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Results for “PLEURAL EFFUSIONS”

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At least 19 recordsLinked to original sources

PubMed2005

A simple laboratory measurement for discrimination of transudative and exudative pleural effusion: pleural viscosity.

BACKGROUND: The initial step in establishing the cause of an effusion is to determine whether the fluid is a transudate or exudate. Plasma viscosity is influenced by the concentration of plasma proteins and lipoproteins with the major contribution resulting from fibrinogen. In this study we aimed to evaluate the role of pleural fluid viscosity in discrimination of transudate and exudates. MATERIALS AND METHODS: We studied prospectively 63 consecutive patients with pleural effusion in whom diagnostic or therapeutic thoracentesis had been performed. The criteria of Light were applied to differentiate transudates from exudates: 33 patients (23 male, 13 female, mean age=68+/-4 years) had exudates and 30 patients (17 male, 13 female, mean age=68+/-5) had transudates (due to congestive heart failure). Measurements of pleural fluid and plasma viscosity were performed using a viscometer. RESULTS: There was no statistically significant difference between patients with transudate and exudates in respect to plasma viscosity. However, pleural viscosities of the patients with exudates were significantly higher than those of patients with transudate (1.37+/-0.16 mPa vs 0.93+/-0.03 mPa s p<0.001, respectively). Pleural viscosity has a high sensitivity, specificity (94%, 93%, respectively), positive and negative predictive value (97%, 97%, respectively) for the discrimination of transudative or exudatetive pleural fluid. CONCLUSION: We have demonstrated for the first time that pleural viscosity of the exudative effusion is higher than that of transudative effusion with high sensitivity, specificity, positive and negative predictive value. Regarding the simplicity of this measurement, it may play a valuable role in the accurate and fast discrimination of pleural fluid.

Aged↗

PubMed1999

[Parapneumonic pleural effusion, pleural empyema: medical and surgical aspects].

The following are essential for prophylaxis and treatment of empyema: antibiotic therapy for pneumonia, based on susceptibility results; early detection of parapneumonic effusions (decubitus radiograph, sonography); immediate diagnostic thoracocentesis if a parapneumonic effusion is large, increasing despite antibiotic therapy, if it is associated with clinical deterioration or if empyema is suspected; assessment of the stage of parapneumonic effusion or empyema (clinical signs, sonography, CT, laboratory parameters); immediate therapeutic thoracocentesis of frank empyema, in loculated empyema fibrinolytic agents may be used; early surgical intervention if conservative management fails; complete thoracoscopic decortication, if necessary open thoracotomy to assure complete reexpansion of the lung.

Empyema, Pleural↗

PubMed1980

[Tuberculous pleural effusion and pleural effusion secondary to non-specific bacterial infection: biochemical differential diagnosis (author's transl)].

The authors study 14 different analytical parameters in the pleural fluid in order to recognize differential biological criteria, helping to establish an etiologic diagnosis in patients with suggestive clinical symptoms and biological data of an infectious process. In a group of 38 patients with bacterial exudative pleural effusion (22 of tuberculous origin and 16 secondary to non-specific bacterial infection), the following parameters were analyzed: total proteins, acid glucoprotein, X1, antytripsin, CDH, acid phosphatase, amylase, cholinest, copper, iron, pCO2, pO2 pH, glucose, and cholesterol. The results of amylase, copper, pCO2, pO2 and pH determinations in the pleural fluid show statistical significant differences between the tuberculous cases and the patients with non-specific infections. Lastly, the authors mention the minimal biological criteria necessary to confirm the tuberculous or non-specific bacterial etiology of a pleural fluid, stressing the value of the levels of cholinesterase, copper, pO2 and pH as differential data.

Copper↗

PubMed2005

Proteomic analysis of human pleural effusion.

Pleural effusion, an accumulation of pleural fluid, contains proteins originating from plasma filtrate and, especially when tissues are damaged, parenchymal interstitial spaces of lungs and/or other organs. This report presents data of the first global proteomic analysis of human pleural effusion. A composite sample was prepared by pooling pleural effusions from seven lung adenocarcinoma patients. Two-dimensional gel electrophoresis analysis of the composite sample revealed 472 silver-stained spots. 242 selected gel spots were subjected to protein identification by in-gel digestion, liquid chromatography-tandem mass spectrometry, and sequence database search. 44 proteins were identified with higher confidence levels (at least two unique peptide sequences matched), while 161 other proteins were identified at the minimal confidence level (only one unique peptide sequence matched). The data provide fundamental information on the composition of protein contents in human pleural effusion. Among these 44 proteins that were identified with higher confidence levels, 7 proteins, retinoblastoma binding protein 7, synaptic vesicle membrane protein, corticosteroid binding globulin precursor, PR-domain containing protein 11, envelope glycoprotein, MSIP043 protein, and titin have not been reported in plasma and may represent proteins specifically present in pleural effusion. These proteins could have originated from parenchymal interstitial spaces and represent potential candidates of useful biomarkers that could not be readily detected in plasma but in pleural effusion. Retinoblastoma binding protein 7 is of special interest since it may play a role in the regulation of cell proliferation and differentiation.

Adenocarcinoma↗

PubMed1983

Ratios of pleural fluid to serum immunoglobulins in malignant pleural effusions.

Pleural fluid and serum protein electrophoresis and quantitative immunoglobulin measurements were carried out in patients with pleural effusions. The mean pleural fluid/serum ratios of IgA, IgG, and IgM were elevated in patients with malignant pleural effusions compared with patients with nonmalignant pleural effusions (P less than 0.04). The sensitivity of a pleural/serum IgA, IgG ratio P greater than 0.6 was 46%, 69%, respectively, and for IgM ratio greater than 0.5 was 28%. The specificity for these same ratios was 89%, 74%, and 100% respectively.

Blood Protein Electrophoresis↗

PubMed2004

Diagnostic utility of pleural fluid IFN-gamma in tuberculosis pleural effusion.

Pleural fluid interferon-gamma (IFN-gamma) levels are increased in patients with tuberculosis (TB) pleural effusion. Recent studies from the west have found that estimation of pleural fluid IFN-gamma levels is an excellent diagnostic strategy for these patients. The diagnostic utility of pleural effusion IFN-gamma level estimation has not been evaluated in patients from developing countries, however. This work was carried out to study the diagnostic utility of IFN-gamma level estimation in patients with TB pleural effusion and to define the best cutoff of IFN-gamma for diagnosis TB pleural effusion. We studied 101 patients with pleural effusion. Of these, 64 were found to have a TB etiology, established by means of various conventional modalities. Measurement of pleural fluid IFN-gamma levels was done by ELISA technique. The median value of pleural fluid IFN-gamma levels in patients with TB (1480 pg/ml, range 3-14,000 pg/ml) was significantly higher (p < 0.001) compared with the non-TB group (3 pg/ml, range 0-900 pg/ml). The receiver operator characteristic (ROC) curve for IFN-gamma showed an area under the curve (AUC) value of 0.954, and the best cutoff was computed to be 138 pg/ml. Using this cutoff for IFN-gamma levels in pleural fluid for the diagnosis of TB, sensitivity, specificity, negative predictive value, and positive predictive value were found to be 90.2%, 97.3%, 85.7%, and 98.3%, respectively. Estimation of IFN-gamma levels in pleural fluid is a useful diagnostic modality for TB pleural effusion. A cutoff of 138 pg/ml provides the best sensitivity and specificity for diagnosis of TB.

Adult↗

PubMed1998

Closed percutaneous pleural brushing: a new method for diagnosis of malignant pleural effusions.

Pleural fluid cytology and pleural biopsy are the two most commonly employed diagnostic tests for malignant pleural effusions. Here, we have introduced a new diagnostic method, namely closed percutaneous pleural brushing, and have compared its diagnostic yield with those of pleural fluid cytology and pleural biopsy in patients with suspected malignant pleural effusion. Forty-three consecutive patients with suspected malignant pleural effusion underwent thoracentesis, closed pleural brushing and closed pleural biopsy using Cope's pleural biopsy needle and a cytological brush (BC-10C) which was introduced into the pleural cavity through the cannula of the same needle. All the samples were sent for bacteriological and cytological studies. Patients had a mean follow-up period of 9.28 +/- 1.87 months during which seven cases whose entire studies were non-diagnostic underwent thoracotomy and open pleural biopsy. Thirty-four cases were finally documented to have malignancy. Closed pleural brushing was positive in 31 (91%) of cases. This was superior to that achieved by either pleural fluid cytology (67%) (P = 0.01) or pleural biopsy (58%) (P = 0.002). No pneumothorax or other major complications were encountered with this method. Closed pleural brushing via Cope's needle is a relatively safe, simple and well-tolerated technique with a high diagnostic yield for patients with malignant pleural effusion. It may substitute for other more invasive and more expensive procedures such as thoracoscopy and thoracotomy in this group of patients.

Aged↗

PubMed1984

[Differential diagnosis of pleural effusions].

Pleural effusion is an important and common clinical finding. Pleural effusions can be readily obtained for analysis, and the examination of the cells therein is considered to be one of the most important diagnostic tools available for differentiating between malignant and non-malignant effusions. The present study was undertaken to test the diagnostic value of the determination of CEA in pleural fluid for a variety of diseases. Sixteen patients with pleural effusions were studied. Seven patients had carcinoma of the cervix, 7 of the ovary and 2 of the corpus. The positive rate of malignant cells was 81%. Among malignant effusions, only 44% of patients showed a CEA value above 10 mg/ml. This investigation suggests that cytological examination of pleural fluid is of considerable clinical significance for diagnosing the nature of pleural effusions, and effusion fluid CEA assay may provide a useful adjunct in the evaluation of effusion fluids for malignancy.

Adenocarcinoma↗

PubMed1995

Comparison of pleural fluid cytology and pleural biopsy in the evaluation of pleural effusion.

Pleural fluid cytology and pleural biopsy results were studied in 65 cases of pleural effusion. The efficacy of pleural biopsy in diagnosis of neoplastic and non-neoplastic pleural diseases was compared. Of the 24 cases with confirmatory evidence of cancer, 17(70.8%) has positive cytologic findings in pleural fluid, whereas pleural biopsy was diagnostic in only 13 cases (54.1%). For non-malignant pleural effusion in 41 cases 40(97.5%) has a definite diagnosis (tuberculous pleuritis, acute fibrinous pleuritis or hydatid cyst) which could be made by cytology while only 31(75.6%) out of 41 were diagnosed on pleural biopsy. The study indicates that cytologic evaluation of pleural fluid is more efficaceous in the diagnosis of malignant and non-malignant pleural disease than percutaneous pleural biopsy.

Biopsy, Needle↗

PubMed1997

Superior vena cava syndrome caused by encapsulated pleural effusion.

Pleural effusion is often a manifestation of the superior vena cava (SVC) syndrome. However, pleural effusion has never been reported to be a cause of the SVC syndrome. We report the case of a 68 yr old male patient who presented with SVC syndrome and respiratory failure, both attributable to an encapsulated pleural effusion over the right upper mediastinum. Simple drainage was performed as a diagnostic and therapeutic procedure. The pleural effusion was confirmed to be a tuberculous empyema. Chest computed tomography (CT) scan is the most appropriate initial diagnostic procedure for superior vena cava syndrome.

Aged↗

PubMed2003

Progressive systemic sclerosis-polymyositis overlap syndrome with eosinophilic pleural effusion.

Pleural fluid rarely occurs in patients with progressive systemic sclerosis (PSS) or polymyositis (PM) with no lesions in the pulmonary area. Pleural fluids in patients with autoimmune diseases are mostly dominated by monocytes and lymphocytes but very rarely contain increased eosinophils. We report a 55-year-old male with PSS-PM overlap syndrome and eosinophilic pleural effusion. Air invasion into the pleural cavity and the antituberculous therapy could be ruled out as causes for the patient's eosinophilic pleural effusion, because the differential eosinophil count was already as high as 19% from the first thoracentesis before the start of antituberculous therapy. Infections and malignant tumor also were unlikely causes based upon the negative pleural fluid results and the negative pleural biopsy findings, except for nonspecific inflammation. After the administration of corticosteroid, the pleural effusion decreased promptly, with normalization of serum creatine phosphokinase and C-reactive protein concentrations.

Anti-Inflammatory Agents↗

PubMed1988

Pleuro-peritoneal shunting. Alternative therapy for pleural effusions.

Pleural effusions are resistant to standard therapy, which causes discomfort and can require prolonged hospitalization. As an alternative, pleuroperitoneal shunting for pleural effusions of various etiologies was evaluated. We implanted 36 shunts in 29 patients. Two patients had bilateral shunts and five had shunt revisions. The effusion was related to a malignancy in 22 patients, postoperative chylothorax in two patients, and other causes in five patients. Therapeutic thoracentesis had been attempted in 28 patients, and eight had had chest tube placement previously with attempted sclerosis. Seven patients had a trapped lung syndrome. There was no operative mortality. All patients were deemed ready for discharge from the hospital if they had recovered from the operation within 48 hours. Five patients had poor results, either because of a moribund status or their refusal or inability to pump the shunt. Of the remaining 24 patients, four had good results with temporary improvement, and excellent results were achieved in 20 patients (83.3%), who experienced symptomatic relief and stabilization or regression of pleural effusion until the time of their death. Patients with chylothorax experienced complete resolution. The 14 patients with malignant effusions had a median survival of 4 months, and there were no instances of peritoneal tumor seeding. In conclusion, pleuroperitoneal shunting is an alternative therapy for pleural effusions that requires a limited hospitalization only, is associated with minimal and short-term discomfort, achieves excellent results in properly selected patients, and is the only viable therapy when lung expansion cannot be achieved.

Adult↗

PubMed1987

Diagnosis and treatment of malignant pleural effusion.

Pleural effusion is a common and important complication of malignancy which may at times be difficult to diagnose or treat. Its well recognized association with numerous diseases plus the limitations of our usual diagnostic tests may occasionally cause difficulty. In the oncology patient there are a number of common medical problems associated with the development of pleural effusion which frequently coexist with the malignancy. Pleural effusion may be a presenting or late sign of cancer, and when recurrent can be a vexing symptomatic problem. Fortunately, an increasing number of effective diagnostic and therapeutic modalities are available which, when judiciously applied, facilitate our approach.

Amylases↗

PubMed1999

[Current value of intrapleural fibrinolysis in the treatment of exudative fibrinous pleural effusions in pleural empyema and hemothorax].

Intrapleural administration of fibrinolytic agents has been in use for fifty years; it has, however, been of clinical importance only for the last twenty years. Parallel to clinical reports procoagulant and fibrinolytic activities in pleural effusions are studied. Most types of pleural injury are characterised by fibrin deposition in the pleural space promoted by concurrent local abnormalities of pathways of fibrin formation and its clearance. Many of the studies of intrapleural fibrinolytics are uncontrolled and retrospective or small and are therefore of limited statistical value. Only five of the studies which are presented in the table are controlled and comparative studies. Intrapleural fibrinolytic therapy was used in exudative fibrinous multi-loculated pleural effusions, pleural empyemas and haemothorax. The global success rate of the studies cited were between 44% and 100%, in most cases more than 80%. The great differences in success rates are due to variations in the pleural diseases and stages of the clinical course, different success criteria, different dosages of fibrinolytic agents, different durations of clamped chest tube drainage and different starting points of therapy during the hospital course. The number of patients enrolled in each study ranged from 8 to 98, the number of children ranged from 2 to 9. Intrapleural fibrinolytic treatment is associated with rare adverse effects. There is no significant systemic fibrinolytic activity of intrapleural fibrinolysis. Intrapleural administration of streptokinase has been reported to lead to antibody formation. Hence, intrapleural fibrinolytic therapy is a useful adjunct in the management of exudative fibrinous multi-loculated pleural effusions, pleural empyemas and haemothorax. There is an increased volume of pleural fluid drainage during the treatment phase, and intrapleural fibrinolysis may reduce the need for more invasive surgical procedures. On the basis of the data of literature we recommend to use a single daily dose of 250,000 U streptokinase or 100,000 U urokinase in 50-100 ml normal saline instilled into a chest tube and to maintain dwell times of 2 to 4 hours. Therapy can be continued up to 2 weeks. The pleural space can be drained by large bore chest tubes or small drainage catheters, both radiologically guided, without preference for one method.

Empyema, Pleural↗

PubMed1987

Pleural fluid lactate in pleural effusion.

Pleural fluid lactate (PFL) and blood lactate (BL) concentrations were simultaneously measured in samples from 46 patients with pleural effusion. PFL exceeded 6 mmol/l in all 15 patients with pyogenic bacterial pleurisy but in only 5 of the other 31 patients. We have found that a PFL-BL difference greater than or equal to 6 mmol/l has a sensitivity of 100% and a specificity of 93.8% in detecting pyogenic pleural effusions. Results are available within 1 h of sample collection, so that PFL-BL difference may become a useful aid in the early assessment of pleural effusions.

Bacterial Infections↗

PubMed2005

Myelomatous pleural effusion.

Pleural effusions in multiple myeloma are relatively infrequent and more so myelomatous ones. We report a 66-year-old man who presented with multiple myeloma and a myelomatous right-sided pleural effusion. The diagnosis was made by repeated cytopathological pleural fluid examinations. The patient received one cycle of cyclophosphamide and methylprednisolone but despite therapy patient showed a downhill course. We reviewed the clinical features of this case and literature concerning multiple myeloma presenting as pleural effusion.

Aged↗

PubMed2001

[A case of Mycobacterium avium lung infection with a pleural effusion].

Pleural effusions seldom accompany nontuberculous mycobacterial infections. We reported one such case of M. avium lung infection with pleural effusion. A 40-year old male was admitted to our hospital complaining of right chest pain and general fatigue. His chest X-ray showed a consolidation in the right lower lung field. The day after admission, a right pleural effusion appeared. The fluid was exudative and microbiological examinations of the effusions, including staining and culturing, proved negative. However, one month afteradmission, acid fast bacilli were observed in his sputum and a subsequent sputum culture specimen revealed the presence of M. avium. Treatment with antimycobacterial agents was promptly commenced and the patient's effusion and lung consolidation was gradually resolved.

Adult↗

PubMed2006

[Talc pleurodesis in malignant pleural effusions].

Pleural effusions associated with malignancy--either malignant or paramalignant diseases--were found in ca. 20% of these patients. Large pleural effusions cause mainly dyspnoea but also cough and chest pain. The presence and degree of dyspnoea depend on the size of the effusion and the patient's underlying pulmonary function. In acute cases and large effusions immediate chest drainage is indicated in symptomatic patients, followed by the treatment of the underlying disease, e. g. chemotherapy. The most effective therapy for controlling reiterated malignant pleural effusions is the thoracoscopic talc poudrage (2.5-10 g) which has been shown to have a success rate of > 90%. Talc induces a broad inflammatory reaction involving mesothelial cells of the pleura, coagulation parameters, fibroblast proliferation eventually leading to symphysis of the pleura. This procedure is reserved for patients who are in good general conditions, who are expected to have a reasonably long survival, and who failed chemical pleurodesis. A good predictor for longer survival time is a Karnofsky Performance Scale > or = 40 indicating a survival time > 30 days, which therefore should be considered prior to the procedure. The adult respiratory distress syndrome (ARDS) is the most important complication initially observed in the US in up to 9% of all cases. ARDS incidence was strongly related to high number (50%) of small talc particles < 15 microm. In summary, talc poudrage or slurry (talc particle size > 10 microm) in malignant pleura effusions is a safe and effective method to induce pleura symphysis. Complaints and complications such as chest pain, transient fever, and empyema are rare or very are which are almost exclusively related to the therapeutic procedure itself.

Dyspnea↗