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At least 91 records · Page 5Linked to original sources
PubMed1998

Diagnostic value of closed percutaneous pleural biopsy vs pleuroscopy in suspected malignant pleural effusion or tuberculous pleurisy in a region with a high incidence of tuberculosis: a comparative, age-dependent study.

OBJECTIVE: To compare the value of closed percutaneous pleural biopsy versus pleuroscopy for diagnosis of undiagnosed exudative pleural effusion in an age-dependent manner. DESIGN: Prospective clinical study. SETTING: University hospitals. PATIENTS: Forty-nine consecutive patients with undiagnosed exudative pleural effusion following the initial clinical and paraclinical investigations, including bronchoscopy. Cases were divided into younger and older groups according to their ages. INTERVENTION: Closed pleural biopsy immediately followed by pleuroscopy with a flexible fiberoptic bronchoscope from the same incision site. RESULTS: In the older age group, pleuroscopy was superior to closed pleural biopsy for the diagnosis of the underlying pleural disease (P = 0.0007), while they were almost equally diagnostic in the younger cases (P = 0.58). CONCLUSION: For those patients with undiagnosed exudative pleural effusion who are older than 50 years of age, pleuroscopy could be chosen as the first procedure of choice as compared to closed pleural biopsy if malignant pleural effusion is suspected.

Adolescent↗
PubMed1994

Chromosome analysis in pleural effusions. Efficiency of this method in the differential diagnosis of pleural effusions.

Various laboratory methods are being used to acquire diagnosis in pleural effusions. However, about 20% of the effusions cannot be diagnosed reliably. Cytogenetic analysis in pleural effusion is not used routinely, although many numerical and/or structural chromosome abnormalities have been observed in malignant pleural effusions. In this study, a total of the 61 pleural effusion samples, 34 malignant which included 19 diffuse pleural malignant mesothelioma, 15 metastatic malignant pleural effusions and 27 benign, were analyzed by direct chromosome analysis method. To the findings obtained in the study, 85.3% (29/34) of the 34 patients with malignant pleural effusion had numerical and/or structural abnormalities, and 3 of them had no mitosis. The patients who had benign pleural effusion indicated no numerical and/or structural abnormalities. We have concluded that if a pleural effusion cannot be reliably differentiated by the usual laboratory methods and especially malignancy is strongly suspected, cytogenetic analysis can be used to differentiate malignant effusions from benign effusions with a small rate of error, and also it can indicate that more invasive diagnostic procedures are necessary.

Adult↗
PubMed2003

Prognostic features of residual pleural thickening in parapneumonic pleural effusions.

The objective of the study was the identification of predictive factors for the development of residual pleural thickening (RPT) in patients with parapneumonic effusion. The design of the prospective study involved investigating patients with parapneumonic pleural effusions diagnosed between March 1991 and December 2000 in the respiratory department of Hospital Ramón y Cajal (Madrid, Spain) which is a 1,500 tertiary-care hospital. The clinical and radiological characteristics and measurements of microbiological and biochemical variables in the pleural fluid taken from the patients were studied. RPT was defined in a posteroanterior chest radiograph as pleural thickening of > or = 10 mm measured at the lateral chest wall at the level of an imaginary line, tangent to the diaphragmatic dome. A total of 48 of the 348 patients studied (13.79%) were found to have RPT. Among the factors studied, only presence of pus in the pleural space, Fine classes IV and V, temperature > or = 38 degrees C and delayed resolution of pleural effusions after diagnosis (> 15 days) were independently associated with the risk of RPT. This study showed that significant residual pleural thickening was not a common complication of parapneumonic pleural effusions. There are certain risk factors for the development of residual pleural thickening. However, this complication was not associated with long-term functional repercussions in the series of patients involved in this study.

Adult↗
PubMed1997

Pleural effusion during bromocriptine exposure in two patients with pre-existing asbestos pleural plaques: a relationship?

Two patients with pleural plaques developed pleural effusion and subsequent diffuse pleural fibrosis 50 and 39 yrs after their first exposure to asbestos. The diagnosis of benign asbestos pleural effusion was suggested, but the work-up finally suggested bromocriptine-induced pleural disease in both patients. These two cases illustrate that drug-induced pleural effusion is an important differential diagnosis of benign asbestos pleural effusion. It is, moreover, possible that pre-existing asbestos pleural lesions, or even asbestos exposure, increases the risk of developing bromocriptine-induced pleural disease.

Antiparkinson Agents↗
PubMed2003

Multilevel and continuous pleural fluid pH likelihood ratios for evaluating malignant pleural effusions.

STUDY OBJECTIVE: Expert consensus recommends testing pleural fluid for pH to assist the selection of patients with malignant pleural effusions for pleurodesis. Although published studies report an association between pleural fluid pH and patient outcomes after pleurodesis, clinicians have no definitive information on how to use pH to select patients for pleurodesis. Thus, we quantitatively assessed different methods for deriving likelihood ratios from pleural fluid pH and evaluated the potential role of pH in selecting patients for pleurodesis. DATA SOURCES: MEDLINE, systematic reviews, article reference lists, and contact with primary authors. STUDY SELECTION: Studies that assessed the impact of pleural fluid pH on survival and pleurodesis failure rates among patients with malignant pleural effusions. DATA EXTRACTION: Primary authors provided their data in electronic spreadsheets. DATA SYNTHESIS: Retrieved data sets included survival and pleurodesis failure rates for 417 patients and 433 patients, respectively. Binary, multilevel, and continuous likelihood ratios were calculated to estimate the likelihood of death within 3 months of pleurodesis or pleurodesis failure rates. Values for the likelihood ratios were compared for each of the three strategies, and relative clinical and statistical significance were assessed. Pleural fluid pH had marginal performance for identifying patients with < 3-month anticipated survival; binary likelihood ratios provided as much information as the multilevel and continuous strategies. Likelihood ratios for identifying patients likely to fail pleurodesis were clinically useful. Continuous likelihood ratios provided statistically more information as compared with the multilevel and binary strategies. CONCLUSIONS: Pleural fluid pH has marginal value for estimating death within 3 months of pleurodesis, and binary likelihood ratios (cut point </= 7.20) perform as well as the other strategies assessed. Pleural fluid pH provides more useful information for estimating the likelihood of pleurodesis failure for which continuous likelihood ratios provide the most information as compared with binary or multilevel likelihood ratios.

Data Interpretation, Statistical↗
PubMedDate not supplied

Detection of minute pleural fluid in the pleural retracted space associated with peripheral lung cancer: evaluation with MR imaging.

PURPOSE: To evaluate the efficacy of magnetic resonance imaging (MRI) in detecting minute pleural fluid in the pleural retracted space (PRS) associated with peripheral lung cancer. MATERIALS AND METHODS: Our subjects were 20 patients with peripheral lung cancer in whom thin-section CT in the lung window setting demonstrated lesions adjacent to the pleural surface, and who were referred for MR imaging. The imaging findings were retrospectively evaluated and correlated with the histopathologic specimens. Pleural fluid was aspirated for cytology under ultrasound (US) guidance in six patients. RESULTS: STIR MR images revealed water SI areas beneath the chest wall associated with the lung cancer, whereas, on CT images, lung cancer and minute pleural fluid in the PRS showed similar soft-tissue density without enabling easy differentiation. Two of the six patients who underwent aspiration cytology showed malignancy. All histopathologic specimens obtained from 18 patients who underwent surgery showed pleural retraction corresponding to the water SI areas on STIR images. Histopathological study revealed that the fibrotic focus of the tumor tended to occur more intensively when the shape of pleural retraction was thinner and deeper. CONCLUSION: Water SI areas on STIR images were thought to suggest pleural fluid retention in the PRS. MRI was sensitive in detecting minute pleural fluid in the PRS and may help to avoid overdiagnosis of chest wall invasion induced from peripheral lung cancers.

Adult↗
PubMed1989

Pleural effusions associated with ethchlorvynol lung injury result from visceral pleural leak.

Traditional thinking suggests that pleural fluid develops on the basis of systemic venous hypertension or a primary pleural process. Recent investigations, however, indicate that both acute lung injury and pulmonary venous hypertension can be important in the pathogenesis of pleural effusions. To evaluate the role of acute lung injury in the formation of pleural effusions, we developed a model of acute, reversible lung injury in NZW rabbits. Intravenous ethchlorvynol (ECV), known to produce permeability edema in humans, was used to produce permeability pulmonary edema in rabbits. The injury was examined over 14 days with bronchoalveolar lavage, pleural fluid analysis, and morphologic analysis. Ethchlorvynol injection (40 mg/kg) produced a PMN-predominant, exudative alveolitis (2 h), alveolar hemorrhage (6 to 10 h), and pleural effusions by 2 h (peak, 10 h). Pathologic findings included a patchy, subpleural, hemorrhagic PMN inflammatory response, which peaked by 24 h, and an acute PMN vasculitis of small arterioles and capillaries; these changes resolved in 5 to 7 days. No parietal pleural abnormalities were observed. We conclude that ECV induces an acute, reversible parenchymal lung injury resulting in a capillary leak and that fluid moves from the interstitium of the lung into the pleural space along a pressure gradient through a relatively permeable mesothelium. The data support the concept that diffuse or localized lung injury can result in pleural effusions.

Acute Disease↗
PubMed1993

Comparison of the Raja and the Abrams pleural biopsy needles in patients with pleural effusion.

In 31 patients with exudative pleural effusions, we compared the diagnostic yield of the Abrams pleural biopsy needle with that of a new instrument, the Raja pleural biopsy needle. Each patient was randomly biopsied with both needles, and a total of 153 pleural biopsies were done, 73 with the Abrams needle and 80 with the Raja needle. No complications resulted from biopsies with either needle. Etiologic diagnoses were possible in 38 (52%) biopsies obtained using the Abrams needle, compared with 66 (82.5%) for those using the Raja needle; the difference in proportions for the diagnostic yield was statistically significant (p < 0.01, two-tailed Fisher's exact test). There were no significant differences between the needles in obtaining etiologic diagnoses in any specific disease category. The difference between the mean size of the pleural specimens obtained with the two needles was also statistically significant (p < 0.001, Mann-Whitney U test). The Raja pleural biopsy needle is easy and safe to use, and despite its smaller external diameter yields a significantly larger pleural tissue sample and significantly increases the diagnostic yield of pleural biopsies compared with the Abrams pleural biopsy needle.

Adult↗
PubMed2002

Cystatin C of pleural effusion as a novel diagnostic aid in pleural diseases of different aetiologies.

There has been considerable recent interest in the potential use of serum cystatin C as a diagnostic tool. Here we examined the hypothesis that the cystatin C level in the pleural effusion can differ from the corresponding serum level. We evacuated pleural effusion fluids from 47 patients by thoracentesis. Cystatin C, beta(2)-microglobulin, inorganic phosphate, creatinine and total protein were quantified in both pleural effusion fluids and corresponding sera. We determined cystatin C levels in pleural effusions and calculated the ratio of cystatin C levels in serum and effusion, to discriminate between effusions caused by severe renal impairment and other types of effusion. Extremely high concentrations of cystatin C in serum/effusion pairs were only measured in patients with renal failure (6.0 +/- 0.8/6.0 +/- 0.8 mg/l, means +/- S.D., n=11). A clearly defined region was found to correspond to pleural effusion caused by renal failure (r=0.954). The quantification of cystatin C in the effusion was justified by the discovery that there were some patients with a high serum cystatin C level but a low effusion concentration, or a low serum cystatin C but a high effusion concentration, indicating causes other than renal failure. In conclusion, the pilot data indicate a relationship between the cystatin C concentration in pleural fluid and the underlying disease. Thus cystatin C levels in pleural effusion and serum may be a valuable criterion for the differential diagnosis of pleural diseases of different aetiologies.

Aged↗
PubMed1990

[Clinical evaluation of pleural effusion--carcinoembryonic antigen (CEA) and adenosine deaminase (ADA) activities in pleural fluids].

We reviewed 327 patients with pleural effusion who had been examined at our department for identification of its cause during the 14 years between 1974 and 1987, and studied the percentages of definitive diagnosis by examining the pleural fluids of patients with malignant tumor and tuberculosis. We also measured the levels of carcinoembryonic antigen (CEA) and adenosine deaminase (ADA) in the pleural fluids of these patients and evaluated their diagnostic usefulness. We further carried out a detailed clinical study of the factors affecting the CEA and ADA activities in the pleural fluids, which are considered to be particularly important in differential diagnosis of patients with pleural effusion. Of 327 patients with pleural effusion, malignancy-related pleurisy was observed in 166 patients (50.8%), and tuberculous pleurisy in 85 (26.0%). The rate of definitive diagnosis based on the examination of the pleural effusion in these patients indicated that 20-30% of them pose difficulty in clinical diagnosis. CEA was positive in 64.7% of patients with malignancy-related pleurisy, and ADA was positive in 97.7% of those with tuberculous pleurisy. These suggested their usefulness as supportive diagnostic methods of those diseases. In addition, CEA was elevated in patients with complications such as empyema, suggesting an effect of non-specific cross-reacting antigen (NCA). ADA showed high values in patients with conditions related to cell-mediated immunological responses as well as empyema and hemolysis. It suggested the release of ADA from blood cells due to hemolysis. These factors must be carefully evaluated in the interpretation of the CEA and ADA activities in pleural effusion.

Adenosine Deaminase↗
PubMed1984

[Results of combined blind pleural biopsy and cytology in the differential diagnosis of pleural effusions].

In 80 patients with pleural effusion of uncleared aetiology cytological, bacteriological and chemical examinations of punctate were combined with blind pleural biopsy. Malignant pleural diseases were verified via pleural biopsy in 48% and in combination with pleural biopsy and cytology in 93% of the cases. About one third of the tuberculosis pleural effusions could be diagnosed histologically. Blind pleural biopsy can be recommended as a method of low risk in differential diagnosis of pleural effusions.

Biopsy↗
PubMed1997

Cultivation of Mycobacterium tuberculosis from pleural tissue and its histopathology in suspected cases of tuberculous pleural effusion.

The majority of idiopathic pleural effusion are considered to be of tuberculous etiology. The culture of bacilli provide most authentic evidence of disease process. This study was carried out on 21 cases of suspected tuberculous pleural effusion. The pleural fluid and tissue was subjected for smear examination, and cultivation of tubercle bacilli along with pleural biopsy. Overall the diagnosis could be made out of 8 (38.09%) cases. The cultivation of Mycobacterium tuberculosis from pleural tissue was more sensitive (33.33%) as compared to histopathology (19.05%). However, the triad of cultivation of Mycobacterium tuberculosis from pleural tissue, pleural histopathology and pleural fluid smear examination or culture should be done in each suspected case of tuberculous effusion.

Adolescent↗
PubMed2005

Microsatellite analysis of pleural supernatants could increase sensitivity of pleural fluid cytology.

Pleural effusions may result from various inflammatory, hemodynamic, or neoplastic conditions. A common diagnostic problem lies in distinguishing malignant from benign pleural effusions using routine cytological evaluation. We studied pleural fluid samples obtained from 14 patients with histologically confirmed malignancy and from 6 patients with benign pleural effusions using 12 microsatellite markers from 8 different chromosomal regions. Supernatants and cellular sediments of all 20 pleural fluid samples were analyzed. Routine cytological examination was 100% specific for malignancy but was only 57% sensitive. Microsatellite analyses of pleural fluid supernatants showed genetic alterations in tumor patients only. However, 50% of pleural effusions that were considered negative for malignancy by routine cytological analysis showed either loss of heterozygosity or microsatellite instability. The sensitivity of pleural fluid examination rose to 79% when routine cytological assessment was supplemented by molecular studies. Our data suggest that microsatellite analysis increases the sensitivity of cytological pleural fluid examination in assessing potential malignancy and that combining cytological and molecular methods may improve yield and certainty in diagnostically challenging cases.

Aged↗
PubMed2005

Tumour cell frequency in pleural lavage in cases with stage I epidermoid lung cancer with no visceral pleural involvement.

BACKGROUND: The presence of tumour cells in the pleural lavage of lung cancer patients with no malignant pleural effusion is a negative prognosticator. In the present study we aimed to determine the lowest frequency of positive pleural lavage in lung cancer. METHODS: The study included 26 consecutive patients who underwent thoracotomy for curative resection for Stage I epidermoid lung cancer. The cases had neither visceral pleural involvement nor obstructive pneumopathy. The patients were applied pleural lavage cytology immediately after thoracotomy. RESULTS: The frequency of malignant cells in pleural lavage was 7.7% (Stage IA, n = 1, and IB, n = 1). CONCLUSION: Our series, in which we predicted the lowest probability of the presence of tumour cells in pleural lavage, had such a frequency of positive tumour cells that should'nt be neglected. The present study concluded that pleural lavage cytology before pulmonary resection should routinely be performed in 'all' lung cancers and that pleural lavage cytology may also be included in the current staging system.

Aged↗
PubMed2005

Resident pleural macrophages are key orchestrators of neutrophil recruitment in pleural inflammation.

RATIONALE: The role played by resident pleural macrophages in the initiation of pleural inflammation is currently unclear. OBJECTIVE: To evaluate the role of resident pleural macrophages in the initiation of inflammation. METHODS: We have used a conditional macrophage ablation strategy to determine the role of resident pleural macrophages in the regulation of neutrophil recruitment in a murine model of experimental pleurisy induced by the administration of carrageenan and formalin- fixed Staphylococcus aureus. MEASUREMENTS AND MAIN RESULTS: Conditional macrophage ablation mice express the human diphtheria toxin receptor under the control of the CD11b promoter such that the administration of diphtheria toxin induces ablation of nearly 97% of resident macrophages. Ablation of resident pleural macrophages before the administration of carrageenan or S. aureus dramatically reduced neutrophil influx into the pleural cavity. In the carrageenan model, the reduction in neutrophil infiltration was associated with marked early reduction in the level of macrophage inflammatory protein 2 as well as reduced levels of various cytokines, including tumor necrosis factor alpha, interleukin 6, and interleukin 10. Adoptive transfer of nontransgenic macrophages partially restored neutrophil infiltration. We also stimulated macrophage-depleted and nondepleted pleural cell populations with carrageenan in vitro and determined the production of chemokines and cytokines. Chemokine and cytokine production was markedly reduced by macrophage depletion, reinforcing the role of resident pleural macrophages in the generation of mediators that initiate acute inflammation. CONCLUSION: These studies indicate a critical role for resident pleural macrophages in sensing perturbation to the local microenvironment and orchestrating subsequent neutrophil infiltration.

Animals↗