were done by obtaining pleural fluid by thoracocentesis in 100 patients after excluding pleural effusion cases of malignancy, transudative effusion. RESULT: 84 cases were tubercular and had high level of ADA in comparison to rest of 16 non-tubercular cases. At level of 50 IU/L of ADA activity test had sensitivity of 97.6%, specificity 87.5%, positive predictive value 97.6%, negative predictive value 87.5%which increased to 100% and 92.8%, 98.6%, and 100% respectively in combination with test of Lymphocytic/Neutrophilic ratio >0.75. CONCLUSION: ADA level with L/N ratio can be important investigation in diagnosis of tubercular pleural effusion cases.

  7. Diagnostic Utility of Pleural Effusion and Serum Cholesterol, Lactic Dehydrogenase and Protein Ratios in the Differentiation between Transudates and Exudates

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    Muaz O. Fagere

    2015-12-01

    Full Text Available This is a descriptive study carried out in Khartoum state hospitals during the period from May 2012 to April 2014. The study aimed to evaluate the diagnostic role of the pleural effusion/serum (CHOL, LDH, and protein 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. Prior to testing, 5 mL of venous blood and 20 mL of pleural effusion samples were prepared in accordance with specific testing requirements. Exudative pleural effusions were observed in 95 (70.4% samples, of which 64 (67.4% belonged to male patients and 31 (32.6% to females. The calculated means for CHOL, LDH, and protein levels in pleural effusion and serum samples between exudate and transudate effusion showed statistically significant differences with the p-value = 0.000. In distinguishing between exudative and transudate pleural effusion, a high Pearson correlation was observed between CHOL ratio and clinical diagnosis (r = 0.971, as well as between CHOL level in effusion samples and LDH level in serum samples (r = 0.867. Sensitivity, specificity, positive predictive value, and negative predictive value analysis of the parameters in the differentiation between exudate and transudate samples revealed the following values: 97.7% and 100%, 100%, and 95%, respectively, for the CHOL ratio; 86%, 97.4%, 97.4%, and 97%, respectively, for the LDH ratio; and 81.4%, 81.6%, 89.7%, and 70.4%, respectively, for the protein ratio. On the basis of the study findings, it could be concluded that estimation of CHO, LDH, and protein ratios can assist in the differentiation between exudative and transudate pleural effusion and thus patient management. Hence, this approach should be included in routine laboratory analyses of pleural effusions. Nevertheless, additional techniques should be incorporated in the diagnosis of doubtful pleural

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

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    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.

  9. Recurrent Uveal Effusion after Laser Iridotomy

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    Sakai, Hiroshi; Yonahara, Michiko; Sakai, Miyako

    2017-01-01

    A 59-year-old woman was seen by an ophthalmologist for blurred vision, ocular pain, headache, and nausea. She was diagnosed with acute primary angle closure (APAC) and successfully treated with medications. Using ultrasound biomicroscopy (UBM), engorged episcleral vein was observed and small uveal effusion was diagnosed after laser peripheral iridotomy (LPI). The uveal effusion disappeared and was again diagnosed by UBM together with anterior segment inflammation with ocular pain. Iritis caused by LPI after APAC might be a cause of uveal effusion in this specific case. PMID:28203193

  10. Recurrent Uveal Effusion after Laser Iridotomy

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    Hiroshi Sakai

    2017-01-01

    Full Text Available A 59-year-old woman was seen by an ophthalmologist for blurred vision, ocular pain, headache, and nausea. She was diagnosed with acute primary angle closure (APAC and successfully treated with medications. Using ultrasound biomicroscopy (UBM, engorged episcleral vein was observed and small uveal effusion was diagnosed after laser peripheral iridotomy (LPI. The uveal effusion disappeared and was again diagnosed by UBM together with anterior segment inflammation with ocular pain. Iritis caused by LPI after APAC might be a cause of uveal effusion in this specific case.

  11. Efficacy of Recombinant Adenoviral Human p53 Gene in Treatment of Malignant Pleural or Peritoneal Effusions%Efficacy of Recombinant Adenoviral Human p53Gene in Treatment of Malignant Pleural or Peritoneal Effusions

    Institute of Scientific and Technical Information of China (English)

    Xin ZHANG; Yi HU; Jinliang WANG; Sujie ZHANG; Haitao TAO; Sun JING; Baishou WU

    2013-01-01

    Background and objective Once the malignant pleural or peritoneal effusion is developed it is difficult to control.This report presents a new method for controlling the malignant effusions.Methods Forty-eight patients,29 males and 19 females with an average age of 61.2 years old,who were satisfied with the study inclusion criteria,were recruited in this study.Twenty-seven and 21 patients had a malignant pleural and peritoneal effusion,respectively.After draining most of fluids,these patients received intra-cavity infusion of rAd-p53 once per week for 4 weeks,at dose of 2×1012 viral particles (VP) diluted into 200 mL of saline solution for pleural effusions,and 4×1012 VP diluted into 500 mL of saline solution for peritoneal effusions.Results Participants were followed up for a median time of 13.6 month.A total of 11 cases,7 with pleural effusions and 4 with peritoneal effusions achieved a complete response (CR),and 20 cases (12 pleural effusions and 8 peritoneal effusions) had a partial response (PR).The overall response rate is 64.6%.Patients' quality of life,assessed by using Karnofsky performance scale (KPS) scores,was improved by an average of 26.4.The one-year of overall survival rate was 54.2% with a median survival time of 12.5 months.There were no serious side effects observed except for self-limited fever found in 79.8% of the cases.Conclusions Intra-cavity infusion of rAd-p53 is an effective and safe treatment for the patients with malignant pleural or peritoneal effusions,especially for those patients who can't tolerate the standard treatments.

  12. Myelomatous pleural effusion: A rare case entity reported from a tertiary care cancer center in South India

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    Govind K Babu

    2017-01-01

    Full Text Available Multiple myeloma (MM is a plasma cell neoplasm and constitutes 10% of hematologic malignancies. Malignant myelomatous pleural effusions are very rare and occur in <1% of cases of MM. In this article, we report a rare case of a patient who initially presented with pleural effusion and was subsequently found to be secondary to MM with an underlying raised IgG paraprotein. The patient symptomatically improved and was in partial remission with palliative radiotherapy, VTD chemotherapy, and bisphosphonates.

  13. Detection of EML4-ALK in lung adenocarcinoma using pleural effusion with FISH, IHC, and RT-PCR methods.

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    Leilei Liu

    Full Text Available Anaplastic lymphoma kinase (ALK and echinoderm microtubule-associated protein-like 4 (EML4 gene rearrangements occur in approximately 5% of non-small-cell lung cancers (NSCLC, leading to the overexpression of anaplastic lymphoma kinase and predicting a response to the targeted inhibitor, crizotinib. Malignant pleural effusion occurs in most patients with advanced lung cancer, especially adenocarcinoma, and tissue samples are not always available from these patients. We attempted to clarify the feasibility of detecting the EML4-ALK fusion gene in pleural effusion cells using different methods. We obtained 66 samples of pleural effusion from NSCLC patients. The pleural effusion fluid was centrifuged, and the cellular components obtained were formalin fixed and paraffin embedded. The EML4-ALK fusion gene status was determined with fluorescent in situ hybridization (FISH, reverse transcription-polymerase chain reaction (RT-PCR, and immunohistochemistry (IHC. EML4-ALK was detected in three of 66 patient samples (4.5% with RT-PCR. When the RT-PCR data were used as the standard, one false positive and one false negative samples were identified with IHC; and one false negative sample was identified with FISH. These results suggest that a block of pleural effusion cells can be used to detect the EML4-ALK fusion gene. IHC had good sensitivity, but low specificity. FISH had low sensitivity, but high specificity. RT-PCR is a good candidate method for detecting EML4-ALK in blocks of pleural effusion cells from lung cancer patients.

  14. Rare cause of paradoxical worsening of pleural effusion in a patient with tuberculosis

    Science.gov (United States)

    Duraikannan, Paramasivan; Saheer, S; Balamugesh, T; Christopher, DJ

    2017-01-01

    A 33-year-old patient, Known case of chronic kidney disease on maintenance dialysis presented with complaints of low-grade fever and weight loss of 2 months duration. Computed tomography (CT) revealed bilateral mild pleural effusion with significant mediastinal and abdominal adenopathy. CT-guided fine-needle aspiration cytology of abdominal lymph nodes and bone marrow culture was suggestive of tuberculosis. The patient was started on four drug anti-tubercular therapy, post 6 weeks of initiation he developed new onset fever and chest X-ray revealed moderate right pleural effusion. Diagnostic thoracocentesis was suggestive of chylothorax. To the best of our knowledge, this is the first case report of chylothorax due to the paradoxical reaction in the HIV-negative tuberculous patient.

  15. Whole-thorax irradiation induces hypoxic respiratory failure, pleural effusions and cardiac remodeling.

    Science.gov (United States)

    Medhora, Meetha; Gao, Feng; Glisch, Chad; Narayanan, Jayashree; Sharma, Ashish; Harmann, Leanne M; Lawlor, Michael W; Snyder, Laura A; Fish, Brian L; Down, Julian D; Moulder, John E; Strande, Jennifer L; Jacobs, Elizabeth R

    2015-03-01

    To study the mechanisms of death following a single lethal dose of thoracic radiation, WAG/RijCmcr (Wistar) rats were treated with 15 Gy to the whole thorax and followed until they were morbid or sacrificed for invasive assays at 6 weeks. Lung function was assessed by breathing rate and arterial oxygen saturation. Lung structure was evaluated histologically. Cardiac structure and function were examined by echocardiography. The frequency and characteristics of pleural effusions were determined. Morbidity from 15 Gy radiation occurred in all rats 5 to 8 weeks after exposure, coincident with histological pneumonitis. Increases in breathing frequencies peaked at 6 weeks, when profound arterial hypoxia was also recorded. Echocardiography analysis at 6 weeks showed pulmonary hypertension and severe right ventricular enlargement with impaired left ventricular function and cardiac output. Histologic sections of the heart revealed only rare foci of lymphocytic infiltration. Total lung weight more than doubled. Pleural effusions were present in the majority of the irradiated rats and contained elevated protein, but low lactate dehydrogenase, when compared with serum from the same animal. Pleural effusions had a higher percentage of macrophages and large monocytes than neutrophils and contained mast cells that are rarely present in other pathological states. Lethal irradiation to rat lungs leads to hypoxia with infiltration of immune cells, edema and pleural effusion. These changes may contribute to pulmonary vascular and parenchymal injury that result in secondary changes in heart structure and function. We report that conditions resembling congestive heart failure contribute to death during radiation pneumonitis, which indicates new targets for therapy. © The Author 2014. Published by Oxford University Press on behalf of The Japan Radiation Research Society and Japanese Society for Radiation Oncology.

  16. Pentoxifylline inhibits the fibrogenic activity of pleural effusions and transforming growth factor-β

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    P. Entzian

    1997-01-01

    Full Text Available Physiopathology of organ fibrosis is far from being completely understood, and the efficacy of the available therapeutic strategies is disappointing. We chose pleural disease for further studies and addressed the questions of which cytokines are relevant in pleural fibrosis and which drugs might interrupt its development. We screened pleural effusions for mediators thought to interfere with fibrogenesis (transforming growth factor-β (TGF-β, tumour necrosis factor α (TNFα, soluble TNF-receptor p55 (sTNF-R and correlated the results with patient clinical outcome in terms of extent of pleural thickenings. We found pleural thickenings correlated with TGF-β (p<0.005 whereas no correlations could be observed with TNFα and sTNF-R. Further, we were interested in finding out how TGF-β effects on fibroblast growth could be modulated. We found that pentoxifylline is able to inhibit both fibroblast proliferation and collagen synthesis independently of the stimulus. We conclude that, judging from in vitro studies, pentoxifylline might offer a new approach in the therapy of pleural as well as pulmonary fibrosis.

  17. Chronic necrotizing pulmonary aspergillosis presenting as bilateral pleural effusion: a case report

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    Rajalingham Sakthiswary

    2012-02-01

    Full Text Available Abstract Introduction Chronic necrotizing pulmonary aspergillosis is an uncommon subacute form of Aspergillus infection. It typically occurs in immunocompromised individuals and in those with underlying lung disease. This interesting case highlights the occurrence of this entity of aspergillosis in an immunocompetent middle-aged woman with atypical radiological findings. To the best of our knowledge this is the first case report of chronic necrotizing pulmonary aspergillosis presenting with pleural effusion. Case presentation Our patient was a 64-year-old Malay woman with a background history of epilepsy but no other comorbidities. She was a lifelong non-smoker. She presented to our facility with a six-month history of productive cough and three episodes of hemoptysis. An initial chest radiograph showed bilateral pleural effusion with bibasal consolidation. Bronchoscopy revealed a white-coated endobronchial tree and bronchoalveolar lavage culture grew Aspergillus niger. A diagnosis of chronic necrotizing pulmonary aspergillosis was made based on the clinical presentation and microbiological results. She responded well to treatment with oral itraconazole. Conclusions The radiological findings in chronic necrotizing pulmonary aspergillosis can be very diverse. This case illustrates that this condition can be a rare cause of bilateral pleural effusion.

  18. Povidone-Iodine and Bleomycin in the Management of Malignant Pleural Effusion

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    Ali Asghar Alavi

    2011-09-01

    Full Text Available "nMalignant pleural effusion is a common complication in certain malignancies. Pleurodesis is the best option most of the time. The purpose of this study was to compare the choice of belomycin with povidone-iodine, which is not only determined by the efficacy of the agent but also by its cost, accessibility, safety, ease of administration and the number of administrations to achieve a complete response. We performed a randomized clinical trial on 39 patients presenting with symptomatic malignant pleural effusion. Patients were selected and randomly assigned to undergo chemical pleurodesis with either bleomycin or povidone-iodine. Primary characteristics of patients were assessed and graded before and after treatment concerning pain, dyspnea, and chest radiographs. A complete response was obtained in 79% of belomycin group and 75% of povidone-iodine group which was not statistically significant. Patients on belomycin treatment had a significantly lower score for dyspnea in one month follow up. This was significant after controlling for age, pain score and dyspnea score after drainage, using general linear model. Due to similar effect and significant cost advantage between bleomycin and povidone-iodine, we conclude that povidone- iodine is the agent of choice when utilizing pleurodesis for control of symptomatic malignant pleural effusions.

  19. Diagnostic value of Light's criteria and albumin gradient in classifying the pathophysiology of pleural effusion formation in cats.

    Science.gov (United States)

    Zoia, Andrea; Drigo, Michele

    2016-08-01

    The primary aim of this study was to assess whether human Light's criteria with the cut-off values previously published for cats are useful and superior to the traditional veterinary classification in diagnosing pathophysiology of fluid formation in cats with pleural effusion. The secondary aim was to assess if the albumin gradient (ALBg) is a reliable criterion for differentiating exudates from transudates in patients with pleural effusion thought to be transudative by clinical criteria but identified as exudative by Light's criteria. Nineteen client-owned cats with pleural effusion were studied. The aetiology of the pleural effusion was used to establish the pathophysiology of its formation. Parameters measured or calculated undergoing statistical analysis included Light's criteria, total protein and total nucleated cell count in the pleural effusions, and the ALBg. Based on the pathophysiology of fluid formation there were seven transudates caused by increased hydrostatic pressure and 12 exudates. There was a significant difference in the accuracy of the Light's criteria in correctly classifying origin of the pleural fluid formation compared with the traditional veterinary classification (84% vs 53%). ALBg values were significantly different between transudates and exudates. One of the three transudates misclassified as exudates by Light's criteria was correctly identified as a transudate by the ALBg. In conclusion, pleural effusion should be classified as either a transudate or an exudate using Light's criteria. In cats with pleural effusion thought to be transudative by clinical criteria, but identified as exudative by Light's criteria, the ALBg may further help in correctly differentiating exudates from transudates. © The Author(s) 2015.

  20. A Novel Bedside Technique for Differentiation of Exudative From Transudative Pleural Effusion

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    Ashraf Ashraf Askari

    2008-11-01

    Full Text Available Background:At present, differentiation between exudative and transudative pleural  effusion is based solely on laboratory measures and is time-consuming. Asimple  bedside method would be of great help to differentiate between these two types of effusions.We present a new method for this purpose assessed in 46 patients.Methods: Standard laboratory tests and our method were tested using the same fluid  samples in 46 patients with pleural effusion. Aprincipal in physics called the capillary Tube law (h=2a/rpg was used to compare the samples. The imbibition of the fluid  level less than 15mm signified exudate and greater than 15mm signified transudate.Results: Our data shows that this method is 74% sensitive and 89.4% specific compared to the standard method when analyzed statistically by the chi-square and Kappa  agreement (Cronbach’s K tests. Conclusion: The capillary tube test has an acceptable validity for bedside diagnosis  of exudative or transudative effusions.  

  1. Acta Medica Indonesiana - The Indonesian Journal of Internal Medicine 153 Malignant Pleural Effusion in Acute Myeloid Leukemia with Hepatitis B Virus Infection

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    C Suharti

    2016-05-01

    Full Text Available Pleural effusions can be the first presentation of a hematologic malignancy. The most common disorders with pleural effusion are Hodgkin and non-Hodgkin lymphoma with a frequency of 20 to 30%, especially if mediastinal involvement. Acute and chronic leukemia are rarely accompanied by pleural involvement. We describe a 46-year-old female with history of progressive dyspnoea. Physical examination was revealed massive left pleural effusion. Complete blood count revealed anemia, trombositopenia and normal leucocyte count. Viral serology test shown positive of HBsAg and total antiHBc. Chest X-ray revealed left pleural effusion. Pleural fluid cytology was myeloblast consistent with acute myeloid leukemia (AML. Bone marrow aspiration smear, bone marrow biopsy smear, and flow cytometry analysis were consistent with acute myeloid leukemia without maturation (AML M0-FAB classification. Key words: Acute myeloid leukemia, pleural effusion, infection.

  2. Fluorescence in situ hybridization as adjunct to cytology improves the diagnosis and directs estimation of prognosis of malignant pleural effusions

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    Han Jingquan

    2012-11-01

    Full Text Available Abstract Background The identification of malignant cells in effusions by conventional cytology is hampered by its limited sensitivity and specificity. The aim of this study was to investigate the value of fluorescence in situ hybridization (FISH as adjuncts to conventional cytologic examination in patients with malignant pleural effusions. Methods We conducted a retrospective cohort study of 93 inpatients with pleural effusions (72 malignant pleural effusions metastatic from 11 different organs and 21 benign over 23 months. All the patients came from Chinese northeast areas. Aspirated pleural fluid underwent cytologic examination and fluorescence in situ hybridization (FISH for aneuploidy. We used FISH in single-colour or if appropriate in dual-colour evaluation to detect chromosomal aberrations (chromosomes 7, 11, and 17 in effusion cells as markers of malignancy, to raise the diagnostic yield and identified the efficiency by diagnostic biopsy. Predominant cytogenetic anomalies and patterns of intratumor cytogenetic heterogeneity were brought in relation to overall survival rate. Results Cytology alone confirmed malignant pleural effusions in 45 of 72 patients (sensitivity 63%, whereas FISH alone positively identified 48 of 72 patients (sensitivity 67%. Both tests had high specificity in predicting benign effusions. If cytology and FISH were considered together, they exhibited 88% sensitivity and 94.5% specificity in discriminating benign and malignant effusions. Combined, the two assays were more sensitive than either test alone. Although the positive predictive value of each test was 94.5%, the negative predictive value of cytology and FISH combined was 78%, better than 47% and 44% for FISH and cytology alone, respectively. There was a significantly prolonged survival rate for patients with aneuploidy for chromosome 17. Conclusions FISH in combination with conventional cytology is a highly sensitive and specific diagnostic tool for detecting

  3. 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.

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

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    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.

  5. Predictors of survival in patients who underwent video‐assisted thoracic surgery talc pleurodesis for malignant pleural effusion

    Science.gov (United States)

    Yoon, Dong Woog; Choi, Yong Soo; Kim, Jhingook; Kim, Hong Kwan; Zo, Jae Ill; Shim, Young Mog

    2016-01-01

    Background Patients with malignant pleural effusion have a limited life expectancy. An increase in pleural and oncological treatment options and more accurate prognostic evaluation may help individualize treatment strategies. The aim of this study was to identify the prognostic indicators of overall survival (OS) after video‐assisted thoracic surgery (VATS) talc pleurodesis for malignant pleural effusion. Methods We examined the medical records of all consecutive patients with malignant pleural effusion who underwent VATS talc pleurodesis from 2006 to 2008 at the Samsung Medical Center. Univariate and multivariate analyses were used to identify predictors of OS after VATS talc pleurodesis. Results During the study period, 91 patients underwent VATS talc pleurodesis to treat malignant pleural effusion. Early (within 30 days) and late (within 90 days) postoperative mortality rates were 9.9% (9 patients), and 25.3% (23), respectively. Median survival time after VATS talc pleurodesis was 10.5 months. The postoperative respiratory complication rate was 11% (10 patients), and included pneumonia (9) and acute respiratory distress syndrome (4). Multivariate analysis revealed that preoperative chemotherapy (P = 0.012), preoperative radiotherapy (P = 0.003), and Eastern Cooperative Oncology Group (ECOG) performance score 3 or 4 (P = 0.013) were independent risk factors of OS after VATS talc pleurodesis. Conclusions We identified previous chemotherapy or radiotherapy and poor performance status (ECOG 3 or 4) as significant predictors of OS after VATS talc pleurodesis. These prognostic factors can help surgeons select candidates for VATS pleurodesis for malignant pleural effusion. PMID:27385980

  6. [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.

  7. Screening Performance Characteristic of Ultrasonography and Radiography in Detection of Pleural Effusion; a Meta-Analysis

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    Mahmoud Yousefifard

    2016-01-01

    Full Text Available Introduction: The role of ultrasonography in detection of pleural effusion has long been a subject of interest but controversial results have been reported. Accordingly, this study aims to conduct a systematic review of the available literature on diagnostic value of ultrasonography and radiography in detection of pleural effusion through a meta-analytic approach. Methods: An extended search was done in databases of Medline, EMBASE, ISI Web of Knowledge, Scopus, Cochrane Library, and ProQuest. Two reviewers independently extracted the data and assessed the quality of the articles. Meta-analysis was performed using a mixed-effects binary regression model. Finally, subgroup analysis was carried out in order to find the sources of heterogeneity between the included studies. Results: 12 studies were included in this meta-analysis (1554 subjects, 58.6% male. Pooled sensitivity of ultrasonography in detection of pleural effusion was 0.94 (95% CI: 0.88-0.97; I2= 84.23, p<0.001 and its pooled specificity was calculated to be 0.98 (95% CI: 0.92-1.0; I2= 88.65, p<0.001, while sensitivity and specificity of chest radiography were 0.51 (95% CI: 0.33-0.68; I2= 91.76, p<0.001 and 0.91 (95% CI: 0.68-0.98; I2= 92.86, p<0.001, respectively. Sensitivity of ultrasonography was found to be higher when the procedure was carried out by an intensivist or a radiologist using 5-10 MHz transducers. Conclusion: Chest ultrasonography, as a screening tool, has a higher diagnostic accuracy in identification of plural effusion compared to radiography. The sensitivity of this imaging modality was found to be higher when performed by a radiologist or an intensivist and using 5-10MHz probes.

  8. Establishment of triglyceride cut-off values to detect chylous ascites and pleural effusions.

    Science.gov (United States)

    Thaler, Markus A; Bietenbeck, Andreas; Schulz, Christoph; Luppa, Peter B

    2017-02-01

    Lipoprotein electrophoresis is the gold standard for the detection of chylous ascites and pleural effusions. It is, however, not suitable as a front-line test and not widely available. Most clinicians must rely solely on the quantitative determination of lipids. The aim of this work was to establish lipid cut-off values for the presence of chylomicrons in pleural and peritoneal fluid. Triglyceride and cholesterol levels from 113 peritoneal and 154 pleural fluid samples investigated for chylomicrons via lipoprotein electrophoresis were considered. Receiver operating characteristic analyses were performed and cut-off levels determined. 54 peritoneal and 59 pleural fluid samples were positive for chylomicrons. In peritoneal fluid, triglycerides and triglycerides/cholesterol ratio exhibited areas under the curve (AUC) not significantly different from each other, but significantly larger than cholesterol alone. The AUC for triglycerides in pleural fluid was significantly larger than the AUCs for cholesterol and the triglycerides/cholesterol ratio. Triglyceride cut-offs with maximum Youden-Index, sensitivity >95%, and specificity >95% were calculated to be 187, 148, and 246mg/dl (2.13, 1.69, and 2.80mmol/l) for peritoneal fluid, and 240, 94, and 240mg/dl (2.74, 1.07, and 2.74mmol/l) for pleural fluid. Triglyceride levels are the best parameter to detect chylous body fluids when lipoprotein electrophoresis is not available. Single-point triglyceride cut-offs of 187 and 240mg/dl (2.13 and 2.74mmol/l) or alternatively equivocal ranges of 148-246 and 94-240mg/dl (1.69-2.80 and 1.07-2.74mmol/l) were established for peritoneal and pleural fluid, respectively. Copyright © 2016 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  9. Clinical Value of Tumor Markers for Determining Cause of Pleural Effusion

    Institute of Scientific and Technical Information of China (English)

    Yan Gu; Kan Zhai; Huan-Zhong Shi

    2016-01-01

    Background: It is often challenging to distinguish tuberculous pleural effusion (TPE) from malignant pleural effusion (MPE);thoracoscopy is among the techniques with the highest diagnostic ability in this regard.However, such invasive examinations cannot be performed on the elderly, or on those in poor physical condition.The aim of this study was to explore the differential diagnostic value of carbohydrate antigen 125 (CA 125), carbohydrate antigen 199 (CA 199), carcinoembryonic antigen (CEA), neuron-specific enolase (NS E), and squamous cell carcinoma (SCC) associated antigen in patients with TPE and MPE.Methods: Using electrochemiluminescence, we measured the concentration of tumor markers (TMs) in the pleural effusion and serum of patients with TPE (n =35) and MPE (n =95).We used receiver operating characteristic (ROC) curve analysis to evaluate the TMs and differentiate between TPE and MPE.Results: The cut-offvalues for each TM in serum were: CA125, 151.55 U/ml;CA199, 9.88 U/ml;CEA, 3.50 ng/ml;NSE, 13.27 ng/ml;and SCC, 0.85 ng/ml.Those in pleural fluid were: CA125, 644.30 U/ml;CA199, 12.08 U/ml;CEA, 3.35 ng/ml;NSE, 9.71 ng/ml;and SCC, 1.35 ng/ml.The cut-offvalues for the ratio ofpleural fluid concentration to serum concentration (P/S ratio) of each TM were: CA125, 5.93;CA199, 0.80;CEA, 1.47;NSE, 0.76;and SCC, 0.90.The P/S ratio showed the highest specificity in the case of CEA (97.14%).ROC curve analysis revealed that, for all TMs, the area under the curve in pleural fluid (0.95) was significantly different from that in serum (0.85;P < 0.001).Conclusions: TMs in TPE differ significantly from those in MPE, especially when detected in pleural fluid.The combined detection of TMs can improve diagnostic sensitivity.

  10. An unexpected finding in a man with multiple pulmonary nodules, a pleural effusion and respiratory failure.

    Science.gov (United States)

    Pang, Yik Lam; Jones, Quentin

    2017-01-01

    We report the case of a 47-year old Caucasian man with a history of depression and high alcohol intake who presented with a one-month history of weight loss, dry cough and abdominal pain. He had no smoking history of note. The patient was treated for a suspected chest infection, however developed respiratory failure and was intubated. A CT showed multiple pulmonary nodules, left pleural thickening extending to the mediastinum and bilateral pleural effusions-larger on the left, suggestive of disseminated malignancy. A broncho-alveolar lavage surprisingly contained numerous acid-fast bacilli and no malignant cells. Treatment for tuberculosis was initiated and the patient recovered gradually. After several weeks, a pyrazinamide-resistant organism was cultured and subsequently identified to be Mycobacterium Bovis. We discuss this unexpected finding and review the literature on Bovine Tuberculosis in humans.

  11. Massive pleural effusion due to paragonimiasis: Biochemical, cytological, and parasitological findings

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    Takhellambam Shantikumar Singh

    2014-01-01

    Full Text Available Paragonimiasis is an important food-borne parasitic zoonosis caused by trematode species of the genus, Paragonimus occurring in many parts of the world except in Australia and Antarctica. In India, it is an emerging parasitic disease, which is endemic in the northeast states where people have a common practice of eating raw or inadequately cooked freshwater crabs. In these states, Paragonimus heterotremus has been identified as the major causative agent of the human paragonimiasis. The most common clinical form of the disease is pulmonary paragonimiasis; however, extra-pulmonary manifestations are not uncommon. Here, we report a case of primary massive unilateral pleural effusion due to paragonimiasis. The diagnosis was confirmed by finding Paragonimus ova in the pleural fluid. The patient was successfully treated with repeated thoracocentesis and a course of praziquantel.

  12. Unilateral or Bilateral Thoracocentesis for Bilateral Pleural Effusion. A Prospective Study.

    Science.gov (United States)

    Ferreiro, Lucía; San José, María Esther; Gude, Francisco; Lama, Adriana; Suárez-Antelo, Juan; Golpe, Antonio; Toubes, M Elena; González-Barcala, Francisco Javier; Álvarez-Dobaño, José Manuel; Valdés, Luis

    2016-04-01

    In the absence of firm recommendations, we analyzed whether unilateral thoracic puncture is sufficient for bilateral pleural effusion (PE), or if the procedure needs to be performed in both sides. Prospective study of patients seen consecutively for bilateral PE during a period of 3 years and 9 months. All patients underwent simultaneous bilateral thoracocentesis. The standard protocol variables collected in our hospital served as study parameters. Size of PE, presence of chest pain or fever, or accompanying lung abnormalities, different attenuation values on chest computed tomography, presence of loculated pleural fluid, and radiological resolution in a single side were also evaluated. A total of 36 patients (19 men; mean age 68.5 ± 16.5 years) were included. The etiology of the effusion was different in each side in only 2 patients (5.6%). In 6/32 cases (18.8%), the biological analysis of the pleural fluid (in terms of transudate/exudate) from both sides did not correspond with the etiological diagnosis of the effusion. Correlation between biochemical parameters analyzed in the fluid from both sides (Pearson's correlation coefficient) ranged between 0.74 (LDH) and 0.998 (NT-proBNP). As different diagnoses in each side were found in only 2 patients, the circumstances in which bilateral diagnostic thoracocentesis would be necessary could not be determined. Simultaneous bilateral thoracocentesis does not appear to be recommendable. Larger series are needed to establish which factors might suggest the need for simultaneous puncture of both PE. Copyright © 2015 SEPAR. Published by Elsevier Espana. All rights reserved.

  13. Bilateral Pleural Effusions as an Initial Presentation in Primary Sjögren's Syndrome

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    Go Makimoto; Michiko Asano; Nobukazu Fujimoto; Yasuko Fuchimoto; Katsuichiro Ono; Shinji Ozaki; Koji Taguchi; Takumi Kishimoto

    2012-01-01

    Sjögren’s syndrome (SS) is a systemic autoimmune disease characterized by sicca symptoms. Interstitial pulmonary fibrosis and tracheobronchial sicca are the most common symptoms of pulmonary involvement in primary SjS, and they are rarely accompanied by serositis such as pleuritis or pericarditis. We report a case of SS presenting initially with bilateral pleural effusions. A 63-year old man was admitted to our hospital with a one-month history of cough, dyspnea, and right chest pain. Chest-c...

  14. Morganella morganii causing solitary liver abscess complicated by pyopericardium and left pleural effusion in a nondiabetic patient.

    Science.gov (United States)

    Tsai, Wen-Cheng; Chang, Liang-Kai

    2002-09-01

    Morganella morganii is a rare cause of solitary liver abscess in Taiwan. The complication of pyopericardium and pleural effusion in nondiabetic patient with solitary liver abscess are also rare. We present a case of a 48-year-old nondiabetic woman who experienced with epigastric discomfort 1 month prior to admission. Chills and fever developed 2 weeks before admission. Physical examination on admission revealed engorgement of the jugular vein over the right neck, precordial friction rubs, and tenderness over the right upper quadrant of abdomen. Chest film showed mild cardiomegaly and left pleural effusion. Computed tomography of the abdomen showed liver abscess, left hepatic lobe, pyopericardium, and left pleural effusion. M. morganii was isolated from 2 sets of blood cultures, one set of hepatic pus culture, and one set of pericardial pus culture. After pigtail drainage of liver abscess, pyopericardium for 12 days, and ceftriaxone intravenous administration for 19 days, the patient was discharged in stable condition.

  15. 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.

  16. Early, dedicated follow-up and treatment of pleural effusions enhance the recovery rate after open cardiac surgery

    DEFF Research Database (Denmark)

    Hansen, Laura Sommer; Hjortdal, Vibeke Elisabeth; Jakobsen, Carl-Johan

    2017-01-01

    OBJECTIVES: Recent studies conclude that cardiac surgery patients are prone to both mortality and morbidity in the weeks after discharge. Complications such as pleural and pericardial effusions may influence physical recovery due to symptoms such as dyspnoea, chest pain and fatigue. Dedicated...... baseline to 30 days after surgery. RESULTS: The mean difference in walking distance after 30 days was 15% (65 ± 22 m) between groups, P = 0.017. No differences were found in the peak expiratory flow or EuroQOL. In patients with pleural effusion, walking distance improved by 22% after thoracentesis (81 ± 42...... m), P cardiac...

  17. Evaluation of lymphatic dysplasia in patients with congenital pleural effusion and ascites using indocyanine green lymphography.

    Science.gov (United States)

    Shibasaki, Jun; Hara, Hisako; Mihara, Makoto; Adachi, Shinya; Uchida, Yasushi; Itani, Yasufumi

    2014-05-01

    To investigate the use of indocyanine green (ICG) lymphography in the diagnosis and assessment of the severity of lymphatic dysfunction in infants and neonates with congenital lymphatic pleural effusion and ascites. We performed ICG lymphography on 10 neonates and infants with congenital lymphatic pleural effusion and ascites. After the subcutaneous injection of ICG, circumferential fluorescent images of lymphatic drainage channels in the extremities and trunk were identified using an infrared camera system. The lymphographic findings were classifiable into 2 patterns-those showing a linear lymphatic pattern, suggesting normal lymphatic flow, and those showing lymphatic channels with retrograde lymphatic flow (dermal backflow pattern), suggesting an abnormal lymphatic flow. We analyzed the severity of the ICG lymphography findings and the clinical outcomes. Based on the ICG lymphography, the severity of lymphatic dysplasia were classified into 4 categories: mild dysplasia, moderate dysplasia, severe dysplasia, and lymphatic hypoplasia. All cases diagnosed with mild (n = 3) or moderate dysplasia (n = 2) survived, and 2 of the 4 cases diagnosed with severe dysplasia died. The duration of endotracheal intubation ranged from 1 to 17 days (median, 7) in the patients with mild or moderate dysplasia and from 25 to 110 days (median, 77) in those with severe dysplasia. The ICG lymphographic findings were consistent with the clinical conditions. This imaging technique may be important to the future clinical management of lymphatic dysplasia in neonates and infants. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. Examination of cytological smears and cell blocks of pleural fluid: Complementary diagnostic value for malignant effusions.

    Science.gov (United States)

    Porcel, J M; Quirós, M; Gatius, S; Bielsa, S

    2017-04-01

    To evaluate the independent usefulness of pleural fluid smear and cell block (CB) preparations for the diagnosis of malignant effusions. A total of 632 cytological smears and 554 CBs from 414 consecutive patients with malignant effusions were retrospectively evaluated. The diagnostic yield of a first specimen was 44% regardless of whether a smear or CB cytologic examination was performed. The use of subsequent separated specimens increased the identification of malignancy to 56%. Overall, 11% of samples found to be negative by cytologic smears showed malignant cells on CBs, whereas 15% of negative CBs were reported as positive on smear slides. Pleural fluid specimens with low red and/or white blood cell counts more frequently resulted in the generation of suboptimal CB preparations. If CBs and smears are prepared and examined, the percentage of positive diagnoses will be greater than if only one method is used. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  19. Spheres derived from lung adenocarcinoma pleural effusions: molecular characterization and tumor engraftment.

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    Rita Mancini

    Full Text Available Malignant pleural effusions (MPEs could represent an excellent source to culture a wide variety of cancer cells from different donors. In this study, we set up culture conditions for cancer cells deriving from MPEs of several patients affected by the most frequent form of lung cancer, namely the subset of non small cell lung cancers (NSCLC classified as Lung Adenocarcinomas (AdenoCa which account for approximately 40% of lung cancer cases. AdenoCa malignant pleural effusions gave rise to in vitro cultures both in adherent and/or in spheroid conditions in almost all cases analyzed. We characterized in greater detail two samples which showed the most efficient propagation in vitro. In these samples we also compared gene profiles of spheroid vs adherent cultures and identified a set of differentially expressed genes. Finally we achieved efficient tumor engraftment in recipient NOD/SCID mice, also upon inoculation of small number of cells, thus suggesting indirectly the presence of tumor initiating cells.

  20. The value of use of amino-terminal brain naturitic peptide as marker in cases of pleural effusion of different etiologies

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    Laila A. Banawan

    2013-10-01

    Conclusion: The results support the feasibility of using the pleural fluid amino terminal proBNP measurement in thoracentesis that would enhance discrimination among the different causes of pleural effusion especially for heart failure patients. Serum and pleural fluid levels of NT-pro BNP were closely correlated and measurement of NT-pro BNP in serum showed equally good diagnostic properties.

  1. Successful management of refractory pleural effusion due to systemic immunoglobulin light chain amyloidosis by vincristine adriamycin dexamethasone chemotherapy: a case report

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    Mima Akira

    2010-10-01

    Full Text Available Abstract Introduction Refractory pleural effusion in systemic immunoglobulin light chain amyloidosis without cardiac decompensation is rarely reported and has a poor prognosis in general (a median survival of 1.6 months. Moreover, the optimum treatment for this condition is still undecided. This is the first report on the successful use of vincristine, adriamycin and dexamethasone chemotherapy for refractory pleural effusion due to systemic immunoglobulin light chain amyloidosis without cardiac decompensation. Case presentation We report the case of a 68-year old Japanese male with systemic immunoglobulin light chain amyloidosis presenting with bilateral pleural effusion (more severe on the right side in the absence of cardiac decompensation that was refractory to diuretic therapy. The patient was admitted for fatigue, exertional dyspnea, and bilateral lower extremity edema. He had been receiving intermittent melphalan and prednisone chemotherapy for seven years. One month before admission, his dyspnea had got worse, and his chest radiograph showed bilateral pleural effusion; the pleural effusion was ascertained to be a transudate. The conventionally used therapeutic measures, including diuretics and thoracocentesis, failed to control pleural effusion. Administration of vincristine, adriamycin, and dexamethasone chemotherapy led to successful resolution of the effusion. Conclusion Treatment with vincristine, adriamycin, and dexamethasone chemotherapy was effective for the refractory pleural effusion in systemic immunoglobulin light chain amyloidosis without cardiac decompensation and appears to be associated with improvement in our patient's prognosis.

  2. Pleural effusion

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  3. Is albumin gradient or fluid to serum albumin ratio better than the pleural fluid lactate dehydroginase in the diagnostic of separation of pleural effusion?

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    Basran Gurnam S

    2002-03-01

    Full Text Available Abstract Background To determine the accuracy of serum-effusion albumin gradient (SEAG and pleural fluid to serum albumin ratio (ALBR in the diagnostic separation of pleural effusion into transudate and exudate and to compare SEAG and ALBR with pleural fluid LDH (FLDH the most widely used test. Methods Data collected from 200 consecutive patients with a known cause of pleural effusion in a United Kingdom district general hospital. Results The median and inter quartile ranges (IQR for SEAG 93.5 (33.8 to 122.5 g/dl, ALBR 0.49 (0.42 to 0.62 and FLDH 98.5 IU/L(76.8 to 127.5 in transudates were significantly lower than the corresponding values for exudates 308.5 (171 to 692, 0.77 (0.63 to 0.85, 344 (216 to 695 all p Conclusion The discriminative value for SEAG and ALBR appears to be similar in the diagnostic separation of transudates and exudates. FLDH is a superior test compared to SEAG and ALBR.

  4. Is albumin gradient or fluid to serum albumin ratio better than the pleural fluid lactate dehydroginase in the diagnostic of separation of pleural effusion?

    Science.gov (United States)

    Joseph, Jose; Badrinath, Padmanabhan; Basran, Gurnam S; Sahn, Steven A

    2002-01-01

    Background To determine the accuracy of serum-effusion albumin gradient (SEAG) and pleural fluid to serum albumin ratio (ALBR) in the diagnostic separation of pleural effusion into transudate and exudate and to compare SEAG and ALBR with pleural fluid LDH (FLDH) the most widely used test. Methods Data collected from 200 consecutive patients with a known cause of pleural effusion in a United Kingdom district general hospital. Results The median and inter quartile ranges (IQR) for SEAG 93.5 (33.8 to 122.5) g/dl, ALBR 0.49 (0.42 to 0.62) and FLDH 98.5 IU/L(76.8 to 127.5) in transudates were significantly lower than the corresponding values for exudates 308.5 (171 to 692), 0.77 (0.63 to 0.85), 344 (216 to 695) all p transudates and exudates. FLDH is a superior test compared to SEAG and ALBR. PMID:11914151

  5. Pleural effusion adenosine deaminase: a candidate biomarker to discriminate between Gram-negative and Gram-positive bacterial infections of the pleural space

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    Ruolin Li

    2016-05-01

    Full Text Available OBJECTIVES: Delay in the treatment of pleural infection may contribute to its high mortality. In this retrospective study, we aimed to evaluate the diagnostic accuracy of pleural adenosine deaminase in discrimination between Gram-negative and Gram-positive bacterial infections of the pleural space prior to selecting antibiotics. METHODS: A total of 76 patients were enrolled and grouped into subgroups according to Gram staining: 1 patients with Gram-negative bacterial infections, aged 53.2±18.6 years old, of whom 44.7% had empyemas and 2 patients with Gram-positive bacterial infections, aged 53.5±21.5 years old, of whom 63.1% had empyemas. The pleural effusion was sampled by thoracocentesis and then sent for adenosine deaminase testing, biochemical testing and microbiological culture. The Mann-Whitney U test was used to examine the differences in adenosine deaminase levels between the groups. Correlations between adenosine deaminase and specified variables were also quantified using Spearman’s correlation coefficient. Moreover, receiver operator characteristic analysis was performed to evaluate the diagnostic accuracy of pleural effusion adenosine deaminase. RESULTS: Mean pleural adenosine deaminase levels differed significantly between Gram-negative and Gram-positive bacterial infections of the pleural space (191.8±32.1 U/L vs 81.0±16.9 U/L, p<0.01. The area under the receiver operator characteristic curve was 0.689 (95% confidence interval: 0.570, 0.792, p<0.01 at the cutoff value of 86 U/L. Additionally, pleural adenosine deaminase had a sensitivity of 63.2% (46.0-78.2%; a specificity of 73.7% (56.9-86.6%; positive and negative likelihood ratios of 2.18 and 0.50, respectively; and positive and negative predictive values of 70.6% and 66.7%, respectively. CONCLUSIONS: Pleural effusion adenosine deaminase is a helpful alternative biomarker for early and quick discrimination of Gram-negative from Gram-positive bacterial infections of the

  6. Herbal extract elemene intrathoracic injection in the treatment of lung cancer patients with malignant pleural effusion: A meta-anaylsis

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    Jiang Chen

    2014-01-01

    Full Text Available Objective: The aim of this study was to evaluate the clinical efficacy of elemene intrapleural injection in the treatment of lung cancer with malignant pleural effusion by meta-analysis. Materials and Methods: PubMed (1960-2014.4, EMBASE (1980-2014.4 and CNKI (1979-2014.4 data bases were searched to identify the randomized controlled trials about elemene intrapleural injection in the treatment of malignant pleural effusion caused by lung cancer. The relativel risk (RR was used to evaluated the the clinical efficacy of elemene intrapleural injection in the treatment of pleural effusion compared to other drugs. Results: A total of 1298 subjects with 14 studies were finally included in this meta-analysis. Meta-analysis showed that the objective response rate (ORR in elemene group was much higher than that in other drugs group (RR =1.20, 95% CI:1.05-1.37, P = 0.008. We performed the sub-groups analysis according to the drugs used in the control group. And the subgroup analyzed demonstrated that the ORR in elemene group was higher than that in Cisplatin (DDP and high sugar group with statistical difference (P 0.05. Conclusion: High clinical efficacy of elemene was found in the treatment malignant pleural effusion in patients with lung cancer.

  7. [Evaluation of coefficient of variation of age in pleural effusion in António Pedro Hospital, Niterói city, state of Rio de Janeiro, Brazil].

    Science.gov (United States)

    da Silva Junior, Cyro Teixeira; Behrsin, Rodolfo Fred; Cardoso, Gilberto Perez; Monteiro, Nicolau Pedro

    2003-01-01

    Pleural effusion is a frequent syndrome in Brazil. Tuberculosis is the most prevalent (P) cause. The coefficient of variation (CV) is a useful single measure of variability. The objective of the present work was to evaluate the coefficient of variation in pleural effusion, having as variable the age. 215 patients had appeared after diagnostic physician and for image of syndrome of pleural effusions. Diagnostic thoracentesis, tests on pleural fluid and others invasive surgical procedures to the approach to a patient with pleural effusion. Tuberculosis (P=56.0%; CV=39,7%), adenocarcinoma (P=11.0%; CV=25.1%), transudates (P=12.0%; CV=19.6%), lymphomas (P=2.0%; CV=34.6%), systemic lupus erythematosus (P=2.0%; CV=38.7%), empyema pleural not tuberculosis (P=5.0%; CV=42.2%), pulmonary infarction (P=4.0 %; CV=30.1%) and parapneumonic (P=4.0 %; CV=38.9%) are the causes more prevalent. The analysis on the date showed that the coefficient of variation of age in pleural effusions was high and very high. The values of the coefficient of variation translate a high degree of dispersion of the age of the patients in each cause of pleural effusion.

  8. Evaluation of ferritin, interleukin-6, interleukin-8 and tumor necrosis factor alpha in the differentiation of exudates and transudates in pleural effusions.

    Science.gov (United States)

    Alexandrakis, M G; Coulocheri, S A; Bouros, D; Eliopoulos, G D

    1999-01-01

    In an attempt to define diagnostic criteria for the differentiation of pleural exudates from transudates, we measured ferritin (FER), interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor-alpha (TNF-alpha) in pleural effusions and blood serum in 84 consecutive patients with pleural effusions of various etiologies. Concentrations of FER, IL-8 and TNF-alpha were significantly higher in serum and pleural effusion in patients with exudates than in patients with transudates. Serum concentrations of IL-6 were not significantly increased in pleural exudate patients (9.78 +/- 17.12 fmol/L) compared to transudate patients (4.05 +/- 2.33 fmol/L), while significant differences were found between pleural exudates and transudates (p exudates from transudates.

  9. Etiology of pleural effusions: analysis of more than 3,000 consecutive thoracenteses.

    Science.gov (United States)

    Porcel, José M; Esquerda, Aureli; Vives, Manuel; Bielsa, Silvia

    2014-05-01

    To investigate the etiology of pleural effusions (PE) in adults and the accuracy of pleural fluid (PF) cytology and cultures in malignant and infectious PE, respectively. Retrospective analysis of all consecutive patients with PE undergoing diagnostic thoracentesis during the last 19 years in a university hospital. The leading causes of PE among the 3,077 patients were: cancer (27%), heart failure (21%), pneumonia (19%), tuberculosis (9%), abdominal surgery (4%), pericardial diseases (4%) and cirrhosis (3%). Tuberculosis was the most common etiology in patients <34 years of age (52%), whereas heart failure predominated in octogenarians (45%). The most common primary tumors in malignant PE were lung (37%) and breast (16%). The overall accuracy of PF cytology was 59%, although it was significantly lower in mesotheliomas (27%) and squamous cell lung cancer (25%). In infectious PE, only 30% of cultures yielded positive results, a percentage which increased two-fold (66%) in purulent fluids (empyemas). Viridans streptococci were the most commonly isolated pathogens (25.5%). The sensitivity of solid media cultures of PF for Mycobacterium tuberculosis was low (18.5%). Three-quarters of patients with PE in whom a diagnostic thoracentesis was indicated had cancer, heart failure, pneumonia or tuberculosis. PF cytology and cultures give false negative results in a significant number of cases. Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.

  10. A new instrument to assess physician skill at thoracic ultrasound, including pleural effusion markup.

    Science.gov (United States)

    Salamonsen, Matthew; McGrath, David; Steiler, Geoff; Ware, Robert; Colt, Henri; Fielding, David

    2013-09-01

    To reduce complications and increase success, thoracic ultrasound is recommended to guide all chest drainage procedures. Despite this, no tools currently exist to assess proceduralist training or competence. This study aims to validate an instrument to assess physician skill at performing thoracic ultrasound, including effusion markup, and examine its validity. We developed an 11-domain, 100-point assessment sheet in line with British Thoracic Society guidelines: the Ultrasound-Guided Thoracentesis Skills and Tasks Assessment Test (UGSTAT). The test was used to assess 22 participants (eight novices, seven intermediates, seven advanced) on two occasions while performing thoracic ultrasound on a pleural effusion phantom. Each test was scored by two blinded expert examiners. Validity was examined by assessing the ability of the test to stratify participants according to expected skill level (analysis of variance) and demonstrating test-retest and intertester reproducibility by comparison of repeated scores (mean difference [95% CI] and paired t test) and the intraclass correlation coefficient. Mean scores for the novice, intermediate, and advanced groups were 49.3, 73.0, and 91.5 respectively, which were all significantly different (P < .0001). There were no significant differences between repeated scores. Procedural training on mannequins prior to unsupervised performance on patients is rapidly becoming the standard in medical education. This study has validated the UGSTAT, which can now be used to determine the adequacy of thoracic ultrasound training prior to clinical practice. It is likely that its role could be extended to live patients, providing a way to document ongoing procedural competence.

  11. Sinus cut-off sign: A helpful sign in the CT diagnosis of diaphragmatic rupture associated with pleural effusion

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    Kaya, Seyda Ors [Pamukkale University Medical School, Department of Thoracic Surgery, Denizli (Turkey)]. E-mail: skaya@pamukkale.edu.tr; Karabulut, Nevzat [Pamukkale University Medical School, Department of Radiology, Denizli (Turkey); Yuncu, Gokhan [Pamukkale University Medical School, Department of Thoracic Surgery, Denizli (Turkey); Sevinc, Serpil [Pamukkale University Medical School, Department of Thoracic Surgery, Denizli (Turkey); Kiroglu, Yilmaz [Pamukkale University Medical School, Department of Radiology, Denizli (Turkey)

    2006-08-15

    The objective of our study was to describe the 'sinus cut-off' sign at CT in the diagnosis of diaphragmatic rupture in patients with blunt abdominal trauma complicated with pleural effusion, and evaluate its utility in an experimental model. Between January 2004 and March 2005, we observed an unusual interruption of costophrenic sinus at CT in three patients with blunt abdominal trauma accompanied with pleural effusion. This observation prompted us to evaluate the utility of this sign in an experimental model. Laparotomically, we created 2 cm diapragmatic lacerations at each hemidiaphragm in two rabbits and pushed up the abdominal viscera with omentum through the defect. To simulate hemothorax, we also injected 5-10 mL of diluted contrast material into the pleural space. Using a dual-slice helical CT scanner, limited thoracoabdominal CT examination was performed before and after injection of intrapleural contrast material. The images were analyzed for the presence of CT signs for diaphragmatic injury. The left posterior costophrenic sulcus was interrupted in all of the three patients with left pleural effusion. While it was associated with other findings of diaphragmatic injury, the 'sinus cut-off sign' was the sole finding in one patient. The sinus cut-off sign was observed on the CT scans of 100% of the rabbits with a left and right sided diaphragmatic rupture. The 'sinus cut-off sign' is useful and can increase the CT detection of acute diaphragmatic injury associated with pleural effusion.

  12. Hepatic hydro thorax: patient with pleural effusion to the right presenting tracer migration to the contralateral thorax projection on early scintigraphic images

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    Ichiki, W.A.; Ribeiro, V.P.B.; Gusman, L.; Coura Filho, G.B.; Sapienza, M.T.; Ono, C.R; Watanabe, T.; Costa, P.L.A.; Hironaka, F.; Cerri, G.G.; Buchpiguel, C.A. [Universidade de Sao Paulo (FMUSP), SP (Brazil). Fac. de Medicina. Hospital das Clinicas

    2008-07-01

    Full text: Introduction: Hepatic hydrothorax is a significant pleural effusion, greater than 500 mL, that appears as a clinical manifestation of portal hypertension in patients with advanced cirrhosis, in the absence of cardiopulmonary disease. Its mechanisms may be explained by migration of ascitic fluid through diaphragm defects. Radioisotope scintigraphy may contribute for the diagnostic of hepatic hydrothorax. Case report: Female, 79 years old, with a history of hepatic cirrhosis due to hepatitis B virus, without primary pulmonary or heart disease. She presented worsening of clinical ascites and dyspnoea, and it was diagnosed an extensive right pleural effusion. She underwent a thoracocentesis with a drainage of 2000 mL of light yellow-citrine fluid with transudate features. The pleural effusion quickly relapsed, leading the hypothesis of a hepatic hydrothorax. A scintigraphy was requested to assess peritoneo-pleural shunt. A dose of 370 MBq (10 mCi) of {sup 99m}Tc sulfur colloid was instilled intraperitoneally. Static images involving the thorax and upper abdomen were acquired at 10, 20, 30 and 40 minutes and 4 hours after injection. At 10 minutes the radiotracer was seen on the left side of the thoracic region. The scintigraphy was repeated three days later, just after new thoracocentesis, due to the tracer progression to the left side of the thorax differed to the location of pleural effusion. Likewise, until 4 hours of the second study, the radiotracer was seen again on the left side of the thorax. However, a delayed image of 24 showed accumulation of the radiotracer in the right pleural cavity, confirming peritoneo-pleural shunt as cause of pleural effusion in this patient. Discussion: Hydrothorax is an uncommon complication in patients with decompensated hepatic cirrhosis. Its mechanisms are still not well elucidated, however, it is known that presence of defects in the diaphragm associated with the imbalance of ascitic fluid volume and the pleural

  13. Concordant and Discordant Exudates and Their Effect on the Accuracy of Light's Criteria to Diagnose Exudative Pleural Effusions.

    Science.gov (United States)

    Ferreiro, Lucía; Sánchez-Sánchez, Rolando; Valdés, Luis; Kummerfeldt, Carlos E; Huggins, John T

    2016-12-01

    To describe the incidence of discordant exudate (DE) effusions, their underlying etiologies and their effect on the accuracy of the Light's criteria to diagnose exudate effusions. A retrospective review of pleural fluid analysis (PFA) from a cohort of patients with pleural effusion (PE) who underwent thoracentesis. PEs were defined as exudative based on the Light's criteria. The effusions were further classified in concordant or DE. From 847 PE samples, 611 (72.1%) were diagnosed as an exudate and 236 (27.9%) as a transudate. In 10.3% of cases (n = 87), there was discordancy between the final pleural fluid diagnosis and the PFA defined by Light's criteria. 281 (33.2%) of the 632 effusions classified as an exudate by Light's criteria were DE (52 transudates and 229 exudates). 182 (65%) of the 281 DE were found to be protein discordant (37 transudates and 145 exudates), and 99 (35.2%) were lactate dehydrogenase discordant (15 transudates and 84 exudates). The positive predictive value and positive likelihood ratio of Light's criteria for the diagnosis of an exudate effusion decreased from 99.4% and 67.4%, respectively, when the exudates were concordant to 81.5% and 1.7, respectively, if they were discordant. In a significant percentage of patients, there is discordancy between the results of the PFA and the final clinical diagnosis. DE decreased the accuracy of Light's criteria to identify exudate PE, increasing the risk of misclassifying a transudate as an exudate. Concordant exudates almost universally established the presence of an exudative PE. Copyright © 2016 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

  14. Deletion status of p16 in effusion smear preparation correlates with that of underlying malignant pleural mesothelioma tissue.

    Science.gov (United States)

    Hida, Tomoyuki; Matsumoto, Shinji; Hamasaki, Makoto; Kawahara, Kunimitsu; Tsujimura, Tohru; Hiroshima, Kenzo; Kamei, Toshiaki; Taguchi, Kenichi; Iwasaki, Akinori; Oda, Yoshinao; Honda, Hiroshi; Nabeshima, Kazuki

    2015-11-01

    Differentiating malignant pleural mesothelioma (MPM) cells morphologically from reactive mesothelial hyperplasia cells is problematic. Homozygous deletion (HD) of p16 (CDKN2A), detected by FISH, is a good marker of malignancy and is useful to differentiate between these cells. However, the correlation between the p16 status of effusion smears and that of the underlying MPM tissues has not been investigated. We used p16-specific FISH to investigate 20 cases of MPM from which both effusion cytologic smears and histologic specimens were available. In five cases, histologic specimens included both an invasive component and surface mesothelial proliferation. In 14 cases (70%), MPM cells in both tissue sections and effusion smears were p16 HD-positive. Conversely, MPM cells in the remaining six tumors (30%) were p16 HD-negative in both tissue sections and effusion smears. For all five MPM cases with surface mesothelial proliferations and invasive components, the effusion smears, surface mesothelial proliferations, and invasive MPM components all displayed p16 deletion. Moreover, the extent to which p16 was deleted in smears highly correlated with the extent of p16 deletion in tissues. The p16 deletion percentages were also similar among smears, tissue surface proliferations, and invasive components. In cases with clinical and radiologic evidence of a diffuse pleural tumor, detection of p16 deletion in cytologic smear samples may permit MPM diagnosis without additional tissue examination. However, the absence of p16 deletion in cytologic smear samples does not preclude MPM.

  15. Efficacy of the addition of positive airway pressure to conventional chest physiotherapy in resolution of pleural effusion after drainage: protocol for a randomised controlled trial

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    Elinaldo da Conceição dos Santos

    2015-04-01

    Discussion: Conventional chest physiotherapy and intermittent positive airway pressure breathing are widely indicated for people with pleural effusion and chest drains; however, no studies have evaluated the real benefit of this type of treatment. Our hypothesis is that optimised lung expansion achieved through the application of intermittent positive airway pressure will accelerate the reabsorption of pleural effusion, decrease the duration of chest drainage and respiratory system impairment, reduce the length of hospital stay, and reduce the incidence of pulmonary complications.

  16. Metabonomics by proton nuclear magnetic resonance in human pleural effusions: A route to discriminate between benign and malignant pleural effusions and to target small molecules as potential cancer biomarkers.

    Science.gov (United States)

    Zennaro, Lucio; Vanzani, Paola; Nicolè, Lorenzo; Cappellesso, Rocco; Fassina, Ambrogio

    2017-05-01

    Cytopathology is a noninvasive and cost-effective method for detecting cancer cells in pleural effusions (PEs), although in many cases, the diagnostic performance is hindered by the paucity of significant cells or the lack of clear morphological criteria. This study presents the results of an omics approach to improving the diagnostic performance of PE cytology. Metabolic profiling with proton nuclear magnetic resonance ((1) H-NMR) was performed for 92 PEs (44 malignant cases of 8 different cancers and 48 benign cases of 7 nonneoplastic conditions). Light's criteria were used to further classify PEs as transudates or exudates, and (1) H-NMR spectroscopy was used to differentiate malignant pleural effusions (mPEs) from benign pleural effusions (bPEs). (1) H-NMR metabolic analysis showed clearly different spectra for mPEs and bPEs in the regions of the signals due to lipids, branched amino acids, and lactate, which were increased in mPEs. Transudates and exudates in bPEs were differentiated as well on the basis of the (1) H-NMR signals from lipids and lipoproteins, which were increased in exudates. Subject to validation in further larger studies, (1) H-NMR metabonomics could be an effective and reliable ancillary tool for PE investigations and diagnoses. Cancer Cytopathol 2017;125:341-348. © 2017 American Cancer Society. © 2017 American Cancer Society.

  17. The diagnostic significance of the detection of cytokeratin 19 mRNA by quantitative RT-PCR in benign and malignant pleural effusions

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    徐峰; 陈杰; 沈华浩; 王选锭; 单江

    2004-01-01

    Objective: To evaluate the diagnostic significance of detecting cytokeratin 19 (CK19) mRNA by quantitative reverse transcription polymerase chain reaction (RT-PCR) in benign and malignant pleural effusions. Methods: CK19mRNA was examined by quantitative RT-PCR and CK19 was detected by Enzyme-linked immunoadsorbent assay (ELISA)in 32 patients with malignant pleural effusions and 35 patients with benign pleural effusions. Results: On the threshold of 200 copies/μl, the positive rate of CK1 9 mRNA in patients with malignant pleural effusions was 62.5%. The positive rates of CK19 mRNA and CK19 in the malignant pleural effusions were significantly higher than those in the benign group (P<0.01). Furthermore, the positive rate of CK19 mRNA was higher than that of CK19 in the malignant group (P<0.05).Conclusion: Detection of CK19 mRNA can be a promising diagnostic marker in differential diagnosis of benign and malignant pleural effusions.

  18. HDL-c levels predict the presence of pleural effusion and the clinical outcome of community-acquired pneumonia.

    Science.gov (United States)

    Saballs, M; Parra, S; Sahun, P; Pellejà, J; Feliu, M; Vasco, C; Gumà, J; Borràs, J L; Masana, L; Castro, A

    2016-01-01

    To investigate if HDL cholesterol (HDL-c) could be a biomarker of the degree of severity according to prognostic prediction scores in community-acquired pneumonia (CAP) or the development of clinical complications such as pleural effusion. We included in a retrospective study 107 patients admitted to the hospital that fulfilled diagnostic criteria for CAP between the 30th October 2011 and 1st September 2012. HDL-c levels at admission, CAP prognosis scores (PSI and CURB65) and clinical outcomes were recorded for the study. Basal HDL-c levels were not statistically different according to prognostics scores neither PSI nor CURB-65. Significantly lower levels of HDL-c were also associated to the development of septic shock and admission to the intensive care unit. HDL-c were inversely correlated with acute phase reactants CRP (r = -0.585, P HDL-c [28.9 (15.5) mg/dl vs. 44.6 (21.1) mg/dl]; P = 0.007. HDL-c is a good predictor of the presence of pleural effusion in multivariate analyses and using ROC analyses [AUC = 0.712 (0.591-0.834), P = 0.006]. HDL-c levels of 10 mg/dl showed a sensitivity of 97.6 % and a specificity of 82.4 % for the presence of pleural effusion. Monitoring HDL-c in CAP is an useful serum marker of acute phase response, clinical outcome and the presence of pleural effusion.

  19. Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score.

    Science.gov (United States)

    Clive, Amelia O; Kahan, Brennan C; Hooper, Clare E; Bhatnagar, Rahul; Morley, Anna J; Zahan-Evans, Natalie; Bintcliffe, Oliver J; Boshuizen, Rogier C; Fysh, Edward T H; Tobin, Claire L; Medford, Andrew R L; Harvey, John E; van den Heuvel, Michel M; Lee, Y C Gary; Maskell, Nick A

    2014-12-01

    Malignant pleural effusion (MPE) causes debilitating breathlessness and predicting survival is challenging. This study aimed to obtain contemporary data on survival by underlying tumour type in patients with MPE, identify prognostic indicators of overall survival and develop and validate a prognostic scoring system. Three large international cohorts of patients with MPE were used to calculate survival by cell type (univariable Cox model). The prognostic value of 14 predefined variables was evaluated in the most complete data set (multivariable Cox model). A clinical prognostic scoring system was then developed and validated. Based on the results of the international data and the multivariable survival analysis, the LENT prognostic score (pleural fluid lactate dehydrogenase, Eastern Cooperative Oncology Group (ECOG) performance score (PS), neutrophil-to-lymphocyte ratio and tumour type) was developed and subsequently validated using an independent data set. Risk stratifying patients into low-risk, moderate-risk and high-risk groups gave median (IQR) survivals of 319 days (228-549; n=43), 130 days (47-467; n=129) and 44 days (22-77; n=31), respectively. Only 65% (20/31) of patients with a high-risk LENT score survived 1 month from diagnosis and just 3% (1/31) survived 6 months. Analysis of the area under the receiver operating curve revealed the LENT score to be superior at predicting survival compared with ECOG PS at 1 month (0.77 vs 0.66, pLENT scoring system is the first validated prognostic score in MPE, which predicts survival with significantly better accuracy than ECOG PS alone. This may aid clinical decision making in this diverse patient population. 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.

  20. Beneficial impact of CCL2 and CCL12 neutralization on experimental malignant pleural effusion.

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    Antonia Marazioti

    Full Text Available Using genetic interventions, we previously determined that C-C motif chemokine ligand 2 (CCL2 promotes malignant pleural effusion (MPE formation in mice. Here we conducted preclinical studies aimed at assessing the specific therapeutic potential of antibody-mediated CCL2 blockade against MPE. For this, murine MPEs or skin tumors were generated in C57BL/6 mice by intrapleural or subcutaneous delivery of lung (LLC or colon (MC38 adenocarcinoma cells. Human lung adenocarcinoma cells (A549 were used to induce MPEs in severe combined immunodeficient mice. Intraperitoneal antibodies neutralizing mouse CCL2 and/or CCL12, a murine CCL2 ortholog, were administered at 10 or 50 mg/kg every three days. We found that high doses of CCL2/12 neutralizing antibody treatment (50 mg/kg were required to limit MPE formation by LLC cells. CCL2 and CCL12 blockade were equally potent inhibitors of MPE development by LLC cells. Combined CCL2 and CCL12 neutralization was also effective against MC38-induced MPE and prolonged the survival of mice in both syngeneic models. Mouse-specific CCL2-blockade limited A549-caused xenogeneic MPE, indicating that host-derived CCL2 also contributes to MPE precipitation in mice. The impact of CCL2/12 antagonism was associated with inhibition of immune and vascular MPE-related phenomena, such as inflammation, new blood vessel assembly and plasma extravasation into the pleural space. We conclude that CCL2 and CCL12 blockade are effective against experimental MPE induced by murine and human adenocarcinoma in mice. These results suggest that CCL2-targeted therapies may hold promise for future use against human MPE.

  1. Establishment of A Malignant Pleural Effusion Mouse Model with Lewis Lung 
Carcinoma Cell Lines Expressing Enhanced Green Fluorescent Protein

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    Xingqun MA

    2012-06-01

    Full Text Available Background and objective Malignant pleural effusion (MPE is a poor prognosis factor in patients with advanced lung cancer. The aim of this study is to establish a mouse model of MPE using Lewis lung carcinoma (LLC cell lines expressing enhanced green fluorescent protein (EGFP. Methods The mouse model was created by injecting LLC-EGFP cells directly into the pleural cavity of mice that were sacrificed periodically. The dynamic growth and metastasis of tumor cells were screened using in vivo fluorescence imaging. The remaining mice were subjected to transverse computed tomography (CT imaging periodically to analyze the formation rate of pleural effusion. The survival rate and tumor metastasis were also observed. Pleural fluid was gently aspirated using a 1 mL syringe and its volume was measured. When two or more mice bore pleural effusion at the same time, we calculated the average volume. The correlation of pleural effusion with the integrated optical density (IOD were analyzed. Results Four days after the inoculation of LLC-EGFP cells, green fluorescence was observed by opening the chest wall. The tumor formation rate was 100%, and the IOD gradually increased after inoculation. The metastasis sites were mediastinal, and the hilar lymph nodes were contralateral pleural as well as pericardial. The metastasis rates were 87%, 73% and 20%, respectively. The CT scan revealed that the formation rates of pleural effusion on days 7, 14 and 21 were 13%, 46% and 53%, respectively. The average volume of pleural effusion increased obviously on day 10 and peaked on day 16 with a value of 0.5 mL. The mean survival time of nude mice was 28.8 days. The volume of pleural effusion and IOD were significantly correlated (r=0.91, P<0.000,1. Conclusion A mouse model of lung cancer malignant pleural effusion was successfully established by injecting LLC lines expressing EGFP into the pleural cavity under a microscope. The model can enable dynamic observations of the

  2. [Paragonimus westermani infection confirmed by the detection of Paragonimus ova in the sputum with bilateral pleural effusion].

    Science.gov (United States)

    Tanijiri, Tsutomu; Yonezu, Seibun; Torii, Yoshitaro; Sugimoto, Hiroyuki; Yokoi, Takashi; Fukuhara, Shirou

    2009-12-01

    A 28-year-old man had a 1-year history of hemoptysis. Consequently, he underwent a medical examination. A right pleural effusion, left hydropneumothorax, and multiple pulmonary nodular shadows were found on chest radiography. During a detailed interview, he reported that the hemoptysis began after eating "kejang" (a raw crab preparation) with a friend a year previously. His peripheral blood eosinophil count and serum IgE level were elevated. In addition, ova were detected in the sputum and bilateral pleural effusion. Morphological examination of the ova and immunoserological examination led to the diagnosis of Paragonimus westermani infection. The pleural effusion could be partially drained, and his symptoms and radiographic results showed improvement after treatment with Praziquantel administered at a dose of 75 mg/(kg x day) for 3 days. After one month, he and his friend ate seasoned raw crabs, Paragonimus was diagnosed in his friend. This case suggests that on encountering a paragonimus infection, everyone who ate food prepared in the same kitchen should be contacted because of possible infection with paragonimus.

  3. Clinical Observation on the Efficacy of Xiaoshui Decoction Combined with Intrapleural Perfusion of Cisplatin in Treating Malignant Pleural Effusion

    Institute of Scientific and Technical Information of China (English)

    SHI Zhan; HE Qing-yong; HUA Bao-jin

    2008-01-01

    Objective: To observe the clinical efficacy of Xiaoshui decoction (XSD, 消水方) combined with intrapleural perfusion of cisplatin in the treatment of malignant pleural effusion. Methods: Fifty-one patients with malignant pleural effusion were randomly assigned to two groups. The treated group (26 patients) received oral administration of XSD combined with intrapleural perfusion of cisplatin, and the control group (25 patients) was only treated with intrapleural perfusion of cisplatin. The effects of the short-term efficacy, quality of life scores and clinical symptom scores of malignant pleural effusion were evaluated. Results: The short-term efficacy in the treated group and the control group was 72.0% and 58.3%, respectively, and no significant difference was found (P>0.05). In contrast, the quality of life in the treated group was significantly improved compared to that of the control group (P<0.05), and so was the symptom remission (P<0.05). Conclusions: The combined therapy of XSD and intrapleural perfusion of cisplatin did not show obvious improvement in short-term efficacy, but the therapy remarkably alleviated the symptoms and improved the quality of life of patients.

  4. Cellular sources of interleukin 16 in benign and malignant pleural effusions

    Institute of Scientific and Technical Information of China (English)

    LI Jian-jun; WEI Wei; SHI Huan-zhong; LI Ying-xin; MO Wu-ning

    2011-01-01

    Background Interleukin 16 (IL-16) can be detected by ELISA in pleural effusion (PE) and its concentration is higher than in serum.This study investigated the cellular sources of IL-16 in PE.Methods The samples of PE were collected from 34 patients who were newly diagnosed having PE in the pleural cavity.We performed cell culture to purify the pleural mesothelial cells (PMC),Wright staining to count the purity and immunocytochemical stain to identify the cultured cells.The intracellular IL-16 expression was detected by flow cytometry (FCM).The different cells in PE were first separated by magnetic cell sorting (MCAS) then the separated cells were cultured in RPMI1640 with 10% fetal calf serum (FCS).We extracted the supernatant and detected IL-16 concentration by ELISA.The IL-16 protein was detected by immunohistochemistry and double immunofluorescence staining.Results The percentages of cells which secreted IL-16 were:CD3+CD8 cells ((74.27±15.56)%,n=34); CD3+CD8+ cells ((69.86±18.55)%,n=34); CD19+ cells ((45.30±18.77)%,n=15); CD14+ cells ((16.91±16.69)%,n=15); and PMC ((2.05±1.85)%,n=7).The concentrations of IL-16 in the supernatant from cultured cells were:CD4+ cells ((102.50±42.51) ng/L,n=5); CD8+ cells ((92.58±18.34) ng/L,n=5); CD19+ cells ((79.85±5.62) ng/L,n=5); CD14+ cells ((58.51±25.38) ng/L,n=5); and PMC ((18.14±8.37) ng/L,n=5).In lymphocytes,monocytes/macrophages and PMC,we could observe the cells that expressed IL-16 protein.In paraffin-embedded sections,we also could observe by immunohistochemistry the CD4+IL-16+ cells,CD8+IL-16+ cells,CD19+IL-16+ cells,and CD14+IL-16+ cells.Conclusions IL-16 in PE is mainly secreted by T lymphocytes,including CD3+CD8- cells and CD3+CD8+celIs.CD19+ cells and CD14+ cells can also secrete IL-16,but the percentage of PMC that can secrete IL-16 is very low.

  5. Meta Analysis of Lentinan Injection plus Cisplatin in Treatment of Malignant Pleural Effusion

    Institute of Scientific and Technical Information of China (English)

    WANG Quan; HE Xi-ran; WANG Man-cai; TIAN Jin-hui

    2011-01-01

    Objective To evaluate the efficacy and safety of lentinan injection plus cisplatin (LIC) in the treatment of malignant pleural effusion (MPE).Methods We searched the database of Cochrane Library,PubMed,EMBASE,ISI Web of Knowledge,Chinese Biomedical Literature Database,Chinese Scientific Journals Full-text Database,Chinese Journal Full-text,and Google Scholar,etc.,up to February 28th,2011 to identify randomized controlled trials (RCTs) about lentinan injection (LI) for MPE,evaluate the quality of the included studies,and analyze the data by Cochrane Collaboration's RevMan5.0 software.Results Twenty-nine RCTs involving 1831 patients were included.Meta analysis results suggested that there were some differences when comparing LIC with control groups suffering from MPE,for LIC could improve the near-term curative effect and the quality of life to some extent.Besides,compared with chemotherapy alone,LI plus chemotherapy had an advantage in relieving adverse reactions,such as gastrointestinal reactions,myelosuppression,chest pain,and general malaise.Conclusion The current evidence indicates that LI may have adjuvant therapeutic effects for MPE.

  6. Assessing the function of homologous recombination DNA repair in malignant pleural effusion (MPE) samples.

    Science.gov (United States)

    Patterson, M J; Sutton, R E; Forrest, I; Sharrock, R; Lane, M; Kaufmann, A; O'Donnell, R; Edmondson, R J; Wilson, B T; Curtin, N J

    2014-07-08

    Patients with malignant pleural effusions (MPEs) generally have advanced disease with poor survival and few therapeutic options. Cells within MPEs may be used to stratify patients for targeted therapy. Targeted therapy with poly(ADP ribose) polymerase inhibitors (PARPi) depends on identifying homologous recombination DNA repair (HRR)-defective cancer cells. We aimed to determine the feasibility of assaying HRR status in MPE cells. A total of 15 MPE samples were collected from consenting patients with non-small-cell lung cancer (NSCLC), mesothelioma and ovarian and breast cancer. Primary cultures were confirmed as epithelial by pancytokeratin, and HRR status was determined by the detection of γH2AX and RAD51 foci following a 24-h exposure to rucaparib, by immunofluorescence microscopy. Massively parallel next-generation sequencing of DNA repair genes was performed on cultured MPE cells. From 15 MPE samples, 13 cultures were successfully established, with HRR function successfully determined in 12 cultures. Four samples - three NSCLC and one mesothelioma - were HRR defective and eight samples - one NSCLC, one mesothelioma, one sarcomatoid, one breast and four ovarian cancers - were HRR functional. No mutations in DNA repair genes were associated with HRR status, but there was probable loss of heterozygosity of FANCG, RPA1 and PARP1. HRR function can be successfully detected in MPE cells demonstrating the potential to stratify patients for targeted therapy with PARPi.

  7. What is the probability of a patient presenting a pleural effusion due to tuberculosis?

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    Denise Duprat Neves

    Full Text Available INTRODUCTION: In Rio de Janeiro, in almost half of the cases of pleural tuberculosis (PT treatment begins without substantiation of diagnosis. We examined variables associated with this disease. METHOD: We studied 215 consecutive patients; 104 had tuberculosis (TB and 111 did not (NTB: 41 neoplasms, 29 transudates, 28 para-pneumonic and 13 other etiologies. Clinical and laboratory variables were assessed in a combined manner using likelihood ratios (LR and Bayes' theorem to determine the probability of PT. RESULTS: Among the variables examined, adenosine deaminase (ADA levels, lymphocyte cell percentage, protein and age were the best indicators for the diagnosis of PT. Association of ADA with any of the other variables led to a LR+ higher than 10 and a LR- lower than 0.1, indicating the presence or absence of PT, with an individual probability of more than 90% or of less than 10% considering that there was a 50% initial probability associated with the presence of PT. CONCLUSIONS: Since ADA is highly sensitive, we can practically exclude TB as the cause of effusion when there are low ADA values. However, to confirm the possibility of TB we recommend that other variables, such as prevalence of lymphocytes (higher than 90%, and high protein levels (more than 4g/dL; low age (less than 45 years also should be considered.

  8. Value of adenosine deaminase activity to diagnosing tuberculous pleural effusion and malignant effusion%腺苷脱氨酶诊断结核性和恶性胸腔积液价值

    Institute of Scientific and Technical Information of China (English)

    唐学义; 林香花; 朱敏

    2011-01-01

    Objective To investigate the clinical value of pleural effusion adenosine deaminase activity to differentiating tuberculous pleural effusion from malignant effusion.Methods A total of 80 inpatients with pleural effusion received thoracoscopy and biopsy of pleura and were diagnosed tuberculous pleuritis (42 cases) and malignant pleural effusion (38 cases).The pleural effusion and adenosine deaminase activity were detected in these two groups.The optimal cutoff for tuberculous pleural effusion was determined with the ROC curve.Results The pleural effusion adenosine deaminase activity and the ratio of pleural fluid to serum adenosine deaminase were (48±25)u/L and 4.2±3.0 in tuberculous pleural effusion patients, significantly higher than those in malignant pleural effusion patients (20±9)u/L and 1.7±1.0 respectively( P<0.01).The serum adenosine deaminase activities were (15±6)u/L and (12±5)u/L in tuberculous pleuritis patients and malignant pleural effusion,which showed no significant difference(P>0.05).The cutoff value of pleural adenosine deaminase determined with ROC curve was 30.7 u/L, the sensitivity was 70.5% and the specificity was 92.2%.Conclusion The pleural effusion adenosine deaminase activity but not the serum adenosine deaminase activity can be used to differentiate tuberculous from malignant pleural effusion.%目的:探讨胸腔积液和血清中腺苷脱氨酶鉴别诊断结核性胸膜炎及恶性胸腔积液的价值.方法:因胸腔积液住院,经胸腔镜检查和胸膜活检病理确诊为结核性胸腹炎患者(结核组)42例和恶性胸腔积液患者(恶性组)38例,分别检测2组胸腔积液及血清中腺苷脱氨酶活性,应用ROC曲线确定结核性胸膜炎患者胸腔积液腺苷脱氨酶的最佳临界值.结果:结核组胸腔积液腺苷脱氨酶活性、胸腔积液腺苷脱氨酶与血清腺苷脱氨酶比值分别为(48±25)u/L和4.2±3.0,高于恶性组的(20±9)u/L和1.7±1.0.差异均有统计学意义(P<0

  9. 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

  10. Analysis of volatile organic compounds in pleural effusions by headspace solid-phase microextraction coupled with cryotrap gas chromatography and mass spectrometry.

    Science.gov (United States)

    Huang, Zhongping; Zhang, Jie; Zhang, Peipei; Wang, Hong; Pan, Zaifa; Wang, Lili

    2016-07-01

    Headspace solid-phase microextraction coupled with cryotrap gas chromatography and mass spectrometry was applied to the analysis of volatile organic compounds in pleural effusions. The highly volatile organic compounds were separated successfully with high sensitivity by the employment of a cryotrap device, with the construction of a cold column head by freezing a segment of metal capillary with liquid nitrogen. A total of 76 volatile organic compounds were identified in 50 pleural effusion samples (20 malignant effusions and 30 benign effusions). Among them, 34 more volatile organic compounds were detected with the retention time less than 8 min, by comparing with the normal headspace solid-phase microextraction coupled with gas chromatography and mass spectrometry method. Furthermore, 24 volatile organic compounds with high occurrence frequency in pleural effusion samples, 18 of which with the retention time less than 8 min, were selected for the comparative analysis. The results of average peak area comparison and box-plot analysis showed that except for cyclohexanone, 2-ethyl-1-hexanol, and tetramethylbenzene, which have been reported as potential cancer biomarkers, cyclohexanol, dichloromethane, ethyl acetate, n-heptane, ethylbenzene, and xylene also had differential expression between malignant and benign effusions. Therefore, the proposed approach was valuable for the comprehensive characterization of volatile organic compounds in pleural effusions.

  11. Increased oxidative stress in exudative pleural effusions: a new marker for the differentiation between exudates and transudates?

    Science.gov (United States)

    Papageorgiou, Evangelia; Kostikas, Konstantinos; Kiropoulos, Theodoros; Karetsi, Eleni; Mpatavanis, Georgios; Gourgoulianis, Konstantinos I

    2005-11-01

    Oxidative stress has been associated with various respiratory disorders. We tested the hypothesis that exudates would present higher levels of oxidative stress compared to transudates, expressing the increased local oxidative burst in the former. Prospective, cross-sectional study. One hundred six consecutive patients who had undergone thoracentesis were studied. Ninety patients with a final diagnosis of pleural effusion were further analyzed. The respiratory department and a clinical laboratory of a tertiary hospital. Subjects underwent diagnostic thoracentesis, and standard biochemical parameters (ie, total protein, lactate dehydrogenase, and albumin levels) were measured in pleural fluid and serum. Oxidative stress levels were assessed with a commercially available method (d-ROMs test; Diacron; Grosseto, Italy) that uses conventional Carratelli units (UCarr). In 14 patients, duplicate measurements of oxidative stress and a second thoracentesis were performed on the following day for the assessment of the repeatability of measurements. Receiver operating characteristic (ROC) analysis was performed in order to determine the optimal cutoff level for the differentiation between exudates and transudates. Oxidative stress levels were higher in exudates compared to transudates (mean [+/- SD] stress level, 274 +/- 72 vs 126 +/- 34 UCarr, respectively; p exudative effusions of different etiologies. The area under the ROC curve was 0.992 (95% confidence interval, 0.945 to 0.997), and the method provided high sensitivity (96.8%), high specificity (96.3%), and high accuracy (96.7%) for the diagnosis of exudates at a cutoff level for oxidative stress of 186 UCarr. Consecutive measurements of oxidative stress in the same samples and on fluid from two different thoracenteses performed on 2 consecutive days presented excellent repeatability. Oxidative stress levels are higher in exudative pleural effusions compared to transudative effusions, probably due to reactive oxygen

  12. A combination of the QuantiFERON-TB Gold In-Tube assay and the detection of adenosine deaminase improves the diagnosis of tuberculous pleural effusion.

    Science.gov (United States)

    Liu, Yuanyuan; Ou, Qinfang; Zheng, Jian; Shen, Lei; Zhang, Bingyan; Weng, Xinhua; Shao, Lingyun; Gao, Yan; Zhang, Wenhong

    2016-08-03

    The differential diagnosis of tuberculous pleural effusion (TPE) and malignant pleural effusion (MPE) remains difficult despite the availability of numerous diagnostic tools. The current study aimed to evaluate the performance of the whole blood QuantiFERON-TB Gold In-Tube (QFT-GIT) assay and conventional laboratory biomarkers in differential diagnosis of TPE and MPE in high tuberculosis prevalence areas. A total of 117 patients with pleural effusions were recruited, including 91 with TPE and 26 with MPE. All of the patients were tested with QFT-GIT, and the conventional biomarkers in both blood and pleural effusion were detected. The level of antigen-stimulated QFT-GIT in the whole blood of TPE patients was significantly higher than that of MPE (2.89 vs 0.33 IU/mL, Pdiagnosis of TPE were 93.0% and 60.0%, respectively. Among the biomarkers in blood and pleural effusion, pleural adenosine deaminase (ADA) was the most prominent biomarker, with a cutoff value of 15.35 IU/L. The sensitivity and specificity for the diagnosis of TPE were 93.4% and 96.2%, respectively. The diagnostic classification tree from the combination of these two biomarkers was 97.8% sensitive and 92.3% specific. Ultimately, the combination of whole blood QFT-GIT with pleural ADA improved both the specificity and positive predictive value to 100%. Thus, QFT-GIT is not superior to pleural ADA in the differential diagnosis of TPE and MPE. Combined whole blood QFT-GIT and pleural ADA detection can improve the diagnosis of TPE.

  13. Exudative pleural effusions in patients over forty years of age--an analysis of seventy-six patients.

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    Prabhudesai P

    1993-10-01

    Full Text Available A prospective study of 76 consecutive patients over the age of 40 years, with exudative pleural effusion, was undertaken to determine the common causes of such a clinical condition. Malignant pleural effusions were the most common in this series, found in 49 patients (64.47%, all but one being metastatic from elsewhere. Forty were secondary to a carcinoma of the bronchus, 3 from carcinoma of the breast, 1 each from carcinoma of the ovary, oesophagus, and larynx; lymphoma accounted for the remaining 2. Infective causes accounted for 24 of the effusions (31.57%. Of the infections, tuberculosis was the most common, accounting for 17 of the 24. Other infective causes included bacterial empyemas in 4, ruptured amoebic liver abscess in 2, and actinomycosis in 1. Pancreatitis, pulmonary thromboembolism, and a post-cardiotomy syndrome were diagnosed in 1 patient each, while the diagnosis remained unknown in the remaining 5 patients. In 2 patients the diagnosis was made on autopsy.

  14. Soluble CD40 in plasma and malignant pleural effusion with non-small cell lung cancer:A potential marker of prognosis

    Institute of Scientific and Technical Information of China (English)

    Chuan-Yong Mu; Pang-Xue Qin; Qiu-Xia Qu; Cheng Chen; Jian-An Huang

    2015-01-01

    Objective: Soluble CD40 (sCD40) is a potential modulator for both antitumor responses and CD40-based immunotherapy;however the levels and significance of sCD40 in non-small cell lung cancer (NSCLC) patients with malignant pleural effusion are unknown. Methods: Forty-eight patients with lung cancer were treated in our institutions from January 2008 to January 2010. Peripheral blood and pleural effusion samples were collected from each subject. sCD40 levels in plasma and malignant pleural effusions supernatant were measured. The CD40L expression on CD3t T-cells was confirmed by flow cytometric direct immunofluorescence analysis. All patients were followed up after the study ended on January 1, 2010. Results: Patients with malignant pleural effusion of NSCLC had elevated circulating and pleural effusion levels of sCD40, and these elevated sCD40 levels were associated with advanced diseases and a poor prognosis. Conclusions: These findings indicate that elevated sCD40 may have a role in modulating antitumor responses and may also be a useful prognostic marker. Copyright © 2015, Chinese Medical Association Production. Production and hosting by Elsevier B.V. on behalf of KeAi Communications Co., Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

  15. A stepwise approach to the etiologic diagnosis of pleural effusion in respiratory intensive care unit and short-term evaluation of treatment

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    Nilesh J Chinchkar

    2015-01-01

    Full Text Available Background: Pleural effusions in respiratory intensive care unit (RICU are associated with diseases of varied etiologies and often carry a grave prognosis. This prospective study was conducted to establish an etiologic diagnosis in a series of such patients before starting treatment. Materials and Methods: Fifty consecutive patients, diagnosed with pleural effusion on admission or during their stay in RICU, were further investigated by a two-step approach. (1 Etiologic diagnosis was established by sequential clinical history and findings on physical examination, laboratory tests, chest radiograph, CECT/HRCT/PET-CT and pleural fluid analysis. (2 Patients who remained undiagnosed were subjected to fiber-optic bronchoscopy, video-assisted thoracoscopic pleural biopsy, and histopathology. Results: Etiologic diagnosis of pleural effusion was established in 44 (88% Metastases (24%; para-pneumonia (22%; congestive cardiac failure (18%; tuberculosis (14%; hemothorax (4%; trapped lung, renal failure, and liver cirrhosis (2% each. Six patients (12% remained undiagnosed, as the final diagnostic thoracoscopic biopsy could not be performed in five and tissue histopathology findings were inconclusive in one. Out of the 50 patients, 10 died in the hospital; 2 left against medical advice; and 2 were referred to oncology center for further treatment. The remaining 36 patients were clinically stabilized and discharged. During a 3-month follow-up, eight of them were re-hospitalized, of which four died. Conclusions: Pleural effusion in RICU carries a high risk of mortality. Etiologic diagnosis can be established in most cases.

  16. Birth characteristics and recurrent otitis media with effusion in young children.

    NARCIS (Netherlands)

    Engel, J.A.M.; Straetemans, M.; Zielhuis, G.A.

    2005-01-01

    OBJECTIVE: To study the association between birth characteristics and the recurrence of otitis media with effusion (OME). METHODS: Prospective cohort study on 136 children aged 2-7 years, who received tympanostomy tubes for bilateral otitis media with effusion. Checkups were planned 1 week after tub

  17. Birth characteristics and recurrent otitis media with effusion in young children.

    NARCIS (Netherlands)

    Engel, J.A.M.; Straetemans, M.; Zielhuis, G.A.

    2005-01-01

    OBJECTIVE: To study the association between birth characteristics and the recurrence of otitis media with effusion (OME). METHODS: Prospective cohort study on 136 children aged 2-7 years, who received tympanostomy tubes for bilateral otitis media with effusion. Checkups were planned 1 week after

  18. Current practices in the management of malignant pleural effusions: a survey among members of the European Society of Thoracic Surgeons.

    Science.gov (United States)

    Scarci, Marco; Caruana, Edward; Bertolaccini, Luca; Bedetti, Benedetta; Brunelli, Alessandro; Varela, Gonzalo; Papagiannopoulos, Kostas; Kuzdzal, Jaroslaw; Massard, Gilbert; Ruffini, Enrico; Falcoz, Pierre Emmanuel; Opitz, Isabelle; Batirel, Hasan; Toker, Alper; Rocco, Gaetano

    2017-03-01

    Malignant pleural effusion (MPE) commonly complicates advanced malignancy and their exact management is still undefined. We undertook a survey to determine the current practice among members of the European Society of Thoracic Surgeons (ESTS). A cross-sectional survey focused on the current practice of management of MPE was developed by the authors. The questions were outlined after a review of the literature and circulated in an Internet-based survey format. Computed tomography (125, 92%) and chest X-ray (106, 78%) are the most common imaging modalities performed in the initial evaluation. Video-assisted thoracoscopic surgery for washout and pleurodesis (93, 68%) was reported as the preferred approach to patients with uncomplicated MPE. Sixty-one (45%) of the responding colleagues routinely use large bore chest tubes for draining malignant effusions. Forty-nine (35%) surgeons would not apply suction to the drainage system, whilst 50 (37%) would use -2 kPa or less. Talc (124, 91%) is the most commonly used sclerosing agent for pleurodesis in the context of malignant pleural effusion. The practice of 76 (56%) of the respondents is not informed by any clinical guidelines, whilst 60 (44%) reported adhering to the 2010 British Thoracic Society Pleural Disease Guideline. Seventy-one (52%) declared that the guidance was in need of updating or revision. This survey demonstrates the lacking adoption of the existing clinical guidance in this field, as well as the need for more contemporary guidelines for a better-informed practice. The ESTS Working Group on the management of MPE has been established for this purpose.

  19. Hydralazine Induced Lupus Syndrome Presenting with Recurrent Pericardial Effusion and a Negative Antinuclear Antibody

    OpenAIRE

    Praneet Iyer; Ahmed Dirweesh; Ritika Zijoo

    2017-01-01

    Drug induced lupus erythematosus (DIL or DILE) is an autoimmune disorder caused by chronic use of certain drugs. We report a unique case of hydralazine induced lupus syndrome (HILS) with a negative antinuclear antibody in a female patient who was on hydralazine for a period of 1.5–2 years and developed recurrent pericardial effusion as a result of it. Initially her condition was managed with a pericardial window. The recurrence of a massive pericardial effusion necessitated a right hemiperica...

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

    OpenAIRE

    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 ...

  1. Recurrent hemorrhagic pericardial effusion in a child due to diffuse lymphangiohemangiomatosis: a case report

    Directory of Open Access Journals (Sweden)

    Bakhshi Sameer

    2010-02-01

    Full Text Available Abstract Introduction Recurrent hemorrhagic pericardial effusion in children with no identifiable cause is a rare presentation. Case presentation We report the case of a 4-year-old Indian girl who presented with recurrent hemorrhagic pericardial effusion. Diffuse lymphangiomatosis was suspected when associated pulmonary involvement, soft tissue mediastinal mass, and lytic bone lesions were found. Pericardiectomy and lung biopsy confirmed the diagnosis of diffuse lymphangiohemangiomatosis. Partial clinical improvement occurred with thalidomide and low-dose radiotherapy, but our patient died from progressive respiratory failure. Conclusion Diffuse lymphangiohemangiomatosis should be considered in the differential diagnosis of hemorrhagic pericardial effusion of unclear cause.

  2. Hydralazine Induced Lupus Syndrome Presenting with Recurrent Pericardial Effusion and a Negative Antinuclear Antibody

    Science.gov (United States)

    Iyer, Praneet; Zijoo, Ritika

    2017-01-01

    Drug induced lupus erythematosus (DIL or DILE) is an autoimmune disorder caused by chronic use of certain drugs. We report a unique case of hydralazine induced lupus syndrome (HILS) with a negative antinuclear antibody in a female patient who was on hydralazine for a period of 1.5–2 years and developed recurrent pericardial effusion as a result of it. Initially her condition was managed with a pericardial window. The recurrence of a massive pericardial effusion necessitated a right hemipericardiectomy. After hydralazine was stopped, she never had any further episodes of pericardial effusion or tamponade. PMID:28194293

  3. Hydralazine Induced Lupus Syndrome Presenting with Recurrent Pericardial Effusion and a Negative Antinuclear Antibody

    Directory of Open Access Journals (Sweden)

    Praneet Iyer

    2017-01-01

    Full Text Available Drug induced lupus erythematosus (DIL or DILE is an autoimmune disorder caused by chronic use of certain drugs. We report a unique case of hydralazine induced lupus syndrome (HILS with a negative antinuclear antibody in a female patient who was on hydralazine for a period of 1.5–2 years and developed recurrent pericardial effusion as a result of it. Initially her condition was managed with a pericardial window. The recurrence of a massive pericardial effusion necessitated a right hemipericardiectomy. After hydralazine was stopped, she never had any further episodes of pericardial effusion or tamponade.

  4. Polyacrylate/nanosilica causes pleural and pericardial effusion, and pulmonary fibrosis and granuloma in rats similar to those observed in exposed workers.

    Science.gov (United States)

    Zhu, Xiaoli; Cao, Wen; Chang, Bing; Zhang, Linyuan; Qiao, Peihuan; Li, Xue; Si, Lifang; Niu, Yingmei; Song, Yuguo

    2016-01-01

    Nanomaterials offer great benefit as well as potential damage to humans. Workers exposed to polyacrylate coatings have pleural effusion, pericardial effusion, and pulmonary fibrosis and granuloma, which are thought to be related to the high exposure to nanomaterials in the coatings. The study aimed to determine whether polyacrylate/silica nanoparticles cause similar toxicity in rats, as observed in exposed workers. Ninety male Wistar rats were randomly divided into five groups with 18 rats in each group. The groups included the saline control group, another control group of polyacrylate only, and low-, intermediate-, and high-dose groups of polyacrylate/nanosilica with concentrations of 3.125, 6.25, and 12.5 mg/kg. Seventy-five rats for the 1-week study were terminated for scheduled necropsy at 24 hours, 3 days, and 7 days postintratracheal instillation. The remaining 15 rats (three males/group) had repeated ultrasound and chest computed tomography examinations in a 2-week study to observe the pleural and pericardial effusion and pulmonary toxicity. We found that polyacrylate/nanosilica resulted in pleural and pericardial effusions, where nanosilica was isolated and detected. Effusion occurred on day 3 and day 5 post-administration of nanocomposites in the 6.25 and 12.5 mg/kg groups, it gradually rose to a maximum on days 7-10 and then slowly decreased and disappeared on day 14. With an increase in polyacrylate/nanosilica concentrations, pleural effusion increased, as shown by ultrasonographic qualitative observations. Pulmonary fibrosis and granuloma were also observed in the high-dose polyacrylate/nanosilica group. Our study shows that polyacrylate/nanosilica results in specific toxicity presenting as pleural and pericardial effusion, as well as pulmonary fibrosis and granuloma, which are almost identical to results in reported patients. These results indicate the urgent need and importance of nanosafety and awareness of toxicity of polyacrylate/nanosilica.

  5. Fluid loading and norepinephrine infusion mask the left ventricular preload decrease induced by pleural effusion.

    Science.gov (United States)

    Wemmelund, Kristian Borup; Ringgård, Viktor Kromann; Vistisen, Simon Tilma; Hyldebrandt, Janus Adler; Sloth, Erik; Juhl-Olsen, Peter

    2017-09-11

    Pleural effusion (PLE) may lead to low blood pressure and reduced cardiac output. Low blood pressure and reduced cardiac output are often treated with fluid loading and vasopressors. This study aimed to determine the impact of fluid loading and norepinephrine infusion on physiologic determinants of cardiac function obtained by ultrasonography during PLE. In this randomised, blinded, controlled laboratory study, 30 piglets (21.9 ± 1.3 kg) had bilateral PLE (75 mL/kg) induced. Subsequently, the piglets were randomised to intervention as follows: fluid loading (80 mL/kg/h for 1.5 h, n = 12), norepinephrine infusion (0.01, 0.03, 0.05, 0.1, 0.2 and 0.3 μg/kg/min (15 min each, n = 12)) or control (n = 6). Main outcome was left ventricular preload measured as left ventricular end-diastolic area. Secondary endpoints included contractility and afterload as well as global measures of circulation. All endpoints were assessed with echocardiography and invasive pressure-flow measurements. PLE decreased left ventricular end-diastolic area, mean arterial pressure and cardiac output (p values  0.05) to baseline. Left ventricular contractility increased with norepinephrine infusion (p = 0.002), but was not affected by fluid loading (p = 0.903). Afterload increased in both active groups (p values > 0.001). Overall, inferior vena cava distensibility remained unchanged during intervention (p values ≥ 0.085). Evacuation of PLE caused numerical increases in left ventricular end-diastolic area, but only significantly so in controls (p = 0.006). PLE significantly reduced left ventricular preload. Both fluid and norepinephrine treatment reverted this effect and normalised global haemodynamic parameters. Inferior vena cava distensibility remained unchanged. The haemodynamic significance of PLE may be underestimated during fluid or norepinephrine administration, potentially masking the presence of PLE.

  6. Proteomic characterization of pleural effusion, a specific host niche of Mycoplasma mycoides subsp. mycoides from cattle with contagious bovine pleuropneumonia (CBPP).

    Science.gov (United States)

    Weldearegay, Yenehiwot B; Pich, Andreas; Schieck, Elise; Liljander, Anne; Gicheru, Nimmo; Wesonga, Hezron; Thiaucourt, Francois; Kiirika, Leonard M; Valentin-Weigand, Peter; Jores, Joerg; Meens, Jochen

    2016-01-10

    Mycoplasma mycoides subsp. mycoides (Mmm) is the causative agent of contagious bovine pleuropneumonia (CBPP), a severe pleuropneumonia in cattle. The abnormal accumulation of pleural fluid, called pleural effusion (PE), is one of the characteristics of this disease. We performed a proteomic analysis of seven PE samples from experimentally infected cattle and characterized their composition with respect to bovine and Mmm proteins. We detected a total of 963 different bovine proteins. Further analysis indicated a strong enrichment of proteins involved in antigen processing, platelet activation and degranulation and apoptosis and an increased abundance of acute phase proteins.With regard to the pathogen, up to 108 viable mycoplasma cells per ml were detected in the PE supernatant. The proteomic analysis revealed 350 mycoplasma proteins, including proteins involved in virulence-associated processes like hydrogen peroxide (H2O2) production and capsule synthesis. The bovine proteins detected will aid to characterize the inflammasome during an acute pleuropneumonia in cattle and the identified mycoplasma proteins will serve as baseline data to be compared with in vitro studies to improve our understanding of pathogenicity mechanisms. Based on our results, we named the pleural effusion an “in vivo niche” of Mmm during the acute phase of CBPP. Biological significance: This is the first study on bovine pleural effusions derived from an infectious disease and the first approach to characterize the proteome of Mycoplasma mycoides in vivo. This study revealed a high number of viable Mmm cells in the pleural effusion. The bovine pleural effusion proteome during Mmm infection is qualitatively similar to plasma, but differs with respect to high abundance of acute phase proteins. On the other hand,Mmm in its natural host produces proteins involved in capsule synthesis, H2O2 production and induction of inflammatory response, supporting previous knowledge on mechanisms underlying

  7. Recurrent hemorrhagic pericardial effusion and tamponade due to filariasis successfully treated with ivermectin and albendazole

    Directory of Open Access Journals (Sweden)

    Santosh Kumar Sinha

    2015-01-01

    Full Text Available Filariasis presenting with pericardial effusion with tamponade is rare. We report a case of a 30-year-old female who was admitted with severe dyspnea and chest pain since 2 days. Echocardiogram showed massive pericardial effusion with tamponade. Pericardial fluid aspiration drained 1.2 L of hemorrhagic fluid. Cytology examination revealed microfilaria of Wuchereria bancrofti. She was treated with diethyl carbamazine and discharged. Six weeks later, she presented again with massive pericardial effusion with cardiac tamponade. Pericardiocentesis was done. Cytology examination revealed microfilaria of W. bancrofti. This time she was treated with ivermectin and albendazole and cured. Hemorrhagic effusion resolved completely. Though relatively uncommon, tropical diseases must always be considered in the etiological diagnosis of recurrent pericardial effusion.

  8. Recurrent Hemorrhagic Pericardial Effusion and Tamponade due to Filariasis Successfully Treated with Ivermectin and Albendazole.

    Science.gov (United States)

    Sinha, Santosh Kumar; Goel, Amit; Sachan, Mohit; Saraf, Sameer; Verma, Chandra Mohan

    2015-01-01

    Filariasis presenting with pericardial effusion with tamponade is rare. We report a case of a 30-year-old female who was admitted with severe dyspnea and chest pain since 2 days. Echocardiogram showed massive pericardial effusion with tamponade. Pericardial fluid aspiration drained 1.2 L of hemorrhagic fluid. Cytology examination revealed microfilaria of Wuchereria bancrofti. She was treated with diethyl carbamazine and discharged. Six weeks later, she presented again with massive pericardial effusion with cardiac tamponade. Pericardiocentesis was done. Cytology examination revealed microfilaria of W. bancrofti. This time she was treated with ivermectin and albendazole and cured. Hemorrhagic effusion resolved completely. Though relatively uncommon, tropical diseases must always be considered in the etiological diagnosis of recurrent pericardial effusion.

  9. Recurrent, symptomatic, late-onset, contralateral subdural effusion following decompressive craniectomy treated by cranial strapping.

    Science.gov (United States)

    Krishnan, Prasad; Roy Chowdhury, Siddhartha

    2015-01-01

    Subdural effusions following decompressive craniotomy for trauma are usually benign, ipsilateral to the craniotomy and resolve spontaneously. Far less common and more dangerous are contralateral subdural effusions causing external cerebral herniation. We report a case of recurrent contralateral effusion and highlight the management dilemmas. Arachnoid tear is probably the cause of these collections. Contralateral subdural effusions should be suspected in patients who have delayed neurological deterioration after an initial improvement particularly in the setting of increased "flap bulge" though they may also be found in patients who remain moribund after initial surgery. There are no clear-cut guidelines on their management due to their rarity. A variety of options like subduro-peritoneal shunt and drainage with simultaneous cranioplasty may be tried. In situations where resources or patient compliance is an issue, tapping the effusion followed by cranial strapping may be tried as was done in our case.

  10. Pleural Effusion in Meigs' Syndrome-Transudate or Exudate?: Systematic Review of the Literature

    National Research Council Canada - National Science Library

    Krenke, Rafal; Maskey-Warzechowska, Marta; Korczynski, Piotr; Zielinska-Krawczyk, Monika; Klimiuk, Joanna; Chazan, Ryszarda; Light, Richard W

    2015-01-01

    Although Meigs' syndrome is regarded as a well-defined entity, contradictory data on pleural fluid characteristics have been presented, with some papers classifying it as a transudate, whereas others...

  11. Comparison of the Diagnostic Accuracy of the MSLN Gene Products, Mesothelin and Megakaryocyte Potentiating Factor, as Biomarkers for Mesothelioma in Pleural Effusions and Serum

    Directory of Open Access Journals (Sweden)

    Jenette Creaney

    2013-01-01

    Full Text Available The MSLN gene products, soluble mesothelin and megakaryocyte potentiating factor (MPF, are being investigated as biomarkers for the asbestos-related cancer malignant mesothelioma (MM. Pleural fluid biomarkers of MM can be elevated when serum levels remain normal. The aim of this study was to determine if this was true for MPF and to compare levels of mesothelin. Biomarker concentrations were compared in 66 MM patients, 39 patients with other malignancies, 37 with benign disease, 18 asbestos-exposed healthy individuals, and 53 patients with chronic kidney disease. In pleural effusions, MPF and soluble mesothelin concentrations were both significantly elevated in MM patients relative to controls. No significant difference between the area under the receiver operator curve (AUC for MPF (0.945±0.02 and mesothelin (0.928±0.03 when distinguishing MM from all other causes of effusion was observed. MPF and mesothelin serum concentrations were highly correlated and of equivalent diagnostic accuracy with AUCs of 0.813±0.04 and 0.829±0.03, respectively. Serum levels of both markers increased with decreasing kidney function. In conclusion, MPF is elevated in the pleural effusions of MM patients similar to that of mesothelin. Mesothelin and MPF convey equivalent diagnostic information for distinguishing MM from other diseases in pleural effusions as well as serum.

  12. Observation of efficacy of tumor infiltrating lymphocytes in treatment of malignant pleural effusion%TIL细胞治疗恶性胸水的疗效观察

    Institute of Scientific and Technical Information of China (English)

    陈建清; 曾道林; 康美玲; 钟小红; 董书春; 刘进兵; 吴晓安

    2011-01-01

    目的 观察肿瘤浸润淋巴细胞(TIL)治疗恶性胸水的疗效.方法 从30例恶性肿瘤胸水中的肿瘤细胞分离得到TIL,并经10%人AB血清RPMI-1640液培养,经rIL-2体外激活培养,随后胸腔注射.结果 完全缓解12例(40.0%),有效15例(50.0%),无效3例(10.0%),总有效率90.0%(27/30).结论 TIL治疗恶性胸腔积液疗效好,毒副作用小,能改善患者的生活质量.%Objective To evaluate the efficacy of tumor infiltrating lymphocytes (TIL)in treatment of patients with malignant pleural effusion. Methods TILs derived from malignant pleural effusion of 30 patients were cultivated in 10% human AB type serum RPMI -1640 liquid medium, activated by rIL-2 in vitro and injected into thoracic cavities. Results CR 12(40. 0% ) ,PR 15(50. 0% ), NR 3( 10. 0% ). Conclusion The result suggests that TILs derived from malignant pleural effusion have good therapeutic efficacy and is safe in patients with malignant pleural effusion and can improve the quality of life of the patients.

  13. Early secretory antigenic target protein-6/culture filtrate protein-10 fusion protein-specific Th1 and Th2 response and its diagnostic value in tuberculous pleural effusion

    Institute of Scientific and Technical Information of China (English)

    戈启萍

    2013-01-01

    Objective To detect the Th1 and Th2 cell percentage in pleural effusion mononuclear cells (PEMCs) stimulated by early secretory antigenic target protein-6 (ESAT-6) /culture filtrate protein-10 (CFP-10) fusion protein (E/C) with flow cytometry (FCM) ,and to explore the local antigen specific Th1 and Th2 response and

  14. Management of Postoperative Pleural Effusion in Lung Cancer%肺癌术后胸腔积液的治疗体会

    Institute of Scientific and Technical Information of China (English)

    李谦平; 王建军; 江科; 杨光海; 郭海周

    2011-01-01

    Objective To study the treatment of postoperative pleural effusion in lung cancer. Methods Sixty-eight cases of lung cancer with postoperative pleural effusion were collected from January 2006 to June 2009 in Union hospital of Tongji Medical College. The treatment methods of pleural effusion included bronchoscopy, antibiotics adjustment, pleurodesis with talcum, DDP and 50 % glucose through a transchest catheter,chest clearance and simultaneously bronchial stump embedment with pericardium or azygos vein. Results Sixty-six patients were cured, although 2 patients failed to remove pleural effusion. Conclusion Postoperative pleural effusion, a common complication induced by surgery in lung cancer, was able to be controlled by strongly treatment.%目的 探讨肺癌术后胸腔积液的治疗.方法 收集2006年1月-2009年6月期间在我院诊治的肺癌术后胸腔积液68例,通过纤维支气管镜吸痰、调整抗生素、经胸管胸腔内注入滑石粉、注入50%葡萄糖、胸腔清理同时行支气管残端心包或奇静脉包埋、胸腔注入顺铂、乳糜胸结扎胸导管治疗胸腔积液.结果 只有2例未能拔除胸管,带管出院,其余均治愈.结论 胸腔积液是肺癌术后一种常见的并发症,积极治疗,效果较好.

  15. Diagnostic value of pleural fluid C - reactive protein and ADA in pleural effusion%联合检测CRP、ADA对胸腔积液病因诊断价值的探讨

    Institute of Scientific and Technical Information of China (English)

    常万松; 薛迪中; 焦鹏飞; 赵伟

    2011-01-01

    目的 探讨联合检测胸液C-反应蛋白(CRP)和腺苷脱氨酶(ADA)在诊断类肺炎性胸腔积液、结核性胸腔积液和癌性胸腔积液的价值.方法 回顾性分析诊断明确的18例类肺炎性胸腔积液、28例结核性胸腔积液和42例癌性胸腔积液患者的临床资料,比较三者胸液中CRP及ADA含量的差别.结果 ①胸液CRP水平:类肺炎性胸腔积液(12.38±8.01)mg/dL,显著高于结核性胸液(3.64±1.85)mg/dL和癌性胸液患者(1.43±1.18)mg/dL(P<0.01),结核性胸腔积液患者胸液CRP水平显著高于癌性胸腔积液患者(P<0.05).②胸液ADA水平:类肺炎性胸腔积液患者(47.73±19.11)U/L,与结核性胸腔积液(84.02±55.11)U/L和癌性胸腔积液患者(26.14±12.09)U/L存在显著统计学差异(P=0.00031).③若两项指标联合检测(即胸液CRP>1mg/dL且ADA>40U/L),则诊断结核性胸腔积液的敏感性为92.7%,特异性为97.3%,较单独检测明显提高准确性.结论 胸液CRP和ADA在类肺炎性、结核性和癌性胸腔积液中分别存在明显著统计学差异,可以单独作为检测指标鉴别胸腔积液性质,联合检测胸液CRP、ADA对胸腔积液性质的鉴别诊断意义更大,准确性明显提高,值得在临床上进一步推广.%Objective To investigate the value of C -reactive protein (CRP) and adenosine de-aminase (ADA) in differential diagnosis of purulent pleuritis with tuberculous pleuritis and cancerous pleural effusion. Methods Pleural fluid CRP and ADA levels were obtained in 18 patients with purulent pleuritis,28 patients with tuberculous pleurtits and 42 patients with cancerous pleural effusion. The CRP and ADA levels of three groups were compared. Results The CRP levels of the purulent pleuritis were higher than that of the tuberculous pleuritis and cancerous pleural effusion obviously (P < 0. 01). The CRP levels of the tuberculous pleuritis were exceeded the cancerous pleural effusions obviously (P < 0. 05). The ADA levels of the

  16. Systematic use of universal 16S rRNA gene polymerase chain reaction (PCR) and sequencing for processing pleural effusions improves conventional culture techniques.

    Science.gov (United States)

    Insa, Rosario; Marín, Mercedes; Martín, Adoración; Martín-Rabadán, Pablo; Alcalá, Luís; Cercenado, Emilia; Calatayud, Laura; Liñares, Josefina; Bouza, Emilio

    2012-03-01

    Conventional culture of pleural fluid samples frequently provides false-negative results. Universal polymerase chain reaction (PCR) of the 16S ribosomal ribonucleic acid (rRNA) gene (16S PCR) has proven useful in the diagnosis of various bacterial infections. We conducted a prospective study to assess the value of 16S PCR in the etiologic diagnosis of pleural effusion. All pleural fluid samples received for culture were also studied using 16S PCR. Positive samples were sequenced for identification. Clinical records and conventional culture results were analyzed to classify pleural fluid samples as infected or not infected. We studied 723 samples. We excluded 188 samples because they were obtained from a long-term chest tube, there was a diagnosis of mycobacterial infection, or there were insufficient data to classify the episode. Finally, 535 pleural fluid samples were analyzed. According to our criteria, 82 (15.3%) were infected and 453 (84.7%) were not infected. In the infected samples, 16S PCR was positive in 67 samples (81.7%) while conventional culture was positive in 45 (54.9%). There were 4 false positives with 16S PCR (0.9%) and 12 with culture (2.6%). The values for the etiologic diagnosis of bacterial pleural effusion of conventional culture compared with 16S PCR were as follows: sensitivity, 54.9%/81.7%; specificity, 97.4%/99.1%; positive predictive value, 76.3%/94.4%; negative predictive value, 92.6%/96.8%; and accuracy, 90.8%/96.5%.When compared with conventional culture, 16S PCR plus sequencing substantially improves the etiologic diagnosis of infectious pleural effusion. In our opinion, this technique should be added to the routine diagnostic armamentarium of clinical microbiology laboratories.

  17. Benign cystic mediastinal teratoma presenting as a massive pleural effusion in a 17-year-old boy.

    Science.gov (United States)

    Montebello, Annalisa; Mizzi, Adrian; Cassar, Paul John; Cassar, Karen

    2017-01-10

    Mediastinal teratomas are a rare, albeit an important differential diagnosis of anterior/middle mediastinal masses in young adults and various atypical presentations have been reported. The authors report a case of a 17-year-old boy who presented with a 2-month history of worsening shortness of breath and pleuritic chest pain. A massive left-sided pleural fluid collection was seen on a chest radiograph (CXR). The pleural fluid was drained and a CT Thorax confirmed the presence of a cystic mass. Following re-accumulation of the fluid, thoracotomy was performed and a benign mediastinal teratoma excised. The patient remained well with no evidence of recurrence on follow-up CXRs a year post operatively.

  18. Pleural and pericardial effusion in a patient with polymyalgia rheumatica: a case presentation.

    Science.gov (United States)

    Sánchez Ruiz-Granados, Elena; del Castillo Madrigal, Matilde; Romero Jiménez, Manuel Jesús

    2013-01-01

    Polymyalgia rheumatica is an inflammatory rheumatic disease that presents with bilateral pain and stiffness affecting mainly proximal muscles. It affects individuals over 50 years of age and it is usually associated with a raised erythrocyte sedimentation rate. Classically, treatment with low-dose corticosteroids results in a dramatic improvement in both symptoms and laboratory findings. We report the case of an 80 years old patient presenting polymyalgia rheumatica coinciding with pleuropericardial effusion. The patient had a very good response to treatment with rapid improvement in the symptomatology and laboratory findings. Polymyalgia Rheumatica is a common disease but it is rarely associated to pleuropericardial effusion. It should be considered in the differential diagnostic in patients presenting with pericardial effusion over 50 of age years due to the good response to treatment. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  19. Early and late morbidity and mortality and life expectancy following thoracoscopic talc insufflation for control of malignant pleural effusions: a review of 400 cases

    Directory of Open Access Journals (Sweden)

    Lyriti Konstantina

    2010-04-01

    Full Text Available Abstract Background Malignant pleural effusion is a common sequelae in patients with certain malignancies. It represents a terminal condition with short median survival (in terms of months and the goal is palliation. Aim of our study is to analyze morbidity, mortality and life expectancy following videothoracoscopic talc poudrage. Materials and methods From September 2004 to October 2009, 400 patients underwent video-assisted thoracic surgery (VATS for malignant pleural effusion. The conditions of patients were assessed and graded before and after treatment concerning morbidity, mortality, success rate of pleurodesis and median survival. Results The median duration of follow up was 40 months (range 4-61 months. All patients demonstrated notable improvement in dyspnea. Intraoperative mortality was zero. The procedure was well tolerated and no significant adverse effects were observed. In hospital mortality was 2% and the pleurodesis success rate was 85%. A poor Karnofsky Performance Status and delay between diagnosis of pleural effusion and pleurodesis were statistically significant factors for in-hospital mortality. The best survival was seen in breast cancer, followed by ovarian cancer, lymphoma and pleural mesothelioma. Conclusions Video-assisted thoracoscopic talc poudrage is an effective and safe procedure that yields a high rate of successful pleurodesis and achieves long-term control with marked dyspnea decrease.

  20. Analysis the reason for failed pleural brushing operation in exudative pleural effusions%渗出性胸腔积液行胸膜刷检操作失败的原因分析

    Institute of Scientific and Technical Information of China (English)

    荣艳; 尹冬梅; 凌敏; 苟安栓

    2014-01-01

    目的:分析渗出性胸胸腔积液行胸膜刷检,部分操作失败,分析其原因,总结教训以提高胸膜刷检成功率。方法:对87例渗出性胸腔积液患者,进行闭式胸膜活检术联合胸膜刷检术。结果:87例患者,胸膜活检113次,成功率92.9%(105/113),胸膜刷检112次,成功率仅73.2%(82/112),胸膜刷检操作成功率明显低于胸膜活检,差异有统计学意义(0.05)。30次未成功的胸膜刷检中,19次因细胞刷未能紧贴胸壁,未取到胸膜组织细胞而致操作失败;6次因胸水量大,操作时无法一次将胸水放干净,而致操作失败;另有5次刷检结果仅见红细胞。结论:胸膜刷检在临床中有操作简单、病人耐受性好、取材范围广等优势,在操作中应不断总结经验教训,逐渐提高胸膜刷检操作成功率,从而发挥它在渗出性胸腔积液病因诊断中的价值。%Objective:To analyse reasons for failed pleural brushing in exudative pleural effusions,And summarize lessons to improve success rate of pleural brushing.Methods:The pleural biopsy and pleural brushing was performed in 87 patients suffering from exudative pleural effusions.Results:Total 113 times pleural biopsy were completed in 87 patients, the puncture success rate was 92.9%(105/113). Total 112 times pleural brushing were also completed in this group, brushes examines success rate was 73.2%(82/112), the differences of success rate between pleural biopsy and pleural brushing was statistical significance (P<0.05). Pleural brushing operation failed 30 times, including 19 times for cells brush failed to close the chest , 6 times for a lot of pleural effusion,and other 5 times for only red blood cells.Conclusion: Pleural brushing has a lot of advantages in clinical practice, such as simple operation, good tolerance, wide operation range.We should constantly sum up experience and lessons, and gradually improve the success rate of pleural

  1. Effect of combined pneumococcal conjugate and polysaccharide vaccination on recurrent otitis media with effusion.

    NARCIS (Netherlands)

    Heerbeek, N. van; Straetemans, M.; Wiertsema, S.P.; Ingels, K.J.A.O.; Rijkers, G.T.; Schilder, A.G.M.; Sanders, E.A.M.; Zielhuis, G.A.

    2006-01-01

    BACKGROUND: Otitis media with effusion (OME) is very common during childhood. Because Streptococcus pneumoniae is one of the most common bacterial pathogens involved in OME, pneumococcal vaccines may have a role in the prevention of recurrent OME. OBJECTIVE: We sought to assess the effect of

  2. Clinical feature of pleural effusion in 78 patients with rheumatoid arthritis%78例类风湿关节炎胸腔积液临床特点分析

    Institute of Scientific and Technical Information of China (English)

    陈文玉; 王娟娟; 王智明

    2016-01-01

    Objective To investigate the feature of pleural effusion in patients with rheumatoid arthritis for the recognition of the disease.Methods The clinical feature of pleural effusion in patients with rheumatoid arthritis was retrospectively analyzed.Results There was no pleural effusion in patients with remission of rheumatoid arthritis,all patients with pleural effusion were in active phase of the disease,especially in moderate and high active phase, significant difference in the number of patients was detected in low,moderate and high active phases of rheumatoid arthritis between groups (P <0.05).The average levels of erythrocyte sedimentation rate and C-reactive protein were significantly higher in pleural effusion group than in non-pleural effusion group.The positive rates of rheumatoid factor and anti-cyclic citrullinated peptide antibody were significantly higher in pleural effusion group than in non-pleural effusion group (P < 0.05 ).The average number of joint tenderness and swollen joint was significantly higher in pleural effusion group than in non-pleural effusion group and the average time of morning stiffness was significantly longer in pleural effusion group than in non-pleural effusion group (P <0.05 ).Compared with non-pleural effusion group,the remission number of patients was significantly decreased in pleural effusion group (P < 0.05 ),and the number of new joint deformity was significantly increased in pleural effusion group (P < 0.05 ).Conclusion Rheumatoid arthritis patients present pleural effusion as an active signal of disease,which was positively correlated with immune index and clinical symptom and should get rigorously treated.%目的:探讨类风湿关节炎胸腔积液的特点,提高对该病的认识。方法回顾分析类风湿关节炎胸腔积液的特点。结果类风湿关节炎缓解状态下无胸腔积液出现,胸腔积液发生在疾病活动期,且集中在疾病中度、高度活动期,两组低、中、高度患者构

  3. Application of non-small cell lung cancer pleural effusion cell blocks in molecular pathological detection

    Institute of Scientific and Technical Information of China (English)

    Ying Zhang; Nan Jiang; Dongdong Qian; Xiangzhou Li; Yu Zhou; Jia Mei; Xiaohui Cao

    2014-01-01

    Objective:The tumor tissues used in molecular pathological detection were usual y obtained by surgery, which would cause trauma and may not be suitable for the terminal cancer patients. This paper evaluated the value of the non-smal celllung cancer (NSCLC) pleural ef usion cellblocks as tumor tissues replacement materials in the application of molecular pathological detection. Methods: Tumor cells were made into cellblocks through stratified centrifugal from 30 NSCLC pa-tients with the pleural ef usion. The immunohistochemistry, fluorescence in situ hybridization (FISH) and gene sequencing methods were employed in our experiments. Results:The tumor cells of cellblock section were rich and could keep part of histological structure. Immunohistochemistry staining could assist diagnosis and tumor parting. Epidermal growth factor receptor (EGFR) FISH-positive was found in 33.33%of the group, high polysomy in 6 cases, amplification in 4 cases. EGFR gene mutations were found in 8 cases of 30 samples, with an incidence of 26.67%, 6 cases were detected in the exon 19, and 2 cases were detected in the exon 21. Conclusion:The NSCLC pleural ef usion cellblocks are useful for the diagnosis and determining the primary source of tumor, instructed targeted therapy.

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

    Directory of Open Access Journals (Sweden)

    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

  5. Diagnostic and prognostic value of SHOX2 and SEPT9 DNA methylation and cytology in benign, paramalignant and malignant pleural effusions.

    Directory of Open Access Journals (Sweden)

    Dimo Dietrich

    Full Text Available Pleural effusions (PE are a common clinical problem. The discrimination between benign (BPE, malignant (MPE and paramalignant (PPE pleural effusions is highly important to ensure appropriate patient treatment. Today, cytology is the gold standard for diagnosing malignant pleural effusions. However, its sensitivity is limited due to the sometimes low abundance of tumor cells and the challenging assessment of cell morphology in cytological samples. This study aimed to develop and validate a diagnostic test, which allows for the highly specific detection of malignant cells in pleural effusions based on the DNA methylation biomarkers SHOX2 and SEPT9. A quantitative real-time PCR assay was developed which enabled the accurate and sensitive detection of SHOX2 and SEPT9 in PEs. Cytological and DNA methylation analyses were conducted in a case control study comprised of PEs from 114 patients (58 cases, 56 controls. Cytological analysis as well as SHOX2 and SEPT9 methylation resulted in 100% specificity. 21% of the cases were cytologically positive and 26% were SHOX2 or SEPT9 methylation positive. The combined analysis of cytology and DNA methylation resulted in an increase of 71% positively classified PEs from cancer patients as compared to cytological analysis alone. The absolute sensitivity of cytology and DNA methylation was not determinable due to the lack of an appropriate gold standard diagnostic for distinguishing between MPEs and PPEs. Therefore, it was unclear which PEs from cancer patients were malignant (containing tumor cells and which PEs were paramalignant and resulted from benign conditions in cancer patients, respectively. Furthermore, DNA methylation analysis in PEs allowed the prognosis of the overall survival in cancer patients (Kaplan-Meier analysis, log rank test, p=0.02 (SHOX2, p=0.02 (SEPT9. The developed test may be used as a diagnostic and prognostic adjunct to existing clinical and cytopathological investigations in patients

  6. Diagnostic and prognostic value of SHOX2 and SEPT9 DNA methylation and cytology in benign, paramalignant and malignant pleural effusions.

    Science.gov (United States)

    Dietrich, Dimo; Jung, Maria; Puetzer, Svenja; Leisse, Annette; Holmes, Emily Eva; Meller, Sebastian; Uhl, Barbara; Schatz, Philipp; Ivascu, Claudia; Kristiansen, Glen

    2013-01-01

    Pleural effusions (PE) are a common clinical problem. The discrimination between benign (BPE), malignant (MPE) and paramalignant (PPE) pleural effusions is highly important to ensure appropriate patient treatment. Today, cytology is the gold standard for diagnosing malignant pleural effusions. However, its sensitivity is limited due to the sometimes low abundance of tumor cells and the challenging assessment of cell morphology in cytological samples. This study aimed to develop and validate a diagnostic test, which allows for the highly specific detection of malignant cells in pleural effusions based on the DNA methylation biomarkers SHOX2 and SEPT9. A quantitative real-time PCR assay was developed which enabled the accurate and sensitive detection of SHOX2 and SEPT9 in PEs. Cytological and DNA methylation analyses were conducted in a case control study comprised of PEs from 114 patients (58 cases, 56 controls). Cytological analysis as well as SHOX2 and SEPT9 methylation resulted in 100% specificity. 21% of the cases were cytologically positive and 26% were SHOX2 or SEPT9 methylation positive. The combined analysis of cytology and DNA methylation resulted in an increase of 71% positively classified PEs from cancer patients as compared to cytological analysis alone. The absolute sensitivity of cytology and DNA methylation was not determinable due to the lack of an appropriate gold standard diagnostic for distinguishing between MPEs and PPEs. Therefore, it was unclear which PEs from cancer patients were malignant (containing tumor cells) and which PEs were paramalignant and resulted from benign conditions in cancer patients, respectively. Furthermore, DNA methylation analysis in PEs allowed the prognosis of the overall survival in cancer patients (Kaplan-Meier analysis, log rank test, p=0.02 (SHOX2), p=0.02 (SEPT9)). The developed test may be used as a diagnostic and prognostic adjunct to existing clinical and cytopathological investigations in patients with PEs of

  7. Trichomonads in pleural effusion: case report, literature review and utility of PCR for species identification.

    Science.gov (United States)

    Leterrier, Marion; Morio, Florent; Renard, Beno T; Poirier, Anne-Sophie; Miegeville, Michel; Chambreuil, Guy

    2012-01-01

    Trichomonas tenax is a flagellated protozoan commonly found in the human oral cavity but of unusual occurrence in pulmonary infections. We describe a case of a 67-year-old patient with glioblastoma who presented with severe pleurisy in the post-operative period while she was receiving high-dose corticotherapy. Several motile flagellated protozoa were identified in the pleural fluid. Trichomonas tenax was identified by molecular methods. Pulmonary infections with Trichomonads might be underestimated because of diagnostic difficulties. The utility of molecular biology for species identification is underlined and the pathogenicity of Trichomonad parasites in human lungs is discussed in light of previously reported cases.

  8. A Multiplexed Cytokeratin Analysis Using Targeted Mass Spectrometry Reveals Specific Profiles in Cancer-Related Pleural Effusions

    Directory of Open Access Journals (Sweden)

    Dominik Domanski

    2016-07-01

    Full Text Available Pleural effusion (PE, excess fluid in the pleural space, is often observed in lung cancer patients and also forms due to many benign ailments. Classifying it quickly is critical, but this remains an analytical challenge often lengthening the diagnosis process or exposing patients to unnecessary risky invasive procedures. We tested the analysis of PE using a multiplexed cytokeratin (CK panel with targeted mass spectrometry–based quantitation for its rapid classification. CK markers are often assessed in pathological examinations for cancer diagnosis and guiding treatment course. We developed methods to simultaneously quantify 33 CKs in PE using peptide standards for increased analytical specificity and a simple CK enrichment method to detect their low amounts. Analyzing 121 PEs associated with a variety of lung cancers and noncancerous causes, we show that abundance levels of 10 CKs can be related to PE etiology. CK-6, CK-7, CK-8, CK-18, and CK-19 were found at significantly higher levels in cancer-related PEs. Additionally, elevated levels of vimentin and actin differentiated PEs associated with bacterial infections. A classifier algorithm effectively grouped PEs into cancer-related or benign PEs with 81% sensitivity and 79% specificity. A set of undiagnosed PEs showed that our method has potential to shorten PE diagnosis time. For the first time, we show that a cancer-relevant panel of simple-epithelial CK markers currently used in clinical assessment can also be quantitated in PEs. Additionally, while requiring less invasive sampling, our methodology demonstrated a significant ability to identify cancer-related PEs in clinical samples and thus could improve patient care in the future.

  9. A Novel Combination of Calprotectin and CXCL12 for Predicting Malignancy in Patients with Exudative Pleural Effusion.

    Science.gov (United States)

    Luo, Jian; Wang, Maoyun; Li, Chuntao; Liang, Binmiao; Liu, Dan; Shi, Chaoli; Jiang, Faming; Wang, Ting; Li, Peijun; Liang, Zongan

    2015-11-01

    Pleural effusion (PE) remains a significant challenge and public health problem, which needs novel noninvasive biomarkers for the precise diagnosis. The aim of this study was to further determine the clinical efficacy and diagnostic accuracy of a novel combination of calprotectin and CXCL12 for predicting malignancy in patients with exudative PE.Calprotectin and CXCL12 concentrations were measured in 95 individuals of exudative PE, with 39 malignant PE (MPE) and 56 benign PE (BPE). The accuracy of calprotectin and CXCL12 levels for discriminating MPE from BPE or tuberculous PE were evaluated using receiver-operating characteristic (ROC) curves. Univariate and multivariate logistic regression analyses were performed to test the association between calprotectin and CXCL12 levels and MPE.Calprotectin and CXCL12 levels of patients with MPE were significantly lower than that of BPE and tuberculous PE (P calprotectin and CXCL12 was 0.683 and 0.641 in MPE and BPE, and a combination of calprotectin ≤500.19 ng/mL and CXCL12 ≤6.11 ng/mL rendered a sensitivity and specificity of 48.72% and 78.57%, respectively. While in MPE and tuberculous PE, the AUC of calprotectin and CXCL12 was 0.696 and 0.690, and a combination of calprotectin ≤421.73 ng/mL and CXCL12 ≤3.71 ng/mL presented a sensitivity and specificity of 25.64% and 95.45%, respectively. Multivariate logistic regression demonstrated that both calprotectin and CXCL12 were independent predictors of MPE.Calprotectin and CXCL12 in pleural fluid are informative diagnostic biomarkers for predicting patients with MPE.

  10. Pleural Covering Application for Recurrent Pneumothorax in a Patient with Birt-Hogg-Dubé Syndrome.

    Science.gov (United States)

    Ebana, Hiroki; Otsuji, Mizuto; Mizobuchi, Teruaki; Kurihara, Masatoshi; Takahashi, Kazuhisa; Seyama, Kuniaki

    2016-06-20

    Birt-Hogg-Dubé syndrome (BHDS) is a rare hereditary disease that presents with multiple lung cysts and recurrent pneumothorax. These cysts occupy predominantly the lower-medial zone of the lung field adjacent to the interlobar fissure, and some of them abut peripheral pulmonary vessels. For the surgical management of pneumothorax with BHDS, the conventional approach of resecting all subpleural cysts and bullae is not feasible. Thus, after handling several bullae by using a stapler or performing ligation as a standardized treatment, we applied to a pleural covering technique to thicken the affected visceral pleura and then to prevent recurrence of pneumothorax. We herein report the successful application of a pleural covering technique via thoracoscopic surgery to treat the recurrent pneumothorax of a 30-year-old man with BHDS. This technique is promising for the management of intractable pneumothorax secondary to BHDS.

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

    Directory of Open Access Journals (Sweden)

    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

  12. Polyacrylate/nanosilica causes pleural and pericardial effusion, and pulmonary fibrosis and granuloma in rats similar to those observed in exposed workers

    Directory of Open Access Journals (Sweden)

    Zhu X

    2016-04-01

    Full Text Available Xiaoli Zhu,1 Wen Cao,2 Bing Chang,3 Linyuan Zhang,3 Peihuan Qiao,3 Xue Li,4 Lifang Si,5 Yingmei Niu,1 Yuguo Song1 1Department of Occupational Medicine and Clinical Toxicology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China; 3Department of Toxicology, National Institute for Occupational Health and Poison Control, China CDC, Beijing, People’s Republic of China; 4Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China; 5Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China Abstract: Nanomaterials offer great benefit as well as potential damage to humans. Workers exposed to polyacrylate coatings have pleural effusion, pericardial effusion, and pulmonary fibrosis and granuloma, which are thought to be related to the high exposure to nanomaterials in the coatings. The study aimed to determine whether polyacrylate/silica nanoparticles cause similar toxicity in rats, as observed in exposed workers. Ninety male Wistar rats were randomly divided into five groups with 18 rats in each group. The groups included the saline control group, another control group of polyacrylate only, and low-, intermediate-, and high-dose groups of polyacrylate/nanosilica with concentrations of 3.125, 6.25, and 12.5 mg/kg. Seventy-five rats for the 1-week study were terminated for scheduled necropsy at 24 hours, 3 days, and 7 days postintratracheal instillation. The remaining 15 rats (three males/group had repeated ultrasound and chest computed tomography examinations in a 2-week study to observe the pleural and pericardial effusion and pulmonary toxicity. We found that polyacrylate/nanosilica resulted in pleural and pericardial effusions, where nanosilica was isolated and detected

  13. 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

    Directory of Open Access Journals (Sweden)

    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

  14. Comorbidity of Kawasaki disease and group a streptococcal pleural effusion in a healthy child: a case report.

    Science.gov (United States)

    Alhammadi, Ahmed H; Hendaus, Mohamed A

    2013-01-01

    Kawasaki disease is an acute self-limiting vasculitis that affects children. The most dreaded complication of Kawasaki disease reported in the literature over the years is coronary artery disease, which is considered as the main cause of acquired heart disease. However, pulmonary associations with Kawasaki disease have been overlooked. We present a rare, if not unique, case of Kawasaki disease associated with group A streptococcus pleural effusion in the English language literature. A search of the PubMed database was carried out, using a combination of the terms "Kawasaki disease", "pneumonia", and "group A streptococcus". The majority of studies conducted in children with Kawasaki disease have concentrated on the coronary artery implications. Kawasaki disease is considered a self-limiting illness, but can have detrimental consequences if not diagnosed early. When there is a prolonged inflammatory reaction, with no infectious agent identified or remittent fever unresponsive to antibiotics, Kawasaki disease should be taken into consideration. Elevated Vβ2+ T cells compared with healthy controls suggest possible involvement of a superantigen in the etiology of Kawasaki disease, so it is wise that the health care provider concentrates not only on the cardiac consequences, but also on pulmonary associations.

  15. Comorbidity of Kawasaki disease and group A streptococcal pleural effusion in a healthy child: a case report

    Directory of Open Access Journals (Sweden)

    Alhammadi AH

    2013-07-01

    Full Text Available Ahmed H Alhammadi, Mohamed A HendausGeneral Pediatrics Section, Department of Pediatrics, Hamad Medical Corporation, Doha, QatarBackground: Kawasaki disease is an acute self-limiting vasculitis that affects children. The most dreaded complication of Kawasaki disease reported in the literature over the years is coronary artery disease, which is considered as the main cause of acquired heart disease. However, pulmonary associations with Kawasaki disease have been overlooked. We present a rare, if not unique, case of Kawasaki disease associated with group A streptococcus pleural effusion in the English language literature. A search of the PubMed database was carried out, using a combination of the terms “Kawasaki disease”, “pneumonia”, and “group A streptococcus”. The majority of studies conducted in children with Kawasaki disease have concentrated on the coronary artery implications. Kawasaki disease is considered a self-limiting illness, but can have detrimental consequences if not diagnosed early. When there is a prolonged inflammatory reaction, with no infectious agent identified or remittent fever unresponsive to antibiotics, Kawasaki disease should be taken into consideration. Elevated Vβ2+ T cells compared with healthy controls suggest possible involvement of a superantigen in the etiology of Kawasaki disease, so it is wise that the health care provider concentrates not only on the cardiac consequences, but also on pulmonary associations.Keywords: Kawasaki disease, pneumonia, group A streptococcus

  16. 尿激酶治疗结核性胸腔积液的研究进展%Urokinase therapy for tuberculous pleural effusion

    Institute of Scientific and Technical Information of China (English)

    黄超文; 冯起校

    2010-01-01

    近年来结核病发病率未见下降趋势.虽然目前研究显示早期积极抗结核治疗、开放引流可有效避免胸膜肥厚、粘连,然而结核病起病隐匿,由于患者发现迟、就诊时间晚或疗程不足,胸腔积液处理不及时,容易产生胸水包裹、分房等,即使在影像学辅助下也难以抽液、充分引流,引起患者治疗难度增加,住院时间增加,最终引起肺功能下降、限制性通气功能障碍等不可逆改变,造成生活质量下降.临床上有用胸腔注入激素、抗结核药的方法 ,但仅仅是减轻炎症渗出而未处理已渗出的积液.近年来临床发现胸腔注入尿激酶可以防治胸膜肥厚、粘连.本文结合近年来研究进展,对结核性胸腔积液病理及尿激酶治疗结核性胸腔积液、预防胸膜肥厚的作用机理做一综述.%The incidence of tuberculosis (TB) has not declined in recent years.Although recent studies have shown that early,aggressive anti-TB treatment combined with tube thoracostomy can effectively prevent pleural thickening and adhesion,pleural effusion is easy to be enveloped and separated because of late medical diagnosis,inadequate treatment,or prolonged pleural effusion.The fluid is difficult to be fully removed even with the assistance of radiology,resulting in the increases in the difficulties of treatment and length of hospital stay,and in eventually the decrease in lung function and in the development of restrictive ventilation dysfunction and other irreversible changes; quality of life in patients declines.Available therapies with pleural injections of hormones or anti-tuberculosis agents only reduce inflammatory infiltration but not completely control the existing effusion.Recent research shows pleural effusion of urokinase can prevent and treat pleural thickening and adhesion.This literature narrates the pathology of tubercular pleural effusion and the mechanism of action of urokinase for effusion to prevent pleural

  17. Recurrent pericardial effusion and tamponade in a patient with Erdheim-Chester disease (ECD).

    Science.gov (United States)

    Mishra, Ajay Kumar; Mani, Sunithi; George, Anu Anna; Sudarsanam, Thambu David

    2015-11-24

    Erdheim-Chester disease (ECD) is a rare xanthogranulomatous disorder characterised by the proliferation of lipid laden histiocytes along with infiltration of various organs of the body. Although commonly presenting with bone pains secondary to bony infiltration, cardiac involvement in the form of periaortic fibrosis and pericardial involvement may be seen in a subgroup of patients. We report a case of ECD presenting as recurrent pericardial effusion along with pericardial tamponade.

  18. Semi-Rigid Thoracoscopic Punch Biopsy Using a Hybrid Knife with a High-Pressure Water Jet for the Diagnosis of Pleural Effusions.

    Science.gov (United States)

    Yin, Yan; Eberhardt, Ralf; Wang, Xiao-Bo; Wang, Qiu-Yue; Kang, Jian; Herth, Felix J F; Hou, Gang

    2016-01-01

    Semi-rigid thoracoscopy is an important technique in the definitive diagnosis of pleural diseases with high diagnostic sensitivity and specificity. Obtaining adequate samples from thickened pleura is the most important limitation of semi-rigid thoracoscopy with a standard flexible forceps (SFF) compared with rigid thoracoscopy, especially in patients with mesothelioma or benign fibrothorax. Developing a convenient, efficient and safe biopsy technique to obtain sufficient samples from such patients is a key topic in semi-rigid thoracoscopy. The hybrid knife (HK) is an innovative design fusing high-pressure water injection and a conventional diathermic knife that can allow for the safe resection of a larger lesion during gastrointestinal endoscopic dissection. Here, we describe 3 patients with unexplained pleural effusion who underwent pleural biopsy using an HK to investigate the potential use of the HK as a new pleural biopsy device in semi-rigid thoracoscopy when pleural lesions are difficult to biopsy using an SFF. The biopsies were obtained successfully by HK, and the diagnosis followed. The sizes of the biopsies collected by HK are larger than those collected by SFF. No complications were observed. Electrocautery biopsy using an HK during semi-rigid thoracoscopy has great potential for diagnosing consistent abnormal pleuras, which are difficult to biopsy with an SFF. © 2016 S. Karger AG, Basel.

  19. Pancreatic Pseudocyst Pleural Fistula in Gallstone Pancreatitis

    Directory of Open Access Journals (Sweden)

    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.

  20. Value of combined detection of CRP in serum and pleural effusion in the etiological diagnosis of pleural effu-sion%血清及胸液C-反应蛋白对胸腔积液病因诊断的研究

    Institute of Scientific and Technical Information of China (English)

    茅敏华; 张金松; 姜觉如

    2015-01-01

    Objective To study the diagnostic value of combined detection of C-reactive protein ( CRP) in both serum and pleural effusion in the diagnosis of parapneumonic effusion, tuberculosis pleuritis and malignant pleu-ral effusion. Methods The study selected 80 patients with pleural effusion to detect and compare the results of CRP in serum and pleural effusion, including 35 patients with parapneumonic effusion, 13 patients with tuberculosis pleu-ritis, and 32 patients with malignant pleural effusions. Results The levels of CRP in serum and pleural effusion were significantly higher in parapneumonic effusion than in tuberculosis pleuritis (P<0. 05), and they were signifi-cantly higher in tuberculosis pleuritis in malignant pleural effusion ( P<0. 05 ) . Conclusion The combined detec-tion of CRP in serum and pleural effusion has great diagnostic value and can be an useful indicator in the differential diagnosis of benign and malignant pleural effusion.%目的:探讨血清及胸液C-反应蛋白( CRP)对类肺炎性胸腔积液、结核性胸腔积液和癌性胸腔积液的价值。方法选取胸腔积液患者80例,其中类肺炎性胸腔积液35例,结核性胸腔积液13例,恶性胸腔积液32例,比较所有患者血清和胸液中CRP的测量值。结果类肺炎性胸腔积液血清及胸液中CRP含量显著高于结核性胸腔积液,差异有统计学意义(P<0.05);结核性胸腔积液血清及胸液中CRP含量显著高于癌性胸腔积液,差异有统计学意义( P<0.05)。结论血清和胸液中CRP对胸腔积液病因诊断具有一定的临床价值;可以作为良恶性胸腔积液鉴别诊断的参考指标。

  1. 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

  2. Clinical analysis of 80 cases of tuberculous pleural effusion and 39 cases malignant pleural effusion%80例结核性及39例恶性胸腔积液的临床分析

    Institute of Scientific and Technical Information of China (English)

    骆文志; 刘升明; 吴义

    2012-01-01

    Aim; Retrospective analysis on clinical manifestation and laboratory test results of tubercu-lous pleural effusion (TBPE) and malignant pleural effusion (MPE) , to probe into the value about the dif-ferent diagnosis of TBPE and MPE. Methods; Eighty hospitalized patients with TBPE or MPE were ana-lyzed retrospectively, particularly the content of CEA, LDH and ADA, which is for getting a better under-standing of TBPE and MPE and improving the ability of differential diagnosis. Results; ①The PLDH lev-els and the PLDH/SLDH ratio were no significant difference in two groups (P >0. 05). ② The differences of the PADA levels,the SADA levels and the PADA/SADA ratios were statistically significant( P <0.05). ③ After making use of multivariable logistic regression analysis, The valuable factors are onset age,fever, color of pleural effussion and the PADA/SADA ratio. Conclusion: ① The content of PADA and SADA were important basis for different diagnosing TBPE and MPE. The PADA is about 40 U/L, which is lower than 45 U/L, that as diagnostic standard is generally adopted; Regarding PADA/SADA = 1 as a liability standard, TBPE is greater than 1, MPE is fewer than 1, which is still need more discussion and the virtual PADA/SADA = (3. 44 ± 1. 38), but the ratio is bigger and more beneficial to TBPE. ②The logistic regression analysis shows putting onset age, fever, color of pleural effussion, ratios of PADA/SADA together for different diagnosis of TBPE and MPE has superior correctness.%目的:回顾性分析结核性和恶性胸腔积液的临床表现和实验室检查结果,探讨其对结核性和恶性胸腔积液鉴别诊断的价值.方法:收集80例结核性胸腔积液患者和39例恶性胸腔积液患者的病例资料,重点对癌胚抗原(CEA)、乳酸脱氢酶(LDH)、腺苷脱氨酶(ADA)测定结果进行统计学分析,为进一步提高对结核性和恶性胸腔积液的认识和更好地鉴别诊断提供依据.结果:①两组

  3. Characterization of novel transforming growth factor-beta type I receptors found in malignant pleural effusion tumor cells

    Directory of Open Access Journals (Sweden)

    Leu Sy-Jye C

    2007-08-01

    Full Text Available Abstract Background Tumors expressing a transforming growth factor-beta type I receptor (TβRI mutant with sequence deletions in a nine-alanine (9A stretch of the signal peptide are reported to be highly associated with disease progression. Expression of this mutant could interfere with endogenous TGFβ signaling in the cell. However, little is known about the importance of the remaining part of the signal peptide on the cellular function of TβRI. Results We cloned and identified four new in-frame deletion variants of TβRI, designated DM1 to DM4, in pleural effusion-derived tumor cells. Intriguingly, DM1 and DM2, with a small region truncated in the putative signal peptide of TβRI, had a serious defect in their protein expression compared with that of the wild-type receptor. Using serial deletion mutagenesis, we characterized a region encoded by nucleotides 16–51 as a key element controlling TβRI protein expression. Consistently, both DM1 and DM2 have this peptide deleted. Experiments using cycloheximde and MG132 further confirmed its indispensable role for the protein stability of TβRI. In contrast, truncation of the 9A-stretch itself or a region downstream to the stretch barely affected TβRI expression. However, variants lacking a region C-terminal to the stretch completely lost their capability to conduct TGFβ-induced transcriptional activation. Intriguingly, expression of DM3 in a cell sensitive to TGFβ made it significantly refractory to TGFβ-mediated growth inhibition. The effect of DM3 was to ablate the apoptotic event induced by TGFβ. Conclusion We identified four new transcript variants of TβRI in malignant effusion tumor cells and characterized two key elements controlling its protein stability and transcriptional activation. Expression of one of variants bestowed cancer cells with a growth advantage in the presence of TGFβ. These results highlight the potential roles of some naturally occurring TβRI variants on the

  4. 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.

  5. Impaired T cell function in malignant pleural effusion is caused by TGF-β derived predominantly from macrophages.

    Science.gov (United States)

    Li, Lifeng; Yang, Li; Wang, Liping; Wang, Fei; Zhang, Zhen; Li, Jieyao; Yue, Dongli; Chen, Xinfeng; Ping, Yu; Huang, Lan; Zhang, Bin; Zhang, Yi

    2016-11-15

    Malignant pleural effusion (MPE) is an indication of advanced cancer. Immune dysfunction often occurs in MPE. We aimed to identify the reason for impaired T cell activity in MPE from lung cancer patients and to provide clues toward potential immune therapies for MPE. The surface inhibitory molecules and cytotoxic activity of T cells in MPE and peripheral blood (PB) were analyzed using flow cytometry. Levels of inflammatory cytokines in MPE and PB were tested using ELISA. TGF-β expression in tumor-associated macrophages (TAMs) was also analyzed. The effect of TAMs on T cells was verified in vitro. Lastly, changes in T cells were evaluated following treatment with anti-TGF-β antibody. We found that expression levels of Tim-3, PD-1 and CTLA-4 in T cells from MPE were upregulated compared with those from PB, but levels of IFN-γ and Granzyme B were downregulated (p TGF-β was significantly higher in MPE than in PB (p TGF-β was mainly produced by TAMs in MPE. When T cells were co-cultured with TAMs, expression levels of Tim-3, PD-1 and CTLA-4 were significantly higher than controls, whereas levels of IFN-γ and Granzyme B were significantly decreased, in a dose-dependent manner (p TGF-β antibody restored the impaired T cell cytotoxic activity in MPE. Our results indicate that macrophage-derived TGF-β plays an important role in impaired T cell cytotoxicity. It will therefore be valuable to develop therapeutic strategies against TGF-β pathway for MPE therapy of lung cancer.

  6. Patient-reported outcomes and associations with pleural effusion in outpatients with heart failure: an observational cohort study.

    Science.gov (United States)

    Gundersen, Guri H; Norekvål, Tone M; Graven, Torbjørn; Haug, Hilde H; Skjetne, Kyrre; Kleinau, Jens O; Gustad, Lise T; Dalen, Håvard

    2017-03-20

    We aimed to study whether patient-reported outcomes, measured by quality of life (QoL) and functional class, are sensitive to pleural effusion (PLE) in patients with heart failure (HF), and to study changes in QoL and functional class during follow-up of PLE. A cohort of 62 patients from an outpatient HF clinic was included. The amount of PLE was quantified using a pocket-sized ultrasound imaging device. Self-reports of QoL and functional class were collected using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the New York Heart Association (NYHA) functional classification. At baseline, 26 (42%) patients had PLE of which 19 (31%) patients had moderate to severe amounts of PLE. Patients with no to mild PLE had a lower MLHFQ score (mean 42, SD 21) compared with patients with a moderate to severe amount of PLE (mean 55, SD 24), p=0.03. For 28 patients (45%) with follow-up data, we observed a linear improvement of the MLHFQ-score (3.2, 95% CI 1.2 to 5.1) with each centimetre reduction of PLE. Correspondingly, patient-reported NYHA-class followed the same pattern as the MLHFQ-score. Our study indicates that patient-reported outcome measures as MLHFQ may be sensitive tools to identify patients with HF at highest risk of symptomatic PLE and that treatment targeting reduction of PLE during follow-up is essential to improvement of QoL and functional capacity of outpatients with HF. NCT01794715; Results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  7. Ipsilateral pleural recurrence after diagnostic transthoracic needle biopsy in pathological stage I lung cancer patients who underwent curative resection.

    Science.gov (United States)

    Moon, Seong Mi; Lee, Dae Geun; Hwang, Na Young; Ahn, Soohyun; Lee, Hyun; Jeong, Byeong-Ho; Choi, Yong Soo; Shim, Young Mog; Kim, Tae Jeong; Lee, Kyung Soo; Kim, Hojoong; Kwon, O Jung; Lee, Kyung Jong

    2017-09-01

    The relationship between transthoracic needle biopsy (TTNB) and pleural recurrence of cancer after curative lung resection remains unclear. We aimed to assess whether TTNB increases the ipsilateral pleural recurrence (IPR) rate and identify other potential risk factors for pleural recurrence after surgery. This retrospective study included 392 patients with p-stage I non-small cell lung cancer with solid or part-solid nodules after curative lung resection in 2009-2010. Imbalances among the characteristics were adjusted using an inverse probability-weighted method based on propensity scoring. Multivariate Cox's regression analysis and the Kaplan-Meier method were used to determine independent risk factors for IPR. A total of 243 (62%) patients received TTNB, while 149 (38%) underwent an alternate, or no, diagnostic technique. IPR was significantly more frequent in the TTNB group (p=0.004), while total recurrence was similar between the groups (p=0.098). After applying the weighted model, diagnostic TTNB (hazard ratio [HR], 5.27; 95% confidence interval [CI], 1.49-18.69; p=0.010), microscopic visceral pleural invasion (HR, 2.76; 95% CI, 1.08-7.01; p=0.033) and microscopic lymphatic invasion (HR, 3.25; 95% CI, 1.30-8.10; p=0.012) were associated with an increased frequency of IPR. Among patients who received TTNB, microscopic lymphatic invasion was a risk factor for IPR (HR, 2.74; 95% CI, 1.10-6.79; p=0.030). The diagnostic TTNB procedure is associated with pleural recurrence but may be unrelated to overall recurrence-free survival in early lung cancer. Moreover, microscopic lymphatic invasion could be a risk factor for pleural recurrence. TTNB should be carefully considered before lung resection and close follow-up to detect if pleural recurrence is needed. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. 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...

  9. Diagnosis of drowning by summation of sodium, potassium and chloride ion levels in pleural effusion: differentiating between freshwater and seawater drowning and application to bathtub deaths.

    Science.gov (United States)

    Yajima, Daisuke; Saito, Hisako; Sato, Kaoru; Hayakawa, Mutsumi; Iwase, Hirotaro

    2013-12-10

    Although electrolyte analysis of pleural effusion at autopsy is useful for the diagnosis of water aspiration (i.e., drowning), the method of comparing each level of sodium (Na(+)), potassium (K(+)), and chloride (Cl(-)) ions does not clearly differentiate between freshwater drowning, seawater drowning, and non-drowning. Therefore, here we introduce the summation of Na(+), K(+), and Cl(-) levels, that is SUM(Na+K+Cl), as a modified diagnostic indicator. In 21 autopsy cases of freshwater drowning, 32 cases of seawater drowning, and 43 non-drowning controls (with pleural effusion), mean SUM(Na+K+Cl) differed significantly between the groups (188.8±33.2, 403.5±107.9, and 239.3±21.7 mEq/L, respectively). We defined a SUM(Na+K+Cl) cut-off value of 282.7 mEq/L as strongly suggestive of seawater aspiration. When these values were applied to the two drowning groups, 15 cases (71%) of freshwater drowning and 29 cases (91%) of seawater drowning were diagnosed correctly. This new approach may be more valid than previous methods in cases found >2 days after death or those with substantial pleural effusion (>100 mL). For an additional 15 bathtub deaths, mean SUM(Na+K+Cl) was 198.8±40.0 mEq/L, and in 14 of these cases (93%) the relationship between cause of death and SUM(Na+K+Cl) could be explained using this method. Forensic pathologists should not depend exclusively on chemical findings and should consider also typical pathological indicators of drowning. This new method may be useful as a supplementary diagnostic tool when used alongside consideration of the pathological findings.

  10. Center line standing pleural effusion drainage tube care%中心静脉置管行胸腔积液引流的护理

    Institute of Scientific and Technical Information of China (English)

    苏颖玲

    2011-01-01

    目的:通过在临床中应用中心静脉置管引流系统治疗恶性胸腔积液,探讨护理工作在其临床应用中的价值.方法:用中心静脉置管法对22例中等量以上的恶性胸腔积液病人进行引流.结果:22例患者中CR、PR分别为7例1例.总有效率约为818%.对患者采取心理护理,病情观察、穿刺部位的护理及并发症的预防等护理措施,使患者化疗后反应明显减轻,无出血、脱管、断管等现象发生.结论:在护理工作配合下的中心静脉置管引流法治疗恶性胸腔积液方便、有效,便于临床开展.%Object: through applicating central venous catheter drainage system in the treatment of malignant pleural effusions in clinical to explore its value and efficacy in clinical application. Method: The central venous catheter on 22 cases of moderate or more patients with malignant pleural effusion drainage. Result: 22 cases of patients with CR, PR, and respectively to 7 cases and 11 cases. The total effective rate is about 8 1. 8%. Conclusion: The central venous catheter drainage system is one type of simple, effective, safe, reliable treatment of malignant pleural effusion drainage method,which is easily accepted by patients

  11. Pigtail Catheter: A Less Invasive Option for Pleural Drainage in Egyptian Patients with Recurrent Hepatic Hydrothorax

    Directory of Open Access Journals (Sweden)

    Mohamed Sharaf-Eldin

    2016-01-01

    Full Text Available Background and Aims. Treatment of hepatic hydrothorax is a clinical challenge. Chest tube insertion for hepatic hydrothorax is associated with high complication rates. We assessed the use of pigtail catheter as a safe and practical method for treatment of recurrent hepatic hydrothorax as it had not been assessed before in a large series of patients. Methods. This study was conducted on 60 patients admitted to Tanta University Hospital, Egypt, suffering from recurrent hepatic hydrothorax. The site of pigtail catheter insertion was determined by ultrasound guidance under complete aseptic measures and proper local anesthesia. Insertion was done by pushing the trocar and catheter until reaching the pleural cavity and then the trocar was withdrawn gradually while inserting the catheter which was then connected to a collecting bag via a triple way valve. Results. The use of pigtail catheter was successful in pleural drainage in 48 (80% patients with hepatic hydrothorax. Complications were few and included pain at the site of insertion in 12 (20% patients, blockage of the catheter in only 2 (3.3% patients, and rapid reaccumulation of fluid in 12 (20% patients. Pleurodesis was performed on 38 patients with no recurrence of fluid within three months of observation. Conclusions. Pigtail catheter insertion is a practical method for treatment of recurrent hepatic hydrothorax with a low rate of complications. This trial is registered with ClinicalTrials.gov Identifier: NCT02119169.

  12. Video-Assisted Thoracoscopic Pericardial Window in the Treatment of Pericardial Effusion: Report of Two Cases

    OpenAIRE

    2013-01-01

    A 54-year-old man had a history of subxiphoid pericardial window due to suspected tuberculous effusions. Seventeen years later, following chronic heart failure and implantation of a pacemaker, he again developed pericardial and pleural effusion, requiring repeated percutaneous pericardiocentesis, pleurocentesis and chest tube drainage. A 5×5-cm section of pericardium was successfully resected with video-assisted thoracic pericardial window. No recurrence of pericardial effusion has since been...

  13. COMPARISION OF ADENOSINE DEAMINASE [ADA] LEVELS WITH CYTO-CHEMICAL ANALYSIS OF PLEURAL FLUIDS TO DIFFERENTIATE TUBERCULAR AND NON â TUBERCULAR EFFUSIONS

    Directory of Open Access Journals (Sweden)

    Choukimath M Sharanabasav

    2013-12-01

    Full Text Available This study is intended to utilize biochemical parameters like ADA and protein levels in comparison with cell count and cell type in pleural fluid to differentiate tubercular and non-tubercular effusions. We have analyzed a total of 208 cases and among them 59.61% cases were ADA positive and 40.39% cases were ADA negative, and 156 cases were exudates and 52 cases were transudates. Categorized these effusions into 4 groups taking consideration of ADA, cell count, lymphocyte and protein levels as exudate with ADA positive, exudate with ADA negative, transudate with ADA positive and transudate with ADA negative. This study has shown promising results to diagnose tuberculosis with immediate and cost effectiveness that can be undertaken by any basic laboratory, in a endemic areas and developing countries like India

  14. Hippocrates (ca 460-375 bc), Introducing Thoracotomy Combined With a Tracheal Intubation for the Parapneumonic Pleural Effusions and Empyema Thoracis.

    Science.gov (United States)

    Tsoucalas, Gregory; Sgantzos, Markos

    2016-12-01

    Hippocrates was the first physician to describe in accuracy pleural effusion and pneumonia. To treat empyema thoracis he had introduced a combined method of tracheal intubation with a simultaneously thoracotomy. The surgical incision was used for the pus to be progressively drainaged. If the patient was too weak to eat, he had suggested for nutritional mixtures to be administered through an oral-gastric tube. Thus Hippocrates composed in his operating theatre, an icon similar to modern surgical operations. © The Author(s) 2016.

  15. Incidence of malignancy in patients with pleural effusion referred for workup by pulmonologists: Diagnostic yield of thoracentesis, and use of other investigational procedures

    DEFF Research Database (Denmark)

    Lindegaard, Dennis V.; Reuter, Simon; Laursen, Christian B.

    2016-01-01

    Introduction Pleural effusion (PE) is a common condition. Malignancy accounts for lt;25% in general populations. The proportion is unknown in patients referred to pulmonologists for workup.Finding malignant cells in PE by thoracentesis suggests metastatic and incurable disease making further tests...... and staging procedures superfluous.Objectives In patients with PE referred to pulmonologists for workup, we wanted to ascertain A) risk of malignancy; B)diagnostic yield of a single thoracentesis; C)time from PE to diagnosis; and D)impact of finding malignant cells in PE on use of additional tests...... immunohistochemistry, or same-day investigational procedures might be underlying causes for this discrepancy....

  16. Expression of YKL-40 and MIP-1a proteins in exudates and transudates: biomarkers for differential diagnosis of pleural effusions? A pilot study.

    Science.gov (United States)

    Adamidi, Tonia; Soulitzis, Nikolaos; Neofytou, Eirini; Zannetos, Savvas; Georgiou, Andreas; Benidis, Kleomenis; Papadopoulos, Alexis; Siafakas, Nikolaos M; Schiza, Sophia E

    2015-12-01

    YKL-40 is an extracellular matrix glycoprotein with a significant role in tissue inflammation and remodeling. MIP-1a has chemotactic and pro-inflammatory properties, and is induced by YKL-40 in several lung disorders. The aim of this study was to determine the levels of YKL-40 and MIP-1a in blood serum and pleural fluids of various pulmonary diseases, and to evaluate their potential role as differential diagnosis biomarkers. We recruited 60 patients (age: 62.5 ± 20.6 years) with pleural effusions: 49 exudates and 11 transudates (T). Exudates were further classified based on the underlying disease: ten with tuberculosis (TB), 13 with lung cancer (LCa), 15 with metastatic cancer (MCa) of non-lung origin and 11 with parapneumonic (PN) effusions. YKL-40 and MIP-1a levels were measured by ELISA. Pleural YKL-40 levels (ng/ml) were similar among all patient groups (TB: 399 ± 36, LCa: 401 ± 112, MCa: 416 ± 34, PN: 401 ± 50, T: 399 ± 42, p = 0.92). On the contrary, YKL-40 was significantly lower in the serum of TB patients (TB: 58 ± 22, LCa: 212 ± 106, MCa: 254 ± 140, PN: 265 ± 140, T: 229 ± 123, p < 0.001). Pleural MIP-1a protein levels (ng/ml) were statistically lower only in patients with LCa (TB: 25.0 ± 20.2, LCa: 7.3 ± 6.0, MCa: 16.1 ± 14.9, PN: 25.4 ± 27.9, T: 18.5 ± 7.9, p = 0.012), a finding also observed in serum MIP-1a levels (TB: 17.1 ± 7.6, LCa: 9.4 ± 7.0, MCa: 28.7 ± 28.7, PN: 33.3 ± 24.0, T: 22.9 ± 8.7, p = 0.003). Our data suggest that both YKL-40 and MIP-1a, particularly in serum, could prove useful for the differentiation of pleural effusions in clinical practice, especially of TB or LCa origin. However, large-scale studies are needed to validate these findings.

  17. 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.

  18. 例IgD多发性骨髓瘤患者多柔比星脂质体化疗后胸腔积液消退%Resolution of pleural effusion in a IgD multiple myeloma after chemotherapy based on liposomal doxorubicin

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    IgD myelomas account for only 2% of all myelomas. This kind of hematological malignancy is severe and carries a bleak prognosis. Pleural effusion is very rare in multiple myeloma. We reported a case in which pleural effusion appeared at the end of the illness of IgD myeloma and treated with liposomal doxorubicin.

  19. CD163+ tumor-associated macrophage is a prognostic biomarker and is associated with therapeutic effect on malignant pleural effusion of lung cancer patients.

    Science.gov (United States)

    Yang, Li; Wang, Fei; Wang, Liping; Huang, Lan; Wang, Jing; Zhang, Bin; Zhang, Yi

    2015-04-30

    CD163+ tumor-associated macrophages (TAMs) play an important role in the progression of cancer. However, the significance of CD163+ TAMs in malignant pleural effusion (MPE) is still unclear. The aim of this study is to evaluate the prognostic value of CD163+ TAMs in MPE, and the regulatory effect of an immune adjuvant (pseudomonas aeruginosa - mannose-sensitive hemagglutinin, PA-MSHA, which is used for MPE treatment in clinic) on CD163+ TAMs in MPE. Here, we found that the percentage of CD163+ TAMs in MPE was significantly higher than that in non-malignant pleural effusion (PCD163+ TAMs in MPE patients were an independent prognostic factor for progression-free survival. M2-related cytokines were highly expressed in MPE-derived CD163+ TAMs than in MPE-derived CD163- macrophages (PCD163+ TAMs frequency in MPE patients was obviously reduced after PA-MSHA treatment in clinic (PCD163+ TAMs in MPE caused by lung cancer is closely correlated with poor prognosis. CD163+ TAMs are associated with therapeutic effect in MPE. PA-MSHA re-educates CD163+ TAMs to M1 macrophages through TLR4-mediated pathway in MPE.

  20. Comparative study of induction chemotherapy and chemoradiotherapy in the treatment of limited-disease small cell lung cancer with ipsilateral pleural effusion%诱导化疗与放化疗联合治疗合并同侧胸腔积液局限期小细胞肺癌的对比研究

    Institute of Scientific and Technical Information of China (English)

    Ying Liu; Xuerong Zuo; Caixia Zhang; Ying Cheng

    2012-01-01

    Objective: The aim of the study was to explore the effects and side effects of induction chemotherapy followed by chemoradiotherapy for limited-disease small cell lung cancer (LD-SCLC) patients with ipsilateral pleural effusion.Methods: From January 2005 to May 2009, 52 LD-SCLC patients with ipsilateral pleural effusion were treated with induction chemotherapy got disappearance of pleural effusion after chemotherapy were underwent thoracic radiotherapy (TRT; 50 Gy/25 fraction) or same chemotherapy regimen; patients without disappearance or with increasing of pleural effusion after chemotherapy were given same chemotherapy regimen.Therapeutic effect was evaluated every two cycles according to RECIST 1.0 and side-effects were evaluated every cycle according to NCI-CTC AE Grades.All patients were followed up, and the median follow-up time was 26 months.Results: The response rate of patients was 80.7% (42/52) after induction chemotherapy and 34 patients got disappearance of pleural effusion.The median survival time, 1- and 2-year survival rates were 15.4 months, 76.9% (40 /52) and 38.5% (20 /52) respectively.The median survival time, 1- and 2-year survival rates of patients with pleural effusion remission received chest radiotherapy (A group, n = 20), patients with pleural effusion remission received chemotherapy (B group, n = 14) and patients without pleural effusion remission received chemotherapy (C group, n = 18) were 21.5 months, including myelosuppression, fatigue, nausea and vomiting.No therapeutic related death was occurred.Conclusion: Induction chemotherapy plus chemoradiotherapy has shown better effect in prolonging survival of small cell lung cancer (SCLC) patients with ipsilateral pleural effusion than chemotherapy alone.The patients with decreased ipsilateral pleural effusion may receive benefit from subsequent TRT.

  1. 胸腔积液患者1116例病因分析%Correlation Analysis of 1 116 cases of patients with pleural effusion

    Institute of Scientific and Technical Information of China (English)

    陈亚欧

    2015-01-01

    目的:探讨胸腔积液的常见病因分布以及与年龄的关系。方法选取2004年1月-2014年12月医院胸腔积液患者1116例进行回顾性病因分析。结果在1116例患者病因分析中,主要诊断结核355例,占31.8%;恶性肿瘤319例,占28.6%;自发性或外伤性液气胸、脓胸或血气胸占10.9%;以肺部感染为主要原因仅占7.3%;其中近1/4患者合并其疾病,最常见的合并症为肺部感染。年龄对于胸腔积液的病因分析提示,40岁前结核为第一病因,而之后恶性肿瘤成为首要病因。结论对于胸腔积液患者,结核、恶性肿瘤仍是最重要的病因;通过年龄相关分析,40岁前结核比率最高,自发性或外伤性液气胸、脓胸或血气胸发生率也较高;随着年龄增长,恶性肿瘤发生率逐渐上升,40岁以后开始为主要病因;并且,年龄的增长,心、肾功能不全,肺部感染引起胸腔积液的几率也随之上升。%Objective To study the distribution of the common causes of pleural effusion and its relationship with age. Methods Where the author hospital from January 2004 to December 2014 1 116 cases of pleural effusion were analyzed retrospectively cause. Results Etiology of 1 116 patients,the primary diagnosis of tuberculosis 355 cases,accounting for 31. 8 percent;319 cases of cancer,accounting for 28. 6% ;in spontaneous or traumatic pneumothorax,empyema or pneumothorax ac-counted for 10. 9% ;with lung infection only 7. 3 per cent mainly due to;nearly a quarter of patients with their disease,the most common complication is lung infection. Age analysis for the cause of pleural effusion prompt,40-year-old former tuberculosis as a first cause,but after becoming the leading cause cancer. Conclusion For patients with pleural effusion,tuberculosis,cancer is still the most important cause;by age-related analysis,the highest rate of tuberculosis 40 years ago,with spontaneous or trau-matic pneumothorax

  2. 恶性胸腔积液腔内化疗的护理%Nursing care of intracavitary chemotherapy for malignant pleural effusion

    Institute of Scientific and Technical Information of China (English)

    龚红英; 李兰

    2015-01-01

    目的:探讨恶性胸腔积液腔内给药化疗的护理。方法:收治晚期肿瘤患者15例,均行腔内化疗,回顾性分析其临床资料。结果:胸腔穿刺置管给药引流和后期维护过程顺利,配合完成治疗。出现引流管渗漏4例,3例堵管,经处理好转,无脱管。结论:在恶性胸腔积液腔内给药化疗的护理配合过程中,护理问题多,但经过细致护理,也可以预防和及时处理,从而达到满意的护理效果。%Objective:To explore the nursing care of intracavitary chemotherapy for malignant pleural effusion.Methods:15 patients with advanced cancer were selected,they were given intraperitoneal chemotherapy,the clinical data were retrospectively analyzed.Results:The process of pleural puncture catheterization for administration and drainage was successful,the treatment was completed with the cooperation of nuring.4 cases had drainage pipe leakage,3 cases had plugging,after treatment,the situation was better,there was no off of tube.Conclusion:In the nursing process of intracavitary chemotherapy for malignant pleural effusion,the nuring problems were more,but after careful nursing,we can timely prevent and treat these problems,so as to achieve the satisfactory effect of nursing.

  3. 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

  4. Microbial profiling does not differentiate between childhood recurrent acute otitis media and chronic otitis media with effusion

    NARCIS (Netherlands)

    Stol, K.; Verhaegh, S.J.; Graamans, K.; Engel, J.A.M.; Sturm, P.D.J.; Melchers, W.J.G.; Meis, J.F.; Warris, A.; Hays, J.P.; Hermans, P.W.M.

    2013-01-01

    OBJECTIVES: Otitis media (OM) is one of the most frequent diseases of childhood, with a minority of children suffering from recurrent acute otitis media (rAOM) or chronic otitis media with effusion (COME), both of which are associated with significant morbidity. We investigated whether the microbiol

  5. Abnormally High Expression of BAFF on T Lymphocytes from Lung Cancer-associated Pleural Effusions and Its Potent Anti-tumor Effect

    Institute of Scientific and Technical Information of China (English)

    Haiyan XU; Xiaozhou HE; Yibei ZHU; Tiangzan YAN; Hongbin MA; Xueguang ZHANG

    2007-01-01

    In the present study, the expressions of B cell activating factor belonging to the tumor necrosis factor family (BAFF) and its receptors (BAFF-R and TACI) on T lymphocytes from malignant pleural effusion (MPE) were examined by fluorescence-activated cell sorting (FACS) analysis, and compared with those on the T lymphocytes from non-malignant pleural effusion (NMPE) and healthy controls. It was found that CD3 positive T lymphocytes (including CD4, CD8, and part of CD25 and CD69 positive cells) of MPE in lung cancer highly and consistently expressed the BAFF molecule, while high expressions of BAFF could only be found in phytohemagglutinin (PHA) or interleukin 2 (IL-2) induced T lymphocytes from NMPE or healthy controls. These results were consistent with the results from BAFF mRNA detection by real-time PCR. In addition, T lymphocytes from MPE expressed significantly more BAFF-R than those from NMPE or healthy controls, while the expression of TACI was increased on CD4+ T cells but decreased on CD8+ T cells when compared with controls. The Annexin/PI assay suggested that recombinant human BAFF (rhBAFF) could promote the survival rate of T lymphocytes from MPE, while the decoy receptor TACI-Fc fusion protein could promote the apoptosis rate of T lymphocytes. Cytokines in the supernatant detected by ELISA assay showed that rhBAFF could significantly upregulate the secretion of IFN-γ in vitro,and the IFN-γ level in the TACI-Fc-treated group resembled that of the control groups. All of these results indicated that the abnormally high expression of BAFF on T lymphocytes from MPE may play a role of antitumor effect.

  6. Value of medical thoracoscopy in diagnosis of pleural effusion of unknown causes%内科胸腔镜在不明原因胸腔积液诊断中的应用

    Institute of Scientific and Technical Information of China (English)

    郭欣

    2014-01-01

    Objective To analyse the value of medical thoracoscopy in the diagnosis of unknown pleural effusion and its safety.Methods 92 cases of unknown pleural effusion treated in our department of respiratory medicine and intensive medicine from April 2010 to April 2013 were examined through medical thoracoscopy,pleural lesion was observed,and the abnormal parts were made biopsy and pathologic examination.Results In 92 patients with pleural effusion,84 cases were diagnosed,the positive rate of diagnosis was 91.3 %,in which 48 cases were malignant pleural effusion,29 cases were tuberculous pleural effusion,four cases were nonspecific inflammation,two cases were purulent pleuritis,one case was sarcoidosis,8 cases had unknown etiology,11 cases had postoperative pain,three cases had fever,and one case had bleeding.Conclusions Medical thoracoscopy is helpful to further clarify the causes of unexplained pleural effusion with superior tolerability,safety,and effectivity,it is worth clinical application.%目的 分析内科胸腔镜在不明原因胸腔积液诊断中的价值及其安全性.方法 对我院呼吸内科及重症医学科2010年4月至2013年4月收治的92例不明原因胸腔积液患者行内科胸腔镜检查,观察胸膜病变,直视下病变处多部位活检并行病理检查.结果 92例胸腔积液患者确诊84例,诊断阳性率为91.3%,其中恶性胸腔积液48例,结核性胸腔积液29例,非特异性炎症4例,化脓性胸膜炎2例,结节病1例,病因不明8例,术后疼痛11例,发热3例,出血1例.结论 内科胸腔镜检查有助于进一步明确不明原因胸腔积液的病因,且患者耐受性好、安全、有效,值得临床推广应用.

  7. 博莱霉素联合局部热疗治疗恶性胸腔积液的临床观察%Clinical observation of bleomycin combined with local thermotherapy in the treatment of malignant pleural effusion

    Institute of Scientific and Technical Information of China (English)

    周洋; 黄河; 张家洪; 龚建化

    2014-01-01

    Objective To observe the clinical effect of bleomycin combined with local thermotherapy in the treatment of NSCLC patients with malignant pleural effusion. Methods 50 NSCLC patients with malignant pleural effusion were randomly divided into two groups. All patients were treated with thoracentesis and inserted central ve-nous catheter to drainage pleural effusion. After exhaustion of pleural effusion, the control group was treated with ble-omycin by pleural perfusion, and the experiment group was treated with local thermotherapy on the base of the control group. The treatment, side effect and quality of life were compared. Results After the treatment, the KPS scores of living quality and the total effective rate of controlling pleural effusion were better in the experiment group than in the control group (P<0. 05), and the side effect was significant lower in the experiment group than in the control group (P<0. 05). Conclusion Bleomycin combined with local thermotherapy has a synergistic effect in the treatment of NSCLC with malignant pleural effusion.%目的:观察博莱霉素联合局部热疗治疗非小细胞肺癌( NSCLC)恶性胸腔积液的临床疗效。方法将50例NSCLC恶性胸腔积液的患者随机分为两组,采用胸腔穿刺术置入中心静脉导管引流胸腔积液,待排尽胸腔积液后,对照组给予胸腔灌注博莱霉素,实验组在对照组的基础上给予患者局部热疗,比较两组治疗情况、毒副反应及生活质量改善情况。结果两组患者治疗后,实验组患者的生活质量KPS评分及控制胸水的总有效率均明显高于对照组(P<0.05),且不良反应明显少于对照组(P<0.05)。结论博莱霉素联合局部热疗治疗NSCLC恶性胸腔积液具有协同作用,值得临床推广。

  8. Indications and morbidity of tube thoracostomy performed for traumatic and non-traumatic free pleural effusions in a low-income setting.

    Science.gov (United States)

    Mefire, Alain Chichom; Fokou, Marcus; Dika, Louis Din

    2014-01-01

    Tube thoracostomy (TT) is widely used to resolve a number of pleural conditions. Few data are available on the complications of TT performed for non-traumatic conditions, especially in low income setting. The aim of this study is to analyse the indications and complications of TT performed for both traumatic and non-traumatic conditions of the chest in a low-income environment. This retrospective study conducted over a four years period in a the Regional Hospital, Limbe in South-West Cameroon analyses the rate and nature of complications after TT performed for both traumatic and non-traumatic conditions. Different factors related to complications are analysed. We analysed 134 patients who had 186 chest tubes inserted. After placement, tubes were either connected to a water seal system (40%) or submitted to suction (60%). Most (91%) procedures were performed for a non-traumatic condition. Non-infectious pleural effusion in patients with HIV infection or pulmonary tuberculosis was the most common indication. Sixty six per-cents of procedures were carried out by a general surgeon. The complication rate was 19.35%. The most common complications included tube dislocation and pneumothorax. Most complications were solved by replacement of the tube. The nature of operator (general surgeon vs general practitioner) was a significant predictor of outcome (p < 0.01). No procedure related death was recorded. TT is a safe and efficient procedure to drain pleural collections of both traumatic and non-traumatic origins, even in low-income settings. The incidence of complications could be reduced by a better training of general practitioners on this procedure.

  9. Advanced laboratory testings for tuberculous pleural effusions%结核性胸腔积液实验室检测方法的研究进展

    Institute of Scientific and Technical Information of China (English)

    任茗睿; 朱艳; 任少华; 叶挺梅

    2014-01-01

    Tuberculous pleurity(TP)is the most important cause for exudative pleural effusions. Microbiological anal-yses of pleural fluid maybe negative in the most setting. Techniques, such as pleural biopsy or thoracoscopy are clini-cally limited by its invasion. Ongoing research has led to implementing a number of additional fluid analyses that may lead to a diagnosis without a need for further invasive procedures. In this review, we discuss the characteristics of TPE that may assist in this important diagnosis, and we highlight the benefits of specific biomarker analyses including adenosine deaminase, interferon and some novel tests.%结核性胸膜炎(TP)是引起渗出性胸腔积液最常见的病因。胸液微生物检查常常阴性。胸膜活检和胸腔镜检查的临床应用因其侵入性而受到限制。通过不懈努力已经推出了一系列无需侵入性操作就可有助诊断的胸腔积液实验室检查。本文就结核性胸膜积液(TPE)的特征进行讨论,以助诊断,重点介绍特异性生物标记试验,包括ADA、干扰素及其他新的检验方法的临床应用研究进展。

  10. 亚砷酸腔内注射治疗恶性胸腔积液的临床观察%Clinical observation of the treatment of malignant pleural effusion by injecting arsenic trioxide into pleural cavity

    Institute of Scientific and Technical Information of China (English)

    孟令新; 迟玉华; 丁兆军; 杨淑光; 王传艳; 张桂芳

    2014-01-01

    目的:评价亚砷酸胸腔注射治疗恶性胸腔积液的临床价值。方法:恶性胸腔积液患者68例,均经细胞学和病理学确诊。随机分为治疗组和对照组,在胸膜腔积液充分引流后,治疗组36例,胸膜腔内注射亚砷酸10-20mg,每天或隔日1次,连续3次。对照组32例,胸膜腔内注射博莱霉素30mg/ m2,7天1次,共1-2次。观察疗效、毒副反应、生活质量。结果:治疗组 CR 10例(27.78%),PR 16例(44.44%),总有效率为72.22%(26/36);对照组 CR 8例(25.00%),PR 15例(46.88%),总有效率为71.88%(23/32),两组有效率差异无显著性(P ﹥0.05)。治疗组注药后胸痛反应明显低于对照组(P ﹤0.05),胃肠道反应、骨髓抑制、发热反应两组间无明显差异(P ﹥0.05)。治疗后两组 KPS 评分均有增加,治疗前后比较有明显差异(P ﹤0.05)。结论:亚砷酸胸腔注射治疗恶性胸腔积液是一种有效、安全的方法。%Objective:To evaluate the clinical value of arsenic trioxide in treating malignant Pleural effusion by in-jecting into Pleural cavity. Methods:Sixty - eight Patients,required to have a cytologically Positive Pleural effusion or a Positive Pleural bioPsy in the Presence of an exudative effusion. After the accumulation of Pleural fluid had been ad-equately drained,36 Patients were randomized to Arsenic trioxide grouP,receiving arsenic trioxide 10 - 20mg,once a day or once two days,on 3 successive times,which were administered via chest tube or directly injected into Pleural cavity. Then the efficacy,toxicity and Perform ancestatus were evaluated. Results:In the Arsenic trioxide grouP,10 Pa-tients(27. 78% )achieved CR and 16 Patients(44. 44% )PR,the overall resPonse rate was 72. 22%(26 / 36). The control grouP 8 Patients(25. 00% )achieved CR and 15 Patients( 46 . 88 % )PR,and the overall resPonse rate was 71. 88%(23 / 32). The two grouPs had no significant

  11. 中心静脉导管置管引流治疗老年胸腔积液的体会%Central Venous Catheter Drainage in Treatment of Senile Pleural Effusion

    Institute of Scientific and Technical Information of China (English)

    彭慧群; 林伟革; 刘龙英

    2015-01-01

    目的:观察中心静脉导管置管引流治疗老年胸腔积液的临床疗效和安全性。方法通过经皮穿刺,将单腔中心静脉导管置入胸膜腔持续引流胸腔积液,可缓解症状,以帮助诊断、注入药物。结果80例胸腔积液患者79例穿刺置管成功,1例因胸壁组织过度肥厚穿刺成功,但置管困难放弃,置管成功率达98.75%。结论中心静脉导管留置胸腔治疗老年胸腔积液是一种简便、有效、安全、创伤小,痛苦少、老年患者容易接受的治疗方法。%Objective To observe the central venous catheter drainage in clinical efifcacy and safety in treatment of elderly patients with pleural effusion. Method Through percutaneous puncture, the single lumen central venous catheter drainage of pleural cavity pleural effusion, can alleviate symptoms, diagnosis, drug injection to help.Results 80 cases of 79 cases of patients with pleural effusion puncture catheter, 1 cases of chest wall hypertrophy due to excessive puncture success, but dififcult to abandon catheter, the success rate of catheterization was 98.75%.Conclusion The central venous catheter drainage in the treatment of senile pleural effusion is a simple, effective, safe, less trauma, treatment less pain, easily accepted by the patients in the elderly.

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

    Directory of Open Access Journals (Sweden)

    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.

  13. Comprehensive genomic analysis of malignant pleural mesothelioma identifies recurrent mutations, gene fusions and splicing alterations.

    Science.gov (United States)

    Bueno, Raphael; Stawiski, Eric W; Goldstein, Leonard D; Durinck, Steffen; De Rienzo, Assunta; Modrusan, Zora; Gnad, Florian; Nguyen, Thong T; Jaiswal, Bijay S; Chirieac, Lucian R; Sciaranghella, Daniele; Dao, Nhien; Gustafson, Corinne E; Munir, Kiara J; Hackney, Jason A; Chaudhuri, Amitabha; Gupta, Ravi; Guillory, Joseph; Toy, Karen; Ha, Connie; Chen, Ying-Jiun; Stinson, Jeremy; Chaudhuri, Subhra; Zhang, Na; Wu, Thomas D; Sugarbaker, David J; de Sauvage, Frederic J; Richards, William G; Seshagiri, Somasekar

    2016-04-01

    We analyzed transcriptomes (n = 211), whole exomes (n = 99) and targeted exomes (n = 103) from 216 malignant pleural mesothelioma (MPM) tumors. Using RNA-seq data, we identified four distinct molecular subtypes: sarcomatoid, epithelioid, biphasic-epithelioid (biphasic-E) and biphasic-sarcomatoid (biphasic-S). Through exome analysis, we found BAP1, NF2, TP53, SETD2, DDX3X, ULK2, RYR2, CFAP45, SETDB1 and DDX51 to be significantly mutated (q-score ≥ 0.8) in MPMs. We identified recurrent mutations in several genes, including SF3B1 (∼2%; 4/216) and TRAF7 (∼2%; 5/216). SF3B1-mutant samples showed a splicing profile distinct from that of wild-type tumors. TRAF7 alterations occurred primarily in the WD40 domain and were, except in one case, mutually exclusive with NF2 alterations. We found recurrent gene fusions and splice alterations to be frequent mechanisms for inactivation of NF2, BAP1 and SETD2. Through integrated analyses, we identified alterations in Hippo, mTOR, histone methylation, RNA helicase and p53 signaling pathways in MPMs.

  14. 改良式胸腔闭式引流在胸腔积液诊疗方面的临床应用探讨%Clinical application of modified thoracic drainage in diagnosis and treatment of pleural effusion

    Institute of Scientific and Technical Information of China (English)

    姚惠莲; 张玉萍

    2015-01-01

    Pleural effusion and pneumothorax is a common disease of Respiratory Medicine, thoracentesis and closed thorac ic drainage as conventional medicine clinical treatment methods of pleural effusion such diseases caused by various reasons in re cent years more and more, combined with China. aging population and the increased incidence of tumors, tumor pleural effusion more and more, take more chest drainage and intrathoracic injection clinic, repeated puncture fluid, complicated operation, in ou r hospital from 2011 to 2015 to 150 cases of pleural effusion in patients with modified thoracic drainage and injection, has been actively exploring in their work, to be creative, to solve this problem, to obtain a more satisfactory results, worthy of promotion.%胸腔积液及气胸是呼吸内科常见疾病,胸腔穿刺术和胸腔闭式引流术作为这类疾病的常规内科临床诊疗方法。近年来各种原因引起的胸腔积液越来越多,加之中国人口老龄化及肿瘤发病率的增高,肿瘤性胸腔积液越来越多,临床上多采取胸腔引流术及胸腔内注药,反复穿刺抽液,操作繁琐,我院自2011年至2015年对150例胸腔积液患者进行改良式胸腔闭式引流及注药,在工作中不断积极探索,勇于创新,解决了这一难题,取得了较为满意的疗效,值得临床推广。

  15. 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

    Directory of Open Access Journals (Sweden)

    Luiz Antonio Rossi

    2005-04-01

    ós-operatório de cirurgia abdominal eletiva é muito freqüente. A maioria dos DPPO é autolimitada, evoluindo de modo assintomático. A ecografia na constatação do DPPO mostrou-se efetiva e sua utilização merece ser difundida.BACKGROUND: Pleural effusion is frequently seen on imaging examinations following elective abdominal surgery and has no clinical significance in most patients. This condition should be distinguished from pulmonary complications that require treatment. OBJECTIVE: To prospectively determine the incidence of pleural effusion in patients submitted to elective abdominal surgery using ultrasound (US, and to assess the possible association with risk factors related to the patients and anesthetic-surgical procedures. MATERIALS AND METHODS: Thirty-seven patients, 21 (56.8% female, and 16 (43.2% male aged 29 to 76 years submitted to elective abdominal surgery were evaluated. US was performed preoperatively and 48 hours after surgery in all patients. Associated risk factors were also assessed - age > 60 years, sex, obesity, smoking history, alcoholism and associated diseases -, and anesthetic-surgical procedure - cancer resection, class ASA > 2, duration of surgery, longitudinal incision and incision > 15 cm. Biliar lithiasis (43.2% and gastrointestinal cancer (43.2% were the main causes leading to surgery. RESULTS: The incidence of postoperative pleural effusion (PPE detected by US was 70.3% (26/37. Two of these patients (5.4% developed pulmonary complications, and one died. The risk factors age > 60 years, smoking history, alcoholism, obesity and associated diseases had no influence on the development of the PPE whereas cancer resection, class ASA > 2, longitudinal incision and incision > 15 cm were significantly statistically associated with the presence of PPE. PPE developed even during antibiotic therapy. The duration of hospitalization was more than 2.4 longer in the patients with PPE. CONCLUSION: PPE is a very frequent condition observed in patients

  16. 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.

  17. Detection of bacteria and viruses in the pleural effusion of children and adults with community-acquired pneumonia.

    Science.gov (United States)

    Marimón, José María; Morales, María; Cilla, Gustavo; Vicente, Diego; Pérez-Trallero, Emilio

    2015-01-01

    To study the etiology and the utility of new molecular methods in the diagnosis of complicated pneumonia with empyema. Bacteria and viruses detection was performed by several traditional and molecular methods in the pleural fluid (PF) of 60 patients (38 children) with community-acquired pneumonia (CAP). Despite prior antimicrobial therapy in 49 (81.7%) CAP patients, an etiological diagnosis could be established in 41 (68.3%), 35 being (58.3%) Streptococcus pneumoniae. PF culture was positive in only 6 patients but each molecular test detected more than 82% of cases. Traditional culture methods have poor diagnostic sensitivity in PF because most CAP patients are under antimicrobial therapy when it is obtained. S. pneumoniae detection by molecular methods highly improves diagnosis.

  18. Characterization, anticancer drug susceptibility and atRA-induced growth inhibition of a novel cell line (HUMEMS) established from pleural effusion of alveolar rhabdomyosarcoma of breast tissue.

    Science.gov (United States)

    Ohi, Satoshi

    2007-05-01

    We recently established a cell line derived from pleural effusion from a 13-year-old girl with primary alveolar rhabdomyosarcoma (RMS with a chromosomal translocation t[2;13]) in the breast tissue. The cell line was designated as HUMEMS. Cases of primary alveolar RMS swelling in the breast are extremely rare (about 0.2% of all RMSs). Therefore, the HUMEMS cell line is an important material for studying therapeutics for malignant tumors in children. The HUMEMS cell line we isolated consisted of two morphological subtypes. One type (SSN cells) is small in size and has a single nucleus. Another (LMN cells) is large in size and has two or more nuclei. Both SSN cells and LMN cells were immunohistochemically positive for desmin and slightly positive for myoglobin. Our data suggested LMN cells are well-differentiated SSN cells. Moreover, in some of the LMN cells, rapid cell contractions (1-5 times/10 sec) were observed. We investigated the anticancer drug susceptibility of the HUMEMS cell line with an oxygen electrode apparatus (Daikin, DOX-10, JPN) and effect of all-trans-retinoic acid (atRA) to the cell line. The atRA-treatment inhibited proliferation of the HUMEMS cells.

  19. 中心静脉导管接负压吸引器在结核性胸腔积液中的应用%Application of central venous catheter connected with the negative pressure aspirator in tuberculous pleural effusion

    Institute of Scientific and Technical Information of China (English)

    王赞

    2014-01-01

    目的:探讨中心静脉导管接负压吸引器在结核性胸腔积液治疗中的疗效。方法:收治结核性胸膜炎患者100例,随机分为两组,治疗组50例,采用中心静脉导管接负压吸引器持续引流胸腔积液;对照组50例,采用常规中心静脉导管接无菌引流袋引流胸腔积液。两组均用2HRZE/10HRE标准抗痨方案治疗,观察胸腔积液引流通畅,胸腔积液消失时间。结果:治疗组胸腔积液吸收时间短,不易造成引流管阻塞。结论:中心静脉导管接负压吸引器引流治疗结核性胸腔积液疗效确切。%Objective:To explore the curative effect of central venous catheter connected with the negative pressure aspirator in tuberculous pleural effusion.Methods:100 patients with tuberculous pleurisy were selected,they were randomly divided into the treatment group and the control group with 50 cases in each.The treatment group was given drainage of the pleural effusion by central venous catheter connected with the negative pressure aspirator.The control group was given drainage of the pleural effusion by the central venous catheter with a sterile drainage bag.The two groups were treated with the standard of 2HRZE/10HRE tuberculosis scheme.Pleural effusion drainage and the hydrothorax disappearance time were observed.Results:In the treatment group,hydrothorax absorption time was short,and it was not easy to cause obstruction of drainage tube.Conclusion:The curative effect of central venous catheter connected with the negative pressure aspirator in tuberculous pleural effusion is obviously.

  20. 良性血性胸腔积液42例临床诊断分析%Clinical Analysis of 42 Cases with Bloody Pleural Effusion Caused by Benign Disease

    Institute of Scientific and Technical Information of China (English)

    王剑利; 杨硕; 俞珊; 李净; 陈红兵

    2012-01-01

    目的 探讨不同病因引起的良性血性胸腔积液的临床特点.方法 分析我院收治的42例良性血性胸腔积液患者的临床资料.结果 42例患者中有结核性胸膜炎27例,占62.8%,其他良性疾病15例(其中肺炎旁4例,系统性红斑狼疮性3例,类风湿性关节炎2例,充血性心力衰竭2例,结节病1例,肝硬化2例,慢性胰腺炎1例),这些患者在既往史、症状及实验室检查等方面各有其特点.结论 良性血性胸腔积液以结核性胸膜炎为主,亦见于其他良性疾病,如果排除恶性肿瘤,且抗结核治疗效果欠佳,则需仔细询问患者既往史,完善有针对性的实验室检查尽早明确病因,积极治疗原发病以改善预后.%Objective To analyze the clinical characteristics of benign bloody pleural effusion from various causes. Methods Analyzed of clinical data of 42 cases with bloody pleural effusion. Results Among 42 patients, 27 cases of the bloody pleural effusion caused by tuberculous pleural effusions( 62. 8% ),15 cases caused by other benign disease( 4 cases of pneumonia, 3 cases of systemic lupus eritematosus, 2 cases of rheumatoid arthritis, 2 cases of congestive heart failure, a case of sarcoidosis, 2 cases of hepatic cirrhosis, and a case of chronic pancreatitis ). These patients' past history, simultaneous symptoms and laboratory examination results were looked at. Conclusion Most bloody pleural effusions caused by tuberculous pleuritis, also other benign diseases. When the possibilities of malignant tumors were excluded and tuberculosis treatment has poor curative effects, it is critical to enquire about the past history of patients thoroughly and to take additional related examinations in order toto determine the diagnosis early, treat properly and improve prognosis.

  1. The Effects of Tumor Infiltrating Lymphocytes for Treatment of Malignant Pleural Effusion Compare to Cisplatin%TIL与顺铂治疗恶性胸腔积液的疗效比较

    Institute of Scientific and Technical Information of China (English)

    陈建清; 康美玲; 钟小红; 曾道林; 刘进兵; 吴晓安

    2011-01-01

    目的 观察肿瘤浸润淋巴细胞(TIL)与顺铂治疗恶性胸腔积液的疗效.方法 40例患者随机选取20例为试验组、对照组,从恶性肿瘤胸腔积液的肿瘤细胞中分离得到TIL,并经10%人AB血清RPMI-1640液培养,经rIL-2体外激活培养,随后胸腔注射;对照组抽取胸腔积液后用顺铂胸腔注射.结果 试验组完全缓解8例(40%),有效10例(50%),无效2例(10%),总有效率90%(18/20);对照组完全缓解7例(35%),有效9例(45%),无效4例(20%),总有效率80%(16/20).两者疗效无统计学意义(P>0.05). 不良反应轻.结论 TIL治疗恶性胸腔积液疗效好,毒副作用小,能改善患者的生活质量.%Objective To evaluate the effect of tumor infilitrating lymphocytes( TIL ) in the treatment of patients with malignant pleural effusion. Methods 40 patients with malignant pleural effusion were randomly divided into two groups. TILs were derived from malignant pleural effusion in the study group, and then cultivated in the 10% AB type serum RPMI -1640 liquid, and activated by rIL-2 in vitro. The TILs were then injected into thoracic cavities. Patients in the control group were given cisplatin after removal of the pleural effusion. Results The CR, PR, and NR were 8 ( 40% ), 10( 50% ) and 2( 10% ) in the study group, with an overall response rate of 90% ( 18/20 ); whereas the CR, PR, and NR were 7 ( 35% ), 9 ( 45% ) and 4 20% ), with an overall response rate was 80% ( 16/20 ). The response rate in the two groups had no significant difference. Conclusion Infusion of TILs derived from malignant pleural is safe and effective in the treatment of patients with malignant pleural.

  2. Pleuropericardial effusion associated with minoxidil administration

    Science.gov (United States)

    Webb, D. B.; Whale, R. J.

    1982-01-01

    A patient on minoxidil developed pericardial and pleural effusions with a high protein content. This finding is not compatible with the view that such effusions in patients taking minoxidil are transudates. PMID:7111124

  3. A preliminary study of 1H-MRS in diagnosis of benign and malignant pleural effusions%1.5T磁共振1H-MRS鉴别良恶性胸腔积液的初步研究

    Institute of Scientific and Technical Information of China (English)

    钟华; 代海洋; 李丽红; 肖叶玉; 吴仁华

    2015-01-01

    Objective To investigate the feasibility of magnetic resonance spectroscopy(MRS) in the diagnosis of benign and malignant pleural effusions. Methods Samples of 46 cases of pleural effusion were collected in clinics after performing pleurocentesis. Among the obtained samples, 20 cases were benign pleural effusion(14 cases of tuberculosis and 6 cases of pneumonia) and 26 cases were malignant pleural effusion ( 18 cases of primary bronchogenic carcinoma , 5 cases of breast carcinoma , 2 cases of primary hepatic carcinoma, and 1 case of gastric carcinoma ). The effusion pleural samples were centrifuged and subjected to 1H MRS examination using a 1.5T MR device. Results The main metabolites in the pleural effusion contain lactate, choline, creatine, myo-inositol(MI), and fatty acids. Area of Lactate:pleural effusion from tuberculosis (5.19±1.31), pneumonia (6.08±1.56) and malignant pleural effusion (2.40±0.43) has statistic significance (F=8.45, P0.05), choline (t=-0.58, P>0.05) and MI (t=1.19, P>0.05) between pleural effusion from tuberculosis (5.19 ±1.31) and pneumonia has no statistic significance. Conclusions Benign and malignant pleural effusions show different MRS characteristics. 1H MRS has certain clinical value in the differentiation of benign and malignant pleural effusions.%目的:探讨磁共振波谱对良、恶性胸腔积液的鉴别诊断价值。方法收集行胸腔穿刺抽液的胸腔积液标本46例,其中原发病确诊为良性者20例(包括肺结核14例、肺炎6例),原发病确诊为恶性者26例(包括原发性肺癌18例、乳腺癌5例、肝癌2例、胃癌1例)。对胸腔积液标本进行离心处理,然后利用1.5T磁共振对胸腔积液标本进行波谱采集,分析良恶性胸腔积液的波谱特征。结果胸腔积液的波谱图中主要的代谢峰有乳酸、胆碱、肌酸、肌醇及脂质等。主要代谢物波峰下面积比较:乳酸:结核性(5.19±1.31)、炎性(6.08±1.56

  4. 瘦素、脂联素联合癌胚抗原在恶性胸腔积液中的诊断价值%Diagnostic value of leptin, adiponectin and carcino-embryonic antigen in patients with malignant pleural effusion

    Institute of Scientific and Technical Information of China (English)

    朱述阳; 何军; 陈亮

    2011-01-01

    目的 探讨瘦素(Lp)、脂联素(Adipo)和癌胚抗原(CEA)对恶性胸腔积液诊断的临床意义。方法 42例良性和36例恶性胸腔积液患者的胸水和血清标本中Lp、Adipo含量采用双抗体夹心酶联免疫吸附法测定,CEA含量采用放射免疫分析法来测定。结果恶性组胸水与血清Lp、CEA含量高于良性组(P值均<0.01);恶性组胸水与血清Adipo含量低于良性组(P值均<0.01);Lp、Adipo和CEA对诊断恶性胸腔积液的敏感性分别是81.0%、76.2%和64.7%,特异性分别是74.0%、77.8%和88.1%,阳性似然比分别是3.12、3.43和5.44;指标联合诊断中以Lp和Adipo分别与CEA联合诊断功效较好,其敏感性和特异性分别是52.4%、96.9%和49.3%、97.4%,阳性似然比分别是16.90和18.96。结论 恶性胸腔积液患者的血清与胸水中Lp、Adipo与CEA浓度对诊断恶性胸腔积液有临床价值,其中以胸水中Lp和Adipo分别与CEA联合诊断功效较好。%Objective To study the clinical value of combined determination of leptin (Lp),adiponectin (Adipo) and carcino-embryonic antigen (CEA) in diagnosis of malignant pleural effusion.Methods The levels of Lp and Adipo were measured by enzyme linked immunosorbent assay and CEA was detected by radioimmunoassay in serum and pleural effusion of 36 patients with malignant pleural effusion and 42 patients with benign disease. Results The concentrations of Lp and CEA in the pleural effusion and serum of patients with malignant pleural effusion were higher than those in patients with benign pleural effusion (all P <0.01). The concentration of Adipo in the pleural effusion and serum of patients with malignant pleural effusion was lower than that in patients with benign pleural effusion (all P <0. 01). The sensitivities of Lp, Adipo,and CEA in pleural effusion were 81.0% ,76.2% ,and 64.7%,the specificities were 74.0%, 77.8%, and 88. 1%, and positive likelihood ratio were 3.12, 3

  5. Differential diagnosis of tuberculosis and lung cancer pleural effusion by CEA, CA125,CA50%CEA、CA125、CA50在结核及肺癌性胸水鉴别中的意义

    Institute of Scientific and Technical Information of China (English)

    冯金栋; 赵卫国; 保鹏涛

    2013-01-01

    Objective:To explore the significance of differential diagnosis of pleural effusion by detection of carci-noembryonic antigen (CEA) ,carbohydrate antigen (CA125) and carbohydrate antigen (CA50). Methods: A total of 126 specimens from pleural effusion diagnosed as TB in 70 cases and lung cancer in 56 cases were collected. CEA, CA125,CA50 in the pleural effusion were analyzed. ResuItS:The expression level and sensitivity of CEA and CA50 in pleural effusion of lung cancer was significantly higher than that in tuberculous (P 0.05). The specificity was only 5.71%. Combining CEA with CA125 to diagnose pleural effusion resulted fom lung cancer, the sensitivity was 92. 11% and combining CA125 with CA50 the sensitivity was 95. 24% . When the concetration of CEA was more than 10ng/ml or the concetration of CA125 was more than 2000U/ml,pleural effusion of lung cancer should be highly suspected. Conclusion;The use of CEA.CA125 and CA50 separately,or in combination is helpful to differential diagnosis of pleural effusion resulted from tuberculosis and lung cancer.%目的:探讨癌胚抗原(CEA)、糖类抗原(CA125)、糖类抗原(CA50)在胸水鉴别诊断中的意义.方法:收集已明确胸水性质的标本126例(结核性70例、癌性56例),检测胸水中CEA、CA125、CA50的数值,进行统计分析.结果:肺癌性胸水中CEA、CA50表达水平及敏感度明显高于结核性胸腔积液(P<0.05),特异性分别为95.71%和98.57%.同样CA125在肺癌性胸水中高表达(P<0.05),但两组敏感度无差异(P>0.05),特异性仅为5.71%;CEA和CA125联合诊断肺癌性胸水的敏感度为92.11%,CA125和CA50联合诊断敏感度为95.24%.CEA> 10ng/ml或CA125> 2000U/ml,可初步定为肺癌性胸水.结论:CEA、CA125、CA50单独或联合检测对鉴别诊断结核及肺癌性胸水有重要临床指导意义.

  6. 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...

  7. Recurrence rate and magma effusion rate for the latest volcanism on Arsia Mons, Mars

    Science.gov (United States)

    Richardson, Jacob A.; Wilson, James A.; Connor, Charles B.; Bleacher, Jacob E.; Kiyosugi, Koji

    2017-01-01

    likely began around 200-300 Ma then first peaked around 150 Ma, with an average production rate of 0.4 vents per Myr. The recurrence rate estimated including stratigraphic data is distinctly bimodal, with a second, lower peak in activity around 100 Ma. Volcanism then waned until the final vents were produced 10-90 Ma. Based on this model, volume flux is also bimodal, reached a peak rate of 1-8 km3 Myr-1 by 150 Ma and remained above half this rate until about 90 Ma, after which the volume flux diminished greatly. The onset of effusive volcanism from 200-150 Ma might be due to a transition of volcanic style away from explosive volcanism that emplaced tephra on the western flank of Arsia Mons, while the waning of volcanism after the 150 Ma peak might represent a larger-scale diminishing of volcanic activity at Arsia Mons related to the emplacement of flank apron lavas.

  8. [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.

  9. Pleural effusion in fibronectin、laminin、collagen type Ⅳ and pleural fibrosis%胸腔积液中纤维连接蛋白、层连蛋白、Ⅳ型胶原与胸膜纤维化的相关性

    Institute of Scientific and Technical Information of China (English)

    邵景韫; 刘安; 戚好文

    2014-01-01

    Objective:To investigate the pleural effusion in fibronectin laminin type Ⅳ collagenand pleural fibrosis .Methods:Using the enzyme immunoassay test in 40 cases of tuberculous exudate and transudate in 40 cases of fibronectin laminin collagen type Ⅳlevel .Results :the tuberculous pleural effusion in fibronectin ,laminin ,collagen type Ⅳ levels were higher than those of transudate(P<0 .05) .Conclusion :fibronectin laminin collagen type Ⅳlevel in pleural fibrosis formation plays an important role in the process .%目的:探讨胸腔积液中纤维连接蛋白(FN )、层连蛋白(LN )、Ⅳ型胶原(ColⅣ)与胸膜纤维化的关系。方法:采用酶联免疫检测仪检测40例结核性渗出液及40例漏出液中的F N、L N、ColⅣ的水平。结果:结核性胸腔积液中FN、LN、ColⅣ水平均高于漏出液(P<0.05)。结论:FN、LN、ColⅣ在胸膜纤维化的形成过程中起重要作用。

  10. Analysis of Applying of Central Venous Catheter in the Treatment of 300 Cases with Pleural Effusion%中心静脉导管在胸腔积液治疗中的应用300例分析

    Institute of Scientific and Technical Information of China (English)

    范昭豪; 邓亮; 戴武强

    2014-01-01

    Objective:To compare the efficacy and safety of the central venous catheter and traditional transthoracic needle in the thoracic puncture treatment of patients with pleural effusion,and to provide the basis for the central venous catheter replacing traditional transthoracic needle in the treatment of patients with pleural effusion in primary hospital. Method:A total of 300 cases with pleural effusion in our hospital from March 2010 to March 2013 were randomly divided into the treatment group and the control group,150 cases in each group.The treatment group was given single lumen central venous catheter for thoracic puncture and the control group was given traditional thoracentesis package thoracic puncture needle for thoracic puncture.The differences of puncture time,incidence of pneumothorax,wound infection rate,hospitalization time of puncture,single liquid pumping success rate and tuberculous pleural effusion hospitalization expenses between the two groups were observed and compared.Result:The puncture time and wound infection rates of the two groups were compared,the differences were not statistically significant(P>0.05).But the incidence of pneumothorax and the number of hospitalization pleural puncture in the treatment group were significantly less than those in the control group,the differences were statistically significant(P0.05)。但治疗组的气胸发生率和住院期间穿刺次数均明显少于对照组,差异均有统计学意义(P<0.05)。且治疗组的单次抽液成功率明显高于对照组,结核性胸腔积液患者住院费用明显少于对照组,差异均有统计学意义(P<0.05)。结论:中心静脉导管行胸腔穿刺抽液治疗可减少气胸发生率,减少抽液次数,单次成功率高,住院费用低,值得在基层医院推广应用。

  11. Classification and identification of malignant tumor cells by IHC in pleural effusion diagnosis%免疫细胞化学方法对胸腔积液中恶性肿瘤细胞的分类与诊断

    Institute of Scientific and Technical Information of China (English)

    陈江帆; 杜明伟; 姜海娇; 王秀茹; 李建华

    2013-01-01

    目的 应用免疫细胞化学对胸腔积液中的肺非小细胞癌分类与恶性间皮瘤的鉴别诊断.方法 利用液基薄层细胞学自动涂片技术方法对筛查出的胸腔积液可疑瘤细胞及瘤细胞标本1158例进行细胞包埋连续切片,分别作肺非小细胞癌(NSCLC)肿瘤细胞标记物CK7、CK5&6、TTF-1、E-ca及恶性间皮瘤标记物MC(Mesothelial Cell,MC)、CR(Calretinin,CR)、P53、Vimentin免疫细胞化学染色.结果 1158例胸腔积液患者确诊为肺腺癌581例,鳞癌509例,腺鳞癌48例,恶性间皮瘤20例.TTF-1在腺癌中有明显高表达,阳性表达率为92.43%;CK5&6在鳞癌中有明显高表达,阳性表达率为97.45%;MC、CR在恶性间皮瘤中有明显高表达,阳性表达率为100.00%和95.00%.结论 液基细胞学与免疫细胞化学技术相结合在胸腔积液鉴别诊断中有很重要的临床意义,CK7、CK5&6、TTF-1、E-ca联合应用可用于胸腔积液中NSCLC之间的分类与诊断,CK5&6、MC、CR、P53、Vimentin联合应用可用于胸腔积液中间皮瘤的定性诊断,值得在临床细胞病理学诊断中推广应用.%Objective To make differentiatial diagnosis of non-small cell cancer and malignant mesothelioma in pleural effusion by immunocytochemical method. Methods Pleural effusion was detected with TCT, and a total of 1158 cases of suspected or confirmed tumor cells of malignant pleural effusion were randomly selected in continuous paraffin-embedded sections. We detected non-small cell lung cancer (NSCLC) cell markers CK7, CK5&6, TTF-1 and E-ca, and malignant mesothelioma markers MC (Mesothelial Cell), CR(Calretinin), P53 and Vimentin immunocytochemical staining. Results Of the 1158 cases of pleural effusion, we confirmed 581 cases of lung adenocarcinoma, 509 squamous carcinoma, 48 adeno-squamous carcinoma, and 20 malignant pleural mesothelioma. Moreover, TTF-1 showed significantly higher expression in adenocarcinoma, with a the positive percentage 92. 43% ; CK5

  12. 中心静脉穿刺导管在癌性胸腔积液中的应用%Application of central venous catheter in Cancerous Pleural Effusion

    Institute of Scientific and Technical Information of China (English)

    曾少云; 陈志军

    2014-01-01

    目的:解决癌性胸腔积液反复穿刺的缺点。方法:收治癌性胸腔积液患者17例,应用中心静脉穿刺导管做胸腔留置引流术。结论:中心静脉穿刺导管引流较传统反复穿刺引流具有很多优点。本方法引流效果明显优于传统引流方法及反复穿刺的方法。%Objective:To solve the disadvantage of malignant pleural effusion repeated puncture.Methods:17 patients with malignant pleural effusion were selected,We did indwelling pleural drainage by central venous catheter.Experience:The central venous catheter has more advantages than the traditional repeated puncture drainage.Conclusion:This method is better than the traditional drainage drainage method and repeated puncture.

  13. Malignant pleural effusions and the role of talc poudrage and talc slurry: a systematic review and meta-analysis

    Science.gov (United States)

    Mummadi, Srinivas; Kumbam, Anusha; Hahn, Peter Y.

    2015-01-01

    Background: Malignant Pleural Effusion (MPE) is common with advanced malignancy. Palliative care with minimal adverse events is the cornerstone of management. Although talc pleurodesis plays an important role in treatment, the best modality of talc application remains controversial.   Objective: To compare rates of successful pleurodesis, rates of respiratory and non-respiratory complications between thoracoscopic talc insufflation/poudrage (TTI) and talc slurry (TS).  Data sources and study selection: MEDLINE (PubMed, OVID),  EBM Reviews (Cochrane database of Systematic Reviews, ACP Journal Club, DARE, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, Health Technology Assessment and NHS Economic Evaluation Database), EMBASE and Scopus. Randomized controlled trials published between 01/01/1980 - 10/1/2014 and comparing the two strategies were selected.  Results: Twenty-eight potential studies were identified of which 24 studies were further excluded, leaving four studies. No statistically significant difference in the probability of successful pleurodesis was observed between TS and TTI groups (RR 1.06; 95 % CI 0.99-1.14; Q statistic, 4.84). There was a higher risk of post procedural respiratory complications in the TTI group compared to the TS group (RR 1.91, 95% CI= 1.24-2.93, Q statistic 3.15). No statistically significant difference in the incidence of non-respiratory complications between the TTI group and the TS group was observed (RR 0.88, 95% CI= 0.72-1.07, Q statistic 4.61). Conclusions: There is no difference in success rates of pleurodesis based on patient centered outcomes between talc poudrage and talc slurry treatments.  Respiratory complications are more common with talc poudrage via thoracoscopy. PMID:25878773

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

    Directory of Open Access Journals (Sweden)

    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.

  15. Clinical observa tion of thermotherapy combined with intra-pleural injection of high dose mannatide in the treating of malignant pleural effusion%热疗联合大剂量甘露聚糖肽胸腔注射治疗恶性胸腔积液的临床观察

    Institute of Scientific and Technical Information of China (English)

    陈维; 魏涛; 陈林

    2015-01-01

    Objective:To study the clinical efficacy, the change of KPS score and side effects induced by thermotherapy combined with intra-pleural injection of high dose mannatide in the treating of malignant pleural effusion. Methods:Thirty-six patients with malignant pleural effusion were randomized into groups after closed drainage. The 18 patients in the observation group were treated with intra-pleural injection of high dose mannatide, and then underwent thermotherapy. The 18 patients in the control group were treated with intra-pleural injection of high dose mannatide. The clinical efficacy, the change of karnofsky (KPS) score and side effects were compared between the groups. Results:The response rate in the observation group was 88.9%, and 66.7% in the control group. There was significant difference between the groups (P0.05). The main toxicities of thermotherapy were induration of subcutaneous fat and local skin scorch. Conclusion:Thermotherapy combined with intra-pleural injection of high dose mannatide can increase efficacy in the treating of malignant pleural effusion, and the toxicity can be tolerated,it was worthy for clinical use.%目的:观察热疗联合大剂量甘露聚糖肽胸腔注射治疗恶性胸腔积液的临床疗效。方法:将36例恶性胸腔积液患者随机分为两组,采用胸腔闭式引流尽可能排尽胸腔积液后,治疗组18例用大剂量甘露聚糖肽胸腔注射后行射频热疗,对照组18例单用大剂量甘露聚糖肽胸腔注射治疗,比较两组的疗效、生活质量改善率和毒副反应。结果:治疗组和对照组治疗有效率分别为88.9%和66.7%,差异有统计学意义(P0.05);热疗主要的毒副反应为皮下脂肪硬结、局部皮肤灼伤。结论:热疗联合大剂量甘露聚糖肽胸腔注射治疗恶性胸腔积液疗效满意,毒副反应可以耐受,值得临床推广。

  16. 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

    Directory of Open Access Journals (Sweden)

    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

  17. 鸦胆子油乳联合丝裂霉素治疗恶性胸腔积液的研究%The application of Yadanzhi grease combined with mitomycin in the treatment of malignant pleural effusion

    Institute of Scientific and Technical Information of China (English)

    徐春华

    2011-01-01

    Objective To observe the curative effects on malignant pleural effusion treated with Yedanzhi (YDZ) grease and mitomycin(MMC). Methods Sixty-seven in patients suffering from malignant pleural effusion were divided into three groups randotnly:24 patients in the treatment group were treated with mitomycin 6 mg and YDZ 60 ml ,22 patients were treated with YDZ and 21 patients were treated with mitomycin. The doses were given one time every week, for 2 ~ 3 weeks. Results The total effective rates in the treatment group, YDZ group and mitomycin group were respectively 83.3% ,59. 1 % and 57. 1% respectively ( P < 0. 05 ). Conclusion The effect of using YDZ and mitomycin together in treatment of malignant pleural effusion is superior to using only YDZ or mitomycin.%目的 研究鸦胆子油乳联用丝裂霉素治疗恶性胸腔积液的疗效.方法 选样67例患有恶性胸腔积液的住院患者,分别胸腔内注射鸦胆子油乳、丝裂霉素与单用鸦胆子油乳、丝裂霉素,每周1次,连续注射2~3周.结果 鸦胆子油乳联用丝裂霉素组治疗有效率83.3% ,鸦胆子油乳组59.1% ,丝裂霉素组57.1%(P<0.05).结论 鸦胆子油乳联用丝裂霉素治疗恶性胸腔积液的疗效明显优于单用鸦胆子油乳、丝裂霉素.

  18. 液基细胞学技术在胸腹水检验中的应用%Application of Liquid-based cytology technology in the research of pleural effusion and the ascites

    Institute of Scientific and Technical Information of China (English)

    蒋康

    2012-01-01

    目的 探讨液基细胞学(Liquid-based cytology)技术在胸腹水检验中的应用价值.方法 将40例胸腹水标本分别采用传统细胞涂片法与液基细胞学方法进行检查,将两组结果进行比较,数据采用卡方检验.结果 本次试验传统涂片确诊癌4例(10%),细胞薄层技术制片确诊癌12例(30%),两种制片方法阳性细胞检出率差异有统计学意义(P<0.05).结论 细胞薄层技术能够提高被检胸腹水的涂片质量,大大提高了恶性细胞的检出率,为临床治疗提供了可靠的诊断依据.%Objective To study the value of Liquid-based cytology technology in test of pleural effusion and the ascites. Methods 40 cases of pleural effusion and the ascites were detected simultaneously and respectively using Liquid-based cytology and traditional cells smears. The consequence of the two groups were compared and analyzed with chisquare test. Results Of the 40 cases, the carcinomatous cases diagnosed by the methods of traditional cells smears were 4 (10% ) , The carcinomatous cases diagnosed by the Liquid-based cytology were 12(30% ). There was obvious difference in the detection rate of the malignant cells between them(P <0. 05). Conclusion Liquid-based cytology methods have improving the smears quality of pleural effusion and the ascites, and improving the rate of diagnose malignant cells obviously, to provide reliable evidence of diagnosis on clinical therapy.

  19. {sup 18F} FDG PET Demonstration of Cancer Recurrence Presenting as Dermatomyositis in a Rare Case of Primary Pleural Lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sang Mi; Kim, Yu Kyeong; Lee, Jong Jin; Lee, Yoon Jong; Kim, Hye Ryung; Choe, Gheeyoung [Seoul National Univ. College of Medicine/Bundang Hospital, Seoul (Korea, Republic of); Lee, Jeong Won [Jeju National Univ. Hospital, Jeju (Korea, Republic of)

    2011-03-15

    Dermatomyositis (DM) or polymyositis (PM) are possibly considered to have an association with malignancies. We describe a case of dermatomyositis in which {sup 18F} fluorodeoxyglucose (FDG)positron emission tomography (PET) was able to detect cancer recurrence earlier than any other modality in a patient with a history of primary pleural lymphoma, a very rare condition of malignancy. Further, a typical finding of dermatomyositis is diffuse hypermetabolism in the bilateral proximal shoulder and pelvic girdle areas was shown on {sup 18F} FDG PET, which can implicate the inflammatory process in the skeletal muscle in dermatomyosistis. This case well illustrates the characteristic {sup 18F} FDG findings of dermatomyositis as well as a capability of {sup 18F} FDG PET in detection of recurrence of lymphoma, even in a rare condition.

  20. Semirigid thoracoscopy in unexplained pleural effusions: An analysis of 40 cases%评价可弯曲内科胸腔镜对不明原因胸腔积液的诊断价值

    Institute of Scientific and Technical Information of China (English)

    戴钰; 田庆; 杨震; 赵微; 王慧霜; 胡绍辉; 陈良安

    2015-01-01

    Objective To evaluate the diagnostic accuracy and safety of semirigid thoracoscopy in unexplained pleural effusions. Methods Clinical data about 40 patients who underwent semirigid thoracoscopy for unexplained pleural effusion from January 2010 to September 2014 in Chinese PLA General Hospital were retrospectively evaluated.Results Of the 40 patients, semirigid thoracoscopy were completed in 37 cases. Of these 37 cases, 15 were pathologically diagnosed with malignant tumor metastases, 7 with mesothelioma, 4 with tuberculous pleuritis, 1 with rheumatoid arthritis related pleural effusion, 5 with non-specific pleuritis, and 5 were still pathologically undetermined. The diagnostic accuracy of semirigid thoracoscopy was 86.5%. No major complication occurred in patients during the procedure.Conclusion Semirigidthoracoscopy is a safe and accurate tool for undiagnosed pleural effusions.%目的评价可弯曲内科胸腔镜对不明原因胸腔积液病因诊断的应用价值.方法 回顾性分析本院呼吸内科2010年1月- 2014年9月行可弯曲内科胸腔镜检查的不明原因胸腔积液患者40例的临床诊断资料.结果 40例中37例完成可弯曲内科胸腔镜检查,其中镜检病理诊断胸膜转移性肿瘤15例,恶性胸膜间皮瘤7例,结核性胸膜炎4例,类风湿关节炎合并胸腔积液1例,非特异性炎症5例,病理诊断不明5例.可弯曲内科胸腔镜病理诊断阳性率为86.5%.所有患者均无严重并发症发生.结论 可弯曲内科胸腔镜检查是一种安全有效地诊断不明原因胸腔积液的方法.

  1. The differential diagnosis value of CEA, CYFRA21-1, NSE and LDH in the blood and pleural fluid of patients with benign or malignant pleural effusion%CEA、CYFRA21-1、NSE、LDH在良恶性胸腔积液中的鉴别诊断价值

    Institute of Scientific and Technical Information of China (English)

    巩强进; 吕志; 吴丹; 胡先纬; 胡杰贵

    2012-01-01

    Objective To determine the differential diagnosis value of the tumor markers Carcinoembryonic Antigen( CEA ), Cy-tokeratin 19 fragment (CYFRA21-1 ),Neuron Specific Enolase( NSE ) and LDH in the blood and pleural fluid of patients with benign or malignant pleural effusion. Methods We prospectively evaluated the value of CEA, CYFRA21-1, NSE and LDH in the blood and pleural fluid of 108 patients with pleural effusion. Of which, 55 were diagnosed with malignant pleural effusion, and 53 were diagnosed with benign effusion. The optimum cut-off points resulting from the best sensitivity-specificity balance in the ROC curves were constructed. Results There were significant differences between malignant and benign cases for CEA and CYFRA21-1, in blood,and for CYFRA21-1、NSE、 CEA、LDH in pleural fluid . In the pleural fluid, the sensitivity and specificity of CEA, CYFRA21-1, NSE and LDH was 90. 9、63. 6、 72.7、36.4% and 98. K83、67. 9、88.1% .respectively. In the blood, the sensitivity and specificity was 89. K87. 3、32. K25. 5% and 92. 5、79. 2、90. 6、92. 5% for CEA, CYFRA21-1, NSE and LDH, respectively. Conclusions The results suggest that these markers might be useful in the differentiation between malignant and benign pleural effusion.%目的 探讨血清及胸腔积液中癌胚抗原(CEA)、细胞角蛋白19片段(CYFRA21-1)、神经特异性烯醇化酶(NSE)、乳酸脱氢酶(LDH)在良恶性胸腔积液鉴别诊断价值.方法 分析我院55例肺癌患者和53例良性胸腔积液患者的血清及胸腔积液中CEA、CYFRA21-1、NSE、LDH检测水平,并根据受试者工作特性(ROC)曲线建立合理的临床判断临界值及检测的敏感性和特异性.结果 恶性患者胸水CYFRA21-1、NSE、CEA、LDH的水平高于良性患者(P<0.05).胸水CEA、CYFRA21-1、NSE、LDH的敏感性和特异性分别为90.9、63.6、72.7、36.4%和98.1、83、67.9、88.7%.血清CEA、CYFRA21-1、NSE、LDH的敏感性和特异性分别为89.1、87.3 、32.1

  2. 良恶性胸腔积液鉴别中SP70检测的临床意义%The significance of protein SP70 detection for differentiating benign and malignant pleural effusion

    Institute of Scientific and Technical Information of China (English)

    杨瑞霞; 曹艳; 王鹏; 许雨乔; 娄鉴芳; 史新惠; 潘世扬; 王芳; 徐建; 黄珮珺; 张燕; 徐娟; 韩月; 朱善军

    2012-01-01

    目的 探讨SP70抗原的检测对鉴别癌性胸腔积液和非癌性胸腔积液的诊断价值.方法 采用病例对照研究.收集2011年7月至2012年2月经临床确诊的肺癌患者胸腔积液108例和非癌性胸腔积液122例,采用双抗体夹心ELISA法对胸腔积液中SP70抗原进行检测;同时与电化学发光法检测CEA、CYFRA21-1和NSE的结果进行比较;采用直接免疫荧光法对胸腔积液脱落细胞上的SP70抗原进行检测,并与HE染色法的脱落细胞学检测结果进行比较,各组间阳性率比较采用x2检验或Fisher确切概率法.结果 癌性胸腔积液患者中SP70、CEA、CYFRA21-1、NSE的阳性率分别为72.2%、58.3%、52.8%和30.6%,显著高于非癌性胸腔积液组(9.8%、13.1%、23.0%和19.7%),SP70、CEA、CYFRA21-1、NSE的特异度分别为90.2%、86.9%、77.0%和80.3%;非小细胞肺癌组的总阳性率显著高于小细胞肺癌组的阳性率(74.3%>0.0%),差异有统计学意义(P=0.02<0.05),癌性胸腔积液患者中SP70的阳性符合率高于传统脱落细胞学HE染色的阳性符合率(72.2%>47.2%),差异有统计学意义(x2=14.03,P<0.05).结论 测定胸腔积液中及脱落细胞上的SP70抗原,能提高癌性胸腔积液诊断的敏感度和特异度.%Objective To investigate the diagnostic value of detection of protein SP70 in differentiating benign and malignant pleural effusion.Methods A case-control study was conducted from July 2011 to February 2012.108 cases of pleural effusion from patients with clinically proven lung cancers and 122 cases of benign pleural effusion were collected.SP70 was detected by Sandwich ELISA,while CEA,CYFRA21-1,NSE were measured by electrochemiluminescence immunoassay for comparison.Meanwhile,protein SP70 on exfoliated cells in pleural effusion was detected by direct immunofluorescence,and was compared with the results of HE staining.The differences between the groups were evaluated by the chisquare

  3. 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

  4. The Impact of Pleural Lavage Cytology Before and After Resection on Prognosis

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    Serdar Ozkan

    2016-09-01

    Full Text Available Aim: Regardless of pleural effusion, presence of tumor in pleural cavity indicates presence of more aggressive tumor. In this study, we analysed positive tumor results in preoperative pleural lavage in operable malignant cases with no pleural fluid according to the mass and mediastinal lymph node characteristics. Material and Method: Pleural lavage before preoperative dissection and after resection was performed on 199 cases that underwent surgery for non small cell lung cancer (NSCLC. Findings of lavage were statistically evaluated based on gender, lesion shape and size, lymph node involvement in positron emission tomography- computed tomography (PET-CT, SUV-max value of lesion, localisation of the lesion, N1 and N2 metastases, local invasion findings, histopathological type of tumor and type of resection. Results: Cases included in this study were followed for four years. Ten of the cases (5% had tumor recurrence and 12 of them (6% had distant organ metastasis. In multivariable analysis, significant correlation was found between the first positive pleural lavage cytology and postoperative distant organ metastasis; the last pleural lavage cytology and tumor recurrence; postoperative distant organ metastasis and lymph node metastasis and the first positive lavage cytology; tumor recurrence and PET-CT lymph node uptake, lymph node metastasis and the last positive pleural lavage cytology. Discussion: Recently there has been an increase in studies on pleural lavage analysis and there is a need for standardization in lavage timing and sampling. We hope that positive lavage cytology, like malign effusion, will be accepted as a prognostic factor in staging as more studies based on wider series are conducted.

  5. Prognostic factors in 44 colorectal cancer patients with malignant pleural effusion and/or ascites%44例结直肠癌合并恶性胸腹腔积液患者的预后分析

    Institute of Scientific and Technical Information of China (English)

    刘毅; 杜春霞; 张弘纲

    2012-01-01

    目的 探讨结直肠癌合并恶性胸腹腔积液的预后因素.方法 回顾性分析2001年1月至2010年12月中国医学科学院肿瘤医院内科结直肠癌合并恶性胸腹腔积液患者的临床资料.结果 44例患者中,治疗后积液完全消失2例,减少16例,稳定6例,增多20例.中位总生存时间为8个月.单因素分析结果显示,KPS评分、肝转移、治疗模式、积液控制率、白蛋白以及胆红素水平与总生存时间有关.结论 KPS评分≥80分、无肝转移、全身化疗、积液控制好、白蛋白和胆红素水平正常的患者预后更好.%Objective To explore prognostic factors in patients with colorectal cancer combined malignant pleural effusion and/or ascites. Methods Clinical data of colorectal cancer patents with malignant pleura! effusion and/or ascites in our hospital from January 2001 to December 2010 were analyzed retrospectively. Results The median survival time was 8 months for all the 44 patients. 2 patients with disappearance of effusion, 16 with decrease of effusion, 6 with no change of effusion and 20 with increase of effusion. Univariate analysis showed that performance status,treatment methods, status of liver metastases, the control of effusions, albumin, hilirubin were prognostic factors. Conclusion KPS 3 80, combined with systemic chemotherapy, without liver metastases, better control of effusions, normal level of albumin and bilirubin seem have a better prognosis.

  6. 留置中心静脉导管治疗恶性胸腔积液的护理分析%Analysis of Nursing Care of Indwelling Central Venous Catheter in the Treatment of Malignant Pleural Effusion

    Institute of Scientific and Technical Information of China (English)

    王春燕

    2015-01-01

    目的:分析留置中心静脉导管治疗恶性胸腔积液的护理措施。方法选取我院收治的50例患者给予留置中心静脉导管治疗,分析治疗效果和护理要点。结果1例导管脱落,化疗过程中死亡2例,气胸1例,未见其他出血等不良反应,优良率为92%。结论科学合理的护理干预措施可显著提高留置中心静脉导管治疗恶性胸腔积液的临床效果。%Objective To analyze the nursing measures of indweling central venous catheter in the treatment of malignant pleural effusion.Methods 50 cases of our hospital were selected to give an indweling central venous catheter treatment, analysis of therapeutic effect and nursing points.Results 1 cases of catheter, 2 cases died during chemotherapy, 1 cases of pneumothorax, no other bleeding and other adverse reactions, the excelent and good rate was 92%.Conclusion Nursing intervention measures of scientific and reasonable can significantly improve the clinical effect of central venous catheter in the treatment of malignant pleural effusion.

  7. 经中心静脉导管引流治疗胸腔积液疗效分析%Analysis of the clinical curative effect of central venous catheter drainage in the treatment of pleural effusion

    Institute of Scientific and Technical Information of China (English)

    杜娟

    2013-01-01

    目的 探讨经中心静脉导管引流治疗胸腔积液的临床疗效.方法 采用中心静脉导管引流对100例胸腔积液患者进行治疗,观察其并发症、不良反应及疗效.结果 治疗12~28 d,100例患者均一次置管成功.临床疗效:完全缓解40例(40.0%)、部分缓解47例(47.0%)、无效13例(13.0%)、总有效率87.0%.并发症:气胸1例、出血2例、感染1例、胸膜反应3例、疼痛3例、皮下气肿2例、脱管1例、并发症发生率13.0%.结论 经中心静脉导管引流治疗胸腔积液的临床疗效显著,值得临床推广应用.%Objective To explore the clinical curative effect of central venous catheter drainage in treating pleural effusion.Methods 100 cases with pleural effusion were treated by the central venous catheter drainage.The curative effect,complications and adverse reactions were observed.Results Ater treatment for 12 ~ 28d,catheter drainage of 100 patients were all successful at the first time.The clinical effect:completely relieve 40 cases(40.0%),clinical partial remission 47 cases(47.0%),inefficient 13 cases (13.0%),and the total effective rate was 87.0%.There were some complications:pneumothorax 1 case,hemorrhage 2 cases,infection 1 case,pleural reaction 3 cases,pain 3 cases,subcutaneous emphysema 2 cases and take off the tube 1 case,the incidence rate of complications was 13.0%.Conclusion Central venous catheter drainage in t.reating pleural effusion has significant curative effect,which is worthy of clinical application.

  8. 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.

  9. 布鲁氏菌病致肺炎并胸腔积液1例报告%A case report on pneumonia and pleural effusion resulted from brucellosis

    Institute of Scientific and Technical Information of China (English)

    高存亮; 胡晓华; 杜春华

    2016-01-01

    目的:探讨布鲁氏菌病致肺炎并胸腔积液的临床表现、胸部影像学表现及治疗方法。方法对1例诊断为布鲁氏菌病所致肺炎并胸腔积液患者的临床资料进行分析。结果该例患者因处理病猪流产物时吸入含布鲁氏菌的气溶胶,导致肺炎及胸腔积液的发生。临床主要表现为发热、畏寒,轻微咳嗽,咯痰少,伴胸闷、气短。影像学表现为右肺多发斑片、结节影伴右侧胸腔积液。血清虎红平板凝集试验阳性,标准试管凝集试验滴度为1∶200。经口服多西环素和利福平,静脉滴注头孢曲松治疗后,患者临床症状缓解,肺部斑片影及胸腔积液吸收好转。结论布鲁氏菌病肺部受累罕见,临床表现多样,无特异性,易被误诊为普通细菌性肺炎或肺结核;了解流行病学资料及职业史有助于本病的诊断。%Objective To investigate the clinical manifestations, chest imaging characteristics and treatment method of pneumonia and pleural effusion resulted from brucellosis.Methods The clinical data of a patient who suffered from pneumonia and pleural effusion resulted from brucellosis was collected and analyzed.Results The patient suffered from pneumonia and pleural effusion because of inhalation of aerosols containing brucella when handling apoblema of sick pigs. The main clinical manifestations included fever, chills, mild cough, mild sputum production, combined with chest congestion and shortness of breath.Chest imaging features were multiple patchy infiltrating shadows and nodules on the right lung combined with right side pleural effusion.Serum rose-bengal plate test was positive, and standard-tube agglutination test resulted in titres of 1∶200.After combination treatment using oral doxycycline plus rifampicin and intravenous ceftriaxone, the clinical symptom of the patient was relieved, chest patch shadows and pleural effusion were improved.Conclusion Brucellosis with

  10. Clinical investigation of ADA in diagnosis and differential diagnosis of tuberculosis and cancerous in pleural effusion%胸液中腺苷脱氨酶活性水平对胸液的鉴别诊断价值

    Institute of Scientific and Technical Information of China (English)

    王翔军

    2009-01-01

    目的 通过检测胸液中腺苷脱氨酶(ADA)活性水平,探讨其对诊断结核性胸膜炎及癌性胸液患者的临床意义.方法 对237例结核性胸膜炎及239例癌性胸液进行ADA 活性检测.结果 结核性胸膜炎患者胸液中ADA活性为(56±18)U/L,癌性胸液(16±8)U/L,前者明显高于后者(P<0.01).结核性胸膜炎组经有效抗结核治疗后胸液中ADA活性明显下降,而癌性胸液化疗后胸液中ADA活性下降不明显.结论 检测胸液ADA活性对鉴别胸液的良、恶性有较大的帮助.可作为结核性胸膜炎的诊断和鉴别诊断以及疗效观察指标,具有重要的临床实用价值.%Objective To investigate the value of ADA in the diagnosis and distinguish diagnosis in tuberculoses and cancerous pleural effusion.Methods ADA activities were examined in 237 tuberculoses pleurisy and 239 cancerous pleural effusion patients.Results ADA activity was(56±18)U/L in the tuberculoses effusion patients,while(16±8)U/L in the cancerous ones.The difference between them had statistically significance(P<0.01).ADA activity decreased obviously in the tuberculoses pleurisy patients after treatment,while not in tad cancerous ones.Conclusions ADA examination is very helpful in the distinguish diagnosis of tuberculoses and cancerous pleural effusion.

  11. 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).

  12. Diagnostic value of medical thoracoscopy for improvement diagnosis accuracy in pleural effusion%内科胸腔镜在提高胸腔积液诊断率中的价值

    Institute of Scientific and Technical Information of China (English)

    侯刚; 王玮; 胡雪君; 王秋月; 李振华; 康健

    2012-01-01

    cytological examinations of pleura] effusion was evaluated. Twenty-seven patients whose diagnosis were not obtained by thoracocentesis and cellular examinations, and 2 cases of malignant pleura) effusion without pathologically determined diagnosis received medical thoracoscopy. The combination of medical thoracoscopy and the method of thoracocentesis and cellular examinations were compared. Results Among the 311 patients, 30 cases were diagnosed as malignant pleural effusion; the other 231 cases had not diagnosed by cytological examinations, but finally confirmed by the methods of individual conditions, medical thoracoscopy and/or bronchoscopy, pulmonary artery CT scan and clinical information. The diagnosis of 231 cases were as follows: 106 cases of malignant pleural effusion, 91 cases of benign pleural effusion, 34 cases were undetermined. The positive diagnosis rate of pleural effusion by cytological examinations only was 28.9 % (80/277). Among twenty-nine cases received medical thoracoscopy, 25 cases got the definite diagnosis with positive diagnosis rate as 86.2 %. The total positive diagnosis rate was improved by the combination of medical thoracoscopy and the method of thoracocentesis and cellular examinations by 37.9 % (105/277), which was significantly higher than that of simple cellular examination (P = 0.024). The diagnosis rate was not improved in pleural effusion cytology of more than 3 times than 2 times, but the expense was higher than that of medical thoracoscopy. Conclusion It is demonstrated that medical thoracoscopy is a safe and effective method to diagnose the pleural effusion of unknown origin with relative high positive diagnostic rate. When twice thoracentesis and cytological examinations have not produced positive diagnosis, medical thoracoscopy should be performed if there is no contraindications exist.

  13. [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.

  14. Synovial hemangioma of the knee with recurrent effusion and pain: a case report.

    Directory of Open Access Journals (Sweden)

    Mohammad Naghi Tahmasbi

    2014-08-01

    Full Text Available Synovial hemangioma is a rare benign malformation of the synovium. It presents frequently in the knee with pain, tenderness, intermittent swelling and recurrent hemarthrosis. MRI can be helpful in diagnosis of synovial hemangioma. In this paper, we present a 45-year-old lady with chronic symptoms and obscure clinical symptoms for 35 years which finally diagnosed and managed arthroscopically as synovial hemangioma of the knee. The patient`s complaints resolved efficiently with no recurrence after one year.

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

    Directory of Open Access Journals (Sweden)

    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.

  16. 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.

  17. B超引导微创闭式胸膜活检术诊断恶性胸腔积液%Diagnostic value of microtrumatic blind pleural biopsy introduced by B-mode ultrasonography to malignant pleural effusion

    Institute of Scientific and Technical Information of China (English)

    厉为良; 李永华; 杨玉波; 吕丽辉; 韩力群; 王爱忠; 华海燕; 余凤群

    2005-01-01

    目的评价B超引导下闭式胸膜活检术诊断恶性胸腔积液(Malignant Pleural Effusion,MPE)的价值. 方法对76例高度疑为MPE而胸水脱落细胞学检查阴性者随机双盲分为常规闭式胸膜活检组(常规组)38例和B超引导微创闭式胸膜活检组(引导组)38例.两组病人均由B超室专人进行胸水定位,常规组以液性暗区最深处为活检穿刺点并加以标记;引导组病人以胸膜增厚最显著处为活检穿刺点并加以标记.经过正规培训的活检者采用20号改良Abrams胸膜活检针在定位标记点处行经皮闭式胸膜活检,在坐位3、6、9点各取胸膜组织1块(共3块),活检成功率达100%. 结果常规组首次活检病理确诊23例,敏感度为65.71%(23/35),特异度为100%(3/3),阳性预测值为100%(23/23),阴性预测值为20%(3/15);引导组首次活检病理确诊33例,敏感度为91.67%(33/36),特异度为100%(2/2),阳性预测值为100%(33/33),阴性预测值为40%(2/5).两组诊断恶性胸腔积液的敏感度比较,差异有显著意义(χ2=5.700,P0.99);两组中余下病理阴性者5例,经胸腔镜检查病理确诊为结核性胸膜炎. 结论 B超引导微创闭式胸膜活检术既价廉、微创,又能大大提高MPE的确诊率,是一种方便、实用的有效方法.

  18. 热疗联合顺铂局部治疗老年恶性胸腔积液的疗效观察%Clinical observation on the efficacy of thermotherapy combined with cisplatin in the treatment of old patients with malignant pleural effusion

    Institute of Scientific and Technical Information of China (English)

    黄永柱

    2013-01-01

    Objective To explore the efficacy of thermotherapy combined with cisplatin in the treatment of old patients with malignant pleural effusion. Methods Forty elderly patients of malignant pleural effusion with chest tightness and shortness of breath were randomly divided into the control group (pleural effusion drainage followed by infusion of 75 mg/m2 cisplatin) and the study group (pleural effusion drainage followed by infusion of 75 mg/m2 cisplatin and then thermotherapy). The absorption of pleural effusion was observed. Results The success rate of thoracen-tesis was 100%. The total effective rate was 90% in the study group and 65% in the control group after treatment, with statistically significant difference between the two groups (P<0.05). No significant abnormal liver and kidney function was found in the two groups. Conclusion Thermotherapy combined with cisplatin after pleural effusion drainage is safe and effective for the treatment of elderly patients with malignant pleural effusion, which is superior than simply infusion of cisplatin.%目的 探讨胸腔注射顺铂联合热疗对老年恶性胸腔积液的疗效.方法 将有胸闷、气促症状的老年恶性胸腔积液患者40例随机分为对照组(胸腔积液引流后,胸腔内注入顺铂75 mg/m2)和实验组(胸腔积液引流后,胸腔内注入顺铂75 mg/m2,并联合热疗),观察胸腔积液吸收变化情况.结果 胸腔穿刺引流术成功率为100%,治疗后评估,实验组20例总有效率为90%,对照组20例总有效率为65%,实验组明显高于对照组(P<0.05);两组均无明显肝、肾功能异常.结论 胸腔穿刺引流术后胸腔注入顺铂及热疗对老年恶性胸腔积液患者的治疗安全、有效,比单纯胸腔内注入顺铂更能有效控制恶性胸腔积液.

  19. 洛铂胸腔灌注联合局部热疗治疗恶性胸腔积液的临床观察%Clinical observation of Lobaplatin combined with local thermotherapy in the treatment of malignant pleural effusion

    Institute of Scientific and Technical Information of China (English)

    周洋; 黄河; 张家洪

    2015-01-01

    目的::观察洛铂胸腔灌注联合局部热疗治疗非小细胞肺癌( NSCLC)恶性胸腔积液的临床疗效。方法:将50例NSCLC恶性胸腔积液的患者随机分为两组,采用胸腔穿刺术置入中心静脉导管引流胸腔积液,待排尽胸腔积液后,对照组给予胸腔灌注洛铂,实验组在对照组的基础上给予患者局部热疗,比较两组治疗情况、毒副反应及生活质量改善情况。结果:两组患者治疗后,实验组患者的生活质量KPS评分及临床疗效均明显高于对照组(P<0.05),且毒副反应明显少于对照组(P<0.05)。结论:洛铂胸腔灌注联合局部热疗治疗NSCLC恶性胸腔积液的疗效显著、毒副反应小,值得临床推广。%Objective:To observe the clinical effect of Lobaplatin combined with local thermotherapy for the treat-ment of NSCLC with malignant pleural effusion. Methods:To divide 50 NSCLC patients with malignant pleural effu-sion into two groups randomly, all patients were treated with thoracentesis and inserted central venous catheter to drainage of pleural effusion. After exhaustion of pleural effusion,the control group was treated with Lobaplatin by pleu-ral perfusion,the trial group was treated with local thermotherapy on the base of the control group. The treatment,side effect and quality of life were compared. Results:After treatment,in was the trial group the KPS score of living quality and the total effective ratio of controlling pleural effusion was significant higher than the control group (P<0. 05),and the side effect was significant lower than the control group(P<0. 05). Conclusion:Lobaplatin pleural perfusion com-bined with local thermotherapy has significant curative effect and less side effect in the treatment of NSCLC with ma-lignant pleural effusion.

  20. 中心静脉导管引流恶性胸腔积液的临床护理分析%Central Venous Catheter Drainage in Clinical Nursing Analysis of Malignant Pleural Effusion

    Institute of Scientific and Technical Information of China (English)

    粟利; 高丽英

    2016-01-01

    Objective The forty-six cases of patients with malignant pleural effusion indwelling central venous catheter, and clinical care points to explore the advantages of central venous catheter drainage of the chest.Methods A retrospective analysis was collected in our department from January 2013 to January 2014 in 72 cases of breast cancer occur in patients with lung cancer and malignant pleural effusion were randomly divided into a treatment group 46 cases and a control group of 26 cases. The control group gives closed thoracic drainage. The treatment group received central venous catheter drainage.Results The patients were successfully completed treatment, serious complications have occurred in the treatment group pleural effusion total effective rate 80.00%remission, KPS score higher and quality of life of patient’s progression-free survival (PFS) and overall survival (OS) significantly prolonged.Conclusion Patients with malignant pleural effusion indwelling central venous catheter with a minimally invasive advantages, through the reasonable clinical nursing science which can significantly reduce the chances of infection and the clinical care is worth attention.%目的:通过46例恶性胸腔积液患者留置中心静脉导管引流,探讨中心静脉导管行胸腔引流的优势及临床护理要点。方法采用回顾性分析的方法,收集我科2013年1月至2014年1月的72例肺癌及乳腺癌患者出现恶性胸水的患者,随机分为治疗组46例和对照组26例,对照组给予胸腔闭式引流术;治疗组给予中心静脉导管引流。结果治疗组患者均顺利完成治疗,未发生严重得并发症,治疗组胸水缓解总有效率达80.00%,生活质量KPS评分较高,患者无进展生存期(PFS)和总生存期(OS)明显延长。结论恶性胸腔积液患者留置中心静脉导管引流具有微创的优势,通过临床合理、科学的护理,可明显降低感染概率,值得临床护理的重视。

  1. Diagnostic value of detection of IFN-γin pleural effusion to tuberculous pleuritis%胸液中IFN-γ对结核性胸膜炎的诊断价值

    Institute of Scientific and Technical Information of China (English)

    李志惠; 赵杰; 崔丹; 刘朋冲

    2014-01-01

    Objective To analyze the diagnostic value of detection of IFN-γ in pleural effusion to tubercu-lous pleuritis. Methods The level of IFN-γ was detected in 147 patients with tuberculous pleuritis and 69 patients with non-tuberculous pleuritis by Elispot technology. Results The level of IFN-γin patients with tuberculous pleuri-tis was significantly higher than that in patients with non-tuberculous pleuritis (P<0. 001). Conclusion The detec-tion of mycobacterium tuberculosis-specific interferon-gamma in pleural effusion by Enzyme-linked immunospot assay is useful for diagnosis of patients with tuberculous pleuritis.%目的:探讨利用酶联免疫斑点( Elispot)法检测胸水结核分枝杆菌特异性IFN-γ在诊断结核性胸膜炎的价值。方法对147例结核性胸膜炎患者(结核性胸膜炎组)、69例非结核性胸膜炎患者(对照组)胸水单个核细胞结核菌抗原特异性IFN-γ分泌水平进行检测,对比两者的检测差异。结果结核性胸膜炎组患者胸水IFN-γ水平显著高于对照组(P<0.001)。结论利用酶联免疫斑点技术检测胸液标本结核分枝杆菌特异性IFN-γ可用于结核性胸膜炎的诊断及鉴别诊断。

  2. 胸腔积液脱落细胞检查在胸膜转移性肺腺癌和恶性间皮瘤所致胸腔积液鉴别诊断中的价值%Value of Exfoliated Cell Examination in Differential Diagnosis of Pleural Effusion Caused by Pleural Metastatic Lung Adenocarcinoma and Malignant Mesothelioma

    Institute of Scientific and Technical Information of China (English)

    周晓明; 李光; 冯学威; 赵立

    2012-01-01

    [Objective] To evaluate the value of vimentin( VIM) , calretinin(CR) , mesothelial cell(MC) , carcinoembryonic antigen(CKA) and thyroid transcription factor-1 (TTF-1) in the differential diagnosis of pleural metastatic lung adenocarcinoma and malignant pleural mesothelioma. [Methods]Totally 42 patients with pleural metastatic lung adenocarcinoma and 31 patients with malignant pleural mesothelioma confirmed by cytologic diagnosis of pleural effusion or pleural pathological examination in our hospital were collected. Immu-nohistostaining method was used to detect TTF-1, CEA, VIM, MC and CR in exfoliated cell of pleural effusion. The sensitivity, specificity, positive predictive value and negative predictive value of above indicators in pleural metastatic lung adenocarcinoma and malignant mesothelioma were calculated. The value of above indicators in differential diagnosis was evaluated. [ResultsJThere were significant differences in the expression of VIM, CR , MC, TTF-1 and CKA between malignant mesothelioma and pleural metastatic lung adenocarcino-ma( P <0. 05). The diagnostic sensitivity, specificity, positive predictive value and negative predictive value of VIM, CR , MC, TTF-1 and CEA showed significant differences between malignant mesothelioma and pleural metastatic lung adenocarcinoma( P <0. 05). [Conclusion]TIF-1, CEA, VIM, CR and MC of exfoliated cell in pleural effusion have high value in the differential diagnosis of malignant pleural mesothelioma and pleural metastatic lung adenocarcinoma.%[目的]探讨评估波形蛋白(VIM)、神经特异度钙结合蛋白(CR)、间皮细胞(MC);癌胚抗原(CEA)、甲状腺转录因子-1(TTF-1)在胸膜转移性肺腺癌和恶性间皮瘤鉴别诊断中的价值.[方法]经胸腔积液细胞学诊断或胸膜活检病理学证实的恶性胸膜间皮瘤(11例)和胸膜转移性肺腺癌(31例),采用免疫组织化学染色检测胸腔积液脱落细胞中TTF-1、CEA、VIM、MC和CR五项指标,计算其在胸

  3. Bicavitary effusion secondary to liver lobe torsion in a dog

    Directory of Open Access Journals (Sweden)

    Khan Z

    2016-04-01

    Full Text Available Zaheda Khan,1 Kathryn Gates,2 Stephen A Simpson,31Emergency and Critical Care, Animal Specialty and Emergency Center, Los Angeles, CA, 2Emergency and Critical Care, Advanced Critical Care, Emergency and Specialty Services, Culver City, CA 3Emergency and Critical Care, Southern California Veterinary Specialty Hospital, Irvine, CA, USA Abstract: We described the diagnosis and successful treatment of pleural and peritoneal effusion secondary to liver lobe torsion in a dog. A 12-year-old female spayed Borzoi dog was referred for heart failure. Emergency room thoracic and abdominal ultrasound showed a large volume of pleural effusion with mild peritoneal effusion and an abdominal mass. Pleural fluid analysis classified the effusion as exudative. A complete ultrasound revealed mild peritoneal effusion and decreased blood flow to the right liver lobe. Other causes of bicavitary effusion were ruled out based on blood work, ultrasound, echocardiogram, and computed tomography. The patient was taken to surgery and diagnosed with caudate liver lobe torsion and had a liver lobectomy. At the 2-week postoperative recheck, the patient was doing well and there was complete resolution of the pleural effusion. Liver lobe torsion is a rare occurrence in dogs and can be difficult to diagnose. Clinical signs are nonspecific for liver lobe torsion and patients may present in respiratory distress with significant pleural fluid accumulation. When assessing patients with pleural and peritoneal effusion, liver lobe torsion should be considered as a differential diagnosis.Keywords: pleural effusion, peritoneal effusion, hepatic torsion

  4. The Impact of Pleural Lavage Cytology Both Before and After Lung Resection on Recurrence of Non-Small Cell Lung Cancer.

    Science.gov (United States)

    Shoji, Fumihiro; Yamazaki, Koji; Kouso, Hidenori; Mori, Ryo; Takeo, Sadanori

    2016-06-01

    Pleural lavage cytology (PLC) involves cytologic examination during surgery for non-small cell lung cancer (NSCLC). The timing regarding the performance of PLC is potentially important; however, a consensus remains to be established. We sought to retrospectively analyze the impact of PLC both before (pre-PLC) and after (post-PLC) lung resection on recurrence in NSCLC. From July 1994 to December 2011, 700 consecutive patients with surgically resected NSCLC were selected. Both pre-PLC and post-PLC status was tested using univariate and multivariate Cox regression analyses of recurrence-free survival (RFS). By analyzing RFS, post-PLC status but not pre-PLC status together with pathologic N factor and pathologic stage, was identified as an independent factor for poor prognosis (p = 0.0040). A statistically significant association was observed between positive post-PLC status and pleural invasion, pathologic T factor, pathologic N factor, pathologic stage, and postoperative recurrence (p = 0.0004, p = 0.0033, p = 0.0001, p recurrence in patients with surgically resected NSCLC. Moreover, post-PLC status might be an additional factor not only for identifying a patient group with a high risk of postoperative recurrence, but also to avoid unnecessary treatment of patients with low risk of postoperative recurrence. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Pleural effusion as the initial extramedullary manifestation of Acute Myeloid Leukemia [v1; ref status: indexed, http://f1000r.es/PEKat0

    Directory of Open Access Journals (Sweden)

    José Nieves-Nieves

    2012-10-01

    Full Text Available Leukemias rarely debut by pleural involvement as the first manifestation of the hematologic malignancy. This complication is most commonly seen in solid tumors such as carcinomas of the breast, lung, gastrointestinal tract and lymphomas. We present a case of a 66 year old male who presented with a pleural leukemic infiltration of his undiagnosed Acute Myeloid Leukemia that was not a complication of the disease extension, but the acute presentation of the illness. Progressive shortness of breath for two weeks, cough, clear sputum and weight loss were the initial complaints. Serum dyscrasia suggested a hematologic abnormality. A chest x-ray performed demonstrated a buildup of fluid with layering in the left pleural cavity. Diagnostic thoracentesis suggested an exudative etiology with cytology remarkable for 62% leukemic myeloblast. The diagnosis was confirmed by bone marrow biopsy with expression of the antigens CD 34+ and CD13+, with unfavorable cytogenetic prognosis and a trisomy 21 chromosomal defect. Chemotherapy was initiated, though no remission achieved with induction chemotherapy. Complications and disease progression precludes in the patient’s death. Although rare, due to the unusual presentation of the disease, this case clearly demonstrates the importance of biochemical analysis and cytopathology specimens obtained in pleural fluid.

  6. 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

    Directory of Open Access Journals (Sweden)

    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

  7. Central venous catheter drainage and injection of thymalfasin combined with cisplatin in treatment of malignant pleural effusion: clinical observation of 86 cases%中心静脉导管引流及注入胸腺法新联合顺铂治疗恶性胸腔积液86例疗效观察

    Institute of Scientific and Technical Information of China (English)

    吴兆成; 钟福强

    2012-01-01

    目的 观察中心静脉导管注入胸腺法新联合顺铂治疗恶性胸腔积液的疗效及不良反应.方法 选择恶性胸腔积液患者86例,胸腔中心静脉置管行闭式引流并腔内注入胸腺法新联合顺铂,每周1次.结果 总有效率为83.7%,生活质量评分提高10~20分,不良反应少.结论 中心静脉导管注入胸腺法新联合顺铂治疗恶性胸腔积液,疗效肯定,不良反应轻.%Objective To observe central venous catheter and injecting thymalfasin combined with cisplatin in treatment of malignant pleural effusion curative effect and adverse reaction. Methods 86 patients with malignant pleural effusion, pleural cavity central venous catheter closed drainage and intraperi-cardial injection of thymalfasin combined with cisplatin, 1 times a week. Results the total effective rate was 83. 72% , the score of life quality to improve 10-20, fewer adverse reactions. Conclusions central venous catheter and injecting thymalfasin combined with cisplatin in treatment of malignant pleural effusion has definite curative effect, and adverse reaction to light.

  8. 培美曲赛联合IL-2治疗恶性胸腔积液的临床研究%Treatment of malignant pleural effusion by Pemetrexed combined with Interleukin-2

    Institute of Scientific and Technical Information of China (English)

    陈良; 张道良; 张颖; 顾月清

    2012-01-01

    OBJECTIVE: To observe the clinical efficacy and safety of intrapleural injection of Pemetrexed combined With Intcrlcukin-2 for malignant pleural effusion. METHOSDS; Thirty-five patients with malignant pleural effusion were divided into combination group(20 cases , including 13 with lung Qdcnocarcinoms.,4 with malignant pleural rne5Otneliorna,3 with hreast cancer) and single-drug group(15 cases,including 12 with lung adenocarcinoma, 1 with malignant pleural mes-Othelbma,2 with breast cancer). All of the patients received closed drainage after percutaneous thoracocentesis. And 200 mg of Pemetrexed and 3 million units of Interleukin-2 were injected through catheter iiitn thoracic cavity in combination group,and 3 million units of interleukin-2 only were done in single-drug group afer the effusion had been drained cleanly and the lung was reexpanded completely. The patients must rotate positions every 10-15 min in bed without pillows for total of 3 cycles. The residual effusion would be drawn out after the drugs had been reserved for 48 h,and the catheter would been pulled out finally. RESULTS; In combination group,14(70. 0%) cases were determined for CR(com-plete response), 4(20. 0%) cases for PRCpartial response), 2(10. 0%) cases for NC( no change),and the ORRCoverall response rate) was 90.0%. In single-drug group,3(20. 0%) cases were determined for CR,4(26. 7%) cases for PR,8 (53. 3%) cases for NCand the ORR was 46. 7%. After 3-month and 6-month follow-up,the rate of SD(stable disease) in combination group were 88. 9% and 77. 8% respectively,and that in single-drug group were 57. 1% and 28. 6%. There were no bone marrow suppression, anaphylaxis and pleural thickening large than 2 cm occurred m two groups. Only 3 (15. 0%) cases in combination group and none in Single-drug group occurred mild nausea and slightly reduction of appetite which acquired improvement after the treatment by Metocloprarnide and Vitamin B. There were 6(30. 0%) cases in combination group,4(26. 7

  9. Clinical Investigation of Hyperthermia Perfusion Extracorporeal Circulatory System in Treatment of Malignant Pleural Effusion%恒温体外循环热灌注治疗恶性胸腔积液的临床观察

    Institute of Scientific and Technical Information of China (English)

    解国清; 廖国清; 李雷; 马太林; 毛利伟

    2011-01-01

    目的:观察恒温体外循环热灌注化疗治疗恶性胸腔积液的临床疗效.方法:于2008 年1月~2011 年4月选择经病理证实的肺癌或恶性间皮瘤同时伴发恶性胸腔积液的患者86 例,随机分为治疗组(n=44) 和对照组(n=42).治疗组用Astronaut 体外循环热疗机热灌注化疗,对照组仅行普通腔内热灌注化疗.两组化疗药物为顺铂,首次剂量90mg,以后每次60mg,1 次/周,共6周.治疗前后测定胸水量,并观察生活质量改善情况及治疗副反应.结果:治疗6周后,治疗组胸腔积液CR18 例,PR20 例,总有效率86.4%,对照组CR11 例,PR17 例,总有效率66.7%,差异有统计学上显著意义(P<0.05).治疗组生活质量改善亦优于对照组(P<0.05).两组患者均出现了轻微的消化道反应,可耐受.结论:体外循环热灌注顺铂治疗恶性胸腔积液,疗效显著.%Objective: To investigate clinical efficacy of hyperthermia perfusion extracorporeal circulatory system in treatment of malignant pleural effusion. Methods: Eighty-six malignant mesothelioma and lung cancer patients with malignant pleural effusion diagnosed by pathological evidences were divided into treatment group(n=44) and control group(n=42) randomly in Jan. 2008 to April 2011. The treatment group was dealt with hyperthermia perfusion extracorporeal circulatory system with DDP injection, while the control group received hyperthermia perfusion and DDP intracavity injection only. The same dose of DDP were injected in two groups, firstly 90mg, and the 60mg each time, once a week, and six times in total. The volume of effusion were measured at the baseline and after treatment. Life quality and side-effects were observed in two groups too. Results: There were 18 complete response (CR) and 20 partial response(PR) in treatment group, the total effective rate was 86.4% , while 11 CR and 17 PR in control group(66.7%). Life quality improved significantly in treatment group compared with control group, while two

  10. Differential diagnostic value of pleural effusion combined with serum ADA and CEA for tubercu lous and malignant pleural exudates%胸水和血清ADA、CEA联合检测对结核性和恶性胸腔积液的诊断价值

    Institute of Scientific and Technical Information of China (English)

    陈辉; 庞华春

    2009-01-01

    Objective To study the diagnostic value of pleural effusion combined with serum adenosine deaminase(ADA),carcinoemhryonic antigen(CEA)in testing tuberculous and malignant pleural exudates.Methods Diagnostic kit for carcinoe mbryonic antigen(CEA)and ADA measured by ELISA and Enzyme continuotrs monitoring method was examined among 91 patients with pleural exudates.Results The ADA activity of tuberculous and malignant exudates were respectively(42.32±17.56)U/L and(10.29 4-6.34)U/L(P<0.01).If the critical value of ADA was larger than 40U/L in tuberculous diagnosis,its sensitivity Was 82.5%and the specificity was92.2%as the critical value of ADA mole than 40U/L.its sensitivity was 92.5%and the specificity Wag 90.2%as the critical value of PADA/SADA more than 1.The CEA activity of tuberculous and malignant exudates were respectively(8.314±3.62)ug/L and (24.7±1 3.6)ug/L(Ppleural exudates,its sensitivity was 58.8%and specificity was 95.0%.If the critical value of PCEA/SCEA was larger than 1 in malignant pleural exudates,its sensitivity was 86.3%and the specificity was 92.5%.Conelusion The test of ADA and CEA of pleural exudates is of great diagnostic value in patients with tubeleulous and malignant pleural effusion.%目的 探讨胸水和血清腺苷脱氨酶(ADA)、癌胚抗原(CEA)联合检测对结核性和恶性胸腔积液的诊断价值.方法 采用酶连续监测法和酶联免疫(ELISA)双抗体夹心法对91例胸腔积液进行胸水和血清ADA和CEA检测分析.结果 ADA活性在结核性和恶性胸腔积液中分别为(42.32±17.56)U/L和(10.29±6.34)U/L(P<0.01).以PADA>40U/L做为诊断结核的临界值,其灵敏性为82.5%,特异性为92.2%;以PADA/SADA>1为临界值,其灵敏性为92.5%,特异性为90.2%.CEA活性在结核性和恶性胸腔积液中分别为(8.31±3.62) μg/L和(24.7±13.6) μg/L(P<0.01).以PCEA>20μg/L做为诊断恶性胸腔积液

  11. 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

  12. Effectiveness and safety of intrapleural tissue plasminogen activator in the prevention of pleural thickening and loculated infected pleural effusions%组织纤溶酶原激活物联合治疗感染性包裹性胸腔积液的疗效观察

    Institute of Scientific and Technical Information of China (English)

    林建聪; 张常然; 李鸣; 周华; 牛媛媛; 刘小云

    2011-01-01

    目的 探讨组织纤溶酶原激活物(tPA)对感染性包裹性胸腔积液的治疗作用.方法 选取胸腔积液中等量以上,超声或胸部CT 提示胸腔内有纤维凝块、纤维分隔形成包裹的病例32 例.随机分成治疗组(n =15)和对照组(n =17).治疗组引流胸水后,胸腔内注入tPA 10 mg +生理盐水50 ml,其余治疗同对照组.观察两组的临床疗效及不良反应.结果 (1)治疗组和对照组的胸腔积液引流量分别为(1020 ±320)ml 和(630 ±105)ml;治疗组和对照组的住院天数分别为(14.0 ± 5.5)d 和(20.0 ±6.7)d;3 个月后胸膜增厚黏连例数分别为5 例(33.3%)和12 例(70.6%),两组比较均有统计学差异(P <0.05);(2)治疗组和对照组的胸膜腔穿刺次数、术后肺功能(潮气量,用力潮气量)比较也有统计学差异(P <0.05);两组均没有严重的并发症发生.结论 胸腔内注射tPA 适用于感染性包裹性胸腔积液的辅助治疗.%Objective To explore the clinical curative effect of intrapleural injection of tissue plasminogen activator ( tPA) in the prevention of loculated infected pleural effusions . Methods 32 patients with loculated effusions were randomized into 2 groups ,intrapleural tPA therapy group and conventional group ( control group) . The patients in therapy group were injected with tPA 10 mg and saline 50 ml intrapleurally after each thoracocentesis . other therapies were similar to control group . The clinical curative effect and adverse effect were observed for the two goups . Results ( 1 ) The mean volume of fluid drained were ( 1020 ±320) ml and ( 630 ± 105 ) ml;The mean time of admission was ( 14. 0 ± 5. 5) d and ( 20. 0 ±6. 7) d; The incidence of pleural adhesion and loculation were 5 cases( 33. 3% ) and 12 cases( 70. 6% ) after 3 months in the therapy group and the control group respectively . There were significant difference for mean volume of fluid drained. mean time of admission and the incidence of pleural adhesion

  13. Neutrophil extracellular traps and bacterial biofilms in middle ear effusion of children with recurrent acute otitis media--a potential treatment target.

    Directory of Open Access Journals (Sweden)

    Ruth B Thornton

    Full Text Available BACKGROUND: Bacteria persist within biofilms on the middle ear mucosa of children with recurrent and chronic otitis media however the mechanisms by which these develop remain to be elucidated. Biopsies can be difficult to obtain from children and their small size limits analysis. METHODS: In this study we aimed to investigate biofilm presence in middle ear effusion (MEE from children with recurrent acute otitis media (rAOM and to determine if these may represent infectious reservoirs similarly to those on the mucosa. We examined this through culture, viability staining and fluorescent in situ hybridisation (FISH to determine bacterial species present. Most MEEs had live bacteria present using viability staining (32/36 and all effusions had bacteria present using the universal FISH probe (26/26. Of these, 70% contained 2 or more otopathogenic species. Extensive DNA stranding was also present. This DNA was largely host derived, representing neutrophil extracellular traps (NETs within which live bacteria in biofilm formations were present. When treated with the recombinant human deoxyribonuclease 1, Dornase alfa, these strands were observed to fragment. CONCLUSIONS: Bacterial biofilms, composed of multiple live otopathogenic species can be demonstrated in the MEEs of children with rAOM and that these contain extensive DNA stranding from NETs. The NETs contribute to the viscosity of the effusion, potentially contributing to its failure to clear as well as biofilm development. Our data indicates that Dornase alfa can fragment these strands and may play a role in future chronic OM treatment.

  14. 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.

  15. 胸水和血清腺苷脱氨酶联合血清结核抗体检测对结核性胸膜炎的临床诊断价值%The clinical value of pleural effusion and serum ADA combined serum TB-AB in the diagnosis of tuberculous pleurisy

    Institute of Scientific and Technical Information of China (English)

    程志武; 祝颖玉

    2013-01-01

    目的 探讨胸水及血清腺苷脱氨酶(ADA)联合血清结核抗体(TB-AB)检测的阳性符合率对结核性胸膜炎的诊断价值.方法 对37例结核性胸膜炎患者的胸水及血清ADA和血清TB-AB进行检测,以及23例非结核性胸膜炎患者的胸水及血清ADA和血清TB-AB进行检测.结果 结核组中胸水ADA阳性率67.6%;血清ADA阳性率62.2%;血清TB-AB阳性率70.3%;以胸水ADA/血清ADA>1.00为临界值其阳性率81.1%;以上阳性率均显著高于非结核组,差异均有统计学意义(P<0.05).结核组中胸水ADA活性和胸水/血清ADA明显高于非结核组,差异有统计学意义(P<0.05);结核组血清ADA活性与非结核组比较,差异无统计学意义(P>0.05).结核性胸膜炎诊断中胸水ADA、血清ADA、胸水/血清ADA及血清中TB-AB的敏感性分别为67.6%、62.2%、81.1%和70.3%,特异性分别为100.0%、87.0%、82.6%和91.3%.结论 胸水及血清ADA水平和血清TB-AB的检测对结核性胸膜炎和非结核性胸膜炎具有诊断和鉴别诊断价值.%Objective To study the diagnostic value of the positive rates of pleural effusion and serum ADA combined with serum TBAB on testing tuberculous pleurisy.Methods To measure pleural effusion and serum ADA and TB-AB in pleural effusion of all the patients (37 cases tuberculous pleural effusion,23 cases non-tuberculous pleural effusion).Results The positive rates of serum ADA and TB-AB in tuberculous pleural effusion group were 62.2% and 70.3%,pleural effusion ADA was 67.6%,pleural serum ADA≥ 1.0 was 81.1%,which were significantly higher than those in non-tuberculosis pleural effusion group (P <0.05).Serum ADA activity of tuberculosis group and pleural /serum ADA were significantly higher than those of non-tuberculosis group,and the difference was statistically significant (P <0.05); the difference between tuberculosis group serum ADA activity and non-tuberculosis group was not statistically

  16. Study on the Clinical Application Value of SP70 Antigen in Differential Diagnosis of Malignant Pleu-ral Effusion%SP70抗原在癌性胸腔积液鉴别诊断中的临床应用价值

    Institute of Scientific and Technical Information of China (English)

    张丹华

    2015-01-01

    目的:探讨SP70抗原检测在癌性胸腔积液鉴别诊断中的应用价值。方法选取2013年1月至2014年1月达州陆军医院收治的200例胸腔积液患者作为研究对象、其中100例癌性胸腔积液,100例非癌性胸腔积液。患者的胸腔积液均检测SP70抗原、癌胚抗原( CEA)、神经元特异性烯醇化酶(NSE)及细胞角质蛋白19片段(Cyfra21-1),并以病理检测结果为金标准,评价其在癌性胸腔积液鉴别诊断中的诊断效能。结果 SP70在诊断癌性胸腔积液时的灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为70.0%、88.0%、79.0%、85.4%、74.6%。鳞癌、腺癌SP70抗原阳性检出率分别为76.5%和83.0%,均高于小细胞癌的26.3%,差异有统计学意义(χ2=12.628,19.549,均P<0.05)。结论与传统的肿瘤标志物相比,SP70抗原在癌性胸腔积液鉴别诊断中具有更高的诊断效能,检测方法简单、无创,有较高的临床应用价值。%Objective To investigate the clinical application value of SP70 antigen in differential diag-nosis of malignant pleural effusion.Methods A total of 200 patients with pleural effusion admitted in Dazhou Army Hospital from Jan.2013 to Jan.2014 were selected as research objects,containing 100 cases of malignant pleural effusion and 100 cases of non-malignant pleural effusion.Levels of SP70 antigen and tumor markers carcino-embryonic antigen(CEA),neuron-specific enolase(NSE),cytokeratin19 fragment(Cyfra21-1) in pleural effusion were detected in all the patients.Taking pathologic detection results as the golden stand-ard,the value of SP70 was assessed in the diagnosis of malignant pleural effusion.Results The sensitivity, specificity,accuracy,positive predictive value,and negative predictive value of SP70 antigen in the diagnosis of malignant pleural effusion was 70.0%,88.0%,79.0%,85.4%,74.6%.Positive rates of squamous cell

  17. Analysis of diagnosis and treatment and prognosis factor for 4 3 8 cases of malignant pleural effusion with lung cancer%438例肺癌恶性胸腔积液的诊治及预后因素分析∗

    Institute of Scientific and Technical Information of China (English)

    邹华; 单锦露; 李梦侠; 李雪梅; 王东

    2015-01-01

    Objective To analyze the characteristics of diagnosis and therapeutic effect of malignant pleural effusion with lung cancer,and explore the prognostic factors and effective diagnosis and treatment plans.Methods A retrospective analysis in-cludes 728 cases of definite pleural effusion with lung cancer from October 2009 to December 2013 in our hospital,which was fol-lowed-up to September 30,2014,and 438 cases were available analyzed.The main outcome measures were incidence,efficiency,pro-gression-free survival and overall survival.Results The overall median progression-free survival and the median survival of malig-nant pleural effusions with lung cancer was respectively 4 months and 8 months.males,small cell lung cancer,massive pleural effu-sion,and right pleural effusion may be the independent factors of local unmanageable malignant pleural effusion by multivariable Lo-gistic regression.The overall survival of pleural effusion with locally control(less than four weeks )was better than those with un-manageable(mOS:9 month vs.5 month,P 2 cycles and takingTKI treatment were significantly reduced (P<0.001;P=0.026).Gender,histological type,pericardial effusion,partial remission time,cycles of chemo-therapy and TKI were the independent prognostic factors for overall survival.The overall survival prognosis of patients with Fe-male,squamous cell carcinoma,no pericardial effusion,and over three cycles of chemotherapy,TKI therapy,and local controlled in 4 weeks was better.Conclusion Male,massive pleural effusion and right pleural effusion are independent predictive factors of local unmanageable malignant pleural effusion.The overall survival of pleural effusion with locally control was better than the patients with refractory control.Histological type,controllable relief time of pleural effusion,cycles of chemotherapy and TKI therapy were the independent predictive factors of progression and overall survival.%目的:分析肺癌恶性胸腔积液的诊治特点及疗效

  18. 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...

  19. 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.

  20. 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

    Directory of Open Access Journals (Sweden)

    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

  1. 单腔中心静脉导管在浆膜腔积液中的应用体会%The Effect Of Central Venous Catheter In Pleural Effusion

    Institute of Scientific and Technical Information of China (English)

    颜杰

    2011-01-01

    目的 通过对比研究的方法探讨单腔中心静脉导管在浆膜腔积液中的应用较传统方法之优势.方法 选取我科自2007年1月至2010年11月收治的经单腔中心静脉导管闭式引流和传统穿刺抽液术的浆膜腔积液患者242例,并从中随机抽取明确诊断结核性胸膜炎的病例各40例进行疗效、胸液吸收、费用等情况对比.结果 闭式引流组在胸液吸收时间、操作次数、住院总费用均少于抽液组,组间差异有统计学意义;引流组不良反应、并发症和形成包裹例数明显少于胸穿组.结论 单腔中心静脉导管在浆膜腔积液中的应用效果明显优于传统胸腔穿刺抽液术.%Objective To confer the effect of central venous catheter in pleural effusion through method of comparative analysis. Methods 242 patients with chest drains by the central venous cathete and by the traditional puncture from January of 2007 to November of 2010 were selected, random selection both 40 patients from tuberculous pleurisy,then analysis effect,absorption and expenses. Result The chest drains treatment group was less than the traditional puncture treatment group in time of absorption, times of puncture and expenses of being in hospital, discrepancy had statistical meaning. The chest drains treatment group was much less than the traditional puncture treatment group in untoward effect and complication. Conclusion The effect of central venous catheter in pleural effusion was better than the traditional puncture.

  2. 微创持续负压引流技术治疗肺癌胸腔积液的护理%Nursing of minimally invasive continuous negative pressure drainage in pleural effusion of lung cancer

    Institute of Scientific and Technical Information of China (English)

    陈海燕; 李铮; 刘瑞华

    2013-01-01

    Objective:To summarize the nursing experience of minimally invasive continuous negative pressure drainage technique in the treatment of pleural effusion of lung cancer. Methods:59 cases with pleural effusion of lung cancer were treated by minimally invasive continuous negative pressure drainage system, psychological nursing in the perioperative period,the monitoring on catheter management and complications of catheterization,the evaluation and predictive nursing for catheter related infection factors. Results;The intubation time 6 -21 d.the average (9.5 ±3.3)d. Markedly effective 20 cases,effective 25 cases,invalid in 14 cases. 12 cases of patients with plugging,the processing procedures,of which 11 cases can continue to drainage,1 case of blood clots blocking pipe for extubation. Conclusion:The key to improve quality of care measures is attach importance to the analysis of the mental needs of patients, keep the drainage unobstructed, complications of catheterization of the monitoring and catheter - related infection prevention.%目的:总结微创持续负压引流技术治疗肺癌胸腔积液的护理经验.方法:应用微创持续负压引流系统治疗肺癌胸腔积液患者59例,做好围手术期心理护理,导管管理及置管并发症监测,导管相关性感染因素评估及预见性护理.结果:带管时间6~21 d,平均(9.5±3.3)d.显效20例,有效25例,无效14例.12例患者出现堵管,经程序化处理,其中11例可继续引流,1例因形成血块堵管需拔管.结论:重视分析患者的心理需求、保持引流的通畅、置管并发症的监测、导管相关性感染的预防是提高护理质量的关键措施.

  3. Nursing experience of central venous catheter for constant drainage in 56 patients with malignant pleural effusion%中心静脉导管在56例恶性胸腔积液患者持续引流中的护理体会

    Institute of Scientific and Technical Information of China (English)

    丁海平; 王元兰

    2013-01-01

    目的 探讨中心静脉导管应用于恶性胸腔积液患者的护理.方法 选择56例胸腔积液患者置入中心静脉导管.结果 有7例患者置管处疼痛后拔管,其余患者均达到治疗周期,未发生其他置管并发症.结论 恶性胸腔积液患者胸腔置入中心静脉导管后,实施有效的护理措施能够保证治疗顺利进行,并减少多次胸腔穿刺的痛苦.%Objective To explore the nursing of central venous catheter in the treatment of patients with malignant pleural effusion. Methods 56 patients with pleural effusion underwent central venous catheterization. Results 7 patients had extubation because of pain in catheterization region; the rest of the patients completed the entire treatment, and no one had other complications of catheterization. Conclusion After central venous catheterization for the patients with malignant pleural effusion, the effective nursing measures should be implemented to ensure the smooth process of treatment and reduce the suffering caused by repeated thoracocentesis.

  4. 热休克蛋白90α在肺癌胸腔积液中的表达及其对胸腔热灌注化疗疗效的影响%Expression of heat shock protein 90α in malignant pleural effusion and its predictive value on effect of hyperthermic pleural perfusion with chemotherapy drug in lung cancer

    Institute of Scientific and Technical Information of China (English)

    张峻青; 王军成; 吴铁鹰; 刘永兰; 卫俊龙

    2016-01-01

    目的 对比热休克蛋白90α(HSP90α)在肺癌胸腔积液及良性胸腔积液中的表达,并分析胸腔循环热灌注化疗前后HSP90α在胸腔积液中表达的变化以及其对疗效的影响.方法 应用酶联免疫吸附试验测定HSP90α在53例肺癌胸腔积液和30例良性胸腔积液患者积液中的表达,观察其表达的差异.在胸腔循环热灌注化疗治疗肺癌胸腔积液前及治疗后72 h观察HSP90α在胸腔积液中表达的变化(治疗周期数为1~5次,平均2.3次),并分析其与疗效的关系.结果 肺癌胸腔积液中HSP90α的表达[(80±34)μg/L]较良性胸腔积液[(31±13)μg/L]高,差异有统计学意义(t=56.400,P<0.01).行胸腔循环热灌注化疗后HSP90α表达水平为(93±32) μg/L,较治疗前增高(t=3.152,P<0.01),治疗后HSP90α/治疗前HSP90α比值与疗效呈负相关(r=-0.291,P<0.05).治疗后HSPg0α/治疗前HSP90α<1.0者中位胸腔积液进展时间为4.3个月,比值1~1.5者为2.3个月,比值>1.5者为1.8个月.结论 HSP90α在肺癌胸腔积液中表达增高,行胸腔热灌注化疗后在胸腔积液中表达升高.热灌注化疗后胸腔积液中HSP90α越低疗效越好,可作为肺癌胸腔积液治疗中的疗效评价指标.%Objective To compare the expression of heat shock protein 90α (HSP90α) in malignant pleural effusion (MPE) and its predictive value on effect of hyperthermic pleural perfusion with chemotherapy drug in lung cancer.Methods The expression of HSP90α in malignant pleural effusion of 53 patients with lung cancer and benign pleural effusion of 30 patients were detected and compared using enzyme-linked immunosorbent assay kits.The patients of lung cancer reveived intrapleural hypothermic perfusion with cisplatin for 1-5 times (average 2.3 times).Before and after treatment,the expression of HSP90α in pleural effusion was measured and its correlation with efficacy was analyzed.Results The expression level of HSP90α in MPE was significantly higher

  5. 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...

  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

    Directory of Open Access Journals (Sweden)

    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. 有创技术在胸腔积液诊断中的应用价值%Clinical application and evaluation of invasive techniques in diagnosis of pleural effusion

    Institute of Scientific and Technical Information of China (English)

    刘庆华; 姚周虹; 万云焱; 林殿杰

    2014-01-01

    Pleural effusion (PE)is a complex etiology and affects the life quality life of patients. Invasive techniques play an important role in the diagnosis of PE.We mainly focus on the clinical application and evaluation of invasive techniques such as thoracocentesis,pleural biopsy and medical thoracoscopy in diagnosis of PE.Thoracocentesis is a simple,convenient and relatively safe technique with less complications which is often used as the initial diagnostic procedure.As pleural biopsy can provide pathological and histological specimens,its confirmed value is superior to conventional methods for diagnosis of PE.However, the positive rate is not satisfied and it can be improved when pleural biopsy is guided by ultrasound or computed tomography (CT).Pleural biopsy has great value in basic-level hospitals.Medical thoracoscopy can visually and clearly display almost whole of the pleura and lungs.Minor lesions and suspicious site can be showed for biopsy with medical thoracoscopy.As a result,the positive rate increases greatly and accordingly. In a word,medical thoracoscopy is a valuable and safe tool with a higher diagnostic rate and lower incidence of complications in clinic.%胸腔积液病因复杂,相当一部分临床诊断困难,有创性技术在其病因诊断中有重要地位。本文详述了有创技术包括胸腔穿刺术、胸膜活检以及内科胸腔镜等在胸腔积液诊断的应用价值。胸腔穿刺术、胸膜活检术常作为最初步的诊疗手段,胸腔穿刺术操作简单、方便、安全、并发症少,临床广泛开展。胸膜活检可以直接提供病理组织学标本,对诊断具有确诊的价值,优于常规的检查方法,但是其阳性率不高,经超声或 CT 引导下进行胸膜活检术可以提高活检阳性率,尤其在尚未开展胸腔镜的基层医院有很大的应用价值。内科胸腔镜可以直观、清晰地观察几乎包括全部壁层胸膜及大部分肺脏

  8. Efficacy of ribonucleic acid Ⅱ intrathoracic injection on malignant pleural effusion%注射用核糖核酸Ⅱ治疗恶性胸腔积液的疗效

    Institute of Scientific and Technical Information of China (English)

    鲁建军; 翁慧雯; 顾勇; 罗红鹤; 钟佛添

    2013-01-01

    目的 观察注射用核糖核酸Ⅱ胸内注入治疗恶性胸腔积液的疗效及其对机体免疫功能的影响.方法 收集2012年3月至2013年2月本院经病理和(或)细胞学确诊的晚期肺部肿瘤所至的恶性胸腔积液的患者63例,经胸腔穿刺抽液或胸腔闭式引流后即时注入注射用核糖核酸Ⅱ300 mg,治疗1周胸部X线显示如仍有胸腔积液再引流后重复给药1次.4周后按WHO规定的临床疗效评定标准,观察注射用核糖核酸Ⅱ的恶性胸腔积液控制疗效,并应用流式细胞仪对比治疗前后(注药前和注药后1周)患者外周血T淋巴细胞的变化情况.结果 注射用核糖核酸Ⅱ胸腔内注入疗法的总体有效率达90.48%,其中完全缓解(CR)30例(47.62%),部分缓解(PR)14例(22.22%),稳定(SR)13例(20.63%),无效6例.治疗后外周血T淋巴细胞亚群中的CD3+、CD4+水平和CD4+/CD8+值较治疗前升高(CD3+:67.49±6.41比64.21±4.87,CD4+:28.72±3.85比24.59±3.47,CD4+/CD8+:0.91±0.07比0.65±0.04,均P<0.05),CD8+水平明显下降(33.96±5.86比38.16±4.89,P<0.05).结论 注射用核糖核酸Ⅱ胸腔内注入疗法治疗恶性胸腔积液的疗效确切,能明显改善机体状况和增强免疫功能.%Objective To determine the efficacy of ribonucleic acid Ⅱ (RNA Ⅱ) intrathoracic injection on malignant pleural effusion and the host immunity.Methods Sixty-three patients with pathologyand (or) cytology-diagnosed malignant pleural effusion admitted to The First Affiliated Hospital,Sun Yatsen University between March 2012 and February 2013 were subjected to RNA Ⅱ (300 mg,once weekly) injection via thoracocentesis or thoracic cavity closed drainage.Repetitive administration was performed in case of pleural effusion as suggested by chest X-ray at week 1.The therapeutic outcomes were assessed based on the WHO criteria.The changes in peripheral blood T cells was assessed using flow cytometry prior to and following one week after the treatment