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PubMed1994

[Detection of antibodies against Legionella pneumophila from pleural effusion--a case report of Legionnaire's pneumonia with pleural effusion].

Using TAT and ELISA, 50 samples of pleural effusion and sera from patients infected with non-Legionella pneumophila were detected for antibodies against Legionella pneumophila serogroups 1 and 6, respectively. The average titre and upper limit value (99%, mean + 2.326S) calculated. In addition, a pleural effusion and a serum from a patient with Legionnaire's pneumonia were also detected by TAT and ELISA. The result showed that the titre of this antibody in his pleural effusion was not only over the upper limit, but also higher than that in his serum.

Adolescent↗
PubMed2005

Kawasaki disease presenting with hemorrhagic pleural effusion.

Hemorrhagic pleural effusion associated with Kawasaki disease KD is very rare and has not been reported in the medical literature. We describe a 5-year-old male with incomplete (atypical) KD who presented with fever and severe respiratory distress due to bilateral pleural effusions. Other features included unilateral cervical lymphadenopathy, swelling of the hands and feet followed by periungual desquamation, elevated erythrocyte sedimentation rate, thrombocytosis and sterile pyuria. Pleural fluid analysis revealed a hemorrhagic exudative effusion. Therapy with high-dose i.v. immunoglobulin resulted in dramatic clinical improvement and resolution of pleural effusion. An echocardiogram obtained at presentation and at 6 weeks of illness was normal. Pediatricians should be aware that hemorrhagic pleural effusion can be a presenting manifestation of KD.

Child, Preschool↗
PubMed1995

Management of malignant pleural effusions.

Malignant pleural effusions are a common complication of advanced cancer, particularly breast and lung cancers. Clinical algorithms for the diagnosis and management of malignant pleural effusions form a framework for the cost-effective provision of meaningful palliation. When the entire episode of care is considered, the optimal therapy for malignant pleural effusions appears to be tube thoracostomy followed by intrapleural bleomycin. Alternative strategies for the delivery of intrapleural therapy (eg, soft catheters) and new intrapleural agents currently are being compared with standard therapy.

Algorithms↗
PubMed2003

Hemorrhagic pleural effusion due to pleural hemangioma.

We report a rare case of isolated pleural hemangioma presenting as recurrent, haemorrhagic pleural effusion. Chest radiograph and computed tomography of chest was suggestive of left apical tumour. Diagnosis of hemangioma was revealed only after thoracotomy and excision of the tumour mass.

Blood Cells↗
PubMed1984

Pleuroperitoneal shunt for intractable pleural effusion.

Intractable pleural effusion secondary to malignant disease is often managed by thoracentesis or sclerotherapy, painful time-consuming procedures that may be ineffective. An alternative technique is to place a pleuroperitoneal shunt as in a 73-year-old man, described in this paper, who had recurrent right and left pleural effusions secondary to inoperable squamous cell carcinoma of the right lung. In his case, sclerotherapy was not attempted on the left side because a pericardial window was functioning. The left pleural effusion was successfully managed by inserting a pleuroperitoneal (LeVeen) shunt.

Aged↗
PubMed1993

Pneumocystis carinii pleural effusion. Pathogenesis and pleural fluid analysis.

We present three new cases of Pneumocystis carinii in pleural effusions of patients with AIDS, bringing the total number of reported cases to six. In our patients, diagnosis was made by visualization of Pneumocystis in pleural fluid stained with Gomori methenamine silver. LDH was greater than 400, and pleural fluid to serum LDH ratio was greater than 1.0 in all cases at time of presentation. All six reported patients have been associated with aerosolized pentamidine, and five of the six had documented underlying Pneumocystis pneumonia. The sixth patient, which we report, presented with primary pleural infection with Pneumocystis. Although we could not document underlying pneumonia, we suspect it was present. Pneumocystis pleural disease appears to be an anatomic extension of smoldering subpleural Pneumocystis pneumonia, and prognosis is not worse than with pneumonia alone.

AIDS-Related Opportunistic Infections↗
PubMed2002

Vascular endothelial growth factor: the key mediator in pleural effusion formation.

Pleural effusion is common in clinical practice. Increased vascular permeability and leakage play a principal role in the development of exudative pleural effusions. In vitro and in vivo evidence have solidly established vascular endothelial growth factor (VEGF), a potent inducer of vascular permeability, as a crucial mediator in pleural fluid formation. VEGF is present in high quantities in human effusions. In the pleural space, mesothelial cells, infiltrating inflammatory cells, and (in malignant pleuritis) cancer cells contribute to the VEGF accumulation in the pleural fluids. Pleural fluid VEGF is biologically active and may promote tumor growth and chemotaxis. Strategies to antagonize the VEGF activity at various target points of its signaling pathway have shown success in vitro and in animal models of malignant pleural or peritoneal effusions. Novel agents targeting VEGF activities are undergoing clinical trials. Regulation of VEGF activity and vascular permeability represent a rapidly expanding field of research, which is likely to provide further insight in the pathophysiology of pleural fluid formation.

Animals↗
PubMed1990

[Pleuroperitoneal shunt in recurrent pleural effusion].

Recurrent pleural effusion is often a problem in metastases from breast cancer, and may be treated by instillation of irritating drugs combined with external drainage for some days. Less frequently chylothorax is a complication to malignant disease. Drainage of the pleural effusion to the peritoneum is possible, and this article describes how four patients with metastases from breast carcinoma and one patient with chylothorax caused by malignant lymphoma were all treated successfully from 40 days to ten months by means of a simple siliconated T-shaped drain from the pleural cavity to the peritoneum. In one patient the drain occluded after three months. It does not seem to be necessary to use drains with valves for this purpose.

Aged↗
PubMed2004

[Complications of malignant tumors--malignant pleural effusions].

Malignant pleural effusion is a complication of malignant diseases that has an appreciable negative impact on the patient's quality of life. In view of the greatly reduced life expectancy of between 3 and 12 months (median), diagnostic and therapeutic management must be orientated to the principles of palliation. Diagnostic measures comprise cytological/histological confirmation of the malignant effusion and, where necessary, of the underlying malignant disease and the extent of the intrathoracic tumor growth. In view of the tendency of malignant pleural effusion to relapse, pleurodesis is indicated, which is most effectively accomplished by video-assisted thoracoscopic talcum poudrage.

Biopsy↗
PubMed1995

Clinical, echocardiographic, and hemodynamic evidence of cardiac tamponade caused by large pleural effusions.

Large pleural effusions are typically associated with dyspnea and potential respiratory compromise. Experimental evidence suggests that with large effusions, increased intrapleural pressure may be transmitted to the pericardial space, resulting in impaired cardiac filling and reduced stroke volume. We report two cases in which large pleural collections were complicated by hypotension. The effusions were due to an infected right hepatic hydrothorax (Case 1) and a left malignant effusion (Case 2). Echocardiography demonstrated right and left ventricular diastolic collapse, respectively, confirming a diagnosis of cardiac tamponade. Large volume thoracentesis resulted in immediate hemodynamic improvement as demonstrated by a reduction in right ventricular and atrial pressures (Case 1) and echocardiographic resolution of left ventricular diastolic collapse (Case 2). These cases establish that large pleural effusions can cause hemodynamically significant cardiac tamponade. In addition, they illustrate how the demonstration of cardiac compressive physiology can significantly alter the therapeutic approach to large pleural effusions.

Adult↗
PubMed2001

Management of parapneumonic pleural effusion.

Parapneumonic pleural effusion is a common and potentially serious complication of pneumonia. The management of parapneumonic pleural effusion involves early diagnosis, adequate empiric antibiotic cover, and appropriate risk categorization. High-risk patients require safe and expedient drainage of the infected pleural space. The management options include thoracentesis, tube thoracostomy, adjunctive intrapleural fibrinolytic therapy, and surgical drainage. The methods of surgical drainage include thoracoscopy, thoracotomy, and decortication. The relative clinical efficacy of these treatment options has been studied in a small number of controlled clinical trials, the results of which have been systematically reviewed by expert panels. Based on the limited clinical evidence, expert reviewers were unable to recommend a best method of pleural drainage. However, the consensus is that an aggressive approach with early surgical drainage results in shorter hospital stays and may be more cost-effective than conservative management. This review discusses the clinical evidence and describes an aggressive sequential management strategy that combines intrapleural fibrinolysis with early surgical drainage.

Clinical Protocols↗
PubMed1996

[Current treatment strategy in malignant pleural effusion].

Malignant pleural effusions are a grave consequence of advanced cancer disease. The successful suppression of pleural fluid reaccumulation can make a major contribution to the management and palliative care of patients with disseminated cancer. Many treatment concepts have been reported in the literature. The recommended therapy in malignant pleural effusions consists of intrapleural instillation of a sclerotic agent to produce pleurodesis. Different substances have been used, including tetracyclines, cytostatic agents, fibrin, talc, Corynebacterium parvum, cytokines and others. We reviewed the most frequently used techniques of pleurodesis in order to define the most effective treatment concept. In 15 prospective randomized trials the success rates varied from 13% with bleomycin to 100% with talc or Corynebacterium parvum. Talc was superior to other agents in 6 of 6, Corynebacterium parvum in 3 of 4 and bleomycin or tetracycline only in 3 of 8 studies. Adverse effects were frequently observed with cytostatic agents, but were very rare in the case of talc or fibrin instillation. Comparing the recently published data pleurodesis with talc appears to be the most effective treatment strategy, followed by Corynebacterium parvum, bleomycin and tetracycline.

Antibiotics, Antineoplastic↗
PubMed2001

Malignant pleural effusions.

Malignant pleural effusions contribute to considerable morbidity in cancer patients and generally portend an overall poor prognosis. Treatment of malignant pleural effusions is palliative; therefore, quality of life issues, as well as the risks and benefits of the therapeutic options, become more critical. In my opinion, factors such as in patient versus outpatient management and associated procedural discomfort are important in the decision-making process, and the patient should participate in these subjective considerations. It is difficult to compare results and determine the true efficacy of different techniques and agents because endpoints and response criteria as well as the extent and method of follow-up vary. In addition, the etiology of the primary complaint, dyspnea, is frequently multifactorial. However, malignant effusions recur, and therefore repeated thoracentesis, especially if the fluid rapidly reaccumulates, is usually not a good long-term solution unless the patient's overall prognosis and current condition prohibits a more invasive option. The standard option for recurrent effusions is insertion of a chest tube. If the lung re-expands, chemical pleurodesis is attempted to achieve adherence of the visceral to the parietal pleura. Sterilized talc is the best sclerosant; it has good efficacy and cost effectiveness and can be administered easily as a slurry at the bedside via a chest tube with minimal patient discomfort and without more aggressive and invasive procedures.

Humans↗
PubMed2005

[Management of malignant pleural effusions].

Malignant pleural effusions with dyspnoea as their most common presenting symptom are a frequent clinical problem in patients with neoplastic disease. Lung carcinoma is the leading cause, followed by breast carcinoma and malignant lymphoma. The frequency of malignant mesothelioma is increasing in industrialized countries. In this overview, which is based on the ERS/ATS Statement 2001, the diagnostic approach, the differential diagnosis including causes of paramalignant effusions, as well as the therapeutic possibilities are described. Pleurodesis is the most important therapeutic modality, today preferably via thoracoscopic talc poudrage. Alternative local and systemic treatment options are discussed in detail. A special emphasis is put on the epidemiology, diagnosis, treatment, and prognosis of malignant effusions in patients with lung and breast carcinomas, and with lymphomas. Finally, open questions are listed which need future research, which will hopefully improve the treatment and prognosis of malignant pleural effusions.

Breast Neoplasms↗
PubMed1989

[The usefulness of cholesterol determination in the etiology of pleural effusion].

95 pleural effusions of different etiology were studied. 25 were transudate, 22 neoplastic, 28 caused by tuberculosis, and 20 miscellaneous. The Light parameters (pleural protein/plasma) (Prot LP/P), Pleural LDH (LDH LP) and LDH pleural/plasma quotient (LDH LP/P) were determined and compared with the efficacy of pleural cholesterol (Chol LP) and pleural cholesterol/plasma quotient (Chol LP/P) to differentiate the transudate from pleural exudate. With Prot LP/P quotient the sensitivity was of 85% and the specificity 91.6%; with LDH LP the sensitivity was of 74.6% and the specificity 97.6%. With the LDH LP/P quotient the sensitivity was of 89% and the specificity 87.8%. The sensitivity of each parameter was similar to that obtained by Light but less specific. All the transudates had levels of chol LP lower than 55 mq/dl (100% specificity) with a sensitivity of 84%. The Chol LP/P quotient had a limit of 0.3, this being its sensitivity of 91.3% and 93.1% its specificity. The presence of both parameters were necessary to the classification and the sensitivity obtained being of 80.3% and the specificity 100%. We concluded that the determinations of Chol LP and the Chol LP/P quotient are of great advantage in differentiating the pleural transudate from pleural exudate and the predictive value is, at least, similar to that obtained by Light.

Adult↗
PubMed1978

Primary coccidioidomycosis in children presenting with massive pleural effusion.

Large pleural effusion as the presenting feature of coccidioidomycosis in childhood has not previously been reported and may cause significant diagnostic difficulty. Three children are described who required prolonged hospitalization and therapy with amphotericin B. Primary coccidioidomycosis should be included in the differential diagnosis of large pleural effusions in pediatric patients who have been in the endemic area. Such effusions suggest a severe form of the disease and may represent evidence of acute dissemination.

Child↗
PubMed2006

Autocrine IL-6-induced Stat3 activation contributes to the pathogenesis of lung adenocarcinoma and malignant pleural effusion.

Malignant pleural effusion (MPE) is a poor prognostic sign for patients with non-small-cell lung cancer (NSCLC). The generation of MPE is largely regulated by vascular endothelial growth factor (VEGF), and upregulation of VEGF by Stat3 has been observed in several types of tumor cells. In this study, we demonstrate constitutively activated Stat3 in several human lung cancer cell lines and in tumor cells infiltrated in the pleurae of patients with adenocarcinoma cell lung cancer (ADCLC) and MPE. The observations suggest that activated Stat3 plays a role in the pathogenesis of ADCLC. In PC14PE6/AS2 cells, a Stat3-positive human ADCLC cell line, autocrine IL-6 activated Stat3 via JAKs, not via Src kinase. PC14PE6/AS2 cells express higher VEGF mRNA and protein than do Stat3-negative PC14PE6/AS2/dnStat3 cells. In an animal model, PC14P6/AS2/dnStat3 cells produced no MPE and less lung metastasis than did PC14P6/AS2 cells. PC14PE6/AS2 cells also expressed higher VEGF protein, microvessel density, and vascular permeability in tumors than did PC14P6/AS2/dnStat3 cells. Therefore, we hypothesize that autocrine IL-6 activation of Stat3 in ADCLC may be involved in the formation of malignant pleural effusion by upregulating VEGF. Higher levels of IL-6 and VEGF were also found in the pleural fluids of patients with ADCLC than in patients with congestive heart failure. The autocrine IL-6/Stat3/VEGF signaling pathway may also be activated in patients with ADCLC and MPE. These findings provide novel targets for the management of MPE.

Adenocarcinoma↗
PubMed1991

Experience with intrapleural natural beta interferon in the treatment of malignant pleural effusions.

Malignant pleural effusion is a common complication of cancer. Intrapleural beta interferon has been recently tested, and responses were obtained in about 1/3 of the patients without considerable side effects. We treated 22 patients with recurrent symptomatic malignant pleural effusions with intrapleural beta interferon at increasing doses (5-15 million units) for a maximum of three courses and obtained only two responses. In our opinion, this schedule cannot be recommended for routine use.

Aged↗