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PubMed1989

[Iron and iron-binding proteins in the differential diagnosis of pleural effusion].

Iron, iron-binding capacity, lactoferrin and total protein were determined in the plasma and pleural fluid of 30 patients with cardiac failure (n = 10), infectious/inflammatory disease (n = 9) and metastatic carcinoma (n = 11). In 16 patients pleural transferrin and ferritin was also measured. Plasma iron and total iron-binding capacity were reduced in inflammatory and neoplastic disease, whereas hyposideremia with normal iron-binding capacity was seen in patients with heart failure. Plasma lactoferrin was reduced in metastatic carcinoma. Exudates (protein greater than or equal to 30 g/l; infectious/inflammatory: 9/9, carcinomatous: 10/11) had significantly higher iron, lactoferrin, transferrin and ferritin concentrations than transudates (protein less than 30 g/l; heart failure: 10/10, carcinomatous: 1/11). Statistically, infectious/inflammatory exudates could be distinguished from neoplastic exudates by a higher median iron concentration (non-parametric Wilcoxon-Mann-Whitney test). Overlap of the respective ranges, however, did not allow a clear-cut differential diagnosis in individual cases. Pleural lactoferrin concentrations, on the other hand, correlated with the pleural granulocyte count and nonspecifically reflect the degree of granulocytic inflammation. Positive pleural/plasma correlations of protein and of iron concentrations were found in exudates only. Within exudates and transudates, on the other hand, total protein correlated with transferrin but not with iron concentrations. Therefore, and because of the substantially higher pleural/plasma ratio for iron than for transferrin concentrations, a quantitatively important, non-transferrin bound iron pool in pleural fluids, most probably ferritin, must be assumed.(ABSTRACT TRUNCATED AT 250 WORDS)

Exudates and Transudates↗
PubMed1996

Pleural fluid in hospitalized pediatric patients.

We reviewed 105 charts of children who were hospitalized in a major teaching hospital between 1987 and 1993 with a diagnosis of pleural effusion established by radiographic study of the chest. There were 75 males and 30 females; mean age was 7.2 years (range 1 day-18 years). Pleural fluid was secondary to trauma, renal disease, or malignancy in 31.5% of patients. Parapneumonic effusions were found in the majority of patients, 64/105 (61%). However, in only 38 of the 64 patients (59%) was an organism isolated from any source. The most common bacterial organism cultured was Haemophilus influenzae (11 patients), followed by Staphylococcus aureus (seven patients). In five of 38 patients, a viral etiology was diagnosed. Pleural fluid was examined in only 35 patients (34%) and a pathogen found in only five (three bacterial, one Candida, one respiratory syncytial virus). It was possible to classify only 17 cases as exudate (fluid/blood protein ratio > or = 0.5) and six cases as transudate (fluid/blood protein < 0.5). Of 64 patients with suspected pleural fluid secondary to infection, 25 (39%) underwent thoracentesis and only 17 (27%) required tube drainage. This study demonstrates a wide spectrum of etiologies for pleural fluid in children, as well as the reduced use of thoracentesis or chest tube drainage in suspected infection. We speculate that this is probably because of the extensive empiric use of broad-spectrum antibiotics. The biochemical criteria established for adults for distinguishing pleural fluid exudates and transudates need to be studied in children.

Adolescent↗
PubMed2002

Radiology of perinephric fluid collections.

The perinephric spaces consist of the subcapsular, perirenal, anterior and posterior pararenal spaces. Fluid may collect in one or more of these compartments; this can be readily demonstrated by cross-sectional imaging, particularly computed tomography (CT). This pictorial review illustrates the radiological manifestations of perinephric fluid collections with their differential diagnosis including perinephric abscess, perirenal urine collection, subcapsular and perirenal hematoma, renal lymphangiomatosis, pancreatic pararenal fluid collections and transudate fluid associated with nephropathies.

Exudates and Transudates↗
PubMed2000

Plasma and salivary IgG subclasses in HIV type 1 infection: evidence of both transudation and local synthesis of IgG in parotid saliva.

In this study we measured the levels of plasma and salivary IgG subclasses in 81 HIV-1-infected individuals and 30 uninfected controls. Salivary IgG1 was increased in HIV-1-infected patients, while salivary IgG2 and IgG4 were decreased. Patients with high levels of plasma anti-HIV-1 IgG antibodies presented a higher CD4+ cell count and lower viral load. High levels of anti-HIV-1 IgG antibodies in plasma were also associated with high levels of anti-HIV-1 IgG antibodies in parotid saliva. In comparing the HIV-1 recognition patterns of salivary IgG with plasma IgG, we determined that plasma and salivary IgG antibodies had similarities as well as differences in their reactivity to HIV-1 antigens. The present study demonstrates that HIV-1 infection affects both plasma and salivary IgG and provides evidence that the origin of HIV-1-specific IgG antibodies in parotid saliva is primarily transudated from plasma; however, some local synthesis of IgG in parotid saliva also occurs.

Adolescent↗
PubMed1984

Intraluminal distension pressure on intestinal lymph flow, serosal transudation and fluid transport in the rat.

Effect of distension pressure (d.p.) on the rate of lymph flow, serosal transudation and fluid transport was studied on an in vivo upper jejunal preparation. In the non-absorptive state with isotonic Na2SO4 solution as the luminal fluid, neither lymph flow nor transudation was increased with increasing d.p. from 0 to 3, 10, 20, 40 or 70 mmHg. Fluid absorption rate (Jv) increased by more than 100% when d.p. was increased from 0 to 3 mmHg whether glucose was present or absent in the luminal fluid (Krebs-Ringer solution). In the presence of glucose, there was no difference in Jv in the range of d.p. between 3 and 70 mmHg. In the absence of glucose Jv decreased when d.p. was above 10 mmHg. Whether with or without glucose, lymph flow did not change between d.p. of 0 and 10 mmHg but decreased at higher pressures. Whether with or without glucose, transudation began to appear at d.p. of 10 mmHg, increased with increasing d.p. up to 70 mmHg, but was much less in the absence of glucose. Protein concentration in the lymph (1.5-2.4% (w/v] and transudation (1.5-2.1% (w/v] was practically the same, suggesting that the latter could have originated from the lymph which leaked out of the serosal membrane. Blood flow in the subserosal capillaries and venules was remarkably reduced when d.p. was above 10 mmHg. In both jejunum and ileum, d.p. never caused fluid secretion during distension but resulted in transient fluid secretion as well as transudation following distension, apparently due to increased capillary filtration as a result of increased capillary permeability by ischaemia (during distension). From the effect of d.p. on the increase of transudation, presumably lymph, it is concluded that luminal hydrostatic pressure may play a role in fluid transport via the lymphatic system.

Animals↗
PubMed1997

Transudative effusions.

Transudative pleural effusions develop because the distribution of hydrostatic and oncotic pressure across the pleura is altered, so that the rate of pleural fluid formation exceeds that of its reabsorption. They are characterized by a low cell and protein content. Congestive heart failure is the most common cause of transudative effusion. The fluid that accumulates in a hepatic hydrothorax, urinothorax, during peritoneal dialysis, and in many patients with nephrotic syndrome may also have the characteristics of a transudate. The development of a transudative effusion indicates that the pleural membranes per se are intact, so that if the underlying problem can be corrected, the effusion will be reabsorbed.

Exudates and Transudates↗
PubMed2003

Contribution of serum immunoglobulin transudate to the antibody immune status of murine intestinal secretions: influence of different sampling procedures.

Serum immunoglobulin transudation into the murine gut after intragastric immunization with the model antigen ovalbumin and cholera toxin adjuvant was investigated with regard to the mucosal sampling technique applied. The levels of serum-derived immunoglobulin A (IgA) turned out to be lowest in feces, intermediate in gut lavage fluid specimens, and highest in filter wick-collected samples. However, these levels did not exceed 2% of total and specific IgA in any mucosal sample type, except after the administration of very high antigen doses (> or =1 mg of antigen per g of body weight), when transudation rates of up to 31% could be measured in filter wick-collected samples from individual animals. Luminal IgG was plasma transudate and/or bile borne and appeared to be reabsorbed at the mucosa to some extent.

Adjuvants, Immunologic↗
PubMed1976

Immunoglobulins and beta-1-C globulin in hydatidiform mole vesicles.

Qualitative and quantitative determinations of immunoglobulins (Ig's) and beta-1-C globulin were carried out in fluid vesicles of hydatidiform moles and carrier mothers. The mean concentration of IgG was 9.9 per cent, IgA had 14.3 per cent, in relation to maternal values. No IgM concentrations were detected in molar fluid. Beta-1-C globulin showed 60.5 per cent concentration in relation to mother's serum. It is suggested that in trophoblast of molar vesicles a selective transudate migration of Ig's by a mechanism of pinocytosis takes place to the vesicular fluid.

Beta-Globulins↗
PubMed2002

An unusual presentation for nephrotic syndrome. Bilateral perirenal subcapsular fluid collection.

We present a 30-year-old man with nephrotic syndrome presenting with bilateral perirenal massive collection compatible with transudation. After drainage of collections kidney biopsy was performed and the histologic diagnosis was focal and segmental glomerulosclerosis. The patient was treated with cyclophosphamide, prednisone, furosemide and enalapril. After remission of nephrotic syndrome renal ultrasound showed complete resolution of perirenal collections. In conclusion, the case shows that perirenal subcapsular transudation is a rare complication of nephrotic syndrome and massive collections can be treated successfully by percutaneous drainage.

Adult↗
PubMed2002

Exudative effusions in congestive heart failure.

OBJECTIVES: Pleural effusions due to congestive heart failure (CHF) typically are transudates, but an occasional patient with CHF is found to have an exudate in the absence of an apparent cause other than CHF. We sought to determine the incidence and clinical significance of such exudative effusions. DESIGN: Patients with CHF and effusions seen during the 7-year period from January 1994 through December 2000 were identified from their hospital discharge diagnoses and radiographs, while those who had undergone thoracentesis were identified from a review of the laboratory logs. The presenting symptoms and clinical course were determined from a review of the medical records. The effect of RBC contamination on pleural fluid lactate dehydrogenase (LDH) levels was determined by measuring the LDH activity of mock pleural fluid containing known amounts of RBC. RESULTS: Seven hundred seventy patients had CHF with an effusion, but only 175 patients underwent a thoracentesis. In this select group, 86 patients had transudates and 89 had exudates. A noncardiac cause for the exudate was readily identified in 59 patients by hospital discharge, and 7 more patients had an etiology found during follow-up. Eleven of the remaining 23 patients had undergone coronary artery bypass graft (CABG) surgery > or = 1 year prior to presentation, and 50% of the effusions in patients who had undergone CABG surgery were exudates. Thus, CHF-related exudates were identified in only 12 patients, and in 4 of these patients the exudates could be explained by RBC contamination of the pleural fluid. The clinical presentation of patients with CHF-associated exudates was similar to that of CHF patients with transudates. CONCLUSION: In most patients who have CHF and an exudative effusion, there is a noncardiac cause for the pleural effusion. The high frequency of exudates in patients with a history of CABG indicates a persistent impairment in lymphatic clearance from the pleural cavity. Exudative effusions due solely to CHF are rare.

Aged↗
PubMed2003

Diagnostic value of adenosine deaminase in nontuberculous lymphocytic pleural effusions.

Adenosine deaminase (ADA) can aid in the diagnosis of tuberculous pleural effusions, but false-positive findings from lymphocytic effusions have been reported. The purpose of this study is to assess the ADA levels in nontuberculous lymphocytic pleural effusions (lymphocyte count > 50%) of different aetiologies. Altogether, 410 nontuberculous lymphocytic pleural fluid samples were consecutively selected. These included malignant effusions (n = 221), idiopathic effusions (n = 76), parapneumonic effusions (n = 35), postcoronary artery bypass graft surgery effusions (n = 6), miscellaneous exudative effusions (n = 21) and transudative effusions (n = 51). The ADA level reached the diagnostic cut-off for tuberculosis (40 U x L(-1)) in seven of the 410 cases (1.71%). The negative predictive value of ADA for the diagnosis of pleural tuberculosis was 99% (403 of 407 cases) in the group of lymphocytic pleural effusions. In five of these seven patients ADA1 and ADA2 were measured, and in all these cases (100%) ADA1/ADA(p) correctly classified these lymphocytic effusions as nontuberculous (ratio < 0.42). This prospective study provides additional evidence that adenosine deaminase levels in nontuberculous lymphocytic pleural effusions seldom exceed the cut-off set for tuberculous effusions. The pleural fluid adenosine deaminase levels were significantly higher in different types of exudative effusions than in transudates. An adenosine deaminase level < 40 IU x L(-1) virtually excluded a diagnosis of tuberculosis in lymphocytic pleural effusions. Adenosine deaminase1/adenosine deaminase(p) correctly classified all nontuberculous lymphocytic pleural effusions with high adenosine deaminase levels.

Adenosine Deaminase↗
PubMedDate not supplied

Alkaline phosphatase in pleural effusions.

BACKGROUND: Pleural effusion (PF) is a common clinical presentation in several diseases. Various parameters from pleural fluid have been studied to identify the cause. The diagnostic value of these parameters varies. The present study was carried out to evaluate the value of alkaline phosphatase concentration in the pleural effusions as a diagnostic tool. METHODS: One hundred and one patients with pleural effusion admitted over a period of two years were studied. The diagnosis was confirmed by pleural biopsy and cytology for malignant cells. RESULTS: Pleural fluid alkaline phosphatase levels of more than 75 mg/dl was found in exudative effusions and less than 75 mg/dl in transudative ones. But it did not differentiate tubercular pleural effusions from other exudative ones. CONCLUSION: Pleural fluid alkaline phosphatase of >75 mg/dl is a useful biochemical marker to suggest exudative effusions.

Adult↗
PubMed1999

Evidence of possible localized specific immunoglobulin E production in middle ear fluid as demonstrated by ELISA testing.

To determine whether IgE in the middle ear represents a passive transudate from the serum or may be produced within the middle ear itself, paired effusion and serum from 18 atopic children with otitis media with effusion were tested by micro-ELISA for specific IgE to 12 allergens. Elevated effusion concentrations of specific IgE were present in 83.3% (15 of 18) of atopic patients, but only 30% (64 of 214) of the serum antibodies appeared in the effusion. The data show that in atopic children with otitis media with effusion, there is no relation between a patient's serum and effusion level of IgE for specific antibodies (P < 0.001), suggesting that IgE in middle ear effusion is not a transudate but more likely reflects an active localized process in atopic patients.

Allergens↗
PubMed1990

Interstitial transudate purines in normoxic and hypoxic immature and mature rabbit hearts.

Interstitial transudate and coronary venous concentrations of adenosine, inosine, and hypoxanthine were determined in isolated isovolumic immature and mature rabbit hearts during normoxia and hypoxia. During normoxia, interstitial transudate adenosine was lower in immature hearts compared with mature hearts. Interstitial transudate concentrations of adenosine, inosine, and hypoxanthine were 130 +/- 16 nM, 699 +/- 88 nM, and 392 +/- 80 nM, respectively, in immature rabbit hearts and 228 +/- 35 nM, 1154 +/- 126 nM, and 287 +/- 30 nM, respectively, in mature rabbit hearts. Interstitial transudate adenosine was significantly lower in the immature hearts. Coronary venous purine concentrations were 6- and 8-fold lower than their respective interstitial transudate concentrations during normoxia in both age groups. Hypoxia significantly increased interstitial transudate purines in both age groups. Interstitial transudate adenosine, inosine, and hypoxanthine increased to 1180 +/- 231 nM, 4049 +/- 500 nM, and 1099 +/- 98 nM, respectively, in immature hearts and to 1225 +/- 300 nM, 5220 +/- 1217 nM, and 876 +/- 147 nM, respectively, in mature hearts. The age-related difference in transudate adenosine levels present during normoxia was not detected during hypoxia. Venous purine levels increased during hypoxia and the gradient from interstitial transudate fluid to venous effluent was abolished for adenosine in both groups. In immature hearts, hypoxia led to higher venous effluent adenosine levels than in the mature hearts. Coronary resistance correlated with interstitial transudate adenosine in both groups, although immature hearts displayed lower resistances at all adenosine levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine↗
PubMed2003

What is the clinical significance of transudative malignant pleural effusion?

BACKGROUND: A few reports of transudative malignant effusion on a small number of patients have suggested the need to perform routine cytologic examination in all cases of transudative pleural effusion, whether encountered for malignancy or not. The purpose of this study was to investigate whether cytologic examination should be performed in all cases of transudative pleural effusion for the diagnosis of malignancy. METHODS: We performed a retrospective study of 229 consecutive patients with malignant pleural effusion, proven either cytologically or with biopsy. In patients with transudative pleural effusion, we reviewed medical records, results of transthoracic echocardiography, fiberoptic bronchoscopy, chest X-ray, chest CT scan, and ultrasonogram of the abdomen. These data were examined with particular attention to identifying whether or not the malignancy was suggested on chest X-ray, examining the involvement of the superior vena cava, great vessels, and lymph nodes, determining the presence of pericardial effusion, and observing the endobronchial obstruction. RESULTS: Transudative malignant pleural effusion was observed in seven (3.1%) of the 229 patients, and was caused either by the malignancy itself (6 patients) or by coexisting cardiac diseases (1 patient). All the patients showed evidence suggesting the presence of malignancy at the time of initial thoracentesis, which facilitated the decision of most clinicians on whether to perform cytologic examination for the diagnosis of malignancy. CONCLUSION: Therefore, in all cases of transudative pleaural effusion, no clinical implications indicating malignancy were found on cytologic examination.

Biopsy↗
PubMed1979

Joint effusions after kidney transplantation.

Thirty-seven consecutive renal transplant recipients were studied prospectively for joint disease. Six developed arthralgias while corticosteroid doses were being lowered. Eleven patients (30%) developed knee effusions at a mean interval of 10 days following transplantation. Synovial fluids were colorless or very pale yellow, with few leukocytes (mean, 28/mm3). These benign transudative effusions did not correlate with immunologic abnormalities, transplant rejection, crystal deposition, or avascular necrosis and may have been due to high dose oral corticosteroid therapy.

Adolescent↗
PubMed1984

Lipid composition of the secretion from human bronchial explant culture.

In this study, we identified and quantitated the lipid components in the secretions of human bronchial explants cultured in a serum-free medium over a period of 50 days. Total lipids represented 6% of the dry material. This amount is considerably lower than that reported for 'normal' human sputum and suggests that the latter is contaminated by serum transudates, alveolar secretions, and microorganisms. Such serum-free culture systems are highly suitable to study cell physiology as it relates to human disease.

Bronchi↗