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PubMed2002

Pleural small cell carcinoma in pre-existent asbestos related pleural disease.

Extrapulmonary small cell carcinoma (SCC) is a very rare disease, and a primary pleural manifestation is extremely rare. A case of SCC of the pleura in a 66-year-old man with pre-existent asbestos-related pleural plaques is presented. This is the first case of pleural SCC in a patient with asbestos-induced pleural disease and the third reported case of a pleural SCC. The SCC developed in an area with pre-existent pleural thickening, underlining the need for careful analysis of alterations in the manifestation of pleural disease in patients with asbestos exposition.

Aged↗
PubMed2004

Ultrastructural study of pleural lymphatic drainage unit and effect of nitric oxide on the drainage capacity of pleural lymphatic stomata in the rat.

The objective of this study was twofold: first to investigate the ultrastructure of the lymphatic drainage unit on the costal pleura of rats by electron microscopy, and secondly to examine the effect of nitric oxide on the pleural lymphatic stomata and fluid absorption from the pleural cavity. The lymphatic drainage unit of the rat costal pleura is composed of three special components: the lymphatic stomata between the mesothelial cells, the initial part of the lymphatic vessels and the underlying connective tissue containing many foramina. The unit is the main passage to drainage fluid, particles and cells in the pleural space. To investigate the regulator of the lymph drainage, nitric oxide synthase inhibitor and nitric oxide donor were injected into the peritoneal cavity of the rats, respectively. Trypan blue was used as tracer. The ultrastructural changes of pleural lymphatic stomata were observed under scanning electron microscope and analyzed by a computer image processing system. It turned out that the area and density of the pleural lymphatic stomata were positively correlated with the nitric oxide quantity (p < 0.05). After the tracer was injected into the pleural cavity, the nitric oxide donor group exhibited a higher trypan blue concentration than the control group (p < 0.05). The ability of the pleura to absorb trypan blue was enhanced because of the larger opening of the lymphatic stomata (p < 0.05). It is suggested that nitric oxide can increase lymphatic absorption of the pleura by opening pleural lymphatic stomata.

Animals↗
PubMed2000

Diagnostic accuracy of pleural fluid polymorphonuclear elastase in the differentiation between pyogenic bacterial infectious and non-infectious pleural effusions.

BACKGROUND AND OBJECTIVES: To establish the diagnostic accuracy of the markers of neutrophil activity (elastase and lysozyme) determined in pleural fluid, for differentiating between pyogenic bacterial infectious and non-infectious pleural effusions. PATIENTS AND METHODS: At our tertiary referral teaching hospital, 160 patients over 14 years with pleural effusion (PE), classified as pyogenic bacterial infectious (41 parapneumonic complicated, 32 parapneumonic non-complicated) and non-infectious (32 neoplasm and 55 undiagnosed pleural exudates) were examined in a prospective study. Polymorphonuclear elastase (PMN-E) was determined by an immunoactivation method and lysozyme by a turbidimetric method. Receiver operating characteristic (ROC) curves were used to evaluate diagnostic accuracy. RESULTS: Pleural fluid PMN-E was the biochemical marker that best differentiated between pyogenic bacterial infectious and non-infectious PE. The ROC area under the curve (AUC) for PMN-E was 0.8276. A PMN-E value over 230 microg/l diagnosed infectious PE with a specificity of 0.81 and a sensitivity of 0.74. The ROC AUC for proteins plus lactate dehydrogenase was 0. 7430. Differences between the two ROC curves were significant (p = 0. 032). After excluding purulent parapneumonic complicated PE, the sensitivity of a pleural fluid PMN-E value equal to or greater than 230 microg/l was 0.64 and the specificity 0.81. CONCLUSIONS: Pleural fluid PMN-E was the marker that best differentiated infectious from non-infectious PE, and PMN-E values lower than 230 microg/l suggest non-infectious PE.

Adolescent↗
PubMed1993

Quinacrine-induced pleural inflammation in malignant pleurisy: relation between drainage time of pleural fluid and local interleukin-1 beta levels.

In this study, the levels of interleukin-1 beta (IL-1 beta) were measured in pleural fluid from patients with chronic malignant pleural effusions, before and during quinacrine-induced pleurodesis. IL-1 beta levels increased significantly within 24 h after the instillation of quinacrine (p < 0.001). The levels of IL-1 beta correlated with the amount of pleural fluid production as well as with the tube drainage treatment time. Thus, the more IL-1 beta levels increased the higher pleural fluid production was seen and a longer drainage treatment time was needed. There were no correlations between IL-1 beta levels and degree of fever, recruitment of pleural leucocytes, activity of pleural coagulation or inhibition of pleural fibrinolysis.

Adult↗
PubMed1989

Raja pleural biopsy needle. A comparison with the Abrams needle in experimental pleural effusion.

The Raja pleural biopsy needle, 3 mm in external diameter and fitted with a titanium alloy biopsy flap, was compared with the Abrams needle in six dogs with experimentally induced pleural effusion. One hundred twenty-four pleural biopsies were performed using either the Raja needle or the Abrams needle (62 with each needle). No complication occurred with either needle. The Raja pleural biopsy needle yielded a statistically significant larger pleural tissue specimen with a statistically significant lower frequency of crush artifacts. The size of the pleura obtained by the Abrams needle averaged 4,401 +/- 559 microns2 (mean +/- SE) compared with 8,652 +/- 1,099 microns2 with the Raja needle (p less than 0.01; Student two-tailed t test). Biopsies by the Abrams needle showed crush artifacts in 25.8% of the specimens, whereas 8.06% of biopsies with the Raja needle showed crush artifacts (p less than 0.02; Fisher's two-tailed exact test). In conclusion, the Raja pleural biopsy needle is safe to use and, despite its smaller diameter (3mm versus 4mm external diameter of the Abrams needle), yields significantly larger and less frequently distorted pleural specimens.

Animals↗
PubMed2002

Pleural-fluid myeloperoxidase in complicated and noncomplicated parapneumonic pleural effusions.

The diagnostic accuracy of myeloperoxidase (MPO) in pleural fluid, for differentiating between complicated and noncomplicated parapneumonic pleural effusions (PPE) evaluated prospectively. Seventy patients aged >18 yrs with PPE (36 complicated and 34 noncomplicated) were studied after admission to a tertiary referral teaching hospital. MPO concentration was measured in plasma and pleural fluid using a double-antibody competitive radioimmunoassay. The concentrations of MPO in complicated and noncomplicated PPE were compared using a Mann-Whitney U-test and multiple logistic regression models were used to predict the odds that an effusion was complicated. MPO pleural-fluid concentrations were significantly higher in complicated than in noncomplicated PPE. After excluding purulent effusions, pleural-fluid MPO was the marker that best differentiated between the two types of PPE: the area under the receiver operating characteristic curve was 0.912, the sensitivity was 87.5% and the specificity was 85.1% at a cut-point limit of 3.000 microg x L(-1). The authors concluded that the concentration of pleural-fluid myeloperoxidase helps to differentiate between nonpurulent complicated and noncomplicated parapneumonic pleural effusions.

Biomarkers↗
PubMed1989

Pleural effusion as the initial manifestation of disseminated cryptococcosis in acquired immune deficiency syndrome. Diagnosis by pleural biopsy.

Pleural effusion is an unusual presentation of cryptococcal infection in the acquired immune deficiency syndrome. Previous investigators have established the diagnosis of cryptococcal pleural disease by culturing pleural fluid, bronchial washings, and extrapulmonary sources. We report the first case of cryptococcal pleural effusion proved by closed pleural biopsy. Pleural biopsy may be an effective and rapid method of determining the etiology of pleural effusion in the acquired immune deficiency syndrome.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Elastance of the pleural space: a predictor for the outcome of pleurodesis in patients with malignant pleural effusion.

BACKGROUND: In patients who have malignant pleural effusion, it is difficult to diagnose trapped lung before thoracoscopy, thoracostomy, and drainage of the effusion. Predicting the outcome of pleurodesis in patients who have malignant pleural effusion without trapped lung is also difficult. OBJECTIVE: To investigate the factors that may be useful in diagnosing trapped lung and predicting the outcome of pleurodesis. DESIGN: Prospective cohort study. SETTING: University medical center. PATIENTS: 65 patients with symptomatic malignant pleural effusion. INTERVENTION: A chest tube was inserted for drainage of the effusion, and pleurodesis was done using bleomycin as the sclerosant. MEASUREMENTS: The pH and glucose levels of the effusion and the elastance of the pleural space (defined as the decline in pleural fluid pressure in cm H2O after removal of 500 mL of effusion) were measured. The outcome of pleurodesis was evaluated 1 month after the chest tube was removed. RESULTS: Patients with an elastance of 19 cm H2O or more had a higher incidence of trapped lung (11 of 14 patients) than did those with an elastance less than 19 cm H2O (3 of 51 patients) (P < 0.001). None of the 14 patients with an elastance of 19 cm H2O or more and none of the 14 patients with a trapped lung had successful pleurodesis. Forty-two of 43 patients with an elastance less than 19 cm H2O who did not have a trapped lung had successful pleurodesis. Elastance seemed to be the best predictor for trapped lung and outcome of pleurodesis, although outcome was also correlated with pH and glucose levels of the effusion. Low-dose bleomycin (30 mg) is as effective as the usual dose of bleomycin (60 mg) for pleurodesis. CONCLUSION: In patients with symptomatic malignant pleural effusion, measurement of the elastance of the pleural space is a simple and effective method for the diagnosis of trapped lung and prediction of the outcome of chemical pleurodesis with bleomycin.

Adult↗
PubMed2003

Clinical evaluation of HER-2/neu protein in malignant pleural effusion-associated lung adenocarcinoma and as a tumor marker in pleural effusion diagnosis.

PURPOSE: Lung adenocarcinoma presenting as malignant pleural effusion (MPE) is common in Taiwan. Microscopically, the involved pleurae are infiltrated by numerous tumor foci, which suggests that the cancer cells are highly invasive. Overexpression of HER-2/neu has been related to proliferation, antiapoptosis, and the high invasiveness of various cancer cells. We therefore were interested in studying the role of HER-2/neu in MPE-associated adenocarcinoma cell lung cancer (ADCLC). EXPERIMENTAL DESIGN: The expression of HER-2/neu in pleural effusion was measured by ELISA. The HER-2/neu protein expression on tumor cells was evaluated by immunohistochemical (IHC) staining, and gene amplification was assayed by fluorescence in situ hybridization. RESULTS: The mean value of HER-2/neu in pleural effusions of patients with ADCLC and other nonmalignant lung diseases was 9.9 and 2.7 ng/ml, respectively. The difference is statistically significant (P < 0.001). Compared with cytokeratin 19 fragment CYFRA 21-1, the performance of HER-2/neu as a tumor marker in pleural effusion diagnosis was better. Overexpression of HER-2/neu in tumor tissues was found in 70% (23 of 32) of patients with MPE-associated ADCLC, 30% (13 of 43) with stage I/II non-small cell lung cancer (NSCLC), and 44% (14 of 32) with stage III NSCLC. The incidence of HER-2/neu overexpression in tumor tissues of patients with MPE-associated ADCLC was significantly higher than that of patients with stage I-III NSCLC without MPE. HER-2/neu gene amplification was uncommon (1.9%). The correlation between the IHC H-score in tumor samples and the pleural effusion level of HER-2/neu was significant (P < 0.01). A higher incidence of HER-2/neu expression beyond the cutoff point (5.5 ng/ml) in pleural effusions was also found in patients whose IHC H-scores were >50. CONCLUSIONS: These findings indicate that HER-2/neu is important in the pathogenesis of MPE-associated ADCLC and is a potential tumor marker for a diagnosis of pleural effusion.

Adenocarcinoma↗
PubMed1983

Pleural biopsy. A report of 750 biopsies performed using Abrams's pleural biopsy punch.

We present the results of 750 consecutive pleural biopsies performed with the Abrams pleural biopsy punch to indicate the effectiveness, safety and ease of the procedure. The biopsies were performed by 27 members of our medical staff. Pleural tissue was obtained in 90% of the biopsy specimens taken from patients with pleural effusions and in 79% of those taken in the absence of pleural fluid. These 'dry' biopsies were restricted to those operators with a minimum experience of 50 previous biopsies. Inclusion of tissue other than pleura occurred more frequently in the 'dry' biopsies (16.6%) than in those with pleural fluid (0.8%). There were no complications which required intervention. The problem of 'idiopathic' pleural disease is discussed. We emphasize the biopsy technique and the need for a constant and interested histologist.

Biopsy, Needle↗
PubMed1995

Experience with closed needle biopsy and pleural fluid cytology in the diagnosis of malignant pleural effusions in Yaounde, Cameroon.

To determine and compare the efficacy of pleural fluid cytology and closed needle biopsy of the pleura in establishing the diagnosis of malignant pleural effusions in Yaounde, we reviewed the medical records of all consecutive patients with a pleural effusion admitted in unit B of the Chest Clinic of the Jamot Hospital between January 1990 and December 1994. Fifty four cases of malignant pleural effusion were diagnosed over this period. Closed needle biopsy of the pleura alone permitted a diagnosis of malignancy involving the pleura in 32 instances while cytological studies of pleural fluid provided a diagnosis in thirty six cases. A combination of both techniques was diagnostic in 48 (88.9%) patients. We recommend that both pleural fluid cytology and closed needle biopsy of the pleura be used concomitantly in the evaluation of pleural effusion for which malignancy is suspected.

Adolescent↗
PubMed2005

[Value of closed pleural biopsy in diagnosis of pleural effusion].

The aim of the study was to assess closed pleural biopsy (CPB) as a diagnostic method of pleural effusion. CPB using Cope needle was performed in 62 patients, proceeded by ultrasound examination. It helped to obtain specimen for histological and microbiological examination even with cases of small amount of fluid. In all 62 patients CPB enabled to diagnose 13 cases with neoplasmatic effusions (majority being adenocarcinomas) and 16 cases of tuberculosis in histological and/or microbiological examination. There were 33 cases with non-specific inflammatory changes. In 7 patients we confirmed neoplastic pleural infiltrates in cytological examination of pleural effusion. In 26 patients videothoracoscopy (VTS) was carried out and 20 of those had post-inflammatory changes. In 4 cases, however we confirmed neoplasmatic effusions and in next 2 cases--tuberculosis. Closed pleural biopsy proves to be an efficient method in diagnosis of Tuberculosis and malignant pleural effusions. However, in 23% of cases with post-inflammatory changes, malignancy and tuberculosis were undiagnosed. This in turn implicates the necessity for further diagnostic procedures including VTS.

Biopsy, Fine-Needle↗
PubMed1997

Distribution of lymphatic stomata on the pleural surface of the thoracic cavity and the surface topography of the pleural mesothelium in the golden hamster.

BACKGROUND: The distribution of lymphatic stomata that open to the pleural cavity is unclear. The distribution and the surface topography of the pleural and visceral pleurae are key factors in the turnover of pleural fluid and respiration physiology. METHODS: Nine golden hamsters (Mesocricetus auratus) from 26 to 33 weeks of age were used for the study. The gross anatomy of the thorax and the arterial supply to the lung were studied in four hamsters. Five thoracic hemispheres, three diaphragms, and tissue blocks of the heart and lung were prepared from the remaining five hamsters. The thoracic hemispheres were fixed in 2.5% glutaraldehyde and the muscular bands at each intercostal space were carefully cut along the costae. The intercostal bands were processed for scanning electron microscopy (SEM) and the localization and the number of lymphatic stomata were recorded. The diaphragms and blocks of the lung and heart were also processed for SEM and the surface topography was observed. RESULTS: The right and left superior lobes of the lung were supplied by the bronchial artery that originated from the right costocervical trunk and left internal thoracic artery, respectively. Lymphatic stomata and mesothelial discontinuities (pores and gaps) were predominantly located in areas lined with cuboidal cells. The areas of cuboidal cells occupied approximately 4.6 mm2, namely, 1% of the total area of the thoracic hemisphere. There were about 1,000 lymphatic stomata per thoracic hemisphere. About 15% of lymphatic stomata were distributed in the ventro-cranial regions of the thoracic wall, with about 85% in the dorsocaudal region. In the former region, lymphatic stomata were found along the costal margins. In the latter, they were predominantly located in the pre- and paravertebral fatty tissue. There were also areas of cuboidal cells on the pleural surface of the diaphragm. Some mesothelial pores and gaps were found, but no lymphatic stomata opened on the pleural surface of the diaphragm. The pleural surface of the lung and that of the heart were lined with flattened polygonal cells. The topography of the surface varied, but there were no mesothelial discontinuities of the type commonly found in the parietal pleura. CONCLUSIONS: 1) The parietal pleura has a surface structure that is more permeable and absorptive for fluid and particulate matter than the visceral pleura. 2) The distribution of lymphatic stomata does not correspond directly to the pleural liquid pressures that have been reported. 3) The functions of lymphatic stomata should be considered not only in terms of fluid turnover but also in terms of self-defense mechanisms. 4) The presence or absence of lymphatic stomata on the diaphragmatic pleura should be re-examined and determined in a variety of animal species.

Animals↗
PubMed2003

Pleural space as a site of ectopic gene delivery: transfection of pleural mesothelial cells with systemic distribution of gene product.

STUDY OBJECTIVES: Successful ectopic gene therapy requires the transfection of the cells at the ectopic site, with local and systemic delivery of the gene product. This study aimed to evaluate the pleural mesothelial surface as a potential site for ectopic gene therapy. DESIGN: A secreted placental alkaline phosphatase (PALP) plasmid was injected bilaterally into the pleural spaces of seven rabbits via a chest tube, while an irrelevant reporter plasmid was injected into seven control rabbits. Blood was collected at baseline and at 24, 48, and 72 h after the injections. Pleural fluid was collected by lavage at 24, 48, and 72 h after the injections. The PALP level was measured by chemiluminesence. MEASUREMENTS AND RESULTS: Significant expressions of PALP proteins were observed in the serum of the treatment rabbits, with a threefold increase over baseline at 24 h, a ninefold increase at 48 h, and a twofold increase at 72 h. The serum PALP levels in the control rabbits remained at baseline levels at all time points. The pleural fluid PALP levels peaked at 24 h and decreased over the next 72 h. Mimicking the in vivo pattern, pleural mesothelial cells transfected in vitro demonstrated a similar increase in PALP levels. CONCLUSIONS: The results of the present short-term pilot study suggest that pleural mesothelial cells can be successfully transfected with plasmids, with increases in both the local and systemic levels of the gene product. The pleural space should be further evaluated for ectopic gene therapy.

Alkaline Phosphatase↗
PubMed2003

[From pneumonic infiltration to parapneumonic effusion--from effusion to pleural empyema: internal medicine aspects of parapneumonic effusion development and pleural empyema].

Infectious processes cause the majority part of all clinically relevant pleural effusions which frequently complicate the course of pneumonia. The assessment of an inflammatory effusion requires a careful history, physical examination, imaging techniques and clinical workup. The presence of polymorphonuclear leukocytes, high LDH-activity (> 200 U/L) and protein level (> 3 g/dL) in a pleural effusion indicates acute inflammation. An effusion is usually called empyema, when large numbers of neutrophils form thick, turbid exudates within preexisting body cavities. A thoracic empyema may occur as a result of primary or secondary pleural pathologies and in most cases involves infection with bacteria, frequently provided by progressing pneumonia. There are several therapeutic options for treatment of parapneumonic effusions and of thoracic empyemata, respectively. Optimal therapeutic management and antimicrobial medication to the infected pleural space depend in part on the stage of the empyema at presentation. Treatment can vary from a conservative medical approach in uncomplicated or small parapneumonic effusions to invasive surgical interventions in fibroprulent or organizational stages of empyema. Empyemata usually progress from a parapneumonic exudative stage (stage I), when the fluid is still sterile, with low leukocyte counts, low LDH, physiological pH, and normal glucose, to the fibropurulent [figures: see text] stage (stage II) with high leukocyte counts, high LDH activity, low pH, and low glucose, and finally to the organizational stage (stage III), in which fibroblasts convert fibrin strands into inelastic membranes. Pleural peels and pockets may compartmentalize the viscous empyematous fluid and can cause serious restrictive ventilatory impairment. Each patient must be individually evaluated to determine the nature of the exudate and the stage of the pleural space infection. Due to its high mortality rate (5%) a thoracic empyema requires prompt treatment. Diagnostic thoracentesis and withdrawal of liquid for the microbiological, cytological and biochemical analysis is urgently recommended in all cases to assess severity of the disease and the likelihood of a complicated or uncomplicated course, and to select the most appropriate treatment option.

Anti-Bacterial Agents↗
PubMed1999

ADA1/ADAp ratio in pleural tuberculosis: an excellent diagnostic parameter in pleural fluid.

We analysed the efficacy of pleural adenosine deaminase (ADAp) and the ADA1/ADAp ratio in the diagnosis of pleural tuberculosis in 103 pleural effusions, 27 of which were tuberculosis (TB) and 76 other diagnoses (non-TB). Smears, cultures and pleural biopsies were carried out in all cases, and were used for final diagnosis. The diagnostic yield of the parameters under study were as follows: smears/cultures of mycobacteria in fluid 11.1%/33.3%; biopsy 33.3%/51.8% and tuberculosis granulomas 85.1%. The levels of ADAp and ADA1/ADAp ratio in TB and non-TB groups showed very significant differences (P < 0.00001); in the TB group: ADAp 54.7 +/- 23.5 IU and ADA1/ADAp 0.27 +/- 0.08; in the non-TB group: ADAp 18.3 +/- 43.2 IU and ADA1/ADAp 0.64 +/- 0.14. The assay established ADA levels in pleural fluid > or = 40 IU and an ADA1/ADAp ratio < or = 0.42 as cut-off levels to identify individuals in the TB group, with a sensitivity of 88.8%/100%, a specificity of 92%/98.6%, a positive predictive value (PPV) of 80%/96.4%, a negative predictive value (NPV) of 95.8%/100% and an accuracy of 91.2%/99.02%. The ADAp levels in 27 patients with TB, showed close correlation with the number of monocyte macrophages (P = 0.001), but not with the number of lymphocytes (P = n.s.). The ADA1/ADAp ratio overcomes the limitations of ADAp (false positives and negatives), and is the most useful parameter for diagnosis on account of a high diagnostic yield, low cost and speed of the assay for identifying a pleural tuberculosis diagnosis, when compared with traditional methods.

Adenosine Deaminase↗
PubMed2002

Preliminary evaluation of soluble IL-2 receptor and type III procollagen N-terminal aminopeptide in pleural fluid for differentiating tuberculous, carcinomatous and parapneumonic pleural effusions.

OBJECTIVE: The aim of the study was to clarify the possibility of using pleural fluid levels of soluble IL-2 receptor (sIL-2R) and type III procollagen N-terminal aminopeptide (PIIIP) for differentiating tuberculous, carcinomatous and parapneumonic pleural effusions. METHODOLOGY: Fifty patients with pleural effusions were investigated retrospectively. The pleural effusions were due to tuberculosis (n = 11), carcinoma (n = 22), pneumonia (n = 9) and heart failure (n = 8). The concentrations of sIL-2R and PIIIP were measured in pleural effusion using commercially available kits. RESULTS: Soluble IL-2 receptor concentrations were highest in the patients with tuberculosis (6,856 +/- 3,212 U/mL), followed by those with carcinoma (4,680 +/- 1,872 U/mL), pneumonia (2,227 +/- 525 U/mL) and heart failure (1,439 +/- 244 U/mL). Significant differences were found between tuberculosis and carcinoma (P = 0.023), carcinoma and pneumonia (P = 0.015), and pneumonia and heart failure (P = 0.002) groups. Type III procollagen N-terminal aminopeptide concentrations were higher in the patients with tuberculosis (262.5 +/- 157.9 U/mL) and pneumonia (257.0 +/- 96.7 U/mL) than in those with carcinoma (48.0 +/- 27.7 U/mL) and heart failure (10.9 +/- 5.6 U/mL). Significant differences were found between tuberculosis and carcinoma (P < 0.001) and pneumonia and carcinoma (P < 0.001). To differentiate effusions, the cutoff points of sIL-2R (2,980 U/mL) and PIIIP (110.0 U/mL) were obtained from the highest concentration in the pneumonia group and in the carcinoma group, respectively. Using these criteria, the sensitivities for differentiating tuberculous, carcinomatous, and parapneumonic effusions were 90.9, 86.4 and 88.9%, respectively, with 100, 95 and 100% specificity, respectively. CONCLUSIONS: The simultaneous determination of sIL-2R and PIIIP concentrations in pleural effusions may be clinically useful in differentiating tuberculous, carcinomatous, and parapneumonic effusions. Further assessments are required to determine the broad clinical application of this assay.

Adult↗
PubMed1997

Mechanisms of pleural liquid formation in pleural inflammation.

Inflammatory processes are a major cause of pleural effusion. Besides being important clinically for diagnosis and treatment of patients with pleural effusions, studies of inflammatory pleural effusions shed light on the mechanisms of pleural liquid formation and also on general mechanisms of inflammation. In this current review, we have chosen papers within the past year that highlight aspects of clinical and research interest concerning inflammation and inflammatory pleural effusions. In some studies, investigators have investigated basic mechanisms of the roles of cytokines and adhesion molecules in inflammatory cell recruitment and leakage of liquid. In other studies, clinicians have attempted to measure inflammatory markers as a means of diagnosis. In light of these studies, we discuss the current understanding of inflammatory pleural effusions and suggest future avenues for exploration.

Adenosine Deaminase↗