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PubMed1997

Diagnostic value of lactate dehydrogenase isoenzyme pattern in pleural effusions.

Lactate dehydrogenase isoenzymes have been used to classify the nature of pleural effusion. Nevertheless, studies have reported conflicting results. The objective of this study was to evaluate the diagnostic value of lactate dehydrogenase isoenzymes in the analysis of pleural effusions. Pleural fluid samples obtained from three respective diagnostic groups: group I transudate (n = 23), group II parapneumonic effusion (n = 29) and group III malignant effusion or pleuritis carcinomatosa (n = 41) were evaluated. Total lactate dehydrogenase activity and lactate dehydrogenase (LDH) isoenzyme pattern were significantly different between transudative (group I) and exudative (group II and III) effusions. Group II and III showed a low percentage of LDH1 (p < 0.001), whereas the percentages of LDH4 (p < 0.001) and LDH5 (p < 0.001) were higher compared to group I. Moreover, in exudative effusions the percentage of LDH1 (p < 0.005), LDH4 (p < 0.005), as well as LDH5 (p < 0.005) were significantly different between parapneumonic and malignant effusions. In contrast to relative lactate dehydrogenase isoenzyme values, the absolute values of lactate dehydrogenase isoenzymes did not differ between group II and group III. Logistic regression analysis yielded a strong discrimination between group I and II+III, simultaneously using lactate dehydrogenase, glucose and protein as explanatory variables. Logistic regression analysis yielded only a weak discrimination between group II and III, simultaneously using lactate dehydrogenase, glucose and the absolute values of LDH2 and LDH4 as explanatory variables. In conclusion, the lactate dehydrogenase isoenzyme pattern differed between pleural effusions of transudative and exudative origin. However, including lactate dehydrogenase isoenzyme activities in the biochemical work-up of pleural effusions did not reveal an additional discriminatory value in the assessment of the classification of these effusions.

Aged↗

PubMed1955

Protein studies of transudates of the middle ear.

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Blood Proteins↗

PubMed1996

Detection of soluble adhesion molecules in pleural effusions.

PURPOSE: Multiple immune functions such as activation of T cells and monocytes or cytolysis of tumor cells are mediated via the adhesion receptor/ligand pairs CD2/LFA-3 and LFA-1/ICAM-1. Because soluble forms of LFA-3 (sLFA-3) and ICAM-1 (sICAM-1) can interfere with these functions, we asked whether increased levels of sLFA-3 and/or sICAM-1 can be found in malignant or inflammatory effusions compared with transudates. METHODS: sLFA-3 and sICAM-1 levels were measured by enzyme-linked immunoassays in pleural effusions from 70 patients (6 transudates, 10 inflammatory, 47 malignant, and 7 other effusions). Twenty pleural fluid samples were tested in parallel for the complete sLFA-3 molecule or sLFA-3-domain 1 only. RESULTS: Increased levels of sICAM-1 were found in all types of exudates compared with transudates. Highest levels of sICAM-1 were measured in malignant exudates, particularly in effusions caused by mesotheliomas, non-small lung cancers, and gynecologic malignancies. This was also true for sLFA-3. However, sLFA-3 levels were not increased in inflammatory effusions. sLFA-3 levels correlated significantly with protein, cholesterol, lactate dehydrogenase, and sICAM-1 levels. Comparison of sLFA-3-domain 1 and the complete sLFA-3 molecule revealed identical sLFA-3 levels, suggesting the absence of nonfunctional split products. CONCLUSIONS: Elevated levels of the complete sLFA-3 molecule were found in malignant pleural effusions, while sICAM-1 level was elevated in both inflammatory and malignant effusions. Secretion of sICAM-1 and sLFA-3 by tumor cells might block T-cell-mediated immune functions such as tumor cytotoxicity. Alternatively, secretion of soluble adhesion molecules might reflect the generalized inflammation within the pleural space.

Adult↗

PubMed1997

The usefulness of diagnostic tests on pericardial fluid.

STUDY OBJECTIVES: To determine the physical, chemical, and cellular characteristics of pericardial fluid in various disease states and to assess their diagnostic accuracies. SETTING: A metropolitan university hospital. DESIGN: Consecutive case series. PATIENTS: One hundred seventy-five hospital patients, aged 1 month to 87 years, who had undergone pericardiocentesis (n = 165) or control subjects who had undergone open heart surgery (n = 10) between 1984 and 1996. MEASUREMENTS: The appearance of pericardial fluid and results of chemistry tests, cell counts, cytologic studies, Gram's stain, and microbial cultures were obtained by chart review. The etiology of each pericardial fluid sample was determined using prospective diagnostic criteria. RESULTS: Exudates differed from transudates by higher leukocyte counts and ratios of fluid to serum lactate dehydrogenase levels. Fluid glucose levels were significantly less in exudates. Sensitivity for detecting exudates was high for specific gravity > 1.015 (90%), fluid total protein > 3.0 g/dL (97%), fluid to serum protein ratio > 0.5 (96%), fluid lactate dehydrogenase ratio > 0.6 (94%), and fluid to serum glucose ratio < 1.0 (85%). None of these indicators were specific. Fluid total protein and specific gravity were moderately correlated (r = 0.56). Fluid cytologic study had a sensitivity of 92% and specificity of 100% for malignant effusion. No other test was diagnostic for a specific etiology. Among infection-associated effusions, culture-positive fluid had more neutrophils, higher lactate dehydrogenase levels, and lower ratios of fluid to serum glucose than culture-negative (parainfective) fluid. CONCLUSIONS: Evaluation of pericardial fluid might be limited to cell count, glucose, protein, and lactate dehydrogenase determinations plus bacterial culture and cytology. While not used routinely, other tests that may be highly specific for particular diseases should be ordered only to confirm a high clinical suspicion.

Adolescent↗

PubMed1961