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PubMed1997

Pleural plaques as risk indicators for malignant pleural mesothelioma: a necropsy-based study.

Pleural plaque is recognized as a reliable marker of previous exposure to asbestos. However, it is controversial whether pleural plaque is a risk indicator for asbestos-related malignancies. In the present study, the thoracic cavities were examined for pleural plaques in 3,005 necropsies performed at the Monfalcone Hospital in people aged 15 years or older. Plaques were classified into three classes: 1, small (plaques measuring 1-4 cm in major diameter); 3, large (plaques involving a major part of a hemithorax); and 2, moderate (intermediate conditions). The prevalences of pleural plaques were 70.9% among men, and 24.0% among women. The prevalences of plaques (total plaques, various classes) among subjects with pleural mesothelioma were compared with those observed in the remaining cases. The series included 92 subjects with malignant pleural mesothelioma (82 men and 10 women). Mesothelioma cases showed higher prevalences of total plaques as well as higher prevalences of classes 1, 2, and 3, when compared with controls. These differences reached the statistical significance for total plaques, and classes 2, 3. The present data are consistent with the idea that pleural plaque is a risk indicator for pleural mesothelioma.

Adolescent↗
PubMedDate not supplied

Role of pleural fluid C-reactive protein concentration in discriminating uncomplicated parapneumonic pleural effusions from complicated parapneumonic effusion and empyema.

The aim of this study was to determine whether pleural fluid C-reactive protein (CRP) is useful in distinguishing complicated parapneumonic pleural effusion (CPPE) and empyema from uncomplicated parapneumonic pleural effusions (UPPE). A total of 69 consecutive patients with parapneumonic effusions were enrolled in the study: 29 with UPPE, 29 with CPPE, and 11 with empyema. Concentrations of standard biochemical parameters together with CRP in the pleural fluid were measured using an immunoturbidimetric assay. Pleural CRP was significantly higher in CPPE (11.6 mg/dl) and in empyema (12.2 mg/dl) than in UPPE (3.9 mg/dl). A cutoff value of 8.7 mg/dl for pleural CRP in the diagnosis of CPPE and empyema resulted in a sensitivity, specificity, and area under the receiver-operating characteristic curve (AUC) of 0.80, 0.97 and 0.94, respectively. Traditional lactic dehydrogenase (LDH) > or = 1000 U/L and glucose < or = 60 mg/dl can differentiate CPPE and empyema from UPPE, with the sensitivity, specificity, and AUC achieving 0.75/0.60.1.00/1.00,0.95/0.22, respectively. However, for the detection of CPPE and empyema, the combination of pleural fluid CRP > or = 8.7 mg/dl and LDH > or = 1000 U/L was valuable in achieving a sensitivity, specificity, and AUC of 0.97/1,00/0.95. This study suggests that measurement of pleural CRP can be useful in the workup of patients with a parapneumonic effusion in order to differentiate CPPE from UPPE.

Adult↗
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↗
PubMed2000

Pleural amyloidosis in a patient with intractable pleural effusion and multiple myeloma.

Pleural involvement of systemic amyloidosis has been rarely reported. We report a case with multiple myeloma presenting an intractable right pleural effusion, in which pleural amyloidosis was diagnosed through pleural biopsy using a Cope needle. The diagnosis of pleural amyloidosis is important, because its refractory pleural effusion should be treated with pleurodesis. Since closed pleural biopsy using a Cope needle is much less invasive than thoracoscopy, the former should be attempted first whenever pleural amyloidosis is suspected.

Aged↗
PubMed1996

Early administration of intrapleural streptokinase in the treatment of multiloculated pleural effusions and pleural empyemas.

In the treatment of multiloculated pleural effusions and empyemas tube thoracostomy often fails and more aggressive surgical therapy is required. Intrapleural administration of fibrinolytics is a valuable alternative. Between October 1994 and December 1995 28 patients (aged 22 to 62 years) with multiloculated pleural effusions were treated with intrapleural instillations of streptokinase after unsuccessful conventional chest tube drainage. Twenty-three pleural effusions were grossly purulent, others were loculated effusions with low pH. The most common cause of the pleural effusions was pneumonia. Duration of illness before hospitalization was 3 to 105 (mean 21.8) days. Treatment with streptokinase was started most commonly one day after chest tube placement. Once a day after clamping the chest tube streptokinase was administered intrapleurally for 10-15 minutes as a solution of 250,000 units in 100 ml normal saline. The tube remained clamped for 3 hours. Two to 8 (mean 3.7) instillations per patient were needed. Twenty-one cases (72.4%) showed excellent resolution of pleural effusion and needed no more therapy. However, one patient died in hospital due to purulent meningitis and bilateral pneumonia. Eight patients needed further surgical treatment, e.g. decortication, in 5 cases together with wedge lung resection. Eleven patients experienced some adverse effects of streptokinase therapy, most frequently chest pain and elevation of body temperature in one case pleural effusion became hemorrhagic, and one patient had nasal bleeding. We conclude that usage of intrapleural streptokinase in the treatment of multiloculated pleural effusions (including pleural empyemas) reduces the need for major surgical interventions in quite a large group of patients.

Adult↗
PubMed2005

Differentiation between malignant and benign pleural effusion in patients with extra-pleural primary malignancies: assessment with positron emission tomography-computed tomography.

OBJECTIVES: We sought to define an accurate diagnostic approach for differentiating benign from malignant pleural effusion on positron emission tomography-computed tomography (PET-CT). MATERIAL AND METHODS: PET-CT studies of 31 patients with primary extrapleural malignancy and pleural effusion were reviewed retrospectively. CT parameters assessed were size and density (Hounsfield units, or HU) of the effusion and density (HU) and morphology of any solid pleural abnormality. Interpretation of PET data included review of the attenuation-corrected and nonattenuation-corrected images. RESULTS: PET-CT parameters that were found to be significant in identifying malignant pleural effusion included focal increased uptake of 18-fluorodeoxyglucose in the pleura (P<0.0001) and the presence of solid pleural abnormalities on CT (P<0.002): the sensitivity was 86% and 71%, respectively, and the specificity was 90% for each of the 2 parameters. A PET-CT pattern composed of pleural uptake and increased effusion activity on nonattenuation-corrected images was associated with sensitivity of 95%, specificity of 80%, positive predictive value of 91%, negative predictive value of 89%, and accuracy of 90%. CONCLUSIONS: On PET-CT, the presence of concomitant pleural abnormalities is the most accurate criterion in determining the malignant nature of pleural effusion.

Adult↗
PubMed1996

CEA, CA 15-3 and CYFRA 21-1 in serum and pleural fluid of patients with pleural effusions.

The role of tumour marker assays in differentiating malignant from benign pleural effusions is not yet clear. This study was designed to prospectively assess the individual and combined diagnostic utility of three tumour markers in patients with pleural effusion. Pleural and serum levels of carcinoembryonic antigen (CEA), carbohydrate antigen 15-3 (CA 15-3) and cytokeratin 19 fragment (CYFRA 21-1) were determined in 115 patients with pleural effusions (42 malignant and 73 benign). The diagnostic utility of each tumour marker was assessed using accuracy to determine the optimal cut-off point, whilst a logistic regression model was used to obtain the optimal combined test. In serum, every marker showed an individual high specificity (over 97%) for malignancy. The sensitivity of CEA, CA 15-3 and CYFRA 21-1 was 36, 48 and 31%, respectively. In patients without renal failure, the sensitivity of CYFRA 21-1 rose to 53%, while those of CEA and CA 15-3 remained almost unchanged. In pleural fluid, CYFRA 21-1 showed low sensitivity (32%) and specificity (82%), while CEA showed the highest sensitivity (57%). Excluding patients with renal failure, the combined determination in serum of CEA, CA 15-3 and CYFRA 21-1 has a high accuracy (88%), similar to that for CEA plus CA 15-3 in pleural fluid (87%). We conclude that CYFRA 21-1 is useless in pleural fluid and should not be used in serum for patients with renal failure. The combined determination of CEA, CA 15-3 and CYFRA 21-1 in serum may obviate its determination in pleural fluid.

Adolescent↗
PubMed2003

Combined use of the polymerase chain reaction and detection of adenosine deaminase activity on pleural fluid improves the rate of diagnosis of pleural tuberculosis.

STUDY OBJECTIVES: Evaluation of the combined use of polymerase chain reaction (PCR) and adenosine deaminase (ADA) activity on the diagnosis of pleural tuberculosis (pTB) in a region of high prevalence of tuberculosis. PATIENTS: PCR and determination of ADA activity were performed on the pleural fluid of every patient presenting with pleural effusion suspected to be associated with tuberculosis. The case definition of pTB involved parameters including the combination of clinical and radiologic findings; biochemical, microbiologic, and cytologic examination of the pleural fluid; and the histopathologic findings of pleural fragments obtained by biopsy. The diagnosis of pTB was confirmed in any patient presenting with positive culture findings of Mycobacterium tuberculosis, either on the pleural fluid or other biological material, or the presence of histopathologic findings suggestive of pTB on pleural biopsy, and also, in the absence of negative laboratory results, those patients with clinical improvement after empirical treatment. RESULTS: We studied 45 patients with pleural effusion. Of these, 16 patients met the diagnosis of pTB by our broad case definition. PCR findings were positive in six patients. The reaction was also positive in a patient whose diagnosis of tuberculosis could not be confirmed. ADA activity was considered positive in 11 patients with pTB. The combined use of PCR and ADA activity confirmed pTB in 14 patients; however, when analyzed in combination with the conventional methods, diagnosis of pTB was achieved in all 16 patients. CONCLUSION: Our results show that, even in a highly endemic area, neither PCR nor ADA activity should be relied on as a single test that substitutes for the diagnostic methods already available, but rather they should be used as an extra tool in the diagnosis of pTB. The combined analysis of PCR and ADA activity, however, is a very useful diagnostic approach to achieve a more rapid and precise diagnosis in the cases of pTB.

Adenosine Deaminase↗
PubMed2004

Soluble receptor-binding cancer antigen expressed on SiSo cells in pleural fluid: a potential diagnostic marker for malignant pleural effusion.

BACKGROUND: We sought a marker to differentiate malignant from nonmalignant pleural effusions. METHODS: We studied 41 patients presenting with pleural effusions to the National Sanyo Hospital between April 2000 and January 2002 (33 men and 8 women; mean age, 68 years). Twenty patients (49%) were proven to have malignant pleural effusions, while 21 patients (51%) had nonmalignant pleural effusions. Thoracentesis was performed. RESULTS: The mean (+/- SD) concentration of receptor-binding cancer antigen expressed on SiSo cells (RCAS1) in malignant pleural effusions, measured by enzyme-linked immunosorbent assay, was significantly higher than that in nonmalignant pleural effusions (15.1 +/- 33.6 vs 1.4 +/- 0.81 U/mL, respectively; p < 0.05). CONCLUSION: The determination of the RCAS1 concentration in pleural fluid is informative in the diagnosis of malignant pleural effusions.

Adult↗
PubMedDate not supplied

[Pleural pressure during thoracocentesis in patients with pleural neoplasms].

In 45 patients with cancerous pleural effusion, thoracocentesis was performed according to the following technique : after local anaesthesia (5 ml of 2% lidocaine) in the posterior part of the 6th intercostal space, thoracocentesis was carried out with a blunt trocar connected to a water manometer. The pleural pressure was measured before removal of the fluid (Po). Then three different techniques of drainage (active suction at -- 80 or -- 40 mmHg or underwater sealed drainage) were randomized. Pleural pressure was measured after removal of every 100 ml and at the end of the procedure (PT). The mean Po +/- SD was respectively -- 4.08 +/- 2.95, -- 3.81 +/- 3.12 and -- 2.53 +/- 2.42 cmH2O for the three different groups of drainage. After drainage, PT was decreased in the three groups, especially after -- 80 mmHg aspiration. In 14 patients, side effects occurred during thoracocentesis and the procedure was stopped. Symptoms, chiefly cough, occurred after a mean removal of 1.1 +/- 0.7 1. PT in these patients was statistically lower (-- 18 +/- 5.59 cmH2O) than in the 31 asymptomatic patients (--11.40 +/- 5.75 cmH2O) (p less than 0.001). In conclusion, the assessment of the pleural pressure during thoracocentesis seems to be convenient in order to prevent any complication of pleural evacuation : pleural evacuation should be stopped if the pleural pressure decreased below -- 18 cmH2O. A depression at -- 80 mmHg is too dangerous for pleural aspiration; -- 40 mmHg or under water sealed drainage are both convenient for a safe and complete evacuation.

Aged↗
PubMed2005

The use of probrain natriuretic peptide in pleural fluid for the diagnosis of pleural effusions resulting from heart failure.

PURPOSE OF REVIEW: Natriuretic peptides are secreted by the myocardium in response to mechanical stretch and have been proposed as a possible test for assisting the diagnosis of heart failure. This article reviews the rationale for measuring N terminal probrain natriuretic peptide in pleural fluid to identify heart failure as the cause of a pleural effusion. RECENT FINDINGS: Rapid and accurate testing of natriuretic peptides as biomarkers for heart failure is now a clinical reality. In patients presenting with dyspnea, heart failure is usually absent at blood brain natriuretic peptide levels less than 100 pg/mL, possible from 100 to 500 pg/mL, and probable at levels greater than 500 pg/mL. In evaluating natriuretic peptide assays, one needs to consider carefully laboratory and biologic variation, including gender, sex, obesity, renal function, and the assay used. Potential future applications of natriuretic peptide testing include the differential diagnosis of pleural effusion. A recent study has shown good diagnostic characteristics in cardiac pleural effusions, with likelihood ratios of 13 and a diagnostic accuracy of more than 90% for pleural fluid N terminal probrain natriuretic peptide levels > or =1500 pg/mL. Specifically, N terminal probrain natriuretic peptide pleural levels correctly categorized most cardiac effusions misclassified as exudates by standard criteria, and discriminated between cardiac and hepatic transudates. SUMMARY: Pleural fluid N terminal probrain natriuretic peptide may help accurately differentiate cardiac from noncardiac conditions in patients presenting with pleural effusion.

Heart Failure↗
PubMed1994

Mononuclear cells in exudative malignant pleural effusions. Characterization of pleural phagocytic cells.

The aims of this study were to develop a methodology for the isolation of highly enriched mononuclear phagocyte populations from exudative malignant pleural effusions (EMPE) and to characterize the phenotype and functional properties of these cells. Pleural effusion mononuclear cells (PEMC) were isolated by Ficoll centrifugation of EMPE and transudative pleural effusions and allowed to adhere to plastic for 1 h to obtain a pleural effusion mononuclear adherent cell (PEMAC) fraction. Only 66.0 +/- 4.2 percent of PEMAC ingested latex particles, indicating that a significant proportion of PEMAC were not phagocytic cells. Latex-positive PEMAC had the morphologic appearance of macrophages and stained positive (97.3 +/- 4.3 percent) with the anti-CD68 monoclonal antibody (MoAb), specific for macrophages. Conversely, latex-negative PEMAC (34.0 +/- 4.1 percent of PEMAC) did not react with the anti-CD68 MoAb and stained with anti-CD3 (34.7 +/- 10.7 percent) and anticytokeratin (50.5 +/- 16.4 percent) MoAbs, indicating that T cells and mesothelial cells were present in the PEMAC fraction. To improve the purification of pleural macrophages, PEMAC were cultured for an additional 18 h and the cells that remained adherent after this period constituted the firmly adherent mononuclear cell (FAMC) fraction. Nearly 90 percent of FAMC ingested latex particles and were CD68-positive. Virtually all FAMC were CD3-negative and cytokeratin-negative. Similar percentages of FAMC from EMPE and transudative effusions expressed the monocyte-lineage markers CD11b and CD14, suggesting that the proportion of monocyte-like mononuclear phagocytes in the pleural space is not increased during local tumor-associated inflammatory responses. The FAMC from EMPE (1) expressed HLA-DR antigens, (2) released interleukin 1 (IL-1) beta and tumor necrosis factor (TNF) alpha, and (3) stimulated allogeneic T-lymphocyte proliferation. The results of this study suggest that pleural mononuclear phagocytes may be involved in tumor-associated inflammatory reactions in the pleural compartment by stimulating the proliferation of other inflammatory cells and by releasing inflammatory cytokines.

Aged↗
PubMed1998

Thoracoscopic talc poudrage in malignant pleural effusions: effective pleurodesis despite low pleural pH.

STUDY OBJECTIVE: To determine the effectiveness of pleurodesis by thoracoscopic talc poudrage (TTP) in patients with low pH malignant pleural effusions. DESIGN: Review of prospectively collected data on all thoracoscopic procedures performed from 1982 to 1996. PATIENTS AND SETTING: Twenty-five members in a prepaid, closed-panel health maintenance organization, whose malignant pleural effusion pH was < or = 7.30. INTERVENTIONS: Pleural fluid pH was measured prior to diagnostic and therapeutic, single puncture, rigid thoracoscopy, under local anesthesia, in an operating room. MEASUREMENTS AND RESULTS: Success of pleurodesis was determined with serial radiographs at 10 days, 30 days, and frequent intervals until death or up to 1 year following the procedure. Failure was indicated by evidence of recurrent fluid or persistence of a space between the visceral and parietal pleura. Morbidity of the procedure, days of chest tube drainage, and days of hospitalization were recorded concurrently during hospitalization and outpatient follow-up. Fifty of the 76 patients found to have a pleural pH measurement had a pleural pH >7.30, averaging 7.37 (7.31 to 7.55). The other 26 patients (34%) with pH < or = 7.30 (low pH) are the subjects of this study, of whom 25 were evaluable. Pleurodesis was successful in 22 of 25 (88%), although 4 died prior to 30 days. The three failures all had trapped lung. Chest tube drainage averaged 3.2+/-1.3 days, which approximated the time of hospitalization (3.3+/-1.1 days). There were no thoracoscopy-related deaths; significant morbidity occurred only in one patient with trapped lung, who had prolonged chest tube drainage before and after TTP, and eventually developed empyema. CONCLUSIONS: TTP is an effective pleurodesis technique in malignant pleural effusions, even when the pleural pH is low. The short hospital stay and high success rate make this approach a good choice in palliating symptomatic malignant pleural effusions.

Adult↗
PubMed2001

Use of an implantable pleural catheter for trapped lung syndrome in patients with malignant pleural effusion.

STUDY OBJECTIVES: We describe a series of patients with symptomatic, refractory malignant pleural effusion (MPE) and underlying trapped lung syndrome who underwent placement of a small-bore, flexible indwelling pleural catheter for home drainage of recurrent MPE. DESIGN: The medical records of 11 consecutive patients who underwent pleural catheter placement for MPE with trapped lung syndrome were reviewed retrospectively. SETTING: Patients were evaluated and followed up in the Pulmonary Outpatient Practice at the Hospital of the University of Pennsylvania. PATIENTS: Nine men and two women with underlying malignancies including lung cancer, lymphoma, and mesothelioma underwent pleural catheter placement. INTERVENTIONS: Thirteen pleural catheters were placed in 11 patients, all under local anesthesia. Patients received detailed instructions for drainage and catheter care. They were reevaluated weekly for the first 2 weeks, and then as clinically indicated. Patients typically performed pleural drainage at home up to 1,000 mL two or three times weekly. MEASUREMENTS AND RESULTS: All patients reported symptomatic benefit, defined as improved dyspnea and exercise tolerance, except for one patient. In 10 patients, the pleural catheters remained in place until death, for 15 to 234 days. The mean length of placement was 115 days. One patient required revision after catheter occlusion. Other complications included catheter infection, localized skin breakdown, and possible cellulitis. CONCLUSION: We have described a series of patients with MPE and trapped lung syndrome for whom placement of a permanent pleural catheter provided a convenient, effective alternative to the procedures currently in use. Our patients reported good symptomatic relief following catheter placement with few major complications.

Aged↗
PubMed2002

Cytoreductive surgery and intraoperative hyperthermic intrathoracic chemotherapy in patients with malignant pleural mesothelioma or pleural metastases of thymoma.

STUDY OBJECTIVES: No established curative treatment is available for pleural thymoma metastases and malignant pleural mesothelioma (MPM). Recently, peritoneal malignancies have been treated by cytoreductive surgery and intraoperative hyperthermic intracavitary perfusion chemotherapy (HIPEC). We investigated the feasibility and safety of this multimodality treatment in the thoracic cavity. DESIGN: Patients with pleural thymoma metastases or early-stage MPM were enrolled in a feasibility study. Morbidity, recurrence, and survival rates were recorded. SETTING: The Netherlands Cancer Institute. PATIENTS: Three patients with pleural thymoma metastases and 11 patients with pleural mesothelioma were treated. INTERVENTIONS: Cytoreductive surgery and intraoperative hyperthermic intrathoracic perfusion chemotherapy (HITHOC) with cisplatin and adriamycin were performed. The mesothelioma patients received adjuvant radiotherapy on the thoracotomy wound and drainage tracts. MEASUREMENTS AND RESULTS: Morbidity and mortality rates were 47% and 0%, respectively. Reoperation was necessary in four cases. Severe chemotherapy-related complications were not observed. A solitary mediastinal and a contralateral pleural thymoma recurrence were successfully treated by radiotherapy and a contralateral HITHOC procedure. All thymoma patients were alive and free of disease after a mean follow-up period of 18 months. After a mean follow-up period of 7.4 months, nine mesothelioma patients are alive. Two mesothelioma patients died of contralateral pleural and peritoneal recurrent disease, while one patient is alive with locoregional recurrence. CONCLUSIONS: Cytoreductive surgery and HITHOC with cisplatin and adriamycin is feasible in patients with pleural thymoma metastases and early-stage MPM, and is associated with acceptable morbidity rates. Early data on locoregional disease control are encouraging, and a phase II study will be conducted.

Adult↗
PubMed1988

Penetration of aminoglycosides in uninfected pleural exudates and in pleural empyemas.

The concentrations of gentamicin, netilmicin, and amikacin were determined after one single intravenous injection in uninfected pleural fluid after thoracotomy and in purulent pleural empyemas. The mean peak concentrations in the pleural fluid after the injection of gentamicin (1.5 mg/kg), netilmicin (2.0 mg/kg), and amikacin (7.5 mg/kg) were 2.9 +/- 0.3 mg/L, 3.7 +/- 0.8 mg/L, and 11.0 +/- 3.1 mg/L, respectively. The pleural penetration of the drugs was very high (from 80.0 to 99.1 percent). By contrast, gentamicin and netilmicin were not detectable in empyema pus; in this exudate the mean peak level of amikacin was 5.7 +/- 2.2 mg/L, with the penetration of this drug being 31.0 percent. The concentrations of parenterally administered aminoglycosides are substantially lower in empyema pus than in sterile pleural fluid. The possibility of poor pleural penetration of some aminoglycosides, as well as the presence of local conditions in pleural empyema unfavorable to the bioactivity of these drugs, must be kept in mind when treating pleural infections.

Amikacin↗
PubMed2001

Diagnostic role of pleural fluid adenosine deaminase in tuberculous pleural effusion.

Between June 1998 and June 2000, 132 consecutive patients with symptomatic exudative lymphocytic pleural effusion were studied to evaluate the diagnostic role of pleural fluid adenosine deaminase (ADAPF) levels. The mean age was 52.2 (SD 16.3) years. The male to female ratio was 1.4:1. The analysis of ADAPF levels was measured base on Giusti's method. Tuberculous pleural effusion was diagnosed in 50 patients (37.9%). Another 59 patients (44.7%) had malignancies, 23 patients (17.4%) had miscellaneous other etiologies (including; 19 with chronic inflammations, 3 with melioidosis, and 1 with systemic lupus erythrematosus). The percentages of pleural fluid lymphocytes and pleural fluid protein in the tuberculous pleural effusion were similar to those with malignancies, but higher than those in the miscellaneous group. The mean value of ADAPF in the tuberculosis group was 93.2 (SD 56.5) U/l, which was significantly higher than for the malignancy and miscellaneous groups (p<0.05, one-way ANOVA). The mean values of ADAPF in the malignancy group were 36.7 (SD 39.2) U/l, and 31.3 (SD 23.4) U/l in miscellaneous group. Three patients were diagnosed with melioidosis and had ADAPF levels of 15, 46.9, and 49.8 U/l, respectively. One patient with systemic lupus erythrematosus had ADAPF levels of 24.1 U/l. A receiver operating characteristic (ROC) curve identified ADAPF level of 48 U/l as the best cut-off value, which in turn yielded a sensitivity of 80% (95% CI, 73 to 87%) and specificity of 80.5% (95% CI, 73.6 to 87.4%). The positive and negative predictive values at this cut-off value were 71.4% and 86.8%, respectively. The likelihood ratios for the diagnosis of tuberculous pleural effusion in patients with ADAPF levels less than 45 U/ l were 1:4, between 45 and 100 U/l were 5:2, and greater than 100 U/l were 7:1. We concluded that ADAPF levels are a useful diagnostic test for tuberculous pleural effusion. In addition, The analyis of ADA levels can be done simply, quickly, and cheaply.

Adenosine Deaminase↗
PubMed1993

[A case of post-traumatic eosinophilic pleural effusion improved by direct infusion of corticosteroid into the pleural space].

A 49-year-old man was admitted with non-productive cough and left chest discomfort. About one month prior to the admission, he suffered a non-penetrating injury to the left anterior chest. Although rib fracture or pleural effusion was not reported, left chest discomfort and non-productive cough progressed gradually. Chest X-ray film and chest CT scan on admission showed left massive pleural effusion. Close examination revealed a marked increase of eosinophils in the pleural effusion (77% of total cell counts). Because malignancy, parasitic disease, and collagen disease were differentiated, we diagnosed this case as post-traumatic eosinophilic pleural effusion, and decided to administers corticosteroid therapy; hydrocortisone 300 mg was infused into the left pleural space. Seven days after the treatment, the pleural effusion and peripheral eosinophilia had completely disappeared. This case suggests that direct infusion of corticosteroid into the pleural space provides greater drug availability in the treatment of post-traumatic eosinophilic pleural effusion related to immunological reaction of the pleura. The indication and dosage of corticosteroids should be established, however, because there have been some reports of cases of improvement without any special treatment.

Eosinophilia↗