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J M Porcel

Publications and source records attributed to J M Porcel.

At least 37 records · Page 2Linked to original sources
PubMed1998

Comparative analysis of Light's criteria and other biochemical parameters for distinguishing transudates from exudates.

OBJECTIVES: To compare the accuracy of Light's criteria for categorizing a pleural effusion as an exudate with several alternative criteria. DESIGN: Prospective evaluation of patients who underwent a diagnostic thoracocentesis. SETTING: Community teaching hospital in Lleida, Spain. PATIENTS AND METHODS: Medical records and pleural fluid characteristics of 241 consecutive patients with pleural effusion admitted over a 29-month period were reviewed. Forty eight of these patients were excluded for different reasons. Light's criteria and a different cutoff level for the pleural fluid cholesterol level were applied and their accuracies were calculated. RESULTS: Of the 193 patients included, 38 (20%) had transudates and 155 (80%) exudates. The accuracy of Light's criteria for identifying exudates was 92% [confidence intervals (CI), 88-96%], with a sensitivity of 97% (CI, 94-100%) and specificity of 71% (CI, 57-85%). A cutoff level of 50 mg dl-1 was selected for pleural cholesterol, which yielded a sensitivity and specificity of 84% (CI, 79-90%), with an accuracy of 84% (CI, 72-96%). Overall, pleural cholesterol misclassified more exudates as transudates than Light's criteria (15 vs. 3.2%, P < 0.001). The combination of pleural cholesterol with lactate dehydroegnase (LDH) or pleural fluid/serum protein ratio revealed a comparable accuracy to that achieved with Light's criteria. CONCLUSIONS: Light's criteria are just as useful as the association of pleural cholesterol and LDH to detect exudates. In the present study, no parameter, including pleural cholesterol, was superior to Light's criteria.

Adolescent↗
PubMed1997

Rapid detection of pneumococcal antigen in lung aspirates: comparison with culture and PCR technique.

Detection of pneumococcal antigen has been used to increase the rate of diagnosis of pneumococcal pneumonia. The present study was designed to determine the value of rapid detection of pneumococcal antigen in samples obtained by transthoracic needle aspiration (TNA) from patients with community-acquired pneumonia (CAP) in a comparative analysis with culture and polymerase chain reaction (PCR). Pneumococcal antigen was detected by latex agglutination. One hundred and ten consecutive patients diagnosed with CAP underwent TNA. Patients were grouped, according to PCR, culture and serological results, into pneumococcal pneumonia (n = 18), other known aetiology (n = 67) and unknown aetiology (n = 25). In patients with pneumococcal pneumonia, antigen was detected in 17 (94.4%) cases. Antigen was detected in one and nine patients with pneumonia of other known or unknown aetiologies, respectively, yielding a specificity of 89.1%. In conclusion, detection of pneumococcal antigen on samples obtained by TNA from patients with CAP provides a sensitive and specific diagnosis of Streptococcus pneumoniae infection. Furthermore, its rapid results would reduce the dependence on empirical treatments.

Adult↗
PubMed1996

Endobronchial metastatic disease: analysis of 32 cases.

Endobronchial metastasis (EM) from nonpulmonary tumors is uncommon. A 9-year retrospective study at the University Hospital Vall d'Hebron (Barcelona, Spain) identified 32 patients with EM. All but four cases were diagnosed by fiberoptic bronchoscopy with bronchial biopsy. Primary tumors included the following types: breast cancer (20), colorectal cancer (3), melanoma (2), gastric cancer (1), neuroblastoma of the olfactory nerve (1), abdominal leiomyosarcoma (1), hypernephroma (1), endometrial carcinoma (1), papillary thyroid cancer (1), and hepatocarcinoma (1). Median age at diagnosis of EM was 58.7 years and median interval from the diagnosis of the primary tumor to the diagnosis of EM was 50.4 months. Seventeen patients (53%) had evidence of other metastatic sites at endobronchial relapse. The more common clinical manifestations included cough (37.5%), haemoptysis (28%), dyspnea (18.7%), and recurrent pulmonary infections (6.2%). Eight patients (25%) had no symptoms. There appears to be a predilection for metastatic involvement of the right and left upper lobe bronchus. Treatment was instituted in 20 patients, and their median survival was 11 months, in comparison with the 3 months found in 12 patients who received only palliative therapy because of advanced disseminated disease. Breast cancer is the most common tumor causing EM. The prognosis of patients with EM depends on the type of the primary tumor and the presence of other metastatic sites. Treatment must be individualized.

Adult↗
PubMed1996

A study of Light's criteria and possible modifications for distinguishing exudative from transudative pleural effusions.

STUDY OBJECTIVE: To determine the usefulness of modifying Light's criteria for the separation of pleural transudates from exudates. DESIGN: Retrospective review of patients who underwent a diagnostic thoracentesis during a 2-year period. SETTING: Community teaching hospital in Lleida, Spain. PATIENTS AND METHODS: Clinical records and pleural fluid characteristics of 230 consecutive patients with pleural effusion underwent a detailed review. Thirty-five of these patients were excluded from the analysis. As suggested recently by Romero et al, different cutoff levels for the criteria of Light et al were applied and their accuracies were calculated. RESULTS: Thirty-nine (20%) pleural effusions were transudates and 156 (80%) were exudates. The accuracy of the criteria of Light et al for identifying exudates was 94.7% (confidence interval, 91.6 to 97.9) in comparison to our own modified criteria (93.1%; confidence interval, 89.5 to 96.7) and the criteria suggested by Romero et al (92.6%; confidence interval, 88.9 to 96.3). These differences were not statistically significant. CONCLUSION: Changing the classic Light's criteria with different cutoff points offers no advantages for discriminating between transudative and exudative pleural effusions.

Adolescent↗
PubMed1995

The value of complement activation products in the assessment of systemic lupus erythematosus flares.

Complement activation products (CAP) have been reported as sensitive markers of disease activity in systemic lupus erythematosus (SLE). We have measured seven parameters of the complement system (C3, C4, factor B, C3a, C4a, iC3b, and the terminal complement complex-TCC-) in 61 SLE patients to study their interrelationship and relative efficacy as diagnostic indicators of lupus activity. Disease activity was judged according to a clinical index (SLEDAI) to be active in 22 and inactive in 39 patients. Subjects with active SLE showed increased levels of C3a, C4a, and TCC compared with those of stable lupus and normal controls, and plasma concentrations of these CAP manifested a positive correlation with disease activity scores. However, values of factor B and iC3b did not correlate with lupus flares. Serum C3 levels were a better reflection of the degree of SLE activity than were C4 levels. The anaphylatoxins were extremely sensitive markers of disease activity but they lacked enough specificity, and iC3b was not at all informative for this purpose. On the whole, TCC concentration was the most useful parameter (77% sensitivity, 80% specificity) to monitor lupus activity, correlating the best with the activity scoring system, and thus offers a better laboratory marker of lupus severity than conventional measurements of complement.

Adolescent↗