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PubMed1977

Reliability of echocardiography in quantitating pericardial effusion: a prospective study.

A method of estimating the volume of pericardial effusion by echocardiography has used the difference between the cubed diameters at end-diastole of the pericardium and epicardium. To evaluate the reliability of this technique in quantitating the volume of pericardial effusion in a prospective study, 22 echocardiograms were obtained in six patients before and after 11 separate pericardiocenteses. The correlation coefficient between the actual volume of aspirated pericardial effusion and the echocardiographically estimated volume of aspirated pericardial effusion was r = 0.27 (P not significant). The volume of pericardial effusion aspirated was overestimated or underestimated by echocardiography by more than 100 ml in seven of 11 estimations (64 percent) and by more than 150 ml in five of 11 estimations (45 percent). Therefore, although echocardiography is the procedure of choice in diagnosing the presence of pericardial effusion, it is not an entirely accurate method of quantitating the volume of pericardial effusion. However, echocardiography can differentiate a large effusion from a moderate or small effusion.

Adult↗
PubMed2001

Expression of cell cycle proteins in ovarian carcinoma cells in serous effusions-biological and prognostic implications.

OBJECTIVE: The aim of this study was to investigate the expression of cell cycle proteins in ovarian carcinoma cells in serous effusions and respective solid tumors. METHODS: Fifty-five malignant effusions and 38 tumors (20 primary, 18 metastatic) were immunohistochemically stained for cyclin A, p27(kip1), and Ki-67. Staining extent (0-100% cells) and intensity (0-3 scale) were scored. Cyclin A and p27(kip1) expression was additionally studied in 29 malignant effusions using immunoblotting. Immunohistochemistry results in effusions were evaluated for possible association with clinicopathologic parameters. RESULTS: Nuclear immunoreactivity for all markers was detected on carcinoma cells in the majority of effusions using immunohistochemistry. Similarly, immunoblotting showed the presence of cyclin A and p27(kip1) in 29/29 and 25/29 specimens, respectively. Intense (3) immunoreactivity for Ki-67 was detected more often in peritoneal effusions, compared with those of pleural location (P = 0.036). Staining in primary and metastatic lesions was generally comparable to that of tumor cells in effusions. Staining for p27(kip1) was more diffuse in effusion specimens obtained prior to the institution of chemotherapy (P = 0.042). In an analysis of all effusions, an association was observed between the number of cells that were immunoreactive for Ki-67, cyclin A, and p27(kip1) (cyclin A-Ki-67: P = 0.008; p27(kip1)-Ki-67: P = 0.019; cyclin A-p27(kip1): P = 0.032). In survival analysis, the presence of more diffuse (P = 0.042) and intense (P = 0.019) staining for cyclin A correlated with prolonged overall survival. CONCLUSIONS: The expression of the studied cell cycle markers does not differ markedly between ovarian carcinoma cells in the pleural and peritoneal cavity, supporting our previous studies of several metastasis-associated molecules. The presence of cyclin-A-positive cell populations is associated with a more favorable disease outcome, possibly due to the targeting of proliferating cells by chemotherapeutic agents. However, the decline in the fraction of p27(kip1)-positive cells in posttreatment specimens may point to additional mechanisms involved in this selection.

Ascitic Fluid↗
PubMed1997

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

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 assessment 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.

Contrast Media↗
PubMed1998

Middle ear effusion among children diagnosed and treated actively for acute otitis media.

UNLABELLED: We assessed the point prevalence of middle ear effusion among day care children in an area where acute otitis media is diagnosed, treated and followed actively. Minitympanometry was used to screen 850 day care centre attendants aged 0.6 to 6.9 years (mean 3.7 years). Tympanometry was performed by two trained nurses at the day care centres and pneumatic otoscopy was done by a paediatrician when effusion was suspected. We found 60 (7.1%) children to have middle ear effusion, which was bilateral in 23 (2.7%) cases. Of the children with bilateral effusion 13 had respiratory symptoms fulfilling the criteria of acute otitis media, 8 of them had experienced acute otitis media during the past 3 weeks and were diagnosed to have otitis media with effusion, and only 2 (0.2%) were asymptomatic children not identified earlier. Of the 37 (4.4%) children with unilateral effusion, 14 had acute otitis media and 23 otitis media with effusion, of whom 12 children (1.4%) had not been identified earlier. The point prevalence of acute otitis media was 3.2% and that of otitis media with effusion 3.9%. CONCLUSION: We conclude that active diagnosis and treatment of acute otitis media practically eliminates such middle ear effusion that could cause significant hearing impairment.

Acoustic Impedance Tests↗
PubMed2005

Angiogenic molecule expression is downregulated in effusions from breast cancer patients.

The objective of this study was to analyze site-related expression of angiogenic molecules in breast carcinoma, with the aim of characterizing phenotypic alterations along the clinical progression from primary tumor to pleural effusion. A total of 49 malignant pleural effusions and 68 corresponding solid tumors were studied for protein and mRNA expression of vascular endothelial growth factor (VEGF) and its receptor KDR, interleukin-8 (IL-8), basic fibroblast growth factor (bFGF) and the alphaV integrin subunit using immunohistochemistry, mRNA in situ hybridization (ISH) and reverse transcription polymerase chain reaction (RT-PCR). Expression was analyzed for possible association with mRNA expression of the Ets-1 and PEA3 transcription factors. The predictive value of angiogenic molecules, PEA3 and Ets-1, and clinical parameters was analyzed for 18 patients. ISH showed the presence of VEGF, IL-8 and bFGF mRNA in the majority of specimens, irrespective of anatomic site (p > 0.05). However, protein expression of IL-8 and bFGF was lower in effusions compared to primary tumors (p = 0.001 for IL-8, p < 0.001 for bFGF). Expression of alphaV integrin showed an opposite change, with higher level in effusions compared to primary tumors (p = 0.03). bFGF and alphaV integrin expression in effusions was also altered compared to lymph node metastases (p = 0.041 and p = 0.016, respectively). IL-8 and Ets-1 (p = 0.035) and VEGF and PEA3 (p = 0.026) mRNA was co-expressed in effusions. In univariate survival analysis, bFGF protein expression in effusions (p = 0.015), PEA3 mRNA expression in primary tumors (p = 0.02) and previous radiation therapy (p = 0.034) predicted shorter disease-free survival. PEA mRNA expression in primary tumors (p = 0.002) and previous chemotherapy (p = 0.048) predicted poor overall survival, with a similar trend for advanced disease stage at diagnosis (p = 0.05). Our data provide evidence regarding molecular changes that occur along the progression of breast carcinoma from primary tumor to effusion, and suggest altered requirement of angiogenic factors in body cavities. The poor disease-free survival for patients with bFGF-positive effusions suggests a role for this growth factor in mediating tumor survival rather than angiogenesis at this site.

Adult↗
PubMed1989

Usefulness of nuclear magnetic resonance imaging for evaluation of pericardial effusions, and comparison with two-dimensional echocardiography.

Nuclear magnetic resonance (NMR) imaging clearly delineates cardiovascular structures without interference from overlying bone and lung tissue. The techniques of NMR imaging and echocardiography were compared in 26 patients with pericardial effusions, 10 of whom had associated pleural effusions. In those patients with fluid detected by both techniques, estimated size of the effusion tended to be somewhat larger by NMR. NMR imaging detected several small pericardial effusions that were not visualized by echocardiography. Both techniques demonstrated loculation well, although NMR imaging was better for detecting fluid located superiorly at the aortic pericardial reflection site, medially at the border of the right atrium and posteriorly at the left ventricular apex. In the 14 patients with documented exudative effusions (10 pericardial, 4 pleural) NMR signals of varying intensity were present in the effusion. One patient had a documented transudative effusion and no NMR signal was observed in the fluid. NMR imaging clearly distinguished pericardial from pleural effusions. NMR imaging is indicated when a suspected pericardial effusions is not detected by echocardiography or when specific localization or fluid characterization is desired.

Adolescent↗
PubMed1994

Clinical significance of pericardial effusion in Q-wave inferior wall acute myocardial infarction.

To assess the clinical significance of pericardial effusion in Q-wave inferior wall acute myocardial infarction, 185 consecutive patients were examined by means of electrocardiogram, echocardiogram and hemodynamic monitoring. A pericardial effusion was present in 44 patients and was absent in 141 patients. Electrocardiographic right ventricular infarction (> or = 1 mm of ST-segment elevation and Q wave in V4R) was detected in 54 patients, with 20 patients having pericardial effusion. Patients with pericardial effusion had significantly more left ventricular segments with advanced asynergy, lower cardiac output, higher pulmonary artery wedge pressure and higher incidence of right ventricular infarction than those without pericardial effusion. There were 17 in-hospital deaths. Although there was no significant difference in the mortality rate between patients with and without right ventricular infarction, a significantly higher hospital mortality rate was observed in patients with pericardial effusion compared to those without it (23 vs 5%). Pericardial effusion was selected with age and pulmonary artery wedge pressure as important variables associated with hospital mortality by the discriminant analysis. Patients who developed pericardial effusion, regardless of right ventricular infarction, had more extensive myocardial damage, and hence, pericardial effusion was one of the predictors of increased hospital mortality.

Acute Disease↗
PubMed1994

Quantification of pericardial effusions by three-dimensional echocardiography.

OBJECTIVES: The purpose of this study was to examine the accuracy of three-dimensional echocardiography for the quantification of asymmetric pericardial effusion volume and to compare this new technique with two-dimensional echocardiography. BACKGROUND: Quantification of pericardial effusion by two-dimensional echocardiography relies on a symmetric distribution of the fluid. Three-dimensional echocardiography can quantitate volume without these limitations, but its accuracy for pericardial effusion volume has not yet been assessed. METHODS: In six open chest dogs, 41 different asymmetrically distributed pericardial effusions of known volume were created by serial infusions of fluid through a pericardial catheter. The hearts were imaged using an automated echocardiographic method that integrates three-dimensional spatial and imaging data. The surfaces of the pericardial sac and heart were then reconstructed, and the volumes of pericardial effusions were calculated. Two-dimensional echocardiography was performed simultaneously, and volumes were calculated using the prolate ellipsoid method. Asymmetric distribution of the fluid was obtained by applying localized hydrostatic pressure to the pericardium. RESULTS: The volumes of pericardial effusion quantified using three-dimensional echocardiography correlated well with actual volumes (y = 1.0x - 1.4, SEE = 7.7 ml, r = 0.98). Two-dimensional echocardiography had an acceptable correlation (y = 1.0x + 2.3, SEE = 23 ml, r = 0.84), but a marked degree of variation from the true value was observed for any individual measurement. CONCLUSIONS: Three-dimensional echocardiography accurately quantifies pericardial effusion volume in vivo, even when the fluid is distributed asymmetrically, whereas two-dimensional echocardiography is less reliable. This new technique may be of clinical value in quantitating pericardial effusion, especially in the serial evaluation of asymmetric or loculated effusions.

Algorithms↗
PubMed1994

Pericardial effusions after cardiac transplantation.

OBJECTIVES: The aim of this study was to determine the etiologic factors in the formation of significant pericardial effusion after orthotopic heart transplantation and to determine the association of pericardial effusion with survival. BACKGROUND: The formation of pericardial effusions has been well described after orthotopic heart transplantation, but the risk factors for development of effusions remain unclear. Rejection and cyclosporine have been cited as possible causes, but anatomic factors have not been studied. METHODS: We conducted a retrospective review of medical records and echocardiograms of 203 consecutive patients at one center, including ischemic time, incidence and severity of rejection, weight difference between donor and recipient and previous cardiac surgical history. Multivariate analysis was performed, and actuarial survival rate curves were calculated according to the Kaplan-Meier method. RESULTS: Eighteen (8.9%) of 203 transplant recipients developed moderate to large pericardial effusions. Forty-four percent of patients required pericardiocentesis, and 28% subsequently required pericardiectomy for management of the effusions. Multivariate analysis identified the presence of a positive weight difference between recipient and donor (recipient weight > donor weight) and the lack of previous median sternotomy as the most powerful predictors of effusion formation. No significant association was found with rejection. There was no difference in actuarial survival rate between patients with and without effusions. CONCLUSIONS: A positive mismatch in weight between recipient and donor and the absence of previous cardiac surgery are associated with the formation of significant pericardial effusions. Closer monitoring of these patients at risk may be warranted.

Adolescent↗
PubMed1990

Presence of dipeptidyl peptidase II, dipeptidyl peptidase IV, and prolyl endopeptidase in effusion from patients with serous otitis media.

We have measured for the first time, using specific substrates and specific fluorometric analyses, activities of three pathophysiologically important peptidases, i.e., dipeptidyl peptidase II, dipeptidyl peptidase IV, and prolyl endopeptidase in effusions from 45 patients with chronic otitis media with effusion. In 20 patients, DPP II and DPP IV were assayed simultaneously in effusions and sera. Activity of PEP was also estimated in effusions and sera from 25 patients. The mean values (+/- SD) of DPP II and DPP IV (n = 45) and PEP (n = 25) in effusion from patients with OME were 0.020 +/- 0.007, 0.66 +/- 0.04, and 0.040 +/- 0.006 nmole/min/mg protein, and 0.21 +/- 0.01, 16.2 +/- 1.87, and 1.90 +/- 0.23 nmole/min/ml of effusion, respectively. The mean values (+/- SD) for DPP II, DPP IV, and PEP in sera were 2.82 +/- 0.18, 54.8 +/- 1.23, and 3.73 +/- 0.33 nmole/min/ml of serum, respectively, which were similar to our previously reported values. Activities of DPP II, DPP IV, and PEP of serous effusions were comparable to those in serum. However, there was no significant correlation between their activities in serum and effusion. This may suggest that the major source of these enzymes in effusions may not be serum but the cells in the middle ear.

Adult↗
PubMed2006

Relation of pericardial effusion to degree of fractional shortening.

The prevalence of significant pericardial effusion in patients with left ventricular (LV) dysfunction has not been reported. The goal of this study was to evaluate the prevalence and severity of pericardial effusion in patients with decreased fractional shortening (FS) using a large echocardiographic database. A retrospective analysis of 24,265 echocardiograms performed at our institution from 1984 to 1998 was undertaken. FS was measured in 18,015 of the echocardiograms. The occurrence of pericardial effusion was correlated with the degree of FS, and FS was stratified into 4 groups: (1) >25%, (2) 17.5% to 25%, (3) 10% to 17.5%, and (4) <10%. On the basis of visual estimation, effusion was divided into 3 groups: mild, moderate, and severe. Pericardial effusion was present in 1,632 of the echocardiograms in which FS was measured. Pericardial effusion was significantly more common in patients with FS <25% and was correlated with the severity of decreased FS (group 1: 8.4%; group 2: 12.8%; group 3: 13.2%; group 4: 14.4%; p <0.0001). However, when categorizing pericardial effusion by severity, only mild pericardial effusion was correlated with decreased FS (group 1: 6.6%; group 2: 11.0%; group 3: 11.1%; group 4: 14.0%; p <0000.1). Our results indicate that the occurrence of moderate to severe pericardial effusion cannot be explained by a decrease in LV systolic function.

Echocardiography↗
PubMed2005

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

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 tube insertion and once every 3 months thereafter. An otologist examined the ear status to assess tube extrusion and otitis media with effusion recurrence. Outcome measure was the recurrence of otitis media with effusion within 6 months after documentation of spontaneous tube extrusion. Birth characteristics were investigated in relation with the recurrence of otitis media with effusion in 90 children with known clinical outcome. RESULTS: No statistically significant associations were found between various birth characteristics and the recurrence of otitis media with effusion. Multivariate analyses showed positive but fairly weak associations between recurrence of otitis media with effusion and low birth weight (<2500 g) and/or low gestational age (<37 weeks) and/or a history of incubator care (odds ratio (OR) 1.95, 95% confidence interval (CI): 0.21-18.2), male sex (OR 1.85, 95% CI: 0.56-6.13) and maternal medication use during pregnancy (OR 4.80, 95% CI: 0.57-40.72). A remarkable finding was the asymmetrical distribution of certain birth characteristics within the group of children with recurrence of otitis media with effusion: children with unilateral recurrence had a relatively lower gestational age, lower birth weight, lower 'birth length to birth weight' ratio than the children with bilateral recurrence. CONCLUSION: These findings suggest that determination of birth characteristics cannot help us in the treatment strategy for recurrent otitis media with effusion in childhood.

Birth Weight↗
PubMed2006

Relationships among tumor burden, tumor size, and the changing concentrations of fibrin degradation products and fibrinolytic factors in the pleural effusions of rabbits with VX2 lung tumors.

The VX2 tumor is derived from a papilloma virus-induced rabbit epithelial cell line. If VX2 tumor cells (trapped in a plasma clot) are introduced intravenously into NZW rabbits, the cells lodge in the lung capillary bed and produce tumors. Independently of the tumor burden (ie, the total tumor weight per rabbit), approximately 15% of rabbits with VX2 lung tumors accumulate an effusion in the interpleural space and this pleural effusion contains products of hemostasis. We hypothesized that these products were of intra-tumoral origin and that they changed in concentration as tumor burden increased. Interrelationships among lung-, tumor-weights, and pleural effusion volumes, and the concentrations of fibrinolytic factors, their catabolic products, and other proteins of pleural effusions were measured in rabbits with a wide range of tumor burdens. Positive correlations between tumor burden and total lung weight and between pleural effusion volume and net lung weight suggested that interstitial fluid from the stroma of tumors passed directly into the extravascular space of the lung(s) and into the interpleural space(s). Analyses of pleural effusions indicated that plasminogen-, alpha(2)-antiplasmin-, and plasminogen activator inhibitor-1-related proteins, urokinase-like- and tissue-plasminogen activator activities, and vascular endothelial growth factor increased in concentration up to a tumor burden of approximately 20-25 g. Plasmin activity and intact fibrinogen were absent. The concentration of fibrin(ogen) degradation products did not change significantly up to a tumor burden of approximately 25 g but increased substantially as tumor burdens exceeded 25 g. In conclusion, interstitial fluid from tumors enters the extravascular space of the host and may accumulate with fluid from non-tumor sources as a pleural effusion. The concentrations of fibrinolytic factors and their products in pleural effusions reflect the tumor burden of the rabbit. Conceivably, the components of a malignant effusion contain much information about the extent of tumor growth.

Animals↗
PubMed2005

HLA-G expression in effusions is a possible marker of tumor susceptibility to chemotherapy in ovarian carcinoma.

OBJECTIVE: We recently showed that the levels of secreted human leukocyte antigen-G (HLA-G), a nonclassical MHC class I antigen, are significantly elevated in malignant effusions in ovarian carcinoma compared to benign ones. The objective of this study was to evaluate the expression and clinical role of HLA-G in effusions and corresponding solid tumors from patients diagnosed with advanced-stage ovarian carcinoma. METHODS: Effusions (= 148), corresponding primary tumors (= 66), and metastatic lesions (= 122) were analyzed using immunohistochemistry with an anti-HLA-G monoclonal antibody. RESULTS: HLA-G was detected in cancer cells in 49/148 (33%) effusions, 33/66 (50%) primary tumors, and 59/122 (48%) solid metastases. These differences did not reach statistical significance. Expression in effusions and solid metastases significantly correlated (P = 0.029). HLA-G expression in tumor cells was significantly lower in effusions obtained during or following chemotherapy (P = 0.038). The presence of HLA-G-positive tumor cells in effusions obtained prior to the institution of chemotherapy correlated with better overall survival (P = 0.042). HLA-G expression in primary tumors and solid metastases did not correlate with any of the clinicopathologic parameters studied. CONCLUSIONS: HLA-G is expressed in a significant number of ovarian carcinomas at all anatomic sites. The reduced expression of HLA-G in post-chemotherapy effusions and its correlation with improved survival may be related to preferential susceptibility of HLA-G-expressing cells at this site. Our findings suggest a new role for HLA-G as a prognostic indicator in advanced-stage ovarian cancer in effusions.

Adult↗
PubMed1998

Pericardial effusion after primary percutaneous transluminal coronary angioplasty in first Q-wave acute myocardial infarction.

To evaluate the incidence and clinical significance of infarction-associated pericardial effusion in patients with successful primary percutaneous transluminal coronary angioplasty, we studied 214 consecutive patients with a first Q-wave acute myocardial infarction. Based on 9 clinical variables, multivariate analysis was performed to determine the important variables related to the occurrence of pericardial effusion. Pericardial effusion was detected by echocardiography in 45 patients (21%); pericardial rub (p <0.001), number of advanced asynergic segments (p <0.001), ventricular aneurysmal motion (p = 0.03), and pulmonary capillary wedge pressure (p = 0.04) were found to be the important variables related to pericardial effusion. Among 45 patients with pericardial effusion, 29 patients with no pericardial rub had significantly higher pulmonary capillary wedge pressure than those with pericardial rub, whereas 16 patients with pericardial rub had a higher incidence of angiographic no reflow and ventricular aneurysmal motion than those without pericardial rub. Patients with pericardial effusion and a pericardial rub had a higher mortality rate than those without pericardial effusion (19% vs 3%; p = 0.02). Thus, pericardial effusion is still a relatively common clinical finding after primary percutaneous transluminal coronary angioplasty, and those with pericardial effusion and a pericardial rub were associated with more severe transmural myocardial damage and higher in-hospital mortality.

Aged↗
PubMed1996

Adenosine deaminase isozymes in tuberculous pleural effusion.

Total adenosine deaminase (ADA) activity and its isozyme (ADA1 and ADA2) activities were measured in pleural effusions and serum samples from patients with tuberculosis and in those from patients with lung cancer as controls. To analyze the cellular source of ADA isozymes in tuberculous pleural effusions, ADA isozyme activities in CD2+ T lymphocytes purified from tuberculous pleural effusions and cultured human cell lines derived from hematopoietic tumors were measured. Tuberculous pleural effusions had a much higher ADA activity than cancerous effusions, and high ADA activity mainly originated from the increase in ADA2 activity. Further, total ADA activity in tuberculous pleural effusions decreased after antituberculosis treatment, because of the decrease in ADA2 activity. On the other hand, measurement of ADA and ADA isozyme activities in T lymphocytes purified from tuberculous pleural effusions and human hematopoietic cell lines showed dominant expression of ADA1 in total ADA activity. In conclusion, we found that ADA2 is a dominant component of tuberculous pleural effusions and that ADA1 is a major component of lymphoid cells. These results suggest that elevation of ADA activity in tuberculous pleural effusions does not always reflect the activation of cell-mediated immunity.

Adenosine Deaminase↗
PubMed1989

Evaluation of pleural and peritoneal effusions.

Certain diseases cause an increase in the amount of fluid present in the pleural and/or peritoneal cavity (an effusion). Uroperitoneum subsequent to kidney, ureter, bladder, or urethra rupture also can cause an increased amount of fluid in the abdomen. Evaluation of fluid samples often is helpful in identifying the mechanism causing the effusion and, occasionally, results in a specific diagnosis. The TP, TNCC, and general cytologic examination can be performed easily, quickly, and inexpensively in-house. The TP and TNCC are used to classify effusions as transudates, modified transudates, or exudates. Transudates usually are caused by hypoalbuminemia, but also can be caused by leakage of fluid from efferent intestinal lymphatics. Cytology and culture usually are not rewarding in the evaluation of transudates. Modified transudates usually are caused by increased vascular permeability or increased intrahepatic hydrostatic pressure. Cytologic and radiographic examinations often are helpful in evaluating patients with modified transudates, while cultures usually are unrewarding. The exudate class encompasses the inflammatory exudates (septic or nonseptic), neoplastic exudates, and chylous effusions. Inflammatory exudates have a high TP and predominantly contain inflammatory cells. They may be septic or nonseptic. When septic, degeneration neutrophils often, but not always, are found. Cultures often are needed to determine whether sepsis is present, to identify the specific organism, and to determine the best therapy. Neoplastic exudates may contain numerous neoplastic cells. If there is concern that the cells are dysplastic instead of neoplastic, the cytology preparation should be referred to a consultant. Chylous effusions usually contain many small lymphocytes with a variable number of neutrophils and macrophages. In chronic chylous effusions, however, neutrophils and/or macrophages may predominate. Chylous effusions usually are differentiated easily from pseudochylous effusions by cytology. Comparison of fluid and serum triglyceride and cholesterol concentrations can be used to differentiate chylous and pseudochylous effusions when differentiation cannot be accomplished by cytology.

Animals↗
PubMed2002

[Percutaneous balloon pericardiotomy in patients with recurrent pericardial effusion].

BACKGROUND: Recurrent symptomatic pericardial effusion can complicate different cardiac and extracardiac diseases. When recurrent pericardial effusion after drainage with conventional catheter techniques occurred the creation of a pericardial window by open surgery used to be the unique treatment available until the recent development of percutaneous balloon pericardiotomy. OBJECTIVE: The aim of this paper is to review our initial experience with percutaneous balloon pericardiotomy for the treatment of patients with recurrent pericardial effusion. PATIENTS AND METHOD: Five patients with recurrent pericardial effusion have been treated with percutaneous pericardiotomy until now. Four patients had malignant pericardial effusion secondary to metastasis of extracardiac tumors, in one patient recurrent pericardial effusion was idiopathic. In all patients percutaneous balloon pericardiotomy was performed with a pediatric valvuloplasty balloon catheter, through a subxiphoid approach. RESULTS: Successful drainage and balloon pericardiotomy was achieved in all patients without severe complications. In all cases only one pericardial site was dilated. Minor complications were registered, which included mainly mild pleural effusion occurring in all patients with spontaneous resolution. During a mean follow-up period of 8.6 6.5 months (range 2 to 18 months) there were no recurrences of effusion or tamponade. Two patients died, 1 month and 9 months after the procedure, due to their malignant condition. CONCLUSIONS: Percutaneous balloon pericardiotomy is an easy and useful technique to manage patients with large recurrent pericardial effusion with a low r

Adult↗